[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5364 Introduced in House (IH)]

113th CONGRESS
  2d Session
                                H. R. 5364

To amend title XXI of the Social Security Act to extend and improve the 
      Children's Health Insurance Program, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 31, 2014

  Mr. Pallone (for himself, Mr. Waxman, Ms. Schakowsky, Ms. Castor of 
  Florida, Mrs. Capps, Mrs. Christensen, Mr. Gene Green of Texas, Mr. 
 Dingell, Mr. Butterfield, Mr. Sarbanes, Mr. Engel, and Mr. Matheson) 
 introduced the following bill; which was referred to the Committee on 
   Energy and Commerce, and in addition to the Committee on Ways and 
 Means, for a period to be subsequently determined by the Speaker, in 
   each case for consideration of such provisions as fall within the 
                jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
To amend title XXI of the Social Security Act to extend and improve the 
      Children's Health Insurance Program, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT; REFERENCES; 
              TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``CHIP Extension and 
Improvement Act of 2014''.
    (b) References to CHIP; Medicaid; Secretary.--In this Act:
            (1) CHIP.--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.) (whether 
        implemented under title XIX, XXI, or both, of the Social 
        Security Act).
            (2) Medicaid.--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) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
    (c) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; amendments to Social Security Act; references; 
                            table of contents.
Sec. 2. General effective date; exception for State legislation; 
                            reliance on law.
                           TITLE I--FINANCING

Sec. 101. 4-year extension of CHIP funding.
Sec. 102. Performance incentive program improvements.
Sec. 103. Child enrollment contingency fund adjustment.
          TITLE II--COVERAGE STABILITY AND REDUCED BUREAUCRACY

Sec. 201. Improving coverage stability.
Sec. 202. Assuring care continuity during transitions among CHIP, 
                            Medicaid, and qualified health plans.
Sec. 203. Continuous eligibility option for certain adults.
Sec. 204. State flexibility to use administrative simplification 
                            policies for enrollment.
Sec. 205. Outreach to targeted populations.
                 TITLE III--BENEFITS AND AFFORDABILITY

Sec. 301. Strengthened cost-sharing protections under CHIP.
Sec. 302. Ensuring coverage of preventive health services under 
                            Medicaid and CHIP.
Sec. 303. Timely immunization coverage.
Sec. 304. Payment parity for Medicaid primary care services.
                      TITLE IV--ACCESS AND QUALITY

                 Subtitle A--Pediatric Quality Measures

Sec. 401. Extending the pediatric quality measures program.
Sec. 402. Enhanced FMAP for activities related to pediatric quality 
                            measures.
Sec. 403. Reporting of full set of pediatric quality measures.
Sec. 404. Technical assistance to States for adopting and utilizing 
                            pediatric quality measures.
Sec. 405. Improving the effectiveness of the pediatric quality 
                            measures.
Sec. 406. Reports regarding State-specific quality of care measures 
                            applied under Medicaid or CHIP.
Sec. 407. Advisory panel regarding pediatric quality.
Sec. 408. Extending and expanding demonstration projects.
             Subtitle B--Continuing Delivery System Reform

Sec. 411. Supporting evidence-based care coordination in communities.
Sec. 412. Ensuring care coordination for children.
                       Subtitle C--Miscellaneous

Sec. 421. Assuring coverage continuity for former foster care children.
Sec. 422. Definition of therapeutic foster care as medical assistance.
Sec. 423. Technical correction.

SEC. 2. GENERAL EFFECTIVE DATE; EXCEPTION FOR STATE LEGISLATION; 
              RELIANCE ON LAW.

    (a) General Effective Date.--Unless otherwise provided in this Act, 
subject to subsections (b) and (c), this Act (and the amendments made 
by this Act) shall take effect on October 1, 2014, and shall apply to 
medical assistance and child health assistance furnished under titles 
XIX and XXI, respectively, of the Social Security Act on or after that 
date.
    (b) Exception for State Legislation.--In the case of a State plan 
under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) or 
a State child health plan under title XXI of such Act (42 U.S.C. 1397aa 
et seq.), which the Secretary 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 2015.--
Notwithstanding any other provision of law, insofar as funds have been 
appropriated under subsection (a)(18) or (m) of section 2104 of the 
Social Security Act (42 U.S.C. 1397dd), as such subsections are in 
effect on the day before the date of the enactment of this Act, to 
provide allotments to States under CHIP for fiscal year 2015--
            (1) any amounts that are so appropriated that are not so 
        allotted and obligated before April 1, 2015, 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) Reliance on Law.--With respect to amendments made by this Act 
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.

                           TITLE I--FINANCING

SEC. 101. 4-YEAR EXTENSION OF CHIP FUNDING.

