[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 2461 Introduced in Senate (IS)]

113th CONGRESS
  2d Session
                                S. 2461

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 SENATE OF THE UNITED STATES

                             June 11, 2014

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

_______________________________________________________________________

                                 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 Act 
of 2014''.
    (b) Amendments to Social Security Act.--Except as otherwise 
specifically provided, whenever in this Act an amendment is expressed 
in terms of an amendment to or repeal of a section or other provision, 
the reference shall be considered to be made to that section or other 
provision of the Social Security Act.
    (c) References to CHIP; Medicaid; Secretary.--In this Act:
            (1) CHIP.--The term ``CHIP'' means the 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.
    (d) 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. Purposes.
Sec. 3. General effective date; exception for State legislation; 
                            reliance on law.
                           TITLE I--FINANCING

Sec. 101. Extension of CHIP.
Sec. 102. Continuation and update of performance incentives.
Sec. 103. Funds to address any Federal funding shortfalls for States.
                  TITLE II--ELIGIBILITY AND ENROLLMENT

                    Subtitle A--Coverage Continuity

Sec. 201. State option to increase upper age limit for children with 
                            special health care needs.
Sec. 202. Improving coverage transitions from Medicaid or CHIP to 
                            coverage under a qualified health plan.
Sec. 203. Assuring coverage continuity for former foster care children.
         Subtitle B--Enrollment Simplification and Improvements

Sec. 211. Automatic enrollment for newborns under CHIP.
Sec. 212. Express Lane Eligibility extension and application to 
                            pregnant women, foster children, and 
                            children with special health care needs.
Sec. 213. Outreach to targeted populations.
                        TITLE III--AFFORDABILITY

Sec. 301. Strengthened cost sharing protections under Medicaid and 
                            CHIP.
                           TITLE IV--BENEFITS

Sec. 401. Preventive health services.
Sec. 402. Timely immunization coverage.
                      TITLE V--ACCESS AND QUALITY

                 Subtitle A--Pediatric Quality Measures

Sec. 501. Extending the pediatric quality measures program.
Sec. 502. Improving the effectiveness of the pediatric quality 
                            measures.
Sec. 503. Annual State reports regarding State-specific quality of care 
                            measures applied under Medicaid or CHIP.
Sec. 504. Advisory panel regarding pediatric quality.
Sec. 505. Extending and expanding demonstration projects.
Subtitle B--Maternal, Infant, and Early Childhood Home Visiting Program

Sec. 511. Supporting evidence-based care coordination in communities.
 Subtitle C--Comparative Study of Medicaid, CHIP, and Qualified Health 
                                 Plans

Sec. 521. GAO study and report.
                      TITLE VI--BUDGETARY EFFECTS

Sec. 601. Budgetary effect of this Act.

SEC. 2. PURPOSES.

    The purposes of this Act are to ensure the extension of CHIP, 
safeguard child-specific health coverage for millions of children, and 
make improvements to promote children's access to cost-effective, high-
quality health care.

SEC. 3. 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, 2015, and shall apply to child 
health assistance and medical assistance provided 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 1 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) 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. EXTENSION OF CHIP.

    (a) Funding.--
            (1) In general.--Section 2104(a) (42 U.S.C. 1397dd(a)) is 
        amended--
                    (A) in paragraph (17), by striking ``and'' at the 
                end;
                    (B) by striking paragraph (18) and inserting the 
                following:
            ``(18) for fiscal year 2015, $21,061,000,000;''; and
                    (C) 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.''.
            (2) Prevention of duplicate appropriations for fiscal year 
        2015.--Expenditures made under section 2104(a)(18) of the 
        Social Security Act (42 U.S.C. 1387dd(a)(18)) pursuant to the 
        amendments made by section 10203 of the Patient Protection and 
        Affordable Care Act (Public Law 111-148) for fiscal year 2015 
        shall be charged to the appropriation provided by the amendment 
        made by paragraph (1) to such section for that fiscal year.
    (b) Allotments.--
            (1) In general.--Section 2104(m) (42 U.S.C. 1397dd(m)) is 
        amended--
                    (A) in paragraph (3)--
                            (i) by striking ``2015'' in the paragraph 
                        heading 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), by striking 
                                ``the sum of--'' and all that follows 
                                through ``2009;'' and inserting ``the 
                                amount made available under subsection 
                                (a)(22)(A),''; and
                                    (II) in subclause (II) of clause 
                                (ii), by striking ``subsection 
                                (a)(18)(B)'' and inserting ``subsection 
                                (a)(22)(B)'';
                    (B) in paragraph (4), by striking ``2015'' and 
                inserting ``2019'';
                    (C) in paragraph (8)--
                            (i) by striking ``2015'' in the paragraph 
                        heading and inserting ``2019''; and
                            (ii) by striking ``for a period in fiscal 
                        year 2015'' and inserting ``for a period in 
                        fiscal year 2019''; and
                    (D) by adding at the end the following new 
                paragraph:
            ``(9) Rebasing and growth factor update rules for fiscal 
        years after fiscal year 2014.--Subject to paragraphs (3), (4), 
        and (6), from the amount made available under subsection (a) 
        for each fiscal year after fiscal year 2014, 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:
                    ``(A) Rebasing in odd-numbered fiscal years.--If 
                the fiscal year is an odd-numbered fiscal year, the 
                allotment of the State is equal to the Federal payments 
                to the State that are attributable to (and countable 
                towards) the total amount of allotments available under 
                this section to the State in the preceding fiscal year 
                (including any payments made to the State under 
                subsections (n) and (o) for the preceding fiscal year 
                as well as amounts redistributed to the State in the 
                preceding fiscal year), multiplied by the allotment 
                increase factor under paragraph (5) for the fiscal 
                year.
                    ``(B) Growth factor update for even-numbered fiscal 
                years.--If the fiscal year is an even-numbered fiscal 
                year, the allotment of the State is equal to the sum 
                of--
                            ``(i) the amount of the State allotment for 
                        the preceding fiscal year; and
                            ``(ii) the amount of any payments made to 
                        the State under subsections (n) and (o) for the 
                        preceding fiscal year,
                multiplied by the allotment increase factor under 
                paragraph (5) for the fiscal year.''.
            (2) One-time appropriation for fiscal year 2019.--Section 
        108 of the Children's Health Insurance Program Reauthorization 
        Act of 2009 (Public Law 111-3), as amended by section 
        10203(d)(2)(F) of the Patient Protection and Affordable Care 
        Act (Public Law 111-148), is amended by striking 
        ``$15,361,000,000'' and all that follows through the second 
        sentence, and inserting ``$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)), 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)) 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).''.
            (3) Conforming amendments.--Section 2104(m) (42 U.S.C. 
        1397dd(m)) is amended--
                    (A) in the subsection heading, by striking ``2015'' 
                and inserting ``2019''; and
                    (B) 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''.
    (c) Extension of Qualifying States Option.--Section 2105(g)(4) (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. CONTINUATION AND UPDATE OF PERFORMANCE INCENTIVES.

