[Congressional Record Volume 161, Number 53 (Tuesday, April 14, 2015)]
[Senate]
[Pages S2176-S2178]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SA 1115. Mr. BENNET (for himself, Ms. Warren, Mr. Menendez, Mr. Reed,
Mrs. Shaheen, Mr. Whitehouse, Ms. Baldwin, Mr. Blumenthal, and Ms.
Mikulski) proposed an amendment to the bill H.R. 2, to amend title
XVIII of the Social Security Act to repeal the Medicare sustainable
growth rate and strengthen Medicare access by improving physician
payments and making other improvements, to reauthorize the Children's
Health Insurance Program, and for other purposes; as follows:
Strike sections 301 through 304, and insert the following:
SEC. 301. 4-YEAR EXTENSION OF THE CHILDREN'S HEALTH INSURANCE
PROGRAM.
(a) Funding.--
(1) In general.--Section 2104(a) of the Social Security Act
(42 U.S.C. 1397dd(a)) is amended--
(A) in paragraph (17), by striking ``and'' at the end; and
(B) by striking paragraph (18) and inserting the following
new paragraphs:
``(18) for fiscal year 2015, $21,061,000,000;
``(19) for fiscal year 2016, $19,300,000,000;
``(20) for fiscal year 2017, $20,300,000,000;
``(21) for fiscal year 2018, $21,300,000,000; and
``(22) for fiscal year 2019, for purposes of making 2 semi-
annual allotments--
``(A) $2,850,000,000 for the period beginning on October 1,
2018, and ending on March 31, 2019; and
``(B) $2,850,000,000 for the period beginning on April 1,
2019, and ending on September 30, 2019.''.
(2) Prevention of duplicate appropriations for fiscal year
2015.--Notwithstanding any other provision of law, insofar as
funds have been appropriated under subsection (a)(18) or (m)
of section 2104 of the Social Security Act (42 U.S.C.
1397dd), or under section 108 of the Children's Health
Insurance Program Reauthorization Act of 2009 (Public Law
111-3), as such subsections and section are in effect on the
day before the date of the enactment of this Act, to provide
allotments to States under the State Children's Health
Insurance Program established under title XXI of the Social
Security Act (42 U.S.C. 1397aa et seq.) (whether implemented
under title XIX, XXI, or both, of the Social Security Act)
for fiscal year 2015--
(A) any amounts that are so appropriated that are not so
allotted and obligated before the date of the enactment of
this Act, are rescinded; and
(B) any amount provided for CHIP allotments to a State
under this section (and the amendments made by this section)
for such fiscal year shall be reduced by the amount of such
appropriations so allotted and obligated before such date.
(b) Allotments.--
(1) In general.--Section 2104(m) of the Social Security Act
(42 U.S.C. 1397dd(m)) is amended--
(A) in the subsection heading, by striking ``Through 2015''
and inserting ``and Thereafter'';
(B) in paragraph (2)--
(i) in the paragraph heading, by striking ``2014'' and
inserting ``2018''; and
(ii) by striking subparagraph (B) and inserting the
following new subparagraph:
``(B) Fiscal year 2013 through 2018.--Subject to paragraphs
(4) and (6), from the amount made available under paragraphs
(16) through (21) of subsection (a) for each of fiscal years
2013 through 2018, 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) Rebasing in fiscal year 2013 and each succeeding odd-
numbered fiscal year.--For fiscal year 2013 and each
succeeding odd-numbered fiscal year, the allotment of the
State is equal to the Federal payments to the State that are
attributable to (and countable toward) the total amount of
allotments available under this section to the State in the
preceding fiscal year (including payments made to the State
under subsection (n) for such preceding fiscal year as well
as amounts redistributed to the State in such preceding
fiscal year), multiplied by the allotment increase factor
under paragraph (5) for such odd-numbered fiscal year.