    (a) Funding.--Section 2104(a) of the Social Security Act (42 U.S.C. 
1397dd(a)) is amended--
            (1) in paragraph (17), by striking ``and'' at the end;
            (2) by striking paragraph (18) and inserting the following 
        new paragraph:
            ``(18) for fiscal year 2015, $21,061,000,000;''; and
            (3) by adding at the end the following new paragraphs:
            ``(19) for fiscal year 2016, $19,300,000,000;
            ``(20) for fiscal year 2017, $20,300,000,000;
            ``(21) for fiscal year 2018, $21,300,000,000; and
            ``(22) for fiscal year 2019, for purposes of making 2 semi-
        annual allotments--
                    ``(A) $2,850,000,000 for the period beginning on 
                October 1, 2018, and ending on March 31, 2019; and
                    ``(B) $2,850,000,000 for the period beginning on 
                April 1, 2019, and ending on September 30, 2019.''.
    (b) Allotments.--
            (1) In general.--Section 2104(m) of the Social Security Act 
        (42 U.S.C. 1397dd(m)) is amended--
                    (A) in the subsection heading, by striking ``2015'' 
                and inserting ``2019'';
                    (B) in paragraph (2)--
                            (i) in the paragraph heading, by striking 
                        ``2014'' and inserting ``2018''; and
                            (ii) by striking subparagraph (B) and 
                        inserting the following new subparagraph:
                    ``(B) Fiscal year 2013 and each succeeding fiscal 
                year.--Subject to paragraphs (4) and (6), from the 
                amount made available under paragraphs (16) through 
                (21) of subsection (a) for fiscal year 2013 and each 
                succeeding fiscal year, 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:
                            ``(i) Rebasing in fiscal year 2013 and each 
                        succeeding odd-numbered fiscal year.--For 
                        fiscal year 2013 and each succeeding odd-
                        numbered fiscal year, the allotment of the 
                        State is equal to the Federal payments to the 
                        State that are attributable to (and countable 
                        toward) the total amount of allotments 
                        available under this section to the State in 
                        the preceding fiscal year (including payments 
                        made to the State under subsection (n) for such 
                        preceding fiscal year as well as amounts 
                        redistributed to the State in such preceding 
                        fiscal year), multiplied by the allotment 
                        increase factor under paragraph (5) for such 
                        odd-numbered fiscal year.
                            ``(ii) Growth factor update for fiscal year 
                        2014 and each succeeding even-numbered fiscal 
                        year.--For fiscal year 2014 and each succeeding 
                        even-numbered fiscal year, the allotment of the 
                        State is equal to the sum of--
                                    ``(I) the amount of the State 
                                allotment under clause (i) for the 
                                preceding fiscal year; and
                                    ``(II) the amount of any payments 
                                made to the State under subsection (n) 
                                for such preceding fiscal year,
                        multiplied by the allotment increase factor 
                        under paragraph (5) for such even-numbered 
                        fiscal year.'';
                    (C) in paragraph (3)--
                            (i) in the heading, by striking ``2015'' 
                        and inserting ``2019'';
                            (ii) in subparagraph (A), by striking 
                        ``paragraph (18)'' and inserting ``paragraph 
                        (22)'';
                            (iii) in subparagraph (B), by striking 
                        ``paragraph (18)'' and inserting ``paragraph 
                        (22)'';
                            (iv) in subparagraph (C)--
                                    (I) by striking ``2014'' each place 
                                it appears and inserting ``2018''; and
                                    (II) by striking ``2015'' and 
                                inserting ``2019''; and
                            (v) in subparagraph (D)--
                                    (I) in clause (i)--
                                            (aa) in subclause (I), by 
                                        striking ``subsection 
                                        (a)(18)(A)'' and inserting 
                                        ``subsection (a)(22)(A)''; and
                                            (bb) in subclause (II), by 
                                        striking ``section 108 of the 
                                        Children's Health Insurance 
                                        Program Reauthorization Act of 
                                        2009'' and inserting ``section 
                                        101(b)(2) of the CHIP Extension 
                                        and Improvement Act of 2014''; 
                                        and
                                    (II) in clause (ii)(II), by 
                                striking ``subsection (a)(18)(B)'' and 
                                inserting ``subsection (a)(22)(B)'';
                    (D) in paragraph (4), by striking ``2015'' and 
                inserting ``2019'';
                    (E) in paragraph (6)--
                            (i) in subparagraph (A), by striking 
                        ``2015'' and inserting ``2019''; and
                            (ii) in the second sentence, by striking 
                        ``or fiscal year 2014'' and inserting ``fiscal 
                        year 2014, fiscal year 2016, or fiscal year 
                        2018''; and
                    (F) in paragraph (8)--
                            (i) in the paragraph heading, by striking 
                        ``2015'' and inserting ``2019''; and
                            (ii) by striking ``for a period in fiscal 
                        year 2015'' and inserting ``for a period in 
                        fiscal year 2019''.
            (2) Supplemental appropriation for fiscal year 2019.--There 
        is appropriated to the Secretary, out of any money in the 
        Treasury not otherwise appropriated, $16,700,000,000 to 
        accompany the allotment made for the period beginning on 
        October 1, 2018, and ending on March 31, 2019, under section 
        2104(a)(22)(A) of the Social Security Act (42 U.S.C. 
        1397dd(a)(22)(A)) (as added by subsection (a)), to remain 
        available until expended. Such amount shall be used to provide 
        allotments to States under paragraph (3) of section 2104(m) of 
        such Act (42 U.S.C. 1397dd(m)) (as amended by paragraph (1)(C)) 
        for the first 6 months of fiscal year 2019 in the same manner 
        as allotments are provided under subsection (a)(22)(A) of such 
        section 2104 and subject to the same terms and conditions as 
        apply to the allotments provided from such subsection 
        (a)(22)(A).
    (c) Extension of Qualifying States Option.--Section 2105(g)(4) of 
the Social Security Act (42 U.S.C. 1397ee(g)(4)) is amended--
            (1) in the paragraph heading, by striking ``2015'' and 
        inserting ``2019''; and
            (2) in subparagraph (A), by striking ``2015'' and inserting 
        ``2019''.

SEC. 102. PERFORMANCE INCENTIVE PROGRAM IMPROVEMENTS.

    (a) Extension Through Fiscal Year 2019.--Section 2105(a)(3) of the 
Social Security Act (42 U.S.C. 1397ee(a)(3)) is amended--
            (1) in subparagraph (A), by striking ``2013'' and inserting 
        ``2019'';
            (2) in subparagraph (E)--
                    (A) in clause (ii)--
                            (i) in the matter preceding subclause (I), 
                        by inserting ``after the application of section 
                        2104(n)(3)(D)(ii) with respect to such 
                        amounts,'' after ``limitation,'';
                            (ii) by striking subclause (I) and 
                        inserting the following new subclause:
                                    ``(I) Unobligated national 
                                allotment for fiscal years 2009 through 
                                2015.--As of December 31 of fiscal year 
                                2009, and as of December 31 of each 
                                succeeding fiscal year through fiscal 
                                year 2015, the portion, if any, of the 
                                amount appropriated under section 
                                2104(a) for such fiscal year that is 
                                unobligated for allotment to a State 
                                under section 2104(m) for such fiscal 
                                year or set aside under subsection 
                                (a)(3) or (b)(2) of section 2111 for 
                                such fiscal year.'';
                            (iii) in subclause (II), by striking 
                        ``2013'' and inserting ``2015''; and
                            (iv) in subclause (III), by striking 
                        ``2013'' and inserting ``2015'';
                    (B) by redesignating clause (iii) as clause (iv); 
                and
                    (C) by inserting after clause (ii), the following 
                new clause:
                            ``(iii) Appropriation for fiscal years 2016 
                        through 2019.--Out of any money in the Treasury 
                        not otherwise appropriated, there are 
                        appropriated $500,000,000 for each of fiscal 
                        years 2016 through 2019 for making payments 
                        under this paragraph. Amounts appropriated for 
                        a fiscal year under this clause shall remain 
                        available for making payments under this 
                        paragraph until January 1 of the following 
                        fiscal year. Any amounts of such appropriations 
                        that remain unexpended or unobligated as of 
                        such date shall be transferred and made 
                        available for making payments under section 
                        2104(n).''; and
            (3) in subparagraph (F)(iii), by striking ``2013'' and 
        inserting ``2019''.
    (b) Updated Performance Incentive Criteria for Fiscal Years 2015 
Through 2019.--Section 2105(a) of the Social Security Act (42 U.S.C. 
1397ee(a)) is amended--
            (1) in paragraph (3)(A), by inserting ``or (5)'' after 
        ``paragraph (4)'';
            (2) in paragraph (4)--
                    (A) in the heading, by inserting ``fiscal years 
                2009 through 2014'' after ``for children''; and
                    (B) in the matter preceding subparagraph (A), by 
                striking ``for a fiscal year if'' and inserting ``for 
                fiscal years 2009 through 2014 if''; and
            (3) by adding at the end the following new paragraph:
            ``(5) Enrollment and retention provisions for children for 
        fiscal year 2015 and succeeding fiscal years.--
                    ``(A) In general.--For purposes of paragraph 
                (3)(A), a State meets the condition of this paragraph 
                for fiscal year 2015 and any succeeding fiscal year if 
                it is implementing at least 5 of the enrollment and 
                retention provisions specified in subparagraph (B) 
                (treating each clause as a separate enrollment and 
                retention provision) throughout the entire fiscal year.
                    ``(B) Enrollment and retention provisions.--The 
                enrollment and retention provisions specified in this 
                subparagraph are the following:
                            ``(i) Continuous eligibility.--The State 
                        has elected the option of continuous 
                        eligibility for a full 12 months for all 
                        children (as defined in section 
                        1902(e)(13)(G)), as well as applying such 
                        policy under its State child health plan under 
                        this title.
                            ``(ii) Express lane eligibility.--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.
                            ``(iii) Presumptive eligibility.--The State 
                        is implementing section 1920A under title XIX 
                        as well as, pursuant to section 2107(e)(1), 
                        under this title.
                            ``(iv) Premium assistance for employer-
                        sponsored plans.--The State is implementing 
                        section 1906A under title XIX or the option 
                        described in section 2105(c)(10) under this 
                        title.
                            ``(v) Seamless coverage options.--In the 
                        case of a State that provides medical 
                        assistance under the State plan under title XIX 
                        through managed care entities (as defined in 
                        section 1932(a)(1)(B)) or health benefits 
                        coverage under the State child health plan 
                        through such entities, the State shall ensure 
                        that at least one such entity offers a 
                        qualified health plan through the Exchange 
                        established under title I of the Patient 
                        Protection and Affordable Care Act in the 
                        State.
                            ``(vi) Retroactive coverage reinstatement 
                        upon premium payment.--The State child health 
                        plan, in the case of an individual whose 
                        coverage under the plan has been terminated for 
                        failure to make premium payments, provides 
                        assistance to such individual for purposes of 
                        the immediate reenrollment of the individual 
                        upon payment of outstanding premiums, with 
                        coverage retroactive to the beginning of the 
                        most recent month for which an outstanding 
                        premium has been paid, and shall not impose any 
                        waiting period or fee as a condition of such 
                        reenrollment.
                            ``(vii) Effective transition to the 
                        community for vulnerable youth.--
                                    ``(I) In general.--Subject to the 
                                subdivision (A) following paragraph 
                                (29) of section 1905(a), the State, 
                                before the date of the release of an 
                                eligible juvenile from any public 
                                institution, and notwithstanding that 
                                the juvenile is an inmate of a public 
                                institution--
                                            ``(aa) screens for 
                                        eligibility for and processes 
                                        any application for medical 
                                        assistance submitted by, or on 
                                        behalf of, such an eligible 
                                        juvenile; and
                                            ``(bb) refers such juvenile 
                                        to health care providers for 
                                        purposes of receiving the 
                                        services described in section 
                                        1905(a)(4)(B) (relating to 
                                        early and periodic screening, 
                                        diagnostic, and treatment 
                                        services defined in section 
                                        1905(r)).
                                    ``(II) Eligible juvenile.--For 
                                purposes of subclause (I), the term 
                                `eligible juvenile' means an individual 
                                who--
                                            ``(aa) is under 19 years of 
                                        age (or such higher age as the 
                                        State has elected under section 
                                        475(8)(B)(iii)); and
                                            ``(bb) is an inmate of a 
                                        public institution.
                                    ``(III) Inmate of a public 
                                institution.--For purposes of this 
                                clause, the term `inmate of a public 
                                institution' has the meaning given such 
                                term for purposes of applying the 
                                subdivision (A) following paragraph 
                                (29) of section 1905(a), taking into 
                                account the exception in such 
                                subdivision for a patient of a medical 
                                institution.''.

