[Congressional Record Volume 153, Number 163 (Thursday, October 25, 2007)]
[House]
[Pages H12042-H12090]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    CHILDREN'S HEALTH INSURANCE PROGRAM REAUTHORIZATION ACT OF 2007

  Mr. DINGELL. Madam Speaker, pursuant to House Resolution 774, I call 
up the bill (H.R. 3963) to amend title XXI of the Social Security Act 
to extend and improve the Children's Health Insurance Program, and for 
other purposes, and ask for its immediate consideration.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 3963

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

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

       (a) Short Title.--This Act may be cited as ``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. Making permanent redistribution of unused fiscal year 2005 
              allotments to address State funding shortfalls; 
              conforming extension of qualifying State authority; 
              redistribution of unused allotments for subsequent fiscal 
              years.
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. Denial of payments for coverage of 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.
Sec. 506. Clarification of coverage of services provided through 
              school-based health centers.

[[Page H12043]]

     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; disallowance for 
              unauthorized expenditures.

              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. Outreach regarding health insurance options available to 
              children.
Sec. 623. 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) through (d), 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.
       (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 the respective plan to meet one or more additional 
     requirements imposed by amendments made by this Act, the 
     respective plan shall not be regarded as failing to comply 
     with the requirements of such title solely on the basis of 
     its failure to meet such an additional requirement before the 
     first day of the first calendar quarter beginning after the 
     close of the first regular session of the State legislature 
     that begins after the date of enactment of this Act. For 
     purposes of the previous sentence, in the case of a State 
     that has a 2-year legislative session, each year of the 
     session shall be considered to be a separate regular session 
     of the State legislature.
       (c) 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) $1,150,000,000 for the period beginning on October 1, 
     2011, and ending on March 31, 2012, and
       ``(B) $1,150,000,000 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 paragraph (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 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

[[Page H12044]]

     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 the State is equal to the Federal payments 
     to the State that are attributable to (and countable towards) 
     the total amount of allotments available under this section 
     to the State in 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 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

[[Page H12045]]

     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. 
     Payments made under this paragraph may only be used to reduce 
     the number of low-income children who do not have health 
     insurance coverage in the State.
       ``(B) Amount for above baseline medicaid child enrollment 
     costs.--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) 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)) 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 
     62.5 percent of the projected per capita State Medicaid 
     expenditures (as determined under subparagraph (D)) for the 
     State and fiscal year under title XIX.
       ``(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 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 plan under title XIX; exceeds
       ``(II) the baseline number of enrollees described in clause 
     (iii) for the State and fiscal year under title XIX;

     but not to exceed 3 percent 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 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 title XIX 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 title 
     XIX, as described in clause (i)(II), and the maximum number 
     of first tier above baseline child enrollees for the State 
     and fiscal year under title XIX, 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 title XIX--

       ``(I) for fiscal year 2008 is equal to the monthly average 
     unduplicated number of qualifying children enrolled in the 
     State plan under title XIX 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 title XIX, 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 medicaid expenditures.--
     For purposes of subparagraph (B), 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 
     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.
       ``(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.

[[Page H12046]]

       ``(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).

       ``(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 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 title XIX, taking 
     into account criteria applied as of such date under title XIX 
     pursuant to a waiver under section 1115.
       ``(G) Application to commonwealths and territories.--The 
     provisions of subparagraph (G) of section 2104(j)(3) shall 
     apply with respect to payment 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 title XIX for the third of such 
     fiscal years shall be the monthly average unduplicated number 
     of qualifying children enrolled in the State plan under title 
     XIX 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 5 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.
       ``(H) Premium assistance subsidies.--The State is 
     implementing the option of providing premium assistance 
     subsidies under section 2105(c)(11) or section 1906A.''.

     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.''.

     SEC. 106. MAKING PERMANENT REDISTRIBUTION OF UNUSED FISCAL 
                   YEAR 2005 ALLOTMENTS TO ADDRESS STATE FUNDING 
                   SHORTFALLS; CONFORMING EXTENSION OF QUALIFYING 
                   STATE AUTHORITY; REDISTRIBUTION OF UNUSED 
                   ALLOTMENTS FOR SUBSEQUENT FISCAL YEARS.

       (a) Redistribution of Unused Fiscal Year 2005 Allotments; 
     Extension of Qualifying State Authority.--Section 136(e) of 
     Public Law 110-92 is amended to read as follows:
       ``(e) Applicability.--
       ``(1) Redistribution of unused fiscal year 2005 
     allotments.--The amendment made by subsection (c) shall apply 
     without regard to any limitation under section 106.
       ``(2) Extension of qualifying state authority.--The 
     amendment made by subsection (d) shall be in effect through 
     the date of the enactment of the Children's Health Insurance 
     Program Reauthorization Act of 2007.''.
       (b) Redistributions of Unused Allotments for Fiscal Years 
     After Fiscal Year 2005.--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

[[Page H12047]]

     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), as amended by section 136(d) of 
     Public Law 110-92--
       (A) by inserting ``subject to paragraph (4),'' after 
     ``Notwithstanding any other provision of law,''; and
       (B) by striking ``2007, or 2008'' and inserting ``or 
     2007''; 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, $13,700,000,000 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 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

[[Page H12048]]

     meaning given the term `child health assistance' in section 
     2110(a) with respect to an individual during the period 
     described in paragraph (2)(A).
       ``(2) Targeted low-income pregnant woman.--The term 
     `targeted low-income pregnant woman' means an individual--
       ``(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 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 paragraph (2) 
     shall apply for purposes of any period beginning on or after 
     January 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.
       ``(2) Termination of chip coverage under applicable 
     existing waivers at the end of 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 December 31, 2008.
       ``(B) Extension upon state request.--If an applicable 
     existing waiver described in subparagraph (A) would otherwise 
     expire before January 1, 2009, and the State requests an 
     extension of such waiver, the Secretary shall grant such an 
     extension, but only through December 31, 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 the period beginning on 
     the date of the enactment of this subsection and ending on 
     December 31, 2008.
       ``(3) 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 September 30, 2008, 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 December 31, 2008, on the application of a 
     State for a Medicaid nonpregnant childless adults waiver that 
     was submitted to the Secretary by September 30, 2008, 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 2009, 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 2008, increased by the percentage 
     increase (if any) in the projected nominal per capita amount 
     of National Health Expenditures for 2009 over 2008, as most 
     recently published by the Secretary; and
       ``(ii) in the case of any succeeding year, allow such 
     expenditures to not exceed the amount in effect under this 
     subparagraph for the preceding year, increased by the 
     percentage increase (if any) in the projected nominal per 
     capita amount of National Health Expenditures for the year 
     involved over the preceding 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

[[Page H12049]]

     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 subparagraph (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.
       ``(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 on October 1, 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. DENIAL OF PAYMENTS FOR COVERAGE OF CHILDREN WITH 
                   EFFECTIVE FAMILY INCOME THAT EXCEEDS 300 
                   PERCENT OF THE POVERTY LINE.

       (a) In General.--Section 2105(c) (42 U.S.C. 1397ee(c)) is 
     amended by adding at the end the following new paragraph:

[[Page H12050]]

       ``(8) Denial of payments for expenditures for child health 
     assistance for children whose effective family income exceeds 
     300 percent of the poverty line.--
       ``(A) In general.--Except as provided in subparagraph (B), 
     for child health assistance furnished after the date of the 
     enactment of this paragraph, no payment shall be made under 
     this section for 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 
     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 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.--Not later than 6 months after the best 
     practice application date described in paragraph (2), each 
     State that has a State child health plan shall submit to the 
     Secretary a State plan amendment describing how the State--
       ``(A) will address CHIP crowd-out; and
       ``(B) will incorporate recommended best practices referred 
     to in such paragraph.
       ``(2) 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).
       ``(3) Secretarial review.--The Secretary shall--
       ``(A) review each State plan amendment submitted under 
     paragraph (1);
       ``(B) determine whether the amendment incorporates 
     recommended best practices referred to in paragraph (2);
       ``(C) in the case of a higher income eligibility State (as 
     defined in section 2105(c)(9)(B)), 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.--
       (1) In general.--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.

[[Page H12051]]

       ``(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).''.
       (2) Construction.--Nothing in the amendment made by 
     paragraph (1) or this section this shall be construed as 
     authorizing the Secretary of Health and Human Services to 
     limit payments under title XXI of the Social Security Act in 
     the case of a State that is not a higher income eligibility 
     State (as defined in section 2105(c)(9)(B) of such Act, as 
     added by paragraph (1)).
       (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 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, 
     coordination with other sources of coverage, target rate of 
     coverage, or medical support order other than under the 
     amendments made by this section. In the case of a State plan 
     amendment which was denied on or after August 16, 2007, on 
     the basis of any such policy or interpretation in effect 
     before the date of the enactment of this Act, if the State 
     submits a modification of such State plan amendment that 
     complies with title XXI of the Social Security Act as amended 
     by this Act, such submitted State plan amendment, as so 
     modified, shall be considered as if it had been submitted (as 
     so modified) as of the date of its original submission, but 
     such State plan amendment shall not be effective before the 
     date of the enactment of this Act and the exception described 
     in subparagraph (B) of section 2105(c)(8) of the Social 
     Security Act, as added by section 114(a), shall not apply to 
     such State plan amendment.
                   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 111, 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

[[Page H12052]]

       ``(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)--
       (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:

[[Page H12053]]

       ``(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 subparagraphs (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.--
       ``(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

[[Page H12054]]

     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 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--

[[Page H12055]]

       ``(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) Alternative State Process for Verification of 
     Declaration of Citizenship or Nationality for Purposes of 
     Eligibility for Medicaid.--
       (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).
       ``(B) If the State receives notice from the Commissioner of 
     Social Security that the name or social security number, or 
     the declaration of citizenship or nationality, of the 
     individual is inconsistent with information in the records 
     maintained by the Commissioner--
       ``(i) the State makes a reasonable effort to identify and 
     address the causes of such inconsistency, including through 
     typographical or other clerical errors, by contacting the 
     individual to confirm the accuracy of the name or social 
     security number submitted or declaration of citizenship or 
     nationality 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 such inconsistency is not resolved under 
     clause (i), 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 resolve the 
     inconsistency 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 
     inconsistency is not resolved.
       ``(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 at least 
     monthly to the Commissioner of Social Security for comparison 
     of 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) and who declares 
     to be a United States citizen or national, with information 
     in records maintained by the Commissioner.
       ``(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, through an on-line system or otherwise, 
     for the electronic submission of, and response to, the 
     information submitted under subparagraph (A) for an 
     individual enrolled in the State plan under this title who 
     declares to be citizen or national on at least a monthly 
     basis; or
       ``(ii) to provide for a determination of the consistency of 
     the information submitted with the information maintainted in 
     the records of the Commissioner 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).
       ``(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 inconsistent submissions bears to the 
     total submissions made for comparison for such month. For 
     purposes of this subparagraph, a name, social security 
     number, or declaration of citizenship or nationality of an 
     individual shall be treated as inconsistent and included in 
     the determination of such percentage only if--
       ``(i) the information submitted by the individual is not 
     consistent with information in records maintained by the 
     Commissioner of Social Security;
       ``(ii) the inconsistency is not resolved by the State;
       ``(iii) the individual was provided with a reasonable 
     period of time to resolve the inconsistency with the 
     Commissioner of Social Security or provide satisfactory 
     documentation of citizenship status 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

[[Page H12056]]

     the total payments under the State plan for the fiscal year 
     for providing medical assistance to individuals who provided 
     inconsistent information as the number of individuals with 
     inconsistent information in excess of 3 percent of such total 
     submitted bears to the total number of individuals with 
     inconsistent 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) Subparagraph (A) and (B) 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 
     that provides for the submission on a real-time basis of the 
     information described in such paragraph.
       ``(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)''.
       (4) Appropriation.--Out of any money in the Treasury of the 
     United States not otherwise appropriated, there are 
     appropriated to the Commissioner of Social Security 
     $5,000,000 to remain available until expended to carry out 
     the Commissioner's responsibilities under section 1902(ee) of 
     the Social Security Act, as added by subsection (a).
       (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 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

[[Page H12057]]

     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 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

[[Page H12058]]

     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).
       ``(N) Coordination with medicaid.--In the case of a 
     targeted low-income child who receives child health 
     assistance through a State plan under title XIX and who 
     voluntarily elects to receive a premium assistance subsidy 
     under this section, the provisions of section 1906A shall 
     apply and shall supersede any other provisions of this 
     paragraph that are inconsistent with such section.''.
       (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).
       ``(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 paragraph (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:

[[Page H12059]]

       ``(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 paragraph (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 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.''.

[[Page H12060]]

       (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 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

[[Page H12061]]

     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 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

[[Page H12062]]

     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.
       ``(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

[[Page H12063]]

     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.--
       ``(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).

[[Page H12064]]

       ``(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.''.
       (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.--

[[Page H12065]]

       (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--
       (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

[[Page H12066]]

     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.
       (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.''.

[[Page H12067]]

     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; DISALLOWANCE 
                   FOR UNAUTHORIZED EXPENDITURES.

       Nothing in this Act allows Federal payment for individuals 
     who are not legal residents. Titles XI, XIX, and XXI of the 
     Social Security Act provide for the disallowance of Federal 
     financial participation for erroneous expenditures under 
     Medicaid and under CHIP, respectively.

              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 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.

[[Page H12068]]

       (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 January 1, 
     2010, 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 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

[[Page H12069]]

     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:
       ``(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. 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.

[[Page H12070]]

       (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. 623. 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 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

[[Page H12071]]

     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 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''.

  The SPEAKER pro tempore. Pursuant to House Resolution 774, 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. Madam Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and to include extraneous material 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. Madam Speaker, I yield myself 3 minutes.
  Madam Speaker, I rise in support of H.R. 3963, the Children's Health 
Insurance Program Reauthorization Act of 2007.
  Madam Speaker, this is not a perfect bill, but it is an excellent 
bipartisan compromise. I would observe that it meets the concerns 
expressed both in the President's veto message and also in the comments 
raised by our Republican colleagues as we debated the bill at earlier 
times.
  I will note that the bill protects health insurance coverage for some 
6 million children who now depend on CHIP. I will observe that it 
provides health coverage for 3.9 million children who are eligible, yet 
remain uninsured. Together, this is a total of better than 10 million 
young Americans who, without this legislation, would not have health 
insurance, and it is to be noted that those same young people will be 
losing their health insurance shortly if we do not act expeditiously on 
this matter.

                              {time}  1430

  As mentioned, the bill makes changes to accommodate the President's 
stated concerns.
  First, it terminates the coverage of childless adults in 1 year.
  Second, it targets bonus payments only to States that increase 
enrollments of the poorest uninsured children, and it prohibits States 
from covering children in families with incomes above $51,000.
  Third, it contains adequate enforcement to ensure that only U.S. 
citizens are covered.
  Fourth, it encourages States to help low-income families to secure 
health insurance provided through their private employer.
  The bill is focused on the private marketplace. The evidence of that 
is the bill has strong support from the private health insurance 
industry. It is supported by the medical community, AMA, children's 
advocates, educators, advocates for people with disabilities, health 
professionals, hospitals, the AARP and others.
  It is solid, bipartisan legislation worked out in careful meetings 
with Members from both parties, including Senator Hatch and others on 
the Senate side who have done such important work on this matter in 
times past, and that includes also our dear friend, Senator Grassley.
  It is solid, bipartisan legislation that addresses the concerns 
expressed by the President and by our colleagues in the House on the 
Republican side. I urge an ``aye'' vote on H.R. 3963.
  Madam Speaker, I reserve the balance of my time.
  Mr. BARTON of Texas. Madam Speaker, I yield 2 minutes to the 
distinguished gentleman from Georgia (Mr. Deal), ranking member of the 
Subcommittee on Health, and I ask unanimous consent that he control the 
minority time for the Committee on Energy and Commerce.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. DEAL of Georgia. Madam Speaker, today we are dealing with a bill 
that supposedly is a fix of the previous legislation that has been 
vetoed. We are all entitled to our opinion, but we should rely on a 
body that gives us the facts, and that is the Congressional Budget 
Office. I would like to look at some of those facts.
  First of all, there is supposed to have been a fix on the issue of 
illegal immigration. CBO still estimates that there will be $3.7 
billion of increased Federal spending and complementary State spending 
that will total some $6.5 billion of additional spending because of 
this change as it relates to the immigration issue over the next 10 
years, and an additional 100,000 adults will gain eligibility because 
of this section.
  The questions that ought to be asked are the two questions that were 
put to the staff of the Social Security Administration, because if we 
are going to allow Social Security numbers to be used as 
identification, these ought to be the questions. They were said to the 
staff. And the question is: Would the name and Social Security number 
verification system in this bill verify that the person submitting the 
name and the Social Security number is who they say they are?
  The answer: No.
  Second question: Would the name and Social Security verification 
system in this bill prevent an illegal alien

[[Page H12072]]