    (a) Extension Through Fiscal Year 2019.--Section 2105(a)(3) (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) by striking subclause (I) and inserting 
                        the following:
                                    ``(I) Unobligated national 
                                allotment.--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.'';
                            (ii) in subclause (II), by striking 
                        ``2013'' and inserting ``2015''; and
                            (iii) 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 $750,000,000 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 through December 31 of the following 
                        fiscal year. Any amount of such appropriations 
                        that remains unexpended or unobligated as of 
                        such date shall be transferred and made 
                        available on January 1 of such following fiscal 
                        year for making payments under section 
                        2104(o).''; 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) (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 ``for fiscal years 
                before fiscal year 2015'' after ``for children''; and
                    (B) in the matter preceding subparagraph (A), by 
                striking ``for a fiscal year if'' and inserting ``for a 
                fiscal year before fiscal year 2015 if''; and
            (3) by adding at the end the following new paragraph:
            ``(5) Enrollment and retention provisions for children for 
        fiscal years after fiscal year 2014.--
                    ``(A) In general.--For purposes of paragraph 
                (3)(A), a State meets the condition of this paragraph 
                for a fiscal year after fiscal year 2014 if it is 
                implementing at least 7 of the enrollment and retention 
                provisions specified in subparagraph (B) (treating each 
                clause of that subparagraph as a separate enrollment 
                and retention provision) throughout the entire fiscal 
                year and achieves a program rating of `effective' or 
                `highly effective' under metrics established by the 
                Secretary under subparagraph (C) for the fiscal year 
                (beginning with the first fiscal year for which such 
                metrics are established).
                    ``(B) Enrollment and retention provisions.--The 
                enrollment and retention provisions specified in this 
                subparagraph are the following:
                            ``(i) 12-month continuous eligibility.--The 
                        State has elected the option of continuous 
                        eligibility for a full 12 months under title 
                        XIX for all children described in section 
                        1902(e)(12) and applies 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) Elimination of chip premiums.--In 
                        the case of any targeted low-income child or a 
                        targeted low-income pregnant woman, the State 
                        child health plan does not impose any 
                        enrollment fee, premium, or similar charge.
                            ``(v) Premium assistance for employer-
                        sponsored plans.--The State has opted to offer 
                        a premium assistance subsidy for qualified 
                        employer-sponsored coverage by implementing 
                        section 1906A under title XIX or the option 
                        described in section 2105(c)(10) under this 
                        title.
                            ``(vi) Comprehensive coverage for pregnant 
                        women.--If the State has elected to offer 
                        pregnancy-related assistance to targeted low-
                        income women (as defined in section 2112(d)(2)) 
                        under section 2112, the State also has elected 
                        to include, as part of such pregnancy-related 
                        assistance and as part of the medical 
                        assistance provided to women under section 
                        1902(e)(5) while pregnant and during the 60-day 
                        period described in such section--
                                    ``(I) dental services necessary to 
                                prevent disease and promote oral 
                                health, restore oral structure to 
                                health and function, and treat 
                                emergency conditions;
                                    ``(II) vision services, including 
                                vision screening and corrective lenses; 
                                and
                                    ``(III) all services covered under 
                                the State child health plan.
                            ``(vii) Improved coverage for pregnant 
                        women.--If the State has elected to offer 
                        pregnancy-related assistance to targeted low-
                        income women (as defined in section 2112(d)(2)) 
                        under section 2112--
                                    ``(I) the State also has elected to 
                                provide that a pregnant woman who is 
                                determined to be eligible for 
                                pregnancy-related assistance under the 
                                amendment to the State child health 
                                plan under section 2112 shall remain 
                                eligible for those benefits until the 
                                end of a period (not to exceed 12 
                                months) following the determination; 
                                and
                                    ``(II) the State is implementing 
                                section 1906A under title XIX.
                            ``(viii) Supplemental dental coverage.--The 
                        State has elected to provide dental-only 
                        supplemental coverage under section 2110(b)(5).
                            ``(ix) Raising chip eligibility age to 
                        align with medicaid eligibility age.--If the 
                        State has elected to provide eligibility as a 
                        child under the State plan under title XIX for 
                        an individual who has attained age 19 or 20, 
                        the State has elected to apply the same age 
                        under the State plan under this title for 
                        purposes of eligibility as a child.
                            ``(x) Increase in income eligibility.--
                                    ``(I) Up to at least 300 percent of 
                                the poverty line.--The State has 
                                elected to extend eligibility for 
                                medical assistance under the State plan 
                                under title XIX or eligibility for 
                                child health assistance under the State 
                                child health plan to any otherwise 
                                eligible child whose family income does 
                                not exceed 300 percent of the poverty 
                                line for a family of the size involved.
                                    ``(II) Rule of construction.--
                                Nothing in subclause (I) shall be 
                                construed as prohibiting a State from 
                                extending eligibility for medical 
                                assistance under the State plan under 
                                title XIX or eligibility for child 
                                health assistance under the State child 
                                health plan to any otherwise eligible 
                                child whose family income exceeds 300 
                                percent of the poverty line.
                            ``(xi) Prohibiting lockout periods.--The 
                        State child health plan permits an individual 
                        whose coverage under the plan has been 
                        terminated for failure to make premium payments 
                        to be immediately reenrolled 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 
                        enrollment fee as a condition of reenrollment.
                            ``(xii) CHIP coverage for children of state 
                        employees.--The State offers enrollment in the 
                        State child health plan for a child who is a 
                        member of a family that is eligible for health 
                        benefits coverage under a State health benefits 
                        plan on the basis of a family member's 
                        employment with a public agency in accordance 
                        with section 2110(b)(6) and provides resources 
                        to help the family member so employed compare 
                        the coverage options for the family member's 
                        child under the State health benefits plan on 
                        the basis of cost and provider networks.
                            ``(xiii) Interagency coordination for 
                        juvenile justice youth.--The State--
                                    ``(I) does not terminate (but may 
                                suspend) enrollment under a State plan 
                                for medical assistance for any 
                                individual under age 21 on the basis 
                                that the individual is an inmate of a 
                                public institution (as defined in 
                                section 435.1010 of title 42, Code of 
                                Federal Regulations);
                                    ``(II) informs such individual 
                                immediately upon release from such 
                                public institution that the 
                                individual's eligibility for medical 
                                assistance is no longer suspended and 
                                the limitations on medical assistance 
                                under the subdivision (A) following 
                                paragraph (29) of section 1905(a) will 
                                no longer apply (unless and until there 
                                is a determination that the individual 
                                no longer meets the State or Federal 
                                eligibility requirements for such 
                                medical assistance);
                                    ``(III) processes any application 
                                for medical assistance submitted by, or 
                                on behalf of any individual under age 
                                21 who is an inmate of a public 
                                institution (as defined in section 
                                435.1010 of title 42, Code of Federal 
                                Regulations) notwithstanding that the 
                                individual is such an inmate; and
                                    ``(IV) screens any individual under 
                                age 21 who is such an inmate for 
                                eligibility for medical assistance 
                                under title XIX or child health 
                                assistance under this title and assists 
                                those individuals who are identified as 
                                likely to be eligible for either such 
                                assistance in applying for either such 
                                assistance and enrolling in either such 
                                plan.
                            ``(xiv) Extended coverage for children with 
                        special health care needs.--The State has 
                        elected to extend eligibility for child health 
                        assistance under the State child health plan 
                        (whether implemented under this title, title 
                        XIX, or both) to individuals under age 26 with 
                        special health care needs by implementing the 
                        option described in section 2110(c)(1)(B).
                    ``(C) Metrics for evaluating program 
                effectiveness.--The Secretary shall establish metrics 
                for evaluating the effectiveness of the State program 
                established under this title (whether implemented under 
                this title, title XIX, or both). Such metrics shall 
                include a system for rating States as `effective', 
                `highly effective', or `in need of improvement'.''.

SEC. 103. FUNDS TO ADDRESS ANY FEDERAL FUNDING SHORTFALLS FOR STATES.

