[Congressional Record Volume 153, Number 143 (Tuesday, September 25, 2007)]
[House]
[Pages H10816-H10885]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
CHILDREN'S HEALTH INSURANCE PROGRAM REAUTHORIZATION ACT OF 2007
Mr. DINGELL. Mr. Speaker, pursuant to H. Res. 675, I call up from the
Speaker's table the bill (H.R. 976) to amend the Internal Revenue Code
of 1986 to provide tax relief for small businesses, and for other
purposes, with Senate amendments thereto, and ask for its immediate
consideration in the House.
The Clerk read the title of the bill.
The SPEAKER pro tempore. The Clerk will designate the Senate
amendments.
The text of the Senate amendments is as follows:
Senate amendments:
Strike out all after the enacting clause and insert:
SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT;
REFERENCES; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Children's
Health Insurance Program Reauthorization Act of 2007''.
(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 Medicaid; CHIP; Secretary.--In this Act:
(1) CHIP.--The term ``CHIP'' means the State Children's
Health Insurance Program established under title XXI of the
Social Security Act (42 U.S.C. 1397aa et seq.).
(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.
[[Page H10817]]
(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.
TITLE I--FINANCING OF CHIP
Sec. 101. Extension of CHIP.
Sec. 102. Allotments for the 50 States and the District of Columbia.
Sec. 103. One-time appropriation.
Sec. 104. Improving funding for the territories under CHIP and
Medicaid.
Sec. 105. Incentive bonuses for States.
Sec. 106. Phase-out of coverage for nonpregnant childless adults under
CHIP; conditions for coverage of parents.
Sec. 107. State option to cover low-income pregnant women under CHIP
through a State plan amendment.
Sec. 108. CHIP Contingency fund.
Sec. 109. Two-year availability of allotments; expenditures counted
against oldest allotments.
Sec. 110. Limitation on matching rate for States that propose to cover
children with effective family income that exceeds 300
percent of the poverty line.
Sec. 111. Option for qualifying States to receive the enhanced portion
of the CHIP matching rate for Medicaid coverage of
certain children.
TITLE II--OUTREACH AND ENROLLMENT
Sec. 201. Grants for outreach and enrollment.
Sec. 202. Increased outreach and enrollment of Indians.
Sec. 203. Demonstration program to permit States to rely on findings by
an Express Lane agency to determine components of a
child's eligibility for Medicaid or CHIP.
Sec. 204. Authorization of certain information disclosures to simplify
health coverage determinations.
TITLE III--REDUCING BARRIERS TO ENROLLMENT
Sec. 301. Verification of declaration of citizenship or nationality for
purposes of eligibility for Medicaid and CHIP.
Sec. 302. Reducing administrative barriers to enrollment.
TITLE IV--REDUCING BARRIERS TO PROVIDING PREMIUM ASSISTANCE
Subtitle A--Additional State Option for Providing Premium Assistance
Sec. 401. Additional State option for providing premium assistance.
Sec. 402. Outreach, education, and enrollment assistance.
Subtitle B--Coordinating Premium Assistance With Private Coverage
Sec. 411. Special enrollment period under group health plans in case of
termination of Medicaid or CHIP coverage or eligibility
for assistance in purchase of employment-based coverage;
coordination of coverage.
TITLE V--STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES OF CHILDREN
Sec. 501. Child health quality improvement activities for children
enrolled in Medicaid or CHIP.
Sec. 502. Improved information regarding access to coverage under CHIP.
Sec. 503. Application of certain managed care quality safeguards to
CHIP.
TITLE VI--MISCELLANEOUS
Sec. 601. Technical correction regarding current State authority under
Medicaid.
Sec. 602. Payment error rate measurement (``PERM'').
Sec. 603. Elimination of counting medicaid child presumptive
eligibility costs against title XXI allotment.
Sec. 604. Improving data collection.
Sec. 605. Deficit Reduction Act technical corrections.
Sec. 606. Elimination of confusing program references.
Sec. 607. Mental health parity in CHIP plans.
Sec. 608. Dental health grants.
Sec. 609. Application of prospective payment system for services
provided by Federally-qualified health centers and rural
health clinics.
Sec. 610. Support for injured servicemembers.
Sec. 611. Military family job protection.
Sec. 612. Sense of Senate regarding access to affordable and meaningful
health insurance coverage.
Sec. 613. Demonstraion projects relating to diabetes prevention.
Sec. 614. Outreach regarding health insurance options available to
children.
TITLE VII--REVENUE PROVISIONS
Sec. 701. Increase in excise tax rate on tobacco products.
Sec. 702. Administrative improvements.
Sec. 703. Time for payment of corporate estimated taxes.
TITLE VIII--EFFECTIVE DATE
Sec. 801. Effective date.
TITLE I--FINANCING OF CHIP
SEC. 101. EXTENSION OF CHIP.
Section 2104(a) (42 U.S.C. 1397dd(a)) is amended--
(1) in paragraph (9), by striking ``and'' at the end;
(2) in paragraph (10), by striking the period at the end
and inserting a semicolon; and
(3) by adding at the end the following new paragraphs:
``(11) for fiscal year 2008, $9,125,000,000;
``(12) for fiscal year 2009, $10,675,000,000;
``(13) for fiscal year 2010, $11,850,000,000;
``(14) for fiscal year 2011, $13,750,000,000; and
``(15) for fiscal year 2012, for purposes of making 2 semi-
annual allotments--
``(A) $1,750,000,000 for the period beginning on October 1,
2011, and ending on March 31, 2012, and
``(B) $1,750,000,000 for the period beginning on April 1,
2012, and ending on September 30, 2012.''.
SEC. 102. ALLOTMENTS FOR THE 50 STATES AND THE DISTRICT OF
COLUMBIA.
(a) In General.--Section 2104 (42 U.S.C. 1397dd) is amended
by adding at the end the following new subsection:
``(i) Determination of Allotments for the 50 States and the
District of Columbia for Fiscal Years 2008 Through 2012.--
``(1) Computation of allotment.--
``(A) In general.--Subject to the succeeding paragraphs of
this subsection, the Secretary shall for each of fiscal years
2008 through 2012 allot to each subsection (b) State from the
available national allotment an amount equal to 110 percent
of--
``(i) in the case of fiscal year 2008, the highest of the
amounts determined under paragraph (2);
``(ii) in the case of each of fiscal years 2009 through
2011, the Federal share of the expenditures determined under
subparagraph (B) for the fiscal year; and
``(iii) beginning with fiscal year 2012, subject to
subparagraph (E), each semi-annual allotment determined under
subparagraph (D).
``(B) Projected state expenditures for the fiscal year.--
For purposes of subparagraphs (A)(ii) and (D), the
expenditures determined under this subparagraph for a fiscal
year are the projected expenditures under the State child
health plan for the fiscal year (as certified by the State
and submitted to the Secretary by not later than August 31 of
the preceding fiscal year).
``(C) Available national allotment.--For purposes of this
subsection, the term `available national allotment' means,
with respect to any fiscal year, the amount available for
allotment under subsection (a) for the fiscal year, reduced
by the amount of the allotments made for the fiscal year
under subsection (c). Subject to paragraph (3)(B), the
available national allotment with respect to the amount
available under subsection (a)(15)(A) for fiscal year 2012
shall be increased by the amount of the appropriation for the
period beginning on October 1 and ending on March 31 of such
fiscal year under section 103 of the Children's Health
Insurance Program Reauthorization Act of 2007.
``(D) Semi-annual allotments.--For purposes of subparagraph
(A)(iii), the semi-annual allotments determined under this
paragraph with respect to a fiscal year are as follows:
``(i) For the period beginning on October 1 and ending on
March 31 of the fiscal year, the Federal share of the portion
of the expenditures determined under subparagraph (B) for the
fiscal year which are allocable to such period.
``(ii) For the period beginning on April 1 and ending on
September 30 of the fiscal year, the Federal share of the
portion of the expenditures determined under subparagraph (B)
for the fiscal year which are allocable to such period.
``(E) Availability.--Each semi-annual allotment made under
subparagraph (A)(iii) shall remain available for expenditure
under this title for periods after the period specified in
subparagraph (D) for purposes of determining the allotment in
the same manner as the allotment would have been available
for expenditure if made for an entire fiscal year.
``(2) Special rule for fiscal year 2008.--
``(A) In general.--For purposes of paragraph (1)(A)(i), the
amounts determined under this paragraph for fiscal year 2008
are as follows:
``(i) The total Federal payments to the State under this
title for fiscal year 2007, multiplied by the annual
adjustment determined under subparagraph (B) for fiscal year
2008.
``(ii) The Federal share of the amount allotted to the
State for fiscal year 2007 under subsection (b), multiplied
by the annual adjustment determined under subparagraph (B)
for fiscal year 2008.
``(iii) Only in the case of--
``(I) a State that received a payment, redistribution, or
allotment under any of paragraphs (1), (2), or (4) of
subsection (h), the amount of the projected total Federal
payments to the State under this title for fiscal year 2007,
as determined on the basis of the November 2006 estimates
certified by the State to the Secretary;
``(II) a State whose projected total Federal payments to
the State under this title for fiscal year 2007, as
determined on the basis of the May 2006 estimates certified
by the State to the Secretary, were at least $95,000,000 but
not more than $96,000,000 higher than the projected total
Federal payments to the State under this title for fiscal
year 2007 on the basis of the November 2006 estimates, the
amount of the projected total Federal payments to the State
under this title for fiscal year 2007 on the basis of the May
2006 estimates; or
``(III) a State whose projected total Federal payments
under this title for fiscal year 2007, as determined on the
basis of the November 2006 estimates certified by the State
to the Secretary, exceeded all amounts available to the State
for expenditure for fiscal year 2007 (including any amounts
paid, allotted, or redistributed to the State in prior fiscal
years), the amount of the projected total Federal payments to
the State under this title for fiscal year 2007, as
determined on the basis of the November 2006 estimates
certified by the State to the Secretary,
multiplied by the annual adjustment determined under
subparagraph (B) for fiscal year 2008.
``(iv) The projected total Federal payments to the State
under this title for fiscal year 2008, as determined on the
basis of the August 2007 projections certified by the State
to the Secretary by not later than September 30, 2007.
[[Page H10818]]
``(B) Annual adjustment for health care cost growth and
child population growth.--The annual adjustment determined
under this subparagraph for a fiscal year with respect to a
State is equal to the product of the amounts determined under
clauses (i) and (ii):
``(i) Per capita health care growth.--1 plus the percentage
increase (if any) in the projected nominal per capita amount
of National Health Expenditures for the calendar year that
begins during the fiscal year involved over the preceding
calendar year, as most recently published by the Secretary.
``(ii) Child population growth.--1.01 plus the percentage
change in the population of children under 19 years of age in
the State from July 1 of the fiscal year preceding the fiscal
year involved to July 1 of the fiscal year involved, as
determined by the Secretary based on the most timely and
accurate published estimates of the Bureau of the Census.
``(C) Definition.--For purposes of subparagraph (B), the
term `fiscal year involved' means the fiscal year for which
an allotment under this subsection is being determined.
``(D) Proration rule.--If, after the application of this
paragraph without regard to this subparagraph, the sum of the
State allotments determined under this paragraph for fiscal
year 2008 exceeds the available national allotment for fiscal
year 2008, the Secretary shall reduce each such allotment on
a proportional basis.
``(3) Alternative allotments for fiscal years 2009 through
2012.--
``(A) In general.--If the sum of the State allotments
determined under paragraph (1)(A)(ii) for any of fiscal years
2009 through 2011 exceeds the available national allotment
for the fiscal year, the Secretary shall allot to each
subsection (b) State from the available national allotment
for the fiscal year an amount equal to the product of--
``(i) the available national allotment for the fiscal year;
and
``(ii) the percentage equal to the sum of the State
allotment factors for the fiscal year determined under
paragraph (4) with respect to the State.
``(B) Special rules beginning in fiscal year 2012.--
Beginning in fiscal year 2012--
``(i) this paragraph shall be applied separately with
respect to each of the periods described in clauses (i) and
(ii) of paragraph (1)(D) and the available national allotment
for each such period shall be the amount appropriated for
such period (rather than the amount appropriated for the
entire fiscal year), reduced by the amount of the allotments
made for the fiscal year under subsection (c) for each such
period, and
``(ii) if--
``(I) the sum of the State allotments determined under
paragraph (1)(A)(iii) for either such period exceeds the
amount of such available national allotment for such period,
the Secretary shall make the allotment for each State for
such period in the same manner as under subparagraph (A), and
``(II) the amount of such available national allotment for
either such period exceeds the sum of the State allotments
determined under paragraph (1)(A)(iii) for such period, the
Secretary shall increase the allotment for each State for
such period by the amount that bears the same ratio to such
excess as the State's allotment determined under paragraph
(1)(A)(iii) for such period (without regard to this
subparagraph) bears to the sum of such allotments for all
States.
``(4) Weighted factors.--
``(A) Factors described.--For purposes of paragraph (3),
the factors described in this subparagraph are the following:
``(i) Projected state expenditures for the fiscal year.--
The ratio of the projected expenditures under the State child
health plan for the fiscal year (as certified by the State to
the Secretary by not later than August 31 of the preceding
fiscal year) to the sum of the projected expenditures under
all such plans for all subsection (b) States for the fiscal
year, multiplied by the applicable percentage weight assigned
under subparagraph (B).
``(ii) Number of low-income children in the state.--The
ratio of the number of low-income children in the State, as
determined on the basis of the most timely and accurate
published estimates of the Bureau of the Census, to the sum
of the number of low-income children so determined for all
subsection (b) States for such fiscal year, multiplied by the
applicable percentage weight assigned under subparagraph (B).
``(iii) Projected state expenditures for the preceding
fiscal year.--The ratio of the projected expenditures under
the State child health plan for the preceding fiscal year (as
determined on the basis of the projections certified by the
State to the Secretary for November of the fiscal year), to
the sum of the projected expenditures under all such plans
for all subsection (b) States for such preceding fiscal year
(as so determined), multiplied by the applicable percentage
weight assigned under subparagraph (B).
``(iv) Actual state expenditures for the second preceding
fiscal year.--The ratio of the actual expenditures under the
State child health plan for the second preceding fiscal year,
as determined by the Secretary on the basis of expenditure
data reported by States on CMS Form 64 or CMS Form 21, to
such sum of the actual expenditures under all such plans for
all subsection (b) States for such second preceding fiscal
year, multiplied by the applicable percentage weight assigned
under subparagraph (B).
``(B) Assignment of weights.--For each of fiscal years 2009
through 2012, the applicable weights assigned under this
subparagraph are the following:
``(i) With respect to the factor described in subparagraph
(A)(i), a weight of 75 percent for each such fiscal year.
``(ii) With respect to the factor described in subparagraph
(A)(ii), a weight of 12\1/2\ percent for each such fiscal
year.
``(iii) With respect to the factor described in
subparagraph (A)(iii), a weight of 7\1/2\ percent for each
such fiscal year.
``(iv) With respect to the factor described in subparagraph
(A)(iv), a weight of 5 percent for each such fiscal year.
``(5) Demonstration of need for increased allotment based
on projected state expenditures exceeding 10 percent of the
preceding fiscal year allotment.--
``(A) In general.--If the projected expenditures under the
State child health plan described in paragraph (1)(B) for any
of fiscal years 2009 through 2012 are at least 10 percent
more than the allotment determined for the State for the
preceding fiscal year (determined without regard to paragraph
(2)(D) or paragraph (3)), and, during the preceding fiscal
year, the State did not receive approval for a State plan
amendment or waiver to expand coverage under the State child
health plan or did not receive a CHIP contingency fund
payment under subsection (k)--
``(i) the State shall submit to the Secretary, by not later
than August 31 of the preceding fiscal year, information
relating to the factors that contributed to the need for the
increase in the State's allotment for the fiscal year, as
well as any other additional information that the Secretary
may require for the State to demonstrate the need for the
increase in the State's allotment for the fiscal year;
``(ii) the Secretary shall--
``(I) review the information submitted under clause (i);
``(II) notify the State in writing within 60 days after
receipt of the information that--
``(aa) the projected expenditures under the State child
health plan are approved or disapproved (and if disapproved,
the reasons for disapproval); or
``(bb) specified additional information is needed; and
``(III) if the Secretary disapproved the projected
expenditures or determined additional information is needed,
provide the State with a reasonable opportunity to submit
additional information to demonstrate the need for the
increase in the State's allotment for the fiscal year.
``(B) Provisional and final allotment.--In the case of a
State described in subparagraph (A) for which the Secretary
has not determined by September 30 of a fiscal year whether
the State has demonstrated the need for the increase in the
State's allotment for the succeeding fiscal year, the
Secretary shall provide the State with a provisional
allotment for the fiscal year equal to 110 percent of the
allotment determined for the State under this subsection for
the preceding fiscal year (determined without regard to
paragraph (2)(D) or paragraph (3)), and may, not later than
November 30 of the fiscal year, adjust the State's allotment
(and the allotments of other subsection (b) States), as
necessary (and, if applicable, subject to paragraph (3)), on
the basis of information submitted by the State in accordance
with subparagraph (A).
``(6) Special rules.--
``(A) Deadline and data for determining fiscal year 2008
allotments.--In computing the amounts under paragraph (2)(A)
and subsection (c)(5)(A) that determine the allotments to
subsection (b) States and territories for fiscal year 2008,
the Secretary shall use the most recent data available to the
Secretary before the start of that fiscal year. The Secretary
may adjust such amounts and allotments, as necessary, on the
basis of the expenditure data for the prior year reported by
States on CMS Form 64 or CMS Form 21 not later than November
30, 2007, but in no case shall the Secretary adjust the
allotments provided under paragraph (2)(A) or subsection
(c)(5)(A) for fiscal year 2008 after December 31, 2007.
``(B) Inclusion of certain expenditures.--
``(i) Projected expenditures of qualifying states.--
Payments made or projected to be made to a qualifying State
described in paragraph (2) of section 2105(g) for
expenditures described in paragraph (1)(B)(ii) or (4)(B) of
that section shall be included for purposes of determining
the projected expenditures described in paragraph (1)(B) with
respect to the allotments determined for each of fiscal years
2009 through 2012 and for purposes of determining the amounts
described in clauses (i) and (iv) of paragraph (2)(A) with
respect to the allotments determined for fiscal year 2008.
``(ii) Projected expenditures under block grant set-asides
for nonpregnant childless adults and parents.--Payments
projected to be made to a State under subsection (a) or (b)
of section 2111 shall be included for purposes of determining
the projected expenditures described in paragraph (1)(B) with
respect to the allotments determined for each of fiscal years
2009 through 2012 (to the extent such payments are permitted
under such section), including for purposes of allocating
such expenditures for purposes of clauses (i) and (ii) of
paragraph (1)(D).
``(7) Subsection (b) state.--In this subsection, the term
`subsection (b) State' means 1 of the 50 States or the
District of Columbia.''.
(b) Conforming Amendments.--Section 2104 (42 U.S.C. 1397dd)
is amended--
(1) in subsection (a), by striking ``subsection (d)'' and
inserting ``subsections (d), (h), and (i)'';
(2) in subsection (b)(1), by striking ``subsection (d)''
and inserting ``subsections (d), (h), and (i)''; and
(3) in subsection (c)(1), by striking ``subsection (d)''
and inserting ``subsections (d), (h), and (i)''.
SEC. 103. ONE-TIME APPROPRIATION.
There is appropriated to the Secretary, out of any money in
the Treasury not otherwise appropriated, $12,500,000,000 to
accompany the allotment made for the period beginning on
October
[[Page H10819]]
1, 2011, and ending on March 31, 2012, under section
2104(a)(15)(A) of the Social Security Act (42 U.S.C.
1397dd(a)(15)(A)) (as added by section 101), to remain
available until expended. Such amount shall be used to
provide allotments to States under subsections (c)(5) and (i)
of section 2104 of the Social Security Act (42 U.S.C. 1397dd)
for the first 6 months of fiscal year 2012 in the same manner
as allotments are provided under subsection (a)(15)(A) of
such section and subject to the same terms and conditions as
apply to the allotments provided from such subsection
(a)(15)(A).
SEC. 104. IMPROVING FUNDING FOR THE TERRITORIES UNDER CHIP
AND MEDICAID.
(a) Update of CHIP Allotments.--Section 2104(c) (42 U.S.C.
1397dd(c)) is amended--
(1) in paragraph (1), by inserting ``and paragraphs (5) and
(6)'' after ``and (i)''; and
(2) by adding at the end the following new paragraphs:
``(5) Annual allotments for territories beginning with
fiscal year 2008.--Of the total allotment amount appropriated
under subsection (a) for a fiscal year beginning with fiscal
year 2008, the Secretary shall allot to each of the
commonwealths and territories described in paragraph (3) the
following:
``(A) Fiscal year 2008.--For fiscal year 2008, the highest
amount of Federal payments to the commonwealth or territory
under this title for any fiscal year occurring during the
period of fiscal years 1998 through 2007, multiplied by the
annual adjustment determined under subsection (i)(2)(B) for
fiscal year 2008, except that clause (ii) thereof shall be
applied by substituting `the United States' for `the State'.
``(B) Fiscal years 2009 through 2012.--
``(i) In general.--For each of fiscal years 2009 through
2012, except as provided in clause (ii), the amount
determined under this paragraph for the preceding fiscal year
multiplied by the annual adjustment determined under
subsection (i)(2)(B) for the fiscal year, except that clause
(ii) thereof shall be applied by substituting `the United
States' for `the State'.
``(ii) Special rule for fiscal year 2012.--In the case of
fiscal year 2012--
``(I) 89 percent of the amount allocated to the
commonwealth or territory for such fiscal year (without
regard to this subclause) shall be allocated for the period
beginning on October 1, 2011, and ending on March 31, 2012,
and
``(II) 11 percent of such amount shall be allocated for the
period beginning on April 1, 2012, and ending on September
30, 2012.''.
(b) Removal of Federal Matching Payments for Data Reporting
Systems From the Overall Limit on Payments to Territories
Under Title XIX.--Section 1108(g) (42 U.S.C. 1308(g)) is
amended by adding at the end the following new paragraph:
``(4) Exclusion of certain expenditures from payment
limits.--With respect to fiscal years beginning with fiscal
year 2008, if Puerto Rico, the Virgin Islands, Guam, the
Northern Mariana Islands, or American Samoa qualify for a
payment under subparagraph (A)(i), (B), or (F) of section
1903(a)(3) for a calendar quarter of such fiscal year, the
payment shall not be taken into account in applying
subsection (f) (as increased in accordance with paragraphs
(1), (2), and (3) of this subsection) to such commonwealth or
territory for such fiscal year.''.
(c) GAO Study and Report.--Not later than September 30,
2009, the Comptroller General of the United States shall
submit a report to the appropriate committees of Congress
regarding Federal funding under Medicaid and CHIP for Puerto
Rico, the United States Virgin Islands, Guam, American Samoa,
and the Northern Mariana Islands. The report shall include
the following:
(1) An analysis of all relevant factors with respect to--
(A) eligible Medicaid and CHIP populations in such
commonwealths and territories;
(B) historical and projected spending needs of such
commonwealths and territories and the ability of capped
funding streams to respond to those spending needs;
(C) the extent to which Federal poverty guidelines are used
by such commonwealths and territories to determine Medicaid
and CHIP eligibility; and
(D) the extent to which such commonwealths and territories
participate in data collection and reporting related to
Medicaid and CHIP, including an analysis of territory
participation in the Current Population Survey versus the
American Community Survey.
(2) Recommendations for improving Federal funding under
Medicaid and CHIP for such commonwealths and territories.
SEC. 105. INCENTIVE BONUSES FOR STATES.
(a) In General.--Section 2104 (42 U.S.C. 1397dd), as
amended by section 102, is amended by adding at the end the
following new subsection:
``(j) Incentive Bonuses.--
``(1) Establishment of incentive pool from unobligated
national allotment and unexpended state allotments.--
``(A) In general.--There is hereby established in the
Treasury of the United States a fund which shall be known as
the `CHIP Incentive Bonuses Pool' (in this subsection
referred to as the `Incentive Pool'). Amounts in the
Incentive Pool are authorized to be appropriated for payments
under this subsection and shall remain available until
expended.
``(B) Deposits through initial appropriation and transfers
of funds.--
``(i) Initial appropriation.--There is appropriated to the
Incentive Pool, out of any money in the Treasury not
otherwise appropriated, $3,000,000,000 for fiscal year 2008.
``(ii) Transfers.--Notwithstanding any other provision of
law, the following amounts are hereby appropriated or
transferred to, deposited in, and made available for
expenditure from the Incentive Pool on the following dates:
``(I) Unexpended fiscal year 2006 and 2007 allotments.--On
December 31, 2007, the sum for all States of the excess (if
any) for each State of--
``(aa) the aggregate allotments provided for the State
under subsection (b) or (c) for fiscal years 2006 and 2007
that are not expended by September 30, 2007, over
``(bb) an amount equal to 50 percent of the allotment
provided for the State under subsection (c) or (i) for fiscal
year 2008 (as determined in accordance with subsection
(i)(6)).
``(II) Unobligated national allotment.--
``(aa) Fiscal years 2008 through 2011.--On December 31 of
fiscal year 2008, and on December 31 of each succeeding
fiscal year through fiscal year 2011, the portion, if any, of
the amount appropriated under subsection (a) for such fiscal
year that is unobligated for allotment to a State under
subsection (c) or (i) for such fiscal year or set aside under
subsection (a)(3) or (b)(2) of section 2111 for such fiscal
year.
``(bb) First half of fiscal year 2012.--On December 31 of
fiscal year 2012, the portion, if any, of the sum of the
amounts appropriated under subsection (a)(15)(A) and under
section 103 of the Children's Health Insurance Program
Reauthorization Act of 2007 for the period beginning on
October 1, 2011, and ending on March 31, 2012, that is
unobligated for allotment to a State under subsection (c) or
(i) for such fiscal year or set aside under subsection (b)(2)
of section 2111 for such fiscal year.
``(cc) Second half of fiscal year 2012.--On June 30 of
fiscal year 2012, the portion, if any, of the amount
appropriated under subsection (a)(15)(B) for the period
beginning on April 1, 2012, and ending on September 30, 2012,
that is unobligated for allotment to a State under subsection
(c) or (i) for such fiscal year or set aside under subsection
(b)(2) of section 2111 for such fiscal year.
``(III) Percentage of state allotments that are unexpended
by the end of the first year of availability beginning with
the fiscal year 2009 allotments.--On October 1 of each of
fiscal years 2009 through 2012, the sum for all States for
such fiscal year (the `current fiscal year') of the excess
(if any) for each State of--
``(aa) the allotment made for the State under subsection
(b), (c), or (i) for the fiscal year preceding the current
fiscal year (reduced by any amounts set aside under section
2111(a)(3)) that is not expended by the end of such preceding
fiscal year, over
``(bb) an amount equal to the applicable percentage (for
the fiscal year) of the allotment made for the State under
subsection (b), (c), or (i) (as so reduced) for such
preceding fiscal year.
For purposes of item (bb), the applicable percentage is 20
percent for fiscal year 2009, and 10 percent for each of
fiscal years 2010, 2011, and 2012.
``(IV) Remainder of state allotments that are unexpended by
the end of the period of availability beginning with the
fiscal year 2006 allotments.--On October 1 of each of fiscal
years 2009 through 2012, the total amount of allotments made
to States under subsection (b), (c), or (i) for the second
preceding fiscal year (third preceding fiscal year in the
case of the fiscal year 2006 allotments) and remaining after
the application of subclause (III) that are not expended by
September 30 of the preceding fiscal year.
``(V) Unexpended transitional coverage block grant for
nonpregnant childless adults.--On October 1, 2009, any
amounts set aside under section 2111(a)(3) that are not
expended by September 30, 2009.
``(VI) Excess chip contingency funds.--
``(aa) Amounts in excess of the aggregate cap.--On October
1 of each of fiscal years 2010 through 2012, any amount in
excess of the aggregate cap applicable to the CHIP
Contingency Fund for the fiscal year under subsection
(k)(2)(B).
``(bb) Unexpended chip contingency fund payments.--On
October 1 of each of fiscal years 2010 through 2012, any
portion of a CHIP Contingency Fund payment made to a State
that remains unexpended at the end of the period for which
the payment is available for expenditure under subsection
(e)(3).
``(VII) Extension of availability for portion of unexpended
state allotments.--The portion of the allotment made to a
State for a fiscal year that is not transferred to the
Incentive Pool under subclause (I) or (III) shall remain
available for expenditure by the State only during the fiscal
year in which such transfer occurs, in accordance with
subclause (IV) and subsection (e)(4).
``(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 Incentive
Pool as are not immediately required for payments from the
Pool. The income derived from these investments constitutes a
part of the Incentive Pool.
``(2) Payments to states increasing enrollment.--
``(A) In general.--Subject to paragraph (3)(D), with
respect to each of fiscal years 2009 through 2012, the
Secretary shall make payments to States from the Incentive
Pool determined under subparagraph (B).
``(B) Determination of payments.--If, for any coverage
period ending in a fiscal year ending after September 30,
2008, the average monthly enrollment of children in the State
plan under title XIX exceeds the baseline monthly average for
such period, the payment made for the fiscal year shall be
equal to the applicable amount determined under subparagraph
(C).
``(C) Applicable amount.--For purposes of subparagraph (B),
the applicable amount is the product determined in accordance
with the following:
``(i) If such excess with respect to the number of
individuals who are enrolled in the State plan
[[Page H10820]]
under title XIX does not exceed 2 percent, the product of $75
and the number of such individuals included in such excess.
``(ii) If such excess with respect to the number of
individuals who are enrolled in the State plan under title
XIX exceeds 2, but does not exceed 5 percent, the product of
$300 and the number of such individuals included in such
excess, less the amount of such excess calculated in clause
(i).
``(iii) If such excess with respect to the number of
individuals who are enrolled in the State plan under title
XIX exceeds 5 percent, the product of $625 and the number of
such individuals included in such excess, less the sum of the
amount of such excess calculated in clauses (i) and (ii).
``(D) Indexing of dollar amounts.--For each coverage period
ending in a fiscal year ending after September 30, 2009, the
dollar amounts specified in subparagraph (C) shall be
increased by the percentage increase (if any) in the
projected nominal per capita amount of National Health
Expenditures for the calendar year beginning on January 1 of
the coverage period over the preceding coverage period, as
most recently published by the Secretary before the beginning
of the coverage period involved.
``(3) Rules relating to enrollment increases.--For purposes
of paragraph (2)(B)--
``(A) Baseline monthly average.--Except as provided in
subparagraph (C), the baseline monthly average for any fiscal
year for a State is equal to--
``(i) the baseline monthly average for the preceding fiscal
year; multiplied by
``(ii) the sum of 1 plus the sum of--
``(I) 0.01; and
``(II) the percentage increase in the population of low-
income children in the State from the preceding fiscal year
to the fiscal year involved, as determined by the Secretary
based on the most timely and accurate published estimates of
the Bureau of the Census before the beginning of the fiscal
year involved.
``(B) Coverage period.--Except as provided in subparagraph
(C), the coverage period for any fiscal year consists of the
last 2 quarters of the preceding fiscal year and the first 2
quarters of the fiscal year.
``(C) Special rules for fiscal year 2009.--With respect to
fiscal year 2009--
``(i) the coverage period for that fiscal year shall be
based on the first 2 quarters of fiscal year 2009; and
``(ii) the baseline monthly average shall be--
``(I) the average monthly enrollment of low-income children
enrolled in the State's plan under title XIX for the first 2
quarters of fiscal year 2007 (as determined over a 6-month
period on the basis of the most recent information reported
through the Medicaid Statistical Information System (MSIS));
multiplied by
``(II) the sum of 1 plus the sum of--
``(aa) 0.02; and
``(bb) the percentage increase in the population of low-
income children in the State from fiscal year 2007 to fiscal
year 2009, as determined by the Secretary based on the most
timely and accurate published estimates of the Bureau of the
Census before the beginning of the fiscal year involved.
``(D) Additional requirement for eligibility for payment.--
For purposes of subparagraphs (B) and (C), the average
monthly enrollment shall be determined without regard to
children who do not meet the income eligibility criteria in
effect on July 19, 2007, for enrollment under the State plan
under title XIX or under a waiver of such plan.
``(4) Time of payment.--Payments under paragraph (2) for
any fiscal year shall be made during the last quarter of such
year.
``(5) Use of payments.--Payments made to a State from the
Incentive Pool shall be used for any purpose that the State
determines is likely to reduce the percentage of low-income
children in the State without health insurance.
``(6) Proration rule.--If the amount available for payment
from the Incentive Pool is less than the total amount of
payments to be made for such fiscal year, the Secretary shall
reduce the payments described in paragraph (2) on a
proportional basis.
``(7) References.--With respect to a State plan under title
XIX, any references to a child in this subsection shall
include a reference to any individual provided medical
assistance under the plan who has not attained age 19 (or, if
a State has so elected under such State plan, age 20 or
21).''.
(b) Redistribution of Unexpended Fiscal Year 2005
Allotments.--Notwithstanding section 2104(f) of the Social
Security Act (42 U.S.C. 1397dd(f)), with respect to fiscal
year 2008, the Secretary shall provide for a redistribution
under such section from the allotments for fiscal year 2005
under subsection (b) and (c) of such section that are not
expended by the end of fiscal year 2007, to each State
described in clause (iii) of section 2104(i)(2)(A) of the
Social Security Act, as added by section 102(a), of an amount
that bears the same ratio to such unexpended fiscal year 2005
allotments as the ratio of the fiscal year 2007 allotment
determined for each such State under subsection (b) of
section 2104 of such Act for fiscal year 2007 (without regard
to any amounts paid, allotted, or redistributed to the State
under section 2104 for any preceding fiscal year) bears to
the total amount of the fiscal year 2007 allotments for all
such States (as so determined).
(c) Conforming Amendment Eliminating Rules for
Redistribution of Unexpended Allotments for Fiscal Years
After 2005.--Effective January 1, 2008, section 2104(f) (42
U.S.C. 1397dd(f)) is amended to read as follows:
``(f) Unallocated Portion of National Allotment and Unused
Allotments.--For provisions relating to the distribution of
portions of the unallocated national allotment under
subsection (a) for fiscal years beginning with fiscal year
2008, and unexpended allotments for fiscal years beginning
with fiscal year 2006, see subsection (j).''.
(d) Additional Funding for the Secretary To Improve
Timeliness of Data Reporting and Analysis for Purposes of
Determining Enrollment Increases Under Medicaid and CHIP.--
(1) Appropriation.--There is appropriated, out of any money
in the Treasury not otherwise appropriated, $5,000,000 to the
Secretary for fiscal year 2008 for the purpose of improving
the timeliness of the data reported and analyzed from the
Medicaid Statistical Information System (MSIS) for purposes
of carrying out section 2104(j)(2)(B) of the Social Security
Act (as added by subsection (a)) and to provide guidance to
States with respect to any new reporting requirements related
to such improvements. Amounts appropriated under this
paragraph shall remain available until expended.
(2) Requirements.--The improvements made by the Secretary
under paragraph (1) shall be designed and implemented
(including with respect to any necessary guidance for States)
so that, beginning no later than October 1, 2008, data
regarding the enrollment of low-income children (as defined
in section 2110(c)(4) of the Social Security Act (42 U.S.C.
1397jj(c)(4)) of a State enrolled in the State plan under
Medicaid or the State child health plan under CHIP with
respect to a fiscal year shall be collected and analyzed by
the Secretary within 6 months of submission.
SEC. 106. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS
ADULTS UNDER CHIP; CONDITIONS FOR COVERAGE OF
PARENTS.
(a) Phase-Out Rules.--
(1) In general.--Title XXI (42 U.S.C. 1397aa et seq.) is
amended by adding at the end the following new section:
``SEC. 2111. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS
ADULTS; CONDITIONS FOR COVERAGE OF PARENTS.
``(a) Termination of Coverage for Nonpregnant Childless
Adults.--
``(1) No new chip waivers; automatic extensions at state
option through fiscal year 2008.--Notwithstanding section
1115 or any other provision of this title, except as provided
in this subsection--
``(A) the Secretary shall not on or after the date of the
enactment of the Children's Health Insurance Program
Reauthorization Act of 2007, approve or renew a waiver,
experimental, pilot, or demonstration project that would
allow funds made available under this title to be used to
provide child health assistance or other health benefits
coverage to a nonpregnant childless adult; and
``(B) notwithstanding the terms and conditions of an
applicable existing waiver, the provisions of paragraphs (2)
and (3) shall apply for purposes of any fiscal year beginning
on or after October 1, 2008, in determining the period to
which the waiver applies, the individuals eligible to be
covered by the waiver, and the amount of the Federal payment
under this title.
``(2) Termination of chip coverage under applicable
existing waivers at the end of fiscal year 2008.--
``(A) In general.--No funds shall be available under this
title for child health assistance or other health benefits
coverage that is provided to a nonpregnant childless adult
under an applicable existing waiver after September 30, 2008.
``(B) Extension upon state request.--If an applicable
existing waiver described in subparagraph (A) would otherwise
expire before October 1, 2008, and the State requests an
extension of such waiver, the Secretary shall grant such an
extension, but only through September 30, 2008.
``(C) Application of enhanced fmap.--The enhanced FMAP
determined under section 2105(b) shall apply to expenditures
under an applicable existing waiver for the provision of
child health assistance or other health benefits coverage to
a nonpregnant childless adult during fiscal year 2008.
``(3) Optional 1-year transitional coverage block grant
funded from state allotment.--Subject to paragraph (4)(B),
each State for which coverage under an applicable existing
waiver is terminated under paragraph (2)(A) may elect to
provide nonpregnant childless adults who were provided child
health assistance or health benefits coverage under the
applicable existing waiver at any time during fiscal year
2008 with such assistance or coverage during fiscal year
2009, as if the authority to provide such assistance or
coverage under an applicable existing waiver was extended
through that fiscal year, but subject to the following terms
and conditions:
``(A) Block grant set aside from state allotment.--The
Secretary shall set aside for the State an amount equal to
the Federal share of the State's projected expenditures under
the applicable existing waiver for providing child health
assistance or health benefits coverage to all nonpregnant
childless adults under such waiver for fiscal year 2008 (as
certified by the State and submitted to the Secretary by not
later than August 31, 2008, and without regard to whether any
such individual lost coverage during fiscal year 2008 and was
later provided child health assistance or other health
benefits coverage under the waiver in that fiscal year),
increased by the annual adjustment for fiscal year 2009
determined under section 2104(i)(2)(B)(i). The Secretary may
adjust the amount set aside under the preceding sentence, as
necessary, on the basis of the expenditure data for fiscal
year 2008 reported by States on CMS Form 64 or CMS Form 21
not later than November 30, 2008, but in no case shall the
Secretary adjust such amount after December 31, 2008.
[[Page H10821]]
``(B) No coverage for nonpregnant childless adults who were
not covered during fiscal year 2008.--
``(i) FMAP applied to expenditures.--The Secretary shall
pay the State for each quarter of fiscal year 2009, from the
amount set aside under subparagraph (A), an amount equal to
the Federal medical assistance percentage (as determined
under section 1905(b) without regard to clause (4) of such
section) of expenditures in the quarter for providing child
health assistance or other health benefits coverage to a
nonpregnant childless adult but only if such adult was
enrolled in the State program under this title during fiscal
year 2008 (without regard to whether the individual lost
coverage during fiscal year 2008 and was reenrolled in that
fiscal year or in fiscal year 2009).
``(ii) Federal payments limited to amount of block grant
set-aside.--No payments shall be made to a State for
expenditures described in this subparagraph after the total
amount set aside under subparagraph (A) for fiscal year 2009
has been paid to the State.
``(4) State option to apply for medicaid waiver to continue
coverage for nonpregnant childless adults.--
``(A) In general.--Each State for which coverage under an
applicable existing waiver is terminated under paragraph
(2)(A) may submit, not later than June 30, 2009, an
application to the Secretary for a waiver under section 1115
of the State plan under title XIX to provide medical
assistance to a nonpregnant childless adult whose coverage is
so terminated (in this subsection referred to as a `Medicaid
nonpregnant childless adults waiver').
``(B) Deadline for approval.--The Secretary shall make a
decision to approve or deny an application for a Medicaid
nonpregnant childless adults waiver submitted under
subparagraph (A) within 90 days of the date of the submission
of the application. If no decision has been made by the
Secretary as of September 30, 2009, on the application of a
State for a Medicaid nonpregnant childless adults waiver that
was submitted to the Secretary by June 30, 2009, the
application shall be deemed approved.
``(C) Standard for budget neutrality.--The budget
neutrality requirement applicable with respect to
expenditures for medical assistance under a Medicaid
nonpregnant childless adults waiver shall--
``(i) in the case of fiscal year 2010, allow expenditures
for medical assistance under title XIX for all such adults to
not exceed the total amount of payments made to the State
under paragraph (3)(B) for fiscal year 2009, increased by the
percentage increase (if any) in the projected nominal per
capita amount of National Health Expenditures for calendar
year 2010 over calendar year 2009, as most recently published
by the Secretary; and
``(ii) in the case of any succeeding fiscal year, allow
such expenditures to not exceed the amount in effect under
this subparagraph for the preceding fiscal year, increased by
the percentage increase (if any) in the projected nominal per
capita amount of National Health Expenditures for the
calendar year that begins during the fiscal year involved
over the preceding calendar year, as most recently published
by the Secretary.
``(b) Rules and Conditions for Coverage of Parents of
Targeted Low-Income Children.--
``(1) Two-year transition period; automatic extension at
state option through fiscal year 2009.--
``(A) No new chip waivers.--Notwithstanding section 1115 or
any other provision of this title, except as provided in this
subsection--
``(i) the Secretary shall not on or after the date of the
enactment of the Children's Health Insurance Program
Reauthorization Act of 2007 approve or renew a waiver,
experimental, pilot, or demonstration project that would
allow funds made available under this title to be used to
provide child health assistance or other health benefits
coverage to a parent of a targeted low-income child; and
``(ii) notwithstanding the terms and conditions of an
applicable existing waiver, the provisions of paragraphs (2)
and (3) shall apply for purposes of any fiscal year beginning
on or after October 1, 2009, in determining the period to
which the waiver applies, the individuals eligible to be
covered by the waiver, and the amount of the Federal payment
under this title.
``(B) Extension upon state request.--If an applicable
existing waiver described in subparagraph (A) would otherwise
expire before October 1, 2009, and the State requests an
extension of such waiver, the Secretary shall grant such an
extension, but only, subject to paragraph (2)(A), through
September 30, 2009.
``(C) Application of enhanced fmap.--The enhanced FMAP
determined under section 2105(b) shall apply to expenditures
under an applicable existing waiver for the provision of
child health assistance or other health benefits coverage to
a parent of a targeted low-income child during fiscal years
2008 and 2009.
``(2) Rules for fiscal years 2010 through 2012.--
``(A) Payments for coverage limited to block grant funded
from state allotment.--Any State that provides child health
assistance or health benefits coverage under an applicable
existing waiver for a parent of a targeted low-income child
may elect to continue to provide such assistance or coverage
through fiscal year 2010, 2011, or 2012, subject to the same
terms and conditions that applied under the applicable
existing waiver, unless otherwise modified in subparagraph
(B).
``(B) Terms and conditions.--
``(i) Block grant set aside from state allotment.--If the
State makes an election under subparagraph (A), the Secretary
shall set aside for the State for each such fiscal year an
amount equal to the Federal share of 110 percent of the
State's projected expenditures under the applicable existing
waiver for providing child health assistance or health
benefits coverage to all parents of targeted low-income
children enrolled under such waiver for the fiscal year (as
certified by the State and submitted to the Secretary by not
later than August 31 of the preceding fiscal year). In the
case of fiscal year 2012, the set aside for any State shall
be computed separately for each period described in clauses
(i) and (ii) of subsection (i))(1)(D) and any increase or
reduction in the allotment for either such period under
subsection (i)(3)(B)(ii) shall be allocated on a pro rata
basis to such set aside.
``(ii) Payments from block grant.--The Secretary shall pay
the State from the amount set aside under clause (i) for the
fiscal year, an amount for each quarter of such fiscal year
equal to the applicable percentage determined under clause
(iii) or (iv) for expenditures in the quarter for
providing child health assistance or other health benefits
coverage to a parent of a targeted low-income child.
``(iii) Enhanced fmap only in fiscal year 2010 for states
with significant child outreach or that achieve child
coverage benchmarks; fmap for any other states.--For purposes
of clause (ii), the applicable percentage for any quarter of
fiscal year 2010 is equal to--
``(I) the enhanced FMAP determined under section 2105(b) in
the case of a State that meets the outreach or coverage
benchmarks described in any of subparagraphs (A), (B), or (C)
of paragraph (3) for fiscal year 2009; or
``(II) the Federal medical assistance percentage (as
determined under section 1905(b) without regard to clause (4)
of such section) in the case of any other State.
``(iv) Amount of federal matching payment in 2011 or
2012.--For purposes of clause (ii), the applicable percentage
for any quarter of fiscal year 2011 or 2012 is equal to--
``(I) the REMAP percentage if--
``(aa) the applicable percentage for the State under clause
(iii) was the enhanced FMAP for fiscal year 2009; and
``(bb) the State met either of the coverage benchmarks
described in subparagraph (B) or (C) of paragraph (3) for the
preceding fiscal year; or
``(II) the Federal medical assistance percentage (as so
determined) in the case of any State to which subclause (I)
does not apply.
For purposes of subclause (I), the REMAP percentage is the
percentage which is the sum of such Federal medical
assistance percentage and a number of percentage points equal
to one-half of the difference between such Federal medical
assistance percentage and such enhanced FMAP.
``(v) No federal payments other than from block grant set
aside.--No payments shall be made to a State for expenditures
described in clause (ii) after the total amount set aside
under clause (i) for a fiscal year has been paid to the
State.
``(vi) No increase in income eligibility level for
parents.--No payments shall be made to a State from the
amount set aside under clause (i) for a fiscal year for
expenditures for providing child health assistance or health
benefits coverage to a parent of a targeted low-income child
whose family income exceeds the income eligibility level
applied under the applicable existing waiver to parents of
targeted low-income children on the date of enactment of the
Children's Health Insurance Program Reauthorization Act of
2007.
``(3) Outreach or coverage benchmarks.--For purposes of
paragraph (2), the outreach or coverage benchmarks described
in this paragraph are as follows:
``(A) Significant child outreach campaign.--The State--
``(i) was awarded a grant under section 2113 for fiscal
year 2009;
``(ii) implemented 1 or more of the process measures
described in section 2104(j)(3)(A)(i) for such fiscal year;
or
``(iii) has submitted a specific plan for outreach for such
fiscal year.
``(B) High-performing state.--The State, on the basis of
the most timely and accurate published estimates of the
Bureau of the Census, ranks in the lowest \1/3\ of States in
terms of the State's percentage of low-income children
without health insurance.
``(C) State increasing enrollment of low-income children.--
The State qualified for a payment from the Incentive Fund
under clause (ii) or (iii) of paragraph (2)(C) of section
2104(j) for the most recent coverage period applicable under
such section.
``(4) Rules of construction.--Nothing in this subsection
shall be construed as prohibiting a State from submitting an
application to the Secretary for a waiver under section 1115
of the State plan under title XIX to provide medical
assistance to a parent of a targeted low-income child that
was provided child health assistance or health benefits
coverage under an applicable existing waiver.
``(c) Applicable Existing Waiver.--For purposes of this
section--
``(1) In general.--The term `applicable existing waiver'
means a waiver, experimental, pilot, or demonstration project
under section 1115, grandfathered under section 6102(c)(3) of
the Deficit Reduction Act of 2005, or otherwise conducted
under authority that--
``(A) would allow funds made available under this title to
be used to provide child health assistance or other health
benefits coverage to--
``(i) a parent of a targeted low-income child;
``(ii) a nonpregnant childless adult; or
``(iii) individuals described in both clauses (i) and (ii);
and
``(B) was in effect during fiscal year 2007.
``(2) Definitions.--
``(A) Parent.--The term `parent' includes a caretaker
relative (as such term is used in carrying out section 1931)
and a legal guardian.
[[Page H10822]]
``(B) Nonpregnant childless adult.--The term `nonpregnant
childless adult' has the meaning given such term by section
2107(f).''.
(2) Conforming amendments.--
(A) Section 2107(f) (42 U.S.C. 1397gg(f)) is amended--
(i) by striking ``, the Secretary'' and inserting ``:
``(1) The Secretary'';
(ii) in the first sentence, by inserting ``or a parent (as
defined in section 2111(c)(2)(A)), who is not pregnant, of a
targeted low-income child'' before the period;
(iii) by striking the second sentence; and
(iv) by adding at the end the following new paragraph:
``(2) The Secretary may not approve, extend, renew, or
amend a waiver, experimental, pilot, or demonstration project
with respect to a State after the date of enactment of the
Children's Health Insurance Program Reauthorization Act of
2007 that would waive or modify the requirements of section
2111.''.
(B) Section 6102(c) of the Deficit Reduction Act of 2005
(Public Law 109-171; 120 Stat. 131) is amended by striking
``Nothing'' and inserting ``Subject to section 2111 of the
Social Security Act, as added by section 106(a)(1) of the
Children's Health Insurance Program Reauthorization Act of
2007, nothing''.
(b) GAO Study and Report.--
(1) In general.--The Comptroller General of the United
States shall conduct a study of whether--
(A) the coverage of a parent, a caretaker relative (as such
term is used in carrying out section 1931), or a legal
guardian of a targeted low-income child under a State health
plan under title XXI of the Social Security Act increases the
enrollment of, or the quality of care for, children, and
(B) such parents, relatives, and legal guardians who enroll
in such a plan are more likely to enroll their children in
such a plan or in a State plan under title XIX of such Act.
(2) Report.--Not later than 2 years after the date of the
enactment of this Act, the Comptroller General shall report
the results of the study to the appropriate committees of
Congress, including recommendations (if any) for changes in
legislation.
SEC. 107. STATE OPTION TO COVER LOW-INCOME PREGNANT WOMEN
UNDER CHIP THROUGH A STATE PLAN AMENDMENT.
(a) In General.--Title XXI (42 U.S.C. 1397aa et seq.), as
amended by section 106(a), is amended by adding at the end
the following new section:
``SEC. 2112. OPTIONAL COVERAGE OF TARGETED LOW-INCOME
PREGNANT WOMEN THROUGH A STATE PLAN AMENDMENT.
``(a) In General.--Subject to the succeeding provisions of
this section, a State may elect through an amendment to its
State child health plan under section 2102 to provide
pregnancy-related assistance under such plan for targeted
low-income pregnant women.
``(b) Conditions.--A State may only elect the option under
subsection (a) if the following conditions are satisfied:
``(1) Medicaid income eligibility level for pregnant women
of at least 185 percent of poverty.--The State has
established an income eligibility level for pregnant women
under subsection (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or
(l)(1)(A) of section 1902 that is at least 185 percent of the
income official poverty line.
``(2) No chip income eligibility level for pregnant women
lower than the state's medicaid level.--The State does not
apply an effective income level for pregnant women under the
State plan amendment that is lower than the effective income
level (expressed as a percent of the poverty line and
considering applicable income disregards) specified under
subsection (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or
(l)(1)(A) of section 1902, on the date of enactment of this
paragraph to be eligible for medical assistance as a pregnant
woman.
``(3) No coverage for higher income pregnant women without
covering lower income pregnant women.--The State does not
provide coverage for pregnant women with higher family income
without covering pregnant women with a lower family income.
``(4) Application of requirements for coverage of targeted
low-income children.--The State provides pregnancy-related
assistance for targeted low-income pregnant women in the same
manner, and subject to the same requirements, as the State
provides child health assistance for targeted low-income
children under the State child health plan, and in addition
to providing child health assistance for such women.
``(5) No preexisting condition exclusion or waiting
period.--The State does not apply any exclusion of benefits
for pregnancy-related assistance based on any preexisting
condition or any waiting period (including any waiting period
imposed to carry out section 2102(b)(3)(C)) for receipt of
such assistance.
``(6) Application of cost-sharing protection.--The State
provides pregnancy-related assistance to a targeted low-
income woman consistent with the cost-sharing protections
under section 2103(e) and applies the limitation on total
annual aggregate cost sharing imposed under paragraph (3)(B)
of such section to the family of such a woman.
``(c) Option To Provide Presumptive Eligibility.--A State
that elects the option under subsection (a) and satisfies the
conditions described in subsection (b) may elect to apply
section 1920 (relating to presumptive eligibility for
pregnant women) to the State child health plan in the same
manner as such section applies to the State plan under title
XIX.
``(d) Definitions.--For purposes of this section:
``(1) Pregnancy-related assistance.--The term `pregnancy-
related assistance' has the meaning given the term `child
health assistance' in section 2110(a) and includes any
medical assistance that the State would provide for a
pregnant woman under the State plan under title XIX during
pregnancy and the period described in paragraph (2)(A).
``(2) Targeted low-income pregnant woman.--The term
`targeted low-income pregnant woman' means a woman--
``(A) during pregnancy and through the end of the month in
which the 60-day period (beginning on the last day of her
pregnancy) ends;
``(B) whose family income does not exceed the income
eligibility level established under the State child health
plan under this title for a targeted low-income child; and
``(C) who satisfies the requirements of paragraphs (1)(A),
(1)(C), (2), and (3) of section 2110(b) in the same manner as
a child applying for child health assistance would have to
satisfy such requirements.
``(e) Automatic Enrollment for Children Born to Women
Receiving Pregnancy-Related Assistance.--If a child is born
to a targeted low-income pregnant woman who was receiving
pregnancy-related assistance under this section on the date
of the child's birth, the child shall be deemed to have
applied for child health assistance under the State child
health plan and to have been found eligible for such
assistance under such plan or to have applied for medical
assistance under title XIX and to have been found eligible
for such assistance under such title, as appropriate, on the
date of such birth and to remain eligible for such assistance
until the child attains 1 year of age. During the period in
which a child is deemed under the preceding sentence to be
eligible for child health or medical assistance, the child
health or medical assistance eligibility identification
number of the mother shall also serve as the identification
number of the child, and all claims shall be submitted and
paid under such number (unless the State issues a separate
identification number for the child before such period
expires).
``(f) States Providing Assistance Through Other Options.--
``(1) Continuation of other options for providing
assistance.--The option to provide assistance in accordance
with the preceding subsections of this section shall not
limit any other option for a State to provide--
``(A) child health assistance through the application of
sections 457.10, 457.350(b)(2), 457.622(c)(5), and
457.626(a)(3) of title 42, Code of Federal Regulations (as in
effect after the final rule adopted by the Secretary and set
forth at 67 Fed. Reg. 61956-61974 (October 2, 2002)), or
``(B) pregnancy-related services through the application of
any waiver authority (as in effect on June 1, 2007).
``(2) Clarification of authority to provide postpartum
services.--Any State that provides child health assistance
under any authority described in paragraph (1) may continue
to provide such assistance, as well as postpartum services,
through the end of the month in which the 60-day period
(beginning on the last day of the pregnancy) ends, in the
same manner as such assistance and postpartum services would
be provided if provided under the State plan under title XIX,
but only if the mother would otherwise satisfy the
eligibility requirements that apply under the State child
health plan (other than with respect to age) during such
period.
``(3) No inference.--Nothing in this subsection shall be
construed--
``(A) to infer congressional intent regarding the legality
or illegality of the content of the sections specified in
paragraph (1)(A); or
``(B) to modify the authority to provide pregnancy-related
services under a waiver specified in paragraph (1)(B).''.
(b) Additional Conforming Amendments.--
(1) No cost sharing for pregnancy-related benefits.--
Section 2103(e)(2) (42 U.S.C. 1397cc(e)(2)) is amended--
(A) in the heading, by inserting ``or pregnancy-related
assistance'' after ``preventive services''; and
(B) by inserting before the period at the end the
following: ``or for pregnancy-related assistance''.
(2) No waiting period.--Section 2102(b)(1)(B) (42 U.S.C.
1397bb(b)(1)(B)) is amended--
(A) in clause (i), by striking ``, and'' at the end and
inserting a semicolon;
(B) in clause (ii), by striking the period at the end and
inserting ``; and''; and
(C) by adding at the end the following new clause:
``(iii) may not apply a waiting period (including a waiting
period to carry out paragraph (3)(C)) in the case of a
targeted low-income pregnant woman provided pregnancy-related
assistance under section 2112.''.
SEC. 108. CHIP CONTINGENCY FUND.
Section 2104 (42 U.S.C. 1397dd), as amended by section 105,
is amended by adding at the end the following new subsection:
``(k) CHIP Contingency Fund.--
``(1) Establishment.--There is hereby established in the
Treasury of the United States a fund which shall be known as
the `CHIP Contingency Fund' (in this subsection referred to
as the `Fund'). Amounts in the Fund are authorized to be
appropriated for payments under this subsection.
``(2) Deposits into fund.--
``(A) Initial and subsequent appropriations.--Subject to
subparagraphs (B) and (E), out of any money in the Treasury
of the United States not otherwise appropriated, there are
appropriated to the Fund--
``(i) for fiscal year 2009, an amount equal to 12.5 percent
of the available national allotment under subsection
(i)(1)(C) for the fiscal year; and
``(ii) for each of fiscal years 2010 through 2012, such
sums as are necessary for making payments to eligible States
for such fiscal year, but
[[Page H10823]]
not in excess of the aggregate cap described in subparagraph
(B).
``(B) Aggregate cap.--Subject to subparagraph (E), the
total amount available for payment from the Fund for each of
fiscal years 2009 through 2012 (taking into account deposits
made under subparagraph (C)), shall not exceed 12.5 percent
of the available national allotment under subsection
(i)(1)(C) for the 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 constitutes a part of
the Fund.
``(D) Transfer of excess funds to the incentive fund.--The
Secretary of the Treasury shall transfer to, and deposit in,
the CHIP Incentive Bonuses Pool established under subsection
(j) any amounts in excess of the aggregate cap described in
subparagraph (B) for a fiscal year.
``(E) Special rules for amounts set aside for parents and
childless adults.--For purposes of subparagraphs (A) and
(B)--
``(i) the available national allotment under subsection
(i)(1)(C) shall be reduced by any amount set aside under
section 2111(a)(3) for block grant payments for transitional
coverage for childless adults; and
``(ii) the Secretary shall establish a separate account in
the Fund for the portion of any amount appropriated to the
Fund for any fiscal year which is allocable to the portion of
the available national allotment under subsection (i)(1)(C)
which is set aside for the fiscal year under section
2111(b)(2)(B)(i) for coverage of parents of low-income
children.
The Secretary shall include in the account established under
clause (ii) any income derived under subparagraph (C) which
is allocable to amounts in such account.
``(3) CHIP contingency fund payments.--
``(A) Payments.--
``(i) In general.--Subject to clauses (ii) and (iii) and
the succeeding subparagraphs of this paragraph, the Secretary
shall pay from the Fund to a State that is an eligible State
for a month of a fiscal year a CHIP contingency fund payment
equal to the Federal share of the shortfall determined under
subparagraph (D). In the case of an eligible State under
subparagraph (D)(i), the Secretary shall not make the payment
under this subparagraph until the State makes, and submits to
the Secretary, a projection of the amount of the shortfall.
``(ii) Separate determinations of shortfalls.--The
Secretary shall separately compute the shortfall under
subparagraph (D) for expenditures for eligible individuals
other than nonpregnant childless adults and parents with
respect to whom amounts are set aside under section 2111, for
expenditures for such childless adults, and for expenditures
for such parents.
``(iii) Payments.--
``(I) Nonpregnant childless adults.--No payments shall be
made from the Fund for nonpregnant childless adults with
respect to whom amounts are set aside under section
2111(a)(3).
``(II) Parents.--Any payments with respect to any shortfall
for parents who are paid from amounts set aside under section
2111(b)(2)(B)(i) shall be made only from the account
established under paragraph (2)(E)(ii) and not from any other
amounts in the Fund. No other payments may be made from such
account.
``(iv) Special rules.--Subparagraphs (B) and (C) shall be
applied separately with respect to shortfalls described in
clause (ii).
``(B) Use of funds.--Amounts paid to an eligible State from
the Fund shall be used only to eliminate the Federal share of
a shortfall in the State's allotment under subsection (i) for
a fiscal year.
``(C) Proration rule.--If the amounts available for payment
from the Fund for a fiscal year are less than the total
amount of payments determined under subparagraph (A) for the
fiscal year, the amount to be paid under such subparagraph to
each eligible State shall be reduced proportionally.
``(D) Eligible state.--
``(i) In general.--A State is an eligible State for a month
if the State is a subsection (b) State (as defined in
subsection (i)(7)), the State requests access to the Fund for
the month, and it is described in clause (ii) or (iii).
``(ii) Shortfall of federal allotment funding of not more
than 5 percent.--The Secretary estimates, on the basis of the
most recent data available to the Secretary or requested from
the State by the Secretary, that the State's allotment for
the fiscal year is at least 95 percent, but less than 100
percent, of the projected expenditures under the State child
health plan for the State for the fiscal year determined
under subsection (i) (without regard to incentive bonuses or
payments for which the State is eligible for under subsection
(j)(2) for the fiscal year).
``(iii) Shortfall of federal allotment funding of more than
5 percent caused by specific events.--The Secretary
estimates, on the basis of the most recent data available to
the Secretary or requested from the State by the Secretary,
that the State's allotment for the fiscal year is less than
95 percent of the projected expenditures under the State
child health plan for the State for the fiscal year
determined under subsection (i) (without regard to incentive
bonuses or payments for which the State is eligible for under
subsection (j)(2) for the fiscal year) and that such
shortfall is attributable to 1 or more of the following
events:
``(I) Stafford act or public health emergency.--The State
has--
``(aa) 1 or more parishes or counties for which a major
disaster has been declared in accordance with section 401 of
the Robert T. Stafford Disaster Relief and Emergency
Assistance Act (42 U.S.C. 5170) and which the President has
determined warrants individual and public assistance from the
Federal Government under such Act; or
``(bb) a public health emergency declared by the Secretary
under section 319 of the Public Health Service Act.
``(II) State economic downturn.--The State unemployment
rate is at least 5.5 percent during any 3-month period during
the fiscal year and such rate is at least 120 percent of the
State unemployment rate for the same period as averaged over
the last 3 fiscal years.
``(III) Event resulting in rise in percentage of low-
income children without health insurance.--The State
experienced a recent event that resulted in an increase in
the percentage of low-income children in the State without
health insurance (as determined on the basis of the most
timely and accurate published estimates of the Bureau of the
Census) that was outside the control of the State and
warrants granting the State access to the Fund (as determined
by the Secretary).
``(E) Payments made to all eligible states on a monthly
basis; authority for pro rata payments.--The Secretary shall
make monthly payments from the Fund to all States that are
determined to be eligible States with respect to a month. If
the sum of the payments to be made from the Fund for a month
exceed the amount in the Fund, the Secretary shall reduce
each such payment on a proportional basis.
``(F) Payments limited to fiscal year of eligibility
determination unless new eligibility basis determined.--No
State shall receive a CHIP contingency fund payment under
this section for a month beginning after September 30 of the
fiscal year in which the State is determined to be an
eligible State under this subsection, except that in the case
of an event described in subclause (I) or (III) of
subparagraph (D)(iii) that occurred after July 1 of the
fiscal year, any such payment with respect to such event
shall remain available until September 30 of the subsequent
fiscal year. Nothing in the preceding sentence shall be
construed as prohibiting a State from being determined to be
an eligible State under this subsection for any fiscal year
occurring after a fiscal year in which such a determination
is made.
``(G) Exemption from determination of percentage of
allotment retained after first year of availability.--In no
event shall payments made to a State under this subsection be
treated as part of the allotment determined for a State for a
fiscal year under subsection (i) for purposes of subsection
(j)(1)(B)(ii)(III).
``(H) Application of allotment reporting rules.--Rules
applicable to States for purposes of receiving payments from
an allotment determined under subsection (c) or (i) shall
apply in the same manner to an eligible State for purposes of
receiving a CHIP contingency fund payment under this
subsection.
``(4) Annual reports.--The Secretary shall annually report
to the Congress on the amounts in the Fund, the specific
events that caused States to apply for payments from the
Fund, and the payments made from the Fund.''.
SEC. 109. TWO-YEAR AVAILABILITY OF ALLOTMENTS; EXPENDITURES
COUNTED AGAINST OLDEST ALLOTMENTS.
Section 2104(e) (42 U.S.C. 1397dd(e)) is amended to read as
follows:
``(e) Availability of Amounts Allotted.--
``(1) In general.--Except as provided in subsection
(j)(1)(B)(ii)(III), amounts allotted to a State pursuant to
this section--
``(A) for each of fiscal years 1998 through 2006, shall
remain available for expenditure by the State through the end
of the second succeeding fiscal year; and
``(B) for each of fiscal years 2007 through 2012, shall
remain available for expenditure by the State only through
the end of the succeeding fiscal year for which such amounts
are allotted.
``(2) Incentive bonuses.--Incentive bonuses paid to a State
under subsection (j)(2) for a fiscal year shall remain
available for expenditure by the State without limitation.
``(3) CHIP contingency fund payments.--Except as provided
in paragraph (3)(F) of subsection (k), CHIP Contingency Fund
payments made to a State under such subsection for a month of
a fiscal year shall remain available for expenditure by the
State through the end of the fiscal year.
``(4) Rule for counting expenditures against chip
contingency fund payments, fiscal year allotments, and
incentive bonuses.--
``(A) In general.--Expenditures under the State child
health plan made on or after October 1, 2007, shall be
counted against--
``(i) first, any CHIP Contingency Fund payment made to the
State under subsection (k) for the earliest month of the
earliest fiscal year for which the payment remains available
for expenditure; and
``(ii) second, amounts allotted to the State for the
earliest fiscal year for which amounts remain available for
expenditure.
``(B) Incentive bonuses.--A State may elect, but is not
required, to count expenditures under the State child health
plan against any incentive bonuses paid to the State under
subsection (j)(2) for a fiscal year.
``(C) Block grant set-asides.--Expenditures for coverage
of--
``(i) nonpregnant childless adults for fiscal year 2009
shall be counted only against the amount set aside for such
coverage under section 2111(a)(3); and
``(ii) parents of targeted low-income children for each of
fiscal years 2010 through 2012, shall be counted only against
the amount set aside for such coverage under section
2111(b)(2)(B)(i).''.
[[Page H10824]]
SEC. 110. LIMITATION ON MATCHING RATE FOR STATES THAT PROPOSE
TO COVER CHILDREN WITH EFFECTIVE FAMILY INCOME
THAT EXCEEDS 300 PERCENT OF THE POVERTY LINE.
(a) FMAP Applied to Expenditures.--Section 2105(c) (42
U.S.C. 1397ee(c)) is amended by adding at the end the
following new paragraph:
``(8) Limitation on matching rate for expenditures for
child health assistance provided to children whose effective
family income exceeds 300 percent of the poverty line.--
``(A) FMAP applied to expenditures.--Except as provided in
subparagraph (B), for fiscal years beginning with fiscal year
2008, the Federal medical assistance percentage (as
determined under section 1905(b) without regard to clause (4)
of such section) shall be substituted for the enhanced FMAP
under subsection (a)(1) with respect to any expenditures for
providing child health assistance or health benefits coverage
for a targeted low-income child whose effective family income
would exceed 300 percent of the poverty line but for the
application of a general exclusion of a block of income that
is not determined by type of expense or type of income.
``(B) Exception.--Subparagraph (A) shall not apply to any
State that, on the date of enactment of the Children's Health
Insurance Program Reauthorization Act of 2007, has an
approved State plan amendment or waiver to provide, or has
enacted a State law to submit a State plan amendment to
provide, expenditures described in such subparagraph under
the State child health plan.''.
(b) Conforming Amendment.--Section 2105(a)(1) (42 U.S.C.
1397dd(a)(1)) is amended, in the matter preceding
subparagraph (A), by inserting ``or subsection (c)(8)'' after
``subparagraph (B)''.
SEC. 111. OPTION FOR QUALIFYING STATES TO RECEIVE THE
ENHANCED PORTION OF THE CHIP MATCHING RATE FOR
MEDICAID COVERAGE OF CERTAIN CHILDREN.
Section 2105(g) (42 U.S.C. 1397ee(g)) is amended--
(1) in paragraph (1)(A), by inserting ``subject to
paragraph (4),'' after ``Notwithstanding any other provision
of law,''; and
(2) by adding at the end the following new paragraph:
``(4) Option for allotments for fiscal years 2008 through
2012.--
``(A) Payment of enhanced portion of matching rate for
certain expenditures.--In the case of expenditures described
in subparagraph (B), a qualifying State (as defined in
paragraph (2)) may elect to be paid from the State's
allotment made under section 2104 for any of fiscal years
2008 through 2012 (insofar as the allotment is available to
the State under subsections (e) and (i) of such section) an
amount each quarter equal to the additional amount that would
have been paid to the State under title XIX with respect to
such expenditures if the enhanced FMAP (as determined under
subsection (b)) had been substituted for the Federal medical
assistance percentage (as defined in section 1905(b)).
``(B) Expenditures described.--For purposes of subparagraph
(A), the expenditures described in this subparagraph are
expenditures made after the date of the enactment of this
paragraph and during the period in which funds are available
to the qualifying State for use under subparagraph (A), for
the provision of medical assistance to individuals residing
in the State who are eligible for medical assistance under
the State plan under title XIX or under a waiver of such plan
and who have not attained age 19 (or, if a State has so
elected under the State plan under title XIX, age 20 or 21),
and whose family income equals or exceeds 133 percent of the
poverty line but does not exceed the Medicaid applicable
income level.''.
TITLE II--OUTREACH AND ENROLLMENT
SEC. 201. GRANTS FOR OUTREACH AND ENROLLMENT.
(a) Grants.--Title XXI (42 U.S.C. 1397aa et seq.), as
amended by section 107, is amended by adding at the end the
following:
``SEC. 2113. GRANTS TO IMPROVE OUTREACH AND ENROLLMENT.
``(a) Outreach and Enrollment Grants; National Campaign.--
``(1) In general.--From the amounts appropriated under
subsection (g), subject to paragraph (2), the Secretary shall
award grants to eligible entities during the period of fiscal
years 2008 through 2012 to conduct outreach and enrollment
efforts that are designed to increase the enrollment and
participation of eligible children under this title and title
XIX.
``(2) Ten percent set aside for national enrollment
campaign.--An amount equal to 10 percent of such amounts
shall be used by the Secretary for expenditures during such
period to carry out a national enrollment campaign in
accordance with subsection (h).
``(b) Priority for Award of Grants.--
``(1) In general.--In awarding grants under subsection (a),
the Secretary shall give priority to eligible entities that--
``(A) propose to target geographic areas with high rates
of--
``(i) eligible but unenrolled children, including such
children who reside in rural areas; or
``(ii) racial and ethnic minorities and health disparity
populations, including those proposals that address cultural
and linguistic barriers to enrollment; and
``(B) submit the most demonstrable evidence required under
paragraphs (1) and (2) of subsection (c).
``(2) Ten percent set aside for outreach to indian
children.--An amount equal to 10 percent of the funds
appropriated under subsection (g) shall be used by the
Secretary to award grants to Indian Health Service providers
and urban Indian organizations receiving funds under title V
of the Indian Health Care Improvement Act (25 U.S.C. 1651 et
seq.) for outreach to, and enrollment of, children who are
Indians.
``(c) Application.--An eligible entity that desires to
receive a grant under subsection (a) shall submit an
application to the Secretary in such form and manner, and
containing such information, as the Secretary may decide.
