[Congressional Record (Bound Edition), Volume 153 (2007), Part 16]
[Senate]
[Pages 21649-21743]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 2529. Mr. KERRY (for himself and Ms. Snowe) submitted an amendment 
intended to be proposed by him to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the appropriate place, insert the following:

     SEC. __. OUTREACH REGARDING HEALTH INSURANCE OPTIONS 
                   AVAILABLE TO CHILDREN.

       (a) Definitions.--In this section--
       (1) the terms ``Administration'' and ``Administrator'' 
     means the Small Business Administration and the Administrator 
     thereof, respectively;
       (2) the term ``certified development company'' means a 
     development company participating in the program under title 
     V of the Small Business Investment Act of 1958 (15 U.S.C. 695 
     et seq.);
       (3) the term ``Medicaid program'' means the program 
     established under title XIX of the Social Security Act (42 
     U.S.C. 1396 et seq.);
       (4) the term ``Service Corps of Retired Executives'' means 
     the Service Corps of Retired Executives authorized by section 
     8(b)(1) of the Small Business Act (15 U.S.C. 637(b)(1));
       (5) the term ``small business concern'' has the meaning 
     given that term in section 3 of the Small Business Act (15 
     U.S.C. 632);
       (6) the term ``small business development center'' means a 
     small business development center described in section 21 of 
     the Small Business Act (15 U.S.C. 648);
       (7) the term ``State'' has the meaning given that term for 
     purposes of title XXI of the Social Security Act (42 U.S.C. 
     1397aa et seq.);
       (8) the term ``State Children's Health Insurance Program'' 
     means the State Children's Health Insurance Program 
     established under title XXI of the Social Security Act (42 
     U.S.C. 1397aa et seq.);
       (9) the term ``task force'' means the task force 
     established under subsection (b)(1); and
       (10) the term ``women's business center'' means a women's 
     business center described in section 29 of the Small Business 
     Act (15 U.S.C. 656).
       (b) Establishment of Task Force.--
       (1) Establishment.--There is established a task force to 
     conduct a nationwide campaign of education and outreach for 
     small business concerns regarding the availability of 
     coverage for children through private insurance options, the 
     Medicaid program, and the State Children's Health Insurance 
     Program.
       (2) Membership.--The task force shall consist of the 
     Administrator, the Secretary of Health and Human Services, 
     the Secretary of Labor, and the Secretary of the Treasury.
       (3) Responsibilities.--The campaign conducted under this 
     subsection shall include--
       (A) efforts to educate the owners of small business 
     concerns about the value of health coverage for children;
       (B) information regarding options available to the owners 
     and employees of small business concerns to make insurance 
     more affordable, including Federal and State tax deductions 
     and credits for health care-related expenses and health 
     insurance expenses and Federal tax exclusion for health 
     insurance options available under employer-sponsored 
     cafeteria plans under section 125 of the Internal Revenue 
     Code of 1986;
       (C) efforts to educate the owners of small business 
     concerns about assistance available through public programs; 
     and
       (D) efforts to educate the owners and employees of small 
     business concerns regarding the availability of the hotline 
     operated as part of the Insure Kids Now program of the 
     Department of Health and Human Services.
       (4) Implementation.--In carrying out this subsection, the 
     task force may--
       (A) use any business partner of the Administration, 
     including--
       (i) a small business development center;
       (ii) a certified development company;
       (iii) a women's business center; and
       (iv) the Service Corps of Retired Executives;
       (B) enter into--
       (i) a memorandum of understanding with a chamber of 
     commerce; and
       (ii) a partnership with any appropriate small business 
     concern or health advocacy group; and
       (C) designate outreach programs at regional offices of the 
     Department of Health and Human Services to work with district 
     offices of the Administration.
       (5) Website.--The Administrator shall ensure that links to 
     information on the eligibility and enrollment requirements 
     for the Medicaid program and State Children's Health 
     Insurance Program of each State are prominently displayed on 
     the website of the Administration.
       (6) Report.--
       (A) In general.--Not later than 2 years after the date of 
     enactment of this Act, and every 2 years thereafter, the 
     Administrator shall submit to the Committee on Small Business 
     and Entrepreneurship of the Senate and the Committee on Small 
     Business of the House of Representatives a report on the 
     status of the nationwide campaign conducted under paragraph 
     (1).
       (B) Contents.--Each report submitted under subparagraph (A) 
     shall include a status update on all efforts made to educate 
     owners and employees of small business concerns on options 
     for providing health insurance for children through public 
     and private alternatives.
                                 ______
                                 
  SA 2530. Mr. BAUCUS (for himself, Mr. Grassley, Mr. Rockefeller, and 
Mr. Hatch) proposed an amendment to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; as follows:

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

       (a) Short Title.--This Act may be cited as the ``Children's 
     Health Insurance Program Reauthorization Act of 2007''.
       (b) Amendments to Social Security Act.--Except as otherwise 
     specifically provided, whenever in this Act an amendment is 
     expressed in terms of an amendment to or repeal of a section 
     or other provision, the reference shall be considered to be 
     made to that section or other provision of the Social 
     Security Act.
       (c) References to Medicaid; CHIP; Secretary.--In this Act:
       (1) CHIP.--The term ``CHIP'' means the State Children's 
     Health Insurance Program established under title XXI of the 
     Social Security Act (42 U.S.C. 1397aa et seq.).
       (2) Medicaid.--The term ``Medicaid'' means the program for 
     medical assistance established under title XIX of the Social 
     Security Act (42 U.S.C. 1396 et seq.).
       (3) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (d) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title; amendments to Social Security Act; references; 
              table of contents.

                       TITLE I--FINANCING OF CHIP

Sec. 101. Extension of CHIP.
Sec. 102. Allotments for the 50 States and the District of Columbia.
Sec. 103. One-time appropriation.
Sec. 104. Improving funding for the territories under CHIP and 
              Medicaid.
Sec. 105. Incentive bonuses for States.
Sec. 106. Phase-out of coverage for nonpregnant childless adults under 
              CHIP; conditions for coverage of parents.
Sec. 107. State option to cover low-income pregnant women under CHIP 
              through a State plan amendment.
Sec. 108. CHIP Contingency fund.
Sec. 109. Two-year availability of allotments; expenditures counted 
              against oldest allotments.
Sec. 110. Limitation on matching rate for States that propose to cover 
              children with effective family income that exceeds 300 
              percent of the poverty line.
Sec. 111. Option for qualifying States to receive the enhanced portion 
              of the CHIP matching rate for Medicaid coverage of 
              certain children.

                   TITLE II--OUTREACH AND ENROLLMENT

Sec. 201. Grants for outreach and enrollment.
Sec. 202. Increased outreach and enrollment of Indians.
Sec. 203. Demonstration project to permit States to rely on findings by 
              an Express Lane agency to determine components of a 
              child's eligibility for Medicaid or CHIP.
Sec. 204. Authorization of certain information disclosures to simplify 
              health coverage determinations.

               TITLE III--REDUCING BARRIERS TO ENROLLMENT

Sec. 301. Verification of declaration of citizenship or nationality for 
              purposes of eligibility for Medicaid and CHIP.
Sec. 302. Reducing administrative barriers to enrollment.

[[Page 21650]]

      TITLE IV--REDUCING BARRIERS TO PROVIDING PREMIUM ASSISTANCE

  Subtitle A--Additional State Option for Providing Premium Assistance

Sec. 401. Additional State option for providing premium assistance.
Sec. 402. Outreach, education, and enrollment assistance.

   Subtitle B--Coordinating Premium Assistance With Private Coverage

Sec. 411. Special enrollment period under group health plans in case of 
              termination of Medicaid or CHIP coverage or eligibility 
              for assistance in purchase of employment-based coverage; 
              coordination of coverage.

 TITLE V--STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES OF CHILDREN

Sec. 501. Child health quality improvement activities for children 
              enrolled in Medicaid or CHIP.
Sec. 502. Improved information regarding access to coverage under CHIP.
Sec. 503. Application of certain managed care quality safeguards to 
              CHIP.

                        TITLE VI--MISCELLANEOUS

Sec. 601. Technical correction regarding current State authority under 
              Medicaid.
Sec. 602. Payment error rate measurement (``PERM'').
Sec. 603. Elimination of counting medicaid child presumptive 
              eligibility costs against title XXI allotment.
Sec. 604. Improving data collection.
Sec. 605. Deficit Reduction Act technical corrections.
Sec. 606. Elimination of confusing program references.
Sec. 607. Mental health parity in CHIP plans.
Sec. 608. Dental health grants.
Sec. 609. Application of prospective payment system for services 
              provided by Federally-qualified health centers and rural 
              health clinics.

                     TITLE VII--REVENUE PROVISIONS

Sec. 701. Increase in excise tax rate on tobacco products.
Sec. 702. Administrative improvements.
Sec. 703. Time for payment of corporate estimated taxes.

                       TITLE VIII--EFFECTIVE DATE

Sec. 801. Effective date.

                       TITLE I--FINANCING OF CHIP

     SEC. 101. EXTENSION OF CHIP.

       Section 2104(a) (42 U.S.C. 1397dd(a)) is amended--
       (1) in paragraph (9), by striking ``and'' at the end;
       (2) in paragraph (10), by striking the period at the end 
     and inserting a semicolon; and
       (3) by adding at the end the following new paragraphs:
       ``(11) for fiscal year 2008, $9,125,000,000;
       ``(12) for fiscal year 2009, $10,675,000,000;
       ``(13) for fiscal year 2010, $11,850,000,000;
       ``(14) for fiscal year 2011, $13,750,000,000; and
       ``(15) for fiscal year 2012, for purposes of making 2 semi-
     annual allotments--
       ``(A) $1,750,000,000 for the period beginning on October 1, 
     2011, and ending on March 31, 2012, and
       ``(B) $1,750,000,000 for the period beginning on April 1, 
     2012, and ending on September 30, 2012.''.

     SEC. 102. ALLOTMENTS FOR THE 50 STATES AND THE DISTRICT OF 
                   COLUMBIA.

       (a) In General.--Section 2104 (42 U.S.C. 1397dd) is amended 
     by adding at the end the following new subsection:
       ``(i) Determination of Allotments for the 50 States and the 
     District of Columbia for Fiscal Years 2008 Through 2012.--
       ``(1) Computation of allotment.--
       ``(A) In general.--Subject to the succeeding paragraphs of 
     this subsection, the Secretary shall for each of fiscal years 
     2008 through 2012 allot to each subsection (b) State from the 
     available national allotment an amount equal to 110 percent 
     of--
       ``(i) in the case of fiscal year 2008, the highest of the 
     amounts determined under paragraph (2);
       ``(ii) in the case of each of fiscal years 2009 through 
     2011, the Federal share of the expenditures determined under 
     subparagraph (B) for the fiscal year; and
       ``(iii) beginning with fiscal year 2012, subject to 
     subparagraph (E), each semi-annual allotment determined under 
     subparagraph (D).
       ``(B) Projected state expenditures for the fiscal year.--
     For purposes of subparagraphs (A)(ii) and (D), the 
     expenditures determined under this subparagraph for a fiscal 
     year are the projected expenditures under the State child 
     health plan for the fiscal year (as certified by the State 
     and submitted to the Secretary by not later than August 31 of 
     the preceding fiscal year).
       ``(C) Available national allotment.--For purposes of this 
     subsection, the term `available national allotment' means, 
     with respect to any fiscal year, the amount available for 
     allotment under subsection (a) for the fiscal year, reduced 
     by the amount of the allotments made for the fiscal year 
     under subsection (c). Subject to paragraph (3)(B), the 
     available national allotment with respect to the amount 
     available under subsection (a)(15)(A) for fiscal year 2012 
     shall be increased by the amount of the appropriation for the 
     period beginning on October 1 and ending on March 31 of such 
     fiscal year under section 103 of the Children's Health 
     Insurance Program Reauthorization Act of 2007.
       ``(D) Semi-annual allotments.--For purposes of subparagraph 
     (A)(iii), the semi-annual allotments determined under this 
     paragraph with respect to a fiscal year are as follows:
       ``(i) For the period beginning on October 1 and ending on 
     March 31 of the fiscal year, the Federal share of the portion 
     of the expenditures determined under subparagraph (B) for the 
     fiscal year which are allocable to such period.
       ``(ii) For the period beginning on April 1 and ending on 
     September 30 of the fiscal year, the Federal share of the 
     portion of the expenditures determined under subparagraph (B) 
     for the fiscal year which are allocable to such period.
       ``(E) Availability.--Each semi-annual allotment made under 
     subparagraph (A)(iii) shall remain available for expenditure 
     under this title for periods after the period specified in 
     subparagraph (D) for purposes of determining the allotment in 
     the same manner as the allotment would have been available 
     for expenditure if made for an entire fiscal year.
       ``(2) Special rule for fiscal year 2008.--
       ``(A) In general.--For purposes of paragraph (1)(A)(i), the 
     amounts determined under this paragraph for fiscal year 2008 
     are as follows:
       ``(i) The total Federal payments to the State under this 
     title for fiscal year 2007, multiplied by the annual 
     adjustment determined under subparagraph (B) for fiscal year 
     2008.
       ``(ii) The Federal share of the amount allotted to the 
     State for fiscal year 2007 under subsection (b), multiplied 
     by the annual adjustment determined under subparagraph (B) 
     for fiscal year 2008.
       ``(iii) Only in the case of--

       ``(I) a State that received a payment, redistribution, or 
     allotment under any of paragraphs (1), (2), or (4) of 
     subsection (h), the amount of the projected total Federal 
     payments to the State under this title for fiscal year 2007, 
     as determined on the basis of the November 2006 estimates 
     certified by the State to the Secretary;
       ``(II) a State whose projected total Federal payments to 
     the State under this title for fiscal year 2007, as 
     determined on the basis of the May 2006 estimates certified 
     by the State to the Secretary, were at least $95,000,000 but 
     not more than $96,000,000 higher than the projected total 
     Federal payments to the State under this title for fiscal 
     year 2007 on the basis of the November 2006 estimates, the 
     amount of the projected total Federal payments to the State 
     under this title for fiscal year 2007 on the basis of the May 
     2006 estimates; or
       ``(III) a State whose projected total Federal payments 
     under this title for fiscal year 2007, as determined on the 
     basis of the November 2006 estimates certified by the State 
     to the Secretary, exceeded all amounts available to the State 
     for expenditure for fiscal year 2007 (including any amounts 
     paid, allotted, or redistributed to the State in prior fiscal 
     years), the amount of the projected total Federal payments to 
     the State under this title for fiscal year 2007, as 
     determined on the basis of the November 2006 estimates 
     certified by the State to the Secretary,

     multiplied by the annual adjustment determined under 
     subparagraph (B) for fiscal year 2008.
       ``(iv) The projected total Federal payments to the State 
     under this title for fiscal year 2008, as determined on the 
     basis of the August 2007 projections certified by the State 
     to the Secretary by not later than September 30, 2007.
       ``(B) Annual adjustment for health care cost growth and 
     child population growth.--The annual adjustment determined 
     under this subparagraph for a fiscal year with respect to a 
     State is equal to the product of the amounts determined under 
     clauses (i) and (ii):
       ``(i) Per capita health care growth.--1 plus the percentage 
     increase (if any) in the projected nominal per capita amount 
     of National Health Expenditures for the calendar year that 
     begins during the fiscal year involved over the preceding 
     calendar year, as most recently published by the Secretary.
       ``(ii) Child population growth.--1.01 plus the percentage 
     change in the population of children under 19 years of age in 
     the State from July 1 of the fiscal year preceding the fiscal 
     year involved to July 1 of the fiscal year involved, as 
     determined by the Secretary based on the most timely and 
     accurate published estimates of the Bureau of the Census.
       ``(C) Definition.--For purposes of subparagraph (B), the 
     term `fiscal year involved' means the fiscal year for which 
     an allotment under this subsection is being determined.
       ``(D) Proration rule.--If, after the application of this 
     paragraph without regard to this subparagraph, the sum of the 
     State allotments determined under this paragraph

[[Page 21651]]

     for fiscal year 2008 exceeds the available national allotment 
     for fiscal year 2008, the Secretary shall reduce each such 
     allotment on a proportional basis.
       ``(3) Alternative allotments for fiscal years 2009 through 
     2012.--
       ``(A) In general.--If the sum of the State allotments 
     determined under paragraph (1)(A)(ii) for any of fiscal years 
     2009 through 2011 exceeds the available national allotment 
     for the fiscal year, the Secretary shall allot to each 
     subsection (b) State from the available national allotment 
     for the fiscal year an amount equal to the product of--
       ``(i) the available national allotment for the fiscal year; 
     and
       ``(ii) the percentage equal to the sum of the State 
     allotment factors for the fiscal year determined under 
     paragraph (4) with respect to the State.
       ``(B) Special rules beginning in fiscal year 2012.--
     Beginning in fiscal year 2012--
       ``(i) this paragraph shall be applied separately with 
     respect to each of the periods described in clauses (i) and 
     (ii) of paragraph (1)(D) and the available national allotment 
     for each such period shall be the amount appropriated for 
     such period (rather than the amount appropriated for the 
     entire fiscal year), reduced by the amount of the allotments 
     made for the fiscal year under subsection (c) for each such 
     period, and
       ``(ii) if--

       ``(I) the sum of the State allotments determined under 
     paragraph (1)(A)(iii) for either such period exceeds the 
     amount of such available national allotment for such period, 
     the Secretary shall make the allotment for each State for 
     such period in the same manner as under subparagraph (A), and
       ``(II) the amount of such available national allotment for 
     either such period exceeds the sum of the State allotments 
     determined under paragraph (1)(A)(iii) for such period, the 
     Secretary shall increase the allotment for each State for 
     such period by the amount that bears the same ratio to such 
     excess as the State's allotment determined under paragraph 
     (1)(A)(iii) for such period (without regard to this 
     subparagraph) bears to the sum of such allotments for all 
     States.

       ``(4) Weighted factors.--
       ``(A) Factors described.--For purposes of paragraph (3), 
     the factors described in this subparagraph are the following:
       ``(i) Projected state expenditures for the fiscal year.--
     The ratio of the projected expenditures under the State child 
     health plan for the fiscal year (as certified by the State to 
     the Secretary by not later than August 31 of the preceding 
     fiscal year) to the sum of the projected expenditures under 
     all such plans for all subsection (b) States for the fiscal 
     year, multiplied by the applicable percentage weight assigned 
     under subparagraph (B).
       ``(ii) Number of low-income children in the state.--The 
     ratio of the number of low-income children in the State, as 
     determined on the basis of the most timely and accurate 
     published estimates of the Bureau of the Census, to the sum 
     of the number of low-income children so determined for all 
     subsection (b) States for such fiscal year, multiplied by the 
     applicable percentage weight assigned under subparagraph (B).
       ``(iii) Projected state expenditures for the preceding 
     fiscal year.--The ratio of the projected expenditures under 
     the State child health plan for the preceding fiscal year (as 
     determined on the basis of the projections certified by the 
     State to the Secretary for November of the fiscal year), to 
     the sum of the projected expenditures under all such plans 
     for all subsection (b) States for such preceding fiscal year 
     (as so determined), multiplied by the applicable percentage 
     weight assigned under subparagraph (B).
       ``(iv) Actual state expenditures for the second preceding 
     fiscal year.--The ratio of the actual expenditures under the 
     State child health plan for the second preceding fiscal year, 
     as determined by the Secretary on the basis of expenditure 
     data reported by States on CMS Form 64 or CMS Form 21, to 
     such sum of the actual expenditures under all such plans for 
     all subsection (b) States for such second preceding fiscal 
     year, multiplied by the applicable percentage weight assigned 
     under subparagraph (B).
       ``(B) Assignment of weights.--For each of fiscal years 2009 
     through 2012, the applicable weights assigned under this 
     subparagraph are the following:
       ``(i) With respect to the factor described in subparagraph 
     (A)(i), a weight of 75 percent for each such fiscal year.
       ``(ii) With respect to the factor described in subparagraph 
     (A)(ii), a weight of 12\1/2\ percent for each such fiscal 
     year.
       ``(iii) With respect to the factor described in 
     subparagraph (A)(iii), a weight of 7\1/2\ percent for each 
     such fiscal year.
       ``(iv) With respect to the factor described in subparagraph 
     (A)(iv), a weight of 5 percent for each such fiscal year.
       ``(5) Demonstration of need for increased allotment based 
     on projected state expenditures exceeding 10 percent of the 
     preceding fiscal year allotment.--
       ``(A) In general.--If the projected expenditures under the 
     State child health plan described in paragraph (1)(B) for any 
     of fiscal years 2009 through 2012 are at least 10 percent 
     more than the allotment determined for the State for the 
     preceding fiscal year (determined without regard to paragraph 
     (2)(D) or paragraph (3)), and, during the preceding fiscal 
     year, the State did not receive approval for a State plan 
     amendment or waiver to expand coverage under the State child 
     health plan or did not receive a CHIP contingency fund 
     payment under subsection (k)--
       ``(i) the State shall submit to the Secretary, by not later 
     than August 31 of the preceding fiscal year, information 
     relating to the factors that contributed to the need for the 
     increase in the State's allotment for the fiscal year, as 
     well as any other additional information that the Secretary 
     may require for the State to demonstrate the need for the 
     increase in the State's allotment for the fiscal year;
       ``(ii) the Secretary shall--

       ``(I) review the information submitted under clause (i);
       ``(II) notify the State in writing within 60 days after 
     receipt of the information that--

       ``(aa) the projected expenditures under the State child 
     health plan are approved or disapproved (and if disapproved, 
     the reasons for disapproval); or
       ``(bb) specified additional information is needed; and

       ``(III) if the Secretary disapproved the projected 
     expenditures or determined additional information is needed, 
     provide the State with a reasonable opportunity to submit 
     additional information to demonstrate the need for the 
     increase in the State's allotment for the fiscal year.

       ``(B) Provisional and final allotment.--In the case of a 
     State described in subparagraph (A) for which the Secretary 
     has not determined by September 30 of a fiscal year whether 
     the State has demonstrated the need for the increase in the 
     State's allotment for the succeeding fiscal year, the 
     Secretary shall provide the State with a provisional 
     allotment for the fiscal year equal to 110 percent of the 
     allotment determined for the State under this subsection for 
     the preceding fiscal year (determined without regard to 
     paragraph (2)(D) or paragraph (3)), and may, not later than 
     November 30 of the fiscal year, adjust the State's allotment 
     (and the allotments of other subsection (b) States), as 
     necessary (and, if applicable, subject to paragraph (3)), on 
     the basis of information submitted by the State in accordance 
     with subparagraph (A).
       ``(6) Special rules.--
       ``(A) Deadline and data for determining fiscal year 2008 
     allotments.--In computing the amounts under paragraph (2)(A) 
     and subsection (c)(5)(A) that determine the allotments to 
     subsection (b) States and territories for fiscal year 2008, 
     the Secretary shall use the most recent data available to the 
     Secretary before the start of that fiscal year. The Secretary 
     may adjust such amounts and allotments, as necessary, on the 
     basis of the expenditure data for the prior year reported by 
     States on CMS Form 64 or CMS Form 21 not later than November 
     30, 2007, but in no case shall the Secretary adjust the 
     allotments provided under paragraph (2)(A) or subsection 
     (c)(5)(A) for fiscal year 2008 after December 31, 2007.
       ``(B) Inclusion of certain expenditures.--
       ``(i) Projected expenditures of qualifying states.--
     Payments made or projected to be made to a qualifying State 
     described in paragraph (2) of section 2105(g) for 
     expenditures described in paragraph (1)(B)(ii) or (4)(B) of 
     that section shall be included for purposes of determining 
     the projected expenditures described in paragraph (1)(B) with 
     respect to the allotments determined for each of fiscal years 
     2009 through 2012 and for purposes of determining the amounts 
     described in clauses (i) and (iv) of paragraph (2)(A) with 
     respect to the allotments determined for fiscal year 2008.
       ``(ii) Projected expenditures under block grant set-asides 
     for nonpregnant childless adults and parents.--Payments 
     projected to be made to a State under subsection (a) or (b) 
     of section 2111 shall be included for purposes of determining 
     the projected expenditures described in paragraph (1)(B) with 
     respect to the allotments determined for each of fiscal years 
     2009 through 2012 (to the extent such payments are permitted 
     under such section), including for purposes of allocating 
     such expenditures for purposes of clauses (i) and (ii) of 
     paragraph (1)(D).
       ``(7) Subsection (b) state.--In this paragraph, the term 
     `subsection (b) State' means 1 of the 50 States or the 
     District of Columbia.''.
       (b) Conforming Amendments.--Section 2104 (42 U.S.C. 1397dd) 
     is amended--
       (1) in subsection (a), by striking ``subsection (d)'' and 
     inserting ``subsections (d), (h), and (i)'';
       (2) in subsection (b)(1), by striking ``subsection (d)'' 
     and inserting ``subsections (d), (h), and (i)''; and
       (3) in subsection (c)(1), by striking ``subsection (d)'' 
     and inserting ``subsections (d), (h), and (i)''.

     SEC. 103. ONE-TIME APPROPRIATION.

       There is appropriated to the Secretary, out of any money in 
     the Treasury not otherwise appropriated, $12,500,000,000 to 
     accompany the allotment made for the period beginning on 
     October 1, 2011, and ending on March 31, 2012, under section 
     2104(a)(15)(A) of the Social Security Act (42 U.S.C. 
     1397dd(a)(15)(A)) (as added by section 101), to remain 
     available

[[Page 21652]]

     until expended. Such amount shall be used to provide 
     allotments to States under subsections (c)(5) and (i) of 
     section 2104 of the Social Security Act (42 U.S.C. 1397dd) 
     for the first 6 months of fiscal year 2012 in the same manner 
     as allotments are provided under subsection (a)(15)(A) of 
     such section and subject to the same terms and conditions as 
     apply to the allotments provided from such subsection 
     (a)(15)(A).

     SEC. 104. IMPROVING FUNDING FOR THE TERRITORIES UNDER CHIP 
                   AND MEDICAID.

       (a) Update of CHIP Allotments.--Section 2104(c) (42 U.S.C. 
     1397dd(c)) is amended--
       (1) in paragraph (1), by inserting ``and paragraphs (5) and 
     (6)'' after ``and (i)''; and
       (2) by adding at the end the following new paragraphs:
       ``(5) Annual allotments for territories beginning with 
     fiscal year 2008.--Of the total allotment amount appropriated 
     under subsection (a) for a fiscal year beginning with fiscal 
     year 2008, the Secretary shall allot to each of the 
     commonwealths and territories described in paragraph (3) the 
     following:
       ``(A) Fiscal year 2008.--For fiscal year 2008, the highest 
     amount of Federal payments to the commonwealth or territory 
     under this title for any fiscal year occurring during the 
     period of fiscal years 1998 through 2007, multiplied by the 
     annual adjustment determined under subsection (i)(2)(B) for 
     fiscal year 2008, except that clause (ii) thereof shall be 
     applied by substituting `the United States' for `the State'.
       ``(B) Fiscal years 2009 through 2012.--
       ``(i) In general.--For each of fiscal years 2009 through 
     2012, except as provided in clause (ii), the amount 
     determined under this paragraph for the preceding fiscal year 
     multiplied by the annual adjustment determined under 
     subsection (i)(2)(B) for the fiscal year, except that clause 
     (ii) thereof shall be applied by substituting `the United 
     States' for `the State'.
       ``(ii) Special rule for fiscal year 2012.--In the case of 
     fiscal year 2012--

       ``(I) 89 percent of the amount allocated to the 
     commonwealth or territory for such fiscal year (without 
     regard to this subclause) shall be allocated for the period 
     beginning on October 1, 2011, and ending on March 31, 2012, 
     and
       ``(II) 11 percent of such amount shall be allocated for the 
     period beginning on April 1, 2012, and ending on September 
     30, 2012.''.

       (b) Removal of Federal Matching Payments for Data Reporting 
     Systems From the Overall Limit on Payments to Territories 
     Under Title XIX.--Section 1108(g) (42 U.S.C. 1308(g)) is 
     amended by adding at the end the following new paragraph:
       ``(4) Exclusion of certain expenditures from payment 
     limits.--With respect to fiscal years beginning with fiscal 
     year 2008, if Puerto Rico, the Virgin Islands, Guam, the 
     Northern Mariana Islands, or American Samoa qualify for a 
     payment under subparagraph (A)(i), (B), or (F) of section 
     1903(a)(3) for a calendar quarter of such fiscal year, the 
     payment shall not be taken into account in applying 
     subsection (f) (as increased in accordance with paragraphs 
     (1), (2), and (3) of this subsection) to such commonwealth or 
     territory for such fiscal year.''.
       (c) GAO Study and Report.--Not later than September 30, 
     2009, the Comptroller General of the United States shall 
     submit a report to the appropriate committees of Congress 
     regarding Federal funding under Medicaid and CHIP for Puerto 
     Rico, the United States Virgin Islands, Guam, American Samoa, 
     and the Northern Mariana Islands. The report shall include 
     the following:
       (1) An analysis of all relevant factors with respect to--
       (A) eligible Medicaid and CHIP populations in such 
     commonwealths and territories;
       (B) historical and projected spending needs of such 
     commonwealths and territories and the ability of capped 
     funding streams to respond to those spending needs;
       (C) the extent to which Federal poverty guidelines are used 
     by such commonwealths and territories to determine Medicaid 
     and CHIP eligibility; and
       (D) the extent to which such commonwealths and territories 
     participate in data collection and reporting related to 
     Medicaid and CHIP, including an analysis of territory 
     participation in the Current Population Survey versus the 
     American Community Survey.
       (2) Recommendations for improving Federal funding under 
     Medicaid and CHIP for such commonwealths and territories.

     SEC. 105. INCENTIVE BONUSES FOR STATES.

       (a) In General.--Section 2104 (42 U.S.C. 1397dd), as 
     amended by section 102, is amended by adding at the end the 
     following new subsection:
       ``(j) Incentive Bonuses.--
       ``(1) Establishment of incentive pool from unobligated 
     national allotment and unexpended state allotments.--
       ``(A) In general.--There is hereby established in the 
     Treasury of the United States a fund which shall be known as 
     the `CHIP Incentive Bonuses Pool' (in this subsection 
     referred to as the `Incentive Pool'). Amounts in the 
     Incentive Pool are authorized to be appropriated for payments 
     under this subsection and shall remain available until 
     expended.
       ``(B) Deposits through initial appropriation and transfers 
     of funds.--
       ``(i) Initial appropriation.--There is appropriated to the 
     Incentive Pool, out of any money in the Treasury not 
     otherwise appropriated, $3,000,000,000 for fiscal year 2008.
       ``(ii) Transfers.--Notwithstanding any other provision of 
     law, the following amounts are hereby appropriated or 
     transferred to, deposited in, and made available for 
     expenditure from the Incentive Pool on the following dates:

       ``(I) Unexpended fiscal year 2006 and 2007 allotments.--On 
     December 31, 2007, the sum for all States of the excess (if 
     any) for each State of--

       ``(aa) the aggregate allotments provided for the State 
     under subsection (b) or (c) for fiscal years 2006 and 2007 
     that are not expended by September 30, 2007, over
       ``(bb) an amount equal to 50 percent of the allotment 
     provided for the State under subsection (c) or (i) for fiscal 
     year 2008 (as determined in accordance with subsection 
     (i)(6)).

       ``(II) Unobligated national allotment.--

       ``(aa) Fiscal years 2008 through 2011.--On December 31 of 
     fiscal year 2008, and on December 31 of each succeeding 
     fiscal year through fiscal year 2011, the portion, if any, of 
     the amount appropriated under subsection (a) for such fiscal 
     year that is unobligated for allotment to a State under 
     subsection (c) or (i) for such fiscal year or set aside under 
     subsection (a)(3) or (b)(2) of section 2111 for such fiscal 
     year.
       ``(bb) First half of fiscal year 2012.--On December 31 of 
     fiscal year 2012, the portion, if any, of the sum of the 
     amounts appropriated under subsection (a)(15)(A) and under 
     section 103 of the Children's Health Insurance Program 
     Reauthorization Act of 2007 for the period beginning on 
     October 1, 2011, and ending on March 31, 2012, that is 
     unobligated for allotment to a State under subsection (c) or 
     (i) for such fiscal year or set aside under subsection (b)(2) 
     of section 2111 for such fiscal year.
       ``(cc) Second half of fiscal year 2012.--On June 30 of 
     fiscal year 2012, the portion, if any, of the amount 
     appropriated under subsection (a)(15)(B) for the period 
     beginning on April 1, 2012, and ending on September 30, 2012, 
     that is unobligated for allotment to a State under subsection 
     (c) or (i) for such fiscal year or set aside under subsection 
     (b)(2) of section 2111 for such fiscal year.

       ``(III) Percentage of state allotments that are unexpended 
     by the end of the first year of availability beginning with 
     the fiscal year 2009 allotments.--On October 1 of each of 
     fiscal years 2009 through 2012, the sum for all States for 
     such fiscal year (the `current fiscal year') of the excess 
     (if any) for each State of--

       ``(aa) the allotment made for the State under subsection 
     (b), (c), or (i) for the fiscal year preceding the current 
     fiscal year (reduced by any amounts set aside under section 
     2111(a)(3)) that is not expended by the end of such preceding 
     fiscal year, over
       ``(bb) an amount equal to the applicable percentage (for 
     the fiscal year) of the allotment made for the State under 
     subsection (b), (c), or (i) (as so reduced) for such 
     preceding fiscal year.

     For purposes of item (bb), the applicable percentage is 20 
     percent for fiscal year 2009, and 10 percent for each of 
     fiscal years 2010, 2011, and 2012.
       ``(IV) Remainder of state allotments that are unexpended by 
     the end of the period of availability beginning with the 
     fiscal year 2006 allotments.--On October 1 of each of fiscal 
     years 2009 through 2012, the total amount of allotments made 
     to States under subsection (b), (c), or (i) for the second 
     preceding fiscal year (third preceding fiscal year in the 
     case of the fiscal year 2006 allotments) and remaining after 
     the application of subclause (III) that are not expended by 
     September 30 of the preceding fiscal year.
       ``(V) Unexpended transitional coverage block grant for 
     nonpregnant childless adults.--On October 1, 2009, any 
     amounts set aside under section 2111(a)(3) that are not 
     expended by September 30, 2009.
       ``(VI)  Excess chip contingency funds.--

       ``(aa) Amounts in excess of the aggregate cap.--On October 
     1 of each of fiscal years 2010 through 2012, any amount in 
     excess of the aggregate cap applicable to the CHIP 
     Contingency Fund for the fiscal year under subsection 
     (k)(2)(B).
       ``(bb) Unexpended chip contingency fund payments.--On 
     October 1 of each of fiscal years 2010 through 2012, any 
     portion of a CHIP Contingency Fund payment made to a State 
     that remains unexpended at the end of the period for which 
     the payment is available for expenditure under subsection 
     (e)(3).

       ``(VII) Extension of availability for portion of unexpended 
     state allotments.--The portion of the allotment made to a 
     State for a fiscal year that is not transferred to the 
     Incentive Pool under subclause (I) or (III) shall remain 
     available for expenditure by the State only during the fiscal 
     year in which such transfer occurs, in accordance with 
     subclause (IV) and subsection (e)(4).

       ``(C) Investment of fund.--The Secretary of the Treasury 
     shall invest, in interest bearing securities of the United 
     States, such currently available portions of the Incentive 
     Pool as are not immediately required for payments from the 
     Pool. The income derived

[[Page 21653]]

     from these investments constitutes a part of the Incentive 
     Pool.
       ``(2) Payments to states increasing enrollment.--
       ``(A) In general.--Subject to paragraph (3)(D), with 
     respect to each of fiscal years 2009 through 2012, the 
     Secretary shall make payments to States from the Incentive 
     Pool determined under subparagraph (B).
       ``(B) Determination of payments.--If, for any coverage 
     period ending in a fiscal year ending after September 30, 
     2008, the average monthly enrollment of children in the State 
     plan under title XIX exceeds the baseline monthly average for 
     such period, the payment made for the fiscal year shall be 
     equal to the applicable amount determined under subparagraph 
     (C).
       ``(C) Applicable amount.--For purposes of subparagraph (B), 
     the applicable amount is the product determined in accordance 
     with the following:
       ``(i) If such excess with respect to the number of 
     individuals who are enrolled in the State plan under title 
     XIX does not exceed 2 percent, the product of $75 and the 
     number of such individuals included in such excess.
       ``(ii) If such excess with respect to the number of 
     individuals who are enrolled in the State plan under title 
     XIX exceeds 2, but does not exceed 5 percent, the product of 
     $300 and the number of such individuals included in such 
     excess, less the amount of such excess calculated in clause 
     (i).
       ``(iii) If such excess with respect to the number of 
     individuals who are enrolled in the State plan under title 
     XIX exceeds 5 percent, the product of $625 and the number of 
     such individuals included in such excess, less the sum of the 
     amount of such excess calculated in clauses (i) and (ii).
       ``(D) Indexing of dollar amounts.--For each coverage period 
     ending in a fiscal year ending after September 30, 2009, the 
     dollar amounts specified in subparagraph (C) shall be 
     increased by the percentage increase (if any) in the 
     projected nominal per capita amount of National Health 
     Expenditures for the calendar year beginning on January 1 of 
     the coverage period over the preceding coverage period, as 
     most recently published by the Secretary before the beginning 
     of the coverage period involved.
       ``(3) Rules relating to enrollment increases.--For purposes 
     of paragraph (2)(B)--
       ``(A) Baseline monthly average.--Except as provided in 
     subparagraph (C), the baseline monthly average for any fiscal 
     year for a State is equal to--
       ``(i) the baseline monthly average for the preceding fiscal 
     year; multiplied by
       ``(ii) the sum of 1 plus the sum of--

       ``(I) 0.01; and
       ``(II) the percentage increase in the population of low-
     income children in the State from the preceding fiscal year 
     to the fiscal year involved, as determined by the Secretary 
     based on the most timely and accurate published estimates of 
     the Bureau of the Census before the beginning of the fiscal 
     year involved.

       ``(B) Coverage period.--Except as provided in subparagraph 
     (C), the coverage period for any fiscal year consists of the 
     last 2 quarters of the preceding fiscal year and the first 2 
     quarters of the fiscal year.
       ``(C) Special rules for fiscal year 2009.--With respect to 
     fiscal year 2009--
       ``(i) the coverage period for that fiscal year shall be 
     based on the first 2 quarters of fiscal year 2009; and
       ``(ii) the baseline monthly average shall be--

       ``(I) the average monthly enrollment of low-income children 
     enrolled in the State's plan under title XIX for the first 2 
     quarters of fiscal year 2007 (as determined over a 6-month 
     period on the basis of the most recent information reported 
     through the Medicaid Statistical Information System (MSIS)); 
     multiplied by
       ``(II) the sum of 1 plus the sum of--

       ``(aa) 0.02; and
       ``(bb) the percentage increase in the population of low-
     income children in the State from fiscal year 2007 to fiscal 
     year 2009, as determined by the Secretary based on the most 
     timely and accurate published estimates of the Bureau of the 
     Census before the beginning of the fiscal year involved.
       ``(D) Additional requirement for eligibility for payment.--
     For purposes of subparagraphs (B) and (C), the average 
     monthly enrollment shall be determined without regard to 
     children who do not meet the income eligibility criteria in 
     effect on July 19, 2007, for enrollment under the State plan 
     under title XIX or under a waiver of such plan.
       ``(4) Time of payment.--Payments under paragraph (2) for 
     any fiscal year shall be made during the last quarter of such 
     year.
       ``(5) Use of payments.--Payments made to a State from the 
     Incentive Pool shall be used for any purpose that the State 
     determines is likely to reduce the percentage of low-income 
     children in the State without health insurance.
       ``(6) Proration rule.--If the amount available for payment 
     from the Incentive Pool is less than the total amount of 
     payments to be made for such fiscal year, the Secretary shall 
     reduce the payments described in paragraph (2) on a 
     proportional basis.
       ``(7) References.--With respect to a State plan under title 
     XIX, any references to a child in this subsection shall 
     include a reference to any individual provided medical 
     assistance under the plan who has not attained age 19 (or, if 
     a State has so elected under such State plan, age 20 or 
     21).''.
       (b) Redistribution of Unexpended Fiscal Year 2005 
     Allotments.--Notwithstanding section 2104(f) of the Social 
     Security Act (42 U.S.C. 1397dd(f)), with respect to fiscal 
     year 2008, the Secretary shall provide for a redistribution 
     under such section from the allotments for fiscal year 2005 
     under subsection (b) and (c) of such section that are not 
     expended by the end of fiscal year 2007, to each State 
     described in clause (iii) of section 2104(i)(2)(A) of the 
     Social Security Act, as added by section 102(a), of an amount 
     that bears the same ratio to such unexpended fiscal year 2005 
     allotments as the ratio of the fiscal year 2007 allotment 
     determined for each such State under subsection (b) of 
     section 2104 of such Act for fiscal year 2007 (without regard 
     to any amounts paid, allotted, or redistributed to the State 
     under section 2104 for any preceding fiscal year) bears to 
     the total amount of the fiscal year 2007 allotments for all 
     such States (as so determined).
       (c) Conforming Amendment Eliminating Rules for 
     Redistribution of Unexpended Allotments for Fiscal Years 
     After 2005.--Effective January 1, 2008, section 2104(f) (42 
     U.S.C. 1397dd(f)) is amended to read as follows:
       ``(f) Unallocated Portion of National Allotment and Unused 
     Allotments.--For provisions relating to the distribution of 
     portions of the unallocated national allotment under 
     subsection (a) for fiscal years beginning with fiscal year 
     2008, and unexpended allotments for fiscal years beginning 
     with fiscal year 2006, see subsection (j).''.
       (d) Additional Funding for the Secretary To Improve 
     Timeliness of Data Reporting and Analysis for Purposes of 
     Determining Enrollment Increases Under Medicaid and CHIP.--
       (1) Appropriation.--There is appropriated, out of any money 
     in the Treasury not otherwise appropriated, $5,000,000 to the 
     Secretary for fiscal year 2008 for the purpose of improving 
     the timeliness of the data reported and analyzed from the 
     Medicaid Statistical Information System (MSIS) for purposes 
     of carrying out section 2104(j)(2)(B) of the Social Security 
     Act (as added by subsection (a)) and to provide guidance to 
     States with respect to any new reporting requirements related 
     to such improvements. Amounts appropriated under this 
     paragraph shall remain available until expended.
       (2) Requirements.--The improvements made by the Secretary 
     under paragraph (1) shall be designed and implemented 
     (including with respect to any necessary guidance for States) 
     so that, beginning no later than October 1, 2008, data 
     regarding the enrollment of low-income children (as defined 
     in section 2110(c)(4) of the Social Security Act (42 U.S.C. 
     1397jj(c)(4)) of a State enrolled in the State plan under 
     Medicaid or the State child health plan under CHIP with 
     respect to a fiscal year shall be collected and analyzed by 
     the Secretary within 6 months of submission.

     SEC. 106. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS 
                   ADULTS UNDER CHIP; CONDITIONS FOR COVERAGE OF 
                   PARENTS.

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

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

       ``(a) Termination of Coverage for Nonpregnant Childless 
     Adults.--
       ``(1) No new chip waivers; automatic extensions at state 
     option through fiscal year 2008.--Notwithstanding section 
     1115 or any other provision of this title, except as provided 
     in this subsection--
       ``(A) the Secretary shall not on or after the date of the 
     enactment of the Children's Health Insurance Program 
     Reauthorization Act of 2007, approve or renew a waiver, 
     experimental, pilot, or demonstration project that would 
     allow funds made available under this title to be used to 
     provide child health assistance or other health benefits 
     coverage to a nonpregnant childless adult; and
       ``(B) notwithstanding the terms and conditions of an 
     applicable existing waiver, the provisions of paragraphs (2) 
     and (3) shall apply for purposes of any fiscal year beginning 
     on or after October 1, 2008, in determining the period to 
     which the waiver applies, the individuals eligible to be 
     covered by the waiver, and the amount of the Federal payment 
     under this title.
       ``(2) Termination of chip coverage under applicable 
     existing waivers at the end of fiscal year 2008.--
       ``(A) In general.--No funds shall be available under this 
     title for child health assistance or other health benefits 
     coverage that is provided to a nonpregnant childless adult 
     under an applicable existing waiver after September 30, 2008.
       ``(B) Extension upon state request.--If an applicable 
     existing waiver described in subparagraph (A) would otherwise 
     expire before October 1, 2008, and the State requests an 
     extension of such waiver, the Secretary shall grant such an 
     extension, but only through September 30, 2008.

[[Page 21654]]

       ``(C) Application of enhanced fmap.--The enhanced FMAP 
     determined under section 2105(b) shall apply to expenditures 
     under an applicable existing waiver for the provision of 
     child health assistance or other health benefits coverage to 
     a nonpregnant childless adult during fiscal year 2008.
       ``(3) Optional 1-year transitional coverage block grant 
     funded from state allotment.--Subject to paragraph (4)(B), 
     each State for which coverage under an applicable existing 
     waiver is terminated under paragraph (2)(A) may elect to 
     provide nonpregnant childless adults who were provided child 
     health assistance or health benefits coverage under the 
     applicable existing waiver at any time during fiscal year 
     2008 with such assistance or coverage during fiscal year 
     2009, as if the authority to provide such assistance or 
     coverage under an applicable existing waiver was extended 
     through that fiscal year, but subject to the following terms 
     and conditions:
       ``(A) Block grant set aside from state allotment.--The 
     Secretary shall set aside for the State an amount equal to 
     the Federal share of the State's projected expenditures under 
     the applicable existing waiver for providing child health 
     assistance or health benefits coverage to all nonpregnant 
     childless adults under such waiver for fiscal year 2008 (as 
     certified by the State and submitted to the Secretary by not 
     later than August 31, 2008, and without regard to whether any 
     such individual lost coverage during fiscal year 2008 and was 
     later provided child health assistance or other health 
     benefits coverage under the waiver in that fiscal year), 
     increased by the annual adjustment for fiscal year 2009 
     determined under section 2104(i)(2)(B)(i). The Secretary may 
     adjust the amount set aside under the preceding sentence, as 
     necessary, on the basis of the expenditure data for fiscal 
     year 2008 reported by States on CMS Form 64 or CMS Form 21 
     not later than November 30, 2008, but in no case shall the 
     Secretary adjust such amount after December 31, 2008.
       ``(B) No coverage for nonpregnant childless adults who were 
     not covered during fiscal year 2008.--
       ``(i) FMAP applied to expenditures.--The Secretary shall 
     pay the State for each quarter of fiscal year 2009, from the 
     amount set aside under subparagraph (A), an amount equal to 
     the Federal medical assistance percentage (as determined 
     under section 1905(b) without regard to clause (4) of such 
     section) of expenditures in the quarter for providing child 
     health assistance or other health benefits coverage to a 
     nonpregnant childless adult but only if such adult was 
     enrolled in the State program under this title during fiscal 
     year 2008 (without regard to whether the individual lost 
     coverage during fiscal year 2008 and was reenrolled in that 
     fiscal year or in fiscal year 2009).
       ``(ii) Federal payments limited to amount of block grant 
     set-aside.--No payments shall be made to a State for 
     expenditures described in this subparagraph after the total 
     amount set aside under subparagraph (A) for fiscal year 2009 
     has been paid to the State.
       ``(4) State option to apply for medicaid waiver to continue 
     coverage for nonpregnant childless adults.--
       ``(A) In general.--Each State for which coverage under an 
     applicable existing waiver is terminated under paragraph 
     (2)(A) may submit, not later than June 30, 2009, an 
     application to the Secretary for a waiver under section 1115 
     of the State plan under title XIX to provide medical 
     assistance to a nonpregnant childless adult whose coverage is 
     so terminated (in this subsection referred to as a `Medicaid 
     nonpregnant childless adults waiver').
       ``(B) Deadline for approval.--The Secretary shall make a 
     decision to approve or deny an application for a Medicaid 
     nonpregnant childless adults waiver submitted under 
     subparagraph (A) within 90 days of the date of the submission 
     of the application. If no decision has been made by the 
     Secretary as of September 30, 2009, on the application of a 
     State for a Medicaid nonpregnant childless adults waiver that 
     was submitted to the Secretary by June 30, 2009, the 
     application shall be deemed approved.
       ``(C) Standard for budget neutrality.--The budget 
     neutrality requirement applicable with respect to 
     expenditures for medical assistance under a Medicaid 
     nonpregnant childless adults waiver shall--
       ``(i) in the case of fiscal year 2010, allow expenditures 
     for medical assistance under title XIX for all such adults to 
     not exceed the total amount of payments made to the State 
     under paragraph (3)(B) for fiscal year 2009, increased by the 
     percentage increase (if any) in the projected nominal per 
     capita amount of National Health Expenditures for calendar 
     year 2010 over calendar year 2009, as most recently published 
     by the Secretary; and
       ``(ii) in the case of any succeeding fiscal year, allow 
     such expenditures to not exceed the amount in effect under 
     this subparagraph for the preceding fiscal year, increased by 
     the percentage increase (if any) in the projected nominal per 
     capita amount of National Health Expenditures for the 
     calendar year that begins during the fiscal year involved 
     over the preceding calendar year, as most recently published 
     by the Secretary.
       ``(b) Rules and Conditions for Coverage of Parents of 
     Targeted Low-Income Children.--
       ``(1) Two-year transition period; automatic extension at 
     state option through fiscal year 2009.--
       ``(A) No new chip waivers.--Notwithstanding section 1115 or 
     any other provision of this title, except as provided in this 
     subsection--
       ``(i) the Secretary shall not on or after the date of the 
     enactment of the Children's Health Insurance Program 
     Reauthorization Act of 2007 approve or renew a waiver, 
     experimental, pilot, or demonstration project that would 
     allow funds made available under this title to be used to 
     provide child health assistance or other health benefits 
     coverage to a parent of a targeted low-income child; and
       ``(ii) notwithstanding the terms and conditions of an 
     applicable existing waiver, the provisions of paragraphs (2) 
     and (3) shall apply for purposes of any fiscal year beginning 
     on or after October 1, 2009, in determining the period to 
     which the waiver applies, the individuals eligible to be 
     covered by the waiver, and the amount of the Federal payment 
     under this title.
       ``(B) Extension upon state request.--If an applicable 
     existing waiver described in subparagraph (A) would otherwise 
     expire before October 1, 2009, and the State requests an 
     extension of such waiver, the Secretary shall grant such an 
     extension, but only, subject to paragraph (2)(A), through 
     September 30, 2009.
       ``(C) Application of enhanced fmap.--The enhanced FMAP 
     determined under section 2105(b) shall apply to expenditures 
     under an applicable existing waiver for the provision of 
     child health assistance or other health benefits coverage to 
     a parent of a targeted low-income child during fiscal years 
     2008 and 2009.
       ``(2) Rules for fiscal years 2010 through 2012.--
       ``(A) Payments for coverage limited to block grant funded 
     from state allotment.--Any State that provides child health 
     assistance or health benefits coverage under an applicable 
     existing waiver for a parent of a targeted low-income child 
     may elect to continue to provide such assistance or coverage 
     through fiscal year 2010, 2011, or 2012, subject to the same 
     terms and conditions that applied under the applicable 
     existing waiver, unless otherwise modified in subparagraph 
     (B).
       ``(B) Terms and conditions.--
       ``(i) Block grant set aside from state allotment.--If the 
     State makes an election under subparagraph (A), the Secretary 
     shall set aside for the State for each such fiscal year an 
     amount equal to the Federal share of 110 percent of the 
     State's projected expenditures under the applicable existing 
     waiver for providing child health assistance or health 
     benefits coverage to all parents of targeted low-income 
     children enrolled under such waiver for the fiscal year (as 
     certified by the State and submitted to the Secretary by not 
     later than August 31 of the preceding fiscal year). In the 
     case of fiscal year 2012, the set aside for any State shall 
     be computed separately for each period described in clauses 
     (i) and (ii) of subsection (i))(1)(D) and any increase or 
     reduction in the allotment for either such period under 
     subsection (i)(3)(B)(ii) shall be allocated on a pro rata 
     basis to such set aside.
       ``(ii) Payments from block grant.--The Secretary shall pay 
     the State from the amount set aside under clause (i) for the 
     fiscal year, an amount for each quarter of such fiscal year 
     equal to the applicable percentage determined under clause 
     (iii) or (iv) for expenditures in the quarter for providing 
     child health assistance or other health benefits coverage to 
     a parent of a targeted low-income child.
       ``(iii) Enhanced fmap only in fiscal year 2010 for states 
     with significant child outreach or that achieve child 
     coverage benchmarks; fmap for any other states.--For purposes 
     of clause (ii), the applicable percentage for any quarter of 
     fiscal year 2010 is equal to--

       ``(I) the enhanced FMAP determined under section 2105(b) in 
     the case of a State that meets the outreach or coverage 
     benchmarks described in any of subparagraphs (A), (B), or (C) 
     of paragraph (3) for fiscal year 2009; or
       ``(II) the Federal medical assistance percentage (as 
     determined under section 1905(b) without regard to clause (4) 
     of such section) in the case of any other State.