    (a) In General.--Section 2104 (42 U.S.C. 1397dd) is amended by 
adding at the end the following new subsection:
    ``(o) Fund To Alleviate CHIP Shortfalls.--
            ``(1) Establishment.--There is hereby established in the 
        Treasury of the United States a fund which shall be known as 
        the `CHIP Shortfall Fund' (in this subsection referred to as 
        the `Fund'). Amounts in the Fund shall be available without 
        further appropriations for payments under this subsection and 
        shall remain available until expended.
            ``(2) Deposits into fund.--
                    ``(A) Initial appropriation.--Out of any money in 
                the Treasury of the United States not otherwise 
                appropriated, there are appropriated to the Fund 
                $3,860,000,000 for fiscal year 2016.
                    ``(B) 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 January 1 of fiscal year 2017, and as of 
                        January 1 of each succeeding fiscal year, the 
                        portion, if any, of the amount appropriated 
                        under subsection (a) for the preceding fiscal 
                        year that is unobligated for allotment to a 
                        State under subsection (m) for such preceding 
                        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 child enrollment 
                        contingency funds.--As of October 1, 2015, any 
                        unobligated amount in the Child Enrollment 
                        Contingency Fund under subsection (n).
                            ``(iv) Unexpended performance incentive 
                        funds.--As of January 1, 2017, and as of 
                        January 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 
                        for such preceding fiscal year.
                    ``(C) 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 shall constitute a part of the Fund.
            ``(3) Shortfall fund payments.--
                    ``(A) Payments to shortfall states.--For each of 
                fiscal years 2016 through 2020, if the Secretary 
                determines that a State is a shortfall State described 
                in paragraph (4) for that fiscal year, 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, an amount equal to the amount described in 
                subparagraph (B) for the State and fiscal year.
                    ``(B) Amount described.--With respect to a State 
                and a fiscal year, the amount described in this 
                subparagraph is the amount of projected expenditures 
                for the State under this title for the fiscal year that 
                exceeds the sum determined under paragraph (4) for the 
                State and fiscal year.
                    ``(C) Proportional reduction.--If the sum of the 
                amounts otherwise payable under this paragraph for a 
                fiscal year exceeds the amount available in the Fund 
                for the fiscal year, the amount to be paid under this 
                paragraph to each State for the fiscal year shall be 
                reduced proportionally.
                    ``(D) Application to commonwealths and 
                territories.--No payment shall be made under this 
                paragraph to a commonwealth or territory described in 
                subsection (c)(3) until such time as the Secretary 
                determines that there are in effect methods, 
                satisfactory to the Secretary, for the collection and 
                reporting of reliable data regarding the expenditures 
                under the State child health plan in order to 
                accurately determine the commonwealth's or territory's 
                eligibility for, and amount of payment, under this 
                paragraph.
            ``(4) Shortfall states described.--For purposes of 
        paragraph (3), with respect to a fiscal year, 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 under 
        this title (whether the State plan is implemented under this 
        title, title XIX, or both) will exceed the sum of--
                    ``(A) the amount of the State's allotments for any 
                preceding fiscal years that remains available for 
                expenditure and that will not be expended by the end of 
                the immediately preceding fiscal year;
                    ``(B) the amount (if any) that will be 
                redistributed to the State under subsection (f) for the 
                fiscal year;
                    ``(C) the amount (if any) of the child enrollment 
                contingency fund payment under subsection (n) for the 
                fiscal year; and
                    ``(D) the amount of the State's allotment for the 
                fiscal year.
            ``(5) Retrospective adjustment.--The Secretary may adjust 
        the determinations made under this subsection with respect to a 
        State and fiscal year as necessary on the basis of the amounts 
        reported by States not later than November 30 of the succeeding 
        fiscal year, as approved by the Secretary.''.
    (b) Technical Amendments.--Section 2104(f) (42 U.S.C. 1397dd(f)) is 
amended--
            (1) in paragraph (1)--
                    (A) by striking ``shortfall States'' and inserting 
                ``redistribution States''; and
                    (B) by striking ``shortfall described'' and 
                inserting ``deficit described''; and
            (2) in paragraph (2)--
                    (A) in the paragraph heading, by striking 
                ``Shortfall'' and inserting ``Redistribution'';
                    (B) in subparagraph (A), by striking ``shortfall 
                State'' and inserting ``redistribution State''; and
                    (C) in subparagraph (B)--
                            (i) by striking ``shortfalls'' and 
                        inserting ``deficits''; and
                            (ii) by striking ``shortfall State'' and 
                        inserting ``redistribution State''.

                  TITLE II--ELIGIBILITY AND ENROLLMENT

                    Subtitle A--Coverage Continuity

SEC. 201. STATE OPTION TO INCREASE UPPER AGE LIMIT FOR CHILDREN WITH 
              SPECIAL HEALTH CARE NEEDS.

    Section 2110(c)(1) (42 U.S.C. 2110(c)(1)) is amended--
            (1) by striking ``The term'' and inserting the following:
                    ``(A) In general.--Subject to subparagraph (B), the 
                term''; and
            (2) by adding at the end the following:
                    ``(B) Children with special health care needs.--At 
                State option, such term includes an individual under 26 
                years of age who has or is at an increased risk of a 
                chronic physical, developmental, behavioral, or 
                emotional condition and who also requires health and 
                related services of a type or amount beyond that 
                required by children typically.''.

SEC. 202. IMPROVING COVERAGE TRANSITIONS FROM MEDICAID OR CHIP TO 
              COVERAGE UNDER A QUALIFIED HEALTH PLAN.

