[Congressional Record Volume 155, Number 175 (Monday, November 30, 2009)]
[Senate]
[Pages S12013-S12016]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 2790. Mr. CASEY submitted an amendment intended to be proposed to 
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. 
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal 
Revenue Code of 1986 to modify the first-time homebuyers credit in the 
case of members of the Armed Forces and certain other Federal 
employees, and for other purposes; which was ordered to lie on the 
table; as follows:

       Beginning on page 436, strike line 18 and all that follows 
     through page 439, line 20, and insert the following:

     SEC. 2101. PROTECTING LOW-INCOME CHILDREN FROM HARM AND 
                   ENSURING THAT THEY BENEFIT FROM HEALTH REFORM.

       (a) Integrating CHIP Eligibility With Methodologies Used 
     for Other Subsidies While Preserving CHIP for Children Who 
     Currently Qualify and Assuring CHIP Coverage for Low-Income 
     Children.--
       (1) Definition of targeted low-income child.--Effective 
     January 1, 2014, section 2110(b)(1) of the Social Security 
     Act (42 U.S.C. 1397jj(b)(1)) is amended by striking 
     subparagraph (B) and inserting the following:
       ``(B) whose family's modified gross income, as determined 
     for purposes of allowing a premium credit assistance amount 
     for the purchase of a qualified health plan under section 36B 
     of the Internal Revenue Code of 1986, does not exceed 250 
     percent of the poverty line for a family of the size 
     involved; and''.
       (2) State plan eligibility requirement.--Section 
     2102(b)(1)(B) of such Act (42 U.S.C. 1397bb(b)(1)(B)) is 
     amended--
       (A) in clause (iii), by striking ``and'' at the end;
       (B) in clause (iv), by striking the period at the end and 
     inserting ``; and'' and
       (C) by adding at the end the following:
       ``(v) with respect to fiscal years beginning with fiscal 
     year 2014, may not deny eligibility or enrollment, because of 
     excess family income, to any child whose family income is at 
     or below the percentage of poverty level specified in section 
     2110(b)(1)(B), determined using the methodology described in 
     such section.''.
       (b) Maintenance of Effort.--Section 2105(d) of the Social 
     Security Act (42 U.S.C. 1397ee(d)) is amended by adding at 
     the end the following:
       ``(3) Continuation of eligibility standards for children.--
       ``(A) Fiscal years before fiscal year 2014.--During the 
     period that begins on the date of enactment of the Patient 
     Protection and Affordable Care Act and ends on September 30, 
     2013, a State shall not have in effect eligibility standards, 
     methodologies, or procedures under its State child health 
     plan (including any waiver under such plan) for children 
     (including children provided medical assistance for which 
     payment is made under section 2105(a)(1)(A)) that are more 
     restrictive than the eligibility standards, methodologies, or 
     procedures, respectively, under such plan (or waiver) as in 
     effect on October 1, 2009.
       ``(B) Fiscal year 2014 and thereafter.--
       ``(i) In general.--Subject to clause (ii), with respect to 
     fiscal years beginning with fiscal year 2014 a State shall 
     not have in effect eligibility standards, methodologies, or 
     procedures under its State child health plan (including any 
     waiver under such plan) for children that are more 
     restrictive than the eligibility methodologies or procedures, 
     respectively, under such plan (or waiver) as in effect on 
     October 1, 2009.
       ``(ii) Exception.--A State that, prior to fiscal year 2014, 
     has an income eligibility standard, methodology, or procedure 
     under its State child health plan (including any waiver under 
     such plan) for children that results in children whose 
     family's modified gross income (as determined for purposes of 
     allowing a premium credit assistance amount for the purchase 
     of a qualified health plan under section 36B of the Internal 
     Revenue Code of 1986) exceeds 250 percent of the poverty line 
     may modify such standard, methodology, or procedure so that 
     it will not result in eligibility for children under the 
     State plan in whose family modified gross income exceeds that 
     percentage of the poverty line.
       ``(C) Rule of construction.--Subparagraphs (A) and (B) 
     shall not be construed as preventing a State from applying 
     eligibility standards, methodologies, or procedures for 
     children under the State child health plan or under any 
     waiver of the plan that are less restrictive than the 
     eligibility standards, methodologies, or procedures, 
     respectively, for children under the plan or waiver that were 
     in effect on October 1, 2009.''.
       (c) Protecting CHIP Children Against Unaffordable Costs for 
     Essential Health Care.--
       (1) Continuation of cost-sharing protections for 
     children.--Section 2103(e) of such Act (42 U.S.C. 1397cc(e)) 
     is amended by adding at the end the following:
       ``(5) Continuation of cost-sharing protections for 
     children.--
       ``(A) In general.--Except as described in subparagraph (B), 
     during the period that begins on the date of enactment of the 
     Patient Protection and Affordable Care Act, a State shall not 
     have in effect cost-sharing policies under its State child 
     health plan (including any waiver under such plan) that 
     increase premiums or out-of-pocket costs above the amounts 
     for children of the same income