SEC. 103. CHILD ENROLLMENT CONTINGENCY FUND ADJUSTMENT.

    (a) In General.--Section 2104(n) of the Social Security Act (42 
U.S.C. 1397dd(n)) is amended--
            (1) in paragraph (2)--
                    (A) by striking ``2014'' and inserting ``2018'' 
                each place it appears in subparagraphs (A)(ii) and (B); 
                and
                    (B) by striking ``2015'' and inserting ``2019'' 
                each place it appears in subparagraphs (A)(ii) and (B);
            (2) in paragraph (3)--
                    (A) in subparagraph (A)--
                            (i) in the heading, by striking ``In 
                        general'' and inserting ``Fiscal years 2009 
                        through 2015'';
                            (ii) in the matter preceding clause (i)--
                                    (I) by striking ``a semi-annual 
                                allotment period for''; and
                                    (II) by striking ``(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)'';
                            (iii) by striking ``or period'' each place 
                        it appears; and
                            (iv) in clause (ii), by striking ``(or in 
                        which the period occurs)'';
                    (B) in subparagraph (B)(ii), by striking ``(or 
                semi-annual period occurring in a fiscal year)'';
                    (C) in subparagraph (C)(ii), by striking ``(or 
                semi-annual period occurring in a fiscal year)'';
                    (D) by redesignating subparagraphs (D), (E), (F), 
                and (G) as subparagraphs (E), (F), (G), and (H), 
                respectively;
                    (E) by inserting after subparagraph (C) the 
                following new subparagraph:
                    ``(D) Fiscal years 2016 through 2019.--
                            ``(i) In general.--For each of fiscal years 
                        2016 through 2018 and each semi-annual 
                        allotment period for fiscal year 2019, if the 
                        Secretary determines that a State is a 
                        shortfall State described in subparagraph (I) 
                        for that fiscal year or period, the Secretary 
                        shall pay the State from the Fund, in addition 
                        to any other payments made to a State under 
                        this title for the fiscal year or period an 
                        amount equal to the amount of projected 
                        expenditures for the State under this title for 
                        the fiscal year or period that exceeds the sum 
                        determined under subparagraph (I) for the State 
                        and fiscal year or period.
                            ``(ii) Transfers.--Notwithstanding any 
                        other provision of this title, the following 
                        amounts shall also be available, without fiscal 
                        year limitation, for making payments from the 
                        Fund:
                                    ``(I) Unobligated national 
                                allotment for fiscal years beginning 
                                with fiscal year 2016.--As of December 
                                31 of fiscal year 2016, and as of 
                                December 31 of each succeeding fiscal 
                                year, 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.
                                    ``(II) Unexpended allotments not 
                                used for redistribution.--As of 
                                November 15 of fiscal year 2016 and 
                                each succeeding fiscal year, the total 
                                amount of allotments made to States 
                                under subsection (a) for the second 
                                preceding fiscal year that is not 
                                expended or redistributed under 
                                subsection (f) during the period in 
                                which such allotments are available for 
                                obligation.
                                    ``(III) Unexpended performance 
                                incentive funds.--As of September 1, 
                                2017, and as of September 1 of each 
                                succeeding calendar year, the portion, 
                                if any, of the amount appropriated 
                                under subparagraph (E)(iii) of section 
                                2105(a)(3) for the preceding fiscal 
                                year that is not expended or obligated 
                                under such section.
                            ``(iii) Investment of fund.--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.'';
                    (F) in subparagraph (E) (as so redesignated), by 
                inserting ``or (D)'' after ``subparagraph (A)''; and
                    (G) in subparagraph (H) (as so redesignated), by 
                inserting ``and regarding the expenditures under the 
                State child health plan'' after ``subparagraphs (A) and 
                (B)''; and
            (3) by adding at the end the following new subparagraph:
                    ``(I) Shortfall states described.--For purposes of 
                subparagraph (D), with respect to a fiscal year or 
                semi-annual allotment period, a shortfall State is a 
                State for which the Secretary estimates, on the basis 
                of the most recent data available to the Secretary, 
                that the projected expenditures for the State for the 
                fiscal year or period under this title (including in 
                the form of coverage described in paragraph (1) or (2) 
                of section 2101, or both) will exceed the sum of--
                            ``(i) the amount of the State's allotments 
                        for any preceding fiscal year or period that 
                        remains available for expenditure and that will 
                        not be expended by the end of the immediately 
                        preceding fiscal year;
                            ``(ii) the amount (if any) that will be 
                        redistributed to the State under subsection (f) 
                        for the fiscal year or period;
                            ``(iii) the portion, if any, of the amount 
                        appropriated under subparagraph (E)(iii) of 
                        section 2105(a)(3) for the preceding fiscal 
                        year or period that is not expended or 
                        obligated under such section; and
                            ``(iv) the amount of the State's allotment 
                        for the fiscal year or period.''.
    (b) Conforming Amendments.--Section 2104(f)(2)(A) of the Social 
Security Act (42 U.S.C. 13957dd(f)(2)(A)) is amended--
            (1) in clause (i), by inserting ``and'' at the end;
            (2) by striking clause (ii); and
            (3) by redesignating clause (iii) as clause (ii).

