Congressional Record, Volume 155 Issue 8 (Wednesday, January 14, 2009)

[Congressional Record Volume 155, Number 8 (Wednesday, January 14, 2009)]
[House]
[Pages H216-H268]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

CHILDREN'S HEALTH INSURANCE PROGRAM REAUTHORIZATION ACT OF 2009

Mr. PALLONE. Madam Speaker, pursuant to House Resolution 52, I call
up the bill (H.R. 2) 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 in the House.
The Clerk read the title of the bill.
The text of the bill is as follows:

H.R. 2

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

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

(a) Short Title.--This Act may be cited as the ``Children's
Health Insurance Program Reauthorization Act of 2009''.
(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:

[[Page H217]]

(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 2009
through 2013.
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. Two-year initial availability of CHIP allotments.
Sec. 106. Redistribution of unused allotments.
Sec. 107. Option for qualifying States to receive the enhanced portion
of the CHIP matching rate for Medicaid coverage of
certain children.
Sec. 108. One-time appropriation.
Sec. 109. Improving funding for the territories under CHIP and
Medicaid.

Subtitle B--Focus on Low-Income Children and Pregnant Women

Sec. 111. State option to cover low-income pregnant women under CHIP
through a State plan amendment.
Sec. 112. Phase-out of coverage for nonpregnant childless adults under
CHIP; conditions for coverage of parents.
Sec. 113. Elimination of counting Medicaid child presumptive
eligibility costs against title XXI allotment.
Sec. 114. Limitation on matching rate for States that propose to cover
children with effective family income that exceeds 300
percent of the poverty line.
Sec. 115. State authority under Medicaid.

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.
Sec. 214. Permitting States to ensure coverage without a 5-year delay
of certain children and pregnant women under the Medicaid
program and CHIP.

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. Clarification of coverage of services provided through
school-based health centers.

TITLE VI--PROGRAM INTEGRITY AND OTHER MISCELLANEOUS PROVISIONS

Subtitle A--Program Integrity and Data Collection

Sec. 601. Payment error rate measurement (``PERM'').
Sec. 602. Improving data collection.
Sec. 603. Updated Federal evaluation of CHIP.
Sec. 604. Access to records for IG and GAO audits and evaluations.
Sec. 605. No Federal funding for illegal aliens.

Subtitle B--Miscellaneous Health Provisions

Sec. 611. Deficit Reduction Act technical corrections.
Sec. 612. References to title XXI.
Sec. 613. Prohibiting initiation of new health opportunity account
demonstration programs.
Sec. 614. Adjustment in computation of Medicaid FMAP to disregard an
extraordinary employer pension contribution.
Sec. 615. Clarification treatment of regional medical center.
Sec. 616. Extension of Medicaid DSH allotments for Tennessee and
Hawaii.

Subtitle C--Other Provisions

Sec. 621. Outreach regarding health insurance options available to
children.
Sec. 622. Sense of the Senate regarding access to affordable and
meaningful health insurance coverage.
Sec. 623. Limitation on Medicare exception to the prohibition on
certain physician referrals for hospitals.

TITLE VII--REVENUE PROVISIONS

Sec. 701. Increase in excise tax rate on tobacco products.
Sec. 702. Administrative improvements.
Sec. 703. Treasury study concerning magnitude of tobacco smuggling in
the United States.
Sec. 704. 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
April 1, 2009, 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) Coordination of CHIP Funding for Fiscal Year 2009.--
Notwithstanding any other provision of law, insofar as funds
have been appropriated under section 2104(a)(11), 2104(k), or
2104(l) of the Social Security Act, as amended by section 201
of Public Law 110-173, to provide allotments to States under
CHIP for fiscal year 2009--
(1) any amounts that are so appropriated that are not so
allotted and obligated before April 1, 2009, 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

[[Page H218]]

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 (10), by striking ``and'' at the end;
(2) by amending paragraph (11), by striking ``each of
fiscal years 2008 and 2009'' and inserting ``fiscal year
2008''; and
(3) by adding at the end the following new paragraphs:
``(12) for fiscal year 2009, $10,562,000,000;
``(13) for fiscal year 2010, $12,520,000,000;
``(14) for fiscal year 2011, $13,459,000,000;
``(15) for fiscal year 2012, $14,982,000,000; and
``(16) for fiscal year 2013, for purposes of making 2 semi-
annual allotments--
``(A) $3,000,000,000 for the period beginning on October 1,
2012, and ending on March 31, 2013, and
``(B) $3,000,000,000 for the period beginning on April 1,
2013, and ending on September 30, 2013.''.

SEC. 102. ALLOTMENTS FOR STATES AND TERRITORIES FOR FISCAL
YEARS 2009 THROUGH 2013.

Section 2104 (42 U.S.C. 1397dd) is amended--
(1) in subsection (b)(1), by striking ``subsection (d)''
and inserting ``subsections (d) and (m)'';
(2) in subsection (c)(1), by striking ``subsection (d)''
and inserting ``subsections (d) and (m)(4)''; and
(3) by adding at the end the following new subsection:
``(m) Allotments for Fiscal Years 2009 Through 2013.--
``(1) For fiscal year 2009.--
``(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 2009
from the amount made available under subsection (a)(12), 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 2008, multiplied by the allotment
increase factor determined under paragraph (5) for fiscal
year 2009.
``(ii) The amount allotted to the State for fiscal year
2008 under subsection (b), multiplied by the allotment
increase factor determined under paragraph (5) for fiscal
year 2009.
``(iii) The projected total Federal payments to the State
under this title for fiscal year 2009, as determined on the
basis of the February 2009 projections certified by the State
to the Secretary by not later than March 31, 2009.
``(B) For the commonwealths and territories.--Subject to
the succeeding provisions of this paragraph and paragraph
(4), the Secretary shall allot for fiscal year 2009 from the
amount made available under subsection (a)(12) 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 1999 through
2008, multiplied by the allotment increase factor determined
under paragraph (5) for fiscal year 2009, except that
subparagraph (B) thereof shall be applied by substituting
`the United States' for `the State'.
``(C) 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 a
revised projection described in subparagraph (A)(iii) in
order to take into account changes in such projections
attributable to the application of paragraph (4) of such
section.
``(2) For fiscal years 2010 through 2012.--
``(A) In general.--Subject to paragraphs (4) and (6), from
the amount made available under paragraphs (13) through (15)
of subsection (a) for each of fiscal years 2010 through 2012,
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 2010.--For
fiscal year 2010, the allotment of the State is equal to the
sum of--

``(I) the amount of the State allotment under paragraph (1)
for fiscal year 2009; and
``(II) the amount of any payments made to the State under
subsection (k), (l), or (n) for fiscal year 2009,

multiplied by the allotment increase factor under paragraph
(5) for fiscal year 2010.
``(ii) Rebasing in fiscal year 2011.--For fiscal year 2011,
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 2010 (including payments made to
the State under subsection (n) for fiscal year 2010 as well
as amounts redistributed to the State in fiscal year 2010),
multiplied by the allotment increase factor under paragraph
(5) for fiscal year 2011.
``(iii) Growth factor update for fiscal year 2012.--For
fiscal year 2012, the allotment of the State is equal to the
sum of--

``(I) the amount of the State allotment under clause (ii)
for fiscal year 2011; and
``(II) the amount of any payments made to the State under
subsection (n) for fiscal year 2011,

multiplied by the allotment increase factor under paragraph
(5) for fiscal year 2012.
``(3) For fiscal year 2013.--
``(A) First half.--Subject to paragraphs (4) and (6), from
the amount made available under subparagraph (A) of paragraph
(16) 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
2009, 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
(16) 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 2012
(including payments made to the State under subsection (n)
for fiscal year 2012 as well as amounts redistributed to the
State in fiscal year 2012), multiplied by the allotment
increase factor under paragraph (5) for fiscal year 2013.
``(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)(16)(A); and
``(II) the amount of the appropriation for such period
under section 108 of the Children's Health Insurance Program
Reauthorization Act of 2009; to

``(ii) the sum of the--

``(I) amount described in clause (i); and
``(II) the amount made available under subsection
(a)(16)(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 2013, 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 2010 and ending with fiscal
year 2013); 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 2010 or fiscal year 2012.
``(7) Availability of amounts for semi-annual periods in
fiscal year 2013.--Each semi-annual allotment made under
paragraph (3) for a period in fiscal year 2013 shall

[[Page H219]]

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:
``(n) 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 2009, an amount equal to 20 percent
of the amount made available under paragraph (12) of
subsection (a) for the fiscal year; and
``(ii) for each of fiscal years 2010 through 2012 (and for
each of the semi-annual allotment periods for fiscal year
2013), 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 2010 through
2012 (and for each of the semi-annual allotment periods for
fiscal year 2013), 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 2009, fiscal year 2010, fiscal year
2011, fiscal year 2012, or a semi-annual allotment period for
fiscal year 2013, 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 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 2009 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
2008 increased by the population growth for children in that
State for the year ending on June 30, 2007 (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 (m)(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 2009 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 2008,
increased by the annual percentage increase in the projected
per capita amount of National Health Expenditures (as
estimated by the Secretary) for 2009; 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 2009 and ending with fiscal year 2013), the Secretary
shall pay from amounts made available under subparagraph (E),
to each State that meets the condition under paragraph (4)
for the fiscal year, an amount equal to the amount described
in subparagraph (B) for the State and fiscal year. The
payment under this paragraph shall be made, to a State for a
fiscal year, as a single payment not later than the last day
of the first calendar quarter of the following fiscal year.
``(B) Amount 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,
respectively; exceeds
``(II) the baseline number of enrollees described in clause
(iii) for the State and fiscal year under title XIX,
respectively;

but not to exceed 10 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

[[Page H220]]

the State and fiscal year under 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 2009 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 from 2007
to 2008 (as estimated by the Bureau of the Census) plus 4
percentage points, and further increased by the population
growth for children in that State from 2008 to 2009 (as
estimated by the Bureau of the Census) plus 4 percentage
points;
``(II) for each of fiscal years 2010, 2011, and 2012, 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 from the
calendar year in which the respective fiscal year begins to
the succeeding calendar year (as estimated by the Bureau of
the Census) plus 3.5 percentage points;
``(III) for each of fiscal years 2013, 2014, and 2015, 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 from the
calendar year in which the respective fiscal year begins to
the succeeding calendar year (as estimated by the Bureau of
the Census) plus 3 percentage points; and
``(IV) 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 from the
calendar year in which the fiscal year involved begins to the
succeeding calendar year (as estimated by the Bureau of the
Census) plus 2 percentage points.

``(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
$3,225,000,000 for fiscal year 2009 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 2009 through 2012.--As of December 31
of fiscal year 2009, and as of December 31 of each succeeding
fiscal year through fiscal year 2012, the portion, if any, of
the amount appropriated under subsection (a) for such fiscal
year that is unobligated for allotment to a State under
subsection (m) for such fiscal year or set aside under
subsection (a)(3) or (b)(2) of section 2111 for such fiscal
year.
``(bb) First half of fiscal year 2013.--As of December 31
of fiscal year 2013, the portion, if any, of the sum of the
amounts appropriated under subsection (a)(16)(A) and under
section 108 of the Children's Health Insurance
Reauthorization Act of 2009 for the period beginning on
October 1, 2012, and ending on March 31, 2013, that is
unobligated for allotment to a State under subsection (m) for
such fiscal year or set aside under subsection (b)(2) of
section 2111 for such fiscal year.
``(cc) Second half of fiscal year 2013.--As of June 30 of
fiscal year 2013, the portion, if any, of the amount
appropriated under subsection (a)(16)(B) for the period
beginning on April 1, 2013, and ending on September 30, 2013,
that is unobligated for allotment to a State under subsection
(m) 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 2010 through 2013,
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, 2007, and
2008 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 2010 through 2013, any
amount in excess of the aggregate cap applicable to the Child
Enrollment Contingency Fund for the fiscal year under section
2104(n).
``(IV) Unexpended transitional coverage block grant for
nonpregnant childless adults.--As of October 1, 2011, any
amounts set aside under section 2111(a)(3) that are not
expended by September 30, 2011.

``(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, 2008, for enrollment under title XIX, taking
into account criteria applied as of such date under title XIX
pursuant to a waiver under section 1115. Such term does not
include any children for whom the State has made an election
to provide medical assistance under section 1903(v)(4).
``(G) Application to commonwealths and territories.--The
provisions of subparagraph (G) of section 2104(n)(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 2008.--In the case
of a State that provides coverage under section 115 of the
Children's Health Insurance Program Reauthorization Act of
2009 for any fiscal year after fiscal year 2008--
``(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 4 of the following enrollment and retention provisions
(treating each subparagraph as a separate enrollment and
retention provision) throughout the entire fiscal year:
``(A) Continuous eligibility.--The State has elected the
option of continuous eligibility for a full 12 months for all
children described in section 1902(e)(12) under title XIX
under 19 years of age, as well as applying such policy under
its State child health plan under this title.
``(B) Liberalization of asset requirements.--The State
meets the requirement specified in either of the following
clauses:
``(i) Elimination of asset test.--The State does not apply
any asset or resource test for eligibility for children under
title XIX or this title.
``(ii) Administrative verification of assets.--The State--

``(I) permits a parent or caretaker relative who is
applying on behalf of a child for medical assistance under
title XIX or child health assistance under this title to
declare and certify by signature under penalty of perjury
information relating to family assets for purposes of
determining and redetermining financial eligibility; and
``(II) takes steps to verify assets through means other
than by requiring documentation from parents and applicants
except in individual cases of discrepancies or where
otherwise justified.

``(C) Elimination of in-person interview requirement.--The
State does not require an application of a child for medical
assistance under title XIX (or for child health assistance
under this title), including an application for renewal of
such assistance, to be made in person nor does the State
require a face-to-face interview, unless there are
discrepancies or individual circumstances justifying an in-
person application or face-to-face interview.
``(D) Use of joint application for medicaid and chip.--The
application form and supplemental forms (if any) and
information verification process is the same for purposes of
establishing and renewing eligibility for children for
medical assistance under title XIX and child health
assistance under this title.
``(E) Automatic renewal (use of administrative renewal).--
``(i) In general.--The State provides, in the case of
renewal of a child's eligibility for medical assistance under
title XIX or child health assistance under this title, a pre-
printed form completed by the State based on the information
available to the State and notice to the parent or caretaker
relative of the child that eligibility of the child will be
renewed and continued based on such information unless the
State is provided other information. Nothing in this clause
shall be construed as preventing a State from verifying,
through electronic and other means, the information so
provided.
``(ii) Satisfaction through demonstrated use of ex parte
process.--A State shall be treated as satisfying the
requirement of

[[Page H221]]

clause (i) if renewal of eligibility of children under title
XIX or this title is determined without any requirement for
an in-person interview, unless sufficient information is not
in the State's possession and cannot be acquired from other
sources (including other State agencies) without the
participation of the applicant or the applicant's parent or
caretaker relative.
``(F) Presumptive eligibility for children.--The State is
implementing section 1920A under title XIX as well as,
pursuant to section 2107(e)(1), under this title.
``(G) Express lane.--The State is implementing the option
described in section 1902(e)(13) under title XIX as well as,
pursuant to section 2107(e)(1), under this title.''.

SEC. 105. TWO-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 2008, shall
remain available for expenditure by the State through the end
of the second succeeding fiscal year; and
``(B) for fiscal year 2009 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. REDISTRIBUTION OF UNUSED ALLOTMENTS.

(a) Beginning With Fiscal Year 2007.--
(1) In general.--Section 2104(f) (42 U.S.C. 1397dd(f)) is
amended--
(A) by striking ``The Secretary'' and inserting the
following:
``(1) In general.--The Secretary'';
(B) 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
(C) by adding at the end the following new paragraph:
``(2) Shortfall states described.--
``(A) In general.--For purposes of paragraph (1), with
respect to a fiscal year, a shortfall State described in this
subparagraph is a State with a State child health plan
approved under this title for which the Secretary estimates
on the basis of the most recent data available to the
Secretary, that the projected expenditures under such plan
for the State for the fiscal year will exceed the sum of--
``(i) the amount of the State's allotments for any
preceding fiscal years that remains available for expenditure
and that will not be expended by the end of the immediately
preceding fiscal year;
``(ii) the amount (if any) of the child enrollment
contingency fund payment under subsection (n); 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.''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply to redistribution of allotments made for fiscal
year 2007 and subsequent fiscal years.
(b) Redistribution of Unused Allotments for Fiscal Year
2006.--Section 2104(k) (42 U.S.C. 1397dd(k)) is amended--
(1) in the subsection heading, by striking ``the First 2
Quarters of'';
(2) in paragraph (1), by striking ``the first 2 quarters
of''; and
(3) in paragraph (6)--
(A) by striking ``the first 2 quarters of''; and
(B) by striking ``March 31'' and inserting ``September
30''.

SEC. 107. OPTION FOR QUALIFYING STATES TO RECEIVE THE
ENHANCED PORTION OF THE CHIP MATCHING RATE FOR
MEDICAID COVERAGE OF CERTAIN CHILDREN.

(a) In General.--Section 2105(g) (42 U.S.C. 1397ee(g)) is
amended--
(1) in paragraph (1)(A), as amended by section 201(b)(1) of
Public Law 110-173--
(A) by inserting ``subject to paragraph (4),'' after
``Notwithstanding any other provision of law,''; and
(B) by striking ``2008, or 2009'' and inserting ``or
2008''; and
(2) by adding at the end the following new paragraph:
``(4) Option for allotments for fiscal years 2009 through
2013.--
``(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
2009 through 2013 (insofar as the allotment is available to
the State under subsections (e) and (m) 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.''.
(b) Repeal of Limitation on Availability of Fiscal Year
2009 Allotments.--Paragraph (2) of section 201(b) of the
Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public
Law 110-173) is repealed.

SEC. 108. ONE-TIME APPROPRIATION.

There is appropriated to the Secretary, out of any money in
the Treasury not otherwise appropriated, $11,406,000,000 to
accompany the allotment made for the period beginning on
October 1, 2012, and ending on March 31, 2013, under section
2104(a)(16)(A) of the Social Security Act (42 U.S.C.
1397dd(a)(16)(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(m) of the Social Security Act (42 U.S.C. 1397dd(i)), as
added by section 102, for the first 6 months of fiscal year
2013 in the same manner as allotments are provided under
subsection (a)(16)(A) of such section 2104 and subject to the
same terms and conditions as apply to the allotments provided
from such subsection (a)(16)(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 2009, 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,
2010, 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:

[[Page H222]]

``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,
2008; 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 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, 2008).
``(2) Clarification of authority to provide postpartum
services.--Any State that provides child health assistance
under any authority described in paragraph (1) may continue
to provide such assistance, as well as postpartum services,
through the end of the month in which the 60-day period
(beginning on the last day of the pregnancy) ends, in the
same manner as such assistance and postpartum services would
be provided if provided under the State plan under title XIX,
but only if the mother would otherwise satisfy the
eligibility requirements that apply under the State child
health plan (other than with respect to age) during such
period.
``(3) No inference.--Nothing in this subsection shall be
construed--
``(A) to infer congressional intent regarding the legality
or illegality of the content of the sections specified in
paragraph (1)(A); or
``(B) to modify the authority to provide pregnancy-related
services under a waiver specified in paragraph (1)(B).''.
(b) Additional Conforming Amendments.--
(1) No cost sharing for pregnancy-related benefits.--
Section 2103(e)(2) (42 U.S.C. 1397cc(e)(2)) is amended--
(A) in the heading, by inserting ``or pregnancy-related
assistance'' after ``preventive services''; and
(B) by inserting before the period at the end the
following: ``or for pregnancy-related assistance''.
(2) No waiting period.--Section 2102(b)(1)(B) (42 U.S.C.
1397bb(b)(1)(B)) is amended--
(A) in clause (i), by striking ``, and'' at the end and
inserting a semicolon;
(B) in clause (ii), by striking the period at the end and
inserting ``; and''; and
(C) by adding at the end the following new clause:
``(iii) may not apply a waiting period (including a waiting
period to carry out paragraph (3)(C)) in the case of a
targeted low-income pregnant woman provided pregnancy-related
assistance under section 2112.''.

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

(a) Phase-Out Rules.--
(1) In general.--Title XXI (42 U.S.C. 1397aa et seq.) is
amended by adding at the end the following new section:

``SEC. 2111. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS
ADULTS; CONDITIONS FOR COVERAGE OF PARENTS.

``(a) Termination of Coverage for Nonpregnant Childless
Adults.--
``(1) No new chip waivers; automatic extensions at state
option through fiscal year 2010.--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 2009, approve or renew a waiver,
experimental, pilot, or demonstration project that would
allow funds made available under this title to be used to
provide child health assistance or other health benefits
coverage to a nonpregnant childless adult; and
``(B) notwithstanding the terms and conditions of an
applicable existing waiver, the provisions of paragraphs (2)
and (3) shall apply for purposes of any period beginning on
or after October 1, 2010, in determining the period to which
the waiver applies, the individuals eligible to be covered by
the waiver, and the amount of the Federal payment under this
title.
``(2) Termination of chip coverage under applicable
existing waivers at the end of fiscal year 2010.--
``(A) In general.--No funds shall be available under this
title for child health assistance or other health benefits
coverage that is provided to a nonpregnant childless adult
under an applicable existing waiver after September 30, 2010.
``(B) Extension upon state request.--If an applicable
existing waiver described in

[[Page H223]]

subparagraph (A) would otherwise expire before October 1,
2010, and the State requests an extension of such waiver, the
Secretary shall grant such an extension, but only through
September 30, 2011.
``(C) Application of enhanced fmap.--The enhanced FMAP
determined under section 2105(b) shall apply to expenditures
under an applicable existing waiver for the provision of
child health assistance or other health benefits coverage to
a nonpregnant childless adult during fiscal year 2010.
``(3) Optional 1-year transitional coverage block grant
funded from state allotment.--Subject to paragraph (4)(B),
each State for which coverage under an applicable existing
waiver is terminated under paragraph (2)(A) may elect to
provide nonpregnant childless adults who were provided child
health assistance or health benefits coverage under the
applicable existing waiver at any time during fiscal year
2010 with such assistance or coverage during fiscal year
2011, as if the authority to provide such assistance or
coverage under an applicable existing waiver was extended
through that fiscal year, but subject to the following terms
and conditions:
``(A) Block grant set aside from state allotment.--The
Secretary shall set aside for the State an amount equal to
the Federal share of the State's projected expenditures under
the applicable existing waiver for providing child health
assistance or health benefits coverage to all nonpregnant
childless adults under such waiver for fiscal year 2010 (as
certified by the State and submitted to the Secretary by not
later than August 31, 2010, and without regard to whether any
such individual lost coverage during fiscal year 2010 and was
later provided child health assistance or other health
benefits coverage under the waiver in that fiscal year),
increased by the annual adjustment for fiscal year 2011
determined under section 2104(m)(5)(A). The Secretary may
adjust the amount set aside under the preceding sentence, as
necessary, on the basis of the expenditure data for fiscal
year 2010 reported by States on CMS Form 64 or CMS Form 21
not later than November 30, 2010, but in no case shall the
Secretary adjust such amount after December 31, 2010.
``(B) No coverage for nonpregnant childless adults who were
not covered during fiscal year 2010.--
``(i) FMAP applied to expenditures.--The Secretary shall
pay the State for each quarter of fiscal year 2011, from the
amount set aside under subparagraph (A), an amount equal to
the Federal medical assistance percentage (as determined
under section 1905(b) without regard to clause (4) of such
section) of expenditures in the quarter for providing child
health assistance or other health benefits coverage to a
nonpregnant childless adult but only if such adult was
enrolled in the State program under this title during fiscal
year 2010 (without regard to whether the individual lost
coverage during fiscal year 2010 and was reenrolled in that
fiscal year or in fiscal year 2011).
``(ii) Federal payments limited to amount of block grant
set-aside.--No payments shall be made to a State for
expenditures described in this subparagraph after the total
amount set aside under subparagraph (A) for fiscal year 2011
has been paid to the State.
``(4) State option to apply for medicaid waiver to continue
coverage for nonpregnant childless adults.--
``(A) In general.--Each State for which coverage under an
applicable existing waiver is terminated under paragraph
(2)(A) may submit, not later than June 30, 2011, an
application to the Secretary for a waiver under section 1115
of the State plan under title XIX to provide medical
assistance to a nonpregnant childless adult whose coverage is
so terminated (in this subsection referred to as a `Medicaid
nonpregnant childless adults waiver').
``(B) Deadline for approval.--The Secretary shall make a
decision to approve or deny an application for a Medicaid
nonpregnant childless adults waiver submitted under
subparagraph (A) within 90 days of the date of the submission
of the application. If no decision has been made by the
Secretary as of September 30, 2011, on the application of a
State for a Medicaid nonpregnant childless adults waiver that
was submitted to the Secretary by June 30, 2011, the
application shall be deemed approved.
``(C) Standard for budget neutrality.--The budget
neutrality requirement applicable with respect to
expenditures for medical assistance under a Medicaid
nonpregnant childless adults waiver shall--
``(i) in the case of fiscal year 2012, allow expenditures
for medical assistance under title XIX for all such adults to
not exceed the total amount of payments made to the State
under paragraph (3)(B) for fiscal year 2011, increased by the
percentage increase (if any) in the projected nominal per
capita amount of National Health Expenditures for calendar
year 2012 over 2011, as most recently published by the
Secretary; and
``(ii) in the case of any succeeding fiscal year, allow
such expenditures to not exceed the amount in effect under
this subparagraph for the preceding fiscal year, increased by
the percentage increase (if any) in the projected nominal per
capita amount of National Health Expenditures for the
calendar year that begins during the fiscal year involved
over the preceding calendar year, as most recently published
by the Secretary.
``(b) Rules and Conditions for Coverage of Parents of
Targeted Low-Income Children.--
``(1) Two-year transition period; automatic extension at
state option through fiscal year 2011.--
``(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 2009 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, 2011, 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, 2011, and the State requests an
extension of such waiver, the Secretary shall grant such an
extension, but only, subject to paragraph (2)(A), through
September 30, 2011.
``(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 the third and
fourth quarters of fiscal year 2009 and during fiscal years
2010 and 2011.
``(2) Rules for fiscal years 2012 through 2013.--
``(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 2012 or 2013, 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 2013, the set aside for any State shall
be computed separately for each period described in
subparagraphs (A) and (B) of section 2104(a)(16) and any
reduction in the allotment for either such period under
section 2104(m)(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 2012 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 2012 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 2011; 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 2013.--For
purposes of clause (ii), the applicable percentage for any
quarter of fiscal year 2013 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 2012; and
``(bb) the State met either of the coverage benchmarks
described in subparagraph (B) or (C) of paragraph (3) for
2012; 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

[[Page H224]]

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
2009.
``(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 2011;
``(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 during fiscal year 2009.
``(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
2009 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
2009, nothing''.
(b) GAO Study and Report.--
(1) In general.--The Comptroller General of the United
States shall conduct a study of whether--
(A) the coverage of a parent, a caretaker relative (as such
term is used in carrying out section 1931), or a legal
guardian of a targeted low-income child under a State health
plan under title XXI of the Social Security Act increases the
enrollment of, or the quality of care for, children, and
(B) such parents, relatives, and legal guardians who enroll
in such a plan are more likely to enroll their children in
such a plan or in a State plan under title XIX of such Act.
(2) Report.--Not later than 2 years after the date of the
enactment of this Act, the Comptroller General shall report
the results of the study to the Committee on Finance of the
Senate and the Committee on Energy and Commerce of the House
of Representatives, including recommendations (if any) for
changes in legislation.

SEC. 113. ELIMINATION OF COUNTING MEDICAID CHILD PRESUMPTIVE
ELIGIBILITY COSTS AGAINST TITLE XXI ALLOTMENT.

(a) In General.--Section 2105(a)(1) (42 U.S.C.
1397ee(a)(1)) is amended--
(1) in the matter preceding subparagraph (A), by striking
``(or, in the case of expenditures described in subparagraph
(B), the Federal medical assistance percentage (as defined in
the first sentence of section 1905(b)))''; and
(2) by striking subparagraph (B) and inserting the
following new subparagraph:
``(B) [reserved]''.
(b) Amendments to Medicaid.--
(1) Eligibility of a newborn.--Section 1902(e)(4) (42
U.S.C. 1396a(e)(4)) is amended in the first sentence by
striking ``so long as the child is a member of the woman's
household and the woman remains (or would remain if pregnant)
eligible for such assistance''.
(2) Application of qualified entities to presumptive
eligibility for pregnant women under medicaid.--Section
1920(b) (42 U.S.C. 1396r-1(b)) is amended by adding after
paragraph (2) the following flush sentence:
``The term `qualified provider' also includes a qualified
entity, as defined in section 1920A(b)(3).''.

SEC. 114. LIMITATION ON MATCHING RATE FOR STATES THAT PROPOSE
TO COVER CHILDREN WITH EFFECTIVE FAMILY INCOME
THAT EXCEEDS 300 PERCENT OF THE POVERTY LINE.

(a) FMAP Applied to Expenditures.--Section 2105(c) (42
U.S.C. 1397ee(c)) is amended by adding at the end the
following new paragraph:
``(8) Limitation on matching rate for expenditures for
child health assistance provided to children whose effective
family income exceeds 300 percent of the poverty line.--
``(A) FMAP applied to expenditures.--Except as provided in
subparagraph (B), for fiscal years beginning with fiscal year
2009, the Federal medical assistance percentage (as
determined under section 1905(b) without regard to clause (4)
of such section) shall be substituted for the enhanced FMAP
under subsection (a)(1) with respect to any expenditures for
providing child health assistance or health benefits coverage
for a targeted low-income child whose effective family income
would exceed 300 percent of the poverty line but for the
application of a general exclusion of a block of income that
is not determined by type of expense or type of income.
``(B) Exception.--Subparagraph (A) shall not apply to any
State that, on the date of enactment of the Children's Health
Insurance Program Reauthorization Act of 2009, has an
approved State plan amendment or waiver to provide, or has
enacted a State law to submit a State plan amendment to
provide, expenditures described in such subparagraph under
the State child health plan.''.
(b) Rule of Construction.--Nothing in the amendments made
by this section shall be construed as--
(1) changing any income eligibility level for children
under title XXI of the Social Security Act; or
(2) changing the flexibility provided States under such
title to establish the income eligibility level for targeted
low-income children under a State child health plan and the
methodologies used by the State to determine income or assets
under such plan.

SEC. 115. STATE AUTHORITY UNDER MEDICAID.

Notwithstanding any other provision of law, including 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, at State option, the Secretary shall provide
the State with the Federal medical assistance percentage
determined for the State for Medicaid with respect to
expenditures described in section 1905(u)(2)(A) of such Act
or otherwise made to provide medical assistance under
Medicaid to a child who could be covered by the State under
CHIP.