    (a) State Coordination Requirement.--Section 2105(d)(3)(B) (42 
U.S.C. 1397ee(d)(3)(B)) is amended--
            (1) in the subparagraph heading, by striking ``shortfalls'' 
        and inserting ``shortfalls; coordination requirements for 
        transitioning to or from exchange coverage'';
            (2) in the first sentence, by striking ``In the event'' and 
        inserting the following:
                            ``(i) Exchange coverage as a result of 
                        funding shortfalls.--In the event''; and
            (3) by adding at the end the following:
                            ``(ii) Coordination requirements for 
                        transitioning to or from exchange coverage.--
                        The State shall establish procedures to 
                        eliminate gaps in coverage and to assist a 
                        child's and pregnant woman's transition from 
                        coverage under the State plan under title XIX 
                        or the State child health plan under this title 
                        (whether implemented under this title, title 
                        XIX, or both) to coverage under a qualified 
                        health plan that has been certified by the 
                        Secretary under subparagraph (C) and is offered 
                        through an Exchange and from coverage under a 
                        qualified health plan to coverage under the 
                        State plan under title XIX or the State child 
                        health plan under this title. Such procedures--
                                    ``(I) shall provide for coverage 
                                for the child's or pregnant woman's 
                                medical home, regardless of whether the 
                                medical home providers are 
                                participating providers under the State 
                                plan under title XIX or the State child 
                                health plan under this title, for a 
                                transitional time to be determined 
                                under regulations promulgated by the 
                                Secretary;
                                    ``(II) in the case of a child or 
                                pregnant woman with a chronic or 
                                complex condition, shall provide that 
                                the State plan under title XIX, or the 
                                State child health plan under this 
                                title (as applicable) shall permit the 
                                child or pregnant woman to continue to 
                                receive treatment from a non-network 
                                provider for a transitional period as 
                                determined under regulations 
                                promulgated by the Secretary;
                                    ``(III) shall require that if the 
                                benefits available and cost-sharing 
                                imposed under a qualified health plan 
                                available to the child or pregnant 
                                woman (as applicable) are not 
                                comparable to the benefits and coverage 
                                available to the child or pregnant 
                                woman under the State plan under title 
                                XIX or the State child health plan 
                                under this title (as applicable) the 
                                child or pregnant woman shall remain 
                                enrolled in the State plan under title 
                                XIX or the State child health plan 
                                under this title for so long as the 
                                child or pregnant woman is otherwise 
                                eligible for coverage under the title 
                                XIX or XXI State plans; and
                                    ``(IV) shall establish a system 
                                under which the State shall record all 
                                transitions of children and pregnant 
                                women from coverage under the State 
                                plan under title XIX or the State child 
                                health plan under this title to 
                                coverage under a qualified health plan 
                                and from coverage under a qualified 
                                health plan to coverage under the State 
                                plan under title XIX or the State child 
                                health plan under this title and submit 
                                a report to the Secretary each fiscal 
                                quarter that includes data on the 
                                number of children and pregnant women 
                                who made such transitions in the 
                                preceding fiscal quarter.''.
    (b) Certification Requirement.--Section 2105(d)(3)(C) (42 U.S.C. 
1397ee(d)(3)(C)) is amended--
            (1) in the subparagraph heading, by striking ``Pediatric'';
            (2) by striking ``With respect to'' and inserting the 
        following:
                            ``(i) In general.--With respect to'';
            (3) by inserting ``and pregnant women'' after ``children'' 
        each place it appears;
            (4) by striking ``are at least comparable to the benefits 
        offered and cost-sharing protections provided under the State 
        child health plan'' and inserting ``meet the comparability 
        standards described in clause (ii) and the continuous coverage 
        requirements described in clause (iii)''; and
            (5) by adding at the end the following new clauses:
                            ``(ii) Comparability standards.--The 
                        Secretary shall develop, in consultation with 
                        non-government stakeholder entities (including 
                        not less than 1 national non-profit 
                        organization focused on children's advocacy), 
                        comparability standards for qualified health 
                        plans seeking certification under clause (i). 
                        Such standards must include standards for the 
                        following areas:
                                    ``(I) Affordability.--The plan must 
                                be comparable to the State child health 
                                plan in terms of affordability, 
                                including premiums, deductibles, co-
                                payments, co-insurance, medical home 
                                maintenance costs, and the cost of 
                                purchasing supplementary coverage for 
                                health benefits and services that are 
                                covered under the State child health 
                                plan but are not covered under the 
                                qualified health plan.
                                    ``(II) Benefits.--The plan must be 
                                comparable to the State child health 
                                plan in terms of pediatric and 
                                pregnancy-related benefits.
                                    ``(III) Network adequacy.--The plan 
                                must be comparable to the State child 
                                health plan in terms of access to 
                                appropriate providers of pediatric and 
                                pregnancy-related services, and must 
                                provide flexibility for children with 
                                special health care needs to remain in 
                                their medical home or seek appropriate 
                                pediatric sub-specialists.
                            ``(iii) Continuous coverage requirements.--
                        The Secretary shall require health plans 
                        seeking certification as qualified health plans 
                        for purposes of an American Health Benefits 
                        Exchange to ensure that--
                                    ``(I) with respect to a child or 
                                pregnant woman who is transitioning 
                                from coverage under a State child 
                                health plan or a State plan under title 
                                XIX--
                                            ``(aa) coverage under the 
                                        qualified health plan shall be 
                                        effective as of the 60-day 
                                        period preceding the date on 
                                        which the first premium payment 
                                        is made for such coverage;
                                            ``(bb) coverage under the 
                                        State child health plan or 
                                        State plan under title XIX 
                                        shall remain in effect during 
                                        the 30-day period that precedes 
                                        the 60-day period described in 
                                        item (aa);
                                            ``(cc) the qualified health 
                                        plan shall provide coverage for 
                                        a child's or a pregnant woman's 
                                        medical home, regardless of 
                                        whether the medical home 
                                        provider is within the network 
                                        of the plan, to allow the child 
                                        or pregnant woman to finish a 
                                        course of treatment for an 
                                        acute illness or a treatment or 
                                        surgery scheduled prior to the 
                                        effective date for coverage 
                                        under the plan under item (aa) 
                                        or for a period of up to 90 
                                        days if, by the end of such 
                                        period, the child or pregnant 
                                        woman is enrolled with a 
                                        medical home provider that is 
                                        within the network of the plan; 
                                        and
                                            ``(dd) in the case of a 
                                        child or pregnant woman with a 
                                        chronic or complex condition, 
                                        the qualified health plan shall 
                                        permit the child or pregnant 
                                        woman to continue to receive 
                                        treatment from a non-network 
                                        provider for a transitional 
                                        time that is not less than 90 
                                        days, or until the child or 
                                        pregnant woman can be enrolled 
                                        with an in-network provider;
                                    ``(II) similar requirements apply 
                                with respect to any child or pregnant 
                                woman who transitions from coverage 
                                under a qualified health plan to 
                                coverage under the State child health 
                                plan or the State plan under title XIX 
                                in accordance with subparagraph 
                                (B)(ii); and
                                    ``(III) a child or pregnant woman 
                                transitioning to or from coverage under 
                                the State child health plan or the 
                                State plan under title XIX and a 
                                qualified health plan is informed of 
                                the differences between the benefits 
                                available and cost-sharing imposed 
                                under the coverage the child or 
                                pregnant woman is transitioning from 
                                and into, and that the pregnant woman 
                                or the parent or guardian of the child 
                                has the option of electing to remain 
                                enrolled in whichever coverage is the 
                                most affordable or provides the best 
                                benefits for the child or pregnant 
                                woman for such period as the Secretary 
                                shall specify.''.
    (c) Prohibition on Transitioning CHIP-Eligible Children.--No child 
who is eligible for coverage under CHIP shall be transitioned from a 
State child health plan to a qualified health plan unless that plan is 
certified under section 2105(d)(3)(C) of the Social Security Act (42 
U.S.C. 1397ee(d)(3)(C)) (as amended by subsection (b)).
    (d) 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), 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).''.
            (2) Effective date.--The amendment made by this subsection 
        applies to taxable years beginning after December 31, 2014.

SEC. 203. ASSURING COVERAGE CONTINUITY FOR FORMER FOSTER CARE CHILDREN.

    (a) In General.--Section 1902(a)(10)(A)(i)(IX) (42 U.S.C. 
1396a(a)(10)(A)(i)(IX)) is amended--
            (1) in item (cc), by striking ``responsibility of the 
        State'' and inserting ``responsibility of a State''; and
            (2) 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 the date of enactment of this Act.

         Subtitle B--Enrollment Simplification and Improvements

SEC. 211. AUTOMATIC ENROLLMENT FOR NEWBORNS UNDER CHIP.

    (a) In General.--Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)) is 
amended--
            (1) by redesignating subparagraphs (E) through (O) as 
        subparagraphs (F) through (P), respectively; and
            (2) by inserting after subparagraph (D) the following new 
        subparagraph:
                    ``(E) Section 1902(e)(4) (relating to automatic 
                coverage for newborns through age 1).''.
    (b) Effective Date.--The amendments made by this section shall take 
effect on the date of enactment of this Act.

SEC. 212. EXPRESS LANE ELIGIBILITY EXTENSION AND APPLICATION TO 
              PREGNANT WOMEN, FOSTER CHILDREN, AND CHILDREN WITH 
              SPECIAL HEALTH CARE NEEDS.

    (a) In General.--Section 1902(e)(13) (42 U.S.C. 1396a(e)(13)) is 
amended--
            (1) in subparagraph (A), by adding at the end the following 
        new clause:
                            ``(iii) State option to extend express lane 
                        eligibility to pregnant women.--At the option 
                        of the State, the State may apply the 
                        provisions of this paragraph with respect to 
                        determining eligibility under this title for a 
                        pregnant woman. In applying this paragraph in 
                        the case of a State electing 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 a pregnant woman.'';
            (2) in subparagraph (G), by adding at the end the following 
        new sentence: ``Notwithstanding the age limit specified in the 
        preceding sentence, such term includes an individual described 
        in subsection (a)(10)(A)(i)(IX) and, at the option of the 
        State, an individual described in section 2110(c)(1)(B).''; and
            (3) by striking subparagraph (I).
    (b) Effective Date.--The amendments made by this section shall take 
effect on the date of enactment of this Act.

SEC. 213. OUTREACH TO TARGETED POPULATIONS.