Such application shall include--
``(1) evidence demonstrating that the entity includes
members who have access to, and credibility with, ethnic or
low-income populations in the communities in which activities
funded under the grant are to be conducted;
``(2) evidence demonstrating that the entity has the
ability to address barriers to enrollment, such as lack of
awareness of eligibility, stigma concerns and punitive fears
associated with receipt of benefits, and other cultural
barriers to applying for and receiving child health
assistance or medical assistance;
``(3) specific quality or outcomes performance measures to
evaluate the effectiveness of activities funded by a grant
awarded under this section; and
``(4) an assurance that the eligible entity shall--
``(A) conduct an assessment of the effectiveness of such
activities against the performance measures;
``(B) cooperate with the collection and reporting of
enrollment data and other information in order for the
Secretary to conduct such assessments; and
``(C) in the case of an eligible entity that is not the
State, provide the State with enrollment data and other
information as necessary for the State to make necessary
projections of eligible children and pregnant women.
``(d) Dissemination of Enrollment Data and Information
Determined From Effectiveness Assessments; Annual Report.--
The Secretary shall--
``(1) make publicly available the enrollment data and
information collected and reported in accordance with
subsection (c)(4)(B); and
``(2) submit an annual report to Congress on the outreach
and enrollment activities conducted with funds appropriated
under this section.
``(e) Maintenance of Effort for States Awarded Grants; No
State Match Required.--In the case of a State that is awarded
a grant under this section--
``(1) the State share of funds expended for outreach and
enrollment activities under the State child health plan shall
not be less than the State share of such funds expended in
the fiscal year preceding the first fiscal year for which the
grant is awarded; and
``(2) no State matching funds shall be required for the
State to receive a grant under this section.
``(f) Definitions.--In this section:
``(1) Eligible entity.--The term `eligible entity' means
any of the following:
``(A) A State with an approved child health plan under this
title.
``(B) A local government.
``(C) An Indian tribe or tribal consortium, a tribal
organization, an urban Indian organization receiving funds
under title V of the Indian Health Care Improvement Act (25
U.S.C. 1651 et seq.), or an Indian Health Service provider.
``(D) A Federal health safety net organization.
``(E) A national, State, local, or community-based public
or nonprofit private organization, including organizations
that use community health workers or community-based doula
programs.
``(F) A faith-based organization or consortia, to the
extent that a grant awarded to such an entity is consistent
with the requirements of section 1955 of the Public Health
Service Act (42 U.S.C. 300x-65) relating to a grant award to
nongovernmental entities.
``(G) An elementary or secondary school.
``(2) Federal health safety net organization.--The term
`Federal health safety net organization' means--
``(A) a Federally-qualified health center (as defined in
section 1905(l)(2)(B));
``(B) a hospital defined as a disproportionate share
hospital for purposes of section 1923;
``(C) a covered entity described in section 340B(a)(4) of
the Public Health Service Act (42 U.S.C. 256b(a)(4)); and
``(D) any other entity or consortium that serves children
under a federally funded program, including the special
supplemental nutrition program for women, infants, and
children (WIC) established under section 17 of the Child
Nutrition Act of 1966 (42 U.S.C. 1786), the Head Start and
Early Head Start programs under the Head Start Act (42 U.S.C.
9801 et seq.), the school lunch program established under the
Richard B. Russell National School Lunch Act, and an
elementary or secondary school.
``(3) Indians; indian tribe; tribal organization; urban
indian organization.--The terms `Indian', `Indian tribe',
`tribal organization', and `urban Indian organization' have
the meanings given such terms in section 4 of the Indian
Health Care Improvement Act (25 U.S.C. 1603).
``(4) Community health worker.--The term `community health
worker' means an individual who promotes health or nutrition
within the community in which the individual resides--
``(A) by serving as a liaison between communities and
health care agencies;
``(B) by providing guidance and social assistance to
community residents;
``(C) by enhancing community residents' ability to
effectively communicate with health care providers;
``(D) by providing culturally and linguistically
appropriate health or nutrition education;
[[Page H10825]]
``(E) by advocating for individual and community health or
nutrition needs; and
``(F) by providing referral and followup services.
``(g) Appropriation.--There is appropriated, out of any
money in the Treasury not otherwise appropriated,
$100,000,000 for the period of fiscal years 2008 through
2012, to remain available until expended, for the purpose of
awarding grants under this section. Amounts appropriated and
paid under the authority of this section shall be in addition
to amounts appropriated under section 2104 and paid to States
in accordance with section 2105, including with respect to
expenditures for outreach activities in accordance with
subsections (a)(1)(D)(iii) and (c)(2)(C) of that section.
``(h) National Enrollment Campaign.--From the amounts made
available under subsection (a)(2), the Secretary shall
develop and implement a national enrollment campaign to
improve the enrollment of underserved child populations in
the programs established under this title and title XIX. Such
campaign may include--
``(1) the establishment of partnerships with the Secretary
of Education and the Secretary of Agriculture to develop
national campaigns to link the eligibility and enrollment
systems for the assistance programs each Secretary
administers that often serve the same children;
``(2) the integration of information about the programs
established under this title and title XIX in public health
awareness campaigns administered by the Secretary;
``(3) increased financial and technical support for
enrollment hotlines maintained by the Secretary to ensure
that all States participate in such hotlines;
``(4) the establishment of joint public awareness outreach
initiatives with the Secretary of Education and the Secretary
of Labor regarding the importance of health insurance to
building strong communities and the economy;
``(5) the development of special outreach materials for
Native Americans or for individuals with limited English
proficiency; and
``(6) such other outreach initiatives as the Secretary
determines would increase public awareness of the programs
under this title and title XIX.''.
(b) Enhanced Administrative Funding for Translation or
Interpretation Services Under CHIP.--Section 2105(a)(1) (42
U.S.C. 1397ee(a)(1)), as amended by section 603, is amended--
(1) in the matter preceding subparagraph (A), by inserting
``(or, in the case of expenditures described in subparagraph
(D)(iv), the higher of 75 percent or the sum of the enhanced
FMAP plus 5 percentage points)'' after ``enhanced FMAP''; and
(2) in subparagraph (D)--
(A) in clause (iii), by striking ``and'' at the end;
(B) by redesignating clause (iv) as clause (v); and
(C) by inserting after clause (iii) the following new
clause:
``(iv) for translation or interpretation services in
connection with the enrollment and use of services under this
title by individuals for whom English is not their primary
language (as found necessary by the Secretary for the proper
and efficient administration of the State plan); and''.
(c) Nonapplication of Administrative Expenditures Cap.--
Section 2105(c)(2) (42 U.S.C. 1397ee(c)(2)) is amended by
adding at the end the following:
``(C) Nonapplication to certain expenditures.--The
limitation under subparagraph (A) shall not apply with
respect to the following expenditures:
``(i) Expenditures funded under section 2113.--Expenditures
for outreach and enrollment activities funded under a grant
awarded to the State under section 2113.''.
SEC. 202. INCREASED OUTREACH AND ENROLLMENT OF INDIANS.
(a) In General.--Section 1139 (42 U.S.C. 1320b-9) is
amended to read as follows:
``SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, HEALTH CARE
FOR INDIANS UNDER TITLES XIX AND XXI.
``(a) Agreements With States for Medicaid and CHIP Outreach
On or Near Reservations To Increase the Enrollment of Indians
in Those Programs.--
``(1) In general.--In order to improve the access of
Indians residing on or near a reservation to obtain benefits
under the Medicaid and State children's health insurance
programs established under titles XIX and XXI, the Secretary
shall encourage the State to take steps to provide for
enrollment on or near the reservation. Such steps may include
outreach efforts such as the outstationing of eligibility
workers, entering into agreements with the Indian Health
Service, Indian Tribes, Tribal Organizations, and Urban
Indian Organizations to provide outreach, education regarding
eligibility and benefits, enrollment, and translation
services when such services are appropriate.
``(2) Construction.--Nothing in paragraph (1) shall be
construed as affecting arrangements entered into between
States and the Indian Health Service, Indian Tribes, Tribal
Organizations, or Urban Indian Organizations for such
Service, Tribes, or Organizations to conduct administrative
activities under such titles.
``(b) Requirement To Facilitate Cooperation.--The
Secretary, acting through the Centers for Medicare & Medicaid
Services, shall take such steps as are necessary to
facilitate cooperation with, and agreements between, States
and the Indian Health Service, Indian Tribes, Tribal
Organizations, or Urban Indian Organizations with respect to
the provision of health care items and services to Indians
under the programs established under title XIX or XXI.
``(c) Definition of Indian; Indian Tribe; Indian Health
Program; Tribal Organization; Urban Indian Organization.--In
this section, the terms `Indian', `Indian Tribe', `Indian
Health Program', `Tribal Organization', and `Urban Indian
Organization' have the meanings given those terms in section
4 of the Indian Health Care Improvement Act.''.
(b) Nonapplication of 10 Percent Limit on Outreach and
Certain Other Expenditures.--Section 2105(c)(2)(C) (42 U.S.C.
1397ee(c)(2)(C)), as added by section 201(c), is amended by
adding at the end the following new clause:
``(ii) Expenditures to increase outreach to, and the
enrollment of, indian children under this title and title
xix.--Expenditures for outreach activities to families of
Indian children likely to be eligible for child health
assistance under the plan or medical assistance under the
State plan under title XIX (or under a waiver of such plan),
to inform such families of the availability of, and to assist
them in enrolling their children in, such plans, including
such activities conducted under grants, contracts, or
agreements entered into under section 1139(a).''.
SEC. 203. DEMONSTRATION PROGRAM TO PERMIT STATES TO RELY ON
FINDINGS BY AN EXPRESS LANE AGENCY TO DETERMINE
COMPONENTS OF A CHILD'S ELIGIBILITY FOR
MEDICAID OR CHIP.
(a) Requirement To Conduct Demonstration Program.--
(1) In general.--The Secretary shall establish a 3-year
demonstration program under which up to 10 States shall be
authorized to rely on a finding made within the preceding 12
months by an Express Lane agency to determine whether a child
has met 1 or more of the eligibility requirements, such as
income, assets or resources, citizenship status, or other
criteria, necessary to determine the child's initial
eligibility, eligibility redetermination, or renewal of
eligibility, for medical assistance under the State Medicaid
plan or child health assistance under the State CHIP plan. A
State selected to participate in the demonstration program--
(A) shall not be required to direct a child (or a child's
family) to submit information or documentation previously
submitted by the child or family to an Express Lane agency
that the State relies on for its Medicaid or CHIP eligibility
determination; and
(B) may rely on information from an Express Lane agency
when evaluating a child's eligibility for medical assistance
under the State Medicaid plan or child health assistance
under the State CHIP plan without a separate, independent
confirmation of the information at the time of enrollment,
redetermination, or renewal.
(2) Payments to states.--From the amount appropriated under
paragraph (1) of subsection (f), after the application of
paragraph (2) of that subsection, the Secretary shall pay the
States selected to participate in the demonstration program
such sums as the Secretary shall determine for expenditures
made by the State for systems upgrades and implementation of
the demonstration program. In no event shall a payment be
made to a State from the amount appropriated under subsection
(f) for any expenditures incurred for providing medical
assistance or child health assistance to a child enrolled in
the State Medicaid plan or the State CHIP plan through
reliance on a finding made by an Express Lane agency.
(b) Requirements; Options for Application.--
(1) State requirements.--A State selected to participate in
the demonstration program established under this section may
rely on a finding of an Express Lane agency only if the
following conditions are met:
(A) Requirement to determine eligibility using regular
procedures if child is first found ineligible.--If reliance
on a finding from an Express Lane agency results in a child
not being found eligible for the State Medicaid plan or the
State CHIP plan, the State would be required to determine
eligibility under such plan using its regular procedures.
(B) Notice.--The State shall inform the families
(especially those whose children are enrolled in the State
CHIP plan) that they may qualify for lower premium payments
or more comprehensive health coverage under the State
Medicaid plan if the family's income were directly evaluated
for an eligibility determination by the State Medicaid
agency, and that, at the family's option, the family may seek
an eligibility determination by the State Medicaid agency.
(C) Compliance with department of homeland security
procedures.--The State may rely on an Express Lane agency
finding that a child is a qualified alien as long as the
Express Lane agency complies with guidance and regulatory
procedures issued by the Secretary of Homeland Security for
eligibility determinations of qualified aliens (as defined in
subsections (b) and (c) of section 431 of the Personal
Responsibility and Work Opportunity Reconciliation Act of
1996 (8 U.S.C. 1641)).
(D) Verification of citizenship or nationality status.--The
State shall satisfy the requirements of section
1902(a)(46)(B) or 2105(c)(9) of the Social Security Act, as
applicable (and as added by section 301 of this Act) for
verifications of citizenship or nationality status.
(E) Coding; application to enrollment error rates.--
(i) In general.--The State agrees to--
(I) assign such codes as the Secretary shall require to the
children who are enrolled in the State Medicaid plan or the
State CHIP plan through reliance on a finding made by an
Express Lane agency for the duration of the State's
participation in the demonstration program;
(II) annually provide the Secretary with a statistically
valid sample (that is approved by Secretary) of the children
enrolled in such plans
[[Page H10826]]
through reliance on such a finding by conducting a full
Medicaid eligibility review of the children identified for
such sample for purposes of determining an eligibility error
rate with respect to the enrollment of such children;
(III) submit the error rate determined under subclause (II)
to the Secretary;
(IV) if such error rate exceeds 3 percent for either of the
first 2 fiscal years in which the State participates in the
demonstration program, demonstrate to the satisfaction of the
Secretary the specific corrective actions implemented by the
State to improve upon such error rate; and
(V) if such error rate exceeds 3 percent for any fiscal
year in which the State participates in the demonstration
program, a reduction in the amount otherwise payable to the
State under section 1903(a) of the Social Security Act (42
Secretary 1396b(a)) for quarters for that fiscal year, equal
to the total amount of erroneous excess payments determined
for the fiscal year only with respect to the children
included in the sample for the fiscal year that are in excess
of a 3 percent error rate with respect to such children.
(ii) No punitive action based on error rate.--The Secretary
shall not apply the error rate derived from the sample under
clause (i) to the entire population of children enrolled in
the State Medicaid plan or the State CHIP plan through
reliance on a finding made by an Express Lane agency, or to
the population of children enrolled in such plans on the
basis of the State's regular procedures for determining
eligibility, or penalize the State on the basis of such error
rate in any manner other than the reduction of payments
provided for under clause (i)(V).
(iii) Rule of construction.--Nothing in this section shall
be construed as relieving a State that participates in the
demonstration program established under this section from
being subject to a penalty under section 1903(u) of the
Social Security Act (42 U.S.C. 1396b(u)) for payments made
under the State Medicaid plan with respect to ineligible
individuals and families that are determined to exceed the
error rate permitted under that section (as determined
without regard to the error rate determined under clause
(i)(II)).
(2) State options for application.--A State selected to
participate in the demonstration program may elect to apply
any of the following:
(A) Satisfaction of chip screen and enroll requirements.--
If the State relies on a finding of an Express Lane agency
for purposes of determining eligibility under the State CHIP
plan, the State may meet the screen and enroll requirements
imposed under subparagraphs (A) and (B) of section 2102(b)(3)
of the Social Security Act (42 U.S.C. 1397bb(b)(3)) by using
any of the following:
(i) Establishing a threshold percentage of the poverty line
that is 30 percentage points (or such other higher number of
percentage points) as the State determines reflects the
income methodologies of the program administered by the
Express Lane Agency and the State Medicaid plan.
(ii) Providing that a child satisfies all income
requirements for eligibility under the State Medicaid plan.
(iii) Providing that a child has a family income that
exceeds the Medicaid applicable income level.
(B) Presumptive eligibility.--The State may provide for
presumptive eligibility under the State CHIP plan for a child
who, based on an eligibility determination of an income
finding from an Express Lane agency, would qualify for child
health assistance under the State CHIP plan. During the
period of presumptive eligibility, the State may determine
the child's eligibility for child health assistance under the
State CHIP plan based on telephone contact with family
members, access to data available in electronic or paper
format, or other means that minimize to the maximum extent
feasible the burden on the family.
(C) Automatic enrollment.--
(i) In general.--The State may initiate and determine
eligibility for medical assistance under the State Medicaid
plan or for child health assistance under the State CHIP plan
without a program application from, or on behalf of, the
child based on data obtained from sources other than the
child (or the child's family), but a child can only be
automatically enrolled in the State Medicaid plan or the
State CHIP plan if the child or the family affirmatively
consents to being enrolled through affirmation and signature
on an Express Lane agency application.
(ii) Information requirement.--A State that elects the
option under clause (i) shall have procedures in place to
inform the child or the child's family of the services that
will be covered under the State Medicaid plan or the State
CHIP plan (as applicable), appropriate methods for using such
services, premium or other cost sharing charges (if any) that
apply, medical support obligations created by the enrollment
(if applicable), and the actions the child or the child's
family must take to maintain enrollment and renew coverage.
(iii) Option to waive signatures.--The State may waive any
signature requirements for enrollment for a child who
consents to, or on whose behalf consent is provided for,
enrollment in the State Medicaid plan or the State CHIP plan.
(3) Signature requirements.--In the case of a State
selected to participate in the demonstration program--
(A) no signature under penalty of perjury shall be required
on an application form for medical assistance under the State
Medicaid plan or child health assistance under the State CHIP
plan to attest to any element of the application for which
eligibility is based on information received from an Express
Lane agency or a source other than an applicant; and
(B) any signature requirement for determination of an
application for medical assistance under the State Medicaid
plan or child health assistance under the State CHIP plan may
be satisfied through an electronic signature.
(4) Rules of construction.--Nothing in this subsection
shall be construed to--
(A) relieve a State of the obligation under section
1902(a)(5) of the Social Security Act (42 U.S.C. 1396a(a)(5))
to determine eligibility for medical assistance under the
State Medicaid plan; or
(B) prohibit any State options otherwise permitted under
Federal law (without regard to this paragraph or the
demonstration program established under this section) that
are intended to increase the enrollment of eligible children
for medical assistance under the State Medicaid plan or child
health assistance under the State CHIP plan, including
options related to outreach, enrollment, applications, or the
determination or redetermination of eligibility.
(c) Limited Waiver of Other Applicable Requirements.--
(1) Social security act.--The Secretary shall waive only
such requirements of the Social Security Act as the Secretary
determines are necessary to carry out the demonstration
program established under this section.
(2) Authorization for participating states to receive
certain data directly relevant to determining eligibility and
correct amount of assistance.--For provisions relating to the
authority of States participating in the demonstration
program to receive certain data directly, see section 204(c).
(d) Evaluation and Report.--
(1) Evaluation.--The Secretary shall conduct, by grant,
contract, or interagency agreement, a comprehensive,
independent evaluation of the demonstration program
established under this section. Such evaluation shall include
an analysis of the effectiveness of the program, and shall
include--
(A) obtaining a statistically valid sample of the children
who were enrolled in the State Medicaid plan or the State
CHIP plan through reliance on a finding made by an Express
Lane agency and determining the percentage of children who
were erroneously enrolled in such plans;
(B) determining whether enrolling children in such plans
through reliance on a finding made by an Express Lane agency
improves the ability of a State to identify and enroll low-
income, uninsured children who are eligible but not enrolled
in such plans;
(C) evaluating the administrative costs or savings related
to identifying and enrolling children in such plans through
reliance on such findings, and the extent to which such costs
differ from the costs that the State otherwise would have
incurred to identify and enroll low-income, uninsured
children who are eligible but not enrolled in such plans; and
(D) any recommendations for legislative or administrative
changes that would improve the effectiveness of enrolling
children in such plans through reliance on such findings.
(2) Report to congress.--Not later than September 30, 2012,
the Secretary shall submit a report to Congress on the
results of the evaluation of the demonstration program
established under this section.
(e) Definitions.--In this section:
(1) Child; children.--With respect to a State selected to
participate in the demonstration program established under
this section, the terms ``child'' and ``children'' have the
meanings given such terms for purposes of the State plans
under titles XIX and XXI of the Social Security Act.
(2) Express lane agency.--
(A) In general.--The term ``Express Lane agency'' means a
public agency that--
(i) is determined by the State Medicaid agency or the State
CHIP agency (as applicable) to be capable of making the
determinations of 1 or more eligibility requirements
described in subsection (a)(1);
(ii) is identified in the State Medicaid plan or the State
CHIP plan; and
(iii) notifies the child's family--
(I) of the information which shall be disclosed in
accordance with this section;
(II) that the information disclosed will be used solely for
purposes of determining eligibility for medical assistance
under the State Medicaid plan or for child health assistance
under the State CHIP plan; and
(III) that the family may elect to not have the information
disclosed for such purposes; and
(iv) enters into, or is subject to, an interagency
agreement to limit the disclosure and use of the information
disclosed.
(B) Inclusion of specific public agencies.--Such term
includes the following:
(i) A public agency that determines eligibility for
assistance under any of the following:
(I) The temporary assistance for needy families program
funded under part A of title IV of the Social Security Act
(42 U.S.C. 601 et seq.).
(II) A State program funded under part D of title IV of
such Act (42 U.S.C. 651 et seq.).
(III) The State Medicaid plan.
(IV) The State CHIP plan.
(V) The Food Stamp Act of 1977 (7 U.S.C. 2011 et seq.).
(VI) The Head Start Act (42 U.S.C. 9801 et seq.).
(VII) The Richard B. Russell National School Lunch Act (42
U.S.C. 1751 et seq.).
(VIII) The Child Nutrition Act of 1966 (42 U.S.C. 1771 et
seq.).
(IX) The Child Care and Development Block Grant Act of 1990
(42 U.S.C. 9858 et seq.).
(X) The Stewart B. McKinney Homeless Assistance Act (42
U.S.C. 11301 et seq.).
(XI) The United States Housing Act of 1937 (42 U.S.C. 1437
et seq.).
(XII) The Native American Housing Assistance and Self-
Determination Act of 1996 (25 U.S.C. 4101 et seq.).
(ii) A State-specified governmental agency that has fiscal
liability or legal responsibility for
[[Page H10827]]
the accuracy of the eligibility determination findings relied
on by the State.
(iii) A public agency that is subject to an interagency
agreement limiting the disclosure and use of the information
disclosed for purposes of determining eligibility under the
State Medicaid plan or the State CHIP plan.
(C) Exclusions.--Such term does not include an agency that
determines eligibility for a program established under the
Social Services Block Grant established under title XX of the
Social Security Act (42 U.S.C. 1397 et seq.) or a private,
for-profit organization.
(D) Rules of construction.--Nothing in this paragraph shall
be construed as--
(i) affecting the authority of a State Medicaid agency to
enter into contracts with nonprofit and for-profit agencies
to administer the Medicaid application process;
(ii) exempting a State Medicaid agency from complying with
the requirements of section 1902(a)(4) of the Social Security
Act (relating to merit-based personnel standards for
employees of the State Medicaid agency and safeguards against
conflicts of interest); or
(iii) authorizing a State Medicaid agency that participates
in the demonstration program established under this section
to use the Express Lane option to avoid complying with such
requirements for purposes of making eligibility
determinations under the State Medicaid plan.
(3) Medicaid applicable income level.--With respect to a
State, the term ``Medicaid applicable income level'' has the
meaning given that term for purposes of such State under
section 2110(b)(4) of the Social Security Act (42 U.S.C.
1397jj(4)).
(4) Poverty line.--The term ``poverty line'' has the
meaning given that term in section 2110(c)(5) of the Social
Security Act (42 U.S.C. 1397jj(c)(5)).
(5) State.--The term ``State'' means 1 of the 50 States or
the District of Columbia.
(6) State chip agency.--The term ``State CHIP agency''
means the State agency responsible for administering the
State CHIP plan.
(7) State chip plan.--The term ``State CHIP plan'' means
the State child health plan established under title XXI of
the Social Security Act (42 U.S.C. 1397aa et seq.), and
includes any waiver of such plan.
(8) State medicaid agency.--The term ``State Medicaid
agency'' means the State agency responsible for administering
the State Medicaid plan.
(9) State medicaid plan.--The term ``State Medicaid plan''
means the State plan established under title XIX of the
Social Security Act (42 U.S.C. 1396 et seq.), and includes
any waiver of such plan.
(f) Appropriation.--
(1) Operational funds.--Out of any funds in the Treasury
not otherwise appropriated, there is appropriated to the
Secretary to carry out the demonstration program established
under this section, $49,000,000 for the period of fiscal
years 2008 through 2012.
(2) Evaluation funds.--$5,000,000 of the funds appropriated
under paragraph (1) shall be used to conduct the evaluation
required under subsection (d).
(3) Budget authority.--Paragraph (1) constitutes budget
authority in advance of appropriations Act and represents the
obligation of the Federal Government to provide for the
payment to States selected to participate in the
demonstration program established under this section of the
amounts provided under such paragraph (after the application
of paragraph (2)).
SEC. 204. AUTHORIZATION OF CERTAIN INFORMATION DISCLOSURES TO
SIMPLIFY HEALTH COVERAGE DETERMINATIONS.
(a) Authorization of Information Disclosure.--Title XIX (42
U.S.C. 1396 et seq.) is amended--
(1) by redesignating section 1939 as section 1940; and
(2) by inserting after section 1938 the following new
section:
``AUTHORIZATION TO RECEIVE PERTINENT INFORMATION
``Sec. 1939. (a) In General.--Notwithstanding any other
provision of law, a Federal or State agency or private entity
in possession of the sources of data directly relevant to
eligibility determinations under this title (including
eligibility files, information described in paragraph (2) or
(3) of section 1137(a), vital records information about
births in any State, and information described in sections
453(i) and 1902(a)(25)(I)) is authorized to convey such data
or information to the State agency administering the State
plan under this title, but only if such conveyance meets the
requirements of subsection (b).
``(b) Requirements for Conveyance.--Data or information may
be conveyed pursuant to this section only if the following
requirements are met:
``(1) The child whose circumstances are described in the
data or information (or such child's parent, guardian,
caretaker relative, or authorized representative) has either
provided advance consent to disclosure or has not objected to
disclosure after receiving advance notice of disclosure and a
reasonable opportunity to object.
``(2) Such data or information are used solely for the
purposes of--
``(A) identifying children who are eligible or potentially
eligible for medical assistance under this title and
enrolling (or attempting to enroll) such children in the
State plan; and
``(B) verifying the eligibility of children for medical
assistance under the State plan.
``(3) An interagency or other agreement, consistent with
standards developed by the Secretary--
``(A) prevents the unauthorized use, disclosure, or
modification of such data and otherwise meets applicable
Federal requirements for safeguarding privacy and data
security; and
``(B) requires the State agency administering the State
plan to use the data and information obtained under this
section to seek to enroll children in the plan.
``(c) Criminal Penalty.--A person described in subsection
(a) who publishes, divulges, discloses, or makes known in any
manner, or to any extent, not authorized by Federal law, any
information obtained under this section shall be fined not
more than $1,000 or imprisoned not more than 1 year, or both,
for each such unauthorized activity.
``(d) Rule of Construction.--The limitations and
requirements that apply to disclosure pursuant to this
section shall not be construed to prohibit the conveyance or
disclosure of data or information otherwise permitted under
Federal law (without regard to this section).''.
(b) Conforming Amendment to Title XXI.--Section 2107(e)(1)
(42 U.S.C. 1397gg(e)(1)) is amended by adding at the end the
following new subparagraph:
``(E) Section 1939 (relating to authorization to receive
data directly relevant to eligibility determinations).''.
(c) Authorization for States Participating in the Express
Lane Demonstration Program To Receive Certain Data Directly
Relevant To Determining Eligibility and Correct Amount of
Assistance.--Only in the case of a State selected to
participate in the Express Lane demonstration program
established under section 203, the Secretary shall enter into
such agreements as are necessary to permit such a State to
receive data directly relevant to eligibility determinations
and determining the correct amount of benefits under the
State CHIP plan or the State Medicaid plan (as such terms are
defined in paragraphs (7) and (9) section 203(e)) from the
following:
(1) The National Directory of New Hires established under
section 453(i) of the Social Security Act (42 U.S.C. 653(i)).
(2) Data regarding enrollment in insurance that may help to
facilitate outreach and enrollment under the State Medicaid
plan, the State CHIP plan, and such other programs as the
Secretary may specify.
TITLE III--REDUCING BARRIERS TO ENROLLMENT
SEC. 301. VERIFICATION OF DECLARATION OF CITIZENSHIP OR
NATIONALITY FOR PURPOSES OF ELIGIBILITY FOR
MEDICAID AND CHIP.
(a) State Option To Verify Declaration of Citizenship or
Nationality for Purposes of Eligibility for Medicaid Through
Verification of Name and Social Security Number.--
(1) Alternative to documentation requirement.--
(A) In general.--Section 1902 (42 U.S.C. 1396a) is
amended--
(i) in subsection (a)(46)--
(I) by inserting ``(A)'' after ``(46)'';
(II) by adding ``and'' after the semicolon; and
(III) by adding at the end the following new subparagraph:
``(B) provide, with respect to an individual declaring to
be a citizen or national of the United States for purposes of
establishing eligibility under this title, that the State
shall satisfy the requirements of--
``(i) section 1903(x); or
``(ii) subsection (dd);''; and
(ii) by adding at the end the following new subsection:
``(dd)(1) For purposes of subsection (a)(46)(B)(ii), the
requirements of this subsection with respect to an individual
declaring to be a citizen or national of the United States
for purposes of establishing eligibility under this title,
are, in lieu of requiring the individual to present
satisfactory documentary evidence of citizenship or
nationality under section 1903(x) (if the individual is not
described in paragraph (2) of that section), as follows:
``(A) The State submits the name and social security number
of the individual to the Commissioner of Social Security as
part of the plan established under paragraph (2).
``(B) If the State receives notice from the Commissioner of
Social Security that the name or social security number of
the individual is invalid, the State--
``(i) notifies the individual of such fact;
(ii) provides the individual with a period of 90 days from
the date on which the notice required under clause (i) is
received by the individual to either present satisfactory
documentary evidence of citizenship or nationality (as
defined in section 1903(x)(3)) or cure the invalid
determination with the Commissioner of Social Security; and
``(iii) disenrolls the individual from the State plan under
this title within 30 days after the end of such 90-day period
if no such documentary evidence is presented.
``(2)(A) Each State electing to satisfy the requirements of
this subsection for purposes of section 1902(a)(46)(B) shall
establish a program under which the State submits each month
to the Commissioner of Social Security for verification the
name and social security number of each individual enrolled
in the State plan under this title that month who has
attained the age of 1 before the date of the enrollment.
``(B) In establishing the State program under this
paragraph, the State may enter into an agreement with the
Commissioner of Social Security to provide for the electronic
submission and verification of the name and social security
number of an individual before the individual is enrolled in
the State plan.
``(3)(A) The State agency implementing the plan approved
under this title shall, at such times and in such form as the
Secretary may specify, provide information on the percentage
each month that the invalid names and numbers submitted bears
to the total submitted for verification.
[[Page H10828]]
``(B) If, for any fiscal year, the average monthly
percentage determined under subparagraph (A) is greater than
7 percent--
``(i) the State shall develop and adopt a corrective plan
to review its procedures for verifying the identities of
individuals seeking to enroll in the State plan under this
title and to identify and implement changes in such
procedures to improve their accuracy; and
``(ii) pay to the Secretary an amount equal to the amount
which bears the same ratio to the total payments under the
State plan for the fiscal year for providing medical
assistance to individuals who provided invalid information as
the number of individuals with invalid information in excess
of 7 percent of such total submitted bears to the total
number of individuals with invalid information.
``(C) The Secretary may waive, in certain limited cases,
all or part of the payment under subparagraph (B)(ii) if the
State is unable to reach the allowable error rate despite a
good faith effort by such State.
``(D) This paragraph shall not apply to a State for a
fiscal year if there is an agreement described in paragraph
(2)(B) in effect as of the close of the fiscal year.
``(4) Nothing in this subsection shall affect the rights of
any individual under this title to appeal any disenrollment
from a State plan.''.
(B) Costs of implementing and maintaining system.--Section
1903(a)(3) (42 U.S.C. 1396b(a)(3)) is amended--
(i) by striking ``plus'' at the end of subparagraph (E) and
inserting ``and'', and
(ii) by adding at the end the following new subparagraph:
``(F)(i) 90 percent of the sums expended during the quarter
as are attributable to the design, development, or
installation of such mechanized verification and information
retrieval systems as the Secretary determines are necessary
to implement section 1902(dd) (including a system described
in paragraph (2)(B) thereof), and
``(ii) 75 percent of the sums expended during the quarter
as are attributable to the operation of systems to which
clause (i) applies, plus''.
(2) Limitation on waiver authority.--Notwithstanding any
provision of section 1115 of the Social Security Act (42
U.S.C. 1315), or any other provision of law, the Secretary
may not waive the requirements of section 1902(a)(46)(B) of
such Act (42 U.S.C. 1396a(a)(46)(B)) with respect to a State.
(3) Conforming amendments.--Section 1903 (42 U.S.C. 1396b)
is amended--
(A) in subsection (i)(22), by striking ``subsection (x)''
and inserting ``section 1902(a)(46)(B)''; and
(B) in subsection (x)(1), by striking ``subsection
(i)(22)'' and inserting ``section 1902(a)(46)(B)(i)''.
(b) Clarification of Requirements Relating to Presentation
of Satisfactory Documentary Evidence of Citizenship or
Nationality.--
(1) Acceptance of documentary evidence issued by a
federally recognized indian tribe.--Section 1903(x)(3)(B) (42
U.S.C. 1396b(x)(3)(B)) is amended--
(A) by redesignating clause (v) as clause (vi); and
(B) by inserting after clause (iv), the following new
clause:
``(v)(I) Except as provided in subclause (II), a document
issued by a federally recognized Indian tribe evidencing
membership or enrollment in, or affiliation with, such tribe
(such as a tribal enrollment card or certificate of degree of
Indian blood).
``(II) With respect to those federally recognized Indian
tribes located within States having an international border
whose membership includes individuals who are not citizens of
the United States, the Secretary shall, after consulting with
such tribes, issue regulations authorizing the presentation
of such other forms of documentation (including tribal
documentation, if appropriate) that the Secretary determines
to be satisfactory documentary evidence of citizenship or
nationality for purposes of satisfying the requirement of
this subsection.''.
(2) Requirement to provide reasonable opportunity to
present satisfactory documentary evidence.--Section 1903(x)
(42 U.S.C. 1396b(x)) is amended by adding at the end the
following new paragraph:
``(4) In the case of an individual declaring to be a
citizen or national of the United States with respect to whom
a State requires the presentation of satisfactory documentary
evidence of citizenship or nationality under section
1902(a)(46)(B)(i), the individual shall be provided at least
the reasonable opportunity to present satisfactory
documentary evidence of citizenship or nationality under this
subsection as is provided under clauses (i) and (ii) of
section 1137(d)(4)(A) to an individual for the submittal to
the State of evidence indicating a satisfactory immigration
status.''.
(3) Children born in the united states to mothers eligible
for medicaid.--
(A) Clarification of rules.--Section 1903(x) (42 U.S.C.
1396b(x)), as amended by paragraph (2), is amended--
(i) in paragraph (2)--
(I) in subparagraph (C), by striking ``or'' at the end;
(II) by redesignating subparagraph (D) as subparagraph (E);
and
(III) by inserting after subparagraph (C) the following new
subparagraph:
``(D) pursuant to the application of section 1902(e)(4)
(and, in the case of an individual who is eligible for
medical assistance on such basis, the individual shall be
deemed to have provided satisfactory documentary evidence of
citizenship or nationality and shall not be required to
provide further documentary evidence on any date that occurs
during or after the period in which the individual is
eligible for medical assistance on such basis); or''; and
(ii) by adding at the end the following new paragraph:
``(5) Nothing in subparagraph (A) or (B) of section
1902(a)(46), the preceding paragraphs of this subsection, or
the Deficit Reduction Act of 2005, including section 6036 of
such Act, shall be construed as changing the requirement of
section 1902(e)(4) that a child born in the United States to
an alien mother for whom medical assistance for the delivery
of such child is available as treatment of an emergency
medical condition pursuant to subsection (v) shall be deemed
eligible for medical assistance during the first year of such
child's life.''.
(B) State requirement to issue separate identification
number.--Section 1902(e)(4) (42 U.S.C. 1396a(e)(4)) is
amended by adding at the end the following new sentence:
``Notwithstanding the preceding sentence, in the case of a
child who is born in the United States to an alien mother for
whom medical assistance for the delivery of the child is made
available pursuant to section 1903(v), the State immediately
shall issue a separate identification number for the child
upon notification by the facility at which such delivery
occurred of the child's birth.''.
(4) Technical amendments.--Section 1903(x)(2) (42 U.S.C.
1396b(x)) is amended--
(A) in subparagraph (B)--
(i) by realigning the left margin of the matter preceding
clause (i) 2 ems to the left; and
(ii) by realigning the left margins of clauses (i) and
(ii), respectively, 2 ems to the left; and
(B) in subparagraph (C)--
(i) by realigning the left margin of the matter preceding
clause (i) 2 ems to the left; and
(ii) by realigning the left margins of clauses (i) and
(ii), respectively, 2 ems to the left.
(c) Application of Documentation System to CHIP.--
(1) In general.--Section 2105(c) (42 U.S.C. 1397ee(c)), as
amended by section 110(a), is amended by adding at the end
the following new paragraph:
``(9) Citizenship documentation requirements.--
``(A) In general.--No payment may be made under this
section with respect to an individual who has, or is,
declared to be a citizen or national of the United States for
purposes of establishing eligibility under this title unless
the State meets the requirements of section 1902(a)(46)(B)
with respect to the individual.
``(B) Enhanced payments.--Notwithstanding subsection (b),
the enhanced FMAP with respect to payments under subsection
(a) for expenditures described in clause (i) or (ii) of
section 1903(a)(3)(F) necessary to comply with subparagraph
(A) shall in no event be less than 90 percent and 75 percent,
respectively.''.
(2) Nonapplication of administrative expenditures cap.--
Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)(C)), as amended
by section 202(b), is amended by adding at the end the
following:
``(iii) Expenditures to comply with citizenship or
nationality verification requirements.--Expenditures
necessary for the State to comply with paragraph (9)(A).''.
(d) Effective Date.--
(1) In general.--
(A) In general.--Except as provided in subparagraph (B),
the amendments made by this section shall take effect on
October 1, 2008.
(B) Technical amendments.--The amendments made by--
(i) paragraphs (1), (2), and (3) of subsection (b) shall
take effect as if included in the enactment of section 6036
of the Deficit Reduction Act of 2005 (Public Law 109-171; 120
Stat. 80); and
(ii) paragraph (4) of subsection (b) shall take effect as
if included in the enactment of section 405 of division B of
the Tax Relief and Health Care Act of 2006 (Public Law 109-
432; 120 Stat. 2996).
(2) Restoration of eligibility.--In the case of an
individual who, during the period that began on July 1, 2006,
and ends on October 1, 2008, was determined to be ineligible
for medical assistance under a State Medicaid plan, including
any waiver of such plan, solely as a result of the
application of subsections (i)(22) and (x) of section 1903 of
the Social Security Act (as in effect during such period),
but who would have been determined eligible for such
assistance if such subsections, as amended by subsection (b),
had applied to the individual, a State may deem the
individual to be eligible for such assistance as of the date
that the individual was determined to be ineligible for such
medical assistance on such basis.
(3) Special transition rule for indians.--During the period
that begins on July 1, 2006, and ends on the effective date
of final regulations issued under subclause (II) of section
1903(x)(3)(B)(v) of the Social Security Act (42 U.S.C.
1396b(x)(3)(B)(v)) (as added by subsection (b)(1)(B)), an
individual who is a member of a federally-recognized Indian
tribe described in subclause (II) of that section who
presents a document described in subclause (I) of such
section that is issued by such Indian tribe, shall be deemed
to have presented satisfactory evidence of citizenship or
nationality for purposes of satisfying the requirement of
subsection (x) of section 1903 of such Act.
SEC. 302. REDUCING ADMINISTRATIVE BARRIERS TO ENROLLMENT.
Section 2102(b) (42 U.S.C. 1397bb(b)) is amended--
(1) by redesignating paragraph (4) as paragraph (5); and
(2) by inserting after paragraph (3) the following new
paragraph:
``(4) Reduction of administrative barriers to enrollment.--
``(A) In general.--Subject to subparagraph (B), the plan
shall include a description of the procedures used to reduce
administrative barriers to the enrollment of children and
pregnant women who are eligible for medical assistance under
title XIX or for child health assistance or
[[Page H10829]]
health benefits coverage under this title. Such procedures
shall be established and revised as often as the State
determines appropriate to take into account the most recent
information available to the State identifying such barriers.
``(B) Deemed compliance if joint application and renewal
process that permits application other than in person.--A
State shall be deemed to comply with subparagraph (A) if the
State's application and renewal forms and supplemental forms
(if any) and information verification process is the same for
purposes of establishing and renewing eligibility for
children and pregnant women for medical assistance under
title XIX and child health assistance under this title, and
such process does not require an application to be made in
person or a face-to-face interview.''.
TITLE IV--REDUCING BARRIERS TO PROVIDING PREMIUM ASSISTANCE
Subtitle A--Additional State Option for Providing Premium Assistance
SEC. 401. ADDITIONAL STATE OPTION FOR PROVIDING PREMIUM
ASSISTANCE.
(a) In General.--Section 2105(c) (42 U.S.C. 1397ee(c)), as
amended by section 301(c), is amended by adding at the end
the following:
``(10) State option to offer premium assistance.--
``(A) In general.--Subject to the succeeding provisions of
this paragraph, a State may elect to offer a premium
assistance subsidy (as defined in subparagraph (C)) for
qualified employer-sponsored coverage (as defined in
subparagraph (B)) to all targeted low-income children who are
eligible for child health assistance under the plan and have
access to such coverage in accordance with the requirements
of this paragraph.
``(B) Qualified employer-sponsored coverage.--
``(i) In general.--Subject to clauses (ii) and (iii), in
this paragraph, the term `qualified employer-sponsored
coverage' means a group health plan or health insurance
coverage offered through an employer--
``(I) that qualifies as creditable coverage as a group
health plan under section 2701(c)(1) of the Public Health
Service Act;
``(II) for which the employer contribution toward any
premium for such coverage is at least 40 percent; and
``(III) to all individuals in a manner that would be
considered a nondiscriminatory eligibility classification for
purposes of paragraph (3)(A)(ii) of section 105(h) of the
Internal Revenue Code of 1986 (but determined without regard
to clause (i) of subparagraph (B) of such paragraph).
``(ii) Exception.--Such term does not include coverage
consisting of--
``(I) benefits provided under a health flexible spending
arrangement (as defined in section 106(c)(2) of the Internal
Revenue Code of 1986); or
``(II) a high deductible health plan (as defined in section
223(c)(2) of such Code) purchased in conjunction with a
health savings account (as defined under section 223(d) of
such Code).
``(iii) Cost-effectiveness alternative to required employer
contribution.--A group health plan or health insurance
coverage offered through an employer that would be considered
qualified employer-sponsored coverage but for the application
of clause (i)(II) may be deemed to satisfy the requirement of
such clause if either of the following applies:
``(I) Application of child-based or family-based test.--The
State establishes to the satisfaction of the Secretary that
the cost of such coverage is less than the expenditures that
the State would have made to enroll the child or the family
(as applicable) in the State child health plan.
``(II) Aggregate program operational costs do not exceed
the cost of providing coverage under the state child health
plan.--If subclause (I) does not apply, the State establishes
to the satisfaction of the Secretary that the aggregate
amount of expenditures by the State for the purchase of all
such coverage for targeted low-income children under the
State child health plan (including administrative
expenditures) does not exceed the aggregate amount of
expenditures that the State would have made for providing
coverage under the State child health plan for all such
children.
``(C) Premium assistance subsidy.--
``(i) In general.--In this paragraph, the term `premium
assistance subsidy' means, with respect to a targeted low-
income child, the amount equal to the difference between the
employee contribution required for enrollment only of the
employee under qualified employer-sponsored coverage and the
employee contribution required for enrollment of the employee
and the child in such coverage, less any applicable premium
cost-sharing applied under the State child health plan
(subject to the limitations imposed under section 2103(e),
including the requirement to count the total amount of the
employee contribution required for enrollment of the employee
and the child in such coverage toward the annual aggregate
cost-sharing limit applied under paragraph (3)(B) of such
section).
``(ii) State payment option.--A State may provide a premium
assistance subsidy either as reimbursement to an employee for
out-of-pocket expenditures or, subject to clause (iii),
directly to the employee's employer.
``(iii) Employer opt-out.--An employer may notify a State
that it elects to opt-out of being directly paid a premium
assistance subsidy on behalf of an employee. In the event of
such a notification, an employer shall withhold the total
amount of the employee contribution required for enrollment
of the employee and the child in the qualified employer-
sponsored coverage and the State shall pay the premium
assistance subsidy directly to the employee.
``(iv) Treatment as child health assistance.--Expenditures
for the provision of premium assistance subsidies shall be
considered child health assistance described in paragraph
(1)(C) of subsection (a) for purposes of making payments
under that subsection.
``(D) Application of secondary payor rules.--The State
shall be a secondary payor for any items or services provided
under the qualified employer-sponsored coverage for which the
State provides child health assistance under the State child
health plan.
``(E) Requirement to provide supplemental coverage for
benefits and cost-sharing protection provided under the state
child health plan.--
``(i) In general.--Notwithstanding section 2110(b)(1)(C),
the State shall provide for each targeted low-income child
enrolled in qualified employer-sponsored coverage,
supplemental coverage consisting of--
``(I) items or services that are not covered, or are only
partially covered, under the qualified employer-sponsored
coverage; and
``(II) cost-sharing protection consistent with section
2103(e).
``(ii) Record keeping requirements.--For purposes of
carrying out clause (i), a State may elect to directly pay
out-of-pocket expenditures for cost-sharing imposed under the
qualified employer-sponsored coverage and collect or not
collect all or any portion of such expenditures from the
parent of the child.
``(F) Application of waiting period imposed under the
state.--Any waiting period imposed under the State child
health plan prior to the provision of child health assistance
to a targeted low-income child under the State plan shall
apply to the same extent to the provision of a premium
assistance subsidy for the child under this paragraph.
``(G) Opt-out permitted for any month.--A State shall
establish a process for permitting the parent of a targeted
low-income child receiving a premium assistance subsidy to
disenroll the child from the qualified employer-sponsored
coverage and enroll the child in, and receive child health
assistance under, the State child health plan, effective on
the first day of any month for which the child is eligible
for such assistance and in a manner that ensures continuity
of coverage for the child.
``(H) Application to parents.--If a State provides child
health assistance or health benefits coverage to parents of a
targeted low-income child in accordance with section 2111(b),
the State may elect to offer a premium assistance subsidy to
a parent of a targeted low-income child who is eligible for
such a subsidy under this paragraph in the same manner as the
State offers such a subsidy for the enrollment of the child
in qualified employer-sponsored coverage, except that--
``(i) the amount of the premium assistance subsidy shall be
increased to take into account the cost of the enrollment of
the parent in the qualified employer-sponsored coverage or,
at the option of the State if the State determines it cost-
effective, the cost of the enrollment of the child's family
in such coverage; and
``(ii) any reference in this paragraph to a child is deemed
to include a reference to the parent or, if applicable under
clause (i), the family of the child.
``(I) Additional state option for providing premium
assistance.--
``(i) In general.--A State may establish an employer-family
premium assistance purchasing pool for employers with less
than 250 employees who have at least 1 employee who is a
pregnant woman eligible for assistance under the State child
health plan (including through the application of an option
described in section 2112(f)) or a member of a family with at
least 1 targeted low-income child and to provide a premium
assistance subsidy under this paragraph for enrollment in
coverage made available through such pool.
``(ii) Access to choice of coverage.--A State that elects
the option under clause (i) shall identify and offer access
to not less than 2 private health plans that are health
benefits coverage that is equivalent to the benefits coverage
in a benchmark benefit package described in section 2103(b)
or benchmark-equivalent coverage that meets the requirements
of section 2103(a)(2) for employees described in clause (i).
``(J) No effect on premium assistance waiver programs.--
Nothing in this paragraph shall be construed as limiting the
authority of a State to offer premium assistance under
section 1906, a waiver described in paragraph (2)(B) or (3),
a waiver approved under section 1115, or other authority in
effect prior to the date of enactment of the Children's
Health Insurance Program Reauthorization Act of 2007.
``(K) Notice of availability.--If a State elects to provide
premium assistance subsidies in accordance with this
paragraph, the State shall--
``(i) include on any application or enrollment form for
child health assistance a notice of the availability of
premium assistance subsidies for the enrollment of targeted
low-income children in qualified employer-sponsored coverage;
``(ii) provide, as part of the application and enrollment
process under the State child health plan, information
describing the availability of such subsidies and how to
elect to obtain such a subsidy; and
``(iii) establish such other procedures as the State
determines necessary to ensure that parents are fully
informed of the choices for receiving child health assistance
under the State child health plan or through the receipt of
premium assistance subsidies.
``(L) Application to qualified employer-sponsored benchmark
coverage.--If a group health plan or health insurance
coverage offered through an employer is certified by an
actuary as health benefits coverage that is equivalent to the
benefits coverage in a benchmark
[[Page H10830]]
benefit package described in section 2103(b) or benchmark-
equivalent coverage that meets the requirements of section
2103(a)(2), the State may provide premium assistance
subsidies for enrollment of targeted low-income children in
such group health plan or health insurance coverage in the
same manner as such subsidies are provided under this
paragraph for enrollment in qualified employer-sponsored
coverage, but without regard to the requirement to provide
supplemental coverage for benefits and cost-sharing
protection provided under the State child health plan under
subparagraph (E).''.
(b) Application to Medicaid.--Section 1906 (42 U.S.C.
1396e) is amended by inserting after subsection (c) the
following:
``(d) A State may elect to offer a premium assistance
subsidy (as defined in section 2105(c)(10)(C)) for qualified
employer-sponsored coverage (as defined in section
2105(c)(10)(B)) to a child who is eligible for medical
assistance under the State plan under this title, to the
parent of such a child, and to a pregnant woman, in the same
manner as such a subsidy for such coverage may be offered
under a State child health plan under title XXI in accordance
with section 2105(c)(10) (except that subparagraph (E)(i)(II)
of such section shall be applied by substituting `1916 or, if
applicable, 1916A' for `2103(e)').''.
(c) GAO Study and Report.--Not later than January 1, 2009,
the Comptroller General of the United States shall study cost
and coverage issues relating to any State premium assistance
programs for which Federal matching payments are made under
title XIX or XXI of the Social Security Act, including under
waiver authority, and shall submit a report to the
appropriate committees of Congress on the results of such
study.
SEC. 402. OUTREACH, EDUCATION, AND ENROLLMENT ASSISTANCE.
(a) Requirement To Include Description of Outreach,
Education, and Enrollment Efforts Related to Premium
Assistance Subsidies in State Child Health Plan.--Section
2102(c) (42 U.S.C. 1397bb(c)) is amended by adding at the end
the following new paragraph:
``(3) Premium assistance subsidies.--Outreach, education,
and enrollment assistance for families of children likely to
be eligible for premium assistance subsidies under the State
child health plan in accordance with paragraphs (2)(B), (3),
or (10) of section 2105(c), or a waiver approved under
section 1115, to inform such families of the availability of,
and to assist them in enrolling their children in, such
subsidies, and for employers likely to provide coverage that
is eligible for such subsidies, including the specific,
significant resources the State intends to apply to educate
employers about the availability of premium assistance
subsidies under the State child health plan.''.
(b) Nonapplication of 10 Percent Limit on Outreach and
Certain Other Expenditures.--Section 2105(c)(2)(C) (42 U.S.C.
1397ee(c)(2)(C)), as amended by section 301(c)(2), is amended
by adding at the end the following new clause:
``(iv) Expenditures for outreach to increase the enrollment
of children under this title and title xix through premium
assistance subsidies.--Expenditures for outreach activities
to families of children likely to be eligible for premium
assistance subsidies in accordance with paragraphs (2)(B),
(3), or (10), or a waiver approved under section 1115, to
inform such families of the availability of, and to assist
them in enrolling their children in, such subsidies, and to
employers likely to provide qualified employer-sponsored
coverage (as defined in subparagraph (B) of such
paragraph).''.
Subtitle B--Coordinating Premium Assistance With Private Coverage
SEC. 411. SPECIAL ENROLLMENT PERIOD UNDER GROUP HEALTH PLANS
IN CASE OF TERMINATION OF MEDICAID OR CHIP
COVERAGE OR ELIGIBILITY FOR ASSISTANCE IN
PURCHASE OF EMPLOYMENT-BASED COVERAGE;
COORDINATION OF COVERAGE.
(a) Amendments to Internal Revenue Code of 1986.--Section
9801(f) of the Internal Revenue Code of 1986 (relating to
special enrollment periods) is amended by adding at the end
the following new paragraph:
``(3) Special rules relating to medicaid and chip.--
``(A) In general.--A group health plan shall permit an
employee who is eligible, but not enrolled, for coverage
under the terms of the plan (or a dependent of such an
employee if the dependent is eligible, but not enrolled, for
coverage under such terms) to enroll for coverage under the
terms of the plan if either of the following conditions is
met:
``(i) Termination of medicaid or chip coverage.--The
employee or dependent is covered under a Medicaid plan under
title XIX of the Social Security Act or under a State child
health plan under title XXI of such Act and coverage of the
employee or dependent under such a plan is terminated as a
result of loss of eligibility for such coverage and the
employee requests coverage under the group health plan not
later than 60 days after the date of termination of such
coverage.
``(ii) Eligibility for employment assistance under medicaid
or chip.--The employee or dependent becomes eligible for
assistance, with respect to coverage under the group health
plan under such Medicaid plan or State child health plan
(including under any waiver or demonstration project
conducted under or in relation to such a plan), if the
employee requests coverage under the group health plan not
later than 60 days after the date the employee or dependent
is determined to be eligible for such assistance.
``(B) Employee outreach and disclosure.--
``(i) Outreach to employees regarding availability of
medicaid and chip coverage.--
``(I) In general.--Each employer that maintains a group
health plan in a State that provides medical assistance under
a State Medicaid plan under title XIX of the Social Security
Act, or child health assistance under a State child health
plan under title XXI of such Act, in the form of premium
assistance for the purchase of coverage under a group health
plan, shall provide to each employee a written notice
informing the employee of potential opportunities then
currently available in the State in which the employee
resides for premium assistance under such plans for health
coverage of the employee or the employee's dependents. For
purposes of compliance with this clause, the employer may use
any State-specific model notice developed in accordance with
section 701(f)(3)(B)(i)(II) of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1181(f)(3)(B)(i)(II)).
``(II) Option to provide concurrent with provision of
summary plan description.--An employer may provide the model
notice applicable to the State in which an employee resides
concurrent with the furnishing of the summary plan
description as provided in section 104(b) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1024).
``(ii) Disclosure about group health plan benefits to
states for medicaid and chip eligible individuals.--In the
case of a participant or beneficiary of a group health plan
who is covered under a Medicaid plan of a State under title
XIX of the Social Security Act or under a State child health
plan under title XXI of such Act, the plan administrator of
the group health plan shall disclose to the State, upon
request, information about the benefits available under the
group health plan in sufficient specificity, as determined
under regulations of the Secretary of Health and Human
Services in consultation with the Secretary that require use
of the model coverage coordination disclosure form developed
under section 411(b)(1)(C) of the Children's Health Insurance
Program Reauthorization Act of 2007, so as to permit the
State to make a determination (under paragraph (2)(B), (3),
or (10) of section 2105(c) of the Social Security Act or
otherwise) concerning the cost-effectiveness of the State
providing medical or child health assistance through premium
assistance for the purchase of coverage under such group
health plan and in order for the State to provide
supplemental benefits required under paragraph (10)(E) of
such section or other authority.''.
(b) Conforming Amendments.--
(1) Amendments to employee retirement income security
act.--
(A) In general.--Section 701(f) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1181(f)) is amended by
adding at the end the following new paragraph:
``(3) Special rules for application in case of medicaid and
chip.--
``(A) In general.--A group health plan, and a health
insurance issuer offering group health insurance coverage in
connection with a group health plan, shall permit an employee
who is eligible, but not enrolled, for coverage under the
terms of the plan (or a dependent of such an employee if the
dependent is eligible, but not enrolled, for coverage under
such terms) to enroll for coverage under the terms of the
plan if either of the following conditions is met:
``(i) Termination of medicaid or chip coverage.--The
employee or dependent is covered under a Medicaid plan under
title XIX of the Social Security Act or under a State child
health plan under title XXI of such Act and coverage of the
employee or dependent under such a plan is terminated as a
result of loss of eligibility for such coverage and the
employee requests coverage under the group health plan (or
health insurance coverage) not later than 60 days after the
date of termination of such coverage.
``(ii) Eligibility for employment assistance under medicaid
or chip.--The employee or dependent becomes eligible for
assistance, with respect to coverage under the group health
plan or health insurance coverage, under such Medicaid plan
or State child health plan (including under any waiver or
demonstration project conducted under or in relation to such
a plan), if the employee requests coverage under the group
health plan or health insurance coverage not later than 60
days after the date the employee or dependent is determined
to be eligible for such assistance.
``(B) Coordination with medicaid and chip.--
``(i) Outreach to employees regarding availability of
medicaid and chip coverage.--
``(I) In general.--Each employer that maintains a group
health plan in a State that provides medical assistance under
a State Medicaid plan under title XIX of the Social Security
Act, or child health assistance under a State child health
plan under title XXI of such Act, in the form of premium
assistance for the purchase of coverage under a group health
plan, shall provide to each employee a written notice
informing the employee of potential opportunities then
currently available in the State in which the employee
resides for premium assistance under such plans for health
coverage of the employee or the employee's dependents.
``(II) Model notice.--Not later than 1 year after the date
of enactment of the Children's Health Insurance Program
Reauthorization Act of 2007, the Secretary and the Secretary
of Health and Human Services, in consultation with Directors
of State Medicaid agencies under title XIX of the Social
Security Act and Directors of State CHIP agencies under title
XXI of such Act, shall jointly develop national and
[[Page H10831]]
State-specific model notices for purposes of subparagraph
(A). The Secretary shall provide employers with such model
notices so as to enable employers to timely comply with the
requirements of subparagraph (A). Such model notices shall
include information regarding how an employee may contact the
State in which the employee resides for additional
information regarding potential opportunities for such
premium assistance, including how to apply for such
assistance.
``(III) Option to provide concurrent with provision of
summary plan description.--An employer may provide the model
notice applicable to the State in which an employee resides
concurrent with the furnishing of the summary plan
description as provided in section 104(b).
``(ii) Disclosure about group health plan benefits to
states for medicaid and chip eligible individuals.--In the
case of a participant or beneficiary of a group health plan
who is covered under a Medicaid plan of a State under title
XIX of the Social Security Act or under a State child health
plan under title XXI of such Act, the plan administrator of
the group health plan shall disclose to the State, upon
request, information about the benefits available under the
group health plan in sufficient specificity, as determined
under regulations of the Secretary of Health and Human
Services in consultation with the Secretary that require use
of the model coverage coordination disclosure form developed
under section 411(b)(1)(C) of the Children's Health Insurance
Program Reauthorization Act of 2007, so as to permit the
State to make a determination (under paragraph (2)(B), (3),
or (10) of section 2105(c) of the Social Security Act or
otherwise) concerning the cost-effectiveness of the State
providing medical or child health assistance through premium
assistance for the purchase of coverage under such group
health plan and in order for the State to provide
supplemental benefits required under paragraph (10)(E) of
such section or other authority.''.
(B) Conforming amendment.--Section 102(b) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1022(b)) is
amended--
(i) by striking ``and the remedies'' and inserting ``, the
remedies''; and
(ii) by inserting before the period the following: ``, and
if the employer so elects for purposes of complying with
section 701(f)(3)(B)(i), the model notice applicable to the
State in which the participants and beneficiaries reside''.
(C) Working group to develop model coverage coordination
disclosure form.--
(i) Medicaid, chip, and employer-sponsored coverage
coordination working group.--
(I) In general.--Not later than 60 days after the date of
enactment of this Act, the Secretary of Health and Human
Services and the Secretary of Labor shall jointly establish a
Medicaid, CHIP, and Employer-Sponsored Coverage Coordination
Working Group (in this subparagraph referred to as the
``Working Group''). The purpose of the Working Group shall be
to develop the model coverage coordination disclosure form
described in subclause (II) and to identify the impediments
to the effective coordination of coverage available to
families that include employees of employers that maintain
group health plans and members who are eligible for medical
assistance under title XIX of the Social Security Act or
child health assistance or other health benefits coverage
under title XXI of such Act.
(II) Model coverage coordination disclosure form
described.--The model form described in this subclause is a
form for plan administrators of group health plans to
complete for purposes of permitting a State to determine the
availability and cost-effectiveness of the coverage available
under such plans to employees who have family members who are
eligible for premium assistance offered under a State plan
under title XIX or XXI of such Act and to allow for
coordination of coverage for enrollees of such plans. Such
form shall provide the following information in addition to
such other information as the Working Group determines
appropriate:
(aa) A determination of whether the employee is eligible
for coverage under the group health plan.
(bb) The name and contract information of the plan
administrator of the group health plan.
(cc) The benefits offered under the plan.
(dd) The premiums and cost-sharing required under the plan.
(ee) Any other information relevant to coverage under the
plan.
(ii) Membership.--The Working Group shall consist of not
more than 30 members and shall be composed of representatives
of--
(I) the Department of Labor;
(II) the Department of Health and Human Services;
(III) State directors of the Medicaid program under title
XIX of the Social Security Act;
(IV) State directors of the State Children's Health
Insurance Program under title XXI of the Social Security Act;
(V) employers, including owners of small businesses and
their trade or industry representatives and certified human
resource and payroll professionals;
(VI) plan administrators and plan sponsors of group health
plans (as defined in section 607(1) of the Employee
Retirement Income Security Act of 1974);
(VII) health insurance issuers; and
(VIII) children and other beneficiaries of medical
assistance under title XIX of the Social Security Act or
child health assistance or other health benefits coverage
under title XXI of such Act.
(iii) Compensation.--The members of the Working Group shall
serve without compensation.
(iv) Administrative support.--The Department of Health and
Human Services and the Department of Labor shall jointly
provide appropriate administrative support to the Working
Group, including technical assistance. The Working Group may
use the services and facilities of either such Department,
with or without reimbursement, as jointly determined by such
Departments.
(v) Report.--
(I) Report by working group to the secretaries.--Not later
than 18 months after the date of the enactment of this Act,
the Working Group shall submit to the Secretary of Labor and
the Secretary of Health and Human Services the model form
described in clause (i)(II) along with a report containing
recommendations for appropriate measures to address the
impediments to the effective coordination of coverage between
group health plans and the State plans under titles XIX and
XXI of the Social Security Act.
(II) Report by secretaries to the congress.--Not later than
2 months after receipt of the report pursuant to subclause
(I), the Secretaries shall jointly submit a report to each
House of the Congress regarding the recommendations contained
in the report under such subclause.
(vi) Termination.--The Working Group shall terminate 30
days after the date of the issuance of its report under
clause (v).
(D) Effective dates.--The Secretary of Labor and the
Secretary of Health and Human Services shall develop the
initial model notices under section 701(f)(3)(B)(i)(II) of
the Employee Retirement Income Security Act of 1974, and the
Secretary of Labor shall provide such notices to employers,
not later than the date that is 1 year after the date of
enactment of this Act, and each employer shall provide the
initial annual notices to such employer's employees beginning
with the first plan year that begins after the date on which
such initial model notices are first issued. The model
coverage coordination disclosure form developed under
subparagraph (C) shall apply with respect to requests made by
States beginning with the first plan year that begins after
the date on which such model coverage coordination disclosure
form is first issued.
(E) Enforcement.--Section 502 of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1132) is amended--
(i) in subsection (a)(6), by striking ``or (8)'' and
inserting ``(8), or (9)''; and
(ii) in subsection (c), by redesignating paragraph (9) as
paragraph (10), and by inserting after paragraph (8) the
following:
``(9)(A) The Secretary may assess a civil penalty against
any employer of up to $100 a day from the date of the
employer's failure to meet the notice requirement of section
701(f)(3)(B)(i)(I). For purposes of this subparagraph, each
violation with respect to any single employee shall be
treated as a separate violation.
``(B) The Secretary may assess a civil penalty against any
plan administrator of up to $100 a day from the date of the
plan administrator's failure to timely provide to any State
the information required to be disclosed under section
701(f)(3)(B)(ii). For purposes of this subparagraph, each
violation with respect to any single participant or
beneficiary shall be treated as a separate violation.''.
(2) Amendments to public health service act.--Section
2701(f) of the Public Health Service Act (42 U.S.C. 300gg(f))
is amended by adding at the end the following new paragraph:
``(3) Special rules for application in case of medicaid and
chip.--
``(A) In general.--A group health plan, and a health
insurance issuer offering group health insurance coverage in
connection with a group health plan, shall permit an employee
who is eligible, but not enrolled, for coverage under the
terms of the plan (or a dependent of such an employee if the
dependent is eligible, but not enrolled, for coverage under
such terms) to enroll for coverage under the terms of the
plan if either of the following conditions is met:
``(i) Termination of medicaid or chip coverage.--The
employee or dependent is covered under a Medicaid plan under
title XIX of the Social Security Act or under a State child
health plan under title XXI of such Act and coverage of the
employee or dependent under such a plan is terminated as a
result of loss of eligibility for such coverage and the
employee requests coverage under the group health plan (or
health insurance coverage) not later than 60 days after the
date of termination of such coverage.
``(ii) Eligibility for employment assistance under medicaid
or chip.--The employee or dependent becomes eligible for
assistance, with respect to coverage under the group health
plan or health insurance coverage, under such Medicaid plan
or State child health plan (including under any waiver or
demonstration project conducted under or in relation to such
a plan), if the employee requests coverage under the group
health plan or health insurance coverage not later than 60
days after the date the employee or dependent is determined
to be eligible for such assistance.
``(B) Coordination with medicaid and chip.--
``(i) Outreach to employees regarding availability of
medicaid and chip coverage.--
``(I) In general.--Each employer that maintains a group
health plan in a State that provides medical assistance under
a State Medicaid plan under title XIX of the Social Security
Act, or child health assistance under a State child health
plan under title XXI of such Act, in the form of premium
assistance for the purchase of coverage under a group health
plan, shall provide to each employee a written notice
informing the employee of potential opportunities then
currently available in the State in which the employee
resides for premium assistance under such plans for health
coverage of the employee or the employee's dependents. For
purposes of compliance with this subclause, the employer
[[Page H10832]]
may use any State-specific model notice developed in
accordance with section 701(f)(3)(B)(i)(II) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C.
1181(f)(3)(B)(i)(II)).
``(II) Option to provide concurrent with provision of
summary plan description.--An employer may provide the model
notice applicable to the State in which an employee resides
concurrent with the furnishing of the summary plan
description as provided in section 104(b) of the Employee
Retirement Income Security Act of 1974.
``(ii) Disclosure about group health plan benefits to
states for medicaid and chip eligible individuals.--In the
case of an enrollee in a group health plan who is covered
under a Medicaid plan of a State under title XIX of the
Social Security Act or under a State child health plan under
title XXI of such Act, the plan administrator of the group
health plan shall disclose to the State, upon request,
information about the benefits available under the group
health plan in sufficient specificity, as determined under
regulations of the Secretary of Health and Human Services in
consultation with the Secretary that require use of the model
coverage coordination disclosure form developed under section
411(b)(1)(C) of the Children's Health Insurance
Reauthorization Act of 2007, so as to permit the State to
make a determination (under paragraph (2)(B), (3), or (10) of
section 2105(c) of the Social Security Act or otherwise)
concerning the cost-effectiveness of the State providing
medical or child health assistance through premium assistance
for the purchase of coverage under such group health plan and
in order for the State to provide supplemental benefits
required under paragraph (10)(E) of such section or other
authority.''.
TITLE V--STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES OF CHILDREN
SEC. 501. CHILD HEALTH QUALITY IMPROVEMENT ACTIVITIES FOR
CHILDREN ENROLLED IN MEDICAID OR CHIP.
(a) Development of Child Health Quality Measures for
Children Enrolled in Medicaid or Chip.--Title XI (42 U.S.C.
1301 et seq.) is amended by inserting after section 1139 the
following new section:
``SEC. 1139A. CHILD HEALTH QUALITY MEASURES.
``(a) Development of an Initial Core Set of Health Care
Quality Measures for Children Enrolled in Medicaid or Chip.--
``(1) In general.--Not later than January 1, 2009, the
Secretary shall identify and publish for general comment an
initial, recommended core set of child health quality
measures for use by State programs administered under titles
XIX and XXI, health insurance issuers and managed care
entities that enter into contracts with such programs, and
providers of items and services under such programs.
``(2) Identification of initial core measures.--In
consultation with the individuals and entities described in
subsection (b)(3), the Secretary shall identify existing
quality of care measures for children that are in use under
public and privately sponsored health care coverage
arrangements, or that are part of reporting systems that
measure both the presence and duration of health insurance
coverage over time.
``(3) Recommendations and dissemination.--Based on such
existing and identified measures, the Secretary shall publish
an initial core set of child health quality measures that
includes (but is not limited to) the following:
``(A) The duration of children's health insurance coverage
over a 12-month time period.
``(B) The availability of a full range of--
``(i) preventive services, treatments, and services for
acute conditions, including services to promote healthy birth
and prevent and treat premature birth; and
``(ii) treatments to correct or ameliorate the effects of
chronic physical and mental conditions in infants, young
children, school-age children, and adolescents.
``(C) The availability of care in a range of ambulatory and
inpatient health care settings in which such care is
furnished.
``(D) The types of measures that, taken together, can be
used to estimate the overall national quality of health care
for children and to perform comparative analyses of pediatric
health care quality and racial, ethnic, and socioeconomic
disparities in child health and health care for children.
``(4) Encourage voluntary and standardized reporting.--Not
later than 2 years after the date of enactment of the
Children's Health Insurance Program Reauthorization Act of
2007, the Secretary, in consultation with States, shall
develop a standardized format for reporting information and
procedures and approaches that encourage States to use the
initial core measurement set to voluntarily report
information regarding the quality of pediatric health care
under titles XIX and XXI.
``(5) Adoption of best practices in implementing quality
programs.--The Secretary shall disseminate information to
States regarding best practices among States with respect to
measuring and reporting on the quality of health care for
children, and shall facilitate the adoption of such best
practices. In developing best practices approaches, the
Secretary shall give particular attention to State
measurement techniques that ensure the timeliness and
accuracy of provider reporting, encourage provider reporting
compliance, encourage successful quality improvement
strategies, and improve efficiency in data collection using
health information technology.
``(6) Reports to congress.--Not later than January 1, 2010,
and every 3 years thereafter, the Secretary shall report to
Congress on--
``(A) the status of the Secretary's efforts to improve--
``(i) quality related to the duration and stability of
health insurance coverage for children under titles XIX and
XXI;
``(ii) the quality of children's health care under such
titles, including preventive health services, health care for
acute conditions, chronic health care, and health services to
ameliorate the effects of physical and mental conditions and
to aid in growth and development of infants, young children,
school-age children, and adolescents with special health care
needs; and
``(iii) the quality of children's health care under such
titles across the domains of quality, including clinical
quality, health care safety, family experience with health
care, health care in the most integrated setting, and
elimination of racial, ethnic, and socioeconomic disparities
in health and health care;
``(B) the status of voluntary reporting by States under
titles XIX and XXI, utilizing the initial core quality
measurement set; and
``(C) any recommendations for legislative changes needed to
improve the quality of care provided to children under titles
XIX and XXI, including recommendations for quality reporting
by States.
``(7) Technical assistance.--The Secretary shall provide
technical assistance to States to assist them in adopting and
utilizing core child health quality measures in administering
the State plans under titles XIX and XXI.