       ``(iv) Amount of federal matching payment in 2011 or 
     2012.--For purposes of clause (ii), the applicable percentage 
     for any quarter of fiscal year 2011 or 2012 is equal to--

       ``(I) the REMAP percentage if the State met either of the 
     coverage benchmarks described in subparagraph (B) or (C) of 
     paragraph (3) for the preceding fiscal year; or
       ``(II) the Federal medical assistance percentage (as so 
     determined) in the case of any State to which subclause (I) 
     does not apply.

     For purposes of subclause (I), the REMAP percentage is the 
     percentage which is the sum of such Federal medical 
     assistance percentage and a number of percentage points equal 
     to one-half of the difference between such Federal medical 
     assistance percentage and such enhanced FMAP.
       ``(v) No federal payments other than from block grant set 
     aside.--No payments shall be made to a State for expenditures 
     described in clause (ii) after the total amount

[[Page 21655]]

     set aside under clause (i) for a fiscal year has been paid to 
     the State.
       ``(vi) No increase in income eligibility level for 
     parents.--No payments shall be made to a State from the 
     amount set aside under clause (i) for a fiscal year for 
     expenditures for providing child health assistance or health 
     benefits coverage to a parent of a targeted low-income child 
     whose family income exceeds the income eligibility level 
     applied under the applicable existing waiver to parents of 
     targeted low-income children on the date of enactment of the 
     Children's Health Insurance Program Reauthorization Act of 
     2007.
       ``(3) Outreach or coverage benchmarks.--For purposes of 
     paragraph (2), the outreach or coverage benchmarks described 
     in this paragraph are as follows:
       ``(A) Significant child outreach campaign.--The State--
       ``(i) was awarded a grant under section 2113 for fiscal 
     year 2009;
       ``(ii) implemented 1 or more of the process measures 
     described in section 2104(j)(3)(A)(i) for such fiscal year; 
     or
       ``(iii) has submitted a specific plan for outreach for such 
     fiscal year.
       ``(B) High-performing state.--The State, on the basis of 
     the most timely and accurate published estimates of the 
     Bureau of the Census, ranks in the lowest \1/3\ of States in 
     terms of the State's percentage of low-income children 
     without health insurance.
       ``(C) State increasing enrollment of low-income children.--
     The State qualified for a payment from the Incentive Fund 
     under paragraph (2)(C) of section 2104(j) for the most recent 
     coverage period applicable under such section.
       ``(4) Rules of construction.--Nothing in this subsection 
     shall be construed as prohibiting a State from submitting an 
     application to the Secretary for a waiver under section 1115 
     of the State plan under title XIX to provide medical 
     assistance to a parent of a targeted low-income child that 
     was provided child health assistance or health benefits 
     coverage under an applicable existing waiver.
       ``(c) Applicable Existing Waiver.--For purposes of this 
     section--
       ``(1) In general.--The term `applicable existing waiver' 
     means a waiver, experimental, pilot, or demonstration project 
     under section 1115, grandfathered under section 6102(c)(3) of 
     the Deficit Reduction Act of 2005, or otherwise conducted 
     under authority that--
       ``(A) would allow funds made available under this title to 
     be used to provide child health assistance or other health 
     benefits coverage to--
       ``(i) a parent of a targeted low-income child;
       ``(ii) a nonpregnant childless adult; or
       ``(iii) individuals described in both clauses (i) and (ii); 
     and
       ``(B) was in effect during fiscal year 2007.
       ``(2) Definitions.--
       ``(A) Parent.--The term `parent' includes a caretaker 
     relative (as such term is used in carrying out section 1931) 
     and a legal guardian.
       ``(B) Nonpregnant childless adult.--The term `nonpregnant 
     childless adult' has the meaning given such term by section 
     2107(f).''.
       (2) Conforming amendments.--
       (A) Section 2107(f) (42 U.S.C. 1397gg(f)) is amended--
       (i) by striking ``, the Secretary'' and inserting ``:
       ``(1) The Secretary'';
       (ii) in the first sentence, by inserting ``or a parent (as 
     defined in section 2111(c)(2)(A)), who is not pregnant, of a 
     targeted low-income child'' before the period;
       (iii) by striking the second sentence; and
       (iv) by adding at the end the following new paragraph:
       ``(2) The Secretary may not approve, extend, renew, or 
     amend a waiver, experimental, pilot, or demonstration project 
     with respect to a State after the date of enactment of the 
     Children's Health Insurance Program Reauthorization Act of 
     2007 that would waive or modify the requirements of section 
     2111.''.
       (B) Section 6102(c) of the Deficit Reduction Act of 2005 
     (Public Law 109-171; 120 Stat. 131) is amended by striking 
     ``Nothing'' and inserting ``Subject to section 2111 of the 
     Social Security Act, as added by section 106(a)(1) of the 
     Children's Health Insurance Program Reauthorization Act of 
     2007, nothing''.
       (b) GAO Study and Report.--
       (1) In general.--The Comptroller General of the United 
     States shall conduct a study of whether--
       (A) the coverage of a parent, a caretaker relative (as such 
     term is used in carrying out section 1931), or a legal 
     guardian of a targeted low-income child under a State health 
     plan under title XXI of the Social Security Act increases the 
     enrollment of, or the quality of care for, children, and
       (B) such parents, relatives, and legal guardians who enroll 
     in such a plan are more likely to enroll their children in 
     such a plan or in a State plan under title XIX of such Act.
       (2) Report.--Not later than 2 years after the date of the 
     enactment of this Act, the Comptroller General shall report 
     the results of the study to the appropriate committees of 
     Congress, including recommendations (if any) for changes in 
     legislation.

     SEC. 107. STATE OPTION TO COVER LOW-INCOME PREGNANT WOMEN 
                   UNDER CHIP THROUGH A STATE PLAN AMENDMENT.

       (a) In General.--Title XXI (42 U.S.C. 1397aa et seq.), as 
     amended by section 106(a), is amended by adding at the end 
     the following new section:

     ``SEC. 2112. OPTIONAL COVERAGE OF TARGETED LOW-INCOME 
                   PREGNANT WOMEN THROUGH A STATE PLAN AMENDMENT.

       ``(a) In General.--Subject to the succeeding provisions of 
     this section, a State may elect through an amendment to its 
     State child health plan under section 2102 to provide 
     pregnancy-related assistance under such plan for targeted 
     low-income pregnant women.
       ``(b) Conditions.--A State may only elect the option under 
     subsection (a) if the following conditions are satisfied:
       ``(1) Medicaid income eligibility level for pregnant women 
     of at least 185 percent of poverty.--The State has 
     established an income eligibility level for pregnant women 
     under subsection (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or 
     (l)(1)(A) of section 1902 that is at least 185 percent of the 
     income official poverty line.
       ``(2) No chip income eligibility level for pregnant women 
     lower than the state's medicaid level.--The State does not 
     apply an effective income level for pregnant women under the 
     State plan amendment that is lower than the effective income 
     level (expressed as a percent of the poverty line and 
     considering applicable income disregards) specified under 
     subsection (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or 
     (l)(1)(A) of section 1902, on the date of enactment of this 
     paragraph to be eligible for medical assistance as a pregnant 
     woman.
       ``(3) No coverage for higher income pregnant women without 
     covering lower income pregnant women.--The State does not 
     provide coverage for pregnant women with higher family income 
     without covering pregnant women with a lower family income.
       ``(4) Application of requirements for coverage of targeted 
     low-income children.--The State provides pregnancy-related 
     assistance for targeted low-income pregnant women in the same 
     manner, and subject to the same requirements, as the State 
     provides child health assistance for targeted low-income 
     children under the State child health plan, and in addition 
     to providing child health assistance for such women.
       ``(5) No preexisting condition exclusion or waiting 
     period.--The State does not apply any exclusion of benefits 
     for pregnancy-related assistance based on any preexisting 
     condition or any waiting period (including any waiting period 
     imposed to carry out section 2102(b)(3)(C)) for receipt of 
     such assistance.
       ``(6) Application of cost-sharing protection.--The State 
     provides pregnancy-related assistance to a targeted low-
     income woman consistent with the cost-sharing protections 
     under section 2103(e) and applies the limitation on total 
     annual aggregate cost sharing imposed under paragraph (3)(B) 
     of such section to the family of such a woman.
       ``(c) Option To Provide Presumptive Eligibility.--A State 
     that elects the option under subsection (a) and satisfies the 
     conditions described in subsection (b) may elect to apply 
     section 1920 (relating to presumptive eligibility for 
     pregnant women) to the State child health plan in the same 
     manner as such section applies to the State plan under title 
     XIX.
       ``(d) Definitions.--For purposes of this section:
       ``(1) Pregnancy-related assistance.--The term `pregnancy-
     related assistance' has the meaning given the term `child 
     health assistance' in section 2110(a) and includes any 
     medical assistance that the State would provide for a 
     pregnant woman under the State plan under title XIX during 
     pregnancy and the period described in paragraph (2)(A).
       ``(2) Targeted low-income pregnant woman.--The term 
     `targeted low-income pregnant woman' means a woman--
       ``(A) during pregnancy and through the end of the month in 
     which the 60-day period (beginning on the last day of her 
     pregnancy) ends;
       ``(B) whose family income does not exceed the income 
     eligibility level established under the State child health 
     plan under this title for a targeted low-income child; and
       ``(C) who satisfies the requirements of paragraphs (1)(A), 
     (1)(C), (2), and (3) of section 2110(b) in the same manner as 
     a child applying for child health assistance would have to 
     satisfy such requirements.
       ``(e) Automatic Enrollment for Children Born to Women 
     Receiving Pregnancy-Related Assistance.--If a child is born 
     to a targeted low-income pregnant woman who was receiving 
     pregnancy-related assistance under this section on the date 
     of the child's birth, the child shall be deemed to have 
     applied for child health assistance under the State child 
     health plan and to have been found eligible for such 
     assistance under such plan or to have applied for medical 
     assistance under title XIX and to have been found eligible 
     for such assistance under such title, as appropriate, on the 
     date of such birth and to remain eligible for such assistance 
     until the child attains 1 year of age. During the period in 
     which a child is deemed under the

[[Page 21656]]

     preceding sentence to be eligible for child health or medical 
     assistance, the child health or medical assistance 
     eligibility identification number of the mother shall also 
     serve as the identification number of the child, and all 
     claims shall be submitted and paid under such number (unless 
     the State issues a separate identification number for the 
     child before such period expires).
       ``(f) States Providing Assistance Through Other Options.--
       ``(1) Continuation of other options for providing 
     assistance.--The option to provide assistance in accordance 
     with the preceding subsections of this section shall not 
     limit any other option for a State to provide--
       ``(A) child health assistance through the application of 
     sections 457.10, 457.350(b)(2), 457.622(c)(5), and 
     457.626(a)(3) of title 42, Code of Federal Regulations (as in 
     effect after the final rule adopted by the Secretary and set 
     forth at 67 Fed. Reg. 61956-61974 (October 2, 2002)), or
       ``(B) pregnancy-related services through the application of 
     any waiver authority (as in effect on June 1, 2007).
       ``(2) Clarification of authority to provide postpartum 
     services.--Any State that provides child health assistance 
     under any authority described in paragraph (1) may continue 
     to provide such assistance, as well as postpartum services, 
     through the end of the month in which the 60-day period 
     (beginning on the last day of the pregnancy) ends, in the 
     same manner as such assistance and postpartum services would 
     be provided if provided under the State plan under title XIX, 
     but only if the mother would otherwise satisfy the 
     eligibility requirements that apply under the State child 
     health plan (other than with respect to age) during such 
     period.
       ``(3) No inference.--Nothing in this subsection shall be 
     construed--
       ``(A) to infer congressional intent regarding the legality 
     or illegality of the content of the sections specified in 
     paragraph (1)(A); or
       ``(B) to modify the authority to provide pregnancy-related 
     services under a waiver specified in paragraph (1)(B).''.
       (b) Additional Conforming Amendments.--
       (1) No cost sharing for pregnancy-related benefits.--
     Section 2103(e)(2) (42 U.S.C. 1397cc(e)(2)) is amended--
       (A) in the heading, by inserting ``or pregnancy-related 
     assistance'' after ``preventive services''; and
       (B) by inserting before the period at the end the 
     following: ``or for pregnancy-related assistance''.
       (2) No waiting period.--Section 2102(b)(1)(B) (42 U.S.C. 
     1397bb(b)(1)(B)) is amended--
       (A) in clause (i), by striking ``, and'' at the end and 
     inserting a semicolon;
       (B) in clause (ii), by striking the period at the end and 
     inserting ``; and''; and
       (C) by adding at the end the following new clause:
       ``(iii) may not apply a waiting period (including a waiting 
     period to carry out paragraph (3)(C)) in the case of a 
     targeted low-income pregnant woman provided pregnancy-related 
     assistance under section 2112.''.

     SEC. 108. CHIP CONTINGENCY FUND.

       Section 2104 (42 U.S.C. 1397dd), as amended by section 105, 
     is amended by adding at the end the following new subsection:
       ``(k) CHIP Contingency Fund.--
       ``(1) Establishment.--There is hereby established in the 
     Treasury of the United States a fund which shall be known as 
     the `CHIP Contingency Fund' (in this subsection referred to 
     as the `Fund'). Amounts in the Fund are authorized to be 
     appropriated for payments under this subsection.
       ``(2) Deposits into fund.--
       ``(A) Initial and subsequent appropriations.--Subject to 
     subparagraphs (B) and (E), out of any money in the Treasury 
     of the United States not otherwise appropriated, there are 
     appropriated to the Fund--
       ``(i) for fiscal year 2009, an amount equal to 12.5 percent 
     of the available national allotment under subsection 
     (i)(1)(C) for the fiscal year; and
       ``(ii) for each of fiscal years 2010 through 2012, such 
     sums as are necessary for making payments to eligible States 
     for such fiscal year, but not in excess of the aggregate cap 
     described in subparagraph (B).
       ``(B) Aggregate cap.--Subject to subparagraph (E), the 
     total amount available for payment from the Fund for each of 
     fiscal years 2009 through 2012 (taking into account deposits 
     made under subparagraph (C)), shall not exceed 12.5 percent 
     of the available national allotment under subsection 
     (i)(1)(C) for the fiscal year.
       ``(C) Investment of fund.--The Secretary of the Treasury 
     shall invest, in interest bearing securities of the United 
     States, such currently available portions of the Fund as are 
     not immediately required for payments from the Fund. The 
     income derived from these investments constitutes a part of 
     the Fund.
       ``(D) Transfer of excess funds to the incentive fund.--The 
     Secretary of the Treasury shall transfer to, and deposit in, 
     the CHIP Incentive Bonuses Pool established under subsection 
     (j) any amounts in excess of the aggregate cap described in 
     subparagraph (B) for a fiscal year.
       ``(E) Special rules for amounts set aside for parents and 
     childless adults.--For purposes of subparagraphs (A) and 
     (B)--
       ``(i) the available national allotment under subsection 
     (i)(1)(C) shall be reduced by any amount set aside under 
     section 2111(a)(3) for block grant payments for transitional 
     coverage for childless adults; and
       ``(ii) the Secretary shall establish a separate account in 
     the Fund for the portion of any amount appropriated to the 
     Fund for any fiscal year which is allocable to the portion of 
     the available national allotment under subsection (i)(1)(C) 
     which is set aside for the fiscal year under section 
     2111(b)(2)(B)(i) for coverage of parents of low-income 
     children.

     The Secretary shall include in the account established under 
     clause (ii) any income derived under subparagraph (C) which 
     is allocable to amounts in such account.
       ``(3) CHIP contingency fund payments.--
       ``(A) Payments.--
       ``(i) In general.--Subject to clauses (ii) and (iii) and 
     the succeeding subparagraphs of this paragraph, the Secretary 
     shall pay from the Fund to a State that is an eligible State 
     for a month of a fiscal year a CHIP contingency fund payment 
     equal to the Federal share of the shortfall determined under 
     subparagraph (D). In the case of an eligible State under 
     subparagraph (D)(i), the Secretary shall not make the payment 
     under this subparagraph until the State makes, and submits to 
     the Secretary, a projection of the amount of the shortfall.
       ``(ii) Separate determinations of shortfalls.--The 
     Secretary shall separately compute the shortfall under 
     subparagraph (D) for expenditures for eligible individuals 
     other than nonpregnant childless adults and parents with 
     respect to whom amounts are set aside under section 2111, for 
     expenditures for such childless adults, and for expenditures 
     for such parents.
       ``(iii) Payments.--

       ``(I) Nonpregnant childless adults.--No payments shall be 
     made from the Fund for nonpregnant childless adults with 
     respect to whom amounts are set aside under section 
     2111(a)(3).
       ``(II) Parents.--Any payments with respect to any shortfall 
     for parents who are paid from amounts set aside under section 
     2111(b)(2)(B)(i) shall be made only from the account 
     established under paragraph (2)(E)(ii) and not from any other 
     amounts in the Fund. No other payments may be made from such 
     account.

       ``(iv) Special rules.--Subparagraphs (B) and (C) shall be 
     applied separately with respect to shortfalls described in 
     clause (ii).
       ``(B) Use of funds.--Amounts paid to an eligible State from 
     the Fund shall be used only to eliminate the Federal share of 
     a shortfall in the State's allotment under subsection (i) for 
     a fiscal year.
       ``(C) Proration rule.--If the amounts available for payment 
     from the Fund for a fiscal year are less than the total 
     amount of payments determined under subparagraph (A) for the 
     fiscal year, the amount to be paid under such subparagraph to 
     each eligible State shall be reduced proportionally.
       ``(D) Eligible state.--
       ``(i) In general.--A State is an eligible State for a month 
     if the State is a subsection (b) State (as defined in 
     subsection (i)(7)), the State requests access to the Fund for 
     the month, and it is described in clause (ii) or (iii).
       ``(ii) Shortfall of federal allotment funding of not more 
     than 5 percent.--The Secretary estimates, on the basis of the 
     most recent data available to the Secretary or requested from 
     the State by the Secretary, that the State's allotment for 
     the fiscal year is at least 95 percent, but less than 100 
     percent, of the projected expenditures under the State child 
     health plan for the State for the fiscal year determined 
     under subsection (i) (without regard to incentive bonuses or 
     payments for which the State is eligible for under subsection 
     (j)(2) for the fiscal year).
       ``(iii) Shortfall of federal allotment funding of more than 
     5 percent caused by specific events.--The Secretary 
     estimates, on the basis of the most recent data available to 
     the Secretary or requested from the State by the Secretary, 
     that the State's allotment for the fiscal year is less than 
     95 percent of the projected expenditures under the State 
     child health plan for the State for the fiscal year 
     determined under subsection (i) (without regard to incentive 
     bonuses or payments for which the State is eligible for under 
     subsection (j)(2) for the fiscal year) and that such 
     shortfall is attributable to 1 or more of the following 
     events:

       ``(I) Stafford act or public health emergency.--The State 
     has--

       ``(aa) 1 or more parishes or counties for which a major 
     disaster has been declared in accordance with section 401 of 
     the Robert T. Stafford Disaster Relief and Emergency 
     Assistance Act (42 U.S.C. 5170) and which the President has 
     determined warrants individual and public assistance from the 
     Federal Government under such Act; or
       ``(bb) a public health emergency declared by the Secretary 
     under section 319 of the Public Health Service Act.

       ``(II) State economic downturn.--The State unemployment 
     rate is at least 5.5 percent during any 13-consecutive week 
     period during the fiscal year and such rate is at

[[Page 21657]]

     least 120 percent of the State unemployment rate for the same 
     period as averaged over the last 3 fiscal years.
       ``(III)  Event resulting in rise in percentage of low-
     income children without health insurance.--The State 
     experienced a recent event that resulted in an increase in 
     the percentage of low-income children in the State without 
     health insurance (as determined on the basis of the most 
     timely and accurate published estimates of the Bureau of the 
     Census) that was outside the control of the State and 
     warrants granting the State access to the Fund (as determined 
     by the Secretary).

       ``(E) Payments made to all eligible states on a monthly 
     basis; authority for pro rata payments.--The Secretary shall 
     make monthly payments from the Fund to all States that are 
     determined to be eligible States with respect to a month. If 
     the sum of the payments to be made from the Fund for a month 
     exceed the amount in the Fund, the Secretary shall reduce 
     each such payment on a proportional basis.
       ``(F) Payments limited to fiscal year of eligibility 
     determination unless new eligibility basis determined.--No 
     State shall receive a CHIP contingency fund payment under 
     this section for a month beginning after September 30 of the 
     fiscal year in which the State is determined to be an 
     eligible State under this subsection, except that in the case 
     of an event described in subclause (I) or (III) of 
     subparagraph (D)(iii) that occurred after July 1 of the 
     fiscal year, any such payment with respect to such event 
     shall remain available until September 30 of the subsequent 
     fiscal year. Nothing in the preceding sentence shall be 
     construed as prohibiting a State from being determined to be 
     an eligible State under this subsection for any fiscal year 
     occurring after a fiscal year in which such a determination 
     is made.
       ``(G) Exemption from determination of percentage of 
     allotment retained after first year of availability.--In no 
     event shall payments made to a State under this subsection be 
     treated as part of the allotment determined for a State for a 
     fiscal year under subsection (i) for purposes of subsection 
     (j)(1)(B)(ii)(III).
       ``(H) Application of allotment reporting rules.--Rules 
     applicable to States for purposes of receiving payments from 
     an allotment determined under subsection (c) or (i) shall 
     apply in the same manner to an eligible State for purposes of 
     receiving a CHIP contingency fund payment under this 
     subsection.
       ``(4) Annual reports.--The Secretary shall annually report 
     to the Congress on the amounts in the Fund, the specific 
     events that caused States to apply for payments from the 
     Fund, and the payments made from the Fund.''.

     SEC. 109. TWO-YEAR AVAILABILITY OF ALLOTMENTS; EXPENDITURES 
                   COUNTED AGAINST OLDEST ALLOTMENTS.

       Section 2104(e) (42 U.S.C. 1397dd(e)) is amended to read as 
     follows:
       ``(e) Availability of Amounts Allotted.--
       ``(1) In general.--Except as provided in subsection 
     (j)(1)(B)(ii)(III), amounts allotted to a State pursuant to 
     this section--
       ``(A) for each of fiscal years 1998 through 2006, shall 
     remain available for expenditure by the State through the end 
     of the second succeeding fiscal year; and
       ``(B) for each of fiscal years 2007 through 2012, shall 
     remain available for expenditure by the State only through 
     the end of the succeeding fiscal year for which such amounts 
     are allotted.
       ``(2) Incentive bonuses.--Incentive bonuses paid to a State 
     under subsection (j)(2) for a fiscal year shall remain 
     available for expenditure by the State without limitation.
       ``(3) CHIP contingency fund payments.--Except as provided 
     in paragraph (3)(F) of subsection (k), CHIP Contingency Fund 
     payments made to a State under such subsection for a month of 
     a fiscal year shall remain available for expenditure by the 
     State through the end of the fiscal year.
       ``(4) Rule for counting expenditures against chip 
     contingency fund payments, fiscal year allotments, and 
     incentive bonuses.--
       ``(A) In general.--Expenditures under the State child 
     health plan made on or after October 1, 2007, shall be 
     counted against--
       ``(i) first, any CHIP Contingency Fund payment made to the 
     State under subsection (k) for the earliest month of the 
     earliest fiscal year for which the payment remains available 
     for expenditure; and
       ``(ii) second, amounts allotted to the State for the 
     earliest fiscal year for which amounts remain available for 
     expenditure.
       ``(B) Incentive bonuses.--A State may elect, but is not 
     required, to count expenditures under the State child health 
     plan against any incentive bonuses paid to the State under 
     subsection (j)(2) for a fiscal year.
       ``(C) Block grant set-asides.--Expenditures for coverage 
     of--
       ``(i) nonpregnant childless adults for fiscal year 2009 
     shall be counted only against the amount set aside for such 
     coverage under section 2111(a)(3); and
       ``(ii) parents of targeted low-income children for each of 
     fiscal years 2010 through 2012, shall be counted only against 
     the amount set aside for such coverage under section 
     2111(b)(2)(B)(i).''.

     SEC. 110. LIMITATION ON MATCHING RATE FOR STATES THAT PROPOSE 
                   TO COVER CHILDREN WITH EFFECTIVE FAMILY INCOME 
                   THAT EXCEEDS 300 PERCENT OF THE POVERTY LINE.

       (a) FMAP Applied to Expenditures.--Section 2105(c) (42 
     U.S.C. 1397ee(c)) is amended by adding at the end the 
     following new paragraph:
       ``(8) Limitation on matching rate for expenditures for 
     child health assistance provided to children whose effective 
     family income exceeds 300 percent of the poverty line.--
       ``(A) FMAP applied to expenditures.--Except as provided in 
     subparagraph (B), for fiscal years beginning with fiscal year 
     2008, the Federal medical assistance percentage (as 
     determined under section 1905(b) without regard to clause (4) 
     of such section) shall be substituted for the enhanced FMAP 
     under subsection (a)(1) with respect to any expenditures for 
     providing child health assistance or health benefits coverage 
     for a targeted low-income child whose effective family income 
     would exceed 300 percent of the poverty line but for the 
     application of a general exclusion of a block of income that 
     is not determined by type of expense or type of income.
       ``(B) Exception.--Subparagraph (A) shall not apply to any 
     State that, on the date of enactment of the Children's Health 
     Insurance Program Reauthorization Act of 2007, has an 
     approved State plan amendment or waiver to provide, or has 
     enacted a State law to submit a State plan amendment to 
     provide, expenditures described in such subparagraph under 
     the State child health plan.''.
       (b) Conforming Amendment.--Section 2105(a)(1) ( 42 U.S.C. 
     1397dd(a)(1)) is amended, in the matter preceding 
     subparagraph (A), by inserting ``or subsection (c)(8)'' after 
     ``subparagraph (B)''.

     SEC. 111. OPTION FOR QUALIFYING STATES TO RECEIVE THE 
                   ENHANCED PORTION OF THE CHIP MATCHING RATE FOR 
                   MEDICAID COVERAGE OF CERTAIN CHILDREN.

       Section 2105(g) (42 U.S.C. 1397ee(g)) is amended--
       (1) in paragraph (1)(A), by inserting ``subject to 
     paragraph (4),'' after ``Notwithstanding any other provision 
     of law,''; and
       (2) by adding at the end the following new paragraph:
       ``(4) Option for allotments for fiscal years 2008 through 
     2012.--
       ``(A) Payment of enhanced portion of matching rate for 
     certain expenditures.--In the case of expenditures described 
     in subparagraph (B), a qualifying State (as defined in 
     paragraph (2)) may elect to be paid from the State's 
     allotment made under section 2104 for any of fiscal years 
     2008 through 2012 (insofar as the allotment is available to 
     the State under subsections (e) and (i) of such section) an 
     amount each quarter equal to the additional amount that would 
     have been paid to the State under title XIX with respect to 
     such expenditures if the enhanced FMAP (as determined under 
     subsection (b)) had been substituted for the Federal medical 
     assistance percentage (as defined in section 1905(b)).
       ``(B) Expenditures described.--For purposes of subparagraph 
     (A), the expenditures described in this subparagraph are 
     expenditures made after the date of the enactment of this 
     paragraph and during the period in which funds are available 
     to the qualifying State for use under subparagraph (A), for 
     the provision of medical assistance to individuals residing 
     in the State who are eligible for medical assistance under 
     the State plan under title XIX or under a waiver of such plan 
     and who have not attained age 19 (or, if a State has so 
     elected under the State plan under title XIX, age 20 or 21), 
     and whose family income equals or exceeds 133 percent of the 
     poverty line but does not exceed the Medicaid applicable 
     income level.''.

                   TITLE II--OUTREACH AND ENROLLMENT

     SEC. 201. GRANTS FOR OUTREACH AND ENROLLMENT.

       (a) Grants.--Title XXI (42 U.S.C. 1397aa et seq.), as 
     amended by section 107, is amended by adding at the end the 
     following:

     ``SEC. 2113. GRANTS TO IMPROVE OUTREACH AND ENROLLMENT.

       ``(a) Outreach and Enrollment Grants; National Campaign.--
       ``(1) In general.--From the amounts appropriated under 
     subsection (g), subject to paragraph (2), the Secretary shall 
     award grants to eligible entities during the period of fiscal 
     years 2008 through 2012 to conduct outreach and enrollment 
     efforts that are designed to increase the enrollment and 
     participation of eligible children under this title and title 
     XIX.
       ``(2) Ten percent set aside for national enrollment 
     campaign.--An amount equal to 10 percent of such amounts 
     shall be used by the Secretary for expenditures during such 
     period to carry out a national enrollment campaign in 
     accordance with subsection (h).
       ``(b) Priority for Award of Grants.--
       ``(1) In general.--In awarding grants under subsection (a), 
     the Secretary shall give priority to eligible entities that--
       ``(A) propose to target geographic areas with high rates 
     of--
       ``(i) eligible but unenrolled children, including such 
     children who reside in rural areas; or
       ``(ii) racial and ethnic minorities and health disparity 
     populations, including those

[[Page 21658]]

     proposals that address cultural and linguistic barriers to 
     enrollment; and
       ``(B) submit the most demonstrable evidence required under 
     paragraphs (1) and (2) of subsection (c).
       ``(2) Ten percent set aside for outreach to indian 
     children.--An amount equal to 10 percent of the funds 
     appropriated under subsection (g) shall be used by the 
     Secretary to award grants to Indian Health Service providers 
     and urban Indian organizations receiving funds under title V 
     of the Indian Health Care Improvement Act (25 U.S.C. 1651 et 
     seq.) for outreach to, and enrollment of, children who are 
     Indians.
       ``(c) Application.--An eligible entity that desires to 
     receive a grant under subsection (a) shall submit an 
     application to the Secretary in such form and manner, and 
     containing such information, as the Secretary may decide. 
     Such application shall include--
       ``(1) evidence demonstrating that the entity includes 
     members who have access to, and credibility with, ethnic or 
     low-income populations in the communities in which activities 
     funded under the grant are to be conducted;
       ``(2) evidence demonstrating that the entity has the 
     ability to address barriers to enrollment, such as lack of 
     awareness of eligibility, stigma concerns and punitive fears 
     associated with receipt of benefits, and other cultural 
     barriers to applying for and receiving child health 
     assistance or medical assistance;
       ``(3) specific quality or outcomes performance measures to 
     evaluate the effectiveness of activities funded by a grant 
     awarded under this section; and
       ``(4) an assurance that the eligible entity shall--
       ``(A) conduct an assessment of the effectiveness of such 
     activities against the performance measures;
       ``(B) cooperate with the collection and reporting of 
     enrollment data and other information in order for the 
     Secretary to conduct such assessments; and
       ``(C) in the case of an eligible entity that is not the 
     State, provide the State with enrollment data and other 
     information as necessary for the State to make necessary 
     projections of eligible children and pregnant women.
       ``(d) Dissemination of Enrollment Data and Information 
     Determined From Effectiveness Assessments; Annual Report.--
     The Secretary shall--
       ``(1) make publicly available the enrollment data and 
     information collected and reported in accordance with 
     subsection (c)(4)(B); and
       ``(2) submit an annual report to Congress on the outreach 
     and enrollment activities conducted with funds appropriated 
     under this section.
       ``(e) Maintenance of Effort for States Awarded Grants; No 
     State Match Required.--In the case of a State that is awarded 
     a grant under this section--
       ``(1) the State share of funds expended for outreach and 
     enrollment activities under the State child health plan shall 
     not be less than the State share of such funds expended in 
     the fiscal year preceding the first fiscal year for which the 
     grant is awarded; and
       ``(2) no State matching funds shall be required for the 
     State to receive a grant under this section.
       ``(f) Definitions.--In this section:
       ``(1) Eligible entity.--The term `eligible entity' means 
     any of the following:
       ``(A) A State with an approved child health plan under this 
     title.
       ``(B) A local government.
       ``(C) An Indian tribe or tribal consortium, a tribal 
     organization, an urban Indian organization receiving funds 
     under title V of the Indian Health Care Improvement Act (25 
     U.S.C. 1651 et seq.), or an Indian Health Service provider.
       ``(D) A Federal health safety net organization.
       ``(E) A national, State, local, or community-based public 
     or nonprofit private organization, including organizations 
     that use community health workers or community-based doula 
     programs.
       ``(F) A faith-based organization or consortia, to the 
     extent that a grant awarded to such an entity is consistent 
     with the requirements of section 1955 of the Public Health 
     Service Act (42 U.S.C. 300x-65) relating to a grant award to 
     nongovernmental entities.
       ``(G) An elementary or secondary school.
       ``(2) Federal health safety net organization.--The term 
     `Federal health safety net organization' means--
       ``(A) a Federally-qualified health center (as defined in 
     section 1905(l)(2)(B));
       ``(B) a hospital defined as a disproportionate share 
     hospital for purposes of section 1923;
       ``(C) a covered entity described in section 340B(a)(4) of 
     the Public Health Service Act (42 U.S.C. 256b(a)(4)); and
       ``(D) any other entity or consortium that serves children 
     under a federally funded program, including the special 
     supplemental nutrition program for women, infants, and 
     children (WIC) established under section 17 of the Child 
     Nutrition Act of 1966 (42 U.S.C. 1786), the Head Start and 
     Early Head Start programs under the Head Start Act (42 U.S.C. 
     9801 et seq.), the school lunch program established under the 
     Richard B. Russell National School Lunch Act, and an 
     elementary or secondary school.
       ``(3) Indians; indian tribe; tribal organization; urban 
     indian organization.--The terms `Indian', `Indian tribe', 
     `tribal organization', and `urban Indian organization' have 
     the meanings given such terms in section 4 of the Indian 
     Health Care Improvement Act (25 U.S.C. 1603).
       ``(4) Community health worker.--The term `community health 
     worker' means an individual who promotes health or nutrition 
     within the community in which the individual resides--
       ``(A) by serving as a liaison between communities and 
     health care agencies;
       ``(B) by providing guidance and social assistance to 
     community residents;
       ``(C) by enhancing community residents' ability to 
     effectively communicate with health care providers;
       ``(D) by providing culturally and linguistically 
     appropriate health or nutrition education;
       ``(E) by advocating for individual and community health or 
     nutrition needs; and
       ``(F) by providing referral and followup services.
       ``(g) Appropriation.--There is appropriated, out of any 
     money in the Treasury not otherwise appropriated, 
     $100,000,000 for the period of fiscal years 2008 through 
     2012, to remain available until expended, for the purpose of 
     awarding grants under this section. Amounts appropriated and 
     paid under the authority of this section shall be in addition 
     to amounts appropriated under section 2104 and paid to States 
     in accordance with section 2105, including with respect to 
     expenditures for outreach activities in accordance with 
     subsections (a)(1)(D)(iii) and (c)(2)(C) of that section.
       ``(h) National Enrollment Campaign.--From the amounts made 
     available under subsection (a)(2), the Secretary shall 
     develop and implement a national enrollment campaign to 
     improve the enrollment of underserved child populations in 
     the programs established under this title and title XIX. Such 
     campaign may include--
       ``(1) the establishment of partnerships with the Secretary 
     of Education and the Secretary of Agriculture to develop 
     national campaigns to link the eligibility and enrollment 
     systems for the assistance programs each Secretary 
     administers that often serve the same children;
       ``(2) the integration of information about the programs 
     established under this title and title XIX in public health 
     awareness campaigns administered by the Secretary;
       ``(3) increased financial and technical support for 
     enrollment hotlines maintained by the Secretary to ensure 
     that all States participate in such hotlines;
       ``(4) the establishment of joint public awareness outreach 
     initiatives with the Secretary of Education and the Secretary 
     of Labor regarding the importance of health insurance to 
     building strong communities and the economy;
       ``(5) the development of special outreach materials for 
     Native Americans or for individuals with limited English 
     proficiency; and
       ``(6) such other outreach initiatives as the Secretary 
     determines would increase public awareness of the programs 
     under this title and title XIX.''.
       (b) Enhanced Administrative Funding for Translation or 
     Interpretation Services Under CHIP.--Section 2105(a)(1) (42 
     U.S.C. 1397ee(a)(1)), as amended by section 603, is amended--
       (1) in the matter preceding subparagraph (A), by inserting 
     ``(or, in the case of expenditures described in subparagraph 
     (D)(iv), the higher of 75 percent or the sum of the enhanced 
     FMAP plus 5 percentage points)'' after ``enhanced FMAP''; and
       (2) in subparagraph (D)--
       (A) in clause (iii), by striking ``and'' at the end;
       (B) by redesignating clause (iv) as clause (v); and
       (C) by inserting after clause (iii) the following new 
     clause:
       ``(iv) for translation or interpretation services in 
     connection with the enrollment and use of services under this 
     title by individuals for whom English is not their primary 
     language (as found necessary by the Secretary for the proper 
     and efficient administration of the State plan); and''.
       (c) Nonapplication of Administrative Expenditures Cap.--
     Section 2105(c)(2) (42 U.S.C. 1397ee(c)(2)) is amended by 
     adding at the end the following:
       ``(C) Nonapplication to certain expenditures.--The 
     limitation under subparagraph (A) shall not apply with 
     respect to the following expenditures:
       ``(i) Expenditures funded under section 2113.--Expenditures 
     for outreach and enrollment activities funded under a grant 
     awarded to the State under section 2113.''.

     SEC. 202. INCREASED OUTREACH AND ENROLLMENT OF INDIANS.

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

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

       ``(a) Agreements With States for Medicaid and CHIP Outreach 
     On or Near Reservations To Increase the Enrollment of Indians 
     in Those Programs.--

[[Page 21659]]

       ``(1) In general.--In order to improve the access of 
     Indians residing on or near a reservation to obtain benefits 
     under the Medicaid and State children's health insurance 
     programs established under titles XIX and XXI, the Secretary 
     shall encourage the State to take steps to provide for 
     enrollment on or near the reservation. Such steps may include 
     outreach efforts such as the outstationing of eligibility 
     workers, entering into agreements with the Indian Health 
     Service, Indian Tribes, Tribal Organizations, and Urban 
     Indian Organizations to provide outreach, education regarding 
     eligibility and benefits, enrollment, and translation 
     services when such services are appropriate.
       ``(2) Construction.--Nothing in paragraph (1) shall be 
     construed as affecting arrangements entered into between 
     States and the Indian Health Service, Indian Tribes, Tribal 
     Organizations, or Urban Indian Organizations for such 
     Service, Tribes, or Organizations to conduct administrative 
     activities under such titles.
       ``(b) Requirement To Facilitate Cooperation.--The 
     Secretary, acting through the Centers for Medicare & Medicaid 
     Services, shall take such steps as are necessary to 
     facilitate cooperation with, and agreements between, States 
     and the Indian Health Service, Indian Tribes, Tribal 
     Organizations, or Urban Indian Organizations with respect to 
     the provision of health care items and services to Indians 
     under the programs established under title XIX or XXI.
       ``(c) Definition of Indian; Indian Tribe; Indian Health 
     Program; Tribal Organization; Urban Indian Organization.--In 
     this section, the terms `Indian', `Indian Tribe', `Indian 
     Health Program', `Tribal Organization', and `Urban Indian 
     Organization' have the meanings given those terms in section 
     4 of the Indian Health Care Improvement Act.''.
       (b) Nonapplication of 10 Percent Limit on Outreach and 
     Certain Other Expenditures.--Section 2105(c)(2)(C) (42 U.S.C. 
     1397ee(c)(2)(C)), as added by section 201(c), is amended by 
     adding at the end the following new clause:
       ``(ii) Expenditures to increase outreach to, and the 
     enrollment of, indian children under this title and title 
     xix.--Expenditures for outreach activities to families of 
     Indian children likely to be eligible for child health 
     assistance under the plan or medical assistance under the 
     State plan under title XIX (or under a waiver of such plan), 
     to inform such families of the availability of, and to assist 
     them in enrolling their children in, such plans, including 
     such activities conducted under grants, contracts, or 
     agreements entered into under section 1139(a).''.

     SEC. 203. DEMONSTRATION PROGRAM TO PERMIT STATES TO RELY ON 
                   FINDINGS BY AN EXPRESS LANE AGENCY TO DETERMINE 
                   COMPONENTS OF A CHILD'S ELIGIBILITY FOR 
                   MEDICAID OR CHIP.

       (a) Requirement To Conduct Demonstration Program.--
       (1) In general.--The Secretary shall establish a 3-year 
     demonstration program under which up to 10 States shall be 
     authorized to rely on a finding made within the preceding 12 
     months by an Express Lane agency to determine whether a child 
     has met 1 or more of the eligibility requirements, such as 
     income, assets or resources, citizenship status, or other 
     criteria, necessary to determine the child's initial 
     eligibility, eligibility redetermination, or renewal of 
     eligibility, for medical assistance under the State Medicaid 
     plan or child health assistance under the State CHIP plan. A 
     State selected to participate in the demonstration program--
       (A) shall not be required to direct a child (or a child's 
     family) to submit information or documentation previously 
     submitted by the child or family to an Express Lane agency 
     that the State relies on for its Medicaid or CHIP eligibility 
     determination; and
       (B) may rely on information from an Express Lane agency 
     when evaluating a child's eligibility for medical assistance 
     under the State Medicaid plan or child health assistance 
     under the State CHIP plan without a separate, independent 
     confirmation of the information at the time of enrollment, 
     redetermination, or renewal.
       (2) Payments to states.--From the amount appropriated under 
     paragraph (1) of subsection (f), after the application of 
     paragraph (2) of that subsection, the Secretary shall pay the 
     States selected to participate in the demonstration program 
     such sums as the Secretary shall determine for expenditures 
     made by the State for systems upgrades and implementation of 
     the demonstration program. In no event shall a payment be 
     made to a State from the amount appropriated under subsection 
     (f) for any expenditures incurred for providing medical 
     assistance or child health assistance to a child enrolled in 
     the State Medicaid plan or the State CHIP plan through 
     reliance on a finding made by an Express Lane agency.
       (b) Requirements; Options for Application.--
       (1) State requirements.--A State selected to participate in 
     the demonstration program established under this section may 
     rely on a finding of an Express Lane agency only if the 
     following conditions are met:
       (A) Requirement to determine eligibility using regular 
     procedures if child is first found ineligible.--If reliance 
     on a finding from an Express Lane agency results in a child 
     not being found eligible for the State Medicaid plan or the 
     State CHIP plan, the State would be required to determine 
     eligibility under such plan using its regular procedures.
       (B) Notice.--The State shall inform the families 
     (especially those whose children are enrolled in the State 
     CHIP plan) that they may qualify for lower premium payments 
     or more comprehensive health coverage under the State 
     Medicaid plan if the family's income were directly evaluated 
     for an eligibility determination by the State Medicaid 
     agency, and that, at the family's option, the family may seek 
     an eligibility determination by the State Medicaid agency.
       (C) Compliance with department of homeland security 
     procedures.--The State may rely on an Express Lane agency 
     finding that a child is a qualified alien as long as the 
     Express Lane agency complies with guidance and regulatory 
     procedures issued by the Secretary of Homeland Security for 
     eligibility determinations of qualified aliens (as defined in 
     subsections (b) and (c) of section 431 of the Personal 
     Responsibility and Work Opportunity Reconciliation Act of 
     1996 (8 U.S.C. 1641)).
       (D) Verification of citizenship or nationality status.--The 
     State shall satisfy the requirements of section 
     1902(a)(46)(B) or 2105(c)(9) of the Social Security Act, as 
     applicable (and as added by section 301 of this Act) for 
     verifications of citizenship or nationality status.
       (E) Coding; application to enrollment error rates.--
       (i) In general.--The State agrees to--

       (I) assign such codes as the Secretary shall require to the 
     children who are enrolled in the State Medicaid plan or the 
     State CHIP plan through reliance on a finding made by an 
     Express Lane agency for the duration of the State's 
     participation in the demonstration program;
       (II) annually provide the Secretary with a statistically 
     valid sample (that is approved by Secretary) of the children 
     enrolled in such plans through reliance on such a finding by 
     conducting a full Medicaid eligibility review of the children 
     identified for such sample for purposes of determining an 
     eligibility error rate with respect to the enrollment of such 
     children;
       (III) submit the error rate determined under subclause (II) 
     to the Secretary;
       (IV) if such error rate exceeds 3 percent for either of the 
     first 2 fiscal years in which the State participates in the 
     demonstration program, demonstrate to the satisfaction of the 
     Secretary the specific corrective actions implemented by the 
     State to improve upon such error rate; and
       (V) if such error rate exceeds 3 percent for any fiscal 
     year in which the State participates in the demonstration 
     program, a reduction in the amount otherwise payable to the 
     State under section 1903(a) of the Social Security Act (42 
     Secretary 1396b(a)) for quarters for that fiscal year, equal 
     to the total amount of erroneous excess payments determined 
     for the fiscal year only with respect to the children 
     included in the sample for the fiscal year that are in excess 
     of a 3 percent error rate with respect to such children.

       (ii) No punitive action based on error rate.--The Secretary 
     shall not apply the error rate derived from the sample under 
     clause (i) to the entire population of children enrolled in 
     the State Medicaid plan or the State CHIP plan through 
     reliance on a finding made by an Express Lane agency, or to 
     the population of children enrolled in such plans on the 
     basis of the State's regular procedures for determining 
     eligibility, or penalize the State on the basis of such error 
     rate in any manner other than the reduction of payments 
     provided for under clause (i)(V).
       (iii) Rule of construction.--Nothing in this section shall 
     be construed as relieving a State that participates in the 
     demonstration program established under this section from 
     being subject to a penalty under section 1903(u) of the 
     Social Security Act (42 U.S.C. 1396b(u)) for payments made 
     under the State Medicaid plan with respect to ineligible 
     individuals and families that are determined to exceed the 
     error rate permitted under that section (as determined 
     without regard to the error rate determined under clause 
     (i)(II)).
       (2) State options for application.--A State selected to 
     participate in the demonstration program may elect to apply 
     any of the following:
       (A) Satisfaction of chip screen and enroll requirements.--
     If the State relies on a finding of an Express Lane agency 
     for purposes of determining eligibility under the State CHIP 
     plan, the State may meet the screen and enroll requirements 
     imposed under subparagraphs (A) and (B) of section 2102(b)(3) 
     of the Social Security Act (42 U.S.C. 1397bb(b) (3)) by using 
     any of the following:
       (i) Establishing a threshold percentage of the poverty line 
     that is 30 percentage points (or such other higher number of 
     percentage points) as the State determines reflects the 
     income methodologies of the program administered by the 
     Express Lane Agency and the State Medicaid plan.
       (ii) Providing that a child satisfies all income 
     requirements for eligibility under the State Medicaid plan.
       (iii) Providing that a child has a family income that 
     exceeds the Medicaid applicable income level.

[[Page 21660]]

       (B) Presumptive eligibility.--The State may provide for 
     presumptive eligibility under the State CHIP plan for a child 
     who, based on an eligibility determination of an income 
     finding from an Express Lane agency, would qualify for child 
     health assistance under the State CHIP plan. During the 
     period of presumptive eligibility, the State may determine 
     the child's eligibility for child health assistance under the 
     State CHIP plan based on telephone contact with family 
     members, access to data available in electronic or paper 
     format, or other means that minimize to the maximum extent 
     feasible the burden on the family.
       (C) Automatic enrollment.--
       (i) In general.--The State may initiate and determine 
     eligibility for medical assistance under the State Medicaid 
     plan or for child health assistance under the State CHIP plan 
     without a program application from, or on behalf of, the 
     child based on data obtained from sources other than the 
     child (or the child's family), but a child can only be 
     automatically enrolled in the State Medicaid plan or the 
     State CHIP plan if the child or the family affirmatively 
     consents to being enrolled through affirmation and signature 
     on an Express Lane agency application.
       (ii) Information requirement.--A State that elects the 
     option under clause (i) shall have procedures in place to 
     inform the child or the child's family of the services that 
     will be covered under the State Medicaid plan or the State 
     CHIP plan (as applicable), appropriate methods for using such 
     services, premium or other cost sharing charges (if any) that 
     apply, medical support obligations created by the enrollment 
     (if applicable), and the actions the child or the child's 
     family must take to maintain enrollment and renew coverage.
       (iii) Option to waive signatures.--The State may waive any 
     signature requirements for enrollment for a child who 
     consents to, or on whose behalf consent is provided for, 
     enrollment in the State Medicaid plan or the State CHIP plan.
       (3) Signature requirements.--In the case of a State 
     selected to participate in the demonstration program--
       (A) no signature under penalty of perjury shall be required 
     on an application form for medical assistance under the State 
     Medicaid plan or child health assistance under the State CHIP 
     plan to attest to any element of the application for which 
     eligibility is based on information received from an Express 
     Lane agency or a source other than an applicant; and
       (B) any signature requirement for determination of an 
     application for medical assistance under the State Medicaid 
     plan or child health assistance under the State CHIP plan may 
     be satisfied through an electronic signature.
       (4) Rules of construction.--Nothing in this subsection 
     shall be construed to--
       (A) relieve a State of the obligation under section 
     1902(a)(5) of the Social Security Act (42 U.S.C. 1396a(a)(5)) 
     to determine eligibility for medical assistance under the 
     State Medicaid plan; or
       (B) prohibit any State options otherwise permitted under 
     Federal law (without regard to this paragraph or the 
     demonstration program established under this section) that 
     are intended to increase the enrollment of eligible children 
     for medical assistance under the State Medicaid plan or child 
     health assistance under the State CHIP plan, including 
     options related to outreach, enrollment, applications, or the 
     determination or redetermination of eligibility.
       (c) Limited Waiver of Other Applicable Requirements.--
       (1) Social security act.--The Secretary shall waive only 
     such requirements of the Social Security Act as the Secretary 
     determines are necessary to carry out the demonstration 
     program established under this section.
       (2) Authorization for participating states to receive 
     certain data directly relevant to determining eligibility and 
     correct amount of assistance.--For provisions relating to the 
     authority of States participating in the demonstration 
     program to receive certain data directly, see section 204(c).
       (d) Evaluation and Report.--
       (1) Evaluation.--The Secretary shall conduct, by grant, 
     contract, or interagency agreement, a comprehensive, 
     independent evaluation of the demonstration program 
     established under this section. Such evaluation shall include 
     an analysis of the effectiveness of the program, and shall 
     include--
       (A) obtaining a statistically valid sample of the children 
     who were enrolled in the State Medicaid plan or the State 
     CHIP plan through reliance on a finding made by an Express 
     Lane agency and determining the percentage of children who 
     were erroneously enrolled in such plans;
       (B) determining whether enrolling children in such plans 
     through reliance on a finding made by an Express Lane agency 
     improves the ability of a State to identify and enroll low-
     income, uninsured children who are eligible but not enrolled 
     in such plans;
       (C) evaluating the administrative costs or savings related 
     to identifying and enrolling children in such plans through 
     reliance on such findings, and the extent to which such costs 
     differ from the costs that the State otherwise would have 
     incurred to identify and enroll low-income, uninsured 
     children who are eligible but not enrolled in such plans; and
       (D) any recommendations for legislative or administrative 
     changes that would improve the effectiveness of enrolling 
     children in such plans through reliance on such findings.
       (2) Report to congress.--Not later than September 30, 2012, 
     the Secretary shall submit a report to Congress on the 
     results of the evaluation of the demonstration program 
     established under this section.
       (e) Definitions.--In this section:
       (1) Child; children.--With respect to a State selected to 
     participate in the demonstration program established under 
     this section, the terms ``child'' and ``children'' have the 
     meanings given such terms for purposes of the State plans 
     under titles XIX and XXI of the Social Security Act.
       (2) Express lane agency.--
       (A) In general.--The term ``Express Lane agency'' means a 
     public agency that--
       (i) is determined by the State Medicaid agency or the State 
     CHIP agency (as applicable) to be capable of making the 
     determinations of 1 or more eligibility requirements 
     described in subsection (a)(1);
       (ii) is identified in the State Medicaid plan or the State 
     CHIP plan; and
       (iii) notifies the child's family--

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

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

       (I) The temporary assistance for needy families program 
     funded under part A of title IV of the Social Security Act 
     (42 U.S.C. 601 et seq.).
       (II) A State program funded under part D of title IV of 
     such Act (42 U.S.C. 651 et seq.).
       (III) The State Medicaid plan.
       (IV) The State CHIP plan.
       (V) The Food Stamp Act of 1977 (7 U.S.C. 2011 et seq.).
       (VI) The Head Start Act (42 U.S.C. 9801 et seq.).
       (VII) The Richard B. Russell National School Lunch Act (42 
     U.S.C. 1751 et seq.).
       (VIII) The Child Nutrition Act of 1966 (42 U.S.C. 1771 et 
     seq.).
       (IX) The Child Care and Development Block Grant Act of 1990 
     (42 U.S.C. 9858 et seq.).
       (X) The Stewart B. McKinney Homeless Assistance Act (42 
     U.S.C. 11301 et seq.).
       (XI) The United States Housing Act of 1937 (42 U.S.C. 1437 
     et seq.).
       (XII) The Native American Housing Assistance and Self-
     Determination Act of 1996 (25 U.S.C. 4101 et seq.).