    (a) Outreach and Enrollment Grants.--Section 2113 (42 U.S.C. 
1397mm) is amended--
            (1) in subsection (a)(1), by striking ``during the period 
        of fiscal years 2009 through 2015''; and
            (2) in subsection (g), by inserting ``and $40,000,000 for 
        each fiscal year thereafter,'' after ``2015,''.
    (b) Outreach to Non-English Speakers and Other Populations.--
            (1) National enrollment campaign requirements.--Such 
        section 2113 is amended--
                    (A) in subsection (h), by striking ``Such 
                campaign'' and inserting ``In addition to the 
                requirements described in subsection (i), such 
                campaign''; and
                    (B) by adding at the end the following subsection:
    ``(i) Required Elements of National Enrollment Campaign.--Beginning 
with fiscal year 2015, each of the following initiatives shall be part 
of the national enrollment campaign:
            ``(1) Initiative to increase enrollment among individuals 
        with limited english proficiency.--An initiative to increase 
        enrollment in the State child health plan under this title or 
        the State plan under title XIX of children from families that 
        speak a primary language other than English that shall 
        include--
                    ``(A) language services, including oral 
                interpreting and written translation services, for 
                individuals with limited proficiency in English; and
                    ``(B) other culturally appropriate efforts to 
                increase enrollment of such children.
            ``(2) Initiative to increase enrollment of children in 
        families with complex or multiple coverage sources.--An 
        initiative to identify and increase enrollment in the State 
        child health plan under this title or the State plan under 
        title XIX of children from families who have multiple coverage 
        sources or other coverage complexities, including children in 
        foster care and children subject to a medical child support 
        order.''.
            (2) Increased reimbursement for state spending on language 
        services.--
                    (A) Medicaid.--Section 1903(a)(2)(E) (42 U.S.C. 
                1396b(a)(2)(E)) is amended by striking ``75 percent'' 
                and inserting ``the higher of 90 percent or the sum of 
                the enhanced FMAP (as defined in section 2105(b)) plus 
                5 percentage points (not to exceed 100 percent)''.
                    (B) CHIP.--Section 2105(a)(1) (42 U.S.C. 
                1397ee(a)(1)) is amended in the matter preceding 
                paragraph (1), by striking ``the higher of 75 percent 
                or the sum of the enhanced FMAP plus 5 percentage 
                points'' and inserting ``the higher of 90 percent or 
                the sum of the enhanced FMAP plus 5 percentage points 
                (not to exceed 100 percent)''.
            (3) Requirement that managed care organizations provide 
        language services to enrollees.--Section 1932(b) (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 medicaid 
        managed care organization under section 1903(m) shall require 
        the organization to provide (at no cost to the individual) 
        language services, including oral interpreting and written 
        translation services, to any individual who is eligible for 
        medical assistance under the State plan under this title and is 
        enrolled with the organization and to a parent or guardian of 
        such individual if such individual, parent, or guardian is in 
        need of such services when interacting with the organization or 
        with any provider receiving payment from the organization.''.
            (4) Translation of applications and other vital 
        documents.--
                    (A) Medicaid.--Section 1902(a) (42 U.S.C. 1396a(a)) 
                is amended--
                            (i) by striking ``and'' at the end of 
                        paragraph (80);
                            (ii) by striking the period at the end of 
                        paragraph (81) and inserting ``; and''; and
                            (iii) by inserting after paragraph (81) the 
                        following new paragraph:
            ``(82) provide for the translation of all documents and 
        materials necessary to make application for medical assistance 
        under the plan, and such other documents and materials as the 
        Secretary may specify, including any such documents and 
        materials that are available via a website, into the primary 
        language spoken by any limited English proficiency group in the 
        State with a population of at least 1000 individuals or that 
        constitutes 5 percent of the State population.''.
                    (B) CHIP.--Section 2107(e)(1), as amended by 
                section 221, is amended--
                            (i) by redesignating subparagraphs (E) 
                        through (P) as subparagraphs (F) through (Q), 
                        respectively; and
                            (ii) by inserting after subparagraph (D) 
                        the following subparagraph:
                    ``(E) Section 1902(a)(82) (relating to the 
                translation of documents and materials).''.
    (c) Primary Language Data Collection.--
            (1) Data from eligible entities.--Section 2113(c)(4)(B) (42 
        U.S.C. 1397mm(c)(4)(B)) is amended by inserting ``under this 
        title and title XIX, individual data on the primary language of 
        enrollees under this title and title XIX (and for such 
        enrollees who are minors or incapacitated, data on the primary 
        language of their parents or guardians)'' after ``enrollment 
        data''.
            (2) Annual report.--
                    (A) CHIP.--Section 2108 (42 U.S.C. 1397hh) is 
                amended--
                            (i) by redesignating the subsection (e) 
                        added by section 501(e)(2) of Public Law 111-3 
                        as subsection (f); and
                            (ii) in paragraph (1) of the subsection (e) 
                        added by section 402 of Public Law 111-3, by 
                        inserting ``and primary language'' after 
                        ``duration of benefits''.
                    (B) Medicaid.--Section 1946(c) (42 U.S.C. 1396w-
                5(c)) is amended by inserting ``demographic'' before 
                ``data on health care disparities''.
    (d) Effective Date.--The amendments made by this section shall take 
effect on the date of enactment of this Act.

                        TITLE III--AFFORDABILITY

SEC. 301. STRENGTHENED COST SHARING PROTECTIONS UNDER MEDICAID AND 
              CHIP.