``(8) Definition of core set.--In this section, the term
`core set' means a group of valid, reliable, and evidence-
based quality measures that, taken together--
``(A) provide information regarding the quality of health
coverage and health care for children;
``(B) address the needs of children throughout the
developmental age span; and
``(C) allow purchasers, families, and health care providers
to understand the quality of care in relation to the
preventive needs of children, treatments aimed at managing
and resolving acute conditions, and diagnostic and treatment
services whose purpose is to correct or ameliorate physical,
mental, or developmental conditions that could, if untreated
or poorly treated, become chronic.
``(b) Advancing and Improving Pediatric Quality Measures.--
``(1) Establishment of pediatric quality measures
program.--Not later than January 1, 2010, the Secretary shall
establish a pediatric quality measures program to--
``(A) improve and strengthen the initial core child health
care quality measures established by the Secretary under
subsection (a);
``(B) expand on existing pediatric quality measures used by
public and private health care purchasers and advance the
development of such new and emerging quality measures; and
``(C) increase the portfolio of evidence-based, consensus
pediatric quality measures available to public and private
purchasers of children's health care services, providers, and
consumers.
``(2) Evidence-based measures.--The measures developed
under the pediatric quality measures program shall, at a
minimum, be--
``(A) evidence-based and, where appropriate, risk adjusted;
``(B) designed to identify and eliminate racial and ethnic
disparities in child health and the provision of health care;
``(C) designed to ensure that the data required for such
measures is collected and reported in a standard format that
permits comparison of quality and data at a State, plan, and
provider level;
``(D) periodically updated; and
``(E) responsive to the child health needs, services, and
domains of health care quality described in clauses (i),
(ii), and (iii) of subsection (a)(6)(A).
``(3) Process for pediatric quality measures program.--In
identifying gaps in existing pediatric quality measures and
establishing priorities for development and advancement of
such measures, the Secretary shall consult with--
``(A) States;
``(B) pediatricians, children's hospitals, and other
primary and specialized pediatric health care professionals
(including members of the allied health professions) who
specialize in the care and treatment of children,
particularly children with special physical, mental, and
developmental health care needs;
``(C) dental professionals, including pediatric dental
professionals;
``(D) health care providers that furnish primary health
care to children and families who live in urban and rural
medically underserved communities or who are members of
distinct population sub-groups at heightened risk for poor
health outcomes;
``(E) national organizations representing consumers and
purchasers of children's health care;
``(F) national organizations and individuals with expertise
in pediatric health quality measurement; and
``(G) voluntary consensus standards setting organizations
and other organizations involved in the advancement of
evidence-based measures of health care.
``(4) Developing, validating, and testing a portfolio of
pediatric quality measures.--As part of the program to
advance pediatric quality measures, the Secretary shall--
``(A) award grants and contracts for the development,
testing, and validation of new, emerging, and innovative
evidence-based measures for children's health care services
across the domains of quality described in clauses (i), (ii),
and (iii) of subsection (a)(6)(A); and
``(B) award grants and contracts for--
``(i) the development of consensus on evidence-based
measures for children's health care services;
``(ii) the dissemination of such measures to public and
private purchasers of health care for children; and
[[Page H10833]]
``(iii) the updating of such measures as necessary.
``(5) Revising, strengthening, and improving initial core
measures.--Beginning no later than January 1, 2012, and
annually thereafter, the Secretary shall publish recommended
changes to the core measures described in subsection (a) that
shall reflect the testing, validation, and consensus process
for the development of pediatric quality measures described
in subsection paragraphs (1) through (4).
``(6) Definition of pediatric quality measure.--In this
subsection, the term `pediatric quality measure' means a
measurement of clinical care that is capable of being
examined through the collection and analysis of relevant
information, that is developed in order to assess 1 or more
aspects of pediatric health care quality in various
institutional and ambulatory health care settings, including
the structure of the clinical care system, the process of
care, the outcome of care, or patient experiences in care.
``(c) Annual State Reports Regarding State-Specific Quality
of Care Measures Applied Under Medicaid or Chip.--
``(1) Annual state reports.--Each State with a State plan
approved under title XIX or a State child health plan
approved under title XXI shall annually report to the
Secretary on the--
``(A) State-specific child health quality measures applied
by the States under such plans, including measures described
in subparagraphs (A) and (B) of subsection (a)(6); and
``(B) State-specific information on the quality of health
care furnished to children under such plans, including
information collected through external quality reviews of
managed care organizations under section 1932 of the Social
Security Act (42 U.S.C. 1396u-4) and benchmark plans under
sections 1937 and 2103 of such Act (42 U.S.C. 1396u-7,
1397cc).
``(2) Publication.--Not later than September 30, 2009, and
annually thereafter, the Secretary shall collect, analyze,
and make publicly available the information reported by
States under paragraph (1).
``(d) Demonstration Projects for Improving the Quality of
Children's Health Care and the Use of Health Information
Technology.--
``(1) In general.--During the period of fiscal years 2008
through 2012, the Secretary shall award not more than 10
grants to States and child health providers to conduct
demonstration projects to evaluate promising ideas for
improving the quality of children's health care provided
under title XIX or XXI, including projects to--
``(A) experiment with, and evaluate the use of, new
measures of the quality of children's health care under such
titles (including testing the validity and suitability for
reporting of such measures);
``(B) promote the use of health information technology in
care delivery for children under such titles;
``(C) evaluate provider-based models which improve the
delivery of children's health care services under such
titles, including care management for children with chronic
conditions and the use of evidence-based approaches to
improve the effectiveness, safety, and efficiency of health
care services for children; or
``(D) demonstrate the impact of the model electronic health
record format for children developed and disseminated under
subsection (f) on improving pediatric health, including the
effects of chronic childhood health conditions, and pediatric
health care quality as well as reducing health care costs.
``(2) Requirements.--In awarding grants under this
subsection, the Secretary shall ensure that--
``(A) only 1 demonstration project funded under a grant
awarded under this subsection shall be conducted in a State;
and
``(B) demonstration projects funded under grants awarded
under this subsection shall be conducted evenly between
States with large urban areas and States with large rural
areas.
``(3) Authority for multistate projects.--A demonstration
project conducted with a grant awarded under this subsection
may be conducted on a multistate basis, as needed.
``(4) Funding.--$20,000,000 of the amount appropriated
under subsection (i) for a fiscal year shall be used to carry
out this subsection.
``(e) Childhood Obesity Demonstration Project.--
``(1) Authority to conduct demonstration.--The Secretary,
in consultation with the Administrator of the Centers for
Medicare & Medicaid Services, shall conduct a demonstration
project to develop a comprehensive and systematic model for
reducing childhood obesity by awarding grants to eligible
entities to carry out such project. Such model shall--
``(A) identify, through self-assessment, behavioral risk
factors for obesity among children;
``(B) identify, through self-assessment, needed clinical
preventive and screening benefits among those children
identified as target individuals on the basis of such risk
factors;
``(C) provide ongoing support to such target individuals
and their families to reduce risk factors and promote the
appropriate use of preventive and screening benefits; and
``(D) be designed to improve health outcomes, satisfaction,
quality of life, and appropriate use of items and services
for which medical assistance is available under title XIX or
child health assistance is available under title XXI among
such target individuals.
``(2) Eligibility entities.--For purposes of this
subsection, an eligible entity is any of the following:
``(A) A city, county, or Indian tribe.
``(B) A local or tribal educational agency.
``(C) An accredited university, college, or community
college.
``(D) A Federally-qualified health center.
``(E) A local health department.
``(F) A health care provider.
``(G) A community-based organization.
``(H) Any other entity determined appropriate by the
Secretary, including a consortia or partnership of entities
described in any of subparagraphs (A) through (G).
``(3) Use of funds.--An eligible entity awarded a grant
under this subsection shall use the funds made available
under the grant to--
``(A) carry out community-based activities related to
reducing childhood obesity, including by--
``(i) forming partnerships with entities, including schools
and other facilities providing recreational services, to
establish programs for after school and weekend community
activities that are designed to reduce childhood obesity;
``(ii) forming partnerships with daycare facilities to
establish programs that promote healthy eating behaviors and
physical activity; and
``(iii) developing and evaluating community educational
activities targeting good nutrition and promoting healthy
eating behaviors;
``(B) carry out age-appropriate school-based activities
that are designed to reduce childhood obesity, including by--
``(i) developing and testing educational curricula and
intervention programs designed to promote healthy eating
behaviors and habits in youth, which may include--
``(I) after hours physical activity programs; and
``(II) science-based interventions with multiple components
to prevent eating disorders including nutritional content,
understanding and responding to hunger and satiety, positive
body image development, positive self-esteem development, and
learning life skills (such as stress management,
communication skills, problemsolving and decisionmaking
skills), as well as consideration of cultural and
developmental issues, and the role of family, school, and
community;
``(ii) providing education and training to educational
professionals regarding how to promote a healthy lifestyle
and a healthy school environment for children;
``(iii) planning and implementing a healthy lifestyle
curriculum or program with an emphasis on healthy eating
behaviors and physical activity; and
``(iv) planning and implementing healthy lifestyle classes
or programs for parents or guardians, with an emphasis on
healthy eating behaviors and physical activity for children;
``(C) carry out educational, counseling, promotional, and
training activities through the local health care delivery
systems including by--
``(i) promoting healthy eating behaviors and physical
activity services to treat or prevent eating disorders, being
overweight, and obesity;
``(ii) providing patient education and counseling to
increase physical activity and promote healthy eating
behaviors;
``(iii) training health professionals on how to identify
and treat obese and overweight individuals which may include
nutrition and physical activity counseling; and
``(iv) providing community education by a health
professional on good nutrition and physical activity to
develop a better understanding of the relationship between
diet, physical activity, and eating disorders, obesity, or
being overweight; and
``(D) provide, through qualified health professionals,
training and supervision for community health workers to--
``(i) educate families regarding the relationship between
nutrition, eating habits, physical activity, and obesity;
``(ii) educate families about effective strategies to
improve nutrition, establish healthy eating patterns, and
establish appropriate levels of physical activity; and
``(iii) educate and guide parents regarding the ability to
model and communicate positive health behaviors.
``(4) Priority.--In awarding grants under paragraph (1),
the Secretary shall give priority to awarding grants to
eligible entities--
``(A) that demonstrate that they have previously applied
successfully for funds to carry out activities that seek to
promote individual and community health and to prevent the
incidence of chronic disease and that can cite published and
peer-reviewed research demonstrating that the activities that
the entities propose to carry out with funds made available
under the grant are effective;
``(B) that will carry out programs or activities that seek
to accomplish a goal or goals set by the State in the Healthy
People 2010 plan of the State;
``(C) that provide non-Federal contributions, either in
cash or in-kind, to the costs of funding activities under the
grants;
``(D) that develop comprehensive plans that include a
strategy for extending program activities developed under
grants in the years following the fiscal years for which they
receive grants under this subsection;
``(E) located in communities that are medically
underserved, as determined by the Secretary;
``(F) located in areas in which the average poverty rate is
at least 150 percent or higher of the average poverty rate in
the State involved, as determined by the Secretary; and
``(G) that submit plans that exhibit multisectoral,
cooperative conduct that includes the involvement of a broad
range of stakeholders, including--
``(i) community-based organizations;
``(ii) local governments;
``(iii) local educational agencies;
``(iv) the private sector;
``(v) State or local departments of health;
``(vi) accredited colleges, universities, and community
colleges;
``(vii) health care providers;
``(viii) State and local departments of transportation and
city planning; and
``(ix) other entities determined appropriate by the
Secretary.
[[Page H10834]]
``(5) Program design.--
``(A) Initial design.--Not later than 1 year after the date
of enactment of the Children's Health Insurance Program
Reauthorization Act of 2007, the Secretary shall design the
demonstration project. The demonstration should draw upon
promising, innovative models and incentives to reduce
behavioral risk factors. The Administrator of the Centers for
Medicare & Medicaid Services shall consult with the Director
of the Centers for Disease Control and Prevention, the
Director of the Office of Minority Health, the heads of other
agencies in the Department of Health and Human Services, and
such professional organizations, as the Secretary determines
to be appropriate, on the design, conduct, and evaluation of
the demonstration.
``(B) Number and project areas.--Not later than 2 years
after the date of enactment of the Children's Health
Insurance Program Reauthorization Act of 2007, the Secretary
shall award 1 grant that is specifically designed to
determine whether programs similar to programs to be
conducted by other grantees under this subsection should be
implemented with respect to the general population of
children who are eligible for child health assistance under
State child health plans under title XXI in order to reduce
the incidence of childhood obesity among such population.
``(6) Report to congress.--Not later than 3 years after the
date the Secretary implements the demonstration project under
this subsection, the Secretary shall submit to Congress a
report that describes the project, evaluates the
effectiveness and cost effectiveness of the project,
evaluates the beneficiary satisfaction under the project, and
includes any such other information as the Secretary
determines to be appropriate.
``(7) Definitions.--In this subsection:
``(A) Federally-qualified health center.--The term
`Federally-qualified health center' has the meaning given
that term in section 1905(l)(2)(B).
``(B) Indian tribe.--The term `Indian tribe' has the
meaning given that term in section 4 of the Indian Health
Care Improvement Act (25 U.S.C. 1603).
``(C) Self-assessment.--The term `self-assessment' means a
form that--
``(i) includes questions regarding--
``(I) behavioral risk factors;
``(II) needed preventive and screening services; and
``(III) target individuals' preferences for receiving
follow-up information;
``(ii) is assessed using such computer generated assessment
programs; and
``(iii) allows for the provision of such ongoing support to
the individual as the Secretary determines appropriate.
``(D) Ongoing support.--The term `ongoing support' means--
``(i) to provide any target individual with information,
feedback, health coaching, and recommendations regarding--
``(I) the results of a self-assessment given to the
individual;
``(II) behavior modification based on the self-assessment;
and
``(III) any need for clinical preventive and screening
services or treatment including medical nutrition therapy;
``(ii) to provide any target individual with referrals to
community resources and programs available to assist the
target individual in reducing health risks; and
``(iii) to provide the information described in clause (i)
to a health care provider, if designated by the target
individual to receive such information.
``(8) Authorization of appropriations.--There is authorized
to be appropriated to carry out this subsection, $25,000,000
for the period of fiscal years 2008 through 2012.
``(f) Development of Model Electronic Health Record Format
for Children Enrolled in Medicaid or CHIP.--
``(1) In general.--Not later than January 1, 2009, the
Secretary shall establish a program to encourage the
development and dissemination of a model electronic health
record format for children enrolled in the State plan under
title XIX or the State child health plan under title XXI that
is--
``(A) subject to State laws, accessible to parents,
caregivers, and other consumers for the sole purpose of
demonstrating compliance with school or leisure activity
requirements, such as appropriate immunizations or physicals;
``(B) designed to allow interoperable exchanges that
conform with Federal and State privacy and security
requirements;
``(C) structured in a manner that permits parents and
caregivers to view and understand the extent to which the
care their children receive is clinically appropriate and of
high quality; and
``(D) capable of being incorporated into, and otherwise
compatible with, other standards developed for electronic
health records.
``(2) Funding.--$5,000,000 of the amount appropriated under
subsection (i) for a fiscal year shall be used to carry out
this subsection.
``(g) Study of Pediatric Health and Health Care Quality
Measures.--
``(1) In general.--Not later than July 1, 2009, the
Institute of Medicine shall study and report to Congress on
the extent and quality of efforts to measure child health
status and the quality of health care for children across the
age span and in relation to preventive care, treatments for
acute conditions, and treatments aimed at ameliorating or
correcting physical, mental, and developmental conditions in
children. In conducting such study and preparing such report,
the Institute of Medicine shall--
``(A) consider all of the major national population-based
reporting systems sponsored by the Federal Government that
are currently in place, including reporting requirements
under Federal grant programs and national population surveys
and estimates conducted directly by the Federal Government;
``(B) identify the information regarding child health and
health care quality that each system is designed to capture
and generate, the study and reporting periods covered by each
system, and the extent to which the information so generated
is made widely available through publication;
``(C) identify gaps in knowledge related to children's
health status, health disparities among subgroups of
children, the effects of social conditions on children's
health status and use and effectiveness of health care, and
the relationship between child health status and family
income, family stability and preservation, and children's
school readiness and educational achievement and attainment;
and
``(D) make recommendations regarding improving and
strengthening the timeliness, quality, and public
transparency and accessibility of information about child
health and health care quality.
``(2) Funding.--Up to $1,000,000 of the amount appropriated
under subsection (i) for a fiscal year shall be used to carry
out this subsection.
``(h) Rule of Construction.--Notwithstanding any other
provision in this section, no evidence based quality measure
developed, published, or used as a basis of measurement or
reporting under this section may be used to establish an
irrebuttable presumption regarding either the medical
necessity of care or the maximum permissible coverage for any
individual child who is eligible for and receiving medical
assistance under title XIX or child health assistance under
title XXI .
``(i) Appropriation.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated for each of
fiscal years 2008 through 2012, $45,000,000 for the purpose
of carrying out this section (other than subsection (e)).
Funds appropriated under this subsection shall remain
available until expended.''.
(b) Increased Matching Rate for Collecting and Reporting on
Child Health Measures.--Section 1903(a)(3)(A) (42 U.S.C.
1396b(a)(3)(A)), is amended--
(1) by striking ``and'' at the end of clause (i); and
(2) by adding at the end the following new clause:
``(iii) an amount equal to the Federal medical assistance
percentage (as defined in section 1905(b)) of so much of the
sums expended during such quarter (as found necessary by the
Secretary for the proper and efficient administration of the
State plan) as are attributable to such developments or
modifications of systems of the type described in clause (i)
as are necessary for the efficient collection and reporting
on child health measures; and''.
SEC. 502. IMPROVED INFORMATION REGARDING ACCESS TO COVERAGE
UNDER CHIP.
(a) Inclusion of Process and Access Measures in Annual
State Reports.--Section 2108 (42 U.S.C. 1397hh) is amended--
(1) in subsection (a), in the matter preceding paragraph
(1), by striking ``The State'' and inserting ``Subject to
subsection (e), the State''; and
(2) by adding at the end the following new subsection:
``(e) Information Required for Inclusion in State Annual
Report.--The State shall include the following information in
the annual report required under subsection (a):
``(1) Eligibility criteria, enrollment, and retention data
(including data with respect to continuity of coverage or
duration of benefits).
``(2) Data regarding the extent to which the State uses
process measures with respect to determining the eligibility
of children under the State child health plan, including
measures such as 12-month continuous eligibility, self-
declaration of income for applications or renewals, or
presumptive eligibility.
``(3) Data regarding denials of eligibility and
redeterminations of eligibility.
``(4) Data regarding access to primary and specialty
services, access to networks of care, and care coordination
provided under the State child health plan, using quality
care and consumer satisfaction measures included in the
Consumer Assessment of Healthcare Providers and Systems
(CAHPS) survey.
``(5) If the State provides child health assistance in the
form of premium assistance for the purchase of coverage under
a group health plan, data regarding the provision of such
assistance, including the extent to which employer-sponsored
health insurance coverage is available for children eligible
for child health assistance under the State child health
plan, the range of the monthly amount of such assistance
provided on behalf of a child or family, the number of
children or families provided such assistance on a monthly
basis, the income of the children or families provided such
assistance, the benefits and cost-sharing protection provided
under the State child health plan to supplement the coverage
purchased with such premium assistance, the effective
strategies the State engages in to reduce any administrative
barriers to the provision of such assistance, and, the
effects, if any, of the provision of such assistance on
preventing the coverage provided under the State child health
plan from substituting for coverage provided under employer-
sponsored health insurance offered in the State.
``(6) To the extent applicable, a description of any State
activities that are designed to reduce the number of
uncovered children in the State, including through a State
health insurance connector program or support for innovative
private health coverage initiatives.''.
(b) GAO Study and Report on Access to Primary and
Speciality Services.--
(1) In general.--The Comptroller General of the United
States shall conduct a study of children's access to primary
and specialty services under Medicaid and CHIP, including--
(A) the extent to which providers are willing to treat
children eligible for such programs;
[[Page H10835]]
(B) information on such children's access to networks of
care;
(C) geographic availability of primary and specialty
services under such programs;
(D) the extent to which care coordination is provided for
children's care under Medicaid and CHIP; and
(E) as appropriate, information on the degree of
availability of services for children under such programs.
(2) Report.--Not later than 2 years after the date of
enactment of this Act, the Comptroller General shall submit a
report to the appropriate committees of Congress on the study
conducted under paragraph (1) that includes recommendations
for such Federal and State legislative and administrative
changes as the Comptroller General determines are necessary
to address any barriers to access to children's care under
Medicaid and CHIP that may exist.
SEC. 503. APPLICATION OF CERTAIN MANAGED CARE QUALITY
SAFEGUARDS TO CHIP.
Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)), as amended by
section 204(b), is amended by redesignating subparagraph (E)
(as added by such section) as subparagraph (F) and by
inserting after subparagraph (D) the following new
subparagraph:
``(E) Subsections (a)(4), (a)(5), (b), (c), (d), and (e) of
section 1932 (relating to requirements for managed care).''.
TITLE VI--MISCELLANEOUS
SEC. 601. TECHNICAL CORRECTION REGARDING CURRENT STATE
AUTHORITY UNDER MEDICAID.
(a) In General.--Only with respect to expenditures for
medical assistance under a State Medicaid plan, including any
waiver of such plan, for fiscal years 2007 and 2008, a State
may elect, notwithstanding the fourth sentence of subsection
(b) of section 1905 of the Social Security Act (42 U.S.C.
1396d) or subsection (u) of such section--
(1) to cover individuals described in section
1902(a)(10)(A)(ii)(IX) of the Social Security Act and, at its
option, to apply less restrictive methodologies to such
individuals under section 1902(r)(2) of such Act or
1931(b)(2)(C) of such Act and thereby receive Federal
financial participation for medical assistance for such
individuals under title XIX of the Social Security Act; or
(2) to receive Federal financial participation for
expenditures for medical assistance under title XIX of such
Act for children described in paragraph (2)(B) or (3) of
section 1905(u) of such Act based on the Federal medical
assistance percentage, as otherwise determined based on the
first and third sentences of subsection (b) of section 1905
of the Social Security Act, rather than on the basis of an
enhanced FMAP (as defined in section 2105(b) of such Act).
(b) Repeal.--Effective October 1, 2008, subsection (a) is
repealed.
(c) Hold Harmless.--No State that elects the option
described in subsection (a) shall be treated as not having
been authorized to make such election and to receive Federal
financial participation for expenditures for medical
assistance described in that subsection for fiscal years 2007
and 2008 as a result of the repeal of the subsection under
subsection (b).
SEC. 602. PAYMENT ERROR RATE MEASUREMENT (``PERM'').
(a) Expenditures Related to Compliance With Requirements.--
(1) Enhanced payments.--Section 2105(c) (42 U.S.C.
1397ee(c)), as amended by section 401(a), is amended by
adding at the end the following new paragraph:
``(11) Enhanced payments.--Notwithstanding subsection (b),
the enhanced FMAP with respect to payments under subsection
(a) for expenditures related to the administration of the
payment error rate measurement (PERM) requirements applicable
to the State child health plan in accordance with the
Improper Payments Information Act of 2002 and parts 431 and
457 of title 42, Code of Federal Regulations (or any related
or successor guidance or regulations) shall in no event be
less than 90 percent.''.
(2) Exclusion of from cap on administrative expenditures.--
Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)C)), as amended
by section 402(b), is amended by adding at the end the
following:
``(v) Payment error rate measurement (perm) expenditures.--
Expenditures related to the administration of the payment
error rate measurement (PERM) requirements applicable to the
State child health plan in accordance with the Improper
Payments Information Act of 2002 and parts 431 and 457 of
title 42, Code of Federal Regulations (or any related or
successor guidance or regulations).''.
(b) Final Rule Required To Be in Effect for All States.--
Notwithstanding parts 431 and 457 of title 42, Code of
Federal Regulations (as in effect on the date of enactment of
this Act), the Secretary shall not calculate or publish any
national or State-specific error rate based on the
application of the payment error rate measurement (in this
section referred to as ``PERM'') requirements to CHIP until
after the date that is 6 months after the date on which a
final rule implementing such requirements in accordance with
the requirements of subsection (c) is in effect for all
States. Any calculation of a national error rate or a State
specific error rate after such final rule in effect for all
States may only be inclusive of errors, as defined in such
final rule or in guidance issued within a reasonable time
frame after the effective date for such final rule that
includes detailed guidance for the specific methodology for
error determinations.
(c) Requirements for Final Rule.--For purposes of
subsection (b), the requirements of this subsection are that
the final rule implementing the PERM requirements shall
include--
(1) clearly defined criteria for errors for both States and
providers;
(2) a clearly defined process for appealing error
determinations by review contractors; and
(3) clearly defined responsibilities and deadlines for
States in implementing any corrective action plans.
(d) Option for Application of Data for Certain States Under
the Interim Final Rule.--
(1) Option for states in first application cycle.--After
the final rule implementing the PERM requirements in
accordance with the requirements of subsection (c) is in
effect for all States, a State for which the PERM
requirements were first in effect under an interim final rule
for fiscal year 2007 may elect to accept any payment error
rate determined in whole or in part for the State on the
basis of data for that fiscal year or may elect to not have
any payment error rate determined on the basis of such data
and, instead, shall be treated as if fiscal year 2010 were
the first fiscal year for which the PERM requirements apply
to the State.
(2) Option for states in second application cycle.--If such
final rule is not in effect for all States by July 1, 2008, a
State for which the PERM requirements were first in effect
under an interim final rule for fiscal year 2008 may elect to
accept any payment error rate determined in whole or in part
for the State on the basis of data for that fiscal year or
may elect to not have any payment error rate determined on
the basis of such data and, instead, shall be treated as if
fiscal year 2011 were the first fiscal year for which the
PERM requirements apply to the State.
(e) Harmonization of MEQC and PERM.--
(1) Reduction of redundancies.--The Secretary shall review
the Medicaid Eligibility Quality Control (in this subsection
referred to as the ``MEQC'') requirements with the PERM
requirements and coordinate consistent implementation of both
sets of requirements, while reducing redundancies.
(2) State option to apply perm data.--A State may elect,
for purposes of determining the erroneous excess payments for
medical assistance ratio applicable to the State for a fiscal
year under section 1903(u) of the Social Security Act (42
U.S.C. 1396b(u)) to substitute data resulting from the
application of the PERM requirements to the State after the
final rule implementing such requirements is in effect for
all States for data obtained from the application of the MEQC
requirements to the State with respect to a fiscal year.
(f) Identification of Improved State-Specific Sample
Sizes.--The Secretary shall establish State-specific sample
sizes for application of the PERM requirements with respect
to State child health plans for fiscal years beginning with
fiscal year 2009, on the basis of such information as the
Secretary determines appropriate. In establishing such sample
sizes, the Secretary shall, to the greatest extent
practicable--
(1) minimize the administrative cost burden on States under
Medicaid and CHIP; and
(2) maintain State flexibility to manage such programs.
SEC. 603. ELIMINATION OF COUNTING MEDICAID CHILD PRESUMPTIVE
ELIGIBILITY COSTS AGAINST TITLE XXI ALLOTMENT.
Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)) is amended--
(1) in the matter preceding subparagraph (A), by striking
``(or, in the case of expenditures described in subparagraph
(B), the Federal medical assistance percentage (as defined in
the first sentence of section 1905(b)))''; and
(2) by striking subparagraph (B) and inserting the
following new subparagraph:
``(B) [reserved]''.
SEC. 604. IMPROVING DATA COLLECTION.
(a) Increased Appropriation.--Section 2109(b)(2) (42 U.S.C.
1397ii(b)(2)) is amended by striking ``$10,000,000 for fiscal
year 2000'' and inserting ``$20,000,000 for fiscal year
2008''.
(b) Use of Additional Funds.--Section 2109(b) (42 U.S.C.
1397ii(b)), as amended by subsection (a), is amended--
(1) by redesignating paragraph (2) as paragraph (4); and
(2) by inserting after paragraph (1), the following new
paragraphs:
``(2) Additional requirements.--In addition to making the
adjustments required to produce the data described in
paragraph (1), with respect to data collection occurring for
fiscal years beginning with fiscal year 2008, in appropriate
consultation with the Secretary of Health and Human Services,
the Secretary of Commerce shall do the following:
``(A) Make appropriate adjustments to the Current
Population Survey to develop more accurate State-specific
estimates of the number of children enrolled in health
coverage under title XIX or this title.
``(B) Make appropriate adjustments to the Current
Population Survey to improve the survey estimates used to
compile the State-specific and national number of low-income
children without health insurance for purposes of determining
allotments under subsections (c) and (i) of section 2104 and
making payments to States from the CHIP Incentive Bonuses
Pool established under subsection (j) of such section, the
CHIP Contingency Fund established under subsection (k) of
such section, and, to the extent applicable to a State, from
the block grant set aside under section 2111(b)(2)(B)(i) for
each of fiscal years 2010 through 2012.
``(C) Include health insurance survey information in the
American Community Survey related to children.
``(D) Assess whether American Community Survey estimates,
once such survey data are first available, produce more
reliable estimates than the Current Population Survey with
respect to the purposes described in subparagraph (B).
[[Page H10836]]
``(E) On the basis of the assessment required under
subparagraph (D), recommend to the Secretary of Health and
Human Services whether American Community Survey estimates
should be used in lieu of, or in some combination with,
Current Population Survey estimates for the purposes
described in subparagraph (B).
``(F) Continue making the adjustments described in the last
sentence of paragraph (1) with respect to expansion of the
sample size used in State sampling units, the number of
sampling units in a State, and using an appropriate
verification element.
``(3) Authority for the secretary of health and human
services to transition to the use of all, or some combination
of, acs estimates upon recommendation of the secretary of
commerce.--If, on the basis of the assessment required under
paragraph (2)(D), the Secretary of Commerce recommends to the
Secretary of Health and Human Services that American
Community Survey estimates should be used in lieu of, or in
some combination with, Current Population Survey estimates
for the purposes described in paragraph (2)(B), the Secretary
of Health and Human Services may provide for a period during
which the Secretary may transition from carrying out such
purposes through the use of Current Population Survey
estimates to the use of American Community Survey estimates
(in lieu of, or in combination with the Current Population
Survey estimates, as recommended), provided that any such
transition is implemented in a manner that is designed to
avoid adverse impacts upon States with approved State child
health plans under this title.''.
SEC. 605. DEFICIT REDUCTION ACT TECHNICAL CORRECTIONS.
(a) State Flexibility in Benefit Packages.--
(1) Clarification of requirement to provide epsdt services
for all children in benchmark benefit packages.--Section
1937(a)(1) (42 U.S.C. 1396u-7(a)(1)), as inserted by section
6044(a) of the Deficit Reduction Act of 2005 (Public Law 109-
171, 120 Stat. 88), is amended--
(A) in subparagraph (A)--
(i) in the matter before clause (i), by striking
``enrollment in coverage that provides'' and inserting
``coverage that'';
(ii) in clause (i), by inserting ``provides'' after
``(i)''; and
(iii) by striking clause (ii) and inserting the following:
``(ii) for any individual described in section
1905(a)(4)(B) who is eligible under the State plan in
accordance with paragraphs (10) and (17) of section 1902(a),
consists of the items and services described in section
1905(a)(4)(B) (relating to early and periodic screening,
diagnostic, and treatment services defined in section
1905(r)) and provided in accordance with the requirements of
section 1902(a)(43).'';
(B) in subparagraph (C)--
(i) in the heading, by striking ``wrap-around'' and
inserting ``additional''; and
(ii) by striking ``wrap-around or''; and
(C) by adding at the end the following new subparagraph:
``(E) Rule of construction.--Nothing in this paragraph
shall be construed as--
``(i) requiring a State to offer all or any of the items
and services required by subparagraph (A)(ii) through an
issuer of benchmark coverage described in subsection (b)(1)
or benchmark equivalent coverage described in subsection
(b)(2); or
``(ii) preventing a State from offering all or any of the
items and services required by subparagraph (A)(ii) through
an issuer of benchmark coverage described in subsection
(b)(1) or benchmark equivalent coverage described in
subsection (b)(2).''.
(2) Correction of reference to children in foster care
receiving child welfare services.--Section
1937(a)(2)(B)(viii) (42 U.S.C. 1396u-7(a)(2)(B)(viii), as
inserted by section 6044(a) of the Deficit Reduction Act of
2005, is amended by striking ``aid or assistance is made
available under part B of title IV to children in foster care
and individuals'' and inserting ``child welfare services are
made available under part B of title IV on the basis of being
a child in foster care or''.
(3) Transparency.--Section 1937 (42 U.S.C. 1396u-7), as
inserted by section 6044(a) of the Deficit Reduction Act of
2005, is amended by adding at the end the following:
``(c) Publication of Provisions Affected.--Not later than
30 days after the date the Secretary approves a State plan
amendment to provide benchmark benefits in accordance with
subsections (a) and (b), the Secretary shall publish in the
Federal Register and on the Internet website of the Centers
for Medicare & Medicaid Services, a list of the provisions of
this title that the Secretary has determined do not apply in
order to enable the State to carry out such plan amendment
and the reason for each such determination.''.
(4) Effective date.--The amendments made by this subsection
shall take effect as if included in the amendment made by
section 6044(a) of the Deficit Reduction Act of 2005.
SEC. 606. ELIMINATION OF CONFUSING PROGRAM REFERENCES.
Section 704 of the Medicare, Medicaid, and SCHIP Balanced
Budget Refinement Act of 1999, as enacted into law by
division B of Public Law 106-113 (113 Stat. 1501A-402) is
repealed.
SEC. 607. MENTAL HEALTH PARITY IN CHIP PLANS.
(a) Assurance of Parity.--Section 2103(c) (42 U.S.C.
1397cc(c)) is amended--
(1) by redesignating paragraph (5) as paragraph (6); and
(2) by inserting after paragraph (4), the following:
``(5) Mental health services parity.--
``(A) In general.--In the case of a State child health plan
that provides both medical and surgical benefits and mental
health or substance abuse benefits, such plan shall ensure
that the financial requirements and treatment limitations
applicable to such mental health or substance abuse benefits
are no more restrictive than the financial requirements and
treatment limitations applied to substantially all medical
and surgical benefits covered by the plan.
``(B) Deemed compliance.--To the extent that a State child
health plan includes coverage with respect to an individual
described in section 1905(a)(4)(B) and covered under the
State plan under section 1902(a)(10)(A) of the services
described in section 1905(a)(4)(B) (relating to early and
periodic screening, diagnostic, and treatment services
defined in section 1905(r)) and provided in accordance with
section 1902(a)(43), such plan shall be deemed to satisfy the
requirements of subparagraph (A).''.
(b) Conforming Amendments.--Section 2103 (42 U.S.C. 1397cc)
is amended--
(1) in subsection (a), in the matter preceding paragraph
(1), by striking ``subsection (c)(5)'' and inserting
``paragraphs (5) and (6) of subsection (c)''; and
(2) in subsection (c)(2), by striking subparagraph (B) and
redesignating subparagraphs (C) and (D) as subparagraphs (B)
and (C), respectively.
SEC. 608. DENTAL HEALTH GRANTS.
(a) In General.--Title XXI (42 U.S.C. 1397aa et seq.), as
amended by section 201, is amended by adding at the end the
following:
``SEC. 2114. DENTAL HEALTH GRANTS.
``(a) Authority To Award Grants.--
``(1) In general.--From the amount appropriated under
subsection (f), the Secretary shall award grants from amounts
to eligible States for the purpose of carrying out programs
and activities that are designed to improve the availability
of dental services and strengthen dental coverage for
targeted low-income children enrolled in State child health
plans.
``(2) Eligible state.--In this section, the term `eligible
State' means a State with an approved State child health plan
under this title that submits an application under subsection
(b) that is approved by Secretary.
``(b) Application.--An eligible State that desires to
receive a grant under this paragraph shall submit an
application to the Secretary in such form and manner, and
containing such information, as the Secretary may require.
Such application shall include--
``(1) a detailed description of--
``(A) the dental services (if any) covered under the State
child health plan; and
``(B) how the State intends to improve dental coverage and
services during fiscal years 2008 through 2012;
``(2) a detailed description of the programs and activities
proposed to be conducted with funds awarded under the grant;
``(3) quality and outcomes performance measures to evaluate
the effectiveness of such activities; and
``(4) an assurance that the State shall--
``(A) conduct an assessment of the effectiveness of such
activities against such performance measures; and
``(B) cooperate with the collection and reporting of data
and other information determined as a result of conducting
such assessments to the Secretary, in such form and manner as
the Secretary shall require.
``(c) Use of Funds.--The programs and activities described
in subsection (a)(1) may include the provision of enhanced
dental coverage under the State child health plan.
``(d) Maintenance of Effort for States Awarded Grants; No
State Match Required.--In the case of a State that is awarded
a grant under this section--
``(1) the State share of funds expended for dental services
under the State child health plan shall not be less than the
State share of such funds expended in the fiscal year
preceding the first fiscal year for which the grant is
awarded; and
``(2) no State matching funds shall be required for the
State to receive a grant under this section.
``(e) Annual Report.--The Secretary shall submit an annual
report to the appropriate committees of Congress regarding
the grants awarded under this section that includes--
``(1) State specific descriptions of the programs and
activities conducted with funds awarded under such grants;
and
``(2) information regarding the assessments required of
States under subsection (b)(4).
``(f) Appropriation.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated, $200,000,000
for the period of fiscal years 2008 through 2012, to remain
available until expended, for the purpose of awarding grants
to States under this section. Amounts appropriated and paid
under the authority of this section shall be in addition to
amounts appropriated under section 2104 and paid to States in
accordance with section 2105.''.
(b) Improved Accessibility of Dental Provider Information
More Accessible to Enrollees Under Medicaid and CHIP.--The
Secretary shall--
(1) work with States, pediatric dentists, and other dental
providers to include on the Insure Kids Now website (http://
www.insurekidsnow.gov/) and hotline (1-877-KIDS-NOW) a
current and accurate list of all dentists and other dental
providers within each State that provide dental services to
children enrolled in the State plan (or waiver) under
Medicaid or the State child health plan (or waiver) under
CHIP, and shall ensure that such list is updated at least
quarterly; and
(2) work with States to include a description of the dental
services provided under each State plan (or waiver) under
Medicaid and each State child health plan (or waiver) under
CHIP on such Insure Kids Now website.
[[Page H10837]]
(c) GAO Study and Report on Access to Oral Health Care,
Including Preventive and Restorative Services.--
(1) In general.--The Comptroller General of the United
States shall conduct a study of children's access to oral
health care, including preventive and restorative services,
under Medicaid and CHIP, including--
(A) the extent to which providers are willing to treat
children eligible for such programs;
(B) information on such children's access to networks of
care;
(C) geographic availability of oral health care, including
preventive and restorative services, under such programs; and
(D) as appropriate, information on the degree of
availability of oral health care, including preventive and
restorative services, for children under such programs.
(2) Report.--Not later than 2 years after the date of
enactment of this Act, the Comptroller General shall submit a
report to the appropriate committees of Congress on the study
conducted under paragraph (1) that includes recommendations
for such Federal and State legislative and administrative
changes as the Comptroller General determines are necessary
to address any barriers to access to oral health care,
including preventive and restorative services, under Medicaid
and CHIP that may exist.
(d) Inclusion of Status of Efforts To Improve Dental Care
in Reports on the Quality of Children's Health Care Under
Medicaid and CHIP.--Section 1139A(a)(6)(ii), as added by
section 501(a), is amended by inserting ``dental care,''
after ``preventive health services,''.
SEC. 609. APPLICATION OF PROSPECTIVE PAYMENT SYSTEM FOR
SERVICES PROVIDED BY FEDERALLY-QUALIFIED HEALTH
CENTERS AND RURAL HEALTH CLINICS.
(a) Application of Prospective Payment System.--
(1) In general.--Section 2107(e)(1) (42 U.S.C.
1397gg(e)(1)), as amended by sections 204(b) and 503, is
amended by inserting after subparagraph (A) the following new
subparagraph (and redesignating the succeeding subparagraphs
accordingly):
``(B) Section 1902(bb) (relating to payment for services
provided by Federally-qualified health centers and rural
health clinics).''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to services provided on or after October 1, 2008.
(b) Transition Grants.--
(1) Appropriation.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated to the
Secretary for fiscal year 2008, $5,000,000, to remain
available until expended, for the purpose of awarding grants
to States with State child health plans under CHIP that are
operated separately from the State Medicaid plan under title
XIX of the Social Security Act (including any waiver of such
plan), or in combination with the State Medicaid plan, for
expenditures related to transitioning to compliance with the
requirement of section 2107(e)(1)(B) of the Social Security
Act (as added by subsection (a)) to apply the prospective
payment system established under section 1902(bb) of the such
Act (42 U.S.C. 1396a(bb)) to services provided by Federally-
qualified health centers and rural health clinics.
(2) Monitoring and report.--The Secretary shall monitor the
impact of the application of such prospective payment system
on the States described in paragraph (1) and, not later than
October 1, 2010, shall report to Congress on any effect on
access to benefits, provider payment rates, or scope of
benefits offered by such States as a result of the
application of such payment system.
SEC. 610. SUPPORT FOR INJURED SERVICEMEMBERS.
(a) Short Title.--This section may be cited as the
``Support for Injured Servicemembers Act''.
(b) Servicemember Family Leave.--
(1) Definitions.--Section 101 of the Family and Medical
Leave Act of 1993 (29 U.S.C. 2611) is amended by adding at
the end the following:
``(14) Active duty.--The term `active duty' means duty
under a call or order to active duty under a provision of law
referred to in section 101(a)(13)(B) of title 10, United
States Code.
``(15) Covered servicemember.--The term `covered
servicemember' means a member of the Armed Forces, including
a member of the National Guard or a Reserve, who is
undergoing medical treatment, recuperation, or therapy, is
otherwise in medical hold or medical holdover status, or is
otherwise on the temporary disability retired list, for a
serious injury or illness.
``(16) Medical hold or medical holdover status.--The term
`medical hold or medical holdover status' means--
``(A) the status of a member of the Armed Forces, including
a member of the National Guard or a Reserve, assigned or
attached to a military hospital for medical care; and
``(B) the status of a member of a reserve component of the
Armed Forces who is separated, whether pre-deployment or
post-deployment, from the member's unit while in need of
health care based on a medical condition identified while the
member is on active duty in the Armed Forces.
``(17) Next of kin.--The term `next of kin', used with
respect to an individual, means the nearest blood relative of
that individual.
``(18) Serious injury or illness.--The term `serious injury
or illness', in the case of a member of the Armed Forces,
means an injury or illness incurred by the member in line of
duty on active duty in the Armed Forces that may render the
member medically unfit to perform the duties of the member's
office, grade, rank, or rating.''.
(2) Entitlement to leave.--Section 102(a) of such Act (29
U.S.C. 2612(a)) is amended by adding at the end the
following:
``(3) Servicemember family leave.--Subject to section 103,
an eligible employee who is the spouse, son, daughter,
parent, or next of kin of a covered servicemember shall be
entitled to a total of 26 workweeks of leave during a 12-
month period to care for the servicemember. The leave
described in this paragraph shall only be available during a
single 12-month period.
``(4) Combined leave total.--During the single 12-month
period described in paragraph (3), an eligible employee shall
be entitled to a combined total of 26 workweeks of leave
under paragraphs (1) and (3). Nothing in this paragraph shall
be construed to limit the availability of leave under
paragraph (1) during any other 12-month period.''.
(3) Requirements relating to leave.--
(A) Schedule.--Section 102(b) of such Act (29 U.S.C.
2612(b)) is amended--
(i) in paragraph (1), in the second sentence--
(I) by striking ``section 103(b)(5)'' and inserting
``subsection (b)(5) or (f) (as appropriate) of section 103'';
and
(II) by inserting ``or under subsection (a)(3)'' after
``subsection (a)(1)''; and
(ii) in paragraph (2), by inserting ``or under subsection
(a)(3)'' after ``subsection (a)(1)''.
(B) Substitution of paid leave.--Section 102(d) of such Act
(29 U.S.C. 2612(d)) is amended--
(i) in paragraph (1)--
(I) by inserting ``(or 26 workweeks in the case of leave
provided under subsection (a)(3))'' after ``12 workweeks''
the first place it appears; and
(II) by inserting ``(or 26 workweeks, as appropriate)''
after ``12 workweeks'' the second place it appears; and
(ii) in paragraph (2)(B), by adding at the end the
following: ``An eligible employee may elect, or an employer
may require the employee, to substitute any of the accrued
paid vacation leave, personal leave, family leave, or medical
or sick leave of the employee for leave provided under
subsection (a)(3) for any part of the 26-week period of such
leave under such subsection.''.
(C) Notice.--Section 102(e)(2) of such Act (29 U.S.C.
2612(e)(2)) is amended by inserting ``or under subsection
(a)(3)'' after ``subsection (a)(1)''.
(D) Spouses employed by same employer.--Section 102(f) of
such Act (29 U.S.C. 2612(f)) is amended--
(i) by redesignating paragraphs (1) and (2) as
subparagraphs (A) and (B), and aligning the margins of the
subparagraphs with the margins of section 102(e)(2)(A);
(ii) by striking ``In any'' and inserting the following:
``(1) In general.--In any''; and
(iii) by adding at the end the following:
``(2) Servicemember family leave.--
``(A) In general.--The aggregate number of workweeks of
leave to which both that husband and wife may be entitled
under subsection (a) may be limited to 26 workweeks during
the single 12-month period described in subsection (a)(3) if
the leave is--
``(i) leave under subsection (a)(3); or
``(ii) a combination of leave under subsection (a)(3) and
leave described in paragraph (1).
``(B) Both limitations applicable.--If the leave taken by
the husband and wife includes leave described in paragraph
(1), the limitation in paragraph (1) shall apply to the leave
described in paragraph (1).''.
(E) Certification.--Section 103 of such Act (29 U.S.C.
2613) is amended by adding at the end the following:
``(f) Certification for Servicemember Family Leave.--An
employer may require that a request for leave under section
102(a)(3) be supported by a certification issued at such time
and in such manner as the Secretary may by regulation
prescribe.''.
(F) Failure to return.--Section 104(c) of such Act (29
U.S.C. 2614(c)) is amended--
(i) in paragraph (2)(B)(i), by inserting ``or under section
102(a)(3)'' before the semicolon; and
(ii) in paragraph (3)(A)--
(I) in clause (i), by striking ``or'' at the end;
(II) in clause (ii), by striking the period and inserting
``; or''; and
(III) by adding at the end the following:
``(iii) a certification issued by the health care provider
of the servicemember being cared for by the employee, in the
case of an employee unable to return to work because of a
condition specified in section 102(a)(3).''.
(G) Enforcement.--Section 107 of such Act (29 U.S.C. 2617)
is amended, in subsection (a)(1)(A)(i)(II), by inserting
``(or 26 weeks, in a case involving leave under section
102(a)(3))'' after ``12 weeks''.
(H) Instructional employees.--Section 108 of such Act (29
U.S.C. 2618) is amended, in subsections (c)(1), (d)(2), and
(d)(3), by inserting ``or under section 102(a)(3)'' after
``section 102(a)(1)''.
(c) Servicemember Family Leave for Civil Service
Employees.--
(1) Definitions.--Section 6381 of title 5, United States
Code, is amended--
(A) in paragraph (5), by striking ``and'' at the end;
(B) in paragraph (6), by striking the period and inserting
``; and''; and
(C) by adding at the end the following:
``(7) the term `active duty' means duty under a call or
order to active duty under a provision of law referred to in
section 101(a)(13)(B) of title 10, United States Code;
``(8) the term `covered servicemember' means a member of
the Armed Forces, including a member of the National Guard or
a Reserve, who is undergoing medical treatment, recuperation,
or therapy, is otherwise in medical hold or medical holdover
status, or is otherwise on the temporary disability retired
list, for a serious injury or illness;
``(9) the term `medical hold or medical holdover status'
means--
[[Page H10838]]
``(A) the status of a member of the Armed Forces, including
a member of the National Guard or a Reserve, assigned or
attached to a military hospital for medical care; and
``(B) the status of a member of a reserve component of the
Armed Forces who is separated, whether pre-deployment or
post-deployment, from the member's unit while in need of
health care based on a medical condition identified while the
member is on active duty in the Armed Forces;
``(10) the term `next of kin', used with respect to an
individual, means the nearest blood relative of that
individual; and
``(11) the term `serious injury or illness', in the case of
a member of the Armed Forces, means an injury or illness
incurred by the member in line of duty on active duty in the
Armed Forces that may render the member medically unfit to
perform the duties of the member's office, grade, rank, or
rating.''.
(2) Entitlement to leave.--Section 6382(a) of such title is
amended by adding at the end the following:
``(3) Subject to section 6383, an employee who is the
spouse, son, daughter, parent, or next of kin of a covered
servicemember shall be entitled to a total of 26
administrative workweeks of leave during a 12-month period to
care for the servicemember. The leave described in this
paragraph shall only be available during a single 12-month
period.
``(4) During the single 12-month period described in
paragraph (3), an employee shall be entitled to a combined
total of 26 administrative workweeks of leave under
paragraphs (1) and (3). Nothing in this paragraph shall be
construed to limit the availability of leave under paragraph
(1) during any other 12-month period.''.
(3) Requirements relating to leave.--
(A) Schedule.--Section 6382(b) of such title is amended--
(i) in paragraph (1), in the second sentence--
(I) by striking ``section 6383(b)(5)'' and inserting
``subsection (b)(5) or (f) (as appropriate) of section
6383''; and
(II) by inserting ``or under subsection (a)(3)'' after
``subsection (a)(1)''; and
(ii) in paragraph (2), by inserting ``or under subsection
(a)(3)'' after ``subsection (a)(1)''.
(B) Substitution of paid leave.--Section 6382(d) of such
title is amended by adding at the end the following: ``An
employee may elect to substitute for leave under subsection
(a)(3) any of the employee's accrued or accumulated annual or
sick leave under subchapter I for any part of the 26-week
period of leave under such subsection.''.
(C) Notice.--Section 6382(e) of such title is amended by
inserting ``or under subsection (a)(3)'' after ``subsection
(a)(1)''.
(D) Certification.--Section 6383 of such title is amended
by adding at the end the following:
``(f) An employing agency may require that a request for
leave under section 6382(a)(3) be supported by a
certification issued at such time and in such manner as the
Office of Personnel Management may by regulation
prescribe.''.
SEC. 611. MILITARY FAMILY JOB PROTECTION.
(a) Short Title.--This section may be cited as the
``Military Family Job Protection Act''.
(b) Prohibition on Discrimination in Employment Against
Certain Family Members Caring for Recovering Members of the
Armed Forces.--A family member of a recovering servicemember
described in subsection (c) shall not be denied retention in
employment, promotion, or any benefit of employment by an
employer on the basis of the family member's absence from
employment as described in that subsection, for a period of
not more than 52 workweeks.
(c) Covered Family Members.--A family member described in
this subsection is a family member of a recovering
servicemember who is--
(1) on invitational orders while caring for the recovering
servicemember;
(2) a non-medical attendee caring for the recovering
servicemember; or
(3) receiving per diem payments from the Department of
Defense while caring for the recovering servicemember.
(d) Treatment of Actions.--An employer shall be considered
to have engaged in an action prohibited by subsection (b)
with respect to a person described in that subsection if the
absence from employment of the person as described in that
subsection is a motivating factor in the employer's action,
unless the employer can prove that the action would have been
taken in the absence of the absence of employment of the
person.
(e) Definitions.--In this section:
(1) Benefit of employment.--The term ``benefit of
employment'' has the meaning given such term in section 4303
of title 38, United States Code.
(2) Caring for.--The term ``caring for'', used with respect
to a recovering servicemember, means providing personal,
medical, or convalescent care to the recovering
servicemember, under circumstances that substantially
interfere with an employee's ability to work.
(3) Employer.--The term ``employer'' has the meaning given
such term in section 4303 of title 38, United States Code,
except that the term does not include any person who is not
considered to be an employer under title I of the Family and
Medical Leave Act of 1993 (29 U.S.C. 2611 et seq.) because
the person does not meet the requirements of section
101(4)(A)(i) of such Act (29 U.S.C. 2611(4)(A)(i)).
(4) Family member.--The term ``family member'', with
respect to a recovering servicemember, has the meaning given
that term in section 411h(b) of title 37, United States Code.
(5) Recovering servicemember.--The term ``recovering
servicemember'' means a member of the Armed Forces, including
a member of the National Guard or a Reserve, who is
undergoing medical treatment, recuperation, or therapy, or is
otherwise in medical hold or medical holdover status, for an
injury, illness, or disease incurred or aggravated while on
active duty in the Armed Forces.
SEC. 612. SENSE OF SENATE REGARDING ACCESS TO AFFORDABLE AND
MEANINGFUL HEALTH INSURANCE COVERAGE.
(a) Findings.--The Senate finds the following:
(1) There are approximately 45 million Americans currently
without health insurance.
(2) More than half of uninsured workers are employed by
businesses with less than 25 employees or are self-employed.
(3) Health insurance premiums continue to rise at more than
twice the rate of inflation for all consumer goods.
(4) Individuals in the small group and individual health
insurance markets usually pay more for similar coverage than
those in the large group market.
(5) The rapid growth in health insurance costs over the
last few years has forced many employers, particularly small
employers, to increase deductibles and co-pays or to drop
coverage completely.
(b) Sense of the Senate.--The Senate--
(1) recognizes the necessity to improve affordability and
access to health insurance for all Americans;
(2) acknowledges the value of building upon the existing
private health insurance market; and
(3) affirms its intent to enact legislation this year that,
with appropriate protection for consumers, improves access to
affordable and meaningful health insurance coverage for
employees of small businesses and individuals by--
(A) facilitating pooling mechanisms, including pooling
across State lines, and
(B) providing assistance to small businesses and
individuals, including financial assistance and tax
incentives, for the purchase of private insurance coverage.
SEC. 613. DEMONSTRATION PROJECTS RELATING TO DIABETES
PREVENTION.
There is authorized to be appropriated $15,000,000 during
the period of fiscal years 2008 through 2012 to fund
demonstration projects in up to 10 States over 3 years for
voluntary incentive programs to promote children's receipt of
relevant screenings and improvements in healthy eating and
physical activity with the aim of reducing the incidence of
type 2 diabetes. Such programs may involve reductions in
cost-sharing or premiums when children receive regular
screening and reach certain benchmarks in healthy eating and
physical activity. Under such programs, a State may also
provide financial bonuses for partnerships with entities,
such as schools, which increase their education and efforts
with respect to reducing the incidence of type 2 diabetes and
may also devise incentives for providers serving children
covered under this title and title XIX to perform relevant
screening and counseling regarding healthy eating and
physical activity. Upon completion of these demonstrations,
the Secretary shall provide a report to Congress on the
results of the State demonstration projects and the degree to
which they helped improve health outcomes related to type 2
diabetes in children in those States.''.
SEC. 614. OUTREACH REGARDING HEALTH INSURANCE OPTIONS
AVAILABLE TO CHILDREN.
(a) Definitions.--In this section--
(1) the terms ``Administration'' and ``Administrator''
means the Small Business Administration and the Administrator
thereof, respectively;
(2) the term ``certified development company'' means a
development company participating in the program under title
V of the Small Business Investment Act of 1958 (15 U.S.C. 695
et seq.);
(3) the term ``Medicaid program'' means the program
established under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.);
(4) the term ``Service Corps of Retired Executives'' means
the Service Corps of Retired Executives authorized by section
8(b)(1) of the Small Business Act (15 U.S.C. 637(b)(1));
(5) the term ``small business concern'' has the meaning
given that term in section 3 of the Small Business Act (15
U.S.C. 632);
(6) the term ``small business development center'' means a
small business development center described in section 21 of
the Small Business Act (15 U.S.C. 648);
(7) the term ``State'' has the meaning given that term for
purposes of title XXI of the Social Security Act (42 U.S.C.
1397aa et seq.);
(8) the term ``State Children's Health Insurance Program''
means the State Children's Health Insurance Program
established under title XXI of the Social Security Act (42
U.S.C. 1397aa et seq.);
(9) the term ``task force'' means the task force
established under subsection (b)(1); and
(10) the term ``women's business center'' means a women's
business center described in section 29 of the Small Business
Act (15 U.S.C. 656).
(b) Establishment of Task Force.--
(1) Establishment.--There is established a task force to
conduct a nationwide campaign of education and outreach for
small business concerns regarding the availability of
coverage for children through private insurance options, the
Medicaid program, and the State Children's Health Insurance
Program.
(2) Membership.--The task force shall consist of the
Administrator, the Secretary of Health and Human Services,
the Secretary of Labor, and the Secretary of the Treasury.
(3) Responsibilities.--The campaign conducted under this
subsection shall include--
(A) efforts to educate the owners of small business
concerns about the value of health coverage for children;
(B) information regarding options available to the owners
and employees of small business concerns to make insurance
more affordable, including Federal and State tax deductions
and
[[Page H10839]]
credits for health care-related expenses and health insurance
expenses and Federal tax exclusion for health insurance
options available under employer-sponsored cafeteria plans
under section 125 of the Internal Revenue Code of 1986;
(C) efforts to educate the owners of small business
concerns about assistance available through public programs;
and
(D) efforts to educate the owners and employees of small
business concerns regarding the availability of the hotline
operated as part of the Insure Kids Now program of the
Department of Health and Human Services.
(4) Implementation.--In carrying out this subsection, the
task force may--
(A) use any business partner of the Administration,
including--
(i) a small business development center;
(ii) a certified development company;
(iii) a women's business center; and
(iv) the Service Corps of Retired Executives;
(B) enter into--
(i) a memorandum of understanding with a chamber of
commerce; and
(ii) a partnership with any appropriate small business
concern or health advocacy group; and
(C) designate outreach programs at regional offices of the
Department of Health and Human Services to work with district
offices of the Administration.
(5) Website.--The Administrator shall ensure that links to
information on the eligibility and enrollment requirements
for the Medicaid program and State Children's Health
Insurance Program of each State are prominently displayed on
the website of the Administration.
(6) Report.--
(A) In general.--Not later than 2 years after the date of
enactment of this Act, and every 2 years thereafter, the
Administrator shall submit to the Committee on Small Business
and Entrepreneurship of the Senate and the Committee on Small
Business of the House of Representatives a report on the
status of the nationwide campaign conducted under paragraph
(1).
(B) Contents.--Each report submitted under subparagraph (A)
shall include a status update on all efforts made to educate
owners and employees of small business concerns on options
for providing health insurance for children through public
and private alternatives.
TITLE VII--REVENUE PROVISIONS
SEC. 701. INCREASE IN EXCISE TAX RATE ON TOBACCO PRODUCTS.
(a) Cigars.--Section 5701(a) of the Internal Revenue Code
of 1986 is amended--
(1) by striking ``$1.828 cents per thousand ($1.594 cents
per thousand on cigars removed during 2000 or 2001)'' in
paragraph (1) and inserting ``$50.00 per thousand'',
(2) by striking ``20.719 percent (18.063 percent on cigars
removed during 2000 or 2001)'' in paragraph (2) and inserting
``53.13 percent'', and
(3) by striking ``$48.75 per thousand ($42.50 per thousand
on cigars removed during 2000 or 2001)'' in paragraph (2) and
inserting ``$3.00 per cigar''.
(b) Cigarettes.--Section 5701(b) of such Code is amended--
(1) by striking ``$19.50 per thousand ($17 per thousand on
cigarettes removed during 2000 or 2001)'' in paragraph (1)
and inserting ``$50.00 per thousand'', and
(2) by striking ``$40.95 per thousand ($35.70 per thousand
on cigarettes removed during 2000 or 2001)'' in paragraph (2)
and inserting ``$104.9999 cents per thousand''.
(c) Cigarette Papers.--Section 5701(c) of such Code is
amended by striking ``1.22 cents (1.06 cents on cigarette
papers removed during 2000 or 2001)'' and inserting ``3.13
cents''.
(d) Cigarette Tubes.--Section 5701(d) of such Code is
amended by striking ``2.44 cents (2.13 cents on cigarette
tubes removed during 2000 or 2001)'' and inserting ``6.26
cents''.
(e) Smokeless Tobacco.--Section 5701(e) of such Code is
amended--
(1) by striking ``58.5 cents (51 cents on snuff removed
during 2000 or 2001)'' in paragraph (1) and inserting
``$1.50'', and
(2) by striking ``19.5 cents (17 cents on chewing tobacco
removed during 2000 or 2001)'' in paragraph (2) and inserting
``50 cents''.
(f) Pipe Tobacco.--Section 5701(f) of such Code is amended
by striking ``$1.0969 cents (95.67 cents on pipe tobacco
removed during 2000 or 2001)'' and inserting ``$2.8126
cents''.
(g) Roll-Your-Own Tobacco.--Section 5701(g) of such Code is
amended by striking ``$1.0969 cents (95.67 cents on roll-
your-own tobacco removed during 2000 or 2001)'' and inserting
``$8.8889 cents''.
(h) Floor Stocks Taxes.--
(1) Imposition of tax.--On tobacco products and cigarette
papers and tubes manufactured in or imported into the United
States which are removed before January 1, 2008, and held on
such date for sale by any person, there is hereby imposed a
tax in an amount equal to the excess of--
(A) the tax which would be imposed under section 5701 of
the Internal Revenue Code of 1986 on the article if the
article had been removed on such date, over
(B) the prior tax (if any) imposed under section 5701 of
such Code on such article.
(2) Credit against tax.--Each person shall be allowed as a
credit against the taxes imposed by paragraph (1) an amount
equal to $500. Such credit shall not exceed the amount of
taxes imposed by paragraph (1) on January 1, 2008, for which
such person is liable.
(3) Liability for tax and method of payment.--
(A) Liability for tax.--A person holding tobacco products,
cigarette papers, or cigarette tubes on January 1, 2008, to
which any tax imposed by paragraph (1) applies shall be
liable for such tax.
(B) Method of payment.--The tax imposed by paragraph (1)
shall be paid in such manner as the Secretary shall prescribe
by regulations.
(C) Time for payment.--The tax imposed by paragraph (1)
shall be paid on or before April 1, 2008.
(4) Articles in foreign trade zones.--Notwithstanding the
Act of June 18, 1934 (commonly known as the Foreign Trade
Zone Act, 48 Stat. 998, 19 U.S.C. 81a et seq.) or any other
provision of law, any article which is located in a foreign
trade zone on January 1, 2008, shall be subject to the tax
imposed by paragraph (1) if--
(A) internal revenue taxes have been determined, or customs
duties liquidated, with respect to such article before such
date pursuant to a request made under the 1st proviso of
section 3(a) of such Act, or
(B) such article is held on such date under the supervision
of an officer of the United States Customs and Border
Protection of the Department of Homeland Security pursuant to
the 2d proviso of such section 3(a).
(5) Definitions.--For purposes of this subsection--
(A) In general.--Any term used in this subsection which is
also used in section 5702 of the Internal Revenue Code of
1986 shall have the same meaning as such term has in such
section.
(B) Secretary.--The term ``Secretary'' means the Secretary
of the Treasury or the Secretary's delegate.
(6) Controlled groups.--Rules similar to the rules of
section 5061(e)(3) of such Code shall apply for purposes of
this subsection.
(7) Other laws applicable.--All provisions of law,
including penalties, applicable with respect to the taxes
imposed by section 5701 of such Code shall, insofar as
applicable and not inconsistent with the provisions of this
subsection, apply to the floor stocks taxes imposed by
paragraph (1), to the same extent as if such taxes were
imposed by such section 5701. The Secretary may treat any
person who bore the ultimate burden of the tax imposed by
paragraph (1) as the person to whom a credit or refund under
such provisions may be allowed or made.
(i) Effective Date.--The amendments made by this section
shall apply to articles removed (as defined in section
5702(j) of the Internal Revenue Code of 1986) after December
31, 2007.
SEC. 702. ADMINISTRATIVE IMPROVEMENTS.
(a) Permit, Report, and Record Requirements for
Manufacturers and Importers of Processed Tobacco.--
(1) Permits.--
(A) Application.--Section 5712 of the Internal Revenue Code
of 1986 is amended by inserting ``or processed tobacco''
after ``tobacco products''.
(B) Issuance.--Section 5713(a) of such Code is amended by
inserting ``or processed tobacco'' after ``tobacco
products''.
(2) Inventories and reports.--
(A) Inventories.--Section 5721 of such Code is amended by
inserting ``, processed tobacco,'' after ``tobacco
products''.
(B) Reports.--Section 5722 of such Code is amended by
inserting ``, processed tobacco,'' after ``tobacco
products''.
(3) Records.--Section 5741 of such Code is amended by
inserting ``, processed tobacco,'' after ``tobacco
products''.
(4) Manufacturer of processed tobacco.--Section 5702 of
such Code is amended by adding at the end the following new
subsection:
``(p) Manufacturer of Processed Tobacco.--
``(1) In general.--The term `manufacturer of processed
tobacco' means any person who processes any tobacco other
than tobacco products.
``(2) Processed tobacco.--The processing of tobacco shall
not include the farming or growing of tobacco or the handling
of tobacco solely for sale, shipment, or delivery to a
manufacturer of tobacco products or processed tobacco.''.
(5) Conforming amendment.--Section 5702(k) of such Code is
amended by inserting ``, or any processed tobacco,'' after
``nontaxpaid tobacco products or cigarette papers or tubes''.
(6) Effective date.--The amendments made by this subsection
shall take effect on January 1, 2008.
(b) Basis for Denial, Suspension, or Revocation of
Permits.--
(1) Denial.--Paragraph (3) of section 5712 of such Code is
amended to read as follows:
``(3) such person (including, in the case of a corporation,
any officer, director, or principal stockholder and, in the
case of a partnership, a partner)--
``(A) is, by reason of his business experience, financial
standing, or trade connections or by reason of previous or
current legal proceedings involving a felony violation of any
other provision of Federal criminal law relating to tobacco
products, cigarette paper, or cigarette tubes, not likely to
maintain operations in compliance with this chapter,
``(B) has been convicted of a felony violation of any
provision of Federal or State criminal law relating to
tobacco products, cigarette paper, or cigarette tubes, or
``(C) has failed to disclose any material information
required or made any material false statement in the
application therefor.''.
(2) Suspension or revocation.--Subsection (b) of section
5713 of such Code is amended to read as follows:
``(b) Suspension or Revocation.--
``(1) Show cause hearing.--If the Secretary has reason to
believe that any person holding a permit--
``(A) has not in good faith complied with this chapter, or
with any other provision of this title involving intent to
defraud,
``(B) has violated the conditions of such permit,
``(C) has failed to disclose any material information
required or made any material false statement in the
application for such permit,
``(D) has failed to maintain his premises in such manner as
to protect the revenue,
``(E) is, by reason of previous or current legal
proceedings involving a felony violation of any
[[Page H10840]]
other provision of Federal criminal law relating to tobacco
products, cigarette paper, or cigarette tubes, not likely to
maintain operations in compliance with this chapter, or
``(F) has been convicted of a felony violation of any
provision of Federal or State criminal law relating to
tobacco products, cigarette paper, or cigarette tubes,
the Secretary shall issue an order, stating the facts
charged, citing such person to show cause why his permit
should not be suspended or revoked.
``(2) Action following hearing.--If, after hearing, the
Secretary finds that such person has not shown cause why his
permit should not be suspended or revoked, such permit shall
be suspended for such period as the Secretary deems proper or
shall be revoked.''.
(c) Application of Internal Revenue Code Statute of
Limitations for Alcohol and Tobacco Excise Taxes.--Section
514(a) of the Tariff Act of 1930 (19 U.S.C. 1514(a)) is
amended by striking ``and section 520 (relating to refunds)''
and inserting ``section 520 (relating to refunds), and
section 6501 of the Internal Revenue Code of 1986 (but only
with respect to taxes imposed under chapters 51 and 52 of
such Code)''.
(d) Expansion of Definition of Roll-Your-Own Tobacco.--
(1) In general.--Section 5702(o) of the Internal Revenue
Code of 1986 is amended by inserting ``or cigars, or for use
as wrappers thereof'' before the period at the end.
(2) Effective date.--The amendment made by this subsection
shall apply to articles removed (as defined in section
5702(j) of the Internal Revenue Code of 1986) after December
31, 2007.
(e) Time of Tax for Unlawfully Manufactured Tobacco
Products.--Section 5703(b)(2) of such Code is amended by
adding at the end the following new subparagraph:
``(F) Special rule for unlawfully manufactured tobacco
products.--In the case of any tobacco products, cigarette
paper, or cigarette tubes produced in the United States at
any place other than the premises of a manufacturer of
tobacco products, cigarette paper, or cigarette tubes that
has filed the bond and obtained the permit required under
this chapter, tax shall be due and payable immediately upon
manufacture.''.
SEC. 703. TIME FOR PAYMENT OF CORPORATE ESTIMATED TAXES.
Subparagraph (B) of section 401(1) of the Tax Increase
Prevention and Reconciliation Act of 2005 is amended by
striking ``114.50 percent'' and inserting ``113.25 percent''.
TITLE VIII--EFFECTIVE DATE
SEC. 801. EFFECTIVE DATE.
(a) In General.--Unless otherwise provided in this Act,
subject to subsection (b), the amendments made by this Act
shall take effect on October 1, 2007, and shall apply to
child health assistance and medical assistance provided on or
after that date without regard to whether or not final
regulations to carry out such amendments have been
promulgated by such date.
(b) Exception for State Legislation.--In the case of a
State plan under title XIX or XXI of the Social Security Act,
which the Secretary determines requires State legislation in
order for the plan to meet the additional requirements
imposed by an amendment made by this Act, the State plan
shall not be regarded as failing to comply with the
requirements of such Act solely on the basis of its failure
to meet these additional requirements 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
preceding 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.
Motion Offered by Mr. Dingell
Mr. DINGELL. Mr. Speaker, pursuant to H. Res. 675, I have a motion at
the desk.
The SPEAKER pro tempore. The Clerk will designate the motion.
The text of the motion is as follows:
Mr. Dingell moves that the House concur in each of the Senate
amendments to H.R. 976 with the respective amendment printed in the
report of the Committee on Rules accompanying H. Res. 675.
The text of the House amendments to the Senate amendments is as
follows:
House amendments to Senate amendments:
In lieu of the matter proposed to be inserted to the text
of the Act, insert the following:
SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT;
REFERENCES; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as ``Children's
Health Insurance Program Reauthorization Act of 2007''.
(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 State Children's
Health Insurance Program established under title XXI of the
Social Security Act (42 U.S.C. 1397aa et seq.).
(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 of this Act
is as follows:
Sec. 1. Short title; amendments to Social Security Act; references;
table of contents.
Sec. 2. Purpose.
Sec. 3. General effective date; exception for State legislation;
contingent effective date; reliance on law.
TITLE I--FINANCING
Subtitle A--Funding
Sec. 101. Extension of CHIP.
Sec. 102. Allotments for States and territories for fiscal years 2008
through 2012.
Sec. 103. Child Enrollment Contingency Fund.
Sec. 104. CHIP performance bonus payment to offset additional
enrollment costs resulting from enrollment and retention
efforts.
Sec. 105. 2-year initial availability of CHIP allotments.
Sec. 106. Redistribution of unused allotments to address State funding
shortfalls.
Sec. 107. Option for qualifying States to receive the enhanced portion
of the CHIP matching rate for Medicaid coverage of
certain children.
Sec. 108. One-time appropriation.
Sec. 109. Improving funding for the territories under CHIP and
Medicaid.
Subtitle B--Focus on Low-Income Children and Pregnant Women
Sec. 111. State option to cover low-income pregnant women under CHIP
through a State plan amendment.
Sec. 112. Phase-Out of coverage for nonpregnant childless adults under
CHIP; conditions for coverage of parents.
Sec. 113. Elimination of counting Medicaid child presumptive
eligibility costs against Title XXI allotment.
Sec. 114. Limitation on matching rate for States that propose to cover
children with effective family income that exceeds 300
percent of the poverty line.