       (ii) A State-specified governmental agency that has fiscal 
     liability or legal responsibility for the accuracy of the 
     eligibility determination findings relied on by the State.
       (iii) A public agency that is subject to an interagency 
     agreement limiting the disclosure and use of the information 
     disclosed for purposes of determining eligibility under the 
     State Medicaid plan or the State CHIP plan.
       (C) Exclusions.--Such term does not include an agency that 
     determines eligibility for a program established under the 
     Social Services Block Grant established under title XX of the 
     Social Security Act (42 U.S.C. 1397 et seq.) or a private, 
     for-profit organization.
       (D) Rules of construction.--Nothing in this paragraph shall 
     be construed as--
       (i) affecting the authority of a State Medicaid agency to 
     enter into contracts with nonprofit and for-profit agencies 
     to administer the Medicaid application process;
       (ii) exempting a State Medicaid agency from complying with 
     the requirements of section 1902(a)(4) of the Social Security 
     Act (relating to merit-based personnel standards for 
     employees of the State Medicaid agency and safeguards against 
     conflicts of interest); or
       (iii) authorizing a State Medicaid agency that participates 
     in the demonstration program established under this section 
     to use the Express Lane option to avoid complying with such 
     requirements for purposes of making eligibility 
     determinations under the State Medicaid plan.
       (3) Medicaid applicable income level.--With respect to a 
     State, the term ``Medicaid applicable income level'' has the 
     meaning given that term for purposes of such State under 
     section 2110(b)(4) of the Social Security Act (42 U.S.C. 
     1397jj(4)).
       (4) Poverty line.--The term ``poverty line'' has the 
     meaning given that term in section 2110(c)(5) of the Social 
     Security Act (42 U.S.C. 1397jj(c)(5)).
       (5) State.--The term ``State'' means 1 of the 50 States or 
     the District of Columbia.
       (6) State chip agency.--The term ``State CHIP agency'' 
     means the State agency responsible for administering the 
     State CHIP plan.

[[Page 21661]]

       (7) State chip plan.--The term ``State CHIP plan'' means 
     the State child health plan established under title XXI of 
     the Social Security Act (42 U.S.C. 1397aa et seq.), and 
     includes any waiver of such plan.
       (8) State medicaid agency.--The term ``State Medicaid 
     agency'' means the State agency responsible for administering 
     the State Medicaid plan.
       (9) State medicaid plan.--The term ``State Medicaid plan'' 
     means the State plan established under title XIX of the 
     Social Security Act (42 U.S.C. 1396 et seq.), and includes 
     any waiver of such plan.
       (f) Appropriation.--
       (1) Operational funds.--Out of any funds in the Treasury 
     not otherwise appropriated, there is appropriated to the 
     Secretary to carry out the demonstration program established 
     under this section, $49,000,000 for the period of fiscal 
     years 2008 through 2012.
       (2) Evaluation funds.--$5,000,000 of the funds appropriated 
     under paragraph (1) shall be used to conduct the evaluation 
     required under subsection (d).
       (3) Budget authority.--Paragraph (1) constitutes budget 
     authority in advance of appropriations Act and represents the 
     obligation of the Federal Government to provide for the 
     payment to States selected to participate in the 
     demonstration program established under this section of the 
     amounts provided under such paragraph (after the application 
     of paragraph (2)).

     SEC. 204. AUTHORIZATION OF CERTAIN INFORMATION DISCLOSURES TO 
                   SIMPLIFY HEALTH COVERAGE DETERMINATIONS.

       (a) Authorization of Information Disclosure.--Title XIX (42 
     U.S.C. 1396 et seq.) is amended--
       (1) by redesignating section 1939 as section 1940; and
       (2) by inserting after section 1938 the following new 
     section:


            ``AUTHORIZATION TO RECEIVE PERTINENT INFORMATION

       ``Sec. 1939.  (a) In General.--Notwithstanding any other 
     provision of law, a Federal or State agency or private entity 
     in possession of the sources of data directly relevant to 
     eligibility determinations under this title (including 
     eligibility files, information described in paragraph (2) or 
     (3) of section 1137(a), vital records information about 
     births in any State, and information described in sections 
     453(i) and 1902(a)(25)(I)) is authorized to convey such data 
     or information to the State agency administering the State 
     plan under this title, but only if such conveyance meets the 
     requirements of subsection (b).
       ``(b) Requirements for Conveyance.--Data or information may 
     be conveyed pursuant to this section only if the following 
     requirements are met:
       ``(1) The child whose circumstances are described in the 
     data or information (or such child's parent, guardian, 
     caretaker relative, or authorized representative) has either 
     provided advance consent to disclosure or has not objected to 
     disclosure after receiving advance notice of disclosure and a 
     reasonable opportunity to object.
       ``(2) Such data or information are used solely for the 
     purposes of--
       ``(A) identifying children who are eligible or potentially 
     eligible for medical assistance under this title and 
     enrolling (or attempting to enroll) such children in the 
     State plan; and
       ``(B) verifying the eligibility of children for medical 
     assistance under the State plan.
       ``(3) An interagency or other agreement, consistent with 
     standards developed by the Secretary--
       ``(A) prevents the unauthorized use, disclosure, or 
     modification of such data and otherwise meets applicable 
     Federal requirements for safeguarding privacy and data 
     security; and
       ``(B) requires the State agency administering the State 
     plan to use the data and information obtained under this 
     section to seek to enroll children in the plan.
       ``(c) Criminal Penalty.--A person described in subsection 
     (a) who publishes, divulges, discloses, or makes known in any 
     manner, or to any extent, not authorized by Federal law, any 
     information obtained under this section shall be fined not 
     more than $1,000 or imprisoned not more than 1 year, or both, 
     for each such unauthorized activity.
       ``(d) Rule of Construction.--The limitations and 
     requirements that apply to disclosure pursuant to this 
     section shall not be construed to prohibit the conveyance or 
     disclosure of data or information otherwise permitted under 
     Federal law (without regard to this section).''.
       (b) Conforming Amendment to Title XXI.--Section 2107(e)(1) 
     (42 U.S.C. 1397gg(e)(1)) is amended by adding at the end the 
     following new subparagraph:
       ``(E) Section 1939 (relating to authorization to receive 
     data directly relevant to eligibility determinations).''.
       (c) Authorization for States Participating in the Express 
     Lane Demonstration Program To Receive Certain Data Directly 
     Relevant To Determining Eligibility and Correct Amount of 
     Assistance.--Only in the case of a State selected to 
     participate in the Express Lane demonstration program 
     established under section 203, the Secretary shall enter into 
     such agreements as are necessary to permit such a State to 
     receive data directly relevant to eligibility determinations 
     and determining the correct amount of benefits under the 
     State CHIP plan or the State Medicaid plan (as such terms are 
     defined in paragraphs (7) and (9) section 203(e)) from the 
     following:
       (1) The National Directory of New Hires established under 
     section 453(i) of the Social Security Act (42 U.S.C. 653(i)).
       (2) The National Income Data collected by the Commissioner 
     of Social Security from information described in 
     subparagraphs (A) and (B) of section 6103(l)(7) of the 
     Internal Revenue Code of 1986, in accordance with the 
     requirements of that section.
       (3) Data regarding enrollment in insurance that may help to 
     facilitate outreach and enrollment under the State Medicaid 
     plan, the State CHIP plan, and such other programs as the 
     Secretary may specify.

               TITLE III--REDUCING BARRIERS TO ENROLLMENT

     SEC. 301. VERIFICATION OF DECLARATION OF CITIZENSHIP OR 
                   NATIONALITY FOR PURPOSES OF ELIGIBILITY FOR 
                   MEDICAID AND CHIP.

       (a) State Option To Verify Declaration of Citizenship or 
     Nationality for Purposes of Eligibility for Medicaid Through 
     Verification of Name and Social Security Number.--
       (1) Alternative to documentation requirement.--
       (A) In general.--Section 1902 (42 U.S.C. 1396a) is 
     amended--
       (i) in subsection (a)(46)--

       (I) by inserting ``(A)'' after ``(46)'';
       (II) by adding ``and'' after the semicolon; and
       (III) by adding at the end the following new subparagraph:

       ``(B) provide, with respect to an individual declaring to 
     be a citizen or national of the United States for purposes of 
     establishing eligibility under this title, that the State 
     shall satisfy the requirements of--
       ``(i) section 1903(x); or
       ``(ii) subsection (dd);''; and
       (ii) by adding at the end the following new subsection:
       ``(dd)(1) For purposes of section 1902(a)(46)(B)(ii), the 
     requirements of this subsection with respect to an individual 
     declaring to be a citizen or national of the United States 
     for purposes of establishing eligibility under this title, 
     are, in lieu of requiring the individual to present 
     satisfactory documentary evidence of citizenship or 
     nationality under section 1903(x) (if the individual is not 
     described in paragraph (2) of that section), as follows:
       ``(A) The State submits the name and social security number 
     of the individual to the Commissioner of Social Security as 
     part of the plan established under paragraph (2).
       ``(B) If the State receives notice from the Commissioner of 
     Social Security that the name or social security number of 
     the individual is invalid, the State--
       ``(i) notifies the individual of such fact;
       ``(ii) provides the individual with an opportunity to cure 
     the invalid determination with the Commissioner of Social 
     Security, followed by a period of 90 days from the date on 
     which the notice required under clause (i) is received by the 
     individual to present satisfactory documentary evidence of 
     citizenship or nationality (as defined in section 
     1903(x)(3)); and
       ``(iii) disenrolls the individual from the State plan under 
     this title within 30 days after the end of such 90-day period 
     if no such documentary evidence is presented.
       ``(2)(A) Each State electing to satisfy the requirements of 
     this subsection for purposes of section 1902(a)(46)(B) shall 
     establish a program under which the State submits each month 
     to the Commissioner of Social Security for verification the 
     name and social security number of each individual enrolled 
     in the State plan under this title that month who has 
     attained the age of 1 before the date of the enrollment.
       ``(B) In establishing the State program under this 
     paragraph, the State may enter into an agreement with the 
     Commissioner of Social Security to provide for the electronic 
     submission and verification of the name and social security 
     number of an individual before the individual is enrolled in 
     the State plan.
       ``(3)(A) The State agency implementing the plan approved 
     under this title shall, at such times and in such form as the 
     Secretary may specify, provide information on the percentage 
     each month that the invalid names and numbers submitted bears 
     to the total submitted for verification.
       ``(B) If, for any fiscal year, the average monthly 
     percentage determined under subparagraph (A) is greater than 
     7 percent--
       ``(i) the State shall develop and adopt a corrective plan 
     to review its procedures for verifying the identities of 
     individuals seeking to enroll in the State plan under this 
     title and to identify and implement changes in such 
     procedures to improve their accuracy; and
       ``(ii) pay to the Secretary an amount equal to the amount 
     which bears the same ratio to the total payments under the 
     State plan for the fiscal year for providing medical 
     assistance to individuals who provided invalid information as 
     the number of individuals with invalid information in excess 
     of 7 percent of

[[Page 21662]]

     such total submitted bears to the total number of individuals 
     with invalid information.
       ``(C) The Secretary may waive, in certain limited cases, 
     all or part of the payment under subparagraph (B)(ii) if the 
     State is unable to reach the allowable error rate despite a 
     good faith effort by such State.
       ``(D) This paragraph shall not apply to a State for a 
     fiscal year if there is an agreement described in paragraph 
     (2)(B) in effect as of the close of the fiscal year.
       ``(4) Nothing in this subsection shall affect the rights of 
     any individual under this title to appeal any disenrollment 
     from a State plan.''.
       (B) Costs of implementing and maintaining system.--Section 
     1903(a)(3) (42 U.S.C. 1396b(a)(3)) is amended--
       (i) by striking ``plus'' at the end of subparagraph (E) and 
     inserting ``and'', and
       (ii) by adding at the end the following new subparagraph:
       ``(F)(i) 90 percent of the sums expended during the quarter 
     as are attributable to the design, development, or 
     installation of such mechanized verification and information 
     retrieval systems as the Secretary determines are necessary 
     to implement section 1902(dd) (including a system described 
     in paragraph (2)(B) thereof), and
       ``(ii) 75 percent of the sums expended during the quarter 
     as are attributable to the operation of systems to which 
     clause (i) applies, plus''.
       (2) Limitation on waiver authority.--Notwithstanding any 
     provision of section 1115 of the Social Security Act (42 
     U.S.C. 1315), or any other provision of law, the Secretary 
     may not waive the requirements of section 1902(a)(46)(B) of 
     such Act (42 U.S.C. 1396a(a)(46)(B)) with respect to a State.
       (3) Conforming amendments.--Section 1903 (42 U.S.C. 1396b) 
     is amended--
       (A) in subsection (i)(22), by striking ``subsection (x)'' 
     and inserting ``section 1902(a)(46)(B)''; and
       (B) in subsection (x)(1), by striking ``subsection 
     (i)(22)'' and inserting ``section 1902(a)(46)(B)(i)''.
       (b) Clarification of Requirements Relating to Presentation 
     of Satisfactory Documentary Evidence of Citizenship or 
     Nationality.--
       (1) Acceptance of documentary evidence issued by a 
     federally recognized indian tribe.--Section 1903(x)(3)(B) (42 
     U.S.C. 1396b(x)(3)(B)) is amended--
       (A) by redesignating clause (v) as clause (vi); and
       (B) by inserting after clause (iv), the following new 
     clause:
       ``(v)(I) Except as provided in subclause (II), a document 
     issued by a federally recognized Indian tribe evidencing 
     membership or enrollment in, or affiliation with, such tribe 
     (such as a tribal enrollment card or certificate of degree of 
     Indian blood).
       ``(II) With respect to those federally recognized Indian 
     tribes located within States having an international border 
     whose membership includes individuals who are not citizens of 
     the United States, the Secretary shall, after consulting with 
     such tribes, issue regulations authorizing the presentation 
     of such other forms of documentation (including tribal 
     documentation, if appropriate) that the Secretary determines 
     to be satisfactory documentary evidence of citizenship or 
     nationality for purposes of satisfying the requirement of 
     this subsection.''.
       (2) Requirement to provide reasonable opportunity to 
     present satisfactory documentary evidence.--Section 1903(x) 
     (42 U.S.C. 1396b(x)) is amended by adding at the end the 
     following new paragraph:
       ``(4) In the case of an individual declaring to be a 
     citizen or national of the United States with respect to whom 
     a State requires the presentation of satisfactory documentary 
     evidence of citizenship or nationality under section 
     1902(a)(46)(B)(i), the individual shall be provided at least 
     the reasonable opportunity to present satisfactory 
     documentary evidence of citizenship or nationality under this 
     subsection as is provided under clauses (i) and (ii) of 
     section 1137(d)(4)(A) to an individual for the submittal to 
     the State of evidence indicating a satisfactory immigration 
     status.''.
       (3) Children born in the united states to mothers eligible 
     for medicaid.--
       (A) Clarification of rules.--Section 1903(x) (42 U.S.C. 
     1396b(x)), as amended by paragraph (2), is amended--
       (i) in paragraph (2)--

       (I) in subparagraph (C), by striking ``or'' at the end;
       (II) by redesignating subparagraph (D) as subparagraph (E); 
     and
       (III) by inserting after subparagraph (C) the following new 
     subparagraph:

       ``(D) pursuant to the application of section 1902(e)(4) 
     (and, in the case of an individual who is eligible for 
     medical assistance on such basis, the individual shall be 
     deemed to have provided satisfactory documentary evidence of 
     citizenship or nationality and shall not be required to 
     provide further documentary evidence on any date that occurs 
     during or after the period in which the individual is 
     eligible for medical assistance on such basis); or''; and
       (ii) by adding at the end the following new paragraph:
       ``(5) Nothing in subparagraph (A) or (B) of section 
     1902(a)(46), the preceding paragraphs of this subsection, or 
     the Deficit Reduction Act of 2005, including section 6036 of 
     such Act, shall be construed as changing the requirement of 
     section 1902(e)(4) that a child born in the United States to 
     an alien mother for whom medical assistance for the delivery 
     of such child is available as treatment of an emergency 
     medical condition pursuant to subsection (v) shall be deemed 
     eligible for medical assistance during the first year of such 
     child's life.''.
       (B) State requirement to issue separate identification 
     number.--Section 1902(e)(4) (42 U.S.C. 1396a(e)(4)) is 
     amended by adding at the end the following new sentence: 
     ``Notwithstanding the preceding sentence, in the case of a 
     child who is born in the United States to an alien mother for 
     whom medical assistance for the delivery of the child is made 
     available pursuant to section 1903(v), the State immediately 
     shall issue a separate identification number for the child 
     upon notification by the facility at which such delivery 
     occurred of the child's birth.''.
       (4) Technical amendments.--Section 1903(x)(2) (42 U.S.C. 
     1396b(x)) is amended--
       (A) in subparagraph (B)--
       (i) by realigning the left margin of the matter preceding 
     clause (i) 2 ems to the left; and
       (ii) by realigning the left margins of clauses (i) and 
     (ii), respectively, 2 ems to the left; and
       (B) in subparagraph (C)--
       (i) by realigning the left margin of the matter preceding 
     clause (i) 2 ems to the left; and
       (ii) by realigning the left margins of clauses (i) and 
     (ii), respectively, 2 ems to the left.
       (c) Application of Documentation System to CHIP.--
       (1) In general.--Section 2105(c) (42 U.S.C. 1397ee(c)), as 
     amended by section 110(a), is amended by adding at the end 
     the following new paragraph:
       ``(9) Citizenship documentation requirements.--
       ``(A) In general.--No payment may be made under this 
     section with respect to an individual who has, or is, 
     declared to be a citizen or national of the United States for 
     purposes of establishing eligibility under this title unless 
     the State meets the requirements of section 1902(a)(46)(B) 
     with respect to the individual.
       ``(B) Enhanced payments.--Notwithstanding subsection (b), 
     the enhanced FMAP with respect to payments under subsection 
     (a) for expenditures described in clause (i) or (ii) of 
     section 1903(a)(3)(F) necessary to comply with subparagraph 
     (A) shall in no event be less than 90 percent and 75 percent, 
     respectively.''.
       (2) Nonapplication of administrative expenditures cap.--
     Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)(C)), as amended 
     by section 202(b), is amended by adding at the end the 
     following:
       ``(iii) Expenditures to comply with citizenship or 
     nationality verification requirements.--Expenditures 
     necessary for the State to comply with paragraph (9)(A).''.
       (d) Effective Date.--
       (1) In general.--The amendments made by this section shall 
     take effect on October 1, 2008.
       (2) Restoration of eligibility.--In the case of an 
     individual who, during the period that began on July 1, 2006, 
     and ends on October 1, 2008, was determined to be ineligible 
     for medical assistance under a State Medicaid plan, including 
     any waiver of such plan, solely as a result of the 
     application of subsections (i)(22) and (x) of section 1903 of 
     the Social Security Act (as in effect during such period), 
     but who would have been determined eligible for such 
     assistance if such subsections, as amended by subsection (b), 
     had applied to the individual, a State may deem the 
     individual to be eligible for such assistance as of the date 
     that the individual was determined to be ineligible for such 
     medical assistance on such basis.
       (3) Special transition rule for indians.--During the period 
     that begins on July 1, 2006, and ends on the effective date 
     of final regulations issued under subclause (II) of section 
     1903(x)(3)(B)(v) of the Social Security Act (42 U.S.C. 
     1396b(x)(3)(B)(v)) (as added by subsection (b)(1)(B)), an 
     individual who is a member of a federally-recognized Indian 
     tribe described in subclause (II) of that section who 
     presents a document described in subclause (I) of such 
     section that is issued by such Indian tribe, shall be deemed 
     to have presented satisfactory evidence of citizenship or 
     nationality for purposes of satisfying the requirement of 
     subsection (x) of section 1903 of such Act.

     SEC. 302. REDUCING ADMINISTRATIVE BARRIERS TO ENROLLMENT.

       Section 2102(b) (42 U.S.C. 1397bb(b)) is amended--
       (1) by redesignating paragraph (4) as paragraph (5); and
       (2) by inserting after paragraph (3) the following new 
     paragraph:
       ``(4) Reduction of administrative barriers to enrollment.--
       ``(A) In general.--Subject to subparagraph (B), the plan 
     shall include a description of the procedures used to reduce 
     administrative barriers to the enrollment of children and 
     pregnant women who are eligible for medical assistance under 
     title XIX or for child health assistance or health benefits 
     coverage under

[[Page 21663]]

     this title. Such procedures shall be established and revised 
     as often as the State determines appropriate to take into 
     account the most recent information available to the State 
     identifying such barriers.
       ``(B) Deemed compliance if joint application and renewal 
     process that permits application other than in person.--A 
     State shall be deemed to comply with subparagraph (A) if the 
     State's application and renewal forms and supplemental forms 
     (if any) and information verification process is the same for 
     purposes of establishing and renewing eligibility for 
     children and pregnant women for medical assistance under 
     title XIX and child health assistance under this title, and 
     such process does not require an application to be made in 
     person or a face-to-face interview.''.

      TITLE IV--REDUCING BARRIERS TO PROVIDING PREMIUM ASSISTANCE

  Subtitle A--Additional State Option for Providing Premium Assistance

     SEC. 401. ADDITIONAL STATE OPTION FOR PROVIDING PREMIUM 
                   ASSISTANCE.

       (a) In General.--Section 2105(c) (42 U.S.C. 1397ee(c)), as 
     amended by section 301(c), is amended by adding at the end 
     the following:
       ``(10) State option to offer premium assistance.--
       ``(A) In general.--Subject to the succeeding provisions of 
     this paragraph, a State may elect to offer a premium 
     assistance subsidy (as defined in subparagraph (C)) for 
     qualified employer-sponsored coverage (as defined in 
     subparagraph (B)) to all targeted low-income children who are 
     eligible for child health assistance under the plan and have 
     access to such coverage in accordance with the requirements 
     of this paragraph.
       ``(B) Qualified employer-sponsored coverage.--
       ``(i) In general.--Subject to clauses (ii) and (iii), in 
     this paragraph, the term `qualified employer-sponsored 
     coverage' means a group health plan or health insurance 
     coverage offered through an employer--

       ``(I) that qualifies as creditable coverage as a group 
     health plan under section 2701(c)(1) of the Public Health 
     Service Act;
       ``(II) for which the employer contribution toward any 
     premium for such coverage is at least 40 percent; and
       ``(III) to all individuals in a manner that would be 
     considered a nondiscriminatory eligibility classification for 
     purposes of paragraph (3)(A)(ii) of section 105(h) of the 
     Internal Revenue Code of 1986 (but determined without regard 
     to clause (i) of subparagraph (B) of such paragraph).

       ``(ii) Exception.--Such term does not include coverage 
     consisting of--

       ``(I) benefits provided under a health flexible spending 
     arrangement (as defined in section 106(c)(2) of the Internal 
     Revenue Code of 1986); or
       ``(II) a high deductible health plan (as defined in section 
     223(c)(2) of such Code) purchased in conjunction with a 
     health savings account (as defined under section 223(d) of 
     such Code).

       ``(iii) Cost-effectiveness alternative to required employer 
     contribution.--A group health plan or health insurance 
     coverage offered through an employer that would be considered 
     qualified employer-sponsored coverage but for the application 
     of clause (i)(II) may be deemed to satisfy the requirement of 
     such clause if either of the following applies:

       ``(I) Application of child-based or family-based test.--The 
     State establishes to the satisfaction of the Secretary that 
     the cost of such coverage is less than the expenditures that 
     the State would have made to enroll the child or the family 
     (as applicable) in the State child health plan.
       ``(II) Aggregate program operational costs do not exceed 
     the cost of providing coverage under the state child health 
     plan.--If subclause (I) does not apply, the State establishes 
     to the satisfaction of the Secretary that the aggregate 
     amount of expenditures by the State for the purchase of all 
     such coverage for targeted low-income children under the 
     State child health plan (including administrative 
     expenditures) does not exceed the aggregate amount of 
     expenditures that the State would have made for providing 
     coverage under the State child health plan for all such 
     children.

       ``(C) Premium assistance subsidy.--
       ``(i) In general.--In this paragraph, the term `premium 
     assistance subsidy' means, with respect to a targeted low-
     income child, the amount equal to the difference between the 
     employee contribution required for enrollment only of the 
     employee under qualified employer-sponsored coverage and the 
     employee contribution required for enrollment of the employee 
     and the child in such coverage, less any applicable premium 
     cost-sharing applied under the State child health plan 
     (subject to the limitations imposed under section 2103(e), 
     including the requirement to count the total amount of the 
     employee contribution required for enrollment of the employee 
     and the child in such coverage toward the annual aggregate 
     cost-sharing limit applied under paragraph (3)(B) of such 
     section).
       ``(ii) State payment option.--A State may provide a premium 
     assistance subsidy either as reimbursement to an employee for 
     out-of-pocket expenditures or, subject to clause (iii), 
     directly to the employee's employer.
       ``(iii) Employer opt-out.--An employer may notify a State 
     that it elects to opt-out of being directly paid a premium 
     assistance subsidy on behalf of an employee. In the event of 
     such a notification, an employer shall withhold the total 
     amount of the employee contribution required for enrollment 
     of the employee and the child in the qualified employer-
     sponsored coverage and the State shall pay the premium 
     assistance subsidy directly to the employee.
       ``(iv) Treatment as child health assistance.--Expenditures 
     for the provision of premium assistance subsidies shall be 
     considered child health assistance described in paragraph 
     (1)(C) of subsection (a) for purposes of making payments 
     under that subsection.
       ``(D) Application of secondary payor rules.--The State 
     shall be a secondary payor for any items or services provided 
     under the qualified employer-sponsored coverage for which the 
     State provides child health assistance under the State child 
     health plan.
       ``(E) Requirement to provide supplemental coverage for 
     benefits and cost-sharing protection provided under the state 
     child health plan.--
       ``(i) In general.--Notwithstanding section 2110(b)(1)(C), 
     the State shall provide for each targeted low-income child 
     enrolled in qualified employer-sponsored coverage, 
     supplemental coverage consisting of--

       ``(I) items or services that are not covered, or are only 
     partially covered, under the qualified employer-sponsored 
     coverage; and
       ``(II) cost-sharing protection consistent with section 
     2103(e).

       ``(ii) Record keeping requirements.--For purposes of 
     carrying out clause (i), a State may elect to directly pay 
     out-of-pocket expenditures for cost-sharing imposed under the 
     qualified employer-sponsored coverage and collect or not 
     collect all or any portion of such expenditures from the 
     parent of the child.
       ``(F) Application of waiting period imposed under the 
     state.--Any waiting period imposed under the State child 
     health plan prior to the provision of child health assistance 
     to a targeted low-income child under the State plan shall 
     apply to the same extent to the provision of a premium 
     assistance subsidy for the child under this paragraph.
       ``(G) Opt-out permitted for any month.--A State shall 
     establish a process for permitting the parent of a targeted 
     low-income child receiving a premium assistance subsidy to 
     disenroll the child from the qualified employer-sponsored 
     coverage and enroll the child in, and receive child health 
     assistance under, the State child health plan, effective on 
     the first day of any month for which the child is eligible 
     for such assistance and in a manner that ensures continuity 
     of coverage for the child.
       ``(H) Application to parents.--If a State provides child 
     health assistance or health benefits coverage to parents of a 
     targeted low-income child in accordance with section 2111(b), 
     the State may elect to offer a premium assistance subsidy to 
     a parent of a targeted low-income child who is eligible for 
     such a subsidy under this paragraph in the same manner as the 
     State offers such a subsidy for the enrollment of the child 
     in qualified employer-sponsored coverage, except that--
       ``(i) the amount of the premium assistance subsidy shall be 
     increased to take into account the cost of the enrollment of 
     the parent in the qualified employer-sponsored coverage or, 
     at the option of the State if the State determines it cost-
     effective, the cost of the enrollment of the child's family 
     in such coverage; and
       ``(ii) any reference in this paragraph to a child is deemed 
     to include a reference to the parent or, if applicable under 
     clause (i), the family of the child.
       ``(I) Additional state option for providing premium 
     assistance.--
       ``(i) In general.--A State may establish an employer-family 
     premium assistance purchasing pool for employers with less 
     than 250 employees who have at least 1 employee who is a 
     pregnant woman eligible for assistance under the State child 
     health plan (including through the application of an option 
     described in section 2112(f)) or a member of a family with at 
     least 1 targeted low-income child and to provide a premium 
     assistance subsidy under this paragraph for enrollment in 
     coverage made available through such pool.
       ``(ii) Access to choice of coverage.--A State that elects 
     the option under clause (i) shall identify and offer access 
     to not less than 2 private health plans that are health 
     benefits coverage that is equivalent to the benefits coverage 
     in a benchmark benefit package described in section 2103(b) 
     or benchmark-equivalent coverage that meets the requirements 
     of section 2103(a)(2) for employees described in clause (i).
       ``(J) No effect on previously approved premium assistance 
     programs.--Nothing in this paragraph shall be construed as 
     limiting the authority of a State to offer premium assistance 
     under section 1906, a waiver described in paragraph (2)(B) or 
     (3), a waiver approved under section 1115, or other authority 
     in effect prior to the date of enactment of the Children's 
     Health Insurance Program Reauthorization Act of 2007.

[[Page 21664]]

       ``(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).''.
       (b) Application to Medicaid.--Section 1906 (42 U.S.C. 
     1396e) is amended by inserting after subsection (c) the 
     following:
       ``(d) A State may elect to offer a premium assistance 
     subsidy (as defined in section 2105(c)(10)(C)) for qualified 
     employer-sponsored coverage (as defined in section 
     2105(c)(10)(B)) to a child who is eligible for medical 
     assistance under the State plan under this title, to the 
     parent of such a child, and to a pregnant woman, in the same 
     manner as such a subsidy for such coverage may be offered 
     under a State child health plan under title XXI in accordance 
     with section 2105(c)(10) (except that subparagraph (E)(i)(II) 
     of such section shall be applied by substituting `1916 or, if 
     applicable, 1916A' for `2103(e)').''.
       (c) GAO Study and Report.--Not later than January 1, 2009, 
     the Comptroller General of the United States shall study cost 
     and coverage issues relating to any State premium assistance 
     programs for which Federal matching payments are made under 
     title XIX or XXI of the Social Security Act, including under 
     waiver authority, and shall submit a report to the 
     appropriate committees of Congress on the results of such 
     study.

     SEC. 402. OUTREACH, EDUCATION, AND ENROLLMENT ASSISTANCE.

       (a) Requirement To Include Description of Outreach, 
     Education, and Enrollment Efforts Related to Premium 
     Assistance Subsidies in State Child Health Plan.--Section 
     2102(c) (42 U.S.C. 1397bb(c)) is amended by adding at the end 
     the following new paragraph:
       ``(3) Premium assistance subsidies.--Outreach, education, 
     and enrollment assistance for families of children likely to 
     be eligible for premium assistance subsidies under the State 
     child health plan in accordance with paragraphs (2)(B), (3), 
     or (10) of section 2105(c), or a waiver approved under 
     section 1115, to inform such families of the availability of, 
     and to assist them in enrolling their children in, such 
     subsidies, and for employers likely to provide coverage that 
     is eligible for such subsidies, including the specific, 
     significant resources the State intends to apply to educate 
     employers about the availability of premium assistance 
     subsidies under the State child health plan.''.
       (b) Nonapplication of 10 Percent Limit on Outreach and 
     Certain Other Expenditures.--Section 2105(c)(2)(C) (42 U.S.C. 
     1397ee(c)(2)(C)), as amended by section 301(c)(2), is amended 
     by adding at the end the following new clause:
       ``(iv) Expenditures for outreach to increase the enrollment 
     of children under this title and title xix through premium 
     assistance subsidies.--Expenditures for outreach activities 
     to families of children likely to be eligible for premium 
     assistance subsidies in accordance with paragraphs (2)(B), 
     (3), or (10), or a waiver approved under section 1115, to 
     inform such families of the availability of, and to assist 
     them in enrolling their children in, such subsidies, and to 
     employers likely to provide qualified employer-sponsored 
     coverage (as defined in subparagraph (B) of such 
     paragraph).''.

   Subtitle B--Coordinating Premium Assistance With Private Coverage

     SEC. 411. SPECIAL ENROLLMENT PERIOD UNDER GROUP HEALTH PLANS 
                   IN CASE OF TERMINATION OF MEDICAID OR CHIP 
                   COVERAGE OR ELIGIBILITY FOR ASSISTANCE IN 
                   PURCHASE OF EMPLOYMENT-BASED COVERAGE; 
                   COORDINATION OF COVERAGE.

       (a) Amendments to Internal Revenue Code of 1986.--Section 
     9801(f) of the Internal Revenue Code of 1986 (relating to 
     special enrollment periods) is amended by adding at the end 
     the following new paragraph:
       ``(3) Special rules relating to medicaid and chip.--
       ``(A) In general.--A group health plan shall permit an 
     employee who is eligible, but not enrolled, for coverage 
     under the terms of the plan (or a dependent of such an 
     employee if the dependent is eligible, but not enrolled, for 
     coverage under such terms) to enroll for coverage under the 
     terms of the plan if either of the following conditions is 
     met:
       ``(i) Termination of medicaid or chip coverage.--The 
     employee or dependent is covered under a Medicaid plan under 
     title XIX of the Social Security Act or under a State child 
     health plan under title XXI of such Act and coverage of the 
     employee or dependent under such a plan is terminated as a 
     result of loss of eligibility for such coverage and the 
     employee requests coverage under the group health plan not 
     later than 60 days after the date of termination of such 
     coverage.
       ``(ii) Eligibility for employment assistance under medicaid 
     or chip.--The employee or dependent becomes eligible for 
     assistance, with respect to coverage under the group health 
     plan under such Medicaid plan or State child health plan 
     (including under any waiver or demonstration project 
     conducted under or in relation to such a plan), if the 
     employee requests coverage under the group health plan not 
     later than 60 days after the date the employee or dependent 
     is determined to be eligible for such assistance.
       ``(B) Employee outreach and disclosure.--
       ``(i) Outreach to employees regarding availability of 
     medicaid and chip coverage.--

       ``(I) In general.--Each employer that maintains a group 
     health plan in a State that provides medical assistance under 
     a State Medicaid plan under title XIX of the Social Security 
     Act, or child health assistance under a State child health 
     plan under title XXI of such Act, in the form of premium 
     assistance for the purchase of coverage under a group health 
     plan, shall provide to each employee a written notice 
     informing the employee of potential opportunities then 
     currently available in the State in which the employee 
     resides for premium assistance under such plans for health 
     coverage of the employee or the employee's dependents. For 
     purposes of compliance with this clause, the employer may use 
     any State-specific model notice issued by the Secretary of 
     Labor or the Secretary of Health and Human Services in 
     accordance with section 701(f)(3)(B) of the Employee 
     Retirement Income Security Act of 1974 (29 U.S.C. 
     1181(f)(3)(B)).
       ``(II) Option to provide concurrent with provision of 
     summary plan description.--An employer may provide the model 
     notice applicable to the State in which an employee resides 
     concurrent with the furnishing of the summary plan 
     description as provided in section 104(b) of the Employee 
     Retirement Income Security Act of 1974 (29 U.S.C. 1024).

       ``(ii) Disclosure about group health plan benefits to 
     states for medicaid and chip eligible individuals.--In the 
     case of a participant or beneficiary of a group health plan 
     who is covered under a Medicaid plan of a State under title 
     XIX of the Social Security Act or under a State child health 
     plan under title XXI of such Act, the plan administrator of 
     the group health plan shall disclose to the State, upon 
     request, information about the benefits available under the 
     group health plan in sufficient specificity, as determined 
     under regulations of the Secretary of Health and Human 
     Services in consultation with the Secretary that require use 
     of the model coverage coordination disclosure form developed 
     under section 411(b)(2)(C) of the Children's Health Insurance 
     Program Reauthorization Act of 2007, so as to permit the 
     State to make a determination (under paragraph (2)(B), (3), 
     or (10) of section 2105(c) of the Social Security Act or 
     otherwise) concerning the cost-effectiveness of the State 
     providing medical or child health assistance through premium 
     assistance for the purchase of coverage under such group 
     health plan and in order for the State to provide 
     supplemental benefits required under paragraph (10)(E) of 
     such section or other authority.''.
       (b) Conforming Amendments.--
       (1) Amendments to employee retirement income security 
     act.--
       (A) In general.--Section 701(f) of the Employee Retirement 
     Income Security Act of 1974 (29 U.S.C. 1181(f)) is amended by 
     adding at the end the following new paragraph:
       ``(3) Special rules for application in case of medicaid and 
     chip.--
       ``(A) In general.--A group health plan, and a health 
     insurance issuer offering group health insurance coverage in 
     connection with a group health plan, shall permit an employee 
     who is eligible, but not enrolled, for coverage under the 
     terms of the plan (or a dependent of such an employee if the 
     dependent is eligible, but not enrolled, for coverage under 
     such terms) to enroll for coverage under the terms of the 
     plan if either of the following conditions is met:
       ``(i) Termination of medicaid or chip coverage.--The 
     employee or dependent is covered under a Medicaid plan under 
     title XIX of the Social Security Act or under a State child 
     health plan under title XXI of such Act and coverage of the 
     employee or dependent under such a plan is terminated as a 
     result of

[[Page 21665]]

     loss of eligibility for such coverage and the employee 
     requests coverage under the group health plan (or health 
     insurance coverage) not later than 60 days after the date of 
     termination of such coverage.
       ``(ii) Eligibility for employment assistance under medicaid 
     or chip.--The employee or dependent becomes eligible for 
     assistance, with respect to coverage under the group health 
     plan or health insurance coverage, under such Medicaid plan 
     or State child health plan (including under any waiver or 
     demonstration project conducted under or in relation to such 
     a plan), if the employee requests coverage under the group 
     health plan or health insurance coverage not later than 60 
     days after the date the employee or dependent is determined 
     to be eligible for such assistance.''.
       ``(B) Coordination with medicaid and chip.--
       ``(i) Outreach to employees regarding availability of 
     medicaid and chip coverage.--

       ``(I) In general.--Each employer that maintains a group 
     health plan in a State that provides medical assistance under 
     a State Medicaid plan under title XIX of the Social Security 
     Act, or child health assistance under a State child health 
     plan under title XXI of such Act, in the form of premium 
     assistance for the purchase of coverage under a group health 
     plan, shall provide to each employee a written notice 
     informing the employee of potential opportunities then 
     currently available in the State in which the employee 
     resides for premium assistance under such plans for health 
     coverage of the employee or the employee's dependents.
       ``(II) Model notice.--Not later than 1 year after the date 
     of enactment of the Children's Health Insurance Program 
     Reauthorization Act of 2007, the Secretary and the Secretary 
     of Health and Human Services, in consultation with Directors 
     of State Medicaid agencies under title XIX of the Social 
     Security Act and Directors of State CHIP agencies under title 
     XXI of such Act, shall jointly develop national and State-
     specific model notices for purposes of subparagraph (A). The 
     Secretary shall provide employers with such model notices so 
     as to enable employers to timely comply with the requirements 
     of subparagraph (A). Such model notices shall include 
     information regarding how an employee may contact the State 
     in which the employee resides for additional information 
     regarding potential opportunities for such premium 
     assistance, including how to apply for such assistance.
       ``(III) Option to provide concurrent with provision of 
     summary plan description.--An employer may provide the model 
     notice applicable to the State in which an employee resides 
     concurrent with the furnishing of the summary plan 
     description as provided in section 104(b).

       ``(ii) Disclosure about group health plan benefits to 
     states for medicaid and chip eligible individuals.--In the 
     case of a participant or beneficiary of a group health plan 
     who is covered under a Medicaid plan of a State under title 
     XIX of the Social Security Act or under a State child health 
     plan under title XXI of such Act, the plan administrator of 
     the group health plan shall disclose to the State, upon 
     request, information about the benefits available under the 
     group health plan in sufficient specificity, as determined 
     under regulations of the Secretary of Health and Human 
     Services in consultation with the Secretary that require use 
     of the model coverage coordination disclosure form developed 
     under section 411(b)(2)(C) of the Children's Health Insurance 
     Program Reauthorization Act of 2007, so as to permit the 
     State to make a determination (under paragraph (2)(B), (3), 
     or (10) of section 2105(c) of the Social Security Act or 
     otherwise) concerning the cost-effectiveness of the State 
     providing medical or child health assistance through premium 
     assistance for the purchase of coverage under such group 
     health plan and in order for the State to provide 
     supplemental benefits required under paragraph (10)(E) of 
     such section or other authority.''.
       (B) Conforming amendment.--Section 102(b) of the Employee 
     Retirement Income Security Act of 1974 (29 U.S.C. 1022(b)) is 
     amended--
       (i) by striking ``and the remedies'' and inserting ``, the 
     remedies''; and
       (ii) by inserting before the period the following: ``, and 
     if the employer so elects for purposes of complying with 
     section 701(f)(3)(B)(i), the model notice applicable to the 
     State in which the participants and beneficiaries reside''.
       (C) Working group to develop model coverage coordination 
     disclosure form.--
       (i) Medicaid, chip, and employer-sponsored coverage 
     coordination working group.--

       (I) In general.--Not later than 60 days after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services and the Secretary of Labor shall jointly establish a 
     Medicaid, CHIP, and Employer-Sponsored Coverage Coordination 
     Working Group (in this subparagraph referred to as the 
     ``Working Group''). The purpose of the Working Group shall be 
     to develop the model coverage coordination disclosure form 
     described in subclause (II) and to identify the impediments 
     to the effective coordination of coverage available to 
     families that include employees of employers that maintain 
     group health plans and members who are eligible for medical 
     assistance under title XIX of the Social Security Act or 
     child health assistance or other health benefits coverage 
     under title XXI of such Act.
       (II) Model coverage coordination disclosure form 
     described.--The model form described in this subclause is a 
     form for plan administrators of group health plans to 
     complete for purposes of permitting a State to determine the 
     availability and cost-effectiveness of the coverage available 
     under such plans to employees who have family members who are 
     eligible for premium assistance offered under a State plan 
     under title XIX or XXI of such Act and to allow for 
     coordination of coverage for enrollees of such plans. Such 
     form shall provide the following information in addition to 
     such other information as the Working Group determines 
     appropriate:

       (aa) A determination of whether the employee is eligible 
     for coverage under the group health plan.
       (bb) The name and contract information of the plan 
     administrator of the group health plan.
       (cc) The benefits offered under the plan.
       (dd) The premiums and cost-sharing required under the plan.
       (ee) Any other information relevant to coverage under the 
     plan.
       (ii) Membership.--The Working Group shall consist of not 
     more than 30 members and shall be composed of representatives 
     of--

       (I) the Department of Labor;
       (II) the Department of Health and Human Services;
       (III) State directors of the Medicaid program under title 
     XIX of the Social Security Act;
       (IV) State directors of the State Children's Health 
     Insurance Program under title XXI of the Social Security Act;
       (V) employers, including owners of small businesses and 
     their trade or industry representatives and certified human 
     resource and payroll professionals;
       (VI) plan administrators and plan sponsors of group health 
     plans (as defined in section 607(1) of the Employee 
     Retirement Income Security Act of 1974); and
       (VII) children and other beneficiaries of medical 
     assistance under title XIX of the Social Security Act or 
     child health assistance or other health benefits coverage 
     under title XXI of such Act.

       (iii) Compensation.--The members of the Working Group shall 
     serve without compensation.
       (iv) Administrative support.--The Department of Health and 
     Human Services and the Department of Labor shall jointly 
     provide appropriate administrative support to the Working 
     Group, including technical assistance. The Working Group may 
     use the services and facilities of either such Department, 
     with or without reimbursement, as jointly determined by such 
     Departments.
       (v) Report.--

       (I) Report by working group to the secretaries.--Not later 
     than 18 months after the date of the enactment of this Act, 
     the Working Group shall submit to the Secretary of Labor and 
     the Secretary of Health and Human Services the model form 
     described in clause (i)(II) along with a report containing 
     recommendations for appropriate measures to address the 
     impediments to the effective coordination of coverage between 
     group health plans and the State plans under titles XIX and 
     XXI of the Social Security Act.
       (II) Report by secretaries to the congress.--Not later than 
     2 months after receipt of the report pursuant to subclause 
     (I), the Secretaries shall jointly submit a report to each 
     House of the Congress regarding the recommendations contained 
     in the report under such subclause.

       (vi) Termination.--The Working Group shall terminate 30 
     days after the date of the issuance of its report under 
     clause (v).
       (D) Effective dates.--The Secretary of Labor and the 
     Secretary of Health and Human Services shall develop the 
     initial model notices under section 701(f)(3)(B)(i)(II) of 
     the Employee Retirement Income Security Act of 1974, and the 
     Secretary of Labor shall provide such notices to employers, 
     not later than the date that is 1 year after the date of 
     enactment of this Act, and each employer shall provide the 
     initial annual notices to such employer's employees beginning 
     with the first plan year that begins after the date on which 
     such initial model notices are first issued. The model 
     coverage coordination disclosure form developed under 
     subparagraph (C) shall apply with respect to requests made by 
     States beginning with the first plan year that begins after 
     the date on which such model coverage coordination disclosure 
     form is first issued.
       (E) Enforcement.--Section 502 of the Employee Retirement 
     Income Security Act of 1974 (29 U.S.C. 1132) is amended--
       (i) in subsection (a)(6), by striking ``or (8)'' and 
     inserting ``(8), or (9)''; and
       (ii) in subsection (c), by redesignating paragraph (9) as 
     paragraph (10), and by inserting after paragraph (8) the 
     following:
       ``(9)(A) The Secretary may assess a civil penalty against 
     any employer of up to $100 a day from the date of the 
     employer's failure to meet the notice requirement of section

[[Page 21666]]

     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.''.

 TITLE V--STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES OF CHILDREN

     SEC. 501. CHILD HEALTH QUALITY IMPROVEMENT ACTIVITIES FOR 
                   CHILDREN ENROLLED IN MEDICAID OR CHIP.

       (a) Development of Child Health Quality Measures for 
     Children Enrolled in Medicaid or Chip.--Title XI (42 U.S.C. 
     1301 et seq.) is amended by inserting after section 1139 the 
     following new section:

     ``SEC. 1139A. CHILD HEALTH QUALITY MEASURES.