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 2009 through 2013 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

[[Page H225]]

``(B) submit the most demonstrable evidence required under
paragraphs (1) and (2) of subsection (c).
``(2) Ten percent set aside for outreach to indian
children.--An amount equal to 10 percent of the funds
appropriated under subsection (g) shall be used by the
Secretary to award grants to Indian Health Service providers
and urban Indian organizations receiving funds under title V
of the Indian Health Care Improvement Act (25 U.S.C. 1651 et
seq.) for outreach to, and enrollment of, children who are
Indians.
``(c) Application.--An eligible entity that desires to
receive a grant under subsection (a) shall submit an
application to the Secretary in such form and manner, and
containing such information, as the Secretary may decide.
Such application shall include--
``(1) evidence demonstrating that the entity includes
members who have access to, and credibility with, ethnic or
low-income populations in the communities in which activities
funded under the grant are to be conducted;
``(2) evidence demonstrating that the entity has the
ability to address barriers to enrollment, such as lack of
awareness of eligibility, stigma concerns and punitive fears
associated with receipt of benefits, and other cultural
barriers to applying for and receiving child health
assistance or medical assistance;
``(3) specific quality or outcomes performance measures to
evaluate the effectiveness of activities funded by a grant
awarded under this section; and
``(4) an assurance that the eligible entity shall--
``(A) conduct an assessment of the effectiveness of such
activities against the performance measures;
``(B) cooperate with the collection and reporting of
enrollment data and other information in order for the
Secretary to conduct such assessments; and
``(C) in the case of an eligible entity that is not the
State, provide the State with enrollment data and other
information as necessary for the State to make necessary
projections of eligible children and pregnant women.
``(d) Dissemination of Enrollment Data and Information
Determined From Effectiveness Assessments; Annual Report.--
The Secretary shall--
``(1) make publicly available the enrollment data and
information collected and reported in accordance with
subsection (c)(4)(B); and
``(2) submit an annual report to Congress on the outreach
and enrollment activities conducted with funds appropriated
under this section.
``(e) Maintenance of Effort for States Awarded Grants; No
State Match Required.--In the case of a State that is awarded
a grant under this section--
``(1) the State share of funds expended for outreach and
enrollment activities under the State child health plan shall
not be less than the State share of such funds expended in
the fiscal year preceding the first fiscal year for which the
grant is awarded; and
``(2) no State matching funds shall be required for the
State to receive a grant under this section.
``(f) Definitions.--In this section:
``(1) Eligible entity.--The term `eligible entity' means
any of the following:
``(A) A State with an approved child health plan under this
title.
``(B) A local government.
``(C) An Indian tribe or tribal consortium, a tribal
organization, an urban Indian organization receiving funds
under title V of the Indian Health Care Improvement Act (25
U.S.C. 1651 et seq.), or an Indian Health Service provider.
``(D) A Federal health safety net organization.
``(E) A national, State, local, or community-based public
or nonprofit private organization, including organizations
that use community health workers or community-based doula
programs.
``(F) A faith-based organization or consortia, to the
extent that a grant awarded to such an entity is consistent
with the requirements of section 1955 of the Public Health
Service Act (42 U.S.C. 300x-65) relating to a grant award to
nongovernmental entities.
``(G) An elementary or secondary school.
``(2) Federal health safety net organization.--The term
`Federal health safety net organization' means--
``(A) a Federally-qualified health center (as defined in
section 1905(l)(2)(B));
``(B) a hospital defined as a disproportionate share
hospital for purposes of section 1923;
``(C) a covered entity described in section 340B(a)(4) of
the Public Health Service Act (42 U.S.C. 256b(a)(4)); and
``(D) any other entity or consortium that serves children
under a federally funded program, including the special
supplemental nutrition program for women, infants, and
children (WIC) established under section 17 of the Child
Nutrition Act of 1966 (42 U.S.C. 1786), the Head Start and
Early Head Start programs under the Head Start Act (42 U.S.C.
9801 et seq.), the school lunch program established under the
Richard B. Russell National School Lunch Act, and an
elementary or secondary school.
``(3) Indians; indian tribe; tribal organization; urban
indian organization.--The terms `Indian', `Indian tribe',
`tribal organization', and `urban Indian organization' have
the meanings given such terms in section 4 of the Indian
Health Care Improvement Act (25 U.S.C. 1603).
``(4) Community health worker.--The term `community health
worker' means an individual who promotes health or nutrition
within the community in which the individual resides--
``(A) by serving as a liaison between communities and
health care agencies;
``(B) by providing guidance and social assistance to
community residents;
``(C) by enhancing community residents' ability to
effectively communicate with health care providers;
``(D) by providing culturally and linguistically
appropriate health or nutrition education;
``(E) by advocating for individual and community health or
nutrition needs; and
``(F) by providing referral and followup services.
``(g) Appropriation.--There is appropriated, out of any
money in the Treasury not otherwise appropriated,
$100,000,000 for the period of fiscal years 2009 through
2013, 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.
``(i) Grants for Outreach and Enrollment of Native American
Beneficiaries.--
``(1) In general.--To overcome language and cultural
barriers to program access by Native Americans, the Secretary
shall establish grant programs to conduct outreach and
enrollment efforts to increase the enrollment and
participation of eligible individuals in programs of the
Social Security Act (42 U.S.C. 1397aa et seq.) and other
Federal health and social service programs.
``(2) Use of tribal benefits-counselors model.--The grant
program under this subsection shall incorporate expansion and
stabilization of the tribal benefits-counselors model
developed in the State of Washington to overcome language and
cultural barriers to Federal programs.
``(3) Recipients.--In order to qualify for a grant under
this subsection, an applicant shall be a national, nonprofit
organization with successful and verifiable experience in
assisting Native Americans access Federal programs.
``(4) Report.--At the end of the period of funding provided
under subsection (f), the Secretary shall submit to Congress
a report on the grants made under this subsection, including
the efficacy of outreach efforts and the cost effectiveness
of projects funded by such grants in improving access to
Federal programs by Native Americans.''.
(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

[[Page H226]]

adding at the end the following new subparagraph:
``(E) an amount equal to 75 percent of so much of the sums
expended during such quarter (as found necessary by the
Secretary for the proper and efficient administration of the
State plan) as are attributable to translation or
interpretation services in connection with the enrollment of,
retention of, and use of services under this title by,
children of families for whom English is not the primary
language; plus''.
(B) Use of community health workers for outreach
activities.--
(i) In general.--Section 2102(c)(1) of such Act (42 U.S.C.
1397bb(c)(1)) is amended by inserting ``(through community
health workers and others)'' after ``Outreach''.
(ii) In federal evaluation.--Section 2108(c)(3)(B) of such
Act (42 U.S.C. 1397hh(c)(3)(B)) is amended by inserting
``(such as through community health workers and others)''
after ``including practices''.

SEC. 202. INCREASED OUTREACH AND ENROLLMENT OF INDIANS.

(a) In General.--Section 1139 (42 U.S.C. 1320b-9) is
amended to read as follows:

``SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, HEALTH CARE
FOR INDIANS UNDER TITLES XIX AND XXI.

``(a) Agreements With States for Medicaid and CHIP Outreach
On or Near Reservations To Increase the Enrollment of Indians
in Those Programs.--
``(1) In general.--In order to improve the access of
Indians residing on or near a reservation to obtain benefits
under the Medicaid and State children's health insurance
programs established under titles XIX and XXI, the Secretary
shall encourage the State to take steps to provide for
enrollment on or near the reservation. Such steps may include
outreach efforts such as the outstationing of eligibility
workers, entering into agreements with the Indian Health
Service, Indian Tribes, Tribal Organizations, and Urban
Indian Organizations to provide outreach, education regarding
eligibility and benefits, enrollment, and translation
services when such services are appropriate.
``(2) Construction.--Nothing in paragraph (1) shall be
construed as affecting arrangements entered into between
States and the Indian Health Service, Indian Tribes, Tribal
Organizations, or Urban Indian Organizations for such
Service, Tribes, or Organizations to conduct administrative
activities under such titles.
``(b) Requirement To Facilitate Cooperation.--The
Secretary, acting through the Centers for Medicare & Medicaid
Services, shall take such steps as are necessary to
facilitate cooperation with, and agreements between, States
and the Indian Health Service, Indian Tribes, Tribal
Organizations, or Urban Indian Organizations with respect to
the provision of health care items and services to Indians
under the programs established under title XIX or XXI.
``(c) Definition of Indian; Indian Tribe; Indian Health
Program; Tribal Organization; Urban Indian Organization.--In
this section, the terms `Indian', `Indian Tribe', `Indian
Health Program', `Tribal Organization', and `Urban Indian
Organization' have the meanings given those terms in section
4 of the Indian Health Care Improvement Act.''.
(b) Nonapplication of 10 Percent Limit on Outreach and
Certain Other Expenditures.--Section 2105(c)(2) (42 U.S.C.
1397ee(c)(2)) is amended by adding at the end the following:
``(C) Nonapplication to certain expenditures.--The
limitation under subparagraph (A) shall not apply with
respect to the following expenditures:
``(i) Expenditures to increase outreach to, and the
enrollment of, indian children under this title and title
xix.--Expenditures for outreach activities to families of
Indian children likely to be eligible for child health
assistance under the plan or medical assistance under the
State plan under title XIX (or under a waiver of such plan),
to inform such families of the availability of, and to assist
them in enrolling their children in, such plans, including
such activities conducted under grants, contracts, or
agreements entered into under section 1139(a).''.

SEC. 203. STATE OPTION TO RELY ON FINDINGS FROM AN EXPRESS
LANE AGENCY TO CONDUCT SIMPLIFIED ELIGIBILITY
DETERMINATIONS.

(a) Application Under Medicaid and CHIP Programs.--
(1) Medicaid.--Section 1902(e) (42 U.S.C. 1396a(e)) is
amended by adding at the end the following:
``(13) Express Lane Option.--
``(A) In general.--
``(i) Option to use a finding from an express lane
agency.--At the option of the State, the State plan may
provide that in determining eligibility under this title for
a child (as defined in subparagraph (G)), the State may rely
on a finding made within a reasonable period (as determined
by the State) from an Express Lane agency (as defined in
subparagraph (F)) when it determines whether a child
satisfies one or more components of eligibility for medical
assistance under this title. The State may rely on a finding
from an Express Lane agency notwithstanding 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, nationality status, or
qualified alien status.--The State shall satisfy the
requirements of sections 1137(d) and 1902(a)(46)(B) for
verifications of citizenship, nationality status, or
qualified alien 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 relieve a State of the obligation to determine
components of eligibility that are not the subject of an
Express Lane agency's finding, as described in subparagraph
(A);
``(ii) 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
``(iii) 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.

[[Page H227]]

``(III) Prompt follow up.--In making such a determination,
the State shall take prompt action to determine whether the
child should be enrolled in medical assistance under this
title or child health assistance under title XXI pursuant to
subparagraphs (A) and (B) of section 2102(b)(3) (relating to
screen and enroll).
``(IV) Requirement for simplified determination.--In making
such a determination, the State shall use procedures that, to
the maximum feasible extent, reduce the burden imposed on the
individual of such determination. Such procedures may not
require the child's parent, guardian, or custodial relative
to provide or verify information that already has been
provided to the State agency by an Express Lane agency or
another source of information unless the State agency has
reason to believe the information is erroneous.
``(V) Availability of chip matching funds during temporary
enrollment period.--Medical assistance for items and services
that are provided to a child enrolled in title XXI during a
temporary enrollment period under this clause shall be
treated as child health assistance under such title.
``(D) Option for automatic enrollment.--
``(i) In general.--The State may initiate and determine
eligibility for medical assistance under the State Medicaid
plan or for child health assistance under the State CHIP plan
without a program application from, or on behalf of, the
child based on data obtained from sources other than the
child (or the child's family), but a child can only be
automatically enrolled in the State Medicaid plan or the
State CHIP plan if the child or the family affirmatively
consents to being enrolled through affirmation and signature
on an Express Lane agency application, if the requirement of
clause (ii) is met.
``(ii) Information requirement.--The requirement of this
clause is that the State informs the parent, guardian, or
custodial relative of the child of the services that will be
covered, appropriate methods for using such services, premium
or other cost sharing charges (if any) that apply, medical
support obligations (under section 1912(a)) created by
enrollment (if applicable), and the actions the parent,
guardian, or relative must take to maintain enrollment and
renew coverage.
``(E) Coding; application to enrollment error rates.--
``(i) In general.--For purposes of subparagraph (A)(iv),
the requirement of this subparagraph for a State is that the
State agrees to--
``(I) assign such codes as the Secretary shall require to
the children who are enrolled in the State Medicaid plan or
the State CHIP plan through reliance on a finding made by an
Express Lane agency for the duration of the State's election
under this paragraph;
``(II) annually provide the Secretary with a statistically
valid sample (that is approved by Secretary) of the children
enrolled in such plans through reliance on such a finding by
conducting a full Medicaid eligibility review of the children
identified for such sample for purposes of determining an
eligibility error rate (as described in clause (iv)) with
respect to the enrollment of such children (and shall not
include such children in any data or samples used for
purposes of complying with a Medicaid Eligibility Quality
Control (MEQC) review or a payment error rate measurement
(PERM) requirement);
``(III) submit the error rate determined under subclause
(II) to the Secretary;
``(IV) if such error rate exceeds 3 percent for either of
the first 2 fiscal years in which the State elects to apply
this paragraph, demonstrate to the satisfaction of the
Secretary the specific corrective actions implemented by the
State to improve upon such error rate; and
``(V) if such error rate exceeds 3 percent for any fiscal
year in which the State elects to apply this paragraph, a
reduction in the amount otherwise payable to the State under
section 1903(a) for quarters for that fiscal year, equal to
the total amount of erroneous excess payments determined for
the fiscal year only with respect to the children included in
the sample for the fiscal year that are in excess of a 3
percent error rate with respect to such children.
``(ii) No punitive action based on error rate.--The
Secretary shall not apply the error rate derived from the
sample under clause (i) to the entire population of children
enrolled in the State Medicaid plan or the State CHIP plan
through reliance on a finding made by an Express Lane agency,
or to the population of children enrolled in such plans on
the basis of the State's regular procedures for determining
eligibility, or penalize the State on the basis of such error
rate in any manner other than the reduction of payments
provided for under clause (i)(V).
``(iii) Rule of construction.--Nothing in this paragraph
shall be construed as relieving a State that elects to apply
this paragraph from being subject to a penalty under section
1903(u), for payments made under the State Medicaid plan with
respect to ineligible individuals and families that are
determined to exceed the error rate permitted under that
section (as determined without regard to the error rate
determined under clause (i)(II)).
``(iv) Error rate defined.--In this subparagraph, the term
`error rate' means the rate of erroneous excess payments for
medical assistance (as defined in section 1903(u)(1)(D)) for
the period involved, except that such payments shall be
limited to individuals for which eligibility determinations
are made under this paragraph and except that in applying
this paragraph under title XXI, there shall be substituted
for references to provisions of this title corresponding
provisions within title XXI.
``(F) Express lane agency.--
``(i) In general.--In this paragraph, the term `Express
Lane agency' means a public agency that--
``(I) is determined by the State Medicaid agency or the
State CHIP agency (as applicable) to be capable of making the
determinations of one or more eligibility requirements
described in subparagraph (A)(i);
``(II) is identified in the State Medicaid plan or the
State CHIP plan; and
``(III) notifies the child's family--

``(aa) of the information which shall be disclosed in
accordance with this paragraph;
``(bb) that the information disclosed will be used solely
for purposes of determining eligibility for medical
assistance under the State Medicaid plan or for child health
assistance under the State CHIP plan; and
``(cc) that the family may elect to not have the
information disclosed for such purposes; and

``(IV) enters into, or is subject to, an interagency
agreement to limit the disclosure and use of the information
disclosed.
``(ii) Inclusion of specific public agencies.--Such term
includes the following:
``(I) A public agency that determines eligibility for
assistance under any of the following:

``(aa) The temporary assistance for needy families program
funded under part A of title IV.
``(bb) A State program funded under part D of title IV.
``(cc) The State Medicaid plan.
``(dd) The State CHIP plan.
``(ee) The Food and Nutrition Act of 2008 (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, 2013.''.
(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

[[Page H228]]

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, 2012,
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 2009 through 2012.
(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 by adding at the end
the following new section:

``SEC. 1942. AUTHORIZATION TO RECEIVE RELEVANT INFORMATION.

``(a) In General.--Notwithstanding any other provision of
law, a Federal or State agency or private entity in
possession of the sources of data directly relevant to
eligibility determinations under this title (including
eligibility files maintained by Express Lane agencies
described in section 1902(e)(13)(F), information described in
paragraph (2) or (3) of section 1137(a), vital records
information about births in any State, and information
described in sections 453(i) and 1902(a)(25)(I)) is
authorized to convey such data or information to the State
agency administering the State plan under this title, to the
extent such conveyance meets the requirements of subsection
(b).
``(b) Requirements for Conveyance.--Data or information may
be conveyed pursuant to subsection (a) only if the following
requirements are met:
``(1) The individual whose circumstances are described in
the data or information (or such individual's parent,
guardian, caretaker relative, or authorized representative)
has either provided advance consent to disclosure or has not
objected to disclosure after receiving advance notice of
disclosure and a reasonable opportunity to object.
``(2) Such data or information are used solely for the
purposes of--
``(A) identifying individuals who are eligible or
potentially eligible for medical assistance under this title
and enrolling or attempting to enroll such individuals in the
State plan; and
``(B) verifying the eligibility of individuals for medical
assistance under the State plan.
``(3) An interagency or other agreement, consistent with
standards developed by the Secretary--
``(A) prevents the unauthorized use, disclosure, or
modification of such data and otherwise meets applicable
Federal requirements safeguarding privacy and data security;
and
``(B) requires the State agency administering the State
plan to use the data and information obtained under this
section to seek to enroll individuals in the plan.
``(c) Penalties for Improper Disclosure.--
``(1) Civil money penalty.--A private entity described in
the subsection (a) that publishes, discloses, or makes known
in any manner, or to any extent not authorized by Federal
law, any information obtained under this section is subject
to a civil money penalty in an amount equal to $10,000 for
each such unauthorized publication or disclosure. The
provisions of section 1128A (other than subsections (a) and
(b) and the second sentence of subsection (f)) shall apply to
a civil money penalty under this paragraph in the same manner
as such provisions apply to a penalty or proceeding under
section 1128A(a).
``(2) Criminal penalty.--A private entity described in the
subsection (a) that willfully publishes, discloses, or makes
known in any manner, or to any extent not authorized by
Federal law, any information obtained under this section
shall be fined not more than $10,000 or imprisoned not more
than 1 year, or both, for each such unauthorized publication
or disclosure.
``(d) Rule of Construction.--The limitations and
requirements that apply to disclosure pursuant to this
section shall not be construed to prohibit the conveyance or
disclosure of data or information otherwise permitted under
Federal law (without regard to this section).''.
(2) Conforming amendment to title xxi.--Section 2107(e)(1)
(42 U.S.C. 1397gg(e)(1)), as amended by subsection (a)(2), is
amended by adding at the end the following new subparagraph:
``(F) Section 1942 (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 the date of the enactment of this Act.

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

[[Page H229]]

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 maintained 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 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) Subparagraphs (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

[[Page H230]]

at the end the following new sentence: ``Notwithstanding the
preceding sentence, in the case of a child who is born in the
United States to an alien mother for whom medical assistance
for the delivery of the child is made available pursuant to
section 1903(v), the State immediately shall issue a separate
identification number for the child upon notification by the
facility at which such delivery occurred of the child's
birth.''.
(4) Technical amendments.--Section 1903(x)(2) (42 U.S.C.
1396b(x)) is amended--
(A) in subparagraph (B)--
(i) by realigning the left margin of the matter preceding
clause (i) 2 ems to the left; and
(ii) by realigning the left margins of clauses (i) and
(ii), respectively, 2 ems to the left; and
(B) in subparagraph (C)--
(i) by realigning the left margin of the matter preceding
clause (i) 2 ems to the left; and
(ii) by realigning the left margins of clauses (i) and
(ii), respectively, 2 ems to the left.
(c) Application of Documentation System to CHIP.--
(1) In general.--Section 2105(c) (42 U.S.C. 1397ee(c)), as
amended by section 114(a), is amended by adding at the end
the following new paragraph:
``(9) Citizenship documentation requirements.--
``(A) In general.--No payment may be made under this
section with respect to an individual who has, or is,
declared to be a citizen or national of the United States for
purposes of establishing eligibility under this title unless
the State meets the requirements of section 1902(a)(46)(B)
with respect to the individual.
``(B) Enhanced payments.--Notwithstanding subsection (b),
the enhanced FMAP with respect to payments under subsection
(a) for expenditures described in clause (i) or (ii) of
section 1903(a)(3)(F) necessary to comply with subparagraph
(A) shall in no event be less than 90 percent and 75 percent,
respectively.''.
(2) Nonapplication of administrative expenditures cap.--
Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)(C)), as amended
by section 202(b), is amended by adding at the end the
following:
``(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, 2009.
(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, 2009, was determined to be ineligible
for medical assistance under a State Medicaid plan, including
any waiver of such plan, solely as a result of the
application of subsections (i)(22) and (x) of section 1903 of
the Social Security Act (as in effect during such period),
but who would have been determined eligible for such
assistance if such subsections, as amended by subsection (b),
had applied to the individual, a State may deem the
individual to be eligible for such assistance as of the date
that the individual was determined to be ineligible for such
medical assistance on such basis.
(3) Special transition rule for indians.--During the period
that begins on July 1, 2006, and ends on the effective date
of final regulations issued under subclause (II) of section
1903(x)(3)(B)(v) of the Social Security Act (42 U.S.C.
1396b(x)(3)(B)(v)) (as added by subsection (b)(1)(B)), an
individual who is a member of a federally-recognized Indian
tribe described in subclause (II) of that section who
presents a document described in subclause (I) of such
section that is issued by such Indian tribe, shall be deemed
to have presented satisfactory evidence of citizenship or
nationality for purposes of satisfying the requirement of
subsection (x) of section 1903 of such Act.

SEC. 212. REDUCING ADMINISTRATIVE BARRIERS TO ENROLLMENT.

Section 2102(b) (42 U.S.C. 1397bb(b)) is amended--
(1) by redesignating paragraph (4) as paragraph (5); and
(2) by inserting after paragraph (3) the following new
paragraph:
``(4) Reduction of administrative barriers to enrollment.--
``(A) In general.--Subject to subparagraph (B), the plan
shall include a description of the procedures used to reduce
administrative barriers to the enrollment of children and
pregnant women who are eligible for medical assistance under
title XIX or for child health assistance or health benefits
coverage under this title. Such procedures shall be
established and revised as often as the State determines
appropriate to take into account the most recent information
available to the State identifying such barriers.
``(B) Deemed compliance if joint application and renewal
process that permits application other than in person.--A
State shall be deemed to comply with subparagraph (A) if the
State's application and renewal forms and supplemental forms
(if any) and information verification process is the same for
purposes of establishing and renewing eligibility for
children and pregnant women for medical assistance under
title XIX and child health assistance under this title, and
such process does not require an application to be made in
person or a face-to-face interview.''.

SEC. 213. MODEL OF INTERSTATE COORDINATED ENROLLMENT AND
COVERAGE PROCESS.

(a) In General.--In order to assure continuity of coverage
of low-income children under the Medicaid program and the
State Children's Health Insurance Program (CHIP), not later
than 18 months after the date of the enactment of this Act,
the Secretary of Health and Human Services, in consultation
with State Medicaid and CHIP directors and organizations
representing program beneficiaries, shall develop a model
process for the coordination of the enrollment, retention,
and coverage under such programs of children who, because of
migration of families, emergency evacuations, natural or
other disasters, public health emergencies, educational
needs, or otherwise, frequently change their State of
residency or otherwise are temporarily located outside of the
State of their residency.
(b) Report to Congress.--After development of such model
process, the Secretary of Health and Human Services shall
submit to Congress a report describing additional steps or
authority needed to make further improvements to coordinate
the enrollment, retention, and coverage under CHIP and
Medicaid of children described in subsection (a).

SEC. 214. PERMITTING STATES TO ENSURE COVERAGE WITHOUT A 5-
YEAR DELAY OF CERTAIN CHILDREN AND PREGNANT
WOMEN UNDER THE MEDICAID PROGRAM AND CHIP.

(a) Purpose.--In order to promote the health of needy
children and pregnant women residing lawfully in the United
States, States should be permitted to waive certain
restrictions which result in a 5-year delay for coverage of
necessary health services for such children and women under
the Medicaid program and CHIP.
(b) Medicaid Program.--Section 1903(v) of the Social
Security Act (42 U.S.C. 1396b(v)) is amended--
(1) in paragraph (1), by striking ``paragraph (2)'' and
inserting ``paragraphs (2) and (4)''; and
(2) by adding at the end the following new paragraph:
``(4)(A) A State may elect (in a plan amendment under this
title) to provide, notwithstanding sections 401(a), 402(b),
403, and 421 of Public Law 104-193, medical assistance under
a State plan under this title to children and pregnant women
who are lawfully residing in the United States (including
battered individuals described in section 431(c) of such Act)
and are otherwise eligible for such assistance.
``(B) Such election may be made only with respect to either
or both of the following categories of individuals:
``(i) Children.
``(ii) Pregnant women.
``(C) In this paragraph:
``(i) The term `pregnant women' means women during
pregnancy (and during the 60-day period beginning on the last
day of the pregnancy).
``(ii) The term `children' means individuals under age 19
(or such higher age as the State has elected under section
1902(l)(1)(D)), including optional targeted low-income
children described in section 1905(u)(2)(B).''.
(c) CHIP.--Section 2107(e)(1) of such Act (42 U.S.C.
1397gg(e)(1)), as amended by section 203(a)(2) and 203(d)(2),
is amended by redesignating subparagraphs (E) and (F) as
subparagraphs (F) and (G), respectively and by inserting
after subparagraph (D) the following new subparagraph:
``(E) Paragraph (4) of section 1903(v), insofar as it
relates to the category of children or pregnant women (as
such terms are defined in such paragraph), but only if the
State has elected to apply such paragraph with respect to
such category of children or pregnant women under title XIX
and only if, in the case of pregnant women, the State has
elected the option under section 2111 to provide assistance
for pregnant women under this title.''.
(d) Conforming Amendment.--Section 423(d)(1) of Public Law
104-193 is amended by inserting before the period the
following: ``and medical or child health assistance furnished
under section 1903(v)(4) or 2107(e)(1)(E), respectively, of
the Social Security Act''.
(e) Effective Date.--The amendments made by this section
take effect on the date of the enactment of this Act.

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) and 211(c), is amended by adding
at the end the following:
``(10) State option to offer premium assistance.--

[[Page H231]]

``(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 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
2009.
``(K) Notice of availability.--If a State elects to provide
premium assistance subsidies in accordance with this
paragraph, the State shall--
``(i) include on any application or enrollment form for
child health assistance a notice of the availability of
premium assistance subsidies for the enrollment of targeted
low-income children in qualified employer-sponsored coverage;
``(ii) provide, as part of the application and enrollment
process under the State child health plan, information
describing the availability of such subsidies and how to
elect to obtain such a subsidy; and
``(iii) establish such other procedures as the State
determines necessary to ensure that parents are fully
informed of the choices for receiving child health assistance
under the State child health plan or through the receipt of
premium assistance subsidies.
``(L) Application to qualified employer-sponsored benchmark
coverage.--If a group health plan or health insurance
coverage offered through an employer is certified by an
actuary as health benefits coverage that is equivalent to the
benefits coverage in a benchmark benefit package described in
section 2103(b) or benchmark-equivalent coverage that meets
the requirements of section 2103(a)(2), the State may provide
premium assistance subsidies for enrollment of targeted low-
income children in such group health plan or health insurance
coverage in the same manner as such subsidies are provided
under this paragraph for enrollment in qualified employer-
sponsored coverage, but without regard to the requirement to
provide supplemental coverage for benefits and cost-sharing
protection provided under the State child health plan under
subparagraph (E).
``(M) Satisfaction of cost-effectiveness test.--Premium
assistance subsidies for qualified employer-sponsored
coverage offered under this paragraph shall be deemed to meet
the requirement of subparagraph (A) of paragraph (3).''.
(2) Determination of cost-effectiveness for premium
assistance or purchase of family coverage.--
(A) In general.--Section 2105(c)(3)(A) (42 U.S.C.
1397ee(c)(3)(A)) is amended by striking ``relative to'' and
all that follows through the comma and inserting ``relative
to
``(i) the amount of expenditures under the State child
health plan, including administrative expenditures, that the
State would

[[Page H232]]

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, 2010,
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 211(c)(2), is amended
by adding at the end the following new clause:
``(iii) 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.--

[[Page H233]]

``(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 2009, 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 2009, 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).

(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.

[[Page H234]]

(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 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 2009, 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, 2010, 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.

[[Page H235]]

``(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
2009, 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, 2011,
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, 2011, the Secretary shall
establish a pediatric quality measures program to--
``(A) improve and strengthen the initial core child health
care quality measures established by the Secretary under
subsection (a);
``(B) expand on existing pediatric quality measures used by
public and private health care purchasers and advance the
development of such new and emerging quality measures; and
``(C) increase the portfolio of evidence-based, consensus
pediatric quality measures available to public and private
purchasers of children's health care services, providers, and
consumers.
``(2) Evidence-based measures.--The measures developed
under the pediatric quality measures program shall, at a
minimum, be--
``(A) evidence-based and, where appropriate, risk adjusted;
``(B) designed to identify and eliminate racial and ethnic
disparities in child health and the provision of health care;
``(C) designed to ensure that the data required for such
measures is collected and reported in a standard format that
permits comparison of quality and data at a State, plan, and
provider level;
``(D) periodically updated; and
``(E) responsive to the child health needs, services, and
domains of health care quality described in clauses (i),
(ii), and (iii) of subsection (a)(6)(A).
``(3) Process for pediatric quality measures program.--In
identifying gaps in existing pediatric quality measures and
establishing priorities for development and advancement of
such measures, the Secretary shall consult with--
``(A) States;
``(B) pediatricians, children's hospitals, and other
primary and specialized pediatric health care professionals
(including members of the allied health professions) who
specialize in the care and treatment of children,
particularly children with special physical, mental, and
developmental health care needs;
``(C) dental professionals, including pediatric dental
professionals;
``(D) health care providers that furnish primary health
care to children and families who live in urban and rural
medically underserved communities or who are members of
distinct population sub-groups at heightened risk for poor
health outcomes;
``(E) national organizations representing children,
including children with disabilities and children with
chronic conditions;
``(F) national organizations representing consumers and
purchasers of children's health care;
``(G) national organizations and individuals with expertise
in pediatric health quality measurement; and
``(H) voluntary consensus standards setting organizations
and other organizations involved in the advancement of
evidence-based measures of health care.
``(4) Developing, validating, and testing a portfolio of
pediatric quality measures.--As part of the program to
advance pediatric quality measures, the Secretary shall--
``(A) award grants and contracts for the development,
testing, and validation of new, emerging, and innovative
evidence-based measures for children's health care services
across the domains of quality described in clauses (i), (ii),
and (iii) of subsection (a)(6)(A); and
``(B) award grants and contracts for--
``(i) the development of consensus on evidence-based
measures for children's health care services;
``(ii) the dissemination of such measures to public and
private purchasers of health care for children; and
``(iii) the updating of such measures as necessary.
``(5) Revising, strengthening, and improving initial core
measures.--Beginning no later than January 1, 2013, 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, 2010, 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 2009
through 2013, 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

[[Page H236]]

conditions and the use of evidence-based approaches to
improve the effectiveness, safety, and efficiency of health
care services for children; or
``(D) demonstrate the impact of the model electronic health
record format for children developed and disseminated under
subsection (f) on improving pediatric health, including the
effects of chronic childhood health conditions, and pediatric
health care quality as well as reducing health care costs.
``(2) Requirements.--In awarding grants under this
subsection, the Secretary shall ensure that--
``(A) only 1 demonstration project funded under a grant
awarded under this subsection shall be conducted in a State;
and
``(B) demonstration projects funded under grants awarded
under this subsection shall be conducted evenly between
States with large urban areas and States with large rural
areas.
``(3) Authority for multistate projects.--A demonstration
project conducted with a grant awarded under this subsection
may be conducted on a multistate basis, as needed.
``(4) Funding.--$20,000,000 of the amount appropriated
under subsection (i) for a fiscal year shall be used to carry
out this subsection.
``(e) Childhood Obesity Demonstration Project.--
``(1) Authority to conduct demonstration.--The Secretary,
in consultation with the Administrator of the Centers for
Medicare & Medicaid Services, shall conduct a demonstration
project to develop a comprehensive and systematic model for
reducing childhood obesity by awarding grants to eligible
entities to carry out such project. Such model shall--
``(A) identify, through self-assessment, behavioral risk
factors for obesity among children;
``(B) identify, through self-assessment, needed clinical
preventive and screening benefits among those children
identified as target individuals on the basis of such risk
factors;
``(C) provide ongoing support to such target individuals
and their families to reduce risk factors and promote the
appropriate use of preventive and screening benefits; and
``(D) be designed to improve health outcomes, satisfaction,
quality of life, and appropriate use of items and services
for which medical assistance is available under title XIX or
child health assistance is available under title XXI among
such target individuals.
``(2) Eligibility entities.--For purposes of this
subsection, an eligible entity is any of the following:
``(A) A city, county, or Indian tribe.
``(B) A local or tribal educational agency.
``(C) An accredited university, college, or community
college.
``(D) A Federally-qualified health center.
``(E) A local health department.
``(F) A health care provider.
``(G) A community-based organization.
``(H) Any other entity determined appropriate by the
Secretary, including a consortia or partnership of entities
described in any of subparagraphs (A) through (G).
``(3) Use of funds.--An eligible entity awarded a grant
under this subsection shall use the funds made available
under the grant to--
``(A) carry out community-based activities related to
reducing childhood obesity, including by--
``(i) forming partnerships with entities, including schools
and other facilities providing recreational services, to
establish programs for after school and weekend community
activities that are designed to reduce childhood obesity;
``(ii) forming partnerships with daycare facilities to
establish programs that promote healthy eating behaviors and
physical activity; and
``(iii) developing and evaluating community educational
activities targeting good nutrition and promoting healthy
eating behaviors;
``(B) carry out age-appropriate school-based activities
that are designed to reduce childhood obesity, including by--
``(i) developing and testing educational curricula and
intervention programs designed to promote healthy eating
behaviors and habits in youth, which may include--

``(I) after hours physical activity programs; and
``(II) science-based interventions with multiple components
to prevent eating disorders including nutritional content,
understanding and responding to hunger and satiety, positive
body image development, positive self-esteem development, and
learning life skills (such as stress management,
communication skills, problemsolving and decisionmaking
skills), as well as consideration of cultural and
developmental issues, and the role of family, school, and
community;

``(ii) providing education and training to educational
professionals regarding how to promote a healthy lifestyle
and a healthy school environment for children;
``(iii) planning and implementing a healthy lifestyle
curriculum or program with an emphasis on healthy eating
behaviors and physical activity; and
``(iv) planning and implementing healthy lifestyle classes
or programs for parents or guardians, with an emphasis on
healthy eating behaviors and physical activity for children;
``(C) carry out educational, counseling, promotional, and
training activities through the local health care delivery
systems including by--
``(i) promoting healthy eating behaviors and physical
activity services to treat or prevent eating disorders, being
overweight, and obesity;
``(ii) providing patient education and counseling to
increase physical activity and promote healthy eating
behaviors;
``(iii) training health professionals on how to identify
and treat obese and overweight individuals which may include
nutrition and physical activity counseling; and
``(iv) providing community education by a health
professional on good nutrition and physical activity to
develop a better understanding of the relationship between
diet, physical activity, and eating disorders, obesity, or
being overweight; and
``(D) provide, through qualified health professionals,
training and supervision for community health workers to--
``(i) educate families regarding the relationship between
nutrition, eating habits, physical activity, and obesity;
``(ii) educate families about effective strategies to
improve nutrition, establish healthy eating patterns, and
establish appropriate levels of physical activity; and
``(iii) educate and guide parents regarding the ability to
model and communicate positive health behaviors.
``(4) Priority.--In awarding grants under paragraph (1),
the Secretary shall give priority to awarding grants to
eligible entities--
``(A) that demonstrate that they have previously applied
successfully for funds to carry out activities that seek to
promote individual and community health and to prevent the
incidence of chronic disease and that can cite published and
peer-reviewed research demonstrating that the activities that
the entities propose to carry out with funds made available
under the grant are effective;
``(B) that will carry out programs or activities that seek
to accomplish a goal or goals set by the State in the Healthy
People 2010 plan of the State;
``(C) that provide non-Federal contributions, either in
cash or in-kind, to the costs of funding activities under the
grants;
``(D) that develop comprehensive plans that include a
strategy for extending program activities developed under
grants in the years following the fiscal years for which they
receive grants under this subsection;
``(E) located in communities that are medically
underserved, as determined by the Secretary;
``(F) located in areas in which the average poverty rate is
at least 150 percent or higher of the average poverty rate in
the State involved, as determined by the Secretary; and
``(G) that submit plans that exhibit multisectoral,
cooperative conduct that includes the involvement of a broad
range of stakeholders, including--
``(i) community-based organizations;
``(ii) local governments;
``(iii) local educational agencies;
``(iv) the private sector;
``(v) State or local departments of health;
``(vi) accredited colleges, universities, and community
colleges;
``(vii) health care providers;
``(viii) State and local departments of transportation and
city planning; and
``(ix) other entities determined appropriate by the
Secretary.
``(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 2009, 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 2009, 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

[[Page H237]]

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 2009 through 2013.
``(f) Development of Model Electronic Health Record Format
for Children Enrolled in Medicaid or CHIP.--
``(1) In general.--Not later than January 1, 2010, 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, 2010, 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 2009 through 2013, $45,000,000 for the purpose
of carrying out this section (other than subsection (e)).
Funds appropriated under this subsection shall remain
available until expended.''.
(b) Increased Matching Rate for Collecting and Reporting on
Child Health Measures.--Section 1903(a)(3)(A) (42 U.S.C.
1396b(a)(3)(A)), is amended--
(1) by striking ``and'' at the end of clause (i); and
(2) by adding at the end the following new clause:
``(iii) an amount equal to the Federal medical assistance
percentage (as defined in section 1905(b)) of so much of the
sums expended during such quarter (as found necessary by the
Secretary for the proper and efficient administration of the
State plan) as are attributable to such developments or
modifications of systems of the type described in clause (i)
as are necessary for the efficient collection and reporting
on child health measures; and''.