from fraudulently using another person's valid name and matching Social 
Security number to obtain Medicaid and SCHIP benefits?
  The answer: No.
  The authors of this bill also claim there is a fix on the issue of 
adults in SCHIP. The fact that CBO still projects that up to 10 percent 
of the enrollees in SCHIP will be adults, not children, in the next 5 
years, and money for poor children shouldn't, in my opinion, go to 
cover adults.
  The fix on the issue of crowd-out. The CBO still estimates there will 
be some 2 million people who will lose their private health insurance 
coverage and become enrolled in a government-run program.
  Then the fix relating to the enrollment of higher income children. 
CBO estimates there will only be some 800,000 who are currently 
eligible for SCHIP who will be enrolled in the next 5 years, but an 
additional 1.1 million people with incomes that are not currently 
eligible for SCHIP will be enrolled in the program.
  I urge a ``no'' vote.
  Madam Speaker, I reserve the balance of my time.
  Mr. RANGEL. Madam Speaker, I yield myself 3 minutes.
  (Mr. RANGEL asked and was given permission to revise and extend his 
remarks.)
  Mr. RANGEL. Madam Speaker and my colleagues, now that the dust has 
settled and the parliamentary games have been played and some of the 
facts that have been distorted have been corrected, we reach the point 
that at the end of the line the question is going to be: Did you vote 
for health care for 10 million children and did you vote to support the 
$35 billion that is necessary to do it?
  I don't think that any of the families of the children or the 
Governors or the agencies that are just waiting to see what is going to 
happen are very interested in the distortions continuing. It is going 
to be very, very simple. Which way do you vote, and if you did not vote 
for the bill, why didn't you?
  Now there may be some particular loyalty to the President, but you 
have to remember that when these voters and people come to you, the 
President's veto message will not be stapled to you and you will have 
to, on your own, be able to explain why you thought what he said was 
true. That's why we rely heavily on some of the President's strongest 
supporters, Senator Orrin Hatch and Senator Chuck Grassley, because as 
a Democrat, I am kind of used to Republicans beating up on me, but I am 
not used to them beating up on the Republican leaders in the Senate 
such as Orrin Hatch and Chuck Grassley. This is particularly so since 
the Senate has assumed so much responsibility in putting together this 
bill which neither you nor I like, but what the heck, we have to play 
the hand that is dealt.
  So remember that just by attacking personalities, it may be like 
getting into a firing squad that is in a circle and we find everybody 
shooting at each other. But really, the winners and losers are going to 
be those children without health coverage and their families who are 
struggling hard. And ultimately, these kids are really America. It 
takes so much to take care of some of the illnesses that could be 
detected.
  And as sensitive as the President is to the poor that are smoking and 
having the tobacco tax increase, tobacco smoking is dangerous for 
America and for our health system. It is very expensive, and it is a 
deterrent to children smoking.
  So when all of this is done, I don't know how many people are going 
to ask you why did you vote no. But please remember that many of the 
reasons that are stated today, the truth will be caught up to the 
allegations and you will have to have a better answer.
  Madam Speaker, I reserve the balance of my time.
  Mr. McCRERY. Madam Speaker, I yield myself 2 minutes.
  First, I want to thank the distinguished gentleman from Michigan, the 
chairman of the Energy and Commerce Committee, Mr. Dingell, for 
requesting unanimous consent that every Member may have 5 days to 
revise and extend his remarks. The reason I say that is we on the 
minority side just got this bill at 8 p.m. last night, so it is going 
to take a few days to understand the changes that have been made, and 
so we may want to revise and extend our remarks when this debate is 
over today.
  This is the third time we have debated a measure like this along 
these lines. I am probably going to repeat some of the things I have 
said earlier because, in our cursory examination of the bill at least, 
it doesn't appear to have changed very much.
  The bill does nothing, for example, to address the cliff in the 
funding of SCHIP, so a future Congress will still face a choice of 
throwing off the SCHIP rolls 6.5 million kids or raising taxes by about 
$40 billion.
  It still relies on a declining revenue source, tobacco taxes, to fund 
a growing program which is likely to exacerbate the funding cliff 
issue. In short, the legislation remains fiscally irresponsible.
  Further, despite some window dressing on this, it appears illegal 
immigrants will be able to use fraudulent Social Security numbers and 
still be able to get SCHIP and Medicaid benefits.
  It still allows States to enroll higher income children at least 
through 2010 and continues to allow States to use a system of so-called 
income disregards to set just about any income limit they please.
  I support SCHIP. I want SCHIP to be extended, but this so-called new 
legislation seems to do absolutely nothing to address the serious flaws 
in the previous proposals.
  Madam Speaker, I reserve the balance of my time.
  The SPEAKER pro tempore. Without objection, the gentleman from 
Michigan yields his time to the gentleman from New Jersey.
  There was no objection.
  Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentleman from 
New York (Mr. Engel).
  Mr. ENGEL. Madam Speaker, I rise in strong support of the SCHIP 
program. The bottom line, my friends, is do we want to fund children's 
health care for poor children in this country or do we not?
  The arguments against it from fiscal conservatives, and I always have 
to question that a bit because our Republican friends have driven up 
the deficit to the greatest in American history, and now they want to 
tell us this program is too expensive.
  One of the reasons the American people are so disenchanted with 
Congress is because the Republicans are blocking a bill that is very, 
very supportive of what American people want. We see here that 72 
percent of the American public, two-thirds of the Senate, the majority 
of the House, 43 State Governors and more than 300 organizations 
support this legislation; and our friends on the other side of the 
aisle are blocking the will of the American people.
  Let's fund this bill. Let's help poor children. Stop with the 
nonsense, stop with the nonsense about New York. We try to help as much 
as we can. Congress ought to help our poor kids. That's the question. 
Do you want to help poor kids, or don't you?
  Mr. DEAL of Georgia. Madam Speaker, I yield 2 minutes to the 
gentlewoman from Tennessee (Mrs. Blackburn).
  Mrs. BLACKBURN. Madam Speaker, I don't think anyone opposes providing 
health care for poor children and children of the working poor. That is 
not what our argument is about today.
  What we do oppose is having a bill before us that covers 400,000 less 
kids in SCHIP than previously. We do oppose having a bill that has a 
funding cliff in 2012 where you just plan to run out of money. Now the 
question is: Why would you vote for a bill where you plan on having a 
program fail?
  Another thing we see in this bill before us, it is going to spend a 
half billion dollars more than SCHIP version one, and it is going to 
cover less kids. So there are plenty of reasons to oppose this bill.
  In addition, you have the issue with illegal immigration. CBO, the 
Congressional Budget Office, projects that section 211 of this bill 
will result in spending $3.7 billion in increased spending on health 
care for this population over the next 10 years.
  And then you get to the issue of adults. Well, what you are talking 
about is getting childless adults off the program, not all adults, just 
childless adults.

[[Page H12073]]

  Madam Speaker, I think we as parents expect our children to grow up 
and expect them to take responsibility. This is not Never Never Land, 
and all adults need to be removed from this program.
  SCHIP, as it was put in place in 1997, is there for poor children, 
children of the working poor. The list could go on and on. We also know 
there is a massive redistribution of taxes within this bill. We have 
all seen those figures.
  On top of that, you look at what goes to the east coast and it is 
harming those children in the middle of the country. I oppose the bill.
  Mr. RANGEL. Madam Speaker, at this time I recognize the chairman of 
the Health Subcommittee who has worked very hard on the Medicare part 
and transferred that knowledge to help perfect the SCHIP bill, Chairman 
Stark, for 2 minutes.
  Mr. STARK. Madam Speaker, I thank the distinguished chairman for 
yielding, and I rise in strong support of this third version of 
legislation to improve and extend the Children's Health Insurance 
Program, and I hope the third time will be a charm.
  Eighty percent of Americans, 72 percent perhaps, a strong bipartisan 
majority in the Senate, nearly every House Democrat, and at last count 
45 House Republicans, all supported this version of SCHIP. President 
Bush and many of my Republican colleagues, however, opposed the 
previous version of this legislation. Supposedly you opposed it 
because, one, it might have enabled the States to provide health care 
to adults.

                              {time}  1445

  Two, children in the middle-income families might get health care. 
And, three, worst of all, undocumented immigrant children might have 
gotten health care. Also, there was a concern by some that we'd run out 
of money. I haven't heard that concern of where we're going to get $1.7 
trillion for a war that we're fighting, but at least you're worried 
about bringing that money to health care.
  The bill before us today answers those criticisms. It should be more 
acceptable to a few more of my Republican colleagues, perhaps even to 
the President. The previous version concerns have been met, rectified, 
and so those who vote against today's legislation can only be voting 
against the government providing health care to poor children who have 
no other means of obtaining medical care. That's the only reason left 
to vote against this. No other way to account for a ``no'' vote.
  But I'm most proud of what this bill does not do. It doesn't 
compromise in covering children. It adds $35 billion in new funding to 
the SCHIP program, and it provides coverage to 10 million additional 
children.
  I urge my colleagues to join with me, making the third time a charm, 
not a strike out, for America's children. With even stronger bipartisan 
support, we may convince President Bush to do right by America's 
children. Let's provide him that opportunity and guide him down the 
path to compassion and humane treatment for all our children.
  Mr. McCRERY. Madam Speaker, at this time I yield 2 minutes to the 
gentleman from Texas (Mr. Sam Johnson).
  (Mr. SAM JOHNSON of Texas asked and was given permission to revise 
and extend his remarks.)
  Mr. SAM JOHNSON of Texas. Madam Speaker, I rise today to simply state 
that facts are funny things. No matter what's said on the floor of this 
House or how many times it's said, facts are facts.
  And the real fact is, this compromise bill is nothing less than a 
bunch of baloney. This bill covers fewer kids, costs more than last 
week's bogus SCHIP bill, and you know, we have a saying in Texas, if 
you put lipstick on a pig, it will still be a pig.
  My biggest concern with this bill is it doesn't fix the illegal 
immigration loophole. The Congressional Budget Office projects that the 
Federal Government will spend almost $4 billion to pay for health 
insurance benefits for illegal immigrants. That doesn't sound like much 
of a solution to me.
  And this bill diverts resources away from kids who need the resources 
most. In fact, in 5 years, 10 percent of the enrollees in the 
Children's Health Insurance Program will not be children but adults. If 
we're going to reauthorize a Children's Health Insurance Program, we 
ought to be sure American kids have access to health insurance, not 
adults, not illegal immigrants.
  I say support poor kids first. The American taxpayer wants, needs, 
and deserves a bill that does just that.
  The SPEAKER pro tempore. Without objection, the gentleman from 
Michigan (Mr. Dingell) reclaims control of his time.
  There was no objection.
  Mr. DINGELL. Madam Speaker, at this time, it is a privilege for me to 
yield 3 minutes to the distinguished chairman of the subcommittee, my 
good friend from New Jersey (Mr. Pallone) who has been a great leader 
in these matters.
  Mr. PALLONE. Madam Speaker, I thank Chairman Dingell.
  I'm really pained when I listen to the last speaker and some of the 
comments that have been made on the other side, you know, calling this 
sincere effort by the Democrats, on a bipartisan basis with the Senate, 
to try to come up with something that we can get you on the other side 
of the aisle to support. You know, I heard words like ``baloney'' and 
``bogus,'' and almost I think actual laughter. And it's a sad day when 
we laugh at this issue which is an issue of whether we're going to 
cover kids so that they don't have to go to an emergency room and can 
actually go to a doctor and get proper health care.
  The Democrats, and this is again bipartisan where some Republicans 
and the Senate Republicans have gone out of their way to try to address 
the concerns that some of the Republicans have expressed, but the 
bottom line is that we can't change the fact that we want to cover 
additional kids, 10 million in total.
  And when we know that the American people support this effort, what 
they support is covering more kids, those that are already eligible and 
not enrolled up to the tune of 10 million kids. Now, that's going to 
take $35 billion over 5 years. You can't get away from it.
  And the President is saying, well, I can't support any new tobacco 
tax to pay for it; I'm going to pay for it out of the existing budget. 
Well, that's simply not possible. If you look at the budget, he's 
actually cutting Medicaid, and one of the things that this bill does is 
to stop those cuts in Medicaid so we can cover the kids that we have.
  Now, we have tried very hard to address each of the three issues that 
the Republicans have raised, and the first one I'd like to talk about 
today is the issue of illegal aliens. There was never anything in this 
provision that allowed illegal aliens to be covered. We have made it 
absolutely clear in this new bill that that is the case and that they 
will not be covered. Anyone who suggests otherwise is just not being 
honest about this.
  The second thing that we did, we tried to address the issue of 
adults. Single adults who are phased out after 2 years now under this 
bill will be phased out after 1 year, and even the parents, yes, 
they're also phased out I think over two or three years. So we're 
addressing that issue.
  And then the third issue that was raised was the issue with regard to 
the income eligibility; and here, again, what we're saying is that if 
you go over 300 percent, okay, other than those that are already 
grandfathered into the program, you're no longer going to be able to 
cover those kids at that $82,000 or the other levels that they 
suggested.
  Now, we've made an honest effort here to accomplish this, and all 
we're asking is that a few more of you come over to our side and join 
the Republicans in the Senate to vote for this legislation. This is an 
honest way to try to achieve a compromise that will allow us to cover 
these 10 million children.
  Now, take this seriously. One of my colleagues said, well, this is 
Never, Neverland. This isn't Never, Neverland. We've had discussions 
with the Republicans. We've talked to you. Give us those votes so we 
can cover the kids.
  Mr. DEAL of Georgia. Madam Speaker, I understand why my colleague 
from New Jersey might like the bill, because his State, that's at 350 
percent of poverty, gets grandfathered in and gives special treatment 
over the majority of States in this country.
  Madam Speaker, I'm pleased to yield 1 minute to a member of the 
Energy and Commerce Committee, Mr. Shadegg from Arizona.

[[Page H12074]]

  Mr. SHADEGG. Madam Speaker, I thank the gentleman for yielding.
  It really is a sad day here in the United States Congress. This is an 
effort in pure politics. If this was an honest effort at compromise, 
how come nobody ever sat down with the President? How come nobody ever 
sat down with our leaders?
  The gentleman just said that they tried to address the issues. 
Everybody here on the floor knows they didn't address the issues.
  Adults remain covered under this legislation, though Republicans said 
adults shouldn't be covered in the child health care program.
  And crowd-out, the issue of people losing their private health 
insurance, causing the private health insurance to go up in cost, was 
not addressed. The CBO, a nonpartisan body, says 2 million people will 
lose their private coverage by crowd-out under this legislation.
  The sad thing is, this is pure politics, and it was demonstrated the 
day that the override attempt failed. Because, on that day, the 
Republicans had an opportunity to celebrate, having sustained the 
President's position. But we weren't proud of that moment or of that 
day because we'd like to deal with the Nation's problems.
  You know who applauded on that day? Democrats applauded when the 
override failed. Why? For political gain, not because they care about 
insurance or kids or kids' health, but because they want political 
gain. That's sad; this is a sad day for this Congress.
  Mr. RANGEL. Madam Speaker, it is my pleasure to yield 1 minute to Mr. 
Lewis, an outstanding member of the committee, the conscience of the 
House of Representatives from the sovereign State of Georgia.
  Mr. LEWIS of Georgia. Madam Speaker, I want to thank my friend, my 
colleague, my chairman for yielding.
  Madam Speaker, I rise today in the spirit of bipartisanship to thank 
all of our colleagues, both Democrats and Republicans, for working 
together to bring forth this important piece of legislation.
  Now is the time, not tomorrow or next week, now is the time to 
reauthorize and expand SCHIP, because there's nothing, but nothing, 
more important than the health of our little children. All of our 
children, all of the poor children are in the same boat, whether black 
or white, Hispanic, Asian American or Native American. They need health 
care to grow strong and survive.
  We, in Congress, have the best possible health care, and now is the 
time to deliver that same promise of health to our Nation's children. 
Suffer the little children. Suffer the little children, all of the 
children.
  The time is always right to do right. We must pass the bill today for 
the children of America.
  Mr. McCRERY. Madam Speaker, it is a pleasure to at this time yield 2 
minutes to the gentleman from Texas (Mr. Brady), a member of the 
committee.
  Mr. BRADY of Texas. Madam Speaker, I voted to create the children's 
health care program, and I believe in it. But let's be honest. These 
changes are more cosmetic than Dr. 90210. This bill still isn't paid 
for. It still doesn't cover poor kids first, and it still allows abuses 
like subsidizing adults to continue.
  And what's especially sad is that today, while the California tragedy 
unfolds, most Americans see homes in flames, lives lost, and families 
huddling in football stadiums as their life's possessions go up in 
flames, the Washington Democrats see political opportunity.
  While dedicated California lawmakers rush home to their communities, 
Democrats rush their bill to the floor.
  It seems like none of us in Congress, either party, ought to look 
like vultures circling above the burned out homes of California 
families gleefully eyeing a cynical chance to try to pass their 
partisan legislation.
  This proves what we said all along. This isn't about the children. 
It's about defeating George Bush. Some hate him so badly they will 
sacrifice whatever morals and integrity to win at all costs.
  Democrats promised to change Washington, but it's business as usual 
up here; and it's the children who lose.
  As parents we teach our kids to sit down and work out their 
differences, that fighting doesn't accomplish anything, that big boys 
and girls find a way to work together. When this political trick fails, 
and it will, why don't we apply the same lessons up here and work 
together to find a reasonable, fiscally responsible way to help cover 
our kids who need our help?
  Mr. DINGELL. Madam Speaker, at this time, I yield 1 minute to the 
distinguished gentleman from Texas (Mr. Gene Green).
  Mr. GENE GREEN of Texas. Madam Speaker, I thank my Chair of the 
Energy and Commerce Committee.
  The legislation before us today is not about politics. It's about 
providing children's health care coverage to 10 million low-income 
American children.
  This bill is paid for. It's paid for more than the $190 billion the 
President's asking for a supplemental to support the war in Iraq and 
Afghanistan. This is for the ten million children and parents who are 
hardworking Americans but cannot afford private health insurance.
  The bill is clear on undocumented children. No Federal funding will 
be spent on undocumented immigrants.
  The bill is clear on childless adults. For 1 year they get coverage, 
and these adults actually got a waiver, these States got a waiver to 
cover these adults. So they're going to have 1 year, and then they're 
off of it.
  The bill is clear on family income. Only the lowest-income children 
are covered with a prohibition on coverage of children above 300 
percent. You can't go above 300 percent. Most are at 200 percent, but 
some are at 300.
  Madam Speaker, 4 months of spending in Iraq is enough to provide 
SCHIP to 10 million children for 5 years. More than 80 percent of the 
American people support it, and I urge my colleagues to support it.
  We've prioritized it to the low-income.
  We've prioritized it to citizens.
  We've prioritized children.
  It's about priorities, not politics, and the Congress should be able 
to put aside politics and unite behind these priorities for our 
children.
  Mr. DEAL of Georgia. Madam Speaker, I am pleased to yield 2\1/2\ 
minutes to another member of the Energy and Commerce Committee, Mr. 
Burgess from Texas.

                              {time}  1500

  Mr. BURGESS. I appreciate the gentleman yielding.
  Madam Speaker, I wonder if I might ask if I could engage the highly 
regarded chairman of the Energy and Commerce Committee for purposes of 
a colloquy.
  Mr. DINGELL. I would be happy to oblige my good friend.
  Mr. BURGESS. I thank the chairman.
  As the chairman knows we, of course, worked on this together last 
night on the Rules Committee until late into the night, so I know the 
chairman and I are both a little under the weather today.
  Mr. Chairman, under the changes that have been made in regards to the 
income disregards in the bill, could a State in its current practice 
still allow a family to exclude from income $500 a year for child care 
expenses?
  Mr. DINGELL. The answer to the question is yes.
  Mr. BURGESS. I thank the chairman.
  Could a State allow a family to exclude from income $20,000 a year 
for housing expenses?
  Mr. DINGELL. That would be a matter to be determined by the State in 
which the transaction and the events occurred.
  Mr. BURGESS. I am not a lawyer, but if I were a lawyer and ask for a 
``yes'' or ``no'' answer, I would assume that's a yes.
  Mr. DINGELL. Well, it's a ``yes'' if the State so decides. It's a 
``no'' if they decide not.
  Mr. BURGESS. Further, then, if the Chair will indulge me, could a 
State allow for a family to exclude from income $10,000 per year for 
transportation expenses?
  Mr. DINGELL. Again, the response is that that is up to the State, and 
there is nothing in the legislation to preclude that.
  Mr. BURGESS. So the answer would be a ``yes'' if to transportation 
expenses.
  If the chairman would, then, could a State allow a family to exclude 
from

[[Page H12075]]

income $10,000 a year for clothing expenses?
  Mr. DINGELL. Again, the answer is if that is so determined by the 
States, the answer is yes.
  Mr. BURGESS. So State income disregards, now, are up to $40,500, if I 
am doing my math correctly? Or if I could then just ask one last 
question, several people have alluded on this floor today that 6.6 
million children will lose their health insurance if the House does not 
act.
  Mr. Chairman, you know and I know that this Congress, this Speaker, 
is not so insensitive as to allow this health insurance to expire for 
these children. We will do an extension. We will do what is required to 
continue to allow coverage for the children until Congress passes the 
bill; is that not correct?
  Mr. DINGELL. Well, I would certainly hope so, but I can't guarantee.
  Mr. BURGESS. Again, reclaiming my time, I cannot think that any 
Speaker of the House would be so insensitive as to allow this program 
to expire.
  The SPEAKER pro tempore. Without objection, the gentleman from 
Georgia (Mr. Lewis) will control the time for the gentleman from New 
York (Mr. Rangel).
  Mr. LEWIS of Georgia. Madam Speaker, I am pleased to yield 1 minute 
to a member of the Ways and Means Committee, the gentlewoman from the 
State of Ohio (Mrs. Jones).
  (Mrs. JONES of Ohio asked and was given permission to revise and 
extend her remarks.)
  Mrs. JONES of Ohio. There is a piece of poetry that starts like this, 
``I'd rather see a sermon than to hear one any day, I'd rather one 
should walk with me than just to show the way.
  ``The eye is a better pupil and more willing than the ear; Advice may 
be misleading, but examples are always clear. And the very best of 
teachers are the ones who live their creeds.''
  It goes on to talk about how you can deliver lectures, but I would 
rather get a lesson by observing what you do.
  I am saying to my colleagues, Democrat and Republican, the children 
of America are listening to us gibe at one another about whether they 
deserve health care. They deserve health care, and we could give it to 
them today.
  They deserve health care because many of them are spending so many 
hours in an emergency room, costly, many of them are spending times at 
home when they could be educated. Many parents are not at work because 
they are staying home with their children. Health care should be a 
right in America, and our children are saying they would rather see a 
sermon than to hear one. They want us to walk and give them health care 
and stop talking about it.
  Mr. McCRERY. Madam Speaker, I yield 2 minutes to the gentleman from 
Wisconsin (Mr. Ryan), a member of the Ways and Means Committee.
  Mr. RYAN of Wisconsin. I thank the gentleman for yielding.
  As we look at this bill, which we received this morning, it still has 
the same policy, just a little different cosmetics. I don't think our 
constituents want us to vote for a bill that makes it easier for 
illegal immigrants to get tax-paid health care. This bill does that.
  I don't think our constituents want us to vote for a bill where we 
spend our constituents's tax dollars to pay for insurance that people 
already have. This bill does that.
  I don't think our constituents want us to vote to create a new 
middle-class entitlement. This does that.
  This bill also is only one-half paid for. That's right, they only pay 
for half of this law, and they have an enormous budget gimmick that 
when you add it all together doubles the cost of this bill.
  So if the goal here is ultimately to get universal health care so 
that everybody has insurance, which I think most of us all share, this 
is not the pathway to do it.
  If you take a look at what it costs to fund 3.9 million people who 
are uninsured, that leaves us another 43 million people uninsured. At 
the spend rate, at the cost of that, if we want to fund everybody, it's 
another $400 billion. That would add $8 trillion to the debt we have 
for our kids and our grandkids.
  By doing it this way, by creating an enormous new entitlement, you 
are making matters worse for the baby boomers. You are making this 
enormous cliff we have of entitlement spending that much deeper.
  Madam Speaker, there is a better way to getting universal access to 
affordable health insurance. This is not the way. We believe in 
patient-centered health care, not government-centered health care. We 
don't think bureaucrats should be running health care, whether they are 
an insurance bureaucrat or a government bureaucrat.
  We think patients and their doctors should be running and making 
health care decisions. Unfortunately, this bill does not do that. This 
bill puts the government squarely in the middle and says if you want 
health care, you got to get it from the government. That's not what we 
believe in. That's not what we should be doing. That's why we should be 
voting against this bill.
  Mr. DINGELL. Madam Speaker, I submit for the Record the disregards 
for children's coverage that have been submitted to us by the 
Congressional Research Service.
  The point here is that the money needs to continue to flow to working 
families so that we can keep them working rather than staying on 
welfare.