       ``(a) Development of an Initial Core Set of Health Care 
     Quality Measures for Children Enrolled in Medicaid or Chip.--
       ``(1) In general.--Not later than January 1, 2009, the 
     Secretary shall identify and publish for general comment an 
     initial, recommended core set of child health quality 
     measures for use by State programs administered under titles 
     XIX and XXI, health insurance issuers and managed care 
     entities that enter into contracts with such programs, and 
     providers of items and services under such programs.
       ``(2) Identification of initial core measures.--In 
     consultation with the individuals and entities described in 
     subsection (b)(3), the Secretary shall identify existing 
     quality of care measures for children that are in use under 
     public and privately sponsored health care coverage 
     arrangements, or that are part of reporting systems that 
     measure both the presence and duration of health insurance 
     coverage over time.
       ``(3) Recommendations and dissemination.--Based on such 
     existing and identified measures, the Secretary shall publish 
     an initial core set of child health quality measures that 
     includes (but is not limited to) the following:
       ``(A) The duration of children's health insurance coverage 
     over a 12-month time period.
       ``(B) The availability of a full range of--
       ``(i) preventive services, treatments, and services for 
     acute conditions, including services to promote healthy birth 
     and prevent and treat premature birth; and
       ``(ii) treatments to correct or ameliorate the effects of 
     chronic physical and mental conditions in infants, young 
     children, school-age children, and adolescents.
       ``(C) The availability of care in a range of ambulatory and 
     inpatient health care settings in which such care is 
     furnished.
       ``(D) The types of measures that, taken together, can be 
     used to estimate the overall national quality of health care 
     for children and to perform comparative analyses of pediatric 
     health care quality and racial, ethnic, and socioeconomic 
     disparities in child health and health care for children.
       ``(4) Encourage voluntary and standardized reporting.--Not 
     later than 2 years after the date of enactment of the 
     Children's Health Insurance Program Reauthorization Act of 
     2007, the Secretary, in consultation with States, shall 
     develop a standardized format for reporting information and 
     procedures and approaches that encourage States to use the 
     initial core measurement set to voluntarily report 
     information regarding the quality of pediatric health care 
     under titles XIX and XXI.
       ``(5) Adoption of best practices in implementing quality 
     programs.--The Secretary shall disseminate information to 
     States regarding best practices among States with respect to 
     measuring and reporting on the quality of health care for 
     children, and shall facilitate the adoption of such best 
     practices. In developing best practices approaches, the 
     Secretary shall give particular attention to State 
     measurement techniques that ensure the timeliness and 
     accuracy of provider reporting, encourage provider reporting 
     compliance, encourage successful quality improvement 
     strategies, and improve efficiency in data collection using 
     health information technology.
       ``(6) Reports to congress.--Not later than January 1, 2010, 
     and every 3 years thereafter, the Secretary shall report to 
     Congress on--
       ``(A) the status of the Secretary's efforts to improve--
       ``(i) quality related to the duration and stability of 
     health insurance coverage for children under titles XIX and 
     XXI;
       ``(ii) the quality of children's health care under such 
     titles, including preventive health services, health care for 
     acute conditions, chronic health care, and health services to 
     ameliorate the effects of physical and mental conditions and 
     to aid in growth and development of infants, young children, 
     school-age children, and adolescents with special health care 
     needs; and
       ``(iii) the quality of children's health care under such 
     titles across the domains of quality, including clinical 
     quality, health care safety, family experience with health 
     care, health care in the most integrated setting, and 
     elimination of racial, ethnic, and socioeconomic disparities 
     in health and health care;
       ``(B) the status of voluntary reporting by States under 
     titles XIX and XXI, utilizing the initial core quality 
     measurement set; and
       ``(C) any recommendations for legislative changes needed to 
     improve the quality of care provided to children under titles 
     XIX and XXI, including recommendations for quality reporting 
     by States.
       ``(7) Technical assistance.--The Secretary shall provide 
     technical assistance to States to assist them in adopting and 
     utilizing core child health quality measures in administering 
     the State plans under titles XIX and XXI.
       ``(8) Definition of core set.--In this section, the term 
     `core set' means a group of valid, reliable, and evidence-
     based quality measures that, taken together--
       ``(A) provide information regarding the quality of health 
     coverage and health care for children;
       ``(B) address the needs of children throughout the 
     developmental age span; and
       ``(C) allow purchasers, families, and health care providers 
     to understand the quality of care in relation to the 
     preventive needs of children, treatments aimed at managing 
     and resolving acute conditions, and diagnostic and treatment 
     services whose purpose is to correct or ameliorate physical, 
     mental, or developmental conditions that could, if untreated 
     or poorly treated, become chronic.
       ``(b) Advancing and Improving Pediatric Quality Measures.--
       ``(1) Establishment of pediatric quality measures 
     program.--Not later than January 1, 2010, the Secretary shall 
     establish a pediatric quality measures program to--
       ``(A) improve and strengthen the initial core child health 
     care quality measures established by the Secretary under 
     subsection (a);
       ``(B) expand on existing pediatric quality measures used by 
     public and private health care purchasers and advance the 
     development of such new and emerging quality measures; and
       ``(C) increase the portfolio of evidence-based, consensus 
     pediatric quality measures available to public and private 
     purchasers of children's health care services, providers, and 
     consumers.
       ``(2) Evidence-based measures.--The measures developed 
     under the pediatric quality measures program shall, at a 
     minimum, be--
       ``(A) evidence-based and, where appropriate, risk adjusted;
       ``(B) designed to identify and eliminate racial and ethnic 
     disparities in child health and the provision of health care;
       ``(C) designed to ensure that the data required for such 
     measures is collected and reported in a standard format that 
     permits comparison of quality and data at a State, plan, and 
     provider level;
       ``(D) periodically updated; and
       ``(E) responsive to the child health needs, services, and 
     domains of health care quality described in clauses (i), 
     (ii), and (iii) of subsection (a)(6)(A).
       ``(3) Process for pediatric quality measures program.--In 
     identifying gaps in existing pediatric quality measures and 
     establishing priorities for development and advancement of 
     such measures, the Secretary shall consult with--
       ``(A) States;
       ``(B) pediatricians, children's hospitals, and other 
     primary and specialized pediatric health care professionals 
     (including members of the allied health professions) who 
     specialize in the care and treatment of children, 
     particularly children with special physical, mental, and 
     developmental health care needs;
       ``(C) dental professionals, including pediatric dental 
     professionals;
       ``(D) health care providers that furnish primary health 
     care to children and families who live in urban and rural 
     medically underserved communities or who are members of 
     distinct population sub-groups at heightened risk for poor 
     health outcomes;
       ``(E) national organizations representing consumers and 
     purchasers of children's health care;
       ``(F) national organizations and individuals with expertise 
     in pediatric health quality measurement; and
       ``(G) voluntary consensus standards setting organizations 
     and other organizations involved in the advancement of 
     evidence-based measures of health care.
       ``(4) Developing, validating, and testing a portfolio of 
     pediatric quality measures.--As part of the program to 
     advance pediatric quality measures, the Secretary shall--
       ``(A) award grants and contracts for the development, 
     testing, and validation of new, emerging, and innovative 
     evidence-based measures for children's health care services 
     across the domains of quality described in clauses (i),(ii), 
     and (iii) of subsection (a)(6)(A); and
       ``(B) award grants and contracts for--
       ``(i) the development of consensus on evidence-based 
     measures for children's health care services;
       ``(ii) the dissemination of such measures to public and 
     private purchasers of health care for children; and

[[Page 21667]]

       ``(iii) the updating of such measures as necessary.
       ``(5) Revising, strengthening, and improving initial core 
     measures.--Beginning no later than January 1, 2012, and 
     annually thereafter, the Secretary shall publish recommended 
     changes to the core measures described in subsection (a) that 
     shall reflect the testing, validation, and consensus process 
     for the development of pediatric quality measures described 
     in subsection paragraphs (1) through (4).
       ``(6) Definition of pediatric quality measure.--In this 
     subsection, the term `pediatric quality measure' means a 
     measurement of clinical care that is capable of being 
     examined through the collection and analysis of relevant 
     information, that is developed in order to assess 1 or more 
     aspects of pediatric health care quality in various 
     institutional and ambulatory health care settings, including 
     the structure of the clinical care system, the process of 
     care, the outcome of care, or patient experiences in care.
       ``(c) Annual State Reports Regarding State-Specific Quality 
     of Care Measures Applied Under Medicaid or Chip.--
       ``(1) Annual state reports.--Each State with a State plan 
     approved under title XIX or a State child health plan 
     approved under title XXI shall annually report to the 
     Secretary on the--
       ``(A) State-specific child health quality measures applied 
     by the States under such plans, including measures described 
     in subparagraphs (A) and (B) of subsection (a)(6); and
       ``(B) State-specific information on the quality of health 
     care furnished to children under such plans, including 
     information collected through external quality reviews of 
     managed care organizations under section 1932 of the Social 
     Security Act (42 U.S.C. 1396u-4) and benchmark plans under 
     sections 1937 and 2103 of such Act (42 U.S.C. 1396u-7, 
     1397cc).
       ``(2) Publication.--Not later than September 30, 2009, and 
     annually thereafter, the Secretary shall collect, analyze, 
     and make publicly available the information reported by 
     States under paragraph (1).
       ``(d) Demonstration Projects for Improving the Quality of 
     Children's Health Care and the Use of Health Information 
     Technology.--
       ``(1) In general.--During the period of fiscal years 2008 
     through 2012, the Secretary shall award not more than 10 
     grants to States and child health providers to conduct 
     demonstration projects to evaluate promising ideas for 
     improving the quality of children's health care provided 
     under title XIX or XXI, including projects to--
       ``(A) experiment with, and evaluate the use of, new 
     measures of the quality of children's health care under such 
     titles (including testing the validity and suitability for 
     reporting of such measures);
       ``(B) promote the use of health information technology in 
     care delivery for children under such titles;
       ``(C) evaluate provider-based models which improve the 
     delivery of children's health care services under such 
     titles, including care management for children with chronic 
     conditions and the use of evidence-based approaches to 
     improve the effectiveness, safety, and efficiency of health 
     care services for children; or
       ``(D) demonstrate the impact of the model electronic health 
     record format for children developed and disseminated under 
     subsection (f) on improving pediatric health, including the 
     effects of chronic childhood health conditions, and pediatric 
     health care quality as well as reducing health care costs.
       ``(2) Requirements.--In awarding grants under this 
     subsection, the Secretary shall ensure that--
       ``(A) only 1 demonstration project funded under a grant 
     awarded under this subsection shall be conducted in a State; 
     and
       ``(B) demonstration projects funded under grants awarded 
     under this subsection shall be conducted evenly between 
     States with large urban areas and States with large rural 
     areas.
       ``(3) Authority for multistate projects.--A demonstration 
     project conducted with a grant awarded under this subsection 
     may be conducted on a multistate basis, as needed.
       ``(4) Funding.--$20,000,000 of the amount appropriated 
     under subsection (i) for a fiscal year shall be used to carry 
     out this subsection.
       ``(e) Childhood Obesity Demonstration Project.--
       ``(1) Authority to conduct demonstration.--The Secretary, 
     in consultation with the Administrator of the Centers for 
     Medicare & Medicaid Services, shall conduct a demonstration 
     project to develop a comprehensive and systematic model for 
     reducing childhood obesity by awarding grants to eligible 
     entities to carry out such project. Such model shall--
       ``(A) identify, through self-assessment, behavioral risk 
     factors for obesity among children;
       ``(B) identify, through self-assessment, needed clinical 
     preventive and screening benefits among those children 
     identified as target individuals on the basis of such risk 
     factors;
       ``(C) provide ongoing support to such target individuals 
     and their families to reduce risk factors and promote the 
     appropriate use of preventive and screening benefits; and
       ``(D) be designed to improve health outcomes, satisfaction, 
     quality of life, and appropriate use of items and services 
     for which medical assistance is available under title XIX or 
     child health assistance is available under title XXI among 
     such target individuals.
       ``(2) Eligibility entities.--For purposes of this 
     subsection, an eligible entity is any of the following:
       ``(A) A city, county, or Indian tribe.
       ``(B) A local or tribal educational agency.
       ``(C) An accredited university, college, or community 
     college.
       ``(D) A Federally-qualified health center.
       ``(E) A local health department.
       ``(F) A health care provider.
       ``(G) A community-based organization.
       ``(H) Any other entity determined appropriate by the 
     Secretary, including a consortia or partnership of entities 
     described in any of subparagraphs (A) through (G).
       ``(3) Use of funds.--An eligible entity awarded a grant 
     under this subsection shall use the funds made available 
     under the grant to--
       ``(A) carry out community-based activities related to 
     reducing childhood obesity, including by--
       ``(i) forming partnerships with entities, including schools 
     and other facilities providing recreational services, to 
     establish programs for after school and weekend community 
     activities that are designed to reduce childhood obesity;
       ``(ii) forming partnerships with daycare facilities to 
     establish programs that promote healthy eating behaviors and 
     physical activity; and
       ``(iii) developing and evaluating community educational 
     activities targeting good nutrition and promoting healthy 
     eating behaviors;
       ``(B) carry out age-appropriate school-based activities 
     that are designed to reduce childhood obesity, including by--
       ``(i) developing and testing educational curricula and 
     intervention programs designed to promote healthy eating 
     behaviors and habits in youth, which may include--

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

       ``(ii) providing education and training to educational 
     professionals regarding how to promote a healthy lifestyle 
     and a healthy school environment for children;
       ``(iii) planning and implementing a healthy lifestyle 
     curriculum or program with an emphasis on healthy eating 
     behaviors and physical activity; and
       ``(iv) planning and implementing healthy lifestyle classes 
     or programs for parents or guardians, with an emphasis on 
     healthy eating behaviors and physical activity for children;
       ``(C) carry out educational, counseling, promotional, and 
     training activities through the local health care delivery 
     systems including by--
       ``(i) promoting healthy eating behaviors and physical 
     activity services to treat or prevent eating disorders, being 
     overweight, and obesity;
       ``(ii) providing patient education and counseling to 
     increase physical activity and promote healthy eating 
     behaviors;
       ``(iii) training health professionals on how to identify 
     and treat obese and overweight individuals which may include 
     nutrition and physical activity counseling; and
       ``(iv) providing community education by a health 
     professional on good nutrition and physical activity to 
     develop a better understanding of the relationship between 
     diet, physical activity, and eating disorders, obesity, or 
     being overweight; and
       ``(D) provide, through qualified health professionals, 
     training and supervision for community health workers to--
       ``(i) educate families regarding the relationship between 
     nutrition, eating habits, physical activity, and obesity;
       ``(ii) educate families about effective strategies to 
     improve nutrition, establish healthy eating patterns, and 
     establish appropriate levels of physical activity; and
       ``(iii) educate and guide parents regarding the ability to 
     model and communicate positive health behaviors.
       ``(4) Priority.--In awarding grants under paragraph (1), 
     the Secretary shall give priority to awarding grants to 
     eligible entities--
       ``(A) that demonstrate that they have previously applied 
     successfully for funds to carry out activities that seek to 
     promote individual and community health and to prevent the 
     incidence of chronic disease and that can cite published and 
     peer-reviewed research demonstrating that the activities that 
     the entities propose to carry out with funds made available 
     under the grant are effective;

[[Page 21668]]

       ``(B) that will carry out programs or activities that seek 
     to accomplish a goal or goals set by the State in the Healthy 
     People 2010 plan of the State;
       ``(C) that provide non-Federal contributions, either in 
     cash or in-kind, to the costs of funding activities under the 
     grants;
       ``(D) that develop comprehensive plans that include a 
     strategy for extending program activities developed under 
     grants in the years following the fiscal years for which they 
     receive grants under this subsection;
       ``(E) located in communities that are medically 
     underserved, as determined by the Secretary;
       ``(F) located in areas in which the average poverty rate is 
     at least 150 percent or higher of the average poverty rate in 
     the State involved, as determined by the Secretary; and
       ``(G) that submit plans that exhibit multisectoral, 
     cooperative conduct that includes the involvement of a broad 
     range of stakeholders, including--
       ``(i) community-based organizations;
       ``(ii) local governments;
       ``(iii) local educational agencies;
       ``(iv) the private sector;
       ``(v) State or local departments of health;
       ``(vi) accredited colleges, universities, and community 
     colleges;
       ``(vii) health care providers;
       ``(viii) State and local departments of transportation and 
     city planning; and
       ``(ix) other entities determined appropriate by the 
     Secretary.
       ``(5) Program design.--
       ``(A) Initial design.--Not later than 1 year after the date 
     of enactment of the Children's Health Insurance Program 
     Reauthorization Act of 2007, the Secretary shall design the 
     demonstration project. The demonstration should draw upon 
     promising, innovative models and incentives to reduce 
     behavioral risk factors. The Administrator of the Centers for 
     Medicare & Medicaid Services shall consult with the Director 
     of the Centers for Disease Control and Prevention, the 
     Director of the Office of Minority Health, the heads of other 
     agencies in the Department of Health and Human Services, and 
     such professional organizations, as the Secretary determines 
     to be appropriate, on the design, conduct, and evaluation of 
     the demonstration.
       ``(B) Number and project areas.--Not later than 2 years 
     after the date of enactment of the Children's Health 
     Insurance Program Reauthorization Act of 2007, the Secretary 
     shall award 1 grant that is specifically designed to 
     determine whether programs similar to programs to be 
     conducted by other grantees under this subsection should be 
     implemented with respect to the general population of 
     children who are eligible for child health assistance under 
     State child health plans under title XXI in order to reduce 
     the incidence of childhood obesity among such population.
       ``(6) Report to congress.--Not later than 3 years after the 
     date the Secretary implements the demonstration project under 
     this subsection, the Secretary shall submit to Congress a 
     report that describes the project, evaluates the 
     effectiveness and cost effectiveness of the project, 
     evaluates the beneficiary satisfaction under the project, and 
     includes any such other information as the Secretary 
     determines to be appropriate.
       ``(7) Definitions.--In this subsection:
       ``(A) Federally-qualified health center.--The term 
     `Federally-qualified health center' has the meaning given 
     that term in section 1905(l)(2)(B).
       ``(B) Indian tribe.--The term `Indian tribe' has the 
     meaning given that term in section 4 of the Indian Health 
     Care Improvement Act (25 U.S.C. 1603).
       ``(C) Self-assessment.--The term `self-assessment' means a 
     form that--
       ``(i) includes questions regarding--

       ``(I) behavioral risk factors;
       ``(II) needed preventive and screening services; and
       ``(III) target individuals' preferences for receiving 
     follow-up information;

       ``(ii) is assessed using such computer generated assessment 
     programs; and
       ``(iii) allows for the provision of such ongoing support to 
     the individual as the Secretary determines appropriate.
       ``(D) Ongoing support.--The term `ongoing support' means--
       ``(i) to provide any target individual with information, 
     feedback, health coaching, and recommendations regarding--

       ``(I) the results of a self-assessment given to the 
     individual;
       ``(II) behavior modification based on the self-assessment; 
     and
       ``(III) any need for clinical preventive and screening 
     services or treatment including medical nutrition therapy;

       ``(ii) to provide any target individual with referrals to 
     community resources and programs available to assist the 
     target individual in reducing health risks; and
       ``(iii) to provide the information described in clause (i) 
     to a health care provider, if designated by the target 
     individual to receive such information.
       ``(8) Authorization of appropriations.--There is authorized 
     to be appropriated to carry out this subsection, $25,000,000 
     for the period of fiscal years 2008 through 2012.
       ``(f) Development of Model Electronic Health Record Format 
     for Children Enrolled in Medicaid or CHIP.--
       ``(1) In general.--Not later than January 1, 2009, the 
     Secretary shall establish a program to encourage the 
     development and dissemination of a model electronic health 
     record format for children enrolled in the State plan under 
     title XIX or the State child health plan under title XXI that 
     is--
       ``(A) subject to State laws, accessible to parents, 
     caregivers, and other consumers for the sole purpose of 
     demonstrating compliance with school or leisure activity 
     requirements, such as appropriate immunizations or physicals;
       ``(B) designed to allow interoperable exchanges that 
     conform with Federal and State privacy and security 
     requirements;
       ``(C) structured in a manner that permits parents and 
     caregivers to view and understand the extent to which the 
     care their children receive is clinically appropriate and of 
     high quality; and
       ``(D) capable of being incorporated into, and otherwise 
     compatible with, other standards developed for electronic 
     health records.
       ``(2) Funding.--$5,000,000 of the amount appropriated under 
     subsection (i) for a fiscal year shall be used to carry out 
     this subsection.
       ``(g) Study of Pediatric Health and Health Care Quality 
     Measures.--
       ``(1) In general.--Not later than July 1, 2009, the 
     Institute of Medicine shall study and report to Congress on 
     the extent and quality of efforts to measure child health 
     status and the quality of health care for children across the 
     age span and in relation to preventive care, treatments for 
     acute conditions, and treatments aimed at ameliorating or 
     correcting physical, mental, and developmental conditions in 
     children. In conducting such study and preparing such report, 
     the Institute of Medicine shall--
       ``(A) consider all of the major national population-based 
     reporting systems sponsored by the Federal Government that 
     are currently in place, including reporting requirements 
     under Federal grant programs and national population surveys 
     and estimates conducted directly by the Federal Government;
       ``(B) identify the information regarding child health and 
     health care quality that each system is designed to capture 
     and generate, the study and reporting periods covered by each 
     system, and the extent to which the information so generated 
     is made widely available through publication;
       ``(C) identify gaps in knowledge related to children's 
     health status, health disparities among subgroups of 
     children, the effects of social conditions on children's 
     health status and use and effectiveness of health care, and 
     the relationship between child health status and family 
     income, family stability and preservation, and children's 
     school readiness and educational achievement and attainment; 
     and
       ``(D) make recommendations regarding improving and 
     strengthening the timeliness, quality, and public 
     transparency and accessibility of information about child 
     health and health care quality.
       ``(2) Funding.--Up to $1,000,000 of the amount appropriated 
     under subsection (i) for a fiscal year shall be used to carry 
     out this subsection.
       ``(h) Rule of Construction.--Notwithstanding any other 
     provision in this section, no evidence based quality measure 
     developed, published, or used as a basis of measurement or 
     reporting under this section may be used to establish an 
     irrebuttable presumption regarding either the medical 
     necessity of care or the maximum permissible coverage for any 
     individual child who is eligible for and receiving medical 
     assistance under title XIX or child health assistance under 
     title XXI .
       ``(i) Appropriation.--Out of any funds in the Treasury not 
     otherwise appropriated, there is appropriated for each of 
     fiscal years 2008 through 2012, $45,000,000 for the purpose 
     of carrying out this section (other than subsection (e)). 
     Funds appropriated under this subsection shall remain 
     available until expended.''.
       (b) Increased Matching Rate for Collecting and Reporting on 
     Child Health Measures.--Section 1903(a)(3)(A) (42 U.S.C. 
     1396b(a)(3)(A)), is amended--
       (1) by striking ``and'' at the end of clause (i); and
       (2) by adding at the end the following new clause:
       ``(iii) an amount equal to the Federal medical assistance 
     percentage (as defined in section 1905(b)) of so much of the 
     sums expended during such quarter (as found necessary by the 
     Secretary for the proper and efficient administration of the 
     State plan) as are attributable to such developments or 
     modifications of systems of the type described in clause (i) 
     as are necessary for the efficient collection and reporting 
     on child health measures; and''.

     SEC. 502. IMPROVED INFORMATION REGARDING ACCESS TO COVERAGE 
                   UNDER CHIP.

       (a) Inclusion of Process and Access Measures in Annual 
     State Reports.--Section 2108 (42 U.S.C. 1397hh) is amended--
       (1) in subsection (a), in the matter preceding paragraph 
     (1), by striking ``The State'' and inserting ``Subject to 
     subsection (e), the State''; and
       (2) by adding at the end the following new subsection:
       ``(e) Information Required for Inclusion in State Annual 
     Report.--The State shall

[[Page 21669]]

     include the following information in the annual report 
     required under subsection (a):
       ``(1) Eligibility criteria, enrollment, and retention data 
     (including data with respect to continuity of coverage or 
     duration of benefits).
       ``(2) Data regarding the extent to which the State uses 
     process measures with respect to determining the eligibility 
     of children under the State child health plan, including 
     measures such as 12-month continuous eligibility, self-
     declaration of income for applications or renewals, or 
     presumptive eligibility.
       ``(3) Data regarding denials of eligibility and 
     redeterminations of eligibility.
       ``(4) Data regarding access to primary and specialty 
     services, access to networks of care, and care coordination 
     provided under the State child health plan, using quality 
     care and consumer satisfaction measures included in the 
     Consumer Assessment of Healthcare Providers and Systems 
     (CAHPS) survey.
       ``(5) If the State provides child health assistance in the 
     form of premium assistance for the purchase of coverage under 
     a group health plan, data regarding the provision of such 
     assistance, including the extent to which employer-sponsored 
     health insurance coverage is available for children eligible 
     for child health assistance under the State child health 
     plan, the range of the monthly amount of such assistance 
     provided on behalf of a child or family, the number of 
     children or families provided such assistance on a monthly 
     basis, the income of the children or families provided such 
     assistance, the benefits and cost-sharing protection provided 
     under the State child health plan to supplement the coverage 
     purchased with such premium assistance, the effective 
     strategies the State engages in to reduce any administrative 
     barriers to the provision of such assistance, and, the 
     effects, if any, of the provision of such assistance on 
     preventing the coverage provided under the State child health 
     plan from substituting for coverage provided under employer-
     sponsored health insurance offered in the State.
       ``(6) To the extent applicable, a description of any State 
     activities that are designed to reduce the number of 
     uncovered children in the State, including through a State 
     health insurance connector program or support for innovative 
     private health coverage initiatives.''.
       (b) GAO Study and Report on Access to Primary and 
     Speciality Services.--
       (1) In general.--The Comptroller General of the United 
     States shall conduct a study of children's access to primary 
     and specialty services under Medicaid and CHIP, including--
       (A) the extent to which providers are willing to treat 
     children eligible for such programs;
       (B) information on such children's access to networks of 
     care;
       (C) geographic availability of primary and specialty 
     services under such programs;
       (D) the extent to which care coordination is provided for 
     children's care under Medicaid and CHIP; and
       (E) as appropriate, information on the degree of 
     availability of services for children under such programs.
       (2) Report.--Not later than 2 years after the date of 
     enactment of this Act, the Comptroller General shall submit a 
     report to the appropriate committees of Congress on the study 
     conducted under paragraph (1) that includes recommendations 
     for such Federal and State legislative and administrative 
     changes as the Comptroller General determines are necessary 
     to address any barriers to access to children's care under 
     Medicaid and CHIP that may exist.

     SEC. 503. APPLICATION OF CERTAIN MANAGED CARE QUALITY 
                   SAFEGUARDS TO CHIP.

       Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)), as amended by 
     section 204(b), is amended by redesignating subparagraph (E) 
     (as added by such section) as subparagraph (F) and by 
     inserting after subparagraph (D) the following new 
     subparagraph:
       ``(E) Subsections (a)(4), (a)(5), (b), (c), (d), and (e) of 
     section 1932 (relating to requirements for managed care).''.

                        TITLE VI--MISCELLANEOUS

     SEC. 601. TECHNICAL CORRECTION REGARDING CURRENT STATE 
                   AUTHORITY UNDER MEDICAID.

       (a) In General.--Only with respect to expenditures for 
     medical assistance under a State Medicaid plan, including any 
     waiver of such plan, for fiscal years 2007 and 2008, a State 
     may elect, notwithstanding the fourth sentence of subsection 
     (b) of section 1905 of the Social Security Act (42 U.S.C. 
     1396d) or subsection (u) of such section--
       (1) to cover individuals described in section 
     1902(a)(10)(A)(ii)(IX) of the Social Security Act and, at its 
     option, to apply less restrictive methodologies to such 
     individuals under section 1902(r)(2) of such Act or 
     1931(b)(2)(C) of such Act and thereby receive Federal 
     financial participation for medical assistance for such 
     individuals under title XIX of the Social Security Act; or
       (2) to receive Federal financial participation for 
     expenditures for medical assistance under title XIX of such 
     Act for children described in paragraph (2)(B) or (3) of 
     section 1905(u) of such Act based on the Federal medical 
     assistance percentage, as otherwise determined based on the 
     first and third sentences of subsection (b) of section 1905 
     of the Social Security Act, rather than on the basis of an 
     enhanced FMAP (as defined in section 2105(b) of such Act).
       (b) Repeal.--Effective October 1, 2008, subsection (a) is 
     repealed.
       (c) Hold Harmless.--No State that elects the option 
     described in subsection (a) shall be treated as not having 
     been authorized to make such election and to receive Federal 
     financial participation for expenditures for medical 
     assistance described in that subsection for fiscal years 2007 
     and 2008 as a result of the repeal of the subsection under 
     subsection (b).

     SEC. 602. PAYMENT ERROR RATE MEASUREMENT (``PERM'').

       (a) Expenditures Related to Compliance With Requirements.--
       (1) Enhanced payments.--Section 2105(c) (42 U.S.C. 
     1397ee(c)), as amended by section 401(a), is amended by 
     adding at the end the following new paragraph:
       ``(11) Enhanced payments.--Notwithstanding subsection (b), 
     the enhanced FMAP with respect to payments under subsection 
     (a) for expenditures related to the administration of the 
     payment error rate measurement (PERM) requirements applicable 
     to the State child health plan in accordance with the 
     Improper Payments Information Act of 2002 and parts 431 and 
     457 of title 42, Code of Federal Regulations (or any related 
     or successor guidance or regulations) shall in no event be 
     less than 90 percent.''.
       (2) Exclusion of from cap on administrative expenditures.--
     Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)C)), as amended 
     by section 402(b), is amended by adding at the end the 
     following:
       ``(v) Payment error rate measurement (perm) expenditures.--
     Expenditures related to the administration of the payment 
     error rate measurement (PERM) requirements applicable to the 
     State child health plan in accordance with the Improper 
     Payments Information Act of 2002 and parts 431 and 457 of 
     title 42, Code of Federal Regulations (or any related or 
     successor guidance or regulations).''.
       (b) Final Rule Required To Be in Effect for All States.--
     Notwithstanding parts 431 and 457 of title 42, Code of 
     Federal Regulations (as in effect on the date of enactment of 
     this Act), the Secretary shall not calculate or publish any 
     national or State-specific error rate based on the 
     application of the payment error rate measurement (in this 
     section referred to as ``PERM'') requirements to CHIP until 
     after the date that is 6 months after the date on which a 
     final rule implementing such requirements in accordance with 
     the requirements of subsection (c) is in effect for all 
     States. Any calculation of a national error rate or a State 
     specific error rate after such final rule in effect for all 
     States may only be inclusive of errors, as defined in such 
     final rule or in guidance issued within a reasonable time 
     frame after the effective date for such final rule that 
     includes detailed guidance for the specific methodology for 
     error determinations.
       (c) Requirements for Final Rule.--For purposes of 
     subsection (b), the requirements of this subsection are that 
     the final rule implementing the PERM requirements shall 
     include--
       (1) clearly defined criteria for errors for both States and 
     providers;
       (2) a clearly defined process for appealing error 
     determinations by review contractors; and
       (3) clearly defined responsibilities and deadlines for 
     States in implementing any corrective action plans.
       (d) Option for Application of Data for Certain States Under 
     the Interim Final Rule.--
       (1) Option for states in first application cycle.--After 
     the final rule implementing the PERM requirements in 
     accordance with the requirements of subsection (c) is in 
     effect for all States, a State for which the PERM 
     requirements were first in effect under an interim final rule 
     for fiscal year 2007 may elect to accept any payment error 
     rate determined in whole or in part for the State on the 
     basis of data for that fiscal year or may elect to not have 
     any payment error rate determined on the basis of such data 
     and, instead, shall be treated as if fiscal year 2010 were 
     the first fiscal year for which the PERM requirements apply 
     to the State.
       (2) Option for states in second application cycle.--If such 
     final rule is not in effect for all States by July 1, 2008, a 
     State for which the PERM requirements were first in effect 
     under an interim final rule for fiscal year 2008 may elect to 
     accept any payment error rate determined in whole or in part 
     for the State on the basis of data for that fiscal year or 
     may elect to not have any payment error rate determined on 
     the basis of such data and, instead, shall be treated as if 
     fiscal year 2011 were the first fiscal year for which the 
     PERM requirements apply to the State.
       (e) Harmonization of MEQC and PERM.--
       (1) Reduction of redundancies.--The Secretary shall review 
     the Medicaid Eligibility Quality Control (in this subsection 
     referred to as the ``MEQC'') requirements with the PERM 
     requirements and coordinate consistent implementation of both 
     sets of requirements, while reducing redundancies.
       (2) State option to apply perm data.--A State may elect, 
     for purposes of determining

[[Page 21670]]

     the erroneous excess payments for medical assistance ratio 
     applicable to the State for a fiscal year under section 
     1903(u) of the Social Security Act (42 U.S.C. 1396b(u)) to 
     substitute data resulting from the application of the PERM 
     requirements to the State after the final rule implementing 
     such requirements is in effect for all States for data 
     obtained from the application of the MEQC requirements to the 
     State with respect to a fiscal year.
       (f) Identification of Improved State-Specific Sample 
     Sizes.--The Secretary shall establish State-specific sample 
     sizes for application of the PERM requirements with respect 
     to State child health plans for fiscal years beginning with 
     fiscal year 2009, on the basis of such information as the 
     Secretary determines appropriate. In establishing such sample 
     sizes, the Secretary shall, to the greatest extent 
     practicable--
       (1) minimize the administrative cost burden on States under 
     Medicaid and CHIP; and
       (2) maintain State flexibility to manage such programs.

     SEC. 603. ELIMINATION OF COUNTING MEDICAID CHILD PRESUMPTIVE 
                   ELIGIBILITY COSTS AGAINST TITLE XXI ALLOTMENT.

       Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)) is amended--
       (1) in the matter preceding subparagraph (A), by striking 
     ``(or, in the case of expenditures described in subparagraph 
     (B), the Federal medical assistance percentage (as defined in 
     the first sentence of section 1905(b)))''; and
       (2) by striking subparagraph (B) and inserting the 
     following new subparagraph:
       ``(B) [reserved]''.

     SEC. 604. IMPROVING DATA COLLECTION.

       (a) Increased Appropriation.--Section 2109(b)(2) (42 U.S.C. 
     1397ii(b)(2)) is amended by striking ``$10,000,000 for fiscal 
     year 2000'' and inserting ``$20,000,000 for fiscal year 
     2008''.
       (b) Use of Additional Funds.--Section 2109(b) (42 U.S.C. 
     1397ii(b)), as amended by subsection (a), is amended--
       (1) by redesignating paragraph (2) as paragraph (4); and
       (2) by inserting after paragraph (1), the following new 
     paragraphs:
       ``(2) Additional requirements.--In addition to making the 
     adjustments required to produce the data described in 
     paragraph (1), with respect to data collection occurring for 
     fiscal years beginning with fiscal year 2008, in appropriate 
     consultation with the Secretary of Health and Human Services, 
     the Secretary of Commerce shall do the following:
       ``(A) Make appropriate adjustments to the Current 
     Population Survey to develop more accurate State-specific 
     estimates of the number of children enrolled in health 
     coverage under title XIX or this title.
       ``(B) Make appropriate adjustments to the Current 
     Population Survey to improve the survey estimates used to 
     compile the State-specific and national number of low-income 
     children without health insurance for purposes of determining 
     allotments under subsections (c) and (i) of section 2104 and 
     making payments to States from the CHIP Incentive Bonuses 
     Pool established under subsection (j) of such section, the 
     CHIP Contingency Fund established under subsection (k) of 
     such section, and, to the extent applicable to a State, from 
     the block grant set aside under section 2112(b)(2)(A)(i) for 
     each of fiscal years 2010 through 2012.
       ``(C) Include health insurance survey information in the 
     American Community Survey related to children.
       ``(D) Assess whether American Community Survey estimates, 
     once such survey data are first available, produce more 
     reliable estimates than the Current Population Survey with 
     respect to the purposes described in subparagraph (B).
       ``(E) On the basis of the assessment required under 
     subparagraph (D), recommend to the Secretary of Health and 
     Human Services whether American Community Survey estimates 
     should be used in lieu of, or in some combination with, 
     Current Population Survey estimates for the purposes 
     described in subparagraph (B).
       ``(F) Continue making the adjustments described in the last 
     sentence of paragraph (1) with respect to expansion of the 
     sample size used in State sampling units, the number of 
     sampling units in a State, and using an appropriate 
     verification element.
       ``(3) Authority for the secretary of health and human 
     services to transition to the use of all, or some combination 
     of, acs estimates upon recommendation of the secretary of 
     commerce.--If, on the basis of the assessment required under 
     paragraph (2)(D), the Secretary of Commerce recommends to the 
     Secretary of Health and Human Services that American 
     Community Survey estimates should be used in lieu of, or in 
     some combination with, Current Population Survey estimates 
     for the purposes described in paragraph (2)(B), the Secretary 
     of Health and Human Services may provide for a period during 
     which the Secretary may transition from carrying out such 
     purposes through the use of Current Population Survey 
     estimates to the use of American Community Survey estimates 
     (in lieu of, or in combination with the Current Population 
     Survey estimates, as recommended), provided that any such 
     transition is implemented in a manner that is designed to 
     avoid adverse impacts upon States with approved State child 
     health plans under this title.''.

     SEC. 605. DEFICIT REDUCTION ACT TECHNICAL CORRECTIONS.

       (a) State Flexibility in Benefit Packages.--
       (1) Clarification of requirement to provide epsdt services 
     for all children in benchmark benefit packages.--Section 
     1937(a)(1) (42 U.S.C. 1396u-7(a)(1)), as inserted by section 
     6044(a) of the Deficit Reduction Act of 2005 (Public Law 109-
     171, 120 Stat. 88), is amended--
       (A) in subparagraph (A)--
       (i) in the matter before clause (i), by striking 
     ``enrollment in coverage that provides'' and inserting 
     ``coverage that'';
       (ii) in clause (i), by inserting ``provides'' after 
     ``(i)''; and
       (iii) by striking clause (ii) and inserting the following:
       ``(ii) for any individual described in section 
     1905(a)(4)(B) who is eligible under the State plan in 
     accordance with paragraphs (10) and (17) of section 1902(a), 
     consists of the items and services described in section 
     1905(a)(4)(B) (relating to early and periodic screening, 
     diagnostic, and treatment services defined in section 
     1905(r)) and provided in accordance with the requirements of 
     section 1902(a)(43).'';
       (B) in subparagraph (C)--
       (i) in the heading, by striking ``wrap-around'' and 
     inserting ``additional''; and
       (ii) by striking ``wrap-around or''; and
       (C) by adding at the end the following new subparagraph:
       ``(E) Rule of construction.--Nothing in this paragraph 
     shall be construed as--
       ``(i) requiring a State to offer all or any of the items 
     and services required by subparagraph (A)(ii) through an 
     issuer of benchmark coverage described in subsection (b)(1) 
     or benchmark equivalent coverage described in subsection 
     (b)(2); or
       ``(ii) preventing a State from offering all or any of the 
     items and services required by subparagraph (A)(ii) through 
     an issuer of benchmark coverage described in subsection 
     (b)(1) or benchmark equivalent coverage described in 
     subsection (b)(2).''.
       (2) Correction of reference to children in foster care 
     receiving child welfare services.--Section 
     1937(a)(2)(B)(viii) (42 U.S.C. 1396u-7(a)(2)(B)(viii), as 
     inserted by section 6044(a) of the Deficit Reduction Act of 
     2005, is amended by striking ``aid or assistance is made 
     available under part B of title IV to children in foster care 
     and individuals'' and inserting ``child welfare services are 
     made available under part B of title IV on the basis of being 
     a child in foster care or''.
       (3) Transparency.--Section 1937 (42 U.S.C. 1396u-7), as 
     inserted by section 6044(a) of the Deficit Reduction Act of 
     2005, is amended by adding at the end the following:
       ``(c) Publication of Provisions Affected.--Not later than 
     30 days after the date the Secretary approves a State plan 
     amendment to provide benchmark benefits in accordance with 
     subsections (a) and (b), the Secretary shall publish in the 
     Federal Register and on the Internet website of the Centers 
     for Medicare & Medicaid Services, a list of the provisions of 
     this title that the Secretary has determined do not apply in 
     order to enable the State to carry out such plan amendment 
     and the reason for each such determination.''.
       (4) Effective date.--The amendments made by this subsection 
     shall take effect as if included in the amendment made by 
     section 6044(a) of the Deficit Reduction Act of 2005.

     SEC. 606. ELIMINATION OF CONFUSING PROGRAM REFERENCES.

       Section 704 of the Medicare, Medicaid, and SCHIP Balanced 
     Budget Refinement Act of 1999, as enacted into law by 
     division B of Public Law 106-113 (113 Stat. 1501A-402) is 
     repealed.

     SEC. 607. MENTAL HEALTH PARITY IN CHIP PLANS.

       (a) Assurance of Parity.--Section 2103(c) (42 U.S.C. 
     1397cc(c)) is amended--
       (1) by redesignating paragraph (5) as paragraph (6); and
       (2) by inserting after paragraph (4), the following:
       ``(5) Mental health services parity.--
       ``(A) In general.--In the case of a State child health plan 
     that provides both medical and surgical benefits and mental 
     health or substance abuse benefits, such plan shall ensure 
     that the financial requirements and treatment limitations 
     applicable to such mental health or substance abuse benefits 
     are no more restrictive than the financial requirements and 
     treatment limitations applied to substantially all medical 
     and surgical benefits covered by the plan.
       ``(B) Deemed compliance.--To the extent that a State child 
     health plan includes coverage with respect to an individual 
     described in section 1905(a)(4)(B) and covered under the 
     State plan under section 1902(a)(10)(A) of the services 
     described in section 1905(a)(4)(B) (relating to early and 
     periodic screening, diagnostic, and treatment services 
     defined in section 1905(r)) and provided in accordance with 
     section 1902(a)(43), such plan shall be deemed to satisfy the 
     requirements of subparagraph (A).''.
       (b) Conforming Amendments.--Section 2103 (42 U.S.C. 1397cc) 
     is amended--

[[Page 21671]]

       (1) in subsection (a), in the matter preceding paragraph 
     (1), by striking ``subsection (c)(5)'' and inserting 
     ``paragraphs (5) and (6) of subsection (c)''; and
       (2) in subsection (c)(2), by striking subparagraph (B) and 
     redesignating subparagraphs (C) and (D) as subparagraphs (B) 
     and (C), respectively.

     SEC. 608. DENTAL HEALTH GRANTS.

       Title XXI (42 U.S.C. 1397aa et seq.), as amended by section 
     201, is amended by adding at the end the following:

     ``SEC. 2114. DENTAL HEALTH GRANTS.

       ``(a) Authority To Award Grants.--
       ``(1) In general.--From the amount appropriated under 
     subsection (e), the Secretary shall award grants from amounts 
     to eligible States for the purpose of carrying out programs 
     and activities that are designed to improve the availability 
     of dental services and strengthen dental coverage for 
     targeted low-income children enrolled in State child health 
     plans.
       ``(2) Eligible state.--In this section, the term `eligible 
     State' means a State with an approved State child health plan 
     under this title that submits an application under subsection 
     (b) that is approved by Secretary.
       ``(b) Application.--An eligible State that desires to 
     receive a grant under this paragraph shall submit an 
     application to the Secretary in such form and manner, and 
     containing such information, as the Secretary may require. 
     Such application shall include--
       ``(1) a detailed description of the programs and activities 
     proposed to be conducted with funds awarded under the grant;
       ``(2) quality and outcomes performance measures to evaluate 
     the effectiveness of such activities; and
       ``(3) an assurance that the State shall--
       ``(A) conduct an assessment of the effectiveness of such 
     activities against such performance measures; and
       ``(B) cooperate with the collection and reporting of data 
     and other information determined as a result of conducting 
     such assessments to the Secretary, in such form and manner as 
     the Secretary shall require.
       ``(c) Maintenance of Effort for States Awarded Grants; No 
     State Match Required.--In the case of a State that is awarded 
     a grant under this section--
       ``(1) the State share of funds expended for dental services 
     under the State child health plan shall not be less than the 
     State share of such funds expended in the fiscal year 
     preceding the first fiscal year for which the grant is 
     awarded; and
       ``(2) no State matching funds shall be required for the 
     State to receive a grant under this section.
       ``(d) Annual Report.--The Secretary shall submit an annual 
     report to the appropriate committees of Congress regarding 
     the grants awarded under this section that includes--
       ``(1) State specific descriptions of the programs and 
     activities conducted with funds awarded under such grants; 
     and
       ``(2) information regarding the assessments required of 
     States under subsection (b)(3).
       ``(e) Appropriation.--Out of any funds in the Treasury not 
     otherwise appropriated, there is appropriated, $200,000,000 
     for the period of fiscal years 2008 through 2012, to remain 
     available until expended, for the purpose of awarding grants 
     to States under this section. Amounts appropriated and paid 
     under the authority of this section shall be in addition to 
     amounts appropriated under section 2104 and paid to States in 
     accordance with section 2105.''.

     SEC. 609. APPLICATION OF PROSPECTIVE PAYMENT SYSTEM FOR 
                   SERVICES PROVIDED BY FEDERALLY-QUALIFIED HEALTH 
                   CENTERS AND RURAL HEALTH CLINICS.

       (a) Application of Prospective Payment System.--
       (1) In general.--Section 2107(e)(1) (42 U.S.C. 
     1397gg(e)(1)), as amended by sections 204(b) and 503, is 
     amended by inserting after subparagraph (A) the following new 
     subparagraph (and redesignating the succeeding subparagraphs 
     accordingly):
       ``(B) Section 1902(bb) (relating to payment for services 
     provided by Federally-qualified health centers and rural 
     health clinics).''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall apply to services provided on or after October 1, 2008.
       (b) Transition Grants.--
       (1) Appropriation.--Out of any funds in the Treasury not 
     otherwise appropriated, there is appropriated to the 
     Secretary for fiscal year 2008, $5,000,000, to remain 
     available until expended, for the purpose of awarding grants 
     to States with State child health plans under CHIP that are 
     operated separately from the State Medicaid plan under title 
     XIX of the Social Security Act (including any waiver of such 
     plan), or in combination with the State Medicaid plan, for 
     expenditures related to transitioning to compliance with the 
     requirement of section 2107(e)(1)(B) of the Social Security 
     Act (as added by subsection (a)) to apply the prospective 
     payment system established under section 1902(bb) of the such 
     Act (42 U.S.C. 1396a(bb)) to services provided by Federally-
     qualified health centers and rural health clinics.
       (2) Monitoring and report.--The Secretary shall monitor the 
     impact of the application of such prospective payment system 
     on the States described in paragraph (1) and, not later than 
     October 1, 2010, shall report to Congress on any effect on 
     access to benefits, provider payment rates, or scope of 
     benefits offered by such States as a result of the 
     application of such payment system.

                     TITLE VII--REVENUE PROVISIONS

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

       (a) Cigars.--Section 5701(a) of the Internal Revenue Code 
     of 1986 is amended--
       (1) by striking ``$1.828 cents per thousand ($1.594 cents 
     per thousand on cigars removed during 2000 or 2001)'' in 
     paragraph (1) and inserting ``$50.00 per thousand'',
       (2) by striking ``20.719 percent (18.063 percent on cigars 
     removed during 2000 or 2001)'' in paragraph (2) and inserting 
     ``53.13 percent'', and
       (3) by striking ``$48.75 per thousand ($42.50 per thousand 
     on cigars removed during 2000 or 2001)'' in paragraph (2) and 
     inserting ``$10.00 per cigar''.
       (b) Cigarettes.--Section 5701(b) of such Code is amended--
       (1) by striking ``$19.50 per thousand ($17 per thousand on 
     cigarettes removed during 2000 or 2001)'' in paragraph (1) 
     and inserting ``$50.00 per thousand'', and
       (2) by striking ``$40.95 per thousand ($35.70 per thousand 
     on cigarettes removed during 2000 or 2001)'' in paragraph (2) 
     and inserting ``$104.9999 cents per thousand''.
       (c) Cigarette Papers.--Section 5701(c) of such Code is 
     amended by striking ``1.22 cents (1.06 cents on cigarette 
     papers removed during 2000 or 2001)'' and inserting ``3.13 
     cents''.
       (d) Cigarette Tubes.--Section 5701(d) of such Code is 
     amended by striking ``2.44 cents (2.13 cents on cigarette 
     tubes removed during 2000 or 2001)'' and inserting ``6.26 
     cents''.
       (e) Smokeless Tobacco.--Section 5701(e) of such Code is 
     amended--
       (1) by striking ``58.5 cents (51 cents on snuff removed 
     during 2000 or 2001)'' in paragraph (1) and inserting 
     ``$1.50'', and
       (2) by striking ``19.5 cents (17 cents on chewing tobacco 
     removed during 2000 or 2001)'' in paragraph (2) and inserting 
     ``50 cents''.
       (f) Pipe Tobacco.--Section 5701(f) of such Code is amended 
     by striking ``$1.0969 cents (95.67 cents on pipe tobacco 
     removed during 2000 or 2001)'' and inserting ``$2.8126 
     cents''.
       (g) Roll-Your-Own Tobacco.--Section 5701(g) of such Code is 
     amended by striking ``$1.0969 cents (95.67 cents on roll-
     your-own tobacco removed during 2000 or 2001)'' and inserting 
     ``$8.8889 cents''.
       (h) Floor Stocks Taxes.--
       (1) Imposition of tax.--On tobacco products and cigarette 
     papers and tubes manufactured in or imported into the United 
     States which are removed before January 1, 2008, and held on 
     such date for sale by any person, there is hereby imposed a 
     tax in an amount equal to the excess of--
       (A) the tax which would be imposed under section 5701 of 
     the Internal Revenue Code of 1986 on the article if the 
     article had been removed on such date, over
       (B) the prior tax (if any) imposed under section 5701 of 
     such Code on such article.
       (2) Credit against tax.--Each person shall be allowed as a 
     credit against the taxes imposed by paragraph (1) an amount 
     equal to $500. Such credit shall not exceed the amount of 
     taxes imposed by paragraph (1) on January 1, 2008, for which 
     such person is liable.
       (3) Liability for tax and method of payment.--
       (A) Liability for tax.--A person holding tobacco products, 
     cigarette papers, or cigarette tubes on January 1, 2008, to 
     which any tax imposed by paragraph (1) applies shall be 
     liable for such tax.
       (B) Method of payment.--The tax imposed by paragraph (1) 
     shall be paid in such manner as the Secretary shall prescribe 
     by regulations.
       (C) Time for payment.--The tax imposed by paragraph (1) 
     shall be paid on or before April 1, 2008.
       (4) Articles in foreign trade zones.--Notwithstanding the 
     Act of June 18, 1934 (commonly known as the Foreign Trade 
     Zone Act, 48 Stat. 998, 19 U.S.C. 81a et seq.) or any other 
     provision of law, any article which is located in a foreign 
     trade zone on January 1, 2008, shall be subject to the tax 
     imposed by paragraph (1) if--
       (A) internal revenue taxes have been determined, or customs 
     duties liquidated, with respect to such article before such 
     date pursuant to a request made under the 1st proviso of 
     section 3(a) of such Act, or
       (B) such article is held on such date under the supervision 
     of an officer of the United States Customs and Border 
     Protection of the Department of Homeland Security pursuant to 
     the 2d proviso of such section 3(a).
       (5) Definitions.--For purposes of this subsection--
       (A) In general.--Any term used in this subsection which is 
     also used in section 5702 of the Internal Revenue Code of 
     1986 shall have the same meaning as such term has in such 
     section.
       (B) Secretary.--The term ``Secretary'' means the Secretary 
     of the Treasury or the Secretary's delegate.
       (6) Controlled groups.--Rules similar to the rules of 
     section 5061(e)(3) of such Code shall apply for purposes of 
     this subsection.

[[Page 21672]]

       (7) Other laws applicable.--All provisions of law, 
     including penalties, applicable with respect to the taxes 
     imposed by section 5701 of such Code shall, insofar as 
     applicable and not inconsistent with the provisions of this 
     subsection, apply to the floor stocks taxes imposed by 
     paragraph (1), to the same extent as if such taxes were 
     imposed by such section 5701. The Secretary may treat any 
     person who bore the ultimate burden of the tax imposed by 
     paragraph (1) as the person to whom a credit or refund under 
     such provisions may be allowed or made.
       (i) Effective Date.--The amendments made by this section 
     shall apply to articles removed (as defined in section 
     5702(j) of the Internal Revenue Code of 1986) after December 
     31, 2007.

     SEC. 702. ADMINISTRATIVE IMPROVEMENTS.

       (a) Permit, Report, and Record Requirements for 
     Manufacturers and Importers of Processed Tobacco.--
       (1) Permits.--
       (A) Application.--Section 5712 of the Internal Revenue Code 
     of 1986 is amended by inserting ``or processed tobacco'' 
     after ``tobacco products''.
       (B) Issuance.--Section 5713(a) of such Code is amended by 
     inserting ``or processed tobacco'' after ``tobacco 
     products''.
       (2) Inventories and reports.--
       (A) Inventories.--Section 5721 of such Code is amended by 
     inserting ``, processed tobacco,'' after ``tobacco 
     products''.
       (B) Reports.--Section 5722 of such Code is amended by 
     inserting ``, processed tobacco,'' after ``tobacco 
     products''.
       (3) Records.--Section 5741 of such Code is amended by 
     inserting ``, processed tobacco,'' after ``tobacco 
     products''.
       (4) Manufacturer of processed tobacco.--Section 5702 of 
     such Code is amended by adding at the end the following new 
     subsection:
       ``(p) Manufacturer of Processed Tobacco.--
       ``(1) In general.--The term `manufacturer of processed 
     tobacco' means any person who processes any tobacco other 
     than tobacco products.
       ``(2) Processed tobacco.--The processing of tobacco shall 
     not include the farming or growing of tobacco or the handling 
     of tobacco solely for sale, shipment, or delivery to a 
     manufacturer of tobacco products or processed tobacco.''.
       (5) Conforming amendment.--Section 5702(k) of such Code is 
     amended by inserting ``, or any processed tobacco,'' after 
     ``nontaxpaid tobacco products or cigarette papers or tubes''.
       (6) Effective date.--The amendments made by this subsection 
     shall take effect on January 1, 2008.
       (b) Basis for Denial, Suspension, or Revocation of 
     Permits.--
       (1) Denial.--Paragraph (3) of section 5712 of such Code is 
     amended to read as follows:
       ``(3) Such person (including, in the case of a corporation, 
     any officer, director, or principal stockholder and, in the 
     case of a partnership, a partner)--
       ``(A) Is, by reason of his business experience, financial 
     standing, or trade connections or by reason of previous or 
     current legal proceedings involving a felony violation of any 
     other provision of Federal criminal law relating to tobacco 
     products, cigarette paper, or cigarette tubes, not likely to 
     maintain operations in compliance with this chapter,
       ``(B) Has been convicted of a felony violation of any 
     provision of Federal or State criminal law relating to 
     tobacco products, cigarette paper, or cigarette tubes, or
       ``(C) Has failed to disclose any material information 
     required or made any material false statement in the 
     application therefor.''.
       (2) Suspension or revocation.--Subsection (b) of section 
     5713 of such Code is amended to read as follows:
       ``(b) Suspension or Revocation.--
       ``(1) Show cause hearing.--If the Secretary has reason to 
     believe that any person holding a permit--
       ``(A) has not in good faith complied with this chapter, or 
     with any other provision of this title involving intent to 
     defraud,
       ``(B) has violated the conditions of such permit,
       ``(C) has failed to disclose any material information 
     required or made any material false statement in the 
     application for such permit,
       ``(D) has failed to maintain his premises in such manner as 
     to protect the revenue,
       ``(E) is, by reason of previous or current legal 
     proceedings involving a felony violation of any other 
     provision of Federal criminal law relating to tobacco 
     products, cigarette paper, or cigarette tubes, not likely to 
     maintain operations in compliance with this chapter, or
       ``(F) has been convicted of a felony violation of any 
     provision of Federal or State criminal law relating to 
     tobacco products, cigarette paper, or cigarette tubes,
     the Secretary shall issue an order, stating the facts 
     charged, citing such person to show cause why his permit 
     should not be suspended or revoked.
       ``(2) Action following hearing.--If, after hearing, the 
     Secretary finds that such person has not shown cause why his 
     permit should not be suspended or revoked, such permit shall 
     be suspended for such period as the Secretary deems proper or 
     shall be revoked.''.
       (c) Application of Internal Revenue Code Statute of 
     Limitations for Alcohol and Tobacco Excise Taxes.--Section 
     514(a) of the Tariff Act of 1930 (19 U.S.C. 1514(a)) is 
     amended by striking ``and section 520 (relating to refunds)'' 
     and inserting ``section 520 (relating to refunds), and 
     section 6501 of the Internal Revenue Code of 1986 (but only 
     with respect to taxes imposed under chapters 51 and 52 of 
     such Code)''.
       (d) Expansion of Definition of Roll-Your-Own Tobacco.--
       (1) In general.--Section 5702(o) of the Internal Revenue 
     Code of 1986 is amended by inserting ``or cigars, or for use 
     as wrappers thereof'' before the period at the end.
       (2) Effective date.--The amendment made by this subsection 
     shall apply to articles removed (as defined in section 
     5702(j) of the Internal Revenue Code of 1986) after December 
     31, 2007.
       (e) Time of Tax for Unlawfully Manufactured Tobacco 
     Products.--Section 5703(b)(2) of such Code is amended by 
     adding at the end the following new subparagraph:
       ``(F) Special rule for unlawfully manufactured tobacco 
     products.--In the case of any tobacco products, cigarette 
     paper, or cigarette tubes produced in the United States at 
     any place other than the premises of a manufacturer of 
     tobacco products, cigarette paper, or cigarette tubes that 
     has filed the bond and obtained the permit required under 
     this chapter, tax shall be due and payable immediately upon 
     manufacture.''.

     SEC. 703. TIME FOR PAYMENT OF CORPORATE ESTIMATED TAXES.

       Subparagraph (B) of section 401(1) of the Tax Increase 
     Prevention and Reconciliation Act of 2005 is amended by 
     striking ``114.50 percent'' and inserting ``113.25 percent''.

                       TITLE VIII--EFFECTIVE DATE

     SEC. 801. EFFECTIVE DATE.

       (a) In General.--Unless otherwise provided in this Act, 
     subject to subsection (b), the amendments made by this Act 
     shall take effect on October 1, 2007, and shall apply to 
     child health assistance and medical assistance provided on or 
     after that date without regard to whether or not final 
     regulations to carry out such amendments have been 
     promulgated by such date.
       (b) Exception for State Legislation.--In the case of a 
     State plan under title XIX or XXI of the Social Security Act, 
     which the Secretary determines requires State legislation in 
     order for the plan to meet the additional requirements 
     imposed by an amendment made by this Act, the State plan 
     shall not be regarded as failing to comply with the 
     requirements of such Act solely on the basis of its failure 
     to meet these additional requirements before the first day of 
     the first calendar quarter beginning after the close of the 
     first regular session of the State legislature that begins 
     after the date of enactment of this Act. For purposes of the 
     preceding sentence, in the case of a State that has a 2-year 
     legislative session, each year of the session shall be 
     considered to be a separate regular session of the State 
     legislature.
                                 ______
                                 
  SA 2531. Mr. MARTINEZ submitted an amendment intended to be proposed 
to amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other puuposes; which was ordered to lie on the 
table; as follows:

       On page 217, after line 25, insert the following:

     SEC. _. CREDITS FOR HURRICANE AND TORNADO MITIGATION 
                   EXPENDITURES.

       (a) Nonrefundable Personal Credit for Hurricane and Tornado 
     Mitigation Property.--
       (1) In general.--Subpart A of part IV of subchapter A of 
     chapter 1 of the Internal Revenue Code of 1986 is amended by 
     inserting after section 25D the following new section:

     ``SEC. 25E. HURRICANE AND TORNADO MITIGATION PROPERTY.