    (a) Medicaid.--
            (1) In general.--Section 1916 (42 U.S.C. 1396o) is 
        amended--
                    (A) in subsection (a)--
                            (i) in subparagraph (E) of paragraph (2), 
                        by striking ``and'' at the end;
                            (ii) in paragraph (3)--
                                    (I) by inserting ``subject to 
                                paragraph (4),'' before ``any 
                                deduction''; and
                                    (II) by striking the period at the 
                                end and inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new paragraph:
            ``(4) the total annual aggregate amount of any premium, 
        enrollment fee, deduction, cost sharing, or similar charge 
        imposed under the plan with respect to such individuals and 
        their families shall not exceed 5 percent of the family income 
        of the individual involved, as applied on a quarterly or 
        monthly basis (as specified by the State).'';
                    (B) in subsection (b)--
                            (i) in subparagraph (E) of paragraph (2), 
                        by striking ``and'' at the end;
                            (ii) in paragraph (3)--
                                    (I) by inserting ``subject to 
                                paragraph (4)'' before ``any 
                                deduction''; and
                                    (II) by striking the period at the 
                                end and inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new paragraph:
            ``(4) the total annual aggregate amount of any premium, 
        enrollment fee, deduction, cost sharing, or similar charge 
        imposed under the plan with respect to such individuals and 
        their families shall not exceed 5 percent of the family income 
        of the individual involved, as applied on a quarterly or 
        monthly basis (as specified by the State).'';
                    (C) in subsection (d), by inserting ``, and 
                provided that the total annual aggregate amount of any 
                such premium, and any enrollment fee, deduction, cost 
                sharing, or similar charge imposed under the plan with 
                respect to such individuals and their families shall 
                not exceed 5 percent of the family income of the 
                individual involved, as applied on a quarterly or 
                monthly basis (as specified by the State)'' before the 
                period; and
                    (D) by adding at the end the following new 
                subsection:
    ``(k) Cost Sharing Tracking; Suspension of Charges; Notification 
Requirements.--
            ``(1) Tracking.--If the State plan imposes premiums, 
        enrollment fees, deductions, cost sharing, or similar charges 
        under this section that, together with any such charges imposed 
        under section 1916A, could cause families to have out-of-pocket 
        expenses that exceed a total aggregate cost sharing limit 
        imposed under subsection (a)(4) or (b)(4) for the month or 
        quarter (as specified by the State), the State shall establish 
        a process for tracking and aggregating such expenses (including 
        expenses incurred for separately administered benefits) that--
                    ``(A) does not rely on documentation provided by 
                the individual or the family;
                    ``(B) is communicated in a manner designed to 
                ensure the privacy of patient-related information; and
                    ``(C) allows for coordination with managed care 
                entities (as defined in section 1932(a)(1)(B)) that are 
                under contract with the State.
            ``(2) Suspension of charges.--When a family reaches any 
        limit for a period imposed on premiums, deductions, cost 
        sharing, or similar charges under this section, no further 
        premiums, deductions, cost sharing, or similar charges (or any 
        portions thereof) shall be imposed on any individual in the 
        family who is eligible for and receiving medical assistance 
        under the plan for the remainder of the period.
            ``(3) Notification requirements.--With respect to a limit 
        imposed on premiums, deductions, cost sharing, or similar 
        charges under this section the State plan shall provide for the 
        notification of providers and each family to which such a limit 
        applies--
                    ``(A) of any such limit applicable to the family;
                    ``(B) when the family has incurred out-of-pocket 
                expenses up to any such limit; and
                    ``(C) when a family reaches any such limit for a 
                period, that the limit has been reached and that no 
                further premiums, deductions, cost sharing, or similar 
                charges (or portions thereof) shall be imposed on any 
                individual in the family who is eligible for and 
                receiving medical assistance under the plan for the 
                remainder of such month or quarter.
            ``(4) Reassessment process.--The State shall establish a 
        process for families that include an individual who is eligible 
        for and receiving medical assistance under the plan to request 
        a reassessment of the family's aggregate limit on premiums, 
        deductions, cost sharing, or similar charges if the family has 
        a change in circumstances, in accordance with criteria 
        specified by the Secretary.
            ``(5) Application of requirements.--The requirements of 
        this subsection shall apply in the same manner to limits 
        imposed under subsections (c), (d), (g), and (i).''.
            (2) State option for alternative premiums and cost 
        sharing.--Section 1916A(b) (42 U.S.C. 1396o-1(b)) is amended--
                    (A) in paragraphs (1)(B)(ii) and (2)(A), by 
                inserting ``or section 1916'' after ``subsection (c) or 
                (e)'' in each place it appears; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(7) Cost sharing tracking; suspension of charges; 
        notification requirements.--
                    ``(A) Tracking.--If the State plan imposes premiums 
                or cost sharing under this section that, together with 
                cost sharing imposed under section 1916, could cause 
                families to have out-of-pocket expenses that exceed the 
                total aggregate limit imposed under paragraph (1) or 
                (2) of this subsection for a month or quarter (as 
                specified by the State), the State shall establish a 
                process for tracking and aggregating such expenses 
                (including expenses for separately administered 
                benefits) that--
                            ``(i) does not rely on documentation 
                        provided by the individual or the family;
                            ``(ii) is communicated in a manner designed 
                        to ensure the privacy of patient-related 
                        information; and
                            ``(iii) allows for coordination with 
                        managed care entities (as defined in section 
                        1932(a)(1)(B)) that are under contract with the 
                        State.
                    ``(B) Suspension of charges.--When a family reaches 
                any limit for a period imposed on premiums or cost 
                sharing under this section, no further premiums or cost 
                sharing (or any portions thereof) shall be imposed on 
                any individual in the family who is eligible for and 
                receiving medical assistance under the plan for the 
                remainder of the period.
                    ``(C) Notification requirements.--With respect to a 
                limit imposed on premiums or cost sharing under 
                paragraph (1) or (2) of this subsection the State plan 
                shall provide for the notification of providers and 
                each family to which such a limit applies--
                            ``(i) of any such limit applicable to the 
                        family;
                            ``(ii) when the family has incurred out-of-
                        pocket expenses up to any such limit; and
                            ``(iii) when a family reaches such a limit 
                        for a period, that the limit has been reached 
                        and that no further premiums or cost sharing 
                        (or portions thereof) shall be imposed on any 
                        individual in the family who is eligible for 
                        and receiving medical assistance under the plan 
                        for the remainder of such month or quarter.
                    ``(D) Reassessment process.--The State shall 
                establish a process for families that include an 
                individual who is eligible for and receiving medical 
                assistance under the plan to request a reassessment of 
                the family's aggregate limit on premiums, deductions, 
                cost sharing, or similar charges if the family has a 
                change in circumstances, in accordance with criteria 
                specified by the Secretary.''.
            (3) Managed care organizations.--Section 1932(a)(5) (42 
        U.S.C. 1396u-2(a)(5)) is amended by adding at the end the 
        following new subparagraph:
                    ``(E) Coordination with providers on cost 
                sharing.--The State shall require that a managed care 
                entity with a contract with the State, as a condition 
                of such contract, comply with the requirements of 
                sections 1916 and 1916A (as applicable), for such 
                individuals who are enrolled with the organization or 
                entity and coordinate with the State with respect to 
                tracking and aggregating an enrollee's family's out-of-
                pocket expenses for premiums, deductions, cost sharing, 
                or similar charges.''.
            (4) Conforming amendments.--Section 1916A(a)(2)(B) (42 
        U.S.C. 1396o-1(a)(2)(B)) is amended--
                    (A) by inserting ``and the tracking, suspension, 
                and notification requirements under subsection (b)(7)'' 
                before ``shall apply''; and
                    (B) by inserting ``and requirements'' after 
                ``limitations''.
    (b) CHIP.--
            (1) In general.--Section 2103(e) (42 U.S.C. 1397cc(e)) is 
        amended--
                    (A) by striking paragraphs (2) and (4);
                    (B) by redesignating paragraph (3) as paragraph 
                (2);
                    (C) in paragraph (2) (as so redesignated)--
                            (i) by striking subparagraph (B);
                            (ii) by redesignating subparagraph (C) as 
                        subparagraph (D); and
                            (iii) by inserting after subparagraph (A) 
                        the following new subparagraphs:
                    ``(B) No cost sharing for pregnancy-related 
                assistance.--The State child health plan may not impose 
                deductions, cost sharing, or similar charges with 
                respect to pregnancy-related assistance.
                    ``(C) Application of medicaid cost sharing 
                limits.--Subject to subparagraphs (A) and (B) and 
                paragraph (3), the State child health plan may only 
                impose deductions, cost sharing, or similar charges to 
                the extent that such charges do not exceed the nominal 
                limits set under section 1916(a)(3).''; and
                    (D) by adding at the end the following new 
                paragraph:
            ``(3) Additional requirements .--
                    ``(A) In general.--Subject to paragraph (2)(A), any 
                premiums, deductions, cost sharing, or similar charges 
                imposed under the State child health plan for medical 
                or dental benefits may be imposed on a sliding scale 
                related to income, except that the total annual 
                aggregate cost sharing imposed for such benefits with 
                respect to all individuals in a family that includes a 
                targeted low-income child or a targeted low-income 
                pregnant woman under this title shall not exceed 5 
                percent of such family's income for the year involved.
                    ``(B) Dental-only supplemental coverage.--With 
                respect to dental-only supplemental coverage offered 
                under section 2110(b)(5), the total annual aggregate 
                cost sharing imposed for such coverage shall not exceed 
                5 percent of a family's income for the year involved, 
                minus the amount the family is required to pay during 
                such year in premiums, deductions, cost sharing, or 
                similar charges for health care services for children 
                in the family enrolled in a group health plan or health 
                insurance coverage offered through an employer.
                    ``(C) Tracking of expenses; suspension of charges; 
                notice; reassessments.--If the State child health plan 
                imposes premiums, deductions, cost sharing, or similar 
                charges that could 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 aggregate cost sharing limit imposed under 
                subparagraph (A) for the year, the State shall--
                            ``(i) establish a process for tracking and 
                        aggregating such expenses (including expenses 
                        incurred for separately administered benefits) 
                        that--
                                    ``(I) does not rely on 
                                documentation provided by the targeted 
                                low-income child, the targeted low-
                                income pregnant woman, or the family;
                                    ``(II) is communicated in a manner 
                                designed to ensure the privacy of 
                                patient-related information; and
                                    ``(III) allows for coordination 
                                with managed care entities and managed 
                                care organizations that are under 
                                contract with the State;
                            ``(ii) when a family reaches the aggregate 
                        cost-sharing limit for a year imposed under 
                        subparagraph (A), not impose any further 
                        premiums or cost sharing (or any portions 
                        thereof) on any targeted low-income child or 
                        targeted low-income pregnant woman in the 
                        family for the remainder of the year;
                            ``(iii) notify providers and each family 
                        that includes a targeted low-income child or a 
                        targeted low-income pregnant woman--
                                    ``(I) of the annual aggregate 
                                limits on out-of-pocket expenses 
                                applicable to the family;
                                    ``(II) when the family has incurred 
                                out-of-pocket expenses up to the annual 
                                aggregate family limit imposed under 
                                subparagraph (A); and
                                    ``(III) when a family reaches the 
                                aggregate out-of-pocket expenses limit 
                                for a year, that the limit has been 
                                reached and that no further premiums, 
                                deductions, cost sharing, or similar 
                                charges (or portions thereof) shall be 
                                imposed on any targeted low-income 
                                child or targeted low-income pregnant 
                                woman in the family for the remainder 
                                of such year; and
                            ``(iv) establish a process for families 
                        that include a targeted low-income child or a 
                        targeted low-income pregnant woman to request a 
                        reassessment of the family's annual aggregate 
                        limit on premiums, deductions, cost sharing, or 
                        similar charges if the family has a change in 
                        circumstances, in accordance with criteria 
                        specified by the Secretary.''.
            (2) Managed care organizations.--Section 2103(f) (42 U.S.C. 
        1397cc(f)) is amended by adding at the end following new 
        paragraph:
            ``(4) Coordination with providers on cost sharing.--The 
        State shall require that a managed care entity or a managed 
        care organization with a contract with the State, as a 
        condition of such contract, comply with the requirements of 
        2103(e) and coordinate with the State with respect to in 
        tracking and aggregating an enrollee's family's out-of-pocket 
        expenses for cost sharing as required under subsection 
        (e)(3)(C).''.
    (c) Conforming Amendments.--
            (1) Section 2105(c)(10)(C)(i) (42 U.S.C. 
        1397ee(c)(10)(C)(i)) is amended by striking ``paragraph (3)(B) 
        of''.
            (2) Section 2112(b)(6) (42 U.S.C. 1397ll(b)(6)) is amended 
        by striking ``paragraph (3)(B) of''.