``(ii) Growth factor update for fiscal year 2014 and each
succeeding even-numbered fiscal year.--Except as provided in
clause (iii), for fiscal year 2014 and each succeeding even-
numbered fiscal year, the allotment of the State is equal to
the sum of--
``(I) the amount of the State allotment under clause (i)
for the preceding fiscal year; and
``(II) the amount of any payments made to the State under
subsection (n) for such preceding fiscal year,
multiplied by the allotment increase factor under paragraph
(5) for such even-numbered fiscal year.
``(iii) Special rule for fiscal year 2016.--For fiscal year
2016, the allotment of the State is equal to the Federal
payments to the State that are attributable to (and countable
toward) the total amount of allotments available under this
section to the State in the preceding fiscal year (including
payments made to the State under subsection (n) for such
preceding fiscal year as well as amounts redistributed to the
State in such preceding fiscal year), but determined as if
the last two sentences of section 2105(b) were in effect in
such preceding fiscal year and then multiplying the result by
the allotment increase factor under paragraph (5) for fiscal
year 2016.'';
(C) in paragraph (3)--
(i) in the heading, by striking ``2015''and inserting
``2019'';
(ii) in subparagraph (A)--
(I) by striking ``paragraph (18)'' and inserting
``paragraph (22)''; and
(II) by striking ``section 108 of the Children's Health
Insurance Program Reauthorization Act of 2009'' and inserting
``section 301(b)(2) of the Medicare Access and CHIP
Reauthorization Act of 2015'';
(iii) in subparagraph (B), by striking ``paragraph (18)''
and inserting ``paragraph (22)'';
(iv) in subparagraph (C)--
(I) by striking ``2014'' each place it appears and
inserting ``2018''; and
(II) by striking ``2015'' and inserting ``2019''; and
(v) in subparagraph (D)--
(I) in clause (i)--
(aa) in subclause (I), by striking ``subsection
(a)(18)(A)'' and inserting ``subsection (a)(22)(A)''; and
(bb) in subclause (II), by striking ``section 108 of the
Children's Health Insurance Program Reauthorization Act of
2009'' and inserting ``section 301(b)(2) of the Medicare
Access and CHIP Reauthorization Act of 2015''; and
(II) in clause (ii)(II), by striking ``subsection
(a)(18)(B)'' and inserting ``subsection (a)(22)(B)'';
(D) in paragraph (4), by striking ``2015'' and inserting
``2019'';
(E) in paragraph (6)--
(i) in subparagraph (A), by striking ``2015'' and inserting
``2019''; and
(ii) in the second sentence, by striking ``or fiscal year
2014'' and inserting ``fiscal year 2014, fiscal year 2016, or
fiscal year 2018''; and
(F) in paragraph (8)--
(i) in the paragraph heading, by striking ``2015'' and
inserting ``2019''; and
(ii) by striking ``for a period in fiscal year 2015'' and
inserting ``for a period in fiscal year 2019''.
(2) One-time appropriation for fiscal year 2019.--There is
appropriated to the Secretary of Health and Human Services,
out of any money in the Treasury not otherwise appropriated,
$16,700,000,000 to accompany the allotment made for the
period beginning on October 1, 2018, and ending on March 31,
2019, under section 2104(a)(22)(A) of the Social Security Act
(42 U.S.C. 1397dd(a)(22)(A)) (as added by subsection (a)(1)),
to remain available until expended. Such amount shall be used
to provide allotments to States under paragraph (3) of
section 2104(m) of such Act (42 U.S.C. 1397dd(m)) (as amended
by paragraph (1)(C)) for the first 6 months of fiscal year
2019 in the same manner as allotments are provided under
subsection (a)(22)(A) of such section 2104 and subject to the
same terms and conditions as apply to the allotments provided
from such subsection (a)(22)(A).
