[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 1980 Introduced in Senate (IS)]

113th CONGRESS
  2d Session
                                S. 1980

 To amend titles XIX and XXI of the Social Security Act to provide for 
     12-month continuous enrollment under the Medicaid program and 
    Children's Health Insurance Program and to promote quality care.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            February 3, 2014

Mr. Rockefeller introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To amend titles XIX and XXI of the Social Security Act to provide for 
     12-month continuous enrollment under the Medicaid program and 
    Children's Health Insurance Program and to promote quality care.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicaid and CHIP Continuous Quality 
Act of 2014''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Every year millions of people are enrolled in Medicaid 
        and the Children's Health Insurance Program (in this section 
        referred to as ``CHIP''), but subsequently lose their coverage, 
        despite still being eligible, because of inefficient and 
        cumbersome paperwork and logistical requirements.
            (2) Data show that the typical enrollee receives Medicaid 
        coverage for about three-quarters of the year. Coverage periods 
        are lower for non-elderly, non-disabled adults than for those 
        with disabilities, seniors, and children.
            (3) Medicaid enrollees with coverage disruption are more 
        likely to be hospitalized for illnesses like asthma, diabetes, 
        or cardiovascular disease that can be effectively managed 
        through ongoing primary medical care and medication, are less 
        likely to be screened for breast cancer, and may have poorer 
        cancer outcomes.
            (4) Children enrolled in CHIP also experience disruptions 
        in health coverage and care. For example, during just a one-
        year period, over one-third of CHIP enrollees were also 
        enrolled in a State's Medicaid program. Transitions between 
        Medicaid and CHIP can cause disruptions in care because the 
        health care coverage and participating providers vary between 
        the two programs.
            (5) Interruptions in coverage can impair the receipt of 
        effective primary care and lead to expensive hospitalizations 
        or emergency room visits.
            (6) Unnecessary enrollment, disenrollment and reenrollment 
        in Medicaid and CHIP result in higher administrative expenses 
        for reenrollment and result in more people uninsured at any 
        given time.
            (7) Stable coverage under Medicaid and CHIP lowers average 
        monthly medical costs. Continuous enrollment also permits 
        better prevention and disease management, leading to fewer 
        serious illnesses and hospitalizations.
            (8) Children with stable coverage are less likely to have 
        unmet medical needs, allowing children to receive the 
        preventive care that is necessary to help them grow into 
        healthy adults.
            (9) For the majority of Medicaid enrollees who are served 
        by Primary Care Case Management (PCCM) or fee-for-service 
        arrangements, there are no Federal requirements for comparable 
        quality monitoring or improvement. No structured oversight 
        exists for Medicaid enrollees when they move between fee-for-
        service and capitated managed care plans. Thus, there currently 
        is no ability to make fair assessments across all modes of care 
        for Medicaid enrollees.

SEC. 3. 12-MONTH CONTINUOUS ENROLLMENT.