Sec. 115. State authority under Medicaid.
Sec. 116. Preventing substitution of CHIP coverage for private
coverage.
TITLE II--OUTREACH AND ENROLLMENT
Subtitle A--Outreach and Enrollment Activities
Sec. 201. Grants and enhanced administrative funding for outreach and
enrollment.
Sec. 202. Increased outreach and enrollment of Indians.
Sec. 203. State option to rely on findings from an Express Lane agency
to conduct simplified eligibility determinations.
Subtitle B--Reducing Barriers to Enrollment
Sec. 211. Verification of declaration of citizenship or nationality for
purposes of eligibility for Medicaid and CHIP.
Sec. 212. Reducing administrative barriers to enrollment.
Sec. 213. Model of Interstate coordinated enrollment and coverage
process.
TITLE III--REDUCING BARRIERS TO PROVIDING PREMIUM ASSISTANCE
Subtitle A--Additional State Option for Providing Premium Assistance
Sec. 301. Additional State option for providing premium assistance.
Sec. 302. Outreach, education, and enrollment assistance.
Subtitle B--Coordinating Premium Assistance With Private Coverage
Sec. 311. Special enrollment period under group health plans in case of
termination of Medicaid or CHIP coverage or eligibility
for assistance in purchase of employment-based coverage;
coordination of coverage.
TITLE IV--STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES
Sec. 401. Child health quality improvement activities for children
enrolled in Medicaid or CHIP.
Sec. 402. Improved availability of public information regarding
enrollment of children in CHIP and Medicaid.
Sec. 403. Application of certain managed care quality safeguards to
CHIP.
TITLE V--IMPROVING ACCESS TO BENEFITS
Sec. 501. Dental benefits.
Sec. 502. Mental health parity in CHIP plans.
Sec. 503. Application of prospective payment system for services
provided by Federally-Qualified Health Centers and rural
health clinics.
Sec. 504. Premium grace period.
Sec. 505. Demonstration projects relating to diabetes prevention.
[[Page H10841]]
Sec. 506. Clarification of coverage of services provided through
school-based health centers.
TITLE VI--PROGRAM INTEGRITY AND OTHER MISCELLANEOUS PROVISIONS
Subtitle A--Program Integrity and Data Collection
Sec. 601. Payment error rate measurement (``PERM'').
Sec. 602. Improving data collection.
Sec. 603. Updated Federal evaluation of CHIP.
Sec. 604. Access to records for IG and GAO audits and evaluations.
Sec. 605. No Federal funding for illegal aliens.
Subtitle B--Miscellaneous Health Provisions
Sec. 611. Deficit Reduction Act technical corrections.
Sec. 612. References to title XXI.
Sec. 613. Prohibiting initiation of new health opportunity account
demonstration programs.
Sec. 614. County medicaid health insuring organizations; GAO report on
Medicaid managed care payment rates.
Sec. 615. Adjustment in computation of Medicaid FMAP to disregard an
extraordinary employer pension contribution.
Sec. 616. Moratorium on certain payment restrictions.
Sec. 617. Medicaid DSH allotments for Tennessee and Hawaii.
Sec. 618. Clarification treatment of regional medical center.
Sec. 619. Extension of SSI web-based asset demonstration project to the
Medicaid program.
Subtitle C--Other Provisions
Sec. 621. Support for injured servicemembers.
Sec. 622. Military family job protection.
Sec. 623. Outreach regarding health insurance options available to
children.
Sec. 624. Sense of Senate regarding access to affordable and meaningful
health insurance coverage.
TITLE VII--REVENUE PROVISIONS
Sec. 701. Increase in excise tax rate on tobacco products.
Sec. 702. Administrative improvements.
Sec. 703. Time for payment of corporate estimated taxes.
SEC. 2. PURPOSE.
It is the purpose of this Act to provide dependable and
stable funding for children's health insurance under titles
XXI and XIX of the Social Security Act in order to enroll all
six million uninsured children who are eligible, but not
enrolled, for coverage today through such titles.
SEC. 3. GENERAL EFFECTIVE DATE; EXCEPTION FOR STATE
LEGISLATION; CONTINGENT EFFECTIVE DATE;
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, 2007, and shall apply to child health assistance and
medical assistance provided on or after that date without
regard to whether or not final regulations to carry out this
Act (or such amendments) have been promulgated by such date.
(b) Exception for State Legislation.--In the case of a
State plan under title XIX or State child health plan under
XXI of the Social Security Act, which the Secretary of Health
and Human Services determines requires State legislation in
order for respective plan to meet one or more additional
requirements imposed by amendments made by this Act, the
respective State 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) Contingent Effective Date for CHIP Funding for Fiscal
Year 2008.--Notwithstanding any other provision of law, if
funds are appropriated under any law (other than this Act) to
provide allotments to States under CHIP for all (or any
portion) of fiscal year 2008--
(1) any amounts that are so appropriated that are not so
allotted and obligated before the date of the enactment of
this Act are rescinded; and
(2) any amount provided for CHIP allotments to a State
under this Act (and the amendments made by this Act) for such
fiscal year shall be reduced by the amount of such
appropriations so allotted and obligated before such date.
(d) Reliance on Law.--With respect to amendments made by
this Act (other than title VII) that become effective as of a
date--
(1) such amendments are effective as of such date whether
or not regulations implementing such amendments have been
issued; and
(2) Federal financial participation for medical assistance
or child health assistance furnished under title XIX or XXI,
respectively, of the Social Security Act on or after such
date by a State in good faith reliance on such amendments
before the date of promulgation of final regulations, if any,
to carry out such amendments (or before the date of guidance,
if any, regarding the implementation of such amendments)
shall not be denied on the basis of the State's failure to
comply with such regulations or guidance.
TITLE I--FINANCING
Subtitle A--Funding
SEC. 101. EXTENSION OF CHIP.
Section 2104(a) (42 U.S.C. 1397dd(a)) is amended--
(1) in paragraph (9), by striking ``and'' at the end;
(2) in paragraph (10), by striking the period at the end
and inserting a semicolon; and
(3) by adding at the end the following new paragraphs:
``(11) for fiscal year 2008, $9,125,000,000;
``(12) for fiscal year 2009, $10,675,000,000;
``(13) for fiscal year 2010, $11,850,000,000;
``(14) for fiscal year 2011, $13,750,000,000; and
``(15) for fiscal year 2012, for purposes of making 2 semi-
annual allotments--
``(A) $1,750,000,000 for the period beginning on October 1,
2011, and ending on March 31, 2012, and
``(B) $1,750,000,000 for the period beginning on April 1,
2012, and ending on September 30, 2012.''.
SEC. 102. ALLOTMENTS FOR STATES AND TERRITORIES FOR FISCAL
YEARS 2008 THROUGH 2012.
Section 2104 (42 U.S.C. 1397dd) is amended--
(1) in subsection (b)(1), by striking ``subsection (d)''
and inserting ``subsections (d) and (i)'';
(2) in subsection (c)(1), by striking ``subsection (d)''
and inserting ``subsections (d) and (i)(4)''; and
(3) by adding at the end the following new subsection:
``(i) Allotments for Fiscal Years 2008 Through 2012.--
``(1) For fiscal year 2008.--
``(A) For the 50 states and the district of columbia.--
Subject to the succeeding provisions of this paragraph and
paragraph (4), the Secretary shall allot for fiscal year 2008
from the amount made available under subsection (a)(11), to
each of the 50 States and the District of Columbia 110
percent of the highest of the following amounts for such
State or District:
``(i) The total Federal payments to the State under this
title for fiscal year 2007, multiplied by the allotment
increase factor determined under paragraph (5) for fiscal
year 2008.
``(ii) The Federal share of the amount allotted to the
State for fiscal year 2007 under subsection (b), multiplied
by the allotment increase factor determined under paragraph
(5) for fiscal year 2008.
``(iii) Only in the case of--
``(I) a State that received a payment, redistribution, or
allotment under any of paragraphs (1), (2), or (4) of
subsection (h), the amount of the projected total Federal
payments to the State under this title for fiscal year 2007,
as determined on the basis of the November 2006 estimates
certified by the State to the Secretary;
``(II) a State whose projected total Federal payments to
the State under this title for fiscal year 2007, as
determined on the basis of the May 2006 estimates certified
by the State to the Secretary, were at least $95,000,000 but
not more than $96,000,000 higher than the projected total
Federal payments to the State under this title for fiscal
year 2007 on the basis of the November 2006 estimates, the
amount of the projected total Federal payments to the State
under this title for fiscal year 2007 on the basis of the May
2006 estimates; or
``(III) a State whose projected total Federal payments
under this title for fiscal year 2007, as determined on the
basis of the November 2006 estimates certified by the State
to the Secretary, exceeded all amounts available to the State
for expenditure for fiscal year 2007 (including any amounts
paid, allotted, or redistributed to the State in prior fiscal
years), the amount of the projected total Federal payments to
the State under this title for fiscal year 2007, as
determined on the basis of the November 2006 estimates
certified by the State to the Secretary,
multiplied by the allotment increase factor determined under
paragraph (5) for fiscal year 2008.
``(iv) The projected total Federal payments to the State
under this title for fiscal year 2008, as determined on the
basis of the August 2007 projections certified by the State
to the Secretary by not later than September 30, 2007.
``(B) For the commonwealths and territories.--Subject to
the succeeding provisions of this paragraph and paragraph
(4), the Secretary shall allot for fiscal year 2008 from the
amount made available under subsection (a)(11) to each of the
commonwealths and territories described in subsection (c)(3)
an amount equal to the highest amount of Federal payments to
the commonwealth or territory under this title for any fiscal
year occurring during the period of fiscal years 1998 through
2007, multiplied by the allotment increase factor determined
under paragraph (5) for fiscal year 2008, except that
subparagraph (B) thereof shall be applied by substituting
`the United States' for `the State'.
``(C) Deadline and data for determining fiscal year 2008
allotments.--In computing the amounts under subparagraphs (A)
and (B) that determine the allotments to States for fiscal
year 2008, the Secretary shall use
[[Page H10842]]
the most recent data available to the Secretary before the
start of that fiscal year. The Secretary may adjust such
amounts and allotments, as necessary, on the basis of the
expenditure data for the prior year reported by States on CMS
Form 64 or CMS Form 21 not later than November 30, 2007, but
in no case shall the Secretary adjust the allotments provided
under subparagraph (A) or (B) for fiscal year 2008 after
December 31, 2007.
``(D) Adjustment for qualifying states.--In the case of a
qualifying State described in paragraph (2) of section
2105(g), the Secretary shall permit the State to submit
revised projection described in subparagraph (A)(iv) in order
to take into account changes in such projections attributable
to the application of paragraph (4) of such section.
``(2) For fiscal years 2009 through 2011.--
``(A) In general.--Subject to paragraphs (4) and (6), from
the amount made available under paragraphs (12) through (14)
of subsection (a) for each of fiscal years 2009 through 2011,
respectively, the Secretary shall compute a State allotment
for each State (including the District of Columbia and each
commonwealth and territory) for each such fiscal year as
follows:
``(i) Growth factor update for fiscal year 2009.--For
fiscal year 2009, the allotment of the State is equal to the
sum of--
``(I) the amount of the State allotment under paragraph (1)
for fiscal year 2008; and
``(II) the amount of any payments made to the State under
subsection (j) for fiscal year 2008,
multiplied by the allotment increase factor under paragraph
(5) for fiscal year 2009.
``(ii) Rebasing in fiscal year 2010.--For fiscal year 2010,
the allotment of a State is equal to the Federal payments to
the State that are attributable to (and countable towards)
the total amount of allotments available under this section
to the State in fiscal year 2009 (including payments made to
the State under subsection (j) for fiscal year 2009 as well
as amounts redistributed to the State in fiscal year 2009)
multiplied by the allotment increase factor under paragraph
(5) for fiscal year 2010.
``(iii) Growth factor update for fiscal year 2011.--For
fiscal year 2011, the allotment of the State is equal to the
sum of--
``(I) the amount of the State allotment under clause (ii)
for fiscal year 2010; and
``(II) the amount of any payments made to the State under
subsection (j) for fiscal year 2010,
multiplied by the allotment increase factor under paragraph
(5) for fiscal year 2011.
``(3) For fiscal year 2012.--
``(A) First half.--Subject to paragraphs (4) and (6), from
the amount made available under subparagraph (A) of paragraph
(15) of subsection (a) for the semi-annual period described
in such paragraph, increased by the amount of the
appropriation for such period under section 108 of the
Children's Health Insurance Program Reauthorization Act of
2007, the Secretary shall compute a State allotment for each
State (including the District of Columbia and each
commonwealth and territory) for such semi-annual period in an
amount equal to the first half ratio (described in
subparagraph (D)) of the amount described in subparagraph
(C).
``(B) Second half.--Subject to paragraphs (4) and (6), from
the amount made available under subparagraph (B) of paragraph
(15) of subsection (a) for the semi-annual period described
in such paragraph, the Secretary shall compute a State
allotment for each State (including the District of Columbia
and each commonwealth and territory) for such semi-annual
period in an amount equal to the amount made available under
such subparagraph multiplied by the ratio of--
``(i) the amount of the allotment to such State under
subparagraph (A); to
``(ii) the total of the amount of all of the allotments
made available under such subparagraph.
``(C) Full year amount based on rebased amount.--The amount
described in this subparagraph for a State is equal to the
Federal payments to the State that are attributable to (and
countable towards) the total amount of allotments available
under this section to the State in fiscal year 2011
(including payments made to the State under subsection (j)
for fiscal year 2011 as well as amounts redistributed to the
State in fiscal year 2011) multiplied by the allotment
increase factor under paragraph (5) for fiscal year 2012.
``(D) First half ratio.--The first half ratio described in
this subparagraph is the ratio of--
``(i) the sum of--
``(I) the amount made available under subsection
(a)(15)(A); and
``(II) the amount of the appropriation for such period
under section 108 of the Children's Health Insurance Program
Reauthorization Act of 2007; to
``(ii) the sum of the--
``(I) amount described in clause (i); and
``(II) the amount made available under subsection
(a)(15)(B).
``(4) Proration rule.--If, after the application of this
subsection without regard to this paragraph, the sum of the
allotments determined under paragraph (1), (2), or (3) for a
fiscal year (or, in the case of fiscal year 2012, for a semi-
annual period in such fiscal year) exceeds the amount
available under subsection (a) for such fiscal year or
period, the Secretary shall reduce each allotment for any
State under such paragraph for such fiscal year or period on
a proportional basis.
``(5) Allotment increase factor.--The allotment increase
factor under this paragraph for a fiscal year is equal to the
product of the following:
``(A) Per capita health care growth factor.--1 plus the
percentage increase in the projected per capita amount of
National Health Expenditures from the calendar year in which
the previous fiscal year ends to the calendar year in which
the fiscal year involved ends, as most recently published by
the Secretary before the beginning of the fiscal year.
``(B) Child population growth factor.--1 plus the
percentage increase (if any) in the population of children in
the State from July 1 in the previous fiscal year to July 1
in the fiscal year involved, as determined by the Secretary
based on the most recent published estimates of the Bureau of
the Census before the beginning of the fiscal year involved,
plus 1 percentage point.
``(6) Increase in allotment to account for approved program
expansions.--In the case of one of the 50 States or the
District of Columbia that--
``(A) has submitted to the Secretary, and has approved by
the Secretary, a State plan amendment or waiver request
relating to an expansion of eligibility for children or
benefits under this title that becomes effective for a fiscal
year (beginning with fiscal year 2009 and ending with fiscal
year 2012); and
``(B) has submitted to the Secretary, before the August 31
preceding the beginning of the fiscal year, a request for an
expansion allotment adjustment under this paragraph for such
fiscal year that specifies--
``(i) the additional expenditures that are attributable to
the eligibility or benefit expansion provided under the
amendment or waiver described in subparagraph (A), as
certified by the State and submitted to the Secretary by not
later than August 31 preceding the beginning of the fiscal
year; and
``(ii) the extent to which such additional expenditures are
projected to exceed the allotment of the State or District
for the year,
subject to paragraph (4), the amount of the allotment of the
State or District under this subsection for such fiscal year
shall be increased by the excess amount described in
subparagraph (B)(i). A State or District may only obtain an
increase under this paragraph for an allotment for fiscal
year 2009 or fiscal year 2011.
``(7) Availability of amounts for semi-annual periods in
fiscal year 2012.--Each semi-annual allotment made under
paragraph (3) for a period in fiscal year 2012 shall remain
available for expenditure under this title for periods after
the end of such fiscal year in the same manner as if the
allotment had been made available for the entire fiscal
year.''.
SEC. 103. CHILD ENROLLMENT CONTINGENCY FUND.
Section 2104 (42 U.S.C. 1397dd), as amended by section 102,
is amended by adding at the end the following new subsection:
``(j) Child Enrollment Contingency Fund.--
``(1) Establishment.--There is hereby established in the
Treasury of the United States a fund which shall be known as
the `Child Enrollment Contingency Fund' (in this subsection
referred to as the `Fund'). Amounts in the Fund shall be
available without further appropriations for payments under
this subsection.
``(2) Deposits into fund.--
``(A) Initial and subsequent appropriations.--Subject to
subparagraphs (B) and (D), out of any money in the Treasury
of the United States not otherwise appropriated, there are
appropriated to the Fund--
``(i) for fiscal year 2008, an amount equal to 20 percent
of the amount made available under paragraph (11) of
subsection (a) for the fiscal year; and
``(ii) for each of fiscal years 2009 through 2011 (and for
each of the semi-annual allotment periods for fiscal year
2012) , such sums as are necessary for making payments to
eligible States for such fiscal year or period, but not in
excess of the aggregate cap described in subparagraph (B).
``(B) Aggregate cap.--The total amount available for
payment from the Fund for each of fiscal years 2009 through
2011 (and for each of the semi-annual allotment periods for
fiscal year 2012), taking into account deposits made under
subparagraph (C), shall not exceed 20 percent of the amount
made available under subsection (a) for the fiscal year or
period.
``(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 constitutes a part of
the Fund.
``(D) Availability of excess funds for performance
bonuses.--Any amounts in excess of the aggregate cap
described in subparagraph (B) for a fiscal year or period
shall be made available for purposes of carrying out section
2105(a)(3) for any succeeding fiscal year and the Secretary
of the Treasury shall reduce the amount in the Fund by the
amount so made available.
``(3) Child enrollment contingency fund payments.--
``(A) In general.--If a State's expenditures under this
title in fiscal year 2008, fiscal year 2009, fiscal year
2010, fiscal year 2011, or a semi-annual allotment period for
fiscal year 2012, exceed the total amount of allotments
available under this section to the State in
[[Page H10843]]
the fiscal year or period (determined without regard to any
redistribution it receives under subsection (f) that is
available for expenditure during such fiscal year or period,
but including any carryover from a previous fiscal year) and
if the average monthly unduplicated number of children
enrolled under the State plan under this title (including
children receiving health care coverage through funds under
this title pursuant to a waiver under section 1115) during
such fiscal year or period exceeds its target average number
of such enrollees (as determined under subparagraph (B)) for
that fiscal year or period, subject to subparagraph (D), the
Secretary shall pay to the State from the Fund an amount
equal to the product of--
``(i) the amount by which such average monthly caseload
exceeds such target number of enrollees; and
``(ii) the projected per capita expenditures under the
State child health plan (as determined under subparagraph (C)
for the fiscal year), multiplied by the enhanced FMAP (as
defined in section 2105(b)) for the State and fiscal year
involved (or in which the period occurs).
``(B) Target average number of child enrollees.--In this
paragraph, the target average number of child enrollees for a
State--
``(i) for fiscal year 2008 is equal to the monthly average
unduplicated number of children enrolled in the State child
health plan under this title (including such children
receiving health care coverage through funds under this title
pursuant to a waiver under section 1115) during fiscal year
2007 increased by the population growth for children in that
State for the year ending on June 30, 2006 (as estimated by
the Bureau of the Census) plus 1 percentage point; or
``(ii) for a subsequent fiscal year (or semi-annual period
occurring in a fiscal year) is equal to the target average
number of child enrollees for the State for the previous
fiscal year increased by the child population growth factor
described in subsection (i)(5)(B) for the State for the prior
fiscal year.
``(C) Projected per capita expenditures.--For purposes of
subparagraph (A)(ii), the projected per capita expenditures
under a State child health plan--
``(i) for fiscal year 2008 is equal to the average per
capita expenditures (including both State and Federal
financial participation) under such plan for the targeted
low-income children counted in the average monthly caseload
for purposes of this paragraph during fiscal year 2007,
increased by the annual percentage increase in the projected
per capita amount of National Health Expenditures (as
estimated by the Secretary) for 2008; or
``(ii) for a subsequent fiscal year (or semi-annual period
occurring in a fiscal year) is equal to the projected per
capita expenditures under such plan for the previous fiscal
year (as determined under clause (i) or this clause)
increased by the annual percentage increase in the projected
per capita amount of National Health Expenditures (as
estimated by the Secretary) for the year in which such
subsequent fiscal year ends.
``(D) Proration rule.--If the amounts available for payment
from the Fund for a fiscal year or period are less than the
total amount of payments determined under subparagraph (A)
for the fiscal year or period, the amount to be paid under
such subparagraph to each eligible State shall be reduced
proportionally.
``(E) Timely payment; reconciliation.--Payment under this
paragraph for a fiscal year or period shall be made before
the end of the fiscal year or period based upon the most
recent data for expenditures and enrollment and the
provisions of subsection (e) of section 2105 shall apply to
payments under this subsection in the same manner as they
apply to payments under such section.
``(F) Continued reporting.--For purposes of this paragraph
and subsection (f), the State shall submit to the Secretary
the State's projected Federal expenditures, even if the
amount of such expenditures exceeds the total amount of
allotments available to the State in such fiscal year or
period.
``(G) 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 enrollment of
children described in subparagraphs (A) and (B) in order to
accurately determine the commonwealth's or territory's
eligibility for, and amount of payment, under this
paragraph.''.
SEC. 104. CHIP PERFORMANCE BONUS PAYMENT TO OFFSET ADDITIONAL
ENROLLMENT COSTS RESULTING FROM ENROLLMENT AND
RETENTION EFFORTS.
Section 2105(a) (42 U.S.C. 1397ee(a)) is amended by adding
at the end the following new paragraphs:
``(3) Performance bonus payment to offset additional
medicaid and chip child enrollment costs resulting from
enrollment and retention efforts.--
``(A) In general.--In addition to the payments made under
paragraph (1), for each fiscal year (beginning with fiscal
year 2008 and ending with fiscal year 2012) the Secretary
shall pay from amounts made available under subparagraph (E),
to each State that meets the condition under paragraph (4)
for the fiscal year, an amount equal to the amount described
in subparagraph (B) for the State and fiscal year. The
payment under this paragraph shall be made, to a State for a
fiscal year, as a single payment not later than the last day
of the first calendar quarter of the following fiscal year.
``(B) Amount.--Subject to subparagraph (E), the amount
described in this subparagraph for a State for a fiscal year
is equal to the sum of the following amounts:
``(i) For above baseline medicaid child enrollment costs.--
``(I) First tier above baseline medicaid enrollees.--An
amount equal to the number of first tier above baseline child
enrollees (as determined under subparagraph (C)(i)) under
title XIX for the State and fiscal year multiplied by 15
percent of the projected per capita State Medicaid
expenditures (as determined under subparagraph (D)(i)) for
the State and fiscal year under title XIX.
``(II) Second tier above baseline medicaid enrollees.--An
amount equal to the number of second tier above baseline
child enrollees (as determined under subparagraph (C)(ii))
under title XIX for the State and fiscal year multiplied by
60 percent of the projected per capita State Medicaid
expenditures (as determined under subparagraph (D)(i)) for
the State and fiscal year under title XIX.
``(ii) For above baseline chip enrollment costs.--
``(I) First tier above baseline chip enrollees.--An amount
equal to the number of first tier above baseline child
enrollees under this title (as determined under subparagraph
(C)(i)) for the State and fiscal year multiplied by 10
percent of the projected per capita State CHIP expenditures
(as determined under subparagraph (D)(ii)) for the State and
fiscal year under this title.
``(II) Second tier above baseline chip enrollees.--An
amount equal to the number of second tier above baseline
child enrollees under this title (as determined under
subparagraph (C)(ii)) for the State and fiscal year
multiplied by 40 percent of the projected per capita State
CHIP expenditures (as determined under subparagraph (D)(ii))
for the State and fiscal year under this title.
``(C) Number of first and second tier above baseline child
enrollees; baseline number of child enrollees.--For purposes
of this paragraph:
``(i) First tier above baseline child enrollees.--The
number of first tier above baseline child enrollees for a
State for a fiscal year under this title or title XIX is
equal to the number (if any, as determined by the Secretary)
by which--
``(I) the monthly average unduplicated number of qualifying
children (as defined in subparagraph (F)) enrolled during the
fiscal year under the State child health plan under this
title or under the State plan under title XIX, respectively;
exceeds
``(II) the baseline number of enrollees described in clause
(iii) for the State and fiscal year under this title or title
XIX, respectively;
but not to exceed 3 percent (in the case of title XIX) or 7.5
percent (in the case of this title) of the baseline number of
enrollees described in subclause (II).
``(ii) Second tier above baseline child enrollees.--The
number of second tier above baseline child enrollees for a
State for a fiscal year under this title or title XIX is
equal to the number (if any, as determined by the Secretary)
by which--
``(I) the monthly average unduplicated number of qualifying
children (as defined in subparagraph (F)) enrolled during the
fiscal year under this title or under title XIX,
respectively, as described in clause (i)(I); exceeds
``(II) the sum of the baseline number of child enrollees
described in clause (iii) for the State and fiscal year under
this title or title XIX, respectively, as described in clause
(i)(II), and the maximum number of first tier above baseline
child enrollees for the State and fiscal year under this
title or title XIX, respectively, as determined under clause
(i).
``(iii) Baseline number of child enrollees.--Subject to
subparagraph (H), the baseline number of child enrollees for
a State under this title or title XIX--
``(I) for fiscal year 2008 is equal to the monthly average
unduplicated number of qualifying children enrolled in the
State child health plan under this title or in the State plan
under title XIX, respectively, during fiscal year 2007
increased by the population growth for children in that State
for the year ending on June 30, 2006 (as estimated by the
Bureau of the Census) plus 1 percentage point; or
``(II) for a subsequent fiscal year is equal to the
baseline number of child enrollees for the State for the
previous fiscal year under this title or title XIX,
respectively, increased by the population growth for children
in that State for the year ending on June 30 before the
beginning of the fiscal year (as estimated by the Bureau of
the Census) plus 1 percentage point.
``(D) Projected per capita state expenditures.--For
purposes of subparagraph (B)--
``(i) Projected per capita state medicaid expenditures.--
The projected per capita State Medicaid expenditures for a
State and fiscal year under title XIX is equal to the average
per capita expenditures (including both State and Federal
financial participation) for children under the State plan
under such title, including under waivers but not including
such children eligible for assistance by virtue of the
receipt of benefits under title XVI, for the most recent
fiscal year for which actual data are available (as
determined by the Secretary), increased (for each subsequent
fiscal year up to and including the fiscal year involved) by
the annual
[[Page H10844]]
percentage increase in per capita amount of National Health
Expenditures (as estimated by the Secretary) for the calendar
year in which the respective subsequent fiscal year ends and
multiplied by a State matching percentage equal to 100
percent minus the Federal medical assistance percentage (as
defined in section 1905(b)) for the fiscal year involved.
``(ii) Projected per capita state chip expenditures.--The
projected per capita State CHIP expenditures for a State and
fiscal year under this title is equal to the average per
capita expenditures (including both State and Federal
financial participation) for children under the State child
health plan under this title, including under waivers, for
the most recent fiscal year for which actual data are
available (as determined by the Secretary), increased (for
each subsequent fiscal year up to and including the fiscal
year involved) by the annual percentage increase in per
capita amount of National Health Expenditures (as estimated
by the Secretary) for the calendar year in which the
respective subsequent fiscal year ends and multiplied by a
State matching percentage equal to 100 percent minus the
enhanced FMAP (as defined in section 2105(b)) for the fiscal
year involved.
``(E) Amounts available for payments.--
``(i) Initial appropriation.--Out of any money in the
Treasury not otherwise appropriated, there are appropriated
$3,000,000,000 for fiscal year 2008 for making payments under
this paragraph, to be available until expended.
``(ii) Transfers.--Notwithstanding any other provision of
this title, the following amounts shall also be available,
without fiscal year limitation, for making payments under
this paragraph:
``(I) Unobligated national allotment.--
``(aa) Fiscal years 2008 through 2011.--As of December 31
of fiscal year 2008, and as of December 31 of each succeeding
fiscal year through fiscal year 2011, the portion, if any, of
the amount appropriated under subsection (a) for such fiscal
year that is unobligated for allotment to a State under
subsection (i) for such fiscal year or set aside under
subsection (a)(3) or (b)(2) of section 2111 for such fiscal
year.
``(bb) First half of fiscal year 2012.--As of December 31
of fiscal year 2012, the portion, if any, of the sum of the
amounts appropriated under subsection (a)(15)(A) and under
section 108 of the Children's Health Insurance
Reauthorization Act of 2007 for the period beginning on
October 1, 2011, and ending on March 31, 2012, that is
unobligated for allotment to a State under subsection (i) for
such fiscal year or set aside under subsection (b)(2) of
section 2111 for such fiscal year.
``(cc) Second half of fiscal year 2012.--As of June 30 of
fiscal year 2012, the portion, if any, of the amount
appropriated under subsection (a)(15)(B) for the period
beginning on April 1, 2012, and ending on September 30, 2012,
that is unobligated for allotment to a State under subsection
(i) for such fiscal year or set aside under subsection (b)(2)
of section 2111 for such fiscal year.
``(II) Unexpended allotments not used for redistribution.--
As of November 15 of each of fiscal years 2009 through 2012,
the total amount of allotments made to States under section
2104 for the second preceding fiscal year (third preceding
fiscal year in the case of the fiscal year 2006 and 2007
allotments) that is not expended or redistributed under
section 2104(f) during the period in which such allotments
are available for obligation.
``(III) Excess child enrollment contingency funds.--As of
October 1 of each of fiscal years 2009 through 2012, any
amount in excess of the aggregate cap applicable to the Child
Enrollment Contingency Fund for the fiscal year under section
2104(j).
``(IV) Unexpended transitional coverage block grant for
nonpregnant childless adults.--As of October 1, 2009, any
amounts set aside under section 2111(a)(3) that are not
expended by September 30, 2009.
``(iii) Proportional reduction.--If the sum of the amounts
otherwise payable under this paragraph for a fiscal year
exceeds the amount available for the fiscal year under this
subparagraph, the amount to be paid under this paragraph to
each State shall be reduced proportionally.
``(F) Qualifying children defined.--For purposes of this
subsection, the term `qualifying children' means, with
respect to this title or title XIX, children who meet the
eligibility criteria (including income, categorical
eligibility, age, and immigration status criteria) in effect
as of July 1, 2007, for enrollment under this title or title
XIX, respectively, taking into account criteria applied as of
such date under this title or title XIX, respectively,
pursuant to a waiver under section 1115.
``(G) Application to commonwealths and territories.--The
provisions of subparagraph (H) of section 2104(j)(3) shall
apply with respect to payments under this paragraph in the
same manner as such provisions apply to payment under such
section.
``(H) Application to states that implement a medicaid
expansion for children after fiscal year 2007.--In the case
of a State that provides coverage under paragraph (1) or (2)
of section 115(b) of the Children's Health Insurance Program
Reauthorization Act of 2007 for any fiscal year after fiscal
year 2007--
``(i) any child enrolled in the State plan under title XIX
through the application of such an election shall be
disregarded from the determination for the State of the
monthly average unduplicated number of qualifying children
enrolled in such plan during the first 3 fiscal years in
which such an election is in effect; and
``(ii) in determining the baseline number of child
enrollees for the State for any fiscal year subsequent to
such first 3 fiscal years, the baseline number of child
enrollees for the State under this title or title XIX for the
third of such fiscal years shall be the monthly average
unduplicated number of qualifying children enrolled in the
State child health plan under this title or in the State plan
under title XIX, respectively, for such third fiscal year.
``(4) Enrollment and retention provisions for children.--
For purposes of paragraph (3)(A), a State meets the condition
of this paragraph for a fiscal year if it is implementing at
least 4 of the following enrollment and retention provisions
(treating each subparagraph as a separate enrollment and
retention provision) throughout the entire fiscal year:
``(A) Continuous eligibility.--The State has elected the
option of continuous eligibility for a full 12 months for all
children described in section 1902(e)(12) under title XIX
under 19 years of age, as well as applying such policy under
its State child health plan under this title.
``(B) Liberalization of asset requirements.--The State
meets the requirement specified in either of the following
clauses:
``(i) Elimination of asset test.--The State does not apply
any asset or resource test for eligibility for children under
title XIX or this title.
``(ii) Administrative verification of assets.--The State--
``(I) permits a parent or caretaker relative who is
applying on behalf of a child for medical assistance under
title XIX or child health assistance under this title to
declare and certify by signature under penalty of perjury
information relating to family assets for purposes of
determining and redetermining financial eligibility; and
``(II) takes steps to verify assets through means other
than by requiring documentation from parents and applicants
except in individual cases of discrepancies or where
otherwise justified.
``(C) Elimination of in-person interview requirement.--The
State does not require an application of a child for medical
assistance under title XIX (or for child health assistance
under this title), including an application for renewal of
such assistance, to be made in person nor does the State
require a face-to-face interview, unless there are
discrepancies or individual circumstances justifying an in-
person application or face-to-face interview.
``(D) Use of joint application for medicaid and chip.--The
application form and supplemental forms (if any) and
information verification process is the same for purposes of
establishing and renewing eligibility for children for
medical assistance under title XIX and child health
assistance under this title.
``(E) Automatic renewal (use of administrative renewal).--
``(i) In general.--The State provides, in the case of
renewal of a child's eligibility for medical assistance under
title XIX or child health assistance under this title, a pre-
printed form completed by the State based on the information
available to the State and notice to the parent or caretaker
relative of the child that eligibility of the child will be
renewed and continued based on such information unless the
State is provided other information. Nothing in this clause
shall be construed as preventing a State from verifying,
through electronic and other means, the information so
provided.
``(ii) Satisfaction through demonstrated use of ex parte
process.--A State shall be treated as satisfying the
requirement of clause (i) if renewal of eligibility of
children under title XIX or this title is determined without
any requirement for an in-person interview, unless sufficient
information is not in the State's possession and cannot be
acquired from other sources (including other State agencies)
without the participation of the applicant or the applicant's
parent or caretaker relative.
``(F) Presumptive eligibility for children.--The State is
implementing section 1920A under title XIX as well as,
pursuant to section 2107(e)(1), under this title.
``(G) Express lane.--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.''.
SEC. 105. 2-YEAR INITIAL AVAILABILITY OF CHIP ALLOTMENTS.
Section 2104(e) (42 U.S.C. 1397dd(e)) is amended to read as
follows:
``(e) Availability of Amounts Allotted.--
``(1) In general.--Except as provided in paragraph (2),
amounts allotted to a State pursuant to this section--
``(A) for each of fiscal years 1998 through 2007, shall
remain available for expenditure by the State through the end
of the second succeeding fiscal year; and
``(B) for fiscal year 2008 and each fiscal year thereafter,
shall remain available for expenditure by the State through
the end of the succeeding fiscal year.
``(2) Availability of amounts redistributed.--Amounts
redistributed to a State under subsection (f) shall be
available for expenditure by the State through the end of the
fiscal year in which they are redistributed.''.
[[Page H10845]]
SEC. 106. REDISTRIBUTION OF UNUSED ALLOTMENTS TO ADDRESS
STATE FUNDING SHORTFALLS.
(a) Fiscal Year 2005 Allotments.--
(1) In general.--Notwithstanding section 2104(f) of the
Social Security Act (42 U.S.C. 1397dd(f)), subject to
paragraph (2), with respect to fiscal year 2008, the
Secretary shall provide for a redistribution under such
section from the allotments for fiscal year 2005 under
subsection (b) and (c) of such section that are not expended
by the end of fiscal year 2007, to each State described in
clause (iii) of section 2104(i)(1)(A) of the Social Security
Act, as added by section 102, of an amount that bears the
same ratio to such unexpended fiscal year 2005 allotments as
the ratio of the fiscal year 2007 allotment determined for
each such State under subsection (b) of section 2104 of such
Act for fiscal year 2007 (without regard to any amounts paid,
allotted, or redistributed to the State under section 2104
for any preceding fiscal year) bears to the total amount of
the fiscal year 2007 allotments for all such States (as so
determined).
(2) Contingency.--Paragraph (1) shall not apply if the
redistribution described in such paragraph has occurred as of
the date of the enactment of this Act.
(b) Allotments for Subsequent Fiscal Years.--Section
2104(f) (42 U.S.C. 1397dd(f)) is amended--
(1) by striking ``The Secretary'' and inserting the
following:
``(1) In general.--The Secretary'';
(2) by striking ``States that have fully expended the
amount of their allotments under this section.'' and
inserting ``States that the Secretary determines with respect
to the fiscal year for which unused allotments are available
for redistribution under this subsection, are shortfall
States described in paragraph (2) for such fiscal year, but
not to exceed the amount of the shortfall described in
paragraph (2)(A) for each such State (as may be adjusted
under paragraph (2)(C)).''; and
(3) by adding at the end the following new paragraph:
``(2) Shortfall states described.--
``(A) In general.--For purposes of paragraph (1), with
respect to a fiscal year, a shortfall State described in this
subparagraph is a State with a State child health plan
approved under this title for which the Secretary estimates
on the basis of the most recent data available to the
Secretary, that the projected expenditures under such plan
for the State for the fiscal year will exceed the sum of--
``(i) 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;
``(ii) the amount (if any) of the child enrollment
contingency fund payment under subsection (j); and
``(iii) the amount of the State's allotment for the fiscal
year.
``(B) Proration rule.--If the amounts available for
redistribution under paragraph (1) for a fiscal year are less
than the total amounts of the estimated shortfalls determined
for the year under subparagraph (A), the amount to be
redistributed under such paragraph for each shortfall State
shall be reduced proportionally.
``(C) Retrospective adjustment.--The Secretary may adjust
the estimates and determinations made under paragraph (1) and
this paragraph with respect to a fiscal year as necessary on
the basis of the amounts reported by States not later than
November 30 of the succeeding fiscal year, as approved by the
Secretary.''.
SEC. 107. OPTION FOR QUALIFYING STATES TO RECEIVE THE
ENHANCED PORTION OF THE CHIP MATCHING RATE FOR
MEDICAID COVERAGE OF CERTAIN CHILDREN.
Section 2105(g) (42 U.S.C. 1397ee(g)) is amended--
(1) in paragraph (1)(A), by inserting ``subject to
paragraph (4),'' after ``Notwithstanding any other provision
of law,''; and
(2) by adding at the end the following new paragraph:
``(4) Option for allotments for fiscal years 2008 through
2012.--
``(A) Payment of enhanced portion of matching rate for
certain expenditures.--In the case of expenditures described
in subparagraph (B), a qualifying State (as defined in
paragraph (2)) may elect to be paid from the State's
allotment made under section 2104 for any of fiscal years
2008 through 2012 (insofar as the allotment is available to
the State under subsections (e) and (i) of such section) an
amount each quarter equal to the additional amount that would
have been paid to the State under title XIX with respect to
such expenditures if the enhanced FMAP (as determined under
subsection (b)) had been substituted for the Federal medical
assistance percentage (as defined in section 1905(b)).
``(B) Expenditures described.--For purposes of subparagraph
(A), the expenditures described in this subparagraph are
expenditures made after the date of the enactment of this
paragraph and during the period in which funds are available
to the qualifying State for use under subparagraph (A), for
the provision of medical assistance to individuals residing
in the State who are eligible for medical assistance under
the State plan under title XIX or under a waiver of such plan
and who have not attained age 19 (or, if a State has so
elected under the State plan under title XIX, age 20 or 21),
and whose family income equals or exceeds 133 percent of the
poverty line but does not exceed the Medicaid applicable
income level.''.
SEC. 108. ONE-TIME APPROPRIATION.
There is appropriated to the Secretary, out of any money in
the Treasury not otherwise appropriated, $12,500,000,000 to
accompany the allotment made for the period beginning on
October 1, 2011, and ending on March 31, 2012, under section
2104(a)(15)(A) of the Social Security Act (42 U.S.C.
1397dd(a)(15)(A)) (as added by section 101), to remain
available until expended. Such amount shall be used to
provide allotments to States under paragraph (3) of
section 2104(i) of the Social Security Act (42 U.S.C.
1397dd(i)), as added by section 102, for the first 6
months of fiscal year 2012 in the same manner as
allotments are provided under subsection (a)(15)(A) of
such section 2104 and subject to the same terms and
conditions as apply to the allotments provided from such
subsection (a)(15)(A).
SEC. 109. IMPROVING FUNDING FOR THE TERRITORIES UNDER CHIP
AND MEDICAID.
(a) Removal of Federal Matching Payments for Data Reporting
Systems From the Overall Limit on Payments to Territories
Under Title XIX.--Section 1108(g) (42 U.S.C. 1308(g)) is
amended by adding at the end the following new paragraph:
``(4) Exclusion of certain expenditures from payment
limits.--With respect to fiscal years beginning with fiscal
year 2008, if Puerto Rico, the Virgin Islands, Guam, the
Northern Mariana Islands, or American Samoa qualify for a
payment under subparagraph (A)(i), (B), or (F) of section
1903(a)(3) for a calendar quarter of such fiscal year, the
payment shall not be taken into account in applying
subsection (f) (as increased in accordance with paragraphs
(1), (2), and (3) of this subsection) to such commonwealth or
territory for such fiscal year.''.
(b) GAO Study and Report.--Not later than September 30,
2009, the Comptroller General of the United States shall
submit a report to the Committee on Finance of the Senate and
the Committee on Energy and Commerce of the House of
Representatives regarding Federal funding under Medicaid and
CHIP for Puerto Rico, the United States Virgin Islands, Guam,
American Samoa, and the Northern Mariana Islands. The report
shall include the following:
(1) An analysis of all relevant factors with respect to--
(A) eligible Medicaid and CHIP populations in such
commonwealths and territories;
(B) historical and projected spending needs of such
commonwealths and territories and the ability of capped
funding streams to respond to those spending needs;
(C) the extent to which Federal poverty guidelines are used
by such commonwealths and territories to determine Medicaid
and CHIP eligibility; and
(D) the extent to which such commonwealths and territories
participate in data collection and reporting related to
Medicaid and CHIP, including an analysis of territory
participation in the Current Population Survey versus the
American Community Survey.
(2) Recommendations regarding methods for the collection
and reporting of reliable data regarding the enrollment under
Medicaid and CHIP of children in such commonwealths and
territories
(3) Recommendations for improving Federal funding under
Medicaid and CHIP for such commonwealths and territories.
Subtitle B--Focus on Low-Income Children and Pregnant Women
SEC. 111. STATE OPTION TO COVER LOW-INCOME PREGNANT WOMEN
UNDER CHIP THROUGH A STATE PLAN AMENDMENT.
(a) In General.--Title XXI (42 U.S.C. 1397aa et seq.), as
amended by section 112(a), is amended by adding at the end
the following new section:
``SEC. 2112. OPTIONAL COVERAGE OF TARGETED LOW-INCOME
PREGNANT WOMEN THROUGH A STATE PLAN AMENDMENT.
``(a) In General.--Subject to the succeeding provisions of
this section, a State may elect through an amendment to its
State child health plan under section 2102 to provide
pregnancy-related assistance under such plan for targeted
low-income pregnant women.
``(b) Conditions.--A State may only elect the option under
subsection (a) if the following conditions are satisfied:
``(1) Minimum income eligibility levels for pregnant women
and children.--The State has established an income
eligibility level--
``(A) for pregnant women under subsection
(a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or (l)(1)(A) of
section 1902 that is at least 185 percent (or such higher
percent as the State has in effect with regard to pregnant
women under this title) of the poverty line applicable to a
family of the size involved, but in no case lower than the
percent in effect under any such subsection as of July 1,
2007; and
``(B) for children under 19 years of age under this title
(or title XIX) that is at least 200 percent of the poverty
line applicable to a family of the size involved.
``(2) No chip income eligibility level for pregnant women
lower than the state's medicaid level.--The State does not
apply an effective income level for pregnant women under the
State plan amendment that is lower than the effective income
level (expressed as a percent of the poverty line
[[Page H10846]]
and considering applicable income disregards) specified under
subsection (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or
(l)(1)(A) of section 1902, on the date of enactment of this
paragraph to be eligible for medical assistance as a pregnant
woman.
``(3) No coverage for higher income pregnant women without
covering lower income pregnant women.--The State does not
provide coverage for pregnant women with higher family income
without covering pregnant women with a lower family income.
``(4) Application of requirements for coverage of targeted
low-income children.--The State provides pregnancy-related
assistance for targeted low-income pregnant women in the same
manner, and subject to the same requirements, as the State
provides child health assistance for targeted low-income
children under the State child health plan, and in addition
to providing child health assistance for such women.
``(5) No preexisting condition exclusion or waiting
period.--The State does not apply any exclusion of benefits
for pregnancy-related assistance based on any preexisting
condition or any waiting period (including any waiting period
imposed to carry out section 2102(b)(3)(C)) for receipt of
such assistance.
``(6) Application of cost-sharing protection.--The State
provides pregnancy-related assistance to a targeted low-
income woman consistent with the cost-sharing protections
under section 2103(e) and applies the limitation on total
annual aggregate cost sharing imposed under paragraph (3)(B)
of such section to the family of such a woman.
``(7) No waiting list for children.--The State does not
impose, with respect to the enrollment under the State child
health plan of targeted low-income children during the
quarter, any enrollment cap or other numerical limitation on
enrollment, any waiting list, any procedures designed to
delay the consideration of applications for enrollment, or
similar limitation with respect to enrollment.
``(c) Option To Provide Presumptive Eligibility.--A State
that elects the option under subsection (a) and satisfies the
conditions described in subsection (b) may elect to apply
section 1920 (relating to presumptive eligibility for
pregnant women) to the State child health plan in the same
manner as such section applies to the State plan under title
XIX.
``(d) Definitions.--For purposes of this section:
``(1) Pregnancy-related assistance.--The term `pregnancy-
related assistance' has the meaning given the term `child
health assistance' in section 2110(a) and includes any
medical assistance that the State would provide for a
pregnant woman under the State plan under title XIX during
the period described in paragraph (2)(A).
``(2) Targeted low-income pregnant woman.--The term
`targeted low-income pregnant woman' means a woman--
``(A) during pregnancy and through the end of the month in
which the 60-day period (beginning on the last day of her
pregnancy) ends;
``(B) whose family income exceeds 185 percent (or, if
higher, the percent applied under subsection (b)(1)(A)) of
the poverty line applicable to a family of the size involved,
but does not exceed the income eligibility level established
under the State child health plan under this title for a
targeted low-income child; and
``(C) who satisfies the requirements of paragraphs (1)(A),
(1)(C), (2), and (3) of section 2110(b) in the same manner as
a child applying for child health assistance would have to
satisfy such requirements.
``(e) Automatic Enrollment for Children Born to Women
Receiving Pregnancy-Related Assistance.--If a child is born
to a targeted low-income pregnant woman who was receiving
pregnancy-related assistance under this section on the date
of the child's birth, the child shall be deemed to have
applied for child health assistance under the State child
health plan and to have been found eligible for such
assistance under such plan or to have applied for medical
assistance under title XIX and to have been found eligible
for such assistance under such title, as appropriate, on the
date of such birth and to remain eligible for such assistance
until the child attains 1 year of age. During the period in
which a child is deemed under the preceding sentence to be
eligible for child health or medical assistance, the child
health or medical assistance eligibility identification
number of the mother shall also serve as the identification
number of the child, and all claims shall be submitted and
paid under such number (unless the State issues a separate
identification number for the child before such period
expires).
``(f) States Providing Assistance Through Other Options.--
``(1) Continuation of other options for providing
assistance.--The option to provide assistance in accordance
with the preceding subsections of this section shall not
limit any other option for a State to provide--
``(A) child health assistance through the application of
sections 457.10, 457.350(b)(2), 457.622(c)(5), and
457.626(a)(3) of title 42, Code of Federal Regulations (as in
effect after the final rule adopted by the Secretary and set
forth at 67 Fed. Reg. 61956-61974 (October 2, 2002)), or
``(B) pregnancy-related services through the application of
any waiver authority (as in effect on June 1, 2007).
``(2) Clarification of authority to provide postpartum
services.--Any State that provides child health assistance
under any authority described in paragraph (1) may continue
to provide such assistance, as well as postpartum services,
through the end of the month in which the 60-day period
(beginning on the last day of the pregnancy) ends, in the
same manner as such assistance and postpartum services would
be provided if provided under the State plan under title XIX,
but only if the mother would otherwise satisfy the
eligibility requirements that apply under the State child
health plan (other than with respect to age) during such
period.
``(3) No inference.--Nothing in this subsection shall be
construed--
``(A) to infer congressional intent regarding the legality
or illegality of the content of the sections specified in
paragraph (1)(A); or
``(B) to modify the authority to provide pregnancy-related
services under a waiver specified in paragraph (1)(B).''.
(b) Additional Conforming Amendments.--
(1) No cost sharing for pregnancy-related benefits.--
Section 2103(e)(2) (42 U.S.C. 1397cc(e)(2)) is amended--
(A) in the heading, by inserting ``OR PREGNANCY-RELATED
ASSISTANCE'' after ``PREVENTIVE SERVICES''; and
(B) by inserting before the period at the end the
following: ``or for pregnancy-related assistance''.
(2) No waiting period.--Section 2102(b)(1)(B) (42 U.S.C.
1397bb(b)(1)(B)) is amended--
(A) in clause (i), by striking ``, and'' at the end and
inserting a semicolon;
(B) in clause (ii), by striking the period at the end and
inserting ``; and''; and
(C) by adding at the end the following new clause:
``(iii) may not apply a waiting period (including a waiting
period to carry out paragraph (3)(C)) in the case of a
targeted low-income pregnant woman provided pregnancy-related
assistance under section 2112.''.
SEC. 112. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS
ADULTS UNDER CHIP; CONDITIONS FOR COVERAGE OF
PARENTS.
(a) Phase-Out Rules.--
(1) In general.--Title XXI (42 U.S.C. 1397aa et seq.) is
amended by adding at the end the following new section:
``SEC. 2111. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS
ADULTS; CONDITIONS FOR COVERAGE OF PARENTS.
``(a) Termination of Coverage for Nonpregnant Childless
Adults.--
``(1) No new chip waivers; automatic extensions at state
option through fiscal year 2008.--Notwithstanding section
1115 or any other provision of this title, except as provided
in this subsection--
``(A) the Secretary shall not on or after the date of the
enactment of the Children's Health Insurance Program
Reauthorization Act of 2007, approve or renew a waiver,
experimental, pilot, or demonstration project that would
allow funds made available under this title to be used to
provide child health assistance or other health benefits
coverage to a nonpregnant childless adult; and
``(B) notwithstanding the terms and conditions of an
applicable existing waiver, the provisions of paragraphs (2)
and (3) shall apply for purposes of any fiscal year beginning
on or after October 1, 2008, in determining the period to
which the waiver applies, the individuals eligible to be
covered by the waiver, and the amount of the Federal payment
under this title.
``(2) Termination of chip coverage under applicable
existing waivers at the end of fiscal year 2008.--
``(A) In general.--No funds shall be available under this
title for child health assistance or other health benefits
coverage that is provided to a nonpregnant childless adult
under an applicable existing waiver after September 30, 2008.
``(B) Extension upon state request.--If an applicable
existing waiver described in subparagraph (A) would otherwise
expire before October 1, 2008, and the State requests an
extension of such waiver, the Secretary shall grant such an
extension, but only through September 30, 2008.
``(C) Application of enhanced fmap.--The enhanced FMAP
determined under section 2105(b) shall apply to expenditures
under an applicable existing waiver for the provision of
child health assistance or other health benefits coverage to
a nonpregnant childless adult during fiscal year 2008.
``(3) Optional 1-year transitional coverage block grant
funded from state allotment.--Subject to paragraph (4)(B),
each State for which coverage under an applicable existing
waiver is terminated under paragraph (2)(A) may elect to
provide nonpregnant childless adults who were provided child
health assistance or health benefits coverage under the
applicable existing waiver at any time during fiscal year
2008 with such assistance or coverage during fiscal year
2009, as if the authority to provide such assistance or
coverage under an applicable existing waiver was extended
through that fiscal year, but subject to the following terms
and conditions:
``(A) Block grant set aside from state allotment.--The
Secretary shall set aside for the State an amount equal to
the Federal share of the State's projected expenditures
[[Page H10847]]
under the applicable existing waiver for providing child
health assistance or health benefits coverage to all
nonpregnant childless adults under such waiver for fiscal
year 2008 (as certified by the State and submitted to the
Secretary by not later than August 31, 2008, and without
regard to whether any such individual lost coverage during
fiscal year 2008 and was later provided child health
assistance or other health benefits coverage under the waiver
in that fiscal year), increased by the annual adjustment for
fiscal year 2009 determined under section 2104(i)(5)(A). The
Secretary may adjust the amount set aside under the preceding
sentence, as necessary, on the basis of the expenditure data
for fiscal year 2008 reported by States on CMS Form 64 or CMS
Form 21 not later than November 30, 2008, but in no case
shall the Secretary adjust such amount after December 31,
2008.
``(B) No coverage for nonpregnant childless adults who were
not covered during fiscal year 2008.--
``(i) FMAP applied to expenditures.--The Secretary shall
pay the State for each quarter of fiscal year 2009, from the
amount set aside under subparagraph (A), an amount equal to
the Federal medical assistance percentage (as determined
under section 1905(b) without regard to clause (4) of such
section) of expenditures in the quarter for providing child
health assistance or other health benefits coverage to a
nonpregnant childless adult but only if such adult was
enrolled in the State program under this title during fiscal
year 2008 (without regard to whether the individual lost
coverage during fiscal year 2008 and was reenrolled in that
fiscal year or in fiscal year 2009).
``(ii) Federal payments limited to amount of block grant
set-aside.--No payments shall be made to a State for
expenditures described in this subparagraph after the total
amount set aside under subparagraph (A) for fiscal year 2009
has been paid to the State.
``(4) State option to apply for medicaid waiver to continue
coverage for nonpregnant childless adults.--
``(A) In general.--Each State for which coverage under an
applicable existing waiver is terminated under paragraph
(2)(A) may submit, not later than June 30, 2009, an
application to the Secretary for a waiver under section 1115
of the State plan under title XIX to provide medical
assistance to a nonpregnant childless adult whose coverage is
so terminated (in this subsection referred to as a `Medicaid
nonpregnant childless adults waiver').
``(B) Deadline for approval.--The Secretary shall make a
decision to approve or deny an application for a Medicaid
nonpregnant childless adults waiver submitted under
subparagraph (A) within 90 days of the date of the submission
of the application. If no decision has been made by the
Secretary as of September 30, 2009, on the application of a
State for a Medicaid nonpregnant childless adults waiver that
was submitted to the Secretary by June 30, 2009, the
application shall be deemed approved.
``(C) Standard for budget neutrality.--The budget
neutrality requirement applicable with respect to
expenditures for medical assistance under a Medicaid
nonpregnant childless adults waiver shall--
``(i) in the case of fiscal year 2010, allow expenditures
for medical assistance under title XIX for all such adults to
not exceed the total amount of payments made to the State
under paragraph (3)(B) for fiscal year 2009, increased by the
percentage increase (if any) in the projected nominal per
capita amount of National Health Expenditures for calendar
year 2010 over calendar year 2009, as most recently published
by the Secretary; and
``(ii) in the case of any succeeding fiscal year, allow
such expenditures to not exceed the amount in effect under
this subparagraph for the preceding fiscal year, increased by
the percentage increase (if any) in the projected nominal per
capita amount of National Health Expenditures for the
calendar year that begins during the fiscal year involved
over the preceding calendar year, as most recently published
by the Secretary.
``(b) Rules and Conditions for Coverage of Parents of
Targeted Low-Income Children.--
``(1) Two-year transition period; automatic extension at
state option through fiscal year 2009.--
``(A) No new chip waivers.--Notwithstanding section 1115 or
any other provision of this title, except as provided in this
subsection--
``(i) the Secretary shall not on or after the date of the
enactment of the Children's Health Insurance Program
Reauthorization Act of 2007 approve or renew a waiver,
experimental, pilot, or demonstration project that would
allow funds made available under this title to be used to
provide child health assistance or other health benefits
coverage to a parent of a targeted low-income child; and
``(ii) notwithstanding the terms and conditions of an
applicable existing waiver, the provisions of paragraphs (2)
and (3) shall apply for purposes of any fiscal year beginning
on or after October 1, 2009, in determining the period to
which the waiver applies, the individuals eligible to be
covered by the waiver, and the amount of the Federal payment
under this title.
``(B) Extension upon state request.--If an applicable
existing waiver described in subparagraph (A) would otherwise
expire before October 1, 2009, and the State requests an
extension of such waiver, the Secretary shall grant such an
extension, but only, subject to paragraph (2)(A), through
September 30, 2009.
``(C) Application of enhanced fmap.--The enhanced FMAP
determined under section 2105(b) shall apply to expenditures
under an applicable existing waiver for the provision of
child health assistance or other health benefits coverage to
a parent of a targeted low-income child during fiscal years
2008 and 2009.
``(2) Rules for fiscal years 2010 through 2012.--
``(A) Payments for coverage limited to block grant funded
from state allotment.--Any State that provides child health
assistance or health benefits coverage under an applicable
existing waiver for a parent of a targeted low-income child
may elect to continue to provide such assistance or coverage
through fiscal year 2010, 2011, or 2012, subject to the same
terms and conditions that applied under the applicable
existing waiver, unless otherwise modified in subparagraph
(B).
``(B) Terms and conditions.--
``(i) Block grant set aside from state allotment.--If the
State makes an election under subparagraph (A), the Secretary
shall set aside for the State for each such fiscal year an
amount equal to the Federal share of 110 percent of the
State's projected expenditures under the applicable existing
waiver for providing child health assistance or health
benefits coverage to all parents of targeted low-income
children enrolled under such waiver for the fiscal year (as
certified by the State and submitted to the Secretary by not
later than August 31 of the preceding fiscal year). In the
case of fiscal year 2012, the set aside for any State shall
be computed separately for each period described in
subparagraphs (A) and (B) of section 2104(a)(15) and any
reduction in the allotment for either such period under
section 2104(i)(4) shall be allocated on a pro rata basis to
such set aside.
``(ii) Payments from block grant.--The Secretary shall pay
the State from the amount set aside under clause (i) for the
fiscal year, an amount for each quarter of such fiscal year
equal to the applicable percentage determined under clause
(iii) or (iv) for expenditures in the quarter for providing
child health assistance or other health benefits coverage to
a parent of a targeted low-income child.
``(iii) Enhanced fmap only in fiscal year 2010 for states
with significant child outreach or that achieve child
coverage benchmarks; fmap for any other states.--For purposes
of clause (ii), the applicable percentage for any quarter of
fiscal year 2010 is equal to--
``(I) the enhanced FMAP determined under section 2105(b) in
the case of a State that meets the outreach or coverage
benchmarks described in any of subparagraphs (A), (B), or (C)
of paragraph (3) for fiscal year 2009; or
``(II) the Federal medical assistance percentage (as
determined under section 1905(b) without regard to clause (4)
of such section) in the case of any other State.
``(iv) Amount of federal matching payment in 2011 or
2012.--For purposes of clause (ii), the applicable percentage
for any quarter of fiscal year 2011 or 2012 is equal to--
``(I) the REMAP percentage if--
``(aa) the applicable percentage for the State under clause
(iii) was the enhanced FMAP for fiscal year 2009; and
``(bb) the State met either of the coverage benchmarks
described in subparagraph (B) or (C) of paragraph (3) for the
preceding fiscal year; or
``(II) the Federal medical assistance percentage (as so
determined) in the case of any State to which subclause (I)
does not apply.
For purposes of subclause (I), the REMAP percentage is the
percentage which is the sum of such Federal medical
assistance percentage and a number of percentage points equal
to one-half of the difference between such Federal medical
assistance percentage and such enhanced FMAP.
``(v) No federal payments other than from block grant set
aside.--No payments shall be made to a State for expenditures
described in clause (ii) after the total amount set aside
under clause (i) for a fiscal year has been paid to the
State.
``(vi) No increase in income eligibility level for
parents.--No payments shall be made to a State from the
amount set aside under clause (i) for a fiscal year for
expenditures for providing child health assistance or health
benefits coverage to a parent of a targeted low-income child
whose family income exceeds the income eligibility level
applied under the applicable existing waiver to parents of
targeted low-income children on the date of enactment of the
Children's Health Insurance Program Reauthorization Act of
2007.
``(3) Outreach or coverage benchmarks.--For purposes of
paragraph (2), the outreach or coverage benchmarks described
in this paragraph are as follows:
``(A) Significant child outreach campaign.--The State--
``(i) was awarded a grant under section 2113 for fiscal
year 2009;
``(ii) implemented 1 or more of the enrollment and
retention provisions described in section 2105(a)(4) for such
fiscal year; or
``(iii) has submitted a specific plan for outreach for such
fiscal year.
``(B) High-performing state.--The State, on the basis of
the most timely and accurate published estimates of the
Bureau of the Census, ranks in the lowest \1/3\ of States in
terms of the State's percentage of low-income children
without health insurance.
[[Page H10848]]
``(C) State increasing enrollment of low-income children.--
The State qualified for a performance bonus payment under
section 2105(a)(3)(B) for the most recent fiscal year
applicable under such section.
``(4) Rules of construction.--Nothing in this subsection
shall be construed as prohibiting a State from submitting an
application to the Secretary for a waiver under section 1115
of the State plan under title XIX to provide medical
assistance to a parent of a targeted low-income child that
was provided child health assistance or health benefits
coverage under an applicable existing waiver.
``(c) Applicable Existing Waiver.--For purposes of this
section--
``(1) In general.--The term `applicable existing waiver'
means a waiver, experimental, pilot, or demonstration project
under section 1115, grandfathered under section 6102(c)(3) of
the Deficit Reduction Act of 2005, or otherwise conducted
under authority that--
``(A) would allow funds made available under this title to
be used to provide child health assistance or other health
benefits coverage to--
``(i) a parent of a targeted low-income child;
``(ii) a nonpregnant childless adult; or
``(iii) individuals described in both clauses (i) and (ii);
and
``(B) was in effect during fiscal year 2007.
``(2) Definitions.--
``(A) Parent.--The term `parent' includes a caretaker
relative (as such term is used in carrying out section 1931)
and a legal guardian.
``(B) Nonpregnant childless adult.--The term `nonpregnant
childless adult' has the meaning given such term by section
2107(f).''.
(2) Conforming amendments.--
(A) Section 2107(f) (42 U.S.C. 1397gg(f)) is amended--
(i) by striking ``, the Secretary'' and inserting ``:
``(1) The Secretary'';
(ii) in the first sentence, by inserting ``or a parent (as
defined in section 2111(c)(2)(A)), who is not pregnant, of a
targeted low-income child'' before the period;
(iii) by striking the second sentence; and
(iv) by adding at the end the following new paragraph:
``(2) The Secretary may not approve, extend, renew, or
amend a waiver, experimental, pilot, or demonstration project
with respect to a State after the date of enactment of the
Children's Health Insurance Program Reauthorization Act of
2007 that would waive or modify the requirements of section
2111.''.
(B) Section 6102(c) of the Deficit Reduction Act of 2005
(Public Law 109-171; 120 Stat. 131) is amended by striking
``Nothing'' and inserting ``Subject to section 2111 of the
Social Security Act, as added by section 112 of the
Children's Health Insurance Program Reauthorization Act of
2007, nothing''.
(b) GAO Study and Report.--
(1) In general.--The Comptroller General of the United
States shall conduct a study of whether--
(A) the coverage of a parent, a caretaker relative (as such
term is used in carrying out section 1931), or a legal
guardian of a targeted low-income child under a State health
plan under title XXI of the Social Security Act increases the
enrollment of, or the quality of care for, children, and
(B) such parents, relatives, and legal guardians who enroll
in such a plan are more likely to enroll their children in
such a plan or in a State plan under title XIX of such Act.
(2) Report.--Not later than 2 years after the date of the
enactment of this Act, the Comptroller General shall report
the results of the study to the Committee on Finance of the
Senate and the Committee on Energy and Commerce of the House
of Representatives, including recommendations (if any) for
changes in legislation.
SEC. 113. ELIMINATION OF COUNTING MEDICAID CHILD PRESUMPTIVE
ELIGIBILITY COSTS AGAINST TITLE XXI ALLOTMENT.
(a) In General.--Section 2105(a)(1) (42 U.S.C.
1397ee(a)(1)) is amended--
(1) in the matter preceding subparagraph (A), by striking
``(or, in the case of expenditures described in subparagraph
(B), the Federal medical assistance percentage (as defined in
the first sentence of section 1905(b)))''; and
(2) by striking subparagraph (B) and inserting the
following new subparagraph:
``(B) [reserved]''.
(b) Amendments to Medicaid.--
(1) Eligibility of a newborn.--Section 1902(e)(4) (42
U.S.C. 1396a(e)(4)) is amended in the first sentence by
striking ``so long as the child is a member of the woman's
household and the woman remains (or would remain if pregnant)
eligible for such assistance''.
(2) Application of qualified entities to presumptive
eligibility for pregnant women under medicaid.--Section
1920(b) (42 U.S.C. 1396r-1(b)) is amended by adding after
paragraph (2) the following flush sentence:
``The term `qualified provider' also includes a qualified
entity, as defined in section 1920A(b)(3).''.
SEC. 114. LIMITATION ON MATCHING RATE FOR STATES THAT PROPOSE
TO COVER CHILDREN WITH EFFECTIVE FAMILY INCOME
THAT EXCEEDS 300 PERCENT OF THE POVERTY LINE.
(a) FMAP Applied to Expenditures.--Section 2105(c) (42
U.S.C. 1397ee(c)) is amended by adding at the end the
following new paragraph:
``(8) Limitation on matching rate for expenditures for
child health assistance provided to children whose effective
family income exceeds 300 percent of the poverty line.--
``(A) FMAP applied to expenditures.--Except as provided in
subparagraph (B), for fiscal years beginning with fiscal year
2008, the Federal medical assistance percentage (as
determined under section 1905(b) without regard to clause (4)
of such section) shall be substituted for the enhanced FMAP
under subsection (a)(1) with respect to any expenditures for
providing child health assistance or health benefits coverage
for a targeted low-income child whose effective family income
would exceed 300 percent of the poverty line but for the
application of a general exclusion of a block of income that
is not determined by type of expense or type of income.
``(B) Exception.--Subparagraph (A) shall not apply to any
State that, on the date of enactment of the Children's Health
Insurance Program Reauthorization Act of 2007, has an
approved State plan amendment or waiver to provide, or has
enacted a State law to submit a State plan amendment to
provide, expenditures described in such subparagraph under
the State child health plan.''.
(b) Rule of Construction.--Nothing in the amendments made
by this section shall be construed as--
(1) changing any income eligibility level for children
under title XXI of the Social Security Act; or
(2) changing the flexibility provided States under such
title to establish the income eligibility level for targeted
low-income children under a State child health plan and the
methodologies used by the State to determine income or assets
under such plan.
SEC. 115. STATE AUTHORITY UNDER MEDICAID.
(a) State Authority to Expand Income or Resource
Eligibility Levels for Children.--Nothing in this Act, the
amendments made by this Act, or title XIX of the Social
Security Act, including paragraph (2)(B) of section 1905(u)
of such Act, shall be construed as limiting the flexibility
afforded States under such title to increase the income or
resource eligibility levels for children under a State plan
or waiver under such title.
(b) State Authority to Receive Payments Under Medicaid for
Providing Medical Assistance to Children Eligible as a Result
of an Income or Resource Eligibility Level Expansion.--A
State may, notwithstanding the fourth sentence of subsection
(b) of section 1905 of the Social Security Act (42 U.S.C.
1396d) or subsection (u) of such section--
(1) cover individuals described in section
1902(a)(10)(A)(ii)(IX) of the Social Security Act and thereby
receive Federal financial participation for medical
assistance for such individuals under title XIX of the Social
Security Act; or
(2) receive Federal financial participation for
expenditures for medical assistance under Medicaid for
children described in paragraph (2)(B) or (3) of section
1905(u) of such Act based on the Federal medical assistance
percentage, as otherwise determined based on the first and
third sentences of subsection (b) of section 1905 of the
Social Security Act, rather than on the basis of an enhanced
FMAP (as defined in section 2105(b) of such Act).
SEC. 116. PREVENTING SUBSTITUTION OF CHIP COVERAGE FOR
PRIVATE COVERAGE.
(a) Findings.--
(1) Congress agrees with the President that low-income
children should be the first priority of all States in
providing child health assistance under CHIP.
(2) Congress agrees with the President and the
Congressional Budget Office that the substitution of CHIP
coverage for private coverage occurs more frequently for
children in families at higher income levels.
(3) Congress agrees with the President that it is
appropriate that States that expand CHIP eligibility to
children at higher income levels should have achieved a high
level of health benefits coverage for low-income children and
should implement strategies to address such substitution.
(4) Congress concludes that the policies specified in this
section (and the amendments made by this section) are the
appropriate policies to address these issues.
(b) Analyses of Best Practices and Methodology in
Addressing Crowd-Out.--
(1) GAO report.--Not later than 18 months after the date of
the enactment of this Act, the Comptroller General of the
United States shall submit to the Committee on Finance of the
Senate and the Committee on Energy and Commerce of the House
of Representatives and the Secretary a report describing the
best practices by States in addressing the issue of CHIP
crowd-out. Such report shall include analyses of--
(A) the impact of different geographic areas, including
urban and rural areas, on CHIP crowd-out;
(B) the impact of different State labor markets on CHIP
crowd-out;
(C) the impact of different strategies for addressing CHIP
crowd-out;
(D) the incidence of crowd-out for children with different
levels of family income; and
(E) the relationship (if any) between changes in the
availability and affordability of dependent coverage under
employer-sponsored health insurance and CHIP crowd-out.
(2) IOM report on methodology.--The Secretary shall enter
into an arrangement with the Institute of Medicine under
which the Institute submits to the Committee on
[[Page H10849]]
Finance of the Senate and the Committee on Energy and
Commerce of the House of Representatives and the Secretary,
not later than 18 months after the date of the enactment of
this Act, a report on--
(A) the most accurate, reliable, and timely way to
measure--
(i) on a State-by-State basis, the rate of public and
private health benefits coverage among low-income children
with family income that does not exceed 200 percent of the
poverty line; and
(ii) CHIP crowd-out, including in the case of children with
family income that exceeds 200 percent of the poverty line;
and
(B) the least burdensome way to gather the necessary data
to conduct the measurements described in subparagraph (A).
Out of any money in the Treasury not otherwise appropriated,
there are hereby appropriated $2,000,000 to carry out this
paragraph for the period ending September 30, 2009.
(3) Incorporation of definitions.--In this section, the
terms ``CHIP crowd-out'', ``children'', ``poverty line'', and
``State'' have the meanings given such terms for purposes of
CHIP.
(4) Definition of chip crowd-out.--Section 2110(c) (42
U.S.C. 1397jj(c)) is amended by adding at the end the
following:
``(9) CHIP crowd-out.--The term `CHIP crowd-out' means the
substitution of--
``(A) health benefits coverage for a child under this
title, for
``(B) health benefits coverage for the child other than
under this title or title XIX.''.