SEC. 402. IMPROVED AVAILABILITY OF PUBLIC INFORMATION
REGARDING ENROLLMENT OF CHILDREN IN CHIP AND
MEDICAID.

(a) Inclusion of Process and Access Measures in Annual
State Reports.--Section 2108 (42 U.S.C. 1397hh) is amended--
(1) in subsection (a), in the matter preceding paragraph
(1), by striking ``The State'' and inserting ``Subject to
subsection (e), the State''; and
(2) by adding at the end the following new subsection:
``(e) Information Required for Inclusion in State Annual
Report.--The State shall include the following information in
the annual report required under subsection (a):
``(1) Eligibility criteria, enrollment, and retention data
(including data with respect to continuity of coverage or
duration of benefits).
``(2) Data regarding the extent to which the State uses
process measures with respect to determining the eligibility
of children under the State child health plan, including
measures such as 12-month continuous eligibility, self-
declaration of income for applications or renewals, or
presumptive eligibility.
``(3) Data regarding denials of eligibility and
redeterminations of eligibility.
``(4) Data regarding access to primary and specialty
services, access to networks of care, and care coordination
provided under the State child health plan, using quality
care and consumer satisfaction measures included in the
Consumer Assessment of Healthcare Providers and Systems
(CAHPS) survey.
``(5) If the State provides child health assistance in the
form of premium assistance for the purchase of coverage under
a group health plan, data regarding the provision of such
assistance, including the extent to which employer-sponsored
health insurance coverage is available for children eligible
for child health assistance under the State child health
plan, the range of the monthly amount of such assistance
provided on behalf of a child or family, the number of
children or families provided such assistance on a monthly
basis, the income of the children or families provided such
assistance, the benefits and cost-sharing protection provided
under the State child health plan to supplement the coverage
purchased with such premium assistance, the effective
strategies the State engages in to reduce any administrative
barriers to the provision of such assistance, and, the
effects, if any, of the provision of such assistance on
preventing the coverage provided under the State child health
plan from substituting for coverage provided under employer-
sponsored health insurance offered in the State.
``(6) To the extent applicable, a description of any State
activities that are designed to reduce the number of
uncovered children in the State, including through a State
health insurance connector program or support for innovative
private health coverage initiatives.''.
(b) Standardized Reporting Format.--
(1) In general.--Not later than 1 year after the date of
enactment of this Act, the Secretary shall specify a
standardized format for States to use for reporting the
information required under section 2108(e) of the Social
Security Act, as added by subsection (a)(2).
(2) Transition period for states.--Each State that is
required to submit a report under subsection (a) of section
2108 of the Social Security Act that includes the information
required under subsection (e) of such section may use up to 3
reporting periods to transition to the reporting of such
information in accordance with the standardized format
specified by the Secretary under paragraph (1).
(c) Additional Funding for the Secretary To Improve
Timeliness of Data Reporting and Analysis for Purposes of
Determining Enrollment Increases Under Medicaid and CHIP.--
(1) Appropriation.--There is appropriated, out of any money
in the Treasury not otherwise appropriated, $5,000,000 to the
Secretary for fiscal year 2009 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.

[[Page H238]]

(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, 2009,
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, 2009.

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, 2009.
(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 (70);
(B) by striking the period at the end of paragraph (71) and
inserting ``; and''; and
(C) by inserting after paragraph (71) the following new
paragraph:
``(72) 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)(72) (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, 2009.
(d) Reporting Information on Dental Health.--
(1) Medicaid.--Section 1902(a)(43)(D)(iii) (42 U.S.C.
1396a(a)(43)(D)(iii)) is amended by inserting ``and other
information relating to the provision of dental services to
such children described in section 2108(e)'' after
``receiving dental services,''.
(2) CHIP.--Section 2108 (42 U.S.C. 1397hh) is amended by
adding at the end the following new subsection:
``(e) Information on Dental Care for Children.--
``(1) In general.--Each annual report under subsection (a)
shall include the following information with respect to care
and services described in section 1905(r)(3) provided to
targeted low-income children enrolled in the State child
health plan under this title at any time during the year
involved:
``(A) The number of enrolled children by age grouping used
for reporting purposes under section 1902(a)(43).
``(B) For children within each such age grouping,
information of the type contained in questions 12(a)-(c) of
CMS Form 416 (that consists of the number of enrolled
targeted low income children who receive any, preventive, or
restorative dental care under the State plan).
``(C) For the age grouping that includes children 8 years
of age, the number of such children who have received a
protective sealant on at least one permanent molar tooth.
``(2) Inclusion of information on enrollees in managed care
plans.--The information under paragraph (1) shall include
information on children who are enrolled in managed care
plans and other private health plans and contracts with such
plans under this title shall provide for the reporting of
such information by such plans to the State.''.
(3) Effective date.--The amendments made by this subsection
shall be effective for annual reports submitted for years
beginning after date of enactment.
(e) Improved Accessibility of Dental Provider Information
to Enrollees Under Medicaid and CHIP.--The Secretary shall--
(1) work with States, pediatric dentists, and other dental
providers (including providers that are, or are affiliated
with, a school of dentistry) to include, not later than 6
months after the date of the enactment of this Act, on the
Insure Kids Now website (http://www.insurekidsnow.gov/) and
hotline (1-877-KIDS-NOW) (or on any successor websites or
hotlines) a current and accurate list of all such dentists
and providers within each State that provide dental services
to children enrolled in the State plan (or waiver) under
Medicaid or the State child health plan (or waiver) under
CHIP, and shall ensure that such list is updated at least
quarterly; and
(2) work with States to include, not later than 6 months
after the date of the enactment of this Act, a description of
the dental services provided under each State plan (or
waiver) under Medicaid and each State child health plan (or
waiver) under CHIP on such Insure Kids Now website, and shall
ensure that such list is updated at least annually.
(f) Inclusion of Status of Efforts To Improve Dental Care
in Reports on the Quality of Children's Health Care Under
Medicaid and CHIP.--Section 1139A(a), as added by section
401(a), is amended--
(1) in paragraph (3)(B)(ii), by inserting ``and, with
respect to dental care, conditions requiring the restoration
of teeth, relief of pain and infection, and maintenance of
dental health'' after ``chronic conditions''; and
(2) in paragraph (6)(A)(ii), by inserting ``dental care,''
after ``preventive health services,''.
(g) GAO Study and Report.--

[[Page H239]]

(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 use disorder benefits, such plan shall
ensure that the financial requirements and treatment
limitations applicable to such mental health or substance use
disorder benefits comply with the requirements of section
2705(a) of the Public Health Service Act in the same manner
as such requirements apply to a group health 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, 2009.
(b) Transition Grants.--
(1) Appropriation.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated to the
Secretary for fiscal year 2009, $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, 2011, 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 the
date of the enactment of this Act.

SEC. 505. 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:
``(11) Enhanced payments.--Notwithstanding subsection (b),
the enhanced FMAP with respect to payments under subsection
(a) for expenditures related to the administration of the
payment error rate measurement (PERM) requirements applicable
to the State child health plan in accordance with the
Improper Payments Information Act of 2002 and parts 431 and
457 of title 42, Code of Federal Regulations (or any related
or successor guidance or regulations) shall in no event be
less than 90 percent.''.
(2) Exclusion of from cap on administrative expenditures.--
Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)C)), as amended
by section 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 new
final rule (in this section referred to as the ``new final
rule'') promulgated after the date of the enactment of this
Act and 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 new final rule in effect for all States
may only be inclusive of errors, as defined in such new final
rule or in guidance issued within a reasonable time frame
after the effective date for such new final rule that
includes detailed guidance for the specific methodology for
error determinations.
(c) Requirements for New Final Rule.--For purposes of
subsection (b), the requirements of this subsection are that
the new 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

[[Page H240]]

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
new 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 or under a final rule for fiscal year
2008 may elect to accept any payment error rate determined in
whole or in part for the State on the basis of data for that
fiscal year or may elect to not have any payment error rate
determined on the basis of such data and, instead, shall be
treated as if fiscal year 2010 or fiscal year 2011 were the
first fiscal year for which the PERM requirements apply to
the State.
(e) Harmonization of MEQC and PERM.--
(1) Reduction of redundancies.--The Secretary shall review
the Medicaid Eligibility Quality Control (in this subsection
referred to as the ``MEQC'') requirements with the PERM
requirements and coordinate consistent implementation of both
sets of requirements, while reducing redundancies.
(2) State option to apply perm data.--A State may elect,
for purposes of determining the erroneous excess payments for
medical assistance ratio applicable to the State for a fiscal
year under section 1903(u) of the Social Security Act (42
U.S.C. 1396b(u)) to substitute data resulting from the
application of the PERM requirements to the State after the
new 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, 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
2009''.
(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 2009, 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(m)(5)(B) and any other data necessary for carrying out
this title.
``(C) Include health insurance survey information in the
American Community Survey related to children.
``(D) Assess whether American Community Survey estimates,
once such survey data are first available, produce more
reliable estimates than the Current Population Survey with
respect to the purposes described in subparagraph (B).
``(E) On the basis of the assessment required under
subparagraph (D), recommend to the Secretary of Health and
Human Services whether American Community Survey estimates
should be used in lieu of, or in some combination with,
Current Population Survey estimates for the purposes
described in subparagraph (B).
``(F) Continue making the adjustments described in the last
sentence of paragraph (1) with respect to expansion of the
sample size used in State sampling units, the number of
sampling units in a State, and using an appropriate
verification element.
``(3) Authority for the secretary of health and human
services to transition to the use of all, or some combination
of, acs estimates upon recommendation of the secretary of
commerce.--If, on the basis of the assessment required under
paragraph (2)(D), the Secretary of Commerce recommends to the
Secretary of Health and Human Services that American
Community Survey estimates should be used in lieu of, or in
some combination with, Current Population Survey estimates
for the purposes described in paragraph (2)(B), the Secretary
of Health and Human Services, in consultation with the
States, may provide for a period during which the Secretary
may transition from carrying out such purposes through the
use of Current Population Survey estimates to the use of
American Community Survey estimates (in lieu of, or in
combination with the Current Population Survey estimates, as
recommended), provided that any such transition is
implemented in a manner that is designed to avoid adverse
impacts upon States with approved State child health plans
under this title.''.

SEC. 603. UPDATED FEDERAL EVALUATION OF CHIP.

Section 2108(c) (42 U.S.C. 1397hh(c)) is amended by
striking paragraph (5) and inserting the following:
``(5) Subsequent evaluation using updated information.--
``(A) In general.--The Secretary, directly or through
contracts or interagency agreements, shall conduct an
independent subsequent evaluation of 10 States with approved
child health plans.
``(B) Selection of states and matters included.--Paragraphs
(2) and (3) shall apply to such subsequent evaluation in the
same manner as such provisions apply to the evaluation
conducted under paragraph (1).
``(C) Submission to congress.--Not later than December 31,
2011, 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 2010 for the purpose
of conducting the evaluation authorized under this paragraph.
Amounts appropriated under this subparagraph shall remain
available for expenditure through fiscal year 2012.''.

SEC. 604. ACCESS TO RECORDS FOR IG AND GAO AUDITS AND
EVALUATIONS.

Section 2108(d) (42 U.S.C. 1397hh(d)) is amended to read as
follows:
``(d) Access to Records for IG and GAO Audits and
Evaluations.--For the purpose of evaluating and auditing the
program established under this title, or title XIX, the
Secretary, the Office of Inspector General, and the
Comptroller General shall have access to any books, accounts,
records, correspondence, and other documents that are related
to the expenditure of Federal funds under this title and that
are in the possession, custody, or control of States
receiving Federal funds under this title or political
subdivisions thereof, or any grantee or contractor of such
States or political subdivisions.''.

SEC. 605. NO FEDERAL FUNDING FOR ILLEGAL ALIENS.

Nothing in this Act allows Federal payment for individuals
who are not lawfully residing in the United States. 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

[[Page H241]]

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. ADJUSTMENT IN COMPUTATION OF MEDICAID FMAP TO
DISREGARD AN EXTRAORDINARY EMPLOYER PENSION
CONTRIBUTION.

(a) In General.--Only for purposes of computing the FMAP
(as defined in subsection (e)) for a State for a fiscal year
(beginning with fiscal year 2006) and applying the FMAP under
title XIX of the Social Security Act, any significantly
disproportionate employer pension or insurance fund
contribution described in subsection (b) shall be disregarded
in computing the per capita income of such State, but shall
not be disregarded in computing the per capita income for the
continental United States (and Alaska) and Hawaii.
(b) Significantly Disproportionate Employer Pension and
Insurance Fund Contribution.--
(1) In general.--For purposes of this section, a
significantly disproportionate employer pension and insurance
fund contribution described in this subsection with respect
to a State is any identifiable employer contribution towards
pension or other employee insurance funds that is estimated
to accrue to residents of such State for a calendar year
(beginning with calendar year 2003) if the increase in the
amount so estimated exceeds 25 percent of the total increase
in personal income in that State for the year involved.
(2) Data to be used.--For estimating and adjustment a FMAP
already calculated as of the date of the enactment of this
Act for a State with a significantly disproportionate
employer pension and insurance fund contribution, the
Secretary shall use the personal income data set originally
used in calculating such FMAP.
(3) Special adjustment for negative growth.--If in any
calendar year the total personal income growth in a State is
negative, an employer pension and insurance fund contribution
for the purposes of calculating the State's FMAP for a
calendar year shall not exceed 125 percent of the amount of
such contribution for the previous calendar year for the
State.
(c) Hold Harmless.--No State shall have its FMAP for a
fiscal year reduced as a result of the application of this
section.
(d) Report.--Not later than May 15, 2009, 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. 615. 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. 616. EXTENSION OF MEDICAID DSH ALLOTMENTS FOR TENNESSEE
AND HAWAII.

Section 1923(f)(6) (42 U.S.C. 1396r-4(f)(6)), as amended by
section 202 of the Medicare Improvements for Patients and
Providers Act of 2008 (Public Law 110-275) is amended--
(1) in the paragraph heading, by striking ``2009 and the
first calendar quarter of fiscal year 2010'' and inserting
``2011 and the first calendar quarter of fiscal year 2012'';
(2) in subparagraph (A)--
(A) in clause (i)--
(i) in the second sentence--

(I) by striking ``and 2009'' and inserting ``, 2009, 2010,
and 2011''; and
(II) by striking ``such portion of''; and

(ii) in the third sentence, by striking ``2010 for the
period ending on December 31, 2009'' and inserting ``2012 for
the period ending on December 31, 2011'';
(B) in clause (ii), by striking ``or for a period in fiscal
year 2010'' and inserting ``2010, 2011, or for period in
fiscal year 2012''; and
(C) in clause (iv)--
(i) in the clause heading, by striking ``2009 and the first
calendar quarter of fiscal year 2010'' and inserting ``2011
and the first calendar quarter of fiscal year 2012''; and
(ii) in each of subclauses (I) and (II), by striking `` or
for a period in fiscal year 2010'' and inserting ``2010,
2011, or for a period in fiscal year 2012''; and
(3) in subparagraph (B)--
(A) in clause (i)--
(i) in the first sentence, by striking ``2009'' and
inserting ``2011''; and
(ii) in the second sentence, by striking ``2010 for the
period ending on December 31, 2009'' and inserting ``2012 for
the period ending on December 31, 2011''.

Subtitle C--Other Provisions

SEC. 621. 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

[[Page H242]]

business concerns to make insurance more affordable,
including Federal and State tax deductions and credits for
health care-related expenses and health insurance expenses
and Federal tax exclusion for health insurance options
available under employer-sponsored cafeteria plans under
section 125 of the Internal Revenue Code of 1986;
(C) efforts to educate the owners of small business
concerns about assistance available through public programs;
and
(D) efforts to educate the owners and employees of small
business concerns regarding the availability of the hotline
operated as part of the Insure Kids Now program of the
Department of Health and Human Services.
(4) Implementation.--In carrying out this subsection, the
task force may--
(A) use any business partner of the Administration,
including--
(i) a small business development center;
(ii) a certified development company;
(iii) a women's business center; and
(iv) the Service Corps of Retired Executives;
(B) enter into--
(i) a memorandum of understanding with a chamber of
commerce; and
(ii) a partnership with any appropriate small business
concern or health advocacy group; and
(C) designate outreach programs at regional offices of the
Department of Health and Human Services to work with district
offices of the Administration.
(5) Website.--The Administrator shall ensure that links to
information on the eligibility and enrollment requirements
for the Medicaid program and State Children's Health
Insurance Program of each State are prominently displayed on
the website of the Administration.
(6) Report.--
(A) In general.--Not later than 2 years after the date of
enactment of this Act, and every 2 years thereafter, the
Administrator shall submit to the Committee on Small Business
and Entrepreneurship of the Senate and the Committee on Small
Business of the House of Representatives a report on the
status of the nationwide campaign conducted under paragraph
(1).
(B) Contents.--Each report submitted under subparagraph (A)
shall include a status update on all efforts made to educate
owners and employees of small business concerns on options
for providing health insurance for children through public
and private alternatives.

SEC. 622. SENSE OF THE SENATE REGARDING ACCESS TO AFFORDABLE
AND MEANINGFUL HEALTH INSURANCE COVERAGE.

(a) Findings.--The Senate finds the following:
(1) There are approximately 45 million Americans currently
without health insurance.
(2) More than half of uninsured workers are employed by
businesses with less than 25 employees or are self-employed.
(3) Health insurance premiums continue to rise at more than
twice the rate of inflation for all consumer goods.
(4) Individuals in the small group and individual health
insurance markets usually pay more for similar coverage than
those in the large group market.
(5) The rapid growth in health insurance costs over the
last few years has forced many employers, particularly small
employers, to increase deductibles and co-pays or to drop
coverage completely.
(b) Sense of the Senate.--The Senate--
(1) recognizes the necessity to improve affordability and
access to health insurance for all Americans;
(2) acknowledges the value of building upon the existing
private health insurance market; and
(3) affirms its intent to enact legislation this year that,
with appropriate protection for consumers, improves access to
affordable and meaningful health insurance coverage for
employees of small businesses and individuals by--
(A) facilitating pooling mechanisms, including pooling
across State lines, and
(B) providing assistance to small businesses and
individuals, including financial assistance and tax
incentives, for the purchase of private insurance coverage.

SEC. 623. LIMITATION ON MEDICARE EXCEPTION TO THE PROHIBITION
ON CERTAIN PHYSICIAN REFERRALS FOR HOSPITALS.

(a) In General.--Section 1877 (42 U.S.C. 1395nn) is
amended--
(1) in subsection (d)(2)--
(A) in subparagraph (A), by striking ``and'' at the end;
(B) in subparagraph (B), by striking the period at the end
and inserting ``; and''; and
(C) by adding at the end the following new subparagraph:
``(C) in the case where the entity is a hospital, the
hospital meets the requirements of paragraph (3)(D).'';
(2) in subsection (d)(3)--
(A) in subparagraph (B), by striking ``and'' at the end;
(B) in subparagraph (C), by striking the period at the end
and inserting ``; and''; and
(C) by adding at the end the following new subparagraph:
``(D) the hospital meets the requirements described in
subsection (i)(1).''; and
(3) by adding at the end the following new subsection:
``(i) Requirements for Hospitals To Qualify for Rural
Provider and Hospital Exception to Ownership or Investment
Prohibition.--
``(1) Requirements described.--For purposes of subsection
(d)(3)(D), the requirements described in this paragraph for a
hospital are as follows:
``(A) Provider agreement.--The hospital had--
``(i) physician ownership or investment on January 1, 2009;
and
``(ii) a provider agreement under section 1866 in effect on
such date.
``(B) Prohibition on physician ownership or investment.--
The percentage of the total value of the ownership or
investment interests held in the hospital, or in an entity
whose assets include the hospital, by physician owners or
investors in the aggregate does not exceed such percentage as
of the date of enactment of this subsection.
``(C) Prohibition on expansion of facility capacity.--
Except as provided in paragraph (3), the number of operating
rooms, procedure rooms, and beds of the hospital at any time
on or after the date of the enactment of this subsection are
no greater than the number of operating rooms, procedure
rooms, and beds as of such date.
``(D) Preventing conflicts of interest.--
``(i) The hospital submits to the Secretary an annual
report containing a detailed description of--

``(I) the identity of each physician owner and physician
investor and any other owners or investors of the hospital;
and
``(II) the nature and extent of all ownership and
investment interests in the hospital.

``(ii) The hospital has procedures in place to require that
any referring physician owner or investor discloses to the
patient being referred, by a time that permits the patient to
make a meaningful decision regarding the receipt of care, as
determined by the Secretary--

``(I) the ownership or investment interest, as applicable,
of such referring physician in the hospital; and
``(II) if applicable, any such ownership or investment
interest of the treating physician.

``(iii) The hospital does not condition any physician
ownership or investment interests either directly or
indirectly on the physician owner or investor making or
influencing referrals to the hospital or otherwise generating
business for the hospital.
``(iv) The hospital discloses the fact that the hospital is
partially owned by physicians--

``(I) on any public website for the hospital; and
``(II) in any public advertising for the hospital.

``(E) Ensuring bona fide ownership and investment.--
``(i) Any ownership or investment interests that the
hospital offers to a physician owner or investor are not
offered on more favorable terms than the terms offered to a
person who is not a physician owner or investor.
``(ii) The hospital (or any investors in the hospital) does
not directly or indirectly provide loans or financing for any
physician owner or investor in the hospital.
``(iii) The hospital (or any investors in the hospital)
does not directly or indirectly guarantee a loan, make a
payment toward a loan, or otherwise subsidize a loan, for any
individual physician owner or investor or group of physician
owners or investors that is related to acquiring any
ownership or investment interest in the hospital.
``(iv) Ownership or investment returns are distributed to
each owner or investor in the hospital in an amount that is
directly proportional to the ownership or investment interest
of such owner or investor in the hospital.
``(v) Physician owners and investors do not receive,
directly or indirectly, any guaranteed receipt of or right to
purchase other business interests related to the hospital,
including the purchase or lease of any property under the
control of other owners or investors in the hospital or
located near the premises of the hospital.
``(vi) The hospital does not offer a physician owner or
investor the opportunity to purchase or lease any property
under the control of the hospital or any other owner or
investor in the hospital on more favorable terms than the
terms offered to an individual who is not a physician owner
or investor.
``(F) Patient safety.--The hospital has the capacity to--
``(i) provide assessment and initial treatment for
patients; and
``(ii) refer and transfer patients to hospitals with the
capability to treat the needs of the patient involved.
``(G) Limitation on application to certain converted
facilities.--The hospital was not converted from an
ambulatory surgical center to a hospital on or after the date
of enactment of this subsection.
``(2) Publication of information reported.--The Secretary
shall publish, and update on an annual basis, the information
submitted by hospitals under paragraph (1)(D)(i) on the
public Internet website of the Centers for Medicare &
Medicaid Services.
``(3) Exception to prohibition on expansion of facility
capacity.--
``(A) Process.--
``(i) Establishment.--The Secretary shall establish and
implement a process under which an applicable hospital (as
defined in subparagraph (E)) may apply for an exception from
the requirement under paragraph (1)(C).

[[Page H243]]

``(ii) Opportunity for community input.--The process under
clause (i) shall provide individuals and entities in the
community in which the applicable hospital applying for an
exception is located with the opportunity to provide input
with respect to the application.
``(iii) Timing for implementation.--The Secretary shall
implement the process under clause (i) on July 1, 2010.
``(iv) Regulations.--Not later than June 1, 2010, the
Secretary shall promulgate regulations to carry out the
process under clause (i).
``(B) Frequency.--The process described in subparagraph (A)
shall permit an applicable hospital to apply for an exception
up to once every 2 years.
``(C) Permitted increase.--
``(i) In general.--Subject to clause (ii) and subparagraph
(D), an applicable hospital granted an exception under the
process described in subparagraph (A) may increase the number
of operating rooms, procedure rooms, and beds of the
applicable hospital above the baseline number of operating
rooms, procedure rooms, and beds of the applicable hospital
(or, if the applicable hospital has been granted a previous
exception under this paragraph, above the number of operating
rooms, procedure rooms, and beds of the hospital after the
application of the most recent increase under such an
exception).
``(ii) 100 percent increase limitation.--The Secretary
shall not permit an increase in the number of operating
rooms, procedure rooms, and beds of an applicable hospital
under clause (i) to the extent such increase would result in
the number of operating rooms, procedure rooms, and beds of
the applicable hospital exceeding 200 percent of the baseline
number of operating rooms, procedure rooms, and beds of the
applicable hospital.
``(iii) Baseline number of operating rooms, procedure
rooms, and beds.--In this paragraph, the term `baseline
number of operating rooms, procedure rooms, and beds' means
the number of operating rooms, procedure rooms, and beds of
the applicable hospital as of the date of enactment of this
subsection.
``(D) Increase limited to facilities on the main campus of
the hospital.--Any increase in the number of operating rooms,
procedure rooms, and beds of an applicable hospital pursuant
to this paragraph may only occur in facilities on the main
campus of the applicable hospital.
``(E) Applicable hospital.--In this paragraph, the term
`applicable hospital' means a hospital--
``(i) that is located in a county in which the percentage
increase in the population during the most recent 5-year
period (as of the date of the application under subparagraph
(A)) is at least 150 percent of the percentage increase in
the population growth of the State in which the hospital is
located during that period, as estimated by Bureau of the
Census and available to the Secretary;
``(ii) whose annual percent of total inpatient admissions
that represent inpatient admissions under the program under
title XIX is equal to or greater than the average percent
with respect to such admissions for all hospitals located in
the county in which the hospital is located;
``(iii) that does not discriminate against beneficiaries of
Federal health care programs and does not permit physicians
practicing at the hospital to discriminate against such
beneficiaries;
``(iv) that is located in a State in which the average bed
capacity in the State is less than the national average bed
capacity; and
``(v) that has an average bed occupancy rate that is
greater than the average bed occupancy rate in the State in
which the hospital is located.
``(F) Procedure rooms.--In this subsection, the term
`procedure rooms' includes rooms in which catheterizations,
angiographies, angiograms, and endoscopies are performed,
except such term shall not include emergency rooms or
departments (exclusive of rooms in which catheterizations,
angiographies, angiograms, and endoscopies are performed).
``(G) Publication of final decisions.--Not later than 60
days after receiving a complete application under this
paragraph, the Secretary shall publish in the Federal
Register the final decision with respect to such application.
``(H) Limitation on review.--There shall be no
administrative or judicial review under section 1869, section
1878, or otherwise of the process under this paragraph
(including the establishment of such process).
``(4) Collection of ownership and investment information.--
For purposes of subparagraphs (A)(i) and (B) of paragraph
(1), the Secretary shall collect physician ownership and
investment information for each hospital.
``(5) Physician owner or investor defined.--For purposes of
this subsection, the term `physician owner or investor' means
a physician (or an immediate family member of such physician)
with a direct or an indirect ownership or investment interest
in the hospital.
``(6) Patient safety requirement.--In the case of a
hospital to which the requirements of paragraph (1) apply,
insofar as the hospital described in this subsection admits a
patient and does not have any physician available on the
premises to provide services during all hours in which the
hospital is providing services to such patient, before
admitting the patient--
``(A) the hospital shall disclose such fact to a patient;
and
``(B) following such disclosure, the hospital shall receive
from the patient a signed acknowledgment that the patient
understands such fact.
``(7) Clarification.--Nothing in this subsection shall be
construed as preventing the Secretary from revoking a
hospital's provider agreement if not in compliance with
regulations implementing section 1866.''.
(b) Enforcement.--
(1) Ensuring compliance.--The Secretary of Health and Human
Services shall establish policies and procedures to ensure
compliance with the requirements described in subsections
(i)(1) and (i)(7) of section 1877 of the Social Security Act,
as added by subsection (a)(3), beginning on the date such
requirements first apply. Such policies and procedures may
include unannounced site reviews of hospitals.
(2) Audits.--Beginning not later than July 1, 2011, the
Secretary of Health and Human Services shall conduct audits
to determine if hospitals violate the requirements referred
to in paragraph (1).

TITLE VII--REVENUE PROVISIONS

SEC. 701. INCREASE IN EXCISE TAX RATE ON TOBACCO PRODUCTS.

(a) Cigars.--
(1) Small cigars.--Paragraph (1) of section 5701(a) of the
Internal Revenue Code of 1986 is amended to read as follows:
``(1) Small cigars.--On cigars, weighing not more than 3
pounds per thousand, the amount determined in accordance with
the following table:

------------------------------------------------------------------------
Tax Rate
``Cigars Removed During Calendar Year-- Per
Thousand--
------------------------------------------------------------------------
2009 or 2010............................................... $12.50
2011 or 2012............................................... $25.00
2013 or 2014............................................... $37.50
2015 or thereafter......................................... $50.00.''.
------------------------------------------------------------------------

(2) Large cigars.--Paragraph (2) of section 5701(a) of such
Code is amended--
(A) by striking ``20.719 percent (18.063 percent on cigars
removed during 2000 or 2001)'' and inserting ``52.4
percent'', and
(B) by striking ``$48.75 per thousand ($42.50 per thousand
on cigars removed during 2000 or 2001)'' and inserting ``40
cents 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''.

[[Page H244]]

(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
``$24.62''.
(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 any tax increase date 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 such date, 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 any tax increase
date, 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.--
(i) In general.--The tax imposed by paragraph (1) shall be
paid on or before August 1, 2009.
(ii) Special rule for small cigars.--In the case of small
cigars, the tax imposed by paragraph (1) on or after January
1, 2011, shall be paid on or before April 1 following any tax
increase date.
(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 any tax increase date 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) Tax increase date.--The term ``tax increase date''
means April 1, 2009, January 1, 2011, January 1, 2013, and
January 1, 2015.
(C) 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 March 31,
2009.

SEC. 702. ADMINISTRATIVE IMPROVEMENTS.

(a) Permit, Inventories, Reports, and Records Requirements
for Manufacturers and Importers of Processed Tobacco.--
(1) Permit.--
(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, reports, and packages.--
(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''.
(C) Packages, marks, labels, and notices.--Section 5723 of
such Code is amended by inserting ``, processed tobacco,''
after ``tobacco products'' each place it appears.
(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.--Sections 5702(j), 5702(k), and
5704(h) 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 April 1, 2009.
(b) Basis for Denial, Suspension, or Revocation of
Permits.--
(1) Denial.--Paragraph (3) of section 5712 of such Code is
amended to read as follows:
``(3) such person (including, in the case of a corporation,
any officer, director, or principal stockholder and, in the
case of a partnership, a partner)--
``(A) is, by reason of his business experience, financial
standing, or trade connections or by reason of previous or
current legal proceedings involving a felony violation of any
other provision of Federal criminal law relating to tobacco
products, processed tobacco, 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, processed tobacco, 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, processed tobacco, 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, processed tobacco, 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 March 31,
2009.
(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 manufactured 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.
(f) Disclosure.--
(1) In general.--Paragraph (1) of section 6103(o) of such
Code is amended by designating the text as subparagraph (A),
moving

[[Page H245]]

such text 2 ems to the right, striking ``Returns'' and
inserting ``(a) in general.--Returns'', and by inserting
after subparagraph (A) (as so redesignated) the following new
subparagraph:
``(B) Use in certain proceedings.--Returns and return
information disclosed to a Federal agency under subparagraph
(A) may be used in an action or proceeding (or in preparation
for such action or proceeding) brought under section 625 of
the American Jobs Creation Act of 2004 for the collection of
any unpaid assessment or penalty arising under such Act.''.
(2) Conforming amendment.--Section 6103(p)(4) of such Code
is amended by striking ``(o)(1)'' both places it appears and
inserting ``(o)(1)(A)''.
(3) Effective date.--The amendments made by this subsection
shall apply on or after the date of the enactment of this
Act.
(g) Transitional Rule.--Any person who--
(1) on April 1 is engaged in business as a manufacturer of
processed tobacco or as an importer of processed tobacco, and
(2) before the end of the 90-day period beginning on such
date, submits an application under subchapter B of chapter 52
of such Code to engage in such business, may, notwithstanding
such subchapter B, continue to engage in such business
pending final action on such application. Pending such final
action, all provisions of such chapter 52 shall apply to such
applicant in the same manner and to the same extent as if
such applicant were a holder of a permit under such chapter
52 to engage in such business.