    (a) Requirement of 12-Month Continuous Enrollment Under Medicaid.--
            (1) In general.--Section 1902(e)(12) of the Social Security 
        Act (42 U.S.C. 1396a(e)), is amended to read as follows:
            ``(12) 12-month continuous enrollment.--
                    ``(A) In general.--Notwithstanding any other 
                provision of this title, a State plan approved under 
                this title (or under any waiver of such plan approved 
                pursuant to section 1115 or section 1915), shall 
                provide that an individual who is determined to be 
                eligible for benefits under such plan (or waiver) shall 
                remain eligible and enrolled for such benefits through 
                the end of the month in which the 12-month period 
                (beginning on the date of determination of eligibility) 
                ends.
                    ``(B) Promoting retention of eligible and enrolled 
                persons beyond 12 months.--The Secretary shall--
                            ``(i) identify methods that promote the 
                        retention of individuals who are enrolled under 
                        the State plan and who remain eligible for 
                        medical assistance beyond the 12-month period 
                        described in subparagraph (A); and
                            ``(ii) actively promote the adoption of 
                        such enrollment retention methods by States, 
                        which should include but not be limited to 
                        issuing guidance and developing resources on 
                        State best practices.
                    ``(C) Enrollment and retention reporting.--
                            ``(i) In general.--Not later than September 
                        30, 2014, the Secretary shall publish the 
                        procedures that States are expected to use to 
                        provide annual enrollment and retention reports 
                        beginning September 30, 2015.
                            ``(ii) State reporting requirements.--At a 
                        minimum, such reporting procedures shall 
                        include a description of State eligibility 
                        criteria and enrollment procedures under this 
                        title, and data regarding enrollment and 
                        retention using standardized reporting formats 
                        determined by the Secretary.
                            ``(iii) Secretary report and publication.--
                        The Secretary shall annually publish enrollment 
                        and retention performance results for all 
                        States beginning not later than June 30, 2016.
                            ``(iv) Each such annual report shall 
                        include estimates of Medicaid enrollment 
                        continuity ratios for each State. In this 
                        clause, the term `enrollment continuity ratio' 
                        means, for a given group, the ratio of the 
                        average monthly enrollment of that group in the 
                        fiscal year divided by the total unduplicated 
                        enrollment for that group in the fiscal year, 
                        expressed as a percentage.
                            ``(v) For purposes of such reports, the 
                        Secretary shall develop both overall ratios for 
                        all enrollees and separate ratios for the 
                        following categories:
                                    ``(I) Children.
                                    ``(II) Individuals whose 
                                eligibility category is related to 
                                being equal to or over the age of 65.
                                    ``(III) Individuals whose 
                                eligibility category is related to 
                                disability or blindness.
                                    ``(IV) Individuals whose 
                                eligibility category is related to 
                                their status as parents and caretaker 
                                relatives of children under 19 or who 
                                are otherwise not elderly, blind or 
                                disabled adults.''.
    (b) Requirement of 12-Month Continuous Enrollment Under CHIP.--
            (1) In general.--Section 2102(b) of the Social Security Act 
        (42 U.S.C. 1397bb(b)) is amended by adding at the end the 
        following new paragraph:
            ``(6) Requirement for 12-month continuous enrollment.--
        Notwithstanding any other provision of this title, a State 
        child health plan that provides child health assistance under 
        this title through a means other than described in section 
        2101(a)(2), shall provide that an individual who is determined 
        to be eligible for benefits under such plan shall remain 
        eligible and enrolled for such benefits through the end of the 
        month in which the 12-month period (beginning on the date of 
        determination of eligibility) ends.''.
            (2) Conforming amendment.--Section 2105(a)(4)(A) of the 
        Social Security Act (42 U.S.C. 1397ee(a)(4)(A)) is amended--
                    (A) by striking ``has elected the option of'' and 
                inserting ``is in compliance with the requirement 
                for''; and
                    (B) by striking ``applying such policy under its 
                State child health plan under this title'' and 
                inserting ``in compliance with section 2102(b)''.
    (c) Effective Date.--
            (1) In general.--Except as provided in paragraph (2) or 
        (3), the amendments made by subsections (a) and (b) shall apply 
        to determinations (and redeterminations) of eligibility made on 
        or after the date that is 18 months after the date of the 
        enactment of this Act.
            (2) Extension of effective date for state law amendment.--
        In the case of a State plan under title XIX or State child 
        health plan under title XXI of the Social Security Act (42 
        U.S.C. 1396 et seq., 42 U.S.C. 1397aa et seq.) which the 
        Secretary of Health and Human Services determines requires 
        State legislation (other than legislation appropriating funds) 
        in order for the respective plan to meet the additional 
        requirement imposed by the amendment made by subsection (a) or 
        (b), respectively, 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 applicable 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 is considered to be a separate regular session of the 
        State legislature.
            (3) Option to implement 12-month continuous eligibility 
        prior to effective date.--A State may elect through a State 
        plan amendment under title XIX or XXI of the Social Security 
        Act (42 U.S.C. 1396 et seq., 42 U.S.C. 1397aa et seq.) to apply 
        the amendment made by subsection (a) or (b), respectively, on 
        any date prior to the 18-month date specified in paragraph (1), 
        but not sooner than the date of the enactment of this Act.