(c) Child Enrollment Contingency Fund.--
(1) In general.--Section 2104(n) of the Social Security Act
(42 U.S.C. 1397dd(n)) is amended--
(A) in paragraph (2)--
(i) in subparagraph (A)--
(I) in the matter preceding clause (i), by striking ``and
(D)'' and inserting ``, (D), and (E)''; and
(II) by striking clause (ii) and inserting the following:
``(ii) for each of--
``(I) fiscal years 2010 through 2014, such sums as are
necessary for making payments to eligible States for such
fiscal year, but not in excess of the aggregate cap described
in subparagraph (B); and
``(II) fiscal years 2015 through 2018 (and for each of the
semi-annual allotment periods for fiscal year 2019), such
sums as are necessary for making payments to eligible States
for such fiscal year or period.''; and
(ii) by striking subparagraph (B) and inserting the
following:
``(B) Aggregate cap.--The total amount available for
payment from the Fund for each of fiscal years 2010 through
2014, 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. In the case of
fiscal years 2015 through 2018 (and for each of the semi-
annual allotment periods for fiscal year 2019), there shall
be no limit on the amount available for payment from the
Fund.'';
(iii) in subparagraph (D)--
(I) by inserting ``before fiscal year 2015'' after ``fiscal
year or period''; and
(II) by striking ``for any succeeding fiscal year''; and
[[Page S2177]]
(iv) by adding at the end the following subparagraph:
``(E) Transfers.--Notwithstanding any other provision of
this title, the following amounts shall also be available,
without fiscal year limitation, for making payments from the
Fund:
``(i) Unobligated national allotment for fiscal years
beginning with fiscal year 2014.--
``(I) Fiscal year 2014 allotment.--As of December 31 of
fiscal year 2015, the portion, if any, of the amount
appropriated under subsection (a) for fiscal year 2014 that
is unobligated for allotment to a State under subsection (m)
for such fiscal year.
``(II) Succeeding fiscal year allotments.--As of December
31 of fiscal year 2016, and each succeeding fiscal year, the
portion, if any, of the amount appropriated under subsection
(a) for the preceding fiscal year that is unobligated for
allotment to a State under subsection (m) for such preceding
fiscal year.
``(ii) Unexpended allotments not used for redistribution.--
As of December 31 of fiscal year 2015, and as of November 15
of each succeeding fiscal year, the total amount of
allotments made to States under subsection (a) for the second
preceding fiscal year that is not expended or redistributed
under subsection (f) during the period in which such
allotments are available for obligation.
``(iii) Unexpended performance incentive funds.--As of
January 1, 2016, and as of January 1 of each succeeding
calendar year, the portion, if any, of the amount
appropriated under section 2105(a)(3)(E)(iii) for the
preceding fiscal year that is not expended or obligated under
such section.''; and
(B) in paragraph (3)--
(i) in subparagraph (A)--
(I) by redesignating clauses (i) and (ii) as subclauses (I)
and (II), respectively, and realigning the left margins
accordingly;
(II) by striking ``If a State's'' and all that follows
through ``2015,'' and inserting the following:
``(i) For fiscal years 2009 through 2014.--If a State's
expenditures under this title in fiscal year 2009, fiscal
year 2010, fiscal year 2011, fiscal year 2012, fiscal year
2013, or fiscal year 2014'';
(III) by striking ``or period'' each place it appears;
(IV) in subclause (II) (as so redesignated), by striking
``(or in which the period occurs)''; and
(V) by adding at the end the following clause:
``(ii) For fiscal years after 2014.--
``(I) In general.--For each of fiscal years 2015 through
2018 (and for each of the semi-annual allotment periods for
fiscal year 2019), if the Secretary determines that a State
is a shortfall State described in subclause (II) for that
fiscal year or period, the Secretary shall pay to the State
from the Fund, in addition to any other payments made to the
State under this title for the fiscal year or period, an
amount equal to the amount described in subclause (III).
``(II) Shortfall states described.--For purposes of this
clause, with respect to a fiscal year or semi-annual
allotment period, a shortfall State is a State for which the
Secretary estimates, on the basis of the most recent data
available to the Secretary, that the projected expenditures
for the State and fiscal year or period under this title
(including in the form of coverage described in paragraph (1)
or (2) of section 2101, or both) will exceed the sum of--
``(aa) the amount of the State's allotments for any
preceding fiscal year that remains available for expenditure
and that will not be expended by the end of the immediately
preceding fiscal year;
``(bb) the amount (if any) that will be redistributed to
the State under subsection (f) for the fiscal year or period;
``(cc) the amount (if any) to be paid to the State in the
first quarter of the fiscal year under section 2105(a)(3);
and
``(dd) the amount of the State's allotment for the fiscal
year or period.