       Within the Medicaid and SCHIP programs, states are 
     permitted to disregard or not count certain types of amounts 
     of family income as decided by the State in determining 
     eligibility for the program.
       This bill maintains this long-standing flexibility to allow 
     States to disregard certain legitimate costs like child care 
     and child support costs, recognizing that this income is not 
     available for a family to spend on health coverage.
       Allowing States to disregard these costs ensures that 
     working families have the money they need to pay for work-
     related expenses to ensure that low-income families can keep 
     their jobs. This is important to keep families from having to 
     go on welfare to get health coverage for their children.
       The following are the monthly disregards applied by States 
     in 2006.
       The state of Alabama disregards $90 of earnings, $200 or 
     $175 of childcare expenses and $50 of child support received 
     for a family in its Medicaid program when determining 
     eligibility for an individual for Medicaid. It disregards $90 
     of earnings, $200 or $175 of childcare expenses and $50 of 
     child support received for a family in its SCHIP program when 
     determining eligibility for an individual in SCHIP.
       The state of Alaska disregards $90 of earnings, $200 or 
     $175 of childcare expenses, $50 of child support received and 
     the full amount of child support paid for a family in its 
     Medicaid program when determining eligibility for an 
     individual for Medicaid. It does not disregard income when 
     determining eligibility for an individual in SCHIP.
       The state of Arizona disregards $90 of earnings, $200 or 
     $175 of childcare expenses, and $50 of child support received 
     for a family in its Medicaid program when determining 
     eligibility for an individual for Medicaid. It does not 
     disregard income when determining eligibility for an 
     individual in SCHIP.
       The state of Arkansas disregards $90 of earnings, $200 or 
     $175 of childcare expenses and $50 of child support received 
     for a family in its Medicaid program when determining 
     eligibility for an individual for Medicaid. It disregards $50 
     of child support received for a family in its ARKids B 
     Medicaid program when determining eligibility for an 
     individual for Medicaid. It does not disregard income when 
     determining eligibility for an individual in SCHIP.
       The state of California disregards $90 of earnings, $200 or 
     $175 of childcare expenses, $50 of child support received and 
     the full amount of child support paid for a family in its 
     Medicaid program when determining eligibility for an 
     individual for Medicaid. It disregards $90 of earnings, $200 
     or $175 of childcare expenses, $50 of child support received 
     and the full amount of child support paid for a family in its 
     SCHIP program when determining eligibility for an individual 
     in SCHIP.
       The state of Colorado disregards $90 of earnings, $200 or 
     $175 of childcare expenses and $50 of child support received 
     for a family in its Medicaid program when determining 
     eligibility for an individual for Medicaid. It disregards all 
     childcare and medical expenses, including health insurance 
     premiums paid in the last 90 days for a family in its SCHIP 
     program when determining eligibility for an individual in 
     SCHIP. Note: Child support received is not counted as income 
     in SCHIP.
       The state of Connecticut disregards $90 of earnings, $200 
     or $175 of childcare expenses and $100 of child support 
     received for a family in its Medicaid program when 
     determining eligibility for an individual for Medicaid. It 
     disregards $90 of earnings, $200 or $175 of childcare 
     expenses and $50 of child support received for a family in 
     its SCHIP program when determining eligibility for an 
     individual in SCHIP.
       The state of Delaware disregards $90 of earnings, $200 or 
     $175 of childcare expenses and $50 of child support received 
     for a family in its Medicaid program when determining 
     eligibility for an individual for Medicaid. It disregards $90 
     of earnings, $200 or $175 of childcare expenses and $50 of 
     child support

[[Page H12076]]

     received for a family in its SCHIP program when determining 
     eligibility for an individual in SCHIP.
       The District of Columbia disregards Under poverty-level, 
     the full amount of child care expenses may be disregarded for 
     families under the federal poverty level, and disregards $100 
     in earnings and the full amount of child care expenses for 
     those under the SCHIP-funded expansion when determining 
     eligibility for an individual for Medicaid. It does not 
     disregard income when determining eligibility for an 
     individual in SCHIP.
       The state of Florida disregards $90 of earnings, $200 or 
     $175 of childcare expenses and $50 of child support received 
     for a family in its Medicaid program when determining 
     eligibility for an individual for Medicaid. It disregards 
     either Medicaid disregards or gross income (whichever is more 
     beneficial to the family) when determining eligibility for an 
     individual in SCHIP.
       The state of Georgia disregards $90 of earnings, $200 or 
     $175 of childcare expenses and $50 of child support received 
     for a family in its Medicaid program when determining 
     eligibility for an individual for Medicaid. It disregards $90 
     of earnings, $200 or $175 of childcare expenses and $50 of 
     child support received for a family in its SCHIP program when 
     determining eligibility for an individual in SCHIP.
       The state of Hawaii disregards $90 of earnings for a family 
     in its Medicaid program when determining eligibility for an 
     individual for Medicaid. It does not disregard income when 
     determining eligibility for an individual in SCHIP.
       The state of Idaho does not disregard income for a family 
     in its Medicaid program when determining eligibility for an 
     individual for Medicaid. It does not disregard income when 
     determining eligibility for an individual in SCHIP.
       The state of Illinois disregards $90 of earnings, $200 or 
     $175 of childcare expenses, $50 of child support received and 
     the full amount of child support paid for a family in its 
     Medicaid program when determining eligibility for an 
     individual for Medicaid. It disregards $90 of earnings, $200 
     or $175 of childcare expenses, $50 of child support received 
     and the full amount of child support paid for a family in its 
     SCHIP program when determining eligibility for an individual 
     in SCHIP.
       The state of Indiana disregards $90 of earnings, $200 or 
     $175 of childcare expenses and $50 of child support received 
     for a family in its Medicaid program when determining 
     eligibility for an individual for Medicaid. It disregards $90 
     of earnings, $200 or $175 of childcare expenses and $50 of 
     child support received for a family in its SCHIP program when 
     determining eligibility for an individual in SCHIP.
       The state of Iowa disregards 20 percent of earnings, $200 
     or $175 of childcare expenses, $50 of child support received 
     and the full amount of child support paid for a family in its 
     Medicaid program when determining eligibility for an 
     individual for Medicaid. It disregards 20 percent of earnings 
     and $50 of child support received for a family in its SCHIP 
     program when determining eligibility for an individual in 
     SCHIP.
       The state of Kansas has a standard disregard of $200 per 
     worker in its Medicaid program when determining eligibility 
     for an individual for Medicaid. It has a standard disregard 
     of $200 per worker in its SCHIP program when determining 
     eligibility for an individual in SCHIP.
       The state of Kentucky disregards $90 of earnings, $200 or 
     $175 of childcare expenses and $50 of child support received 
     for a family in its Medicaid program when determining 
     eligibility for an individual for Medicaid. It disregards $90 
     of earnings, $200 or $175 of childcare expenses and $50 of 
     child support received for a family in its SCHIP program when 
     determining eligibility for an individual in SCHIP.
       The state of Louisiana disregards $90 of earnings, $200 or 
     $175 of childcare expenses, $50 of child support received and 
     the full amount of child support paid for a family in its 
     Medicaid program when determining eligibility for an 
     individual for Medicaid. It does not disregard income when 
     determining eligibility for an individual in SCHIP.
       The state of Maine disregards $90 of earnings, $200 or $175 
     of childcare expenses and the full amount of child support 
     paid. There is an income exclusion of $50 of child support 
     received for a family in its Medicaid program when 
     determining eligibility for an individual for Medicaid. It 
     disregards $50 of child support received for a family in its 
     SCHIP program when determining eligibility for an individual 
     in SCHIP.
       The state of Maryland disregards $90 of earnings, $200 or 
     $175 of childcare expenses, $50 of child support received and 
     the actual amount of child support paid for a family in its 
     Medicaid program when determining eligibility for an 
     individual for Medicaid. It disregards $90 of earnings, $200 
     or $175 of childcare expenses, $50 of child support received 
     and the actual amount of child support paid for a family 
     in its SCHIP program when determining eligibility for an 
     individual in SCHIP.
       The state of Massachusetts does not disregard income when 
     determining eligibility for an individual for Medicaid. It 
     does not disregard income when determining eligibility for an 
     individual in SCHIP.
       The state of Michigan disregards $90 of earnings, a 
     standard $200 of childcare expenses, $50 of child support 
     received, the full amount of child support paid and a $60 
     deduction for legal guardians (if a guardianship arrangement 
     is in place) for a family in its Medicaid program when 
     determining eligibility for an individual for Medicaid. It 
     disregards $90 of earnings, a standard $200 of childcare 
     expenses, $50 of child support received, the full amount of 
     child support paid and a $60 deduction for legal guardians 
     (if a guardianship arrangement is in place) for a family in 
     its SCHIP program when determining eligibility for an 
     individual in SCHIP.
       The state of Minnesota disregards $90 of work expenses, 
     $200/$175 for childcare and child support paid for its 
     Medical Assistance for children ages 2-19. MinnesotaCare 
     (waiver coverage) is based on gross family income. A gross 
     income test is used for SCHIP-funded Medicaid for infants, 
     with some protections so that no child could be adversely 
     affected by the gross income test. It does not disregard 
     income when determining eligibility for an individual in 
     SCHIP.
       The state of Mississippi disregards $90 of earnings, $200 
     or $175 of childcare expenses and $50 of child support 
     received for a family in its Medicaid program when 
     determining eligibility for an individual for Medicaid. It 
     disregards $90 of earnings, $200 or $175 of childcare 
     expenses and $50 of child support received for a family in 
     its SCHIP program when determining eligibility for an 
     individual in SCHIP.
       The state of Missouri disregards $90 of earnings and $200 
     or $175 of childcare expenses for a family in its Medicaid 
     program when determining eligibility for an individual for 
     Medicaid. Its Medicaid expansion program is based on gross 
     income. It does not disregard when determining eligibility 
     for an individual in SCHIP.
       The state of Montana disregards $120 of work expenses and 
     up to $200 of childcare expenses for a family in its Medicaid 
     program when determining eligibility for an individual for 
     Medicaid. It disregards $120 of work expenses and up to $200 
     of childcare expenses for a family in its SCHIP program when 
     determining eligibility for an individual in SCHIP.
       The state of Nebraska disregards $100 of earnings plus all 
     childcare expenses for a family in its Medicaid program when 
     determining eligibility for an individual for Medicaid. It 
     does not disregard income when determining eligibility for an 
     individual in SCHIP.
       The state of Nevada disregards 20 percent or $90 of 
     earnings (whichever is greater) and the full amount of 
     childcare expenses for a family in its Medicaid program when 
     determining eligibility for an individual for Medicaid. It 
     does not disregard income when determining eligibility for 
     an individual in SCHIP.
       The state of New Hampshire disregards $90 of earnings, $200 
     or $175 of childcare expenses and the full amount of child 
     support paid for a family in its Medicaid program when 
     determining eligibility for an individual for Medicaid. It 
     disregards $90 of earnings, $200 or $175 of childcare 
     expenses and the full amount of child support paid for a 
     family in its SCHIP program when determining eligibility for 
     an individual in SCHIP.
       The state of New Jersey disregards $90 of earnings, $200 or 
     $175 of childcare expenses, $50 of child support received and 
     the full amount of child support paid for a family in its 
     Medicaid program when determining eligibility for an 
     individual for Medicaid. It does not disregard income when 
     determining eligibility for an individual in SCHIP.
       The state of New Mexico disregards income based on a 
     child's age for its Medicaid program when determining 
     eligibility for an individual for Medicaid: children age six 
     and older get $90 of earnings, $175 of childcare expenses and 
     $50 of child support received. Children under age six get 
     earnings disregard of $750 per assistance unit, $375 or 
     actual child care expenses and $50 of child support received. 
     It does not disregard income when determining eligibility for 
     an individual in SCHIP.
       The state of New York disregards $90 of earnings, $200 or 
     $175 of childcare expenses and $50 of child support received 
     for a family in its Medicaid program when determining 
     eligibility for an individual for Medicaid. It does not 
     disregard income when determining eligibility for an 
     individual in SCHIP.
       The state of North Carolina disregards $90 of earnings, 
     $200 or $175 of childcare expenses, $50 of child support 
     received and the full amount of child support paid for a 
     family in its Medicaid program when determining eligibility 
     for an individual for Medicaid. It disregards $90 of 
     earnings, $200 or $175 of childcare expenses, $50 of child 
     support received and the full amount of child support paid 
     for a family in its SCHIP program when determining 
     eligibility for an individual in SCHIP.
       The state of North Dakota disregards $90 of actual work 
     expenses (in the form of payroll taxes) or $30 work training 
     expenses, all reasonable childcare expenses, $50 of child 
     support received and the full amount of child support paid, 
     and premiums paid for other health insurance for a family in 
     its Medicaid program when determining eligibility for an 
     individual for Medicaid. It disregards $90 of actual work 
     expenses (in the form of payroll taxes), all reasonable 
     childcare expenses, and the full amount child support paid 
     for a family in its SCHIP program when determining 
     eligibility for an individual in SCHIP.
       The state of Ohio disregards $90 of earnings, $200 or $175 
     of childcare expenses, $50 of child support received and the 
     full amount of child support paid for a family in 
     its Medicaid program when determining eligibility

[[Page H12077]]

     for an individual for Medicaid. It does not disregard 
     income when determining eligibility for an individual in 
     SCHIP.
       The state of Oklahoma disregards $120 of earnings, $200 or 
     $175 of childcare expenses and $50 of child support received 
     for a family in its Medicaid program when determining 
     eligibility for an individual for Medicaid. It does not 
     disregard income when determining eligibility for an 
     individual in SCHIP.
       The state of Oregon does not disregard income when 
     determining eligibility for an individual for Medicaid. It 
     does not disregard income when determining eligibility for an 
     individual in SCHIP.
       The state of Pennsylvania disregards $120 of earnings, $200 
     or $175 of childcare expenses and $50 of child support 
     received for a family in its Medicaid program when 
     determining eligibility for an individual for Medicaid. It 
     disregards $120 of earnings and $200 or $175 of childcare 
     expenses for a family in its SCHIP program when determining 
     eligibility for an individual in SCHIP.
       The state of Rhode Island disregards $90 of earnings, $200 
     or $175 of childcare expenses and $50 of child support 
     received for a family in its Medicaid program when 
     determining eligibility for an individual for Medicaid. It 
     does not disregard income when determining eligibility for an 
     individual in SCHIP.
       The state of South Carolina disregards $100 of earnings, up 
     to $200 for actual childcare expenses and $50 of child 
     support received for a family in its Medicaid program when 
     determining eligibility for an individual for Medicaid. It 
     does not disregard income when determining eligibility for an 
     individual in SCHIP.
       The state of South Dakota disregards 20 percent of 
     earnings, $200 or $175 of childcare expenses, $50 of child 
     support received and the full amount of child support paid 
     for a family in its Medicaid program when determining 
     eligibility for an individual for Medicaid. It disregards all 
     childcare expenses ($500 family maximum), $50 of child 
     support received and the full amount of child support paid 
     for a family in its SCHIP program when determining 
     eligibility for an individual in SCHIP.
       The state of Tennessee disregards $50 of child support 
     received for a family in its ``regular'' Medicaid program 
     when determining eligibility for an individual for Medicaid. 
     It disregards $90 of earnings, $20 of unearned income, $200 
     or $175 of childcare expenses and $50 of child support 
     received for a family in its Medicaid expansion program when 
     determining eligibility for an individual for Medicaid. It 
     does not disregard income for a family in its SCHIP program 
     when determining eligibility for an individual in SCHIP.
       The state of Texas disregards $120 of earnings, $200 or 
     $175 of childcare expenses, $50 of child support received and 
     the full amount of child support paid for a family in 
     its Medicaid program when determining eligibility for an 
     individual for Medicaid. It does not disregard income when 
     determining eligibility for an individual in SCHIP.
       The state of Utah disregards $90 of earnings, $200 or $175 
     of childcare expenses and $50 of child support received for a 
     family in its Medicaid program when determining eligibility 
     for an individual for Medicaid. It does not disregard income 
     for a family in its SCHIP program when determining 
     eligibility for an individual in SCHIP. No income of a child 
     under the age of 19 is considered unless they are a head of 
     household.
       The state of Vermont disregards $90 of earnings, $200 or 
     $175 of childcare expenses and $50 of child support received 
     for a family in its Medicaid program when determining 
     eligibility for an individual for Medicaid. The state also 
     disregards earned income of anyone under 18 and earned income 
     of anyone under 22 who is a full-time student when 
     determining eligibility for an individual for Medicaid. It 
     does not disregard income when determining eligibility for an 
     individual in SCHIP, except for earned income of anyone under 
     18 and earned income of anyone under 22 who is a full-time 
     student when determining eligibility for an individual for 
     SCHIP.
       The state of Virginia disregards $90 of earnings, $200 or 
     $175 of childcare expenses and $50 of child support received 
     for a family in its Medicaid program when determining 
     eligibility for an individual for Medicaid. It does not 
     disregard income when determining eligibility for an 
     individual in SCHIP.
       The state of Washington disregards $90 of earnings, all 
     reasonable work-related childcare expenses and the full 
     amount of child support paid for a family in its Medicaid 
     program when determining eligibility for an individual for 
     Medicaid. It disregards $90 of earnings and all reasonable 
     work-related childcare expenses for a family in its SCHIP 
     program when determining eligibility for an individual in 
     SCHIP.
       The state of West Virginia disregards $90 of work expenses, 
     $200 or $175 of childcare expenses and $50 of child support 
     received for a family in its Medicaid program when 
     determining eligibility for an individual for Medicaid. It 
     disregards $90 of work expenses, $200 or $175 of childcare 
     expenses and $50 of child support received for a family in 
     its SCHIP program when determining eligibility for an 
     individual in SCHIP.
       The state of Wisconsin disregards $90 of earnings, $200 or 
     $175 of childcare expenses, $50 of child support received and 
     the full amount of child support paid for a family in its 
     Medicaid program when determining eligibility for an 
     individual for Medicaid. It does not disregard income when 
     determining eligibility for an individual in SCHIP.
       The state of Wyoming disregards income based on marital 
     status for a family in its Medicaid program when determining 
     eligibility for an individual for Medicaid. Married couples 
     automatically get a standard $400 deduction. If not married 
     and both parents are working they get the $400 deduction. If 
     unmarried with one parent working, there is $200 deduction. 
     There is also a $50 deduction for child support received. It 
     does not disregard income when determining eligibility for an 
     individual in SCHIP.