SEC. 4. PREVENTING THE APPLICATION UNDER CHIP OF COVERAGE WAITING 
              PERIODS.

    (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)--
                    (A) by striking ``in the case of'' and inserting 
                ``in the case of a targeted low-income child (including 
                a child provided dental-only supplemental coverage 
                under section 2110(b)(5)) or in the case of''; and
                    (B) by adding ``and'' after the semicolon;
            (2) by striking clause (iv); and
            (3) by redesignating clause (v) as clause (iv).
    (b) Conforming Amendments.--Section 2105(c)(10) of the Social 
Security Act (42 U.S.C. 1397ee(c)(10)) is amended by striking 
subparagraph (F) and redesignating subparagraphs (G) through (M) as 
subparagraphs (F) through (L), respectively.
    (c) Effective Date.--The amendments made by this section shall take 
effect on the date of enactment of this Act.

SEC. 5. PERFORMANCE BONUSES FOR ENROLLMENT AND RETENTION IMPROVEMENTS 
              FOR CERTAIN INDIVIDUALS.

    (a) Medicaid.--Section 1903 of the Social Security Act (42 U.S.C. 
1396b) is amended by adding at the end the following new subsection:
    ``(aa) Performance Bonuses for Enrollment and Retention of Low-
Income Individuals.--
            ``(1) In general.--In addition to performance bonuses for 
        enrollment and retention described in section 2105(a) (related 
        to children), a State may qualify for 1 or more performance 
        bonuses related to the enrollment and retention of individuals 
        described in section 1902(e)(12)(C)(iii)(III). For purposes of 
        this paragraph, a State meets the condition of this paragraph 
        for such individuals if, for each category of individuals 
        specified in section 1902(e)(12)(C)(iii)(III) and selected by 
        the State for additional enrollment and retention provisions, 
        the State is implementing at least 3 of the following 
        enrollment and retention provisions (treating each subparagraph 
        as a separate enrollment and retention provision) throughout 
        the entire fiscal year:
                    ``(A) Aligning treatment of income under medicaid 
                with that of other insurance affordability programs.--
                The State implements policies, including prorating 
                income over annual periods, so as to align its 
                treatment of income for purposes of a determination of 
                eligibility for medical assistance with that of other 
                affordability insurance programs with the goal of 
                eliminating inconsistent determinations among these 
                programs.
                    ``(B) Maintaining coverage for individuals during 
                periods of transition.--
                            ``(i) In general.--Upon determination that 
                        an individual is no longer eligible for medical 
                        assistance, the State implements policies to 
                        maintain eligibility for medical assistance, 
                        including enrollment in the managed care 
                        organization in which the individual was 
                        enrolled at the time of the determination of 
                        ineligibility, during the period of time in 
                        which--
                                    ``(I) eligibility-related 
                                information is transmitted to the other 
                                insurance affordability programs;
                                    ``(II) a determination is made as 
                                to for which other insurance 
                                affordability program the individual is 
                                eligible; and
                                    ``(III) coverage in such program 
                                and any related managed care 
                                organization becomes effective.
                            ``(ii) Managed care organization 
                        continuity.--The State shall also implement 
                        policies to enroll the individual in the 
                        managed care organization in which the 
                        individual was a member prior to the loss of 
                        medical assistance eligibility, if such managed 
                        care organization participates in the other 
                        insurance affordability program, unless the 
                        individual voluntarily selects a separate 
                        managed care organization.
                    ``(C) Enhanced data-sharing between agencies.--The 
                State utilizes findings from an American Health Benefit 
                Exchange, an Express Lane Agency (as identified by the 
                State and as described in section 1902(e)(13)(F)) or 
                the Social Security Administration or other agencies 
                administering employment, educational, or social 
                services programs as identified by the State, to 
                document income, assets, residency, age or other 
                relevant information in determining or renewing 
                eligibility.
                    ``(D) Eligibility based on pending status.--The 
                State maintains eligibility for enrollees whose renewal 
                status has not yet been determined and for whom 
                eligibility based on alternative eligibility criteria 
                has not yet been ruled out.
                    ``(E) Default reenrollment in managed care 
                organization.--In the case of individuals who are 
                determined to be eligible for medical assistance under 
                this title after the loss of eligibility for fewer than 
                6 months, and who previously had been members of a 
                managed care organization, the State re-enrolls the 
                individual in the managed care organization in which 
                the individual was a member prior to the loss of 