SEC. 703. TREASURY STUDY CONCERNING MAGNITUDE OF TOBACCO
SMUGGLING IN THE UNITED STATES.

Not later than one year after the date of the enactment of
this Act, the Secretary of the Treasury shall conduct a study
concerning the magnitude of tobacco smuggling in the United
States and submit to Congress recommendations for the most
effective steps to reduce tobacco smuggling. Such study shall
also include a review of the loss of Federal tax receipts due
to illicit tobacco trade in the United States and the role of
imported tobacco products in the illicit tobacco trade in the
United States.

SEC. 704. TIME FOR PAYMENT OF CORPORATE ESTIMATED TAXES.

The percentage under subparagraph (C) of section 401(1) of
the Tax Increase Prevention and Reconciliation Act of 2005 in
effect on the date of the enactment of this Act is increased
by 1 percentage point.

The SPEAKER pro tempore. Pursuant to House Resolution 52, the
gentleman from New Jersey (Mr. Pallone), the gentleman from Missouri
(Mr. Blunt), the gentleman from New York (Mr. Rangel), and the
gentleman from California (Mr. Herger) each will control 15 minutes.
The Chair recognizes the gentleman from New Jersey.

General Leave

Mr. PALLONE. Madam Speaker, I ask unanimous consent that every Member
have 5 legislative days in which to revise and extend their remarks and
include extraneous material on the legislation now before us.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from New Jersey?
There was no objection.
Mr. PALLONE. Madam Speaker, I yield myself 1 minute.
Madam Speaker, we have been working to reauthorize the Children's
Health Insurance Program for the past 2 years. In the last Congress, we
passed legislation that enjoyed bipartisan support in both the House
and Senate as well as the support of the American people.
Unfortunately, it did not enjoy the support of the President, who
vetoed our bill not once, but twice, and went on to proclaim that
uninsured children can simply go to the emergency room to have their
medical needs met.
But this is a new day in Washington. Soon we will have a new
President who has committed himself to reforming our Nation's health
care system so every American can access affordable and quality health
care. The bill we are considering today makes a down payment on that
promise by putting the health and well-being of our children first.
Madam Speaker, this bill will make critical improvements to CHIP.
There will be more resources for States to enroll eligible children.
There will be better benefits. As a result, there will be 11 million
children who will have access to the quality health coverage they need
and deserve.

{time} 1230

The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. PALLONE. Madam Speaker, I yield myself another 15 seconds.
After 2 years of trying to get this bill enacted, we are now nearing
the finish line and with not a moment to spare. As the Nation moves
deeper into a recession and unemployment rates continue to rise,
millions of Americans are joining the ranks of the uninsured, many of
whom are children. We can't delay. We must enact this legislation now.
Madam Speaker, I reserve the balance of my time.
Mr. BLUNT. Madam Speaker, I yield myself 2 minutes.
As I have returned to a more active role in the Energy and Commerce
Committee, Madam Speaker, in this Congress, I will say I was surprised
not to have a markup of this bill.
We don't have to reauthorize this program until April. Certainly I'm
for, as almost all the Members are for, a reauthorization of the
current program and even for discussing how we can make that program
better. But we didn't have a markup. We didn't see the bill, at least I
haven't seen it, until today. And I have concerns about this bill.
Certainly there are several reasons to look at this bill and think we
could have improved it, bring it to the floor.
Poor kids first, poor children first being served was the reason to
have SCHIP, for children whose families couldn't afford insurance. This
bill doesn't require the States to meet any kind of threshold standard
that would ensure that States were doing everything they could to find
kids who needed insurance before they begin to spend money to find kids
who may not have the same need.
Under the bill several thousands of American families would be poor
enough to qualify for SCHIP and have the government pay for their
health care, but they'd be rich enough to still be required to pay the
alternative minimum tax. The bill changes welfare participation laws by
eliminating the 5-year waiting period for legal immigrants to lawfully
reside in the country before they can participate in this program. The
bill significantly weakens provisions in current law requiring
citizenship verification standards before an individual can be enrolled
in this particular program. The bill will ship 2.4 million privately
insured children to a government-run program.
We think we have a better response. While there will be debate about
how this bill is paid for, the biggest problem in the paid-for is in
the 10th year, the final year, we assume that 65 percent of the people
who are receiving the benefit----
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. BLUNT. Madam Speaker, I yield myself 30 more seconds.
In the final bill, we assume that 65 percent of the children
receiving the benefit wouldn't get the benefit anymore.
It seems to me this bill needs more work, would have benefited from a
committee hearing. It doesn't prioritize poor kids to ensure that they
get health care first.
I look forward to the debate today.
Madam Speaker, I reserve the balance of my time.
Mr. RANGEL. Madam Speaker, I yield myself such time as I may consume,
and that won't be long.
This is a great opportunity for Members who have returned to this
Congress, but it's a better opportunity for the new Members.
I won't be speaking on this bill because so many people want to be
associated with this on our side. And I'm convinced it's not a
Republican/Democratic issue. It's an issue of whether the families of
11 million kids are going to get health care. You cannot say in dollars
and cents what it's worth. We had overwhelming support in the other
Congress. Now we don't have the threat of a veto.
So I hope that you consider the children and not technical things
that you're seeking in perfection.
Madam Speaker, I yield the balance of my time over to Pete Stark, who
for over a year has attempted to perfect this bill to reach the
popularity and support it's gained on both sides of the aisle. I thank
Chairman Waxman for the work that his committee and Mr. Dingell have
made to make certain that we all read from the same page. And I look
forward to this being the beginning where one day this Congress can say
that no child will be able to say they're not covered by a decent
health care program. So by unanimous consent I do hope that you will
allow me to turn the balance of my time and

[[Page H246]]

my thanks to Chairman Stark, who brought us to this point once again.
The SPEAKER pro tempore. Without objection, the gentleman from
California will control the time.
There was no objection.
Mr. BLUNT. Madam Speaker, I yield 1 minute to a member of the Health
Subcommittee of the full committee, Mr. Shadegg from Arizona.
Mr. SHADEGG. Madam Speaker, this is a sad day. It's a sad day because
we are about to adopt a radically different bill than the bills that
were before with no hearings and no amendments. I would suggest
democracy deserves better.
About an hour ago, the Democratic majority leader told the tragic
story of Deamonte Driver, a 12-year-old Maryland boy who died in 2007
from complications resulting from what started as a simple toothache.
The majority leader used Deamonte's story to argue that we need to
expand SCHIP.
Stunningly, however, Deamonte Driver's story is a story of a
government health care program that failed. This was a child that went
into a government health care program. It failed him so miserably, he
died.
Several colleagues on the opposite side of the aisle argue that
Republicans don't care about health care. That's dead wrong. We care
about health care for America's poor and America's children. What we
are against and adamantly against is promising Americans health care
but failing to live up to that promise. That is what this bill will do.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. BLUNT. Madam Speaker, I yield the gentleman an additional 30
seconds.
Mr. SHADEGG. The Republican alternative is to give every single
American family, every single one, the ability to buy a health care
plan of their choice, not just the rich, not just the poor, but even
those who don't respond to a government request that they enroll. We
want to put them in a position to buy the health care they need by
their choice from the doctor they choose.
That's not good enough for the other side. They want to expand
government programs that in the tragic story of Deamonte Driver
resulted in the death of a 12-year-old boy from a problem that started
as a toothache.
Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentleman from
California, the chairman of the Energy and Commerce Committee (Mr.
Waxman).
(Mr. WAXMAN asked and was given permission to revise and extend his
remarks.)
Mr. WAXMAN. Madam Speaker, I want to thank the gentleman from New
Jersey, a very able chairman of the subcommittee of the Energy and
Commerce Committee, for his authorship and managing this bill today.
This is an important bill, and I want to commend Chairman Emeritus
John Dingell for all the work he has done on this legislation.
This bill and everything that's in it has already passed the House in
the last 2 years; so we're not talking about anything new. What we are
talking about is legislation that President Bush vetoed twice even
though there was a strong bipartisan majority in the House and the
Senate to try to get this legislation into law. The original program
was a bipartisan program adopted in 1998, and it's going to be
expiring; so we need to reauthorize it.
This bill is a down payment, a down payment on health care for all
Americans. But at least we will start covering millions of low-income
children, children who are right above the poverty line.
I urge support for the legislation.
Ten years ago, a Democratic President and Republican Congress worked
together to pass a landmark program to provide health care to children
who had fallen through the cracks of our health care system.
That program--CHIP--expires in less than 3 months. This bill extends
and improves that program and makes the largest investment in
children's health since the original CHIP law was enacted.
It provides new outreach tools and bonus payments to states that find
and enroll these children.
The bill provides a new option to cover pregnant women in CHIP. It
provides states the ability to ensure that children don't have to wait
5 years for health care just because they are legal immigrants residing
in this country.
This bill is not the end but the beginning of a health reform effort
that will ensure all children and all Americans will have health care
coverage.
I urge my colleagues to support this bill. Let's send to incoming
President Obama legislation that will make all the difference in the
lives of millions of children across this Nation.
Mr. BLUNT. Madam Speaker, I yield 1 minute to the gentleman from
Texas, Dr. Burgess, who is on our committee and on the subcommittee.
Mr. BURGESS. I thank the gentleman for yielding.
Madam Speaker, the bill before us today is going to harm access to
high-quality hospital care by prohibiting physician ownership of
hospitals.
In past Congresses there have been attempts to prohibit physician
ownership, and they have been struck down due in large part by the
recognition of many Members of Congress across the aisle and on this
side that these few physician-owned hospitals are doing a great job.
Patients like going there. Physicians and nurses like working there.
And I will just tell you as someone who has worked in a physician-owned
facility, there's nothing like the pride of ownership in helping you
deliver first class care.
The bill before us today will put rural Americans at risk. Physician-
owned hospitals also provide care in many rural areas of this country
where patients have few health care options.
The attack on physician-owned hospitals will hurt the economy in a
number of States. It's estimated up to $4 billion is generated in
activity in these facilities in eight States in the country including
my own home State of Texas.
During this time of economic downturn, it is simply irresponsible to
shut down a strong stream of economic activity in these States while
shutting down patient access to care.
Mr. STARK. Madam Speaker, I am delighted to yield 1 minute to the
distinguished gentleman from Washington, Dr. McDermott.
(Mr. McDERMOTT asked and was given permission to revise and extend
his remarks.)
Mr. McDERMOTT. Madam Speaker, I rise in strong support for SCHIP
reauthorization legislation, and I want to thank Speaker Pelosi for her
leadership in bringing this bill to the floor as the first bill.
H.R. 2 clearly says that change has arrived for our country and our
children. Instead of a veto pen that was used last year by the outgoing
President to deny health care to children, our new President will sign
this legislation and in so doing to begin a new chapter in America's
commitment to its children and our future.
H.R. 2 is a real down payment on our efforts to get universal access
to affordable health care for all Americans. It builds on a successful
model that has expanded access to millions of children nationwide.
Health care should be a right, not a privilege for the rich in
America. This legislation affirms the commitment of the new Congress to
serve all the people, not merely those with means who can pay any price
for health care while the Nation pays a steep price for not covering
its children. H.R. 2 represents an additional 4 million children who
will get health care.
It's time to act, now.
H.R. 2 means an additional 4 million children will have access to
health care. It will provide access to preventive health care and this
alone means America will raise healthier children who will grow to
become healthier and more productive adults.
The American people have spoken. They want a more compassionate
response to our Nation's problems. Today, we are voting with our heads
and hearts to do just that. This is not about ideology or party. It is
about providing health care to children. H.R. 2 represents real change.
l am proud to represent a State that took the lead on expanded access
for children. In 1994, 3 years before the enactment of the original
SCHIP, Washington State expanded access to children up to 200 percent
of the Federal poverty level.
This was a huge commitment and clearly my State took the lead. As a
result we have fewer children uninsured. We have a healthier population
and more integrated primary care. It's a commitment that worked for all
of us in the State.
H.R. 2 recognizes Washington State's efforts and includes language
that will allow the State to access a more than $30 million to maintain
this commitment. H.R. 2 rewards States like Washington who knew early
on

[[Page H247]]

that providing quality affordable health care to children was a sound
and humane investment.
H.R. 2 will also allow Washington State to expand our successful
program to cover more uninsured children in working families. The bill
provides greater flexibility and will allow the State to meet the needs
of our low income working families.
I am also grateful that this legislation includes important access
for legal immigrant children who are currently denied coverage--
children who are born in the U.S. and are legal U.S. citizens. In
Washington State we have provided coverage for these children. But the
State is doing this alone without the full partnership of the Federal
Government. H.R. 2 corrects this error and will allow Washington State
to maintain coverage for more than 3,000 children.
Madam Speaker, we need to do the right thing. Providing universal
coverage for children is an objective that we should all support. This
legislation takes us one step closer to meeting this goal. I urge my
colleagues to support this bill.
Mr. BLUNT. Madam Speaker, I yield 1 minute to the gentleman from
Texas, a member of the Ways and Means Committee (Mr. Culberson).
Mr. CULBERSON. Madam Speaker, the most open, allegedly transparent
Congress in the history of America has begun this session by throwing
out a bill that may cost upwards of $100 billion over 10 years that was
written in secret. This bill has never had a committee hearing, not
allowed amendments. There are no amendments allowed on the floor of the
House.
No one would consider buying a house, buying a car without reading
the contract; yet you're asking the American people to spend borrowed
money, up to $100 billion of borrowed money--every dollar we spend from
this day forward is borrowed money--asking us to spend up to $100
billion over 10 years and not knowing what's in the bill. This is a
blind ``yes'' vote for all of you.
We all support health insurance for children, but we must remember
the $62 trillion of unfunded liability that our children and
grandchildren are facing today. The money we spend today is going to be
passed on to future generations, and it's essential that the public be
given the right to read these bills. This bill was not even posted up
on the Web site publicly until about 24 hours ago. What are you afraid
of?
Let the sunshine in and let the public read your legislation.
Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentleman from
Michigan, the chairman emeritus of the Energy and Commerce Committee
(Mr. Dingell).
(Mr. DINGELL asked and was given permission to revise and extend his
remarks.)
Mr. DINGELL. I thank the gentleman for yielding.
Madam Speaker, I stand in strong support of H.R. 2, the Children's
Health Insurance Program Reauthorization Act of 2009. This bill was
passed twice last year by overwhelming votes, with the support of large
numbers of my Republican colleagues.
Since its inception CHIP has covered more than 7 million children who
otherwise would not have had health care. H.R. 2 would extend coverage
to 4 million more children identically situated.
Since last year when this bill passed, more than 1 million children
have lost their health coverage because parents were laid off and lost
employer-based coverage. My own State is particularly hard hit with
over 150,000 uninsured children. These children are our treasure and we
must see to it that they are protected, educated, nurtured, and
properly fed.
The bill is only a beginning. I look forward to working with the new
administration towards reforming our health care system. We must not
stop until all Americans qualify for quality, affordable health care.
I urge my colleagues to vote again for the CHIP Reauthorization Act
of 2009. This bill will be signed into law, and it will help 4 million
kids that without this bill would have no health care.
Mr. BLUNT. Madam Speaker, I yield 1 minute to the gentleman from
Michigan, a member of the Health Subcommittee, Mr. Rogers.

{time} 1245

Mr. ROGERS of Michigan. Madam Speaker, we have seen pictures of
children on the floor, certainly touched our hearts. We have heard
stories, I think from the new gentleman, the new Member from Colorado,
who talked about the 100,000 kids who are eligible and not enrolled.
But what we haven't heard today, or we haven't seen, are the faces of
hundreds of thousands of senior citizens who will be told, when this is
signed into law, you cannot go get your cancer care. You cannot go get
your pain care at the hospital of your choice that your doctor has
referred you to.
We found one hospital in Washington where 90,000 Medicare seniors
will not be able to get the care that they have and the relationship
that they have with their doctors. We can do better.
We should not pit kids against seniors. We don't have to do that. And
what you say to that family in Colorado is, you may be a family of four
making $21,000, and we haven't found you yet to get connected to the
services you deserve, but we think we are going to go out and find that
family in New Jersey making $80,000. Apparently that $80,000 family is
more important than that Colorado $21,000 family.
Let's get our priorities right. Let's not pit kids against seniors.
I would urge a strong ``no'' vote against the bill.

Announcement By the Speaker Pro Tempore

The SPEAKER pro tempore. Members are reminded to heed the gavel and
conclude their remarks within the time yielded.
Mr. STARK. Madam Speaker, I am pleased to recognize the distinguished
gentleman from Georgia (Mr. Lewis) for 1 minute, and Mr. Lewis
understands that the AARP has endorsed this bill.
Mr. LEWIS of Georgia. Madam Speaker, I want to thank the chairman for
yielding.
Madam Speaker, at long last we will do what is right for our Nation's
poorest children. Today we will expand SCHIP to 4 million more
children. We have a mission, an obligation and a mandate to provide
health insurance for all Americans and now we have a Congress and a
President who will meet that obligation for our children.
It has taken too long. This Nation has been wrong to choose war and
greed over children and health. Children need our help. They have a
right to health care.
Today we will do what is right and pass this expansion of SCHIP.
Mr. BLUNT. Madam Speaker, I yield 1 minute to the newest member of
our committee, who is going to add a lot on health care issues, Dr.
Gingrey from Georgia.
Mr. GINGREY of Georgia. Madam Speaker, I rise in opposition to H.R.
2, not because of the 4 million children expansion, as my colleague
from Georgia on the other side of the aisle, the distinguished
Representative John Lewis just said. It's not that; it's that we are
expanding beyond the original intent of the bill. And the chairman, Mr.
Waxman, said in his remarks, right above the poverty line.
Indeed, 200 percent of the Federal poverty level is the intent of the
bill, and yet there are States, 13 of them, who are using a gimmick
called ``income disregard'' to lower the income of a family so that
they become eligible, not only for this program but for Medicaid.
That's wrong. That's gaming the system.
If you had allowed a modified open rule so that we could have brought
amendments to correct that and other things, then I would certainly be
very comfortable and enthusiastic in supporting this bill and
supporting the expansion. But, no, you wouldn't allow that, so I am
going to have to regretfully oppose the bill.
Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentlewoman from
Colorado, the vice chair of our committee, Ms. DeGette.
(Ms. DeGETTE asked and was given permission to revise and extend her
remarks.)
Ms. DeGETTE. Madam Speaker, 6 million children in this country who
are currently eligible for SCHIP and Medicaid do not have health
insurance. These children's parents work, but they cannot afford to
ensure that their children have well-child care, and they have to
resort to the emergency room for even the most basic services, like
treatment for an ear infection. This is wrong.
Today's bill will help these families, but with a number of changes
that vastly improve the legislation. It allows States to give coverage
to pregnant women and people who are here

[[Page H248]]

legally. It preserves simplified outreach and enrollment procedures.
Madam Speaker, in the face of the current economic downturn, it is
even more vital that we enact this bill. Sharp increases in
unemployment are adding to the ranks of the uninsured, while at the
same time State budgets are shrinking, and the safety net is struggling
to meet this increased demand.
Because, Madam Speaker, we need to provide this care for our kids
because in the most civilized country in the world, no child should go
without health care.
Mr. BLUNT. Madam Speaker, I yield 1 minute to the gentlelady from
Tennessee (Mrs. Blackburn).
Mrs. BLACKBURN. Madam Speaker, you know, it is so interesting as we
have this debate, SCHIP, as it was originally put in place, is
something that we are all for. That program as a block grant program
worked well.
But, Madam Speaker, here is a 285-page bill that the Democrat
majority laid on the table yesterday about 1:00.
In that bill, it allows for expansion of coverage to adults. We know
that there were over 700,000 adults on this program at some point in
2006. We also know I had an amendment that would have removed, phased
out all non-pregnant adults from this program and that amendment was
not allowed.
This bill, this bill, will actually crowd out a lot of the low-income
children who have benefited from being on the SCHIP program, and I find
that very unfortunate that we will reduce the amount of health care
available to the children of the working poor and allow the expansion
of adults and middle-income children.
Mr. STARK. Madam Speaker, I am pleased to yield 1 minute to the
distinguished gentleman from New Jersey (Mr. Pascrell) who understands
that many of the adults on the program last year were pregnant women.
Mr. PASCRELL. Madam Speaker, you can't have it both ways. You can't
be for it and then you are going to vote against it.
I am listening to the many people on the other side. Substance is
more important than process. You don't get it. You don't understand it.
So I am in strong support as a proud cosponsor of the Children's
Health Insurance Program which does reauthorize and is fiscally
responsible, reasonable. This is long overdue.
Ensuring health coverage for our Nation's children is a critical
first step in any health reform effort. In fact, it's the least we can
do. If we can't have universal care automatically right now, then we
need to at least take care of the children of our country. You say you
agree with it, then you ought to vote for it.
Taking swift and decisive action on this legislation has become
critically important. As unemployment climbs, the ranks of the
uninsured swell, and the roles of our safety-net programs grow. I am
particularly proud that this bill provides flexibility in determining
eligibility criteria that makes sense for individual States.
Higher income eligibilities, for example, are common sense in States
like New Jersey where a dollar simply doesn't go as far.
In New Jersey, we have set out on an ambitious endeavor to cover
every child by July of this year, including the 267,000 currently
uninsured children in our State.
It is estimated that as many as 130,000 of these children are
eligible for FamilyCare, New Jersey's CHIP plan, but are not currently
enrolled.
Passing the important legislation that is before us will help States
like mine to take the steps necessary to ensure that every child has
access to affordable, quality health care.
The stakes are bigger now than ever, so it is time to cast aside
political games and pass this bill.
Mr. BLUNT. Madam Speaker, I yield 1 minute to the gentleman from
Nebraska, a member of our committee, Mr. Terry.
Mr. TERRY. Madam Speaker, under this legislation, physician-owned
hospitals would be banned in the future. This includes the Bellevue
Medical Center currently under construction in my congressional
district.
This first photo is a view of the finished--this is 48 hours old,
this photo here, showing a nice steel structure and a half-completed
building. If this bill would pass today, construction on this facility
has to stop because it's 40 percent owned by physicians. The other
partner in here is a hospital. We have two facilities like this in my
district.
Now, not only is it appalling that we are going to have to shut down
construction on it or else not accept Medicare patients, but the fact
is the community that this is being built in is a town, it's
incorporated within the Omaha area, about 50, 60,000 people and also
has a base, an Air Force base on it. There are no other medical
facilities in this general area. This will be it, and we will be
shutting this down.
Madam Speaker, I rise today in opposition to this SCHIP bill.
Under this legislation, physician-owned hospitals would be banned in
the future. This includes the Bellevue Medical Center currently under
construction in my congressional district. Also, the Midwest
Neuroscience Center and Nebraska Orthopedic Hospital, which are both
specialty hospitals that would not be allowed to expand under this
legislation. The Bellevue Medical Center, to be located at Highway 370
and 25th Street in Bellevue, will have 60 inpatient and observation
beds which will all be private rooms. Potential future expansion can
allow for additional 60 beds. In addition to general medical services,
the hospital will provide labor and delivery care, emergency care,
inpatient and outpatient surgery and intensive care. Facilities will
feature state-of-the-art diagnostic services and equipment, including a
cardiac catheterization lab, radiology, lab testing and pharmacy on
premises. There will be a medical office building adjacent to hospital
which will house patient clinics.
Construction of the Bellevue Medical Center is ongoing. It started
late in 2007 and is expected to be completed later this year with a
total cost of $135 million. Sixty percent of this hospital will be
owned by the Nebraska Medical Center, which is a community hospital,
and up to 40 percent of this hospital will be owned by community
physicians and faculty of the University of Nebraska College of
Medicine. Unfortunately, under Sec. 623, Bellevue Medical Center would
have had to have their Medicare Agreement signed by January 1, 2009, in
order to be compliant. This is very unfortunate for a number of
reasons, but none larger than the community in which this hospital will
serve.
The location in which the hospital is being built is an ideal
location for a new hospital since there is a population of almost
100,000 people who can take advantage of it. This would include the
city of Bellevue, Offutt Air Force Base and Plattsmouth. In particular,
the Bellevue Medical Center would have a strong focus on serving the
healthcare needs of the following military related personnel in the
Bellevue area: 10,000 active duty personnel, 20,000 dependents of
active duty personnel and 11,000 military retirees.
Bellevue's other medical facility, Ehrling Bergquist Clinic, located
at Offutt Air Force Base, no longer has inpatient services and has
limited outpatient services. Operations at this clinic include same-day
surgery, and urgent care. As a result, the Bellevue Medical Center is
needed to meet the hospital needs of the Offutt community. The Bellevue
Medical Center will also serve as a training area for Air Force
physicians, including approximately one-third of the Air Forces's
complement of family practice physicians.
This hospital is also needed to serve the fast-growing population of
Sarpy county, which according to the U.S. Census Bureau, is the fastest
growing county by population in Nebraska and western Iowa. Nebraska
Governor Dave Heineman and the Bellevue Chamber of Commerce support the
Bellevue Medical Center.
Madam Speaker, this is one of the major reasons that I cannot support
this legislation and will be voting against it today.
Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentlewoman from
California (Ms. Eshoo).
Ms. ESHOO. Madam Speaker, I thank the chairman of our subcommittee,
Mr. Pallone, also Mr. Dingell, Mr. Waxman, and everyone that's been
involved in shaping this legislation.
Senator Hubert Humphrey was very fond of saying that a society is
measured on how it treats those in the autumn of their lives and how it
treats those in the spring of their lives.
Today we rise to honor the young in our country with legislation that
will provide for them what is one of the great necessities of life, and
that is health care. We will not have healthy adults in our country
unless we have healthy children.
Today we put down a magnificent down payment to ensure health care
for 11 million children in our country. This is a smartly drafted bill.
Why? Because it is responsible, because it is paid for.
Over 90 percent of the providers are private sector. So I think today
is not only a profound moment in the Congress, but a sacred one. I look
forward

[[Page H249]]

to its passage and what it will do to strengthen our country and
strengthening our country's children.
Mr. BLUNT. Madam Speaker, I yield 1 minute to the gentleman from
Indiana (Mr. Buyer).
Mr. BUYER. I thank the gentleman for yielding.
Madam Speaker, a lot of my colleagues, some of whom were here in
1997, voted against the Balanced Budget Act of 1997, actually voted
against the SCHIP program.
So you are coming here to the floor now accusing Republicans saying
if you are going to go vote against this you are voting against
children.
When we passed this on a bipartisan basis, please don't do that. I am
not going to come here to the floor and say, oh, you were against
children because you voted against the Balanced Budget Act. So let's be
really accurate with regard to our language.
One thing that does concern me right now is when you look at the
number of adults that are on the SCHIP program, every time an adult is
in that program, over 700,000 of them, it costs more money.
So what we should be doing is saying in agreement here SCHIP is a
good program. Republicans created the SCHIP program. When we worked
with Bill Clinton in doing welfare reform, we said we are going to put
people to work. We are going to take care of those children.
The States then got all overeager and excited in a good economy and
expanded the eligibility.
Now, as the economy turns down, now we have President-elect Obama----
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. BLUNT. Madam Speaker, I yield the gentleman an additional 30
seconds.
Mr. BUYER. He is now proposing in the stimulus plan to say well, gee,
let's go to the Federal Government. We don't want to change our
program. Let's go to the Federal Government and ask for 200 billion-
plus to bail out those judgments of the past.
So what, we are going to stimulate the past as now we are going to
add to exacerbate the problem here on the House floor? Let's stop and
pause and think about what we are doing here, folks. Let's look at this
program to actually cover children. You are about to say of the 700,000
adults that are on the program, by 2013 we could have over 1.4 million
in the program.
For every adult that is in this program, we are taking away more
money that actually could cover children.
Mr. STARK. Madam Speaker, I am delighted to yield 1 minute to the
distinguished Congresswoman from Florida (Ms. Kosmas).
Ms. KOSMAS. Thank you, Mr. Chairman.
Madam Speaker, I am pleased today to rise, my first time on the floor
of the House, to speak in favor of the State Children's Health
Insurance Program Reauthorization Act.
This bill, for me, is an opportunity for working families in my
district to provide health care to their children. Let me say it again,
it's an opportunity for parents to provide health care, working
families to provide health care for their children. In these tough
economic times, we have more and more families which are unemployed or
underemployed, and this gives them an opportunity to give their
children the health care that they need and deserve.
With many of them providing health care to their children through
emergency rooms, as opposed to having this access to quality care, we
are losing both an efficiency factor and an economic factor.
So I rise again, as I say, to speak in favor of this bill. Providing
health care to children is not just the right thing to do, but this is
an economic investment that we are making in the future of those who
will carry us forward into the next generation.
Mr. BLUNT. Madam Speaker, I yield 1 minute to the gentleman from
Indiana (Mr. Burton).
Mr. BURTON of Indiana. I don't want to discuss things that have
already been discussed, but the things that concern me are things like
this will be a magnet for more illegal aliens coming into this country
because it's going to provide a mechanism for illegals to get coverage
under this bill.
It's going to cost $44 billion more than the baseline. It's going to
involve a tax increase.
You know, one of the things that really concerns me about what we are
doing is we passed a bailout bill for $700 billion. We are going to
pass another bill here, a supplemental, it's going to be $1.2 trillion.
We spent $14 billion for the auto industry.
This is going to cost $44 billion over the baseline. Where do you
think all this money is coming from? And I wish my colleagues would
start thinking about the kids in the future as well as what we are
talking about today. Because the inflation problem they are going to
face is going to be huge.
You have got to print this money. It has got to come from someplace.
And the kids of kids of today and tomorrow are going to have to pay
through the nose for the things we are doing today. We don't have all
the money to do these things, and yet we are spending. That will lead
to hyperinflation down the road and severe economic problems.