(c) Development of Best Practice Recommendations.--Section
2107 (42 U.S.C. 1397gg) is amended by adding at the end the
following:
``(g) Development of Best Practice Recommendations.--Within
6 months after the date of receipt of the reports under
subsections (a) and (b) of section 116 of the Children's
Health Insurance Program Reauthorization Act of 2007, the
Secretary, in consultation with States, including Medicaid
and CHIP directors in States, shall publish in the Federal
Register, and post on the public website for the Department
of Health and Human Services--
``(1) recommendations regarding best practices for States
to use to address CHIP crowd-out; and
``(2) uniform standards for data collection by States to
measure and report--
``(A) health benefits coverage for children with family
income below 200 percent of the poverty line; and
``(B) on CHIP crowd-out, including for children with family
income that exceeds 200 percent of the poverty line.
The Secretary, in consultation with States, including
Medicaid and CHIP directors in States, may from time to time
update the best practice recommendations and uniform
standards set published under paragraphs (1) and (2) and
shall provide for publication and posting of such updated
recommendations and standards.''.
(d) Requirement to Address CHIP Crowd-Out; Secretarial
Review.--Section 2106 (42 U.S.C. 1397ff) is amended by adding
at the end the following:
``(f) Requirement to Address CHIP Crowd-Out; Secretarial
Review.--
``(1) In general.--Each State that, on or after the best
practice application date described in paragraph (3), submits
a plan amendment (or waiver request) to provide for
eligibility for child health assistance under the State child
health plan for higher income children described in section
2105(c)(9)(D) (relating to children whose effective family
income exceeds 300 percent of the poverty line) shall include
with such plan amendment or request a description of how the
State--
``(A) will address CHIP crowd-out for such children; and
``(B) will incorporate recommended best practices referred
to in such paragraph.
``(2) Application to certain states.--Each State that, as
of the best practice application date described in paragraph
(3), has a State child health plan that provides (whether
under the plan or through a waiver) for eligibility for child
health assistance for children referred to in paragraph (1)
shall submit to the Secretary, not later than 6 months after
the date of such application, a State plan amendment
describing how the State--
``(A) will address CHIP crowd-out for such children; and
``(B) will incorporate recommended best practices referred
to in such paragraph.
``(3) Best practice application date.--The best practice
application date described in this paragraph is the date that
is 6 months after the date of publication of recommendations
regarding best practices under section 2107(g)(1).
``(4) Secretarial review.--The Secretary shall--
``(A) review each State plan amendment or waiver request
submitted under paragraph (1) or (2);
``(B) determine whether the amendment or request
incorporates recommended best practices referred to in
paragraph (3);
``(C) determine whether the State meets the enrollment
targets required under reference section 2105(c)(9)(C); and
``(D) notify the State of such determinations.''.
(e) Limitation on Payments for States Covering Higher
Income Children.--Section 2105(c) (42 U.S.C. 1397ee(c)), as
amended by section 114(a), is amended by adding at the end
the following new subsection:
``(9) Limitation on payments for states covering higher
income children.--
``(A) Determinations.--
``(i) In general.--The Secretary shall determine, for each
State that is a higher income eligibility State as of April 1
of 2010 and each subsequent year, whether the State meets the
target rate of coverage of low-income children required under
subparagraph (C) and shall notify the State in that month of
such determination.
``(ii) Determination of failure.--If the Secretary
determines in such month that a higher income eligibility
State does not meet such target rate of coverage, subject to
subparagraph (E), no payment shall be made as of October 1 of
such year on or after October 1, 2010, under this section for
child health assistance provided for higher-income children
(as defined in subparagraph (D)) under the State child health
plan unless and until the State establishes it is in
compliance with such requirement.
``(B) Higher income eligibility state.--A higher income
eligibility State described in this clause is a State that--
``(i) applies under its State child health plan an
eligibility income standard for targeted low-income children
that exceeds 300 percent of the poverty line; or
``(ii) because of the application of a general exclusion of
a block of income that is not determined by type of expense
or type of income, applies an effective income standard under
the State child health plan for such children that exceeds
300 percent of the poverty line.
``(C) Requirement for target rate of coverage of low-income
children.--
``(i) In general.--The requirement of this subparagraph for
a State is that the rate of health benefits coverage (both
private and public) for low-income children in the State is
not statistically significantly (at a p=0.05 level) less than
the target rate of coverage specified in clause (ii).
``(ii) Target rate.--The target rate of coverage specified
in this clause is the average rate (determined by the
Secretary) of health benefits coverage (both private and
public) as of January 1, 2010, among the 10 of the 50 States
and the District of Columbia with the highest percentage of
health benefits coverage (both private and public) for low-
income children.
``(iii) Standards for data.-- In applying this
subparagraph, rates of health benefits coverage for States
shall be determined using the uniform standards identified by
the Secretary under section 2107(g)(2).
``(D) Higher-income child.--For purposes of this paragraph,
the term `higher income child' means, with respect to a State
child health plan, a targeted low-income child whose family
income--
``(i) exceeds 300 percent of the poverty line; or
``(ii) would exceed 300 percent of the poverty line if
there were not taken into account any general exclusion
described in subparagraph (B)(ii).
``(E) Notice and opportunity to comply with target rate.--
If the Secretary makes a determination described in
subparagraph (A)(ii) in April of a year, the Secretary--
``(i) shall provide the State with the opportunity to
submit and implement a corrective action plan for the State
to come into compliance with the requirement of subparagraph
(C) before October 1 of such year;
``(ii) shall not effect a denial of payment under
subparagraph (A) on the basis of such determination before
October 1 of such year; and
``(iii) shall not effect such a denial if the Secretary
determines that there is a reasonable likelihood that the
implementation of such a correction action plan will bring
the State into compliance with the requirement of
subparagraph (C).''.
(f) Treatment of Medical Support Orders.--Section 2102(b)
(42 U.S.C. 1397bb(c)) is amended by adding at the end the
following::
``(5) Treatment of medical support orders.--
``(A) In general.--Nothing in this title shall be construed
to allow the Secretary to require that a State deny
eligibility for child health assistance to a child who is
otherwise eligible on the basis of the existence of a valid
medical support order being in effect.
``(B) State election.--A State may elect to limit
eligibility for child health assistance to a targeted low-
income child on the basis of the existence of a valid medical
support order on the child's behalf, but only if the State
does not deny such eligibility for a child on such basis if
the child asserts that the order is not being complied with
for any of the reasons described in subparagraph (C) unless
the State demonstrates that none of such reasons applies in
the case involved.
``(C) Reasons for noncompliance.--The reasons described in
this subparagraph for noncompliance with a medical support
order with respect to a child are that the child is not being
provided health benefits coverage pursuant to such order
because--
``(i) of failure of the noncustodial parent to comply with
the order;
``(ii) of the failure of an employer, group health plan or
health insurance issuer to comply with such order; or
``(iii) the child resides in a geographic area in which
benefits under the health benefits coverage are generally
unavailable.''.
(g) Effective Date of Amendments; Consistency of
Policies.--The amendments made by this section shall take
effect as if enacted on August 16, 2007. The Secretary may
not impose (or continue in effect) any requirement, prevent
the implementation of
[[Page H10850]]
any provision, or condition the approval of any provision
under any State child health plan, State plan amendment, or
waiver request on the basis of any policy or interpretation
relating to CHIP crowd-out or medical support order other
than under the amendments made by this section.
TITLE II--OUTREACH AND ENROLLMENT
Subtitle A--Outreach and Enrollment Activities
SEC. 201. GRANTS AND ENHANCED ADMINISTRATIVE FUNDING FOR
OUTREACH AND ENROLLMENT.
(a) Grants.--Title XXI (42 U.S.C. 1397aa et seq.), as
amended by section 107, is amended by adding at the end the
following:
``SEC. 2113. GRANTS TO IMPROVE OUTREACH AND ENROLLMENT.
``(a) Outreach and Enrollment Grants; National Campaign.--
``(1) In general.--From the amounts appropriated under
subsection (g), subject to paragraph (2), the Secretary shall
award grants to eligible entities during the period of fiscal
years 2008 through 2012 to conduct outreach and enrollment
efforts that are designed to increase the enrollment and
participation of eligible children under this title and title
XIX.
``(2) Ten percent set aside for national enrollment
campaign.--An amount equal to 10 percent of such amounts
shall be used by the Secretary for expenditures during such
period to carry out a national enrollment campaign in
accordance with subsection (h).
``(b) Priority for Award of Grants.--
``(1) In general.--In awarding grants under subsection (a),
the Secretary shall give priority to eligible entities that--
``(A) propose to target geographic areas with high rates
of--
``(i) eligible but unenrolled children, including such
children who reside in rural areas; or
``(ii) racial and ethnic minorities and health disparity
populations, including those proposals that address cultural
and linguistic barriers to enrollment; and
``(B) submit the most demonstrable evidence required under
paragraphs (1) and (2) of subsection (c).
``(2) Ten percent set aside for outreach to indian
children.--An amount equal to 10 percent of the funds
appropriated under subsection (g) shall be used by the
Secretary to award grants to Indian Health Service providers
and urban Indian organizations receiving funds under title V
of the Indian Health Care Improvement Act (25 U.S.C. 1651 et
seq.) for outreach to, and enrollment of, children who are
Indians.
``(c) Application.--An eligible entity that desires to
receive a grant under subsection (a) shall submit an
application to the Secretary in such form and manner, and
containing such information, as the Secretary may decide.
Such application shall include--
``(1) evidence demonstrating that the entity includes
members who have access to, and credibility with, ethnic or
low-income populations in the communities in which activities
funded under the grant are to be conducted;
``(2) evidence demonstrating that the entity has the
ability to address barriers to enrollment, such as lack of
awareness of eligibility, stigma concerns and punitive fears
associated with receipt of benefits, and other cultural
barriers to applying for and receiving child health
assistance or medical assistance;
``(3) specific quality or outcomes performance measures to
evaluate the effectiveness of activities funded by a grant
awarded under this section; and
``(4) an assurance that the eligible entity shall--
``(A) conduct an assessment of the effectiveness of such
activities against the performance measures;
``(B) cooperate with the collection and reporting of
enrollment data and other information in order for the
Secretary to conduct such assessments; and
``(C) in the case of an eligible entity that is not the
State, provide the State with enrollment data and other
information as necessary for the State to make necessary
projections of eligible children and pregnant women.
``(d) Dissemination of Enrollment Data and Information
Determined From Effectiveness Assessments; Annual Report.--
The Secretary shall--
``(1) make publicly available the enrollment data and
information collected and reported in accordance with
subsection (c)(4)(B); and
``(2) submit an annual report to Congress on the outreach
and enrollment activities conducted with funds appropriated
under this section.
``(e) Maintenance of Effort for States Awarded Grants; No
State Match Required.--In the case of a State that is awarded
a grant under this section--
``(1) the State share of funds expended for outreach and
enrollment activities under the State child health plan shall
not be less than the State share of such funds expended in
the fiscal year preceding the first fiscal year for which the
grant is awarded; and
``(2) no State matching funds shall be required for the
State to receive a grant under this section.
``(f) Definitions.--In this section:
``(1) Eligible entity.--The term `eligible entity' means
any of the following:
``(A) A State with an approved child health plan under this
title.
``(B) A local government.
``(C) An Indian tribe or tribal consortium, a tribal
organization, an urban Indian organization receiving funds
under title V of the Indian Health Care Improvement Act (25
U.S.C. 1651 et seq.), or an Indian Health Service provider.
``(D) A Federal health safety net organization.
``(E) A national, State, local, or community-based public
or nonprofit private organization, including organizations
that use community health workers or community-based doula
programs.
``(F) A faith-based organization or consortia, to the
extent that a grant awarded to such an entity is consistent
with the requirements of section 1955 of the Public Health
Service Act (42 U.S.C. 300x-65) relating to a grant award to
nongovernmental entities.
``(G) An elementary or secondary school.
``(2) Federal health safety net organization.--The term
`Federal health safety net organization' means--
``(A) a Federally-qualified health center (as defined in
section 1905(l)(2)(B));
``(B) a hospital defined as a disproportionate share
hospital for purposes of section 1923;
``(C) a covered entity described in section 340B(a)(4) of
the Public Health Service Act (42 U.S.C. 256b(a)(4)); and
``(D) any other entity or consortium that serves children
under a federally funded program, including the special
supplemental nutrition program for women, infants, and
children (WIC) established under section 17 of the Child
Nutrition Act of 1966 (42 U.S.C. 1786), the Head Start and
Early Head Start programs under the Head Start Act (42 U.S.C.
9801 et seq.), the school lunch program established under the
Richard B. Russell National School Lunch Act, and an
elementary or secondary school.
``(3) Indians; indian tribe; tribal organization; urban
indian organization.--The terms `Indian', `Indian tribe',
`tribal organization', and `urban Indian organization' have
the meanings given such terms in section 4 of the Indian
Health Care Improvement Act (25 U.S.C. 1603).
``(4) Community health worker.--The term `community health
worker' means an individual who promotes health or nutrition
within the community in which the individual resides--
``(A) by serving as a liaison between communities and
health care agencies;
``(B) by providing guidance and social assistance to
community residents;
``(C) by enhancing community residents' ability to
effectively communicate with health care providers;
``(D) by providing culturally and linguistically
appropriate health or nutrition education;
``(E) by advocating for individual and community health or
nutrition needs; and
``(F) by providing referral and followup services.
``(g) Appropriation.--There is appropriated, out of any
money in the Treasury not otherwise appropriated,
$100,000,000 for the period of fiscal years 2008 through
2012, for the purpose of awarding grants under this section.
Amounts appropriated and paid under the authority of this
section shall be in addition to amounts appropriated under
section 2104 and paid to States in accordance with section
2105, including with respect to expenditures for outreach
activities in accordance with subsections (a)(1)(D)(iii) and
(c)(2)(C) of that section.
``(h) National Enrollment Campaign.--From the amounts made
available under subsection (a)(2), the Secretary shall
develop and implement a national enrollment campaign to
improve the enrollment of underserved child populations in
the programs established under this title and title XIX. Such
campaign may include--
``(1) the establishment of partnerships with the Secretary
of Education and the Secretary of Agriculture to develop
national campaigns to link the eligibility and enrollment
systems for the assistance programs each Secretary
administers that often serve the same children;
``(2) the integration of information about the programs
established under this title and title XIX in public health
awareness campaigns administered by the Secretary;
``(3) increased financial and technical support for
enrollment hotlines maintained by the Secretary to ensure
that all States participate in such hotlines;
``(4) the establishment of joint public awareness outreach
initiatives with the Secretary of Education and the Secretary
of Labor regarding the importance of health insurance to
building strong communities and the economy;
``(5) the development of special outreach materials for
Native Americans or for individuals with limited English
proficiency; and
``(6) such other outreach initiatives as the Secretary
determines would increase public awareness of the programs
under this title and title XIX.''.
(b) Enhanced Administrative Funding for Translation or
Interpretation Services Under CHIP and Medicaid.--
(1) CHIP.--Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)), as
amended by section 113, is amended--
(A) in the matter preceding subparagraph (A), by inserting
``(or, in the case of expenditures described in subparagraph
(D)(iv), the higher of 75 percent or the sum of the enhanced
FMAP plus 5 percentage points)'' after ``enhanced FMAP''; and
(B) in subparagraph (D)--
[[Page H10851]]
(i) in clause (iii), by striking ``and'' at the end;
(ii) by redesignating clause (iv) as clause (v); and
(iii) by inserting after clause (iii) the following new
clause:
``(iv) for translation or interpretation services in
connection with the enrollment of, retention of, and use of
services under this title by, individuals for whom English is
not their primary language (as found necessary by the
Secretary for the proper and efficient administration of the
State plan); and''.
(2) Medicaid.--
(A) Use of medicaid funds.--Section 1903(a)(2) (42 U.S.C.
1396b(a)(2)) is amended by adding at the end the following
new subparagraph:
``(E) an amount equal to 75 percent of so much of the sums
expended during such quarter (as found necessary by the
Secretary for the proper and efficient administration of the
State plan) as are attributable to translation or
interpretation services in connection with the enrollment of,
retention of, and use of services under this title by,
children of families for whom English is not the primary
language; plus''.
(B) Use of community health workers for outreach
activities.--
(i) In general.--Section 2102(c)(1) of such Act (42 U.S.C.
1397bb(c)(1)) is amended by inserting ``(through community
health workers and others)'' after ``Outreach''.
(ii) In federal evaluation.--Section 2108(c)(3)(B) of such
Act (42 U.S.C. 1397hh(c)(3)(B)) is amended by inserting
``(such as through community health workers and others)''
after ``including practices''.
SEC. 202. INCREASED OUTREACH AND ENROLLMENT OF INDIANS.
(a) In General.--Section 1139 (42 U.S.C. 1320b-9) is
amended to read as follows:
``SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, HEALTH CARE
FOR INDIANS UNDER TITLES XIX AND XXI.
``(a) Agreements With States for Medicaid and CHIP Outreach
On or Near Reservations To Increase the Enrollment of Indians
in Those Programs.--
``(1) In general.--In order to improve the access of
Indians residing on or near a reservation to obtain benefits
under the Medicaid and State children's health insurance
programs established under titles XIX and XXI, the Secretary
shall encourage the State to take steps to provide for
enrollment on or near the reservation. Such steps may include
outreach efforts such as the outstationing of eligibility
workers, entering into agreements with the Indian Health
Service, Indian Tribes, Tribal Organizations, and Urban
Indian Organizations to provide outreach, education regarding
eligibility and benefits, enrollment, and translation
services when such services are appropriate.
``(2) Construction.--Nothing in paragraph (1) shall be
construed as affecting arrangements entered into between
States and the Indian Health Service, Indian Tribes, Tribal
Organizations, or Urban Indian Organizations for such
Service, Tribes, or Organizations to conduct administrative
activities under such titles.
``(b) Requirement To Facilitate Cooperation.--The
Secretary, acting through the Centers for Medicare & Medicaid
Services, shall take such steps as are necessary to
facilitate cooperation with, and agreements between, States
and the Indian Health Service, Indian Tribes, Tribal
Organizations, or Urban Indian Organizations with respect to
the provision of health care items and services to Indians
under the programs established under title XIX or XXI.
``(c) Definition of Indian; Indian Tribe; Indian Health
Program; Tribal Organization; Urban Indian Organization.--In
this section, the terms `Indian', `Indian Tribe', `Indian
Health Program', `Tribal Organization', and `Urban Indian
Organization' have the meanings given those terms in section
4 of the Indian Health Care Improvement Act.''.
(b) Nonapplication of 10 Percent Limit on Outreach and
Certain Other Expenditures.--Section 2105(c)(2) (42 U.S.C.
1397ee(c)(2)) is amended by adding at the end the following:
``(C) Nonapplication to certain expenditures.--The
limitation under subparagraph (A) shall not apply with
respect to the following expenditures:
``(i) Expenditures to increase outreach to, and the
enrollment of, indian children under this title and title
xix.--Expenditures for outreach activities to families of
Indian children likely to be eligible for child health
assistance under the plan or medical assistance under the
State plan under title XIX (or under a waiver of such plan),
to inform such families of the availability of, and to assist
them in enrolling their children in, such plans, including
such activities conducted under grants, contracts, or
agreements entered into under section 1139(a).''.
SEC. 203. STATE OPTION TO RELY ON FINDINGS FROM AN EXPRESS
LANE AGENCY TO CONDUCT SIMPLIFIED ELIGIBILITY
DETERMINATIONS.
(a) Application Under Medicaid and CHIP Programs.--
(1) Medicaid.--Section 1902(e) (42 U.S.C. 1396a(e)) is
amended by adding at the end the following:
``(13) Express Lane Option.--
``(A) In general.--
``(i) Option to use a finding from an express lane
agency.--At the option of the State, the State plan may
provide that in determining eligibility under this title for
a child (as defined in subparagraph (G)), the State may rely
on a finding made within a reasonable period (as determined
by the State) from an Express Lane agency (as defined in
subparagraph (F)) when it determines whether a child
satisfies one or more components of eligibility for medical
assistance under this title. The State may rely on a finding
from an Express Lane agency notwithstanding sections
1902(a)(46)(B) and 1137(d) and any differences in budget
unit, disregard, deeming or other methodology, if the
following requirements are met:
``(I) Prohibition on determining children ineligible for
coverage.--If a finding from an Express Lane agency would
result in a determination that a child does not satisfy an
eligibility requirement for medical assistance under this
title and for child health assistance under title XXI, the
State shall determine eligibility for assistance using its
regular procedures.
``(II) Notice requirement.--For any child who is found
eligible for medical assistance under the State plan under
this title or child health assistance under title XXI and who
is subject to premiums based on an Express Lane agency's
finding of such child's income level, the State shall provide
notice that the child may qualify for lower premium payments
if evaluated by the State using its regular policies and of
the procedures for requesting such an evaluation.
``(III) Compliance with screen and enroll requirement.--The
State shall satisfy the requirements under (A) and (B) of
section 2102(b)(3) (relating to screen and enroll) before
enrolling a child in child health assistance under title XXI.
At its option, the State may fulfill such requirements in
accordance with either option provided under subparagraph (C)
of this paragraph.
``(IV) Verification of citizenship or nationality status.--
The State shall satisfy the requirements of section
1902(a)(46)(B) or 2105(c)(10), as applicable for
verifications of citizenship or nationality status.
``(V) Coding.--The State meets the requirements of
subparagraph (E).
``(ii) Option to apply to renewals and redeterminations.--
The State may apply the provisions of this paragraph when
conducting initial determinations of eligibility,
redeterminations of eligibility, or both, as described in the
State plan.
``(B) Rules of construction.--Nothing in this paragraph
shall be construed--
``(i) to limit or prohibit a State from taking any actions
otherwise permitted under this title or title XXI in
determining eligibility for or enrolling children into
medical assistance under this title or child health
assistance under title XXI; or
``(ii) to modify the limitations in section 1902(a)(5)
concerning the agencies that may make a determination of
eligibility for medical assistance under this title.
``(C) Options for satisfying the screen and enroll
requirement.--
``(i) In general.--With respect to a child whose
eligibility for medical assistance under this title or for
child health assistance under title XXI has been evaluated by
a State agency using an income finding from an Express Lane
agency, a State may carry out its duties under subparagraphs
(A) and (B) of section 2102(b)(3) (relating to screen and
enroll) in accordance with either clause (ii) or clause
(iii).
``(ii) Establishing a screening threshold.--
``(I) In general.--Under this clause, the State establishes
a screening threshold set as a percentage of the Federal
poverty level that exceeds the highest income threshold
applicable under this title to the child by a minimum of 30
percentage points or, at State option, a higher number of
percentage points that reflects the value (as determined by
the State and described in the State plan) of any differences
between income methodologies used by the program administered
by the Express Lane agency and the methodologies used by the
State in determining eligibility for medical assistance under
this title.
``(II) Children with income not above threshold.--If the
income of a child does not exceed the screening threshold,
the child is deemed to satisfy the income eligibility
criteria for medical assistance under this title regardless
of whether such child would otherwise satisfy such criteria.
``(III) Children with income above threshold.--If the
income of a child exceeds the screening threshold, the child
shall be considered to have an income above the Medicaid
applicable income level described in section 2110(b)(4) and
to satisfy the requirement under section 2110(b)(1)(C)
(relating to the requirement that CHIP matching funds be used
only for children not eligible for Medicaid). If such a child
is enrolled in child health assistance under title XXI, the
State shall provide the parent, guardian, or custodial
relative with the following:
``(aa) Notice that the child may be eligible to receive
medical assistance under the State plan under this title if
evaluated for such assistance under the State's regular
procedures and notice of the process through which a parent,
guardian, or custodial relative can request that the State
evaluate the child's eligibility for medical assistance under
this title using such regular procedures.
``(bb) A description of differences between the medical
assistance provided under this title and child health
assistance under title XXI, including differences in cost-
sharing requirements and covered benefits.
``(iii) Temporary enrollment in chip pending screen and
enroll.--
[[Page H10852]]
``(I) In general.--Under this clause, a State enrolls a
child in child health assistance under title XXI for a
temporary period if the child appears eligible for such
assistance based on an income finding by an Express Lane
agency.
``(II) Determination of eligibility.--During such temporary
enrollment period, the State shall determine the child's
eligibility for child health assistance under title XXI or
for medical assistance under this title in accordance with
this clause.
``(III) Prompt follow up.--In making such a determination,
the State shall take prompt action to determine whether the
child should be enrolled in medical assistance under this
title or child health assistance under title XXI pursuant to
subparagraphs (A) and (B) of section 2102(b)(3) (relating to
screen and enroll).
``(IV) Requirement for simplified determination.--In making
such a determination, the State shall use procedures that, to
the maximum feasible extent, reduce the burden imposed on the
individual of such determination. Such procedures may not
require the child's parent, guardian, or custodial relative
to provide or verify information that already has been
provided to the State agency by an Express Lane agency or
another source of information unless the State agency has
reason to believe the information is erroneous.
``(V) Availability of chip matching funds during temporary
enrollment period.--Medical assistance for items and services
that are provided to a child enrolled in title XXI during a
temporary enrollment period under this clause shall be
treated as child health assistance under such title.
``(D) Option for automatic enrollment.--
``(i) In general.--The State may initiate and determine
eligibility for medical assistance under the State Medicaid
plan or for child health assistance under the State CHIP plan
without a program application from, or on behalf of, the
child based on data obtained from sources other than the
child (or the child's family), but a child can only be
automatically enrolled in the State Medicaid plan or the
State CHIP plan if the child or the family affirmatively
consents to being enrolled through affirmation and signature
on an Express Lane agency application, if the requirement of
clause (ii) is met.
``(ii) Information requirement.--The requirement of this
clause is that the State informs the parent, guardian, or
custodial relative of the child of the services that will be
covered, appropriate methods for using such services, premium
or other cost sharing charges (if any) that apply, medical
support obligations (under section 1912(a)) created by
enrollment (if applicable), and the actions the parent,
guardian, or relative must take to maintain enrollment and
renew coverage.
``(E) Coding; application to enrollment error rates.--
``(i) In general.--For purposes of subparagraph (A)(iv),
the requirement of this subparagraph for a State is that the
State agrees to--
``(I) assign such codes as the Secretary shall require to
the children who are enrolled in the State Medicaid plan or
the State CHIP plan through reliance on a finding made by an
Express Lane agency for the duration of the State's election
under this paragraph;
``(II) annually provide the Secretary with a statistically
valid sample (that is approved by Secretary) of the children
enrolled in such plans through reliance on such a finding by
conducting a full Medicaid eligibility review of the children
identified for such sample for purposes of determining an
eligibility error rate (as described in clause (iv)) with
respect to the enrollment of such children (and shall not
include such children in any data or samples used for
purposes of complying with a Medicaid Eligibility Quality
Control (MEQC) review or a payment error rate measurement
(PERM) requirement);
``(III) submit the error rate determined under subclause
(II) to the Secretary;
``(IV) if such error rate exceeds 3 percent for either of
the first 2 fiscal years in which the State elects to apply
this paragraph, demonstrate to the satisfaction of the
Secretary the specific corrective actions implemented by the
State to improve upon such error rate; and
``(V) if such error rate exceeds 3 percent for any fiscal
year in which the State elects to apply this paragraph, a
reduction in the amount otherwise payable to the State under
section 1903(a) for quarters for that fiscal year, equal to
the total amount of erroneous excess payments determined for
the fiscal year only with respect to the children included in
the sample for the fiscal year that are in excess of a 3
percent error rate with respect to such children.
``(ii) No punitive action based on error rate.--The
Secretary shall not apply the error rate derived from the
sample under clause (i) to the entire population of children
enrolled in the State Medicaid plan or the State CHIP plan
through reliance on a finding made by an Express Lane agency,
or to the population of children enrolled in such plans on
the basis of the State's regular procedures for determining
eligibility, or penalize the State on the basis of such error
rate in any manner other than the reduction of payments
provided for under clause (i)(V).
``(iii) Rule of construction.--Nothing in this paragraph
shall be construed as relieving a State that elects to apply
this paragraph from being subject to a penalty under section
1903(u), for payments made under the State Medicaid plan with
respect to ineligible individuals and families that are
determined to exceed the error rate permitted under that
section (as determined without regard to the error rate
determined under clause (i)(II)).
``(iv) Error rate defined.--In this subparagraph, the term
`error rate' means the rate of erroneous excess payments for
medical assistance (as defined in section 1903(u)(1)(D)) for
the period involved, except that such payments shall be
limited to individuals for which eligibility determinations
are made under this paragraph and except that in applying
this paragraph under title XXI, there shall be substituted
for references to provisions of this title corresponding
provisions within title XXI.
``(F) Express lane agency.--
``(i) In general.--In this paragraph, the term `Express
Lane agency' means a public agency that--
``(I) is determined by the State Medicaid agency or the
State CHIP agency (as applicable) to be capable of making the
determinations of one or more eligibility requirements
described in subparagraph (A)(i);
``(II) is identified in the State Medicaid plan or the
State CHIP plan; and
``(III) notifies the child's family--
``(aa) of the information which shall be disclosed in
accordance with this paragraph;
``(bb) that the information disclosed will be used solely
for purposes of determining eligibility for medical
assistance under the State Medicaid plan or for child health
assistance under the State CHIP plan; and
``(cc) that the family may elect to not have the
information disclosed for such purposes; and
``(IV) enters into, or is subject to, an interagency
agreement to limit the disclosure and use of the information
disclosed.
``(ii) Inclusion of specific public agencies.--Such term
includes the following:
``(I) A public agency that determines eligibility for
assistance under any of the following:
``(aa) The temporary assistance for needy families program
funded under part A of title IV.
``(bb) A State program funded under part D of title IV.
``(cc) The State Medicaid plan.
``(dd) The State CHIP plan.
``(ee) The Food Stamp Act of 1977 (7 U.S.C. 2011 et seq.).
``(ff) The Head Start Act (42 U.S.C. 9801 et seq.).
``(gg) The Richard B. Russell National School Lunch Act (42
U.S.C. 1751 et seq.).
``(hh) The Child Nutrition Act of 1966 (42 U.S.C. 1771 et
seq.).
``(ii) The Child Care and Development Block Grant Act of
1990 (42 U.S.C. 9858 et seq.).
``(jj) The Stewart B. McKinney Homeless Assistance Act (42
U.S.C. 11301 et seq.).
``(kk) The United States Housing Act of 1937 (42 U.S.C.
1437 et seq.).
``(ll) The Native American Housing Assistance and Self-
Determination Act of 1996 (25 U.S.C. 4101 et seq.).
``(II) A State-specified governmental agency that has
fiscal liability or legal responsibility for the accuracy of
the eligibility determination findings relied on by the
State.
``(III) A public agency that is subject to an interagency
agreement limiting the disclosure and use of the information
disclosed for purposes of determining eligibility under the
State Medicaid plan or the State CHIP plan.
``(iii) Exclusions.--Such term does not include an agency
that determines eligibility for a program established under
the Social Services Block Grant established under title XX or
a private, for-profit organization.
``(iv) Rules of construction.--Nothing in this paragraph
shall be construed as--
``(I) exempting a State Medicaid agency from complying with
the requirements of section 1902(a)(4) relating to merit-
based personnel standards for employees of the State Medicaid
agency and safeguards against conflicts of interest); or
``(II) authorizing a State Medicaid agency that elects to
use Express Lane agencies under this subparagraph to use the
Express Lane option to avoid complying with such requirements
for purposes of making eligibility determinations under the
State Medicaid plan.
``(v) Additional definitions.--In this paragraph:
``(I) State.--The term `State' means 1 of the 50 States or
the District of Columbia.
``(II) State chip agency.--The term `State CHIP agency'
means the State agency responsible for administering the
State CHIP plan.
``(III) State chip plan.--The term `State CHIP plan' means
the State child health plan established under title XXI and
includes any waiver of such plan.
``(IV) State medicaid agency.--The term `State Medicaid
agency' means the State agency responsible for administering
the State Medicaid plan.
``(V) State medicaid plan.--The term `State Medicaid plan'
means the State plan established under title XIX and includes
any waiver of such plan.
``(G) Child defined.--For purposes of this paragraph, the
term `child' means an individual under 19 years of age, or,
at the option of a State, such higher age, not to exceed 21
years of age, as the State may elect.
``(H) Application.--This paragraph shall not apply to with
respect to eligibility determinations made after September
30, 2012.''.
(2) CHIP.--Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)) is
amended by redesignating
[[Page H10853]]
subparagraphs (B), (C), and (D) as subparagraphs (C), (D),
and (E), respectively, and by inserting after subparagraph
(A) the following new subparagraph:
``(B) Section 1902(e)(13) (relating to the State option to
rely on findings from an Express Lane agency to help evaluate
a child's eligibility for medical assistance).''.
(b) Evaluation and Report.--
(1) Evaluation.--The Secretary shall conduct, by grant,
contract, or interagency agreement, a comprehensive,
independent evaluation of the option provided under the
amendments made by subsection (a). Such evaluation shall
include an analysis of the effectiveness of the option, and
shall include--
(A) obtaining a statistically valid sample of the children
who were enrolled in the State Medicaid plan or the State
CHIP plan through reliance on a finding made by an Express
Lane agency and determining the percentage of children who
were erroneously enrolled in such plans;
(B) determining whether enrolling children in such plans
through reliance on a finding made by an Express Lane agency
improves the ability of a State to identify and enroll low-
income, uninsured children who are eligible but not enrolled
in such plans;
(C) evaluating the administrative costs or savings related
to identifying and enrolling children in such plans through
reliance on such findings, and the extent to which such costs
differ from the costs that the State otherwise would have
incurred to identify and enroll low-income, uninsured
children who are eligible but not enrolled in such plans; and
(D) any recommendations for legislative or administrative
changes that would improve the effectiveness of enrolling
children in such plans through reliance on such findings.
(2) Report to congress.--Not later than September 30, 2011,
the Secretary shall submit a report to Congress on the
results of the evaluation under paragraph (1).
(3) Funding.--
(A) In general.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated to the
Secretary to carry out the evaluation under this subsection
$5,000,000 for the period of fiscal years 2008 through 2011.
(B) Budget authority.--Subparagraph (A) constitutes budget
authority in advance of appropriations Act and represents the
obligation of the Federal Government to provide for the
payment of such amount to conduct the evaluation under this
subsection.
(c) Electronic Transmission of Information.--Section 1902
(42 U.S.C. 1396a) is amended by adding at the end the
following new subsection:
``(dd) Electronic Transmission of Information.--If the
State agency determining eligibility for medical assistance
under this title or child health assistance under title XXI
verifies an element of eligibility based on information from
an Express Lane Agency (as defined in subsection (e)(13)(F)),
or from another public agency, then the applicant's signature
under penalty of perjury shall not be required as to such
element. Any signature requirement for an application for
medical assistance may be satisfied through an electronic
signature, as defined in section 1710(1) of the Government
Paperwork Elimination Act (44 U.S.C. 3504 note). The
requirements of subparagraphs (A) and (B) of section
1137(d)(2) may be met through evidence in digital or
electronic form.''.
(d) Authorization of Information Disclosure.--
(1) In general.--Title XIX is amended--
(A) by redesignating section 1939 as section 1940; and
(B) by inserting after section 1938 the following new
section:
``SEC. 1939. AUTHORIZATION TO RECEIVE RELEVANT INFORMATION.
``(a) In General.--Notwithstanding any other provision of
law, a Federal or State agency or private entity in
possession of the sources of data directly relevant to
eligibility determinations under this title (including
eligibility files maintained by Express Lane agencies
described in section 1902(e)(13)(F), information described in
paragraph (2) or (3) of section 1137(a), vital records
information about births in any State, and information
described in sections 453(i) and 1902(a)(25)(I)) is
authorized to convey such data or information to the State
agency administering the State plan under this title, to the
extent such conveyance meets the requirements of subsection
(b).
``(b) Requirements for Conveyance.--Data or information may
be conveyed pursuant to subsection (a) only if the following
requirements are met:
``(1) The individual whose circumstances are described in
the data or information (or such individual's parent,
guardian, caretaker relative, or authorized representative)
has either provided advance consent to disclosure or has not
objected to disclosure after receiving advance notice of
disclosure and a reasonable opportunity to object.
``(2) Such data or information are used solely for the
purposes of--
``(A) identifying individuals who are eligible or
potentially eligible for medical assistance under this title
and enrolling or attempting to enroll such individuals in the
State plan; and
``(B) verifying the eligibility of individuals for medical
assistance under the State plan.
``(3) An interagency or other agreement, consistent with
standards developed by the Secretary--
``(A) prevents the unauthorized use, disclosure, or
modification of such data and otherwise meets applicable
Federal requirements safeguarding privacy and data security;
and
``(B) requires the State agency administering the State
plan to use the data and information obtained under this
section to seek to enroll individuals in the plan.
``(c) Penalties for Improper Disclosure.--
``(1) Civil money penalty.--A private entity described in
the subsection (a) that publishes, discloses, or makes known
in any manner, or to any extent not authorized by Federal
law, any information obtained under this section is subject
to a civil money penalty in an amount equal to $10,000 for
each such unauthorized publication or disclosure. The
provisions of section 1128A (other than subsections (a) and
(b) and the second sentence of subsection (f)) shall apply to
a civil money penalty under this paragraph in the same manner
as such provisions apply to a penalty or proceeding under
section 1128A(a).
``(2) Criminal penalty.--A private entity described in the
subsection (a) that willfully publishes, discloses, or makes
known in any manner, or to any extent not authorized by
Federal law, any information obtained under this section
shall be fined not more than $10,000 or imprisoned not more
than 1 year, or both, for each such unauthorized publication
or disclosure.
``(d) Rule of Construction.--The limitations and
requirements that apply to disclosure pursuant to this
section shall not be construed to prohibit the conveyance or
disclosure of data or information otherwise permitted under
Federal law (without regard to this section).''.
(2) Conforming amendment to title xxi.--Section 2107(e)(1)
(42 U.S.C. 1397gg(e)(1)), as amended by subsection (a)(2), is
amended by adding at the end the following new subparagraph:
``(F) Section 1939 (relating to authorization to receive
data directly relevant to eligibility determinations).''.
(3) Conforming amendment to provide access to data about
enrollment in insurance for purposes of evaluating
applications and for chip.--Section 1902(a)(25)(I)(i) (42
U.S.C. 1396a(a)(25)(I)(i)) is amended--
(A) by inserting ``(and, at State option, individuals who
apply or whose eligibility for medical assistance is being
evaluated in accordance with section 1902(e)(13)(D))'' after
``with respect to individuals who are eligible''; and
(B) by inserting ``under this title (and, at State option,
child health assistance under title XXI)'' after ``the State
plan''.
(e) Authorization for States Electing Express Lane Option
To Receive Certain Data Directly Relevant To Determining
Eligibility and Correct Amount of Assistance.--The Secretary
shall enter into such agreements as are necessary to permit a
State that elects the Express Lane option under section
1902(e)(13) of the Social Security Act to receive data
directly relevant to eligibility determinations and
determining the correct amount of benefits under a State
child health plan under CHIP or a State plan under Medicaid
from the following:
(1) The National Directory of New Hires established under
section 453(i) of the Social Security Act (42 U.S.C. 653(i)).
(2) Data regarding enrollment in insurance that may help to
facilitate outreach and enrollment under the State Medicaid
plan, the State CHIP plan, and such other programs as the
Secretary may specify.
(f) Effective Date.--The amendments made by this section
are effective on January 1, 2008.
Subtitle B--Reducing Barriers to Enrollment
SEC. 211. VERIFICATION OF DECLARATION OF CITIZENSHIP OR
NATIONALITY FOR PURPOSES OF ELIGIBILITY FOR
MEDICAID AND CHIP.
(a) State Option To Verify Declaration of Citizenship or
Nationality for Purposes of Eligibility for Medicaid Through
Verification of Name and Social Security Number.--
(1) Alternative to documentation requirement.--
(A) In general.--Section 1902 (42 U.S.C. 1396a), as amended
by section 203(c), is amended--
(i) in subsection (a)(46)--
(I) by inserting ``(A)'' after ``(46)'';
(II) by adding ``and'' after the semicolon; and
(III) by adding at the end the following new subparagraph:
``(B) provide, with respect to an individual declaring to
be a citizen or national of the United States for purposes of
establishing eligibility under this title, that the State
shall satisfy the requirements of--
``(i) section 1903(x); or
``(ii) subsection (ee);''; and
(ii) by adding at the end the following new subsection:
``(ee)(1) For purposes of subsection (a)(46)(B)(ii), the
requirements of this subsection with respect to an individual
declaring to be a citizen or national of the United States
for purposes of establishing eligibility under this title,
are, in lieu of requiring the individual to present
satisfactory documentary evidence of citizenship or
nationality under section 1903(x) (if the individual is not
described in paragraph (2) of that section), as follows:
``(A) The State submits the name and social security number
of the individual to the Commissioner of Social Security as
part of the program established under paragraph (2).
[[Page H10854]]
``(B) If the State receives notice from the Commissioner of
Social Security that the name or social security number of
the individual is invalid--
``(i) the State makes a reasonable effort to identify and
address the causes of such invalid match, including through
typographical or other clerical errors, by contacting the
individual to confirm the accuracy of the name or social
security number, respectively, submitted, and by taking such
additional actions as the Secretary, through regulation or
other guidance, or the State may identify, and continues to
provide the individual with medical assistance while making
such effort; and
``(ii) in the case that the name or social security number
of the individual remains invalid after such reasonable
efforts, the State--
``(I) notifies the individual of such fact;
``(II) provides the individual with a period of 90 days
from the date on which the notice required under subclause
(I) is received by the individual to either present
satisfactory documentary evidence of citizenship or
nationality (as defined in section 1903(x)(3)) or cure the
invalid determination with the Commissioner of Social
Security (and continues to provide the individual with
medical assistance during such 90-day period); and
``(III) disenrolls the individual from the State plan under
this title within 30 days after the end of such 90-day period
if no such documentary evidence is presented or if such
invalid determination is not cured.
``(2)(A) Each State electing to satisfy the requirements of
this subsection for purposes of section 1902(a)(46)(B) shall
establish a program under which the State submits each month
to the Commissioner of Social Security for verification the
name and social security number of each individual newly
enrolled in the State plan under this title that month who is
not described in section 1903(x)(2).
``(B) In establishing the State program under this
paragraph, the State may enter into an agreement with the
Commissioner of Social Security--
``(i) to provide for the electronic submission and
verification, through an on-line system or otherwise, of the
name and social security number of an individual enrolled in
the State plan under this title;
``(ii) to submit to the Commissioner the names and social
security numbers of such individuals on a batch basis,
provided that such batches are submitted at least on a
monthly basis; or
``(iii) to provide for the verification of the names and
social security numbers of such individuals through such
other method as agreed to by the State and the Commissioner
and approved by the Secretary, provided that such method is
no more burdensome for individuals to comply with than any
burdens that may apply under a method described in clause (i)
or (ii).
``(C) The program established under this paragraph shall
provide that, in the case of any individual who is required
to submit a social security number to the State under
subparagraph (A) and who is unable to provide the State with
such number, shall be provided with at least the reasonable
opportunity to present satisfactory documentary evidence of
citizenship or nationality (as defined in section 1903(x)(3))
as is provided under clauses (i) and (ii) of section
1137(d)(4)(A) to an individual for the submittal to the State
of evidence indicating a satisfactory immigration status.
``(3)(A) The State agency implementing the plan approved
under this title shall, at such times and in such form as the
Secretary may specify, provide information on the percentage
each month that the invalid names and numbers submitted bears
to the total submitted for verification. For purposes of the
previous sentence, a name or social security number of an
individual shall be treated as invalid and included in the
determination of such percentage only if--
``(i) the name or social security number, respectively,
submitted by the individual does not match Social Security
Administration records;
``(ii) the inconsistency between the name or number,
respectively, so submitted and the Social Security
Administration records could not be resolved by the State;
``(iii) the individual was provided with a reasonable
period of time to resolve the inconsistency with the Social
Security Administration or provide satisfactory documentation
of citizenship and did not successfully resolve such
inconsistency; and
``(iv) payment has been made for an item or service
furnished to the individual under this title.
``(B) If, for any fiscal year, the average monthly
percentage determined under subparagraph (A) is greater than
3 percent--
``(i) the State shall develop and adopt a corrective plan
to review its procedures for verifying the identities of
individuals seeking to enroll in the State plan under this
title and to identify and implement changes in such
procedures to improve their accuracy; and
``(ii) pay to the Secretary an amount equal to the amount
which bears the same ratio to the total payments under the
State plan for the fiscal year for providing medical
assistance to individuals who provided invalid information as
the number of individuals with invalid information in excess
of 3 percent of such total submitted bears to the total
number of individuals with invalid information.
``(C) The Secretary may waive, in certain limited cases,
all or part of the payment under subparagraph (B)(ii) if the
State is unable to reach the allowable error rate despite a
good faith effort by such State.
``(D) This paragraph shall not apply to a State for a
fiscal year if there is an agreement described in paragraph
(2)(B) in effect as of the close of the fiscal year.
``(4) Nothing in this subsection shall affect the rights of
any individual under this title to appeal any disenrollment
from a State plan.''.
(B) Costs of implementing and maintaining system.--Section
1903(a)(3) (42 U.S.C. 1396b(a)(3)) is amended--
(i) by striking ``plus'' at the end of subparagraph (E) and
inserting ``and'', and
(ii) by adding at the end the following new subparagraph:
``(F)(i) 90 percent of the sums expended during the quarter
as are attributable to the design, development, or
installation of such mechanized verification and information
retrieval systems as the Secretary determines are necessary
to implement section 1902(ee) (including a system described
in paragraph (2)(B) thereof), and
``(ii) 75 percent of the sums expended during the quarter
as are attributable to the operation of systems to which
clause (i) applies, plus''.
(2) Limitation on waiver authority.--Notwithstanding any
provision of section 1115 of the Social Security Act (42
U.S.C. 1315), or any other provision of law, the Secretary
may not waive the requirements of section 1902(a)(46)(B) of
such Act (42 U.S.C. 1396a(a)(46)(B)) with respect to a State.
(3) Conforming amendments.--Section 1903 (42 U.S.C. 1396b)
is amended--
(A) in subsection (i)(22), by striking ``subsection (x)''
and inserting ``section 1902(a)(46)(B)''; and
(B) in subsection (x)(1), by striking ``subsection
(i)(22)'' and inserting ``section 1902(a)(46)(B)(i)''.
(b) Clarification of Requirements Relating to Presentation
of Satisfactory Documentary Evidence of Citizenship or
Nationality.--
(1) Acceptance of documentary evidence issued by a
federally recognized indian tribe.--Section 1903(x)(3)(B) (42
U.S.C. 1396b(x)(3)(B)) is amended--
(A) by redesignating clause (v) as clause (vi); and
(B) by inserting after clause (iv), the following new
clause:
``(v)(I) Except as provided in subclause (II), a document
issued by a federally recognized Indian tribe evidencing
membership or enrollment in, or affiliation with, such tribe
(such as a tribal enrollment card or certificate of degree of
Indian blood).
``(II) With respect to those federally recognized Indian
tribes located within States having an international border
whose membership includes individuals who are not citizens of
the United States, the Secretary shall, after consulting with
such tribes, issue regulations authorizing the presentation
of such other forms of documentation (including tribal
documentation, if appropriate) that the Secretary determines
to be satisfactory documentary evidence of citizenship or
nationality for purposes of satisfying the requirement of
this subsection.''.
(2) Requirement to provide reasonable opportunity to
present satisfactory documentary evidence.--Section 1903(x)
(42 U.S.C. 1396b(x)) is amended by adding at the end the
following new paragraph:
``(4) In the case of an individual declaring to be a
citizen or national of the United States with respect to whom
a State requires the presentation of satisfactory documentary
evidence of citizenship or nationality under section
1902(a)(46)(B)(i), the individual shall be provided at least
the reasonable opportunity to present satisfactory
documentary evidence of citizenship or nationality under this
subsection as is provided under clauses (i) and (ii) of
section 1137(d)(4)(A) to an individual for the submittal to
the State of evidence indicating a satisfactory immigration
status.''.
(3) Children born in the united states to mothers eligible
for medicaid.--
(A) Clarification of rules.--Section 1903(x) (42 U.S.C.
1396b(x)), as amended by paragraph (2), is amended--
(i) in paragraph (2)--
(I) in subparagraph (C), by striking ``or'' at the end;
(II) by redesignating subparagraph (D) as subparagraph (E);
and
(III) by inserting after subparagraph (C) the following new
subparagraph:
``(D) pursuant to the application of section 1902(e)(4)
(and, in the case of an individual who is eligible for
medical assistance on such basis, the individual shall be
deemed to have provided satisfactory documentary evidence of
citizenship or nationality and shall not be required to
provide further documentary evidence on any date that occurs
during or after the period in which the individual is
eligible for medical assistance on such basis); or''; and
(ii) by adding at the end the following new paragraph:
``(5) Nothing in subparagraph (A) or (B) of section
1902(a)(46), the preceding paragraphs of this subsection, or
the Deficit Reduction Act of 2005, including section 6036 of
such Act, shall be construed as changing the requirement of
section 1902(e)(4) that a child born in the United States to
an alien mother for whom medical assistance for the delivery
of such child is available as treatment of an emergency
medical condition pursuant to
[[Page H10855]]
subsection (v) shall be deemed eligible for medical
assistance during the first year of such child's life.''.
(B) State requirement to issue separate identification
number.--Section 1902(e)(4) (42 U.S.C. 1396a(e)(4)) is
amended by adding at the end the following new sentence:
``Notwithstanding the preceding sentence, in the case of a
child who is born in the United States to an alien mother for
whom medical assistance for the delivery of the child is made
available pursuant to section 1903(v), the State immediately
shall issue a separate identification number for the child
upon notification by the facility at which such delivery
occurred of the child's birth.''.
(4) Technical amendments.--Section 1903(x)(2) (42 U.S.C.
1396b(x)) is amended--
(A) in subparagraph (B)--
(i) by realigning the left margin of the matter preceding
clause (i) 2 ems to the left; and
(ii) by realigning the left margins of clauses (i) and
(ii), respectively, 2 ems to the left; and
(B) in subparagraph (C)--
(i) by realigning the left margin of the matter preceding
clause (i) 2 ems to the left; and
(ii) by realigning the left margins of clauses (i) and
(ii), respectively, 2 ems to the left.
(c) Application of Documentation System to CHIP.--
(1) In general.--Section 2105(c) (42 U.S.C. 1397ee(c)), as
amended by sections 114(a) and 116(c), is amended by adding
at the end the following new paragraph:
``(10) Citizenship documentation requirements.--
``(A) In general.--No payment may be made under this
section with respect to an individual who has, or is,
declared to be a citizen or national of the United States for
purposes of establishing eligibility under this title unless
the State meets the requirements of section 1902(a)(46)(B)
with respect to the individual.
``(B) Enhanced payments.--Notwithstanding subsection (b),
the enhanced FMAP with respect to payments under subsection
(a) for expenditures described in clause (i) or (ii) of
section 1903(a)(3)(F) necessary to comply with subparagraph
(A) shall in no event be less than 90 percent and 75 percent,
respectively.''.
(2) Nonapplication of administrative expenditures cap.--
Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)(C)), as amended
by section 202(b), is amended by adding at the end the
following:
``(ii) Expenditures to comply with citizenship or
nationality verification requirements.--Expenditures
necessary for the State to comply with paragraph (9)(A).''.
(d) Effective Date.--
(1) In general.--
(A) In general.--Except as provided in subparagraph (B),
the amendments made by this section shall take effect on
October 1, 2008.
(B) Technical amendments.--The amendments made by--
(i) paragraphs (1), (2), and (3) of subsection (b) shall
take effect as if included in the enactment of section 6036
of the Deficit Reduction Act of 2005 (Public Law 109-171; 120
Stat. 80); and
(ii) paragraph (4) of subsection (b) shall take effect as
if included in the enactment of section 405 of division B of
the Tax Relief and Health Care Act of 2006 (Public Law 109-
432; 120 Stat. 2996).
(2) Restoration of eligibility.--In the case of an
individual who, during the period that began on July 1, 2006,
and ends on October 1, 2008, was determined to be ineligible
for medical assistance under a State Medicaid plan, including
any waiver of such plan, solely as a result of the
application of subsections (i)(22) and (x) of section 1903 of
the Social Security Act (as in effect during such period),
but who would have been determined eligible for such
assistance if such subsections, as amended by subsection (b),
had applied to the individual, a State may deem the
individual to be eligible for such assistance as of the
date that the individual was determined to be ineligible
for such medical assistance on such basis.
(3) Special transition rule for indians.--During the period
that begins on July 1, 2006, and ends on the effective date
of final regulations issued under subclause (II) of section
1903(x)(3)(B)(v) of the Social Security Act (42 U.S.C.
1396b(x)(3)(B)(v)) (as added by subsection (b)(1)(B)), an
individual who is a member of a federally-recognized Indian
tribe described in subclause (II) of that section who
presents a document described in subclause (I) of such
section that is issued by such Indian tribe, shall be deemed
to have presented satisfactory evidence of citizenship or
nationality for purposes of satisfying the requirement of
subsection (x) of section 1903 of such Act.
SEC. 212. REDUCING ADMINISTRATIVE BARRIERS TO ENROLLMENT.
Section 2102(b) (42 U.S.C. 1397bb(b)) is amended--
(1) by redesignating paragraph (4) as paragraph (5); and
(2) by inserting after paragraph (3) the following new
paragraph:
``(4) Reduction of administrative barriers to enrollment.--
``(A) In general.--Subject to subparagraph (B), the plan
shall include a description of the procedures used to reduce
administrative barriers to the enrollment of children and
pregnant women who are eligible for medical assistance under
title XIX or for child health assistance or health benefits
coverage under this title. Such procedures shall be
established and revised as often as the State determines
appropriate to take into account the most recent information
available to the State identifying such barriers.
``(B) Deemed compliance if joint application and renewal
process that permits application other than in person.--A
State shall be deemed to comply with subparagraph (A) if the
State's application and renewal forms and supplemental forms
(if any) and information verification process is the same for
purposes of establishing and renewing eligibility for
children and pregnant women for medical assistance under
title XIX and child health assistance under this title, and
such process does not require an application to be made in
person or a face-to-face interview.''.
SEC. 213. MODEL OF INTERSTATE COORDINATED ENROLLMENT AND
COVERAGE PROCESS.
(a) In General.--In order to assure continuity of coverage
of low-income children under the Medicaid program and the
State Children's Health Insurance Program (CHIP), not later
than 18 months after the date of the enactment of this Act,
the Secretary of Health and Human Services, in consultation
with State Medicaid and CHIP directors and organizations
representing program beneficiaries, shall develop a model
process for the coordination of the enrollment, retention,
and coverage under such programs of children who, because of
migration of families, emergency evacuations, natural or
other disasters, public health emergencies, educational
needs, or otherwise, frequently change their State of
residency or otherwise are temporarily located outside of the
State of their residency.
(b) Report to Congress.--After development of such model
process, the Secretary of Health and Human Services shall
submit to Congress a report describing additional steps or
authority needed to make further improvements to coordinate
the enrollment, retention, and coverage under CHIP and
Medicaid of children described in subsection (a).
TITLE III--REDUCING BARRIERS TO PROVIDING PREMIUM ASSISTANCE
Subtitle A--Additional State Option for Providing Premium Assistance
SEC. 301. ADDITIONAL STATE OPTION FOR PROVIDING PREMIUM
ASSISTANCE.
(a) CHIP.--
(1) In general.--Section 2105(c) (42 U.S.C. 1397ee(c)), as
amended by sections 114(a), 116(c), and 211(c), is amended by
adding at the end the following:
``(11) State option to offer premium assistance.--
``(A) In general.--A State may elect to offer a premium
assistance subsidy (as defined in subparagraph (C)) for
qualified employer-sponsored coverage (as defined in
subparagraph (B)) to all targeted low-income children who are
eligible for child health assistance under the plan and have
access to such coverage in accordance with the requirements
of this paragraph. No subsidy shall be provided to a targeted
low-income child under this paragraph unless the child (or
the child's parent) voluntarily elects to receive such a
subsidy. A State may not require such an election as a
condition of receipt of child health assistance.
``(B) Qualified employer-sponsored coverage.--
``(i) In general.--Subject to clause (ii), in this
paragraph, the term `qualified employer-sponsored coverage'
means a group health plan or health insurance coverage
offered through an employer--
``(I) that qualifies as creditable coverage as a group
health plan under section 2701(c)(1) of the Public Health
Service Act;
``(II) for which the employer contribution toward any
premium for such coverage is at least 40 percent; and
``(III) that is offered to all individuals in a manner that
would be considered a nondiscriminatory eligibility
classification for purposes of paragraph (3)(A)(ii) of
section 105(h) of the Internal Revenue Code of 1986 (but
determined without regard to clause (i) of subparagraph (B)
of such paragraph).
``(ii) Exception.--Such term does not include coverage
consisting of--
``(I) benefits provided under a health flexible spending
arrangement (as defined in section 106(c)(2) of the Internal
Revenue Code of 1986); or
``(II) a high deductible health plan (as defined in section
223(c)(2) of such Code), without regard to whether the plan
is purchased in conjunction with a health savings account (as
defined under section 223(d) of such Code).
``(C) Premium assistance subsidy.--
``(i) In general.--In this paragraph, the term `premium
assistance subsidy' means, with respect to a targeted low-
income child, the amount equal to the difference between the
employee contribution required for enrollment only of the
employee under qualified employer-sponsored coverage and the
employee contribution required for enrollment of the employee
and the child in such coverage, less any applicable premium
cost-sharing applied under the State child health plan
(subject to the limitations imposed under section 2103(e),
including the requirement to count the total amount of the
employee contribution required for enrollment of the employee
and the child in such coverage toward the annual aggregate
cost-sharing limit applied under paragraph (3)(B) of such
section).
``(ii) State payment option.--A State may provide a premium
assistance subsidy either
[[Page H10856]]
as reimbursement to an employee for out-of-pocket
expenditures or, subject to clause (iii), directly to the
employee's employer.
``(iii) Employer opt-out.--An employer may notify a State
that it elects to opt-out of being directly paid a premium
assistance subsidy on behalf of an employee. In the event of
such a notification, an employer shall withhold the total
amount of the employee contribution required for enrollment
of the employee and the child in the qualified employer-
sponsored coverage and the State shall pay the premium
assistance subsidy directly to the employee.
``(iv) Treatment as child health assistance.--Expenditures
for the provision of premium assistance subsidies shall be
considered child health assistance described in paragraph
(1)(C) of subsection (a) for purposes of making payments
under that subsection.
``(D) Application of secondary payor rules.--The State
shall be a secondary payor for any items or services provided
under the qualified employer-sponsored coverage for which the
State provides child health assistance under the State child
health plan.
``(E) Requirement to provide supplemental coverage for
benefits and cost-sharing protection provided under the state
child health plan.--
``(i) In general.--Notwithstanding section 2110(b)(1)(C),
the State shall provide for each targeted low-income child
enrolled in qualified employer-sponsored coverage,
supplemental coverage consisting of--
``(I) items or services that are not covered, or are only
partially covered, under the qualified employer-sponsored
coverage; and
``(II) cost-sharing protection consistent with section
2103(e).
``(ii) Record keeping requirements.--For purposes of
carrying out clause (i), a State may elect to directly pay
out-of-pocket expenditures for cost-sharing imposed under the
qualified employer-sponsored coverage and collect or not
collect all or any portion of such expenditures from the
parent of the child.
``(F) Application of waiting period imposed under the
state.--Any waiting period imposed under the State child
health plan prior to the provision of child health assistance
to a targeted low-income child under the State plan shall
apply to the same extent to the provision of a premium
assistance subsidy for the child under this paragraph.
``(G) Opt-out permitted for any month.--A State shall
establish a process for permitting the parent of a targeted
low-income child receiving a premium assistance subsidy to
disenroll the child from the qualified employer-sponsored
coverage and enroll the child in, and receive child health
assistance under, the State child health plan, effective on
the first day of any month for which the child is eligible
for such assistance and in a manner that ensures continuity
of coverage for the child.
``(H) Application to parents.--If a State provides child
health assistance or health benefits coverage to parents of a
targeted low-income child in accordance with section 2111(b),
the State may elect to offer a premium assistance subsidy to
a parent of a targeted low-income child who is eligible for
such a subsidy under this paragraph in the same manner as the
State offers such a subsidy for the enrollment of the child
in qualified employer-sponsored coverage, except that--
``(i) the amount of the premium assistance subsidy shall be
increased to take into account the cost of the enrollment of
the parent in the qualified employer-sponsored coverage or,
at the option of the State if the State determines it cost-
effective, the cost of the enrollment of the child's family
in such coverage; and
``(ii) any reference in this paragraph to a child is deemed
to include a reference to the parent or, if applicable under
clause (i), the family of the child.
``(I) Additional state option for providing premium
assistance.--
``(i) In general.--A State may establish an employer-family
premium assistance purchasing pool for employers with less
than 250 employees who have at least 1 employee who is a
pregnant woman eligible for assistance under the State child
health plan (including through the application of an option
described in section 2112(f)) or a member of a family with at
least 1 targeted low-income child and to provide a premium
assistance subsidy under this paragraph for enrollment in
coverage made available through such pool.
``(ii) Access to choice of coverage.--A State that elects
the option under clause (i) shall identify and offer access
to not less than 2 private health plans that are health
benefits coverage that is equivalent to the benefits coverage
in a benchmark benefit package described in section 2103(b)
or benchmark-equivalent coverage that meets the requirements
of section 2103(a)(2) for employees described in clause (i).
``(iii) Clarification of payment for administrative
expenditures.--Nothing in this subparagraph shall be
construed as permitting payment under this section for
administrative expenditures attributable to the establishment
or operation of such pool, except to the extent that such
payment would otherwise be permitted under this title.
``(J) No effect on premium assistance waiver programs.--
Nothing in this paragraph shall be construed as limiting the
authority of a State to offer premium assistance under
section 1906 or 1906A, a waiver described in paragraph (2)(B)
or (3), a waiver approved under section 1115, or other
authority in effect prior to the date of enactment of the
Children's Health Insurance Program Reauthorization Act of
2007.
``(K) Notice of availability.--If a State elects to provide
premium assistance subsidies in accordance with this
paragraph, the State shall--
``(i) include on any application or enrollment form for
child health assistance a notice of the availability of
premium assistance subsidies for the enrollment of targeted
low-income children in qualified employer-sponsored coverage;
``(ii) provide, as part of the application and enrollment
process under the State child health plan, information
describing the availability of such subsidies and how to
elect to obtain such a subsidy; and
``(iii) establish such other procedures as the State
determines necessary to ensure that parents are fully
informed of the choices for receiving child health assistance
under the State child health plan or through the receipt of
premium assistance subsidies.
``(L) Application to qualified employer-sponsored benchmark
coverage.--If a group health plan or health insurance
coverage offered through an employer is certified by an
actuary as health benefits coverage that is equivalent to the
benefits coverage in a benchmark benefit package described in
section 2103(b) or benchmark-equivalent coverage that meets
the requirements of section 2103(a)(2), the State may provide
premium assistance subsidies for enrollment of targeted low-
income children in such group health plan or health insurance
coverage in the same manner as such subsidies are provided
under this paragraph for enrollment in qualified employer-
sponsored coverage, but without regard to the requirement to
provide supplemental coverage for benefits and cost-sharing
protection provided under the State child health plan under
subparagraph (E).
``(M) Satisfaction of cost-effectiveness test.--Premium
assistance subsidies for qualified employer-sponsored
coverage offered under this paragraph shall be deemed to meet
the requirement of subparagraph (A) of paragraph (3).''.
(2) Determination of cost-effectiveness for premium
assistance or purchase of family coverage.--
(A) In general.--Section 2105(c)(3)(A) (42 U.S.C.
1397ee(c)(3)(A)) is amended by striking ``relative to'' and
all that follows through the comma and inserting ``relative
to
``(i) the amount of expenditures under the State child
health plan, including administrative expenditures, that the
State would have made to provide comparable coverage of the
targeted low-income child involved or the family involved (as
applicable); or
``(ii) the aggregate amount of expenditures that the State
would have made under the State child health plan, including
administrative expenditures, for providing coverage under
such plan for all such children or families.''.
(B) Nonapplication to previously approved coverage.--The
amendment made by subparagraph (A) shall not apply to
coverage the purchase of which has been approved by the
Secretary under section 2105(c)(3) of the Social Security Act
prior to the date of enactment of this Act.
(b) Medicaid.--Title XIX is amended by inserting after
section 1906 the following new section:
``PREMIUM ASSISTANCE OPTION FOR CHILDREN
``Sec. 1906A. (a) In General.--A State may elect to offer
a premium assistance subsidy (as defined in subsection (c))
for qualified employer-sponsored coverage (as defined in
subsection (b)) to all individuals under age 19 who are
entitled to medical assistance under this title (and to the
parent of such an individual) who have access to such
coverage if the State meets the requirements of this section.
``(b) Qualified Employer-Sponsored Coverage.--
``(1) In general.--Subject to paragraph (2)), in this
paragraph, the term `qualified employer-sponsored coverage'
means a group health plan or health insurance coverage
offered through an employer--
``(A) that qualifies as creditable coverage as a group
health plan under section 2701(c)(1) of the Public Health
Service Act;
``(B) for which the employer contribution toward any
premium for such coverage is at least 40 percent; and
``(C) that is offered to all individuals in a manner that
would be considered a nondiscriminatory eligibility
classification for purposes of paragraph (3)(A)(ii) of
section 105(h) of the Internal Revenue Code of 1986 (but
determined without regard to clause (i) of subparagraph (B)
of such paragraph).
``(2) Exception.--Such term does not include coverage
consisting of--
``(A) benefits provided under a health flexible spending
arrangement (as defined in section 106(c)(2) of the Internal
Revenue Code of 1986); or
``(B) a high deductible health plan (as defined in section
223(c)(2) of such Code), without regard to whether the plan
is purchased in conjunction with a health savings account (as
defined under section 223(d) of such Code).
``(3) Treatment as third party liability.--The State shall
treat the coverage provided under qualified employer-
sponsored coverage as a third party liability under section
1902(a)(25).
[[Page H10857]]
``(c) Premium Assistance Subsidy.--In this section, the
term `premium assistance subsidy' means the amount of the
employee contribution for enrollment in the qualified
employer-sponsored coverage by the individual under age 19 or
by the individual's family. Premium assistance subsidies
under this section shall be considered, for purposes of
section 1903(a), to be a payment for medical assistance.
``(d) Voluntary Participation.--
``(1) Employers.--Participation by an employer in a premium
assistance subsidy offered by a State under this section
shall be voluntary. An employer may notify a State that it
elects to opt-out of being directly paid a premium assistance
subsidy on behalf of an employee.
``(2) Beneficiaries.--No subsidy shall be provided to an
individual under age 19 under this section unless the
individual (or the individual's parent) voluntarily elects to
receive such a subsidy. A State may not require such an
election as a condition of receipt of medical assistance.
State may not require, as a condition of an individual under
age 19 (or the individual's parent) being or remaining
eligible for medical assistance under this title, apply for
enrollment in qualified employer-sponsored coverage under
this section.
``(3) Opt-out permitted for any month.--A State shall
establish a process for permitting the parent of an
individual under age 19 receiving a premium assistance
subsidy to disenroll the individual from the qualified
employer-sponsored coverage.
``(e) Requirement to Pay Premiums and Cost-Sharing and
Provide Supplemental Coverage.--In the case of the
participation of an individual under age 19 (or the
individual's parent) in a premium assistance subsidy under
this section for qualified employer-sponsored coverage, the
State shall provide for payment of all enrollee premiums for
enrollment in such coverage and all deductibles, coinsurance,
and other cost-sharing obligations for items and services
otherwise covered under the State plan under this title
(exceeding the amount otherwise permitted under section 1916
or, if applicable, section 1916A). The fact that an
individual under age 19 (or a parent) elects to enroll in
qualified employer-sponsored coverage under this section
shall not change the individual's (or parent's) eligibility
for medical assistance under the State plan, except insofar
as section 1902(a)(25) provides that payments for such
assistance shall first be made under such coverage.''.
(c) GAO Study and Report.--Not later than January 1, 2009,
the Comptroller General of the United States shall study cost
and coverage issues relating to any State premium assistance
programs for which Federal matching payments are made under
title XIX or XXI of the Social Security Act, including under
waiver authority, and shall submit a report to the Committee
on Finance of the Senate and the Committee on Energy and
Commerce of the House of Representatives on the results of
such study.
SEC. 302. OUTREACH, EDUCATION, AND ENROLLMENT ASSISTANCE.
(a) Requirement To Include Description of Outreach,
Education, and Enrollment Efforts Related to Premium
Assistance Subsidies in State Child Health Plan.--Section
2102(c) (42 U.S.C. 1397bb(c)) is amended by adding at the end
the following new paragraph:
``(3) Premium assistance subsidies.--In the case of a State
that provides for premium assistance subsidies under the
State child health plan in accordance with paragraphs (2)(B),
(3), or (10) of section 2105(c), or a waiver approved under
section 1115, outreach, education, and enrollment assistance
for families of children likely to be eligible for such
subsidies, to inform such families of the availability of,
and to assist them in enrolling their children in, such
subsidies, and for employers likely to provide coverage that
is eligible for such subsidies, including the specific,
significant resources the State intends to apply to educate
employers about the availability of premium assistance
subsidies under the State child health plan.''.
(b) Nonapplication of 10 Percent Limit on Outreach and
Certain Other Expenditures.--Section 2105(c)(2)(C) (42 U.S.C.
1397ee(c)(2)(C)), as amended by section 301(c)(2), is amended
by adding at the end the following new clause:
``(iv) Expenditures for outreach to increase the enrollment
of children under this title and title xix through premium
assistance subsidies.--Expenditures for outreach activities
to families of children likely to be eligible for premium
assistance subsidies in accordance with paragraphs (2)(B),
(3), or (10), or a waiver approved under section 1115, to
inform such families of the availability of, and to assist
them in enrolling their children in, such subsidies, and to
employers likely to provide qualified employer-sponsored
coverage (as defined in subparagraph (B) of such paragraph),
but not to exceed an amount equal to 1.25 percent of the
maximum amount permitted to be expended under subparagraph
(A) for items described in subsection (a)(1)(D).''.
Subtitle B--Coordinating Premium Assistance With Private Coverage
SEC. 311. SPECIAL ENROLLMENT PERIOD UNDER GROUP HEALTH PLANS
IN CASE OF TERMINATION OF MEDICAID OR CHIP
COVERAGE OR ELIGIBILITY FOR ASSISTANCE IN
PURCHASE OF EMPLOYMENT-BASED COVERAGE;
COORDINATION OF COVERAGE.
(a) Amendments to Internal Revenue Code of 1986.--Section
9801(f) of the Internal Revenue Code of 1986 (relating to
special enrollment periods) is amended by adding at the end
the following new paragraph:
``(3) Special rules relating to medicaid and chip.--
``(A) In general.--A group health plan shall permit an
employee who is eligible, but not enrolled, for coverage
under the terms of the plan (or a dependent of such an
employee if the dependent is eligible, but not enrolled, for
coverage under such terms) to enroll for coverage under the
terms of the plan if either of the following conditions is
met:
``(i) Termination of medicaid or chip coverage.--The
employee or dependent is covered under a Medicaid plan under
title XIX of the Social Security Act or under a State child
health plan under title XXI of such Act and coverage of the
employee or dependent under such a plan is terminated as a
result of loss of eligibility for such coverage and the
employee requests coverage under the group health plan not
later than 60 days after the date of termination of such
coverage.
``(ii) Eligibility for employment assistance under medicaid
or chip.--The employee or dependent becomes eligible for
assistance, with respect to coverage under the group health
plan under such Medicaid plan or State child health plan
(including under any waiver or demonstration project
conducted under or in relation to such a plan), if the
employee requests coverage under the group health plan not
later than 60 days after the date the employee or dependent
is determined to be eligible for such assistance.