                eligibility, unless the individual voluntarily selects 
                a separate managed care organization.
            ``(2) Performance bonus payment to offset costs resulting 
        from 12-month continuous enrollment for medicaid enrollees.--
                    ``(A) Authority to make bonus payments.--
                            ``(i) In general.--In addition to the 
                        payments provided under section 2105(a) of the 
                        Social Security Act, subject to subparagraph 
                        (C) the Secretary shall make payments to a 
                        State (beginning with fiscal year 2016) that 
                        satisfies the requirements of subparagraph (B).
                            ``(ii) Regulations.--Payments to States 
                        shall be allocated annually among States in 
                        accordance with regulations promulgated by the 
                        Secretary not later than July 1, 2015.
                            ``(iii) Timing.--The payment under this 
                        paragraph shall be made, to a State for a 
                        fiscal year, as a single payment not later than 
                        the last day of the first calendar quarter of 
                        the following fiscal year to which the 
                        performance payment applies.
                    ``(B) State eligibility for bonus payments.--A 
                State shall be eligible for bonus payments under this 
                subsection if--
                            ``(i) the State has adopted at least 3 of 
                        the 5 policies described in subparagraphs (A) 
                        through (E) of paragraph (1); and
                            ``(ii) the State is able to demonstrate 
                        improvement in the continuity of enrollment by 
                        aged, blind, and disabled and adult 
                        populations, compared to its baseline 
                        performance in fiscal year 2013.
                    ``(C) Amounts available for payments.--
                            ``(i) In general.--The total amount of 
                        payments under paragraphs (1) and (2) of this 
                        section shall be equal to $500,000,000 for 
                        fiscal year 2016 for making payments under this 
                        paragraph, to be available until expended.
                            ``(ii) Budget authority.--This subsection 
                        constitutes budget authority in advance of 
                        appropriations Acts and represents the 
                        obligation of the Secretary to provide for the 
                        payment of amounts provided under this 
                        subsection.
                    ``(D) Uses of enrollment and retention performance 
                bonuses.--Nothing in this section shall prohibit a 
                State from establishing criteria which would permit the 
                State to distribute a portion of the proceeds of any 
                performance bonuses received pursuant to this section 
                to financially support providers who have contributed 
                to improved enrollment and retention activities. For 
                purposes of allocation of Enrollment and Retention 
                Performance Bonuses the definition of provider shall 
                have the meaning given to it in a State Plan.''.
    (b) Extension of CHIP Performance Bonus To Align With 
Reauthorization of State Allotments.--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 
        ``2015'';
            (2) in subparagraph (E)(ii)--
                    (A) in the heading for subclause (I)(aa), by 
                striking ``2012'' and inserting ``2014'';
                    (B) in subclause (I)(aa)--
                            (i) by striking ``2012'' and inserting 
                        ``2014'';
                            (ii) by striking ``subsection (a)'' and 
                        inserting ``section 2104(a)''; and
                            (iii) by striking ``subsection (m)'' and 
                        inserting ``section 2104(m)'';
                    (C) in the heading for subclause (I)(bb), by 
                striking ``2013'' and inserting ``2015'';
                    (D) in subclause (I)(bb)--
                            (i) by striking ``fiscal year 2013'' and 
                        inserting ``fiscal year 2015'';
                            (ii) by striking ``subsection (a)(16)(A)'' 
                        and inserting ``section 2104(a)(18)(A)'';
                            (iii) by striking ``October 1, 2012, and 
                        ending on March 31, 2013'' and inserting 
                        ``October 1, 2014, and ending on March 31, 
                        2015'';
                            (iv) by striking ``subsection (m)'' and 
                        inserting ``section 2104(m)''; and
                            (v) by striking ``or set aside under 
                        subsection (b)(2) of section 2111 for such 
                        fiscal year'';
                    (E) in the heading for subclause (I)(cc), by 
                striking ``2013'' and inserting ``2015'';
                    (F) in subclause (I)(cc)--
                            (i) by striking ``2013'' each place it 
                        appears and inserting ``2015'';
                            (ii) by striking ``subsection (a)(16)(B)'' 
                        and inserting ``section 2104(a)(18)(B)'';
                            (iii) by striking ``subsection (m)'' and 
                        inserting ``section 2104(m)''; and
                            (iv) by striking ``or set aside under 
                        subsection (b)(2) of section 2111 for such 
                        fiscal year'';
                    (G) in subclause (II), by striking ``2013'' and 
                inserting ``2015''; and
                    (H) in subclause (III), by striking ``2013'' and 
                inserting ``2015''; and
            (3) in subparagraph (F)(iii), by striking ``2013'' and 
        inserting ``2015''.