       ``(a) Allowance of Credit.--In the case of an individual, 
     there shall be allowed as a credit against the tax imposed by 
     this chapter for the taxable year an amount equal to 25 
     percent of the qualified hurricane and tornado mitigation 
     property expenditures made by the taxpayer during such 
     taxable year.
       ``(b) Maximum Credit.--The credit allowed under subsection 
     (a) for any taxable year shall not exceed $5,000.
       ``(c) Qualified Hurricane and Tornado Mitigation 
     Expenditure.--For purposes of this section--
       ``(1) In general.--The term `qualified hurricane and 
     tornado mitigation property expenditure' means an expenditure 
     for property--
       ``(A) to improve the strength of a roof deck attachment,
       ``(B) to create a secondary water barrier to prevent water 
     intrusion,
       ``(C) to improve the durability of a roof covering,
       ``(D) to brace gable-end walls,
       ``(E) to reinforce the connection between a roof and 
     supporting wall,
       ``(F) to protect openings from penetration by windborne 
     debris, or

[[Page 21673]]

       ``(G) to protect exterior doors and garages,
     in a qualified dwelling unit owned by the taxpayer.
       ``(2) Qualified dwelling unit.--The term `qualified 
     dwelling unit' means a dwelling unit that is assessed at a 
     value that is less than $1,000,000 by the locality in which 
     such dwelling unit is located and with respect to the taxable 
     year for which the credit described in subsection (a) is 
     allowed.
       ``(d) Limitation.--An expenditure shall be taken into 
     account in determining the qualified hurricane and tornado 
     mitigation property expenditures made by the taxpayer during 
     the taxable year only if the onsite preparation, assembly, or 
     original installation of the property with respect to which 
     such expenditure is made has been completed in a manner that 
     is deemed to be adequate by a State-certified inspector.
       ``(e) Labor Costs.--For purposes of this section, 
     expenditures for labor costs properly allocable to the onsite 
     preparation, assembly, or original installation of the 
     property described in subsection (c) shall be taken into 
     account in determining the qualified hurricane and tornado 
     mitigation property expenditures made by the taxpayer during 
     the taxable year.
       ``(f) Inspection Costs.--For purposes of this section, 
     expenditures for inspection costs properly allocable to the 
     inspection of the preparation, assembly, or installation of 
     the property described in subsection (c) shall be taken into 
     account in determining the qualified hurricane and tornado 
     mitigation property expenditures made by the taxpayer during 
     the taxable year.''.
       (2) Conforming amendment.--The table of sections for 
     subpart A of part IV of subchapter A of chapter 1 of such 
     Code is amended by inserting after the item relating to 
     section 25D the following new item:

``Sec. 25E. Hurricane and tornado mitigation property.''.
       (3) Effective date.--The amendments made by this subsection 
     shall apply to taxable years beginning after December 31, 
     2007.
       (b) Business Related Credit for Hurricane and Tornado 
     Mitigation.--
       (1) In general.--Subpart D of part IV of subchapter A of 
     chapter 1 of the Internal Revenue Code of 1986 is amended by 
     inserting after section 45N the following new section:

     ``SEC. 45O. HURRICANE AND TORNADO MITIGATION CREDIT.

       ``(a) General Rule.--For purposes of section 38, the 
     hurricane and tornado mitigation credit determined under this 
     section for any taxable year is an amount equal to 25 percent 
     of the qualified hurricane and tornado mitigation property 
     expenditures made by the taxpayer during the taxable year.
       ``(b) Maximum Credit.--The amount of the credit determined 
     under subsection (a) for any taxable year shall not exceed 
     $5,000.
       ``(c) Qualified Hurricane and Tornado Mitigation 
     Expenditure.--For purposes of this section--
       ``(1) In general.--The term `qualified hurricane and 
     tornado mitigation property expenditure' means an expenditure 
     for property--
       ``(A) to improve the strength of a roof deck attachment,
       ``(B) to create a secondary water barrier to prevent water 
     intrusion,
       ``(C) to improve the durability of a roof covering,
       ``(D) to brace gable-end walls,
       ``(E) to reinforce the connection between a roof and 
     supporting wall,
       ``(F) to protect openings from penetration by windborne 
     debris, or
       ``(G) to protect exterior doors and garages,
     in a qualified place of business owned by the taxpayer.
       ``(2) Qualified place of business.--The term `qualified 
     place of business' means a place of business that is assessed 
     at a value that is less than $5,000,000 by the locality in 
     which such business is located and with respect to the 
     taxable year for which the credit described in subsection (a) 
     is allowed.
       ``(d) Limitation.--An expenditure shall be taken into 
     account in determining the qualified hurricane and tornado 
     mitigation property expenditures made by the taxpayer during 
     the taxable year only if the onsite preparation, assembly, or 
     original installation of the property with respect to which 
     such expenditure is made has been completed in a manner that 
     is deemed to be adequate by a State-certified inspector.
       ``(e) Labor Costs.--For purposes of this section, 
     expenditures for labor costs properly allocable to the onsite 
     preparation, assembly, or original installation of the 
     property described in subsection (c) shall be taken into 
     account in determining the qualified hurricane and tornado 
     mitigation property expenditures made by the taxpayer during 
     the taxable year.
       ``(f) Inspection Costs.--For purposes of this section, 
     expenditures for inspection costs properly allocable to the 
     inspection of the preparation, assembly, or installation of 
     the property described in subsection (c) shall be taken into 
     account in determining the qualified hurricane and tornado 
     mitigation property expenditures made by the taxpayer during 
     the taxable year.''.
       (2) Conforming amendments.--
       (A) Section 38(b) of such Code is amended by striking 
     ``plus'' at the end of paragraph (30), by striking the period 
     at the end of paragraph (31) and inserting ``, plus'', and by 
     adding at the end the following new paragraph:
       ``(32) the hurricane and tornado mitigation credit 
     determined under section 45O(a).''.
       (B) The table of sections for subpart D of part IV of 
     subchapter A of chapter 1 of such Code is amended by 
     inserting after the item relating to section 45N the 
     following new item:

``Sec. 45O. Hurricane and tornado mitigation credit.''.

       (3) Effective date.--The amendments made by this subsection 
     shall apply to taxable years beginning after December 31, 
     2007.
                                 ______
                                 
  SA 2532. Mr. MARTINEZ (for himself and Mr. Vitter) submitted an 
amendment intended to be proposed to amendment SA 2530 proposed by Mr. 
Baucus (for himself, Mr. Grassley, Mr. Rockefeller, and Mr. Hatch) to 
the bill H.R. 976, to amend the Internal Revenue Code of 1986 to 
provide tax relief for small businesses, and for other purposes; which 
was ordered to lie on the table; as follows:

       On page 217, after line 25, insert the following:

     SEC. 61_. CREDIT FOR QUALIFIED ELEMENTARY AND SECONDARY 
                   EDUCATION TUITION.

       (a) In General.--Subpart A of part IV of subchapter A of 
     chapter 1 of the Internal Revenue Code of 1986 (relating to 
     nonrefundable personal credits) is amended by inserting after 
     section 25D the following new section:

     ``SEC. 25E. QUALIFIED ELEMENTARY AND SECONDARY EDUCATION 
                   TUITION.

       ``(a) Allowance of Credit.--There shall be allowed as a 
     credit against the tax imposed by this chapter for a taxable 
     year an amount equal to the qualified elementary and 
     secondary education tuition paid or incurred by the taxpayer 
     during the taxable year.
       ``(b) Dollar Limitation.--The amount allowed as a credit 
     under subsection (a) with respect to the taxpayer for any 
     taxable year shall not exceed--
       ``(1) $4,500 in the case of a joint return,
       ``(2) $4,500 in the case of an individual who is not 
     married, and
       ``(3) $2,250 in the case of a married individual filing a 
     separate return.
       ``(c) Qualified Elementary and Secondary Education 
     Tuition.--
       ``(1) In general.--The term `qualified elementary and 
     secondary education tuition' means expenses for tuition which 
     are incurred in connection with the enrollment or attendance 
     of any dependent of the taxpayer with respect to whom the 
     taxpayer is allowed a deduction under section 151 as an 
     elementary or secondary school student at a private or 
     religious school.
       ``(2) School.--The term `school' means any school which 
     provides elementary education or secondary education 
     (kindergarten through grade 12), as determined under State 
     law.''.
       (b) Clerical Amendment.--The table of sections for subpart 
     A of part IV of subchapter A of chapter 1 of such Code is 
     amended by inserting after the item relating to section 25D 
     the following new item:

``Sec. 25E. Qualified elementary and secondary education tuition.''.

       (c) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2006.
                                 ______
                                 
  SA 2533. Mr. MARTINEZ submitted an amendment intended to be proposed 
to amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 217, after line 25, insert the following:

     SEC. 61_. SPACEPORTS TREATED LIKE AIRPORTS UNDER EXEMPT 
                   FACILITY BOND RULES.

       (a) In General.--Paragraph (1) of section 142(a) of the 
     Internal Revenue Code of 1986 (relating to exempt facility 
     bonds) is amended to read as follows:
       ``(1) airports and spaceports,''.
       (b) Treatment of Ground Leases.--Paragraph (1) of section 
     142(b) of the Internal Revenue Code of 1986 (relating to 
     certain facilities must be governmentally owned) is amended 
     by adding at the end the following new subparagraph:
       ``(C) Special rule for spaceport ground leases.--For 
     purposes of subparagraph (A), spaceport property which is 
     located on land owned by the United States and which is used 
     by a governmental unit pursuant to a lease (as defined in 
     section 168(h)(7)) from the United States shall be treated as 
     owned by such unit if--
       ``(i) the lease term (within the meaning of section 
     168(i)(3)) is at least 15 years, and
       ``(ii) such unit would be treated as owning such property 
     if such lease term were equal to the useful life of such 
     property.''.
       (c) Definition of Spaceport.--Section 142 of the Internal 
     Revenue Code of 1986 is amended by adding at the end the 
     following new subsection:

[[Page 21674]]

       ``(n) Spaceport.--
       ``(1) In general.--For purposes of subsection (a)(1), the 
     term `spaceport' means--
       ``(A) any facility directly related and essential to 
     servicing spacecraft, enabling spacecraft to launch or 
     reenter, or transferring passengers or space cargo to or from 
     spacecraft, but only if such facility is located at, or in 
     close proximity to, the launch site or reentry site, and
       ``(B) any other functionally related and subordinate 
     facility at or adjacent to the launch site or reentry site at 
     which launch services or reentry services are provided, 
     including a launch control center, repair shop, maintenance 
     or overhaul facility, and rocket assembly facility.
       ``(2) Additional terms.--For purposes of paragraph (1)--
       ``(A) Space cargo.--The term `space cargo' includes 
     satellites, scientific experiments, other property 
     transported into space, and any other type of payload, 
     whether or not such property returns from space.
       ``(B) Spacecraft.--The term `spacecraft' means a launch 
     vehicle or a reentry vehicle.
       ``(C) Other terms.--The terms `launch', `launch site', 
     `launch services', `launch vehicle', `payload', `reenter', 
     `reentry services', `reentry site', and `reentry vehicle' 
     shall have the respective meanings given to such terms by 
     section 70102 of title 49, United States Code (as in effect 
     on the date of enactment of this subsection).''.
       (d) Exception From Federally Guaranteed Bond Prohibition.--
     Paragraph (3) of section 149(b) of the Internal Revenue Code 
     of 1986 (relating to exceptions) is amended by adding at the 
     end the following new subparagraph:
       ``(E) Exception for spaceports.--Paragraph (1) shall not 
     apply to any exempt facility bond issued as part of an issue 
     described in paragraph (1) of section 142(a) to provide a 
     spaceport in situations where--
       ``(i) the guarantee of the United States (or an agency or 
     instrumentality thereof) is the result of payment of rent, 
     user fees, or other charges by the United States (or any 
     agency or instrumentality thereof), and
       ``(ii) the payment of the rent, user fees, or other charges 
     is for, and conditioned upon, the use of the spaceport by the 
     United States (or any agency or instrumentality thereof).''.
       (e) Conforming Amendment.--The heading for section 142(c) 
     of the Internal Revenue Code of 1986 is amended by inserting 
     ``Spaceports,'' after ``Airports,''.
       (f) Effective Date.--The amendments made by this section 
     shall apply to obligations issued after the date of the 
     enactment of this Act.
                                 ______
                                 
  SA 2534. Mr. DORGAN (for himself, Mr. Johnson, Ms. Murkowski, Mr. 
Stevens, and Mr. Bingaman) submitted an amendment intended to be 
proposed to amendment SA 2530 proposed by Mr. Baucus ( for himself, Mr. 
Grassley, Mr. Rockefeller, and Mr. Hatch) to the bill H.R 976, to amend 
the Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; as follows:

       At the end, add the following:

                TITLE __--INDIAN HEALTH CARE IMPROVEMENT

     SEC. _01. SHORT TITLE.

       This title may be cited as the ``Indian Health Care 
     Improvement Act Amendments of 2007''.

                 Subtitle A--Amendments to Indian Laws

     SEC. _11. INDIAN HEALTH CARE IMPROVEMENT ACT AMENDED.

       (a) In General.--The Indian Health Care Improvement Act (25 
     U.S.C. 1601 et seq.) is amended to read as follows:

     ``SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       ``(a) Short Title.--This Act may be cited as the `Indian 
     Health Care Improvement Act'.
       ``(b) Table of Contents.--The table of contents for this 
     Act is as follows:

``Sec. 1. Short title; table of contents.
``Sec. 2. Findings.
``Sec. 3. Declaration of national Indian health policy.
``Sec. 4. Definitions.

       ``TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT

``Sec. 101. Purpose.
``Sec. 102. Health professions recruitment program for Indians.
``Sec. 103. Health professions preparatory scholarship program for 
              Indians.
``Sec. 104. Indian health professions scholarships.
``Sec. 105. American Indians Into Psychology Program.
``Sec. 106. Scholarship programs for Indian Tribes.
``Sec. 107. Indian Health Service extern programs.
``Sec. 108. Continuing education allowances.
``Sec. 109. Community Health Representative Program.
``Sec. 110. Indian Health Service Loan Repayment Program.
``Sec. 111. Scholarship and Loan Repayment Recovery Fund.
``Sec. 112. Recruitment activities.
``Sec. 113. Indian recruitment and retention program.
``Sec. 114. Advanced training and research.
``Sec. 115. Quentin N. Burdick American Indians Into Nursing Program.
``Sec. 116. Tribal cultural orientation.
``Sec. 117. INMED Program.
``Sec. 118. Health training programs of community colleges.
``Sec. 119. Retention bonus.
``Sec. 120. Nursing residency program.
``Sec. 121. Community Health Aide Program.
``Sec. 122. Tribal Health Program administration.
``Sec. 123. Health professional chronic shortage demonstration 
              programs.
``Sec. 124. National Health Service Corps.
``Sec. 125. Substance abuse counselor educational curricula 
              demonstration programs.
``Sec. 126. Behavioral health training and community education 
              programs.
``Sec. 127. Authorization of appropriations.

                      ``TITLE II--HEALTH SERVICES

``Sec. 201. Indian Health Care Improvement Fund.
``Sec. 202. Catastrophic Health Emergency Fund.
``Sec. 203. Health promotion and disease prevention services.
``Sec. 204. Diabetes prevention, treatment, and control.
``Sec. 205. Shared services for long-term care.
``Sec. 206. Health services research.
``Sec. 207. Mammography and other cancer screening.
``Sec. 208. Patient travel costs.
``Sec. 209. Epidemiology centers.
``Sec. 210. Comprehensive school health education programs.
``Sec. 211. Indian youth program.
``Sec. 212. Prevention, control, and elimination of communicable and 
              infectious diseases.
``Sec. 213. Other authority for provision of services.
``Sec. 214. Indian women's health care.
``Sec. 215. Environmental and nuclear health hazards.
``Sec. 216. Arizona as a contract health service delivery area.
``Sec. 216A. North Dakota and South Dakota as contract health service 
              delivery area.
``Sec. 217. California contract health services program.
``Sec. 218. California as a contract health service delivery area.
``Sec. 219. Contract health services for the Trenton service area.
``Sec. 220. Programs operated by Indian Tribes and Tribal 
              Organizations.
``Sec. 221. Licensing.
``Sec. 222. Notification of provision of emergency contract health 
              services.
``Sec. 223. Prompt action on payment of claims.
``Sec. 224. Liability for payment.
``Sec. 225. Office of Indian Men's Health.
``Sec. 226. Authorization of appropriations.

                        ``TITLE III--FACILITIES

``Sec. 301. Consultation; construction and renovation of facilities; 
              reports.
``Sec. 302. Sanitation facilities.
``Sec. 303. Preference to Indians and Indian firms.
``Sec. 304. Expenditure of non-Service funds for renovation.
``Sec. 305. Funding for the construction, expansion, and modernization 
              of small ambulatory care facilities.
``Sec. 306. Indian health care delivery demonstration projects.
``Sec. 307. Land transfer.
``Sec. 308. Leases, contracts, and other agreements.
``Sec. 309. Study on loans, loan guarantees, and loan repayment.
``Sec. 310. Tribal leasing.
``Sec. 311. Indian Health Service/tribal facilities joint venture 
              program.
``Sec. 312. Location of facilities.
``Sec. 313. Maintenance and improvement of health care facilities.
``Sec. 314. Tribal management of Federally-owned quarters.
``Sec. 315. Applicability of Buy American Act requirement.
``Sec. 316. Other funding for facilities.
``Sec. 317. Authorization of appropriations.

                 ``TITLE IV--ACCESS TO HEALTH SERVICES

``Sec. 401. Treatment of payments under Social Security Act health 
              benefits programs.
``Sec. 402. Grants to and contracts with the Service, Indian Tribes, 
              Tribal Organizations, and Urban Indian Organizations to 
              facilitate outreach, enrollment, and coverage of Indians 
              under Social Security Act health benefit programs and 
              other health benefits programs.
``Sec. 403. Reimbursement from certain third parties of costs of health 
              services.
``Sec. 404. Crediting of reimbursements.
``Sec. 405. Purchasing health care coverage.
``Sec. 406. Sharing arrangements with Federal agencies.

[[Page 21675]]

``Sec. 407. Payor of last resort.
``Sec. 408. Nondiscrimination under Federal health care programs in 
              qualifications for reimbursement for services.
``Sec. 409. Consultation.
``Sec. 410. State Children's Health Insurance Program (SCHIP).
``Sec. 411. Exclusion waiver authority for affected Indian Health 
              Programs and safe harbor transactions under the Social 
              Security Act.
``Sec. 412. Premium and cost sharing protections and eligibility 
              determinations under Medicaid and SCHIP and protection of 
              certain Indian property from Medicaid estate recovery.
``Sec. 413. Treatment under Medicaid and SCHIP managed care.
``Sec. 414. Navajo Nation Medicaid Agency feasibility study.
``Sec. 415. General exceptions.
``Sec. 416. Authorization of appropriations.

              ``TITLE V--HEALTH SERVICES FOR URBAN INDIANS

``Sec. 501. Purpose.
``Sec. 502. Contracts with, and grants to, Urban Indian Organizations.
``Sec. 503. Contracts and grants for the provision of health care and 
              referral services.
``Sec. 504. Contracts and grants for the determination of unmet health 
              care needs.
``Sec. 505. Evaluations; renewals.
``Sec. 506. Other contract and grant requirements.
``Sec. 507. Reports and records.
``Sec. 508. Limitation on contract authority.
``Sec. 509. Facilities.
``Sec. 510. Division of Urban Indian Health.
``Sec. 511. Grants for alcohol and substance abuse-related services.
``Sec. 512. Treatment of certain demonstration projects.
``Sec. 513. Urban NIAAA transferred programs.
``Sec. 514. Conferring with Urban Indian Organizations.
``Sec. 515. Urban youth treatment center demonstration.
``Sec. 516. Grants for diabetes prevention, treatment, and control.
``Sec. 517. Community Health Representatives.
``Sec. 518. Effective date.
``Sec. 519. Eligibility for services.
``Sec. 520. Further authorizations.
``Sec. 521. Authorization of appropriations.

                ``TITLE VI--ORGANIZATIONAL IMPROVEMENTS

``Sec. 601. Establishment of the Indian Health Service as an agency of 
              the Public Health Service.
``Sec. 602. Automated management information system.
``Sec. 603. Authorization of appropriations.

                ``TITLE VII--BEHAVIORAL HEALTH PROGRAMS

``Sec. 701. Behavioral health prevention and treatment services.
``Sec. 702. Memoranda of agreement with the Department of the Interior.
``Sec. 703. Comprehensive behavioral health prevention and treatment 
              program.
``Sec. 704. Mental health technician program.
``Sec. 705. Licensing requirement for mental health care workers.
``Sec. 706. Indian women treatment programs.
``Sec. 707. Indian youth program.
``Sec. 708. Indian youth telemental health demonstration project.
``Sec. 709. Inpatient and community-based mental health facilities 
              design, construction, and staffing.
``Sec. 710. Training and community education.
``Sec. 711. Behavioral health program.
``Sec. 712. Fetal alcohol spectrum disorders programs.
``Sec. 713. Child sexual abuse and prevention treatment programs.
``Sec. 714. Domestic and sexual violence prevention and treatment.
``Sec. 715. Behavioral health research.
``Sec. 716. Definitions.
``Sec. 717. Authorization of appropriations.

                      ``TITLE VIII--MISCELLANEOUS

``Sec. 801. Reports.
``Sec. 802. Regulations.
``Sec. 803. Plan of implementation.
``Sec. 804. Availability of funds.
``Sec. 805. Limitation on use of funds appropriated to Indian Health 
              Service.
``Sec. 806. Eligibility of California Indians.
``Sec. 807. Health services for ineligible persons.
``Sec. 808. Reallocation of base resources.
``Sec. 809. Results of demonstration projects.
``Sec. 810. Provision of services in Montana.
``Sec. 811. Moratorium.
``Sec. 812. Tribal employment.
``Sec. 813. Severability provisions.
``Sec. 814. Establishment of National Bipartisan Commission on Indian 
              Health Care.
``Sec. 815. Confidentiality of medical quality assurance records; 
              qualified immunity for participants.
``Sec. 816. Appropriations; availability.
``Sec. 817. Authorization of appropriations.

     ``SEC. 2. FINDINGS.

       ``Congress makes the following findings:
       ``(1) Federal health services to maintain and improve the 
     health of the Indians are consonant with and required by the 
     Federal Government's historical and unique legal relationship 
     with, and resulting responsibility to, the American Indian 
     people.
       ``(2) A major national goal of the United States is to 
     provide the resources, processes, and structure that will 
     enable Indian Tribes and tribal members to obtain the 
     quantity and quality of health care services and 
     opportunities that will eradicate the health disparities 
     between Indians and the general population of the United 
     States.
       ``(3) A major national goal of the United States is to 
     provide the quantity and quality of health services which 
     will permit the health status of Indians to be raised to the 
     highest possible level and to encourage the maximum 
     participation of Indians in the planning and management of 
     those services.
       ``(4) Federal health services to Indians have resulted in a 
     reduction in the prevalence and incidence of preventable 
     illnesses among, and unnecessary and premature deaths of, 
     Indians.
       ``(5) Despite such services, the unmet health needs of the 
     American Indian people are severe and the health status of 
     the Indians is far below that of the general population of 
     the United States.

     ``SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POLICY.

       ``Congress declares that it is the policy of this Nation, 
     in fulfillment of its special trust responsibilities and 
     legal obligations to Indians--
       ``(1) to assure the highest possible health status for 
     Indians and Urban Indians and to provide all resources 
     necessary to effect that policy;
       ``(2) to raise the health status of Indians and Urban 
     Indians to at least the levels set forth in the goals 
     contained within the Healthy People 2010 or successor 
     objectives;
       ``(3) to ensure maximum Indian participation in the 
     direction of health care services so as to render the persons 
     administering such services and the services themselves more 
     responsive to the needs and desires of Indian communities;
       ``(4) to increase the proportion of all degrees in the 
     health professions and allied and associated health 
     professions awarded to Indians so that the proportion of 
     Indian health professionals in each Service Area is raised to 
     at least the level of that of the general population;
       ``(5) to require that all actions under this Act shall be 
     carried out with active and meaningful consultation with 
     Indian Tribes and Tribal Organizations, and conference with 
     Urban Indian Organizations, to implement this Act and the 
     national policy of Indian self-determination;
       ``(6) to ensure that the United States and Indian Tribes 
     work in a government-to-government relationship to ensure 
     quality health care for all tribal members; and
       ``(7) to provide funding for programs and facilities 
     operated by Indian Tribes and Tribal Organizations in amounts 
     that are not less than the amounts provided to programs and 
     facilities operated directly by the Service.

     ``SEC. 4. DEFINITIONS.

       ``For purposes of this Act:
       ``(1) The term `accredited and accessible' means on or near 
     a reservation and accredited by a national or regional 
     organization with accrediting authority.
       ``(2) The term `Area Office' means an administrative 
     entity, including a program office, within the Service 
     through which services and funds are provided to the Service 
     Units within a defined geographic area.
       ``(3) The term `Assistant Secretary' means the Assistant 
     Secretary for Indian Health.
       ``(4)(A) The term `behavioral health' means the blending of 
     substance (alcohol, drugs, inhalants, and tobacco) abuse and 
     mental health prevention and treatment, for the purpose of 
     providing comprehensive services.
       ``(B) The term `behavioral health' includes the joint 
     development of substance abuse and mental health treatment 
     planning and coordinated case management using a 
     multidisciplinary approach.
       ``(5) The term `California Indians' means those Indians who 
     are eligible for health services of the Service pursuant to 
     section 806.
       ``(6) The term `community college' means--
       ``(A) a tribal college or university, or
       ``(B) a junior or community college.
       ``(7) The term `contract health service' means health 
     services provided at the expense of the Service or a Tribal 
     Health Program by public or private medical providers or 
     hospitals, other than the Service Unit or the Tribal Health 
     Program at whose expense the services are provided.
       ``(8) The term `Department' means, unless otherwise 
     designated, the Department of Health and Human Services.
       ``(9) The term `disease prevention' means the reduction, 
     limitation, and prevention of disease and its complications 
     and reduction in the consequences of disease, including--
       ``(A) controlling--
       ``(i) the development of diabetes;
       ``(ii) high blood pressure;
       ``(iii) infectious agents;

[[Page 21676]]

       ``(iv) injuries;
       ``(v) occupational hazards and disabilities;
       ``(vi) sexually transmittable diseases; and
       ``(vii) toxic agents; and
       ``(B) providing--
       ``(i) fluoridation of water; and
       ``(ii) immunizations.
       ``(10) The term `health profession' means allopathic 
     medicine, family medicine, internal medicine, pediatrics, 
     geriatric medicine, obstetrics and gynecology, podiatric 
     medicine, nursing, public health nursing, dentistry, 
     psychiatry, osteopathy, optometry, pharmacy, psychology, 
     public health, social work, marriage and family therapy, 
     chiropractic medicine, environmental health and engineering, 
     allied health professions, and any other health profession.
       ``(11) The term `health promotion' means--
       ``(A) fostering social, economic, environmental, and 
     personal factors conducive to health, including raising 
     public awareness about health matters and enabling the people 
     to cope with health problems by increasing their knowledge 
     and providing them with valid information;
       ``(B) encouraging adequate and appropriate diet, exercise, 
     and sleep;
       ``(C) promoting education and work in conformity with 
     physical and mental capacity;
       ``(D) making available safe water and sanitary facilities;
       ``(E) improving the physical, economic, cultural, 
     psychological, and social environment;
       ``(F) promoting culturally competent care; and
       ``(G) providing adequate and appropriate programs, which 
     may include--
       ``(i) abuse prevention (mental and physical);
       ``(ii) community health;
       ``(iii) community safety;
       ``(iv) consumer health education;
       ``(v) diet and nutrition;
       ``(vi) immunization and other prevention of communicable 
     diseases, including HIV/AIDS;
       ``(vii) environmental health;
       ``(viii) exercise and physical fitness;
       ``(ix) avoidance of fetal alcohol spectrum disorders;
       ``(x) first aid and CPR education;
       ``(xi) human growth and development;
       ``(xii) injury prevention and personal safety;
       ``(xiii) behavioral health;
       ``(xiv) monitoring of disease indicators between health 
     care provider visits, through appropriate means, including 
     Internet-based health care management systems;
       ``(xv) personal health and wellness practices;
       ``(xvi) personal capacity building;
       ``(xvii) prenatal, pregnancy, and infant care;
       ``(xviii) psychological well-being;
       ``(xix) reproductive health and family planning;
       ``(xx) safe and adequate water;
       ``(xxi) healthy work environments;
       ``(xxii) elimination, reduction, and prevention of 
     contaminants that create unhealthy household conditions 
     (including mold and other allergens);
       ``(xxiii) stress control;
       ``(xxiv) substance abuse;
       ``(xxv) sanitary facilities;
       ``(xxvi) sudden infant death syndrome prevention;
       ``(xxvii) tobacco use cessation and reduction;
       ``(xxviii) violence prevention; and
       ``(xxix) such other activities identified by the Service, a 
     Tribal Health Program, or an Urban Indian Organization, to 
     promote achievement of any of the objectives described in 
     section 3(2).
       ``(12) The term `Indian', unless otherwise designated, 
     means any person who is a member of an Indian Tribe or is 
     eligible for health services under section 806, except that, 
     for the purpose of sections 102 and 103, the term also means 
     any individual who--
       ``(A)(i) irrespective of whether the individual lives on or 
     near a reservation, is a member of a tribe, band, or other 
     organized group of Indians, including those tribes, bands, or 
     groups terminated since 1940 and those recognized now or in 
     the future by the State in which they reside; or
       ``(ii) is a descendant, in the first or second degree, of 
     any such member;
       ``(B) is an Eskimo or Aleut or other Alaska Native;
       ``(C) is considered by the Secretary of the Interior to be 
     an Indian for any purpose; or
       ``(D) is determined to be an Indian under regulations 
     promulgated by the Secretary.
       ``(13) The term `Indian Health Program' means--
       ``(A) any health program administered directly by the 
     Service;
       ``(B) any Tribal Health Program; or
       ``(C) any Indian Tribe or Tribal Organization to which the 
     Secretary provides funding pursuant to section 23 of the Act 
     of June 25, 1910 (25 U.S.C. 47) (commonly known as the `Buy 
     Indian Act').
       ``(14) The term `Indian Tribe' has the meaning given the 
     term in the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450 et seq.).
       ``(15) The term `junior or community college' has the 
     meaning given the term by section 312(e) of the Higher 
     Education Act of 1965 (20 U.S.C. 1058(e)).
       ``(16) The term `reservation' means any federally 
     recognized Indian Tribe's reservation, Pueblo, or colony, 
     including former reservations in Oklahoma, Indian allotments, 
     and Alaska Native Regions established pursuant to the Alaska 
     Native Claims Settlement Act (43 U.S.C. 1601 et seq.).
       ``(17) The term `Secretary', unless otherwise designated, 
     means the Secretary of Health and Human Services.
       ``(18) The term `Service' means the Indian Health Service.
       ``(19) The term `Service Area' means the geographical area 
     served by each Area Office.
       ``(20) The term `Service Unit' means an administrative 
     entity of the Service, or a Tribal Health Program through 
     which services are provided, directly or by contract, to 
     eligible Indians within a defined geographic area.
       ``(21) The term `telehealth' has the meaning given the term 
     in section 330K(a) of the Public Health Service Act (42 
     U.S.C. 254c-16(a)).
       ``(22) The term `telemedicine' means a telecommunications 
     link to an end user through the use of eligible equipment 
     that electronically links health professionals or patients 
     and health professionals at separate sites in order to 
     exchange health care information in audio, video, graphic, or 
     other format for the purpose of providing improved health 
     care services.
       ``(23) The term `tribal college or university' has the 
     meaning given the term in section 316(b)(3) of the Higher 
     Education Act (20 U.S.C. 1059c(b)(3)).
       ``(24) The term `Tribal Health Program' means an Indian 
     Tribe or Tribal Organization that operates any health 
     program, service, function, activity, or facility funded, in 
     whole or part, by the Service through, or provided for in, a 
     contract or compact with the Service under the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.).
       ``(25) The term `Tribal Organization' has the meaning given 
     the term in the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450 et seq.).
       ``(26) The term `Urban Center' means any community which 
     has a sufficient Urban Indian population with unmet health 
     needs to warrant assistance under title V of this Act, as 
     determined by the Secretary.
       ``(27) The term `Urban Indian' means any individual who 
     resides in an Urban Center and who meets 1 or more of the 
     following criteria:
       ``(A) Irrespective of whether the individual lives on or 
     near a reservation, the individual is a member of a tribe, 
     band, or other organized group of Indians, including those 
     tribes, bands, or groups terminated since 1940 and those 
     tribes, bands, or groups that are recognized by the States in 
     which they reside, or who is a descendant in the first or 
     second degree of any such member.
       ``(B) The individual is an Eskimo, Aleut, or other Alaska 
     Native.
       ``(C) The individual is considered by the Secretary of the 
     Interior to be an Indian for any purpose.
       ``(D) The individual is determined to be an Indian under 
     regulations promulgated by the Secretary.
       ``(28) The term `Urban Indian Organization' means a 
     nonprofit corporate body that (A) is situated in an Urban 
     Center; (B) is governed by an Urban Indian-controlled board 
     of directors; (C) provides for the participation of all 
     interested Indian groups and individuals; and (D) is capable 
     of legally cooperating with other public and private entities 
     for the purpose of performing the activities described in 
     section 503(a).

       ``TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT

     ``SEC. 101. PURPOSE.

       ``The purpose of this title is to increase, to the maximum 
     extent feasible, the number of Indians entering the health 
     professions and providing health services, and to assure an 
     optimum supply of health professionals to the Indian Health 
     Programs and Urban Indian Organizations involved in the 
     provision of health services to Indians.

     ``SEC. 102. HEALTH PROFESSIONS RECRUITMENT PROGRAM FOR 
                   INDIANS.

       ``(a) In General.--The Secretary, acting through the 
     Service, shall make grants to public or nonprofit private 
     health or educational entities, Tribal Health Programs, or 
     Urban Indian Organizations to assist such entities in meeting 
     the costs of--
       ``(1) identifying Indians with a potential for education or 
     training in the health professions and encouraging and 
     assisting them--
       ``(A) to enroll in courses of study in such health 
     professions; or
       ``(B) if they are not qualified to enroll in any such 
     courses of study, to undertake such postsecondary education 
     or training as may be required to qualify them for 
     enrollment;
       ``(2) publicizing existing sources of financial aid 
     available to Indians enrolled in any course of study referred 
     to in paragraph (1) or who are undertaking training necessary 
     to qualify them to enroll in any such course of study; or
       ``(3) establishing other programs which the Secretary 
     determines will enhance and facilitate the enrollment of 
     Indians in, and the subsequent pursuit and completion by them

[[Page 21677]]

     of, courses of study referred to in paragraph (1).
       ``(b) Grants.--
       ``(1) Application.--The Secretary shall not make a grant 
     under this section unless an application has been submitted 
     to, and approved by, the Secretary. Such application shall be 
     in such form, submitted in such manner, and contain such 
     information, as the Secretary shall by regulation prescribe 
     pursuant to this Act. The Secretary shall give a preference 
     to applications submitted by Tribal Health Programs or Urban 
     Indian Organizations.
       ``(2) Amount of grants; payment.--The amount of a grant 
     under this section shall be determined by the Secretary. 
     Payments pursuant to this section may be made in advance or 
     by way of reimbursement, and at such intervals and on such 
     conditions as provided for in regulations issued pursuant to 
     this Act. To the extent not otherwise prohibited by law, 
     grants shall be for 3 years, as provided in regulations 
     issued pursuant to this Act.

     ``SEC. 103. HEALTH PROFESSIONS PREPARATORY SCHOLARSHIP 
                   PROGRAM FOR INDIANS.

       ``(a) Scholarships Authorized.--The Secretary, acting 
     through the Service, shall provide scholarship grants to 
     Indians who--
       ``(1) have successfully completed their high school 
     education or high school equivalency; and
       ``(2) have demonstrated the potential to successfully 
     complete courses of study in the health professions.
       ``(b) Purposes.--Scholarship grants provided pursuant to 
     this section shall be for the following purposes:
       ``(1) Compensatory preprofessional education of any 
     recipient, such scholarship not to exceed 2 years on a full-
     time basis (or the part-time equivalent thereof, as 
     determined by the Secretary pursuant to regulations issued 
     under this Act).
       ``(2) Pregraduate education of any recipient leading to a 
     baccalaureate degree in an approved course of study 
     preparatory to a field of study in a health profession, such 
     scholarship not to exceed 4 years. An extension of up to 2 
     years (or the part-time equivalent thereof, as determined by 
     the Secretary pursuant to regulations issued pursuant to this 
     Act) may be approved.
       ``(c) Other Conditions.--Scholarships under this section--
       ``(1) may cover costs of tuition, books, transportation, 
     board, and other necessary related expenses of a recipient 
     while attending school;
       ``(2) shall not be denied solely on the basis of the 
     applicant's scholastic achievement if such applicant has been 
     admitted to, or maintained good standing at, an accredited 
     institution; and
       ``(3) shall not be denied solely by reason of such 
     applicant's eligibility for assistance or benefits under any 
     other Federal program.

     ``SEC. 104. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.

       ``(a) In General.--
       ``(1) Authority.--The Secretary, acting through the 
     Service, shall make scholarship grants to Indians who are 
     enrolled full or part time in accredited schools pursuing 
     courses of study in the health professions. Such scholarships 
     shall be designated Indian Health Scholarships and shall be 
     made in accordance with section 338A of the Public Health 
     Services Act (42 U.S.C. 254l), except as provided in 
     subsection (b) of this section.
       ``(2) Determinations by secretary.--The Secretary, acting 
     through the Service, shall determine--
       ``(A) who shall receive scholarship grants under subsection 
     (a); and
       ``(B) the distribution of the scholarships among health 
     professions on the basis of the relative needs of Indians for 
     additional service in the health professions.
       ``(3) Certain delegation not allowed.--The administration 
     of this section shall be a responsibility of the Assistant 
     Secretary and shall not be delegated in a contract or compact 
     under the Indian Self-Determination and Education Assistance 
     Act (25 U.S.C. 450 et seq.).
       ``(b) Active Duty Service Obligation.--
       ``(1) Obligation met.--The active duty service obligation 
     under a written contract with the Secretary under this 
     section that an Indian has entered into shall, if that 
     individual is a recipient of an Indian Health Scholarship, be 
     met in full-time practice equal to 1 year for each school 
     year for which the participant receives a scholarship award 
     under this part, or 2 years, whichever is greater, by service 
     in 1 or more of the following:
       ``(A) In an Indian Health Program.
       ``(B) In a program assisted under title V of this Act.
       ``(C) In the private practice of the applicable profession 
     if, as determined by the Secretary, in accordance with 
     guidelines promulgated by the Secretary, such practice is 
     situated in a physician or other health professional shortage 
     area and addresses the health care needs of a substantial 
     number of Indians.
       ``(D) In a teaching capacity in a tribal college or 
     university nursing program (or a related health profession 
     program) if, as determined by the Secretary, the health 
     service provided to Indians would not decrease.
       ``(2) Obligation deferred.--At the request of any 
     individual who has entered into a contract referred to in 
     paragraph (1) and who receives a degree in medicine 
     (including osteopathic or allopathic medicine), dentistry, 
     optometry, podiatry, or pharmacy, the Secretary shall defer 
     the active duty service obligation of that individual under 
     that contract, in order that such individual may complete any 
     internship, residency, or other advanced clinical training 
     that is required for the practice of that health profession, 
     for an appropriate period (in years, as determined by the 
     Secretary), subject to the following conditions:
       ``(A) No period of internship, residency, or other advanced 
     clinical training shall be counted as satisfying any period 
     of obligated service under this subsection.
       ``(B) The active duty service obligation of that individual 
     shall commence not later than 90 days after the completion of 
     that advanced clinical training (or by a date specified by 
     the Secretary).
       ``(C) The active duty service obligation will be served in 
     the health profession of that individual in a manner 
     consistent with paragraph (1).
       ``(D) A recipient of a scholarship under this section may, 
     at the election of the recipient, meet the active duty 
     service obligation described in paragraph (1) by service in a 
     program specified under that paragraph that--
       ``(i) is located on the reservation of the Indian Tribe in 
     which the recipient is enrolled; or
       ``(ii) serves the Indian Tribe in which the recipient is 
     enrolled.
       ``(3) Priority when making assignments.--Subject to 
     paragraph (2), the Secretary, in making assignments of Indian 
     Health Scholarship recipients required to meet the active 
     duty service obligation described in paragraph (1), shall 
     give priority to assigning individuals to service in those 
     programs specified in paragraph (1) that have a need for 
     health professionals to provide health care services as a 
     result of individuals having breached contracts entered into 
     under this section.
       ``(c) Part-Time Students.--In the case of an individual 
     receiving a scholarship under this section who is enrolled 
     part time in an approved course of study--
       ``(1) such scholarship shall be for a period of years not 
     to exceed the part-time equivalent of 4 years, as determined 
     by the Secretary;
       ``(2) the period of obligated service described in 
     subsection (b)(1) shall be equal to the greater of--
       ``(A) the part-time equivalent of 1 year for each year for 
     which the individual was provided a scholarship (as 
     determined by the Secretary); or
       ``(B) 2 years; and
       ``(3) the amount of the monthly stipend specified in 
     section 338A(g)(1)(B) of the Public Health Service Act (42 
     U.S.C. 254l(g)(1)(B)) shall be reduced pro rata (as 
     determined by the Secretary) based on the number of hours 
     such student is enrolled.
       ``(d) Breach of Contract.--
       ``(1) Specified breaches.--An individual shall be liable to 
     the United States for the amount which has been paid to the 
     individual, or on behalf of the individual, under a contract 
     entered into with the Secretary under this section on or 
     after the date of enactment of the Indian Health Care 
     Improvement Act Amendments of 2007 if that individual--
       ``(A) fails to maintain an acceptable level of academic 
     standing in the educational institution in which he or she is 
     enrolled (such level determined by the educational 
     institution under regulations of the Secretary);
       ``(B) is dismissed from such educational institution for 
     disciplinary reasons;
       ``(C) voluntarily terminates the training in such an 
     educational institution for which he or she is provided a 
     scholarship under such contract before the completion of such 
     training; or
       ``(D) fails to accept payment, or instructs the educational 
     institution in which he or she is enrolled not to accept 
     payment, in whole or in part, of a scholarship under such 
     contract, in lieu of any service obligation arising under 
     such contract.
       ``(2) Other breaches.--If for any reason not specified in 
     paragraph (1) an individual breaches a written contract by 
     failing either to begin such individual's service obligation 
     required under such contract or to complete such service 
     obligation, the United States shall be entitled to recover 
     from the individual an amount determined in accordance with 
     the formula specified in subsection (l) of section 110 in the 
     manner provided for in such subsection.
       ``(3) Cancellation upon death of recipient.--Upon the death 
     of an individual who receives an Indian Health Scholarship, 
     any outstanding obligation of that individual for service or 
     payment that relates to that scholarship shall be canceled.
       ``(4) Waivers and suspensions.--
       ``(A) In general.--The Secretary shall provide for the 
     partial or total waiver or suspension of any obligation of 
     service or payment of a recipient of an Indian Health 
     Scholarship if the Secretary determines that--
       ``(i) it is not possible for the recipient to meet that 
     obligation or make that payment;
       ``(ii) requiring that recipient to meet that obligation or 
     make that payment would result in extreme hardship to the 
     recipient; or

[[Page 21678]]

       ``(iii) the enforcement of the requirement to meet the 
     obligation or make the payment would be unconscionable.
       ``(B) Factors for consideration.--Before waiving or 
     suspending an obligation of service or payment under 
     subparagraph (A), the Secretary shall consult with the 
     affected Area Office, Indian Tribes, or Tribal Organizations, 
     or confer with the affected Urban Indian Organizations, and 
     may take into consideration whether the obligation may be 
     satisfied in a teaching capacity at a tribal college or 
     university nursing program under subsection (b)(1)(D).
       ``(5) Extreme hardship.--Notwithstanding any other 
     provision of law, in any case of extreme hardship or for 
     other good cause shown, the Secretary may waive, in whole or 
     in part, the right of the United States to recover funds made 
     available under this section.
       ``(6) Bankruptcy.--Notwithstanding any other provision of 
     law, with respect to a recipient of an Indian Health 
     Scholarship, no obligation for payment may be released by a 
     discharge in bankruptcy under title 11, United States Code, 
     unless that discharge is granted after the expiration of the 
     5-year period beginning on the initial date on which that 
     payment is due, and only if the bankruptcy court finds that 
     the nondischarge of the obligation would be unconscionable.

     ``SEC. 105. AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM.

       ``(a) Grants Authorized.--The Secretary, acting through the 
     Service, shall make grants of not more than $300,000 to each 
     of 9 colleges and universities for the purpose of developing 
     and maintaining Indian psychology career recruitment programs 
     as a means of encouraging Indians to enter the behavioral 
     health field. These programs shall be located at various 
     locations throughout the country to maximize their 
     availability to Indian students and new programs shall be 
     established in different locations from time to time.
       ``(b) Quentin N. Burdick Program Grant.--The Secretary 
     shall provide a grant authorized under subsection (a) to 
     develop and maintain a program at the University of North 
     Dakota to be known as the `Quentin N. Burdick American 
     Indians Into Psychology Program'. Such program shall, to the 
     maximum extent feasible, coordinate with the Quentin N. 
     Burdick Indian Health Programs authorized under section 
     117(b), the Quentin N. Burdick American Indians Into Nursing 
     Program authorized under section 115(e), and existing 
     university research and communications networks.
       ``(c) Regulations.--The Secretary shall issue regulations 
     pursuant to this Act for the competitive awarding of grants 
     provided under this section.
       ``(d) Conditions of Grant.--Applicants under this section 
     shall agree to provide a program which, at a minimum--
       ``(1) provides outreach and recruitment for health 
     professions to Indian communities including elementary, 
     secondary, and accredited and accessible community colleges 
     that will be served by the program;
       ``(2) incorporates a program advisory board comprised of 
     representatives from the tribes and communities that will be 
     served by the program;
       ``(3) provides summer enrichment programs to expose Indian 
     students to the various fields of psychology through 
     research, clinical, and experimental activities;
       ``(4) provides stipends to undergraduate and graduate 
     students to pursue a career in psychology;
       ``(5) develops affiliation agreements with tribal colleges 
     and universities, the Service, university affiliated 
     programs, and other appropriate accredited and accessible 
     entities to enhance the education of Indian students;
       ``(6) to the maximum extent feasible, uses existing 
     university tutoring, counseling, and student support 
     services; and
       ``(7) to the maximum extent feasible, employs qualified 
     Indians in the program.
       ``(e) Active Duty Service Requirement.--The active duty 
     service obligation prescribed under section 338C of the 
     Public Health Service Act (42 U.S.C. 254m) shall be met by 
     each graduate who receives a stipend described in subsection 
     (d)(4) that is funded under this section. Such obligation 
     shall be met by service--
       ``(1) in an Indian Health Program;
       ``(2) in a program assisted under title V of this Act; or
       ``(3) in the private practice of psychology if, as 
     determined by the Secretary, in accordance with guidelines 
     promulgated by the Secretary, such practice is situated in a 
     physician or other health professional shortage area and 
     addresses the health care needs of a substantial number of 
     Indians.
       ``(f) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $2,700,000 for 
     each of fiscal years 2008 through 2017.

     ``SEC. 106. SCHOLARSHIP PROGRAMS FOR INDIAN TRIBES.

       ``(a) In General.--
       ``(1) Grants authorized.--The Secretary, acting through the 
     Service, shall make grants to Tribal Health Programs for the 
     purpose of providing scholarships for Indians to serve as 
     health professionals in Indian communities.
       ``(2) Amount.--Amounts available under paragraph (1) for 
     any fiscal year shall not exceed 5 percent of the amounts 
     available for each fiscal year for Indian Health Scholarships 
     under section 104.
       ``(3) Application.--An application for a grant under 
     paragraph (1) shall be in such form and contain such 
     agreements, assurances, and information as consistent with 
     this section.
       ``(b) Requirements.--
       ``(1) In general.--A Tribal Health Program receiving a 
     grant under subsection (a) shall provide scholarships to 
     Indians in accordance with the requirements of this section.
       ``(2) Costs.--With respect to costs of providing any 
     scholarship pursuant to subsection (a)--
       ``(A) 80 percent of the costs of the scholarship shall be 
     paid from the funds made available pursuant to subsection 
     (a)(1) provided to the Tribal Health Program; and
       ``(B) 20 percent of such costs may be paid from any other 
     source of funds.
       ``(c) Course of Study.--A Tribal Health Program shall 
     provide scholarships under this section only to Indians 
     enrolled or accepted for enrollment in a course of study 
     (approved by the Secretary) in 1 of the health professions 
     contemplated by this Act.
       ``(d) Contract.--
       ``(1) In general.--In providing scholarships under 
     subsection (b), the Secretary and the Tribal Health Program 
     shall enter into a written contract with each recipient of 
     such scholarship.
       ``(2) Requirements.--Such contract shall--
       ``(A) obligate such recipient to provide service in an 
     Indian Health Program or Urban Indian Organization, in the 
     same Service Area where the Tribal Health Program providing 
     the scholarship is located, for--
       ``(i) a number of years for which the scholarship is 
     provided (or the part-time equivalent thereof, as determined 
     by the Secretary), or for a period of 2 years, whichever 
     period is greater; or
       ``(ii) such greater period of time as the recipient and the 
     Tribal Health Program may agree;
       ``(B) provide that the amount of the scholarship--
       ``(i) may only be expended for--

       ``(I) tuition expenses, other reasonable educational 
     expenses, and reasonable living expenses incurred in 
     attendance at the educational institution; and
       ``(II) payment to the recipient of a monthly stipend of not 
     more than the amount authorized by section 338(g)(1)(B) of 
     the Public Health Service Act (42 U.S.C. 254m(g)(1)(B)), with 
     such amount to be reduced pro rata (as determined by the 
     Secretary) based on the number of hours such student is 
     enrolled, and not to exceed, for any year of attendance for 
     which the scholarship is provided, the total amount required 
     for the year for the purposes authorized in this clause; and

       ``(ii) may not exceed, for any year of attendance for which 
     the scholarship is provided, the total amount required for 
     the year for the purposes authorized in clause (i);
       ``(C) require the recipient of such scholarship to maintain 
     an acceptable level of academic standing as determined by the 
     educational institution in accordance with regulations issued 
     pursuant to this Act; and
       ``(D) require the recipient of such scholarship to meet the 
     educational and licensure requirements appropriate to each 
     health profession.
       ``(3) Service in other service areas.--The contract may 
     allow the recipient to serve in another Service Area, 
     provided the Tribal Health Program and Secretary approve and 
     services are not diminished to Indians in the Service Area 
     where the Tribal Health Program providing the scholarship is 
     located.
       ``(e) Breach of Contract.--
       ``(1) Specific breaches.--An individual who has entered 
     into a written contract with the Secretary and a Tribal 
     Health Program under subsection (d) shall be liable to the 
     United States for the Federal share of the amount which has 
     been paid to him or her, or on his or her behalf, under the 
     contract if that individual--
       ``(A) fails to maintain an acceptable level of academic 
     standing in the educational institution in which he or she is 
     enrolled (such level as determined by the educational 
     institution under regulations of the Secretary);
       ``(B) is dismissed from such educational institution for 
     disciplinary reasons;
       ``(C) voluntarily terminates the training in such an 
     educational institution for which he or she is provided a 
     scholarship under such contract before the completion of such 
     training; or
       ``(D) fails to accept payment, or instructs the educational 
     institution in which he or she is enrolled not to accept 
     payment, in whole or in part, of a scholarship under such 
     contract, in lieu of any service obligation arising under 
     such contract.
       ``(2) Other breaches.--If for any reason not specified in 
     paragraph (1), an individual breaches a written contract by 
     failing to either begin such individual's service obligation 
     required under such contract or to complete such service 
     obligation, the United States shall be entitled to recover 
     from the individual an amount determined in accordance with 
     the formula specified in subsection (l) of section 110 in the 
     manner provided for in such subsection.