          TITLE II--COVERAGE STABILITY AND REDUCED BUREAUCRACY

SEC. 201. IMPROVING COVERAGE STABILITY.

    (a) In General.--Section 2102(b)(1)(B) of the Social Security Act 
(42 U.S.C. 1397bb(b)(1)(B)) is amended--
            (1) in clause (iii), by striking ``in the case of a 
        targeted low-income pregnant woman provided pregnancy-related 
        assistance under section 2112''; and
            (2) in clause (iv), by striking ``at State option,''.
    (b) Conforming Amendments.--
            (1) Section 2105(c)(10) of the Social Security Act (42 
        U.S.C. 1397(ee)(10)) is amended--
                    (A) by striking subparagraph (F); and
                    (B) by redesignating subparagraphs (G) through (M) 
                as subparagraphs (F) through (L), respectively.
            (2) Section 2112(b)(5) of the Social Security Act (42 
        U.S.C. 1397ll(b)(5)) is amended--
                    (A) in the heading, by striking ``or waiting 
                period''; and
                    (B) by striking ``or any waiting period'' and all 
                that follows through ``receipt of such assistance''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on the date of enactment of this Act.

SEC. 202. ASSURING CARE CONTINUITY DURING TRANSITIONS AMONG CHIP, 
              MEDICAID, AND QUALIFIED HEALTH PLANS.

    (a) Minimum Essential Coverage.--
            (1) In general.--Section 5000A(f) of the Internal Revenue 
        Code of 1986 is amended by adding at the end the following:
            ``(6) Pregnancy-related assistance under chip.--With 
        respect to a targeted low-income pregnant woman (as defined in 
        section 2112(d)(2) of the Social Security Act (42 U.S.C. 
        1397ll(d)(2))), notwithstanding paragraph (1)(A)(iii), the term 
        `minimum essential coverage', at the option of such a woman, 
        shall not include pregnancy-related assistance (as defined in 
        section 2112(d)(1) of the Social Security Act (42 U.S.C. 
        1397ll(d)(1))).''.
            (2) Effective date.--The amendment made by this subsection 
        applies to taxable years beginning after December 31, 2014.
    (b) Continuity of Care.--The Secretary of Health and Human Services 
shall issue regulations for purposes of ensuring continuity of care for 
children who--
            (1) are undergoing an active course of treatment; and
            (2) involuntarily change coverage under health insurance, 
        the State plan under the Medicaid program under title XIX of 
        the Social Security Act, or the State child health plan under 
        title XXI of such Act during such course of treatment for any 
        reason, including a reason related to a change in income, 
        health plan termination, or a material change or changes to the 
        plan's health benefits coverage.
    (c) Ensuring Comparability of Coverage.--
            (1) In general.--Not later than 18 months after the date of 
        the enactment of the CHIP Extension and Improvement Act of 
        2014, the Secretary of Health and Human Services shall review, 
        with respect to a State, the benefits (by each benefit class) 
        offered for children and the cost-sharing imposed with respect 
        to such benefits by qualified health plans offered through an 
        Exchange established under title I of the Patient Protection 
        and Affordable Care Act in the State. The Secretary shall make 
        the findings of such review available on the public Internet 
        site of the Department of Health and Human Services.
            (2) Regulations required.--If, following such review, the 
        Secretary determines that benefits and cost-sharing protections 
        referred to in paragraph (1) are not comparable to the benefits 
        (by each benefit class) offered and cost-sharing protections 
        provided under the State child health plan under title XXI of 
        the Social Security Act (42 U.S.C. 1397aa et seq.) in the 
        State, the Secretary, not later than January 1, 2017, shall 
        issue a rule, to apply with respect to plan years beginning in 
        2019, establishing requirements designed to ensure that such 
        qualified health plans offer benefits and cost-sharing 
        protections that are comparable to the benefits and cost-
        sharing protections provided under such State child health plan 
        for plan year 2019.

SEC. 203. STATE FLEXIBILITY TO PROVIDE FOR CONTINUOUS ELIGIBILITY.

    Section 1902(e)(12) of the Social Security Act (42 U.S.C. 
1396a(e)(12)) is amended to read as follows:
            ``(12) Continuous eligibility option.--
                    ``(A) Children.--At the option of the State, the 
                plan may provide that a child (as defined in paragraph 
                (13)(G)) who is determined to be eligible for benefits 
                under a State plan approved under this title under 
                subsection (a)(10)(A) shall remain eligible for those 
                benefits until the earlier of--
                            ``(i) the end of a period (not to exceed 12 
                        months) following the determination; or
                            ``(ii) the time that the child exceeds the 
                        age specified in such paragraph (13)(G).
                    ``(B) Certain nonelderly adults.--
                            ``(i) In general.--At the option of the 
                        State, the plan may provide that in the case of 
                        an eligible adult who is determined to be 
                        eligible for benefits under a State plan 
                        approved under this title (or a waiver of such 
                        plan), the eligible adult shall remain eligible 
                        for those benefits until the end of a period 
                        (not to exceed 12 months) following the 
                        determination.
                            ``(ii) Eligible adult defined.--In this 
                        subparagraph, the term `eligible adult' means--
                                    ``(I) an individual (other than a 
                                child) whose income eligibility under 
                                the State plan or under a waiver of the 
                                plan for medical assistance is 
                                determined under paragraph (14); and
                                    ``(II) an individual included in 
                                any other group of individuals the 
                                Secretary determines appropriate.''.

SEC. 204. STATE FLEXIBILITY TO USE ADMINISTRATIVE SIMPLIFICATION 
              POLICIES FOR ENROLLMENT.

    (a) Permanent Extension of Medicaid and CHIP Express Lane Option.--
Section 1902(e)(13) of the Social Security Act (42 U.S.C. 1396a(e)(13)) 
is amended by striking subparagraph (I).
    (b) Extending Express Lane Eligibility to Adults.--Section 
1902(e)(13)(A) of the Social Security Act (42 U.S.C. 1396a(e)(13)(A)) 
is amended by adding at the end the following new clause:
                    ``(iii) State option to extend express lane 
                eligibility to adults.--
                            ``(I) In general.--At the option of the 
                        State, the State may apply the provisions of 
                        this paragraph with respect to determining 
                        eligibility under this title for an eligible 
                        individual (as defined in subclause (II)). In 
                        applying this paragraph in the case of a State 
                        making such an option, any reference in this 
                        paragraph to a child with respect to this title 
                        (other than a reference to child health 
                        assistance) shall be deemed to be a reference 
                        to an eligible individual.
                            ``(II) Eligible individual defined.--In 
                        this clause, the term `eligible individual' 
                        means--
                                    ``(aa) any individual (other than a 
                                child) whose income eligibility under 
                                the State plan or under a waiver of the 
                                plan for medical assistance is 
                                determined under paragraph (14); and
                                    ``(bb) an individual included in 
                                any other group of individuals the 
                                Secretary determines appropriate.''.

SEC. 205. OUTREACH TO TARGETED POPULATIONS.