{time} 1300

Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentleman from
Texas (Mr. Gene Green).
(Mr. GENE GREEN of Texas asked and was given permission to revise and
extend his remarks.)
Mr. GENE GREEN of Texas. Madam Speaker, I thank our Chair of our
subcommittee.
I rise in strong support and as a cosponsor of H.R. 2, the Children's
Health Insurance Program Reauthorization Act, or CHIPRA. During the
110th Congress, we made two attempts to reauthorize the SCHIP program.
Unfortunately, both these bills were vetoed by the President.
With 6 million American children currently eligible yet unenrolled,
the passage of this bill is overdue. CHIPRA reauthorizes SCHIP through
2013 and extends SCHIP coverage to 7 million children already enrolled,
but the SCHIP program covers 4 million more children. Eleven million
children will be covered under SCHIP when we pass this bill.
The bill includes a provision that I am proud is in there, H.R. 465,
the Immigrant Children's Health Improvement Act, which gives the States
the option to cover children and pregnant women of lawfully residing
children in our country. These are not illegal immigrants. They are
children who go to school and go to daycare with our children and our
grandchildren. Those children ought to have health care to protect our
own children.
CHIPRA also includes language from another bill of mine, H.R. 1238,
which provides one year of emergency Medicaid coverage for children
born in the U.S. and their mothers, which is crucial in protecting the
health and wellness of newborns born in this country.
I do have to express my disappointment that the bill did not include
the provision that was included in the first SCHIP bill we passed which
would guarantee that children in families earning less than 200 percent
of the poverty level will have 12 months of continuous eligibility
under SCHIP.
The outreach and enrollment package includes an incentive for States
to provide this eligibility guarantee.
But for a State like mine, we need to ensure that the State of Texas
does right by Texas children and doesn't use the flexibility inherent
in the program to kick them off the rolls on a budgetary whim.
The 175,000 Texas children who were kicked off the rolls in 2003 know
all too well of the State's willingness to balance the State budget on
their backs, and I hoped that this bill would take away the State's
ability to do that in the future.
However, the need to reauthorize SCHIP before the program expires on
March 31st is more important than political battles.
I hope my colleagues will join me in supporting this legislation and
sending a strong message to the President that we must abandon partisan
politics and reauthorize SCHIP for America's low-income children.
Mr. BLUNT. Madam Speaker, I yield 1 minute to the gentleman from Iowa
(Mr. Latham).
(Mr. LATHAM asked and was given permission to revise and extend his
remarks.)
Mr. LATHAM. Madam Speaker, I thank the gentleman.
Madam Speaker, there is no question the State Children's Health
Insurance Program needs to be reauthorized to provide the funds
necessary to maintain current coverage and enroll currently eligible
low-income children.
In the past I have supported bipartisan legislation that represented
the

[[Page H250]]

input of both parties to reauthorize the SCHIP program, H.R. 976 and
H.R. 3963, including legislation that was vetoed by President Bush.
However, I cannot support this partisan legislation before us today
because Democrats have radically departed from the bipartisan agreement
that had been reached.
First, they have removed the provision that would have capped
eligibility for SCHIP for families making over 300 percent of the
Federal poverty line, or roughly $63,000 per family of four, allowing
unlimited expansion of the program in the future. Furthermore, there
are no requirements that a certain level of coverage for low-income
children be met before expanding eligibility to higher income groups.
Second, they have rescinded a requirement in current law that
noncitizens who are here must legally wait 5 years to become eligible
for the SCHIP program.
The bill also reduces citizenship verification requirements for the
Medicaid program, potentially allowing illegal aliens to game the
system to obtain taxpayer-funded welfare benefits.
At a time when nearly 70 percent of uninsured American children are
already eligible for Medicaid or SCHIP, our economy is weak and the
budget deficit is soaring, it makes no sense to put non-citizens or
wealthier children ahead of poor American children from hard-working,
tax paying families who desperately need access to these programs.''
Mr. STARK. Madam Speaker, I yield 1 minute to the distinguished
gentleman from Maryland (Mr. Van Hollen).
Mr. VAN HOLLEN. I thank my colleague.
Madam Speaker, this is a moment of important substance and important
symbolism. The substance and merits of this bill are clear. We are
going to preserve health coverage for 7 million American children and
expand it to another 4 million children from working families who earn
too much to qualify for Medicaid, but do not earn enough to be able to
afford the very high costs of private health insurance.
Taking this bill up right now also sends a very important signal that
change has come to Washington, DC as a result of the last election.
President Bush twice vetoed this legislation on children's health. We
will soon have a new President, President Barack Obama, who as one of
his first acts as President will sign this legislation, a President who
understands the hardships American families are struggling under at a
time when more than 2 million Americans have lost their jobs in just 2
months.
The difference could not be clearer. The current President used his
mighty veto pen to say ``no,'' to veto and protect the status quo. The
new President will use that pen to say ``yes,'' to change the status
quo and provide health care to 4 million new American children as we
continue to protect 7 million American children. That is change we can
believe in.
Mr. BLUNT. Can I ask how much time is remaining on each side?
The SPEAKER pro tempore. The gentleman from Missouri (Mr. Blunt) has
90 seconds remaining; the gentleman from California (Mr. Herger) has 15
minutes remaining; the gentleman from New Jersey (Mr. Pallone) has 8\3/
4\ minutes remaining; and the gentleman from California (Mr. Stark) has
9 minutes remaining.
Mr. BLUNT. I reserve the balance of my time.
Mr. HERGER. Madam Speaker, I yield myself such time as I may consume.
Madam Speaker, I rise in support of SCHIP and believe its
reauthorization is critical to millions of children, but I am opposed
to the bill before us today. This legislation does nothing to make
private health coverage more affordable. By expanding a program that
severely underpays doctors in my State of California, it may result in
higher costs for private coverage. And assuming that the increased
tobacco tax achieves the goal of discouraging smoking, it commits an
irrational policy of financing a growing program through a declining
revenue source.
In addition, this new version would effectively shut down physician-
owned hospitals currently under construction, including a $40 million
project in my district in Yuba City, California, scheduled to open in a
couple of months. This will be a severe blow to a small county that has
long had one of the highest unemployment rates in California.
Madam Speaker, in the middle of the worst economic downturn in
decades, this provision would destroy jobs in Yuba City and in dozens
of other cities across America.
I would urge all of my colleagues to ask themselves, do you believe
that a corporate board halfway across the country would do a better job
of holding down costs and ensuring high quality care than a team of
local doctors, and, if so, are you certain enough that you are willing
to deny your constituents the opportunity to make that choice?
I urge rejection of this misguided provision and a ``no'' vote.
I reserve the balance of my time.
Mr. PALLONE. Madam Speaker, I yield to the gentlewoman from New York
(Mrs. Maloney) for the purpose of a unanimous consent request.
(Mrs. MALONEY asked and was given permission to revise and extend her
remarks.)
Mrs. MALONEY. Madam Speaker, I rise in strong support of this bill.
Madam Speaker, if history is any guide, the current recession will
lead to a substantial increase in the demand for children's health care
coverage under SCHIP and Medicaid.
Rising unemployment and staggering job losses have left many families
without health insurance. The high cost of private coverage means more
and more Americans are turning to state programs for assistance.
But state budgets are already strained by the recession, and many
have already enacted budget cuts that would reduce funding for these
programs.
My home state of New York has been forced to propose such cuts.
Unprecedented need combined with a shortage of funding is creating a
perfect storm--a storm that can only be avoided if Congress votes to
reauthorize the Children's Health Insurance Program.
Over the next 4\1/2\ years, our bill, H.R. 2, would preserve coverage
for the more than 7 million children currently covered by SCHIP, and
extend coverage to nearly 4 million children who are currently
uninsured.
Passing SCHIP reauthorization would guarantee sufficient funding
levels for the Children's Health Insurance Program to serve future
enrollment needs. It would bring much needed stability to the program,
giving states fiscal security to plan for expansions and make
improvements in advance of broader health care reform.
This legislation will make covering children the top priority for
SCHIP, while also giving states the option to enroll mothers during
pregnancy. And under the bill all children enrolled in SCHIP will have
dental coverage and access to mental health services.
We are in an economic crisis as serious as any this nation has ever
faced. As families struggle to make ends meet, and states are forced to
make difficult budget cuts, we cannot afford to leave millions of
children without the health insurance they so critically need.
We have the opportunity now to make good on our commitment to helping
America's families in these tough economic times.
I urge my colleagues to vote ``yes'' on H.R. 2.
Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentleman from
Georgia (Mr. Barrow).
Mr. BARROW. Madam Speaker, I thank the gentleman.
Madam Speaker, I am proud to be up here today to support H.R. 2, the
Children's Health Insurance Program Reauthorization Act of 2009. It has
been a long time coming. I am glad we are considering this bill on the
floor so early in this Congress, when we spent most of the last 2 years
trying to enact it. I think it says something very positive about the
commitment of this new Congress and of our new President to improving
health care for all Americans.
H.R. 2 will allow us to enroll 4 million more kids in programs like
Georgia's PeachCare who are just as eligible as the 7 million kids
already enrolled. It is not a free lunch. Parents will still have to
pay what they can afford to pay, but the kids will be able to go to the
doctor, where they get good preventive care at the lowest cost, and
keep them out of the emergency room, where they get the least effective
care at the greatest possible cost to the taxpayer. That is more health
care, better outcomes, at less cost. It is not only the right thing to
do, it is the smart thing to do, and that is why I am proud to be a
cosponsor of this legislation and urge all of my colleagues to support
it.
Mr. HERGER. Madam Speaker, I yield 2 minutes to the gentleman from
Texas (Mr. Sam Johnson), a member of the Health Subcommittee.

[[Page H251]]

(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 in strong
opposition to a provision in this bill that would have drastic
consequences for hospitals in my district and hospitals around the
Nation. Everyone in this Chamber can agree that health care in this
country needs transformation. America has always been a leader when it
comes to medical research, training the best, the brightest, and
providing superior care. We need to make sure that tradition continues.
Physicians across the country have decided they can provide better
health care to more people by engaging in the process. Some doctors
have decided to play a role in the care delivered in the hospitals in
their community, and studies show that this has resulted in higher
quality care and higher patient satisfaction.
Physician-owned hospitals employ highly skilled workers. They are an
engine in the local economy, and language in this bill will devastate
most of them. I say most, because a handful of hospitals located in
special congressional districts will have rights that hospitals in my
district and the majority of others will not. Why do only a handful of
Members of Congress receive the privilege of a carve-out for their
hospitals?
Many facilities have poured millions of dollars into constructing
hospitals that will be forced to shut down because of this bill. Baylor
Hospital in particular in my district is in the process of adding
additional operating rooms and hospital beds to serve the community
needs. This local hospital won't be able to complete the project
because of this bill.
I ask my colleagues on both sides of the aisle to work with me to see
that all existing hospitals and those under development are treated the
same in this legislation. No carve-outs, no special privileges. It has
to be all fair and all the same. Physician-owned hospitals have proven
over and over again they spur greater choice and offer higher quality
care to patients. These hospitals all deserve the right to be able to
continue to serve their community. That is the American way.
Mr. STARK. Madam Speaker, at this time I am pleased to yield 1 minute
to the distinguished gentlewoman from Nevada (Ms. Berkley).
Ms. BERKLEY. I thank the gentleman for yielding.
I rise in support of this long-overdue legislation. Coming from a
State with one of the highest percentages of uninsured children, it is
essential to reauthorize SCHIP to extend the program to cover more low-
income uninsured children.
In 2007, more than 40,000 youngsters benefited from the Nevada Check
Up program. This bill will enable Nevada to continue coverage for these
children and to reach out to a portion of the 70,000 children currently
eligible who remain uninsured. This bill also includes funding to
improve outreach to eligible populations. Increased funding and the
focus on outreach and enrollment will help extend coverage to thousands
of additional Nevada children and an additional 4 million kids
nationwide.
I urge my colleagues to support this bill. I look forward to having a
President in the White House that is anxious to sign it.
Mr. HERGER. Madam Speaker, I yield 2 minutes to the gentleman from
Wisconsin (Mr. Ryan), a member of the Health Subcommittee.
(Mr. RYAN of Wisconsin asked and was given permission to revise and
extend his remarks.)
Mr. RYAN of Wisconsin. Madam Speaker, today is the beginning of a new
Congress. Our new President hasn't even taken the oath of office and we
are throwing fiscal discipline out the door. This whole idea of PAYGO
is gone. It doesn't exist. It is a charade.
Let's take a look at what this bill actually does. This bill proposes
to add all these new kids on the SCHIP program, and then in the out-
years it shoves them off a cliff, taking 7 million children off of the
SCHIP program. They do this only to carve and jam this bill into
compliance with PAYGO.
I received a letter from the CBO just this morning that if this bill
was actually carried through, if you didn't kick all of these children
off of this program, it would cost $42 billion more. This bill has a
$42 billion deficit hole in it. The spending increase in SCHIP in this
bill increases on average 23 percent a year. Madam Speaker, Medicare is
going bankrupt according to the trustees, and that increases at 6.5
percent a year.
We are being deprived of a bipartisan opportunity to extend the
current SCHIP program, which would have an enormous vote here if you
brought a bipartisan bill to the table. That is not what is happening.
Budget gimmicks, fiscal irresponsibility, a $42 billion deficit, and
the creation of a brand new entitlement program. And what is worse, we
are committing our taxpayer dollars, which are so precious in this
difficult economic time, to pay for insurance that people already have.
2.4 million people who already have private health insurance are going
to get kicked off of their private health insurance and the taxpayers
are going to pick up the tab. That is not fiscal responsibility.
Let's solve the uninsured problem. Let's come together and fix the
health care problems in America. Let's not bankrupt the country. Let's
not play budget gimmicks. Let's not throw PAYGO out the window. And
let's not take away the health insurance that people already have and
make them have government-sponsored health insurance. We should reject
this bill.

U.S. Congress,

Congressional Budget Office,

Washington, DC, January 14, 2009.
Hon. Paul Ryan,
Ranking Member, Committee on the Budget, House of
Representatives, Washington, DC.
Dear Congressman: As you requested, the Congressional
Budget Office (CBO) has estimated the budgetary effects of
modifying H.R. 2, the Children's Health Insurance Program
Reauthorization Act of 2009, to extend the program's
authorization through 2019 in a manner that would provide
sufficient funding to allow states to meet demand for
increasing enrollment within the program's parameters. If
H.R. 2 were changed to authorize the Children's Health
Insurance Program (CHIP) through 2019 and to provide
sufficient funding for such increasing enrollment throughout
that period, CBO estimates that enacting that alternative
version of the bill would increase deficits by $41.6 billion
over the 2009-2019 period. In contrast, CBO estimates that
the version of H.R. 2 introduced in the House of
Representatives on January 13, 2009, would result in a net
reduction in deficits of $0.4 billion over that 11-year
period.
The introduced version of H.R. 2 would authorize CHIP
through 2013 and would provide significant funding increases
over the next few years, leading up to a total funding level
of $17.4 billion in 2013. The program's funding for the
second half of fiscal year 2013 would be $3 billion. Under
baseline rules, that amount annualized--$6 billion--would be
projected for each subsequent year. The estimated cost of the
bill assumes that funding level for CHIP for fiscal years
2014 through 2019. On that basis, CBO estimates that the
introduced version of H.R. 2 would increase federal direct
spending by $73.3 billion through 2019, including the costs
of other provisions in the bill. (That spending would be
offset by increases in federal tax revenues totaling $73.6
billion over the same period, primarily from increases in the
excise taxes levied on tobacco products.)
As an alternative to the introduced version of H.R. 2, you
requested that CBO assume the CHIP rules and structure as
currently delineated in H.R. 2 would remain unchanged through
2019 and that sufficient funding would be made available
after 2013 to accommodate projected enrollment growth. The
projected enrollment growth is based on expected growth in
the total population, as well as changes in the health
insurance market and the economy as a whole. Under those
assumptions, CBO estimates that average monthly enrollment in
CHIP would rise from about 9 million in 2013 to about 12
million in 2019.
Based on the assumptions you specified, CBO estimates total
changes in direct spending of $115.2 billion, as compared
with the $73.3 billion increase we estimate for the
introduced version of H.R. 2. (Revenue increases would remain
unchanged.) Thus, the net budget impact of a modified version
of H.R. 2, as you specified, would be an increase in deficits
totaling $41.6 billion over the 2009-2019 period.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contacts are Robert
Stewart and Sean Dunbar.
Sincerely,
Robert A. Sunshine,
Acting Director.

Mr. PALLONE. Madam Speaker, I yield 30 seconds to the gentlewoman
from California (Mrs. Capps).
Mrs. CAPPS. Madam Speaker, I have 30 seconds to explain why H.R. 2,
the State Children's Health Insurance Program, means everything to a
school nurse.

[[Page H252]]

{time} 1315

And I'll just tell you, I can see the faces of the children I cared
for as best as I could who would have benefited so dramatically from
this program. And I'll tell you what this feels like now, as so many
moms and dads are losing their jobs and need this program even more.
And my State, California, is cutting even the children who presently
are served so dramatically.
And give States the option of covering pregnant women. That is the
greatest thing we can do for the health of a child is to cover the mom.
Mr. HERGER. Madam Speaker, I yield 3 minutes to the ranking member of
the Ways and Means Committee, the gentleman from Michigan (Mr. Camp).
Mr. CAMP. Madam Speaker, I believe every child in America should have
access to quality health care. The Children's Health Insurance Program
has done just that for those in families without the means to provide
or buy insurance on their own.
SCHIP was created as a bipartisan program, and it was one I was proud
to support. The bill before us today, however, not only threatens the
core mission of the program, which is providing health care to low-
income children, but creates a new entitlement that will demand higher
taxes on all Americans in just a few short years.
Let me first state the obvious problem with this bill. A children's
health program should not be used to cover adults, noncitizens,
potentially illegal immigrants and those making $80,000 a year.
There's another problem with the bill, one the majority hopes you
ignore. This bill blatantly attempts to hide the true cost of the bill
to the American taxpayer. It's irresponsible and untenable to fund a
children's health program with the revenue stream that's fast drying
up. Increasing the cigarette tax, regardless of your support for such
an idea, does not, will not, and cannot cover the cost of this program.
The Democrats are blowing a giant cloud of smoke into the face of the
American taxpayers, and I believe the impending tax increases that must
come to cover this program will have us all in a severe coughing fit.
The Democrats want you to ignore the fact that the percentage of
Americans who smoke has been dropping for decades. But research and
logic both show that raising the prices of cigarettes will lead to less
smoking and fewer tax dollars coming into the Federal Treasury. Yet,
the only way for this funding scheme to work is if the majority finds
22.4 million new smokers. I can't wait to see the look on Senator
Daschle's face when the Speaker tells the soon to be Health and Human
Services Secretary that little tidbit.
But in all seriousness, with its funding base declining, SCHIP costs
will increase exponentially. CBO predicts that SCHIP spending will more
than double under the Democrats proposal. The resulting gap between
program spending and revenue becomes staggering, a gap the Democrats
will soon ask the American taxpayers to fill.
In closing, I'd like to add one final note. This bill represents a
broken promise to lower- and middle-income Americans. President-elect
Obama promised that no one making less than $250,000 per year would see
their taxes go up; yet, under this proposal, a working-class family
with two adult smokers would face hundreds of dollars in additional
Federal tobacco taxes each year.
We haven't made it to Inauguration Day, and House leaders are already
breaking this campaign promise. That might be a record, even here in
Washington, D.C.
Let's keep SCHIP focused on low-income children. Let's not ask 22.4
million Americans to start smoking, and let's demand a better
bipartisan bill.
I ask my colleagues to vote ``no'' on this bill.
Mr. STARK. Madam Speaker, I am pleased to recognize Mr. Schauer from
Michigan for 1 minute.
Mr. SCHAUER. Madam Speaker, I came to Washington to be a voice for
those in my State who are hurting.
H.R. 2 will help children and families who are victims of our
economic crisis; 100,000 children in Michigan lack health insurance.
That is immoral and weakens our economy. This bill ensures
comprehensive health care coverage for children, and is an investment
in prevention and approved overall health status for America.
With Michigan's economy in crisis, with our Nation's economy
struggling, with our families losing health insurance due to this
recession and unfair trade, now is exactly the right time, colleagues,
to act, to cover 11 million children with the health care coverage they
deserve and need.
Mr. HERGER. Madam Speaker, I yield 1 minute to the gentleman from
Louisiana (Mr. Boustany), who is a physician.
Mr. BOUSTANY. Madam Speaker, as a physician, we all recognize the
importance of high quality health care for all children in this
country. In addition to the declining source of revenue as a means to
pay for this, which I believe is an irresponsible way to legislate on
health care, there's a serious other problem that needs to be discussed
and that is, does this bill provide real access to quality health care?
Too often children on Medicaid and SCHIP receive fewer visits from
primary care providers than those with private coverage. That's clear.
And they are much more likely to seek care in the emergency room when
it's late. They don't get the necessary screenings and vaccinations.
GAO criticized government-run programs like SCHIP for disregarding
patients' access problems.
It's disappointing to me, as a physician, that the majority rushed
this flawed bill to the floor without permitting any opportunity for
improvements. I offered an amendment that went to Rules which was not
allowed, which would have encouraged States to measure and report
provider access problems for SCHIP programs. It would also require
States to report their plans to limit ``crowd out'' of private
coverage.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. BOUSTANY. I would like to include the rest of my statement in the
Record.
In section 402 of their bill, Majority leaders failed to address the
access problems I brought to their attention last year.
Their vague language does not require states to uniformly report
primary care visits.
It does not mention surveying parents on whether sick children
received needed care quickly.
It also fails to require states to describe their plans to avoid
displacing children's private coverage.
We need to help poor children first.
A plastic government coverage card that delays access to needed care
is an insult to low-income families.
Congress has a duty to help enrolled children who--despite being
covered--still can't find a doctor to treat them when they're sick.
Mr. PALLONE. Madam Speaker, I would yield 1 minute to the gentleman
from New York (Mr. Engel).
Mr. ENGEL. Madam Speaker, I rise in strong support of the bill. I am
so proud that under our new administration we'll finally enact a
comprehensive, robust reauthorization of the SCHIP program which will
provide health care to over 11 million low-income children. No more
playing politics with our children, no more Presidential vetoes of this
bill. We are finally going to do what is right for our Nation.
It simply makes economic sense to cover the uninsured. When we fail
to provide our citizens with primary and preventive care, routine
health problems compound into emergency conditions.
New York, my home State, operates a separate stand-alone program
under SCHIP called Child Health Plus. As of December 2006, nearly
400,000 children were enrolled and receiving comprehensive health care
coverage in the program. As the third largest SCHIP program in the
Nation, New York reduced the number of uninsured children in the State
by 40 percent. We are only one of seven States to do that. And New
York's program has increased enrollment by over a quarter of a million
children since the start of SCHIP. SCHIP also contributed to a nearly
30 percent increase in children enrolled in Medicaid.
This is necessary. It is good. We should all support this bill.
The SPEAKER pro tempore. The gentleman from California (Mr. Herger)
has 5 minutes remaining. The gentleman from New Jersey (Mr. Pallone)
has 6\1/4\ minutes remaining. The gentleman from California (Mr. Stark)
has 7 minutes remaining.

[[Page H253]]

Mr. HERGER. Madam Speaker, I yield 1 minute to the gentleman from
Georgia (Mr. Linder).
Mr. LINDER. Madam Speaker, when SCHIP first passed about a dozen
years ago, Georgia's program was called Peach Care. It was open to
large numbers of people, and millions signed up, many of whom came off
private health insurance to do so. A friend of mine, who made $150,000
a year, signed up too. She never used it. But you could sign up by the
Internet.
Some of that's been tightened up, but this bill opens that back up
again. You're eligible by just stating your Social Security Number, no
need to prove who you are.
The 5-year waiting period that's always been in place for legal
immigrants who come here sponsored, is erased. And we all know that
sooner or later we're going to have an amnesty for those 20 million
illegals, and that will dwarf this system.
I was in dental school in 1936 when Lyndon Johnson delivered the
great society speech; and he said, using easily quantifiable user
statistics, we know that by 1990, Medicare will cost $9 billion, and
Medicaid will cost $1 billion. He was wrong. And this will be abused
also.
Mr. STARK. Madam Speaker, at this time I am delighted to yield 1
minute to the distinguished gentleman from California (Mr. Thompson).
Mr. THOMPSON of California. Madam Speaker, I rise in strong support
of this bill because investing in children's health care is one of the
wisest choices we can make. Children have to be healthy to get an
education and to achieve their full potential as adults. When kids see
the doctor more regularly, they receive the preventive services that
keep them healthier longer, and they are less likely to end up in the
emergency room, which saves everyone money.
Almost a quarter of a million children in my State of California are
uninsured. That's simply not acceptable. In contrast to President
Bush's multiple vetoes of similar bills, today, with President-elect
Obama's enthusiastic support, the House will vote to provide coverage
for 4 million, 4 million additional children.
Madam Speaker, that truly is change we can believe in.
Mr. HERGER. How much time do we have, Madam Speaker?
The SPEAKER pro tempore. The gentleman from California (Mr. Herger)
has 4 minutes remaining; the gentleman from New Jersey has 6\1/4\
minutes; the gentleman from California (Mr. Stark) has 6 minutes; and
the gentleman from Missouri has 90 seconds.
Mr. PALLONE. Madam Speaker, I yield 30 seconds to the gentlewoman
from the Virgin Islands (Mrs. Christensen).
Mrs. CHRISTENSEN. Madam Speaker, I am proud today to rise for the 11
million children who will have health coverage when we pass H.R. 2 for
the first time and it's finally signed into law by the incoming
President.
CHIPRA will make a significant down payment on President-elect
Obama's and our promise to insure all of our children. And it
rightfully refuses to leave out children and pregnant woman legally
admitted into our country.
It includes dental and mental health care, and will help eliminate
health disparities because many of those covered children will be
children of color. Healthy children have a better chance to also become
healthy adults.
It's the right thing to do. It should not have take this long, and I
urge my colleagues to pass it for the good of our children and the good
of our country.
Mr. HERGER. Madam Speaker, I continue to reserve my time.
Mr. STARK. Madam Speaker, I am delighted to yield 1 minute to the
distinguished gentlewoman from Colorado (Ms. Markey).
Ms. MARKEY of Colorado. Madam Speaker, I rise today in support of
H.R. 2, the reauthorization of SCHIP.
When our Nation faces tough economic times, we must look beyond the
grim statistics to see the true cost of our struggles. Seven percent of
this Nation is unemployed, which leaves too many families without
health insurance. 170,000 children in Colorado alone have no health
coverage. That's more than one in eight.
How we as a Nation approach health care for our children speaks not
just to our economic priorities but to our moral priorities.
Colorado ranks seventh worst nationally in the rate of uninsured
children. As the mother of three kids who knows the worry and heartache
that comes with caring late into the night for a sick child, that is
one statistic I hope I have a hand in changing.
I as all of my colleagues on both sides of the aisle to pledge their
support for our children and vote for this bill.
Mr. STARK. Madam Speaker, at this time I am delighted to yield 1
minute to the distinguished gentleman from Georgia (Mr. Scott).
Mr. SCOTT of Georgia. Madam Speaker, I represent Georgia, which has
300,000 children who badly need coverage in this legislation. Let me
take a part of my moment here, if I may, to respond to what I think are
some misstatements from the other side because this is, indeed, a
children's health program, and they've mentioned about adults being on
this program.
One category of adults, Madam Speaker, is pregnant women. Of all
adults, a pregnant woman with child in her womb, they need care. They
should be and are covered in this.
As far as the other category, here's what the bill says as far as
parents. No new waivers to cover parents in the CHIP program will be
allowed. That's in this bill.
What about childless adults who don't have? The bill says the current
law, that prohibition on waivers to cover coverage of childless adults
is retained. Childless adults are prohibited in this law.
Issue of illegal immigration; only legal immigrant children and their
pregnant immigrant legal immigrant women are covered under this bill.

{time} 1330

Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentleman from
Illinois (Mr. Foster).
Mr. FOSTER. Madam Speaker, I rise in strong support of H.R. 2, the
Children's Health Insurance Program Reauthorization Act of 2009.
This historic legislation renews and improves SCHIP. It extends
coverage to 4 million uninsured children who are currently eligible for
but who are not enrolled in SCHIP and in Medicaid.
As a fiscal conservative, I am also proud that even in today's
financial storm and even under scoring rules that do not fully reflect
the long-term fiscal benefits of providing adequate health care to
children that the bill is fully paid for. With a modest increase in
tobacco sales tax providing a bulk of the funding, we are able to
provide coverage to millions of children and not add to the deficit.
This bill honors our moral commitment to help our youngest children
in their health while ensuring that this legislation does not hinder
their future by saddling them with huge debts.
The bill could not come at a better time. Our economy continues to
worsen, and more and more people are at risk of losing their health
care. This program will help give millions of parents the peace of mind
that their children at least will have access to health care.
Mr. HERGER. Madam Speaker, I yield 1 minute to the gentlewoman from
Florida (Ms. Ginny Brown-Waite).
Ms. GINNY BROWN-WAITE of Florida. Madam Speaker, first of all, let me
state that I support health insurance for children. As a matter of
fact, it was my bill on the floor of the Senate where we created
KidCare.
Where did the money come from? It was from a historic vote that I
cast to be able to go after the tobacco companies for settlement.
That's where the money came from originally for the SCHIP program, but
the bill we have before us today is not a bill that taxpayers can
support.
First of all, there is no prohibition against crowd-out. In other
words, it pushes children off of private insurance onto the government
program, and it does allow States to continue for at least 2 years the
enrollment of adults. It actually does nothing to prohibit illegal
aliens from being on the program, and that's something that taxpayers
are very concerned about. Additionally, Madam Speaker, there is no
incentive here, really, to go after and to have low-income children
covered by this bill.

[[Page H254]]

For those reasons, I oppose it.
Mr. STARK. Madam Speaker, I reserve the balance of my time.
Mr. PALLONE. Madam Speaker, I would yield 30 seconds to the
gentlewoman from New Hampshire (Ms. Shea-Porter).
Ms. SHEA-PORTER. Madam Speaker, I support H.R. 2, the Children's
Health Insurance Program Reauthorization Act of 2009.
We have children in New Hampshire and in America who need us to fight
for them. Unemployment is rising. Even working families are losing
their health insurance. Providing more money now will give 4 million
more children health insurance. This is a moral issue. We are the only
nation in the world that does not provide health care to all of its
children. This is simply unconscionable.
I am proud to support this legislation to help New Hampshire's
children and America's children.
Mr. HERGER. Madam Speaker, I yield 2 minutes to the Republican whip,
the gentleman from Virginia (Mr. Cantor).
Mr. CANTOR. Madam Speaker, I rise today to underscore that all of us,
Republicans and Democrats alike, desire to ensure that all children of
low-income working families have access to high-quality, affordable
health care. But at this time in our economy when deficits threaten to
climb to $1.6 trillion, without Republican input or without any debate,
the majority has rushed a bill to the floor that substantially expands
the reach of this program beyond its original intended purpose. All the
while, a substantial portion of the existing target population has
never been reached.
It is with much disappointment that I stand in opposition to this
bill today, because it could have had significant bipartisan support
had the majority opened the process to our substantive ideas.
Before our ideas and solutions were shut out at the Rules Committee,
we sent President-elect Obama and Speaker Pelosi a letter which
outlined four central issues that we had hoped would be addressed.
First: We believe that the SCHIP bill should follow the original
intent of the law. That is to cover children in low-income working
families.
Second: We Republicans believe that expanding SCHIP should not shift
children away from private health insurance options into government-run
programs that are funded exclusively by the taxpayers. Instead, we
should be providing families who are currently uninsured with more
affordable options to better meet their needs, not a one-size-fits-all
government solution.
Third: We Republicans believe that the legislation should include
meaningful provisions to prevent fraudulent activity by those who seek
to illegally gain access to this program.
Finally, Madam Speaker, when Congress reauthorizes the program, we
must do so responsibly. The budget gimmicks included in this bill
suggest that the majority is not seriously trying to comply with PAYGO.
This bill will only put the States and the Federal Government into
further debt. I don't think there is any question that many in this
House want to do the right thing. Unfortunately, Madam Speaker, I feel
this bill doesn't quite reach this mark.
Mr. PALLONE. Madam Speaker, we inquire of the time that is remaining.
The SPEAKER pro tempore. The gentleman from New Jersey has 4\1/4\
minutes remaining. The gentleman from California (Mr. Stark) has 4
minutes remaining. The gentleman from California (Mr. Herger) has 1
minute remaining. The gentleman from Missouri has 90 seconds remaining.
Mr. PALLONE. Madam Speaker, at this time, I would yield 30 seconds to
the gentleman from New York (Mr. Massa).
Mr. MASSA. Madam Speaker, I am compelled to observe that, while Rome
burns, my friends and colleagues across the aisle argue process.
We were elected to come here and make a difference in the lives of
the people who we represent. Today, I will proudly cast a vote in the
affirmative for the expanded State Children's Health Insurance Program
Reauthorization Act of 2009 to do exactly that.
We are in a time of financial and economic crisis, and we cannot
ignore the individuals who have sent us here to help them. It is a
plain and clear call to action. It is wrong to say that you support
children's health care and, at the same time, vote against it. This is
not about process. It is about standing with America's children, and I
am proud to do so today.
The SPEAKER pro tempore. The Chair will recognize in reverse order
the managers for closing comments. That would be Mr. Herger, followed
by Mr. Stark, followed by Mr. Blunt, followed by Mr. Pallone.
Mr. PALLONE. Madam Speaker, I have some additional speakers, though.
I yield 30 seconds to the gentleman from Virginia (Mr. Connolly).
Mr. CONNOLLY of Virginia. Madam Speaker, this vote is about values.
If you are an uninsured kid in America and you have appendicitis, the
chance of death is five times that of a kid who is insured. This is
about values. We are the only developed country in the world that does
not extend full health insurance to its children. History has shown no
nation can truly consider itself great without providing for the well-
being of its most vulnerable.
I urge my colleagues to support this legislation.
Madam Speaker, I rise in support of the bill. It is clear that the
Congress sees value in this critical investment in our Nation's
children, having passed a similar measure not once but twice in its
last session. Thankfully, we will now have a President who shares that
same compassion and commitment to our low- and middle-income working
families.
Given the ongoing economic crisis, the number of at-risk children
will only continue to increase. The number of Americans who are now
unemployed, and ostensibly now without health care, has increased by
more than half in the past year, from 4.7 percent to 7.2 percent
nationally. When you factor in the skyrocketing costs of health care,
coupled with the economic pinch being placed on people's pocketbooks,
today's American families are being bled dry and countless children are
being left without health care. In that context, we are making a
critical investment in the health of our Nation by adding these 4
million children to the 7 million already covered by SCHIP.
The long-term risk of not making this investment now will surely cost
us more. Let me cite just one example: It is my understanding that an
uninsured child diagnosed with appendicitis is 5 times more likely to
die as a result of lack of access to medical attention than a child who
is has been insured. By expanding access to more working families, we
begin to lay the foundation for the principles by which we hope to
overhaul our Nation's health care system.
As my colleagues may be aware, the United States is the only
developed nation in the world that does not provide health care for all
of its children. That is unconscionable. As history has proven, no
nation can truly consider itself great without providing for the well-
being of its most vulnerable.
Mr. PALLONE. Madam Speaker, I would yield 30 seconds to the gentleman
from Iowa (Mr. Loebsack).
Mr. LOEBSACK. Madam Speaker, we have voted for similar SCHIP measures
in the past, but those efforts were thwarted time and time again. I
believe today is a new day.
Today, we will send a clear message to those who need our help the
most--our children. This Congress and the new administration will tell
the 38,000 uninsured children in Iowa and the millions more across the
country that we care and that we will no longer leave them without the
health care they need.
I look forward to casting my vote in strong support of this
legislation. I urge my colleagues to do the same.
Mr. STARK. Madam Speaker, at this time, I am delighted to recognize
for 1 minute the distinguished gentleman from Illinois (Mr. Davis).
(Mr. DAVIS of Illinois asked and was given permission to revise and
extend his remarks.)
Mr. DAVIS of Illinois. Madam Speaker, I am pleased to rise in strong
support of the Children's Health Insurance Program Reauthorization Act
of 2009.
I am pleased to note that my State, the State of Illinois, has made
it possible for every child to receive access to health care and to see
that this action takes place across the country so that every child, no
matter who he or she might be, has an opportunity to grow and develop
to become the kind of person that his or her potential provides.
It is a great day for the United States of America. It is a great day
for this Congress. It is a great day for all of the children in
America.