                           TITLE IV--BENEFITS

SEC. 401. PREVENTIVE HEALTH SERVICES.

    (a) Preventive Health Services.--
            (1) Medicaid.--Section 1905 (42 U.S.C. 1396d) is amended--
                    (A) in subsection (a)(4)--
                            (i) by striking ``and'' before ``(D)''; and
                            (ii) by inserting before the semicolon at 
                        the end the following new subparagraph: ``; and 
                        (E) preventive services described in subsection 
                        (ee)''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(ee) Preventive Services.--
            ``(1) In general.--For purposes of subsection (a)(4)(E), 
        the preventive services described in this subsection are 
        diagnostic, screening, and preventive services not otherwise 
        described in subsection (a) or required by subsection (r) that 
        the Secretary determines are appropriate for children or 
        pregnant women entitled to medical assistance under this title, 
        including--
                    ``(A) evidence-based items or services that have in 
                effect a rating of `A' or `B' in the current 
                recommendations of the United States Preventive 
                Services Task Force;
                    ``(B) with respect to pregnant women, immunizations 
                that have in effect a recommendation from the Advisory 
                Committee on Immunization Practices of the Centers for 
                Disease Control and Prevention with respect to the 
                individual involved;
                    ``(C) with respect to infants, children, and 
                adolescents, evidence-informed preventive care and 
                screenings provided for in the comprehensive guidelines 
                supported by the Health Resources and Services 
                Administration; and
                    ``(D) with respect to women, such additional 
                preventive care and screenings not described in this 
                paragraph as provided for in comprehensive guidelines 
                supported by the Health Resources and Services 
                Administration for purposes of this paragraph.
            ``(2) Additional services.--Nothing in this subsection 
        shall be construed to limit the application of any requirement 
        of subsection (r) or to prohibit a State plan under this title 
        from providing coverage for services in addition to those 
        recommended by United States Preventive Services Task Force or 
        to prohibit coverage of services.''.
            (2) Elimination of cost-sharing.--
                    (A) Subsections (a)(2)(D) and (b)(2)(D) of section 
                1916 (42 U.S.C. 1396o) are each amended by inserting 
                ``preventive services described in section 1905(ee),'' 
                after ``emergency services (as defined by the 
                Secretary),''.
                    (B) Section 1916A(a)(1) (42 U.S.C. 1396o-1(a)(1)) 
                is amended by inserting ``, preventive services 
                described in section 1905(ee),'' after ``subsection 
                (c)''.
            (3) Interval period for inclusion of new recommendations in 
        state plans.--With respect to a recommendation issued on or 
        after the date of enactment of this Act that adds new 
        preventive services to the requirements described in subsection 
        (ee) of section 1905 of the Social Security Act, the Secretary 
        shall establish a maximum interval period, which shall not be 
        longer than 6 months, between the date on which the 
        recommendation is issued and the plan year for which a State 
        plan for medical assistance under title XIX of the Social 
        Security Act shall be required to include such preventive 
        service.
    (b) CHIP.--Section 2103 (42 U.S.C. 1397cc) is amended--
            (1) in subsection (a), in the matter preceding paragraph 
        (1), by striking ``and (7)'' and inserting ``(7), and (8)''; 
        and
            (2) in subsection (c)--
                    (A) by redesignating paragraph (8) as paragraph 
                (9); and
                    (B) by inserting after paragraph (7), the following 
                new paragraph:
            ``(8) Preventive services.--The child health assistance 
        provided to a targeted low-income child and pregnancy-related 
        assistance provided to a targeted low-income pregnant woman 
        shall include coverage of preventive services for children or 
        pregnant women required under a State plan under title XIX 
        under subsections (a)(4)(E) and (ee) of section 1905 and no 
        deductible, cost sharing or similar charge shall be imposed 
        under the State child health plan with respect to such 
        services.''.

SEC. 402. TIMELY IMMUNIZATION COVERAGE.

    (a) Coverage for Newly Approved Vaccines Within 30 Days.--
            (1) In general.--Section 1928(e) (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) (42 U.S.C. 
        1397cc(c)(1)(D)) is amended by inserting ``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) (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) Coding for Vaccine Administration.--Section 1928 (42 U.S.C. 
1396s) is amended--
            (1) by striking subsection (g) and inserting:
    ``(g) [Reserved].''; and
            (2) in subsection (h)(6), by striking ``a vaccine'' and 
        inserting ``each vaccine component''.
    (d) Effective Date.--The amendments made by this section shall take 
effect on the date of enactment of this Act.

                      TITLE V--ACCESS AND QUALITY

                 Subtitle A--Pediatric Quality Measures

SEC. 501. EXTENDING THE PEDIATRIC QUALITY MEASURES PROGRAM.

    (a) In General.--Section 1139A(i) (42 U.S.C. 1320b-9a(i)) is 
amended by inserting ``, and for each of fiscal years 2014 through 
2019, $50,000,000,'' after ``$45,000,000''.
    (b) Effective Date.--The amendment made by this section shall take 
effect on the date of enactment of this Act.

SEC. 502. IMPROVING THE EFFECTIVENESS OF THE PEDIATRIC QUALITY 
              MEASURES.

    (a) In General.--Section 1139A(b) (42 U.S.C. 1320b-9a(b)) is 
amended--
            (1) in paragraph (4)--
                    (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) establish a program to continue and enhance 
                pediatric quality measures program centers of 
                excellence, which may include developing centers of 
                excellence with a particular emphasis on patient and 
                family experience and 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.''; and
            (2) by amending paragraph (5) to read as follows:
            ``(5) Revising, strengthening, and improving initial core 
        measures.--
                    ``(A) In general.--The Secretary shall annually 
                publish recommended changes to the core measures 
                described in subsection (a) that--
                            ``(i) are consistent with the purposes of 
                        the pediatric quality measures program 
                        established under paragraph (1);
                            ``(ii) meet the conditions specified in 
                        paragraph (2);
                            ``(iii) were developed by the Secretary in 
                        consultation with the entities specified in 
                        subparagraphs (A) through (H) of paragraph (3); 
                        and
                            ``(iv) were developed, validated, or tested 
                        through a grant awarded under paragraph (4).
                    ``(B) Additional recommended changes.--Beginning 
                not later than 1 year after the date of enactment of 
                the CHIP Extension Act of 2014, the recommended changes 
                published 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 diverse health care settings, 
                        including both inpatient and ambulatory 
                        settings;
                            ``(iv) to encourage the development, 
                        implementation, and stewardship of core 
                        measures that can be used at the State, 
                        hospital, practice, and plan levels, including 
                        a sustainable mechanism to maintain and 
                        disseminate such measures and collect and 
                        report data on such measures; and
                            ``(v) to facilitate the adoption, 
                        dissemination, stewardship, and reporting of 
                        such measures as well as measures developed 
                        through the pediatric quality measures program 
                        at the State, hospital, practice, and plan 
                        levels and 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.''.
    (b) Effective Date.--The amendments made by this section shall take 
effect on the date of enactment of this Act.