    (a) Outreach and Enrollment Grants.--Section 2113 of the Social 
Security Act (42 U.S.C. 1397mm) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1), by striking ``during the 
                period of fiscal years 2009 through 2015''; and
                    (B) in paragraph (2)--
                            (i) in the heading, by striking ``Ten 
                        percent set aside'' and inserting ``Set 
                        aside''; and
                            (ii) by striking ``10 percent'' and 
                        inserting ``15 percent''; and
            (2) in subsection (g), by inserting ``and $40,000,000 for 
        each fiscal year thereafter, to remain available until 
        expended'' after ``2015,''.
    (b) Requirement That Managed Care Organizations Provide Language 
Services to Enrollees.--Section 1932(b) of the Social Security Act (42 
U.S.C. 1396u-2(b)) is amended by adding at the end the following new 
paragraph:
            ``(9) Language services.--Each contract with a managed care 
        entity under section 1903(m) or under section 1905(t)(3) shall 
        require the entity to provide and pay for language services, 
        including oral interpretation and written translation services, 
        for an individual and the parent or guardian of such individual 
        who is eligible for medical assistance under the State plan 
        under this title and is enrolled with the entity and is limited 
        English proficient when interacting with the entity or with any 
        provider receiving payment from the entity. Such language 
        services shall be provided in conjunction with all covered 
        items and services that are available to such individuals under 
        the contract.''.
    (c) Medicaid Health Care Disparities.--Section 1946 of the Social 
Security Act (42 U.S.C. 1396w-5) is amended by adding at the end the 
following new subsection:
    ``(d) Appropriation.--Out of any funds in the Treasury not 
otherwise appropriated, there are appropriated to carry out this 
section $20,000,000, to remain available until expended.''.
    (d) Effective Date.--The amendments made by this section take 
effect on the date of enactment of this Act.

                 TITLE III--BENEFITS AND AFFORDABILITY

SEC. 301. STRENGTHENED COST-SHARING PROTECTIONS UNDER CHIP.

    Section 2103(e) of the Social Security Act (42 U.S.C. 1397cc(e)) is 
amended--
            (1) in paragraph (3)(B)--
                    (A) by inserting ``, including with respect to 
                benefits for dental services,'' after ``State child 
                health plan'';
                    (B) by striking ``annual aggregate cost-sharing'' 
                and inserting ``aggregate cost-sharing''; and
                    (C) by striking ``for the year involved'' and 
                inserting ``, as applied on a quarterly or monthly 
                basis (as specified by the State)''; and
            (2) by adding at the end the following new paragraph:
            ``(5) Additional requirements.--
                    ``(A) Tracking of expenses; notice.--Except as 
                provided in subparagraph (B), in the case of a State 
                child health plan that imposes premiums, deductibles, 
                cost sharing, or similar charges that could (as 
                determined by the Secretary) cause families that 
                include a targeted low-income child or a targeted low-
                income pregnant woman to have out-of-pocket expenses 
                that exceed the limit imposed under paragraph (3)(B) 
                for a month or quarter (as applicable under the State 
                plan), the State child health plan shall--
                            ``(i) establish an electronic process for 
                        tracking such expenses that does not rely on 
                        documentation provided by the targeted low-
                        income child, the targeted low-income pregnant 
                        woman, or the family; and
                            ``(ii) notify each such family--
                                    ``(I) of the aggregate monthly or 
                                quarterly limits on out-of-pocket 
                                expenses applicable to the family 
                                imposed under paragraph (3)(B); and
                                    ``(II) that no premiums, 
                                deductibles, cost sharing, or similar 
                                charges shall be imposed on any 
                                targeted low-income child or targeted 
                                low-income pregnant woman in the family 
                                for the remainder of any month or 
                                quarter with respect to which the 
                                family has reached the aggregate 
                                monthly or quarterly family limit 
                                imposed under such paragraph applicable 
                                to the family.
                    ``(B) Managed care entities or organizations.--In 
                the case of a State child health plan that provides 
                child health assistance through managed care entities 
                or organizations, the entities or organizations shall, 
                with respect to families described in subparagraph 
                (A)--
                            ``(i) establish an electronic process 
                        described in subparagraph (A)(i); and
                            ``(ii) coordinate with the State agency 
                        responsible for implementing the State child 
                        health plan under this title to ensure that any 
                        premiums, deductibles, cost sharing, or similar 
                        charges imposed on such a family are included 
                        in the aggregate limit applicable to the family 
                        under paragraph (3)(B).''.

SEC. 302. ENSURING COVERAGE OF PREVENTIVE HEALTH SERVICES UNDER 
              MEDICAID AND CHIP.

    (a) Medicaid.--
            (1) Clarifying preventive coverage.--Section 1905(a)(13) of 
        the Social Security Act (42 U.S.C. 1396d(a)(13)) is amended--
                    (A) by striking subparagraphs (A) and (B);
                    (B) by redesignating subparagraph (C) as 
                subparagraph (B); and
                    (C) by inserting before subparagraph (B) (as so 
                redesignated) the following new subparagraph:
                    ``(A) the items and services described in 
                paragraphs (1) through (5) of section 2713(a) of the 
                Public Health Service Act; and''.
            (2) Conforming amendment.--Section 1902(a)(10)(A) of the 
        Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended in 
        the matter preceding clause (i), by inserting ``, (13)(A)'' 
        before ``, (17)''.
    (b) CHIP.--Section 2103(c)(1)(D) of the Social Security Act (42 
U.S.C. 1397cc(c)(1)(D)) is amended by striking ``Well-baby'' and 
inserting ``Items and services described in paragraphs (1) through (5) 
of section 2713(a) of the Public Health Service Act, including well-
baby''.
    (c) Cost-Sharing Prohibitions.--
            (1) In general.--Section 1916 of the Social Security Act 
        (42 U.S.C. 1396(o)) is amended--
                    (A) in subsection (a)(2)--
                            (i) in subparagraph (D), by striking ``or'' 
                        at the end;
                            (ii) in subparagraph (E), by striking 
                        ``hospice care (as defined in section 1905(o)); 
                        and'' at the end and inserting ``hospice care 
                        (as defined in section 1905(o)), or''; and
                            (iii) by adding at the end the following 
                        new subparagraph:
                    ``(F) items and services described in section 
                1905(a)(13)(A); and''; and
                    (B) in subsection (b)(2)--
                            (i) in subparagraph (D), by striking ``or'' 
                        at the end;
                            (ii) in subparagraph (E), by striking 
                        ``hospice care (as defined in section 1905(o)); 
                        and'' at the end and inserting ``hospice care 
                        (as defined in section 1905(o)), or''; and
                            (iii) by adding at the end the following 
                        new subparagraph:
                    ``(F) items and services described in section 
                1905(a)(13)(A); and''.
            (2) State option.--Section 1916A(b)(3)(B) of the Social 
        Security Act (42 U.S.C. 1396o-1(b)(3)(B)) is amended by adding 
        at the end the following new clause:
                            ``(xi) Items and services described in 
                        section 1905(a)(13)(A).''.

SEC. 303. TIMELY IMMUNIZATION COVERAGE.