``(B) Employee outreach and disclosure.--
``(i) Outreach to employees regarding availability of
medicaid and chip coverage.--
``(I) In general.--Each employer that maintains a group
health plan in a State that provides medical assistance under
a State Medicaid plan under title XIX of the Social Security
Act, or child health assistance under a State child health
plan under title XXI of such Act, in the form of premium
assistance for the purchase of coverage under a group health
plan, shall provide to each employee a written notice
informing the employee of potential opportunities then
currently available in the State in which the employee
resides for premium assistance under such plans for health
coverage of the employee or the employee's dependents. For
purposes of compliance with this clause, the employer may use
any State-specific model notice developed in accordance with
section 701(f)(3)(B)(i)(II) of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1181(f)(3)(B)(i)(II)).
``(II) Option to provide concurrent with provision of plan
materials to employee.--An employer may provide the model
notice applicable to the State in which an employee resides
concurrent with the furnishing of materials notifying the
employee of health plan eligibility, concurrent with
materials provided to the employee in connection with an open
season or election process conducted under the plan, or
concurrent with the furnishing of the summary plan
description as provided in section 104(b) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1024).
``(ii) Disclosure about group health plan benefits to
states for medicaid and chip eligible individuals.--In the
case of a participant or beneficiary of a group health plan
who is covered under a Medicaid plan of a State under title
XIX of the Social Security Act or under a State child health
plan under title XXI of such Act, the plan administrator of
the group health plan shall disclose to the State, upon
request, information about the benefits available under the
group health plan in sufficient specificity, as determined
under regulations of the Secretary of Health and Human
Services in consultation with the Secretary that require use
of the model coverage coordination disclosure form developed
under section 311(b)(1)(C) of the Children's Health Insurance
Program Reauthorization Act of 2007, so as to permit the
State to make a determination (under paragraph (2)(B), (3),
or (10) of section 2105(c) of the Social Security Act or
otherwise) concerning the cost-effectiveness of the State
providing medical or child health assistance through premium
assistance for the purchase of coverage under such group
health plan and in order for the State to provide
supplemental benefits required under paragraph (10)(E) of
such section or other authority.''.
(b) Conforming Amendments.--
(1) Amendments to employee retirement income security
act.--
(A) In general.--Section 701(f) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1181(f)) is amended by
adding at the end the following new paragraph:
``(3) Special rules for application in case of medicaid and
chip.--
``(A) In general.--A group health plan, and a health
insurance issuer offering group health insurance coverage in
connection with a group health plan, shall permit an employee
who is eligible, but not enrolled, for coverage under the
terms of the plan (or a dependent of such an employee if the
dependent is eligible, but not enrolled, for coverage under
such terms) to enroll for coverage under the terms of the
plan if either of the following conditions is met:
``(i) Termination of medicaid or chip coverage.--The
employee or dependent is covered under a Medicaid plan under
title XIX of the Social Security Act or under a State child
health plan under title XXI of such Act and coverage of the
employee or dependent
[[Page H10858]]
under such a plan is terminated as a result of loss of
eligibility for such coverage and the employee requests
coverage under the group health plan (or health insurance
coverage) not later than 60 days after the date of
termination of such coverage.
``(ii) Eligibility for employment assistance under medicaid
or chip.--The employee or dependent becomes eligible for
assistance, with respect to coverage under the group health
plan or health insurance coverage, under such Medicaid plan
or State child health plan (including under any waiver or
demonstration project conducted under or in relation to such
a plan), if the employee requests coverage under the group
health plan or health insurance coverage not later than 60
days after the date the employee or dependent is determined
to be eligible for such assistance.
``(B) Coordination with medicaid and chip.--
``(i) Outreach to employees regarding availability of
medicaid and chip coverage.--
``(I) In general.--Each employer that maintains a group
health plan in a State that provides medical assistance under
a State Medicaid plan under title XIX of the Social Security
Act, or child health assistance under a State child health
plan under title XXI of such Act, in the form of premium
assistance for the purchase of coverage under a group health
plan, shall provide to each employee a written notice
informing the employee of potential opportunities then
currently available in the State in which the employee
resides for premium assistance under such plans for health
coverage of the employee or the employee's dependents.
``(II) Model notice.--Not later than 1 year after the date
of enactment of the Children's Health Insurance Program
Reauthorization Act of 2007, the Secretary and the Secretary
of Health and Human Services, in consultation with Directors
of State Medicaid agencies under title XIX of the Social
Security Act and Directors of State CHIP agencies under title
XXI of such Act, shall jointly develop national and State-
specific model notices for purposes of subparagraph (A). The
Secretary shall provide employers with such model notices so
as to enable employers to timely comply with the requirements
of subparagraph (A). Such model notices shall include
information regarding how an employee may contact the State
in which the employee resides for additional information
regarding potential opportunities for such premium
assistance, including how to apply for such assistance.
``(III) Option to provide concurrent with provision of plan
materials to employee.--An employer may provide the model
notice applicable to the State in which an employee resides
concurrent with the furnishing of materials notifying the
employee of health plan eligibility, concurrent with
materials provided to the employee in connection with an open
season or election process conducted under the plan, or
concurrent with the furnishing of the summary plan
description as provided in section 104(b)..
``(ii) Disclosure about group health plan benefits to
states for medicaid and chip eligible individuals.--In the
case of a participant or beneficiary of a group health plan
who is covered under a Medicaid plan of a State under title
XIX of the Social Security Act or under a State child health
plan under title XXI of such Act, the plan administrator of
the group health plan shall disclose to the State, upon
request, information about the benefits available under the
group health plan in sufficient specificity, as determined
under regulations of the Secretary of Health and Human
Services in consultation with the Secretary that require use
of the model coverage coordination disclosure form developed
under section 311(b)(1)(C) of the Children's Health Insurance
Program Reauthorization Act of 2007, so as to permit the
State to make a determination (under paragraph (2)(B), (3),
or (10) of section 2105(c) of the Social Security Act or
otherwise) concerning the cost-effectiveness of the State
providing medical or child health assistance through premium
assistance for the purchase of coverage under such group
health plan and in order for the State to provide
supplemental benefits required under paragraph (10)(E) of
such section or other authority.''.
(B) Conforming amendment.--Section 102(b) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1022(b)) is
amended--
(i) by striking ``and the remedies'' and inserting ``, the
remedies''; and
(ii) by inserting before the period the following: ``, and
if the employer so elects for purposes of complying with
section 701(f)(3)(B)(i), the model notice applicable to the
State in which the participants and beneficiaries reside''.
(C) Working group to develop model coverage coordination
disclosure form.--
(i) Medicaid, chip, and employer-sponsored coverage
coordination working group.--
(I) In general.--Not later than 60 days after the date of
enactment of this Act, the Secretary of Health and Human
Services and the Secretary of Labor shall jointly establish a
Medicaid, CHIP, and Employer-Sponsored Coverage Coordination
Working Group (in this subparagraph referred to as the
``Working Group''). The purpose of the Working Group shall be
to develop the model coverage coordination disclosure form
described in subclause (II) and to identify the impediments
to the effective coordination of coverage available to
families that include employees of employers that maintain
group health plans and members who are eligible for medical
assistance under title XIX of the Social Security Act or
child health assistance or other health benefits coverage
under title XXI of such Act.
(II) Model coverage coordination disclosure form
described.--The model form described in this subclause is a
form for plan administrators of group health plans to
complete for purposes of permitting a State to determine the
availability and cost-effectiveness of the coverage available
under such plans to employees who have family members who are
eligible for premium assistance offered under a State plan
under title XIX or XXI of such Act and to allow for
coordination of coverage for enrollees of such plans. Such
form shall provide the following information in addition to
such other information as the Working Group determines
appropriate:
(aa) A determination of whether the employee is eligible
for coverage under the group health plan.
(bb) The name and contract information of the plan
administrator of the group health plan.
(cc) The benefits offered under the plan.
(dd) The premiums and cost-sharing required under the plan.
(ee) Any other information relevant to coverage under the
plan.
(ii) Membership.--The Working Group shall consist of not
more than 30 members and shall be composed of representatives
of--
(I) the Department of Labor;
(II) the Department of Health and Human Services;
(III) State directors of the Medicaid program under title
XIX of the Social Security Act;
(IV) State directors of the State Children's Health
Insurance Program under title XXI of the Social Security Act;
(V) employers, including owners of small businesses and
their trade or industry representatives and certified human
resource and payroll professionals;
(VI) plan administrators and plan sponsors of group health
plans (as defined in section 607(1) of the Employee
Retirement Income Security Act of 1974);
(VII) health insurance issuers; and
(VIII) children and other beneficiaries of medical
assistance under title XIX of the Social Security Act or
child health assistance or other health benefits coverage
under title XXI of such Act.
(iii) Compensation.--The members of the Working Group shall
serve without compensation.
(iv) Administrative support.--The Department of Health and
Human Services and the Department of Labor shall jointly
provide appropriate administrative support to the Working
Group, including technical assistance. The Working Group may
use the services and facilities of either such Department,
with or without reimbursement, as jointly determined by such
Departments.
(v) Report.--
(I) Report by working group to the secretaries.--Not later
than 18 months after the date of the enactment of this Act,
the Working Group shall submit to the Secretary of Labor and
the Secretary of Health and Human Services the model form
described in clause (i)(II) along with a report containing
recommendations for appropriate measures to address the
impediments to the effective coordination of coverage between
group health plans and the State plans under titles XIX and
XXI of the Social Security Act.
(II) Report by secretaries to the congress.--Not later than
2 months after receipt of the report pursuant to subclause
(I), the Secretaries shall jointly submit a report to each
House of the Congress regarding the recommendations contained
in the report under such subclause.
(vi) Termination.--The Working Group shall terminate 30
days after the date of the issuance of its report under
clause (v).
(D) Effective dates.--The Secretary of Labor and the
Secretary of Health and Human Services shall develop the
initial model notices under section 701(f)(3)(B)(i)(II) of
the Employee Retirement Income Security Act of 1974, and the
Secretary of Labor shall provide such notices to employers,
not later than the date that is 1 year after the date of
enactment of this Act, and each employer shall provide the
initial annual notices to such employer's employees beginning
with the first plan year that begins after the date on which
such initial model notices are first issued. The model
coverage coordination disclosure form developed under
subparagraph (C) shall apply with respect to requests made by
States beginning with the first plan year that begins after
the date on which such model coverage coordination disclosure
form is first issued.
(E) Enforcement.--Section 502 of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1132) is amended--
(i) in subsection (a)(6), by striking ``or (8)'' and
inserting ``(8), or (9)''; and
(ii) in subsection (c), by redesignating paragraph (9) as
paragraph (10), and by inserting after paragraph (8) the
following:
``(9)(A) The Secretary may assess a civil penalty against
any employer of up to $100 a day from the date of the
employer's failure to meet the notice requirement of section
701(f)(3)(B)(i)(I). For purposes of this subparagraph, each
violation with respect to
[[Page H10859]]
any single employee shall be treated as a separate violation.
``(B) The Secretary may assess a civil penalty against any
plan administrator of up to $100 a day from the date of the
plan administrator's failure to timely provide to any State
the information required to be disclosed under section
701(f)(3)(B)(ii). For purposes of this subparagraph, each
violation with respect to any single participant or
beneficiary shall be treated as a separate violation.''.
(2) Amendments to public health service act.--Section
2701(f) of the Public Health Service Act (42 U.S.C. 300gg(f))
is amended by adding at the end the following new paragraph:
``(3) Special rules for application in case of medicaid and
chip.--
``(A) In general.--A group health plan, and a health
insurance issuer offering group health insurance coverage in
connection with a group health plan, shall permit an employee
who is eligible, but not enrolled, for coverage under the
terms of the plan (or a dependent of such an employee if the
dependent is eligible, but not enrolled, for coverage under
such terms) to enroll for coverage under the terms of the
plan if either of the following conditions is met:
``(i) Termination of medicaid or chip coverage.--The
employee or dependent is covered under a Medicaid plan under
title XIX of the Social Security Act or under a State child
health plan under title XXI of such Act and coverage of the
employee or dependent under such a plan is terminated as a
result of loss of eligibility for such coverage and the
employee requests coverage under the group health plan (or
health insurance coverage) not later than 60 days after the
date of termination of such coverage.
``(ii) Eligibility for employment assistance under medicaid
or chip.--The employee or dependent becomes eligible for
assistance, with respect to coverage under the group health
plan or health insurance coverage, under such Medicaid plan
or State child health plan (including under any waiver or
demonstration project conducted under or in relation to such
a plan), if the employee requests coverage under the group
health plan or health insurance coverage not later than 60
days after the date the employee or dependent is determined
to be eligible for such assistance.
``(B) Coordination with medicaid and chip.--
``(i) Outreach to employees regarding availability of
medicaid and chip coverage.--
``(I) In general.--Each employer that maintains a group
health plan in a State that provides medical assistance under
a State Medicaid plan under title XIX of the Social Security
Act, or child health assistance under a State child health
plan under title XXI of such Act, in the form of premium
assistance for the purchase of coverage under a group health
plan, shall provide to each employee a written notice
informing the employee of potential opportunities then
currently available in the State in which the employee
resides for premium assistance under such plans for health
coverage of the employee or the employee's dependents. For
purposes of compliance with this subclause, the employer may
use any State-specific model notice developed in accordance
with section 701(f)(3)(B)(i)(II) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1181(f)(3)(B)(i)(II)).
``(II) Option to provide concurrent with provision of plan
materials to employee.--An employer may provide the model
notice applicable to the State in which an employee resides
concurrent with the furnishing of materials notifying the
employee of health plan eligibility, concurrent with
materials provided to the employee in connection with an open
season or election process conducted under the plan, or
concurrent with the furnishing of the summary plan
description as provided in section 104(b) of the Employee
Retirement Income Security Act of 1974.
``(ii) Disclosure about group health plan benefits to
states for medicaid and chip eligible individuals.--In the
case of an enrollee in a group health plan who is covered
under a Medicaid plan of a State under title XIX of the
Social Security Act or under a State child health plan under
title XXI of such Act, the plan administrator of the group
health plan shall disclose to the State, upon request,
information about the benefits available under the group
health plan in sufficient specificity, as determined under
regulations of the Secretary of Health and Human Services in
consultation with the Secretary that require use of the model
coverage coordination disclosure form developed under section
311(b)(1)(C) of the Children's Health Insurance
Reauthorization Act of 2007, so as to permit the State to
make a determination (under paragraph (2)(B), (3), or (10) of
section 2105(c) of the Social Security Act or otherwise)
concerning the cost-effectiveness of the State providing
medical or child health assistance through premium assistance
for the purchase of coverage under such group health plan and
in order for the State to provide supplemental benefits
required under paragraph (10)(E) of such section or other
authority.''.
TITLE IV--STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES
SEC. 401. CHILD HEALTH QUALITY IMPROVEMENT ACTIVITIES FOR
CHILDREN ENROLLED IN MEDICAID OR CHIP.
(a) Development of Child Health Quality Measures for
Children Enrolled in Medicaid or Chip.--Title XI (42 U.S.C.
1301 et seq.) is amended by inserting after section 1139 the
following new section:
``SEC. 1139A. CHILD HEALTH QUALITY MEASURES.
``(a) Development of an Initial Core Set of Health Care
Quality Measures for Children Enrolled in Medicaid or Chip.--
``(1) In general.--Not later than January 1, 2009, the
Secretary shall identify and publish for general comment an
initial, recommended core set of child health quality
measures for use by State programs administered under titles
XIX and XXI, health insurance issuers and managed care
entities that enter into contracts with such programs, and
providers of items and services under such programs.
``(2) Identification of initial core measures.--In
consultation with the individuals and entities described in
subsection (b)(3), the Secretary shall identify existing
quality of care measures for children that are in use under
public and privately sponsored health care coverage
arrangements, or that are part of reporting systems that
measure both the presence and duration of health insurance
coverage over time.
``(3) Recommendations and dissemination.--Based on such
existing and identified measures, the Secretary shall publish
an initial core set of child health quality measures that
includes (but is not limited to) the following:
``(A) The duration of children's health insurance coverage
over a 12-month time period.
``(B) The availability and effectiveness of a full range
of--
``(i) preventive services, treatments, and services for
acute conditions, including services to promote healthy
birth, prevent and treat premature birth, and detect the
presence or risk of physical or mental conditions that could
adversely affect growth and development; and
``(ii) treatments to correct or ameliorate the effects of
physical and mental conditions, including chronic conditions,
in infants, young children, school-age children, and
adolescents.
``(C) The availability of care in a range of ambulatory and
inpatient health care settings in which such care is
furnished.
``(D) The types of measures that, taken together, can be
used to estimate the overall national quality of health care
for children, including children with special needs, and to
perform comparative analyses of pediatric health care quality
and racial, ethnic, and socioeconomic disparities in child
health and health care for children.
``(4) Encourage voluntary and standardized reporting.--Not
later than 2 years after the date of enactment of the
Children's Health Insurance Program Reauthorization Act of
2007, the Secretary, in consultation with States, shall
develop a standardized format for reporting information and
procedures and approaches that encourage States to use the
initial core measurement set to voluntarily report
information regarding the quality of pediatric health care
under titles XIX and XXI.
``(5) Adoption of best practices in implementing quality
programs.--The Secretary shall disseminate information to
States regarding best practices among States with respect to
measuring and reporting on the quality of health care for
children, and shall facilitate the adoption of such best
practices. In developing best practices approaches, the
Secretary shall give particular attention to State
measurement techniques that ensure the timeliness and
accuracy of provider reporting, encourage provider reporting
compliance, encourage successful quality improvement
strategies, and improve efficiency in data collection using
health information technology.
``(6) Reports to congress.--Not later than January 1, 2010,
and every 3 years thereafter, the Secretary shall report to
Congress on--
``(A) the status of the Secretary's efforts to improve--
``(i) quality related to the duration and stability of
health insurance coverage for children under titles XIX and
XXI;
``(ii) the quality of children's health care under such
titles, including preventive health services, health care for
acute conditions, chronic health care, and health services to
ameliorate the effects of physical and mental conditions and
to aid in growth and development of infants, young children,
school-age children, and adolescents with special health care
needs; and
``(iii) the quality of children's health care under such
titles across the domains of quality, including clinical
quality, health care safety, family experience with health
care, health care in the most integrated setting, and
elimination of racial, ethnic, and socioeconomic disparities
in health and health care;
``(B) the status of voluntary reporting by States under
titles XIX and XXI, utilizing the initial core quality
measurement set; and
``(C) any recommendations for legislative changes needed to
improve the quality of care provided to children under titles
XIX and XXI, including recommendations for quality reporting
by States.
``(7) Technical assistance.--The Secretary shall provide
technical assistance to States to assist them in adopting and
utilizing core child health quality measures in administering
the State plans under titles XIX and XXI.
``(8) Definition of core set.--In this section, the term
`core set' means a group of
[[Page H10860]]
valid, reliable, and evidence-based quality measures that,
taken together--
``(A) provide information regarding the quality of health
coverage and health care for children;
``(B) address the needs of children throughout the
developmental age span; and
``(C) allow purchasers, families, and health care providers
to understand the quality of care in relation to the
preventive needs of children, treatments aimed at managing
and resolving acute conditions, and diagnostic and treatment
services whose purpose is to correct or ameliorate physical,
mental, or developmental conditions that could, if untreated
or poorly treated, become chronic.
``(b) Advancing and Improving Pediatric Quality Measures.--
``(1) Establishment of pediatric quality measures
program.--Not later than January 1, 2010, the Secretary shall
establish a pediatric quality measures program to--
``(A) improve and strengthen the initial core child health
care quality measures established by the Secretary under
subsection (a);
``(B) expand on existing pediatric quality measures used by
public and private health care purchasers and advance the
development of such new and emerging quality measures; and
``(C) increase the portfolio of evidence-based, consensus
pediatric quality measures available to public and private
purchasers of children's health care services, providers, and
consumers.
``(2) Evidence-based measures.--The measures developed
under the pediatric quality measures program shall, at a
minimum, be--
``(A) evidence-based and, where appropriate, risk adjusted;
``(B) designed to identify and eliminate racial and ethnic
disparities in child health and the provision of health care;
``(C) designed to ensure that the data required for such
measures is collected and reported in a standard format that
permits comparison of quality and data at a State, plan, and
provider level;
``(D) periodically updated; and
``(E) responsive to the child health needs, services, and
domains of health care quality described in clauses (i),
(ii), and (iii) of subsection (a)(6)(A).
``(3) Process for pediatric quality measures program.--In
identifying gaps in existing pediatric quality measures and
establishing priorities for development and advancement of
such measures, the Secretary shall consult with--
``(A) States;
``(B) pediatricians, children's hospitals, and other
primary and specialized pediatric health care professionals
(including members of the allied health professions) who
specialize in the care and treatment of children,
particularly children with special physical, mental, and
developmental health care needs;
``(C) dental professionals, including pediatric dental
professionals;
``(D) health care providers that furnish primary health
care to children and families who live in urban and rural
medically underserved communities or who are members of
distinct population sub-groups at heightened risk for poor
health outcomes;
``(E) national organizations representing children,
including children with disabilities and children with
chronic conditions;
``(F) national organizations representing consumers and
purchasers of children's health care;
``(G) national organizations and individuals with expertise
in pediatric health quality measurement; and
``(H) voluntary consensus standards setting organizations
and other organizations involved in the advancement of
evidence-based measures of health care.
``(4) Developing, validating, and testing a portfolio of
pediatric quality measures.--As part of the program to
advance pediatric quality measures, the Secretary shall--
``(A) award grants and contracts for the development,
testing, and validation of new, emerging, and innovative
evidence-based measures for children's health care services
across the domains of quality described in clauses (i), (ii),
and (iii) of subsection (a)(6)(A); and
``(B) award grants and contracts for--
``(i) the development of consensus on evidence-based
measures for children's health care services;
``(ii) the dissemination of such measures to public and
private purchasers of health care for children; and
``(iii) the updating of such measures as necessary.
``(5) Revising, strengthening, and improving initial core
measures.--Beginning no later than January 1, 2012, and
annually thereafter, the Secretary shall publish recommended
changes to the core measures described in subsection (a) that
shall reflect the testing, validation, and consensus process
for the development of pediatric quality measures described
in subsection paragraphs (1) through (4).
``(6) Definition of pediatric quality measure.--In this
subsection, the term `pediatric quality measure' means a
measurement of clinical care that is capable of being
examined through the collection and analysis of relevant
information, that is developed in order to assess 1 or more
aspects of pediatric health care quality in various
institutional and ambulatory health care settings, including
the structure of the clinical care system, the process of
care, the outcome of care, or patient experiences in care.
``(7) Construction.--Nothing in this section shall be
construed as supporting the restriction of coverage, under
title XIX or XXI or otherwise, to only those services that
are evidence-based.
``(c) Annual State Reports Regarding State-Specific Quality
of Care Measures Applied Under Medicaid or Chip.--
``(1) Annual state reports.--Each State with a State plan
approved under title XIX or a State child health plan
approved under title XXI shall annually report to the
Secretary on the--
``(A) State-specific child health quality measures applied
by the States under such plans, including measures described
in subparagraphs (A) and (B) of subsection (a)(6); and
``(B) State-specific information on the quality of health
care furnished to children under such plans, including
information collected through external quality reviews of
managed care organizations under section 1932 of the Social
Security Act (42 U.S.C. 1396u-4) and benchmark plans under
sections 1937 and 2103 of such Act (42 U.S.C. 1396u-7,
1397cc).
``(2) Publication.--Not later than September 30, 2009, and
annually thereafter, the Secretary shall collect, analyze,
and make publicly available the information reported by
States under paragraph (1).
``(d) Demonstration Projects for Improving the Quality of
Children's Health Care and the Use of Health Information
Technology.--
``(1) In general.--During the period of fiscal years 2008
through 2012, the Secretary shall award not more than 10
grants to States and child health providers to conduct
demonstration projects to evaluate promising ideas for
improving the quality of children's health care provided
under title XIX or XXI, including projects to--
``(A) experiment with, and evaluate the use of, new
measures of the quality of children's health care under such
titles (including testing the validity and suitability for
reporting of such measures);
``(B) promote the use of health information technology in
care delivery for children under such titles;
``(C) evaluate provider-based models which improve the
delivery of children's health care services under such
titles, including care management for children with chronic
conditions and the use of evidence-based approaches to
improve the effectiveness, safety, and efficiency of health
care services for children; or
``(D) demonstrate the impact of the model electronic health
record format for children developed and disseminated under
subsection (f) on improving pediatric health, including the
effects of chronic childhood health conditions, and pediatric
health care quality as well as reducing health care costs.
``(2) Requirements.--In awarding grants under this
subsection, the Secretary shall ensure that--
``(A) only 1 demonstration project funded under a grant
awarded under this subsection shall be conducted in a State;
and
``(B) demonstration projects funded under grants awarded
under this subsection shall be conducted evenly between
States with large urban areas and States with large rural
areas.
``(3) Authority for multistate projects.--A demonstration
project conducted with a grant awarded under this subsection
may be conducted on a multistate basis, as needed.
``(4) Funding.--$20,000,000 of the amount appropriated
under subsection (i) for a fiscal year shall be used to carry
out this subsection.
``(e) Childhood Obesity Demonstration Project.--
``(1) Authority to conduct demonstration.--The Secretary,
in consultation with the Administrator of the Centers for
Medicare & Medicaid Services, shall conduct a demonstration
project to develop a comprehensive and systematic model for
reducing childhood obesity by awarding grants to eligible
entities to carry out such project. Such model shall--
``(A) identify, through self-assessment, behavioral risk
factors for obesity among children;
``(B) identify, through self-assessment, needed clinical
preventive and screening benefits among those children
identified as target individuals on the basis of such risk
factors;
``(C) provide ongoing support to such target individuals
and their families to reduce risk factors and promote the
appropriate use of preventive and screening benefits; and
``(D) be designed to improve health outcomes, satisfaction,
quality of life, and appropriate use of items and services
for which medical assistance is available under title XIX or
child health assistance is available under title XXI among
such target individuals.
``(2) Eligibility entities.--For purposes of this
subsection, an eligible entity is any of the following:
``(A) A city, county, or Indian tribe.
``(B) A local or tribal educational agency.
``(C) An accredited university, college, or community
college.
``(D) A Federally-qualified health center.
``(E) A local health department.
``(F) A health care provider.
``(G) A community-based organization.
[[Page H10861]]
``(H) Any other entity determined appropriate by the
Secretary, including a consortia or partnership of entities
described in any of subparagraphs (A) through (G).
``(3) Use of funds.--An eligible entity awarded a grant
under this subsection shall use the funds made available
under the grant to--
``(A) carry out community-based activities related to
reducing childhood obesity, including by--
``(i) forming partnerships with entities, including schools
and other facilities providing recreational services, to
establish programs for after school and weekend community
activities that are designed to reduce childhood obesity;
``(ii) forming partnerships with daycare facilities to
establish programs that promote healthy eating behaviors and
physical activity; and
``(iii) developing and evaluating community educational
activities targeting good nutrition and promoting healthy
eating behaviors;
``(B) carry out age-appropriate school-based activities
that are designed to reduce childhood obesity, including by--
``(i) developing and testing educational curricula and
intervention programs designed to promote healthy eating
behaviors and habits in youth, which may include--
``(I) after hours physical activity programs; and
``(II) science-based interventions with multiple components
to prevent eating disorders including nutritional content,
understanding and responding to hunger and satiety, positive
body image development, positive self-esteem development, and
learning life skills (such as stress management,
communication skills, problemsolving and decisionmaking
skills), as well as consideration of cultural and
developmental issues, and the role of family, school, and
community;
``(ii) providing education and training to educational
professionals regarding how to promote a healthy lifestyle
and a healthy school environment for children;
``(iii) planning and implementing a healthy lifestyle
curriculum or program with an emphasis on healthy eating
behaviors and physical activity; and
``(iv) planning and implementing healthy lifestyle classes
or programs for parents or guardians, with an emphasis on
healthy eating behaviors and physical activity for children;
``(C) carry out educational, counseling, promotional, and
training activities through the local health care delivery
systems including by--
``(i) promoting healthy eating behaviors and physical
activity services to treat or prevent eating disorders, being
overweight, and obesity;
``(ii) providing patient education and counseling to
increase physical activity and promote healthy eating
behaviors;
``(iii) training health professionals on how to identify
and treat obese and overweight individuals which may include
nutrition and physical activity counseling; and
``(iv) providing community education by a health
professional on good nutrition and physical activity to
develop a better understanding of the relationship between
diet, physical activity, and eating disorders, obesity, or
being overweight; and
``(D) provide, through qualified health professionals,
training and supervision for community health workers to--
``(i) educate families regarding the relationship between
nutrition, eating habits, physical activity, and obesity;
``(ii) educate families about effective strategies to
improve nutrition, establish healthy eating patterns, and
establish appropriate levels of physical activity; and
``(iii) educate and guide parents regarding the ability to
model and communicate positive health behaviors.
``(4) Priority.--In awarding grants under paragraph (1),
the Secretary shall give priority to awarding grants to
eligible entities--
``(A) that demonstrate that they have previously applied
successfully for funds to carry out activities that seek to
promote individual and community health and to prevent the
incidence of chronic disease and that can cite published and
peer-reviewed research demonstrating that the activities that
the entities propose to carry out with funds made available
under the grant are effective;
``(B) that will carry out programs or activities that seek
to accomplish a goal or goals set by the State in the Healthy
People 2010 plan of the State;
``(C) that provide non-Federal contributions, either in
cash or in-kind, to the costs of funding activities under the
grants;
``(D) that develop comprehensive plans that include a
strategy for extending program activities developed under
grants in the years following the fiscal years for which they
receive grants under this subsection;
``(E) located in communities that are medically
underserved, as determined by the Secretary;
``(F) located in areas in which the average poverty rate is
at least 150 percent or higher of the average poverty rate in
the State involved, as determined by the Secretary; and
``(G) that submit plans that exhibit multisectoral,
cooperative conduct that includes the involvement of a broad
range of stakeholders, including--
``(i) community-based organizations;
``(ii) local governments;
``(iii) local educational agencies;
``(iv) the private sector;
``(v) State or local departments of health;
``(vi) accredited colleges, universities, and community
colleges;
``(vii) health care providers;
``(viii) State and local departments of transportation and
city planning; and
``(ix) other entities determined appropriate by the
Secretary.
``(5) Program design.--
``(A) Initial design.--Not later than 1 year after the date
of enactment of the Children's Health Insurance Program
Reauthorization Act of 2007, the Secretary shall design the
demonstration project. The demonstration should draw upon
promising, innovative models and incentives to reduce
behavioral risk factors. The Administrator of the Centers for
Medicare & Medicaid Services shall consult with the Director
of the Centers for Disease Control and Prevention, the
Director of the Office of Minority Health, the heads of other
agencies in the Department of Health and Human Services, and
such professional organizations, as the Secretary determines
to be appropriate, on the design, conduct, and evaluation of
the demonstration.
``(B) Number and project areas.--Not later than 2 years
after the date of enactment of the Children's Health
Insurance Program Reauthorization Act of 2007, the Secretary
shall award 1 grant that is specifically designed to
determine whether programs similar to programs to be
conducted by other grantees under this subsection should be
implemented with respect to the general population of
children who are eligible for child health assistance under
State child health plans under title XXI in order to reduce
the incidence of childhood obesity among such population.
``(6) Report to congress.--Not later than 3 years after the
date the Secretary implements the demonstration project under
this subsection, the Secretary shall submit to Congress a
report that describes the project, evaluates the
effectiveness and cost effectiveness of the project,
evaluates the beneficiary satisfaction under the project, and
includes any such other information as the Secretary
determines to be appropriate.
``(7) Definitions.--In this subsection:
``(A) Federally-qualified health center.--The term
`Federally-qualified health center' has the meaning given
that term in section 1905(l)(2)(B).
``(B) Indian tribe.--The term `Indian tribe' has the
meaning given that term in section 4 of the Indian Health
Care Improvement Act (25 U.S.C. 1603).
``(C) Self-assessment.--The term `self-assessment' means a
form that--
``(i) includes questions regarding--
``(I) behavioral risk factors;
``(II) needed preventive and screening services; and
``(III) target individuals' preferences for receiving
follow-up information;
``(ii) is assessed using such computer generated assessment
programs; and
``(iii) allows for the provision of such ongoing support to
the individual as the Secretary determines appropriate.
``(D) Ongoing support.--The term `ongoing support' means--
``(i) to provide any target individual with information,
feedback, health coaching, and recommendations regarding--
``(I) the results of a self-assessment given to the
individual;
``(II) behavior modification based on the self-assessment;
and
``(III) any need for clinical preventive and screening
services or treatment including medical nutrition therapy;
``(ii) to provide any target individual with referrals to
community resources and programs available to assist the
target individual in reducing health risks; and
``(iii) to provide the information described in clause (i)
to a health care provider, if designated by the target
individual to receive such information.
``(8) Authorization of appropriations.--There is authorized
to be appropriated to carry out this subsection, $25,000,000
for the period of fiscal years 2008 through 2012.
``(f) Development of Model Electronic Health Record Format
for Children Enrolled in Medicaid or CHIP.--
``(1) In general.--Not later than January 1, 2009, the
Secretary shall establish a program to encourage the
development and dissemination of a model electronic health
record format for children enrolled in the State plan under
title XIX or the State child health plan under title XXI that
is--
``(A) subject to State laws, accessible to parents,
caregivers, and other consumers for the sole purpose of
demonstrating compliance with school or leisure activity
requirements, such as appropriate immunizations or physicals;
``(B) designed to allow interoperable exchanges that
conform with Federal and State privacy and security
requirements;
``(C) structured in a manner that permits parents and
caregivers to view and understand the extent to which the
care their children receive is clinically appropriate and of
high quality; and
``(D) capable of being incorporated into, and otherwise
compatible with, other standards developed for electronic
health records.
``(2) Funding.--$5,000,000 of the amount appropriated under
subsection (i) for a fiscal year shall be used to carry out
this subsection.
``(g) Study of Pediatric Health and Health Care Quality
Measures.--
[[Page H10862]]
``(1) In general.--Not later than July 1, 2009, the
Institute of Medicine shall study and report to Congress on
the extent and quality of efforts to measure child health
status and the quality of health care for children across the
age span and in relation to preventive care, treatments for
acute conditions, and treatments aimed at ameliorating or
correcting physical, mental, and developmental conditions in
children. In conducting such study and preparing such report,
the Institute of Medicine shall--
``(A) consider all of the major national population-based
reporting systems sponsored by the Federal Government that
are currently in place, including reporting requirements
under Federal grant programs and national population surveys
and estimates conducted directly by the Federal Government;
``(B) identify the information regarding child health and
health care quality that each system is designed to capture
and generate, the study and reporting periods covered by each
system, and the extent to which the information so generated
is made widely available through publication;
``(C) identify gaps in knowledge related to children's
health status, health disparities among subgroups of
children, the effects of social conditions on children's
health status and use and effectiveness of health care, and
the relationship between child health status and family
income, family stability and preservation, and children's
school readiness and educational achievement and attainment;
and
``(D) make recommendations regarding improving and
strengthening the timeliness, quality, and public
transparency and accessibility of information about child
health and health care quality.
``(2) Funding.--Up to $1,000,000 of the amount appropriated
under subsection (i) for a fiscal year shall be used to carry
out this subsection.
``(h) Rule of Construction.--Notwithstanding any other
provision in this section, no evidence based quality measure
developed, published, or used as a basis of measurement or
reporting under this section may be used to establish an
irrebuttable presumption regarding either the medical
necessity of care or the maximum permissible coverage for any
individual child who is eligible for and receiving medical
assistance under title XIX or child health assistance under
title XXI .
``(i) Appropriation.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated for each of
fiscal years 2008 through 2012, $45,000,000 for the purpose
of carrying out this section (other than subsection (e)).
Funds appropriated under this subsection shall remain
available until expended.''.
(b) Increased Matching Rate for Collecting and Reporting on
Child Health Measures.--Section 1903(a)(3)(A) (42 U.S.C.
1396b(a)(3)(A)), is amended--
(1) by striking ``and'' at the end of clause (i); and
(2) by adding at the end the following new clause:
``(iii) an amount equal to the Federal medical assistance
percentage (as defined in section 1905(b)) of so much of the
sums expended during such quarter (as found necessary by the
Secretary for the proper and efficient administration of the
State plan) as are attributable to such developments or
modifications of systems of the type described in clause (i)
as are necessary for the efficient collection and reporting
on child health measures; and''.
SEC. 402. IMPROVED AVAILABILITY OF PUBLIC INFORMATION
REGARDING ENROLLMENT OF CHILDREN IN CHIP AND
MEDICAID.
(a) Inclusion of Process and Access Measures in Annual
State Reports.--Section 2108 (42 U.S.C. 1397hh) is amended--
(1) in subsection (a), in the matter preceding paragraph
(1), by striking ``The State'' and inserting ``Subject to
subsection (e), the State''; and
(2) by adding at the end the following new subsection:
``(e) Information Required for Inclusion in State Annual
Report.--The State shall include the following information in
the annual report required under subsection (a):
``(1) Eligibility criteria, enrollment, and retention data
(including data with respect to continuity of coverage or
duration of benefits).
``(2) Data regarding the extent to which the State uses
process measures with respect to determining the eligibility
of children under the State child health plan, including
measures such as 12-month continuous eligibility, self-
declaration of income for applications or renewals, or
presumptive eligibility.
``(3) Data regarding denials of eligibility and
redeterminations of eligibility.
``(4) Data regarding access to primary and specialty
services, access to networks of care, and care coordination
provided under the State child health plan, using quality
care and consumer satisfaction measures included in the
Consumer Assessment of Healthcare Providers and Systems
(CAHPS) survey.
``(5) If the State provides child health assistance in the
form of premium assistance for the purchase of coverage under
a group health plan, data regarding the provision of such
assistance, including the extent to which employer-sponsored
health insurance coverage is available for children eligible
for child health assistance under the State child health
plan, the range of the monthly amount of such assistance
provided on behalf of a child or family, the number of
children or families provided such assistance on a monthly
basis, the income of the children or families provided such
assistance, the benefits and cost-sharing protection provided
under the State child health plan to supplement the coverage
purchased with such premium assistance, the effective
strategies the State engages in to reduce any administrative
barriers to the provision of such assistance, and, the
effects, if any, of the provision of such assistance on
preventing the coverage provided under the State child health
plan from substituting for coverage provided under employer-
sponsored health insurance offered in the State.
``(6) To the extent applicable, a description of any State
activities that are designed to reduce the number of
uncovered children in the State, including through a State
health insurance connector program or support for innovative
private health coverage initiatives.''.
(b) Standardized Reporting Format.--
(1) In general.--Not later than 1 year after the date of
enactment of this Act, the Secretary shall specify a
standardized format for States to use for reporting the
information required under section 2108(e) of the Social
Security Act, as added by subsection (a)(2).
(2) Transition period for states.--Each State that is
required to submit a report under subsection (a) of section
2108 of the Social Security Act that includes the information
required under subsection (e) of such section may use up to 3
reporting periods to transition to the reporting of such
information in accordance with the standardized format
specified by the Secretary under paragraph (1).
(c) Additional Funding for the Secretary To Improve
Timeliness of Data Reporting and Analysis for Purposes of
Determining Enrollment Increases Under Medicaid and CHIP.--
(1) Appropriation.--There is appropriated, out of any money
in the Treasury not otherwise appropriated, $5,000,000 to the
Secretary for fiscal year 2008 for the purpose of improving
the timeliness of the data reported and analyzed from the
Medicaid Statistical Information System (MSIS) for purposes
of providing more timely data on enrollment and eligibility
of children under Medicaid and CHIP and to provide guidance
to States with respect to any new reporting requirements
related to such improvements. Amounts appropriated under this
paragraph shall remain available until expended.
(2) Requirements.--The improvements made by the Secretary
under paragraph (1) shall be designed and implemented
(including with respect to any necessary guidance for States
to report such information in a complete and expeditious
manner) so that, beginning no later than October 1, 2008,
data regarding the enrollment of low-income children (as
defined in section 2110(c)(4) of the Social Security Act (42
U.S.C. 1397jj(c)(4)) of a State enrolled in the State plan
under Medicaid or the State child health plan under CHIP with
respect to a fiscal year shall be collected and analyzed by
the Secretary within 6 months of submission.
(d) GAO Study and Report on Access to Primary and
Speciality Services.--
(1) In general.--The Comptroller General of the United
States shall conduct a study of children's access to primary
and specialty services under Medicaid and CHIP, including--
(A) the extent to which providers are willing to treat
children eligible for such programs;
(B) information on such children's access to networks of
care;
(C) geographic availability of primary and specialty
services under such programs;
(D) the extent to which care coordination is provided for
children's care under Medicaid and CHIP; and
(E) as appropriate, information on the degree of
availability of services for children under such programs.
(2) Report.--Not later than 2 years after the date of
enactment of this Act, the Comptroller General shall submit a
report to the Committee on Finance of the Senate and the
Committee on Energy and Commerce of the House of
Representatives on the study conducted under paragraph (1)
that includes recommendations for such Federal and State
legislative and administrative changes as the Comptroller
General determines are necessary to address any barriers to
access to children's care under Medicaid and CHIP that may
exist.
SEC. 403. APPLICATION OF CERTAIN MANAGED CARE QUALITY
SAFEGUARDS TO CHIP.
(a) In General.--Section 2103(f) of Social Security Act (42
U.S.C. 1397bb(f)) is amended by adding at the end the
following new paragraph:
``(3) Compliance with managed care requirements.--The State
child health plan shall provide for the application of
subsections (a)(4), (a)(5), (b), (c), (d), and (e) of section
1932 (relating to requirements for managed care) to coverage,
State agencies, enrollment brokers, managed care entities,
and managed care organizations under this title in the same
manner as such subsections apply to coverage and such
entities and organizations under title XIX.''.
[[Page H10863]]
(b) Effective Date.--The amendment made by subsection (a)
shall apply to contract years for health plans beginning on
or after July 1, 2008.
TITLE V--IMPROVING ACCESS TO BENEFITS
SEC. 501. DENTAL BENEFITS.
(a) Coverage.--
(1) In general.--Section 2103 (42 U.S.C. 1397cc) is
amended--
(A) in subsection (a)--
(i) in the matter before paragraph (1), by striking
``subsection (c)(5)'' and inserting ``paragraphs (5) and (7)
of subsection (c)''; and
(ii) in paragraph (1), by inserting ``at least'' after
``that is''; and
(B) in subsection (c)--
(i) by redesignating paragraph (5) as paragraph (7); and
(ii) by inserting after paragraph (4), the following:
``(5) Dental benefits.--
``(A) In general.--The child health assistance provided to
a targeted low-income child shall include coverage of dental
services necessary to prevent disease and promote oral
health, restore oral structures to health and function, and
treat emergency conditions.
``(B) Permitting use of dental benchmark plans by certain
states.--A State may elect to meet the requirement of
subparagraph (A) through dental coverage that is equivalent
to a benchmark dental benefit package described in
subparagraph (C).
``(C) Benchmark dental benefit packages.--The benchmark
dental benefit packages are as follows:
``(i) FEHBP children's dental coverage.--A dental benefits
plan under chapter 89A of title 5, United States Code, that
has been selected most frequently by employees seeking
dependent coverage, among such plans that provide such
dependent coverage, in either of the previous 2 plan years.
``(ii) State employee dependent dental coverage.--A dental
benefits plan that is offered and generally available to
State employees in the State involved and that has been
selected most frequently by employees seeking dependent
coverage, among such plans that provide such dependent
coverage, in either of the previous 2 plan years.
``(iii) Coverage offered through commercial dental plan.--A
dental benefits plan that has the largest insured commercial,
non-medicaid enrollment of dependent covered lives of such
plans that is offered in the State involved.''.
(2) Assuring access to care.--Section 2102(a)(7)(B) (42
U.S.C. 1397bb(c)(2)) is amended by inserting ``and services
described in section 2103(c)(5)'' after ``emergency
services''.
(3) Effective date.--The amendments made by paragraph (1)
shall apply to coverage of items and services furnished on or
after October 1, 2008.
(b) Dental Education for Parents of Newborns.--The
Secretary shall develop and implement, through entities that
fund or provide perinatal care services to targeted low-
income children under a State child health plan under title
XXI of the Social Security Act, a program to deliver oral
health educational materials that inform new parents about
risks for, and prevention of, early childhood caries and the
need for a dental visit within their newborn's first year of
life.
(c) Provision of Dental Services Through FQHCs.--
(1) Medicaid.--Section 1902(a) (42 U.S.C. 1396a(a)) is
amended--
(A) by striking ``and'' at the end of paragraph (69);
(B) by striking the period at the end of paragraph (70) and
inserting ``; and''; and
(C) by inserting after paragraph (70) the following new
paragraph:
``(71) provide that the State will not prevent a Federally-
qualified health center from entering into contractual
relationships with private practice dental providers in the
provision of Federally-qualified health center services.''.
(2) CHIP.--Section 2107(e)(1) (42 U.S.C. 1397g(e)(1)), as
amended by subsections (a)(2) and (d)(2) of section 203, is
amended by inserting after subparagraph (B) the following new
subparagraph (and redesignating the succeeding subparagraphs
accordingly):
``(C) Section 1902(a)(71) (relating to limiting FQHC
contracting for provision of dental services).''.
(3) Effective date.--The amendments made by this subsection
shall take effect on January 1, 2008.
(d) Reporting Information on Dental Health.--
(1) Medicaid.--Section 1902(a)(43)(D)(iii) (42 U.S.C.
1396a(a)(43)(D)(iii)) is amended by inserting ``and other
information relating to the provision of dental services to
such children described in section 2108(e)'' after
``receiving dental services,''.
(2) CHIP.--Section 2108 (42 U.S.C. 1397hh) is amended by
adding at the end the following new subsection:
``(e) Information on Dental Care for Children.--
``(1) In general.--Each annual report under subsection (a)
shall include the following information with respect to care
and services described in section 1905(r)(3) provided to
targeted low-income children enrolled in the State child
health plan under this title at any time during the year
involved:
``(A) The number of enrolled children by age grouping used
for reporting purposes under section 1902(a)(43).
``(B) For children within each such age grouping,
information of the type contained in questions 12(a)-(c) of
CMS Form 416 (that consists of the number of enrolled
targeted low income children who receive any, preventive, or
restorative dental care under the State plan).
``(C) For the age grouping that includes children 8 years
of age, the number of such children who have received a
protective sealant on at least one permanent molar tooth.
``(2) Inclusion of information on enrollees in managed care
plans.--The information under paragraph (1) shall include
information on children who are enrolled in managed care
plans and other private health plans and contracts with such
plans under this title shall provide for the reporting of
such information by such plans to the State.''.
(3) Effective date.--The amendments made by this subsection
shall be effective for annual reports submitted for years
beginning after date of enactment.
(e) Improved Accessibility of Dental Provider Information
to Enrollees Under Medicaid and CHIP.--The Secretary shall--
(1) work with States, pediatric dentists, and other dental
providers (including providers that are, or are affiliated
with, a school of dentistry) to include, not later than 6
months after the date of the enactment of this Act, on the
Insure Kids Now website (http://www.insurekidsnow.gov/) and
hotline (1-877-KIDS-NOW) (or on any successor websites or
hotlines) a current and accurate list of all such dentists
and providers within each State that provide dental services
to children enrolled in the State plan (or waiver) under
Medicaid or the State child health plan (or waiver) under
CHIP, and shall ensure that such list is updated at least
quarterly; and
(2) work with States to include, not later than 6 months
after the date of the enactment of this Act, a description of
the dental services provided under each State plan (or
waiver) under Medicaid and each State child health plan (or
waiver) under CHIP on such Insure Kids Now website, and shall
ensure that such list is updated at least annually.
(f) Inclusion of Status of Efforts To Improve Dental Care
in Reports on the Quality of Children's Health Care Under
Medicaid and CHIP.--Section 1139A(a), as added by section
401(a), is amended--
(1) in paragraph (3)(B)(ii), by inserting ``and, with
respect to dental care, conditions requiring the restoration
of teeth, relief of pain and infection, and maintenance of
dental health'' after ``chronic conditions''; and
(2) in paragraph (6)(A)(ii), by inserting ``dental care,''
after ``preventive health services,''.
(g) GAO Study and Report.--
(1) Study.--The Comptroller General of the United States
shall provide for a study that examines--
(A) access to dental services by children in underserved
areas;
(B) children's access to oral health care, including
preventive and restorative services, under Medicaid and CHIP,
including--
(i) the extent to which dental providers are willing to
treat children eligible for such programs;
(ii) information on such children's access to networks of
care, including such networks that serve special needs
children; and
(iii) geographic availability of oral health care,
including preventive and restorative services, under such
programs; and
(C) the feasibility and appropriateness of using qualified
mid-level dental health providers, in coordination with
dentists, to improve access for children to oral health
services and public health overall.
(2) Report.--Not later than 18 months year after the date
of the enactment of this Act, the Comptroller General shall
submit to Congress a report on the study conducted under
paragraph (1). The report shall include recommendations for
such Federal and State legislative and administrative changes
as the Comptroller General determines are necessary to
address any barriers to access to oral health care, including
preventive and restorative services, under Medicaid and CHIP
that may exist.
SEC. 502. MENTAL HEALTH PARITY IN CHIP PLANS.
(a) Assurance of Parity.--Section 2103(c) (42 U.S.C.
1397cc(c)), as amended by section 501(a)(1)(B), is amended by
inserting after paragraph (5), the following:
``(6) Mental health services parity.--
``(A) In general.--In the case of a State child health plan
that provides both medical and surgical benefits and mental
health or substance abuse benefits, such plan shall ensure
that the financial requirements and treatment limitations
applicable to such mental health or substance abuse benefits
are no more restrictive than the financial requirements and
treatment limitations applied to substantially all medical
and surgical benefits covered by the plan.
``(B) Deemed compliance.--To the extent that a State child
health plan includes coverage with respect to an individual
described in section 1905(a)(4)(B) and covered under the
State plan under section 1902(a)(10)(A) of the services
described in section 1905(a)(4)(B) (relating to early and
periodic screening, diagnostic, and treatment services
defined in section 1905(r)) and provided in accordance with
section 1902(a)(43), such plan shall be deemed to satisfy the
requirements of subparagraph (A).''.
(b) Conforming Amendments.--Section 2103 (42 U.S.C. 1397cc)
is amended--
[[Page H10864]]
(1) in subsection (a), as amended by section
501(a)(1)(A)(i), in the matter preceding paragraph (1), by
inserting ``, (6),'' after ``(5)''; and
(2) in subsection (c)(2), by striking subparagraph (B) and
redesignating subparagraphs (C) and (D) as subparagraphs (B)
and (C), respectively.
SEC. 503. APPLICATION OF PROSPECTIVE PAYMENT SYSTEM FOR
SERVICES PROVIDED BY FEDERALLY-QUALIFIED HEALTH
CENTERS AND RURAL HEALTH CLINICS.
(a) Application of Prospective Payment System.--
(1) In general.--Section 2107(e)(1) (42 U.S.C.
1397gg(e)(1)), as amended by section 501(c)(2) is amended by
inserting after subparagraph (C) the following new
subparagraph (and redesignating the succeeding subparagraphs
accordingly):
``(D) Section 1902(bb) (relating to payment for services
provided by Federally-qualified health centers and rural
health clinics).''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to services provided on or after October 1, 2008.
(b) Transition Grants.--
(1) Appropriation.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated to the
Secretary for fiscal year 2008, $5,000,000, to remain
available until expended, for the purpose of awarding grants
to States with State child health plans under CHIP that are
operated separately from the State Medicaid plan under title
XIX of the Social Security Act (including any waiver of such
plan), or in combination with the State Medicaid plan, for
expenditures related to transitioning to compliance with the
requirement of section 2107(e)(1)(D) of the Social Security
Act (as added by subsection (a)) to apply the prospective
payment system established under section 1902(bb) of the such
Act (42 U.S.C. 1396a(bb)) to services provided by Federally-
qualified health centers and rural health clinics.
(2) Monitoring and report.--The Secretary shall monitor the
impact of the application of such prospective payment system
on the States described in paragraph (1) and, not later than
October 1, 2010, shall report to Congress on any effect on
access to benefits, provider payment rates, or scope of
benefits offered by such States as a result of the
application of such payment system.
SEC. 504. PREMIUM GRACE PERIOD.
(a) In General.--Section 2103(e)(3) (42 U.S.C.
1397cc(e)(3)) is amended by adding at the end the following
new subparagraph:
``(C) Premium grace period.--The State child health plan--
``(i) shall afford individuals enrolled under the plan a
grace period of at least 30 days from the beginning of a new
coverage period to make premium payments before the
individual's coverage under the plan may be terminated; and
``(ii) shall provide to such an individual, not later than
7 days after the first day of such grace period, notice--
``(I) that failure to make a premium payment within the
grace period will result in termination of coverage under the
State child health plan; and
``(II) of the individual's right to challenge the proposed
termination pursuant to the applicable Federal regulations.
For purposes of clause (i), the term `new coverage period'
means the month immediately following the last month for
which the premium has been paid.''.
(b) Effective Date.--The amendment made by subsection (a)
shall apply to new coverage periods beginning on or after
January 1, 2009.
SEC. 505. DEMONSTRATION PROJECTS RELATING TO DIABETES
PREVENTION.
There is authorized to be appropriated $15,000,000 during
the period of fiscal years 2008 through 2012 to fund
demonstration projects in up to 10 States over 3 years for
voluntary incentive programs to promote children's receipt of
relevant screenings and improvements in healthy eating and
physical activity with the aim of reducing the incidence of
type 2 diabetes. Such programs may involve reductions in
cost-sharing or premiums when children receive regular
screening and reach certain benchmarks in healthy eating and
physical activity. Under such programs, a State may also
provide financial bonuses for partnerships with entities,
such as schools, which increase their education and efforts
with respect to reducing the incidence of type 2 diabetes and
may also devise incentives for providers serving children
covered under this title and title XIX to perform relevant
screening and counseling regarding healthy eating and
physical activity. Upon completion of these demonstrations,
the Secretary shall provide a report to Congress on the
results of the State demonstration projects and the degree to
which they helped improve health outcomes related to type 2
diabetes in children in those States.
SEC. 506. CLARIFICATION OF COVERAGE OF SERVICES PROVIDED
THROUGH SCHOOL-BASED HEALTH CENTERS.
Section 2103(c) (42 U.S.C. 1397cc(c)), as amended by
section 501(a)(1)(B), is amended by adding at the end the
following new paragraph:
``(8) Availability of coverage for items and services
furnished through school-based health centers.--Nothing in
this title shall be construed as limiting a State's ability
to provide child health assistance for covered items and
services that are furnished through school-based health
centers.''.
TITLE VI--PROGRAM INTEGRITY AND OTHER MISCELLANEOUS PROVISIONS
Subtitle A--Program Integrity and Data Collection
SEC. 601. PAYMENT ERROR RATE MEASUREMENT (``PERM'').
(a) Expenditures Related to Compliance With Requirements.--
(1) Enhanced payments.--Section 2105(c) (42 U.S.C.
1397ee(c)), as amended by section 301(a), is amended by
adding at the end the following new paragraph:
``(12) Enhanced payments.--Notwithstanding subsection (b),
the enhanced FMAP with respect to payments under subsection
(a) for expenditures related to the administration of the
payment error rate measurement (PERM) requirements applicable
to the State child health plan in accordance with the
Improper Payments Information Act of 2002 and parts 431 and
457 of title 42, Code of Federal Regulations (or any related
or successor guidance or regulations) shall in no event be
less than 90 percent.''.
(2) Exclusion of from cap on administrative expenditures.--
Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)C)), as amended
by section 302(b)), is amended by adding at the end the
following:
``(iv) Payment error rate measurement (perm)
expenditures.--Expenditures related to the administration of
the payment error rate measurement (PERM) requirements
applicable to the State child health plan in accordance with
the Improper Payments Information Act of 2002 and parts 431
and 457 of title 42, Code of Federal Regulations (or any
related or successor guidance or regulations).''.
(b) Final Rule Required To Be in Effect for All States.--
Notwithstanding parts 431 and 457 of title 42, Code of
Federal Regulations (as in effect on the date of enactment of
this Act), the Secretary shall not calculate or publish any
national or State-specific error rate based on the
application of the payment error rate measurement (in this
section referred to as ``PERM'') requirements to CHIP until
after the date that is 6 months after the date on which a
final rule implementing such requirements in accordance with
the requirements of subsection (c) is in effect for all
States. Any calculation of a national error rate or a State
specific error rate after such final rule in effect for all
States may only be inclusive of errors, as defined in such
final rule or in guidance issued within a reasonable time
frame after the effective date for such final rule that
includes detailed guidance for the specific methodology for
error determinations.
(c) Requirements for Final Rule.--For purposes of
subsection (b), the requirements of this subsection are that
the final rule implementing the PERM requirements shall--
(1) include--
(A) clearly defined criteria for errors for both States and
providers;
(B) a clearly defined process for appealing error
determinations by--
(i) review contractors; or
(ii) the agency and personnel described in section
431.974(a)(2) of title 42, Code of Federal Regulations, as in
effect on September 1, 2007, responsible for the development,
direction, implementation, and evaluation of eligibility
reviews and associated activities; and
(C) clearly defined responsibilities and deadlines for
States in implementing any corrective action plans; and
(2) provide that the payment error rate determined for a
State shall not take into account payment errors resulting
from the State's verification of an applicant's self-
declaration or self-certification of eligibility for, and the
correct amount of, medical assistance or child health
assistance, if the State process for verifying an applicant's
self-declaration or self-certification satisfies the
requirements for such process applicable under regulations
promulgated by the Secretary or otherwise approved by the
Secretary.
(d) Option for Application of Data for States in First
Application Cycle Under the Interim Final Rule.--After the
final rule implementing the PERM requirements in accordance
with the requirements of subsection (c) is in effect for all
States, a State for which the PERM requirements were first in
effect under an interim final rule for fiscal year 2007 may
elect to accept any payment error rate determined in whole or
in part for the State on the basis of data for that fiscal
year or may elect to not have any payment error rate
determined on the basis of such data and, instead, shall be
treated as if fiscal year 2010 were the first fiscal year for
which the PERM requirements apply to the State.
(e) Harmonization of MEQC and PERM.--
(1) Reduction of redundancies.--The Secretary shall review
the Medicaid Eligibility Quality Control (in this subsection
referred to as the ``MEQC'') requirements with the PERM
requirements and coordinate consistent implementation of both
sets of requirements, while reducing redundancies.
(2) State option to apply perm data.--A State may elect,
for purposes of determining the erroneous excess payments for
medical assistance ratio applicable to the State for a fiscal
year under section 1903(u) of the Social Security Act (42
U.S.C. 1396b(u)) to substitute data resulting from the
application of the PERM requirements to the State after the
final rule implementing such requirements is in effect for
all States for data obtained from the application of the MEQC
requirements to the State with respect to a fiscal year.
[[Page H10865]]
(3) State option to apply meqc data.--For purposes of
satisfying the requirements of subpart Q of part 431 of title
42, Code of Federal Regulations, as in effect on September 1,
2007, relating to Medicaid eligibility reviews, a State may
elect to substitute data obtained through MEQC reviews
conducted in accordance with section 1903(u) of the Social
Security Act (42 U.S.C. 1396b(u)) for data required for
purposes of PERM requirements, but only if the State MEQC
reviews are based on a broad, representative sample of
Medicaid applicants or enrollees in the States.
(f) Identification of Improved State-Specific Sample
Sizes.--The Secretary shall establish State-specific sample
sizes for application of the PERM requirements with respect
to State child health plans for fiscal years beginning with
fiscal year 2009, on the basis of such information as the
Secretary determines appropriate. In establishing such sample
sizes, the Secretary shall, to the greatest extent
practicable--
(1) minimize the administrative cost burden on States under
Medicaid and CHIP; and
(2) maintain State flexibility to manage such programs.
SEC. 602. IMPROVING DATA COLLECTION.
(a) Increased Appropriation.--Section 2109(b)(2) (42 U.S.C.
1397ii(b)(2)) is amended by striking ``$10,000,000 for fiscal
year 2000'' and inserting ``$20,000,000 for fiscal year
2008''.
(b) Use of Additional Funds.--Section 2109(b) (42 U.S.C.
1397ii(b)), as amended by subsection (a), is amended--
(1) by redesignating paragraph (2) as paragraph (4); and
(2) by inserting after paragraph (1), the following new
paragraphs:
``(2) Additional requirements.--In addition to making the
adjustments required to produce the data described in
paragraph (1), with respect to data collection occurring for
fiscal years beginning with fiscal year 2008, in appropriate
consultation with the Secretary of Health and Human Services,
the Secretary of Commerce shall do the following:
``(A) Make appropriate adjustments to the Current
Population Survey to develop more accurate State-specific
estimates of the number of children enrolled in health
coverage under title XIX or this title.
``(B) Make appropriate adjustments to the Current
Population Survey to improve the survey estimates used to
determine the child population growth factor under section
2104(i)(5)(B) and any other data necessary for carrying out
this title.
``(C) Include health insurance survey information in the
American Community Survey related to children.
``(D) Assess whether American Community Survey estimates,
once such survey data are first available, produce more
reliable estimates than the Current Population Survey with
respect to the purposes described in subparagraph (B).
``(E) On the basis of the assessment required under
subparagraph (D), recommend to the Secretary of Health and
Human Services whether American Community Survey estimates
should be used in lieu of, or in some combination with,
Current Population Survey estimates for the purposes
described in subparagraph (B).
``(F) Continue making the adjustments described in the last
sentence of paragraph (1) with respect to expansion of the
sample size used in State sampling units, the number of
sampling units in a State, and using an appropriate
verification element.
``(3) Authority for the secretary of health and human
services to transition to the use of all, or some combination
of, acs estimates upon recommendation of the secretary of
commerce.--If, on the basis of the assessment required under
paragraph (2)(D), the Secretary of Commerce recommends to the
Secretary of Health and Human Services that American
Community Survey estimates should be used in lieu of, or in
some combination with, Current Population Survey estimates
for the purposes described in paragraph (2)(B), the Secretary
of Health and Human Services, in consultation with the
States, may provide for a period during which the Secretary
may transition from carrying out such purposes through the
use of Current Population Survey estimates to the use of
American Community Survey estimates (in lieu of, or in
combination with the Current Population Survey estimates, as
recommended), provided that any such transition is
implemented in a manner that is designed to avoid adverse
impacts upon States with approved State child health plans
under this title.''.
SEC. 603. UPDATED FEDERAL EVALUATION OF CHIP.
Section 2108(c) (42 U.S.C. 1397hh(c)) is amended by
striking paragraph (5) and inserting the following:
``(5) Subsequent evaluation using updated information.--
``(A) In general.--The Secretary, directly or through
contracts or interagency agreements, shall conduct an
independent subsequent evaluation of 10 States with approved
child health plans.
``(B) Selection of states and matters included.--Paragraphs
(2) and (3) shall apply to such subsequent evaluation in the
same manner as such provisions apply to the evaluation
conducted under paragraph (1).
``(C) Submission to congress.--Not later than December 31,
2010, the Secretary shall submit to Congress the results of
the evaluation conducted under this paragraph.
``(D) Funding.--Out of any money in the Treasury of the
United States not otherwise appropriated, there are
appropriated $10,000,000 for fiscal year 2009 for the purpose
of conducting the evaluation authorized under this paragraph.
Amounts appropriated under this subparagraph shall remain
available for expenditure through fiscal year 2011.''.
SEC. 604. ACCESS TO RECORDS FOR IG AND GAO AUDITS AND
EVALUATIONS.
Section 2108(d) (42 U.S.C. 1397hh(d)) is amended to read as
follows:
``(d) Access to Records for IG and GAO Audits and
Evaluations.--For the purpose of evaluating and auditing the
program established under this title, or title XIX, the
Secretary, the Office of Inspector General, and the
Comptroller General shall have access to any books, accounts,
records, correspondence, and other documents that are related
to the expenditure of Federal funds under this title and that
are in the possession, custody, or control of States
receiving Federal funds under this title or political
subdivisions thereof, or any grantee or contractor of such
States or political subdivisions.''.
SEC. 605. NO FEDERAL FUNDING FOR ILLEGAL ALIENS.
Nothing in this Act allows Federal payment for individuals
who are not legal residents.
Subtitle B--Miscellaneous Health Provisions
SEC. 611. DEFICIT REDUCTION ACT TECHNICAL CORRECTIONS.
(a) Clarification of Requirement to Provide EPSDT Services
for All Children in Benchmark Benefit Packages Under
Medicaid.--Section 1937(a)(1) (42 U.S.C. 1396u-7(a)(1)), as
inserted by section 6044(a) of the Deficit Reduction Act of
2005 (Public Law 109-171, 120 Stat. 88), is amended--
(1) in subparagraph (A)--
(A) in the matter before clause (i)--
(i) by striking ``Notwithstanding any other provision of
this title'' and inserting ``Notwithstanding section 1902 (a)
(1) (relating to statewideness), section 1902
(a)(10)(B)(relating to comparability) and any other provision
of this title which would be directly contrary to the
authority under this section and subject to subsection (E)'';
and
(ii) by striking ``enrollment in coverage that provides''
and inserting ``coverage that'';
(B) in clause (i), by inserting ``provides'' after ``(i)'';
and
(C) by striking clause (ii) and inserting the following:
``(ii) for any individual described in section
1905(a)(4)(B) who is eligible under the State plan in
accordance with paragraphs (10) and (17) of section 1902(a),
consists of the items and services described in section
1905(a)(4)(B) (relating to early and periodic screening,
diagnostic, and treatment services defined in section
1905(r)) and provided in accordance with the requirements of
section 1902(a)(43).'';
(2) in subparagraph (C)--
(A) in the heading, by striking ``WRAP-AROUND'' and
inserting ``ADDITIONAL''; and
(B) by striking ``wrap-around or''; and
(3) by adding at the end the following new subparagraph:
``(E) Rule of construction.--Nothing in this paragraph
shall be construed as--
``(i) requiring a State to offer all or any of the items
and services required by subparagraph (A)(ii) through an
issuer of benchmark coverage described in subsection (b)(1)
or benchmark equivalent coverage described in subsection
(b)(2);
``(ii) preventing a State from offering all or any of the
items and services required by subparagraph (A)(ii) through
an issuer of benchmark coverage described in subsection
(b)(1) or benchmark equivalent coverage described in
subsection (b)(2); or
``(iii) affecting a child's entitlement to care and
services described in subsections (a)(4)(B) and (r) of
section 1905 and provided in accordance with section
1902(a)(43) whether provided through benchmark coverage,
benchmark equivalent coverage, or otherwise.''.
(b) Correction of Reference to Children in Foster Care
Receiving Child Welfare Services.--Section
1937(a)(2)(B)(viii) (42 U.S.C. 1396u-7(a)(2)(B)(viii), as
inserted by section 6044(a) of the Deficit Reduction Act of
2005, is amended by striking ``aid or assistance is made
available under part B of title IV to children in foster care
and individuals'' and inserting ``child welfare services are
made available under part B of title IV on the basis of being
a child in foster care or''.
(c) Transparency.--Section 1937 (42 U.S.C. 1396u-7), as
inserted by section 6044(a) of the Deficit Reduction Act of
2005, is amended by adding at the end the following:
``(c) Publication of Provisions Affected.--With respect to
a State plan amendment to provide benchmark benefits in
accordance with subsections (a) and (b) that is approved by
the Secretary, the Secretary shall publish on the Internet
website of the Centers for Medicare & Medicaid Services, a
list of the provisions of this title that the Secretary has
determined do not apply in order to enable the State to carry
out the plan amendment and the reason for each such
determination on the date such approval is made, and shall
publish such list in the Federal Register and not later than
30 days after such date of approval.''.
(d) Effective Date.--The amendments made by subsections
(a), (b), and (c) of this section shall take effect as if
included in the
[[Page H10866]]
amendment made by section 6044(a) of the Deficit Reduction
Act of 2005.
SEC. 612. REFERENCES TO TITLE XXI.
Section 704 of the Medicare, Medicaid, and SCHIP Balanced
Budget Refinement Act of 1999, as enacted into law by
division B of Public Law 106-113 (113 Stat. 1501A-402) is
repealed.
SEC. 613. PROHIBITING INITIATION OF NEW HEALTH OPPORTUNITY
ACCOUNT DEMONSTRATION PROGRAMS.
After the date of the enactment of this Act, the Secretary
of Health and Human Services may not approve any new
demonstration programs under section 1938 of the Social
Security Act (42 U.S.C. 1396u-8).
SEC. 614. COUNTY MEDICAID HEALTH INSURING ORGANIZATIONS; GAO
REPORT ON MEDICAID MANAGED CARE PAYMENT RATES.
(a) In General.--Section 9517(c)(3) of the Consolidated
Omnibus Budget Reconciliation Act of 1985 (42 U.S.C. 1396b
note), as added by section 4734 of the Omnibus Budget
Reconciliation Act of 1990 and as amended by section 704 of
the Medicare, Medicaid, and SCHIP Benefits Improvement and
Protection Act of 2000, is amended--
(1) in subparagraph (A), by inserting ``, in the case of
any health insuring organization described in such
subparagraph that is operated by a public entity established
by Ventura County, and in the case of any health insuring
organization described in such subparagraph that is operated
by a public entity established by Merced County'' after
``described in subparagraph (B)''; and
(2) in subparagraph (C), by striking ``14 percent'' and
inserting ``16 percent''.
(b) Effective Date.--The amendments made by subsection (a)
shall take effect on the date of the enactment of this Act.
(c) GAO Report on Actuarial Soundness of Medicaid Managed
Care Payment Rates.--Not later than 18 months after the date
of the enactment of this Act, the Comptroller General of the
United States shall submit a report to the Committee on
Finance of the Senate and the Committee on Energy and
Commerce of the House of Representatives analyzing the extent
to which State payment rates for medicaid managed care
organizations under title XIX of the Social Security Act are
actuarially sound.
SEC. 615. ADJUSTMENT IN COMPUTATION OF MEDICAID FMAP TO
DISREGARD AN EXTRAORDINARY EMPLOYER PENSION
CONTRIBUTION.
(a) In General.--Only for purposes of computing the FMAP
(as defined in subsection (e)) for a State for a fiscal year
(beginning with fiscal year 2006) and applying the FMAP under
title XIX of the Social Security Act, any significantly
disproportionate employer pension or insurance fund
contribution described in subsection (b) shall be disregarded
in computing the per capita income of such State, but shall
not be disregarded in computing the per capita income for the
continental United States (and Alaska) and Hawaii.
(b) Significantly Disproportionate Employer Pension and
Insurance Fund Contribution.--
(1) In general.--For purposes of this section, a
significantly disproportionate employer pension and insurance
fund contribution described in this subsection with respect
to a State is any identifiable employer contribution towards
pension or other employee insurance funds that is estimated
to accrue to residents of such State for a calendar year
(beginning with calendar year 2003) if the increase in the
amount so estimated exceeds 25 percent of the total increase
in personal income in that State for the year involved.
(2) Data to be used.--For estimating and adjustment a FMAP
already calculated as of the date of the enactment of this
Act for a State with a significantly disproportionate
employer pension and insurance fund contribution, the
Secretary shall use the personal income data set originally
used in calculating such FMAP.
(3) Special adjustment for negative growth.--If in any
calendar year the total personal income growth in a State is
negative, an employer pension and insurance fund contribution
for the purposes of calculating the State's FMAP for a
calendar year shall not exceed 125 percent of the amount of
such contribution for the previous calendar year for the
State.
(c) Hold Harmless.--No State shall have its FMAP for a
fiscal year reduced as a result of the application of this
section.