[[Page S12014]]

     level (stated as a percentage of the Federal poverty level) 
     under such plan (or waiver) as in effect on October 1, 2009.
       ``(B) Exception.--With respect to fiscal years beginning 
     with fiscal year 2014, a State may increase cost-sharing 
     amounts above those described in subparagraph (A) by an 
     amount that does not exceed the median percentage increase in 
     national household income since fiscal year 2013, as 
     determined by the Secretary, for households with incomes at 
     or below the percentage of poverty level specified in section 
     2110(b)(1)(B).
       ``(C) Rule of construction.--This paragraph shall not be 
     construed to prevent a State from reducing premiums or out-
     of-pocket costs below the amounts described in subparagraph 
     (A).''.
       (2) Equitable coverage of essential benefits.--Section 
     2103(f) of such Act (42 U.S.C. 1397cc(f)) is amended by 
     adding at the end the following:
       ``(4) Equitable coverage of essential benefits.--With 
     respect to fiscal years beginning with fiscal year 2014, the 
     State plan for child health assistance (including any waiver 
     under such plan) may not deny (whether through a restriction 
     on amount, duration, or scope, through excluding a category 
     of health care services or items, or otherwise) a service or 
     item to a child whose family income is at or below the 
     percentage of poverty level specified in section 
     2110(b)(1)(B), determined using the methodology described in 
     such section, if the State would cover or be required to 
     cover such service or item had the child qualified for 
     medical assistance under sub-clause (IV), (VI) or (VII) of 
     section 1902(a)(10)(i).''.
       (d) Basing Federal Payments on State Conditions, Rather 
     Than Inflexible Dollar Amounts.--Section 2104(a) of such Act 
     (42 U.S.C. 1397dd(a)) is amended by striking paragraph (16) 
     and inserting the following:
       ``(16) notwithstanding any other provision of this title, 
     for each of fiscal years 2013 through 2019, such amounts as 
     are necessary to carry out this title.''.
       (e) Defraying State Expansion Costs With Additional Federal 
     Dollars.--Section 2105(b) of such Act (42 U.S.C. 1397dd(b)) 
     is amended--
       (1) by striking ``For purposes'' and inserting the 
     following:
       ``(1) In general.--For purposes''; and
       (2) by adding at the end the following:
       ``(2) Option for increased federal financial participation 
     beginning in fiscal year 2014.--Notwithstanding paragraph 
     (1), beginning with fiscal year 2014, the enhanced FMAP 
     determined for a State for a fiscal year (or for any portion 
     of a fiscal year occurring during such period) shall be 
     increased by 23 percentage points, but in no case shall 
     exceed 94 percent. The increase in the enhanced FMAP under 
     the preceding sentence shall not apply with respect to 
     determining the payment to a State under subsection (a)(1) 
     for expenditures described in subparagraph (D) of that 
     subsection, paragraphs (8), (9), or (11) of subsection (c), 
     or clause (4) of the first sentence of section 1905(b). A 
     State may not qualify for an enhanced FMAP pursuant to this 
     paragraph unless it implements--
       ``(A) each enrollment and retention provision described in 
     subparagraphs (A), (B)(i), and (C) through (G), respectively, 
     of section 2105(a)(4); and
       ``(B) any other practice for eligibility determination, 
     enrollment or retention that the Secretary finds--
       ``(i) has a substantial impact increasing the number of 
     eligible children who receive health coverage through State 
     plans for child health assistance under this title or State 
     plans for medical assistance under title XIX;
       ``(ii) reduces erroneous eligibility determinations under 
     the state plans described in clause (i); and
       ``(iii) lowers operational administrative costs under the 
     state plans described in clause (i).''.
       (f) Continuing Performance Bonuses for States That Enroll 
     Large Numbers of Eligible Children.--Section 2105(a)(3) of 
     such Act (42 U.S.C. 1397dd(a)(3)) is amended--
       (1) in subparagraph (A), by striking ``and ending with 
     fiscal year 2013''; and
       (2) in subparagraph (E), by adding at the end the 
     following:
       ``(iv) Later appropriations.--There is appropriated, out of 
     any money in the Treasury not otherwise appropriated, for 
     each of fiscal years 2013 through 2019, 25 percent of the 
     amount described in clause (i), adjusted to reflect the 
     proportionate change in Consumer Price Index for All Urban 
     Consumers since fiscal year 2009, as determined by the 
     Secretary.''.
       (g) Giving Families the Option of Using Their Federal 
     Income Tax Returns to Establish Eligibility.--Section 6055 of 
     the Internal Revenue Code of 1986, as added by section 
     1502(a) of the Patient Protection and Affordable Care Act, is 
     amended by adding at the end the following:
       ``(f) Use of Individual Income Tax Returns to Help 
     Determine Eligibility for Subsidies.--
       ``(1) In general.--For taxable years beginning not later 
     than January 1, 2012, the Secretary shall develop forms that 
     require all individuals filing returns with respect to income 
     taxes under subtitle A--
       ``(A) to identify the members of the individual's household 
     who lack health insurance at the time the return is filed; 
     and
       ``(B) to indicate whether there are members of the 
     individual's household who are under 19 years of age and for 
     whom the individual requests disclosure of pertinent tax 
     return information, pursuant to section 6103(c), to agencies 
     determining eligibility for subsidies for purposes of helping 
     such agencies determine whether the applicable household 
     members qualify for subsidies.
     In developing the applicable language on tax forms, the 
     Secretary shall consult with the Secretary of Health and 
     Human Services. The goals of such consultation shall include 
     maximizing the form's comprehensibility to low-income 
     taxpayers and the convenience of making such identification 
     and indication.
       ``(2) Transfer of information.--When an individual 
     identifies a household member pursuant to paragraph (1)(B), 
     the Secretary shall promptly transfer pertinent tax return 
     information to all agencies determining eligibility for 
     subsidies in such member's state of residence, except that 
     such transfer shall not take place to an agency unless it is 
     subject to an enforceable agreement or other legal obligation 
     that meets the Secretary's requirements for safeguarding 
     taxpayer privacy and data security. The transfer described in 
     this paragraph may take place through the data matching 
     program described in section 1413(c)(2) of the Patient 
     Protection and Affordable Care Act.
       ``(3) Eligibility determination.--
       ``(A) In general.--Notwithstanding any other provision of 
     law except subparagraph (B), when an agency determining 
     eligibility for subsidies receives the information described 
     in paragraph (2), it shall determine such eligibility on the 
     basis of such information and other information obtainable by 
     data-matching, to the maximum extent possible.
       ``(B) Exceptions.--An agency described in subparagraph (A) 
     shall base eligibility on information other than described in 
     paragraph (2) (including through seeking additional 
     information from the applicable individual or household 
     member, if such information cannot be obtained through other 
     means)--
       ``(i) to the extent that an eligibility requirement for 
     subsidies cannot be decided based on the information 
     described in subparagraph (A);
       ``(ii) if the agency has good reason to believe that the 
     information described in subparagraph (A) is inaccurate; or
       ``(iii) if the information described in subparagraph (A) 
     does not result in a finding of eligibility for medical 
     assistance under title XIX of the Social Security Act, in 
     which case--