    (a) Coverage for Newly Approved Vaccines Within 30 Days.--
            (1) In general.--Section 1928(e) of the Social Security Act 
        (42 U.S.C. 1396s(e)) is amended by adding at the end the 
        following new sentence: ``Each revision of the list established 
        by such Advisory Committee shall apply to the purchase, 
        delivery, and administration of pediatric vaccines under this 
        section not later than 30 days after the date such Advisory 
        Committee approves the revision.''.
            (2) Conforming amendment.--Section 2103(c)(1)(D) of the 
        Social Security Act (42 U.S.C. 1397cc(c)(1)(D)) is amended by 
        inserting ``, administered in accordance with the schedule 
        referred to in section 1928(c)(2)(B)(i) for pediatric 
        vaccines'' after ``immunizations''.
    (b) Treatment of CHIP-Eligible Children as Federally Vaccine-
Eligible Children.--Section 1928(b)(2) of the Social Security Act (42 
U.S.C. 1396s(b)(2)) is amended--
            (1) in subparagraph (A)(i), by inserting ``or CHIP-
        eligible'' after ``medicaid-eligible''; and
            (2) in subparagraph (B), by striking clause (i) and 
        inserting the following:
                            ``(i) The term `medicaid-eligible or CHIP-
                        eligible child' means, with respect to a child, 
                        a child who is entitled to medical assistance 
                        under a State plan approved under this title or 
                        a waiver of such plan, or who is eligible for 
                        child health assistance under a State child 
                        health plan approved under title XXI.''.
    (c) Effective Date.--The amendments made by this section take 
effect on the date of enactment of this Act.

SEC. 304. PAYMENT PARITY FOR MEDICAID PRIMARY CARE SERVICES.

    (a) In General.--Section 1902(a)(13)(C) of the Social Security Act 
(42 U.S.C. 1396a(a)(13)(C)) is amended--
            (1) by striking ``2013 and 2014'' and inserting ``calendar 
        years 2014 through 2019'';
            (2) by striking ``, general internal medicine'' and 
        inserting ``, general internal medicine, neurology, psychiatry, 
        obstetrics and gynecology'';
            (3) by inserting ``or a health care practitioner who is a 
        nurse practitioner, physician assistant, or clinical nurse 
        specialist (as such terms are defined in section 1861(aa)(5)) 
        or a certified nurse midwife (as defined in section 
        1861(gg)(2))'' after ``pediatric medicine''; and
            (4) by striking ``such services and physician'' and 
        inserting ``such services and physician or health care 
        practitioner''.
    (b) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after the first day of the 
first calendar quarter that begins after the date of the enactment of 
this Act.

                      TITLE IV--ACCESS AND QUALITY

                 Subtitle A--Pediatric Quality Measures

SEC. 401. EXTENDING THE PEDIATRIC QUALITY MEASURES PROGRAM.

    Section 1139A(i) of the Social Security Act (42 U.S.C. 1320b-9a(i)) 
is amended by inserting ``, and for each of fiscal years 2015 through 
2019, $50,000,000,'' after ``$45,000,000''.

SEC. 402. ENHANCED FMAP FOR ACTIVITIES RELATED TO PEDIATRIC QUALITY 
              MEASURES.

    Section 1903(a)(3)(A)(iii) of the Social Security Act (42 U.S.C. 
1396b(a)(3)(A)(iii)) is amended to read as follows:
                    ``(iii) 95 percent of so much of the sums expended 
                during any such quarter in fiscal years 2015, 2016, and 
                2017, 90 percent of so much of the sums expended during 
                any such quarter in fiscal years 2018 and 2019, and the 
                higher of an amount equal to the Federal medical 
                assistance percentage (as defined in section 1905(b)) 
                or 75 percent of so much of the sums expended during 
                any such quarter in any fiscal year thereafter (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 
                the core set of child health quality measures under 
                subsections (a), (b), (c), and (f) of section 1139A; 
                and''.

SEC. 403. REPORTING OF FULL SET OF PEDIATRIC QUALITY MEASURES.

    Section 1139A(a)(4) of the Social Security Act (42 U.S.C. 1320b-
9a(a)(4)) is amended--
            (1) in the heading, by striking ``Encourage voluntary and 
        standardized'' and inserting ``Standardized'';
            (2) by striking ``Not later than'' and inserting the 
        following:
                    ``(A) Encouraging voluntary reporting.--Not later 
                than''; and
            (3) by adding at the end the following new subparagraph:
                    ``(B) Other reporting.--Not later than five years 
                after the date of the enactment of the CHIP Extension 
                and Improvement Act of 2014, the Secretary shall 
                require that each State submit information on the core 
                set of child health quality measures (as in effect on 
                such date of enactment), as updated under subsection 
                (b)(5).''.

SEC. 404. TECHNICAL ASSISTANCE TO STATES FOR ADOPTING AND UTILIZING 
              PEDIATRIC QUALITY MEASURES.

    Section 1139A(a)(7) of the Social Security Act (42 U.S.C. 1320b-
9a(a)(7)) is amended to read as follows:
            ``(7) Technical assistance.--
                    ``(A) In general.--The Secretary shall provide 
                technical assistance to States to assist them in 
                adopting and utilizing the core set of child health 
                measures in administering the State plans under titles 
                XIX and XXI, including by assisting States in building 
                their data collection infrastructures.
                    ``(B) Funding.--$5,000,000 of the amount 
                appropriated under subsection (i) for a fiscal year 
                shall be used to carry out this paragraph.''.

SEC. 405. IMPROVING THE EFFECTIVENESS OF THE PEDIATRIC QUALITY 
              MEASURES.