(d) Report.--Not later than May 15, 2008, the Secretary
shall submit to the Congress a report on the problems
presented by the current treatment of pension and insurance
fund contributions in the use of Bureau of Economic Affairs
calculations for the FMAP and for Medicaid and on possible
alternative methodologies to mitigate such problems.
(e) FMAP Defined.--For purposes of this section, the term
``FMAP'' means the Federal medical assistance percentage, as
defined in section 1905(b) of the Social Security Act (42
U.S.C. 1396(d)).
SEC. 616. MORATORIUM ON CERTAIN PAYMENT RESTRICTIONS.
Notwithstanding any other provision of law, the Secretary
of Health and Human Services shall not, prior to May 28,
2008, take any action (through promulgation of regulation,
issuance of regulatory guidance, use of federal payment audit
procedures, or other administrative action, policy, or
practice, including a Medical Assistance Manual transmittal
or letter to State Medicaid directors) to restrict coverage
or payment under title XIX of the Social Security Act for
rehabilitation services, or school-based administration,
transportation, or medical services if such restrictions are
more restrictive in any aspect than those applied to such
coverage or payment as of July 1, 2007.
SEC. 617. MEDICAID DSH ALLOTMENTS FOR TENNESSEE AND HAWAII.
(a) Tennessee.--The DSH allotments for Tennessee for each
fiscal year beginning with fiscal year 2008 under subsection
(f)(3) of section 1923 of the Social Security Act (42 U.S.C.
1396r-4) are deemed to be $30,000,000. The Secretary of
Health and Human Services may impose a limitation on the
total amount of payments made to hospitals under the TennCare
Section 1115 waiver only to the extent that such limitation
is necessary to ensure that a hospital does not receive
payment in excess of the amounts described in subsection (f)
of such section or as necessary to ensure that the waiver
remains budget neutral.
(b) Hawaii.--Section 1923(f)(6) (42 U.S.C. 1396r-4(f)(6))
is amended--
(1) in the paragraph heading, by striking ``for fiscal year
2007''; and
(2) in subparagraph (B)--
(A) in clause (i), by striking ``Only with respect to
fiscal year 2007'' and inserting ``With respect to each of
fiscal years 2007 and 2008'';
(B) by redesignating clause (ii) as clause (iv); and
(C) by inserting after clause (i), the following new
clauses:
``(ii) Treatment as a low-dsh state.--With respect to
fiscal year 2009 and each fiscal year thereafter,
notwithstanding the table set forth in paragraph (2), the DSH
allotment for Hawaii shall be increased in the same manner as
allotments for low DSH States are increased for such fiscal
year under clauses (ii) and (iii) of paragraph (5)(B).
``(iii) Certain hospital payments.--The Secretary may not
impose a limitation on the total amount of payments made to
hospitals under the QUEST section 1115 Demonstration Project
except to the extent that such limitation is necessary to
ensure that a hospital does not receive payments in excess of
the amounts described in subsection (g), or as necessary to
ensure that such payments under the waiver and such payments
pursuant to the allotment provided in this section do not, in
the aggregate in any year, exceed the amount that the
Secretary determines is equal to the Federal medical
assistance percentage component attributable to
disproportionate share hospital payment adjustments for such
year that is reflected in the budget neutrality provision of
the QUEST Demonstration Project.''.
SEC. 618. CLARIFICATION TREATMENT OF REGIONAL MEDICAL CENTER.
(a) In General.--Nothing in section 1903(w) of the Social
Security Act (42 U.S.C. 1396b(w)) shall be construed by the
Secretary of Health and Human Services as prohibiting a
State's use of funds as the non-Federal share of expenditures
under title XIX of such Act where such funds are transferred
from or certified by a publicly-owned regional medical center
located in another State and described in subsection (b), so
long as the Secretary determines that such use of funds is
proper and in the interest of the program under title XIX.
(b) Center Described.--A center described in this
subsection is a publicly-owned regional medical center that--
(1) provides level 1 trauma and burn care services;
(2) provides level 3 neonatal care services;
(3) is obligated to serve all patients, regardless of
ability to pay;
(4) is located within a Standard Metropolitan Statistical
Area (SMSA) that includes at least 3 States;
(5) provides services as a tertiary care provider for
patients residing within a 125-mile radius; and
(6) meets the criteria for a disproportionate share
hospital under section 1923 of such Act (42 U.S.C. 1396r-4)
in at least one State other than the State in which the
center is located.
SEC. 619. EXTENSION OF SSI WEB-BASED ASSET DEMONSTRATION
PROJECT TO THE MEDICAID PROGRAM.
(a) In General.--Beginning on October 1, 2012, the
Secretary of Health and Human Services shall provide for the
application to asset eligibility determinations under the
Medicaid program under title XIX of the Social Security Act
of the automated, secure, web-based asset verification
request and response process being applied for determining
eligibility for benefits under the Supplemental Security
Income (SSI) program under title XVI of such Act under a
demonstration project conducted under the authority of
section 1631(e)(1)(B)(ii) of such Act (42 U.S.C.
1383(e)(1)(B)(ii)).
(b) Limitation.--Such application shall only extend to
those States in which such demonstration project is operating
and only for the period in which such project is otherwise
provided.
(c) Rules of Application.--For purposes of carrying out
subsection (a), notwithstanding any other provision of law,
information obtained from a financial institution that is
used for purposes of eligibility determinations under such
demonstration project with respect to the Secretary of Health
and Human Services under the SSI program may also be shared
and used by States for purposes of eligibility determinations
under the Medicaid program. In applying section
1631(e)(1)(B)(ii) of the Social Security Act under this
subsection, references to the Commissioner of Social Security
and benefits
[[Page H10867]]
under title XVI of such Act shall be treated as including a
reference to a State described in subsection (b) and medical
assistance under title XIX of such Act provided by such a
State.
Subtitle C--Other Provisions
SEC. 621. SUPPORT FOR INJURED SERVICEMEMBERS.
(a) Short Title.--This section may be cited as the
``Support for Injured Servicemembers Act''.
(b) Servicemember Family Leave.--
(1) Definitions.--Section 101 of the Family and Medical
Leave Act of 1993 (29 U.S.C. 2611) is amended by adding at
the end the following:
``(14) Active duty.--The term `active duty' means duty
under a call or order to active duty under a provision of law
referred to in section 101(a)(13)(B) of title 10, United
States Code.
``(15) Covered servicemember.--The term `covered
servicemember' means a member of the Armed Forces, including
a member of the National Guard or a Reserve, who is
undergoing medical treatment, recuperation, or therapy, is
otherwise in medical hold or medical holdover status, or is
otherwise on the temporary disability retired list, for a
serious injury or illness.
``(16) Medical hold or medical holdover status.--The term
`medical hold or medical holdover status' means--
``(A) the status of a member of the Armed Forces, including
a member of the National Guard or a Reserve, assigned or
attached to a military hospital for medical care; and
``(B) the status of a member of a reserve component of the
Armed Forces who is separated, whether pre-deployment or
post-deployment, from the member's unit while in need of
health care based on a medical condition identified while the
member is on active duty in the Armed Forces.
``(17) Next of kin.--The term `next of kin', used with
respect to an individual, means the nearest blood relative of
that individual.
``(18) Serious injury or illness.--The term `serious injury
or illness', in the case of a member of the Armed Forces,
means an injury or illness incurred by the member in line of
duty on active duty in the Armed Forces that may render the
member medically unfit to perform the duties of the member's
office, grade, rank, or rating.''.
(2) Entitlement to leave.--Section 102(a) of such Act (29
U.S.C. 2612(a)) is amended by adding at the end the
following:
``(3) Servicemember family leave.--Subject to section 103,
an eligible employee who is the spouse, son, daughter,
parent, or next of kin of a covered servicemember shall be
entitled to a total of 26 workweeks of leave during a 12-
month period to care for the servicemember. The leave
described in this paragraph shall only be available during a
single 12-month period.
``(4) Combined leave total.--During the single 12-month
period described in paragraph (3), an eligible employee shall
be entitled to a combined total of 26 workweeks of leave
under paragraphs (1) and (3). Nothing in this paragraph shall
be construed to limit the availability of leave under
paragraph (1) during any other 12-month period.''.
(3) Requirements relating to leave.--
(A) Schedule.--Section 102(b) of such Act (29 U.S.C.
2612(b)) is amended--
(i) in paragraph (1), in the second sentence--
(I) by striking ``section 103(b)(5)'' and inserting
``subsection (b)(5) or (f) (as appropriate) of section 103'';
and
(II) by inserting ``or under subsection (a)(3)'' after
``subsection (a)(1)''; and
(ii) in paragraph (2), by inserting ``or under subsection
(a)(3)'' after ``subsection (a)(1)''.
(B) Substitution of paid leave.--Section 102(d) of such Act
(29 U.S.C. 2612(d)) is amended--
(i) in paragraph (1)--
(I) by inserting ``(or 26 workweeks in the case of leave
provided under subsection (a)(3))'' after ``12 workweeks''
the first place it appears; and
(II) by inserting ``(or 26 workweeks, as appropriate)''
after ``12 workweeks'' the second place it appears; and
(ii) in paragraph (2)(B), by adding at the end the
following: ``An eligible employee may elect, or an employer
may require the employee, to substitute any of the accrued
paid vacation leave, personal leave, family leave, or medical
or sick leave of the employee for leave provided under
subsection (a)(3) for any part of the 26-week period of such
leave under such subsection.''.
(C) Notice.--Section 102(e)(2) of such Act (29 U.S.C.
2612(e)(2)) is amended by inserting ``or under subsection
(a)(3)'' after ``subsection (a)(1)''.
(D) Spouses employed by same employer.--Section 102(f) of
such Act (29 U.S.C. 2612(f)) is amended--
(i) by redesignating paragraphs (1) and (2) as
subparagraphs (A) and (B), and aligning the margins of the
subparagraphs with the margins of section 102(e)(2)(A);
(ii) by striking ``In any'' and inserting the following:
``(1) In general.--In any''; and
(iii) by adding at the end the following:
``(2) Servicemember family leave.--
``(A) In general.--The aggregate number of workweeks of
leave to which both that husband and wife may be entitled
under subsection (a) may be limited to 26 workweeks during
the single 12-month period described in subsection (a)(3) if
the leave is--
``(i) leave under subsection (a)(3); or
``(ii) a combination of leave under subsection (a)(3) and
leave described in paragraph (1).
``(B) Both limitations applicable.--If the leave taken by
the husband and wife includes leave described in paragraph
(1), the limitation in paragraph (1) shall apply to the leave
described in paragraph (1).''.
(E) Certification.--Section 103 of such Act (29 U.S.C.
2613) is amended by adding at the end the following:
``(f) Certification for Servicemember Family Leave.--An
employer may require that a request for leave under section
102(a)(3) be supported by a certification issued at such time
and in such manner as the Secretary may by regulation
prescribe.''.
(F) Failure to return.--Section 104(c) of such Act (29
U.S.C. 2614(c)) is amended--
(i) in paragraph (2)(B)(i), by inserting ``or under section
102(a)(3)'' before the semicolon; and
(ii) in paragraph (3)(A)--
(I) in clause (i), by striking ``or'' at the end;
(II) in clause (ii), by striking the period and inserting
``; or''; and
(III) by adding at the end the following:
``(iii) a certification issued by the health care provider
of the servicemember being cared for by the employee, in the
case of an employee unable to return to work because of a
condition specified in section 102(a)(3).''.
(G) Enforcement.--Section 107 of such Act (29 U.S.C. 2617)
is amended, in subsection (a)(1)(A)(i)(II), by inserting
``(or 26 weeks, in a case involving leave under section
102(a)(3))'' after ``12 weeks''.
(H) Instructional employees.--Section 108 of such Act (29
U.S.C. 2618) is amended, in subsections (c)(1), (d)(2), and
(d)(3), by inserting ``or under section 102(a)(3)'' after
``section 102(a)(1)''.
(c) Servicemember Family Leave for Civil Service
Employees.--
(1) Definitions.--Section 6381 of title 5, United States
Code, is amended--
(A) in paragraph (5), by striking ``and'' at the end;
(B) in paragraph (6), by striking the period and inserting
``; and''; and
(C) by adding at the end the following:
``(7) the term `active duty' means duty under a call or
order to active duty under a provision of law referred to in
section 101(a)(13)(B) of title 10, United States Code;
``(8) the term `covered servicemember' means a member of
the Armed Forces, including a member of the National Guard or
a Reserve, who is undergoing medical treatment, recuperation,
or therapy, is otherwise in medical hold or medical holdover
status, or is otherwise on the temporary disability retired
list, for a serious injury or illness;
``(9) the term `medical hold or medical holdover status'
means--
``(A) the status of a member of the Armed Forces, including
a member of the National Guard or a Reserve, assigned or
attached to a military hospital for medical care; and
``(B) the status of a member of a reserve component of the
Armed Forces who is separated, whether pre-deployment or
post-deployment, from the member's unit while in need of
health care based on a medical condition identified while the
member is on active duty in the Armed Forces;
``(10) the term `next of kin', used with respect to an
individual, means the nearest blood relative of that
individual; and
``(11) the term `serious injury or illness', in the case of
a member of the Armed Forces, means an injury or illness
incurred by the member in line of duty on active duty in the
Armed Forces that may render the member medically unfit to
perform the duties of the member's office, grade, rank, or
rating.''.
(2) Entitlement to leave.--Section 6382(a) of such title is
amended by adding at the end the following:
``(3) Subject to section 6383, an employee who is the
spouse, son, daughter, parent, or next of kin of a covered
servicemember shall be entitled to a total of 26
administrative workweeks of leave during a 12-month period to
care for the servicemember. The leave described in this
paragraph shall only be available during a single 12-month
period.
``(4) During the single 12-month period described in
paragraph (3), an employee shall be entitled to a combined
total of 26 administrative workweeks of leave under
paragraphs (1) and (3). Nothing in this paragraph shall be
construed to limit the availability of leave under paragraph
(1) during any other 12-month period.''.
(3) Requirements relating to leave.--
(A) Schedule.--Section 6382(b) of such title is amended--
(i) in paragraph (1), in the second sentence--
(I) by striking ``section 6383(b)(5)'' and inserting
``subsection (b)(5) or (f) (as appropriate) of section
6383''; and
(II) by inserting ``or under subsection (a)(3)'' after
``subsection (a)(1)''; and
(ii) in paragraph (2), by inserting ``or under subsection
(a)(3)'' after ``subsection (a)(1)''.
(B) Substitution of paid leave.--Section 6382(d) of such
title is amended by adding at the end the following: ``An
employee may elect to substitute for leave under subsection
(a)(3) any of the employee's accrued or accumulated annual or
sick leave under subchapter I for any part of the 26-week
period of leave under such subsection.''.
(C) Notice.--Section 6382(e) of such title is amended by
inserting ``or under subsection (a)(3)'' after ``subsection
(a)(1)''.
(D) Certification.--Section 6383 of such title is amended
by adding at the end the following:
[[Page H10868]]
``(f) An employing agency may require that a request for
leave under section 6382(a)(3) be supported by a
certification issued at such time and in such manner as the
Office of Personnel Management may by regulation
prescribe.''.
SEC. 622. MILITARY FAMILY JOB PROTECTION.
(a) Short Title.--This section may be cited as the
``Military Family Job Protection Act''.
(b) Prohibition on Discrimination in Employment Against
Certain Family Members Caring for Recovering Members of the
Armed Forces.--A family member of a recovering servicemember
described in subsection (c) shall not be denied retention in
employment, promotion, or any benefit of employment by an
employer on the basis of the family member's absence from
employment as described in that subsection, for a period of
not more than 52 workweeks.
(c) Covered Family Members.--A family member described in
this subsection is a family member of a recovering
servicemember who is--
(1) on invitational orders while caring for the recovering
servicemember;
(2) a non-medical attendee caring for the recovering
servicemember; or
(3) receiving per diem payments from the Department of
Defense while caring for the recovering servicemember.
(d) Treatment of Actions.--An employer shall be considered
to have engaged in an action prohibited by subsection (b)
with respect to a person described in that subsection if the
absence from employment of the person as described in that
subsection is a motivating factor in the employer's action,
unless the employer can prove that the action would have been
taken in the absence of the absence of employment of the
person.
(e) Definitions.--In this section:
(1) Benefit of employment.--The term ``benefit of
employment'' has the meaning given such term in section 4303
of title 38, United States Code.
(2) Caring for.--The term ``caring for'', used with respect
to a recovering servicemember, means providing personal,
medical, or convalescent care to the recovering
servicemember, under circumstances that substantially
interfere with an employee's ability to work.
(3) Employer.--The term ``employer'' has the meaning given
such term in section 4303 of title 38, United States Code,
except that the term does not include any person who is not
considered to be an employer under title I of the Family and
Medical Leave Act of 1993 (29 U.S.C. 2611 et seq.) because
the person does not meet the requirements of section
101(4)(A)(i) of such Act (29 U.S.C. 2611(4)(A)(i)).
(4) Family member.--The term ``family member'', with
respect to a recovering servicemember, has the meaning given
that term in section 411h(b) of title 37, United States Code.
(5) Recovering servicemember.--The term ``recovering
servicemember'' means a member of the Armed Forces, including
a member of the National Guard or a Reserve, who is
undergoing medical treatment, recuperation, or therapy, or is
otherwise in medical hold or medical holdover status, for an
injury, illness, or disease incurred or aggravated while on
active duty in the Armed Forces.
SEC. 623. OUTREACH REGARDING HEALTH INSURANCE OPTIONS
AVAILABLE TO CHILDREN.
(a) Definitions.--In this section--
(1) the terms ``Administration'' and ``Administrator''
means the Small Business Administration and the Administrator
thereof, respectively;
(2) the term ``certified development company'' means a
development company participating in the program under title
V of the Small Business Investment Act of 1958 (15 U.S.C. 695
et seq.);
(3) the term ``Medicaid program'' means the program
established under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.);
(4) the term ``Service Corps of Retired Executives'' means
the Service Corps of Retired Executives authorized by section
8(b)(1) of the Small Business Act (15 U.S.C. 637(b)(1));
(5) the term ``small business concern'' has the meaning
given that term in section 3 of the Small Business Act (15
U.S.C. 632);
(6) the term ``small business development center'' means a
small business development center described in section 21 of
the Small Business Act (15 U.S.C. 648);
(7) the term ``State'' has the meaning given that term for
purposes of title XXI of the Social Security Act (42 U.S.C.
1397aa et seq.);
(8) the term ``State Children's Health Insurance Program''
means the State Children's Health Insurance Program
established under title XXI of the Social Security Act (42
U.S.C. 1397aa et seq.);
(9) the term ``task force'' means the task force
established under subsection (b)(1); and
(10) the term ``women's business center'' means a women's
business center described in section 29 of the Small Business
Act (15 U.S.C. 656).
(b) Establishment of Task Force.--
(1) Establishment.--There is established a task force to
conduct a nationwide campaign of education and outreach for
small business concerns regarding the availability of
coverage for children through private insurance options, the
Medicaid program, and the State Children's Health Insurance
Program.
(2) Membership.--The task force shall consist of the
Administrator, the Secretary of Health and Human Services,
the Secretary of Labor, and the Secretary of the Treasury.
(3) Responsibilities.--The campaign conducted under this
subsection shall include--
(A) efforts to educate the owners of small business
concerns about the value of health coverage for children;
(B) information regarding options available to the owners
and employees of small business concerns to make insurance
more affordable, including Federal and State tax deductions
and credits for health care-related expenses and health
insurance expenses and Federal tax exclusion for health
insurance options available under employer-sponsored
cafeteria plans under section 125 of the Internal Revenue
Code of 1986;
(C) efforts to educate the owners of small business
concerns about assistance available through public programs;
and
(D) efforts to educate the owners and employees of small
business concerns regarding the availability of the hotline
operated as part of the Insure Kids Now program of the
Department of Health and Human Services.
(4) Implementation.--In carrying out this subsection, the
task force may--
(A) use any business partner of the Administration,
including--
(i) a small business development center;
(ii) a certified development company;
(iii) a women's business center; and
(iv) the Service Corps of Retired Executives;
(B) enter into--
(i) a memorandum of understanding with a chamber of
commerce; and
(ii) a partnership with any appropriate small business
concern or health advocacy group; and
(C) designate outreach programs at regional offices of the
Department of Health and Human Services to work with district
offices of the Administration.
(5) Website.--The Administrator shall ensure that links to
information on the eligibility and enrollment requirements
for the Medicaid program and State Children's Health
Insurance Program of each State are prominently displayed on
the website of the Administration.
(6) Report.--
(A) In general.--Not later than 2 years after the date of
enactment of this Act, and every 2 years thereafter, the
Administrator shall submit to the Committee on Small Business
and Entrepreneurship of the Senate and the Committee on Small
Business of the House of Representatives a report on the
status of the nationwide campaign conducted under paragraph
(1).
(B) Contents.--Each report submitted under subparagraph (A)
shall include a status update on all efforts made to educate
owners and employees of small business concerns on options
for providing health insurance for children through public
and private alternatives.
SEC. 624. SENSE OF SENATE REGARDING ACCESS TO AFFORDABLE AND
MEANINGFUL HEALTH INSURANCE COVERAGE.
(a) Findings.--The Senate finds the following:
(1) There are approximately 45 million Americans currently
without health insurance.
(2) More than half of uninsured workers are employed by
businesses with less than 25 employees or are self-employed.
(3) Health insurance premiums continue to rise at more than
twice the rate of inflation for all consumer goods.
(4) Individuals in the small group and individual health
insurance markets usually pay more for similar coverage than
those in the large group market.
(5) The rapid growth in health insurance costs over the
last few years has forced many employers, particularly small
employers, to increase deductibles and co-pays or to drop
coverage completely.
(b) Sense of the Senate.--The Senate--
(1) recognizes the necessity to improve affordability and
access to health insurance for all Americans;
(2) acknowledges the value of building upon the existing
private health insurance market; and
(3) affirms its intent to enact legislation this year that,
with appropriate protection for consumers, improves access to
affordable and meaningful health insurance coverage for
employees of small businesses and individuals by--
(A) facilitating pooling mechanisms, including pooling
across State lines, and
(B) providing assistance to small businesses and
individuals, including financial assistance and tax
incentives, for the purchase of private insurance coverage.
TITLE VII--REVENUE PROVISIONS
SEC. 701. INCREASE IN EXCISE TAX RATE ON TOBACCO PRODUCTS.
(a) Cigars.--Section 5701(a) of the Internal Revenue Code
of 1986 is amended--
(1) by striking ``$1.828 cents per thousand ($1.594 cents
per thousand on cigars removed during 2000 or 2001)'' in
paragraph (1) and inserting ``$50.00 per thousand'',
(2) by striking ``20.719 percent (18.063 percent on cigars
removed during 2000 or 2001)'' in paragraph (2) and inserting
``52.988 percent'', and
(3) by striking ``$48.75 per thousand ($42.50 per thousand
on cigars removed during 2000 or 2001)'' in paragraph (2) and
inserting ``$3.00 per cigar''.
(b) Cigarettes.--Section 5701(b) of such Code is amended--
(1) by striking ``$19.50 per thousand ($17 per thousand on
cigarettes removed during 2000
[[Page H10869]]
or 2001)'' in paragraph (1) and inserting ``$50.00 per
thousand'', and
(2) by striking ``$40.95 per thousand ($35.70 per thousand
on cigarettes removed during 2000 or 2001)'' in paragraph (2)
and inserting ``$105.00 per thousand''.
(c) Cigarette Papers.--Section 5701(c) of such Code is
amended by striking ``1.22 cents (1.06 cents on cigarette
papers removed during 2000 or 2001)'' and inserting ``3.13
cents''.
(d) Cigarette Tubes.--Section 5701(d) of such Code is
amended by striking ``2.44 cents (2.13 cents on cigarette
tubes removed during 2000 or 2001)'' and inserting ``6.26
cents''.
(e) Smokeless Tobacco.--Section 5701(e) of such Code is
amended--
(1) by striking ``58.5 cents (51 cents on snuff removed
during 2000 or 2001)'' in paragraph (1) and inserting
``$1.50'', and
(2) by striking ``19.5 cents (17 cents on chewing tobacco
removed during 2000 or 2001)'' in paragraph (2) and inserting
``50 cents''.
(f) Pipe Tobacco.--Section 5701(f) of such Code is amended
by striking ``$1.0969 cents (95.67 cents on pipe tobacco
removed during 2000 or 2001)'' and inserting ``$2.8126
cents''.
(g) Roll-Your-Own Tobacco.--Section 5701(g) of such Code is
amended by striking ``$1.0969 cents (95.67 cents on roll-
your-own tobacco removed during 2000 or 2001)'' and inserting
``$8.8889 cents''.
(h) Floor Stocks Taxes.--
(1) Imposition of tax.--On tobacco products (other than
cigars described in section 5701(a)(2) of the Internal
Revenue Code of 1986) and cigarette papers and tubes
manufactured in or imported into the United States which are
removed before January 1, 2008, and held on such date for
sale by any person, there is hereby imposed a tax in an
amount equal to the excess of--
(A) the tax which would be imposed under section 5701 of
such Code on the article if the article had been removed on
such date, over
(B) the prior tax (if any) imposed under section 5701 of
such Code on such article.
(2) Credit against tax.--Each person shall be allowed as a
credit against the taxes imposed by paragraph (1) an amount
equal to $500. Such credit shall not exceed the amount of
taxes imposed by paragraph (1) on January 1, 2008, for which
such person is liable.
(3) Liability for tax and method of payment.--
(A) Liability for tax.--A person holding tobacco products,
cigarette papers, or cigarette tubes on January 1, 2008, to
which any tax imposed by paragraph (1) applies shall be
liable for such tax.
(B) Method of payment.--The tax imposed by paragraph (1)
shall be paid in such manner as the Secretary shall prescribe
by regulations.
(C) Time for payment.--The tax imposed by paragraph (1)
shall be paid on or before April 1, 2008.
(4) Articles in foreign trade zones.--Notwithstanding the
Act of June 18, 1934 (commonly known as the Foreign Trade
Zone Act, 48 Stat. 998, 19 U.S.C. 81a et seq.) or any other
provision of law, any article which is located in a foreign
trade zone on January 1, 2008, shall be subject to the tax
imposed by paragraph (1) if--
(A) internal revenue taxes have been determined, or customs
duties liquidated, with respect to such article before such
date pursuant to a request made under the 1st proviso of
section 3(a) of such Act, or
(B) such article is held on such date under the supervision
of an officer of the United States Customs and Border
Protection of the Department of Homeland Security pursuant to
the 2d proviso of such section 3(a).
(5) Definitions.--For purposes of this subsection--
(A) In general.--Any term used in this subsection which is
also used in section 5702 of the Internal Revenue Code of
1986 shall have the same meaning as such term has in such
section.
(B) Secretary.--The term ``Secretary'' means the Secretary
of the Treasury or the Secretary's delegate.
(6) Controlled groups.--Rules similar to the rules of
section 5061(e)(3) of such Code shall apply for purposes of
this subsection.
(7) Other laws applicable.--All provisions of law,
including penalties, applicable with respect to the taxes
imposed by section 5701 of such Code shall, insofar as
applicable and not inconsistent with the provisions of this
subsection, apply to the floor stocks taxes imposed by
paragraph (1), to the same extent as if such taxes were
imposed by such section 5701. The Secretary may treat any
person who bore the ultimate burden of the tax imposed by
paragraph (1) as the person to whom a credit or refund under
such provisions may be allowed or made.
(i) Effective Date.--The amendments made by this section
shall apply to articles removed (as defined in section
5702(j) of the Internal Revenue Code of 1986) after December
31, 2007.
SEC. 702. ADMINISTRATIVE IMPROVEMENTS.
(a) Permit, Report, and Record Requirements for
Manufacturers and Importers of Processed Tobacco.--
(1) Permits.--
(A) Application.--Section 5712 of the Internal Revenue Code
of 1986 is amended by inserting ``or processed tobacco''
after ``tobacco products''.
(B) Issuance.--Section 5713(a) of such Code is amended by
inserting ``or processed tobacco'' after ``tobacco
products''.
(2) Inventories and reports.--
(A) Inventories.--Section 5721 of such Code is amended by
inserting ``, processed tobacco,'' after ``tobacco
products''.
(B) Reports.--Section 5722 of such Code is amended by
inserting ``, processed tobacco,'' after ``tobacco
products''.
(3) Records.--Section 5741 of such Code is amended by
inserting ``, processed tobacco,'' after ``tobacco
products''.
(4) Manufacturer of processed tobacco.--Section 5702 of
such Code is amended by adding at the end the following new
subsection:
``(p) Manufacturer of Processed Tobacco.--
``(1) In general.--The term `manufacturer of processed
tobacco' means any person who processes any tobacco other
than tobacco products.
``(2) Processed tobacco.--The processing of tobacco shall
not include the farming or growing of tobacco or the handling
of tobacco solely for sale, shipment, or delivery to a
manufacturer of tobacco products or processed tobacco.''.
(5) Conforming amendment.--Section 5702(k) of such Code is
amended by inserting ``, or any processed tobacco,'' after
``nontaxpaid tobacco products or cigarette papers or tubes''.
(6) Effective date.--The amendments made by this subsection
shall take effect on January 1, 2008.
(b) Basis for Denial, Suspension, or Revocation of
Permits.--
(1) Denial.--Paragraph (3) of section 5712 of such Code is
amended to read as follows:
``(3) such person (including, in the case of a corporation,
any officer, director, or principal stockholder and, in the
case of a partnership, a partner)--
``(A) is, by reason of his business experience, financial
standing, or trade connections or by reason of previous or
current legal proceedings involving a felony violation of any
other provision of Federal criminal law relating to tobacco
products, cigarette paper, or cigarette tubes, not likely to
maintain operations in compliance with this chapter,
``(B) has been convicted of a felony violation of any
provision of Federal or State criminal law relating to
tobacco products, cigarette paper, or cigarette tubes, or
``(C) has failed to disclose any material information
required or made any material false statement in the
application therefor.''.
(2) Suspension or revocation.--Subsection (b) of section
5713 of such Code is amended to read as follows:
``(b) Suspension or Revocation.--
``(1) Show cause hearing.--If the Secretary has reason to
believe that any person holding a permit--
``(A) has not in good faith complied with this chapter, or
with any other provision of this title involving intent to
defraud,
``(B) has violated the conditions of such permit,
``(C) has failed to disclose any material information
required or made any material false statement in the
application for such permit,
``(D) has failed to maintain his premises in such manner as
to protect the revenue,
``(E) is, by reason of previous or current legal
proceedings involving a felony violation of any other
provision of Federal criminal law relating to tobacco
products, cigarette paper, or cigarette tubes, not likely to
maintain operations in compliance with this chapter, or
``(F) has been convicted of a felony violation of any
provision of Federal or State criminal law relating to
tobacco products, cigarette paper, or cigarette tubes,
the Secretary shall issue an order, stating the facts
charged, citing such person to show cause why his permit
should not be suspended or revoked.
``(2) Action following hearing.--If, after hearing, the
Secretary finds that such person has not shown cause why his
permit should not be suspended or revoked, such permit shall
be suspended for such period as the Secretary deems proper or
shall be revoked.''.
(3) Effective date.--The amendments made by this subsection
shall take effect on the date of the enactment of this Act.
(c) Application of Internal Revenue Code Statute of
Limitations for Alcohol and Tobacco Excise Taxes.--
(1) In general.--Section 514(a) of the Tariff Act of 1930
(19 U.S.C. 1514(a)) is amended by striking ``and section 520
(relating to refunds)'' and inserting ``section 520 (relating
to refunds), and section 6501 of the Internal Revenue Code of
1986 (but only with respect to taxes imposed under chapters
51 and 52 of such Code)''.
(2) Effective date.--The amendment made by this subsection
shall apply to articles imported after the date of the
enactment of this Act.
(d) Expansion of Definition of Roll-Your-Own Tobacco.--
(1) In general.--Section 5702(o) of the Internal Revenue
Code of 1986 is amended by inserting ``or cigars, or for use
as wrappers thereof'' before the period at the end.
(2) Effective date.--The amendment made by this subsection
shall apply to articles removed (as defined in section
5702(j) of the Internal Revenue Code of 1986) after December
31, 2007.
(e) Time of Tax for Unlawfully Manufactured Tobacco
Products.--
(1) In general.--Section 5703(b)(2) of such Code is amended
by adding at the end the following new subparagraph:
``(F) Special rule for unlawfully manufactured tobacco
products.--In the case of
[[Page H10870]]
any tobacco products, cigarette paper, or cigarette tubes
produced in the United States at any place other than the
premises of a manufacturer of tobacco products, cigarette
paper, or cigarette tubes that has filed the bond and
obtained the permit required under this chapter, tax shall be
due and payable immediately upon manufacture.''.
(2) Effective date.--The amendment made by this subsection
shall take effect on the date of the enactment of this Act.
SEC. 703. TIME FOR PAYMENT OF CORPORATE ESTIMATED TAXES.
Subparagraph (B) of section 401(1) of the Tax Increase
Prevention and Reconciliation Act of 2005 is amended by
striking ``114.75 percent'' and inserting ``113.75 percent''.
In lieu of the matter proposed to be inserted to the title
of the Act, insert the following: ``An Act to amend title XXI
of the Social Security Act to extend and improve the
Children's Health Insurance Program, and for other
purposes.''.
The SPEAKER pro tempore. Pursuant to House Resolution 675, the
gentleman from Michigan (Mr. Dingell), the gentleman from Texas (Mr.
Barton), the gentleman from New York (Mr. Rangel), and the gentleman
from Louisiana (Mr. McCrery) each will control 15 minutes.
The Chair recognizes the gentleman from Michigan.
General Leave
Mr. DINGELL. Mr. Speaker, I ask unanimous consent that all Members
may have 5 legislative days to revise and extend their remarks and
include therein extraneous matter on the bill under consideration.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Michigan?
There was no objection.
Mr. DINGELL. Mr. Speaker, I yield myself 2 minutes.
Mr. Speaker, I rise in support of H.R. 976, the Children's Health
Insurance Program Reauthorization Act of 2007.
Ten years ago a Republican Congress and a Democratic President passed
a landmark program to reach children who had fallen through the cracks
of the health care system. These kids weren't poor enough to qualify
for Medicaid, and their parents, most of whom worked, couldn't afford
health insurance on their own.
Today this program provides health care for 6 million children across
the Nation. Those 6 million kids today are in jeopardy because this
successful program will expire September 30. The legislation before us
will continue helping these 6 million of our children and extend health
care to 4 million more of our young people.
This bill is for parents like Ms. Molina, a mother of two children
who worked two part-time jobs but still could not afford health
insurance. CHIP got her kids treatment for dental work, two sprained
ankles, one broken arm, and a severe burn.
It's for parents like Ms. Mingeldorff, the mother of a child born 25
weeks prematurely who would have had to turn down a job without health
insurance because it would have made her ineligible for Medicaid.
This bill is for every child who needs a vaccination, a cavity
filled, chemotherapy, insulin, antidepressants, or other life-
sustaining health care.
I urge my colleagues to vote for the children in your district and to
remember this legislation will provide health care for 6 million who
are now deriving that and 4 million more. The issue here is are you for
or against health care for the kids under the SCHIP program?
Mr. Speaker, I reserve the balance of my time.
Mr. DEAL of Georgia. Mr. Speaker, on behalf of the House Energy and
Commerce Committee, I reserve the balance of my time at this point.
Mr. RANGEL. Mr. Speaker, I yield myself 3 minutes.
My friends, this is almost an historic occasion because, like the
President of the United States said, it is our intention to extend
health care to cover 10 million kids.
I don't care how you cut it. You can call it socialized medicine. You
can say it's outside of the budget. But when you go home, the question
basically is going to be were you with the kids or were you not? It is
not just the human and right thing to do, but from a fiscal point of
view, how many billions of dollars do we save by providing preventative
care to these youngsters? And certainly from a tax writer's point of
view, how many of these kids are going to grow to be productive workers
so that they can pay taxes and make a contribution to this great
Republic?
{time} 1845
I don't know how you're going to explain how the kids can go to
emergency wards if they get ill, as the President of the United States
has indicated; but I know one thing, those of us who have kids and
grandkids want the very best for them, and we do have this occasion
now.
Now, there are a lot of complaints from the other side that they did
not participate in the writing of this bill. Having been in the
minority for so long, let me say that every one of you on the
Republican side that did not participate, that complained, you have
good cause. You were not involved. And I might heartily add, neither
were Members on the Democratic side involved.
If you really want to find out who called the shots on this bill,
which is not the House bill, it's those people on the other side of the
Capitol that believe that everything that has to pass the Senate, that
you need 60 votes for. And that's the long and the short of it. So, you
may call it the Democratic majority, as I once did, but they're being
held hostage by the Republican minority.
And so I participated in terms of seeing what they wanted to do. And
believe me, what they said to the House of Representatives, Republicans
and Democrats alike, take it or leave it. And so if you want to join
with me in looking for someone to criticize, after the debate we can
meet in the lobby and talk about it.
But you had an opportunity to vote for a better bill; it was here.
And for those who are concerned that legal immigrants can't get
services, I hope you voted for the House bill because it was in there.
But if you really want to complain about it being un-American, walk
with me to the other side, and we'll find the culprits who did it, and
they're not Democrats.
Mr. Speaker, I reserve the balance of my time.
Announcement By the Speaker Pro Tempore
The SPEAKER pro tempore. Members are reminded to address their
remarks to the Chair.
Mr. McCRERY. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, the debate this evening should not be about who is for
insurance for children and who is against health insurance for
children. The fact is that all of us, Democrats and Republicans alike,
want SCHIP to be reauthorized. We will vote tomorrow, I believe, for a
temporary extension of the program, and I predict that there will be a
huge bipartisan vote in favor of extending the program to give this
House more time to develop a true bipartisan reauthorization, long-term
reauthorization of the SCHIP program.
I do expect, Mr. Speaker, this bill to pass tonight, but I also
expect the President to veto this bill, and I expect his veto to be
sustained by this House. At that point, I'm very hopeful that, for the
first time in this process, the minority in this House will be included
in discussions about how we should reauthorize the SCHIP program,
because to this point, frankly, we have not been included at all. We
have not been asked for our recommendations for a reauthorization; we
were not even given a substitute when this matter came to the floor
originally here in the House of Representatives.
So perhaps after the President vetoes and we sustain the veto, then
maybe we will be brought into the room and we will have a chance to
discuss with the majority what we think is the appropriate level of
reauthorization for funding for this program and perhaps some of our
ideas with respect to limiting those eligible for this program to the
universe of people who were originally intended to be helped by the
program, that is, low-income children whose family incomes are too high
to qualify for Medicaid but too low to buy a policy in the individual
market outside of the workplace.
So, Mr. Speaker, this evening I suggest that, rather than point
fingers and say you're against kids and we're for kids, you're for
tobacco, we're against tobacco, that we get through this debate and
then get through the next step of the process, which I hope will be
more bipartisan and more cooperative, to allow us to get a real
reauthorization that we can all support as we did in the mid-1990s when
we created this program.
[[Page H10871]]
Now, we only got this bill, this so-called compromise, last night, so
we've been diligently going through it all night and all day today.
We're not sure of everything that's in this bill, but I can enumerate a
number of things that we believe to be facts and I think are important
in this debate for this particular bill.
First of all is the matter of funding. This bill is not even close to
being fully funded. Budget gimmicks are replete. The proposal assumes
that funding will drop to about one-fourth of the funding in the year
2013, and then another $5 million cut after that. We all know that's
not going to happen. But that was done, and I understand, just to make
the budget numbers work; but Members ought to know what they're voting
for.
Another thing that we're told by the Congressional Budget Office, a
nonpartisan arm of the House and the Senate, is that under this
proposal 2 million children will move from private health insurance to
government health insurance. Now, surely that's not what we want. We
don't want the SCHIP program, do we, to move children from private
insurance into government insurance? That wasn't the intent of this
program when it started.
And on the tax side, on the pay-for side, this bill proposes that we
pay for a program with clearly growing requirements, growing needs with
a funding source that is going to be declining, depleting, the tobacco
tax. As you raise the tax on tobacco, you exacerbate the trend that has
been evident in this country for a number of years of declining use of
tobacco.
So to propose funding a growing program with a declining revenue
source is, I would submit, irresponsible fiscal policy.
I have a few other speakers who are going to talk about some of the
other weaknesses in this legislation.
At this time, I would reserve the balance of my time.
Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the distinguished
gentleman from New Jersey, the chairman of the subcommittee, Mr.
Pallone.
Mr. PALLONE. I want to thank my chairman, Mr. Dingell, Mr. Rangel,
Mr. Stark, and all who worked, including on the Senate side, to put
this bill together.
It does pain me a great deal, though, to hear my Republican
colleagues, and specifically the ranking member of the Ways and Means
Committee, basically advocate for the President's veto of this
legislation. And I say that because I know that 10 years ago, when we
established the SCHIP program, it was bipartisan, President Clinton,
Speaker Gingrich. And the fact of the matter is it was done for
practical reasons because we knew there were kids, as was said by the
gentleman from Louisiana, who were not getting health care on the job,
but whose incomes, because their parents were working, were too high to
be eligible for Medicaid.
Now, all we're doing today is being as practical as we were 10 years
ago. We know that there are 6 million kids, almost twice who were
enrolled in the program, who are eligible for this program under the
same eligibility requirements as 10 years ago who are not enrolled in
the program because we don't have enough money to pay for it and we
haven't had enough outreach to get them enrolled.
There is nothing new here. This is the same block grant that Speaker
Gingrich and President Clinton advocated 10 years ago. But practically
speaking, we know that for the first time in the last 2 years the
number of uninsured kids is now going up instead of going down, so we
have to do something about it. And we sat down with the Republicans in
the Senate, with the Democrats in the Senate and the Democrats here in
the House, and we came up with a solution, which was the tobacco tax.
Now, this is fully funded. And the tobacco tax is a great way to pay
for it because if you tax people who are smoking and they smoke less,
then we have less health problems, and it's directly related to trying
to provide health insurance. So don't tell me it's not paid for. It is
paid for. It's paid for in a good way. There is no change in
eligibility here. We are simply trying to cover the same kids that are
eligible but not enrolled.
And if you go along with the President's veto of this legislation,
what you're saying is that not only the kids that are not enrolled, but
even those who are now in the program won't be able to get their health
insurance. Shame on you for that.
Mr. DEAL of Georgia. Mr. Speaker, I yield myself 3\1/2\ minutes.
We're debating the reauthorization of a bill that has been in place
for 10 years. It would seem to me that, in doing so, we should learn
from the mistakes that were made in the initial legislation and attempt
to correct them. I believe the legislation before us tonight overlooks
that opportunity.
We have seen the House version that passed here earlier, and we have
now seen a Senate version; and the one before us tonight is very
similar to the Senate version of this legislation. But it appears to me
that we have some questions to ask about that. CBO says that there are
300,000 fewer uninsured low-income children who will be enrolled under
the bill before us today than would have been enrolled under the
original Senate bill, and yet the amount of money that is being spent
is almost exactly the same, an additional $35 billion over the next 5
years. When you couple that $35 billion with the baseline budgeting and
the amount of money that States will have to put into the program, we
find that we're going to be spending about $60 billion over the next 5
years for a program that for the first 10 years was only a $40 billion
program. And when you do include that State funding into the mix, it
will be $200 billion over the next 10 years.
Now, who are we going to insure by putting this substantial amount of
new money into the program? Once again, the Congressional Budget Office
attempts to answer that question. They say that there will be an
additional 800,000 children, currently SCHIP eligible, being enrolled
in the program by the year 2012. And if that is truly the focus, which
it should be the focus of the program, then what are we getting by
spending an additional $60 billion? If you divide $60 billion by the
additional 800,000 children, that means that this bill is going to
require that we spend $74,000 per child. Now, I know the government can
throw money away, but I believe that is certainly an excessive amount
of money.
Now, who are these children that are going to be the new enrollees?
Once again, CBO tells us that, of the additional children who are going
to be potentially enrolled, that about half of them are children who
already have private health insurance, a 50 percent crowd-out of the
existing insurance market.
Now, they also tell us that we ought to be concerned about the fact
that if there are potentially going to be as many as 2 million children
who will have been moved out of their private insurance into this
government-subsidized program, we're also told that Medicaid and also
SCHIP generally pay less than the private insurance market pays, that
means that the health care providers, the doctors and the hospitals,
are going to have to absorb another 2 million patients who are going to
be reimbursing them at a lower rate. Another error in the original
program, it was for children, and yet we know that four States
currently have more adults than children in their program.
Under this bill before us, CBO estimates that in the next 5 years
there will still be 780,000 adults enrolled in the Children's Health
Care Program.
Mr. Speaker, I reserve the balance of my time.
Parliamentary Inquiry
Mr. RANGEL. I have a parliamentary inquiry, Mr. Speaker.
The SPEAKER pro tempore. The gentleman will state his inquiry.
Mr. RANGEL. Does it violate any of the House rules if I refer to the
bill before this House as the ``Republican-controlled Senate'' bill?
The SPEAKER pro tempore. The gentleman is not stating a parliamentary
inquiry.
Mr. RANGEL. Well, does it violate any of the House rules if I refer
to this bill as a bill that is a Senate bill controlled by the
Republicans on the other side of the House? I want to make it clear
it's not a House bill.
The SPEAKER pro tempore. If a point of order is made against the
gentleman's referring to the bill in that manner, the Speaker will rule
on the matter.
[[Page H10872]]
{time} 1900
Mr. RANGEL. Mr. Speaker, I yield myself such time as I may consume
because I want to share a lot of complaints about what those
Republicans did to a good, decent House bill. So if you want to join
with me with your criticism, don't criticize anyone here. It is not my
fault that your leaders were excluded from the so-called
``conference.'' We had no conference.
I know how it feels to have been in the minority, having been there
for a decade. So I share with you why you were left out. But had I been
in charge, and not the Senate, I would have wanted you there, your
judgment. Even if it was just to read the bill over and over and over,
at least you would have been participating.
I yield to the chairman of the Health Subcommittee. No one is in a
better position to let you know that this is not the House bill. As
hard as he worked to reform Medicare, to make certain that we preserved
it, to reform that bill, to get $5 billion for the people in the rural
areas, to help the aged poor, and really to help the doctors that work
hard every day and deserve a decent reimbursement, that, my friends,
was in the House bill. But our friends on the other side, the
Republicans said, ``No, take it or leave it.''
Mr. Speaker, I yield 2 minutes to the gentleman that worked hard for
the House bill, the gentleman from California (Mr. Stark).
(Mr. STARK asked and was given permission to revise and extend his
remarks.)
Mr. STARK. Mr. Speaker, as my distinguished chairman has suggested,
this is a modest proposal, with all due respect to Mr. Swift. I am not
proud of the bill or the process. I would say to my distinguished
ranking member from the Ways and Means Committee that they were
accorded every opportunity at every point to participate in this bill,
and they know it. They were not excluded until they decided they did
not want to help us pass the CHAMP bill, which was a far better bill.
At this point, I have to thank my colleagues on both sides of the
aisle who have helped us pass a bill that would have added a million
additional children. It was a far better bill for children. It would
have expanded coverage to legal immigrant children. It was better also
for senior citizens. But I also have to thank our leadership and the
commitment of Speaker Pelosi to suggest that when we come back, after,
as we expect this bill will be vetoed, we will remember that there were
a tremendous number of proposals in here which would have helped not
only children, but seniors, financial help for low-income seniors,
mental health parity for Medicare, improved Medicare benefits and
health benefits, preventive care, rural health parity, consumer
protections in part D, improved dialysis procedures, protection of
Medicare from privatization, and the preservation of the Medicare
system by doing away with the excessive spending in Medicare Advantage.
The allegiance of groups like AARP, the AMA, Families USA, the
Alliance for Retired Americans, the National Committee to Preserve
Medicare and Social Security, the AHA, all of whom helped us pass
CHAMP, all have been ignored in the bill before us today.
I want to make it perfectly clear, I had no part in backing away from
not only my commitments, the commitments of many of my colleagues, to
these groups or to America's seniors. I know the Speaker will help us
return to that commitment and pass those procedures in the future.
Mr. Speaker, I rise in support of H.R. 976, the Children's Health
Insurance Program Reauthorization Act.
As many of my colleagues have made clear, this bill is far better
than what President Bush prefers. It will provide $35 billion in new
funds for the CHIP program, which will enable 6.6 million children to
keep their health care at the end of the month and provide coverage to
nearly 4 million currently uninsured children.
President Bush proclaims to want a ``clean extension'' of the CHIP
program, but don't believe him on this any more than you did on weapons
of mass destruction, ``mission accomplished'' or take your pick of lies
he's told. He knows full well that his proposal would mean taking
health care away from needy children.
The CHIP program is a block grant so it provides a capped amount of
funding to States each year. The existing program is broken. We've
already had to pass legislation this year to provide additional funds
to keep more than 13 States from dropping children from their CHIP
roles. If the President has his way, those States will soon have to
take away their health coverage anyway.
That's why I'll vote for this bill today. It is better than the
status quo--and far better than the direction President Bush wants to
take us all with regard to health coverage.
But, I am not proud of this bill or this process.
On August 1st, we passed a far better bill through the House of
Representatives.
First, the Children's Health Insurance and Medicare Protection Act,
CHAMP, was better for children. It invested $50 billion into the
program and covered more than a million children. CHAMP also allowed
States to use Federal funds to appropriately expand coverage to legal
immigrant children and corrected a misguided regulation issued by the
Bush administration on citizenship documentation that forced thousands
of American children to lose their health coverage through Medicaid.
However, not only was the CHAMP Act better for children, it also
provided overdue and much needed improvements to senior citizens and
people with disabilities on Medicare. In the House, we combined
children with seniors and created a bill that improved the health of
our youngest and most needy and our oldest.
Unfortunately, Senate Republicans refused to allow our bills to go to
conference. They refused to even consider attaching any Medicare
provisions to the CHIP reauthorization. As a result, we are here today
with a reduced CHIP package that cedes most of the House CHIP
reauthorization bill to the Senate's preferred language.
I'm also not certain about whether we will really take up Medicare
later this year and adopt the important Medicare improvements we passed
in the House.
All of the following provisions from the CHAMP Act are now at risk:
financial help for low-income seniors, Medicare mental health parity,
improved Medicare preventive health benefits, prevention of the pending
physician payment cuts, rural health parity, consumer protections in
Part D, improved dialysis procedures, protection of Medicare from
privatization through massive overpayments to private plans, and
preservation of the Medicare system.
In my opinion, the allegiance of groups like AARP, the AMA, Families
USA, the Alliance for Retired Americans, the National Committee to
Preserve Medicare, and Social Security and the AHA--which helped us
pass CHAMP--have been ignored in the bill before us today.
I want to close by making it perfectly clear that I had no part in
backing away from my commitments to any Members of Congress, these
groups, or to America's seniors in requesting your support for our
broader CHAMP Act. I will do everything I can to see all sections of
CHAMP become law. I urge my colleagues in the House and advocates
across the country to urge leaders in both the House and the Senate to
do the same.
Mr. McCRERY. Mr. Speaker, at this time, I yield 2 minutes to the
gentleman from Michigan (Mr. Camp), the distinguished member of the
Ways and Means Committee, the ranking member of the Health
Subcommittee.
Mr. CAMP of Michigan. Mr. Speaker, I thank the gentleman for
yielding.
Mr. Speaker, this bill clearly isn't about helping low-income
children. If it were, it would have support from both parties and the
President would be eagerly waiting to sign it into law. This is a
missed opportunity. Virtually everyone supports providing health
insurance to low-income children. But when a Federal health program for
children starts covering not only families, but childless adults making
three and four times the poverty level, it has clearly lost its focus.
It is clear that Democrats want taxpayers to fund, and the Federal
Government to directly provide, health care benefits to millions of
more Americans, even for those families making over $80,000 a year.
They are using SCHIP as a vehicle and the children it is intended to
cover as a shield to get one step closer to total Government control
over our health care system. The current plan to expand SCHIP is in
dire need of a second opinion. Instead of moving further and further
away from the core mission, we should be reforming the program to
ensure it is truly helping America's uninsured children.
The nonpartisan Congressional Budget Office stipulates that the
proposed expansion would cover an additional 5.8 million Americans at a
cost of $35 billion. Alarmingly, more than one out of every three
individuals already has private insurance. The bill before us does
little more than move children and upper-income families from private
insurance plans to taxpayer-funded
[[Page H10873]]
plans. That is a prescription for the type of government largess that
stifles economies and unduly burdens taxpayers. It is not a
prescription for reducing the number of uninsured Americans.
State's and children's advocates should take a second look at this
bill. Because of shoddy funding sources, this bill is likely to harm
more States and health care programs than it helps. A Heritage
Foundation study showed that as many as 28 States, including Michigan,
stand to have a net loss of $10 to $700 million in revenue.
This bill is designed poorly, funded poorly, and will do little to
help lower-income Americans obtain health coverage. The President
should veto this bill. Congress should work in a bipartisan fashion, as
we did nearly 10 years ago when the program was created, to make
certain that children in America have access to a health care system.
Mr. DINGELL. Mr. Speaker, I yield to the distinguished gentlewoman
from California (Ms. Eshoo) 1 minute.
Ms. ESHOO. Mr. Speaker, I thank the chairman of the Energy and
Commerce Committee for his devotion to this issue during his entire
career in the Congress. I don't think that this is a complicated
question that is here before us today. I think that it is very clear.
It is very clear in terms of the values of the American people. Why
wouldn't a Congress, any Congress, offer health insurance for its most
vulnerable citizens, the little ones, of our country?
That is what is on the floor today. That is what is on the floor.
They are smart, and they are grinning. Grinning. But do you know what?
There are going to be the votes for this bill, and the bill is going to
pass. And imagine the person that stands at the doctor's door and not
allow children to go through: the President of the United States.
This is a bipartisan effort. The people of our country want us to
come together for the families of this country, for the betterment of
our country, to make an investment. Yes, through taxing tobacco. I
would rather tax tobacco and protect the children of our country than
to blow $10 billion a month in Iraq. I am proud of the Democrats. I am
proud of the Republicans that support it. We should pass this and say a
prayer that the President will come out of his cloud and sign the bill.
The SPEAKER pro tempore. Without objection, the gentleman from Texas
will claim the time controlled previously by the gentleman from
Georgia.
There was no objection.
Mr. BARTON of Texas. Mr. Speaker, I would like to recognize a member
of the committee, the gentleman from Arizona (Mr. Shadegg), for 2
minutes.
Mr. SHADEGG. I thank the gentleman for yielding.
Mr. Speaker, I rise in strong support of health care for America's
poor and near-poor children. I also rise in equally strong opposition
to this bill.
For more than a decade, I have introduced into the United States
Congress every single year a bill that would give every single child
covered by this bill health insurance. Indeed, it would provide to
every family covered by this bill a source of money, tax funds, to them
and their family, to buy the health insurance they need for them and
their children. But make no mistake about it. This bill is a fraud. The
American people are smart. They know it is a fraud. This bill is
Congress playing fast and loose with the facts. If we are going to have
a debate about covering every single American, let's have that debate.
But let's not hide it in a debate about children's health care.
The American people are generous to a fault. They want to cover poor
children. They want to cover children who are uninsured. The SCHIP
program we have was supposed to do just that. But this program is a
fraud. It doesn't cover just poor and near-poor. It covers middle-class
families. Some will say, ``Oh, it is capped at 300 percent of the
Federal poverty level.'' But under the law and the language in the
bill, States can define income any way they want. Therefore, there is
no cap on income. It doesn't just cover uninsured children. It covers
more children who are insured already than those who are uninsured. CBO
says that if we pass this bill, 2 million children currently covered by
insurance, getting better coverage than they will get under this bill,
will lose that coverage and go on SCHIP. Be proud of reducing the
quality of the care they get. In fact, this bill isn't even limited to
children. Indeed, this bill will cover adults. In Wisconsin today, 75
percent of the SCHIP money is used to cover adults. In Minnesota, it is
61 percent. In Arizona, we do the same.
Mr. Speaker, if we want to have a debate about universal care, I am
for that debate. I have got that bill. But don't have a bill that is a
fraud. We must be honest in this debate. This bill will hurt children's
health care in America.
Mr. RANGEL. Mr. Speaker, I am going to act as if I didn't hear that
gentleman call this bill a fraud four times. I was in that back room
with Senator Grassley, Senator Reid and our dear friend Orrin Hatch.
It's their bill. So you call it what you want. But please don't call it
a fraud, because it is a Senate bill. And they are very sensitive over
there. So I just want to make that clear.
Mr. Speaker, it is my pleasure to give 1 minute to the gentleman from
Illinois (Mr. LaHood). I cannot think of a Member of this House that
has worked harder in trying to bring civility, no matter what the issue
was. I heard he wasn't going to run for reelection. I just want him to
know publicly that both sides of the aisle will miss him.
(Mr. LaHOOD asked and was given permission to revise and extend his
remarks.)
Mr. LaHOOD. Mr. Speaker, this is a bill about children and about
health care. Now, all of us in this Chamber have the very best health
care insurance in the world, bar none. We should be willing to share
those kinds of resources with kids in this country. Why should children
have to go to an emergency room when they have the flu? Why should
children have to go to an emergency room when they have a cold? Why
should children have to go to emergency rooms when they are sick? They
shouldn't. Not in America. Not where we have the very best health care
in the world. My friends, we should give to our children the access to
health care that we have, those of us that serve in the House and the
Senate.
This is a bipartisan compromise. This is an opportunity to take a
Republican initiative, share it, move on and give the opportunity to
children. I encourage Members to do that, to play on the Republican
initiative that was started years ago and to say, we have a bipartisan
opportunity to give good health care to children.
Mr. Speaker, I urge my colleagues, particularly on the Republican
side, to vote for this proposal.
I thank the chairman for the time.
The debate about whether or not to reauthorize and expand the State
Children's Health Insurance Program should be easy. This legislation is
the product of a bipartisan group that worked to produce a compromise
that should be acceptable to all of us. With the shortfall we have seen
in several states over the past year, reauthorization of the program at
current funding levels is unacceptable. Earlier this year, Illinois
faced a $247 million SCHIP shortfall. Many other states were a similar
situation before the shortfalls were addressed with new appropriations.
By passing this bill today, we may be able to prevent future shortfalls
which jeopardize those state programs designed to cover the costs for
low income families who can't afford adequate health insurance for
their children.
Of the estimated six million low-income children who are not eligible
for Medicaid, more than 250,000 children were covered by All Kids,
Illinois' successful children's insurance program. More than half of
those children live in working and middle class families that make too
much to qualify for Medicaid but can't afford private insurance. In
2005, more than 25% of all uninsured children in Illinois fell into the
$25,000-$35,000 income level range, having nearly doubled from 13% in
2002. At that rate of growth, we must continue to see this program
through. With passage of this legislation today, it is estimated that
an additional 154,000 Illinois children will be afforded health
insurance. An additional 3.8 million children nationwide will be
covered.
I urge my colleagues to support this vital piece of legislation. It
is imperative that we continue to look out for the future health and
well-being of this Nation, and that starts with our children today.
{time} 1915
Mr. McCRERY. Mr. Speaker, before I recognize our next speaker, I
yield myself such time as I may consume.
Mr. Speaker, I agree with the gentleman that children ought not have
to go to emergency rooms to get care,
[[Page H10874]]
that children ought to be able to go to their family doctor; but
there's a good way and a not-so-good way to provide that.
This bill provides a government healthcare program for that. We would
much rather provide a private health insurance plan for that. I would
submit that there is a vast difference in those approaches.
Mr. Speaker, at this time I would yield 2 minutes to the
distinguished gentleman from Texas (Mr. Sam Johnson), a member of the
Ways and Means Committee and ranking member of the Social Security
Subcommittee.
(Mr. SAM JOHNSON of Texas asked and was given permission to revise
and extend his remarks.)
Mr. SAM JOHNSON of Texas. Mr. Speaker, I must oppose this bill today,
but I have got to make it clear that I do support children's health
insurance. I believe this bill flat misses the mark. While well-
intentioned, this legislation is a massive expansion of a government-
run healthcare program that takes resources away from the very children
it was meant to help.
As ranking member of the Social Security Subcommittee on Ways and
Means, I am deeply disturbed by the part of this bill that makes it
easier for illegal immigrants to be covered under this program. In the
last Congress, Republicans worked hard to ensure that everyone in this
children's health program are really U.S. citizens. Because of that
effort, States now require applicants to show documents like birth
certificates, driver's licenses or passports in order to prove U.S.
citizenship.
This new legislation weakens this standard. All applicants would
simply be asked to provide a Social Security number and a name that
would then be verified by the Social Security Administration. This
process is ripe for massive fraud and abuse that will leave American
tax dollars paying for healthcare for illegal immigrants.
In addition, we have the responsibility here in Congress to spend the
taxpayer dollar wisely. I know my constituents don't want the Federal
Government doling out billions of dollars to pay for illegal
immigrants' health care.
Congress should just pass a responsible extension of this important
program before it expires, not play politics with our kids' health
care. Americans deserve, want, and need for our children to have good
health care, and we need to do it today.
Mr. DINGELL. Mr. Speaker, with affection and respect for my good
friend from Texas, I would observe that none of the abuses that he
points out have been found in the years in which this legislation has
been in place, and there are none of the abuses that he would find here
going to come forward.
Mr. Speaker, I am delighted to yield 1 minute to my friend, the
distinguished gentlewoman from California (Mrs. Capps), a real expert
in the field of health care and a caring and concerned practitioner as
a nurse. We are grateful that she is with us.
Mrs. CAPPS. Thank you, Chairman Dingell, for your leadership.
Mr. Speaker, I rise today in strong support of this bill and in
support of America's children. We have two choices today: we can vote
for this excellent bipartisan bill, which Senator Hatch appropriately
called ``an honest compromise which improves a program that works,'' or
we can vote against this bill and not only deny millions of children
the chance to finally access health care, but strip it away from
children who are already covered.
Trust me: as a nurse, I know the power and prudence of providing this
health care coverage for our kids. It is indeed an accomplishment that
Congress can be proud of.
This bill is responsible, and it's the right thing to do. Make no
mistake, it is a compromise bill. But if we fail to pass this bill and
even one child loses health coverage, we have failed our most important
constituents, our children.
I urge my colleagues, I strongly urge my colleagues to join me in
supporting this legislation. Vote ``yes'' to protect children's health.
``Suffer the little children.''
Mr. BARTON of Texas. Mr. Speaker, I would yield myself 2 minutes.
Mr. Speaker, we have spent most of today actually trying to read the
bill. I have the bill in front of me. In this 2-minute period, I want
to discuss section 605 of the bill. Section 605 of the bill has the
title: ``No Federal funding for illegal aliens.'' It is a very brief
section, two lines: ``Nothing in this act allows Federal payment for
individuals who are not legal residents.'' That is it.
So the title of section 605 would have you believe there's going to
be no Federal funding for illegal aliens. When you specifically read
the section, it just says nothing in the act allows payment. It doesn't
prohibit it.
Now, if the authors of section 605 really don't want illegal aliens
to receive funding under this bill, this section ought to read
something like this: ``This act prohibits Federal payments for
individuals who are not legal residents or citizens.''
Mr. Speaker, I would ask unanimous consent to substitute the language
that I just read: ``This act prohibits Federal payments for individuals
who are not legal residents or citizens.''
Mr. DINGELL. Reserving the right to object, will the gentleman
restate his unanimous consent request?
Mr. BARTON of Texas. Mr. Speaker, my unanimous consent request is to
substitute for what is in the bill: ``Nothing in this act allows
Federal payment for individuals who are not legal residents,'' that is
in the bill, I ask unanimous consent to substitute: ``This act
prohibits Federal payments for individuals who are not legal residents
or citizens.''
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Texas?
Mr. DINGELL. Mr. Speaker, that would contravene the understandings we
had with our good friends in the Senate who insisted on this language.
I have to object.
The SPEAKER pro tempore. Objection is heard.
Mr. BARTON of Texas. The gentleman from Michigan has objected, and I
respect that objection. But what that means is that they want illegal
residents of the United States of America to get these benefits. That
is what the objection means. So for that reason alone, I would ask that
we vote against this bill.
Mr. Speaker, I reserve the balance of my time.
Mr. RANGEL. Let me tell you what it means, distinguished ranking
member. Distinguished ranking member, what it means is that the deal
that we cut, if we change anything over here, the Republicans on the
other side are going to drop everything. So we are trying to cooperate
with this Republican Senate bill. So even if the distinguished
gentlemen here would want to agree, we can't do it. We are held hostage
by the other side.
Let us put down our arguments and march over there and correct this
thing. But I agree with you, that language should have been corrected
with both Houses, but the Republicans objected to any changes or any
additions.
Mr. Speaker, I yield 1 minute to the distinguished gentleman from
Illinois (Mr. Emanuel), a member of the Ways and Means Committee who is
a leader in the Democratic Party, a leader in our Congress, and a
leader in our country. We are proud to have him on this bill.
(Mr. EMANUEL asked and was given permission to revise and extend his
remarks.)
Mr. EMANUEL. Last week the President asked for $200 billion more for
the war in Iraq. In the same week, the White House said that the
bipartisan plan to give 10 million children health care included
``excessive spending'' and threatened to veto it.
I agree we have excessive spending. In Iraq. For 41 days of the war
in Iraq, 10 million U.S. children would get health care; 41 days of the
war in Iraq, where we have been at war for over 4\1/2\ years.
Make no mistakes, this debate is not about spending. It is about
priorities. So it is no surprise that the President finds himself
increasingly isolated from Republicans here on Capitol Hill, in the
Senate, in the House, and Republicans in the State capitals around
America.
This President is isolated from where the American people are. They
would like to see 10 million children get their health care.
Just listen to what Republicans have been saying. Senate Republican
Orrin Hatch: ``We're talking about kids who basically don't have
coverage. I think the President's had some pretty bad advice.''
[[Page H10875]]
Senator Charles Grassley, another Republican, said that the
bipartisan plan ``breaks the legislative impasse and should have strong
support from both Democrats and Republicans.''
From minimum wage, to lobbying reform, to veterans health care, to
college education, we have passed bipartisan solutions to problems
facing America. That is what this bill does.
Thank you for the Republican support for this Democrat initiative. It
is right for America's children. It is time to put them first, 10
million kids.
Mr. McCRERY. Mr. Speaker, I yield 3 minutes to the gentleman from
Wisconsin (Mr. Ryan), another distinguished member of the Ways and
Means Committee.
Mr. RYAN of Wisconsin. I thank the gentleman for yielding.
Mr. Speaker, a couple of things: number one, we are not dedicating
enough time to this debate. A half-hour is not enough time to debate
what this is really all about. This is not just about health care,
health insurance for low-income children. If that is all this was
about, then we could pass this with 2 minutes of debate, unanimous
consent, voice vote, everyone would agree.
That is not what this debate is about. This debate goes far beyond
that, and the American people deserve to have a much more honest, much
more thorough debate about what really is being discussed here.
This is a misleading bill. This is a misleading debate. This is
misleading, number one, because this is really all about whether or not
the Federal Government should run health care for most Americans or
not.
All of us in this room, Republicans and Democrats, believe that
Americans ought to have access to affordable health insurance. All
Americans. We all believe that. The question is, should the government
run it, or should health care be a decision between patients and their
doctors? Let's have a debate about that.
The reason this is a misleading debate is because this bill takes
more health insurance away from children with private insurance than it
gives to children without insurance. We are taking more people off of
private insurance than we are giving to uninsured children. If we
wanted to just give uninsured children health insurance, let's do it.
This bill is misleading because it gives children health insurance
for 5 years, and then it pushes them off a cliff. I call it the
majority's ``bait and switch SCHIP funding.'' It says 5 million
children get it now; 5 million children 6 months into 2012 get nothing.
$41 billion is hidden out of this bill. Who believes that that is going
to happen? In order to contort their way into their PAYGO rule, they
are giving on the one hand and taking out with the other.
But what this debate is really about is putting the government in the
middle of that decision between the patient and their doctor. I don't
want a bureaucrat running health care. I don't want an HMO bureaucrat
running health care, and I don't want a government bureaucrat running
health care. I want patients running health care with their doctors.
That is what this debate is really about. This debate is about
getting more and more and more government in the middle of the health
care decisions between patients and their doctors. This is a debate
about getting us on that path toward government-run health care. That
is a big debate. It deserves more than a half-hour of debate.
And, unfortunately, the majority is misleading the American people by
saying this is only about low-income children, when they are bringing
us a bill that displaces kids off of private health insurance, goes to
virtually to anybody of any income if a State wants to, and goes way
beyond the idea of insuring low-income children.
Let's give low-income children health insurance, and let's have a big
debate on whether the government ought to be running health care in
America or not.
Mr. DINGELL. Mr. Speaker, I would observe an interesting point, and
that is the Congressional Budget Office says that we are taking care of
4 million additional kids who are identical in all particulars to those
we now care for under SCHIP. There is no vast increase in socialized
medicine or anything of that sort, as we hear from the other side.
Mr. Speaker, I yield 1 minute to the distinguished gentlewoman from
California (Ms. Solis).
Ms. SOLIS. I thank our chairman of the Energy and Commerce Committee
for allowing me to speak this evening.
Mr. Speaker, I rise with a very heavy heart today in support of this
so-called Children's Health Insurance Program because I can't afford
not to have our children covered. That is what SCHIP has been about for
the last 10 years. We need to continue that service to those kids who
are covered. It hopefully will not be dropped off, and we can continue
to expand the program.
I will tell you that I do have differences with our party, and
especially the Republican Senate Members that refused to allow for
coverage of legal permanent resident children and pregnant women.
We passed a good bill, the CHAMP Act. We worked very hard, and I
thank our leaders of our committee and our Members for allowing us the
opportunity to provide interpretive services for hard-to-reach
populations, to go out and do the right thing and to get more children
enrolled.
{time} 1930
This is not the expansion that many of us envisioned that are sitting
here tonight, but it is the best we can do. I can tell you, we had a
meeting earlier with Speaker Pelosi. She has made a commitment to
continue the discussion with us, and we will make that a priority for
the people that we represent here in America.
If we can send troops, send our soldiers to defend our country and
yet not cover their families and their children, then we have moral
corruption going on in this Congress. I support this bill. Again, I say
I have a heavy heart.
Mr. BARTON of Texas. Mr. Speaker, I yield myself 1 minute.
Mr. Speaker, I want to acknowledge my good friend, Mr. Rangel, the
distinguished chairman of the Ways and Means Committee. I now know who
the problem is; it is those big, bad bully Republicans in the Senate. I
didn't realize that.
Mr. RANGEL. I can discuss it in some detail.
Mr. BARTON of Texas. It is my time.
The SPEAKER pro tempore (Mr. Schiff). The gentleman from Texas
controls the time.
Mr. BARTON of Texas. Now that I know what the problem is, I am going
to call over there. They are good friends of mine, Mr. Hatch and Mr.
Grassley. And tell them that now that we have identified the problem,
will they accept the language that Mr. Dingell objected to, and when we
are here next week on the House floor when this bill is vetoed by the
President, I would expect my good friend from New York to accept that
change in the language.
Mr. RANGEL. If we can get them to open up this, we can do business.
Mr. BARTON of Texas. I know we can. I think my time has expired, but
I just want to commend him because now I know where the problem is. It
is those big bad bully Republicans and these two wily negotiators, Mr.
Rangel and Mr. Dingell, who are two of the most distinguished, able
legislators in the history of the Congress, have been buffaloed by a
couple of scallywags over in the Senate.
Mr. RANGEL. Mr. Speaker, it is my pleasure to yield 1 minute to the
gentlewoman from Pennsylvania (Ms. Schwartz) who is an outstanding
member of the Ways and Means Committee.
Ms. SCHWARTZ. Mr. Speaker, as one of the original architects of CHIP
in Pennsylvania, I have seen firsthand that it is possible to bring
together public and private stakeholders and expand health coverage to
millions of children, children of working families who cannot afford
the increasing cost of coverage.