  Madam Speaker, I yield to the distinguished gentlewoman from Oregon 
(Ms. Hooley) for 1 minute.
  Ms. HOOLEY. I thank my good friend from Michigan for yielding.
  Madam Speaker, this vote today is about what kind of a country are 
we. This vote today is about what our priorities are. This vote today 
is about what our values are. Just the interest rate on funds to pay 
for the Iraq war are $25 billion a year; yet our President believes 
that spending $12 billion a year on children's health care is too much. 
I strongly reject the argument that we are spending too much on our 
children. Our children deserve better. Our children deserve a healthy 
start.
  I have heard over and over from my constituents about the vital 
importance of the State Children's Health Insurance Program. Nearly 
60,000 children in Oregon currently receive health care through SCHIP, 
and the legislation before the House today will provide for an 
additional 36,000 children. I know hardworking parents who can't afford 
health insurance for their children. They don't know what to do. How am 
I going to cover my kids?
  Thankfully, today, we are taking strong action to ensure that 
thousands of fewer working families in Oregon will have to endure the 
agony of having a sick child for whom they cannot afford medical care.
  I urge my colleagues to vote for this bill.
  The SPEAKER pro tempore. Without objection, the gentleman from Texas 
(Mr. Barton) reclaims control of the time.
  There was no objection.
  Mr. BARTON of Texas. Madam Speaker, could I ask the amount of time 
remaining on all sides.
  The SPEAKER pro tempore. The gentleman from Texas has 7\1/2\ minutes. 
The gentleman from Michigan has 6 minutes. The gentleman from Georgia 
has 8 minutes. The gentleman from Louisiana has 8 minutes.
  Mr. BARTON of Texas. Madam Speaker, I reserve the balance of my time.
  Mr. LEWIS of Georgia. Madam Speaker, I ask unanimous consent that 
Mrs. Jones control the time until Mr. Rangel returns.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Georgia?
  There was no objection.
  Mrs. JONES of Ohio. Madam Speaker, I yield 1 minute to my colleague 
and good friend from the Ways and Means Committee, Allyson Schwartz, 
from the great State of Pennsylvania.
  Ms. SCHWARTZ. Madam Speaker, the American people are clear, they want 
this Congress and the President to ensure that America's children have 
access to health coverage. American parents on behalf of the children 
who get health care coverage under the CHIP program are clear: CHIP is 
working. Health care under CHIP is affordable and is accessible.
  We have compromised, but we are determined. We are determined to 
continue and to extend CHIP for America's children, 10 million American 
children of working families. This bill before us is reasonable, it is 
smart, and it is responsible. A majority of Congress agrees; yet the 
President and some in Congress are still unsure.
  The choice is clear: Vote for health care for America's children or 
stand in the way. The American people are watching, they are waiting, 
and maybe, most importantly, they are hoping we will do the right thing 
and 10 million American children will have access to health coverage.
  Let's make it happen. It's time to make this vote work. Today is the 
day for a majority of Republicans to join us.
  Mr. McCRERY. Madam Speaker, I request unanimous consent to allow Mr. 
Camp of Michigan, ranking member of the Health Subcommittee of the Ways 
and Means Committee, to allocate the remainder of my time.

[[Page H12078]]

  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Louisiana?
  There was no objection.
  Mr. CAMP of Michigan. Madam Speaker, I yield 1\1/2\ minutes to the 
gentleman from Louisiana.
  Mr. BOUSTANY. I thank my colleague for yielding time.
  Madam Speaker, our Democratic friends claim that they won't consider 
covering anything less than 10 million children, and yet the 
Congressional Budget Office shows that their own bill falls short yet 
again. It also fails to give real priority to poor children. It imposes 
billions of dollars in new taxes on poor families, and we know that 
this tax revenue stream won't even cover the expense of the bill in the 
outyears, and it causes millions to lose private coverage.
  Finally, despite warnings from GAO, it also ignores provider access, 
something that's critical for our children in the SCHIP programs 
throughout the country. I know in my State of Louisiana we have a 
serious access problem, despite the fact that we have 106,000 children 
in the State covered by SCHIP, 6,000 who should be on it not covered, 
and yet all of them have significant access problems.
  I ask the question, why did our Democratic friends block debate on 
any amendments that would have addressed these and other concerns? We 
really shouldn't be playing political games with this. We shouldn't be 
playing games with children's medical care.
  I urge my colleagues to oppose this bill, and let's work together in 
good faith to improve coverage and access for children.
  Mr. DINGELL. Madam Speaker, I yield to a Member for whom I have great 
personal affection and respect, Mr. Andrews of New Jersey, for 1 
minute.
  (Mr. ANDREWS asked and was given permission to revise and extend his 
remarks.)
  Mr. ANDREWS. I thank my dear friend for yielding.
  Madam Speaker, why would someone not vote for health insurance for 10 
million American children? There is the excuse that the bill covers 
illegal aliens.
  Read section 605 of the bill; it doesn't. There is the excuse that it 
covers adults, not children. Read section 112 of the bill, which is 
called termination of coverage of nonpregnant childless adults. There 
is the excuse that it covers a lot of wealthy kids, but there is the 
fact that 91.3 percent of the children covered come from families that 
make less than $40,000 a year, and the rest live in States that are 
very, very expensive to live in, like mine in New Jersey.
  Then there is the excuse that, well, it's bad for the budget somehow, 
unlike the $109 billion they want to send to Iraq. But the 
Congressional Budget Office, the nonpartisan Congressional Budget 
Office says that over 10 years this bill saves $200 million for the 
Federal Treasury.
  Ladies and gentlemen, no more excuses, vote ``yes''.
  Mr. BARTON of Texas. Madam Speaker, I yield myself 1\1/2\ minutes.
  I want to talk about enforcement of this 300 percent above the 
poverty line. The people that wrote the bill claimed that we have got 
this hard cap above 300 percent in terms of family income.
  But if you look on page 76 of the bill, the first part of it, 
starting with line 5, says, ``no payment shall be made under this 
section for 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.''
  That sounds okay, but then here is the gotcha, beginning on line 13, 
``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.''
  So you leave it up to the States to say you can't have an income 
level over 300 percent, but you can deduct $20,000 for a housing 
allowance or you can deduct $15,000 for shelter or whatever.

                              {time}  1515

  So what you've got here is the classic bait and switch. I would say 
that the majority has listened to some of the concerns of the minority, 
but you're not really ready to address them substantively. You put the 
right verbiage in the first paragraph and then you take it away in the 
second. At some point in time we need to sit down together and really 
work these things out to make sure that you not only have the verbiage, 
you also have the enforcement. Now when that day comes, we will have a 
bipartisan bill. But that day is not today.
  Mrs. JONES of Ohio. Madam Speaker, it gives me great pleasure to 
yield 1 minute to one of our new Members from the great State of 
Florida, Mr. Tim Mahoney.
  Mr. MAHONEY of Florida. Madam Speaker, as a father, it is 
unfathomable to me why the President chose to deny health care coverage 
to children. It's incomprehensible to me that some of my colleagues 
would play politics with a child's health.
  I always tell my daughter that in life you don't get do-overs. Well, 
apparently here in Congress you do.
  The President and my colleagues across the aisle have the opportunity 
that is very rare, and that is to have a second chance to do it right.
  Last week I met with pediatricians at a hospital in Port St. Lucie 
where doctors painted a stark picture of the challenges faced by 
children without insurance.
  I then went across the street to a daycare center and visited 
children who rely on Florida's CHIP program, KidCare, for the health 
care needs, kids like 4-year-old Samantha, and 2-year-old Hannah, 4-
year-old Rafael and 2-year-old Julian.
  The President opposes SCHIP because he thinks that children from 
working families that go to work, pay their taxes but can't afford 
health insurance shouldn't go to the doctor. He says it's too many kids 
and too expensive, even though the bill is paid for without putting our 
country further into debt.
  Madam Speaker, I would ask the President, which child would you deny 
health care coverage to, Julian or Hannah? Which child is one too many?
  Mr. CAMP of Michigan. Mr. Speaker, at this time I yield 1\1/2\ 
minutes to the gentleman from Georgia (Mr. Price).
  (Mr. PRICE of Georgia asked and was given permission to revise and 
extend his remarks.)
  Mr. PRICE of Georgia. Madam Speaker, I want to say to my friend from 
Michigan, the chairman of the committee, that he says that this bill is 
coming to the floor today because all of the concerns in a letter that 
were about this bill have been addressed.
  Well, as a physician and a coauthor of that letter, I respectfully 
disagree. The letter said that SCHIP ought to be reserved for low-
income kids first. In fact, what this bill does is provide incentives 
to ensure higher-income kids before poor kids.
  The letter said that SCHIP ought to be for children only. In fact, 
CBO estimates that over 700,000 adults will be on the program in 2012, 
not in 1 year, in 2012.
  The letter said that SCHIP ought to cover low-income American 
children. In fact, the bill weakens both Medicaid and SCHIP citizenship 
verification, and all with a huge tax increase.
  Madam Speaker, Members ought to know that there's an alternative. 
There are multiple alternatives. One of them is H.R. 3888. It would 
provide insurance for the same number of kids. It would not move any 
kids from private personal insurance to government-run insurance. It 
would make certain that personal choices were respected, and it would 
not increase taxes.
  So why proceed today? Why is the majority party proceeding today? 
Because it's all about politics. In fact, they've already had their 
cronies purchase TV and radio ads in the districts of folks that they 
believe aren't going to support this for political gain. It's all about 
politics. Not about policy and it certainly isn't about the kids.
  As a physician, there's a specific diagnosis for that. It's called 
``a crying shame.''
  Mr. DINGELL. Madam Speaker, it's a privilege for me to yield at this 
time 1 minute to a very valuable Member of this body, our friend and 
colleague, Mr. Altmire of Pennsylvania.
  Mr. ALTMIRE. Madam Speaker, I want to thank my colleagues on the 
other side for their weeks of expressing to us what their concerns were 
about the SCHIP bills that we've passed. And I'm happy to say that 
we've heard

[[Page H12079]]

those concerns, and in this bill that we're voting on today we address 
those concerns.
  They were concerned, as am I, about coverage for illegal immigrants. 
And this bill expressly prohibits coverage of illegal immigrants.
  They were concerned about the coverage of adults, including adults 
who are currently covered in the SCHIP program. This bill eliminates 
coverage for those adults and all childless adults.
  And they were concerned about income levels. They wanted to keep this 
program for low-income children, and this bill today caps at 300 
percent of poverty the qualification level for families to get into the 
SCHIP program. So there should be no reason for any of my colleagues on 
the other side to vote against this bill.
  Let's vote to ensure 10 million children receive the health care that 
they deserve.
  Mr. BARTON of Texas. Madam Speaker, I'd like to yield 2 minutes to 
the distinguished policy chairman of the Republican Conference, 
Congressman McCotter.
  Mr. McCOTTER. Madam Speaker, as a husband, as a father, as a former 
child, I respect very much what we are endeavoring to accomplish today. 
But we always have to remember that it is not simply enough to do the 
right thing; we must do the right thing the right way. And again, that 
is the purpose of this debate.
  Much of what we hear outside of these walls tends to mute the serious 
discussion that we have. I know that following this debate there will 
be those ads or others that will say that Republicans do not like kids. 
I assure you, Republicans like kids, and not just medium rare with a 
side of fries. We do care about the future of children. But it is the 
comprehensive holistic approach to the care of children which we 
discuss too little in this body.
  It is my belief that what we should have done, to truly put poor kids 
first, was that from the first moments of the first 100 hours this 
should have been the first bill we could have done. Instead, other 
bills were passed and billions were spent.
  We have seen appropriation bills come through this Chamber repeatedly 
where billions are spent, and there was no talk of putting kids first 
and helping poor kids have health insurance.
  And now today we reach the point where the only way we can help poor 
children is to raise taxes on the American people. This is not a 
prioritization of children and their health care.
  I am prepared to accept the majority when they say that they have, 
the second time around is the charm and they have fixed access of 
illegals to this program. I am prepared to be concerned about poor kids 
and kids who are in the margins. But I do ask them to reconsider 
raising taxes, because we do not want to see one day where our children 
grow up to be the healthiest people in the unemployment line.
  Mrs. JONES of Ohio. I reserve the balance of my time.
  Mr. CAMP of Michigan. Madam Speaker, at this time I yield 2 minutes 
to the distinguished minority whip, the gentleman from Missouri (Mr. 
Blunt).
  Mr. BLUNT. Madam Speaker, here we are again. It seems to be just the 
same act in the same play, the same time.
  Why are we having this vote today? I really don't know. Many of our 
Members believe it's because the TV ads, the radio ads have already 
been bought in their districts, and if they didn't have this vote today 
somehow that money might be wasted. I don't know that I believe that.
  Many of our Members believe we're having the vote on a day when seven 
Republicans from California can't be here to make our ``no'' votes on 
this bill appear to be less than they really are. In fact, I asked that 
this bill not be voted on today for that reason.
  What I wonder is why we weren't allowed to see the bill. If this bill 
is such a great bill, if this bill solved these problems, what would 
have been the harm of seeing the bill? In fact, a lot of the debate 
today would have been a different debate if the bill would have been 
laid down last night and we'd have had the vote next Wednesday or next 
Thursday.
  This idea that somehow we have to get it done before November 16 
because that's the day that this extension ends doesn't make any sense 
to anybody. We're going to be here well beyond that.
  Once again we go through this process where we're told we've checked 
the boxes, but then when you look at where the boxes have been checked, 
they really don't do the job.
  We ought to get to poor kids first. When we get to kids at 300 
percent of the level of poverty, that's 54 percent of all the families 
in America would have their kids have insurance through the government.
  I've talked to several people in my district that say, I don't mind 
helping poor kids, but I'm really offended when I'm helping kids whose 
families make more than I do. I'm really offended as someone who has 
raised their family when I'm paying taxes to provide insurance for 
families who make $20,000 more than I do.
  And the Congressional Budget Office believes that the verification 
standards aren't right yet. I think this is a step in that direction.
  Let's get this bill right. Let's see the bill. Let's vote ``no'' 
today and get to work on a serious proposal.
  Mr. DINGELL. Madam Speaker, at this time I reserve.
  Mr. BARTON of Texas. Madam Speaker, I yield 2 minutes to the 
distinguished gentleman from Texas (Mr. Hensarling).
  Mr. HENSARLING. Madam Speaker, we're not having a debate today on 
whether or not to reauthorize SCHIP. What we're really having a debate 
about is a tale of two SCHIPs, because it was 10 years ago that 
Republicans created SCHIP to provide health insurance benefits to 
uninsured low-income American children. And every Republican stands 
ready today to reauthorize that program and fund that program.
  But yet, again, Democrats are coming with their tale of SCHIP, an 
SCHIP that instead is transforming this program to give additional 
benefits to adults before children, illegal immigrants before 
Americans, the insured before the uninsured, and, finally, the higher-
income before lower-income.
  These are the facts. The program was designed for those up to 200 
percent of the Federal poverty level. The Democrats will increase it 
explicitly up to 300 percent; but with all their loopholes, even 
wealthier families will qualify, shortchanging low-income, uninsured 
American children to subsidize higher-income families.
  Although the program was designed for children, 13 States insure 
adults. Three cover more adults than children. Democrats continue this 
practice, shortchanging low-income, uninsured American children in 
order to subsidize adults.
  Although the program was designed for the Americans, the Democrats 
still strip out proof of citizenship measures. Democrats shortchange 
low-income, uninsured American children in order to subsidize illegal 
immigrants.
  Although the program was designed to help the uninsured, CBO reports 
that the plan will, in effect, take 2 million off of private health 
insurance. Democrats shortchange low-income, uninsured American 
children in order to subsidize the already insured.
  Let's put the children first and the politics second. Let's reject 
this bill, and let's reauthorize the real SCHIP program for our 
children.
  Mrs. JONES of Ohio. Madam Speaker, we continue to reserve our time.
  Mr. CAMP of Michigan. Madam Speaker, at this time I yield myself 2 
minutes.
  This bill, both in terms of its scope, expanding a low-income 
children's program to cover adults and middle-class families, and cost, 
$35 billion in new taxes and spending, remains unacceptable. And it's 
truly unfortunate.
  This House, this Congress, and this President support SCHIP. The 
failure to form a bipartisan compromise to provide low-income American 
children with health insurance is nothing short of a failure of the 
majority's leadership. The minor changes, tinkering, clarifications we 
see today do not a compromise make.
  Compromise, by definition, is a settlement of differences in which 
each side makes concessions. The previous bill doubled the cost of this 
program, and this bill costs a half billion more beyond that than the 
last one. The majority has not made one concession in this cosmetic re-
draft. It's the same

[[Page H12080]]

bill with the same objections, and we should not compromise our 
principles to satisfy their political aims.
  What we have before us is a bill that continues to allow Federal 
resources, 10 percent or more, to be diverted away from low-income 
children and given to adults, a bill that provides a back door to 
illegal immigrants to get Federal benefits to the tune of $3.7 billion, 
and a bill that continues to force at least 2 million families out of 
their current plan and into a government program.

                              {time}  1530

  While Southern California has burned, the Speaker has this House 
fiddling and posturing. Worse yet, the majority is manipulating that 
tragedy and is tying this vote to ensure our votes are reduced. It's as 
crass a tactic as I have seen in my time in Congress.
  It is past time for the game to end, and it is past time for the 
majority to engage in a serious negotiation with us on how to renew and 
improve this program.
  I urge my colleagues to again vote ``no'' and again send a message 
that low-income children's health insurance is not an issue to be 
politicized. We can do better than this.
  Madam Speaker, I reserve the balance of my time.
  Mr. DINGELL. Madam Speaker, at this time I yield 1 minute to the very 
distinguished gentleman from North Carolina (Mr. Butterfield).
  Mr. BUTTERFIELD. Madam Speaker, I want to thank the gentleman for 
yielding this time to me and also thank him for his leadership as the 
chairman of the Energy and Commerce Committee.
  I also want to thank the Democratic leadership for bringing this bold 
and visionary legislation to the House floor today. I also want to 
thank my Republican friends who are willing to vote with us on this 
important measure.
  Madam Speaker, I represent the 15th poorest district in the United 
States of America. Thirty percent of the children in my congressional 
district live below the poverty level. So this is not an academic 
discussion; that is real serious business for the people of my district 
in North Carolina.
  So I ask my friends and colleagues today to listen to this debate. 
Don't let it just go over your head. But if you would please listen to 
this debate, listen to the plea of the children of America, and please 
consider voting for this very important legislation. The children of my 
district, the children of America need you.
  Mr. BARTON of Texas. Madam Speaker, I think I only have 2 minutes 
left.
  The SPEAKER pro tempore (Mrs. Tauscher). The gentleman is correct.
  Mr. BARTON of Texas. I reserve that time.
  Mrs. JONES of Ohio. Madam Speaker, I yield myself such time as I may 
consume. I wish to submit a letter from the Congressional Budget 
Office, dated October 25, 2007, to Speaker Pelosi. And it specifically 
says under current law individuals who apply for Medicaid and claim to 
be U.S. citizens are required to provide certain documents, passport or 
birth certificate, in order to receive any such health care.
  ``Section 211 would allow States the option to either use the 
requirements created in the DRA for citizenship documentation under 
Medicaid or instead verify an individual's name and Social Security 
number with the Social Security Administration. Some States have 
reported a drop in enrollment since implementation of the DRA because 
some Medicaid applicants have had difficulty satisfying the 
documentation requirement. Available evidence, based on State reports 
and other information provided by State officials, suggests that 
virtually all of those who have been unable to provide the required 
documentation are U.S. citizens.''