       ``(I) the agency shall provide the individual with notice 
     of--

       ``(aa) the circumstances under which such individual or 
     applicable household members may qualify for additional 
     assistance; and
       ``(bb) an opportunity to request a determination of whether 
     such circumstances apply to the individual or applicable 
     household members; and

       ``(II) if the individual requests such a determination, the 
     agency shall ensure that the individual and applicable 
     household members receive--

       ``(aa) an opportunity to provide any additional information 
     needed to determine whether the circumstances described in 
     sub-clause (I)(aa) apply;
       ``(bb) a determination of whether the circumstances 
     described in subclause (I)(aa) apply (but only if the 
     individual or applicable household members furnish requested 
     information that is necessary to such determination); and
       ``(cc) receive any subsidies for which the individual or 
     applicable household members qualify.
       ``(4) Definitions.--In this subsection:
       ``(A) Household.--The term `household' includes the 
     individual filing the return, the individual's spouse (if 
     any), and all dependents of the individual or the 
     individual's spouse (if any).
       ``(B) Subsidies.--The term `subsidies' includes premium 
     credits under section 36B, medical assistance under title XIX 
     of the Social Security Act, child health assistance under 
     title XXI of such Act, and cost-sharing subsidies under 
     section 1402 of the Patient Protection and Affordable Care 
     Act.
       ``(C) Pertinent tax information.--The term `pertinent tax 
     information' refers to all information on the tax return that 
     is potentially relevant to determining the applicable 
     household member's eligibility for subsidies or that may 
     facilitate data-matching with other records that are 
     potentially relevant to determining such eligibility.
       ``(5) Rule of construction.--Nothing in this subsection 
     shall be construed to forbid the Secretary, pursuant to 
     section 6013(c) and other applicable legal authority, or the 
     Secretary of Health and Human Services from implementing, 
     with respect to individuals who have attained age 19, 
     policies and procedures similar to those described in 
     paragraphs (1) through (3) with respect to individuals under 
     19 years of age.''.
       (h) Continuing CHIP Outreach and Enrollment Grants.--
     Section 2113(a) of the Social Security Act (42 U.S.C. 
     1397mm(a)) is amended--
       (1) in paragraph (2), by striking ``such amounts'' and 
     inserting ``the amounts described in paragraph (1)''; and
       (2) by adding at the end the following:
       ``(3) Additional grants for fiscal year 2012 and 
     thereafter.--There is appropriated, out of any money in the 
     Treasury not otherwise appropriated, $50,000,000 for each of 
     fiscal years 2012 through 2019, for purposes of awarding 
     grants to eligible entities to conduct outreach and 
     enrollment efforts that are designed to increase the 
     enrollment and participation of eligible children under this

[[Page S12015]]