[[Page 21679]]

       ``(3) Cancellation upon death of recipient.--Upon the death 
     of an individual who receives an Indian Health Scholarship, 
     any outstanding obligation of that individual for service or 
     payment that relates to that scholarship shall be canceled.
       ``(4) Information.--The Secretary may carry out this 
     subsection on the basis of information received from Tribal 
     Health Programs involved or on the basis of information 
     collected through such other means as the Secretary deems 
     appropriate.
       ``(f) Relation to Social Security Act.--The recipient of a 
     scholarship under this section shall agree, in providing 
     health care pursuant to the requirements herein--
       ``(1) not to discriminate against an individual seeking 
     care on the basis of the ability of the individual to pay for 
     such care or on the basis that payment for such care will be 
     made pursuant to a program established in title XVIII of the 
     Social Security Act or pursuant to the programs established 
     in title XIX or title XXI of such Act; and
       ``(2) to accept assignment under section 1842(b)(3)(B)(ii) 
     of the Social Security Act for all services for which payment 
     may be made under part B of title XVIII of such Act, and to 
     enter into an appropriate agreement with the State agency 
     that administers the State plan for medical assistance under 
     title XIX, or the State child health plan under title XXI, of 
     such Act to provide service to individuals entitled to 
     medical assistance or child health assistance, respectively, 
     under the plan.
       ``(g) Continuance of Funding.--The Secretary shall make 
     payments under this section to a Tribal Health Program for 
     any fiscal year subsequent to the first fiscal year of such 
     payments unless the Secretary determines that, for the 
     immediately preceding fiscal year, the Tribal Health Program 
     has not complied with the requirements of this section.

     ``SEC. 107. INDIAN HEALTH SERVICE EXTERN PROGRAMS.

       ``(a) Employment Preference.--Any individual who receives a 
     scholarship pursuant to section 104 or 106 shall be given 
     preference for employment in the Service, or may be employed 
     by a Tribal Health Program or an Urban Indian Organization, 
     or other agencies of the Department as available, during any 
     nonacademic period of the year.
       ``(b) Not Counted Toward Active Duty Service Obligation.--
     Periods of employment pursuant to this subsection shall not 
     be counted in determining fulfillment of the service 
     obligation incurred as a condition of the scholarship.
       ``(c) Timing; Length of Employment.--Any individual 
     enrolled in a program, including a high school program, 
     authorized under section 102(a) may be employed by the 
     Service or by a Tribal Health Program or an Urban Indian 
     Organization during any nonacademic period of the year. Any 
     such employment shall not exceed 120 days during any calendar 
     year.
       ``(d) Nonapplicability of Competitive Personnel System.--
     Any employment pursuant to this section shall be made without 
     regard to any competitive personnel system or agency 
     personnel limitation and to a position which will enable the 
     individual so employed to receive practical experience in the 
     health profession in which he or she is engaged in study. Any 
     individual so employed shall receive payment for his or her 
     services comparable to the salary he or she would receive if 
     he or she were employed in the competitive system. Any 
     individual so employed shall not be counted against any 
     employment ceiling affecting the Service or the Department.

     ``SEC. 108. CONTINUING EDUCATION ALLOWANCES.

       ``In order to encourage scholarship and stipend recipients 
     under sections 104, 105, 106, and 115 and health 
     professionals, including community health representatives and 
     emergency medical technicians, to join or continue in an 
     Indian Health Program and to provide their services in the 
     rural and remote areas where a significant portion of Indians 
     reside, the Secretary, acting through the Service, may--
       ``(1) provide programs or allowances to transition into an 
     Indian Health Program, including licensing, board or 
     certification examination assistance, and technical 
     assistance in fulfilling service obligations under sections 
     104, 105, 106, and 115; and
       ``(2) provide programs or allowances to health 
     professionals employed in an Indian Health Program to enable 
     them for a period of time each year prescribed by regulation 
     of the Secretary to take leave of their duty stations for 
     professional consultation, management, leadership, and 
     refresher training courses.

     ``SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PROGRAM.

       ``(a) In General.--Under the authority of the Act of 
     November 2, 1921 (25 U.S.C. 13) (commonly known as the 
     `Snyder Act'), the Secretary, acting through the Service, 
     shall maintain a Community Health Representative Program 
     under which Indian Health Programs--
       ``(1) provide for the training of Indians as community 
     health representatives; and
       ``(2) use such community health representatives in the 
     provision of health care, health promotion, and disease 
     prevention services to Indian communities.
       ``(b) Duties.--The Community Health Representative Program 
     of the Service, shall--
       ``(1) provide a high standard of training for community 
     health representatives to ensure that the community health 
     representatives provide quality health care, health 
     promotion, and disease prevention services to the Indian 
     communities served by the Program;
       ``(2) in order to provide such training, develop and 
     maintain a curriculum that--
       ``(A) combines education in the theory of health care with 
     supervised practical experience in the provision of health 
     care; and
       ``(B) provides instruction and practical experience in 
     health promotion and disease prevention activities, with 
     appropriate consideration given to lifestyle factors that 
     have an impact on Indian health status, such as alcoholism, 
     family dysfunction, and poverty;
       ``(3) maintain a system which identifies the needs of 
     community health representatives for continuing education in 
     health care, health promotion, and disease prevention and 
     develop programs that meet the needs for continuing 
     education;
       ``(4) maintain a system that provides close supervision of 
     Community Health Representatives;
       ``(5) maintain a system under which the work of Community 
     Health Representatives is reviewed and evaluated; and
       ``(6) promote traditional health care practices of the 
     Indian Tribes served consistent with the Service standards 
     for the provision of health care, health promotion, and 
     disease prevention.

     ``SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT PROGRAM.

       ``(a) Establishment.--The Secretary, acting through the 
     Service, shall establish and administer a program to be known 
     as the Service Loan Repayment Program (hereinafter referred 
     to as the `Loan Repayment Program') in order to ensure an 
     adequate supply of trained health professionals necessary to 
     maintain accreditation of, and provide health care services 
     to Indians through, Indian Health Programs and Urban Indian 
     Organizations.
       ``(b) Eligible Individuals.--To be eligible to participate 
     in the Loan Repayment Program, an individual must--
       ``(1)(A) be enrolled--
       ``(i) in a course of study or program in an accredited 
     educational institution (as determined by the Secretary under 
     section 338B(b)(1)(c)(i) of the Public Health Service Act (42 
     U.S.C. 254l-1(b)(1)(c)(i))) and be scheduled to complete such 
     course of study in the same year such individual applies to 
     participate in such program; or
       ``(ii) in an approved graduate training program in a health 
     profession; or
       ``(B) have--
       ``(i) a degree in a health profession; and
       ``(ii) a license to practice a health profession;
       ``(2)(A) be eligible for, or hold, an appointment as a 
     commissioned officer in the Regular or Reserve Corps of the 
     Public Health Service;
       ``(B) be eligible for selection for civilian service in the 
     Regular or Reserve Corps of the Public Health Service;
       ``(C) meet the professional standards for civil service 
     employment in the Service; or
       ``(D) be employed in an Indian Health Program or Urban 
     Indian Organization without a service obligation; and
       ``(3) submit to the Secretary an application for a contract 
     described in subsection (e).
       ``(c) Application.--
       ``(1) Information to be included with forms.--In 
     disseminating application forms and contract forms to 
     individuals desiring to participate in the Loan Repayment 
     Program, the Secretary shall include with such forms a fair 
     summary of the rights and liabilities of an individual whose 
     application is approved (and whose contract is accepted) by 
     the Secretary, including in the summary a clear explanation 
     of the damages to which the United States is entitled under 
     subsection (l) in the case of the individual's breach of 
     contract. The Secretary shall provide such individuals with 
     sufficient information regarding the advantages and 
     disadvantages of service as a commissioned officer in the 
     Regular or Reserve Corps of the Public Health Service or a 
     civilian employee of the Service to enable the individual to 
     make a decision on an informed basis.
       ``(2) Clear language.--The application form, contract form, 
     and all other information furnished by the Secretary under 
     this section shall be written in a manner calculated to be 
     understood by the average individual applying to participate 
     in the Loan Repayment Program.
       ``(3) Timely availability of forms.--The Secretary shall 
     make such application forms, contract forms, and other 
     information available to individuals desiring to participate 
     in the Loan Repayment Program on a date sufficiently early to 
     ensure that such individuals have adequate time to carefully 
     review and evaluate such forms and information.
       ``(d) Priorities.--
       ``(1) List.--Consistent with subsection (k), the Secretary 
     shall annually--
       ``(A) identify the positions in each Indian Health Program 
     or Urban Indian Organization for which there is a need or a 
     vacancy; and

[[Page 21680]]

       ``(B) rank those positions in order of priority.
       ``(2) Approvals.--Notwithstanding the priority determined 
     under paragraph (1), the Secretary, in determining which 
     applications under the Loan Repayment Program to approve (and 
     which contracts to accept), shall--
       ``(A) give first priority to applications made by 
     individual Indians; and
       ``(B) after making determinations on all applications 
     submitted by individual Indians as required under 
     subparagraph (A), give priority to--
       ``(i) individuals recruited through the efforts of an 
     Indian Health Program or Urban Indian Organization; and
       ``(ii) other individuals based on the priority rankings 
     under paragraph (1).
       ``(e) Recipient Contracts.--
       ``(1) Contract required.--An individual becomes a 
     participant in the Loan Repayment Program only upon the 
     Secretary and the individual entering into a written contract 
     described in paragraph (2).
       ``(2) Contents of contract.--The written contract referred 
     to in this section between the Secretary and an individual 
     shall contain--
       ``(A) an agreement under which--
       ``(i) subject to subparagraph (C), the Secretary agrees--

       ``(I) to pay loans on behalf of the individual in 
     accordance with the provisions of this section; and
       ``(II) to accept (subject to the availability of 
     appropriated funds for carrying out this section) the 
     individual into the Service or place the individual with a 
     Tribal Health Program or Urban Indian Organization as 
     provided in clause (ii)(III); and

       ``(ii) subject to subparagraph (C), the individual agrees--

       ``(I) to accept loan payments on behalf of the individual;
       ``(II) in the case of an individual described in subsection 
     (b)(1)--

       ``(aa) to maintain enrollment in a course of study or 
     training described in subsection (b)(1)(A) until the 
     individual completes the course of study or training; and
       ``(bb) while enrolled in such course of study or training, 
     to maintain an acceptable level of academic standing (as 
     determined under regulations of the Secretary by the 
     educational institution offering such course of study or 
     training); and

       ``(III) to serve for a time period (hereinafter in this 
     section referred to as the `period of obligated service') 
     equal to 2 years or such longer period as the individual may 
     agree to serve in the full-time clinical practice of such 
     individual's profession in an Indian Health Program or Urban 
     Indian Organization to which the individual may be assigned 
     by the Secretary;

       ``(B) a provision permitting the Secretary to extend for 
     such longer additional periods, as the individual may agree 
     to, the period of obligated service agreed to by the 
     individual under subparagraph (A)(ii)(III);
       ``(C) a provision that any financial obligation of the 
     United States arising out of a contract entered into under 
     this section and any obligation of the individual which is 
     conditioned thereon is contingent upon funds being 
     appropriated for loan repayments under this section;
       ``(D) a statement of the damages to which the United States 
     is entitled under subsection (l) for the individual's breach 
     of the contract; and
       ``(E) such other statements of the rights and liabilities 
     of the Secretary and of the individual, not inconsistent with 
     this section.
       ``(f) Deadline for Decision on Application.--The Secretary 
     shall provide written notice to an individual within 21 days 
     on--
       ``(1) the Secretary's approving, under subsection (e)(1), 
     of the individual's participation in the Loan Repayment 
     Program, including extensions resulting in an aggregate 
     period of obligated service in excess of 4 years; or
       ``(2) the Secretary's disapproving an individual's 
     participation in such Program.
       ``(g) Payments.--
       ``(1) In general.--A loan repayment provided for an 
     individual under a written contract under the Loan Repayment 
     Program shall consist of payment, in accordance with 
     paragraph (2), on behalf of the individual of the principal, 
     interest, and related expenses on government and commercial 
     loans received by the individual regarding the undergraduate 
     or graduate education of the individual (or both), which 
     loans were made for--
       ``(A) tuition expenses;
       ``(B) all other reasonable educational expenses, including 
     fees, books, and laboratory expenses, incurred by the 
     individual; and
       ``(C) reasonable living expenses as determined by the 
     Secretary.
       ``(2) Amount.--For each year of obligated service that an 
     individual contracts to serve under subsection (e), the 
     Secretary may pay up to $35,000 or an amount equal to the 
     amount specified in section 338B(g)(2)(A) of the Public 
     Health Service Act, whichever is more, on behalf of the 
     individual for loans described in paragraph (1). In making a 
     determination of the amount to pay for a year of such service 
     by an individual, the Secretary shall consider the extent to 
     which each such determination--
       ``(A) affects the ability of the Secretary to maximize the 
     number of contracts that can be provided under the Loan 
     Repayment Program from the amounts appropriated for such 
     contracts;
       ``(B) provides an incentive to serve in Indian Health 
     Programs and Urban Indian Organizations with the greatest 
     shortages of health professionals; and
       ``(C) provides an incentive with respect to the health 
     professional involved remaining in an Indian Health Program 
     or Urban Indian Organization with such a health professional 
     shortage, and continuing to provide primary health services, 
     after the completion of the period of obligated service under 
     the Loan Repayment Program.
       ``(3) Timing.--Any arrangement made by the Secretary for 
     the making of loan repayments in accordance with this 
     subsection shall provide that any repayments for a year of 
     obligated service shall be made no later than the end of the 
     fiscal year in which the individual completes such year of 
     service.
       ``(4) Reimbursements for tax liability.--For the purpose of 
     providing reimbursements for tax liability resulting from a 
     payment under paragraph (2) on behalf of an individual, the 
     Secretary--
       ``(A) in addition to such payments, may make payments to 
     the individual in an amount equal to not less than 20 percent 
     and not more than 39 percent of the total amount of loan 
     repayments made for the taxable year involved; and
       ``(B) may make such additional payments as the Secretary 
     determines to be appropriate with respect to such purpose.
       ``(5) Payment schedule.--The Secretary may enter into an 
     agreement with the holder of any loan for which payments are 
     made under the Loan Repayment Program to establish a schedule 
     for the making of such payments.
       ``(h) Employment Ceiling.--Notwithstanding any other 
     provision of law, individuals who have entered into written 
     contracts with the Secretary under this section shall not be 
     counted against any employment ceiling affecting the 
     Department while those individuals are undergoing academic 
     training.
       ``(i) Recruitment.--The Secretary shall conduct recruiting 
     programs for the Loan Repayment Program and other manpower 
     programs of the Service at educational institutions training 
     health professionals or specialists identified in subsection 
     (a).
       ``(j) Applicability of Law.--Section 214 of the Public 
     Health Service Act (42 U.S.C. 215) shall not apply to 
     individuals during their period of obligated service under 
     the Loan Repayment Program.
       ``(k) Assignment of Individuals.--The Secretary, in 
     assigning individuals to serve in Indian Health Programs or 
     Urban Indian Organizations pursuant to contracts entered into 
     under this section, shall--
       ``(1) ensure that the staffing needs of Tribal Health 
     Programs and Urban Indian Organizations receive consideration 
     on an equal basis with programs that are administered 
     directly by the Service; and
       ``(2) give priority to assigning individuals to Indian 
     Health Programs and Urban Indian Organizations that have a 
     need for health professionals to provide health care services 
     as a result of individuals having breached contracts entered 
     into under this section.
       ``(l) Breach of Contract.--
       ``(1) Specific breaches.--An individual who has entered 
     into a written contract with the Secretary under this section 
     and has not received a waiver under subsection (m) shall be 
     liable, in lieu of any service obligation arising under such 
     contract, to the United States for the amount which has been 
     paid on such individual's behalf under the contract if that 
     individual--
       ``(A) is enrolled in the final year of a course of study 
     and--
       ``(i) fails to maintain an acceptable level of academic 
     standing in the educational institution in which he or she is 
     enrolled (such level determined by the educational 
     institution under regulations of the Secretary);
       ``(ii) voluntarily terminates such enrollment; or
       ``(iii) is dismissed from such educational institution 
     before completion of such course of study; or
       ``(B) is enrolled in a graduate training program and fails 
     to complete such training program.
       ``(2) Other breaches; formula for amount owed.--If, for any 
     reason not specified in paragraph (1), an individual breaches 
     his or her written contract under this section by failing 
     either to begin, or complete, such individual's period of 
     obligated service in accordance with subsection (e)(2), the 
     United States shall be entitled to recover from such 
     individual an amount to be determined in accordance with the 
     following formula: A=3Z(t-s/t) in which--
       ``(A) `A' is the amount the United States is entitled to 
     recover;
       ``(B) `Z' is the sum of the amounts paid under this section 
     to, or on behalf of, the individual and the interest on such 
     amounts which would be payable if, at the time the amounts 
     were paid, they were loans bearing interest at the maximum 
     legal prevailing rate, as determined by the Secretary of the 
     Treasury;
       ``(C) `t' is the total number of months in the individual's 
     period of obligated service in accordance with subsection 
     (f); and

[[Page 21681]]

       ``(D) `s' is the number of months of such period served by 
     such individual in accordance with this section.
       ``(3) Deductions in medicare payments.--Amounts not paid 
     within such period shall be subject to collection through 
     deductions in Medicare payments pursuant to section 1892 of 
     the Social Security Act.
       ``(4) Time period for repayment.--Any amount of damages 
     which the United States is entitled to recover under this 
     subsection shall be paid to the United States within the 1-
     year period beginning on the date of the breach or such 
     longer period beginning on such date as shall be specified by 
     the Secretary.
       ``(5) Recovery of delinquency.--
       ``(A) In general.--If damages described in paragraph (4) 
     are delinquent for 3 months, the Secretary shall, for the 
     purpose of recovering such damages--
       ``(i) use collection agencies contracted with by the 
     Administrator of General Services; or
       ``(ii) enter into contracts for the recovery of such 
     damages with collection agencies selected by the Secretary.
       ``(B) Report.--Each contract for recovering damages 
     pursuant to this subsection shall provide that the contractor 
     will, not less than once each 6 months, submit to the 
     Secretary a status report on the success of the contractor in 
     collecting such damages. Section 3718 of title 31, United 
     States Code, shall apply to any such contract to the extent 
     not inconsistent with this subsection.
       ``(m) Waiver or Suspension of Obligation.--
       ``(1) In general.--The Secretary shall by regulation 
     provide for the partial or total waiver or suspension of any 
     obligation of service or payment by an individual under the 
     Loan Repayment Program whenever compliance by the individual 
     is impossible or would involve extreme hardship to the 
     individual and if enforcement of such obligation with respect 
     to any individual would be unconscionable.
       ``(2) Canceled upon death.--Any obligation of an individual 
     under the Loan Repayment Program for service or payment of 
     damages shall be canceled upon the death of the individual.
       ``(3) Hardship waiver.--The Secretary may waive, in whole 
     or in part, the rights of the United States to recover 
     amounts under this section in any case of extreme hardship or 
     other good cause shown, as determined by the Secretary.
       ``(4) Bankruptcy.--Any obligation of an individual under 
     the Loan Repayment Program for payment of damages may be 
     released by a discharge in bankruptcy under title 11 of the 
     United States Code only if such discharge is granted after 
     the expiration of the 5-year period beginning on the first 
     date that payment of such damages is required, and only if 
     the bankruptcy court finds that nondischarge of the 
     obligation would be unconscionable.
       ``(n) Report.--The Secretary shall submit to the President, 
     for inclusion in the report required to be submitted to 
     Congress under section 801, a report concerning the previous 
     fiscal year which sets forth by Service Area the following:
       ``(1) A list of the health professional positions 
     maintained by Indian Health Programs and Urban Indian 
     Organizations for which recruitment or retention is 
     difficult.
       ``(2) The number of Loan Repayment Program applications 
     filed with respect to each type of health profession.
       ``(3) The number of contracts described in subsection (e) 
     that are entered into with respect to each health profession.
       ``(4) The amount of loan payments made under this section, 
     in total and by health profession.
       ``(5) The number of scholarships that are provided under 
     sections 104 and 106 with respect to each health profession.
       ``(6) The amount of scholarship grants provided under 
     section 104 and 106, in total and by health profession.
       ``(7) The number of providers of health care that will be 
     needed by Indian Health Programs and Urban Indian 
     Organizations, by location and profession, during the 3 
     fiscal years beginning after the date the report is filed.
       ``(8) The measures the Secretary plans to take to fill the 
     health professional positions maintained by Indian Health 
     Programs or Urban Indian Organizations for which recruitment 
     or retention is difficult.

     ``SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOVERY FUND.

       ``(a) Establishment.--There is established in the Treasury 
     of the United States a fund to be known as the Indian Health 
     Scholarship and Loan Repayment Recovery Fund (hereafter in 
     this section referred to as the `LRRF'). The LRRF shall 
     consist of such amounts as may be collected from individuals 
     under section 104(d), section 106(e), and section 110(l) for 
     breach of contract, such funds as may be appropriated to the 
     LRRF, and interest earned on amounts in the LRRF. All amounts 
     collected, appropriated, or earned relative to the LRRF shall 
     remain available until expended.
       ``(b) Use of Funds.--
       ``(1) By secretary.--Amounts in the LRRF may be expended by 
     the Secretary, acting through the Service, to make payments 
     to an Indian Health Program--
       ``(A) to which a scholarship recipient under section 104 
     and 106 or a loan repayment program participant under section 
     110 has been assigned to meet the obligated service 
     requirements pursuant to such sections; and
       ``(B) that has a need for a health professional to provide 
     health care services as a result of such recipient or 
     participant having breached the contract entered into under 
     section 104, 106, or section 110.
       ``(2) By tribal health programs.--A Tribal Health Program 
     receiving payments pursuant to paragraph (1) may expend the 
     payments to provide scholarships or recruit and employ, 
     directly or by contract, health professionals to provide 
     health care services.
       ``(c) Investment of Funds.--The Secretary of the Treasury 
     shall invest such amounts of the LRRF as the Secretary of 
     Health and Human Services determines are not required to meet 
     current withdrawals from the LRRF. Such investments may be 
     made only in interest bearing obligations of the United 
     States. For such purpose, such obligations may be acquired on 
     original issue at the issue price, or by purchase of 
     outstanding obligations at the market price.
       ``(d) Sale of Obligations.--Any obligation acquired by the 
     LRRF may be sold by the Secretary of the Treasury at the 
     market price.

     ``SEC. 112. RECRUITMENT ACTIVITIES.

       ``(a) Reimbursement for Travel.--The Secretary, acting 
     through the Service, may reimburse health professionals 
     seeking positions with Indian Health Programs or Urban Indian 
     Organizations, including individuals considering entering 
     into a contract under section 110 and their spouses, for 
     actual and reasonable expenses incurred in traveling to and 
     from their places of residence to an area in which they may 
     be assigned for the purpose of evaluating such area with 
     respect to such assignment.
       ``(b) Recruitment Personnel.--The Secretary, acting through 
     the Service, shall assign 1 individual in each Area Office to 
     be responsible on a full-time basis for recruitment 
     activities.

     ``SEC. 113. INDIAN RECRUITMENT AND RETENTION PROGRAM.

       ``(a) In General.--The Secretary, acting through the 
     Service, shall fund, on a competitive basis, innovative 
     demonstration projects for a period not to exceed 3 years to 
     enable Tribal Health Programs and Urban Indian Organizations 
     to recruit, place, and retain health professionals to meet 
     their staffing needs.
       ``(b) Eligible Entities; Application.--Any Tribal Health 
     Program or Urban Indian Organization may submit an 
     application for funding of a project pursuant to this 
     section.

     ``SEC. 114. ADVANCED TRAINING AND RESEARCH.

       ``(a) Demonstration Program.--The Secretary, acting through 
     the Service, shall establish a demonstration project to 
     enable health professionals who have worked in an Indian 
     Health Program or Urban Indian Organization for a substantial 
     period of time to pursue advanced training or research areas 
     of study for which the Secretary determines a need exists.
       ``(b) Service Obligation.--An individual who participates 
     in a program under subsection (a), where the educational 
     costs are borne by the Service, shall incur an obligation to 
     serve in an Indian Health Program or Urban Indian 
     Organization for a period of obligated service equal to at 
     least the period of time during which the individual 
     participates in such program. In the event that the 
     individual fails to complete such obligated service, the 
     individual shall be liable to the United States for the 
     period of service remaining. In such event, with respect to 
     individuals entering the program after the date of enactment 
     of the Indian Health Care Improvement Act Amendments of 2007, 
     the United States shall be entitled to recover from such 
     individual an amount to be determined in accordance with the 
     formula specified in subsection (l) of section 110 in the 
     manner provided for in such subsection.
       ``(c) Equal Opportunity for Participation.--Health 
     professionals from Tribal Health Programs and Urban Indian 
     Organizations shall be given an equal opportunity to 
     participate in the program under subsection (a).

     ``SEC. 115. QUENTIN N. BURDICK AMERICAN INDIANS INTO NURSING 
                   PROGRAM.

       ``(a) Grants Authorized.--For the purpose of increasing the 
     number of nurses, nurse midwives, and nurse practitioners who 
     deliver health care services to Indians, the Secretary, 
     acting through the Service, shall provide grants to the 
     following:
       ``(1) Public or private schools of nursing.
       ``(2) Tribal colleges or universities.
       ``(3) Nurse midwife programs and advanced practice nurse 
     programs that are provided by any tribal college or 
     university accredited nursing program, or in the absence of 
     such, any other public or private institutions.
       ``(b) Use of Grants.--Grants provided under subsection (a) 
     may be used for 1 or more of the following:
       ``(1) To recruit individuals for programs which train 
     individuals to be nurses, nurse midwives, or advanced 
     practice nurses.
       ``(2) To provide scholarships to Indians enrolled in such 
     programs that may pay the tuition charged for such program 
     and other

[[Page 21682]]

     expenses incurred in connection with such program, including 
     books, fees, room and board, and stipends for living 
     expenses.
       ``(3) To provide a program that encourages nurses, nurse 
     midwives, and advanced practice nurses to provide, or 
     continue to provide, health care services to Indians.
       ``(4) To provide a program that increases the skills of, 
     and provides continuing education to, nurses, nurse midwives, 
     and advanced practice nurses.
       ``(5) To provide any program that is designed to achieve 
     the purpose described in subsection (a).
       ``(c) Applications.--Each application for a grant under 
     subsection (a) shall include such information as the 
     Secretary may require to establish the connection between the 
     program of the applicant and a health care facility that 
     primarily serves Indians.
       ``(d) Preferences for Grant Recipients.--In providing 
     grants under subsection (a), the Secretary shall extend a 
     preference to the following:
       ``(1) Programs that provide a preference to Indians.
       ``(2) Programs that train nurse midwives or advanced 
     practice nurses.
       ``(3) Programs that are interdisciplinary.
       ``(4) Programs that are conducted in cooperation with a 
     program for gifted and talented Indian students.
       ``(5) Programs conducted by tribal colleges and 
     universities.
       ``(e) Quentin N. Burdick Program Grant.--The Secretary 
     shall provide 1 of the grants authorized under subsection (a) 
     to establish and maintain a program at the University of 
     North Dakota to be known as the `Quentin N. Burdick American 
     Indians Into Nursing Program'. Such program shall, to the 
     maximum extent feasible, coordinate with the Quentin N. 
     Burdick Indian Health Programs established under section 
     117(b) and the Quentin N. Burdick American Indians Into 
     Psychology Program established under section 105(b).
       ``(f) Active Duty Service Obligation.--The active duty 
     service obligation prescribed under section 338C of the 
     Public Health Service Act (42 U.S.C. 254m) shall be met by 
     each individual who receives training or assistance described 
     in paragraph (1) or (2) of subsection (b) that is funded by a 
     grant provided under subsection (a). Such obligation shall be 
     met by service--
       ``(1) in the Service;
       ``(2) in a program of an Indian Tribe or Tribal 
     Organization conducted under the Indian Self-Determination 
     and Education Assistance Act (25 U.S.C. 450 et seq.) 
     (including programs under agreements with the Bureau of 
     Indian Affairs);
       ``(3) in a program assisted under title V of this Act;
       ``(4) in the private practice of nursing if, as determined 
     by the Secretary, in accordance with guidelines promulgated 
     by the Secretary, such practice is situated in a physician or 
     other health shortage area and addresses the health care 
     needs of a substantial number of Indians; or
       ``(5) in a teaching capacity in a tribal college or 
     university nursing program (or a related health profession 
     program) if, as determined by the Secretary, health services 
     provided to Indians would not decrease.

     ``SEC. 116. TRIBAL CULTURAL ORIENTATION.

       ``(a) Cultural Education of Employees.--The Secretary, 
     acting through the Service, shall require that appropriate 
     employees of the Service who serve Indian Tribes in each 
     Service Area receive educational instruction in the history 
     and culture of such Indian Tribes and their relationship to 
     the Service.
       ``(b) Program.--In carrying out subsection (a), the 
     Secretary shall establish a program which shall, to the 
     extent feasible--
       ``(1) be developed in consultation with the affected Indian 
     Tribes, Tribal Organizations, and Urban Indian Organizations;
       ``(2) be carried out through tribal colleges or 
     universities;
       ``(3) include instruction in American Indian studies; and
       ``(4) describe the use and place of traditional health care 
     practices of the Indian Tribes in the Service Area.

     ``SEC. 117. INMED PROGRAM.

       ``(a) Grants Authorized.--The Secretary, acting through the 
     Service, is authorized to provide grants to colleges and 
     universities for the purpose of maintaining and expanding the 
     Indian health careers recruitment program known as the 
     `Indians Into Medicine Program' (hereinafter in this section 
     referred to as `INMED') as a means of encouraging Indians to 
     enter the health professions.
       ``(b) Quentin N. Burdick Grant.--The Secretary shall 
     provide 1 of the grants authorized under subsection (a) to 
     maintain the INMED program at the University of North Dakota, 
     to be known as the `Quentin N. Burdick Indian Health 
     Programs', unless the Secretary makes a determination, based 
     upon program reviews, that the program is not meeting the 
     purposes of this section. Such program shall, to the maximum 
     extent feasible, coordinate with the Quentin N. Burdick 
     American Indians Into Psychology Program established under 
     section 105(b) and the Quentin N. Burdick American Indians 
     Into Nursing Program established under section 115.
       ``(c) Regulations.--The Secretary, pursuant to this Act, 
     shall develop regulations to govern grants pursuant to this 
     section.
       ``(d) Requirements.--Applicants for grants provided under 
     this section shall agree to provide a program which--
       ``(1) provides outreach and recruitment for health 
     professions to Indian communities including elementary and 
     secondary schools and community colleges located on 
     reservations which will be served by the program;
       ``(2) incorporates a program advisory board comprised of 
     representatives from the Indian Tribes and Indian communities 
     which will be served by the program;
       ``(3) provides summer preparatory programs for Indian 
     students who need enrichment in the subjects of math and 
     science in order to pursue training in the health 
     professions;
       ``(4) provides tutoring, counseling, and support to 
     students who are enrolled in a health career program of study 
     at the respective college or university; and
       ``(5) to the maximum extent feasible, employs qualified 
     Indians in the program.

     ``SEC. 118. HEALTH TRAINING PROGRAMS OF COMMUNITY COLLEGES.

       ``(a) Grants to Establish Programs.--
       ``(1) In general.--The Secretary, acting through the 
     Service, shall award grants to accredited and accessible 
     community colleges for the purpose of assisting such 
     community colleges in the establishment of programs which 
     provide education in a health profession leading to a degree 
     or diploma in a health profession for individuals who desire 
     to practice such profession on or near a reservation or in an 
     Indian Health Program.
       ``(2) Amount of grants.--The amount of any grant awarded to 
     a community college under paragraph (1) for the first year in 
     which such a grant is provided to the community college shall 
     not exceed $250,000.
       ``(b) Grants for Maintenance and Recruiting.--
       ``(1) In general.--The Secretary, acting through the 
     Service, shall award grants to accredited and accessible 
     community colleges that have established a program described 
     in subsection (a)(1) for the purpose of maintaining the 
     program and recruiting students for the program.
       ``(2) Requirements.--Grants may only be made under this 
     section to a community college which--
       ``(A) is accredited;
       ``(B) has a relationship with a hospital facility, Service 
     facility, or hospital that could provide training of nurses 
     or health professionals;
       ``(C) has entered into an agreement with an accredited 
     college or university medical school, the terms of which--
       ``(i) provide a program that enhances the transition and 
     recruitment of students into advanced baccalaureate or 
     graduate programs that train health professionals; and
       ``(ii) stipulate certifications necessary to approve 
     internship and field placement opportunities at Indian Health 
     Programs;
       ``(D) has a qualified staff which has the appropriate 
     certifications;
       ``(E) is capable of obtaining State or regional 
     accreditation of the program described in subsection (a)(1); 
     and
       ``(F) agrees to provide for Indian preference for 
     applicants for programs under this section.
       ``(c) Technical Assistance.--The Secretary shall encourage 
     community colleges described in subsection (b)(2) to 
     establish and maintain programs described in subsection 
     (a)(1) by--
       ``(1) entering into agreements with such colleges for the 
     provision of qualified personnel of the Service to teach 
     courses of study in such programs; and
       ``(2) providing technical assistance and support to such 
     colleges.
       ``(d) Advanced Training.--
       ``(1) Required.--Any program receiving assistance under 
     this section that is conducted with respect to a health 
     profession shall also offer courses of study which provide 
     advanced training for any health professional who--
       ``(A) has already received a degree or diploma in such 
     health profession; and
       ``(B) provides clinical services on or near a reservation 
     or for an Indian Health Program.
       ``(2) May be offered at alternate site.--Such courses of 
     study may be offered in conjunction with the college or 
     university with which the community college has entered into 
     the agreement required under subsection (b)(2)(C).
       ``(e) Priority.--Where the requirements of subsection (b) 
     are met, grant award priority shall be provided to tribal 
     colleges and universities in Service Areas where they exist.

     ``SEC. 119. RETENTION BONUS.

       ``(a) Bonus Authorized.--The Secretary may pay a retention 
     bonus to any health professional employed by, or assigned to, 
     and serving in, an Indian Health Program or Urban Indian 
     Organization either as a civilian employee or as a 
     commissioned officer in the Regular or Reserve Corps of the 
     Public Health Service who--
       ``(1) is assigned to, and serving in, a position for which 
     recruitment or retention of personnel is difficult;
       ``(2) the Secretary determines is needed by Indian Health 
     Programs and Urban Indian Organizations;
       ``(3) has--

[[Page 21683]]

       ``(A) completed 2 years of employment with an Indian Health 
     Program or Urban Indian Organization; or
       ``(B) completed any service obligations incurred as a 
     requirement of--
       ``(i) any Federal scholarship program; or
       ``(ii) any Federal education loan repayment program; and
       ``(4) enters into an agreement with an Indian Health 
     Program or Urban Indian Organization for continued employment 
     for a period of not less than 1 year.
       ``(b) Rates.--The Secretary may establish rates for the 
     retention bonus which shall provide for a higher annual rate 
     for multiyear agreements than for single year agreements 
     referred to in subsection (a)(4), but in no event shall the 
     annual rate be more than $25,000 per annum.
       ``(c) Default of Retention Agreement.--Any health 
     professional failing to complete the agreed upon term of 
     service, except where such failure is through no fault of the 
     individual, shall be obligated to refund to the Government 
     the full amount of the retention bonus for the period covered 
     by the agreement, plus interest as determined by the 
     Secretary in accordance with section 110(l)(2)(B).
       ``(d) Other Retention Bonus.--The Secretary may pay a 
     retention bonus to any health professional employed by a 
     Tribal Health Program if such health professional is serving 
     in a position which the Secretary determines is--
       ``(1) a position for which recruitment or retention is 
     difficult; and
       ``(2) necessary for providing health care services to 
     Indians.

     ``SEC. 120. NURSING RESIDENCY PROGRAM.

       ``(a) Establishment of Program.--The Secretary, acting 
     through the Service, shall establish a program to enable 
     Indians who are licensed practical nurses, licensed 
     vocational nurses, and registered nurses who are working in 
     an Indian Health Program or Urban Indian Organization, and 
     have done so for a period of not less than 1 year, to pursue 
     advanced training. Such program shall include a combination 
     of education and work study in an Indian Health Program or 
     Urban Indian Organization leading to an associate or 
     bachelor's degree (in the case of a licensed practical nurse 
     or licensed vocational nurse), a bachelor's degree (in the 
     case of a registered nurse), or advanced degrees or 
     certifications in nursing and public health.
       ``(b) Service Obligation.--An individual who participates 
     in a program under subsection (a), where the educational 
     costs are paid by the Service, shall incur an obligation to 
     serve in an Indian Health Program or Urban Indian 
     Organization for a period of obligated service equal to 1 
     year for every year that nonprofessional employee (licensed 
     practical nurses, licensed vocational nurses, nursing 
     assistants, and various health care technicals), or 2 years 
     for every year that professional nurse (associate degree and 
     bachelor-prepared registered nurses), participates in such 
     program. In the event that the individual fails to complete 
     such obligated service, the United States shall be entitled 
     to recover from such individual an amount determined in 
     accordance with the formula specified in subsection (l) of 
     section 110 in the manner provided for in such subsection.

     ``SEC. 121. COMMUNITY HEALTH AIDE PROGRAM.

       ``(a) General Purposes of Program.--Under the authority of 
     the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as 
     the `Snyder Act'), the Secretary, acting through the Service, 
     shall develop and operate a Community Health Aide Program in 
     Alaska under which the Service--
       ``(1) provides for the training of Alaska Natives as health 
     aides or community health practitioners;
       ``(2) uses such aides or practitioners in the provision of 
     health care, health promotion, and disease prevention 
     services to Alaska Natives living in villages in rural 
     Alaska; and
       ``(3) provides for the establishment of teleconferencing 
     capacity in health clinics located in or near such villages 
     for use by community health aides or community health 
     practitioners.
       ``(b) Specific Program Requirements.--The Secretary, acting 
     through the Community Health Aide Program of the Service, 
     shall--
       ``(1) using trainers accredited by the Program, provide a 
     high standard of training to community health aides and 
     community health practitioners to ensure that such aides and 
     practitioners provide quality health care, health promotion, 
     and disease prevention services to the villages served by the 
     Program;
       ``(2) in order to provide such training, develop a 
     curriculum that--
       ``(A) combines education in the theory of health care with 
     supervised practical experience in the provision of health 
     care;
       ``(B) provides instruction and practical experience in the 
     provision of acute care, emergency care, health promotion, 
     disease prevention, and the efficient and effective 
     management of clinic pharmacies, supplies, equipment, and 
     facilities; and
       ``(C) promotes the achievement of the health status 
     objectives specified in section 3(2);
       ``(3) establish and maintain a Community Health Aide 
     Certification Board to certify as community health aides or 
     community health practitioners individuals who have 
     successfully completed the training described in paragraph 
     (1) or can demonstrate equivalent experience;
       ``(4) develop and maintain a system which identifies the 
     needs of community health aides and community health 
     practitioners for continuing education in the provision of 
     health care, including the areas described in paragraph 
     (2)(B), and develop programs that meet the needs for such 
     continuing education;
       ``(5) develop and maintain a system that provides close 
     supervision of community health aides and community health 
     practitioners;
       ``(6) develop a system under which the work of community 
     health aides and community health practitioners is reviewed 
     and evaluated to assure the provision of quality health care, 
     health promotion, and disease prevention services; and
       ``(7) ensure that pulpal therapy (not including pulpotomies 
     on deciduous teeth) or extraction of adult teeth can be 
     performed by a dental health aide therapist only after 
     consultation with a licensed dentist who determines that the 
     procedure is a medical emergency that cannot be resolved with 
     palliative treatment, and further that dental health aide 
     therapists are strictly prohibited from performing all other 
     oral or jaw surgeries, provided that uncomplicated 
     extractions shall not be considered oral surgery under this 
     section.
       ``(c) Program Review.--
       ``(1) Neutral panel.--
       ``(A) Establishment.--The Secretary, acting through the 
     Service, shall establish a neutral panel to carry out the 
     study under paragraph (2).
       ``(B) Membership.--Members of the neutral panel shall be 
     appointed by the Secretary from among clinicians, economists, 
     community practitioners, oral epidemiologists, and Alaska 
     Natives.
       ``(2) Study.--
       ``(A) In general.--The neutral panel established under 
     paragraph (1) shall conduct a study of the dental health aide 
     therapist services provided by the Community Health Aide 
     Program under this section to ensure that the quality of care 
     provided through those services is adequate and appropriate.
       ``(B) Parameters of study.--The Secretary, in consultation 
     with interested parties, including professional dental 
     organizations, shall develop the parameters of the study.
       ``(C) Inclusions.--The study shall include a determination 
     by the neutral panel with respect to--
       ``(i) the ability of the dental health aide therapist 
     services under this section to address the dental care needs 
     of Alaska Natives;
       ``(ii) the quality of care provided through those services, 
     including any training, improvement, or additional oversight 
     required to improve the quality of care; and
       ``(iii) whether safer and less costly alternatives to the 
     dental health aide therapist services exist.
       ``(D) Consultation.--In carrying out the study under this 
     paragraph, the neutral panel shall consult with Alaska Tribal 
     Organizations with respect to the adequacy and accuracy of 
     the study.
       ``(3) Report.--The neutral panel shall submit to the 
     Secretary, the Committee on Indian Affairs of the Senate, and 
     the Committee on Natural Resources of the House of 
     Representatives a report describing the results of the study 
     under paragraph (2), including a description of--
       ``(A) any determination of the neutral panel under 
     paragraph (2)(C); and
       ``(B) any comments received from an Alaska Tribal 
     Organization under paragraph (2)(D).
       ``(d) Nationalization of Program.--
       ``(1) In general.--Except as provided in paragraph (2), the 
     Secretary, acting through the Service, may establish a 
     national Community Health Aide Program in accordance with the 
     program under this section, as the Secretary determines to be 
     appropriate.
       ``(2) Exception.--The national Community Health Aide 
     Program under paragraph (1) shall not include dental health 
     aide therapist services.
       ``(3) Requirement.--In establishing a national program 
     under paragraph (1), the Secretary shall not reduce the 
     amount of funds provided for the Community Health Aide 
     Program described in subsections (a) and (b).

     ``SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.

       ``The Secretary, acting through the Service, shall, by 
     contract or otherwise, provide training for Indians in the 
     administration and planning of Tribal Health Programs.

     ``SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE 
                   DEMONSTRATION PROGRAMS.

       ``(a) Demonstration Programs Authorized.--The Secretary, 
     acting through the Service, may fund demonstration programs 
     for Tribal Health Programs to address the chronic shortages 
     of health professionals.
       ``(b) Purposes of Programs.--The purposes of demonstration 
     programs funded under subsection (a) shall be--
       ``(1) to provide direct clinical and practical experience 
     at a Service Unit to health profession students and residents 
     from medical schools;

[[Page 21684]]

       ``(2) to improve the quality of health care for Indians by 
     assuring access to qualified health care professionals; and
       ``(3) to provide academic and scholarly opportunities for 
     health professionals serving Indians by identifying all 
     academic and scholarly resources of the region.
       ``(c) Advisory Board.--The demonstration programs 
     established pursuant to subsection (a) shall incorporate a 
     program advisory board composed of representatives from the 
     Indian Tribes and Indian communities in the area which will 
     be served by the program.

     ``SEC. 124. NATIONAL HEALTH SERVICE CORPS.

       ``(a) No Reduction in Services.--The Secretary shall not--
       ``(1) remove a member of the National Health Service Corps 
     from an Indian Health Program or Urban Indian Organization; 
     or
       ``(2) withdraw funding used to support such member, unless 
     the Secretary, acting through the Service, has ensured that 
     the Indians receiving services from such member will 
     experience no reduction in services.
       ``(b) Exemption From Limitations.--National Health Service 
     Corps scholars qualifying for the Commissioned Corps in the 
     Public Health Service shall be exempt from the full-time 
     equivalent limitations of the National Health Service Corps 
     and the Service when serving as a commissioned corps officer 
     in a Tribal Health Program or an Urban Indian Organization.

     ``SEC. 125. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL CURRICULA 
                   DEMONSTRATION PROGRAMS.

       ``(a) Contracts and Grants.--The Secretary, acting through 
     the Service, may enter into contracts with, or make grants 
     to, accredited tribal colleges and universities and eligible 
     accredited and accessible community colleges to establish 
     demonstration programs to develop educational curricula for 
     substance abuse counseling.
       ``(b) Use of Funds.--Funds provided under this section 
     shall be used only for developing and providing educational 
     curriculum for substance abuse counseling (including paying 
     salaries for instructors). Such curricula may be provided 
     through satellite campus programs.
       ``(c) Time Period of Assistance; Renewal.--A contract 
     entered into or a grant provided under this section shall be 
     for a period of 3 years. Such contract or grant may be 
     renewed for an additional 2-year period upon the approval of 
     the Secretary.
       ``(d) Criteria for Review and Approval of Applications.--
     Not later than 180 days after the date of enactment of the 
     Indian Health Care Improvement Act Amendments of 2007, the 
     Secretary, after consultation with Indian Tribes and 
     administrators of tribal colleges and universities and 
     eligible accredited and accessible community colleges, shall 
     develop and issue criteria for the review and approval of 
     applications for funding (including applications for renewals 
     of funding) under this section. Such criteria shall ensure 
     that demonstration programs established under this section 
     promote the development of the capacity of such entities to 
     educate substance abuse counselors.
       ``(e) Assistance.--The Secretary shall provide such 
     technical and other assistance as may be necessary to enable 
     grant recipients to comply with the provisions of this 
     section.
       ``(f) Report.--Each fiscal year, the Secretary shall submit 
     to the President, for inclusion in the report which is 
     required to be submitted under section 801 for that fiscal 
     year, a report on the findings and conclusions derived from 
     the demonstration programs conducted under this section 
     during that fiscal year.
       ``(g) Definition.--For the purposes of this section, the 
     term `educational curriculum' means 1 or more of the 
     following:
       ``(1) Classroom education.
       ``(2) Clinical work experience.
       ``(3) Continuing education workshops.

     ``SEC. 126. BEHAVIORAL HEALTH TRAINING AND COMMUNITY 
                   EDUCATION PROGRAMS.

       ``(a) Study; List.--The Secretary, acting through the 
     Service, and the Secretary of the Interior, in consultation 
     with Indian Tribes and Tribal Organizations, shall conduct a 
     study and compile a list of the types of staff positions 
     specified in subsection (b) whose qualifications include, or 
     should include, training in the identification, prevention, 
     education, referral, or treatment of mental illness, or 
     dysfunctional and self destructive behavior.
       ``(b) Positions.--The positions referred to in subsection 
     (a) are--
       ``(1) staff positions within the Bureau of Indian Affairs, 
     including existing positions, in the fields of--
       ``(A) elementary and secondary education;
       ``(B) social services and family and child welfare;
       ``(C) law enforcement and judicial services; and
       ``(D) alcohol and substance abuse;
       ``(2) staff positions within the Service; and
       ``(3) staff positions similar to those identified in 
     paragraphs (1) and (2) established and maintained by Indian 
     Tribes and Tribal Organizations (without regard to the 
     funding source).
       ``(c) Training Criteria.--
       ``(1) In general.--The appropriate Secretary shall provide 
     training criteria appropriate to each type of position 
     identified in subsection (b)(1) and (b)(2) and ensure that 
     appropriate training has been, or shall be provided to any 
     individual in any such position. With respect to any such 
     individual in a position identified pursuant to subsection 
     (b)(3), the respective Secretaries shall provide appropriate 
     training to, or provide funds to, an Indian Tribe or Tribal 
     Organization for training of appropriate individuals. In the 
     case of positions funded under a contract or compact under 
     the Indian Self-Determination and Education Assistance Act 
     (25 U.S.C. 450 et seq.), the appropriate Secretary shall 
     ensure that such training costs are included in the contract 
     or compact, as the Secretary determines necessary.
       ``(2) Position specific training criteria.--Position 
     specific training criteria shall be culturally relevant to 
     Indians and Indian Tribes and shall ensure that appropriate 
     information regarding traditional health care practices is 
     provided.
       ``(d) Community Education on Mental Illness.--The Service 
     shall develop and implement, on request of an Indian Tribe, 
     Tribal Organization, or Urban Indian Organization, or assist 
     the Indian Tribe, Tribal Organization, or Urban Indian 
     Organization to develop and implement, a program of community 
     education on mental illness. In carrying out this subsection, 
     the Service shall, upon request of an Indian Tribe, Tribal 
     Organization, or Urban Indian Organization, provide technical 
     assistance to the Indian Tribe, Tribal Organization, or Urban 
     Indian Organization to obtain and develop community 
     educational materials on the identification, prevention, 
     referral, and treatment of mental illness and dysfunctional 
     and self-destructive behavior.
       ``(e) Plan.--Not later than 90 days after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2007, the Secretary shall develop a plan under 
     which the Service will increase the health care staff 
     providing behavioral health services by at least 500 
     positions within 5 years after the date of enactment of this 
     section, with at least 200 of such positions devoted to 
     child, adolescent, and family services. The plan developed 
     under this subsection shall be implemented under the Act of 
     November 2, 1921 (25 U.S.C. 13) (commonly known as the 
     `Snyder Act').

     ``SEC. 127. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2017 to 
     carry out this title.

                      ``TITLE II--HEALTH SERVICES

     ``SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND.

       ``(a) Use of Funds.--The Secretary, acting through the 
     Service, is authorized to expend funds, directly or under the 
     authority of the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450 et seq.), which are 
     appropriated under the authority of this section, for the 
     purposes of--
       ``(1) eliminating the deficiencies in health status and 
     health resources of all Indian Tribes;
       ``(2) eliminating backlogs in the provision of health care 
     services to Indians;
       ``(3) meeting the health needs of Indians in an efficient 
     and equitable manner, including the use of telehealth and 
     telemedicine when appropriate;
       ``(4) eliminating inequities in funding for both direct 
     care and contract health service programs; and
       ``(5) augmenting the ability of the Service to meet the 
     following health service responsibilities with respect to 
     those Indian Tribes with the highest levels of health status 
     deficiencies and resource deficiencies:
       ``(A) Clinical care, including inpatient care, outpatient 
     care (including audiology, clinical eye, and vision care), 
     primary care, secondary and tertiary care, and long-term 
     care.
       ``(B) Preventive health, including mammography and other 
     cancer screening in accordance with section 207.
       ``(C) Dental care.
       ``(D) Mental health, including community mental health 
     services, inpatient mental health services, dormitory mental 
     health services, therapeutic and residential treatment 
     centers, and training of traditional health care 
     practitioners.
       ``(E) Emergency medical services.
       ``(F) Treatment and control of, and rehabilitative care 
     related to, alcoholism and drug abuse (including fetal 
     alcohol spectrum disorders) among Indians.
       ``(G) Injury prevention programs, including data collection 
     and evaluation, demonstration projects, training, and 
     capacity building.
       ``(H) Home health care.
       ``(I) Community health representatives.
       ``(J) Maintenance and improvement.
       ``(b) No Offset or Limitation.--Any funds appropriated 
     under the authority of this section shall not be used to 
     offset or limit any other appropriations made to the Service 
     under this Act or the Act of November 2, 1921 (25 U.S.C. 13) 
     (commonly known as the `Snyder Act'), or any other provision 
     of law.
       ``(c) Allocation; Use.--
       ``(1) In general.--Funds appropriated under the authority 
     of this section shall be allocated to Service Units, Indian 
     Tribes, or Tribal Organizations. The funds allocated to each 
     Indian Tribe, Tribal Organization, or

[[Page 21685]]

     Service Unit under this paragraph shall be used by the Indian 
     Tribe, Tribal Organization, or Service Unit under this 
     paragraph to improve the health status and reduce the 
     resource deficiency of each Indian Tribe served by such 
     Service Unit, Indian Tribe, or Tribal Organization.
       ``(2) Apportionment of allocated funds.--The apportionment 
     of funds allocated to a Service Unit, Indian Tribe, or Tribal 
     Organization under paragraph (1) among the health service 
     responsibilities described in subsection (a)(5) shall be 
     determined by the Service in consultation with, and with the 
     active participation of, the affected Indian Tribes and 
     Tribal Organizations.
       ``(d) Provisions Relating to Health Status and Resource 
     Deficiencies.--For the purposes of this section, the 
     following definitions apply:
       ``(1) Definition.--The term `health status and resource 
     deficiency' means the extent to which--
       ``(A) the health status objectives set forth in section 
     3(2) are not being achieved; and
       ``(B) the Indian Tribe or Tribal Organization does not have 
     available to it the health resources it needs, taking into 
     account the actual cost of providing health care services 
     given local geographic, climatic, rural, or other 
     circumstances.
       ``(2) Available resources.--The health resources available 
     to an Indian Tribe or Tribal Organization include health 
     resources provided by the Service as well as health resources 
     used by the Indian Tribe or Tribal Organization, including 
     services and financing systems provided by any Federal 
     programs, private insurance, and programs of State or local 
     governments.
       ``(3) Process for review of determinations.--The Secretary 
     shall establish procedures which allow any Indian Tribe or 
     Tribal Organization to petition the Secretary for a review of 
     any determination of the extent of the health status and 
     resource deficiency of such Indian Tribe or Tribal 
     Organization.
       ``(e) Eligibility for Funds.--Tribal Health Programs shall 
     be eligible for funds appropriated under the authority of 
     this section on an equal basis with programs that are 
     administered directly by the Service.
       ``(f) Report.--By no later than the date that is 3 years 
     after the date of enactment of the Indian Health Care 
     Improvement Act Amendments of 2007, the Secretary shall 
     submit to Congress the current health status and resource 
     deficiency report of the Service for each Service Unit, 
     including newly recognized or acknowledged Indian Tribes. 
     Such report shall set out--
       ``(1) the methodology then in use by the Service for 
     determining Tribal health status and resource deficiencies, 
     as well as the most recent application of that methodology;
       ``(2) the extent of the health status and resource 
     deficiency of each Indian Tribe served by the Service or a 
     Tribal Health Program;
       ``(3) the amount of funds necessary to eliminate the health 
     status and resource deficiencies of all Indian Tribes served 
     by the Service or a Tribal Health Program; and
       ``(4) an estimate of--
       ``(A) the amount of health service funds appropriated under 
     the authority of this Act, or any other Act, including the 
     amount of any funds transferred to the Service for the 
     preceding fiscal year which is allocated to each Service 
     Unit, Indian Tribe, or Tribal Organization;
       ``(B) the number of Indians eligible for health services in 
     each Service Unit or Indian Tribe or Tribal Organization; and
       ``(C) the number of Indians using the Service resources 
     made available to each Service Unit, Indian Tribe or Tribal 
     Organization, and, to the extent available, information on 
     the waiting lists and number of Indians turned away for 
     services due to lack of resources.
       ``(g) Inclusion in Base Budget.--Funds appropriated under 
     this section for any fiscal year shall be included in the 
     base budget of the Service for the purpose of determining 
     appropriations under this section in subsequent fiscal years.
       ``(h) Clarification.--Nothing in this section is intended 
     to diminish the primary responsibility of the Service to 
     eliminate existing backlogs in unmet health care needs, nor 
     are the provisions of this section intended to discourage the 
     Service from undertaking additional efforts to achieve equity 
     among Indian Tribes and Tribal Organizations.
       ``(i) Funding Designation.--Any funds appropriated under 
     the authority of this section shall be designated as the 
     `Indian Health Care Improvement Fund'.