``(III) Amount described.--With respect to a State and
fiscal year or period, the amount described in this subclause
is equal to the amount by which the projected expenditures
for the State under this title for the fiscal year or period
(estimated by the Secretary on the basis of the most recent
data available to the Secretary) exceed the sum determined
under subclause (II) for the State and fiscal year or period.
``(IV) Retrospective adjustment.--The Secretary may adjust
the determinations made under this clause with respect to a
State and fiscal year or period 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.'';
(ii) in subparagraph (B)(ii), by striking ``(or semi-annual
period occurring in a fiscal year)'';
(iii) in subparagraph (C)--
(I) in the matter preceding clause (i), by striking
``subparagraph (A)(ii)'' and inserting ``subparagraph
(A)(i)(II)''; and
(II) in clause (ii), by striking ``(or semi-annual period
occurring in a fiscal year)''; and
(iv) in subparagraph (G), by inserting ``the expenditures
under the State child health plan and'' after ``regarding''.
(2) Conforming amendment.--Section 2104(f)(2)(A)(ii) of the
Social Security Act (42 U.S.C. 13957dd(f)(2)(A)(ii)) is
amended by inserting ``only in the case of a fiscal year
before fiscal year 2015,'' before ``the amount''.
(d) Extension and Update of Performance Incentive
Payments.--
(1) Extension through fiscal year 2019.--Section 2105(a)(3)
of the Social Security Act (42 U.S.C. 1397ee(a)(3)) is
amended--
(A) in subparagraph (A)--
(i) by striking ``2013'' and inserting ``2019''; and
(ii) in the second sentence, by inserting ``, except that
payment under this paragraph may be made to a State for
fiscal year 2014 as a single payment not later than December
31, 2015'' before the period;
(B) in subparagraph (E)--
(i) in clause (ii)--
(I) by striking subclause (I) and inserting the following:
``(I) Unobligated national allotment for fiscal years 2009
through 2013.--As of December 31 of fiscal year 2009, and as
of December 31 of each succeeding fiscal year through fiscal
year 2013, the portion, if any, of the amount appropriated
under section 2104(a) for such fiscal year that is
unobligated for allotment to a State under section 2104(m)
for such fiscal year or set aside under subsection (a)(3) or
(b)(2) of section 2111 for such fiscal year.'';
(II) in subclause (III), by striking ``2013'' and inserting
``2014'';
(ii) by redesignating clause (iii) as clause (iv); and
(iii) by inserting after clause (ii) the following new
clause:
``(iii) Appropriation for fiscal years 2015 through 2019.--
Out of any money in the Treasury not otherwise appropriated,
there are appropriated $500,000,000 for each of fiscal years
2015 through 2019 for making payments under this paragraph.
Amounts appropriated for a fiscal year under this clause
shall remain available for making payments under this
paragraph until January 1 of the following fiscal year. Any
amounts of such appropriations that remain unexpended or
unobligated as of such date shall be transferred and made
available for making payments under section 2104(n).''; and
(C) in subparagraph (F)(iii), by striking ``2013'' and
inserting ``2019''.
(2) Updated performance incentive criteria for fiscal years
2015 through 2019.--Section 2105(a) of the Social Security
Act (42 U.S.C. 1397ee(a)) is amended--
(A) in paragraph (3)(A), by inserting ``or (5)'' after
``paragraph (4)'';
(B) in paragraph (4)--
(i) in the heading, by inserting ``fiscal years 2009
through 2014'' after ``for children''; and
(ii) in the matter preceding subparagraph (A), by striking
``for a fiscal year if'' and inserting ``for fiscal years
2009 through 2014 if''; and
(C) by adding at the end the following new paragraph:
``(5) Enrollment and retention provisions for children for
fiscal year 2015 and succeeding fiscal years.--
``(A) In general.--For purposes of paragraph (3)(A), a
State meets the condition of this paragraph for fiscal year
2015 and any succeeding fiscal year if it is implementing at
least 4 of the enrollment and retention provisions specified
in subparagraph (B) (treating each clause as a separate
enrollment and retention provision) throughout the entire
fiscal year.