                                                    U.S. Congress,


                                  Congressional Budget Office,

                                Washington, DC., October 25, 2007.
     Hon. Nancy Pelosi,
     Speaker, House of Representatives,
     Washington, DC, October 25, 2007.
       Dear Madam Speaker: As you requested, I am providing 
     additional information on CBO's estimate of the budgetary 
     impact of section 211 of H.R. 3963, the Children's Health 
     Insurance Program Reauthorization Act of 2007, as introduced 
     on October 24, 2007.
       Under current law, individuals who apply for Medicaid and 
     claim to be U.S. citizens are required to provide certain 
     documents (such as a passport or birth certificate, and, in 
     certain circumstances, a driver's license or other 
     documentation that establishes identity) to demonstrate that 
     they are citizens. That provision was enacted in the Deficit 
     Reduction Act of 2005 (DRA, Public Law 109-171), and has been 
     effective since July 1, 2006. (Before the DRA provision took 
     effect, those individuals were permitted to attest to their 
     citizenship, under penalty of perjury.)
       Section 211 would allow states the option to either use the 
     requirements created in the DRA for citizenship documentation 
     under Medicaid or instead verify an individual's name and 
     Social Security number with the Social Security 
     Administration. Some states have reported a drop in 
     enrollment since implementation of the DRA because some 
     Medicaid applicants have had difficulty satisfying the 
     documentation requirement. Available evidence, based on state 
     reports and other information provided by state officials, 
     suggests that virtually all of those who have been unable to 
     provide the required documentation are U.S. citizens.
       Under H.R. 3963, CBO expects that most states would use the 
     option to rely on the Social Security Administration to 
     verify eligibility. CBO estimates that change would result in 
     an additional 500,000 enrollees in Medicaid in fiscal year 
     2008 and an additional 200,000 enrollees in subsequent years.
       If you wish further details on this estimate, we will be 
     pleased to provide them. The CBO staff contacts are Matt 
     Kapuscinski and Eric Rollins.
           Sincerely,
                                                  Peter R. Orszag,
                                                         Director.

  Madam Speaker, I reserve the balance of my time.
  Mr. CAMP of Michigan. I reserve the balance of my time.
  Mr. DINGELL. Madam Speaker, at this time I reserve the balance of my 
time.
  Mr. BARTON of Texas. Madam Speaker, may I inquire as to the order of 
close.
  The SPEAKER pro tempore. The Chair will recognize Members for closing 
speeches in reverse order of opening: Mr. Camp, Mrs. Tubbs Jones, Mr. 
Barton and Mr. Dingell.
  Mr. CAMP of Michigan. At this time I ask unanimous consent to have 
the gentleman from Texas (Mr. Barton) control the remainder of my time.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Michigan?
  There was no objection.
  Mrs. JONES of Ohio. Madam Speaker, at this time I seek unanimous 
consent to have the gentleman from California (Mr. Stark), the Chair of 
the Health Subcommittee of the Ways and Means Committee, manage the 
balance of the time on this bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from Ohio?
  There was no objection.
  Mr. STARK. Madam Speaker, at this time I am honored to yield 3 
minutes to the distinguished gentleman from North Dakota (Mr. Pomeroy).
  Mr. POMEROY. Madam Speaker, I got to be a father late in life so that 
now I have got an 11-year-old and a 14-year-old at home.
  And last winter I had a real long, miserable, anxious weekend, one 
that any parent probably has experienced. I had a sick kid and I didn't 
know what to do. A fever higher than I was comfortable with. The 
disposition of my little fellow, very different than usual. And in the 
end, we sought some medical care.
  I have spent a lot of time thinking about that weekend as we have 
thought about this SCHIP because there are families with sick young'uns 
and they don't know what to do, but they cannot afford medical care. 
They don't have coverage. They don't have Medicaid for the poorest of 
the poor. But by virtue of working in a place that doesn't provide 
employer-provided health insurance, by virtue of earning an income that 
doesn't let them afford it, they're uncovered.
  What do you do? The cost of one trip to an emergency room is a 
month's rent. What do you do? You pray and you hope that the little one 
gets better. And, fortunately, they often do. But, tragically, they 
sometimes don't. So when that long-delayed trip to the doctor or the 
hospital occurs, we have got a runaway health issue that the parent has 
had to sit and watch develop, all the while trying to figure out how to 
handle this situation.
  We can make this problem go away for 10 million children by moving 
this legislation forward. To me, this isn't a Democrat, this isn't a 
Republican matter. This is a matter of basic morality. Are we going to 
help families get access to medical care by getting insurance coverage 
for their kids so they don't have to pick between bankruptcy

[[Page H12081]]

and trying to address their kids' medical problem in a more timely way? 
It's as simple as that.
  Gosh, the rhetoric has gotten so heated, this and that, one charge or 
another. But what we have tried to do is take many of the issues that 
were offered in support of sustaining the veto of the President 
stopping this insurance coverage for children from taking place. We 
tried to address it in this bill.
  They said families earning $83,000 can get this kind of coverage. It 
wasn't true, but we have taken steps in this bill to make absolutely 
certain it couldn't happen under any circumstances.
  They said parents are getting coverage. Well, there are a few 
isolated examples of where grandfathered programs allowed that, but we 
have phased that out.
  We have listened and we have responded, and it's time for this side 
to take ``yes'' for an answer because there is something that has got 
to rise above the daily squabbling in this place, and that is 
responding to the needs of families to get their kids the health care 
they need. Vote ``yes'' on this bill.
  Mr. BARTON of Texas. Madam Speaker, I yield myself 2 minutes.
  (Mr. BARTON of Texas asked and was given permission to revise and 
extend his remarks.)
  Mr. BARTON of Texas. Madam Speaker, I'm reminded of a homeowner who 
is getting ready to sell their home. It's a little older shop and it's 
shopworn and has not seen its best day. So they have a building 
inspector come out to inspect the home before they put it up for 
market. And the inspector gives the report, and the inspector says, 
``You've got some major termite damage in the walls, and I think you 
need to really rebuild the walls.''
  And the homeowner says, ``We'll paint over it.''
  He says, ``Your plumbing is all rusted out. I think you really need 
to replace the plumbing.''
  And the homeowner says, ``We'll paint over it.''
  Then he says, ``I think your insulation and your electrical system's 
very frayed and you need to replace it.''
  And the homeowner says, ``Well, we'll paint over it.''
  What we have here today is basically the same bill that we had last 
week where we sustained the President's veto. Our friends on the 
majority side of the aisle have just painted over it.
  Now, they are saying the right rhetorical things. They're saying that 
nobody above 300 percent of poverty is going to get a benefit, but they 
then disregard the enforcement mechanisms that would enforce that.
  They say in section 605 that no illegal alien is going to get a 
benefit, but then they change the enforcement mechanisms so that if 
somebody has a Social Security card and a name to it, that's all they 
have to do to prove citizenship, and the Social Security 
Administration, rightfully so, says that is really not a proof of 
citizenship if you are able to get a Social Security card.
  And they claim that they're going to take the adults off the program 
within a year, but according to the CBO, at least a half million adults 
are still going to be on the program in 5 years.
  So it's the same bill with a little bit different paint. In Texas we 
have a saying, ``You can put lipstick on a pig, but it's still a pig.''
  This bill is a pig. It may be a good pig. It may be a nice pig. It 
may be intended to be the right kind of pig. But it's still a pig.
  Vote ``no'' on the bill.
  Mr. DINGELL. Madam Speaker, at this time I yield 2 minutes to the 
distinguished gentleman from New Jersey, the chairman of the 
Subcommittee on Health, my friend (Mr. Pallone).
  Mr. PALLONE. Madam Speaker, I continue to be upset by the Republican 
characterizations of this bill as a ``pig'' or the effort to trivialize 
what we do here today. I think it's very unfortunate we have gotten to 
that point.
  There have been a lot of distortions on the other side from the 
Republicans. But the one that I have to correct today is the continued 
mention of the fact that this bill is not going to cover 10 million 
children or that somehow the CBO has said it's not 10 million but it's 
7.4 million.
  What they have neglected to point out is that the difference are the 
kids that we are going to enroll under Medicaid, and CBO has emphasized 
that over and over again. There are 7.4 million covered by SCHIP, but 
the addition up to the 10 is essentially covered by Medicaid. And those 
are the lowest income kids of all. This bill does the best job of 
making sure that those low-income children who are eligible for 
Medicaid and not enrolled would, in fact, get insurance.
  The Republicans continue to forget and eliminate the fact that this 
bill also addresses the Medicaid program. There are a lot of kids at 
the very lowest end, less than 100 percent of poverty, who are not 
enrolled in Medicaid because there hasn't been the proper outreach to 
get them enrolled. So what we are doing here is providing for that 
outreach.
  So don't tell me we're not covering 10 million children. We are. And 
the ones you are not mentioning are the lowest income of all.
  And then I heard my colleagues talk about the illegal aliens again. 
Once again, we have put in provisions here that you have to verify 
whether it's through the Social Security Administration or it's through 
documentation. Now, there is probably some person to come and 
misrepresent who they are. But the fact of the matter is that the CBO 
says in that letter that was introduced by the gentlewoman from Ohio 
into the Record that virtually no one that's on this program is an 
illegal alien.
  The fact of the matter is that the Republicans continue these 
distortions. There are no illegal aliens. There are 10 million children 
covered.

                              {time}  1545

  Mr. BARTON of Texas. Madam Speaker, to close the debate on the 
minority side, I'm very pleased to yield 1 minute to the distinguished 
minority leader from the great State of Ohio (Mr. Boehner).
  Mr. BOEHNER. I want to thank my colleague for yielding.
  Madam Speaker and my colleagues, if you feel as though we've been 
here before, it's because we have.
  Last week, we had a vote to override the President's veto. The votes 
were here to sustain the President's veto. I said during that debate 
that Republicans and Democrats had created this program together; 
Republicans and Democrats want to reauthorize this program together. 
The issues that separate us are not that great; we can sit down and 
resolve those issues. That has not happened.
  As has been pointed out during this debate today, there are 
differences. There were some attempts to address those differences; but 
by and large most of them, as my colleague from Texas pointed out, were 
just painted over, little tweaks with words here and little tweaks with 
words there. And you've already heard about the deficiencies in this 
bill.
  But that's not why I rise. Why I rise is because this doesn't have to 
be this way. There is no reason why we, on both sides of the aisle, 
can't come together and resolve the few differences we have in this 
bill that are well known now.
  This bill is not being brought up today in a rush, delivered by 7:30 
last night, a 293-page bill with all kinds of changes in it. We're not 
debating this bill today to pass it. We're debating this bill again 
today to play another political game. You know it; I know it. I sat 
with the majority leader yesterday, along with the minority whip, to 
say, Mr. Majority Leader, we can resolve these differences. We can fix 
this and we can reauthorize this program. We were turned down.
  The chairman of the Democrat Caucus stopped my staffer and said, We 
don't care whether you'll give us the votes to pass this or not because 
if you don't, we'll just pull this bill and we'll wrap it around your 
necks in the next election. Political games, political games, political 
games. Exactly what the American public are sick of, and you all know 
it. Everyone knows this is nothing more than a political game, trying 
to score political points, getting ready for the next legislation. I 
thought the American people sent us here to deal with their problems. I 
think they sent us here to work together to deal with their problems in 
a way that we can be proud of.
  Nothing has happened this year in this Congress. You think about it. 
Step back over the course of this year, nothing has happened yet. And 
let me tell

[[Page H12082]]

you, we've got another 14 months left in this Congress and nothing is 
going to happen. Why? Because all the majority wants to do is play 
political games and not reach across the aisle and get things done.
  My promised accomplishments over the 17 years that I've been here, 
three big legislative projects that I've worked on, were all done in a 
bipartisan manner. Members from both sides of the aisle that played a 
significant role in coming together, dealing with issues like education 
reform, dealing with issues like financial services modernization, 
dealing with issues like the Pension Protection Act that we did last 
year, we did it together.
  And when you think about the little bit of differences in this bill, 
you begin to wonder once again why Congress' approval rating is at a 
dismal 10 or 15 percent. Why? Because people are tired of watching this 
process not work.
  This bill is not going to become law. The votes are there to sustain 
the President's veto; the President has made it clear he is going to 
veto it. How long are we going to play the games before we get serious 
about resolving our differences?
  This is a sad day. And I think a lot of my friends on both sides of 
the aisle realize this is a sad day when we can't come together and 
deal with the issues the American people want us to deal with and deal 
with them like adults, adults that are willing to sit down and work 
together and to resolve those differences.
  So I say to my colleagues, even those of my colleagues who voted for 
this, if you're tired of the political games, if you're tired of 
Congress' approval rating being at these ridiculous levels, let's all 
just vote ``no.'' Let's vote ``no'' and stop this bill. And then we can 
sit down and resolve the differences we have, and we can do it in a 
bipartisan manner and show the American people that we can, in fact, 
work together on their behalf.
  Mr. RANGEL. Madam Speaker, at this time I would like to yield 2 
minutes to the gentleman from Illinois, an outstanding member of the 
Ways and Means Committee, Mr. Rahm Emanuel.
  Mr. EMANUEL. Madam Speaker, I helped negotiate the original SCHIP 
when I worked for President Clinton. It was President Clinton who 
proposed the SCHIP bill, not the Republicans; in fact, they opposed it. 
Then they agreed, after the Balanced Budget Agreement, that we would 
have pediatric care, eye and dental; but it was President Clinton that 
demanded it and made it a precondition before any agreement on the 
Balanced Budget Agreement.
  Now, I believe the sincerity that my colleagues support this, and I 
believe the sincerity of what they said in their letter, which is why 
we answered every one of those questions, both the sincerity in 
supporting it, and the sincerity of those remarks. At some point, you 
have to understand that you can take yes for an answer, and that is, we 
have provided that answer.
  Second is, Dolores Sweeney lives in my district. She works for an 
insurance company. Dolores Sweeney has three kids. Her insurance 
company does not provide her or her kids health care. She does right by 
her kids; she earns a paycheck, not a welfare check. If her kids got 
sick, she would go to Medicaid and go to welfare, but she's doing right 
by her children because she's working and teaching them right from 
wrong. Her kids are in SCHIP. And without this program, her kids will 
live one illness away from Medicaid. Medicaid is for them, for the 
poor. SCHIP is for parents who work full time earning a paycheck, not a 
welfare check. They're doing right by their children.
  Now, I believe in the sincerity of your position, which is why we 
answered that in the last two weeks. This vote is to say whether 10 
million children will get the health care they deserve, whose parents 
work full-time. These are parents who are doing right.
  Now, the President at one time referred to SCHIP, the Children's 
Health Insurance Program, as excessive spending; yet this week he 
submitted a request for $200 billion more for Iraq. These kids are our 
future. Iraq is stealing our future from America.
  Mr. DINGELL. Madam Speaker, I yield to my distinguished friend, the 
majority leader, the balance of my time for purposes of closing.
  Mr. HOYER. I thank my friend for yielding.
  This is a good day. This is a good day because we have another 
opportunity to extend to children, 4 million of whom are not covered by 
health insurance, coverage.
  I don't know how many families that is, but it's obviously millions 
of families who will have the confidence that if their child gets sick, 
they will have insurance. They can access health care. They can try to 
make their children well.
  I want to refer briefly to my friend Mr. Boehner's comments because I 
agree with him that the American public expected us to come here and 
work together. But let us review this legislative process.
  First of all, we had committee hearings. I want to tell my friend 
from Texas, those committee hearings were difficult. We didn't really 
get to the committee hearings and committee markups that we wanted to 
have. I think that's unfortunate. That was not our fault, I suggest to 
you.
  Secondly, let me say that we passed a major bill through this House, 
approximately $90 billion. It dealt with a number of subjects, 
including doctor reimbursements so that they would continue to serve 
those who are poor under Medicaid and, indeed, under Medicare, so the 
reimbursement levels under Medicare would be appropriate.
  We dealt with rural hospitals so that they would be reimbursed at 
levels that allowed them to continue to serve our rural communities. We 
dealt with some other issues. And, yes, we dealt with children's health 
insurance.
  That bill went to the Senate. And there were a lot of Members of your 
party who didn't like the expansive bill. But before it got there, you 
offered a motion to recommit on our bill. You cut our spending cuts, 
you did not agree with those, but you adopted the revenues from the tax 
increase in cigarettes in your motion to recommit. Most of you, perhaps 
not all, but most of you voted for that motion to recommit. So this 
funding source is one that we have agreed to and everybody has voted 
for.
  When it got to the Senate, we made a tremendous compromise. And we 
went from a $90 billion bill covering rural hospitals and doctors' 
reimbursement and poor people who would have been marginalized, 
perhaps, by the cuts to Medicare Advantage. And we made a compromise, 
mainly with Republicans in the Senate who felt that they wanted a more 
restricted bill. So that bill that is confronting us now is now a $35 
billion bill, a very substantial compromise, I will suggest to you.
  That bill then passed the Senate, went to the President, he vetoed 
it, it came back here, and you made a determination, some of you, not 
to vote to override the President's veto. So those 4 million children 
don't yet have a health insurance bill.
  Then 38 of you wrote to the Speaker and said that you wanted to see 
certain changes. We addressed that. We addressed it very substantively, 
we addressed it very carefully, and we addressed it in a bipartisan 
way. And because this bill has to go through the Senate, we then 
engaged Senator Hatch and Senator Grassley so that it would not be 
simply Democrats saying, well, we'll take this and not that. And it was 
a very considered judgment applied, and almost all of the points raised 
in that letter were addressed.
  Now, I had the opportunity this morning to meet with, not all 38, but 
the majority of those 38. Obviously they were correct that there was 
not more time to discuss this. I think that was a fair analysis. But 
the fact of the matter is that careful attention and compromise was 
taken.
  Mr. Boehner is correct, I met with Mr. Boehner and Mr. Blunt. We have 
a good relationship; we have the ability to talk. But I will tell you 
that one of the indications I had was that those changes would not 
affect at least one of those votes because, philosophically, that 
leader is not for this bill. I understand that, that's a fair position 
to take. We're for this bill. We want to see this bill go forward.
  But I will say to my friends on this side of the aisle, on the 
Republican side of the aisle, I want to continue to work with those who 
really want to see, as that letter of 38 said, reauthorization effected 
because that's what we want to see. And we will continue to work

[[Page H12083]]

with you. This bill will go to the Senate; it will be considered there 
in the Senate.
  We have significant, concrete changes to the legislation vetoed by 
President Bush, changes that are designed to address the concerns 
expressed by the President and by a number of Republican Members. We 
listened carefully to the criticisms of the vetoed bill. We reviewed 
the letter, as I've said, that the 38 Republicans sent to the 
President, as well as other letters that were distributed. I misspoke, 
I said it was sent to the Speaker. I observe only that apparently you 
wanted to negotiate with the President.
  We also worked closely with Senators Grassley and Hatch, who met 
extensively with House Republicans. The bottom line is this: we have 
taken a bipartisan compromise that was strongly supported by the 
American people and by the overwhelming Members of both Houses of the 
Congress of the United States and worked to make it an even stronger 
bipartisan compromise.
  Specifically, this legislation clarifies that it targets low-income 
children. That was one of the concerns. The compromises we have reached 
in the legislative language appended to the legislation today do, in 
fact, accomplish that objective. Prohibiting CHIP coverage above 300 
percent of the Federal poverty level that the President talked a lot 
about, talked about the 83,000, we have prevented that. We said that is 
not going to happen.