     ``SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND.

       ``(a) Establishment.--There is established an Indian 
     Catastrophic Health Emergency Fund (hereafter in this section 
     referred to as the `CHEF') consisting of--
       ``(1) the amounts deposited under subsection (f); and
       ``(2) the amounts appropriated to CHEF under this section.
       ``(b) Administration.--CHEF shall be administered by the 
     Secretary, acting through the headquarters of the Service, 
     solely for the purpose of meeting the extraordinary medical 
     costs associated with the treatment of victims of disasters 
     or catastrophic illnesses who are within the responsibility 
     of the Service.
       ``(c) Conditions on Use of Fund.--No part of CHEF or its 
     administration shall be subject to contract or grant under 
     any law, including the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450 et seq.), nor shall 
     CHEF funds be allocated, apportioned, or delegated on an Area 
     Office, Service Unit, or other similar basis.
       ``(d) Regulations.--The Secretary shall promulgate 
     regulations consistent with the provisions of this section 
     to--
       ``(1) establish a definition of disasters and catastrophic 
     illnesses for which the cost of the treatment provided under 
     contract would qualify for payment from CHEF;
       ``(2) provide that a Service Unit shall not be eligible for 
     reimbursement for the cost of treatment from CHEF until its 
     cost of treating any victim of such catastrophic illness or 
     disaster has reached a certain threshold cost which the 
     Secretary shall establish at--
       ``(A) the 2000 level of $19,000; and
       ``(B) for any subsequent year, not less than the threshold 
     cost of the previous year increased by the percentage 
     increase in the medical care expenditure category of the 
     consumer price index for all urban consumers (United States 
     city average) for the 12-month period ending with December of 
     the previous year;
       ``(3) establish a procedure for the reimbursement of the 
     portion of the costs that exceeds such threshold cost 
     incurred by--
       ``(A) Service Units; or
       ``(B) whenever otherwise authorized by the Service, non-
     Service facilities or providers;
       ``(4) establish a procedure for payment from CHEF in cases 
     in which the exigencies of the medical circumstances warrant 
     treatment prior to the authorization of such treatment by the 
     Service; and
       ``(5) establish a procedure that will ensure that no 
     payment shall be made from CHEF to any provider of treatment 
     to the extent that such provider is eligible to receive 
     payment for the treatment from any other Federal, State, 
     local, or private source of reimbursement for which the 
     patient is eligible.
       ``(e) No Offset or Limitation.--Amounts appropriated to 
     CHEF under this section shall not be used to offset or limit 
     appropriations made to the Service under the authority of the 
     Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the 
     `Snyder Act'), or any other law.
       ``(f) Deposit of Reimbursement Funds.--There shall be 
     deposited into CHEF all reimbursements to which the Service 
     is entitled from any Federal, State, local, or private source 
     (including third party insurance) by reason of treatment 
     rendered to any victim of a disaster or catastrophic illness 
     the cost of which was paid from CHEF.

     ``SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION SERVICES.

       ``(a) Findings.--Congress finds that health promotion and 
     disease prevention activities--
       ``(1) improve the health and well-being of Indians; and
       ``(2) reduce the expenses for health care of Indians.
       ``(b) Provision of Services.--The Secretary, acting through 
     the Service and Tribal Health Programs, shall provide health 
     promotion and disease prevention services to Indians to 
     achieve the health status objectives set forth in section 
     3(2).
       ``(c) Evaluation.--The Secretary, after obtaining input 
     from the affected Tribal Health Programs, shall submit to the 
     President for inclusion in the report which is required to be 
     submitted to Congress under section 801 an evaluation of--
       ``(1) the health promotion and disease prevention needs of 
     Indians;
       ``(2) the health promotion and disease prevention 
     activities which would best meet such needs;
       ``(3) the internal capacity of the Service and Tribal 
     Health Programs to meet such needs; and
       ``(4) the resources which would be required to enable the 
     Service and Tribal Health Programs to undertake the health 
     promotion and disease prevention activities necessary to meet 
     such needs.

     ``SEC. 204. DIABETES PREVENTION, TREATMENT, AND CONTROL.

       ``(a) Determinations Regarding Diabetes.--The Secretary, 
     acting through the Service, and in consultation with Indian 
     Tribes and Tribal Organizations, shall determine--
       ``(1) by Indian Tribe and by Service Unit, the incidence 
     of, and the types of complications resulting from, diabetes 
     among Indians; and
       ``(2) based on the determinations made pursuant to 
     paragraph (1), the measures (including patient education and 
     effective ongoing monitoring of disease indicators) each 
     Service Unit should take to reduce the incidence of, and 
     prevent, treat, and control the complications resulting from, 
     diabetes among Indian Tribes within that Service Unit.
       ``(b) Diabetes Screening.--To the extent medically 
     indicated and with informed consent, the Secretary shall 
     screen each Indian who receives services from the Service for 
     diabetes and for conditions which indicate a high risk that 
     the individual will become diabetic and establish a cost-
     effective approach to ensure ongoing monitoring of disease 
     indicators. Such screening and monitoring may be conducted by 
     a Tribal Health

[[Page 21686]]

     Program and may be conducted through appropriate Internet-
     based health care management programs.
       ``(c) Diabetes Projects.--The Secretary shall continue to 
     maintain each model diabetes project in existence on the date 
     of enactment of the Indian Health Care Improvement Act 
     Amendments of 2007, any such other diabetes programs operated 
     by the Service or Tribal Health Programs, and any additional 
     diabetes projects, such as the Medical Vanguard program 
     provided for in title IV of Public Law 108-87, as implemented 
     to serve Indian Tribes. Tribal Health Programs shall receive 
     recurring funding for the diabetes projects that they operate 
     pursuant to this section, both at the date of enactment of 
     the Indian Health Care Improvement Act Amendments of 2007 and 
     for projects which are added and funded thereafter.
       ``(d) Dialysis Programs.--The Secretary is authorized to 
     provide, through the Service, Indian Tribes, and Tribal 
     Organizations, dialysis programs, including the purchase of 
     dialysis equipment and the provision of necessary staffing.
       ``(e) Other Duties of the Secretary.--
       ``(1) In general.--The Secretary shall, to the extent 
     funding is available--
       ``(A) in each Area Office, consult with Indian Tribes and 
     Tribal Organizations regarding programs for the prevention, 
     treatment, and control of diabetes;
       ``(B) establish in each Area Office a registry of patients 
     with diabetes to track the incidence of diabetes and the 
     complications from diabetes in that area; and
       ``(C) ensure that data collected in each Area Office 
     regarding diabetes and related complications among Indians 
     are disseminated to all other Area Offices, subject to 
     applicable patient privacy laws.
       ``(2) Diabetes control officers.--
       ``(A) In general.--The Secretary may establish and maintain 
     in each Area Office a position of diabetes control officer to 
     coordinate and manage any activity of that Area Office 
     relating to the prevention, treatment, or control of diabetes 
     to assist the Secretary in carrying out a program under this 
     section or section 330C of the Public Health Service Act (42 
     U.S.C. 254c-3).
       ``(B) Certain activities.--Any activity carried out by a 
     diabetes control officer under subparagraph (A) that is the 
     subject of a contract or compact under the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.), and any funds made available to carry out such an 
     activity, shall not be divisible for purposes of that Act.

     ``SEC. 205. SHARED SERVICES FOR LONG-TERM CARE.

       ``(a) Long-Term Care.--Notwithstanding any other provision 
     of law, the Secretary, acting through the Service, is 
     authorized to provide directly, or enter into contracts or 
     compacts under the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450 et seq.) with Indian Tribes or 
     Tribal Organizations for, the delivery of long-term care 
     (including health care services associated with long-term 
     care) provided in a facility to Indians. Such agreements 
     shall provide for the sharing of staff or other services 
     between the Service or a Tribal Health Program and a long-
     term care or related facility owned and operated (directly or 
     through a contract or compact under the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.)) by such Indian Tribe or Tribal Organization.
       ``(b) Contents of Agreements.--An agreement entered into 
     pursuant to subsection (a)--
       ``(1) may, at the request of the Indian Tribe or Tribal 
     Organization, delegate to such Indian Tribe or Tribal 
     Organization such powers of supervision and control over 
     Service employees as the Secretary deems necessary to carry 
     out the purposes of this section;
       ``(2) shall provide that expenses (including salaries) 
     relating to services that are shared between the Service and 
     the Tribal Health Program be allocated proportionately 
     between the Service and the Indian Tribe or Tribal 
     Organization; and
       ``(3) may authorize such Indian Tribe or Tribal 
     Organization to construct, renovate, or expand a long-term 
     care or other similar facility (including the construction of 
     a facility attached to a Service facility).
       ``(c) Minimum Requirement.--Any nursing facility provided 
     for under this section shall meet the requirements for 
     nursing facilities under section 1919 of the Social Security 
     Act.
       ``(d) Other Assistance.--The Secretary shall provide such 
     technical and other assistance as may be necessary to enable 
     applicants to comply with the provisions of this section.
       ``(e) Use of Existing or Underused Facilities.--The 
     Secretary shall encourage the use of existing facilities that 
     are underused or allow the use of swing beds for long-term or 
     similar care.

     ``SEC. 206. HEALTH SERVICES RESEARCH.

       ``(a) In General.--The Secretary, acting through the 
     Service, shall make funding available for research to further 
     the performance of the health service responsibilities of 
     Indian Health Programs.
       ``(b) Coordination of Resources and Activities.--The 
     Secretary shall also, to the maximum extent practicable, 
     coordinate departmental research resources and activities to 
     address relevant Indian Health Program research needs.
       ``(c) Availability.--Tribal Health Programs shall be given 
     an equal opportunity to compete for, and receive, research 
     funds under this section.
       ``(d) Use of Funds.--This funding may be used for both 
     clinical and nonclinical research.
       ``(e) Evaluation and Dissemination.--The Secretary shall 
     periodically--
       ``(1) evaluate the impact of research conducted under this 
     section; and
       ``(2) disseminate to Tribal Health Programs information 
     regarding that research as the Secretary determines to be 
     appropriate.

     ``SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREENING.

       ``The Secretary, acting through the Service or Tribal 
     Health Programs, shall provide for screening as follows:
       ``(1) Screening mammography (as defined in section 1861(jj) 
     of the Social Security Act) for Indian women at a frequency 
     appropriate to such women under accepted and appropriate 
     national standards, and under such terms and conditions as 
     are consistent with standards established by the Secretary to 
     ensure the safety and accuracy of screening mammography under 
     part B of title XVIII of such Act.
       ``(2) Other cancer screening that receives an A or B rating 
     as recommended by the United States Preventive Services Task 
     Force established under section 915(a)(1) of the Public 
     Health Service Act (42 U.S.C. 299b-4(a)(1)). The Secretary 
     shall ensure that screening provided for under this paragraph 
     complies with the recommendations of the Task Force with 
     respect to--
       ``(A) frequency;
       ``(B) the population to be served;
       ``(C) the procedure or technology to be used;
       ``(D) evidence of effectiveness; and
       ``(E) other matters that the Secretary determines 
     appropriate.

     ``SEC. 208. PATIENT TRAVEL COSTS.

       ``(a) Definition of Qualified Escort.--In this section, the 
     term `qualified escort' means--
       ``(1) an adult escort (including a parent, guardian, or 
     other family member) who is required because of the physical 
     or mental condition, or age, of the applicable patient;
       ``(2) a health professional for the purpose of providing 
     necessary medical care during travel by the applicable 
     patient; or
       ``(3) other escorts, as the Secretary or applicable Indian 
     Health Program determines to be appropriate.
       ``(b) Provision of Funds.--The Secretary, acting through 
     the Service and Tribal Health Programs, is authorized to 
     provide funds for the following patient travel costs, 
     including qualified escorts, associated with receiving health 
     care services provided (either through direct or contract 
     care or through a contract or compact under the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.)) under this Act--
       ``(1) emergency air transportation and non-emergency air 
     transportation where ground transportation is infeasible;
       ``(2) transportation by private vehicle (where no other 
     means of transportation is available), specially equipped 
     vehicle, and ambulance; and
       ``(3) transportation by such other means as may be 
     available and required when air or motor vehicle 
     transportation is not available.

     ``SEC. 209. EPIDEMIOLOGY CENTERS.

       ``(a) Establishment of Centers.--The Secretary shall 
     establish an epidemiology center in each Service Area to 
     carry out the functions described in subsection (b). Any new 
     center established after the date of enactment of the Indian 
     Health Care Improvement Act Amendments of 2007 may be 
     operated under a grant authorized by subsection (d), but 
     funding under such a grant shall not be divisible.
       ``(b) Functions of Centers.--In consultation with and upon 
     the request of Indian Tribes, Tribal Organizations, and Urban 
     Indian communities, each Service Area epidemiology center 
     established under this section shall, with respect to such 
     Service Area--
       ``(1) collect data relating to, and monitor progress made 
     toward meeting, each of the health status objectives of the 
     Service, the Indian Tribes, Tribal Organizations, and Urban 
     Indian communities in the Service Area;
       ``(2) evaluate existing delivery systems, data systems, and 
     other systems that impact the improvement of Indian health;
       ``(3) assist Indian Tribes, Tribal Organizations, and Urban 
     Indian Organizations in identifying their highest priority 
     health status objectives and the services needed to achieve 
     such objectives, based on epidemiological data;
       ``(4) make recommendations for the targeting of services 
     needed by the populations served;
       ``(5) make recommendations to improve health care delivery 
     systems for Indians and Urban Indians;
       ``(6) provide requested technical assistance to Indian 
     Tribes, Tribal Organizations, and Urban Indian Organizations 
     in the development of local health service priorities and 
     incidence and prevalence rates of disease and other illness 
     in the community; and

[[Page 21687]]

       ``(7) provide disease surveillance and assist Indian 
     Tribes, Tribal Organizations, and Urban Indian communities to 
     promote public health.
       ``(c) Technical Assistance.--The Director of the Centers 
     for Disease Control and Prevention shall provide technical 
     assistance to the centers in carrying out the requirements of 
     this section.
       ``(d) Grants for Studies.--
       ``(1) In general.--The Secretary may make grants to Indian 
     Tribes, Tribal Organizations, Indian organizations, and 
     eligible intertribal consortia to conduct epidemiological 
     studies of Indian communities.
       ``(2) Eligible intertribal consortia.--An intertribal 
     consortium or Indian organization is eligible to receive a 
     grant under this subsection if--
       ``(A) the intertribal consortium is incorporated for the 
     primary purpose of improving Indian health; and
       ``(B) the intertribal consortium is representative of the 
     Indian Tribes or urban Indian communities in which the 
     intertribal consortium is located.
       ``(3) Applications.--An application for a grant under this 
     subsection shall be submitted in such manner and at such time 
     as the Secretary shall prescribe.
       ``(4) Requirements.--An applicant for a grant under this 
     subsection shall--
       ``(A) demonstrate the technical, administrative, and 
     financial expertise necessary to carry out the functions 
     described in paragraph (5);
       ``(B) consult and cooperate with providers of related 
     health and social services in order to avoid duplication of 
     existing services; and
       ``(C) demonstrate cooperation from Indian Tribes or Urban 
     Indian Organizations in the area to be served.
       ``(5) Use of funds.--A grant awarded under paragraph (1) 
     may be used--
       ``(A) to carry out the functions described in subsection 
     (b);
       ``(B) to provide information to and consult with tribal 
     leaders, urban Indian community leaders, and related health 
     staff on health care and health service management issues; 
     and
       ``(C) in collaboration with Indian Tribes, Tribal 
     Organizations, and urban Indian communities, to provide the 
     Service with information regarding ways to improve the health 
     status of Indians.
       ``(e) Access to Information.--An epidemiology center 
     operated by a grantee pursuant to a grant awarded under 
     subsection (d) shall be treated as a public health authority 
     for purposes of the Health Insurance Portability and 
     Accountability Act of 1996 (Public Law 104-191; 110 Stat. 
     2033), as such entities are defined in part 164.501 of title 
     45, Code of Federal Regulations (or a successor regulation). 
     The Secretary shall grant such grantees access to and use of 
     data, data sets, monitoring systems, delivery systems, and 
     other protected health information in the possession of the 
     Secretary.

     ``SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION PROGRAMS.

       ``(a) Funding for Development of Programs.--In addition to 
     carrying out any other program for health promotion or 
     disease prevention, the Secretary, acting through the 
     Service, is authorized to award grants to Indian Tribes and 
     Tribal Organizations to develop comprehensive school health 
     education programs for children from pre-school through grade 
     12 in schools for the benefit of Indian and Urban Indian 
     children.
       ``(b) Use of Grant Funds.--A grant awarded under this 
     section may be used for purposes which may include, but are 
     not limited to, the following:
       ``(1) Developing health education materials both for 
     regular school programs and afterschool programs.
       ``(2) Training teachers in comprehensive school health 
     education materials.
       ``(3) Integrating school-based, community-based, and other 
     public and private health promotion efforts.
       ``(4) Encouraging healthy, tobacco-free school 
     environments.
       ``(5) Coordinating school-based health programs with 
     existing services and programs available in the community.
       ``(6) Developing school programs on nutrition education, 
     personal health, oral health, and fitness.
       ``(7) Developing behavioral health wellness programs.
       ``(8) Developing chronic disease prevention programs.
       ``(9) Developing substance abuse prevention programs.
       ``(10) Developing injury prevention and safety education 
     programs.
       ``(11) Developing activities for the prevention and control 
     of communicable diseases.
       ``(12) Developing community and environmental health 
     education programs that include traditional health care 
     practitioners.
       ``(13) Violence prevention.
       ``(14) Such other health issues as are appropriate.
       ``(c) Technical Assistance.--Upon request, the Secretary, 
     acting through the Service, shall provide technical 
     assistance to Indian Tribes and Tribal Organizations in the 
     development of comprehensive health education plans and the 
     dissemination of comprehensive health education materials and 
     information on existing health programs and resources.
       ``(d) Criteria for Review and Approval of Applications.--
     The Secretary, acting through the Service, and in 
     consultation with Indian Tribes and Tribal Organizations, 
     shall establish criteria for the review and approval of 
     applications for grants awarded under this section.
       ``(e) Development of Program for BIA-Funded Schools.--
       ``(1) In general.--The Secretary of the Interior, acting 
     through the Bureau of Indian Affairs and in cooperation with 
     the Secretary, acting through the Service, and affected 
     Indian Tribes and Tribal Organizations, shall develop a 
     comprehensive school health education program for children 
     from preschool through grade 12 in schools for which support 
     is provided by the Bureau of Indian Affairs.
       ``(2) Requirements for programs.--Such programs shall 
     include--
       ``(A) school programs on nutrition education, personal 
     health, oral health, and fitness;
       ``(B) behavioral health wellness programs;
       ``(C) chronic disease prevention programs;
       ``(D) substance abuse prevention programs;
       ``(E) injury prevention and safety education programs; and
       ``(F) activities for the prevention and control of 
     communicable diseases.
       ``(3) Duties of the secretary.--The Secretary of the 
     Interior shall--
       ``(A) provide training to teachers in comprehensive school 
     health education materials;
       ``(B) ensure the integration and coordination of school-
     based programs with existing services and health programs 
     available in the community; and
       ``(C) encourage healthy, tobacco-free school environments.

     ``SEC. 211. INDIAN YOUTH PROGRAM.

       ``(a) Program Authorized.--The Secretary, acting through 
     the Service, is authorized to establish and administer a 
     program to provide grants to Indian Tribes, Tribal 
     Organizations, and Urban Indian Organizations for innovative 
     mental and physical disease prevention and health promotion 
     and treatment programs for Indian preadolescent and 
     adolescent youths.
       ``(b) Use of Funds.--
       ``(1) Allowable uses.--Funds made available under this 
     section may be used to--
       ``(A) develop prevention and treatment programs for Indian 
     youth which promote mental and physical health and 
     incorporate cultural values, community and family 
     involvement, and traditional health care practitioners; and
       ``(B) develop and provide community training and education.
       ``(2) Prohibited use.--Funds made available under this 
     section may not be used to provide services described in 
     section 707(c).
       ``(c) Duties of the Secretary.--The Secretary shall--
       ``(1) disseminate to Indian Tribes and Tribal Organizations 
     information regarding models for the delivery of 
     comprehensive health care services to Indian and Urban Indian 
     adolescents;
       ``(2) encourage the implementation of such models; and
       ``(3) at the request of an Indian Tribe or Tribal 
     Organization, provide technical assistance in the 
     implementation of such models.
       ``(d) Criteria for Review and Approval of Applications.--
     The Secretary, in consultation with Indian Tribes and Tribal 
     Organizations, and in conference with Urban Indian 
     Organizations, shall establish criteria for the review and 
     approval of applications or proposals under this section.

     ``SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF 
                   COMMUNICABLE AND INFECTIOUS DISEASES.

       ``(a) Grants Authorized.--The Secretary, acting through the 
     Service, and after consultation with the Centers for Disease 
     Control and Prevention, may make grants available to Indian 
     Tribes and Tribal Organizations for the following:
       ``(1) Projects for the prevention, control, and elimination 
     of communicable and infectious diseases, including 
     tuberculosis, hepatitis, HIV, respiratory syncytial virus, 
     hanta virus, sexually transmitted diseases, and H. Pylori.
       ``(2) Public information and education programs for the 
     prevention, control, and elimination of communicable and 
     infectious diseases.
       ``(3) Education, training, and clinical skills improvement 
     activities in the prevention, control, and elimination of 
     communicable and infectious diseases for health 
     professionals, including allied health professionals.
       ``(4) Demonstration projects for the screening, treatment, 
     and prevention of hepatitis C virus (HCV).
       ``(b) Application Required.--The Secretary may provide 
     funding under subsection (a) only if an application or 
     proposal for funding is submitted to the Secretary.
       ``(c) Coordination With Health Agencies.--Indian Tribes and 
     Tribal Organizations receiving funding under this section are 
     encouraged to coordinate their activities with the Centers 
     for Disease Control and Prevention and State and local health 
     agencies.
       ``(d) Technical Assistance; Report.--In carrying out this 
     section, the Secretary--

[[Page 21688]]

       ``(1) may, at the request of an Indian Tribe or Tribal 
     Organization, provide technical assistance; and
       ``(2) shall prepare and submit a report to Congress 
     biennially on the use of funds under this section and on the 
     progress made toward the prevention, control, and elimination 
     of communicable and infectious diseases among Indians and 
     Urban Indians.

     ``SEC. 213. OTHER AUTHORITY FOR PROVISION OF SERVICES.

       ``(a) Funding Authorized.--The Secretary, acting through 
     the Service, Indian Tribes, and Tribal Organizations, may 
     provide funding under this Act to meet the objectives set 
     forth in section 3 of this Act through health care-related 
     services and programs not otherwise described in this Act, 
     including--
       ``(1) hospice care;
       ``(2) assisted living;
       ``(3) long-term care; and
       ``(4) home- and community-based services.
       ``(b) Terms and Conditions.--
       ``(1) In general.--Any service provided under this section 
     shall be in accordance with such terms and conditions as are 
     consistent with accepted and appropriate standards relating 
     to the service, including any licensing term or condition 
     under this Act.
       ``(2) Standards.--
       ``(A) State standards.--Any service authorized under this 
     section provided by the Service, an Indian Tribe, or a Tribal 
     Organization shall be in accordance with the standards for 
     such service established by the State in which such service 
     is or will be provided.
       ``(B) Secretarial standards.--In the absence of State 
     standards for provision of a service authorized under this 
     section as described in paragraph (1), the Secretary may, by 
     regulation, establish standards for the provision of such 
     service.
       ``(C) Tribal standards.--In the absence of State standards 
     as described in subparagraph (A) and Secretarial standards as 
     described in subparagraph (B) for provision of a service 
     authorized under this section, an Indian Tribe or Tribal 
     Organization, pursuant to the fourth sentence of section 
     102(a)(2) of the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450f(a)(2)), shall propose 
     standards under which the Indian Tribe or Tribal Organization 
     will provide such service, which shall be the standards 
     applicable to such service on approval of the agreement of 
     the Indian Tribe or Tribal Organization pursuant to that Act 
     (25 U.S.C. 450 et seq.).
       ``(D) Verification.--If a service authorized under this 
     section is provided by an Indian Tribe or Tribal Organization 
     pursuant to the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450 et seq.), the verification by 
     the Secretary that the service meets the State standards 
     described in subparagraph (A) shall be considered to meet the 
     terms and conditions required under this subsection.
       ``(3) Eligibility.--The following individuals shall be 
     eligible to receive long-term care under this section:
       ``(A) Individuals who are unable to perform a certain 
     number of activities of daily living without assistance.
       ``(B) Individuals with a mental impairment, such as 
     dementia, Alzheimer's disease, or another disabling mental 
     illness, who may be able to perform activities of daily 
     living under supervision.
       ``(C) Such other individuals as an applicable Indian Health 
     Program determines to be appropriate.
       ``(c) Definitions.--For the purposes of this section, the 
     following definitions shall apply:
       ``(1) The term `home- and community-based services' means 1 
     or more of the services specified in paragraphs (1) through 
     (9) of section 1929(a) of the Social Security Act (42 U.S.C. 
     1396t(a)) (whether provided by the Service or by an Indian 
     Tribe or Tribal Organization pursuant to the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.)) that are or will be provided in accordance with the 
     standards described in subsection (b).
       ``(2) The term `hospice care' means the items and services 
     specified in subparagraphs (A) through (H) of section 
     1861(dd)(1) of the Social Security Act (42 U.S.C. 
     1395x(dd)(1)), and such other services which an Indian Tribe 
     or Tribal Organization determines are necessary and 
     appropriate to provide in furtherance of this care.
       ``(d) Authorization of Convenient Care Services.--The 
     Secretary, acting through the Service, Indian Tribes, and 
     Tribal Organizations, may also provide funding under this Act 
     to meet the objectives set forth in section 3 of this Act for 
     convenient care services programs pursuant to section 
     306(c)(2)(A).

     ``SEC. 214. INDIAN WOMEN'S HEALTH CARE.

       ``The Secretary, acting through the Service and Indian 
     Tribes, Tribal Organizations, and Urban Indian Organizations, 
     shall monitor and improve the quality of health care for 
     Indian women of all ages through the planning and delivery of 
     programs administered by the Service, in order to improve and 
     enhance the treatment models of care for Indian women.

     ``SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZARDS.

       ``(a) Studies and Monitoring.--The Secretary and the 
     Service shall conduct, in conjunction with other appropriate 
     Federal agencies and in consultation with concerned Indian 
     Tribes and Tribal Organizations, studies and ongoing 
     monitoring programs to determine trends in the health hazards 
     to Indian miners and to Indians on or near reservations and 
     Indian communities as a result of environmental hazards which 
     may result in chronic or life threatening health problems, 
     such as nuclear resource development, petroleum 
     contamination, and contamination of water sources and of the 
     food chain. Such studies shall include--
       ``(1) an evaluation of the nature and extent of health 
     problems caused by environmental hazards currently exhibited 
     among Indians and the causes of such health problems;
       ``(2) an analysis of the potential effect of ongoing and 
     future environmental resource development on or near 
     reservations and Indian communities, including the cumulative 
     effect over time on health;
       ``(3) an evaluation of the types and nature of activities, 
     practices, and conditions causing or affecting such health 
     problems, including uranium mining and milling, uranium mine 
     tailing deposits, nuclear power plant operation and 
     construction, and nuclear waste disposal; oil and gas 
     production or transportation on or near reservations or 
     Indian communities; and other development that could affect 
     the health of Indians and their water supply and food chain;
       ``(4) a summary of any findings and recommendations 
     provided in Federal and State studies, reports, 
     investigations, and inspections during the 5 years prior to 
     the date of enactment of the Indian Health Care Improvement 
     Act Amendments of 2007 that directly or indirectly relate to 
     the activities, practices, and conditions affecting the 
     health or safety of such Indians; and
       ``(5) the efforts that have been made by Federal and State 
     agencies and resource and economic development companies to 
     effectively carry out an education program for such Indians 
     regarding the health and safety hazards of such development.
       ``(b) Health Care Plans.--Upon completion of such studies, 
     the Secretary and the Service shall take into account the 
     results of such studies and develop health care plans to 
     address the health problems studied under subsection (a). The 
     plans shall include--
       ``(1) methods for diagnosing and treating Indians currently 
     exhibiting such health problems;
       ``(2) preventive care and testing for Indians who may be 
     exposed to such health hazards, including the monitoring of 
     the health of individuals who have or may have been exposed 
     to excessive amounts of radiation or affected by other 
     activities that have had or could have a serious impact upon 
     the health of such individuals; and
       ``(3) a program of education for Indians who, by reason of 
     their work or geographic proximity to such nuclear or other 
     development activities, may experience health problems.
       ``(c) Submission of Report and Plan to Congress.--The 
     Secretary and the Service shall submit to Congress the study 
     prepared under subsection (a) no later than 18 months after 
     the date of enactment of the Indian Health Care Improvement 
     Act Amendments of 2007. The health care plan prepared under 
     subsection (b) shall be submitted in a report no later than 1 
     year after the study prepared under subsection (a) is 
     submitted to Congress. Such report shall include recommended 
     activities for the implementation of the plan, as well as an 
     evaluation of any activities previously undertaken by the 
     Service to address such health problems.
       ``(d) Intergovernmental Task Force.--
       ``(1) Establishment; members.--There is established an 
     Intergovernmental Task Force to be composed of the following 
     individuals (or their designees):
       ``(A) The Secretary of Energy.
       ``(B) The Secretary of the Environmental Protection Agency.
       ``(C) The Director of the Bureau of Mines.
       ``(D) The Assistant Secretary for Occupational Safety and 
     Health.
       ``(E) The Secretary of the Interior.
       ``(F) The Secretary of Health and Human Services.
       ``(G) The Assistant Secretary.
       ``(2) Duties.--The Task Force shall--
       ``(A) identify existing and potential operations related to 
     nuclear resource development or other environmental hazards 
     that affect or may affect the health of Indians on or near a 
     reservation or in an Indian community; and
       ``(B) enter into activities to correct existing health 
     hazards and ensure that current and future health problems 
     resulting from nuclear resource or other development 
     activities are minimized or reduced.
       ``(3) Chairman; meetings.--The Secretary of Health and 
     Human Services shall be the Chairman of the Task Force. The 
     Task Force shall meet at least twice each year.
       ``(e) Health Services to Certain Employees.--In the case of 
     any Indian who--
       ``(1) as a result of employment in or near a uranium mine 
     or mill or near any other environmental hazard, suffers from 
     a work-related illness or condition;
       ``(2) is eligible to receive diagnosis and treatment 
     services from an Indian Health Program; and
       ``(3) by reason of such Indian's employment, is entitled to 
     medical care at the expense of such mine or mill operator or 
     entity

[[Page 21689]]

     responsible for the environmental hazard, the Indian Health 
     Program shall, at the request of such Indian, render 
     appropriate medical care to such Indian for such illness or 
     condition and may be reimbursed for any medical care so 
     rendered to which such Indian is entitled at the expense of 
     such operator or entity from such operator or entity. Nothing 
     in this subsection shall affect the rights of such Indian to 
     recover damages other than such amounts paid to the Indian 
     Health Program from the employer for providing medical care 
     for such illness or condition.

     ``SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DELIVERY 
                   AREA.

       ``(a) In General.--For fiscal years beginning with the 
     fiscal year ending September 30, 1983, and ending with the 
     fiscal year ending September 30, 2016, the State of Arizona 
     shall be designated as a contract health service delivery 
     area by the Service for the purpose of providing contract 
     health care services to members of federally recognized 
     Indian Tribes of Arizona.
       ``(b) Maintenance of Services.--The Service shall not 
     curtail any health care services provided to Indians residing 
     on reservations in the State of Arizona if such curtailment 
     is due to the provision of contract services in such State 
     pursuant to the designation of such State as a contract 
     health service delivery area pursuant to subsection (a).

     ``SEC. 216A. NORTH DAKOTA AND SOUTH DAKOTA AS A CONTRACT 
                   HEALTH SERVICE DELIVERY AREA.

       ``(a) In General.--Beginning in fiscal year 2003, the 
     States of North Dakota and South Dakota shall be designated 
     as a contract health service delivery area by the Service for 
     the purpose of providing contract health care services to 
     members of federally recognized Indian Tribes of North Dakota 
     and South Dakota.
       ``(b) Limitation.--The Service shall not curtail any health 
     care services provided to Indians residing on any 
     reservation, or in any county that has a common boundary with 
     any reservation, in the State of North Dakota or South Dakota 
     if such curtailment is due to the provision of contract 
     services in such States pursuant to the designation of such 
     States as a contract health service delivery area pursuant to 
     subsection (a).

     ``SEC. 217. CALIFORNIA CONTRACT HEALTH SERVICES PROGRAM.

       ``(a) Funding Authorized.--The Secretary is authorized to 
     fund a program using the California Rural Indian Health Board 
     (hereafter in this section referred to as the `CRIHB') as a 
     contract care intermediary to improve the accessibility of 
     health services to California Indians.
       ``(b) Reimbursement Contract.--The Secretary shall enter 
     into an agreement with the CRIHB to reimburse the CRIHB for 
     costs (including reasonable administrative costs) incurred 
     pursuant to this section, in providing medical treatment 
     under contract to California Indians described in section 
     806(a) throughout the California contract health services 
     delivery area described in section 218 with respect to high 
     cost contract care cases.
       ``(c) Administrative Expenses.--Not more than 5 percent of 
     the amounts provided to the CRIHB under this section for any 
     fiscal year may be for reimbursement for administrative 
     expenses incurred by the CRIHB during such fiscal year.
       ``(d) Limitation on Payment.--No payment may be made for 
     treatment provided hereunder to the extent payment may be 
     made for such treatment under the Indian Catastrophic Health 
     Emergency Fund described in section 202 or from amounts 
     appropriated or otherwise made available to the California 
     contract health service delivery area for a fiscal year.
       ``(e) Advisory Board.--There is established an advisory 
     board which shall advise the CRIHB in carrying out this 
     section. The advisory board shall be composed of 
     representatives, selected by the CRIHB, from not less than 8 
     Tribal Health Programs serving California Indians covered 
     under this section at least \1/2\ of whom of whom are not 
     affiliated with the CRIHB.

     ``SEC. 218. CALIFORNIA AS A CONTRACT HEALTH SERVICE DELIVERY 
                   AREA.

       ``The State of California, excluding the counties of 
     Alameda, Contra Costa, Los Angeles, Marin, Orange, 
     Sacramento, San Francisco, San Mateo, Santa Clara, Kern, 
     Merced, Monterey, Napa, San Benito, San Joaquin, San Luis 
     Obispo, Santa Cruz, Solano, Stanislaus, and Ventura, shall be 
     designated as a contract health service delivery area by the 
     Service for the purpose of providing contract health services 
     to California Indians. However, any of the counties listed 
     herein may only be included in the contract health services 
     delivery area if funding is specifically provided by the 
     Service for such services in those counties.

     ``SEC. 219. CONTRACT HEALTH SERVICES FOR THE TRENTON SERVICE 
                   AREA.

       ``(a) Authorization for Services.--The Secretary, acting 
     through the Service, is directed to provide contract health 
     services to members of the Turtle Mountain Band of Chippewa 
     Indians that reside in the Trenton Service Area of Divide, 
     McKenzie, and Williams counties in the State of North Dakota 
     and the adjoining counties of Richland, Roosevelt, and 
     Sheridan in the State of Montana.
       ``(b) No Expansion of Eligibility.--Nothing in this section 
     may be construed as expanding the eligibility of members of 
     the Turtle Mountain Band of Chippewa Indians for health 
     services provided by the Service beyond the scope of 
     eligibility for such health services that applied on May 1, 
     1986.

     ``SEC. 220. PROGRAMS OPERATED BY INDIAN TRIBES AND TRIBAL 
                   ORGANIZATIONS.

       ``The Service shall provide funds for health care programs 
     and facilities operated by Tribal Health Programs on the same 
     basis as such funds are provided to programs and facilities 
     operated directly by the Service.

     ``SEC. 221. LICENSING.

       ``Health care professionals employed by a Tribal Health 
     Program shall, if licensed in any State, be exempt from the 
     licensing requirements of the State in which the Tribal 
     Health Program performs the services described in its 
     contract or compact under the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450 et seq.).

     ``SEC. 222. NOTIFICATION OF PROVISION OF EMERGENCY CONTRACT 
                   HEALTH SERVICES.

       ``With respect to an elderly Indian or an Indian with a 
     disability receiving emergency medical care or services from 
     a non-Service provider or in a non-Service facility under the 
     authority of this Act, the time limitation (as a condition of 
     payment) for notifying the Service of such treatment or 
     admission shall be 30 days.

     ``SEC. 223. PROMPT ACTION ON PAYMENT OF CLAIMS.

       ``(a) Deadline for Response.--The Service shall respond to 
     a notification of a claim by a provider of a contract care 
     service with either an individual purchase order or a denial 
     of the claim within 5 working days after the receipt of such 
     notification.
       ``(b) Effect of Untimely Response.--If the Service fails to 
     respond to a notification of a claim in accordance with 
     subsection (a), the Service shall accept as valid the claim 
     submitted by the provider of a contract care service.
       ``(c) Deadline for Payment of Valid Claim.--The Service 
     shall pay a valid contract care service claim within 30 days 
     after the completion of the claim.

     ``SEC. 224. LIABILITY FOR PAYMENT.

       ``(a) No Patient Liability.--A patient who receives 
     contract health care services that are authorized by the 
     Service shall not be liable for the payment of any charges or 
     costs associated with the provision of such services.
       ``(b) Notification.--The Secretary shall notify a contract 
     care provider and any patient who receives contract health 
     care services authorized by the Service that such patient is 
     not liable for the payment of any charges or costs associated 
     with the provision of such services not later than 5 business 
     days after receipt of a notification of a claim by a provider 
     of contract care services.
       ``(c) No Recourse.--Following receipt of the notice 
     provided under subsection (b), or, if a claim has been deemed 
     accepted under section 223(b), the provider shall have no 
     further recourse against the patient who received the 
     services.

     ``SEC. 225. OFFICE OF INDIAN MEN'S HEALTH.

       ``(a) Establishment.--The Secretary may establish within 
     the Service an office to be known as the `Office of Indian 
     Men's Health' (referred to in this section as the `Office').
       ``(b) Director.--
       ``(1) In general.--The Office shall be headed by a 
     director, to be appointed by the Secretary.
       ``(2) Duties.--The director shall coordinate and promote 
     the status of the health of Indian men in the United States.
       ``(c) Report.--Not later than 2 years after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2007, the Secretary, acting through the 
     director of the Office, shall submit to Congress a report 
     describing--
       ``(1) any activity carried out by the director as of the 
     date on which the report is prepared; and
       ``(2) any finding of the director with respect to the 
     health of Indian men.

     ``SEC. 226. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2017 to 
     carry out this title.

                        ``TITLE III--FACILITIES

     ``SEC. 301. CONSULTATION; CONSTRUCTION AND RENOVATION OF 
                   FACILITIES; REPORTS.

       ``(a) Prerequisites for Expenditure of Funds.--Prior to the 
     expenditure of, or the making of any binding commitment to 
     expend, any funds appropriated for the planning, design, 
     construction, or renovation of facilities pursuant to the Act 
     of November 2, 1921 (25 U.S.C. 13) (commonly known as the 
     `Snyder Act'), the Secretary, acting through the Service, 
     shall--
       ``(1) consult with any Indian Tribe that would be 
     significantly affected by such expenditure for the purpose of 
     determining and, whenever practicable, honoring tribal 
     preferences concerning size, location, type, and other 
     characteristics of any facility on which such expenditure is 
     to be made; and
       ``(2) ensure, whenever practicable and applicable, that 
     such facility meets the construction standards of any 
     accrediting body

[[Page 21690]]

     recognized by the Secretary for the purposes of the Medicare, 
     Medicaid, and SCHIP programs under titles XVIII, XIX, and XXI 
     of the Social Security Act by not later than 1 year after the 
     date on which the construction or renovation of such facility 
     is completed.
       ``(b) Closures.--
       ``(1) Evaluation required.--Notwithstanding any other 
     provision of law, no facility operated by the Service, or any 
     portion of such facility, may be closed if the Secretary has 
     not submitted to Congress not less than 1 year, and not more 
     than 2 years, before the date of the proposed closure an 
     evaluation, completed not more than 2 years before the 
     submission, of the impact of the proposed closure that 
     specifies, in addition to other considerations--
       ``(A) the accessibility of alternative health care 
     resources for the population served by such facility;
       ``(B) the cost-effectiveness of such closure;
       ``(C) the quality of health care to be provided to the 
     population served by such facility after such closure;
       ``(D) the availability of contract health care funds to 
     maintain existing levels of service;
       ``(E) the views of the Indian Tribes served by such 
     facility concerning such closure;
       ``(F) the level of use of such facility by all eligible 
     Indians; and
       ``(G) the distance between such facility and the nearest 
     operating Service hospital.
       ``(2) Exception for certain temporary closures.--Paragraph 
     (1) shall not apply to any temporary closure of a facility or 
     any portion of a facility if such closure is necessary for 
     medical, environmental, or construction safety reasons.
       ``(c) Health Care Facility Priority System.--
       ``(1) In general.--
       ``(A) Priority system.--The Secretary, acting through the 
     Service, shall maintain a health care facility priority 
     system, which--
       ``(i) shall be developed in consultation with Indian Tribes 
     and Tribal Organizations;
       ``(ii) shall give Indian Tribes' needs the highest 
     priority;
       ``(iii)(I) may include the lists required in paragraph 
     (2)(B)(ii); and
       ``(II) shall include the methodology required in paragraph 
     (2)(B)(v); and
       ``(III) may include such other facilities, and such 
     renovation or expansion needs of any health care facility, as 
     the Service, Indian Tribes, and Tribal Organizations may 
     identify; and
       ``(iv) shall provide an opportunity for the nomination of 
     planning, design, and construction projects by the Service, 
     Indian Tribes, and Tribal Organizations for consideration 
     under the priority system at least once every 3 years, or 
     more frequently as the Secretary determines to be 
     appropriate.
       ``(B) Needs of facilities under isdeaa agreements.--The 
     Secretary shall ensure that the planning, design, 
     construction, renovation, and expansion needs of Service and 
     non-Service facilities operated under contracts or compacts 
     in accordance with the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450 et seq.) are fully 
     and equitably integrated into the health care facility 
     priority system.
       ``(C) Criteria for evaluating needs.--For purposes of this 
     subsection, the Secretary, in evaluating the needs of 
     facilities operated under a contract or compact under the 
     Indian Self-Determination and Education Assistance Act (25 
     U.S.C. 450 et seq.), shall use the criteria used by the 
     Secretary in evaluating the needs of facilities operated 
     directly by the Service.
       ``(D) Priority of certain projects protected.--The priority 
     of any project established under the construction priority 
     system in effect on the date of enactment of the Indian 
     Health Care Improvement Act Amendments of 2007 shall not be 
     affected by any change in the construction priority system 
     taking place after that date if the project--
       ``(i) was identified in the fiscal year 2008 Service budget 
     justification as--

       ``(I) 1 of the 10 top-priority inpatient projects;
       ``(II) 1 of the 10 top-priority outpatient projects;
       ``(III) 1 of the 10 top-priority staff quarters 
     developments; or
       ``(IV) 1 of the 10 top-priority Youth Regional Treatment 
     Centers;

       ``(ii) had completed both Phase I and Phase II of the 
     construction priority system in effect on the date of 
     enactment of such Act; or
       ``(iii) is not included in clause (i) or (ii) and is 
     selected, as determined by the Secretary--

       ``(I) on the initiative of the Secretary; or
       ``(II) pursuant to a request of an Indian Tribe or Tribal 
     Organization.

       ``(2) Report; contents.--
       ``(A) Initial comprehensive report.--
       ``(i) Definitions.--In this subparagraph:

       ``(I) Facilities appropriation advisory board.--The term 
     `Facilities Appropriation Advisory Board' means the advisory 
     board, comprised of 12 members representing Indian tribes and 
     2 members representing the Service, established at the 
     discretion of the Assistant Secretary--

       ``(aa) to provide advice and recommendations for policies 
     and procedures of the programs funded pursuant to facilities 
     appropriations; and
       ``(bb) to address other facilities issues.

       ``(II) Facilities needs assessment workgroup.--The term 
     `Facilities Needs Assessment Workgroup' means the workgroup 
     established at the discretion of the Assistant Secretary--

       ``(aa) to review the health care facilities construction 
     priority system; and
       ``(bb) to make recommendations to the Facilities 
     Appropriation Advisory Board for revising the priority 
     system.
       ``(ii) Initial report.--

       ``(I) In general.--Not later than 1 year after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2007, the Secretary shall submit to the 
     Committee on Indian Affairs of the Senate and the Committee 
     on Natural Resources of the House of Representatives a report 
     that describes the comprehensive, national, ranked list of 
     all health care facilities needs for the Service, Indian 
     Tribes, and Tribal Organizations (including inpatient health 
     care facilities, outpatient health care facilities, 
     specialized health care facilities (such as for long-term 
     care and alcohol and drug abuse treatment), wellness centers, 
     staff quarters and hostels associated with health care 
     facilities, and the renovation and expansion needs, if any, 
     of such facilities) developed by the Service, Indian Tribes, 
     and Tribal Organizations for the Facilities Needs Assessment 
     Workgroup and the Facilities Appropriation Advisory Board.
       ``(II) Inclusions.--The initial report shall include--

       ``(aa) the methodology and criteria used by the Service in 
     determining the needs and establishing the ranking of the 
     facilities needs; and
       ``(bb) such other information as the Secretary determines 
     to be appropriate.
       ``(iii) Updates of report.--Beginning in calendar year 
     2011, the Secretary shall--

       ``(I) update the report under clause (ii) not less 
     frequently that once every 5 years; and
       ``(II) include the updated report in the appropriate annual 
     report under subparagraph (B) for submission to Congress 
     under section 801.

       ``(B) Annual reports.--The Secretary shall submit to the 
     President, for inclusion in the report required to be 
     transmitted to Congress under section 801, a report which 
     sets forth the following:
       ``(i) A description of the health care facility priority 
     system of the Service established under paragraph (1).
       ``(ii) Health care facilities lists, which may include--

       ``(I) the 10 top-priority inpatient health care facilities;
       ``(II) the 10 top-priority outpatient health care 
     facilities;
       ``(III) the 10 top-priority specialized health care 
     facilities (such as long-term care and alcohol and drug abuse 
     treatment);
       ``(IV) the 10 top-priority staff quarters developments 
     associated with health care facilities; and
       ``(V) the 10 top-priority hostels associated with health 
     care facilities.

       ``(iii) The justification for such order of priority.
       ``(iv) The projected cost of such projects.
       ``(v) The methodology adopted by the Service in 
     establishing priorities under its health care facility 
     priority system.
       ``(3) Requirements for preparation of reports.--In 
     preparing the report required under paragraph (2), the 
     Secretary shall--
       ``(A) consult with and obtain information on all health 
     care facilities needs from Indian Tribes and Tribal 
     Organizations; and
       ``(B) review the total unmet needs of all Indian Tribes and 
     Tribal Organizations for health care facilities (including 
     hostels and staff quarters), including needs for renovation 
     and expansion of existing facilities.
       ``(d) Review of Methodology Used for Health Facilities 
     Construction Priority System.--
       ``(1) In general.--Not later than 1 year after the 
     establishment of the priority system under subsection 
     (c)(1)(A), the Comptroller General of the United States shall 
     prepare and finalize a report reviewing the methodologies 
     applied, and the processes followed, by the Service in making 
     each assessment of needs for the list under subsection 
     (c)(2)(A)(ii) and developing the priority system under 
     subsection (c)(1), including a review of--
       ``(A) the recommendations of the Facilities Appropriation 
     Advisory Board and the Facilities Needs Assessment Workgroup 
     (as those terms are defined in subsection (c)(2)(A)(i)); and
       ``(B) the relevant criteria used in ranking or prioritizing 
     facilities other than hospitals or clinics.
       ``(2) Submission to congress.--The Comptroller General of 
     the United States shall submit the report under paragraph (1) 
     to--
       ``(A) the Committees on Indian Affairs and Appropriations 
     of the Senate;
       ``(B) the Committees on Natural Resources and 
     Appropriations of the House of Representatives; and
       ``(C) the Secretary.
       ``(e) Funding Condition.--All funds appropriated under the 
     Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the 
     `Snyder Act'), for the planning, design, construction,

[[Page 21691]]

     or renovation of health facilities for the benefit of 1 or 
     more Indian Tribes shall be subject to the provisions of the 
     Indian Self-Determination and Education Assistance Act (25 
     U.S.C. 450 et seq.).
       ``(f) Development of Innovative Approaches.--The Secretary 
     shall consult and cooperate with Indian Tribes and Tribal 
     Organizations, and confer with Urban Indian Organizations, in 
     developing innovative approaches to address all or part of 
     the total unmet need for construction of health facilities, 
     including those provided for in other sections of this title 
     and other approaches.

     ``SEC. 302. SANITATION FACILITIES.