     title and title XIX and, with respect to fiscal years 
     beginning with fiscal year 2014, premium credits under 
     section 36B of the Internal Revenue Code of 1986 and cost-
     sharing subsidies under section 1402 of the Patient 
     Protection and Affordable Care Act. Such grants and 
     appropriations shall supplement and not supplant grants and 
     appropriations that are made pursuant to other provisions of 
     this section.''.
       (i) Secretarial Report Comparing CHIP to Subsidized 
     Coverage in the Exchange.--
       (1) In general.--Not later than March 1, 2016, the 
     Secretary of Health and Human Services (in this subsection 
     referred to as the ``Secretary'') shall submit to Congress a 
     report that compares--
       (A) the health plan coverage offered to eligible children 
     in fiscal year 2015 by an average or median State plan for 
     child health assistance under title XXI of the Social 
     Security Act; and
       (B) the health plan coverage that such children would have 
     received in fiscal year 2015 if they were enrolled in a 
     qualified health benefits plan through an Exchange 
     established by the State under section 1311 of the Patient 
     Protection and Affordable Care Act, and received all premium 
     credits under section 36B of the Internal Revenue Code of 
     1986 and all cost-sharing subsidies under section 1402 of the 
     Patient Protection and Affordable Care Act for which such 
     children would have qualified if they were not eligible for 
     child health assistance under title XXI of the Social 
     Security Act.
       (2) Policy analysis.--If, as to an aspect of health plan 
     coverage described in paragraph (3) (except as provided in 
     the next sentence of this paragraph), the Secretary finds 
     that the coverage described in paragraph (1)(A) is more 
     favorable to families and children than is the coverage 
     described in paragraph (1)(B), the report shall describe 
     policy changes that would be needed to improve the latter 
     coverage so that it reaches the level of favorability 
     achieved by the former coverage. The analysis described in 
     the previous sentence need not address the aspect of health 
     plan coverage described in paragraph (3)(C)).
       (3) Health plan coverage.--In this subsection, the term 
     ``health plan coverage'' includes the following:
       (A) The adequacy of covered benefits in meeting the health 
     care needs of children, including those with special health 
     care needs.
       (B) Families' out-of-pocket and premium costs.
       (C) Public-sector costs.
       (D) Adequacy of pediatric provider networks.
       (E) Quality of care measures focused specifically on 
     children.
       (F) Legal protections for children.
       (G) Barriers to enrollment and service utilization.
       (H) Interstate variation.
       (I) Continuity of coverage and care.
       (J) The impact of placing children and parents in different 
     health plans.
       (4) Rule of construction.--Nothing in this subsection shall 
     be construed to prevent the report required under paragraph 
     (1) from--
       (A) analyzing State programs of child health assistance 
     under title XXI of the Social Security Act that go beyond the 
     average or median such program; or
       (B) including in its comparative analysis factors in 
     addition to those described in paragraph (3).
       (j) Safeguarding Program Integrity and Improving Efficiency 
     by Providing Health Subsidy Programs With Access to the 
     National Directory of New Hires.--Section 453(j) of the 
     Social Security Act (42 U.S.C. 653(j)) is amended by adding 
     at the end the following:
       ``(12) Information comparisons and disclosure to assist in 
     administration of health subsidy programs.--
       ``(A) In general.--If, for purposes of administering a 
     State's medical assistance program under title XIX, a State's 
     children's health assistance program under title XXI, premium 
     assistance under section 36B of the Internal Revenue Code of 
     1986, or reduced cost-sharing subsidies under section 1402 of 
     the Patient Protection and Affordable Care Act, a State or 
     Federal agency responsible for the administration of the 
     program transmits to the Secretary the names and social 
     security account numbers of individuals, the Secretary shall 
     disclose to such agency information on the individuals and 