[[Page H255]]

Mr. STARK. Madam Speaker, if I may, I will yield myself 2 minutes.
I just want to rise and ask my colleagues to support H.R. 2. It has
done a lot of things. It expands insurance coverage to another 4
million children. You can argue one way or the other that they may have
insurance someplace else, but this will guarantee that those 4 million
additional children will get the medical care or the insurance and,
without which, they will not get first-class medical care in this
country.
We've passed this bill in several different forms in the past, and I
want to thank the 40 or 50 Members from across the aisle who have
supported it in the past. We've made some changes, and we've
acknowledged the legitimacy of all legal residents in our Nation by
giving States the option to cover them if they choose.
I am glad to report that the bill is fully financed. We can argue
about what happens 4 or 5 years out, but I am sure we'll have more of
an argument on whether the very rich should enjoy escaping the capital
gains tax or whether we should do away with the inheritance tax, which
will bother many of the opponents much more than the idea of the
tobacco tax or, indeed, the prohibition on the unethical kickbacks that
physicians receive from ownership hospitals, most of which are of
questionable safety and quality. This legislation expands health
coverage to our Nation's children, and it is worthy of our support.
I would like to take just a moment to thank the staff members who
have worked so hard over the past almost 2 years. From the staff on the
Committee on Energy and Commerce: Bridgett Taylor, Karen Nelson, Andy
Schneider, Amy Hall, Purvee Kempf, Tim Gronninger, Hasan Sansour, and
Bobby Clark.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. STARK. Madam Speaker, I yield myself an additional 10 seconds.
From our own staff on the Committee on Ways and Means Health
Subcommittee: our staff director--Cybele Bjorklund--Jennifer Friedman,
Debbie Curtis, Karen McAfee, Chiquita Brooks-LaSure, and Drew Dawson.
I urge the passage of H.R. 2.
I reserve the balance of my time.
Mr. BLUNT. Inquiring, does the gentleman have any additional speakers
besides his closing comments?
Mr. PALLONE. I do not, but I was going to ask how much time remains.
The SPEAKER pro tempore. The gentleman from Missouri has 90 seconds
remaining. The gentleman from California (Mr. Herger) has 1 minute
remaining. The gentleman from California (Mr. Stark) has 1 minute
remaining. The gentleman from New Jersey has 2\3/4\ minutes remaining.
Mr. PALLONE. Madam Speaker, I would yield myself a minute and a half.
I just want to stress how important this bill is and also that it is,
essentially, the same bill that we passed in the last Congress. It was
bipartisan. It was passed in both houses with a fairly large margin.
The only thing that stood in the way was President Bush's veto.
Now we do have a new President. We know that he has supported the
legislation. It is so crucial for the children of this country, for the
4 million or so now who are eligible but for whom there is no funding,
who will be covered by this legislation. It is fully paid for.
Particularly now, when we have a recession and when we know that so
many people are losing their jobs and, as a consequence, their health
insurance for themselves and for their families, what could be more
important than making sure that those families' children are covered by
this legislation?

{time} 1345

I must say I'm very proud of the fact that we are here in the first
week, essentially, of this new Congress passing this bill. I know the
other body is about to pass it as well and that we will be able to send
it to the President and have it be one of the first accomplishments of
his Presidency and of this Congress.
I know Mr. Stark already thanked the various staff members, so I
won't thank them again. But I do want to pay particular attention to
Bridgett Taylor because I know that she worked on this legislation for
2 years or more and was even there when we first passed the SCHIP bill
10 years before that. And it has always been one of the things that she
cares so much about. But I want to thank all of the staff people and
all of my colleagues for all of the work that they've done on this
legislation.
Mr. HERGER. Madam Speaker, I reserve the 1 minute I have to close,
but I would yield to the gentleman from Missouri (Mr. Blunt) for the
time that he has that he controls.
Mr. BLUNT. Madam Speaker, I yield my minute-and-a-half to the ranking
member of the Health Subcommittee on Energy and Commerce, the gentleman
from Georgia (Mr. Deal).
Mr. DEAL of Georgia. I appreciate the gentleman yielding.
Madam Speaker, very few bills come to the floor of this House with so
much rhetoric disassociated from facts as we have heard in this bill.
Now, let's talk about a few of the real facts.
First of all, the program was designed, at its outset, to insure
children that were above the Medicaid level of poverty but below 200
percent of poverty. All of the stories that we have heard today--from
both sides of the aisle, quite frankly--as to examples of children who
are uninsured, in almost every one of those instances are children that
should have been insured under the current law under either SCHIP or
Medicaid but are unenrolled.
One of the amendments that I offered that was not allowed was an
amendment that said before you can go up the poverty scale, you should
have a 90-percent saturation of those children that are below 200
percent of poverty. Many States that are well above the 300 percent of
poverty still have not covered a quarter of their children that are
below the 200 percent of poverty level.
So ``poor children first'' is not in this bill.
Secondly, with regard to the issue of illegal immigration. Now, you
can say that illegal immigrants will not be allowed, but you are
removing the requirements of certification of eligibility. And by the
way, pregnant women, regardless of their immigration status, are
considered ``children'' under the SCHIP bill in everybody's version of
the law.
Now, if you're not acknowledging that illegals are going to be
enrolled in this program by virtue of the change you're making in this
bill, then you ought to talk to CBO because CBO says in the next 10
years that the Federal Government will spend $5.1 billion and States
will spend $3.85 billion on people who are illegally in this country.
Mr. STARK. Madam Speaker, I'm delighted to recognize the Speaker of
the House, the distinguished gentlelady from California (Ms. Pelosi).
The SPEAKER pro tempore. The gentlewoman from California is
recognized for 1 minute.
Ms. PELOSI. Madam Speaker, I thank the gentleman from California for
yielding.
My colleagues, this is a day of triumph for America's children. With
what I expect to be a strong bipartisan vote, the House will bring us
one step closer to providing health care for 11 million children in
America.
With this action and with the legislation last week to ensure equal
pay for equal work for women, Congress makes clear that we put women
and children first. It is important that we have this legislation up so
soon in this new Congress because children are our top priority. We
like to be considered a Congress for the children, a Congress for the
future.
At a time of economic crisis, nothing could be more essential than
ensuring that children of hardworking families receive the quality
health care they deserve. Many of these children are from families of
hardworking Americans who have lost their jobs through no fault of
their own. It's sad to say that America lost 2.6 million jobs last
year. Over half a million jobs were lost in the month of December--
500,000 jobs in the month of December alone. It was actually 526,000
jobs. Each month, until we have an economic recovery initiative, we
will continue to lose at least 500,000 jobs per month.
With such job loss, America sees the health care coverage that we all
need for our children disappear. For every 1 percent increase in the
unemployment rate, it is estimated that as many as 1.5 million
Americans will lose their

[[Page H256]]

health care coverage. A record 47 million Americans, including nearly 9
million children, are without health insurance now.
Ensuring that children have access to affordable health care just
makes sense. It's not just about addressing their health needs when
they are sick. It's about keeping them healthy in advance. It's about
prevention. It's about diet, not diabetes; it's about prevention, not
amputation. It's about a healthier America.
Contrary to the views of some, an emergency room is not good health
care on a regular basis. An emergency room is, as it describes, for
emergencies--not for ongoing health care. So for those who say that all
people in our country have access to health care, that they can go to
an emergency room, I don't know what they could be thinking.
By ensuring health care coverage for 11 million children, families
will have regular doctor visits and preventative care. We will ensure
that children get the care they need and the health care costs are not
inflated due to expensive emergency room care.
That is why more than 80 percent of the American people support this
legislation. It's bipartisan. It is fully paid for by a 61-cent tax on
a pack of cigarettes as the major part of its funding, and it
represents a new direction because, again, it is good health care for
America's children. It is paid for.
We have fought in the last Congress together, Democrats and
Republicans, in the House and in the Senate to pass this legislation--
which we did--but it was vetoed. At the time, President Bush said that
we could not afford this legislation, that we could not afford to
insure America's children. Forty days in Iraq equals over 10 million
children in America insured for 1 year. Forty days in Iraq, 1 year
insuring over 10 million children. We certainly can afford to do that.
We look forward to bringing this legislation to President Obama's
desk as one of the first bills that he will sign. And when we do, we
owe a great deal of gratitude to Chairman Henry Waxman of the Energy
and Commerce Committee, Chairman Rangel of the Ways and Means
Committee, Chairman Emeritus John Dingell, who's worked on this issue
for a very long time and engineered it through the last Congress. Thank
you, Mr. Dingell. Congressman Pallone, the Chair of the subcommittee;
Congressman Stark, the Chair of the appropriate Committee on Ways and
Means; the Congressional Hispanic Caucus, which led the fight to make
sure that legal immigrant children are covered under this legislation,
and our Congressional Black Caucus. All elements of our Congress, a
coalition, and on the outside, because we could not succeed with just
our inside maneuvering on legislation so important and so pervasive in
its impact.
Without the support of more than 300 organizations, from AARP to the
YMCA and everything in between, the March of Dimes, Easter Seals,
almost every organization you can name supports this SCHIP; and they
support providing quality, affordable health care to America's
children, and they support doing it by the passage of the State
Children's Health Insurance Program legislation that we have before us
today.
So I thank all of those in the Congress for their leadership in
making this important day possible for America's children. It's
important to children because of their health. It's important because
it's paid for. We do something great for children without adding to our
deficit and delivering mountains of debt to future generations.
So this, all in all, is great for kids. Let's keep our reputation
going as a Congress for children and give a strong bipartisan vote to
this important legislation.
Mr. HERGER. Madam Speaker, I yield the remainder of our time to the
minority leader, the gentleman from Ohio (Mr. Boehner).
The SPEAKER pro tempore. The gentleman from Ohio is recognized for 1
minute.
Mr. BOEHNER. Madam Speaker, let me thank my colleague from California
for yielding.
I rise today in opposition to this bill, frankly because of my strong
support for the SCHIP program.
In 1997, Republicans here in Congress worked with our Democrat
colleagues to create the State Children's Health Insurance Program. I
was there, and many of you were here as well. And throughout that
process it was bipartisan, it was fair, and open discussion and open
debate. And unfortunately today, the voices of millions of Americans
who want to provide input into this proposal have been silenced in the
process.
Earlier this week, I wrote to Speaker Pelosi and President-elect
Obama expressing our willingness to work together on this critical
issue. We outlined our principles for this program's reauthorization.
The principles are nothing new. In fact, they're the same principles
that led to the creation of SCHIP in 1997.
And they are this: This program ought to cover poor children first.
Unfortunately in many States, more than two-thirds of those enrolled in
the SCHIP program are adults. And there is nothing in this bill that
really does ensure that poor children will be brought into the program
first.
Secondly, taxpayer funds for this program should not be used to fund
benefits for illegal immigrants. And there's been this big debate about
whether it does or it doesn't, but the fact is that while the bill says
we will not cover illegal immigrants in this bill, the whole
verification process that should be in here to ensure that only
American citizens and legal residents are entitled to these benefits,
no verification to speak of is contained in the bill.
And we also believe that SCHIP should not force children with private
insurance into a State-run health insurance program. Last year in this
proposal, there was language that made it clear that children with a
private health insurance program, that they should stay in that private
program and not be pushed into the State-run program. Unfortunately,
the bill before us does not reflect these principles, the same ones
that have guided this program since its creation.
I believe that the bill before us would undermine the original intent
of the SCHIP program by expanding the program to adults, illegal
immigrants, and upper-income families who already have access to
private health insurance.

{time} 1400

I think taxpayers deserve better, and, more importantly, our Nation's
children deserve better. That's why today Republicans will offer a
better way.
I said on the opening day, when I gave the gavel to Ms. Pelosi, that
Republicans would not just be the party of ``no,'' that we would come
to this floor with better solutions. And the better solution that we
will offer here soon is a program that would reauthorize SCHIP for 7
years, not the 4\1/2\ years that we see in the majority's bill; it will
reflect our principles, and make it clear that poor children should be
covered first; and it will fully fund the SCHIP program without raising
taxes on American families across our country.
Madam Speaker, Federal funds targeted for low-income children should
benefit low-income children, period. Only one measure on the floor
today will serve those children's interests, and that's what the motion
to recommit will contain. So I would urge my colleagues to vote ``yes''
on the motion to recommit and ``no'' on the underlying bill.
Mr. MARKEY of Massachusetts. Madam Speaker, I rise today in strong
support of the Children's Health Insurance Program Reauthorization Act
of 2009.
I am proud to be an original cosponsor of this important legislation
to expand the highly successful State Children's Health Insurance
Program (SCHIP). This bill will allow the program to provide health
insurance to an additional 4 million low-income children on top of the
nearly 7 million who already benefit from the program.
In my home State, SCHIP enrollment is part of the reason why
Massachusetts has the lowest rate of uninsured children in the country.
More than 180,000 Massachusetts children receive health coverage
through SCHIP, and this reauthorization will allow the state to cover
even more children who currently do not have health insurance.
It is unfortunate that the previous two attempts to reauthorize SCHIP
were vetoed by President Bush, who chose to side with big corporations
over children. With the current economic crisis causing significant job
losses,

[[Page H257]]

millions of Americans also are losing their health coverage, making
today's vote even more urgent.
While President Bush twice dashed the hopes of millions of low-income
families in need of health care for their children, the incoming Obama
administration recognizes the value of ensuring that all low-income
children get the health care they need.
I urge my colleagues to stand with the hard working families who want
to provide their children with the health care they need. Vote yes on
this critical legislation.
Mrs. BACHMANN. Madam Speaker, today I rise in opposition to H.R. 2,
the Children's Health Insurance Reauthorization Act of 2009. While I
support the State Children's Health Insurance Program, SCHIP, and its
continued reauthorization, the proposal before the House today
reauthorizes this program in an irresponsible manner, at a time when
the American people need responsible government more than ever.
As you know, I recently joined many of my Republican colleagues in a
letter to you, Madam Speaker, and to President-elect Obama asking that
any reauthorization of SCHIP contain commonsense provisions to ensure
that the program's mission is fulfilled. For instance, SCHIP is meant
to ensure that children without means can gain access to health care.
The program is designed to cover them first, before extending coverage
to children whose families may be able to afford coverage.
Unfortunately, the bill with which we have been presented includes no
requirement that states focus the funds in this bill on low-income
children. There is a likelihood that the failure to include such a
provision will lead to funds being diverted from the children who need
them most, particularly in the states that have expanded their SCHIP
programs most dramatically.
Another concern that I have is the impact of this legislation on the
private insurance market and the families who depend upon it. In
scoring this legislation, the Congressional Budget Office (CBO)
estimated that 2.4 million people will drop their existing private
insurance, opting instead for the public program. This ``crowding out''
will constrict the health insurance pool and further increase the cost
of private insurance for millions more. Given the ranks of Americans
who already cannot afford health insurance, this is the last thing the
American people need.
There are other concerns that I have with this bill and with the way
it is being pushed through with so little debate and no opportunity for
amendment. While the House leadership has again promised that it will
work in a bipartisan fashion, bringing both sides of the aisle together
to build consensus legislation, this promise has turned out to be
nothing more than empty to the American public. I urge my colleagues to
join me in opposing this legislation.
Mr. POMEROY. Madam Speaker, I rise today in strong support of H.R. 2,
the Children's Health Insurance Program Reauthorization Act of 2009.
We were all deeply disappointed that President Bush vetoed bipartisan
legislation that would have reauthorized the popular State Children's
Health Insurance Program, SCHIP, not once, but twice during the 110th
Congress. However, under a new Congress and a new incoming President, I
am pleased that we can finally move forward with bringing health care
to 11 million needy low-income children.
In my own State of North Dakota, there are roughly 14,000 children
who lack health care coverage. Under this legislation, the nearly 3,600
children who are already covered under the Healthy Steps program will
continue to obtain the care they need and there is the potential to
cover many more given the $100 million in outreach and enrollment
grants as well as the $3.2 billion in performance grants to states to
help enroll needy children who are eligible but currently enrolled in
SCHIP.
Our Nation's current economic crisis illustrates just how urgent the
need is to reauthorize SCHIP. With 2 million jobs lost in 2008, more
and more needy children are finding themselves without health care
coverage this year. That is why I urge my colleagues to join me in
standing up for 11 million children and pass this important bipartisan
piece of legislation.
Ms. EDDIE-BERNICE JOHNSON of Texas. Madam Speaker, I rise in support
of H.R. 2, the Children's Health Insurance Program Reauthorization Act
of 2009.
Texas ranks last in the Nation in terms of taking care of its
children. A report released in 2009 by the organization called,
``Texans Care for Children'' contains dismal statistics.
For example:
Texas continues to rank 50th out of 50 among the States in health
coverage for children.
Infant mortality rates have steadily climbed in Texas this decade,
while remaining unchanged in the Nation as a whole.
Texas still ranks near the bottom in child hunger, child poverty, and
child deaths from abuse or neglect.
The State of Texas continues to be ineffective at resolving the
problem of uninsured children in our State.
I am sympathetic to States' needs to avoid revenue shortfalls
regarding SCHIP, and so I support Congress allocating the funds needed
to cover children in need.
Today's legislation is similar to a bill passed by Congress in 2007
and vetoed by the President.
It would provide health care coverage to 11 million children in this
country who currently have none.
I support a generous expansion of this program.
Children with health insurance are more likely to be up to date on
immunizations and to receive treatment for sore throats, ear aches and
other illnesses.
Good health means fewer sick days and better school performance--and
less burden on our emergency rooms.
As a nurse, I can not over-emphasize how important it is for young
people to have a medical home.
Having a family physician can prevent so many minor illnesses from
developing into serious, expensive illnesses.
Health care coverage of children just makes good sense.
I urge my colleagues to avoid delay in passing this bill, as it is
critical for the health of so many children.
Mr. MORAN of Virginia. Madam Speaker, I rise today in strong support
of H.R. 2, the Children's Health Insurance Program Reauthorization Act
of 2009. Truly, we face a health care crisis in this country--in the
richest country on Earth; 47 million Americans do not have health
insurance, including 9 million children. The need is even greater in
these sad economic times. With rising unemployment, more families are
losing their health insurance. This bill will go a long way to provide
health care for uninsured children and fulfilling our moral obligation
to them.
In my home State of Virginia, the CHIP program currently provides
coverage to 144,163 low-income children each year. The CHIP
Reauthorization Act will help us cover an additional 75,000 children.
It 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, primarily 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.
In the past, there has been misleading and false information
regarding the bill's treatment of illegal aliens. Critics of the
legislation seem to ignore existing Federal law and provisions in the
CHIP Reauthorization Act that prevent federal funds from being spent to
provide benefits for illegal immigrants. What H.R. 2 does do is offer
an opportunity for States to waive a five year waiting period on legal
non citizens. Current law requires a five-year waiting period before
legal immigrants are eligible for CHIP. Allowing State flexibility in
this regard is sound public health policy that would enable thousands
of American children access to vital health services to help them live
better, healthier, and more productive lives. The bill does not mandate
the change, but leaves it to the states to make their own decisions.
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 grow to become healthy
and productive adults. 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. Ultimately, covering all our children is a moral
imperative--it is the only possible humane, responsible course of
action. I urge a yes vote on H.R. 2.
Mr. CARSON of Indiana. Madam Speaker, I rise today on behalf of the
thousands of uninsured children in Indianapolis, Indiana.
In this recession, many of my constituents can no longer afford the
skyrocketing cost of health care. Without checkups or medication for
their children, they sit powerless.
So, I implore those who oppose this bill to think of the uninsured
children in their congressional districts. Should they be made to
suffer from rising health care costs and an unstable job market? And
should your constituents suffer because their children hang between
Medicaid and private insurance? The

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answer to both of these questions should be an unwavering no.
There are few opportunities in this body where the right decision is
so obvious. Support our children by voting yes on SCHIP.
Mr. SMITH of Texas. Madam Speaker, I oppose this bill for many
reasons. In my role as the ranking member of the Judiciary Committee I
want to point out a few immigration provisions that undermine personal
responsibility and burden American taxpayers.
In the Personal Responsibility and Work Opportunity Reconciliation
Act of 1996, Congress, with the overwhelming support of the American
people, required that legal immigrants wait 5 years after coming to the
United States before receiving welfare benefits.
It's only fair that American taxpayers not foot the medical bills of
foreign nationals who arrive with a sponsor's pledge not to become a
``public charge.''
H.R. 2, changes current law and allows immigrants to get medical
benefits at the expense of U.S. taxpayers.
Immigrants, both legal and illegal, already have a federally mandated
right to emergency medical care. That mandate has helped bankrupt
hospitals all over the United States.
Federal law requires that the American sponsor of new immigrants sign
an affidavit of support stating that they will be responsible for any
public costs incurred by the immigrant. Unfortunately, those affidavits
have never been enforced and immigrant sponsors know they will not be
held accountable if the immigrants receive welfare and become public
charges.
The 5-year waiting period for immigrants to receive government
benefits is the last line of defense for the U.S. taxpayer. It should
not be repealed or altered in any way
Prior to laws enacted in 1996, the cost of welfare for immigrants had
jumped to $8 billion a year. The number of noncitizens on Supplemental
Security Income increased more than 600 percent between 1982 and 1995.
Both of those numbers will be much higher if H.R. 2 is enacted.
At a time when government spending is out of control, and when
States, cities and American citizens are struggling to make ends meet,
the last thing we need is to change good policy and further burden U.S.
taxpayers.
This legislation should be opposed.
Mr. KLEIN of Florida. Madam Speaker, I rise in strong support of the
Children's Health Insurance Program Reauthorization Act of 2009. This
critical legislation will take care of unfinished business from the
110th Congress by providing health insurance coverage to 11 million
children along with enacting needed reforms to the CHIP program.
I applaud Speaker Pelosi for bringing this bill to the floor so
quickly and President-Elect Obama for calling on Congres to have this
legislation ready when he takes office. To be frank, this bill can't
come fast enough for the millions of children without basic healthcare
coverage and for the low-income families struggling to make ends meet.
Never in my life has our country been in such a precarious state. Our
once soaring economy is teetering, with unemployment at 7.2 percent,
and the traditional pillars of our economy are struggling to stay in
business. Now more than ever, the government must fill its role by
helping the most vulnerable in our society meet their basic needs like
healthcare.
Madam Speaker, we're not asking my colleagues to take a leap of faith
on some untested program. Created a decade ago, the State Children's
Health Insurance Program is a product of true bipartisanship. A
Republican Congress passed it, and a Democratic President signed it
into law. And it is not an entitlement program; it is an empowerment
program that encourages enrollment into private health insurance
programs and a sliding scale for premiums based on a working family's
ability to pay.
In my home State of Florida, CHIP is administered through the Healthy
Kids Program. During my tenure in the Florida State Senate, I helped
oversee its implementation while serving on various committees. While
we ran into some roadblocks with enrollment, I can say that people from
both parties as well as the business community felt it was an
innovative way to provide health care coverage to hundreds of thousands
of low income children in Florida.
Madam Speaker, passing CHIP legislation today is our first test of
leadership in the 111th Congress. If we fail--if we fail our children--
then we must ask ourselves what leadership means in a time of crisis
and whether we deserve the trust of the American people.
Mrs. CHRISTENSEN. Madam Speaker, I rise today for 11 million
reasons--the 7 million children whose insurance will continue and the
more than 4 million other children who will be insured for the first
time--many of whom are children of color--with the passage of H.R. 2.
I must commend Chairmen Pallone, Waxman and Dingell--whose steadfast
efforts to expand health coverage to millions of American Children and
whose unwillingness to accept mediocrity is why we are here today.
If we are all having dejavu, it is because we have done this twice
before. And we are here today not just because of the charm on the
third try, but because this year we will have a new president who will
finally sign it into law.
H.R. 2 will not only make a significant down payment on President
elect Obama's and our promise to insure all of our country's children,
it rightfully refuses to leave out children and pregnant women who have
been legally admitted into our country. Doing this is not only the
right thing to do it is the least we can do to insure the health of all
of our children.
This bill also includes important expansions to the program for
screening and prevention as well as dental and mental health care,
addressing child health in a more holistic way
Because more than half of all uninsured children are racial and
ethnic minorities, this bill will help to eliminate health disparities
in this most vulnerable group and improve the outlook for their health
later in adulthood.
Today we have the opportunity to reach across the political aisle to
do the right thing--to make the health and health care needs of our
nation's children the priority they must be--to make sure that every
child has the opportunity to reach their fullest potential, so that our
Nation can too.
I urge all of my colleagues to vote for H.R. 2--to vote for America's
children. It is nothing less than a vote for the future of our country.
Mr. CUELLAR. Madam Speaker, I rise today in strong support of the
Children's Health Insurance Program.
Growing up as the son of migrant parents, I was among the millions of
American children who had no health insurance. When someone in our
family got sick, seeing a doctor simply wasn't an option.
I got lucky. Even without health insurance, I grew up into a healthy
adult. But I could just as easily have ended up going untreated for a
chronic disease or serious injury, and a lifetime of opportunities
would have evaporated. It is unacceptable that 1.4 million Texas kids
continue to bear that risk today.
When I served in the Texas State House, I had the honor of launching
the first CHIP program in Texas at Farias Elementary School in Laredo.
The program later expanded statewide, and today, it has helped millions
of Texas families--families like the one I grew up with--afford to see
a doctor.
In these difficult economic times, as millions of Texas families
struggle with job losses and pay cuts, CHIP is more important than
ever. For families living on the financial edge, CHIP is a critical
source of care, support, and peace of mind.
Mr. HONDA. Madam Speaker, I rise today in support of H.R. 2, the
State Children's Health Insurance Program Reauthorization Act of 2009.
Over the last 2 years, it has become necessary to fund the Children's
Health Insurance Program in some States through supplemental
appropriations as program wait-lists grew and children waited for care.
Now, with the country in the midst of the severest financial crisis in
decades, parents are more concerned than ever about the health and
well-being of their children. The bill before us today represents an
investment in our Nation's safety net; by preserving and expanding the
program to provide coverage for 11 million children over the next 4\1/
2\ years, the bill alleviates some of the stress placed on men and
women faced with unemployment.
My home county of Santa Clara was the first in the Nation to ensure
that every child with parents at or below 300 percent of the federal
poverty level has real access to regular health care as a result of
being insured. The county's Children's Health Initiative raises its own
money to add to State and Federal funding in order to keep all the
children of my district healthy--last year, the program enrolled over
144,000 children and serves as a model for 17 other California
counties.
This innovation is threatened by the county's $220 million projected
budget deficit for fiscal year 2009; and we in Santa Clara County face
the possibility of deep cuts in our healthcare system totaling nearly
$100 million. The budget woes of the State of California limit the
assistance it can provide, and so without this reauthorization of
SCHIP, the financial burden on the county would be significantly
heavier. I'm proud to vote today for legislation that will provide our
program and our county's children with much needed stability for the
next 4\1/2\ years.
As the chairman of the Congressional Asian Pacific American Caucus,
it is particularly gratifying to see the inclusion of a provision in
this bill that will allow States to waive the 5-year waiting period for
Medicaid and SCHIP imposed on pregnant women and children who are
legally present in the United States. It is morally unconscionable that
pregnant women and innocent children have been made victims of a
raucous and frequently misleading immigration debate. Hundreds of
thousands of people from Asian countries immigrated legally to the
United States in 2007 and 2008; at the very least the children in those

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families deserve to have health insurance and access to care. CAPAC has
consistently joined with the Congressional Black Caucus and
Congressional Hispanic Caucus in advocating for protection of this
vulnerable population and I thank Speaker Pelosi and our other House
leadership for redressing this injustice.
The passage of this bill protects the health of millions of American
children. It is the first step in a long journey toward repairing our
healthcare system and providing universal coverage, care, and access to
the people of our Nation, and I look forward to working with my
colleagues to complete that journey. I urge the Senate to act in as
swift and responsible manner as we do today and pass this bill.
Mr. BARTON of Texas. Madam Speaker, as we debate this new SCHIP bill,
I think it is important to figure out what we know about the bill and
the undemocratic methods that produced it.
First, we know that few, if any, Members of Congress actually have
read the bill. Despite the promises made by Majority Leader Hoyer on
Friday that we would get at least 48 hours to review the bill, the new,
285 page SCHIP bill only turned up yesterday at 11:20. The 48 hours
that Majority Leader Hoyer promised somehow shrank to less than 24
hours. The Rules Committee met without an official score from the
Congressional Budget Office. I will stipulate that Members may not
always read the legislation they vote on, but most of us at least read
the summaries and analyses that our staff members prepare. And every
one of us has a right to the time required to know what these bills
contain.
That's what the regular legislative process is all about--listening,
thinking, proposing, thinking some more, amending and debating.
Implicit in normal process is the notion that all useful ideas may not
reside exclusively in the minds of the Speaker's assistants.
And all this careful listening and critical thinking by House Members
is supposed to happen before we vote. Democrats seem to think that's
got it backwards. They want to vote first and think later. It's all
about bills written in private, delivered at night, and ramrodded
through here with the blink of an eye. Now, I recognize that a strong
majority can do things that way, and Republicans aren't without sin.
But when secrecy and arrogance are combined with perfect efficiency,
the country always seems to pay a heavy price.
On this bill especially, I've been treated better by used car
salesmen. They didn't want me looking too closely at their products,
but they didn't dump a wreck on my front lawn after sundown and tell me
I had to buy it or else. The Democrats don't want anyone to inspect
their product, either, and maybe that's because it has the qualities of
a used Edsel.
There has been no process, much less any fair process. Evidently
changes have been made to the bill from 2 years ago, but what are they?
There have still been no committee markups on any SCHIP legislation and
no legislative hearings. And I can't find evidence that a single one of
the numerous suggested improvements to past SCHIP bills has been
incorporated into this one. The majority is interested in what it wants
and nothing else.
We also know, Madam Speaker, that today is largely a political
exercise. The Senate is actually going to have a real markup in the
Senate Finance Committee. I'll say that again to make sure my friends
on the other side of the aisle heard what I said: The Senate is
actually going to put their SCHIP bill through the full committee
process, including considering ideas from people not on the Democrat
leadership staff.
It's possible to legislate the right way, and it's pitiful that the
people's House is reduced to taking lessons in democracy from our
friends in the Senate.
Over here, the tricks don't stop with tactics. Every Member of this
body understands that they will be vilified if they don't fall in line
and support this bill. If you don't vote for the Democrats' SCHIP bill,
your constituents will be told that you hate kids. Your people will be
told that the only way to ensure that kids get health care is by
supporting the bill produced by the Democrat leadership without a
whisper of a complaint. They want the people to believe that there are
no other ideas and no other options.
Well, Madam Speaker, I want to make clear to the American people that
my Republican colleagues and I do want to reauthorize the SCHIP
program. We have repeatedly reached out to the Democrats and have asked
for a chance to sit down with them and work on a compromise that can
become law. Last year, we heard many impassioned speeches about how
important it was to override the President's veto of the Democrats'
bills, but after these votes those same people were literally
applauding when the veto was not overridden. That's right, Madam
Speaker, there were Democrats applauding on the floor of the House when
the bill they supported was rejected. That's more than partisan
politics, that is cynicism and deception at their ugliest.
Madam Speaker, when the Democrats stop making this about political
advantage at the expense of low-income children, and decide to actually
produce a serious, passable SCHIP program, I am still ready to work
with them.
As it stands now, I urge all Members to reject this cynical ploy and
vote ``no'' on this deeply flawed and highly partisan bill.
Mr. KUCINICH. Madam Speaker, I rise in strong support of H.R. 2,
which will provide health care for 4 million previously uninsured
children. In Ohio, it will make the difference for up to 50,000 kids.
Ohio has had to suspend its efforts to expand eligibility to children
because of tight State budgets. At the same time, the number of
eligible children is growing rapidly as more parents lose their jobs or
simply watch the premiums of private health insurance companies
skyrocket beyond their means. This bill is needed more than ever.
The bill also includes mental health parity as well as dental
coverage. Dental coverage is a topic I explored in the Domestic Policy
Subcommittee of the Oversight and Government Reform Committee in a 7-
month investigation into the death of 12-year-old Deamonte Driver. He
died of a brain infection caused by tooth decay.
Finally, the bill allows states the option to cover children born
outside the U.S. but now here legally. This provision will not only
give these children the health care they deserve but will also save
States money by allowing them to move routine care from the emergency
room to the doctors office where it belongs. I fought for this
provision in a previous version of this bill when it was excluded. I am
glad to see that it has been retained this time and look forward to its
passage.
Every child has a right to health care. This bill is a step in the
right direction.
I urge my colleagues to pass the SCHIP reauthorization.
Mrs. CAPPS. Madam Speaker, I rise in strong support of this
legislation to strengthen SCHIP and in strong support of America's
children.
As a former school nurse, I consider it a crime that there are
children in America who cannot access all of the healthcare services
they need.
And today we have an opportunity to fix this injustice.
The excellent bill we have before us will ensure that millions of
children in working families can get the proper preventive and primary
care they need to ensure a healthy childhood.
I am also pleased to see that this bill preserves State options to
cover pregnant women.
After all, the health of a mother is the greatest contributor to a
child's health.
The current economic climate only adds to the urgency of this
legislation.
States are experiencing budget shortfalls which threaten the status
of children already enrolled in SCHIP.
And as parents lose their jobs; their health coverage is lost, too.
So I hope every one of my colleagues will join me in voting ``yes''
on this bill today and secure a better future for the health of our
children and grandchildren.
Ms. HIRONO. Madam Speaker, I rise today in strong support of H.R. 2,
the Children's Health Insurance Program (CHIP) Reauthorization Act of
2009.
I believe our Nation must show true compassion for the most
vulnerable among us, and CHIP is a program that helps millions of low-
income American children to receive health care so they can grow up in
good health.
Since its creation in 1997, CHIP has been successful in providing
vital health care coverage for children in families who cannot afford
private insurance yet earn too much to qualify for Medicaid. There are
now 6.6 million children enrolled in the program, which includes 20,000
keiki (children) from my home State of Hawaii.
Regrettably twice in 110th Congress, President George W. Bush vetoed
bipartisan bills that would have reauthorized and improved CHIP in
order to provide secure health coverage for millions of uninsured
children in working families. These vetoes were made despite the fact
that the bills had passed in both the House and Senate with strong
bipartisan majorities. As a result of these vetoes, Congress was only
able to provide a short-term extension of CHIP, through March of 2009,
but was not able to enact program improvements to help States reach
additional uninsured children.
The bill before us today is based on the two previously vetoed
bipartisan bills. It also offers the 111th Congress the opportunity to
right the wrongs of the out-going administration. President-elect Obama
has previously expressed strong support for CHIP because it provides a
much-needed down-payment on children's health. By extending health
coverage to millions more children, this legislation is an important
first step in stemming the rising tide of the uninsured.