``(B) Enrollment and retention provisions.--The enrollment
and retention provisions specified in this subparagraph are
the following:
``(i) 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.
``(ii) Express lane eligibility.--The State is implementing
the option described in section 1902(e)(13) under title XIX
as well as, pursuant to section 2107(e)(1), under this title.
``(iii) Presumptive eligibility.--The State provides
medical assistance to children during a presumptive
eligibility period by implementing section 1920A under title
XIX as well as, pursuant to section 2107(e)(1), under this
title, and ensures that such period begins with the
determination by any qualified entity that the family income
of the child does not exceed the applicable level of income
eligibility under the State plan. A State shall not satisfy
this provision if the only type of entity recognized by the
State as a qualified entity is a hospital that has elected to
be a qualified entity under section 1902(a)(47)(B).
``(iv) Premium assistance for employer-sponsored plans.--
The State has opted to offer a premium assistance subsidy for
qualified employer-sponsored coverage by implementing section
1906A under title XIX or the option described in section
2105(c)(10) under this title.
``(v) Elimination of waiting periods.--The State does not
impose a waiting period for coverage of any individual under
the State child health plan and ensures that no waiting
period applies in the case of coverage provided to any
individual eligible for coverage under the State child health
plan through coverage purchased by the State under section
2105(c)(3) or employer-sponsored coverage subsidized by the
State under section 1906A of title XIX or section 2105(c)(10)
of this title.
``(vi) Automated tracking of cost sharing or lower cap on
cost sharing.--In the
[[Page S2178]]
case of a State child health plan that imposes premiums,
deductibles, cost sharing, or similar charges that could (as
determined by the Secretary) cause families that include an
individual receiving assistance under the plan to have out-
of-pocket expenses that exceed the limit imposed under
section 2103(e)(3)(B), the State has either--
``(I) established, or, in the case of a State child health
plan that provides child health assistance through managed
care entities or organizations, required such entities or
organizations to coordinate with the State agency responsible
for implementing the State child health plan under this title
in establishing--
``(aa) an electronic process for tracking such expenses
that does not rely on documentation provided by the
individual or the family; and
``(bb) a system for notifying each such family of the
aggregate monthly or quarterly limits on out-of-pocket
expenses applicable to the family under section 2103(e)(3)(B)
and explaining to each such family that no such expenses
shall be imposed on any individual in the family for the
remainder of any month or quarter with respect to which the
family has reached the applicable aggregate monthly or
quarterly family limit imposed under such section; or
``(II) elected to eliminate deductibles, copayments,
coinsurance, or other forms of cost-sharing (other than
premiums) imposed under this title with respect to any
individual receiving coverage under the State child health
plan.
``(vii) Real-time eligibility determinations through the
use of enhanced data sources.--With respect to applications
and renewals for medical assistance under title XIX or child
health assistance under this title for a fiscal year, the
State meets the following criteria for all income
determinations made using modified adjusted gross income
under section 1902(e)(14)(A):
``(I) The State relies on enhanced data sources (which may
include, but shall not be limited to, the data sources
available under section 1137 or the federal Data Services
Hub) to make the determinations.
``(II) In the case of initial applications, the State makes
at least 50 percent of the determinations within 24 hours of
receiving the application. If a State successfully makes the
required minimum percentage of timely determinations for a
fiscal year, such State shall not receive credit for meeting
this provision in any subsequent fiscal year unless the State
makes a percentage of timely income determinations that is at
least 5 percentage points higher (or, if at least 75 percent
of the State's determinations in a previous fiscal year were
timely, 1 percentage point higher) than the percentage that
the State achieved in the last fiscal year in which the State
received credit for meeting this provision.