                              {time}  1600

  It clarifies that illegal immigrants are not eligible for coverage 
under CHIP. I have not reviewed the prescription drug bill that you 
passed, but the legislation, I think, in this bill is stronger on that 
issue.
  It clarifies that this bill is focused on children. That was a 
legitimate objection raised on your side of the aisle. We took that 
into consideration because we believed it was something we should 
respond to because that was our intent, to focus on children. As a 
result, we have phased out coverage for childless adults over 1 year, 
not 2. Some said that this is just tweaking. To have the time of 
phaseout, it seems to me, is a very significant change.
  And, it clarifies that this bill seeks to minimize the number of 
children moving from private insurance to CHIP, ``crowd-out,'' 
requiring all States to develop plans and implement recommended best 
practices for minimizing so-called ``crowd-out.''
  We think we tried to respond, and we did respond, we believe, to the 
concerns you raised. These are significant, concrete changes, changes 
that neither affect nor undermine our principal objective and 
commitment: to ensure that 10 million American children from low-income 
working families who are eligible for coverage under CHIP guidelines 
today can participate in this successful program.
  I, again, remind my colleagues that this indeed was the stated 
objective of the President of the United States, when, at the 
Republican National Convention in 2004, he promised, in seeking 
reelection by the American public, he promised this: ``In a new term, 
we will lead an aggressive effort to enroll millions,'' with an S, 
``millions of children who are eligible but not signed up for 
government health insurance programs.'' He went on to say this: ``We 
will not allow a lack of attention, or information, to stand between 
these children and the health care they need.''
  Unfortunately, what stands between the children and the health care 
they need is the President's veto. We continue to try to achieve the 
President's expressed objective. I urge my colleagues, I urge my 
colleagues on both sides of the aisle. Mr. Boehner is correct. This is 
not a partisan issue. There is not a Member on your side of the aisle 
that doesn't care about our children. There is not a Member on our side 
of the aisle that doesn't care about our children. We have an 
opportunity to add 4 million children to the health coverage of our 
country, just as the President said he wanted to do.
  I urge you to stand with the bipartisan majorities in Congress, 
including 45 House Republicans and 18 Senate Republicans who voted for 
the first CHIP bill. This bill, in some ways, in my opinion, is a 
better bill for the suggestions made from your side of the aisle.
  Stand with the States' Governors, the American Medical Association, 
the Association of Health Insurance Plans, the pharmaceutical 
companies, nurses, children's advocates and others who support this 
bill. Stand with the American people, 81 percent of whom support this 
legislation. Stand with the 10 million American children who will 
receive the health coverage they need and deserve under this 
legislation.
  This bipartisan compromise addresses your concerns.
  Let us give ``yes'' for an answer to America's children. Vote for 
this bill. It is good for America. It is good for our children.
  Ms. KILPATRICK. Madam Speaker, today, Congress, once again, wrote a 
prescription to the President for American children and their families 
that needs to be filled immediately. I am proud of the fact that 
Congress has sent to the Senate, and will soon send to the President, 
an insurance remedy for so many working families. I strongly support 
H.R. 3963, the Children's Health Insurance Program Reauthorization Act 
of 2007, the modified bill to reauthorize and expand the State 
Children's Health Insurance Program or SCHIP. Working with the 
Minority, we were able to quickly craft a bill that addresses the 
concerns of most, if not all, Members of Congress.
  In the wealthiest country in the world, far too many children are 
without health insurance. We can afford to spend $10 billion per month 
in a war in Iraq, but we cannot spend $35 billion over 5 years to 
protect our children? We cannot support those working families who 
cannot afford or do not have access to affordable health insurance? 
Over 81 percent of Americans, when asked this very question, agree with 
the Democratic Party that we need to take care of our children, and we 
need to take care of them now. Since the inception of SCHIP, the number 
of uninsured children has been reduced by one third. However, millions 
of children still remain uninsured or underinsured.
  The revised bill before Congress today still would expand SCHIP to 
cover 10 million children and increase spending on the program to $35 
billion over 5 years, funded with a 61 cent per pack increase in the 
federal cigarette tax. The bill would limit coverage to children in 
families with annual incomes below 300 percent of the federal poverty 
level, and performance bonuses would be offered to states that enroll 
greater numbers of children in Medicaid. The bill also would offer 
performance bonuses to states that provide subsidies to employed 
parents to offset the cost of enrolling their children in a private 
health insurance plan.
  Passing this legislation should be a bipartisan issue. SCHIP was 
created to address the growing problem of children in the United States 
without health insurance. SCHIP assists children whose family's income 
falls above the threshold for Medicaid, but who still cannot afford to 
purchase medical insurance coverage. More than two thirds of the 
children who will be covered under this bill are ethnic minorities.
  A lack of medical insurance not only harms children, but their 
families and the community as a whole. Reauthorizing this bill is so 
important because children without health insurance do not receive 
regular checkups and doctor visits that every child needs. May I remind 
my colleagues that less than 10 miles from where we vote, a little boy 
died from the lack of getting a simple dental examination. Furthermore, 
millions of children won't get the preventive care they need and will 
likely receive care in emergency rooms if this bill is not 
reauthorized. This only drives up the cost of medical care for 
everyone.
  SCHIP gives working families the peace of mind that their children 
will have accessible and affordable health care. Healthy children do 
not get unnecessary diseases and go to school ready to learn. Healthy 
children become healthy teenagers, who ultimately will become healthy 
adults. Although children are about 30 percent of our population, they 
are 100 percent of our future. This $35 billion is a wise investment in 
the future of America.
  In the Bible, in the chapter of Isaiah, it says that ``the wolf shall 
dwell with the lamb, and the leopard shall lie down with the kid, and 
the calf and the young lion and the fatted domestic animal together; 
and a little child shall lead them.'' Today, Congress worked together 
to stand up for the children of our Nation. The President, and 
Congress, ignored the wisdom in protecting our children one time too 
many; it is now time to erase that mistake. We have that opportunity 
now.
  SCHIP is a smart investment in our Nation's children and working 
families. Congress has changed the course of the discussion of health 
care for our children and working families; we have confronted the 
crises of the lack of health insurance; we will continue the legacy of 
caring for some of the least of our brothers and sisters. I look 
forward to quick passage of this bill in the Senate, and the 
President's enacting this bill into law. Our children deserve no less.
  Mr. SALI. Madam Speaker, for the third time this Congress, the House 
of Representatives

[[Page H12084]]

is again addressing the reauthorization of the State Children's Health 
Insurance Program, or SCHIP. For the third time, this House is 
considering a bill that would move millions of children away from 
private health insurance into government-run health care, substantially 
raise taxes, and dramatically increase federal spending.
  Recently the President vetoed an SCHIP bill precisely because of 
these concerns. Yet here we are today with a bill that is remarkably 
similar. I am afraid that this Congress is not serious in addressing 
America's health care challenges, particularly health care for 
America's children. The majority purports that this bill is ``for the 
children.'' That phrase--``for the children''--is used like a club by 
our friends across the aisle whenever they want to pass bad bills. If 
we really care about children, we won't pass legislation that takes a 
giant step toward government-run health care.
  That said, Madam Speaker, I am interested in more than this bill's 
title or good intentions. The success or failure of all legislation 
must be judged not by its intentions, but how it will affect real 
people, real families.
  Madam Speaker, this bill is not the right policy for our children. 
Government health care is the most expensive and least efficient health 
care you can get. And that's exactly what this bill will produce. The 
Congressional Budget Office states that 2 million people actually will 
lose their private health insurance coverage and become enrolled in a 
government-run program.
  This bill explodes funding for SCHIP above current law by $35.4 
billion over 5 years and $71.5 billion over 10 years. The majority 
claims to fund this by raising taxes on tobacco products, yet the irony 
is that 22 million more smokers will be needed in just the next 5 years 
to fund the SCHIP bill we're considering.
  Let me get this straight: We want healthy children and cancerous 
adults. I'm pretty new here in Congress, but even for a new kid on the 
Congressional block that doesn't seem to add up.
  This bill is not about poor children. The bill defines the poverty 
level to qualify for SCHIP at 300 percent, which is around $62,000 for 
a family of four. That's $16,000 more than the median income in my home 
state.
  Additionally, loopholes will allow states to define this poverty 
level and employ ``income disregards,'' thereby allowing families with 
even higher incomes to qualify for this expensive program.
  Ostensibly ``for the children,'' this bill actually would increase 
the number of adults on SCHIP. The CBO projects that over 700,000 
adults may be enrolled in SCHIP in FY2012. Shouldn't we be working to 
move people off of government health care and into private-sector care 
that works much better? We say we're for personal responsibility, free 
markets and red tape, yet this bill would create dependency, bigger 
government and more bureaucracy.
  Finally, this bill substantially weakens the citizenship requirements 
to qualify for SCHIP, inviting fraud and abuse of this program by 
illegal aliens. The CBO projects that this fiscal disaster could cost 
the taxpayer around $3.7 billion in increased federal spending over the 
next 10 years.
  This bill also changes the period of time a state has to spend its 
SCHIP allotment from 3 years to 2 years. This will significantly 
increase the strain on state budgets.
  This proposal is not about good intentions, soothing sentiments, or 
warm feelings. It's about real people, real taxpayers, and real, 
quality, affordable and accessible health care. It fails miserably in 
every category.
  I urge my colleagues to vote ``no'' on this fatally flawed bill.
  Mr. CONYERS. Madam Speaker, today the House votes yet again on 
legislation that never should have been a subject of controversy: a 
bill that provides health care for our Nation's children. When we 
debated overriding the President's veto of the original SCHIP bill last 
week, most House Republicans offered excuses for denying children 
health care based on a series of misrepresentations and distortions of 
the facts. Today the bill's opponents have no more excuses to hide 
behind. We have consulted with Republicans who want to support this 
bill and have amended it to address their concerns. It should now be 
clear to all that the real reason some continue to oppose SCHIP is 
because they oppose universal health care for all Americans.
  Republicans voting no on last week's veto override offered four 
reasons for their unwillingness to support health coverage for 
America's children. These concerns had, in fact, already been addressed 
in the original bill, but now we have dealt with them even more 
explicitly.
  Republicans argued that the bill did not focus enough on covering 
poor children. I find this particular objection rather ironic, since 
the same Republicans who used this argument rarely support legislation 
designed to help the poor. But, it is not surprising that they would 
use disingenuous tactics to block health care for children. For them, 
anything goes when it comes to stopping Americans from getting the 
radical idea that the government should guarantee this basic human 
right. This revised bill addresses those arguments by mandating that 
SCHIP eligibility will be capped at families earning 300 percent of the 
federal poverty level, around $60,000 for a family of four, and by 
offering bonus payments to States for enrolling the lowest income 
children into Medicaid.
  Opponents of health care for children contended that the original 
bill provided coverage to illegal immigrants. In reality, this bill 
denied coverage to all immigrants, even legal ones, explicitly stating 
that illegal immigrants were ineligible. But these facts did not hinder 
the Republicans from making their false claim. We have now clarified 
our intent that illegal immigrants will not be covered by requiring 
that applicants for SCHIP provide their Social Security number, which 
must be verified by the Social Security Administration.
  Republicans opposed the original bill because it allowed States to 
use the funding to cover adults. For them, a person's right to health 
care ends at age 18. I would disagree, but in any case this bill now 
phases out any adults covered under SCHIP over a 1-year period, instead 
of the 2-year period under the original bill.

  Finally, further changes have been made to clarify that this 
legislation is designed to minimize children moving from private 
insurance to SCHIP, also known as ``crowd-out.'' I am a critic of 
private health insurance, with its costly and unnecessary 
administrative, waste, advertising and profits, but this bill should 
allay any concern that a government health plan, with its much lower 
overhead costs and more comprehensive coverage, would diminish the role 
of private insurance companies. We will actually allow States to 
subsidize people to buy private coverage under this bill to prevent 
them from moving to government coverage.
  The President and his supporters are now left with only one argument 
for opposing this bill: that it costs too much. The original House-
passed version authorized an additional $50 billion for SCHIP over 5 
years; our compromise with the Senate brought the total down to $35 
billion. This additional funding will ensure that SCHIP will cover 10 
million children who otherwise would not have access to health care. 
The President began this debate by offering to add only $5 billion, 
which would have resulted in 800,000 children currently covered by 
SCHIP losing their coverage. He is now saying that he's willing to go 
to up to $20 billion, but no more. I would like the President to 
explain to the American people how he can afford $12 billion for a 
single month in Iraq but can't seem to find $35 billion over 5 years to 
give our children health care. Supporters of the contention that we 
can't afford this bill either care more about war than children, or are 
simply not serious.
  Now that the Republicans' stated reasons for opposing this 
legislation have been addressed, one wonders what is actually 
motivating those who will continue to vote no. I believe that the 
President and his supporters continue to oppose this legislation 
because they are afraid. They are afraid of SCHIP because it 
demonstrates that health care guaranteed by the government is workable, 
it is affordable, and it is popular. They worry that if SCHIP is 
expanded, even more Americans will begin to demand that the government 
guarantee health care to all our citizens, not just to poor children. 
After all, every other industrialized nation does so, while spending 
less than we do and while achieving better health outcomes for its 
citizens. These Republicans apparently intend to use every means at 
their disposal to ensure that health care in this country remains a 
privilege for those who can afford it, rather than a right guaranteed 
to all.
  Madam Speaker, today's vote raises a moral question. Simply put: will 
we, as a nation, take responsibility for ensuring that our children 
have the health care they need? Any other issue raised in this debate, 
particularly given the revisions to the bill, is an obfuscation meant 
to hide the fact that the party claiming the mantle of ``family 
values'' is in fact unwilling to back that slogan with substance. There 
is only one vote today that truly supports America's families. It is a 
vote in favor of this legislation.
  Mrs. CHRISTENSEN. Madam Speaker, I rise in strong support of the bill 
to continue and expand the Children's Health Insurance Program that is 
on the floor today and to urge every member of this body to vote for 
it.
  Certainly there is no better investment that we can make than in our 
children, and this bill does so by ensuring that an additional almost 4 
million children will have access to comprehensive health care--care 
that includes dental care and other important services.
  And while many of us would have wished to cover every single child 
who currently lives without health insurance without regard to legality 
of their presence in this country, we are happy that at least all who 
are legally here have the opportunity for coverage. I am also 
disappointed that the Territories will not get full

[[Page H12085]]

state-like treatment, but there are improvements for us as well.
  This is a big step forward for our country, which continues to lag 
behind every other industrialized country in the quality of its 
people's health.
  And every penny that is spent on increasing access to care when 
needed, on providing preventive care and early care will save this 
country many more billions, and has the potential to help reduce health 
care costs and save Medicare into the future.
  Madam Speaker, as we move to keep our promise to America's children, 
I only hope that we can continue on this road to invest in the health 
and health care of minority and rural populations. I only hope that we 
stand together to close the gaps in our health care system and reduce 
the racial and ethnic, as well as geographic and gender differences in 
health status because certainly providing preventive, early and 
culturally competent care to these will pay further dividends, further 
reduce the cost of health care and make this a better and stronger 
country.
  I urge all of my colleagues to vote in favor of our Nation's 
children's health and health care; I urge my colleagues to vote in 
favor of expanding and strengthening the Children's Health Insurance 
Program. Today is the day for us to stop talking about doing better; 
today is the day to actually start doing better, and, the children 
shall lead the way.
  Ms. ESHOO. Madam Speaker, I rise in strong support of this children's 
health insurance bill, and I'm proud to be a cosponsor of it.
  This bill is the result of a great deal of work to meet concerns of 
colleagues in the minority. We want them to join us in voting for it in 
order to override a presidential veto and finally enroll 10 million 
children in the State Children's Health Insurance Program.
  The bill makes it legislatively clear that no adults will be 
covered--only children are.
  The bill makes it legislatively clear that non-citizens will not be 
covered.
  The bill makes it legislatively clear that only low-income children 
will be covered.
  The bill makes it legislatively clear that no one earning $83,000 a 
year will receive coverage under this bill.
  While we've addressed every significant objection to this bill, we 
have not compromised on the number of children covered. Our goal has 
been to cover ten million low-income, uninsured children and we do.
  Virtually everyone with a stake in public health and healthcare is 
calling for this bill to be passed. There are 270 groups supporting 
this bill: 43 Republican and Democratic governors; the American Medical 
Association; AARP; America's Health Insurance Plans (AHIP); the 
Healthcare Leadership Council; and Catholic Charities, among others.
  This is an extraordinary investment in our children and our 
collective future. I urge every Member of the House to vote for it, and 
when we do it, it will be a major victory for the little ones in our 
country.
  Mr. HINOJOSA. Madam Speaker, I rise today in strong support of the 
reauthorization of the State Children Health Insurance Program. In the 
decade since its enactment, the SCHIP block grant program has exceeded 
expectations by providing quality health care to millions of American 
children.
  In my state of Texas, over 20 percent of all children--that's 
approximately 1.4 million kids--are not covered by health insurance 
today. This means that 1.4 million young Texans have no access to 
adequate medical care and are not receiving the preventive or primary 
care they need to lead productive lives. This is a moral travesty and 
an unacceptable failure of our Nation's leadership.
  The SCHIP program invests in our children and our future. Without 
adequate health care, our efforts to improve our educational and child 
care systems are less effective. Should our children not begin their 
lives in good health, they will surely be hampered by increasing 
medical problems as they reach adulthood.
  The President has already demonstrated his unwillingness to make this 
commitment to America's children once. No one should withhold 
healthcare from children in order to score cheap political points or to 
make divisive partisan attacks. I urge my colleagues in Congress and 
President Bush to join together in support of American families and 
children by voting for the reauthorization of SCHIP.
  Mr. ORTIZ. Madam Speaker, this is the second time in so many weeks we 
are standing up for America's children. After the President vetoed the 
State Children's Health Insurance bill, he has still not seen the light 
. . . but he has felt the heat.
  Since that veto, and a flurry of negotiations to tweak the bill to 
engage the President to sign it, the American people have spoken out 
with gusto: they believe this is a commonsense bill that will serve our 
children.
  And so this bill is before us again.
  I urge Members of the House and the President to stand this time with 
working families and children . . . not with insurance companies. The 
President's veto cut off health care for over 120,000 kids in Texas.
  Congress created SCHIP in 1997 with broad bipartisan support. This 
year, 6 million children have health care because of SCHIP. The program 
has worked well in Texas. This has been an excellent investment for our 
nation, given that health care costs without insurance would be much 
more expensive.
  The President highlighted his support for SCHIP while running for re-
election in 2004. Today we are giving him--and those who stood with him 
in sustaining his veto--one more chance to do the right thing for 
America's children.
  This children's healthcare program was never intended to replace 
Medicaid. It only covers the children of parents who earn too much to 
qualify for Medicaid, but earn too little to purchase private health 
insurance. For the President to continue to misrepresent this fact 
shows a tremendous lack of sensitivity for working Americans who often 
take on two jobs to simply feed and clothe their children.
  It is these families who need to know we are on their side, and I 
urge the President this time around to join us in taking care of ``the 
least of these.''
  I urge my colleagues to support this bill. We are the last hope of 
children and families all over this country.
  Mr. UDALL of Colorado. Madam Speaker, I rise in strong 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. 3963 
does not end health care inequality, but it would PROVIDE continued 
coverage for children not covered by Medicaid, 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 and the President should have accepted this 
compromise legislation. Because the President would not accept the bi-
partisan compromise bill we passed earlier, these six million children 
will go without health insurance unless Congress acts.
  This legislation would assure continued coverage for those now 
enrolled and would ALSO provide coverage for an additional four million 
children who currently qualify, but who are not yet enrolled under 
CHIP.
  The past concerns raised against SCHIP reauthorization by some have 
been addressed. The language concerning coverage levels and citizenship 
have been clarified and strengthened to remove any doubt that illegal 
immigrants are not covered under SCHIP.
  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 voted 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, in a compromise with the Senate, Congress did not send the 
CHAMP bill to the president. Instead, we passed a more limited, 
bipartisan compromise. Regrettably, the president chose to veto it and 
his veto was sustained.
  So here we are again, the bill in front of us today deserves our 
strong support. 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. 3963 has the support of the American Medical Association, 
American Association of Retired Persons, Catholic Health Association, 
Healthcare Leadership Council, National Associations of Children's 
Hospitals, American Nurses Association, U.S. Conference of Mayors, 
NAACP, American Cancer Society Cancer Action Network, and United Way of 
America.
  It is imperative that we pass this legislation in order 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. STEARNS. Madam Speaker, today we will again vote on a Government-
run health insurance program for children: one that only a handful of 
people in the Democrat leadership have crafted, and one which only a 
handful of