As the September 30 deadline to reauthorize CHIP quickly approaches,
American families are counting on us to ensure health coverage for
millions of American children.
The Democratic majority understands the needs of working families and
has negotiated for weeks to craft a commonsense compromise legislation
before us. This plan has a broad-based coalition of supporters ranging
from our Nation's seniors and unions and businesses, insurance
companies and health care providers, all of whom have come together to
support CHIP.
[[Page H10876]]
American families expect action, and 10 million uninsured American
children are depending on us. It is time to put children ahead of
politics. Vote ``yes.'' Vote for America's children. Tell the President
to end his veto threats and vote to make health coverage available and
affordable to 10 million American children.
Mr. McCRERY. Mr. Speaker, due to the imbalance of time remaining, I
would at this time withhold calling on a speaker, and I reserve the
balance of my time.
Mr. BARTON of Texas. Mr. Speaker, I yield 1 minute to the gentleman
from Georgia (Mr. Kingston).
Mr. KINGSTON. Mr. Speaker, I thank the gentleman for yielding, and I
rise to oppose this bill.
As much as anything, I want to say the children's health care bill,
you would think would get a little more dignity in the process around
here. This is a 299-page bill which we received, ``we,'' minority
Republicans, received at 6 p.m. last night, or maybe even later than
that. That doesn't give you a lot of time to work on a bill and have
any kind of bipartisan deliberations.
Plus, there is no motion to recommit. Now I know that is inside-the-
Beltway stuff, but this is important if you are talking children's
health care.
What I do know is that in the bill, adults are still allowed to be
covered by it. Adults can push poor children out of the way because
States are going to politically favor them and let them have the
opportunity to be insured.
I know there is a massive tax increase. I know there is very little
sympathy for smokers these days, but it is still a tax increase on the
backs of the smokers. And in order to get enough money to pay for this,
it would require 22 million new smokers in the United States of
America.
Now, maybe the Democrat Party is planning to pass out cigarettes at
the schools and say to the kids: Hey, look, start smoking so you can
finance your own insurance company. And you'll probably be needing it,
by the way, wink-wink. But in the meantime, the government gets to
grow. The bureaucracy gets to grow. The nanny-state, more like the
Nurse Ratchet states, continues to grow at the expense of children. I
urge a ``no'' vote on this.
Mr. RANGEL. Mr. Speaker, I think my time along with Mr. McCrery's is
short. If you can give us the amount of time, I think I am going to
pass right now.
The SPEAKER pro tempore. The gentleman from New York has 4\1/2\
minutes remaining. The gentleman from Louisiana has 2\1/2\ minutes
remaining. The gentleman from Texas has 5\1/2\ minutes remaining. The
gentleman from Michigan has 7\1/2\ minutes remaining.
Mr. RANGEL. Mr. Speaker, I reserve the balance of my time.
Mr. DINGELL. Mr. Speaker, I am delighted to yield 1 minute to a very
able member of our committee, the gentlewoman from Oregon (Ms. Hooley).
Ms. HOOLEY. Mr. Speaker, I rise today in strong support of H.R. 976.
In Oregon alone, 37,000 new children will receive access to health care
under this bill. Those children are counting on us to act today before
this critical program expires.
Although many speakers before me have focused on the big picture by
citing the number of children impacted by this legislation, I implore
my colleagues to not lose sight of the small picture: the impact SCHIP
has on the life of a single child.
The core purpose of this legislation is to ensure that a single child
with the flu can go to the doctor or that a single child with cancer
can receive chemotherapy. SCHIP simply allows the interaction between
health care providers and the child to occur millions of times over.
I hope the House will put aside petty partisan differences and show
strong bipartisan support for H.R. 976, that the President will stand
alone if he vetoes this critical piece of legislation.
I can give the President 10 million reasons why he should put down
his veto pen once we pass this bill, H.R. 976: the 10 million children
who will otherwise go without access to health care if we do not pass
this bill. I urge a ``yes'' vote on H.R. 976.
Mr. BARTON of Texas. Mr. Speaker, I yield 1 minute to the gentleman
from Indiana (Mr. Pence).
(Mr. PENCE asked and was given permission to revise and extend his
remarks.)
Mr. PENCE. Mr. Speaker, I thank the gentleman for yielding.
I rise in opposition to this SCHIP proposal. I see this as a bad deal
for America, which is not to say that I oppose a reauthorization of
this program or its essential elements. And in the continuing
resolution this week, we will see to it that this program does not
lapse as a virtue of my vote.
But beyond the budget gimmickry, beyond increasing taxpayer liability
for illegal immigrants, this compromise is no deal the American people
should accept.
It is interesting that a health insurance program for poor kids
doesn't require your kids to be poor. Families with incomes of up to
$83,000 a year could be entitled to assistance in health insurance in
this program. Also, a State program to provide health insurance for
children doesn't require families to have children to participate. This
program allows childless adults to continue to receive SCHIP through
2012.
Also, it pays for all of this by raising taxes 61 cents per pack and
more on cigars. The headline ought to read, ``Smokers in America to pay
for middle class welfare.''
Congress should reject this SCHIP program, continue this program, and
reject all of the bad elements of this bad deal.
Mr. RANGEL. Mr. Speaker, I yield 1 minute to Mr. Jason Altmire, a
distinguished gentleman from Pennsylvania.
Mr. ALTMIRE. Mr. Speaker, there has been a lot of conversation about
how this is a Federal Government program and how this is a move to
expand Government's role in health care, so I thought I would take a
moment, a minute, to talk about what is really in this bill.
This is an expansion of an existing program created 10 years ago in a
Republican Congress. It is a capped block grant. The amount of money is
capped. It flows through the States, and almost every State in the
country administers the program through the private health insurance
market. Through the private market.
This could not be anything further from a big, government-run
program. It is administered by the States and contracted out to the
private market.
And yes, these are families that have income. They are families that
work hard and play by the rules, and they are families that can't
afford health care for their children. Is there any better cause in
this country that we can work on in this Congress than that issue? I
ask my colleagues to support this bill.
Mr. BARTON of Texas. Mr. Speaker, I yield myself 2 minutes.
Mr. Speaker, since we have not had a markup and since we have not had
a legislative hearing, and I know it is cumbersome to actually refer to
specific sections of the bill on the floor, especially of what is
portrayed to be a conference report, which this is not, which is not
amendable, but I want to go back and talk about this eligibility.
There is a section in the bill, section 203: ``State option to rely
on findings from an express lane agency to conduct simplified
eligibility determinations.'' On the face of it, that would seem to be
a good thing. This section is very complicated. It is 10 to 15 pages
long.
But it does say in this section that a parent of a child that might
be eligible can self-verify. If you are approached by one of these
express lane agencies, it is up to the parent of the child to self-
determine, to self-certify that they are indeed eligible. That would
appear to be something that we need to work on.
Then it goes on when it defines the actual express lane agencies on
page 123 of the bill, in subparagraph (F), it goes through and lists
the kind of public agencies that are express lane agencies. They
apparently include Medicare part D, Medicaid, Food Stamp Act, Head
Start Act, National School Lunch Act, Child Nutrition Act, Stewart B.
McKinney Homeless Assistance Act, United States Housing Act, Native
American Housing Assistance Act, and so on and so on.
Again on the face of it, those are all agencies that might be of some
assistance, but I doubt that their requirements are the same as the
requirements for the base bill for SCHIP in
[[Page H10877]]
terms of income eligibility and age determination. For example, I doubt
that the Stewart B. McKinney Homeless Assistance Act has an age
requirement at all.
So again, when the President vetoes this bill and we are back working
together on a bipartisan basis, these are the kinds of things I hope to
clarify and tighten up.
Mr. DINGELL. Mr. Speaker, it is a pleasure and a privilege for me to
yield time to a distinguished member of the Committee on Energy and
Commerce, the respected gentlewoman from New Mexico, a very valuable
member of our committee (Mrs. Wilson).
{time} 1945
Mrs. WILSON of New Mexico. Mr. Speaker, my colleague from New York,
Mr. Rangel, says this is not a House bill; and he's right, it isn't.
When the House first passed its version of this bill, I opposed it,
particularly because it funded that House version of the bill through
reductions in Medicare spending. This bill is a compromise. It is a
much better bill. It's not a great bill, but it's a good bill.
I was a cabinet secretary in New Mexico for children at the time
SCHIP was initially implemented. It was established by a Republican
Congress and a Democrat President and it works. It gets kids health
insurance that they need.
We have big challenges in health care, but this isn't one of them.
Don't let the perfect be the enemy of the good. I would ask my
colleagues to join together and to support this bill tonight for the
good of all of us.
Mr. BARTON of Texas. Mr. Speaker, I yield 1 minute to a distinguished
Member from Texas (Mr. Hensarling).
Mr. McCRERY. Mr. Speaker, I yield 30 seconds to the gentleman from
Texas (Mr. Hensarling).
Mr. HENSARLING. I thank the gentleman for yielding.
Mr. Speaker, let nobody make a mistake about it. I know the Democrats
are trying to cast this as a debate about insuring poor children.
That's false. We have Medicaid. We could reauthorize the current SCHIP
program now in the snap of a finger, but that's not what this is about.
Instead, this is a debate about who will control health care in
America. Will it be families and doctors, or will it be government
bureaucrats? This is a proxy fight for the Democrats to take that first
step towards socialized, government-run health care in America. That's
what this is all about, and there should be no mistake about it.
We've got a program for children that insures adults. We've got a
program ostensibly to help the poor that can subsidize people making
$82,000 a year, and they're going to do all this with a huge tax
increase on smokers, and we're going to need 22 million new smokers in
10 years just to pay for it.
If this bill passes not today not tomorrow but at some time, the
children of America will suffer. If this program passes, and I hope all
the mothers of America are paying very careful attention to this,
because if this passes, in the years to come they won't wait minutes or
hours to see a doctor of their choice. They will wait weeks and months
to see a doctor chosen by a government bureaucrat, and that doctor will
not be the doctor of today. It will be somebody who is less competent,
less able to take care of their child, and that's what this is all
about.
If you care about the children, reject this bill tonight.
Mr. RANGEL. Mr. Speaker, it's my pleasure to yield 1 minute to Dr.
Steve Kagen, who would share his views with us.
Mr. KAGEN. Mr. Speaker, the vote we will cast today will ask a simple
question: Whose side are you on? Are you on the side of the millions of
children who lack access to health care? Are you on the side of
families who are working hard, but still cannot afford the cost of
health insurance today in America? Are you on the side of the American
people who demand, who demand that this Congress find a solution to the
impossible costs for health care across the country? Or are you on the
side of powerful special interests?
The bill before us will cover nearly 38,000 additional uninsured
children in Wisconsin, and I'm on their side. Whose side are you on?
The American people will remember tonight, how you cast your vote. That
question tonight will be answered in your vote, and tonight will answer
the needs of those who need us the most, and that's our Nation's
children, for they are our future.
Vote ``yes.''
Mr. McCRERY. Mr. Speaker, I only have one speaker left to close, so I
would reserve the balance of my time.
Mr. BARTON of Texas. Mr. Speaker, I also only have one speaker,
that's myself, to close. What is the order of closure?
The SPEAKER pro tempore. The Chair will recognize Members to close in
the reverse order of opening: Mr. McCrery, Mr. Rangel, Mr. Barton, and
lastly Mr. Dingell.
Mr. RANGEL. Mr. Speaker, I have two speakers so I think I will
reserve my time at this time until we can get a little equality in the
time. I think I only have 2\1/2\ minutes.
Mr. DINGELL. Mr. Speaker, I yield to the distinguished gentleman from
Washington (Mr. Inslee) 1 minute.
(Mr. INSLEE asked and was given permission to revise and extend his
remarks.)
Mr. INSLEE. Mr. Speaker, 10 million low-income American children will
get health care coverage under this bill to renew SCHIP. Some of us
think that is not such a bad thing.
This legislation is especially important to my home State of
Washington because it will cut in half the number of uninsured kids in
Washington State. It does that by fixing a long-standing inequity that
punished Washington and 10 other States because we provided coverage
for kids just above the poverty line, and we fix that long-standing
inequity tonight.
If you're a Member from the State of Washington, Wisconsin, New
Mexico, Connecticut, Wisconsin, Rhode Island, Minnesota, Maryland, New
Hampshire, Vermont and Tennessee, vote for this bill and you can go
home telling your constituents we fixed this long-term unfairness.
I'd like to thank Chairman Dingell for including a 100 percent
permanent fix in the House SCHIP bill that we passed in early August.
I'm grateful that we retained that fix, and I hope we'll make sure that
we do this on a permanent basis ultimately.
So we need to pass this bill tonight, extend coverage and fix that
inequity.
Mr. DINGELL. Mr. Speaker, I yield to the distinguished gentlewoman
from California (Ms. Roybal-Allard) 1 minute.
Ms. ROYBAL-ALLARD. Mr. Speaker, I hoped I would rise today in strong
support of this SCHIP conference agreement that ensures millions of
additional children access to health care.
While I am pleased that we are increasing our investment in
children's health, I'm deeply disappointed that final product denies
health care to legal immigrant children.
The Senate Republicans' failure to include the House-passed Immigrant
Children's Health Improvement Act in the conference agreement is a
tragically missed opportunity to address existing health disparities
among vulnerable legal immigrant children and pregnant women.
More than 20 States, including California, have recognized that
increasing access to care for legal immigrant children and pregnant
women is good public health policy and cost-effective care.
Unfortunately, this bill ignores that fact.
This debate is not about immigration. This debate is about health
care and our moral imperative to value the life of every child and to
ensure that race and income do not determine the health status of any
child in our wealthy Nation.
Mr. RANGEL. Mr. Speaker, I yield 1 minute to an outstanding member of
the Ways and Means Committee from the sovereign State of New Jersey
(Mr. Pascrell).
(Mr. PASCRELL asked and was given permission to revise and extend his
remarks.)
Mr. PASCRELL. Mr. Speaker, 90 million Americans, nearly one-third of
our Nation's population, had no health insurance for some or all of the
past 2 years. Please let it sink in.
It is shameful that roughly 10 million of these uninsured are
children. Ninety percent of those kids live in working households and a
majority in two-parent families who simply cannot afford health
coverage. Six million children are in imminent danger of losing their
[[Page H10878]]
coverage if Congress fails to reauthorize SCHIP now.
We've heard many things this evening and that is, you've stooped to
conquer. You accuse the Republicans and Democrats who support this
legislation of wanting to do this for illegals. Then you accuse the
Republicans and Democrats who support this legislation of supporting
socialized medicine. And that wasn't bad enough. You went to the next
thing. You accused Democrats and Republicans of encouraging smoking,
and then you said that we want to aid the rich and comfort the rich.
Read the legislation. This is good legislation for America. Help the
children for a change. Let's come together and vote for this
legislation.
Mr. DINGELL. Mr. Speaker, at this time I yield myself 2 minutes.
We have here before us a bill which gives $35 billion to strengthen
and improve children's health coverage. It protects 6 million children
today covered by SCHIP. It adds an additional 4 million. It is the
largest investment in children's health since the passage of the
original Children's Health Insurance Program in 1997.
It provides $300 million in outreach grants for the States, community
organizations, tribal organizations, and national initiatives. It
provides a new express lane initiative for one-stop enrollment. It
facilitates enrollments for newborns so coverage starts immediately. It
does more than this. It revises the current SCHIP program formula to
more accurately attract State need in that it follows the House
provisions.
It provides the children enrollment program contingencies adjustment
allotments to States to succeed in reaching the eligible but the
unenrolled.
It does more. It provides dental coverage for CHIP children. It also
provides mental health coverage for children. It provides grant money
for diabetes clarification and prevention. It clarifies the coverage of
school-based clinic services through the CHIP program. It creates a new
option for CHIP programs to subsidize employer options and employer
coverage for children whose parents may already have access to
coverage.
It does not do any of the things that were charged on the other side
because it does not change the law that CHIP now has in place. It just
offers additional benefits to children under the SCHIP program.
It is a program which will cover 4 million more kids. It has to be
passed by the first of the next month or else all of these kids are
going to lose their coverage.
I was at the Governors' meeting in northern Michigan, and the one
thing that the Governors were unanimous on is that we need to pass this
SCHIP because it is an essential program and an essential part of their
program for the care of our kids.
It is a piece of legislation that will make this country better. Take
care of our kids. See to it that we do the job that we should in making
health care available for all of our kids.
I yield back the balance of my time, excepting I'm going to save time
to yield to my dear friend, the majority leader, to close.
The SPEAKER pro tempore. The gentleman reserves the balance of his
time.
Mr. McCRERY. Mr. Speaker, I believe all of the controllers of time
are ready to close.
Mr. Speaker, the gentleman that spoke right before me, the
distinguished chairman of the Energy and Commerce Committee, said that
this bill provides $35 billion for children. This bill actually
provides a lot more than that. It's $35 billion in new, additional
spending on top of the $25 billion that the program as currently
structured spends. So we're more than doubling on paper the cost of
this program. And when you consider that there's another, oh,
approximately $30 billion that the tax increase in this bill does not
cover, we're getting up to tripling, quadrupling the size of this
program.
Now, the gentleman earlier said that no abuses such as illegal
immigrants gaining benefits have ever been identified. Well, I would
refer the gentleman to the 2005 HHS Inspector General report in which
the Inspector General says that 47 States allowed self-declaration in
the United States citizenship for Medicaid and he asked for those
States to give him an audit.
Only one State did that, the State of Oregon. The Secretary of State
provided an audit, and in that audit he found out of 812 individuals
sampled, who were Medicaid beneficiaries in that State, 25 of them were
noneligible noncitizens.
So, Mr. Speaker, under the provisions in this bill, which liberalize
the current law treatment of qualification of individuals for this
program, we indeed expect to see abuses of this.
So, Mr. Speaker, I urge all of us to vote ``no'' on this so that we
can sustain the President's veto if the bill passes and then get
together for a true bipartisan compromise on this important program.
The SPEAKER pro tempore. The time of the gentleman has expired.
{time} 2000
Mr. RANGEL. Mr. Speaker, when Congresswoman Nancy Pelosi shattered
the glass ceiling and made history as the first woman to become Speaker
in the history of the United States Congress, the one picture that
remained to commemorate this great event was the children that were
there when she was sworn in. It wasn't a symbol of the war or the
deficit or the Republicans or Democrats; it was this Congress sharing
with the rest of the country our deep commitment to the children of our
country. And that is our investment.
Whether you are liberal, conservative, Republican, or Democrat, no
one can challenge that our most precious human beings are those who
cannot protect themselves. We have this opportunity to join with the
Speaker as she closes this argument to set aside the partisanship and
to be able to say, no matter what our differences, it was the children,
it was the children that prevailed, and I voted with them.
I yield the balance of my time to the Speaker of the House of
Representatives, Congresswoman Nancy Pelosi.
Ms. PELOSI. Mr. Speaker, I thank the gentleman for yielding, and I
thank the distinguished chairman for recalling to mind that opening day
here when I accepted the gavel on behalf of the children of America,
all of the children of America. And when we had this debate before in
Congress, we talked about perhaps the children listening to this
debate, hearing what Members of Congress were saying. And I expressed
my hope that they would consider this the children's Congress.
I thank the chairman of the Ways and Means Committee, Mr. Rangel, for
his leadership, and Mr. Stark, the Chair of the Health Subcommittee for
helping to make this the children's Congress with this legislation. I
thank the distinguished chairman of the Energy and Commerce Committee
for his tremendous leadership.
Mr. Rangel and Mr. Dingell went into the conversations with the
Republican leadership in the Senate on this bill, true champions of
America's children, knowing the facts and figures, the provisions,
every provision of the bill with such authority as they argued on
behalf of America's children so effectively that this legislation
before us reflects many of the provisions that were in the House bill.
We had to agree to the Senate language in terms of the $35 billion and
the pay-for with the tax on tobacco. We had hoped that we could do more
in terms of the money allocated for this purpose so that we could cover
more children.
As I praise Mr. Dingell, I also want to acknowledge the fabulous
leadership of Mr. Pallone, Chairman Pallone of the Subcommittee on
Health in the Energy and Commerce Committee. Because of their
leadership, we were able to join Senator Reid, Chairman Baucus,
Chairman Rockefeller, Ranking Member Grassley, and Ranking Member Hatch
in having a very bipartisan conversation on this subject. The people
who were in the room that evening cared about passing a serious piece
of legislation to expand health care for America's children. Not to
expand the eligibility, as some on the other side of this House would
have you believe, but to expand the number of kids who could be served
if they met the eligibility. I, myself, had hoped that we could go
beyond that and have eligible children in America who were legal
immigrants. I was told that that would not fly in the Senate; that is a
fight we will hold for another day.
But I am pleased as one who represents a minority majority district
[[Page H10879]]
from a majority minority State, where our State is blessed with a
beautiful diversity, that of the additional children, nearly 4 million
additional children covered, 67 percent of those children are minority
children. Two-thirds of those children are children from families who
are working hard, playing by the rules, lifting themselves out of
poverty. They are the working poor in America. They are those who have
aspired to the middle class to change that status and want to stay
there. They simply don't make enough money to afford the private health
insurance that this SCHIP initiative enables them to do. In fact, 72
percent, my colleagues might be interested to know that 72 percent of
the children on this SCHIP program get their health coverage from
private health insurance.
There are many misrepresentations, and I think they are probably
unwitting because I assume that every person in this Congress cares
about insuring as many children in our country as possible. How could
it not be so? It is a deeply held value in our country that our
children, as President Kennedy said, are our greatest resource and our
best hope for the future. We must invest in them. We have a moral
responsibility to do so.
When we had the debate on this bill and it first came to the floor, I
was delighted in quoting a poem from my youth from Longfellow when he
said, ``Between the dark and the daylight, when the night is beginning
to lower, comes a pause in the day's occupation that is known as the
children's hour.'' This is the children's hour for us in the Congress
of the United States.
I quoted Longfellow then, I am reminded of the Bible tonight, and I
speak with all of the sincerity and all of the hope to President Bush
in the hope that he will change his mind to dig deeply into his heart
and think about the children in America who don't have health care.
Because, if not, I think that the President is giving new meaning to
the words ``suffer, little children.'' Suffer, little children, if your
parents can't afford health insurance, but they are working hard and
they are not on Medicaid, but you will suffer because they are
struggling to give you the best possible future. Suffer, little
children, if your family has played by the rules and they have come to
this country and you are here as a legal immigrant, because if you are
sick, you will not get health care unless your parents can afford
private insurance. Suffer, little children, if you are sick because you
haven't had the proper nutrition, the proper prevention, the proper
early intervention to your affliction, that you should go directly to
the emergency room. But until you can get into that emergency room with
enough of a serious illness, you will suffer. That is just not right.
I would hope that the President would have had a change of heart and
mind since he was Governor of Texas. When he was Governor of Texas, the
SCHIP program there, in meeting the needs of the children of Texas,
ranked 49th in the country; 49th in the country. Forty-eight States
were doing better in meeting the health needs of their children as
reflected in the outreach of the SCHIP program. Does that mean that
Texas is the 49th wealthiest State in the Union, that the children in
that State can all afford private health care? I don't think so,
especially since that State, as with mine, is blessed with beautiful
diversity and people, again, families who come to America, families who
are part of our country, who are struggling to make ends meet to build
a better future for their children. And building that better future is
what our country is all about, and those newcomers make America more
American. I heard the President say that.
We also heard him say that in this term of office that he would
enroll every child who is eligible. I am sure our distinguished
majority leader will bring that to the attention of this body.
What is interesting about this is that the President, if he persists
in vetoing this bill, and by the way, you don't have to be a Latin
scholar to know that ``veto'' means ``I forbid.'' With that pen, the
President says, I forbid struggling families in America to have health
care for their children. I forbid every child to be treated the same if
they have an ailment.
How did any one of us decide that we were going to choose, you will
have health care and you will not, in a country as great as ours when
we are talking about our children? We are talking about our children.
So that is why the Conference of Mayors, the U.S. Conference of
Mayors, a bipartisan organization, has overwhelmingly supported this
legislation. That is why 43 Governors sent us a letter in July urging
us to come to bipartisan agreement on legislation that would
reauthorize SCHIP to care for many more children in our country. So
when I hear the President say that we don't want to help children, we
just want to do politics, I don't think he means that. So I hope he
doesn't mean that he is going to veto the bill.
Senator Grassley said of the President: The President's understanding
of our bill is wrong. I urge him to reconsider his veto message based
on our bill, not something that someone on his staff told him wrongly
is in the bill. Actually, he said, ``in my bill,'' Senator Grassley
said. And Senator Hatch said: We are talking about kids who basically
don't have coverage. I think the President has some pretty bad advice
on this.
And I want to also commend Representative Ray LaHood and join you,
Mr. Chairman, in saying what a privilege it is to call him
``colleague'' and to serve with him in the Congress, and thank him for
his leadership in making a distinction between what is about the
children and what is about politics in this House.
I talked about the mayors; I talked about the Governors. Nearly 300
organizations in our country, alphabetically from AARP to YMCA and
everything alphabetically in between, Families USA.
I heard someone say the doctors should be making the decisions. The
American Medical Association firmly supports this bill. The President
of the AMA stood with us in a press conference today to support this
legislation. The Society of Pediatrics. Everyone who has anything to do
or cares about children in our country knows that this bill is the way
to go. It is not everything I want, believe me, it is not the bill I
would have written. I would have been far more generous and it would
have been paid for in perhaps a different way, but it would have been
paid for; because in terms of bringing benefits to our children, we
have absolutely no intention of heaping debt onto them.
The Catholic Hospitals Association, again, the list goes on and on
about who supports this bill. It is a long list; it is a comprehensive
list. And I might include in it that, across the country,
overwhelmingly, the American people know and respect the value of
taking care of America's children, all of America's children. Two-
thirds, two-thirds of those polled among Republican voters, 2-1, they
support passing this legislation and having it signed into law.
Why does the President want to isolate himself from caring for
America's children? Let's hope and let's pray that a very big, strong
bipartisan vote tonight will send him a message to rethink his
position.
I see a child in the Chamber. Our constant inspiration of what we do
here is supposed to be about the future, and the future demands that we
invest in health, the education, and the well-being of our children.
So, my colleagues, vote as if the children are watching. Please vote
as if the children are watching, and please send them a message that
this is the children's Congress.
{time} 2015
Mr. BARTON of Texas. Mr. Speaker, may I inquire as to how much time I
have.
The SPEAKER pro tempore. The gentleman from Texas has 1\1/2\ minutes
remaining. The gentleman from Michigan has 1 minute remaining.
Mr. BARTON of Texas. Mr. Speaker, I yield myself the balance of the
time.
(Mr. BARTON of Texas asked and was given permission to revise and
extend his remarks.)
Mr. BARTON of Texas. And since I really have a real minute and a
half, I'm going to try to go through this as quickly as possible.
Republicans want to reauthorize the SCHIP program. We do want to
refocus it on the original intent of the program, which was near-low-
income children in families between 100 and 200 percent of poverty. We
understand that
[[Page H10880]]
in the 10 years of the program's existence that waivers have been given
and there are some States that cover up to 350 percent of poverty, and
some States cover adults.
But as our distinguished Speaker just said, Republicans are for the
children, and we want to focus the SCHIP funds on those children and
those families that don't have private insurance and aren't covered by
Medicaid; and we believe that that is children in families somewhere
between 100 percent of poverty and 200 percent of poverty.
And when the President rightfully vetoes this bill, and when the
House of Representatives rightfully sustains the President's veto, it
is my hope that we will get with the other body and the Democratic
leadership at the leadership level and Chairman Dingell and Chairman
Rangel, and we will work out a bipartisan compromise that does cover
the health care needs of the needy children of America that currently,
in spite of our best efforts, do not have the health insurance and the
health coverage that they need.
To make that possible, we have to defeat this bill, or at least get
enough votes to sustain the President's veto of this bill, and then
work together in the near future to do some of the things that we have
talked about on the floor this evening.
Vote ``no'' on the SCHIP bill this evening.
Mr. DINGELL. Mr. Speaker, at this time I yield to the distinguished
majority leader the balance of my time for purposes of closing.
Mr. HOYER. Mr. Speaker, for those of us who have served in this body
for some period of time, all of us know that the gentleman from
Michigan (Mr. Dingell) has been as focused on health care for all
Americans as anybody who's served in this body, with the sole
exception, perhaps, of his father. For over half a century, the
Dingells have focused on making sure that Americans in the richest land
on the face of the Earth had access to health care.
I want to congratulate my friend, Mr. Dingell, and I want to
congratulate his partner, Charlie Rangel, one of the senior Members of
this House, chairman of the Ways and Means Committee, who has worked
collaboratively with Jim McCrery, and I want to congratulate Jim
McCrery; I'll congratulate him again while he's listening; who has
worked, I think, positively with the chairman, and I thank him for
that.
I rise in support of this legislation. Today the Members of this body
must answer this fundamental question: Will you stand with millions of
American children who, through no fault of their own, but they live in
families of limited means, have no health insurance? Or will you stand
with the few, including at least now President Bush, although I hope he
changes his mind, who are ideologically opposed to this legislation,
and thus being willing to leave millions of American children stranded
without the health insurance coverage they need and that they deserve?
Mr. Speaker, the bottom line is this: we must not sacrifice the
health of our children on the altar of a conservative ideology. We must
pass this bill.
The fact is, President Bush himself stated on the campaign trail in
2004, in fact, it was at the Republican Convention, and I would hope
all my Republican colleagues would listen to the President's quote, if
you haven't already seen it and read it. He said this as he addressed
the American people asking them for their vote for a second term, which
they gave him. He said this: ``In a new term, we will lead an
aggressive effort to enroll millions of children who are eligible but
not signed up for government health insurance programs.''
President Bush said that as he appealed to the American public for
their support for a second term, that he would aggressively pursue a
program of adding millions of children, eligible but not included, in
the health insurance program.
``We will not allow a lack of attention or information to stand
between these children and the health care they need.'' That is what
President Bush said to the American public from the convention floor in
2004. We, tonight, are going to give him the opportunity to fulfill
that promise to the American public.
Unfortunately, the President is threatening to renege on his campaign
promise and to veto this legislation. Let's be clear: this fiscally
responsible legislation will ensure that some 10 million children will
receive health insurance coverage. That's approximately 4 million more
than are covered under the Children's Health Insurance Program today.
And so what we consider today is not young Master Snyder, who was on
this floor, or Gemma Frost, with whom we met earlier today. Gemma Frost
will be covered. Luckily, Master Snyder's father is covered, as all of
us are, under a Federal Employee Health Benefit Plan to which our
employer contributes. Gemma Frost was not so lucky.
The truth is, those 4 million additional children are eligible under
existing guidelines, not new guidelines that we've created. They are
the children that were eligible that President Bush talked about in
2004 that he wanted to vigorously assume inclusion in the program.
Millions, he referred to.
This legislation does not change eligibility guidelines. It simply
strengthens CHIP's financing, increases coverage for low-income
children, and improves the quality of care they will receive.
In contrast, under the President's proposal, and I hope my friends
would put this fact in juxtaposition to the President's representation
in 2004 on the floor of the national convention that you held as your
party, his proposal would decrease, by 800,000 children, the numbers
that would be covered under CHIP in the future. Now, that's included in
the 4 million, so actually it's a net 4 million difference between the
proposals.
Ladies and gentlemen, we ought not to retreat from our children's
health. We ought not to retreat from working families concerned about
the inclusion of their children.
And I suggest to my friends concerned about cost, we ought not to
give the answer, they can go to the emergency room. Why not? Because
all of us know that is the most expensive intervention in the health
care system in America. And so not only do we put our children at risk,
but we compound our costs.
It's no wonder, Mr. Speaker, that this legislation has received
strong support from Members of both sides of the aisle, as well as a
wide range of health care providers, including private insurers,
doctors and hospitals.
For example, Senator Hatch has already been quoted, but it bears
repeating. He said: ``We're talking about kids who basically don't have
coverage. I think the President had some pretty bad advice on this.''
Don't take that bad advice. Let us join hands; let us be together on
this issue. You voted on a prescription drug program far more expensive
than this one, and unpaid for.
Senator Grassley stated: ``The President's understanding of our bill
is wrong.''
That's the former chairman of the Finance Committee, Republican,
senior Member of the United States Senate. He says, ``The President's
wrong.'' He urges him, he says, ``I urge him to reconsider his veto
message.''
Every one of us, as we vote tonight, can send a strong message that
will perhaps help him to reconsider that position.
Now, let me say, those who complain that this bill will induce people
with private insurance to drop their coverage and enroll in the CHIP
program are simply grasping at straws. Why do I say that? The fact is,
even America's health insurance lobbying group supports this bill.
Finally, let me mention two other points. First, I am very pleased
that this legislation includes a comprehensive dental benefit that will
give low-income children the dental care they need and will provide
States with flexibility in how they provide such care.
Why do I bring that up?
Dental care is important. A 12-year-old child who lived approximately
8 miles from this Chamber, Deamonte Driver was his name, he was 12
years of age. He had three siblings. He got a toothache. His mother did
not have coverage and tried to get coverage, tried to get dental care,
and she could not get dental care, and that toothache became an
infection in the brain, and Deamonte Driver died just months ago, just
9 or 10 miles from where we stand. That is one of the reasons, one of
the
[[Page H10881]]
four million reasons that I stand here to say that we need to pass this
legislation.
Secondly, I'm very disappointed that the Senate Republicans insisted
that we remove the House-passed provision on Medicare, as well as our
provision that would have allowed legal immigrants who pay taxes to be
eligible.
Why is that of concern?
Because my granddaughter, 5 years of age, who just started
kindergarten, she may sit next to one of those children in her
kindergarten class, and that child who is legally in the United States
may get sick. But if that child cannot access health care and sits next
to my granddaughter, my granddaughter is at risk.
We want everybody in this country to be healthy so that the rest of
us can be assured that we operate in a healthy environment. That is why
we want that provision.
Ladies and gentlemen of this House, Speaker Pelosi was right: I don't
believe there's a person in this House that doesn't care about their
own children, about their neighbor's children, and about the children
of our country. All of us care. We need to come together, however, and
see how that care can be transformed into meaningful, tangible help.
Mr. Speaker, we have a rare and wonderful opportunity tonight to do
the right thing, to put aside partisanship, to elevate the practical,
responsible, and moral solution above the ideological.
Mr. Speaker, I urge my colleagues on both sides of the aisle, let's
seize this opportunity. Let's do the right thing. Let's stand with
America's children. Let us pass this historic legislation.
Ms. HIRONO. Mr. Speaker, I rise today in support of H.R. 976, the
reauthorization of the Children's Health Insurance Program (CHIP).
I believe our nation must show true compassion for the most
vulnerable among us, and CHIP is a program that helps millions of low-
income American children to receive health care so they can grow up in
good health.
Since its creation in 1997, CHIP has been successful in providing
vital health care coverage for children in families who cannot afford
private insurance yet earn too much to qualify for Medicaid.
There are now 6.6 million children emolled in the program.
Unless we act now, they are in danger of losing their health
coverage, as CHIP expires on September 30th.
Leaders in the House and Senate have worked hard to bring this
conference bill to the floor.
In supporting the conference bill, I want to note that the bill
passed by the House earlier is a stronger bill in its coverage of more
children in need and in eliminating the automatic cuts to Medicare
reimbursements set to take effect in 2008 and 2009. Eliminating these
automatic cuts was at the top of the list of needed legislation by
medical and health care groups.
I am hopeful that we will address their concerns through another bill
before the cuts go into effect.
I am also deeply disappointed that Senate Republicans insisted on the
removal of provisions providing coverage for the children of legal
immigrants. Such discrimination based on immigrant status should have
no place in a bill providing health care to children.
While work remains to be done, I also want to point out that under
this bill we would preserve the coverage of more than 20,000 children
in Hawai`i, and in addition 12,000 children in Hawai`i who currently
are uninsured would gain coverage.
We would preserve coverage for the 6.6 million children nationwide
currently covered by CHIP and extend coverage to an additional 3.8
million children who are eligible for coverage but not enrolled. Thus
passing this bill would provide health care coverage for more than 10
million American children.
A new report by Families USA indicates that during a 2-year period
almost 35 percent of Americans under age 65 lacked healthcare
insurance. Hawai'i is better than average in this regard, but 29
percent of our state's residents under age 65 still lacked insurance at
some point during the past 2 years.
I support providing all Americans with high quality, affordable
health care, and I hope that Congress will continue to move in that
direction. But until we reach that goal, we should take steps that help
our most vulnerable populations, including low-income children. This is
precisely the group that CHIP will help, if we can get it reauthorized
and signed into law.
I support CHIP because it is the compassionate, just, moral and the
right thing to do. In fact, it is also highly cost-effective. It costs
less than $3.50 a day to cover a child through CHIP. It would be far
more expensive for taxpayers to leave these children uninsured and
having to pick up the tab for indigent care in emergency rooms.
I urge my colleagues to vote for this bill.
Ms. WOOLSEY. Mr. Speaker, I rise in support of H.R. 976, the
Children's Health and Medicare Protection Act. While the bill is not as
strong as the House passed version, it has several good provisions that
deserve our support. This bill invests $35 billion in our children,
providing health insurance for an additional four million children and
bringing the total number of children covered by SCHIP to ten million.
This bill will also help states provide millions of children with the
dental and mental health services they so desperately need.
While this is a very good bill, it is not perfect and I hope it will
serve as a starting point in a larger conversation about how we find a
way to ensure coverage for everyone, but particularly for children and
low income seniors, the most vulnerable amongst us. I look forward to
working with my colleagues in the House and Senate to come to an
agreement on how to increase coverage to the level the House bill
provided. Additionally, I would like to join my colleagues in covering
legal immigrant children and pregnant women, which the House bill
ensured. Finally, I hope that the House and Senate will agree upon a
strong Medicare bill that rolls back payment cuts and addresses
payments based solely upon where a physician practices. This has made
it incredibly difficult for physicians in Sonoma County to continue to
see Medicare patients. The House bill addressed the geographic inequity
and is a great starting point for a conversation about how to address
this serious issue.
Additionally, as the Chairwoman of the House Subcommittee on
Workforce Protections, I am proud to support the language in this bill
that will provide military families with the protections they need in
the workplace. For the first time since Congress passed the Family and
Medical Leave Act (FMLA) fourteen years ago, this bill will amend FMLA
to provide the spouse, child, parent, and closest blood relative of an
injured service member with six months of unpaid, job protected leave
to care for their injured loved ones. Congressman George Miller and I
worked closely with Senators Christopher Dodd and Hillary Rodham
Clinton to ensure that the provisions of H.R. 3481, the Support for
Injured Servicemembers Act, were included as part of the final
compromise reached between the House and Senate, and I commend the
Democratic Leadership for their strong support for our Nation's wounded
warriors and their families. Military families should never have to
risk losing their jobs in order to meet the needs of their loved ones,
and with this bill, we are one step closer to fulfilling our promise to
them.
Passing this bill will mean a real investment for our children and I
hope that we consider it a starting point for a conversation about
covering every child.
Ms. SCHAKOWSKY. Mr. Speaker, I want to start by thanking Chairman
Dingell as well as the Democratic leadership for working so hard to
bring the Children's Health Insurance Program reauthorization bill
before us today. H.R. 976 is not a compromise that was easily come by,
and it's important to recognize the hard work that has gone into it.
Let's be clear, today each of us is either voting for providing
healthcare to more uninsured children, or voting against covering more
uninsured kids.
This bill is not the bill that I would have written, nor is it as
good as the bill that passed the House. But it will cover the 6.6
million children currently covered by CHIP and will reach an additional
4 million kids. It also provides children with dental coverage and
finally puts mental health services on par with other medical benefits
covered under the program. This bill will also improve quality
improvement, outreach, and enrollment efforts under CHIP, and will
target those most in need. It is a good bill that we think will get to
the President's desk. Thus, I think the commitment this bill makes to
our children should be celebrated.
Yet, we need to push further and pass several provisions that were in
the house bill, including meaningful improvements in access to basic
health services, including granting access to our legal immigrant
children, more affordable prescription drug costs and benefits for
senior citizens and people with disabilities, and adequate
reimbursements for physicians that provide critical care to the
Medicare population.
Incredibly, President Bush has pledged to veto this compromise,
bipartisan, bicameral measure. The President and the Congressional
Republican leadership say that we cannot afford it. We can't afford to
cover children, but we can afford the war in Iraq. The bill to provide
health care to children will cost $35 billion over the next 5 years--
but we will spend over $50 billion in the next 5 months in Iraq.
While this bill could have been so much more to so many of our
constituents, it does
[[Page H10882]]
bring us a necessary, moderate expansion of the Children's Health
Insurance Program and I urge my colleagues to support it.
Mr. MARKEY. Mr. Speaker, I rise today in strong support of this
compromise legislation which will provide healthcare for 10 million
low-income American children.
This bill will give 4 million currently uninsured children a healthy
start in life.
Yet in a confirmation of the White House's pitiless priorities,
President Bush is threatening to veto this bill if we spend any more
than $5 billion dollars over 5 years to help poor American children get
health care.
This year alone, the President requested 40 times that amount--$200
billion dollars--for the wars in Iraq and Afghanistan, yet he has
threatened to veto SCHIP on the basis that it spends too much money on
American children.
The President constantly chooses Corporations over Children, spending
billions on tax cuts for millionaires and subsidies for his friends in
big oil without batting an eyelash. But when it comes to giving our
country's poor children health care, he can't find the heart to come up
with the money.
Today's debate is a major moment in the history of health care, and a
veto will place the President firmly on the wrong side of history.
By vetoing this bill, President Bush will expose himself as a
Compassionless Conservative.
By vetoing SCHIP, the President will dash hopes of millions of
working families who dreamed that they would be able to provide health
care for their sick children.
I urge you to stand with those working families and help their
children get the health care they need. Vote yes on this critical
legislation.
Mr. UDALL of Colorado. Mr. Speaker, I rise in support of this bill.
Dr. Martin Luther King, Jr. said ``Of all the forms of inequality,
injustice in health care is the most shocking and inhumane.'' H.R. 976
does not end health care inequality, but it will provide continued
coverage for children not covered by Medicare but whose parents cannot
afford to buy insurance and whose employers do not provide it.
These children--currently 6 million of them--are now eligible for
coverage under the Children's Health Insurance Program (CHIP)--but that
program is set to expire at the end of this month. If Congress does not
act, these six million will no longer have access to quality,
affordable health insurance. This bill responds to that urgent need.
This legislation would assure continued coverage for those now
enrolled and would provide coverage for an additional four million
children who currently qualify, but who are not yet enrolled under
CHIP.
I believe that health care should be a right, not a privilege, and
this act is a step in the right direction toward that goal. So, I will
support it although I wish it went further.
Despite claims by some, this bill does not change the basic nature of
the CHIP program. Instead, it maintains current eligibility
requirements for CHIP. The majority of uninsured children are currently
eligible for coverage--but better outreach and adequate funding are
needed to identify and enroll them. This bill gives states the tools
and incentives necessary to reach millions of uninsured children who
are eligible for, but not enrolled in, the program.
Earlier this year, I vote for the ``CHAMP'' bill to extend CHIP. The
House of Representatives passed that bill, and I had hoped the Senate
would follow suit. It would have increased funding for the CHIP program
to $50 million, instead of the lesser amount provided by this bill. The
CHAMP bill would have also addressed major health care issues, first by
protecting traditional Medicare and second by addressing the
catastrophic 10 percent payment cuts to physicians who serve Medicare
patients.
However, the bill before us represents a compromise between the House
and the Senate and deserves support today. It will pay for continued
CHIP coverage by raising the federal tax by $0.61 per pack of
cigarettes and similar amounts on other tobacco products. According to
the American Cancer Society, this means that youth smoking will be
reduced by seven percent while overall smoking will be reduced by four
percent, with the potential that 900,000 lives will be saved.
H.R. 976 has the support of the American Medical Association,
American Association of Retired Persons, Catholic Health Association,
Healthcare Leadership Council, National Association of Children's
Hospitals, American Nurses Association, US Conference of Mayors, NAACP,
American Cancer Society Cancer Action Network, and United Way of
America.
I am proud to vote for this bill that seeks to protect those that are
most vulnerable in our society by increasing health insurance coverage
for low-income children. I hope that we have the opportunity to take up
the other important Medicare issues addressed in the CHAMP bill soon.
Mr. RAMSTAD. Mr. Speaker, I rise in strong support of H.R. 976, which
extends and expands the State Children's Health Insurance Program
(SCHIP).
We have a moral obligation to cover all our children so every child
in America can grow up healthy. It's the right thing to do; it's also
the cost-effective thing to do.
The great Minnesotan Hubert H. Humphrey once said that a key moral
test of government is how we treat those who are in the dawn of life,
the children. We must not flunk this moral test!
My home state of Minnesota started covering children through its
medical assistance program even before SCHIP was created, but we still
have far too many children without coverage--73,000 kids.
That's why I strongly support extending and expanding SCHIP. I also
hope we can work together to provide greater access to private
insurance coverage for America's children and other uninsured
Americans.
This SCHIP legislation also avoids cutting any of the payments to
Medicare Advantage and other critical programs, as it is financed
primarily by a cigarette tax increase. So this bill will cover our
children without cutting benefits for our seniors.
I urge my colleagues to support this bill. With an expiration of this
crucial program looming on September 30, we cannot afford to wait any
longer. It's time to break down the barriers to health care for our
kids. It's time to reauthorize SCHIP. It's time that all kids have a
chance to grow up healthy.
Like the U.S. Senate, we should pass this SCHIP reauthorization with
a strong bipartisan vote.
Let's put children's health first and do the right thing. Let's pass
this reauthorization of SCHIP and reduce the number of uninsured
children by at least 70 percent.
There is no better investment than to invest in the health and well-
being of America's children.
Mr. BACA. Mr. Speaker, I ask unanimous consent to revise and extend
my remarks. I support the Children's Health Insurance Program Act.
It's a shame that we live in the richest country of the world, yet
3.8 million children are uninsured. 33,000 of these children are in my
District.
This bill is not about politics, it's about helping hardworking
families and the poorest among us.
Leaving children uninsured is unacceptable. With health care costs
going up, working families are on the edge. Expanding coverage is the
only solution.
I am disappointed that this bill does not cover pregnant women and
children who are legal permanent residents. This is a health care
issue, not an immigration issue.
A simple pre-natal exam can detect future complications and prevent
costly visits to the emergency room. This would save tax payers
millions of dollars in the end.
No mother who is working here legally and paying taxes should have to
choose between buying baby formula and taking her infant to the doctor.
No child should die from a sore throat or be denied access to
lifesaving treatments. It costs less than $3.50 a day to cover a child
through SCHIP.
This is not the time to play politics, our children must come first.
I urge my colleagues to support this bill.
Mr. WELDON of Florida. Mr. Speaker, I rise as a supporter of the
State Children Health Insurance Program (SCHIP), which focuses on
covering children in families at or below 200 percent of the poverty
level ($41,000 per year). I have voted to extend this program and to
provide additional resources to ensure that those living in families
below 200 percent of the poverty level ($41,000) have access to
affordable health insurance through the SCHIP program.
What I cannot support is the Democrat's SCHIP bill, because their
bill: 1. Fails to place a priority on first enrolling uninsured
children in households earning less than $41,000 per year (200 percent
of the federal poverty level); 2. Expands government subsidies to those
making nearly $80,000 per year; 3. Spends half of the additional SCHIP
dollars to enroll children in the government SCHIP program who were
otherwise enrolled in private insurance; and 4. Virtually eliminates
all funding for SCHIP beyond 2012 because they have no way to sustain
funding for SCHIP beyond that date.
It is fiscally irresponsible to expand this program by enticing
millions of children in families earning as much as $82,000 per year to
drop private coverage and enroll in the SCHIP program that cannot be
sustained. In August, House Democrat leaders forced an earlier version
of SCHIP through the House that cut over $150 billion from Medicare and
moved that money into SCHIP so that they would have a way to pay for
millions of new SCHIP enrollees over the next ten years, including
millions of currently insured children from middle and upper middle
class families.
Their plan to cut Medicare was rejected not only by Republicans, but
by the U.S. Senate,
[[Page H10883]]
and most importantly by the public at large. But now the bill before us
is simply a bait and switch. They have brought a bill before us today
that nearly triples the size of SCHIP over the next five years--
including enrolling millions of children currently ensured by private
plans--only this time they have chosen to hide from the public how they
plan to pay for the program for the next ten years. They ramp up the
annual budget of SCHIP to nearly $14 billion a year, and then they
simply leave it to a future Congress to find a way to continue paying
for the massively expanded SCHIP program. It turns out that their
nearly tripling of the federal cigarette taxes still leaves them tens
of billions of dollars short. Americans should be on notice that in
2012 the Democrats will ask for another $180 billion to continue SCHIP
for another ten years.
Particularly troubling is that by significantly expanding SCHIP
enrollment eligibility those in families making upwards of $80,000 per
year, the Congressional Budget Office (CBO) estimates that millions of
new SCHIP enrollees will be children that move from private coverage to
the SCHIP program. By moving children from private insurance onto the
government program, this bill essentially enrolls five uninsured
children for the price of ten. Enticing millions of children to drop
private coverage and sign up for SCHIP is short-sighted and fiscally
irresponsible, particularly given that it goes bankrupt in 2012.
What we should be doing is focusing this program on enrolling
uninsured children in households earning less than $41,000 per year.
Mr. Chairman, our children and the American taxpayers deserve better
that what the Democrat leadership has put before us today.
In February of this year, states that had overspent their SCHIP
funding grants came to Congress begging for more money to ``insure
uninsured poor children.'' The root problem in many of these states was
the fact that they had use their federal grant to enroll children in
the SCHIP program who were neither poor nor uninsured. New Jersey, for
example had used their grant to enroll children in families with
incomes of more than $72,000, even though there were and still are over
150,000 children in New Jersey in households earning less than $41,000
who are uninsured.
I offered an amendment in February that would have refocus SCHIP to
make sure that children in families under 200 percent of the poverty
level were covered first. My amendment was rejected by the liberal
majority on the Committee, who stated that they had no intent to
refocus SCHIP on lower income children. Rather, they planned to
continue expanding the program to those well above the poverty level--
to include adults and illegal immigrants--as a step toward universal
government-run health care. In today's Washington Post, liberal
columnist E.J. Dionne Jr., removes any doubt of this goal by writing:
``This battle [over SCHIP] is central to the long-term goal of
universal coverage.''
While the press releases about today's bill focus on uninsured low-
income children, the language in the bill is about much more than
uninsured low-income children. If the bill before us was focused on
low-income uninsured children, I would be voting for it. The bill
before us does the opposite. It repeals recent rules requiring states
to ensure that at least 95 percent of those under 200 percent of the
poverty level are insured under their state SCHIP programs. Democrats
leaders in Congress have responded to the rule by arguing that there is
no way to ensure a 95 percent enrollment rate of uninsured children in
households earning less than $41,000 per year. They argue that since
they cannot achieve the goal we should simply expand the program to
those in households earning more than $80,000 or more a year.
They use budget gimmicks to say that their bill is balance and paid
for through higher cigarette taxes. The Heritage Foundation has
estimated that the amount of money Democrats estimate they will raise
from higher cigarette taxes comes up billions of dollars short and that
over the next 10 years they will have to find 22 million new smokers to
bring in the amount of cigarette tax revenue they hope to raise. (It is
also noteworthy that lower-income Americans pay a higher percentage of
cigarette taxes, but it is middle-income Americans that will receive
most of the expanded SCHIP benefits under this bill.)
I am also concerned over provisions included in the bill that repeal
the requirement that individuals must prove citizenship in order to
enroll in Medicaid and SCHIP. This opens the program to fraud and the
enrollment of illegal immigrants. In 2006, the Inspector General (IG)
of the Department of Health and Human Services found that 46 states
allowed anyone seeking Medicaid or SCHIP to simply state they were
citizens. The IG found that 27 states never sought to verify that
enrollees were indeed citizens. The Congressional Budget Office (CBO)
estimates that repealing this requirement will cost $1.9 billion.
And finally from a Florida perspective, Florida taxpayers come up
short. Florida taxpayer will send $700 million more to Washington than
we will receive back in SCHIP allocations. Where will Florida taxpayer
dollars end up going? Residents of California, New York, Texas, New
Mexico, Arizona and New Jersey will be the biggest recipients of
Florida tax dollars. Yet, Florida has a higher rate of uninsured
children that several of these.
Florida voters will also be asked to foot part of the bill for a $1.2
billion earmark inserted into the 300-page bill at the last minute by
the powerful chairman of the committee for his home state of Michigan.
Mr. BARTON of Texas. Mr. Speaker, here we are again.
Once again, we are being forced by the Democratic Leadership of the
House to vote on a bill of vital importance to millions of our
constituents without the ability to actually analyze its contents.
Once again, Mr. Speaker, we are being forced by the Democratic
Leadership to vote less than 24 hours after they introduced a bill that
is hundreds of pages long and spends hundreds of billions of the
taxpayers' dollars.
Once again, Mr. Speaker, we are being forced to vote on a bill that
was concocted in secret and unveiled in the middle of the night.
When this sort of thing happens, everybody wonders what the Majority
is trying to hide, and why they need to hide anything.
I truly hope that the Democratic Leadership does not expect me to
vote in favor of a 299-page bill that Republicans saw for the first
time at 6:36 p.m. yesterday evening. I believe in faith, but not in
blind faith.
I challenge the supporters of this bill to come to the floor of this
House, look people in the eye, and say that they understand all of the
provisions that are actually in this bill. Because I have some
questions for you.
Mr. Speaker, it would be a compliment to say that the so-called
process which produced this bill is an abuse of our democratic system
of government. It was so much worse than garden-variety abuse. It was a
travesty and an abomination, and it was pathetic. Yet, I'm sure that
some will show up here with a handful of talking points from the staff
who actually wrote this legislation, and explain to us that it is not a
pathetic abomination, but a wondrous triumph of bipartisanship.
I challenge any Member that would claim that this bill is bipartisan
to give me the name of one Republican in the entire House of
Representatives who directly participated in these discussions. Name
just one.
I know that the authors of this bill certainly did not consult with
either Mr. Deal or myself; I know that they have not included any
Members of the Republican Leadership in the House; and I'm not aware of
a single Republican Member of the Energy and Commerce Committee or the
Ways and Means Committee being invited to participate in this process.
Now we have not had time to analyze this product that the Democrats
are going to bring to the floor today but the Congressional Budget
Office has. Yesterday at the Rules Committee, it was stated that this
bill would put 4.4 million new people on to SCHIP. However, according
to the CBO close to a million of those children were already enrolled
in Medicaid and over 1.5 million of those newly enrolled in SCHIP were
already enrolled in private coverage.
It was also stated last night at the Rules Committee that this bill
does not expand eligibility under SCHIP. If that is the case then why
does the CBO estimate 1.2 million of the newly enrolled people in SCHIP
come from expanding the populations that are eligible for the program?
Now those comments last night could have been misstatements because
people just really do not know what is in this bill. It is difficult to
know what is in a bill that no one has seen.
Mr. Speaker, I wonder if someone can explain to me why the Democratic
Leadership has decided to wait until just days before SCHIP expires to
bring their reauthorization to the House floor. We have known for well
over 10 years that the current SCHIP authorization would expire on
September 30, 2007, and the Democratic Leadership in the House and the
Senate have known since early November that they would be in charge of
actually producing a bill to reauthorize this vital health care program
for low-income, uninsured children. Yet, here they are, a full 10
months later, jamming a bill through the House with fewer than three
legislative days before the entire program expires and children's
health care stops.
Well, Mr. Speaker, I was not sent here by the 6th District of Texas
to be quiet and do what the gentle lady from San Francisco instructs me
to do. I was sent here to represent my constituents' best interests and
I demand the ability to do what I have sworn to do.
We all know that the President has promised to veto this version of
the bill, so why are we wasting precious time on a bill that we all
know doesn't stand a chance of ever becoming law?
While we are down here on the floor participating in this Theatre of
the Absurd, the
[[Page H10884]]
Democratic Leadership is in the back rooms trying to figure how they
will extend the SCHIP program for another 6 months or a year. We all
know this to be a fact, but I guess the Democrats want to pick a fight
with the president so they can pretend that he is against children, and
only then will they permit everybody to do the right thing and extend
SCHIP.
Mr. Speaker, I'm sorry it's come to this. The pettiness of this
transparent political strategy to damage and weaken the president is a
new low. I regret that the state of political strategy has come to
this.
I'd hoped that we would not engage in this game, and it's still not
too late to stop it. We could start debating how to best extend the
SCHIP program so that we can actually do the job people sent us here to
do. We still have a chance to write a responsible, long-term
reauthorization of the SCHIP program. Now, it's true that writing a
solid, bipartisan bill will not give the president a black eye, but
that's the price that Democrats will have to pay. Given that millions
of needy children are depending on us, it doesn't seem like a big
price.
Mr. VAN HOLLEN. Mr. Speaker, I rise in strong support of the
bipartisan, bicameral Children's Health Insurance Program (CHIP)
Reauthorization Act of 2007.
The CHIP Reauthorization Act will reauthorize and improve the very
successful Children's Health Insurance Program, CHIP, for 5 years. This
bipartisan bill will preserve coverage for the 6 million children
currently enrolled who otherwise would have no access to health
insurance while, according to the non-partisan Congressional Budget
Office (CBO), extending coverage to 3.8 million children who are not
enrolled in the program. By reauthorizing this very important program,
we will strengthen CHIP's financing, improve the quality of health care
children receive, and increase health insurance coverage for low-income
children.
I am pleased that this bill maintains the guaranteed dental coverage
and mental health parity provisions that were in the CHAMP Act. Good
oral health care is important to the overall health of children. No
family should have to suffer the loss of a child because they lack the
access to care, as happened in the tragic case of Deamonte Driver, a
12-year-old Marylander who died earlier this year when an infection
from an untreated abscessed tooth spread to his brain.
This legislation increases the tobacco tax by 61 cents to a total of
one dollar. Increasing the tobacco tax will save billions in health
costs and is one of the most effective ways to reduce tobacco use,
especially among young children. The 2000 U.S. Surgeon General's report
found that increasing the price of tobacco products will decrease the
prevalence of tobacco use, particularly among kids and young adults. In
short, raising the tobacco tax will prevent thousands of children from
starting to smoke and the proceeds of the tax will be used to provide
health coverage for children. That is a win-win result.
The President has said that he will veto this bipartisan bill. Not so
long ago in a September 2004 speech, he promised to expand coverage of
CHIP to include eligible children who are not yet enrolled in the
program.
Now the President has reversed course. In his July 2007 speech in
Cleveland, Ohio, he forgot his 2004 pledge and stated, ``I mean, people
have access to health care in America. After all, you just go to an
emergency room.'' I am disappointed that he will wield his veto pen on
such promising legislation. I hope he will reconsider his position and
help Congress provide health insurance to millions of America's
children.
Mr. Speaker, I urge my colleagues to vote for this much needed
bipartisan legislation.
Mr. HONDA. Mr. Speaker, I rise today in support of the Children's
Health Insurance Program Reauthorization Act of 2007 and to express my
dismay over one particular matter not addressed by today's conference
agreement.
Since its creation in 1997, the CHIP's flexibility, in combination
with existing Medicaid programs, has proven highly effective in
reducing the number of children who are uninsured in the United States.
The bill before us today will invest $35 billion in the program over
the next 5 years, ensuring that 6.6 million children currently enrolled
will continue to have a health program and allowing for the growth in
the program predicted over the next 10 years.
I am glad that the bill will allow California and other innovative
states to continue to cover families--the health of children is
inextricably entwined with that of the family as a whole. I am
especially pleased that this bill includes full dental coverage and
mental health parity, recognizing that physical health care is only one
part of effective health coverage.
Despite the desperately needed reforms contained in this legislation,
I am deeply disappointed that the conferees did not include language
from the House-passed Children's Health and Medicare Protection, CHAMP,
Act that would have given states the option of choosing to waive the
five year waiting period for Medicaid and CHIP imposed on pregnant
women and children who are legally present in the United States. It is
unconscionable that Congress will make pregnant women and innocent
children pawns in a raucous and frequently misleading immigration
debate. I was proud that the House included language that would allow
states to make their own decision on this matter and I am saddened that
Congress bowed to reactionary anti-immigrant voices on this particular
matter and excluded it from this conference agreement.
Despite my concern, I support this legislation, as I believe that it
is too important to allow to lapse. I hope that House leadership will
take note of my and others' concerns about the denial of coverage to
legally present, otherwise eligible, immigrant children and pregnant
women and will work with us to bring this matter to resolution in as
swift a manner as possible.
I am glad that the Democratic and Republican leadership have been so
active in ensuring that we get this bill to the President before the
program expires on September 30th, 2007. With passage of this bill, the
health of millions of American children will depend on the stroke of
the President's pen. I am sure that I express the sentiments of
millions of Americans when I say that I hope the President will make
the morally correct choice not to veto healthcare for children when
this agreement reaches his desk.
Mr. LEVIN. Mr. Speaker, I rise in strong support of the State
Children's Health Insurance Reauthorization Act of 2007. This
legislation renews and strengthens a program that provides health
insurance to children whose families cannot afford it on the private
market.
The legislation we are voting on today will extend children's health
insurance to enroll almost 4 million kids that are currently eligible
for the program and not yet enrolled. That's in addition to the 6
million low-income children already receiving health care under the
SCHIP program nationwide, including 55,000 kids in my home state of
Michigan.
I regret that many of the provisions the House included this summer
did not make it into the compromise bill. I'm hopeful that we will work
with the Senate to approve legislation before the year's end in order
to ensure Medicare beneficiary access to physicians and stop the
further erosion of Medicare solvency. Nonetheless, I support this
legislation and urge my colleagues to vote in support of the compromise
bill.
Providing health care for children should not be a partisan issue.
The legislation has the support of a large majority of state governors,
Republicans and Democrats alike. The bill has broad bipartisan support
in the Senate; unfortunately, most of the Republican minority in the
House has failed to join us in crafting this compromise and the
President has threatened to veto this important legislation. So it
comes down to this: Clearly, a majority of the House will vote for the
SCHIP bill today; the only real question is whether the House will pass
this bill with enough votes to discourage a Presidential veto. Do we
stand with the President or with kids who need health care coverage?
Instead of working with Congress to expand health care coverage for
children, the President's proposal would actually cause 840,000 kids
that are currently covered under SCHIP to lose their benefits, not to
mention leave hanging the 4 million children that Congress' bill would
bring into the program.
The American people want the children of America covered by health
insurance. A bipartisan majority of House and Senate Members are
committed to carrying this out. The question remains as to whether or
not the Bush Administration will get on board.
Mr. DINGELL. Mr. Speaker, I insert these remarks into the Record in
response to some unfortunate remarks made on the House floor regarding
a provision in the Children's Health Insurance Program Reauthorization
Act, H.R. 976. A statement was made suggesting that a certain provision
had been inserted in the bill to solely benefit my home State of
Michigan, a statement that could not be further from the truth. The
provision for which this accusation was made in reality would ensure
that all States would not be penalized due to factors in Medicaid
funding that are beyond their control.
The Medicaid Federal Medical Assistance Percentage, FMAP, is the
formula used to calculate the amount of Federal funding distributed to
States to offset Medicaid expenses. The Federal Government's share of a
State's Medicaid funding is based on the State's per capita income. Put
simply, States with lower per capita incomes receive more Federal
Medicaid funding; States with higher per capita incomes receive lower
Federal Medicaid funding.
Due to recent changes to accounting rules, the current FMAP formula
needs to be updated. Accounting rules that require employers to pre-
fund employee pension and insurance funds may cause a State's per
capita income to be calculated far higher than it really is. To
[[Page H10885]]
comply with the rules, employers may occasionally have to make large
transfers to a pension or insurance fund. This money is counted in the
calculation of a State's per capita income in the year of the transfer,
even though it may not be paid out for years. When this occurs, a State
then appears wealthier than it is, causing the State to lose Medicaid
funding.
The FMAP adjustment included in the CHIP Reauthorization Act corrects
this unfair penalty. It simply ensures that when an employer makes a
significantly disproportionate pension or insurance contribution, the
State is not denied much-needed Medicaid funding.
This adjustment provision is not limited to any single State. In fact
it now applies to three States, Michigan, Indiana and Ohio. It may well
be that many more States will have cause to complain about this soon,
unless it is corrected. It would apply to any State in any instance
where there is a significantly disproportionate employer pension or
insurance fund contribution that exceeds 25 percent of a State's
increase in personal income for a year.
{time} 2030
The SPEAKER pro tempore. All time for debate has expired.
Pursuant to House Resolution 675, the previous question is ordered.
The question is on the motion offered by the gentleman from Michigan
(Mr. Dingell).
The question was taken; and the Speaker pro tempore announced that
the noes appeared to have it.
Mr. RANGEL. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, this 15-
minute vote on agreeing to the motion will be followed by a 5-minute
vote on suspending the rules and agreeing to House Resolution 590.
The vote was taken by electronic device, and there were--yeas 265,
nays 159, answered ``present'' 1, not voting 8, as follows:
[Roll No. 906]
YEAS--265
Abercrombie
Ackerman
Allen
Altmire
Andrews
Arcuri
Baca
Baird
Baldwin
Barrow
Bean
Becerra
Berkley
Berman
Berry
Bishop (GA)
Bishop (NY)
Blumenauer
Bono
Boswell
Boucher
Boyd (FL)
Boyda (KS)
Brady (PA)
Braley (IA)
Brown, Corrine
Buchanan
Butterfield
Capito
Capps
Capuano
Cardoza
Carnahan
Carney
Castle
Chandler
Clarke
Clay
Cleaver
Clyburn
Cohen
Conyers
Cooper
Costa
Costello
Courtney
Cramer
Crowley
Cuellar
Cummings
Davis (AL)
Davis (CA)
Davis (IL)
Davis, Lincoln
Davis, Tom
DeFazio
DeGette
DeLauro
Dent
Dicks
Dingell
Doggett
Donnelly
Doyle
Edwards
Ehlers
Ellison
Ellsworth
Emanuel
Emerson
Engel
English (PA)
Eshoo
Farr
Fattah
Ferguson
Filner
Fossella
Frank (MA)
Gerlach
Giffords
Gilchrest
Gillibrand
Gonzalez
Gordon
Green, Al
Green, Gene
Grijalva
Gutierrez
Hall (NY)
Hare
Harman
Hastings (FL)
Herseth Sandlin
Higgins
Hinchey
Hinojosa
Hirono
Hobson
Hodes
Holden
Holt
Honda
Hooley
Hoyer
Inslee
Israel
Jackson (IL)
Jackson-Lee (TX)
Jefferson
Johnson (GA)
Jones (OH)
Kagen
Kanjorski
Kaptur
Kennedy
Kildee
Kilpatrick
Kind
King (NY)
Kirk
Klein (FL)
LaHood
Lampson
Langevin
Lantos
Larsen (WA)
Larson (CT)
Latham
LaTourette
Lee
Levin
Lewis (GA)
Lipinski
LoBiondo
Loebsack
Lofgren, Zoe
Lowey
Lynch
Mahoney (FL)
Maloney (NY)
Markey
Matheson
Matsui
McCarthy (NY)
McCollum (MN)
McDermott
McGovern
McHugh
McMorris Rodgers
McNerney
McNulty
Meek (FL)
Meeks (NY)
Melancon
Michaud
Miller (MI)
Miller (NC)
Miller, George
Mitchell
Mollohan
Moore (KS)
Moore (WI)
Moran (KS)
Moran (VA)
Murphy (CT)
Murphy, Patrick
Murphy, Tim
Murtha
Nadler
Napolitano
Neal (MA)
Oberstar
Obey
Olver
Ortiz
Pallone
Pascrell
Pastor
Payne
Pelosi
Perlmutter
Peterson (MN)
Petri
Platts
Pomeroy
Porter
Price (NC)
Pryce (OH)
Rahall
Ramstad
Rangel
Regula
Rehberg
Reichert
Renzi
Reyes
Richardson
Rodriguez
Ross
Rothman
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Salazar
Sanchez, Linda T.
Sanchez, Loretta
Sarbanes
Schakowsky
Schiff
Schwartz
Scott (GA)
Scott (VA)
Serrano
Sestak
Shays
Shea-Porter
Sherman
Shuler
Simpson
Sires
Skelton
Slaughter
Smith (NJ)
Smith (WA)
Snyder
Solis
Space
Spratt
Stark
Stupak
Sutton
Tanner
Tauscher
Thompson (CA)
Thompson (MS)
Tiberi
Tierney
Towns
Turner
Udall (CO)
Udall (NM)
Upton
Van Hollen
Velazquez
Visclosky
Walsh (NY)
Walz (MN)
Wasserman Schultz
Waters
Watt
Waxman
Weiner
Welch (VT)
Wexler
Wilson (NM)
Wilson (OH)
Wolf
Woolsey
Wu
Wynn
Yarmuth
Young (AK)
Young (FL)
NAYS--159
Aderholt
Akin
Alexander
Bachmann
Bachus
Baker
Barrett (SC)
Bartlett (MD)
Barton (TX)
Biggert
Bilbray
Bilirakis
Bishop (UT)
Blackburn
Blunt
Boehner
Bonner
Boozman
Boren
Boustany
Brady (TX)
Broun (GA)
Brown (SC)
Brown-Waite, Ginny
Burgess
Burton (IN)
Buyer
Calvert
Camp (MI)
Campbell (CA)
Cannon
Cantor
Carter
Castor
Chabot
Coble
Cole (OK)
Conaway
Crenshaw
Culberson
Davis (KY)
Davis, David
Deal (GA)
Diaz-Balart, L.
Diaz-Balart, M.
Doolittle
Drake
Dreier
Duncan
Etheridge
Everett
Fallin
Feeney
Flake
Forbes
Fortenberry
Foxx
Franks (AZ)
Frelinghuysen
Gallegly
Garrett (NJ)
Gingrey
Gohmert
Goode
Goodlatte
Granger
Graves
Hall (TX)
Hastert
Hastings (WA)
Hayes
Heller
Hensarling
Hill
Hoekstra
Hulshof
Hunter
Inglis (SC)
Issa
Johnson (IL)
Johnson, Sam
Jones (NC)
Jordan
Keller
King (IA)
Kingston
Kline (MN)
Knollenberg
Kucinich
Kuhl (NY)
Lamborn
Lewis (CA)
Lewis (KY)
Linder
Lucas
Lungren, Daniel E.
Mack
Manzullo
Marchant
Marshall
McCarthy (CA)
McCaul (TX)
McCotter
McCrery
McHenry
McIntyre
McKeon
Mica
Miller (FL)
Miller, Gary
Musgrave
Myrick
Neugebauer
Nunes
Paul
Pearce
Pence
Peterson (PA)
Pickering
Pitts
Price (GA)
Putnam
Radanovich
Reynolds
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Ros-Lehtinen
Roskam
Royce
Ryan (WI)
Sali
Saxton
Schmidt
Sensenbrenner
Sessions
Shadegg
Shimkus
Shuster
Smith (NE)
Smith (TX)
Souder
Stearns
Sullivan
Tancredo
Taylor
Terry
Thornberry
Tiahrt
Walberg
Walden (OR)
Wamp
Weldon (FL)
Weller
Westmoreland
Whitfield
Wicker
Wilson (SC)
ANSWERED ``PRESENT''--1
Watson
NOT VOTING--8
Carson
Cubin
Davis, Jo Ann
Delahunt
Herger
Jindal
Johnson, E. B.
Poe
Announcement By the Speaker Pro Tempore
The SPEAKER pro tempore (during the vote). Members have 2 minutes
remaining to cast their votes.
{time} 2053
Messrs. PASTOR, ORTIZ, GRIJALVA, GUTIERREZ and MEEK of Florida
changed their vote from ``nay'' to ``yea.''
Mr. REYES and Mrs. NAPOLITANO changed their vote from ``present'' to
``yea.''
So the motion was agreed to.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
____________________