SEC. 6. MEASURING AND REPORTING ON COMPARABLE HEALTH CARE QUALITY 
              MEASURES FOR ALL PERSONS ENROLLED IN MEDICAID.

    (a) Quality Assurance Standards.--Section 1932(c)(1) of the Social 
Security Act (42 U.S.C. 1396u-2(c)(1)) is amended in subparagraph (A), 
by inserting after ``1903(m)'' the following: ``or comparable primary 
care case management services providers described in section 1905(t) as 
well as health care services furnished in fee-for-service settings''.
    (b) Adult Health Quality Measures.--Title XI of the Social Security 
Act (42 U.S.C. 1301 et seq.), as amended by section 2701 of the Patient 
Protection and Affordable Care Act (Public Law 111-148), is amended at 
section 1139B (42 U.S.C. 1320b-9b)--
            (1) by adding after (b)(3) the following:
            ``(4) Quality reporting for medicaid eligible adults.--
        Beginning January 1, 2016, the Secretary shall require States 
        to use the measures and approaches identified in paragraph (3) 
        of this subsection to report on the initial core set of quality 
        measures for Medicaid eligible adults identified in paragraph 
        (2), subject to revisions made by (5)(B) of this subsection.'';
            (2) by redesignating subsection (b)(4) as (b)(5) and (b)(5) 
        as (b)(6);
            (3) in subsection (d)(1)(B) inserting after ``Section 1937 
        of this title'' the following: ``or comparable primary care 
        case management services providers described in section 1905(t) 
        as well as health care services furnished in fee-for-service 
        settings''; and
            (4) in subsection (d)(2) by inserting after ``(1)'' the 
        following: ``including analysis of comparable quality measures 
        for Medicaid eligible adults who receive their health services 
        through managed care, primary care case management, and fee-
        for-service settings''.
    (c) Pediatric Health Care Measures.--
            (1) In general.--Title XI of the Social Security Act, is 
        amended at section 1139A(a) (42 U.S.C. 1320b-9a(a)) by--
                    (A) inserting after paragraph (4) as if it were 
                included upon enactment:
            ``(5) Reporting of pediatric health care measures.--Not 
        later than five years after the date of enactment of the 
        Medicaid Continuous Quality Act of 2012, States shall use the 
        procedures and approaches identified in paragraph (4) to report 
        information on the initial core measurement set regarding the 
        quality of pediatric health care under titles XIX and XXI.'';
                    (B) redesignating paragraphs (5), (6), (7) and (8) 
                as (6), (7), (8) and (9), respectively; and
                    (C) in subsection (c)(1)(B), inserting after 
                ``section 2103 of such Act'' the following: ``or 
                comparable primary care case management services 
                providers described in section 1905(t) as well as 
                health care services furnished in fee-for-service 
                settings''.