     their employers maintained in the National Directory of New 
     Hires, subject to this paragraph.
       ``(B) Condition on disclosure by the secretary.--The 
     Secretary shall make a disclosure under subparagraph (A) only 
     to the extent that the Secretary determines that the 
     disclosure would not interfere with the effective operation 
     of the program under this part.
       ``(C) Use and disclosure of information by state or federal 
     agencies.--
       ``(i) In general.--A State or Federal agency may not use or 
     disclose information provided under this paragraph except for 
     purposes of administering a program referred to in 
     subparagraph (A).
       ``(ii) Information security.--A State or Federal agency 
     shall have in effect data security and control policies that 
     the Secretary finds adequate to ensure the security of 
     information obtained under this paragraph and to ensure that 
     access to such information is restricted to authorized 
     persons for purposes of authorized uses and disclosures.
       ``(iii) Penalty for misuse of information.--An officer or 
     employee of a State agency described in this paragraph who 
     fails to comply with this subparagraph shall be subject to 
     the sanctions under subsection (l)(2) to the same extent as 
     if the officer or employee were an officer or employee of the 
     United States.
       ``(D) Procedural requirements.--State or Federal agencies 
     requesting information under this paragraph shall adhere to 
     uniform procedures established by the Secretary governing 
     information requests and data matching under this paragraph.
       ``(E) Reimbursement of costs.--The State or Federal agency 
     shall reimburse the Secretary, in accordance with subsection 
     (k)(3), for the costs incurred by the Secretary in furnishing 
     the information requested under this paragraph.''.
       (k) Deficit Reduction Contingency.--
       (1) In general.--If a deficit reduction contingency applies 
     to this section and the amendments made by this section, then 
     there is appropriated, for each of fiscal years 2010 through 
     2019, to the Fund for Vulnerable Children and Families 
     described in paragraph (2), out of any money in the Treasury 
     not otherwise appropriated, an amount equal to 50 percent of 
     the annualized deficit reduction contingency amount.
       (2) The fund for vulnerable children and families.--
       (A) Authority to establish.--If a deficit reduction 
     contingency applies as described in paragraph (1), the 
     Secretary of Health and Human Services shall establish a Fund 
     for Vulnerable Children and Families. Any dollars 
     appropriated or donated to such Fund shall be used for any of 
     the following purposes:
       (i) Combating infant mortality.
       (ii) Providing additional supports or services for low-
     income children with autism spectrum disorders or other 
     disabilities.
       (iii) Assisting in the provision of services to improve 
     health care services (including mental health care services) 
     for children in foster care under the responsibility of a 
     State and homeless children.
       (B) Annual reports.--The Secretary shall provide annual 
     reports to the Congress that provide a full accounting of the 
     revenue and expenditures of the Fund for Vulnerable Children 
     and Families.
       (3) Definitions.--In this subsection:
       (A) Deficit reduction contingency.--A ``deficit reduction 
     contingency'' applies to this section and the amendments made 
     by this section if the Director of the Congressional Budget 
     Office has found that such provisions, taken together (but 
     without regard to this subsection), will cause a net 
     reduction in the projected Federal budget deficit over the 
     period of fiscal years 2010 through 2019.
       (B) Annualized deficit reduction contingency amount.--The 
     term ``annualized deficit reduction contingency amount'' 
     means the amount of the net deficit reduction described in 
     subparagraph (A) divided by 10.
       (l) Conforming Amendment to Title XXI Medicaid Maintenance 
     of Effort.--Section 2105(d)(1) of the Social Security Act (42 
     U.S.C. 1397ee(d)(1)) is amended by adding before the period 
     ``, except as required under section 1902(e)(14)''.
                                 ______
                                 