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I urge my colleagues to join me and vote in support of this bill and
of the health and well-being of children most in need of our help.
Ms. TSONGAS. Madam Speaker, today, I rise in support of legislation
we will be considering today to expand the Children's Health Insurance
Program.
This bill provides coverage to children whose families cannot afford
private insurance, and would expand access to health insurance for
millions of children nationally--over 200,000 living in Massachusetts.
I first voted to override the President Bush's veto of similar
legislation on the day I was sworn into office. It was my first vote
and one of which I am enormously proud. Tens of thousands of people
from my District, and millions more across the country, both
Republicans and Democrats, have made their support for this program
resoundingly clear.
This program is also important to my State of Massachusetts, where
the program was first developed, because it is a critical component of
the groundbreaking universal Massachusetts Health Care Plan.
Today, I stand with a strong bipartisan majority ready to give our
Nation's children a chance at a healthy childhood and I urge my
colleagues to do the same.
Mr. SIRES. Madam Speaker, I rise today to speak about the State
Children's Health Insurance Program or SCHIP. This is a successful,
popular, bipartisan program that currently provides private health care
coverage for more than 6 million children who would otherwise go
without care. I am very proud to stand here today and say I will vote
for a bill that provides health care to children in need, and that
President-elect Obama said he would sign into law.
Our action could not come at a better time. With rising unemployment,
many families can no longer afford their health insurance. This bill
brings them needed relief. Now parents can find comfort knowing their
children will have access to health care while they look for a new job.
This is particularly important in my home State of New Jersey.
FamilyCare in New Jersey serves 122,000 children every year, a small
percentage of which come from families with incomes up to 350 percent
of the poverty line. It is expensive to live in my State, and even
these families need help getting by. I am happy that this bill
maintains the State's right to serve these families.
Today we get to make a real impact on the lives of many struggling
families. I am proud to support H.R. 2, the SCHIP Reauthorization Act
of 2009.
Mr. BARTON of Texas. Madam Speaker, I rise today to discuss an
unrelated issue that has been neatly tucked into this bill. The issue
is timely access to quality hospital care in our Nation's communities.
The Majority says we don't need any regular legislative process with
this bill because everyone knows what's in it. Well, my staff received
this 285-page bill at 11:20 a.m. yesterday. Even with full knowledge of
what went into previous versions of this legislation, it isn't
reasonable to expect that people will be able to gain a good
understanding of the new bill with that sort of time constraint. I
would also note that since the last time the House voted on an SCHIP
bill, we've added more than 60 new Members.
This is politics as usual, and it should give every new Member great
pause before voting for this bill, or any bill. I don't believe that
any of our new Members comes from a background where they were expected
to approve a major policy on the basis of the idea that, well, it's
been here before, so we don't need to read it or understand it. In
fact, didn't most of us run against that sort of deceptive politics in
Washington?
I want to point out to the new Members that your vote today could
also cause hospitals in your district to close. Hospitals that are
under construction now and intended to serve your constituents soon may
never see a patient. And why will that happen? Because a few Members of
your conference with clout believe physicians in your communities
shouldn't own hospitals. They say that the people who care for and
about their communities, who have a personal stake in the care that is
delivered, those people should not be trusted.
We have had no hearings on the issue of physician ownership of
hospitals in the last two Congresses. The Health Subcommittee did have
one hearing last year to discuss health disparities and we heard from a
physician from Louisiana. His story illustrates what can happen when
physicians are able to help their communities. After Katrina, hospitals
were closing and residents couldn't get care. The doctors in these
communities made a difference by coming together to make sure people
could continue to receive health care. Why on earth would we want to
eliminate people's ability to serve their community?
Why are the opponents of physician-owned hospitals so antagonistic?
I'm not sure, because these hospitals provide higher quality care at
lower costs than other hospitals. They have higher patient satisfaction
rates and don't experience workforce shortages like other hospitals do.
I offered an amendment along with Congressman Johnson and Dr. Burgess
to strike the section that was written to eliminate physician-owned
hospitals. Unfortunately, the Rules Committee rejected that idea.
Congressman Boren and Congresswoman Jackson-Lee proposed a very fair
amendment that would have delayed the implementation of Section 623 to
July 1, 2010, so hospitals that are currently under construction could
finish being completed and serve patients. That amendment also was
rejected.
Last week, the House changed the rules on motions to recommit stating
we could continue to have the committee and amendment process to voice
our concerns. Madam Speaker, this has had neither, and it is a shame
because the provision of quality hospital care is too important to be
eliminated due to some philosophical bent of a couple of your senior
Members.
New Members, this is an early to important test: do you vote your
district or do you vote your leadership? Do you vote your hospitals or
do you vote for a policy that was concocted in private in Washington.
Madam Speaker, in 1997, the Republican Congress enacted the State
Children's Health Insurance Program to help children's families near
poverty. But now, true to their big government agenda, the Democrat
Congress wants to send the President-elect a massive increase in the
SCHIP Program that will usher in a new era of socialized medicine in
America.
This bill will take a program designed to help children near the
poverty level and expand it to include families with incomes of up to
$84,000 a year.
And Democrats will pay for this middle class entitlement with a 61
cent--$1 per pack tax increase on cigarettes.
Let's provide health insurance for children of the poor, but let's
reject a liberal Democratic Congress attempt to create middle class
entitlements on the backs of American smokers.
Since Congress has already reauthorized and fully funded SCHIP
through March 31, 2009, we should work in a bipartisan manner to
thoughtfully develop a longer-term reauthorization of the State
Children's Health Insurance Program.
While I have been pleased to support SCHIP in the past, and continue
to support its original intention to cover needy children who do not
qualify for Medicaid, the bill being considered today hardly resembles
the bipartisan compromise reached in 1997.
My Republican colleagues and I are eager to work with Democrats--as
we did more than 10 years ago--to ensure that needy children receive
health care coverage. As the program expands, health care for needy
children is jeopardized. Republicans will work tirelessly to see that
every currently eligible child is covered first and that taxes are not
raised on the poorest among us.
The Democrats' SCHIP bill spends billions of dollars to substitute
private health insurance coverage with government-run healthcare
coverage. The Democrats' SCHIP bill taxes the poor to benefit the
middle class. The bill uses the funding gained from taxing the poor to
pay for expanding SCHIP eligibility to higher-income families. The
Democrats' SCHIP bill focuses on enrolling higher-income kids instead
of low-income, uninsured kids. The Democrats' SCHIP bill enables
illegal aliens to fraudulently enroll in Medicaid and SCHIP.
Short of finding at least 22.4 million new smokers (the number
required to adequately fund SCHIP) Democrats will be forced to either
kick millions of children off of health insurance or raise taxes on all
of us by tens of billions of dollars.
It is irresponsible to fund a children's health program, particularly
one targeted at vulnerable children, with a declining revenue stream.
The revenue to fund this expansion will soon disappear, causing all
of us to pay more in taxes.
The percentage of Americans who smoke has been dropping for decades.
And research and logic both show that raising the prices of cigarettes
will lead to less smoking, and therefore less revenue.
The Democrat expansion of SCHIP takes money from taxpayers in States
like Indiana to pay for middle class children in wealthier States.
I oppose this legislation and urge my colleagues to do the same.
Mr. LARSON of Connecticut. Madam Speaker, I rise today in support of
the reauthorization of SCHIP, an important piece of legislation that
has become even more necessary now than it was when we started working
on it 2 years ago. I commend my colleagues, Congressman Pallone,
Congressman Waxman, the dean of the House, Congressman John Dingell,
Congressman Rangel, Congressman Stark, and many others for their
tireless efforts on this bill.
Madam Speaker, by passing this bill today we will provide health care
for 11 million children. This is not just a bipartisan achievement, it
is the right thing to do.

[[Page H261]]

With the economic downturn and some of the worst unemployment numbers
we've seen in decades, rising health insurance costs are making it
increasingly difficult for families to afford health care for their
children. States faced with the constitutional responsibility of
balancing their budgets have been cutting programs that provide
children with access to health care. Some states have already cut
thousands of children from their CHIP programs and more States are
considering drastic action. By reauthorizing SCHIP, we will enable
States to prevent the loss in health coverage for many of these
children and allow more uninsured families to participate in the
program. In Connecticut alone this legislation will mean thousands of
our 43,000 uninsured children will now be covered.
One story that has been brought to my attention is the story of the
Farr family in Manchester, CT. Joseph and Danielle Farr are in their
early thirties. They are hardworking citizens who have a young child
soon to turn 1. They have a household income that is just $15 above
Medicaid. But they qualify for SCHIP, which they call a ``godsend'' for
their family.
The Farrs just learned that Joe is likely to be laid off from his job
in March--a story familiar to many Americans. But, thanks to SCHIP,
their son will continue to get the health care he needs. By
reauthorizing SCHIP we will make sure that families like the Farrs will
continue to have health care for their child even if they do fall
victim to the economic downturn.
This bill will increase outreach efforts targeted at children
currently eligible but not enrolled in the program and also give
pregnant women access to health care through SCHIP. While we still have
many more miles to travel on the road to fulfilling the promise of
health care reform, this, Madam Speaker, is a down-payment on that
effort. I am proud to support this legislation and urge my colleagues
to stand with us, to stand with our children, and pass this bill.
Ms. LEE of California. Madam Speaker, I rise in strong support of
H.R. 2, the State Children's Health Insurance Program (SCHIP)
Reauthorization bill.
I want to thank Chairman Waxman and Chairman Pallone and all the
staff for their work in ensuring that this bill moves forward as one of
our highest priorities in the 111th Congress.
Today we will take the long overdue step to expand health insurance
coverage to over 11 million children throughout the country.
As our Nation remains mired in the depths of the worst economic
crisis since the Great Depression, the action we take now could not be
more important or more necessary.
The fact is that the economic policies of the outgoing administration
have left our Nation in worse shape than we were 8 years ago.
Today, more people are living in poverty, more people are living
without health insurance, and more people are unemployed than they were
8 years ago.
As always, it is the most vulnerable, the children, who suffer the
greatest during tough economic times like these.
Passage of the SCHIP legislation today will at least help to make
life a little easier for 4 million more children who will receive
health coverage under this expanded program.
Although I strongly support this legislation, I believe it can still
be improved, most immediately by removing the citizenship verification
requirements that remain in this bill.
Ultimately we must move our Nation towards a universal health care
system to cover all children and all Americans. Nonetheless this bill
is an important step forward.
Madam Speaker, the Nation's children have waited far too long for
this moment. I urge my colleagues to pass this bill.
Ms. JACKSON-LEE of Texas. Madam Speaker, I rise today in strong
support for the ``Children's Health Insurance Program Reauthorization
Act of 2009.'' We stand today, closer to helping 4 million children
without health insurance. No longer will these children be forced to
live with fear of getting sick.
Today is a great day. Today we can bring 4 million children into the
fold. Today we can tell those 4 million children that are begging for
help that Yes We Can!

NATIONALLY AND IN TEXAS

There are an estimated 8.9 million uninsured children in America.
Overall, about 11.3 percent of children in the United States are
uninsured, but the percentage of uninsured children in each State
varies widely. Based on a 3-year average, there were an estimated 20.9
percent of uninsured children (under 19 years of age) in the Texas,
representing 1,454,000 of the State's children.
According to the Institute of Medicine, uninsured people are less
likely to use preventive services and receive regular care. They are
also more likely to delay care, resulting in poorer health and
outcomes. Texas has the highest uninsured rates of all 50 States and
the District of Columbia (2005-2007). Almost one-quarter, 24.4 percent,
of Texans are uninsured compared to 15.3 percent of the general U.S.
population.
Data show that virtually all the net reduction in SCHIP enrollment
has been among children in families with incomes below 150 percent FPL.
The number of below-poverty children has dropped by more than 68
percent, and the number of children between 101-150 percent FPL has
dropped by more than one-third since September 2003. I want to share
with you just some of the scary health statistics that are affecting
children:
74 percent of uninsured children eligible for SCHIP or Medicaid but
not enrolled.
11 percent of uninsured children in families not eligible for
Medicaid or SCHIP with incomes below.
15 percent of uninsured children in families with incomes over 300
percent of the Federal poverty level who are ineligible for Medicaid
and SCHIP.
90 percent of uninsured children that come from families where at
least one parent works.
50 percent of two-parent families of uninsured children in which both
parents work.
3.4 million uninsured children who are white, non-Hispanic.
1.6 million uninsured children who are African American.
3.3 million uninsured children who are Hispanic.
670,000 uninsured children of other racial and ethnic backgrounds.
In the great State of Texas, there is a young man named Jason who had
SCHIP health insurance for years, and the coverage was life saving.
When he was in a car accident over a year ago, SCHIP covered his
treatment and all the medical bills. His family needs SCHIP because
they cannot afford private health coverage. The parents work hard, but
the father's employment in pest control is seasonal and provides only
about $35,000 annually. Jason's mother is wheelchair-bound with
multiple sclerosis and has significant health care expenses.
When Jason lost SCHIP a year ago, his mother suspected they had been
denied because of the 2003 Ford truck the family purchased so that she
could transport her wheelchair. Prior to last year, she had never had
problems renewing coverage, and the family's income had not change. But
the income guidelines had changed.
New SCHIP guidelines that took effect in December 2005 do not count
children over 18 years of age as family members. Although their full-
time student daughter lives at home, she is not counted as part of the
family, and, as a result, they are about $50 a month above the income
limit for a family of three. So now the entire family is uninsured.
This lack of coverage means that when Jason gets sick or hurt, they
have to delay paying other bills to pay for medical care.
Lack of coverage also has affected Jason's performance in school. He
has been sick quite a bit in the past few years with allergies and has
missed many days of school because his eyes become swollen and he is
unable to breathe. School officials had reprimanded the mother about
his absences but now realize that Jason has some serious health issues.
Finally we will be able to help people like Jason and assuage his
mothers concerns. We are able to insure those who need it most.

PHYSICIAN-OWNED HOSPITALS

Sadly, there is one portion of this bill I did have some trouble
with, the restrictions on physician-owned hospitals. Yesterday, my dear
friend from Oklahoma, Congressman Boren, and I were able to voice a
very real concern that we had with the prohibition on physician-owned
hospitals.
As the bill was originally written there was a provision in the bill
that would have drastically affected the quality of care available to
Houston residents and people in urban communities across the entire
country.

JACKSON-LEE AMENDMENT

Yesterday, I put forth an amendment that would have exempted General
Acute Care Full Service Physician-Owned Hospitals from section 1877 of
the Social Security Act, as added by section 623 in SCHIP. There is no
direct evidence that demonstrates that overutilization of services and
improper self-referrals are in any more excess at General Acute Care
Full Service Physician-Owned Hospitals.
My amendment would have exempted responsible and efficient physician-
owned hospitals to develop, purchase, sell, and/or transfer their
interests.

BOREN/JACKSON-LEE AMENDMENT

My amendment with Congressman Boren would have provided an extension
for the January 1, 2009 grandfather clause for physician-owned
hospitals to allow physician-owned hospitals currently under
construction to be completed.
At least 85 hospitals across the Nation have been affected. Boren/
Jackson-Lee does not differentiate between General Acute Care, Full
Service, and Specialty Hospitals.
The exceptions that exist to grandfather in certain physician owned
hospitals are inadequate and will affect more than 85 hospitals

[[Page H262]]

that are currently in development and under construction. It will also
restrict sales and transfers of many responsible physician-owned
hospitals.
In my district of Houston, TX the population has grown close to 4.5
million people, and there are only approximately 16,000 beds available
in the city. Eliminating physician ownership in general acute care
hospitals would only contribute to this ever growing problem.
While many specialty hospitals are accused of turning away uninsured
and Medicaid patients and practicing only profitable healthcare,
responsible physician-owned hospitals do just the opposite.
Physician-owned hospitals like St. Joseph Medical Center in my
district provide essential emergency, maternity, and psychiatric care
for their patients. They delivered over 6,000 babies in 2008, of which
3,700 were insured by Medicaid. Currently they provide $14M in
uninsured care in the Houston market. A Houston institution for 120
years, St. Joseph Medical Center is also a major provider of
psychiatric beds as it currently operates 102 of the 800 licensed beds
in Houston.
While Members of the Texas delegation have continued to support
general acute-care hospitals and their future development; we still
believe that general acute-care hospitals still need to be able to:
Maintain a minimum number of physicians available at all times to
provide service;
Provide a significant amount of charity care;
Treat at least 1/6 of its outpatient visits for emergency medical
conditions on an urgent basis without requiring a previously scheduled
appointment;
Maintain at least ten full time interns or residents-in-training in a
teaching program;
Advertise or present themselves to the public as a place which
provides emergency care;
Serve as a disproportionate share provider, serving a low income
community with a disproportionate share of low income patients; and
Have at least 90 hospital beds available to patients.
This issue is of the utmost importance to me because I, like others
in the Democratic Caucus, have hospitals and hospital systems such as
University Hospital Systems of Houston in my district that would have
been greatly affected by this provision.

ST. JOSEPH MEDICAL CENTER

In 2006, St. Joseph Medical Center, downtown Houston's first and only
teaching hospital, was on the verge of closing its doors. When I
learned that they were going to shut down this hospital and turn it
into high-end condominiums, I personally worked with the hospital
board, community leaders, and local government to ensure this did not
take place. Eventually, after I was assured that it would be
responsibly managed and its doors would remain open, I was able to help
a hospital corporation, in partnership with physicians, which has
purchased the hospital and has made it the premier hospital in the
region to keep open St. Joseph's doors including its qualified
emergency room responsive to a heavily populated downtown Houston.
This formerly troubled medical center is now in the process of
reopening Houston Heights Hospital, the fourth oldest acute care
hospital in Houston. Without language that specifically addresses this
distinction, this project too will come to an end.
Sadly, it remains unclear if CHIP provides for physician-owned
hospitals to still be considered grandfathered if have a sale or
transfer at the same ownership rate or at a different physician-
ownership rate.
Between December 2007 and December 2008, the U.S. economy shed about
2.6 million jobs, while Texas made significant gains. Texas' nonfarm
employment registered a stable 2.1 percent growth rate over the year,
even as the Nation's job losses reached their worst level since 2003.
CBO forecasts the following:
A marked contraction in the U.S. economy in calendar year 2009, with
real (inflation adjusted) gross domestic product (GDP) falling by 2.2
percent;
A slow recovery in 2010, with real GDP growing by only 1.5 percent;
An unemployment rate that will exceed 9 percent early in 2010.
The U.S. Bureau of Labor Statistics announced on November 21, 2009,
that October's unemployment rate was 6.5 percent, a jump of 0.4
percent, which was double what most economists expected and its highest
level in 14 years. The economy has now lost 1.2 million jobs since the
beginning of the year, with nearly half of those losses occurring in
the last 3 months alone, pointing to acceleration in the pace of
erosion in labor markets. It is more important than ever in this
economy that children's health care is not sacrificed.
Madam Speaker, my faith is renewed in the process that is so often
maligned in the media. Thoughtful and deliberate actions were taken to
improve this legislation that would not only help the children of my
district and many others across the nation, but also it was able to
address concerns that many of us, myself included have on these
specialty hospitals.
I look forward to a day when every child is covered and can play on
football fields and jungle gyms without their parents fearing a
bankrupting injury to their child. This legislation is piece of mind to
4 million families, and I will joyfully cast my vote for passage of
this important legislation.
Mr. LEVIN. Madam Speaker, some of the issues we debate in Congress
are complicated. This one is quite simple. Americans want the children
of this country covered by health insurance.
The State Children's Health Insurance Program currently covers about
7 million children, including 114,000 kids in my home State of
Michigan. However, there are still about 9 million children in our
country who are uninsured. This is unconscionable. No mother should
have to worry about whether she can pay for the health care her child
needs. No father should have to take his son to the emergency room
because he does not have insurance to visit a primary care doctor. No
society should allow a child to go without the security health
insurance provides.
Congress passed two SCHIP bills last session. Both pieces of
legislation were bipartisan, and both cleared the House and Senate with
large majorities. Unfortunately, President Bush vetoed these bills.
As economic conditions have worsened over the course of the last year
and more and more children have lost health insurance, this bill has
become even more vital to ensuring that children do not fall through
the cracks of our current health care system. The legislation under
consideration today would extend coverage to another 4 million low-
income children. It is an important step toward the goal of ensuring
that all Americans, especially children, have the quality and
affordable health care they need.
President-elect Obama strongly supports this SCHIP legislation. I can
think of no better beginning to the next 4 years than to send the new
President this critical investment in children's health. I urge my
colleagues to vote for passage of H.R. 2, the Children's Health
Insurance Program Reauthorization Act of 2009.
Mr. POSEY. Mr. Speaker, I rise to express both my support for the
State Children's Health Insurance Program, SCHIP, and my reservations
about the particular SCHIP bill, H.R. 2, that is before us today. I
would also add that I am pleased to support an alternative version that
will be offered as a substitute today. This alternative focuses SCHIP
on low income children and addresses the problems with the underlying
bill.
Our nation faces very serious financial challenges. The Congressional
Budget Office, CBO, projects that this year's Federal budget deficit
will be nearly $1.2 trillion dollars. In other words one out of every
three dollars that the Federal Government will spend this year will be
borrowed from future generations. Given that our children and
grandchildren will have to pay back everything that this generation
borrows, we must give the greatest scrutiny to each and every dollar
that is spent.
I am committed to working to assist lower-income children who lack
insurance. SCHIP was established as a bipartisan program to insure
children in families too poor to pay for insurance but not poor enough
to qualify for Medicaid. If that was what the bill before us did, I
would be voting for it. Unfortunately, H.R. 2 goes well beyond focusing
specifically on these children.
H.R. 2 expands SCHIP to extend taxpayer subsidies to the children of
those living in, for example, New Jersey and making more than $80,000
per year, 400 percent of the poverty level.
The CBO estimates that 2.4 million of the new enrollees in SCHIP will
be children who simply dropped private coverage to enroll in SCHIP.
Given our massive Federal deficit, does it make sense to borrow money
from our children and grandchildren in order to enroll in SCHIP
children who currently have other private insurance?
H.R. 2 continues to allow states to enroll single adults in SCHIP.
Over 600,000 are enrolled in the SCHIP program and three states have
more adults enrolled in SCHIP than children. This is particularly
troubling given that in many states with large numbers of adults
enrolled in SCHIP, many qualified children remain uninsured. This is a
misappropriation of limited resources and children should not have to
sit on the sidelines while able-bodied adults take their benefits.
H.R. 2 also repeals safeguards that were put in place to ensure that
illegal immigrants were not enrolled in taxpayer subsidized SCHIP.
Removing these safeguards will actually encourage illegal immigration
by offering taxpayer funded benefits to people who bypass our laws and
enter the U.S. illegally. In a sense, it gives foreign nationals an
incentive to break our immigration laws.
Finally, in an admission by the sponsors of H.R. 2 that the bill is
unaffordable, the bill assumes that millions of children will be
dropped

[[Page H263]]

from the SCHIP program in 2013 in order to meet the technical
requirements of Federal budget rules. Does anyone really believe that
the Congress would kick millions of people out of SCHIP in 2013? It's
time for this Congress to be honest with the American people and this
bill does not meet that test. By employing this budget gimmick, the
sponsors of H.R. 2 are admitting that the bill is unaffordable.
I am fully supportive of legislation that would focus on ensuring
that lower income children are able to enroll in SCHIP. This bill falls
far short of that goal.
In conclusion let me say that we have until March 31 to reauthorize
SCHIP. Congress should use that time wisely to further examine the
effectiveness of this program to date and address these shortcomings. I
am disappointed that this 286-page bill is being rushed to the House
floor under a closed process that denies Members of the House the
opportunity to have an up or down vote on amendments that would address
these concerns. I believe that America's children deserve better.
Mr. ABERCROMBIE. Madam Speaker, I rise today to address an issue
raised by my colleagues regarding Hawaii's Keiki Care program as a
reason not to expand SCHIP. It was suggested earlier today that the
Keiki (meaning ``child'') Care program was cancelled due to perceived
crowd-out, a situation where parents drop their children's private
insurance in order to enroll into a free government program.
I have supported the State Legislature's efforts to expand health
care coverage for children and followed the implementation of Keiki
Care closely. The statements made about a crowd-out problem leading to
the program's demise were baseless. The Keiki Care program had no
problems with crowd-out. First of all, it was intentionally designed to
prevent such behavior in requiring that children who wish to enroll
must be uninsured continuously for 6 months. Secondly, if parents were
indeed hoping to drop their insurance and wait 6 months to enroll, then
Keiki Care would have seen a spike in enrollment. Blue Cross Blue
Shield Hawaii, the health insurance provider for Keiki Care, did not
see any spikes in enrollment and have no evidence to believe crowd-out
occurred.
Furthermore, there was little incentive for parents to switch to the
Keiki Care program from any private health plan. The health insurance
plan offered under Keiki Care was basic preventative care. This means
that parents would have had to pay for expanded care costs out of
pocket. In looking closer at the Keiki Care program, it is evident that
a parent with a full coverage plan for their child would have no
incentive to drop a private insurance for this basic, prevention-
centered plan.
The State Administration has given various explanations regarding the
decision to end Keiki Care, including a growing budget deficit.
However, the facts about the program are clear. There was never a
problem regarding crowd-out and if continued, the program would have
helped to cover more of Hawaii's uninsured children. Therefore, Madam
Speaker, it is my hope that by clarifying the details regarding Keiki
Care, it will no longer be used as a rationale that has no basis in
fact against SCHIP or other efforts to expand health insurance to
children and the uninsured.
Mr. BACA. Madam Speaker, I rise today in strong support of H.R. 2, to
extend and improve the Children's Health Insurance Program.
Families in my district in San Bernardino, California, are struggling
to make ends meet and bring food to the table.
Congress must answer to these and other families across America.
SCHIP is a vital component of our country's health system, allowing
for individual states to take care of our most vulnerable, America's
children.
A facility in my district, the Community Hospital of San Bernardino
is about to rip apart at the seams.
Without SCHIP, they will either have to turn away or eat the cost of
4,000 families enrolled in Healthy Families, California's version of
SCHIP.
If SCHIP is not reauthorized, these alarming figures will jump even
higher, further jeopardizing their ability to provide care for our
community.
This problem is even worse when you consider the impact of the
recession, and the growing number of unemployed and without health
insurance.
I urge my colleagues to help these families, do the responsible thing
and vote for SCHIP.
Mr. DINGELL. Madam Speaker, I stand in strong support of H.R. 2, the
Children's Health Insurance Program, CHIP, Reauthorization Act of 2009.
In 1997, a Republican Congress and Democratic President passed a
landmark program to reach children who had fallen through the cracks of
our healthcare system. These kids weren't poor enough to qualify for
Medicaid, and their parents--most of whom worked--couldn't afford
health insurance. The CHIP program has proven to be a major success--
covering more than 7 million children who otherwise would not have
health coverage.
Last year, my colleagues and I tried, on two occasions, to
reauthorize this program and expand it to provide care for many more
kids in need of its services. Unfortunately, President Bush stood in
our way--not once, but twice. I am confident President-elect Obama has
his priorities straight and will do what President Bush refused to do--
provide much needed health care for our nation's children.
The current economic crisis increases the importance of the CHIP
program. More than 1 million children have lost their health coverage
because their parents were laid off and lost their employer-based
coverage over the past year.
This is especially true in Michigan, which has over 150,000 children
uninsured. While Michigan has one of the lowest rates of uninsured
children in the country, I fear that the number of uninsured will
worsen as Michigan's unemployment rate continues to increase. Recent
reports suggest that Michigan's unemployment rate will reach 11.3
percent by the end of the year.
H.R. 2 is critical in this regard because it not only will continue
to provide coverage for the 7 million kids already participating in the
CHIP program, but will extend health care to 4 million more.
H.R. 2 is for every child out there who needs a vaccination, a cavity
filled, chemotherapy, insulin, antidepressants and more life sustaining
health care.
This bill is a great first step as we begin our work to reform the
nation's health care system and provide health coverage for 47 million
uninsured Americans. I look forward to working with my colleagues,
Senator Daschle, and President-elect Obama to continue the work. We
will not stop until all Americans have access to quality, affordable
healthcare.
I encourage all of my colleagues to vote for the children in your
district, and for all of America's children. Vote for H.R. 2, the
Children's Health Insurance Program, CHIP, Reauthorization Act of 2009.
Mr. LANGEVIN. Madam Speaker, I rise today in strong support of H.R.
2, the Children's Health Insurance Program Reauthorization Act. This
legislation represents a crucial and long overdue investment in the
health and wellbeing of our nation's most valuable assets--our
children.
Since 1997, the State Children's Health Insurance Program (SCHIP) has
successfully provided health coverage to millions of low income
children across the country who would not otherwise be able to access
these services. I have been especially proud of the Rite Care program
in my home state of Rhode Island, which covered approximately 24,000
children last year under both the SCHIP and Medicaid programs. However,
too many children and their families remain without access to proper
health services. We must reaffirm our commitment at the federal level
to ensure states have the means to address the health care needs of our
constituents, particularly in the midst of an economic crisis that has
resulted in dramatic increases in unemployment levels.
H.R. 2 will ensure health coverage for a total of 11 million American
children by reauthorizing SCHIP for four and a half years and extending
coverage to an additional 4 million uninsured children who are
currently eligible for, but not enrolled in, SCHIP and Medicaid. Two-
thirds of uninsured children are eligible for coverage through SCHIP
and Medicaid, but better outreach and adequate funding are needed to
identify and enroll them. This bill provides $100 million in grants for
new outreach activities to states, local governments, schools,
community-based organizations and other safety-net providers. It also
improves SCHIP by ensuring dental coverage for children, mental health
services on par with medical and surgical benefits, as well as improved
access to private coverage options through premium assistance
subsidies.
Finally, H.R. 2 reauthorizes and improves SCHIP without adding to our
ballooning federal deficit. Since the cost of the bill is completely
offset, it will allow us to make a much-needed investment in the health
of our children without requiring them to pay for it in the future.
As many of my colleagues know, universal access to health care has
been a top priority of mine throughout my tenure in Congress. I can
think of no better place to start than by guaranteeing that children
across the country receive the health care services they both require
and deserve. I, therefore, urge all of my colleagues to support passage
of this measure.
Mr. PALLONE. Madam Speaker, I yield back the balance of my time.
The SPEAKER pro tempore. All time for debate has expired.
Pursuant to House Resolution 52, the bill is considered read and the
previous question is ordered.
The question is on the engrossment and third reading of the bill.

[[Page H264]]

The bill was ordered to be engrossed and read a third time, and was
read the third time.

Motion to Recommit

Mr. DEAL of Georgia. Madam Speaker, I have a motion at the desk.
The SPEAKER pro tempore. Is the gentleman opposed to the bill?
Mr. DEAL of Georgia. I am in its current form.
Mr. WAXMAN. Madam Speaker, I reserve a point of order.
The SPEAKER pro tempore. A point of order is reserved.
The Clerk will report the motion to recommit.
The Clerk read as follows:
Mr. Deal of Georgia moves to recommit the bill, H.R. 2, to
the Committee on Energy and Commerce with instructions to
report the same back to the House forthwith with the
following amendment:
Strike all after the enacting clause and insert the
following:

SECTION 1. SHORT TITLE.

This Act may be cited as the ``SCHIP Full Funding Extension
Act of 2009''.

SEC. 2. EXTENDING SCHIP FUNDING THROUGH FISCAL YEAR 2015.