``(III) In the case of renewals, the State makes at least
50 percent of the determinations within 24 hours of receiving
the renewal. If a State successfully makes the required
minimum percentage of timely determinations for a fiscal
year, such State shall not receive credit for meeting this
provision in any subsequent fiscal year unless the State
makes a percentage of timely income determinations that is at
least 5 percentage points higher (or, if at least 75 percent
of the State's determinations in a previous fiscal year were
timely, 1 percentage point higher) than the percentage that
the State achieved in the last fiscal year in which the State
received credit for meeting this provision.
``(viii) Elimination of premiums or retroactive
reinstatement upon premium payment.--The State has elected to
either--
``(I) impose no premiums for coverage under the State child
health plan; or
``(II) in the case of an individual whose coverage under
the State child health plan has been terminated for failure
to make premium payments, provide assistance to such
individual for purposes of immediate reenrollment of the
individual upon payment of outstanding premiums, with
coverage retroactive to the beginning of the most recent
month for which an outstanding premium has been paid, and
shall not impose any waiting period or fee as a condition of
such reenrollment.''.
(e) Extension of Qualifying States Option.--Section
2105(g)(4) of the Social Security Act (42 U.S.C.
1397ee(g)(4)) is amended--
(1) in the paragraph heading, by striking ``2015'' and
inserting ``2019''; and
(2) in subparagraph (A), by striking ``2015'' and inserting
``2019''.
(f) Extension of Certain Programs and Demonstration
Projects.--
(1) Quality care for children demonstration project.--
Section 1139A(d)(1) of the Social Security Act (42 U.S.C.
1320b-9a(d)(1)) is amended in the matter before subparagraph
(A) by inserting ``, and during the period of fiscal years
2016 through 2019, the Secretary shall award not more than 10
grants,'' before ``to States''.
(2) Childhood obesity demonstration project.--Section
1139A(e)(8) of the Social Security Act (42 U.S.C. 1320b-
9a(e)(8)) is amended by inserting ``, and $25,000,000 for the
period of fiscal years 2015 though 2019'' after ``2014''.
(3) Pediatric quality measures program.--Section 1139A(i)
of the Social Security Act (42 U.S.C. 1320b-9a(i)) is amended
in the first sentence by inserting before the period at the
end the following: ``, and there is appropriated for each of
fiscal years 2016 through 2019, $45,000,000 for the purpose
of carrying out this section (other than subsections (e),
(f), and (g)).''.
(4) Outreach and enrollment grants; national campaign.--
Section 2113 of the Social Security Act (42 U.S.C. 1397mm) is
amended--
(A) in subsection (a)(1), by striking ``2015'' and
inserting ``2019''; and
(B) in subsection (g), by inserting ``, and $80,000,000 for
the period of fiscal years 2016 through 2019, to remain
available until expended,'' after ``2015''.
(g) Express Lane Eligibility.--Section 1902(e)(13)(I) of
the Social Security Act (42 U.S.C. 1396a(e)(13)(I)) is
amended by striking ``September 30, 2015'' and inserting
``September 30, 2019''.
(h) Authority To Use Income Determination Made Under
Certain Programs.--Section 1902(e)(14) of the Social Security
Act (42 U.S.C. 1396a(e)(14)) is amended--
(1) in subparagraph (A), in the first sentence, by striking
``subparagraph (D)'' and inserting ``subparagraphs (D) and
(J)''; and
(2) by adding at the end the following new subparagraph:
``(J) Use of income determination made under certain other
programs.--
``(i) In general.--For purposes of determining income
eligibility for medical assistance under the State plan or
under any waiver of such plan, a State may use a
determination of income made by--
``(I) the State program funded under part A of title IV; or
``(II) the supplemental nutrition assistance program
established under the Food and Nutrition Act of 2008.
``(ii) Sunset.--Clause (i) shall not apply after September
30, 2019.''.
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