    Section 1139A(b) of the Social Security Act (42 U.S.C. 1320b-9a(b)) 
is amended--
            (1) in paragraph (4)--
                    (A) by striking the paragraph heading and inserting 
                the following: ``Ensuring the development, maintenance, 
                and reporting of a portfolio of pediatric quality 
                measures'';
                    (B) in subparagraph (A), by striking ``and'' at the 
                end;
                    (C) in subparagraph (B)(iii)--
                            (i) by inserting ``establishment of a 
                        sustainable mechanism for maintaining and'' 
                        before ``updating''; and
                            (ii) by striking ``as necessary.'' and 
                        inserting ``in alignment with the most recent 
                        version of the `Blueprint for the Measures 
                        Management System' published by the Centers for 
                        Medicare & Medicaid Services, as necessary; 
                        and''; and
                    (D) by adding at the end the following new 
                subparagraph:
                    ``(C) award grants or contracts to continue and 
                enhance the pediatric quality measures program, which 
                shall include awarding grants and contracts with a 
                particular emphasis on--
                            ``(i) patient and family experience or 
                        coordination of care;
                            ``(ii) pediatric populations that are small 
                        in size and may be most effectively addressed 
                        by aggregating data across multiple States, 
                        including pediatric populations with medical 
                        complexity and pediatric populations with rare 
                        conditions;
                            ``(iii) the impacts of changes in life 
                        events over various stages of child and 
                        adolescent development, including changes in 
                        morbidity and mortality, dependence status, and 
                        developmental stages, and the impacts of such 
                        changes on subsequent health and health care 
                        quality; and
                            ``(iv) establishing a sustainable mechanism 
                        for identifying and assisting States in 
                        developing a standardized data infrastructure 
                        for the collection and national reporting of 
                        pediatric quality measures, including 
                        developing precise data element definitions and 
                        utilizing consistent data collection 
                        methods.'';
            (2) by striking paragraph (5) and inserting the following 
        new paragraph:
            ``(5) Revising, strengthening, and improving initial core 
        measures.--
                    ``(A) In general.--The Secretary shall annually 
                issue a rule (in accordance with section 553 of title 
                5, United States Code) to amend the core set of child 
                health quality measures described in subsection (a) so 
                that such core set--
                            ``(i) is consistent with the purposes of 
                        the pediatric quality measures program 
                        established under paragraph (1);
                            ``(ii) meets the conditions specified in 
                        paragraph (2);
                            ``(iii) includes measures that--
                                    ``(I) were developed by the 
                                Secretary in consultation with the 
                                entities specified in subparagraphs (A) 
                                through (H) of paragraph (3);
                                    ``(II) were developed, validated, 
                                tested, or maintained through a grant 
                                or contract awarded under paragraph 
                                (4); and
                                    ``(III) were submitted to the 
                                Secretary for consideration that were 
                                not developed under such a grant or 
                                contract; and
                            ``(iv) takes into account the reports and 
                        demonstration projects described in 
                        subparagraphs (c), (d), (e), and (f) of this 
                        section.
                    ``(B) Additional changes.--Beginning not later than 
                one year after the date of the enactment of the CHIP 
                Extension and Improvement Act of 2014, the amendments 
                made to the core set of measures under subparagraph (A) 
                shall include changes--
                            ``(i) to measure the type of children's 
                        health insurance coverage or other health 
                        benefits coverage available over time, in 
                        addition to the presence, stability, and 
                        duration of such health insurance coverage or 
                        such health benefits coverage over time, for 
                        purposes of examining enrollment changes of a 
                        child from one type of coverage to another;
                            ``(ii) to ensure that the measures reflect 
                        the care provided to the diverse pediatric 
                        population, including adolescents and children 
                        with special health care needs and the 
                        management of acute and chronic conditions;
                            ``(iii) to ensure that the measures reflect 
                        care provided in all health care settings in 
                        which an individual enrolled in the State plan 
                        under title XIX receives care; and
                            ``(iv) to encourage the adoption of 
                        pediatric quality measures at the State, plan, 
                        community, facility, and provider level 
                        attribution, as well as across different health 
                        care delivery and coverage systems, including 
                        coverage provided through the Exchanges 
                        established under title I of the Patient 
                        Protection and Affordable Care Act.'';
            (3) in paragraph (6)--
                    (A) by striking ``clinical care'' and inserting 
                ``clinical effectiveness, patient safety, population 
                and public health, patient and family engagement, care 
                coordination, or efficiency''; and
                    (B) by striking ``in various institutional and 
                ambulatory health care settings''; and
            (4) by adding at the end the following new paragraph:
            ``(8) Funding.--$20,000,000 of the amount appropriated 
        under subsection (i) for a fiscal year shall be used to carry 
        out this subsection.''.

SEC. 406. REPORTS REGARDING STATE-SPECIFIC QUALITY OF CARE MEASURES 
              APPLIED UNDER MEDICAID OR CHIP.

    Section 1139A(c)(1) of the Social Security Act (42 U.S.C. 1320b-
9a(c)) is amended--
            (1) in subparagraph (A), by striking ``and'' at the end;
            (2) in subparagraph (B), by striking the period at the end 
        and inserting a semicolon; and
            (3) by adding at the end the following new subparagraphs:
                    ``(C) State-specific information on the annual 
                progress toward, and efforts to overcome barriers to, 
                reporting on all quality measures within the core set 
                of child health quality measures, as updated under 
                subsection (b)(5); and
                    ``(D) beginning not later than 5 years after the 
                date of the enactment of this subparagraph, State-
                specific information on all quality measures within the 
                core set of child health quality measures, as updated 
                under subsection (b)(5).''.

SEC. 407. ADVISORY PANEL REGARDING PEDIATRIC QUALITY.

    (a) In General.--Section 1139A(g) of the Social Security Act (42 
U.S.C. 1320b-9a(g)) is amended--
            (1) in the heading, by striking ``Study of'' and inserting 
        ``Stakeholder Input and Reports on'';
            (2) by redesignating paragraph (2) as paragraph (3); and
            (3) by inserting after paragraph (1) the following new 
        paragraph:
            ``(2) Pediatric quality measurement.--Not later than 18 
        months after the date of the enactment of this paragraph, the 
        Secretary, in consultation with representatives of State 
        agencies responsible for administering the Medicaid program 
        under title XIX and the Children's Health Insurance Program 
        under title XXI and representatives of relevant provider 
        organizations, shall submit (and periodically update) to the 
        Committee on Energy and Commerce of the House of 
        Representatives and the Committee on Finance of the Senate a 
        report that takes into account the priorities and goals to be 
        established pursuant to section 1890(b)(7)(E). Such report 
        shall include--
                    ``(A) strategic and detailed operational plans to 
                address and overcome barriers to State collection of, 
                and reporting of, all quality measures within the core 
                set of child health quality measures, as updated under 
                subsection (b)(5);
                    ``(B) an analysis of the types of incentives, 
                including Federal funding and any associated amounts 
                necessary for States to collect and report on all 
                quality measures within the core set of child health 
                quality measures, as updated under subsection (b)(5); 
                and
                    ``(C) a standardized format and plan for States to 
                collect and report on all quality measures within the 
                core set of child health quality measures, as updated 
                under subsection (b)(5).''.
    (b) Inclusion of Child and Adult Health Quality Measures for Multi-
Stakeholder Group Input.--Section 1890(b)(7) of the Social Security Act 
(42 U.S.C. 1395aaa(b)(7)) is amended--
            (1) in subparagraph (B)(i)(I), by inserting ``1139A(a), 
        1139B,'' after ``sections''; and
            (2) by adding at the end the following new subparagraph:
                    ``(E) Pediatric quality measurement.--With respect 
                to quality and efficiency measures for use pursuant to 
                section 1139A(a), the entity shall convene a panel, 
                composed of health experts (including experts employed 
                by the Federal Government and experts not so employed) 
                to establish priorities and goals for child health to--
                            ``(i) advise and make recommendations to 
                        the Secretary regarding changes that may be 
                        made to the core set of child health quality 
                        measures, as updated under section 1139A(b)(5);
                            ``(ii) establish standards for the 
                        timeliness and accuracy of data collected and 
                        reported for purposes of such measures; and
                            ``(iii) review and make recommendations, at 
                        least annually, for strategies to enhance the 
                        timeliness, accuracy, and utility of such 
                        measures.''.

SEC. 408. EXTENDING AND EXPANDING DEMONSTRATION PROJECTS.