SEC. 503. ANNUAL STATE REPORTS REGARDING STATE-SPECIFIC QUALITY OF CARE 
              MEASURES APPLIED UNDER MEDICAID OR CHIP.

    (a) In General.--Section 1139A(c) (42 U.S.C. 1320b-9a(c)) is 
amended by adding at the end the following new paragraph:
            ``(3) Data collection and reporting on full set of core 
        measures.--Beginning not later than 5 years after the date of 
        enactment of this paragraph, the information reported under 
        paragraph (1) shall include State-specific information on the 
        full set of pediatric core measures.''.
    (b) Effective Date.--The amendment made by this section shall take 
effect on the date of enactment of this Act.

SEC. 504. ADVISORY PANEL REGARDING PEDIATRIC QUALITY.

    (a) In General.--Section 1139A(g) (42 U.S.C. 1320b-9a(g)) is 
amended--
            (1) in the subsection heading, by striking ``Study of'' and 
        inserting ``Studies and Reports on'';
            (2) by redesignating paragraph (2) as paragraph (4); and
            (3) by inserting after paragraph (1) the following new 
        paragraphs:
            ``(2) Expert panel.--The Secretary 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 as recommended in the 
        report submitted under paragraph (1) by the Institute of 
        Medicine. Such panel shall--
                    ``(A) advise and make recommendations to the 
                Secretary regarding changes that may be made to the 
                core measures described in subsection (a);
                    ``(B) establish standards for the timeliness and 
                accuracy of data so collected and reported; and
                    ``(C) review and make recommendations, on an annual 
                basis, for strategies to enhance the timeliness, 
                accuracy, and utility of the core measures.
            ``(3) Collecting and reporting full set of core measures.--
        Not later than 1 year after the date of enactment of this 
        paragraph, the Secretary, in consultation with representatives 
        of State agencies responsible for administering Medicaid and 
        the State Children's Health Insurance Program and 
        representatives of relevant provider organizations, shall 
        submit to the Committee on Energy and Commerce of the House of 
        Representatives and the Committee on Finance of the Senate a 
        report identifying--
                    ``(A) strategies to address and overcome barriers 
                to State collection of and reporting of the full set of 
                pediatric core measures;
                    ``(B) an analysis of the amount of Federal funding 
                needed to incentivize States to collect and report on 
                the full set of pediatric core measures; and
                    ``(C) a standardized format and plan for States to 
                collect and report on the full set of pediatric core 
                measures.''.
    (b) Effective Date.--The amendments made by this section shall take 
effect on the date of enactment of this Act.

SEC. 505. 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) (42 U.S.C. 1320b-9a(d)) is amended--
            (1) in paragraph (1)--
                    (A) in the matter preceding subparagraph (A)--
                            (i) by inserting ``, and during the period 
                        of fiscal years 2014 through 2019, the 
                        Secretary shall award not less than 10 
                        grants,'' after ``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), such grants shall be 
                awarded for projects that--
                            ``(i) give priority to collaboratives that 
                        would have 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 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 2014 through 2019, 
                $36,000,000 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) (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''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on the date of enactment of this Act.

Subtitle B--Maternal, Infant, and Early Childhood Home Visiting Program

SEC. 511. SUPPORTING EVIDENCE-BASED CARE COORDINATION IN COMMUNITIES.

    (a) In General.--Section 511(j)(1) (42 U.S.C. 711(j)(1)) is amended 
by striking subparagraph (F) and inserting the following:
                    ``(F) $400,000,000 for each of fiscal years 2015 
                through 2019.''.
    (b) Prevention of Duplicate Appropriations for Fiscal Year 2015.--
Expenditures made pursuant to the amendments made by section 209 of the 
Protecting Access to Medicare Act of 2014 (Public Law 113-93) for 
fiscal year 2015 shall be charged to the appropriation provided by the 
amendment made by subsection (a) for such fiscal year.
    (c) Effective Date.--The amendment made by this section shall take 
effect on the date of enactment of this Act.

 Subtitle C--Comparative Study of Medicaid, CHIP, and Qualified Health 
                                 Plans

SEC. 521. GAO STUDY AND REPORT.

    (a) Study.--The Comptroller General of the United States shall 
conduct a study of each State in which individuals eligible for medical 
assistance under a State plan under title XIX of the Social Security 
Act (42 U.S.C. 1396 et seq.) or for child health assistance under a 
State child health plan under title XXI of the Social Security Act (42 
U.S.C. 1397aa et seq.) are provided such assistance through enrollment 
in a qualified health plan or employer-sponsored insurance. Such study 
shall determine, for each such State--
            (1) the number of such individuals enrolled in an employer-
        sponsored health plan to whom wraparound services are offered;
            (2) the number of such individuals enrolled in an employer-
        sponsored health plan who use wraparound services for any 
        purpose during the plan year;
            (3) the average cost of wraparound services per individual 
        enrolled in an employer-sponsored health plan who uses such 
        services;
            (4) the number of such individuals with ``developmental 
        disabilities'' (as defined in section 102(8) of the 
        Developmental Disabilities Assistance and Bill of Rights Act of 
        2000 (42 U.S.C. 15002(8))), enrolled in an employer-sponsored 
        health plan who used wrap-around benefits;
            (5) the number of disabled individuals enrolled in an 
        employer-sponsored health plan who use wraparound benefits for 
        habilitative services, rehabilitative services, or home health 
        services;
            (6) the number of such individuals enrolled in qualified 
        health plans;
            (7) average premiums and cost-sharing per such individual 
        enrolled in a qualified health plan; and
            (8) comparative data with respect to the benefits offered 
        to such individuals under qualified health plans as compared to 
        the benefits offered to such individuals under State plans 
        under title XIX or XXI of the Social Security Act.
    (b) Reports.--Not later than 2 years after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall submit to the Committee on Energy and Commerce of the House of 
Representatives and the Committee on Finance of the Senate a report on 
the findings of the study conducted under subsection (a) that includes 
any recommendations or proposed legislation. Not later than 4 years 
after the date of enactment of this Act, the Comptroller General of the 
United States shall submit to the Committee on Energy and Commerce of 
the House of Representatives and the Committee on Finance of the Senate 
an updated report on the findings of the study conducted under 
subsection (a) that includes any recommendations or proposed 
legislation.
    (c) Definitions.--For purposes of this section:
            (1) Qualified health plan.--The term ``qualified health 
        plan'' means a health plan that is offered through an American 
        Health Benefits Exchange established under the Patient 
        Protection and Affordable Care Act (Public Law 111-148).
            (2) Wraparound services.--The term ``wraparound services'' 
        means services provided by a State plan under title XIX or XXI 
        of the Social Security Act that are provided as a supplement to 
        items or services for which coverage is not offered or is 
        limited under a qualified health plan or an employer-sponsored 
        health plan.

                      TITLE VI--BUDGETARY EFFECTS

SEC. 601. BUDGETARY EFFECT OF THIS ACT.

    The budgetary effects of this Act, for the purpose of complying 
with the Statutory Pay-As-You-Go Act of 2010, shall be determined by 
reference to the latest statement titled ``Budgetary Effects of PAYGO 
Legislation'' for this Act, submitted for printing in the Congressional 
Record by the Chairman of the Committee on the Budget of the House of 
Representatives, as long as such statement has been submitted prior to 
the vote on passage of this Act.
                                 <all>