(a) Through Fiscal Year 2015.--
(1) In general.--Section 2104 of the Social Security Act
(42 U.S.C. 1397dd), as amended by section 201 of the
Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public
Law 110-173), is amended--
(A) in subsection (a)(11), by striking ``and 2009'' and
inserting ``, 2009, 2010, 2011, 2012, 2013, 2014, and 2015'';
and
(B) in subsection (c)(4)(B), by striking ``through 2009''
and inserting ``through 2015''.
(2) Availability of extended funding.--Funds made available
from any allotment made from funds appropriated under
subsection (a)(11) or (c)(4)(B) of section 2104 of the Social
Security Act (42 U.S.C. 1397dd) for fiscal year 2009, 2010,
2011, 2012, 2013, 2014, or 2015 shall not be available for
child health assistance for items and services furnished
after September 30, 2015.
(b) Extension of Treatment of Qualifying States.--
(1) In general.--Section 2105(g)(1)(A) of the Social
Security Act (42 U.S.C. 1397ee(g)(1)(A)), as amended by
section 201(b) of the Medicare, Medicaid, and SCHIP Extension
Act of 2007 (Public Law 110-173), is amended by striking ``or
2009'' and inserting ``2009, 2010, 2011, 2012, 2013, 2014, or
2015''.
(2) Conforming amendment.--Section 201(b) of such Public
Law is amended by striking paragraph (2).
(c) Additional Allotments To Maintain SCHIP Programs
Through Fiscal Year 2015.--Section 2104 of the Social
Security Act (42 U.S.C. 1397dd) is amended by striking
subsection (l) and inserting the following new subsections:
``(l) Additional Allotments To Maintain SCHIP Programs for
Fiscal Year 2009.--
``(1) Appropriation; allotment authority.--For the purpose
of providing additional allotments described in subparagraphs
(A) and (B) of paragraph (3), there is appropriated, out of
any money in the Treasury not otherwise appropriated, such
sums as may be necessary, not to exceed $3,000,000,000 for
fiscal year 2009.
``(2) Shortfall states described.--For purposes of
paragraph (3), a shortfall State described in this paragraph
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 Federal
share amount of the projected expenditures under such plan
for such State for fiscal year 2009 will exceed the sum of--
``(A) the amount of the State's allotments for each of
fiscal years 2007 and 2008 that will not be expended by the
end of fiscal year 2008;
``(B) the amount, if any, that is to be redistributed to
the State during fiscal year 2009 in accordance with
subsection (i); and
``(C) the amount of the State's allotment for fiscal year
2009.
``(3) Allotments.--In addition to the allotments provided
under subsections (b) and (c), subject to paragraph (4), of
the amount available for the additional allotments under
paragraph (1) for fiscal year 2009, the Secretary shall
allot--
``(A) to each shortfall State described in paragraph (2)
not described in subparagraph (B), such amount as the
Secretary determines will eliminate the estimated shortfall
described in such paragraph for the State; and
``(B) to each commonwealth or territory described in
subsection (c)(3), an amount equal to the percentage
specified in subsection (c)(2) for the commonwealth or
territory multiplied by 1.05 percent of the sum of the
amounts determined for each shortfall State under
subparagraph (A).
``(4) Proration rule.--If the amounts available for
additional allotments under paragraph (1) are less than the
total of the amounts determined under subparagraphs (A) and
(B) of paragraph (3), the amounts computed under such
subparagraphs shall be reduced proportionally.
``(5) Retrospective adjustment.--The Secretary may adjust
the estimates and determinations made to carry out this
subsection as necessary on the basis of the amounts reported
by States not later than November 30, 2008, on CMS Form 64 or
CMS Form 21, as the case may be, and as approved by the
Secretary.
``(6) One-year availability; no redistribution of
unexpended additional allotments.--Notwithstanding
subsections (e) and (f), amounts allotted to a State pursuant
to this subsection for fiscal year 2009, subject to paragraph
(5), shall only remain available for expenditure by the State
through September 30, 2009. Any amounts of such allotments
that remain unexpended as of such date shall not be subject
to redistribution under subsection (f).
``(m) Additional Allotments To Maintain SCHIP Programs for
Fiscal Year 2010.--
``(1) Appropriation; allotment authority.--For the purpose
of providing additional allotments described in subparagraphs
(A) and (B) of paragraph (3), there is appropriated, out of
any money in the Treasury not otherwise appropriated, such
sums as may be necessary, not to exceed $4,000,000,000 for
fiscal year 2010.
``(2) Shortfall states described.--For purposes of
paragraph (3), a shortfall State described in this paragraph
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 Federal
share amount of the projected expenditures under such plan
for such State for fiscal year 2010 will exceed the sum of--
``(A) the amount of the State's allotments for each of
fiscal years 2008 and 2009 that will not be expended by the
end of fiscal year 2009;
``(B) the amount, if any, that is to be redistributed to
the State during fiscal year 2010 in accordance with
subsection (f); and
``(C) the amount of the State's allotment for fiscal year
2010.
``(3) Allotments.--In addition to the allotments provided
under subsections (b) and (c), subject to paragraph (4), of
the amount available for the additional allotments under
paragraph (1) for fiscal year 2010, the Secretary shall
allot--
``(A) to each shortfall State described in paragraph (2)
not described in subparagraph (B) such amount as the
Secretary determines will eliminate the estimated shortfall
described in such paragraph for the State; and
``(B) to each commonwealth or territory described in
subsection (c)(3), an amount equal to the percentage
specified in subsection (c)(2) for the commonwealth or
territory multiplied by 1.05 percent of the sum of the
amounts determined for each shortfall State under
subparagraph (A).
``(4) Proration rule.--If the amounts available for
additional allotments under paragraph (1) are less than the
total of the amounts determined under subparagraphs (A) and
(B) of paragraph (3), the amounts computed under such
subparagraphs shall be reduced proportionally.
``(5) Retrospective adjustment.--The Secretary may adjust
the estimates and determinations made to carry out this
subsection as necessary on the basis of the amounts reported
by States not later than November 30, 2010, on CMS Form 64 or
CMS Form 21, as the case may be, and as approved by the
Secretary.
``(6) Availability; no redistribution of unexpended
additional allotments.--Notwithstanding subsections (e) and
(f), amounts allotted to a State pursuant to this subsection
for fiscal year 2010, subject to paragraph (5), shall only
remain available for expenditure by the State through
September 30, 2010. Any amounts of such allotments that
remain unexpended as of such date shall not be subject to
redistribution under subsection (f).
``(n) Application to Fiscal Years 2011, 2012, 2013, 2014,
or 2015.--
``(1) In general.--Subject to paragraph (2), subsection (m)
shall apply to each of fiscal years 2011, 2012, 2013, 2014,
or 2015 in the same manner such subsection applies to fiscal
year 2010.
``(2) Application.--In applying subsection (m) under
paragraph (1) with respect to--
``(A) fiscal year 2011--
``(i) each reference to a year or date in such subsection
shall be deemed a reference to the following year or to one
year after such date, respectively; and
``(ii) the reference to `$4,000,000,000' in paragraph (1)
of such subsection shall be deemed a reference to
`$5,000,000,000';
``(B) fiscal year 2012--
``(i) each reference to a year or date in such subsection
shall be deemed a reference to the second following year or
to two years after such date, respectively; and
``(ii) the reference to `$4,000,000,000' in paragraph (1)
of such subsection shall be deemed a reference to
`$6,000,000,000';
``(C) fiscal year 2013--
``(i) each reference to a year or date in such subsection
shall be deemed a reference to the third following year or to
three years after such date, respectively; and
``(ii) the reference to `$4,000,000,000' in paragraph (1)
of such subsection shall be deemed a reference to
`$6,000,000,000';
``(D) fiscal year 2014--
``(i) each reference to a year or date in such subsection
shall be deemed a reference to the fourth following year or
to four years after such date, respectively; and
``(ii) the reference to `$4,000,000,000' in paragraph (1)
of such subsection shall be deemed a reference to
`$7,000,000,000'; and
``(E) fiscal year 2015--
``(i) each reference to a year or date in such subsection
shall be deemed a reference to the fifth following year or to
five years after such date, respectively; and

[[Page H265]]

``(ii) the reference to `$4,000,000,000' in paragraph (1)
of such subsection shall be deemed a reference to
`$7,000,000,000'.''.

SEC. 3. OPTION FOR QUALIFYING STATES TO RECEIVE THE ENHANCED
PORTION OF THE SCHIP MATCHING RATE FOR MEDICAID
COVERAGE OF CERTAIN CHILDREN.

Section 2105(g) of the Social Security Act (42 U.S.C.
1397ee(g)) is amended--
(1) in paragraph (1)(A), by inserting ``subject to
paragraph (4),'' after ``Notwithstanding any other provision
of law,''; and
(2) by adding at the end the following new paragraph:
``(4) Option for certain allotments.--
``(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 fiscal year
(beginning with fiscal year 2009) (insofar as the allotment
is available to the State under subsection (e) 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, and whose family income
equals or exceeds 133 percent of the poverty line but does
not exceed the Medicaid applicable income level.''.

SEC. 4. REQUIRING OUTREACH AND COVERAGE BEFORE EXPANSION OF
ELIGIBILITY.

(a) State Plan Required to Specify How It Will Achieve
Health Benefits Coverage for 90 Percent of Low-Income
Children.--
(1) In general.--Section 2102(a) of the Social Security Act
(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 State for each fiscal year (beginning with
fiscal year 2010) will achieve, through eligibility and
benefits provided for under the plan and otherwise, a rate of
health benefits coverage (whether private or public) for low-
income children in the State that is at least 90 percent.''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply to State child health plans for fiscal years
beginning with fiscal year 2010.
(b) Limitation on Program Expansions Until Lowest Income
Eligible Individuals Enrolled.--Section 2105(c) (42 U.S.C.
1397dd(c)) is amended by adding at the end the following new
paragraph:
``(8) Limitation on increased coverage of higher income
children.--For child health assistance furnished in a fiscal
year beginning with fiscal year 2010:
``(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 (in
accordance with any methodology established by the Secretary)
that the State has met the 90 percent retrospective coverage
test specified in subparagraph (B) for the previous fiscal
year.
``(B) 90 percent coverage test.--The 90 percent
retrospective coverage test specified in this subparagraph
is, for a State for a fiscal year, that on average for any 3-
consecutive month period during the fiscal year, at least 90
percent of low-income children residing in the State have
health benefits coverage (whether private or public).
``(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,
2009;
``(ii) to a pregnant woman who is enrolled for assistance
under this title as of September 30, 2009, through the
completion of the post-partum period following completion of
her pregnancy; and
``(iii) for items and services furnished before October 1,
2009, to an individual who is not a targeted low-income child
and who is enrolled for assistance under this title as of
September 30, 2009.
``(D) Promulgation of methodology.--Not later than July 1,
2009, the Secretary shall issue regulations that establish a
methodology by which States meet the requirements of
subparagraph (A).
``(E) Determination of income based on gross family income
without disregards or exclusions.--
``(i) In general.--For purposes of this paragraph, the
family income shall be determined under subparagraph (A) (and
under subparagraph (B) for purposes of determining who is a
low-income child, as defined in section 2110(c)(4)) based on
gross family income.
``(ii) Gross family income defined.--

``(I) In general.--Subject to subclause (II), in this
subparagraph, the term `gross family income' means, with
respect to an individual, gross income (as defined by the
Secretary in regulations) for the members of the individual's
family. For purposes of the previous sentence, in defining
`gross income' the Secretary shall, to the maximum extent
practicable, include income from whatever source, other than
amounts deducted under section 62(a)(1) of the Internal
Revenue Code of 1986.
``(II) Income disregards authorized.--A State may provide,
through a State plan amendment and with the approval of the
Secretary, for the disregard from gross family income of one
or more amounts so long as the total amount of such
disregards for a family does not exceed $250 per month, or
$3,000 per year.''.

SEC. 5. SCHIP GROSS INCOME ELIGIBILITY CEILING.

(a) Application of SCHIP Eligibility Ceiling.--
(1) In general.--Section 2110 of the Social Security Act
(42 U.S.C. 1397jj) is amended--
(A) in subsection (b)(1)--
(i) by striking ``and'' at the end of subparagraph (B);
(ii) by striking the period at the end of subparagraph (C)
and inserting ``; and''; and
(iii) by adding at the end the following new subparagraph:
``(D) whose gross family income (as defined in subsection
(c)(9)) does not exceed 300 percent of the poverty line.'';
and
(B) in subsection (c), by adding at the end the following
new paragraph:
``(9) Gross family income.--
``(A) In general.--Subject to subparagraph (B), the term
`gross family income' means, with respect to an individual,
gross income (as defined by the Secretary in regulations) for
the members of the individual's family. For purposes of the
previous sentence, in defining `gross income' the Secretary
shall, to the maximum extent practicable, include income from
whatever source, other than amounts deducted under section
62(a)(1) of the Internal Revenue Code of 1986.
``(B) Income disregards authorized.--A State may provide,
through a State plan amendment and with the approval of the
Secretary, for the disregard from gross family income of one
or more amounts so long as the total amount of such
disregards for a family does not exceed $250 per month, or
$3,000 per year.''.
(2) Denial of federal matching payments for state schip
expenditures for individuals with gross family income above
300 percent of the poverty line.--Section 2105(c) of the
Social Security Act (42 U.S.C. 1397ee(c)), as amended by
section 4(b), is amended by adding at the end the following
new paragraph:
``(9) Denial of payments for expenditures for child health
assistance for individuals whose gross family income exceeds
300 percent of the poverty line.--No payment may be made
under this section, for any expenditures for providing child
health assistance or health benefits coverage under a State
child health plan under this title, including under a waiver
under section 1115, with respect to an individual whose gross
family income (as defined in section 2110(c)(9)) exceeds 300
percent of the poverty line.''.
(b) Effective Date; Transition.--
(1) In general.--Subject to paragraph (2), the amendments
made by this section shall apply to payments made for items
and services furnished on or after the first day of the first
calendar quarter beginning more than 90 days after the date
of the enactment of this Act.
(2) Transition.--The amendments made by--
(A) subsection (a)(1) shall not apply to an individual who
was receiving, or was determined eligible to receive, child
health assistance or health benefits coverage under a State
child health plan under title XXI of the Social Security Act,
including under a waiver under section 1115 of such Act, as
of the day before the date of the enactment of this Act,
until such date as the individual is determined ineligible
using income standards or methodologies in place as of the
day before the date of the enactment of this Act; and
(B) subsection (a)(2) shall not apply to payment for items
and services furnished to an individual described in clause
(i);

SEC. 6. TIME FOR PAYMENT OF CORPORATE ESTIMATED TAXES.

(a) 5-Year Period.--The percentage under subparagraph (C)
of section 401(1) of the Tax Increase Prevention and
Reconciliation Act of 2005 in effect on the date of the
enactment of this Act is increased by 19 percentage points.
(b) 10-Year Period.--Notwithstanding section 6655 of the
Internal Revenue Code of 1986--
(1) the amount of any required installment of corporate
estimated tax which is otherwise due in July, August, or
September of 2018 shall be 130 percent of such amount, and
(2) the amount of the next required installment after the
installment referred to in paragraph (1) shall be
appropriately reduced to reflect the amount of the increase
by reason of paragraph (1).

[[Page H266]]

Mr. WAXMAN (during the reading). Madam Speaker, I ask unanimous
consent that the motion to recommit be considered read, and I also
withdraw my point of order.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from California?
There was no objection.
The SPEAKER pro tempore. Reservation of the point of order is
withdrawn.
The gentleman from Georgia is recognized for 5 minutes in support of
his motion.
Mr. DEAL of Georgia. Madam Speaker, the Republican motion to recommit
replaces what I consider to be a deeply flawed bill that has been
offered and also has improvements to the SCHIP proposal that we are
considering.
Unlike H.R. 2, the Republican motion to recommit fully funds SCHIP
program for the next 7 years, not 4\1/2\ years as the underlying bill
would do, and thereby ensures that needy families and those with low
incomes will be covered and eligible under SCHIP through fiscal year
2015. According to the Congressional Budget Office, the motion to
recommit will not cause a single SCHIP enrolled child to lose his or
her health care coverage.
Unlike the bill that is under consideration, H.R. 2, the motion to
recommit puts poor children first by holding States accountable for not
finding and enrolling their low-income, uninsured children. Each year,
States would be required to report to the Secretary of HHS how they
intend to ensure that at least 90 percent of their children with family
incomes under $40,000 per year have quality health care coverage in
either a public or private health care plan. States would also be
required to demonstrate that they have met this 90 percent coverage
target before they are able to shift their enrollment activities to
higher income families.
Unlike H.R. 2, the motion to recommit maintains the requirement in
current law that States verify the identity and citizenship status of
Medicaid and SCHIP applicants and prevents illegal aliens and other
unqualified individuals from fraudulently gaining access to these
taxpayer-funded programs.
Unlike H.R. 2, the Republican motion to recommit preserves limited
SCHIP dollars for low-income, uninsured children by preventing States
from abusing the income-disregard loophole that is in the current law
and would be continued under the underlying bill.
Unlike H.R. 2, the Republican motion to recommit Federal funds will
be reserved for families with incomes under 300 percent of the Federal
poverty level, which is currently $63,600 for a family of four.
This motion to recommit is compliant with the majority's PAYGO rules
by asking corporations with assets in excess of $1 billion to shift
some estimated tax payments due in fiscal year 2009 to fiscal year
2018.
The majority has repeatedly used this short-term shifting of funding
to meet the 5-year PAYGO requirements, and we're using it today to
comply with the majority's PAYGO requirements without raising taxes.
Fully paid for without increasing taxes on the American people is
what this motion to recommit would provide. And unlike the underlying
bill, H.R. 2, the Republican recommit motion will actually allow
President-elect Obama to keep his promise to the American people of not
increasing their taxes.
We believe that these fundamental changes from the underlying bill
not only improve it, but extend the life of it for a full 7-year period
and is altogether appropriate, and does not include increasing taxes on
the American people.
We believe in the SCHIP program. We think that it should be properly
applied in States and applied primarily to those who are low-income,
poor families first rather than going up the economic scale of
eligibility.
For these reasons, I would urge this body to adopt the motion to
recommit and to pass a bill for a 7-year period that fully funds and
assures States and families that their children will be covered.
Madam Speaker, I yield back the balance of my time.
Mr. PALLONE. Madam Speaker, I rise in opposition to the motion to
recommit.
The SPEAKER pro tempore. The gentleman from New Jersey is recognized
for 5 minutes.
Mr. PALLONE. Madam Speaker, it wasn't enough that President Bush
vetoed two children's health bills that would have made great advances
in children's health. Now my Republican colleagues are trying to
undermine the coverage gains that would be made in this bill.
This proposal being put forward by my Republican colleagues isn't a
way to put poor kids first. It's a way to stop States from moving
forward to help additional uninsured children.
The CHIP bill already puts poor kids first by targeting enrollment
bonuses only to the poorest kids, those in Medicaid. Eight in ten newly
insured children under CHIP have incomes below current eligibility
levels. The Republican proposal is simply a way to stop States from
moving forward.
Unfortunately, the reality of today is that these moderate income
families who would be excluded under this motion are struggling to make
ends meet, too. Health costs have been rising much faster than income
over the past decade. A family at 300 percent of poverty, for example,
earning $52,800 a year--these so-called rich folks, according to
Republicans--now spend an average of 19 percent of their income on
premiums for employer-sponsored coverage if they even have access to
it. Ten years ago, that same family was only spending 11 percent of
income on premiums for their employer plan.
The CHIP bill moves us forward. It's the largest investment in
children's health since the original CHIP law was passed in '97. And
this Congress will do more for children, and it's an excellent step
forward.
Now I want to mention that research shows that no means tested
program reaches 90 percent of the individuals or families eligible for
it. Moreover, there is not reliable State-by-State data to even measure
participation rates accurately among the States.
While the Bush administration initially attempted to establish
measures like Mr. Deal is talking about, leading independent academic
and research institutions discredited the Bush administration's target
rate, such as CBO and the Urban Institute, and the Bush administration
has moved away from its initial administrative directive of enforcing
such limits on States the way this motion would do.
So again, the point is we need to move forward. This is simply a
rouse essentially to gut the bill for those moderate-income families
that would benefit for it.
I would urge my colleagues to oppose this motion to recommit. Let's
move the bill as originally proposed. It will do great things for
America's children.
Madam Speaker, I yield back the balance of my time.
The SPEAKER pro tempore. 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. DEAL of Georgia. Madam Speaker, I object to the vote on the
ground that a quorum is not present and make the point of order that a
quorum is not present.
The SPEAKER pro tempore. Evidently a quorum is not present.
The Sergeant at Arms will notify absent Members.
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 179,
nays 247, not voting 7, as follows:

[Roll No. 15]

YEAS--179

Aderholt
Akin
Alexander
Austria
Bachmann
Bachus
Barrett (SC)
Bartlett
Barton (TX)
Biggert
Bilbray
Bilirakis
Bishop (UT)
Blackburn
Blunt
Boehner
Bonner
Bono Mack
Boozman
Boustany
Brady (TX)
Bright
Broun (GA)
Brown (SC)
Brown-Waite, Ginny
Burgess
Burton (IN)
Buyer
Calvert
Camp
Campbell
Cantor
Cao
Capito
Carter
Cassidy
Castle
Chaffetz
Coble
Coffman (CO)
Cole
Conaway
Crenshaw
Culberson
Davis (KY)
Deal (GA)
Dent
Diaz-Balart, L.
Diaz-Balart, M.
Dreier
Duncan
Ehlers
Emerson
Fallin
Flake
Fleming
Forbes
Fortenberry
Foxx
Franks (AZ)
Frelinghuysen
Gallegly

[[Page H267]]

Garrett (NJ)
Gerlach
Gingrey (GA)
Gohmert
Goodlatte
Granger
Graves
Guthrie
Hall (TX)
Harper
Hastings (WA)
Heller
Hensarling
Herger
Hoekstra
Hunter
Inglis
Issa
Jenkins
Johnson (IL)
Johnson, Sam
Jones
Jordan (OH)
King (IA)
King (NY)
Kingston
Kirk
Kline (MN)
Lamborn
Lance
Latham
LaTourette
Latta
Lee (NY)
Lewis (CA)
Linder
Lucas
Luetkemeyer
Lummis
Lungren, Daniel E.
Mack
Manzullo
Marchant
Marshall
McCarthy (CA)
McCaul
McClintock
McCotter
McHenry
McHugh
McIntyre
McKeon
McMorris Rodgers
Mica
Miller (FL)
Miller (MI)
Miller, Gary
Minnick
Moran (KS)
Murphy, Tim
Myrick
Neugebauer
Nunes
Olson
Paul
Paulsen
Pence
Petri
Pitts
Platts
Poe (TX)
Posey
Price (GA)
Putnam
Radanovich
Rehberg
Reichert
Roe (TN)
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Rooney
Ros-Lehtinen
Roskam
Royce
Ryan (WI)
Scalise
Schmidt
Schock
Sensenbrenner
Sessions
Shadegg
Shimkus
Shuster
Simpson
Smith (NE)
Smith (TX)
Souder
Stearns
Taylor
Terry
Thompson (PA)
Thornberry
Tiahrt
Tiberi
Turner
Upton
Walden
Wamp
Westmoreland
Whitfield
Wilson (SC)
Wittman
Wolf
Young (AK)
Young (FL)

NAYS--247

Abercrombie
Ackerman
Adler (NJ)
Altmire
Andrews
Arcuri
Baca
Baird
Baldwin
Barrow
Bean
Becerra
Berkley
Berman
Berry
Bishop (GA)
Bishop (NY)
Blumenauer
Boccieri
Boren
Boswell
Boyd
Brady (PA)
Braley (IA)
Brown, Corrine
Buchanan
Butterfield
Capps
Capuano
Cardoza
Carnahan
Carney
Carson (IN)
Castor (FL)
Chandler
Childers
Clarke
Clay
Cleaver
Clyburn
Cohen
Connolly (VA)
Cooper
Costa
Costello
Courtney
Crowley
Cuellar
Cummings
Dahlkemper
Davis (AL)
Davis (CA)
Davis (IL)
Davis (TN)
DeFazio
DeGette
Delahunt
DeLauro
Dicks
Dingell
Doggett
Donnelly (IN)
Doyle
Driehaus
Edwards (MD)
Edwards (TX)
Ellison
Ellsworth
Engel
Eshoo
Etheridge
Farr
Fattah
Filner
Foster
Frank (MA)
Fudge
Giffords
Gillibrand
Gonzalez
Gordon (TN)
Grayson
Green, Al
Green, Gene
Griffith
Grijalva
Gutierrez
Hall (NY)
Halvorson
Hare
Harman
Hastings (FL)
Heinrich
Higgins
Hill
Himes
Hinchey
Hinojosa
Hirono
Hodes
Holden
Holt
Honda
Hoyer
Inslee
Israel
Jackson (IL)
Jackson-Lee (TX)
Johnson (GA)
Johnson, E. B.
Kagen
Kanjorski
Kaptur
Kennedy
Kildee
Kilpatrick (MI)
Kilroy
Kind
Kirkpatrick (AZ)
Kissell
Klein (FL)
Kosmas
Kratovil
Kucinich
Langevin
Larsen (WA)
Larson (CT)
Lee (CA)
Levin
Lewis (GA)
Lipinski
LoBiondo
Loebsack
Lofgren, Zoe
Lowey
Lujan
Lynch
Maffei
Maloney
Markey (CO)
Markey (MA)
Massa
Matheson
Matsui
McCarthy (NY)
McCollum
McDermott
McGovern
McMahon
McNerney
Meek (FL)
Meeks (NY)
Melancon
Michaud
Miller (NC)
Miller, George
Mitchell
Mollohan
Moore (KS)
Moore (WI)
Moran (VA)
Murphy (CT)
Murphy, Patrick
Murtha
Nadler (NY)
Napolitano
Neal (MA)
Nye
Oberstar
Obey
Olver
Ortiz
Pallone
Pascrell
Pastor (AZ)
Payne
Perlmutter
Perriello
Peters
Peterson
Pingree (ME)
Polis (CO)
Pomeroy
Price (NC)
Rahall
Rangel
Reyes
Richardson
Rodriguez
Ross
Rothman (NJ)
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Salazar
Sanchez, Linda T.
Sanchez, Loretta
Sarbanes
Schakowsky
Schauer
Schiff
Schrader
Schwartz
Scott (GA)
Scott (VA)
Serrano
Sestak
Shea-Porter
Shuler
Sires
Skelton
Slaughter
Smith (NJ)
Smith (WA)
Space
Speier
Spratt
Stark
Stupak
Sutton
Tanner
Tauscher
Teague
Thompson (CA)
Thompson (MS)
Tierney
Titus
Tonko
Towns
Tsongas
Van Hollen
Velazquez
Visclosky
Walz
Wasserman Schultz
Waters
Watson
Watt
Waxman
Weiner
Welch
Wexler
Wilson (OH)
Woolsey
Wu
Yarmuth

NOT VOTING--7

Boucher
Conyers
Herseth Sandlin
Sherman
Snyder
Solis (CA)
Sullivan

{time} 1435

Mr. HALL of New York, Ms. FUDGE, Ms. LORETTA SANCHEZ of California,
Messrs. CARNEY, SIRES, FARR, Ms. SPEIER, and Mr. RAHALL changed their
vote from ``yea'' to ``nay.''
Messrs. ROSKAM, NUNES, CANTOR, LaTOURETTE, ROGERS of Kentucky, and
GERLACH changed their vote from ``nay'' to ``yea.''
So the motion to recommit was rejected.
The result of the vote was announced as above recorded.
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.

Recorded Vote

Mr. CARDOZA. Madam Speaker, I demand a recorded vote.
A recorded vote was ordered.
The SPEAKER pro tempore. This is a 5-minute vote.
The vote was taken by electronic device, and there were--ayes 289,
noes 139, not voting 6, as follows:

[Roll No. 16]

AYES--289

Abercrombie
Ackerman
Adler (NJ)
Altmire
Andrews
Arcuri
Austria
Baca
Baird
Baldwin
Barrow
Bean
Becerra
Berkley
Berman
Berry
Bishop (GA)
Bishop (NY)
Blumenauer
Boccieri
Bono Mack
Boren
Boswell
Boyd
Brady (PA)
Braley (IA)
Brown, Corrine
Buchanan
Butterfield
Cao
Capito
Capps
Capuano
Cardoza
Carnahan
Carney
Carson (IN)
Castle
Castor (FL)
Chandler
Childers
Clarke
Clay
Cleaver
Clyburn
Cohen
Connolly (VA)
Conyers
Cooper
Costa
Costello
Courtney
Crowley
Cuellar
Cummings
Dahlkemper
Davis (AL)
Davis (CA)
Davis (IL)
Davis (TN)
DeFazio
DeGette
Delahunt
DeLauro
Dent
Diaz-Balart, L.
Diaz-Balart, M.
Dicks
Dingell
Doggett
Donnelly (IN)
Doyle
Driehaus
Edwards (MD)
Edwards (TX)
Ehlers
Ellison
Ellsworth
Emerson
Engel
Eshoo
Etheridge
Farr
Fattah
Filner
Foster
Frank (MA)
Frelinghuysen
Fudge
Gerlach
Giffords
Gillibrand
Gonzalez
Gordon (TN)
Grayson
Green, Al
Green, Gene
Griffith
Grijalva
Gutierrez
Hall (NY)
Halvorson
Hare
Harman
Hastings (FL)
Heinrich
Herseth Sandlin
Higgins
Hill
Himes
Hinchey
Hinojosa
Hirono
Hodes
Holden
Holt
Honda
Hoyer
Inslee
Israel
Jackson (IL)
Jackson-Lee (TX)
Johnson (GA)
Johnson, E. B.
Kagen
Kanjorski
Kaptur
Kennedy
Kildee
Kilpatrick (MI)
Kilroy
Kind
King (NY)
Kirk
Kirkpatrick (AZ)
Kissell
Klein (FL)
Kosmas
Kratovil
Kucinich
Lance
Langevin
Larsen (WA)
Larson (CT)
LaTourette
Lee (CA)
Lee (NY)
Levin
Lewis (GA)
Lipinski
LoBiondo
Loebsack
Lofgren, Zoe
Lowey
Lujan
Lynch
Maffei
Maloney
Markey (CO)
Markey (MA)
Massa
Matheson
Matsui
McCarthy (NY)
McCollum
McCotter
McDermott
McGovern
McHugh
McIntyre
McMahon
McNerney
Meek (FL)
Melancon
Michaud
Miller (MI)
Miller (NC)
Miller, George
Minnick
Mitchell
Mollohan
Moore (KS)
Moore (WI)
Moran (KS)
Moran (VA)
Murphy (CT)
Murphy, Patrick
Murphy, Tim
Murtha
Nadler (NY)
Napolitano
Neal (MA)
Nye
Oberstar
Obey
Olver
Ortiz
Pallone
Pascrell
Pastor (AZ)
Paulsen
Payne
Pelosi
Perlmutter
Perriello
Peters
Peterson
Petri
Pingree (ME)
Platts
Polis (CO)
Pomeroy
Price (NC)
Rahall
Rangel
Rehberg
Reichert
Reyes
Richardson
Rodriguez
Rogers (AL)
Ros-Lehtinen
Ross
Rothman (NJ)
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Salazar
Sanchez, Linda T.
Sanchez, Loretta
Sarbanes
Schakowsky
Schauer
Schiff
Schrader
Schwartz
Scott (GA)
Scott (VA)
Serrano
Sestak
Shea-Porter
Shuler
Simpson
Sires
Skelton
Slaughter
Smith (NJ)
Smith (WA)
Space
Speier
Spratt
Stark
Stupak
Sutton
Tanner
Tauscher
Taylor
Teague
Thompson (CA)
Thompson (MS)
Thompson (PA)
Tiberi
Tierney
Titus
Tonko
Towns
Tsongas
Turner
Upton
Van Hollen
Velazquez
Visclosky
Walz
Wasserman Schultz
Waters
Watson
Watt
Waxman
Weiner
Welch
Wexler
Wilson (OH)
Wolf
Woolsey
Wu
Yarmuth
Young (AK)
Young (FL)

NOES--139

Aderholt
Akin
Alexander
Bachmann
Bachus
Barrett (SC)
Bartlett
Barton (TX)
Biggert
Bilbray
Bilirakis
Bishop (UT)
Blackburn
Blunt
Boehner
Bonner
Boozman
Boustany
Brady (TX)
Bright
Broun (GA)
Brown (SC)
Brown-Waite, Ginny
Burgess
Burton (IN)
Buyer
Calvert
Camp
Campbell
Cantor
Carter
Cassidy
Chaffetz
Coble
Coffman (CO)
Cole
Conaway
Crenshaw
Culberson
Davis (KY)
Deal (GA)
Dreier
Duncan
Fallin
Flake
Fleming
Forbes
Fortenberry
Foxx
Franks (AZ)
Gallegly
Garrett (NJ)
Gingrey (GA)
Gohmert
Goodlatte
Granger
Graves
Guthrie
Hall (TX)
Harper
Hastings (WA)
Heller
Hensarling
Herger
Hoekstra
Hunter
Inglis
Issa
Jenkins
Johnson (IL)
Johnson, Sam
Jones
Jordan (OH)
King (IA)

[[Page H268]]

Kingston
Kline (MN)
Lamborn
Latham
Latta
Lewis (CA)
Linder
Lucas
Luetkemeyer
Lummis
Lungren, Daniel E.
Mack
Manzullo
Marchant
Marshall
McCarthy (CA)
McCaul
McClintock
McHenry
McKeon
McMorris Rodgers
Mica
Miller (FL)
Miller, Gary
Myrick
Neugebauer
Nunes
Olson
Paul
Pence
Pitts
Poe (TX)
Posey
Price (GA)
Putnam
Radanovich
Roe (TN)
Rogers (KY)
Rogers (MI)
Rohrabacher
Rooney
Roskam
Royce
Ryan (WI)
Scalise
Schmidt
Schock
Sensenbrenner
Sessions
Shadegg
Shimkus
Shuster
Smith (NE)
Smith (TX)
Souder
Stearns
Terry
Thornberry
Tiahrt
Walden
Wamp
Westmoreland
Whitfield
Wilson (SC)
Wittman

NOT VOTING--6

Boucher
Meeks (NY)
Sherman
Snyder
Solis (CA)
Sullivan

Announcement by the Speaker Pro Tempore

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

{time} 1445

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. MEEKS of New York. Madam Speaker, on Rollcall No. 16, I was
avoidably delayed and just missed the vote. Had I been present, I would
have voted ``aye.''

____________________