    (a) Strengthening Demonstration Projects for Improving the Quality 
of Children's Health Care and the Use of Health Information 
Technology.--Section 1139A(d) of the Social Security Act (42 U.S.C. 
1320b-9a(d)) is amended--
            (1) in paragraph (1)--
                    (A) in the matter preceding subparagraph (A)--
                            (i) by striking ``2009 through 2013, the 
                        Secretary shall award not more than 10 grants'' 
                        and inserting ``2015 through 2019, the 
                        Secretary shall award not fewer than 10 
                        grants,''; and
                            (ii) by inserting ``(including oral care)'' 
                        after ``health care'';
                    (B) in subparagraph (C), by striking ``or'' at the 
                end;
                    (C) in subparagraph (D), by striking the period at 
                the end and inserting a semicolon; and
                    (D) by adding at the end the following new 
                subparagraphs:
                    ``(E) examine and address barriers to effective 
                delivery of perinatal care and its impact on birth 
                outcomes and subsequent pregnancies and children's 
                health;
                    ``(F) implement and expand pediatric and perinatal 
                learning and quality improvement collaboratives on the 
                quality of children's and pregnant women's health care, 
                including improving patient outcomes, reducing health 
                costs, and addressing health disparities;
                    ``(G) encourage and evaluate the use at the State 
                level of payment reform and related policy proposals 
                for purposes of promoting higher quality of care for 
                children, including the shared savings program 
                established under section 1899 and other methods of 
                encouraging integrated care models; or
                    ``(H) with respect to the model electronic health 
                record format for children developed and disseminated 
                under subsection (f)--
                            ``(i) assess the extent to which the format 
                        has been incorporated into widely used 
                        electronic health record formats;
                            ``(ii) implement standards and activities 
                        that result in increased use of such format; 
                        and
                            ``(iii) evaluate the impact of the 
                        increased use of such format.'';
            (2) in paragraph (2)--
                    (A) in subparagraph (A), by striking ``and'' at the 
                end;
                    (B) in subparagraph (B), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(C) with respect to grants awarded for projects 
                described in paragraph (1)(F)--
                            ``(i) give priority to collaboratives that 
                        would demonstrate substantial impacts on the 
                        pediatric population by--
                                    ``(I) affecting a large percentage 
                                of such population or by substantially 
                                improving outcomes in a smaller 
                                population;
                                    ``(II) reducing the cost of, and 
                                other barriers to access to, health 
                                care for children, including children 
                                with medically complex illnesses or 
                                chronic conditions;
                                    ``(III) having a high likelihood to 
                                reduce disparities in health status; or
                                    ``(IV) potentially having long-term 
                                health impacts by addressing childhood 
                                precursors to adult conditions; and
                            ``(ii) encourage coordination with other 
                        sources of funding in the expansion of 
                        pediatric learning collaboratives, including by 
                        coordinating care and utilizing community 
                        health workers (as defined in section 399V(k) 
                        of the Public Health Service Act (42 U.S.C. 
                        280g-11(k))).''; and
            (3) in paragraph (4)--
                    (A) by inserting ``For each of fiscal years 2009 
                through 2013,'' before ``$20,000,000''; and
                    (B) by adding at the end the following new 
                sentence: ``For each of fiscal years 2015 through 2019, 
                $25,000,000 of the amount appropriated under subsection 
                (i) for a fiscal year shall be used to carry out this 
                subsection.''.
    (b) Extending Funding for Childhood Obesity Demonstration 
Projects.--Section 1139A(e)(8) of the Social Security Act (42 U.S.C. 
1320b-9a(e)(8)) is amended by inserting ``, and for the period of 
fiscal years 2015 through 2019, $25,000,000'' after ``2014''.

             Subtitle B--Continuing Delivery System Reform

SEC. 411. SUPPORTING EVIDENCE-BASED CARE COORDINATION IN COMMUNITIES.

    (a) In General.--Section 511(j)(1) of the Social Security Act (42 
U.S.C. 711(j)(1)) is amended--
            (1) in subparagraph (D), by inserting ``and'' at the end;
            (2) in subparagraph (E), by striking ``fiscal year 2014; 
        and'' and inserting ``each of fiscal years 2014 through 
        2019.''; and
            (3) by striking subparagraph (F).
    (b) Effective Date.--The amendments made by this section shall take 
effect on the date of enactment of this Act.

SEC. 412. ENSURING CARE COORDINATION FOR CHILDREN.

    Section 2706 of the Patient Protection and Affordable Care Act (42 
U.S.C. 1396a note) is amended--
            (1) in subsection (a)(2), by striking ``2016'' and 
        inserting ``2019''; and
            (2) in subsection (e), by striking ``appropriated'' and all 
        that follows through the period at the end and inserting the 
        following: ``appropriated to carry out this section--
            ``(1) for fiscal year 2014, such sums as are necessary;
            ``(2) for each of fiscal years 2015 through 2019, 
        $100,000,000; and
            ``(3) for the period beginning on October 1, 2019, and 
        ending on December 31, 2019, $25,000,000.''.

                       Subtitle C--Miscellaneous

SEC. 421. ASSURING COVERAGE CONTINUITY FOR FORMER FOSTER CARE CHILDREN.

    (a) In General.--Section 1902(a)(10)(A)(i)(IX) of the Social 
Security Act (42 U.S.C. 1396a(a)(10)(A)(i)(IX)) is amended--
            (1) in item (bb), by striking ``are not described in or 
        enrolled under'' and inserting ``are not described in and are 
        not enrolled under'';
            (2) in item (cc), by striking ``responsibility of the 
        State'' and inserting ``responsibility of a State''; and
            (3) in item (dd), by striking ``the State plan under this 
        title or under a waiver of the'' and inserting ``a State plan 
        under this title or under a waiver of such a''.
    (b) Effective Date.--The amendments made by this section shall take 
effect on July 1, 2015.

SEC. 422. DEFINITION OF THERAPEUTIC FOSTER CARE AS MEDICAL ASSISTANCE.

    (a) In General.--Section 1905 of the Social Security Act (42 U.S.C. 
1396d) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (28), by striking ``and'' at the 
                end;
                    (B) by redesignating paragraph (29) as paragraph 
                (30); and
                    (C) by inserting after paragraph (28) the following 
                new paragraph:
            ``(29) therapeutic foster care services described in 
        subsection (ee); and''; and
            (2) by adding at the end the following new subsection:
    ``(ee)(1) For purposes of subsection (a)(29), subject to 
subparagraph (C), therapeutic foster care services described in this 
subsection are services provided for children who have not attained age 
21, and who, as a result of mental illness, other emotional or 
behavioral disorders, medically fragile conditions, or developmental 
disabilities, need the level of care provided in an institution 
(including a psychiatric residential treatment facility) or nursing 
facility the cost of which could be reimbursed under the State plan but 
who can be cared for or maintained in a community placement, through a 
qualified therapeutic foster care program described in paragraph (2).
    ``(2) A qualified therapeutic foster care program described in this 
paragraph is a program that--
            ``(A) is licensed by the State and accredited by the Joint 
        Commission on Accreditation of Healthcare Organizations, the 
        Commission on Accreditation of Rehabilitation Facilities, the 
        Council on Accreditation, or by another equivalent 
        accreditation agency (or agencies) as the Secretary may 
        recognize;
            ``(B) provides structured daily activities, including the 
        development, improvement, monitoring, and reinforcing of age-
        appropriate social, communication and behavioral skills, 
        trauma-informed and gender-responsive services, crisis 
        intervention and crisis support services, medication 
        monitoring, counseling, and case management, and may furnish 
        other intensive community services; and
            ``(C) provides foster care parents with specialized 
        training and consultation in the management of children with 
        mental illness, trauma, other emotional or behavioral 
        disorders, medically fragile conditions, or developmental 
        disabilities, and specific additional training on the needs of 
        each child provided such services.
    ``(3) In making coverage determinations under paragraph (1), a 
State may employ medical necessity criteria that are similar to the 
medical necessity criteria applied to coverage determinations for other 
services and supports under this title.
    ``(4) The services described in this subsection do not include the 
training referred to in paragraph (2)(C).''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to calendar quarters beginning on or after the date of enactment 
of this Act.

SEC. 423. TECHNICAL CORRECTION.

    (a) In General.--Section 1917(d)(4)(A) of the Social Security Act 
(42 U.S.C. 1396p(d)(4)(A)) is amended by inserting ``the individual,'' 
after ``for the benefit of such individual by''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to trusts established on or after the date of the enactment of 
this Act.
                                 <all>