[[Page H12086]]

people received before it was introduced under the cover of night. The 
Democrat leadership, in the 110th Congress, has continually attempted 
to ram through legislation that has completely ignored the legislative 
process, and time after time nothing has been accomplished. This 
behavior is why this Democrat-led Congress has an abysmal 11 percent 
approval rate.
  The facts provided by the Congressional Budget Office, CBO, state 
that the bill before us today will provide free Government-run health 
care to a family, including adults, earning more than $60,000 a year. 
This bill will also increase taxes on tobacco, the revenue of which 
will not be set aside for this program, but rather will be put into the 
Treasury for general use. In addition, this bill allows over 10 percent 
of the funds allotted to provide health care for low-income children to 
be used by adults, therefore limiting the amount of money available for 
needy children. Finally, this legislation fails to ensure that illegal 
aliens, both children and adults, will not take money away from low-
income American children. CBO estimates that under current 
documentation requirements, 3.7 billion taxpayer dollars will be spent 
on providing health care to people who have broken our laws and come to 
our country illegally.
  The flaws in this legislation are evident and, in my opinion, 
correctable. Yet, the Democrat leadership refuses to allow this bill to 
go through the legislative process, a process that has worked in this 
Chamber for centuries. It is my hope that the Democrat leadership will 
release their grip on power and allow the legislative process to create 
a true bipartisan bill so that our Nation's low-income children may 
receive quality, efficient, and responsible health care.
  Mr. McGOVERN. Madam Speaker, I rise in strong support of the 
Children's Health Insurance Program Reauthorization Act. I thank and 
commend the distinguished Chair of the Energy and Commerce Committee, 
Mr. Dingell, and the chair of the Ways and Means Committee, Mr. Rangel, 
as well as the subcommittee chairs, Mr. Pallone and Mr. Stark, for 
their hard work and dedication in bringing this bill to the floor 
today. I also want to commend the Speaker of the House, Nancy Pelosi, 
for her dedication to the children of America and her steadfast support 
for a strong, inclusive S-CHIP bill.
  The issue before us is simple. Either you believe that 10 million 
low-income kids deserve health care or you don't.
  I know the President and some of my Republican colleagues don't want 
to have this debate. They don't want another vote on the S-CHIP bill. 
They want this issue to just go away.
  Well, I have some news.
  This isn't going away. We're going to keep fighting until 10 million 
kids get the health care they so desperately need.
  It is astounding to me--it literally takes my breath away--to watch 
President Bush fight to deny health care to children. It is shameful.
  From day one, President Bush and the Republican leadership in the 
House trashed Democratic proposals to insure children who--at no fault 
of their own--are falling through the cracks of the health care system.
  It's clear that America's health care system is broken. Too many are 
uninsured. Too many rely on emergency rooms for their health care. And, 
at the same time, health care costs continue to rise--making it harder 
for businesses to provide their workers with the health care they need 
and making it too expensive for individual families to buy on their 
own. And God forbid if you have a pre-existing condition--you can 
forget it.

  All of us here in Congress have world-class health care, and so do 
our kids. Maybe the problem is that not enough members of Congress 
understand what it's like to struggle, to spend sleepless nights 
worrying about a sick child, wondering how you're going to pay for 
their doctor's visits.
  Today, the Democratic majority--with the help of some brave 
Republican Members--will once again approve an S-CHIP bill that 
provides health care to 10 million children.
  This is what we were sent to Congress to do.
  The only logical conclusion we can take from President Bush's veto, 
from the partisan political attacks on a 12-year-old boy and his 
family, and from the continued stonewalling of this bill, is that the 
majority of Republicans don't want to provide health care to children.
  It's that simple. Republican leaders tried to block this bill in the 
Energy and Commerce Committee. Then they stretched the truth about who 
would be covered.
  Let's be honest here--the House and the Senate will approve this bill 
and President Bush--the former compassionate conservative candidate--
will veto it. The question is, how many Republicans will continue to 
vote to deny health care to 10 million children and how many will--for 
the well-being of these children--decide to stop playing politics and 
vote to override the veto?
  Madam Speaker, House Democrats have come more than halfway. This bill 
doesn't go as far as I would like, but it's a good, bipartisan effort. 
It addresses the issues raised by some on the other side of the aisle. 
The bill President Bush vetoed never provided health care to illegal 
immigrants--despite the incorrect claims coming from the other side. 
This bill makes that even clearer. The bill President Bush vetoed never 
provided health care to families making $83,000 a year and neither does 
this bill. The bill President Bush vetoed took 2 years to phase out 
adults currently on the S-CHIP program and this bill speeds that 
timeline up to 1 year.

  Let me be clear--under this bill, families who can afford health care 
will not be eligible for S-CHIP. Under this bill, illegal immigrants 
will not be eligible for S-CHIP. Under this bill, adults will not be 
eligible for S-CHIP.
  But 10 million American children who don't have health care will get 
the help they so desperately need. The time has come for the members of 
this body to make a choice--will they stand with the children of 
America, or will they stand with President Bush?
  I know where I stand, Madam Speaker.
  It's time to stop playing games with the lives of children. It's time 
to pass this bill.
  Mr. MORAN of Virginia. Madam Speaker, I rise today in strong support 
of the Children's Health Insurance Program Reauthorization Act of 2007. 
Truly, we face a health care crisis in this country--in the richest 
country on Earth, 46 million Americans do not have health insurance, 
including 9 million children. Today's bipartisan, bicameral compromise 
is not a perfect solution to that problem but is a decisive, strong 
step towards covering uninsured kids and fulfilling our moral 
obligation to our children.
  In my home state of Virginia, the CHIP program currently provides 
coverage to 137,642 low-income children each year; 171,642 children in 
Virginia remain uninsured, and the CHIP Reauthorization Act will help 
us cover 74,200 of these children. The CHIP Reauthorization Act will 
ensure that these children have access to high quality health care, 
including the preventative services that children need to be healthy 
and successful in school and later in life. This bill will provide 
dental and mental health benefits on par with medical and surgical 
services--truly ensuring that the whole child's health is provided for.
  The CHIP Reauthorization Act does this without increasing the 
deficit, by increasing the Federal excise tax on cigarettes. In my view 
as chairman of the Congressional Prevention Caucus, an increase in the 
Federal tobacco tax is sound public health policy. It provides a 
reliable revenue source to offset the costs of expanding coverage to 
low-income children and it will reduce health care costs in this 
country by reducing the prevalence of chronic disease.
  This bill also addresses a serious problem arising from the 
implementation of the Deficit Reduction Act of 2005. Opponents of this 
responsible, common-sense, humane adjustment claim that language in the 
2005 Deficit Reduction Act, DRA, that imposed harsher citizenship 
verification requirements on state Medicaid programs, is the only 
barrier protecting taxpayer dollars from being spent on healthcare for 
illegal immigrants. Madam Speaker, nothing could be further from the 
truth.
  First and foremost, existing Federal law and provisions in the CHIP 
Reauthorization Act prevent Federal funds from being spent to provide 
benefits for illegal immigrants. Section 605 specifically states that 
``nothing in this act allows Federal payment for individuals who are 
not legal immigrants.'' Illegal immigrants have never been eligible for 
Medicaid, and nothing in the CHIP Reauthorization Act would change that 
fact.

  Secondly, the DRA requirements have overwhelmingly failed to save 
taxpayer dollars. Instead, they have imposed substantial additional 
costs on taxpayers while reducing health care benefits available to 
poor children. Wait times have skyrocketed, and measures to streamline 
the application process have been rendered impossible.
  Third, these draconian requirements, which are far stricter than 
those employed by other government programs, have caused tens of 
thousands of U.S. citizen children to lose health insurance coverage. 
In Virginia, there was a net decline of more than 11,000 children 
enrolled in Medicaid during the first 9 months of implementation. 
Kansas has seen a net decline of 14,000 children. The Virginia State 
Medicaid Office has identified a total of two undocumented immigrants 
during this period.
  The debate about reauthorizing SCHIP should be about the public 
health and improving the health of our children. In a recent survey, 90 
percent of parents applying for Medicaid for their children indicated 
that they have no other health coverage available. Allowing State 
flexibility in citizenship verification is sound public health policy 
that would enable thousands of American children access to vital

[[Page H12087]]

health services to help them live better, healthier, and more 
productive lives. Twenty-four Senators, twelve Governors, and fifty-one 
other House Members joined me in requesting that this important 
provision be included. I thank the Committees for including this 
provision, and for working with our Republican colleagues to improve 
the provision and ensure that SCHIP and Medicaid serve the low-income 
American children they were aimed at.
  Reauthorizing SCHIP is sound public health policy--research shows 
that children who have access to health insurance are substantially 
more likely to access key preventative services, miss fewer days of 
school due to illness, get better grades, and continue to have superior 
outcomes later in life. Moreover, the financial benefits of covering 
children vastly outweigh the costs--one need only compare the cost of a 
visit to a primary care provider to the cost of a night spent in the 
emergency room to see this. But above all, covering all our children is 
a moral imperative--it is the only possible humane, responsible course 
of action. I urge a yes vote on the underlying bill, and furthermore, 
would urge the President, in the strongest possible terms, not to veto 
this vitally needed, responsible legislation to cover the most 
vulnerable members of our society: our children.
  The SPEAKER pro tempore. All time for debate has expired.
  Pursuant to House Resolution 774, the bill is considered read and the 
previous question is ordered.
  The question is on the engrossment and third reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.


           Motion to Recommit Offered by Mr. Barton of Texas

  Mr. BARTON of Texas. Madam Speaker, I have a motion to recommit at 
the desk.
  The SPEAKER pro tempore. Is the gentleman opposed to the bill?
  Mr. BARTON of Texas. In its current form I am.
  The SPEAKER pro tempore. The Clerk will report the motion to 
recommit.
  The Clerk read as follows:

       Mr. Barton of Texas moves to recommit the bill H.R. 3963 to 
     the Committee on Energy and Commerce with instructions to 
     report the same back to the House forthwith with the 
     following amendments:
       Strike section 104 (relating to CHIP performance bonus 
     payments) (page 28, line 1, through page 42, line 20).
       After section 109 (page 51, after line 9), insert the 
     following:

     SEC. 110. REQUIRING OUTREACH AND COVERAGE BEFORE EXPANSION OF 
                   ELIGIBILITY.

       (a) State Plan Required To Specify How It Will Achieve 
     Coverage for 90 Percent of Targeted Low-Income Children.--
       (1) In general.--Section 2102(a) (42 U.S.C. 1397bb(a)) is 
     amended--
       (A) in paragraph (6), by striking ``and'' at the end;
       (B) in paragraph (7), by striking the period at the end and 
     inserting ``; and''; and
       (C) by adding at the end the following new paragraph:
       ``(8) how the eligibility and benefits provided for under 
     the plan for each fiscal year (beginning with fiscal year 
     2009) will allow for the State's annual funding allotment to 
     cover at least 90 percent of the eligible targeted low-income 
     children in the State.''.
       (2) Effective date.--The amendments made by paragraph (1) 
     shall apply to State child health plans for fiscal years 
     beginning with fiscal year 2009.
       (b) Limitation on Program Expansions Until Lowest Income 
     Eligible Individuals Enrolled.--Section 2105(c) (42 U.S.C. 
     1397dd(c)), as amended in this Act, is amended by adding at 
     the end the following new paragraph:
       ``(13) Limitation on increased coverage of higher income 
     children.--For child health assistance furnished in a fiscal 
     year beginning with fiscal year 2008:
       ``(A) Special rules for payment for children with family 
     income above 200 percent of poverty line.--In the case of 
     child health assistance for a targeted low-income child in a 
     family the income of which exceeds 200 percent (but does not 
     exceed 300 percent) of the poverty line applicable to a 
     family of the size involved no payment shall be made under 
     this section for such assistance unless the State 
     demonstrates to the satisfaction of the Secretary that--
       ``(i) the State has met the 90 percent retrospective 
     coverage test specified in subparagraph (B)(i) for the 
     previous fiscal year; and
       ``(ii) the State will meet the 90 percent prospective 
     coverage test specified in subparagraph (B)(ii) for the 
     fiscal year.
       ``(B) 90 percent coverage tests.--
       ``(i) Retrospective test.--The 90 percent retrospective 
     coverage test specified in this clause is, for a State for a 
     fiscal year, that on average during the fiscal year, the 
     State has enrolled under this title or title XIX at least 90 
     percent of the individuals residing in the State who--

       ``(I) are children under 19 years of age (or are pregnant 
     women) and are eligible for medical assistance under title 
     XIX; or
       ``(II) are targeted low-income children whose family income 
     does not exceed 200 percent of the poverty line and who are 
     eligible for child health assistance under this title.

       ``(ii) Prospective test.--The 90 percent prospective test 
     specified in this clause is, for a State for a fiscal year, 
     that on average during the fiscal year, the State will enroll 
     under this title or title XIX at least 90 percent of the 
     individuals residing in the State who--

       ``(I) are children under 19 years of age (or are pregnant 
     women) and are eligible for medical assistance under title 
     XIX; or
       ``(II) are targeted low-income children whose family income 
     does not exceed such percent of the poverty line (in excess 
     of 200 percent) as the State elects consistent with this 
     paragraph and who are eligible for child health assistance 
     under this title.

       ``(C) Grandfather.--Subparagraphs (A) and (B) shall not 
     apply to the provision of child health assistance--
       ``(i) to a targeted low-income child who is enrolled for 
     child health assistance under this title as of September 30, 
     2007;
       ``(ii) to a pregnant woman who is enrolled for assistance 
     under this title as of September 30, 2007, through the 
     completion of the post-partum period following completion of 
     her pregnancy; and
       ``(iii) for items and services furnished before October 1, 
     2008, to an individual who is not a targeted low-income child 
     and who is enrolled for assistance under this title as of 
     September 30, 2007.''.
       (c) Standardization of Income Determinations.--
       (1) In general.--Section 2110 (42 U.S.C. 1397jj) is amended 
     by adding at the end the following new subsection:
       ``(d) Standardization of Income Determinations.--In 
     determining family income under this title (including in the 
     case of a State child health plan that provides health 
     benefits coverage in the manner described in section 
     2101(a)(2)), a State shall base such determination on gross 
     income (including amounts that would be included in gross 
     income if they were not exempt from income taxation).''.
       (2) Effective date.--the amendment made by paragraph (1) 
     shall apply to determinations (and redeterminations) of 
     income made on or after October 1, 2008.
       Amend section 112 (page 59, line 13, through page 74, line 
     15) to read as follows:

     SEC. 112. PHASE-OUT OF COVERAGE FOR NONPREGNANT ADULTS UNDER 
                   CHIP; CONDITIONS FOR COVERAGE OF PARENTS.

       (a) 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 ADULTS.

       ``(a) Termination of Coverage for Nonpregnant Adults.--
       ``(1) No new chip waivers; automatic extensions at state 
     option through 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 adult; and
       ``(B) notwithstanding the terms and conditions of an 
     applicable existing waiver, the provisions of paragraph (2) 
     shall apply for purposes of any period beginning on or after 
     January 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.
       ``(2) Termination of chip coverage under applicable 
     existing waivers at the end of 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 adult under an 
     applicable existing waiver after December 31, 2008.
       ``(B) 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 the period beginning on 
     the date of the enactment of this subsection and ending on 
     December 31, 2008.
       ``(3) State option to apply for medicaid waiver to continue 
     coverage for nonpregnant 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 September 30, 2008, 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 December 31, 2008, on the application of a

[[Page H12088]]

     State for a Medicaid nonpregnant childless adults waiver that 
     was submitted to the Secretary by September 30, 2008, 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 2009, 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 2008, increased by the percentage 
     increase (if any) in the projected nominal per capita amount 
     of National Health Expenditures for 2009 over 2008, as most 
     recently published by the Secretary; and
       ``(ii) in the case of any succeeding year, allow such 
     expenditures to not exceed the amount in effect under this 
     subparagraph for the preceding year, increased by the 
     percentage increase (if any) in the projected nominal per 
     capita amount of National Health Expenditures for the year 
     involved over the preceding year, as most recently published 
     by the Secretary.
       ``(b) 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 on October 1, 2007.
       ``(2) Definitions.--The term `nonpregnant adult' means any 
     individual who is not a targeted low-income pregnant woman 
     (as defined in section 2112(d)(2)) or a targeted low-income 
     child.''.
       (b) Conforming Amendments.--
       (1) Section 2107(f) (42 U.S.C. 1397gg(f)) is amended--
       (A) by striking ``, the Secretary'' and inserting ``:
       ``(1) The Secretary'';
       (B) in the first sentence, by striking ``childless'';
       (C) by striking the second sentence; and
       (D) 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.''.
       (2) 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''.
       In the paragraph (8)(A) added by section 114(a), strike (on 
     page 76, line 12)``would exceed 300 percent of the poverty 
     line'' and all that follows through ``type of expense or type 
     of income'' (on line 16) and insert ``will exceed 300 percent 
     of the poverty line.''.
       Amend the paragraph (9)(B) added by section 116(e) (page 
     85, beginning on line 21) to read as follows:
       ``(B) Higher income eligibility state.--A higher income 
     eligibility State described in this clause is a State that 
     applies under its State child health plan an eligibility 
     income standard for targeted low-income children that exceeds 
     300 percent of the poverty line.''.

       Amend section 211 (page 130, line 9, through page 146, line 
     11) to read as follows:

     SEC. 211. APPLICATION OF CITIZENSHIP DOCUMENTATION 
                   REQUIREMENTS.

       (a) In General.--Section 2105(c) (42 U.S.C. 1397dd(c)), as 
     amended by sections 114(a) and 116(c), is amended by adding 
     at the end the following new paragraph:
       ``(10) Application of citizenship documentation 
     requirements.--
       ``(A) In general.--Subject to subparagraph (B), no payment 
     may be made under this section to a State with respect to 
     amounts expended for child health assistance for an 
     individual who declares under section 1137(d)(1)(A) to be a 
     citizen or national of the United States for purposes of 
     establishing eligibility for benefits under this title, 
     unless the requirement of section 1903(x) is met.
       ``(B) Treatment of pregnant women.--For purposes of 
     applying subparagraph (A) in the case of a pregnant woman who 
     qualifies for child health assistance by virtue of the 
     application of section 457.10 of title 42, Code of Federal 
     Regulations, the requirement of such section shall be deemed 
     to be satisfied by the presentation of documentation of 
     personal identity described in section 274A(b)(1)(D) of the 
     Immigration and Nationality Act or any other documentation of 
     personal identity of such other type as the Secretary finds, 
     by regulation, provides a reliable means of 
     identification.''.
       (b) Effective Date.--The amendment made by paragraph (1) 
     shall apply to eligibility determinations and 
     redeterminations made after March 31, 2008.
       In the paragraph (11) added by section 301(a), add at the 
     end the following (page 160, after line 13):
       ``(O) Requirement for certain states.--Effective October 1, 
     2009, any State that provides for child health assistance 
     under this title for children in families with income that 
     exceeds 200 percent of the poverty line shall elect and 
     implement the option under this paragraph.''.
       In section 605 (on page 251, beginning on line 8), strike 
     ``Nothing in this Act allows Federal payment for individuals 
     who are not legal residents.'' and insert ``Notwithstanding 
     any other provision of law, no Federal payment shall be made 
     under title XXI of the Social Security Act for any individual 
     who is not a legal resident of the United States.''.
       Strike section 613 (page 255, lines 14 through 20).

  Mr. BARTON of Texas (during the reading). Madam Speaker, I ask 
unanimous consent that the motion to recommit be considered as read.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  Mr. DINGELL. I object. I reserve a point of order.
  The SPEAKER pro tempore. Objection is heard.
  The point of order is reserved.
  The Clerk will continue to read.