  SA 2791. Ms. MIKULSKI (for herself, Mr. Harkin, Mrs. Boxer, and Mr. 
Franken) proposed an amendment to amendment SA 2786 proposed by Mr. 
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill 
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the 
first-time homebuyers credit in the case of members of the Armed Forces 
and certain other Federal employees, and for other purposes; as 
follows:

       On page 17, strike lines 9 through 24, and insert the 
     following: ``ance coverage shall, at a minimum provide 
     coverage for and shall not impose any cost sharing 
     requirements for--
       ``(1) evidence-based items or services that have in effect 
     a rating of `A' or `B' in the current recommendations of the 
     United States Preventive Services Task Force;
       ``(2) immunizations that have in effect a recommendation 
     from the Advisory Committee on Immunization Practices of the 
     Centers for Disease Control and Prevention with respect to 
     the individual involved; and
       ``(3) with respect to infants, children, and adolescents, 
     evidence-informed preventive care and screenings provided for 
     in the comprehensive guidelines supported by the Health 
     Resources and Services Administration.
       ``(4) with respect to women, such additional preventive 
     care and screenings not described in paragraph (1) as 
     provided for in comprehensive guidelines supported by the 
     Health Resources and Services Administration for purposes of 
     this paragraph.''.

     ``Nothing in this subsection shall be construed to prohibit a 
     plan or issuer from providing coverage for services in 
     addition to those recommended by United States Preventive 
     Services Task Force or to deny coverage for services that are 
     not recommended by such Task Force.''.

[[Page S12016]]



                          ____________________