SEC. 7. PERFORMANCE BONUSES FOR SIGNIFICANT ACHIEVEMENT IN MEDICAID 
              QUALITY PERFORMANCE.

    Section 1932(c)(1) of the Social Security Act (42 U.S.C. 1396u-
2(c)(1)) is amended by adding at the end the following new 
subparagraph:
                    ``(F) Performance bonus for quality performance 
                achievement.--
                            ``(i) In general.--The Secretary shall 
                        establish a Medicaid Quality Performance Bonus 
                        fund for awarding performance bonuses to States 
                        for high attainment and improvement on a core 
                        set of quality measures related to the goals 
                        and purposes of the Medicaid program.
                            ``(ii) Quality performance bonus 
                        methodology.--Not later than three years after 
                        the date of enactment of this Act, the 
                        Secretary shall establish a methodology for 
                        awarding Medicaid Quality Performance bonuses 
                        to States not less than annually which will be 
                        based on the annual State reports required 
                        under section 1138B of title XI of the Social 
                        Security Act, in accordance with regulations 
                        promulgated by the Secretary.
                            ``(iii) Quality performance measurement 
                        bonuses.--Medicaid Quality Performance Bonus 
                        funds will be awarded to up to 10 States that 
                        meet thresholds established by the Secretary 
                        for--
                                    ``(I) the top five States achieving 
                                the designation of superior quality 
                                performing State; or
                                    ``(II) five States demonstrating 
                                the greatest relative level of annual 
                                improvement in quality performance.
                            ``(iv) Initial appropriation.--The total 
                        amount of payments under this subparagraph 
                        shall be equal to $500,000,000 for making 
                        payments under this subparagraph, to be 
                        available until expended.
                This subparagraph constitutes budget authority in 
                advance of appropriations Acts and represents the 
                obligation of the Secretary to provide for the payment 
                of amounts provided under this subparagraph.
                            ``(v) Uses of quality performance bonus 
                        funds.--
                                    ``(I) Designation for quality 
                                improvement activities.--As a condition 
                                of receiving a bonus fund award under 
                                clause (iii), a State shall agree to 
                                designate at least 75 percent of the 
                                performance bonus funds for the 
                                development and operation of quality-
                                related initiatives that will directly 
                                benefit providers, including--
                                            ``(aa) provider pay-for-
                                        performance programs;
                                            ``(bb) provider 
                                        collaboration initiatives that 
                                        have been demonstrated to 
                                        improve performance on quality;
                                            ``(cc) provider quality 
                                        improvement initiatives, 
                                        including those aimed at 
                                        improving care for special and 
                                        hard-to-reach populations; and
                                            ``(dd) Secretary-approved 
                                        activities and initiatives that 
                                        a State may pursue to encourage 
                                        quality improvement and 
                                        patient-focused high value 
                                        care.
                        Nothing in this subparagraph shall prohibit a 
                        State from establishing criteria for the State 
                        provider performance program that limits the 
                        award to a particular provider type(s), that 
                        limits application to a specific geographic 
                        area, or that directs incentive programs for 
                        quality-related activities for specific 
                        populations, including individuals eligible 
                        under this title and title XVIII of the Social 
                        Security Act, hard-to-reach populations.
                                    ``(II) Remaining bonus funds.--
                                States may designate up to 25 percent 
                                of the quality performance bonus award 
                                for activities related to the goals and 
                                purposes of the program.
                            ``(vi) Definition of providers.--For 
                        purposes of allocation of Medicaid Quality 
                        Performance Bonuses the definition of provider 
                        shall have the meaning given to it in a State 
                        Plan. Nothing in this section shall prohibit a 
                        State from investing bonus funds into quality 
                        improvement activities for managed care 
                        entities.''.
                                 <all>