                              {time}  1615

  Mr. DINGELL. Madam Speaker, I withdraw my point of order.
  The SPEAKER pro tempore. The gentleman withdraws his point of order.
  Pursuant to the rule, the gentleman from Texas is recognized for 5 
minutes in support of his motion.
  Mr. BARTON of Texas. Madam Speaker, I appreciate my good friend, Mr. 
Dingell, asking that the motion to recommit be read. I did the same 
thing in committee on the 593-page bill, so I think payback is fair. So 
I don't have a problem with that. I hope that the Members in the 
Chamber actually listened to the reading of the Clerk, because those 
that did will agree with me on the following things.
  First of all, we have taken the 293-page bill that we got at 
approximately 7 p.m. last evening and left most of it untouched. We 
have changed approximately 15 pages of a 293-page bill. We have 
listened carefully to our friends on the majority side at what they say 
they want, and we have tried to implement those changes in this motion 
to recommit.
  We start out with the fact that our friends on the majority side 
agree with us that SCHIP should be for the poor and the near-poor in 
American society. This motion to recommit eliminates the loophole for 
income-disregards that would allow States to actually cover children 
and families in all probability well above 300 percent. So we have an 
elimination action in this motion to recommit that would eliminate that 
loophole.
  We also believe that before you go above 200 percent of poverty, you 
should cover the children below 200 percent of poverty, so we have a 
requirement in the motion to recommit that States cannot go above 200 
percent of poverty until they have covered at least 90 percent of the 
eligible SCHIP and Medicare children below 200 percent of the poverty 
line.
  We take statements like Chairman Rangel of the Ways and Means 
Committee and Chairman Dingell of the Energy and Commerce Committee at 
face value when they say they don't want illegal aliens to be covered 
in the bill. We put a requirement in the motion to recommit that 
applies the same citizenship documentation requirements for SCHIP as we 
have for Medicaid in the Deficit Reduction Act and applies those to the 
16 States that it does not currently apply to.
  We also take the majority at their word when they say that they 
really want SCHIP to be for children. The motion to recommit would take 
all adults off the program within 1 year except for pregnant women. We 
would continue to cover pregnant women under the SCHIP program.
  We have a concern about when you begin to go above 200 percent of 
poverty that you actually begin to crowd out the private insurance 
market, so we do have a requirement in the motion to recommit that if a 
State wants to go above 200 percent of poverty, they have to have, they 
must have, a premium support assistance program that would give those 
families that have private insurance the option to continue to receive 
the private insurance, and they get premium assistance from that State 
government.

[[Page H12089]]

  Finally, the motion to recommit has been scored by the CBO as saving 
at least $10 billion from the pending bill.
  Also, in full disclosure, I need to point out we do not change in the 
motion to recommit the pay-for, so the portion of the underlying bill 
that does have a tobacco tax, we do not touch that. We don't try to 
move it up, we don't try to move it down, we don't try to substitute 
for it. The motion to recommit that we offered in August had that same 
provision, but I think in the interests of full disclosure, we need to 
put that on the table.
  Madam Speaker, I yield back the balance of my time.
  Mr. DINGELL. Madam Speaker, I rise in opposition to the motion to 
recommit.
  The SPEAKER pro tempore. The gentleman from Michigan is recognized 
for 5 minutes.
  Mr. DINGELL. Madam Speaker, I begin with an expression of my 
affection and respect for my good friend from Texas (Mr. Barton). In 
most matters he is an extraordinarily fine legislator, except on 
occasions when he offers these motions to recommit.
  I begin by pointing out that my good friend's motion to recommit is 
the same tax about which there have been such prodigious complaints by 
my Republican colleagues, but that fewer kids are covered, and that 
there are many impediments inserted into the bill by the motion to 
recommit to covering the number of kids.
  Having said that, my colleagues on the other side say they want to 
ensure that lowest-income States are covered, but they strike the bonus 
payments that CBO says will get 1.9 million of the lowest-income 
children covered who would not otherwise be covered.

                              {time}  1630

  Second, they say they are for working families. But it is interesting 
to note that they are forcing, by this, many of the working families 
who would receive coverage under the bill before us are forced to go 
onto welfare in order to get health care because they strike the 
provisions which would discourage that kind of unfortunate event. My 
colleagues, I would observe, still have the wrong medicine for the 
problem.
  Now, in addition to this, the recommit would prohibit States looking 
to expand coverage to a family of three at $52,000 from doing so unless 
they meet arbitrary enrollment targets. The result of that is, of 
course, again harder for people who deserve and need this kind of 
relief to get this kind of benefit.
  The last point I want to make here is their proposal does not remedy 
the current problem that has caused thousands of children to lose 
health coverage due to Republican bureaucratic requirements. I would 
point out something else, and that is my good friends have essentially 
in this, as near as I can figure, reenacted the President's proposal, 
which would set forth a directive to the States as to how they will 
administer this, something that has caused a huge outrage amongst the 
States, amongst persons affected and amongst advocates for the poor and 
the unfortunate. This is perhaps the worst part of what the proposal to 
recommit does.
  Let's look at what the bill does. The bill increases the number of 
children who are eligible for coverage, for health insurance, from 6.6 
to 10 million young Americans. It must be observed that we are doing 
this amidst a circumstance where we have seen significant increases in 
the number of our children joining the ranks of the uninsured.
  The bill does more. It sees to it that we take care of the problem. 
Nearly 70 percent of all uninsured children are from families below 
$41,300 for a family of four. Of the 9 million uninsured children, 
nearly two-thirds are either preschool or elementary school age. This 
is the time when health care becomes singularly precious and important 
to them.
  I would remind my colleagues that a Nation is judged by how it treats 
and cares for those who are most vulnerable and least able to help 
themselves. The bill sees to it that we amplify and include greater 
numbers of those who are most dependent upon others for their survival.
  But in addition to that, I would remind my colleagues that this 
legislation is something which is of great importance because we are 
talking about the future of the kids. Giving them health care now when 
they have need of it is something that ensures that Americans in the 
future will be the kind of productive, valuable citizens who are able 
to carry forward the competition of this Nation in some of its most 
difficult, competitive times.
  Now, this bill would significantly increase and improve access for 
needed health care to children. The proposal in the motion to recommit 
significantly cuts back on that.
  I urge my colleagues to vote ``no'' on the motion to recommit and 
vote for the bill.
  The SPEAKER pro tempore (Mrs. Tauscher). Without objection, the 
previous question is ordered on the motion to recommit.
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion to recommit.
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.
  Mr. BARTON of Texas. Madam Speaker, on that I demand the yeas and 
nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 9 of rule XX, the Chair 
will reduce to 5 minutes the minimum time for any electronic vote on 
the question of passage.
  The vote was taken by electronic device, and there were--yeas 164, 
nays 242, not voting 26, as follows:

                            [Roll No. 1008]

                               YEAS--164

     Aderholt
     Akin
     Alexander
     Bachmann
     Bachus
     Baker
     Barrett (SC)
     Bartlett (MD)
     Barton (TX)
     Biggert
     Bilirakis
     Bishop (UT)
     Blackburn
     Blunt
     Boehner
     Bonner
     Bono
     Boozman
     Boustany
     Brady (TX)
     Broun (GA)
     Brown (SC)
     Brown-Waite, Ginny
     Buchanan
     Burgess
     Burton (IN)
     Camp (MI)
     Campbell (CA)
     Cannon
     Cantor
     Carter
     Castle
     Chabot
     Coble
     Cole (OK)
     Conaway
     Crenshaw
     Cubin
     Culberson
     Davis (KY)
     Davis, David
     Davis, Tom
     Deal (GA)
     Dent
     Doolittle
     Drake
     Duncan
     Ehlers
     English (PA)
     Everett
     Fallin
     Feeney
     Flake
     Forbes
     Fortenberry
     Foxx
     Franks (AZ)
     Frelinghuysen
     Garrett (NJ)
     Gerlach
     Gilchrest
     Gingrey
     Gohmert
     Goode
     Goodlatte
     Granger
     Hall (TX)
     Heller
     Hensarling
     Herger
     Hobson
     Hoekstra
     Hulshof
     Inglis (SC)
     Johnson (IL)
     Johnson, Sam
     Jones (NC)
     Jordan
     Keller
     King (IA)
     Kingston
     Kirk
     Kline (MN)
     Knollenberg
     Kuhl (NY)
     Lamborn
     Latham
     LaTourette
     Lewis (KY)
     Linder
     Lucas
     Lungren, Daniel E.
     Mack
     Manzullo
     Marchant
     McCarthy (CA)
     McCaul (TX)
     McCotter
     McCrery
     McKeon
     McMorris Rodgers
     Mica
     Miller (FL)
     Miller (MI)
     Moran (KS)
     Murphy, Tim
     Musgrave
     Myrick
     Neugebauer
     Nunes
     Paul
     Pearce
     Pence
     Peterson (PA)
     Petri
     Pickering
     Pitts
     Platts
     Poe
     Porter
     Price (GA)
     Pryce (OH)
     Putnam
     Radanovich
     Regula
     Rehberg
     Reynolds
     Rogers (AL)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Roskam
     Royce
     Ryan (WI)
     Sali
     Saxton
     Schmidt
     Sensenbrenner
     Sessions
     Shadegg
     Shimkus
     Simpson
     Smith (NE)
     Smith (TX)
     Souder
     Stearns
     Sullivan
     Terry
     Thornberry
     Tiahrt
     Tiberi
     Turner
     Upton
     Walberg
     Walden (OR)
     Walsh (NY)
     Wamp
     Weldon (FL)
     Weller
     Westmoreland
     Whitfield
     Wicker
     Wilson (SC)
     Young (FL)

                               NAYS--242

     Abercrombie
     Ackerman
     Allen
     Altmire
     Andrews
     Arcuri
     Baca
     Baird
     Baldwin
     Barrow
     Bean
     Becerra
     Berkley
     Berman
     Berry
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Boswell
     Boucher
     Boyd (FL)
     Boyda (KS)
     Brady (PA)
     Braley (IA)
     Brown, Corrine
     Butterfield
     Capito
     Capps
     Capuano
     Cardoza
     Carnahan
     Carney
     Castor
     Chandler
     Clarke
     Clay
     Cleaver
     Clyburn
     Cohen
     Conyers
     Cooper
     Costa
     Costello
     Courtney
     Cramer
     Crowley
     Cuellar
     Cummings
     Davis (AL)
     Davis (IL)
     Davis, Lincoln
     DeGette
     Delahunt
     DeLauro
     Diaz-Balart, L.
     Diaz-Balart, M.
     Dicks
     Dingell
     Doggett
     Donnelly
     Doyle
     Edwards
     Ellison
     Ellsworth
     Emanuel
     Emerson
     Engel
     Eshoo
     Etheridge
     Farr
     Fattah
     Ferguson
     Fossella
     Frank (MA)
     Giffords
     Gillibrand
     Gonzalez
     Gordon
     Graves
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Hall (NY)
     Hare
     Harman
     Hastings (FL)
     Hayes
     Herseth Sandlin
     Higgins
     Hill
     Hinchey
     Hinojosa
     Hirono
     Hodes
     Holden
     Holt
     Honda
     Hooley
     Hoyer
     Inslee
     Israel
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     Johnson (GA)
     Jones (OH)
     Kagen
     Kanjorski
     Kaptur
     Kennedy
     Kildee
     Kind

[[Page H12090]]


     King (NY)
     Klein (FL)
     Kucinich
     LaHood
     Lampson
     Langevin
     Lantos
     Larsen (WA)
     Larson (CT)
     Lee
     Levin
     Lewis (GA)
     Lipinski
     LoBiondo
     Loebsack
     Lofgren, Zoe
     Lowey
     Lynch
     Mahoney (FL)
     Maloney (NY)
     Markey
     Marshall
     Matheson
     Matsui
     McCarthy (NY)
     McCollum (MN)
     McDermott
     McGovern
     McHugh
     McNerney
     McNulty
     Meek (FL)
     Meeks (NY)
     Melancon
     Michaud
     Miller (NC)
     Miller, George
     Mitchell
     Mollohan
     Moore (KS)
     Moore (WI)
     Moran (VA)
     Murphy (CT)
     Murphy, Patrick
     Murtha
     Nadler
     Napolitano
     Neal (MA)
     Oberstar
     Obey
     Olver
     Ortiz
     Pallone
     Pascrell
     Pastor
     Payne
     Perlmutter
     Peterson (MN)
     Pomeroy
     Price (NC)
     Rahall
     Ramstad
     Rangel
     Reichert
     Renzi
     Reyes
     Richardson
     Rodriguez
     Ros-Lehtinen
     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
     Sherman
     Shuler
     Sires
     Skelton
     Slaughter
     Smith (NJ)
     Smith (WA)
     Snyder
     Solis
     Space
     Spratt
     Stark
     Stupak
     Sutton
     Tanner
     Tauscher
     Taylor
     Thompson (CA)
     Thompson (MS)
     Tierney
     Towns
     Tsongas
     Udall (CO)
     Udall (NM)
     Van Hollen
     Velazquez
     Visclosky
     Walz (MN)
     Wasserman Schultz
     Waters
     Watson
     Watt
     Waxman
     Weiner
     Welch (VT)
     Wexler
     Wilson (NM)
     Wolf
     Woolsey
     Wu
     Wynn
     Yarmuth

                             NOT VOTING--26

     Bilbray
     Boren
     Buyer
     Calvert
     Carson
     Davis (CA)
     DeFazio
     Dreier
     Filner
     Gallegly
     Hastert
     Hastings (WA)
     Hunter
     Issa
     Jindal
     Johnson, E. B.
     Kilpatrick
     Lewis (CA)
     McHenry
     McIntyre
     Miller, Gary
     Shea-Porter
     Shuster
     Tancredo
     Wilson (OH)
     Young (AK)

                              {time}  1657

  Ms. TSONGAS, Mr. GORDON of Tennessee, Mr. TOWNS and Mrs. CAPITO 
changed their vote from ``yea'' to ``nay.''
  Mr. SHIMKUS changed his vote from ``nay'' to ``yea.''
  Mr. COSTA changed his vote from ``present'' to ``nay.''
  So the motion to recommit was rejected.
  The result of the vote was announced as above recorded.
  Stated for:
  Mr. McHENRY. Madam Speaker, on rollcall No. 1008 I am not recorded 
because I was unavoidably detained on my return to the Capitol. Had I 
been present, I would have voted ``yea.''
  Stated against:
  Mr. FILNER. Madam Speaker, on rollcall No. 1008, I was not present 
because I was helping my constituents cope with the fire crisis in San 
Diego, CA. Had I been present, I would have voted ``nay.''
  The SPEAKER pro tempore. The question is on the passage of the bill.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. BARTON of Texas. Madam Speaker, on that I demand the yeas and 
nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. This will be a 5-minute vote.
  The vote was taken by electronic device, and there were--yeas 265, 
nays 142, not voting 26, as follows:

                            [Roll No. 1009]

                               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
     Castor
     Chandler
     Clarke
     Clay
     Cleaver
     Clyburn
     Cohen
     Conyers
     Cooper
     Costa
     Costello
     Courtney
     Cramer
     Crowley
     Cuellar
     Cummings
     Davis (AL)
     Davis (IL)
     Davis, Lincoln
     Davis, Tom
     Delahunt
     DeLauro
     Dent
     Dicks
     Dingell
     Doggett
     Donnelly
     Doyle
     Edwards
     Ellison
     Ellsworth
     Emanuel
     Emerson
     Engel
     English (PA)
     Eshoo
     Etheridge
     Farr
     Fattah
     Ferguson
     Fossella
     Frank (MA)
     Gerlach
     Giffords
     Gilchrest
     Gillibrand
     Gonzalez
     Gordon
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Hall (NY)
     Hare
     Harman
     Hastings (FL)
     Herseth Sandlin
     Higgins
     Hill
     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
     Kind
     King (NY)
     Kirk
     Klein (FL)
     Kucinich
     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
     McIntyre
     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
     Sherman
     Shuler
     Simpson
     Sires
     Skelton
     Slaughter
     Smith (NJ)
     Smith (WA)
     Snyder
     Solis
     Space
     Spratt
     Stark
     Stupak
     Sutton
     Tanner
     Tauscher
     Taylor
     Thompson (CA)
     Thompson (MS)
     Tiberi
     Tierney
     Towns
     Tsongas
     Turner
     Udall (CO)
     Udall (NM)
     Upton
     Van Hollen
     Velazquez
     Visclosky
     Walsh (NY)
     Walz (MN)
     Wasserman Schultz
     Waters
     Watson
     Watt
     Waxman
     Weiner
     Welch (VT)
     Wexler
     Wilson (NM)
     Wolf
     Woolsey
     Wu
     Wynn
     Yarmuth
     Young (FL)

                               NAYS--142

     Aderholt
     Akin
     Alexander
     Bachmann
     Bachus
     Baker
     Barrett (SC)
     Bartlett (MD)
     Barton (TX)
     Biggert
     Bilirakis
     Bishop (UT)
     Blackburn
     Blunt
     Boehner
     Bonner
     Boozman
     Boustany
     Brady (TX)
     Broun (GA)
     Brown (SC)
     Brown-Waite, Ginny
     Burgess
     Burton (IN)
     Camp (MI)
     Campbell (CA)
     Cannon
     Cantor
     Carter
     Chabot
     Coble
     Cole (OK)
     Conaway
     Crenshaw
     Cubin
     Culberson
     Davis (KY)
     Davis, David
     Deal (GA)
     Diaz-Balart, L.
     Diaz-Balart, M.
     Doolittle
     Drake
     Duncan
     Ehlers
     Everett
     Fallin
     Feeney
     Flake
     Forbes
     Fortenberry
     Foxx
     Franks (AZ)
     Frelinghuysen
     Garrett (NJ)
     Gingrey
     Gohmert
     Goode
     Goodlatte
     Granger
     Graves
     Hall (TX)
     Hayes
     Heller
     Hensarling
     Herger
     Hoekstra
     Hulshof
     Inglis (SC)
     Johnson (IL)
     Johnson, Sam
     Jones (NC)
     Jordan
     Keller
     King (IA)
     Kingston
     Kline (MN)
     Knollenberg
     Kuhl (NY)
     Lamborn
     Lewis (KY)
     Linder
     Lucas
     Lungren, Daniel E.
     Mack
     Manzullo
     Marchant
     Marshall
     McCarthy (CA)
     McCaul (TX)
     McCotter
     McCrery
     McKeon
     Mica
     Miller (FL)
     Musgrave
     Myrick
     Neugebauer
     Nunes
     Paul
     Pearce
     Pence
     Peterson (PA)
     Pickering
     Pitts
     Poe
     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
     Smith (NE)
     Smith (TX)
     Souder
     Stearns
     Sullivan
     Terry
     Thornberry
     Tiahrt
     Walberg
     Walden (OR)
     Wamp
     Weldon (FL)
     Weller
     Westmoreland
     Whitfield
     Wicker
     Wilson (SC)

                             NOT VOTING--26

     Bilbray
     Boren
     Buyer
     Calvert
     Carson
     Davis (CA)
     DeFazio
     DeGette
     Dreier
     Filner
     Gallegly
     Hastert
     Hastings (WA)
     Hunter
     Issa
     Jindal
     Johnson, E. B.
     Kilpatrick
     Lewis (CA)
     McHenry
     Miller, Gary
     Shea-Porter
     Shuster
     Tancredo
     Wilson (OH)
     Young (AK)


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore (during the vote). Members are advised there 
are 2 minutes remaining on this vote.

                              {time}  1706

  So the bill was passed.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.
       Stated for:
  Mr. FILNER. Madam Speaker, on rollcall No. 1009, I was not present 
because I was helping my constituents cope with the fire crisis in San 
Diego, CA. Had I been present, I would have voted ``yea.''
  Mr. McHENRY. Mr. Speaker, on rollcall No. 1009 I am not recorded 
because I was unavoidably detained on my return to the Capitol. Had I 
been present, I would have voted ``nay.''

                          ____________________