       ``(a) Findings.--Congress finds the following:
       ``(1) The provision of sanitation facilities is primarily a 
     health consideration and function.
       ``(2) Indian people suffer an inordinately high incidence 
     of disease, injury, and illness directly attributable to the 
     absence or inadequacy of sanitation facilities.
       ``(3) The long-term cost to the United States of treating 
     and curing such disease, injury, and illness is substantially 
     greater than the short-term cost of providing sanitation 
     facilities and other preventive health measures.
       ``(4) Many Indian homes and Indian communities still lack 
     sanitation facilities.
       ``(5) It is in the interest of the United States, and it is 
     the policy of the United States, that all Indian communities 
     and Indian homes, new and existing, be provided with 
     sanitation facilities.
       ``(b) Facilities and Services.--In furtherance of the 
     findings made in subsection (a), Congress reaffirms the 
     primary responsibility and authority of the Service to 
     provide the necessary sanitation facilities and services as 
     provided in section 7 of the Act of August 5, 1954 (42 U.S.C. 
     2004a). Under such authority, the Secretary, acting through 
     the Service, is authorized to provide the following:
       ``(1) Financial and technical assistance to Indian Tribes, 
     Tribal Organizations, and Indian communities in the 
     establishment, training, and equipping of utility 
     organizations to operate and maintain sanitation facilities, 
     including the provision of existing plans, standard details, 
     and specifications available in the Department, to be used at 
     the option of the Indian Tribe, Tribal Organization, or 
     Indian community.
       ``(2) Ongoing technical assistance and training to Indian 
     Tribes, Tribal Organizations, and Indian communities in the 
     management of utility organizations which operate and 
     maintain sanitation facilities.
       ``(3) Priority funding for operation and maintenance 
     assistance for, and emergency repairs to, sanitation 
     facilities operated by an Indian Tribe, Tribal Organization 
     or Indian community when necessary to avoid an imminent 
     health threat or to protect the investment in sanitation 
     facilities and the investment in the health benefits gained 
     through the provision of sanitation facilities.
       ``(c) Funding.--Notwithstanding any other provision of 
     law--
       ``(1) the Secretary of Housing and Urban Development is 
     authorized to transfer funds appropriated under the Native 
     American Housing Assistance and Self-Determination Act of 
     1996 (25 U.S.C. 4101 et seq.) to the Secretary of Health and 
     Human Services;
       ``(2) the Secretary of Health and Human Services is 
     authorized to accept and use such funds for the purpose of 
     providing sanitation facilities and services for Indians 
     under section 7 of the Act of August 5, 1954 (42 U.S.C. 
     2004a);
       ``(3) unless specifically authorized when funds are 
     appropriated, the Secretary shall not use funds appropriated 
     under section 7 of the Act of August 5, 1954 (42 U.S.C. 
     2004a), to provide sanitation facilities to new homes 
     constructed using funds provided by the Department of Housing 
     and Urban Development;
       ``(4) the Secretary of Health and Human Services is 
     authorized to accept from any source, including Federal and 
     State agencies, funds for the purpose of providing sanitation 
     facilities and services and place these funds into contracts 
     or compacts under the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450 et seq.);
       ``(5) except as otherwise prohibited by this section, the 
     Secretary may use funds appropriated under the authority of 
     section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), to 
     fund up to 100 percent of the amount of an Indian Tribe's 
     loan obtained under any Federal program for new projects to 
     construct eligible sanitation facilities to serve Indian 
     homes;
       ``(6) except as otherwise prohibited by this section, the 
     Secretary may use funds appropriated under the authority of 
     section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a) to 
     meet matching or cost participation requirements under other 
     Federal and non-Federal programs for new projects to 
     construct eligible sanitation facilities;
       ``(7) all Federal agencies are authorized to transfer to 
     the Secretary funds identified, granted, loaned, or 
     appropriated whereby the Department's applicable policies, 
     rules, and regulations shall apply in the implementation of 
     such projects;
       ``(8) the Secretary of Health and Human Services shall 
     enter into interagency agreements with Federal and State 
     agencies for the purpose of providing financial assistance 
     for sanitation facilities and services under this Act;
       ``(9) the Secretary of Health and Human Services shall, by 
     regulation, establish standards applicable to the planning, 
     design, and construction of sanitation facilities funded 
     under this Act; and
       ``(10) the Secretary of Health and Human Services is 
     authorized to accept payments for goods and services 
     furnished by the Service from appropriate public authorities, 
     nonprofit organizations or agencies, or Indian Tribes, as 
     contributions by that authority, organization, agency, or 
     tribe to agreements made under section 7 of the Act of August 
     5, 1954 (42 U.S.C. 2004a), and such payments shall be 
     credited to the same or subsequent appropriation account as 
     funds appropriated under the authority of section 7 of the 
     Act of August 5, 1954 (42 U.S.C. 2004a).
       ``(d) Certain Capabilities Not Prerequisite.--The financial 
     and technical capability of an Indian Tribe, Tribal 
     Organization, or Indian community to safely operate, manage, 
     and maintain a sanitation facility shall not be a 
     prerequisite to the provision or construction of sanitation 
     facilities by the Secretary.
       ``(e) Financial Assistance.--The Secretary is authorized to 
     provide financial assistance to Indian Tribes, Tribal 
     Organizations, and Indian communities for operation, 
     management, and maintenance of their sanitation facilities.
       ``(f) Operation, Management, and Maintenance of 
     Facilities.--The Indian Tribe has the primary responsibility 
     to establish, collect, and use reasonable user fees, or 
     otherwise set aside funding, for the purpose of operating, 
     managing, and maintaining sanitation facilities. If a 
     sanitation facility serving a community that is operated by 
     an Indian Tribe or Tribal Organization is threatened with 
     imminent failure and such operator lacks capacity to maintain 
     the integrity or the health benefits of the sanitation 
     facility, then the Secretary is authorized to assist the 
     Indian Tribe, Tribal Organization, or Indian community in the 
     resolution of the problem on a short-term basis through 
     cooperation with the emergency coordinator or by providing 
     operation, management, and maintenance service.
       ``(g) ISDEAA Program Funded on Equal Basis.--Tribal Health 
     Programs shall be eligible (on an equal basis with programs 
     that are administered directly by the Service) for--
       ``(1) any funds appropriated pursuant to this section; and
       ``(2) any funds appropriated for the purpose of providing 
     sanitation facilities.
       ``(h) Report.--
       ``(1) Required contents.--The Secretary, in consultation 
     with the Secretary of Housing and Urban Development, Indian 
     Tribes, Tribal Organizations, and tribally designated housing 
     entities (as defined in section 4 of the Native American 
     Housing Assistance and Self-Determination Act of 1996 (25 
     U.S.C. 4103)) shall submit to the President, for inclusion in 
     the report required to be transmitted to Congress under 
     section 801, a report which sets forth--
       ``(A) the current Indian sanitation facility priority 
     system of the Service;
       ``(B) the methodology for determining sanitation 
     deficiencies and needs;
       ``(C) the criteria on which the deficiencies and needs will 
     be evaluated;
       ``(D) the level of initial and final sanitation deficiency 
     for each type of sanitation facility for each project of each 
     Indian Tribe or Indian community;
       ``(E) the amount and most effective use of funds, derived 
     from whatever source, necessary to accommodate the sanitation 
     facilities needs of new homes assisted with funds under the 
     Native American Housing Assistance and Self-Determination Act 
     (25 U.S.C. 4101 et seq.), and to reduce the identified 
     sanitation deficiency levels of all Indian Tribes and Indian 
     communities to level I sanitation deficiency as defined in 
     paragraph (3)(A); and
       ``(F) a 10-year plan to provide sanitation facilities to 
     serve existing Indian homes and Indian communities and new 
     and renovated Indian homes.
       ``(2) Uniform methodology.--The methodology used by the 
     Secretary in determining, preparing cost estimates for, and 
     reporting sanitation deficiencies for purposes of paragraph 
     (1) shall be applied uniformly to all Indian Tribes and 
     Indian communities.
       ``(3) Sanitation deficiency levels.--For purposes of this 
     subsection, the sanitation deficiency levels for an 
     individual, Indian Tribe, or Indian community sanitation 
     facility to serve Indian homes are determined as follows:
       ``(A) A level I deficiency exists if a sanitation facility 
     serving an individual, Indian Tribe, or Indian community--
       ``(i) complies with all applicable water supply, pollution 
     control, and solid waste disposal laws; and
       ``(ii) deficiencies relate to routine replacement, repair, 
     or maintenance needs.
       ``(B) A level II deficiency exists if a sanitation facility 
     serving an individual, Indian Tribe, or Indian community 
     substantially or recently complied with all applicable water

[[Page 21692]]

     supply, pollution control, and solid waste laws and any 
     deficiencies relate to--
       ``(i) small or minor capital improvements needed to bring 
     the facility back into compliance;
       ``(ii) capital improvements that are necessary to enlarge 
     or improve the facilities in order to meet the current needs 
     for domestic sanitation facilities; or
       ``(iii) the lack of equipment or training by an Indian 
     Tribe, Tribal Organization, or an Indian community to 
     properly operate and maintain the sanitation facilities.
       ``(C) A level III deficiency exists if a sanitation 
     facility serving an individual, Indian Tribe or Indian 
     community meets 1 or more of the following conditions--
       ``(i) water or sewer service in the home is provided by a 
     haul system with holding tanks and interior plumbing;
       ``(ii) major significant interruptions to water supply or 
     sewage disposal occur frequently, requiring major capital 
     improvements to correct the deficiencies; or
       ``(iii) there is no access to or no approved or permitted 
     solid waste facility available.
       ``(D) A level IV deficiency exists--
       ``(i) if a sanitation facility for an individual home, an 
     Indian Tribe, or an Indian community exists but--

       ``(I) lacks--

       ``(aa) a safe water supply system; or
       ``(bb) a waste disposal system;

       ``(II) contains no piped water or sewer facilities; or
       ``(III) has become inoperable due to a major component 
     failure; or

       ``(ii) if only a washeteria or central facility exists in 
     the community.
       ``(E) A level V deficiency exists in the absence of a 
     sanitation facility, where individual homes do not have 
     access to safe drinking water or adequate wastewater 
     (including sewage) disposal.
       ``(i) Definitions.--For purposes of this section, the 
     following terms apply:
       ``(1) Indian community.--The term `Indian community' means 
     a geographic area, a significant proportion of whose 
     inhabitants are Indians and which is served by or capable of 
     being served by a facility described in this section.
       ``(2) Sanitation facilities.--The terms `sanitation 
     facility' and `sanitation facilities' mean safe and adequate 
     water supply systems, sanitary sewage disposal systems, and 
     sanitary solid waste systems (and all related equipment and 
     support infrastructure).

     ``SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS.

       ``(a) Buy Indian Act.--The Secretary, acting through the 
     Service, may use the negotiating authority of section 23 of 
     the Act of June 25, 1910 (25 U.S.C. 47, commonly known as the 
     `Buy Indian Act'), to give preference to any Indian or any 
     enterprise, partnership, corporation, or other type of 
     business organization owned and controlled by an Indian or 
     Indians including former or currently federally recognized 
     Indian Tribes in the State of New York (hereinafter referred 
     to as an `Indian firm') in the construction and renovation of 
     Service facilities pursuant to section 301 and in the 
     construction of sanitation facilities pursuant to section 
     302. Such preference may be accorded by the Secretary unless 
     the Secretary finds, pursuant to regulations, that the 
     project or function to be contracted for will not be 
     satisfactory or such project or function cannot be properly 
     completed or maintained under the proposed contract. The 
     Secretary, in arriving at such a finding, shall consider 
     whether the Indian or Indian firm will be deficient with 
     respect to--
       ``(1) ownership and control by Indians;
       ``(2) equipment;
       ``(3) bookkeeping and accounting procedures;
       ``(4) substantive knowledge of the project or function to 
     be contracted for;
       ``(5) adequately trained personnel; or
       ``(6) other necessary components of contract performance.
       ``(b) Labor Standards.--
       ``(1) In general.--For the purposes of implementing the 
     provisions of this title, contracts for the construction or 
     renovation of health care facilities, staff quarters, and 
     sanitation facilities, and related support infrastructure, 
     funded in whole or in part with funds made available pursuant 
     to this title, shall contain a provision requiring compliance 
     with subchapter IV of chapter 31 of title 40, United States 
     Code (commonly known as the `Davis-Bacon Act'), unless such 
     construction or renovation--
       ``(A) is performed by a contractor pursuant to a contract 
     with an Indian Tribe or Tribal Organization with funds 
     supplied through a contract or compact authorized by the 
     Indian Self-Determination and Education Assistance Act (25 
     U.S.C. 450 et seq.), or other statutory authority; and
       ``(B) is subject to prevailing wage rates for similar 
     construction or renovation in the locality as determined by 
     the Indian Tribes or Tribal Organizations to be served by the 
     construction or renovation.
       ``(2) Exception.--This subsection shall not apply to 
     construction or renovation carried out by an Indian Tribe or 
     Tribal Organization with its own employees.

     ``SEC. 304. EXPENDITURE OF NON-SERVICE FUNDS FOR RENOVATION.

       ``(a) In General.--Notwithstanding any other provision of 
     law, if the requirements of subsection (c) are met, the 
     Secretary, acting through the Service, is authorized to 
     accept any major expansion, renovation, or modernization by 
     any Indian Tribe or Tribal Organization of any Service 
     facility or of any other Indian health facility operated 
     pursuant to a contract or compact under the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.), including--
       ``(1) any plans or designs for such expansion, renovation, 
     or modernization; and
       ``(2) any expansion, renovation, or modernization for which 
     funds appropriated under any Federal law were lawfully 
     expended.
       ``(b) Priority List.--
       ``(1) In general.--The Secretary shall maintain a separate 
     priority list to address the needs for increased operating 
     expenses, personnel, or equipment for such facilities. The 
     methodology for establishing priorities shall be developed 
     through regulations. The list of priority facilities will be 
     revised annually in consultation with Indian Tribes and 
     Tribal Organizations.
       ``(2) Report.--The Secretary shall submit to the President, 
     for inclusion in the report required to be transmitted to 
     Congress under section 801, the priority list maintained 
     pursuant to paragraph (1).
       ``(c) Requirements.--The requirements of this subsection 
     are met with respect to any expansion, renovation, or 
     modernization if--
       ``(1) the Indian Tribe or Tribal Organization--
       ``(A) provides notice to the Secretary of its intent to 
     expand, renovate, or modernize; and
       ``(B) applies to the Secretary to be placed on a separate 
     priority list to address the needs of such new facilities for 
     increased operating expenses, personnel, or equipment; and
       ``(2) the expansion, renovation, or modernization--
       ``(A) is approved by the appropriate area director of the 
     Service for Federal facilities; and
       ``(B) is administered by the Indian Tribe or Tribal 
     Organization in accordance with any applicable regulations 
     prescribed by the Secretary with respect to construction or 
     renovation of Service facilities.
       ``(d) Additional Requirement for Expansion.--In addition to 
     the requirements under subsection (c), for any expansion, the 
     Indian Tribe or Tribal Organization shall provide to the 
     Secretary additional information pursuant to regulations, 
     including additional staffing, equipment, and other costs 
     associated with the expansion.
       ``(e) Closure or Conversion of Facilities.--If any Service 
     facility which has been expanded, renovated, or modernized by 
     an Indian Tribe or Tribal Organization under this section 
     ceases to be used as a Service facility during the 20-year 
     period beginning on the date such expansion, renovation, or 
     modernization is completed, such Indian Tribe or Tribal 
     Organization shall be entitled to recover from the United 
     States an amount which bears the same ratio to the value of 
     such facility at the time of such cessation as the value of 
     such expansion, renovation, or modernization (less the total 
     amount of any funds provided specifically for such facility 
     under any Federal program that were expended for such 
     expansion, renovation, or modernization) bore to the value of 
     such facility at the time of the completion of such 
     expansion, renovation, or modernization.

     ``SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, AND 
                   MODERNIZATION OF SMALL AMBULATORY CARE 
                   FACILITIES.

       ``(a) Grants.--
       ``(1) In general.--The Secretary, acting through the 
     Service, shall make grants to Indian Tribes and Tribal 
     Organizations for the construction, expansion, or 
     modernization of facilities for the provision of ambulatory 
     care services to eligible Indians (and noneligible persons 
     pursuant to subsections (b)(2) and (c)(1)(C)). A grant made 
     under this section may cover up to 100 percent of the costs 
     of such construction, expansion, or modernization. For the 
     purposes of this section, the term `construction' includes 
     the replacement of an existing facility.
       ``(2) Grant agreement required.--A grant under paragraph 
     (1) may only be made available to a Tribal Health Program 
     operating an Indian health facility (other than a facility 
     owned or constructed by the Service, including a facility 
     originally owned or constructed by the Service and 
     transferred to an Indian Tribe or Tribal Organization).
       ``(b) Use of Grant Funds.--
       ``(1) Allowable uses.--A grant awarded under this section 
     may be used for the construction, expansion, or modernization 
     (including the planning and design of such construction, 
     expansion, or modernization) of an ambulatory care facility--
       ``(A) located apart from a hospital;
       ``(B) not funded under section 301 or section 306; and
       ``(C) which, upon completion of such construction or 
     modernization will--
       ``(i) have a total capacity appropriate to its projected 
     service population;
       ``(ii) provide annually no fewer than 150 patient visits by 
     eligible Indians and other users who are eligible for 
     services in such facility in accordance with section 
     807(c)(2); and

[[Page 21693]]

       ``(iii) provide ambulatory care in a Service Area 
     (specified in the contract or compact under the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.)) with a population of no fewer than 1,500 eligible 
     Indians and other users who are eligible for services in such 
     facility in accordance with section 807(c)(2).
       ``(2) Additional allowable use.--The Secretary may also 
     reserve a portion of the funding provided under this section 
     and use those reserved funds to reduce an outstanding debt 
     incurred by Indian Tribes or Tribal Organizations for the 
     construction, expansion, or modernization of an ambulatory 
     care facility that meets the requirements under paragraph 
     (1). The provisions of this section shall apply, except that 
     such applications for funding under this paragraph shall be 
     considered separately from applications for funding under 
     paragraph (1).
       ``(3) Use only for certain portion of costs.--A grant 
     provided under this section may be used only for the cost of 
     that portion of a construction, expansion, or modernization 
     project that benefits the Service population identified above 
     in subsection (b)(1)(C) (ii) and (iii). The requirements of 
     clauses (ii) and (iii) of paragraph (1)(C) shall not apply to 
     an Indian Tribe or Tribal Organization applying for a grant 
     under this section for a health care facility located or to 
     be constructed on an island or when such facility is not 
     located on a road system providing direct access to an 
     inpatient hospital where care is available to the Service 
     population.
       ``(c) Grants.--
       ``(1) Application.--No grant may be made under this section 
     unless an application or proposal for the grant has been 
     approved by the Secretary in accordance with applicable 
     regulations and has set forth reasonable assurance by the 
     applicant that, at all times after the construction, 
     expansion, or modernization of a facility carried out using a 
     grant received under this section--
       ``(A) adequate financial support will be available for the 
     provision of services at such facility;
       ``(B) such facility will be available to eligible Indians 
     without regard to ability to pay or source of payment; and
       ``(C) such facility will, as feasible without diminishing 
     the quality or quantity of services provided to eligible 
     Indians, serve noneligible persons on a cost basis.
       ``(2) Priority.--In awarding grants under this section, the 
     Secretary shall give priority to Indian Tribes and Tribal 
     Organizations that demonstrate--
       ``(A) a need for increased ambulatory care services; and
       ``(B) insufficient capacity to deliver such services.
       ``(3) Peer review panels.--The Secretary may provide for 
     the establishment of peer review panels, as necessary, to 
     review and evaluate applications and proposals and to advise 
     the Secretary regarding such applications using the criteria 
     developed pursuant to subsection (a)(1).
       ``(d) Reversion of Facilities.--If any facility (or portion 
     thereof) with respect to which funds have been paid under 
     this section, ceases, at any time after completion of the 
     construction, expansion, or modernization carried out with 
     such funds, to be used for the purposes of providing health 
     care services to eligible Indians, all of the right, title, 
     and interest in and to such facility (or portion thereof) 
     shall transfer to the United States unless otherwise 
     negotiated by the Service and the Indian Tribe or Tribal 
     Organization.
       ``(e) Funding Nonrecurring.--Funding provided under this 
     section shall be nonrecurring and shall not be available for 
     inclusion in any individual Indian Tribe's tribal share for 
     an award under the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450 et seq.) or for reallocation or 
     redesign thereunder.

     ``SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRATION 
                   PROJECTS.

       ``(a) In General.--The Secretary, acting through the 
     Service, is authorized to carry out, or to enter into 
     contracts under the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450 et seq.) with Indian Tribes or 
     Tribal Organizations to carry out, a health care delivery 
     demonstration project to test alternative means of delivering 
     health care and services to Indians through facilities.
       ``(b) Use of Funds.--The Secretary, in approving projects 
     pursuant to this section, may authorize such contracts for 
     the construction and renovation of hospitals, health centers, 
     health stations, and other facilities to deliver health care 
     services and is authorized to--
       ``(1) waive any leasing prohibition;
       ``(2) permit carryover of funds appropriated for the 
     provision of health care services;
       ``(3) permit the use of other available funds;
       ``(4) permit the use of funds or property donated from any 
     source for project purposes;
       ``(5) provide for the reversion of donated real or personal 
     property to the donor; and
       ``(6) permit the use of Service funds to match other funds, 
     including Federal funds.
       ``(c) Health Care Demonstration Projects.--
       ``(1) General projects.--
       ``(A) Criteria.--The Secretary may approve under this 
     section demonstration projects that meet the following 
     criteria:
       ``(i) There is a need for a new facility or program, such 
     as a program for convenient care services, or the 
     reorientation of an existing facility or program.
       ``(ii) A significant number of Indians, including Indians 
     with low health status, will be served by the project.
       ``(iii) The project has the potential to deliver services 
     in an efficient and effective manner.
       ``(iv) The project is economically viable.
       ``(v) For projects carried out by an Indian Tribe or Tribal 
     Organization, the Indian Tribe or Tribal Organization has the 
     administrative and financial capability to administer the 
     project.
       ``(vi) The project is integrated with providers of related 
     health and social services and is coordinated with, and 
     avoids duplication of, existing services in order to expand 
     the availability of services.
       ``(B) Priority.--In approving demonstration projects under 
     this paragraph, the Secretary shall give priority to 
     demonstration projects, to the extent the projects meet the 
     criteria described in subparagraph (A), located in any of the 
     following Service Units:
       ``(i) Cass Lake, Minnesota.
       ``(ii) Mescalero, New Mexico.
       ``(iii) Owyhee, Nevada.
       ``(iv) Schurz, Nevada.
       ``(v) Ft. Yuma, California.
       ``(2) Convenient care service projects.--
       ``(A) Definition of convenient care service.--In this 
     paragraph, the term `convenient care service' means any 
     primary health care service, such as urgent care services, 
     nonemergent care services, prevention services and 
     screenings, and any service authorized by sections 203 or 
     213(d), that is--
       ``(i) provided outside the regular hours of operation of a 
     health care facility; or
       ``(ii) offered at an alternative setting.
       ``(B) Approval.--In addition to projects described in 
     paragraph (1), in any fiscal year, the Secretary is 
     authorized to approve not more than 10 applications for 
     health care delivery demonstration projects that--
       ``(i) include a convenient care services program as an 
     alternative means of delivering health care services to 
     Indians; and
       ``(ii) meet the criteria described in subparagraph (C).
       ``(C) Criteria.--The Secretary shall approve under 
     subparagraph (B) demonstration projects that meet all of the 
     following criteria:
       ``(i) The criteria set forth in paragraph (1)(A).
       ``(ii) There is a lack of access to health care services at 
     existing health care facilities, which may be due to limited 
     hours of operation at those facilities or other factors.
       ``(iii) The project--

       ``(I) expands the availability of services; or
       ``(II) reduces--

       ``(aa) the burden on Contract Health Services; or
       ``(bb) the need for emergency room visits.
       ``(d) Peer Review Panels.--The Secretary may provide for 
     the establishment of peer review panels, as necessary, to 
     review and evaluate applications using the criteria described 
     in paragraphs (1)(A) and (2)(C) of subsection (c).
       ``(e) Technical Assistance.--The Secretary shall provide 
     such technical and other assistance as may be necessary to 
     enable applicants to comply with this section.
       ``(f) Service to Ineligible Persons.--Subject to section 
     807, the authority to provide services to persons otherwise 
     ineligible for the health care benefits of the Service, and 
     the authority to extend hospital privileges in Service 
     facilities to non-Service health practitioners as provided in 
     section 807, may be included, subject to the terms of that 
     section, in any demonstration project approved pursuant to 
     this section.
       ``(g) Equitable Treatment.--For purposes of subsection (c), 
     the Secretary, in evaluating facilities operated under any 
     contract or compact under the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450 et seq.), shall use 
     the same criteria that the Secretary uses in evaluating 
     facilities operated directly by the Service.
       ``(h) Equitable Integration of Facilities.--The Secretary 
     shall ensure that the planning, design, construction, 
     renovation, and expansion needs of Service and non-Service 
     facilities that are the subject of a contract or compact 
     under the Indian Self-Determination and Education Assistance 
     Act (25 U.S.C. 450 et seq.) for health services are fully and 
     equitably integrated into the implementation of the health 
     care delivery demonstration projects under this section.

     ``SEC. 307. LAND TRANSFER.

       ``Notwithstanding any other provision of law, the Bureau of 
     Indian Affairs and all other agencies and departments of the 
     United States are authorized to transfer, at no cost, land 
     and improvements to the Service for the provision of health 
     care services. The Secretary is authorized to accept such 
     land and improvements for such purposes.

     ``SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS.

       ``The Secretary, acting through the Service, may enter into 
     leases, contracts, and other agreements with Indian Tribes 
     and Tribal Organizations which hold (1) title to, (2) a 
     leasehold interest in, or (3) a beneficial

[[Page 21694]]

     interest in (when title is held by the United States in trust 
     for the benefit of an Indian Tribe) facilities used or to be 
     used for the administration and delivery of health services 
     by an Indian Health Program. Such leases, contracts, or 
     agreements may include provisions for construction or 
     renovation and provide for compensation to the Indian Tribe 
     or Tribal Organization of rental and other costs consistent 
     with section 105(l) of the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450j(l)) and regulations 
     thereunder.

     ``SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND LOAN 
                   REPAYMENT.

       ``(a) In General.--The Secretary, in consultation with the 
     Secretary of the Treasury, Indian Tribes, and Tribal 
     Organizations, shall carry out a study to determine the 
     feasibility of establishing a loan fund to provide to Indian 
     Tribes and Tribal Organizations direct loans or guarantees 
     for loans for the construction of health care facilities, 
     including--
       ``(1) inpatient facilities;
       ``(2) outpatient facilities;
       ``(3) staff quarters;
       ``(4) hostels; and
       ``(5) specialized care facilities, such as behavioral 
     health and elder care facilities.
       ``(b) Determinations.--In carrying out the study under 
     subsection (a), the Secretary shall determine--
       ``(1) the maximum principal amount of a loan or loan 
     guarantee that should be offered to a recipient from the loan 
     fund;
       ``(2) the percentage of eligible costs, not to exceed 100 
     percent, that may be covered by a loan or loan guarantee from 
     the loan fund (including costs relating to planning, design, 
     financing, site land development, construction, 
     rehabilitation, renovation, conversion, improvements, medical 
     equipment and furnishings, and other facility-related costs 
     and capital purchase (but excluding staffing));
       ``(3) the cumulative total of the principal of direct loans 
     and loan guarantees, respectively, that may be outstanding at 
     any 1 time;
       ``(4) the maximum term of a loan or loan guarantee that may 
     be made for a facility from the loan fund;
       ``(5) the maximum percentage of funds from the loan fund 
     that should be allocated for payment of costs associated with 
     planning and applying for a loan or loan guarantee;
       ``(6) whether acceptance by the Secretary of an assignment 
     of the revenue of an Indian Tribe or Tribal Organization as 
     security for any direct loan or loan guarantee from the loan 
     fund would be appropriate;
       ``(7) whether, in the planning and design of health 
     facilities under this section, users eligible under section 
     807(c) may be included in any projection of patient 
     population;
       ``(8) whether funds of the Service provided through loans 
     or loan guarantees from the loan fund should be eligible for 
     use in matching other Federal funds under other programs;
       ``(9) the appropriateness of, and best methods for, 
     coordinating the loan fund with the health care priority 
     system of the Service under section 301; and
       ``(10) any legislative or regulatory changes required to 
     implement recommendations of the Secretary based on results 
     of the study.
       ``(c) Report.--Not later than September 30, 2009, the 
     Secretary shall submit to the Committee on Indian Affairs of 
     the Senate and the Committee on Natural Resources and the 
     Committee on Energy and Commerce of the House of 
     Representatives a report that describes--
       ``(1) the manner of consultation made as required by 
     subsection (a); and
       ``(2) the results of the study, including any 
     recommendations of the Secretary based on results of the 
     study.

     ``SEC. 310. TRIBAL LEASING.

       ``A Tribal Health Program may lease permanent structures 
     for the purpose of providing health care services without 
     obtaining advance approval in appropriation Acts.

     ``SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES JOINT 
                   VENTURE PROGRAM.

       ``(a) In General.--The Secretary, acting through the 
     Service, shall make arrangements with Indian Tribes and 
     Tribal Organizations to establish joint venture demonstration 
     projects under which an Indian Tribe or Tribal Organization 
     shall expend tribal, private, or other available funds, for 
     the acquisition or construction of a health facility for a 
     minimum of 10 years, under a no-cost lease, in exchange for 
     agreement by the Service to provide the equipment, supplies, 
     and staffing for the operation and maintenance of such a 
     health facility. An Indian Tribe or Tribal Organization may 
     use tribal funds, private sector, or other available 
     resources, including loan guarantees, to fulfill its 
     commitment under a joint venture entered into under this 
     subsection. An Indian Tribe or Tribal Organization shall be 
     eligible to establish a joint venture project if, when it 
     submits a letter of intent, it--
       ``(1) has begun but not completed the process of 
     acquisition or construction of a health facility to be used 
     in the joint venture project; or
       ``(2) has not begun the process of acquisition or 
     construction of a health facility for use in the joint 
     venture project.
       ``(b) Requirements.--The Secretary shall make such an 
     arrangement with an Indian Tribe or Tribal Organization only 
     if--
       ``(1) the Secretary first determines that the Indian Tribe 
     or Tribal Organization has the administrative and financial 
     capabilities necessary to complete the timely acquisition or 
     construction of the relevant health facility; and
       ``(2) the Indian Tribe or Tribal Organization meets the 
     need criteria determined using the criteria developed under 
     the health care facility priority system under section 301, 
     unless the Secretary determines, pursuant to regulations, 
     that other criteria will result in a more cost-effective and 
     efficient method of facilitating and completing construction 
     of health care facilities.
       ``(c) Continued Operation.--The Secretary shall negotiate 
     an agreement with the Indian Tribe or Tribal Organization 
     regarding the continued operation of the facility at the end 
     of the initial 10 year no-cost lease period.
       ``(d) Breach of Agreement.--An Indian Tribe or Tribal 
     Organization that has entered into a written agreement with 
     the Secretary under this section, and that breaches or 
     terminates without cause such agreement, shall be liable to 
     the United States for the amount that has been paid to the 
     Indian Tribe or Tribal Organization, or paid to a third party 
     on the Indian Tribe's or Tribal Organization's behalf, under 
     the agreement. The Secretary has the right to recover 
     tangible property (including supplies) and equipment, less 
     depreciation, and any funds expended for operations and 
     maintenance under this section. The preceding sentence does 
     not apply to any funds expended for the delivery of health 
     care services, personnel, or staffing.
       ``(e) Recovery for Nonuse.--An Indian Tribe or Tribal 
     Organization that has entered into a written agreement with 
     the Secretary under this subsection shall be entitled to 
     recover from the United States an amount that is proportional 
     to the value of such facility if, at any time within the 10-
     year term of the agreement, the Service ceases to use the 
     facility or otherwise breaches the agreement.
       ``(f) Definition.--For the purposes of this section, the 
     term `health facility' or `health facilities' includes 
     quarters needed to provide housing for staff of the relevant 
     Tribal Health Program.

     ``SEC. 312. LOCATION OF FACILITIES.

       ``(a) In General.--In all matters involving the 
     reorganization or development of Service facilities or in the 
     establishment of related employment projects to address 
     unemployment conditions in economically depressed areas, the 
     Bureau of Indian Affairs and the Service shall give priority 
     to locating such facilities and projects on Indian lands, or 
     lands in Alaska owned by any Alaska Native village, or 
     village or regional corporation under the Alaska Native 
     Claims Settlement Act (43 U.S.C. 1601 et seq.), or any land 
     allotted to any Alaska Native, if requested by the Indian 
     owner and the Indian Tribe with jurisdiction over such lands 
     or other lands owned or leased by the Indian Tribe or Tribal 
     Organization. Top priority shall be given to Indian land 
     owned by 1 or more Indian Tribes.
       ``(b) Definition.--For purposes of this section, the term 
     `Indian lands' means--
       ``(1) all lands within the exterior boundaries of any 
     reservation; and
       ``(2) any lands title to which is held in trust by the 
     United States for the benefit of any Indian Tribe or 
     individual Indian or held by any Indian Tribe or individual 
     Indian subject to restriction by the United States against 
     alienation.

     ``SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH CARE 
                   FACILITIES.

       ``(a) Report.--The Secretary shall submit to the President, 
     for inclusion in the report required to be transmitted to 
     Congress under section 801, a report which identifies the 
     backlog of maintenance and repair work required at both 
     Service and tribal health care facilities, including new 
     health care facilities expected to be in operation in the 
     next fiscal year. The report shall also identify the need for 
     renovation and expansion of existing facilities to support 
     the growth of health care programs.
       ``(b) Maintenance of Newly Constructed Space.--The 
     Secretary, acting through the Service, is authorized to 
     expend maintenance and improvement funds to support 
     maintenance of newly constructed space only if such space 
     falls within the approved supportable space allocation for 
     the Indian Tribe or Tribal Organization. Supportable space 
     allocation shall be defined through the health care facility 
     priority system under section 301(c).
       ``(c) Replacement Facilities.--In addition to using 
     maintenance and improvement funds for renovation, 
     modernization, and expansion of facilities, an Indian Tribe 
     or Tribal Organization may use maintenance and improvement 
     funds for construction of a replacement facility if the costs 
     of renovation of such facility would exceed a maximum 
     renovation cost threshold. The maximum renovation cost 
     threshold shall be determined through the negotiated 
     rulemaking process provided for under section 802.

     ``SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY-OWNED QUARTERS.

       ``(a) Rental Rates.--
       ``(1) Establishment.--Notwithstanding any other provision 
     of law, a Tribal Health

[[Page 21695]]

     Program which operates a hospital or other health facility 
     and the federally-owned quarters associated therewith 
     pursuant to a contract or compact under the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.) shall have the authority to establish the rental rates 
     charged to the occupants of such quarters by providing notice 
     to the Secretary of its election to exercise such authority.
       ``(2) Objectives.--In establishing rental rates pursuant to 
     authority of this subsection, a Tribal Health Program shall 
     endeavor to achieve the following objectives:
       ``(A) To base such rental rates on the reasonable value of 
     the quarters to the occupants thereof.
       ``(B) To generate sufficient funds to prudently provide for 
     the operation and maintenance of the quarters, and subject to 
     the discretion of the Tribal Health Program, to supply 
     reserve funds for capital repairs and replacement of the 
     quarters.
       ``(3) Equitable funding.--Any quarters whose rental rates 
     are established by a Tribal Health Program pursuant to this 
     subsection shall remain eligible for quarters improvement and 
     repair funds to the same extent as all federally-owned 
     quarters used to house personnel in Services-supported 
     programs.
       ``(4) Notice of rate change.--A Tribal Health Program which 
     exercises the authority provided under this subsection shall 
     provide occupants with no less than 60 days notice of any 
     change in rental rates.
       ``(b) Direct Collection of Rent.--
       ``(1) In general.--Notwithstanding any other provision of 
     law, and subject to paragraph (2), a Tribal Health Program 
     shall have the authority to collect rents directly from 
     Federal employees who occupy such quarters in accordance with 
     the following:
       ``(A) The Tribal Health Program shall notify the Secretary 
     and the subject Federal employees of its election to exercise 
     its authority to collect rents directly from such Federal 
     employees.
       ``(B) Upon receipt of a notice described in subparagraph 
     (A), the Federal employees shall pay rents for occupancy of 
     such quarters directly to the Tribal Health Program and the 
     Secretary shall have no further authority to collect rents 
     from such employees through payroll deduction or otherwise.
       ``(C) Such rent payments shall be retained by the Tribal 
     Health Program and shall not be made payable to or otherwise 
     be deposited with the United States.
       ``(D) Such rent payments shall be deposited into a separate 
     account which shall be used by the Tribal Health Program for 
     the maintenance (including capital repairs and replacement) 
     and operation of the quarters and facilities as the Tribal 
     Health Program shall determine.
       ``(2) Retrocession of authority.--If a Tribal Health 
     Program which has made an election under paragraph (1) 
     requests retrocession of its authority to directly collect 
     rents from Federal employees occupying federally-owned 
     quarters, such retrocession shall become effective on the 
     earlier of--
       ``(A) the first day of the month that begins no less than 
     180 days after the Tribal Health Program notifies the 
     Secretary of its desire to retrocede; or
       ``(B) such other date as may be mutually agreed by the 
     Secretary and the Tribal Health Program.
       ``(c) Rates in Alaska.--To the extent that a Tribal Health 
     Program, pursuant to authority granted in subsection (a), 
     establishes rental rates for federally-owned quarters 
     provided to a Federal employee in Alaska, such rents may be 
     based on the cost of comparable private rental housing in the 
     nearest established community with a year-round population of 
     1,500 or more individuals.

     ``SEC. 315. APPLICABILITY OF BUY AMERICAN ACT REQUIREMENT.

       ``(a) Applicability.--The Secretary shall ensure that the 
     requirements of the Buy American Act apply to all 
     procurements made with funds provided pursuant to section 
     317. Indian Tribes and Tribal Organizations shall be exempt 
     from these requirements.
       ``(b) Effect of Violation.--If it has been finally 
     determined by a court or Federal agency that any person 
     intentionally affixed a label bearing a `Made in America' 
     inscription or any inscription with the same meaning, to any 
     product sold in or shipped to the United States that is not 
     made in the United States, such person shall be ineligible to 
     receive any contract or subcontract made with funds provided 
     pursuant to section 317, pursuant to the debarment, 
     suspension, and ineligibility procedures described in 
     sections 9.400 through 9.409 of title 48, Code of Federal 
     Regulations.
       ``(c) Definitions.--For purposes of this section, the term 
     `Buy American Act' means title III of the Act entitled `An 
     Act making appropriations for the Treasury and Post Office 
     Departments for the fiscal year ending June 30, 1934, and for 
     other purposes', approved March 3, 1933 (41 U.S.C. 10a et 
     seq.).

     ``SEC. 316. OTHER FUNDING FOR FACILITIES.

       ``(a) Authority to Accept Funds.--The Secretary is 
     authorized to accept from any source, including Federal and 
     State agencies, funds that are available for the construction 
     of health care facilities and use such funds to plan, design, 
     and construct health care facilities for Indians and to place 
     such funds into a contract or compact under the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.). Receipt of such funds shall have no effect on the 
     priorities established pursuant to section 301.
       ``(b) Interagency Agreements.--The Secretary is authorized 
     to enter into interagency agreements with other Federal 
     agencies or State agencies and other entities and to accept 
     funds from such Federal or State agencies or other sources to 
     provide for the planning, design, and construction of health 
     care facilities to be administered by Indian Health Programs 
     in order to carry out the purposes of this Act and the 
     purposes for which the funds were appropriated or for which 
     the funds were otherwise provided.
       ``(c) Establishment of Standards.--The Secretary, through 
     the Service, shall establish standards by regulation for the 
     planning, design, and construction of health care facilities 
     serving Indians under this Act.

     ``SEC. 317. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2017 to 
     carry out this title.

                 ``TITLE IV--ACCESS TO HEALTH SERVICES

     ``SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SECURITY ACT 
                   HEALTH BENEFITS PROGRAMS.

       ``(a) Disregard of Medicare, Medicaid, and SCHIP Payments 
     in Determining Appropriations.--Any payments received by an 
     Indian Health Program or by an Urban Indian Organization 
     under title XVIII, XIX, or XXI of the Social Security Act for 
     services provided to Indians eligible for benefits under such 
     respective titles shall not be considered in determining 
     appropriations for the provision of health care and services 
     to Indians.
       ``(b) Nonpreferential Treatment.--Nothing in this Act 
     authorizes the Secretary to provide services to an Indian 
     with coverage under title XVIII, XIX, or XXI of the Social 
     Security Act in preference to an Indian without such 
     coverage.
       ``(c) Use of Funds.--
       ``(1) Special fund.--
       ``(A) 100 percent pass-through of payments due to 
     facilities.--Notwithstanding any other provision of law, but 
     subject to paragraph (2), payments to which a facility of the 
     Service is entitled by reason of a provision of the Social 
     Security Act shall be placed in a special fund to be held by 
     the Secretary. In making payments from such fund, the 
     Secretary shall ensure that each Service Unit of the Service 
     receives 100 percent of the amount to which the facilities of 
     the Service, for which such Service Unit makes collections, 
     are entitled by reason of a provision of the Social Security 
     Act.
       ``(B) Use of funds.--Amounts received by a facility of the 
     Service under subparagraph (A) shall first be used (to such 
     extent or in such amounts as are provided in appropriation 
     Acts) for the purpose of making any improvements in the 
     programs of the Service operated by or through such facility 
     which may be necessary to achieve or maintain compliance with 
     the applicable conditions and requirements of titles XVIII 
     and XIX of the Social Security Act. Any amounts so received 
     that are in excess of the amount necessary to achieve or 
     maintain such conditions and requirements shall, subject to 
     consultation with the Indian Tribes being served by the 
     Service Unit, be used for reducing the health resource 
     deficiencies (as determined under section 201(d)) of such 
     Indian Tribes.
       ``(2) Direct payment option.--Paragraph (1) shall not apply 
     to a Tribal Health Program upon the election of such Program 
     under subsection (d) to receive payments directly. No payment 
     may be made out of the special fund described in such 
     paragraph with respect to reimbursement made for services 
     provided by such Program during the period of such election.
       ``(d) Direct Billing.--
       ``(1) In general.--Subject to complying with the 
     requirements of paragraph (2), a Tribal Health Program may 
     elect to directly bill for, and receive payment for, health 
     care items and services provided by such Program for which 
     payment is made under title XVIII or XIX of the Social 
     Security Act or from any other third party payor.
       ``(2) Direct reimbursement.--
       ``(A) Use of funds.--Each Tribal Health Program making the 
     election described in paragraph (1) with respect to a program 
     under a title of the Social Security Act shall be reimbursed 
     directly by that program for items and services furnished 
     without regard to subsection (c)(1), but all amounts so 
     reimbursed shall be used by the Tribal Health Program for the 
     purpose of making any improvements in facilities of the 
     Tribal Health Program that may be necessary to achieve or 
     maintain compliance with the conditions and requirements 
     applicable generally to such items and services under the 
     program under such title and to provide additional health 
     care services, improvements in health care facilities and 
     Tribal Health Programs, any health care related purpose, or 
     otherwise to achieve the objectives provided in section 3 of 
     this Act.
       ``(B) Audits.--The amounts paid to a Tribal Health Program 
     making the election described in paragraph (1) with respect 
     to a

[[Page 21696]]

     program under a title of the Social Security Act shall be 
     subject to all auditing requirements applicable to the 
     program under such title, as well as all auditing 
     requirements applicable to programs administered by an Indian 
     Health Program. Nothing in the preceding sentence shall be 
     construed as limiting the application of auditing 
     requirements applicable to amounts paid under title XVIII, 
     XIX, or XXI of the Social Security Act.
       ``(C) Identification of source of payments.--Any Tribal 
     Health Program that receives reimbursements or payments under 
     title XVIII, XIX, or XXI of the Social Security Act, shall 
     provide to the Service a list of each provider enrollment 
     number (or other identifier) under which such Program 
     receives such reimbursements or payments.
       ``(3) Examination and implementation of changes.--
       ``(A) In general.--The Secretary, acting through the 
     Service and with the assistance of the Administrator of the 
     Centers for Medicare & Medicaid Services, shall examine on an 
     ongoing basis and implement any administrative changes that 
     may be necessary to facilitate direct billing and 
     reimbursement under the program established under this 
     subsection, including any agreements with States that may be 
     necessary to provide for direct billing under a program under 
     a title of the Social Security Act.
       ``(B) Coordination of information.--The Service shall 
     provide the Administrator of the Centers for Medicare & 
     Medicaid Services with copies of the lists submitted to the 
     Service under paragraph (2)(C), enrollment data regarding 
     patients served by the Service (and by Tribal Health 
     Programs, to the extent such data is available to the 
     Service), and such other information as the Administrator may 
     require for purposes of administering title XVIII, XIX, or 
     XXI of the Social Security Act.
       ``(4) Withdrawal from program.--A Tribal Health Program 
     that bills directly under the program established under this 
     subsection may withdraw from participation in the same manner 
     and under the same conditions that an Indian Tribe or Tribal 
     Organization may retrocede a contracted program to the 
     Secretary under the authority of the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.). All cost accounting and billing authority under the 
     program established under this subsection shall be returned 
     to the Secretary upon the Secretary's acceptance of the 
     withdrawal of participation in this program.
       ``(5) Termination for failure to comply with 
     requirements.--The Secretary may terminate the participation 
     of a Tribal Health Program or in the direct billing program 
     established under this subsection if the Secretary determines 
     that the Program has failed to comply with the requirements 
     of paragraph (2). The Secretary shall provide a Tribal Health 
     Program with notice of a determination that the Program has 
     failed to comply with any such requirement and a reasonable 
     opportunity to correct such noncompliance prior to 
     terminating the Program's participation in the direct billing 
     program established under this subsection.
       ``(e) Related Provisions Under the Social Security Act.--
     For provisions related to subsections (c) and (d), see 
     sections 1880, 1911, and 2107(e)(1)(D) of the Social Security 
     Act.

     ``SEC. 402. GRANTS TO AND CONTRACTS WITH THE SERVICE, INDIAN 
                   TRIBES, TRIBAL ORGANIZATIONS, AND URBAN INDIAN 
                   ORGANIZATIONS TO FACILITATE OUTREACH, 
                   ENROLLMENT, AND COVERAGE OF INDIANS UNDER 
                   SOCIAL SECURITY ACT HEALTH BENEFIT PROGRAMS AND 
                   OTHER HEALTH BENEFITS PROGRAMS.

       ``(a) Indian Tribes and Tribal Organizations.--From funds 
     appropriated to carry out this title in accordance with 
     section 416, the Secretary, acting through the Service, shall 
     make grants to or enter into contracts with Indian Tribes and 
     Tribal Organizations to assist such Tribes and Tribal 
     Organizations in establishing and administering programs on 
     or near reservations and trust lands to assist individual 
     Indians--
       ``(1) to enroll for benefits under a program established 
     under title XVIII, XIX, or XXI of the Social Security Act and 
     other health benefits programs; and
       ``(2) with respect to such programs for which the charging 
     of premiums and cost sharing is not prohibited under such 
     programs, to pay premiums or cost sharing for coverage for 
     such benefits, which may be based on financial need (as 
     determined by the Indian Tribe or Tribes or Tribal 
     Organizations being served based on a schedule of income 
     levels developed or implemented by such Tribe, Tribes, or 
     Tribal Organizations).
       ``(b) Conditions.--The Secretary, acting through the 
     Service, shall place conditions as deemed necessary to effect 
     the purpose of this section in any grant or contract which 
     the Secretary makes with any Indian Tribe or Tribal 
     Organization pursuant to this section. Such conditions shall 
     include requirements that the Indian Tribe or Tribal 
     Organization successfully undertake--
       ``(1) to determine the population of Indians eligible for 
     the benefits described in subsection (a);
       ``(2) to educate Indians with respect to the benefits 
     available under the respective programs;
       ``(3) to provide transportation for such individual Indians 
     to the appropriate offices for enrollment or applications for 
     such benefits; and
       ``(4) to develop and implement methods of improving the 
     participation of Indians in receiving benefits under such 
     programs.
       ``(c) Application to Urban Indian Organizations.--
       ``(1) In general.--The provisions of subsection (a) shall 
     apply with respect to grants and other funding to Urban 
     Indian Organizations with respect to populations served by 
     such organizations in the same manner they apply to grants 
     and contracts with Indian Tribes and Tribal Organizations 
     with respect to programs on or near reservations.
       ``(2) Requirements.--The Secretary shall include in the 
     grants or contracts made or provided under paragraph (1) 
     requirements that are--
       ``(A) consistent with the requirements imposed by the 
     Secretary under subsection (b);
       ``(B) appropriate to Urban Indian Organizations and Urban 
     Indians; and
       ``(C) necessary to effect the purposes of this section.
       ``(d) Facilitating 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 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 XVIII, XIX, or XXI of the Social Security Act.
       ``(e) Agreements Relating to Improving Enrollment of 
     Indians Under Social Security Act Health Benefits Programs.--
     For provisions relating to agreements between the Secretary, 
     acting through the Service, and Indian Tribes, Tribal 
     Organizations, and Urban Indian Organizations for the 
     collection, preparation, and submission of applications by 
     Indians for assistance under the Medicaid and State 
     children's health insurance programs established under titles 
     XIX and XXI of the Social Security Act, and benefits under 
     the Medicare program established under title XVIII of such 
     Act, see subsections (a) and (b) of section 1139 of the 
     Social Security Act.
       ``(f) Definition of Premiums and Cost Sharing.--In this 
     section:
       ``(1) Premium.--The term `premium' includes any enrollment 
     fee or similar charge.
       ``(2) Cost sharing.--The term `cost sharing' includes any 
     deduction, deductible, copayment, coinsurance, or similar 
     charge.

     ``SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS 
                   OF HEALTH SERVICES.

       ``(a) Right of Recovery.--Except as provided in subsection 
     (f), the United States, an Indian Tribe, or Tribal 
     Organization shall have the right to recover from an 
     insurance company, health maintenance organization, employee 
     benefit plan, third-party tortfeasor, or any other 
     responsible or liable third party (including a political 
     subdivision or local governmental entity of a State) the 
     reasonable charges billed by the Secretary, an Indian Tribe, 
     or Tribal Organization in providing health services through 
     the Service, an Indian Tribe, or Tribal Organization to any 
     individual to the same extent that such individual, or any 
     nongovernmental provider of such services, would be eligible 
     to receive damages, reimbursement, or indemnification for 
     such charges or expenses if--
       ``(1) such services had been provided by a nongovernmental 
     provider; and
       ``(2) such individual had been required to pay such charges 
     or expenses and did pay such charges or expenses.
       ``(b) Limitations on Recoveries From States.--Subsection 
     (a) shall provide a right of recovery against any State, only 
     if the injury, illness, or disability for which health 
     services were provided is covered under--
       ``(1) workers' compensation laws; or
       ``(2) a no-fault automobile accident insurance plan or 
     program.
       ``(c) Nonapplication of Other Laws.--No law of any State, 
     or of any political subdivision of a State and no provision 
     of any contract, insurance or health maintenance organization 
     policy, employee benefit plan, self-insurance plan, managed 
     care plan, or other health care plan or program entered into 
     or renewed after the date of the enactment of the Indian 
     Health Care Amendments of 1988, shall prevent or hinder the 
     right of recovery of the United States, an Indian Tribe, or 
     Tribal Organization under subsection (a).
       ``(d) No Effect on Private Rights of Action.--No action 
     taken by the United States, an Indian Tribe, or Tribal 
     Organization to enforce the right of recovery provided under 
     this section shall operate to deny to the injured person the 
     recovery for that portion of the person's damage not covered 
     hereunder.
       ``(e) Enforcement.--
       ``(1) In general.--The United States, an Indian Tribe, or 
     Tribal Organization may enforce the right of recovery 
     provided under subsection (a) by--
       ``(A) intervening or joining in any civil action or 
     proceeding brought--

[[Page 21697]]

       ``(i) by the individual for whom health services were 
     provided by the Secretary, an Indian Tribe, or Tribal 
     Organization; or
       ``(ii) by any representative or heirs of such individual, 
     or
       ``(B) instituting a civil action, including a civil action 
     for injunctive relief and other relief and including, with 
     respect to a political subdivision or local governmental 
     entity of a State, such an action against an official 
     thereof.
       ``(2) Notice.--All reasonable efforts shall be made to 
     provide notice of action instituted under paragraph (1)(B) to 
     the individual to whom health services were provided, either 
     before or during the pendency of such action.
       ``(3) Recovery from tortfeasors.--
       ``(A) In general.--In any case in which an Indian Tribe or 
     Tribal Organization that is authorized or required under a 
     compact or contract issued pursuant to the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.) to furnish or pay for health services to a person who 
     is injured or suffers a disease on or after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2007 under circumstances that establish grounds 
     for a claim of liability against the tortfeasor with respect 
     to the injury or disease, the Indian Tribe or Tribal 
     Organization shall have a right to recover from the 
     tortfeasor (or an insurer of the tortfeasor) the reasonable 
     value of the health services so furnished, paid for, or to be 
     paid for, in accordance with the Federal Medical Care 
     Recovery Act (42 U.S.C. 2651 et seq.), to the same extent and 
     under the same circumstances as the United States may recover 
     under that Act.
       ``(B) Treatment.--The right of an Indian Tribe or Tribal 
     Organization to recover under subparagraph (A) shall be 
     independent of the rights of the injured or diseased person 
     served by the Indian Tribe or Tribal Organization.
       ``(f) Limitation.--Absent specific written authorization by 
     the governing body of an Indian Tribe for the period of such 
     authorization (which may not be for a period of more than 1 
     year and which may be revoked at any time upon written notice 
     by the governing body to the Service), the United States 
     shall not have a right of recovery under this section if the 
     injury, illness, or disability for which health services were 
     provided is covered under a self-insurance plan funded by an 
     Indian Tribe, Tribal Organization, or Urban Indian 
     Organization. Where such authorization is provided, the 
     Service may receive and expend such amounts for the provision 
     of additional health services consistent with such 
     authorization.
       ``(g) Costs and Attorneys' Fees.--In any action brought to 
     enforce the provisions of this section, a prevailing 
     plaintiff shall be awarded its reasonable attorneys' fees and 
     costs of litigation.
       ``(h) Nonapplication of Claims Filing Requirements.--An 
     insurance company, health maintenance organization, self-
     insurance plan, managed care plan, or other health care plan 
     or program (under the Social Security Act or otherwise) may 
     not deny a claim for benefits submitted by the Service or by 
     an Indian Tribe or Tribal Organization based on the format in 
     which the claim is submitted if such format complies with the 
     format required for submission of claims under title XVIII of 
     the Social Security Act or recognized under section 1175 of 
     such Act.
       ``(i) Application to Urban Indian Organizations.--The 
     previous provisions of this section shall apply to Urban 
     Indian Organizations with respect to populations served by 
     such Organizations in the same manner they apply to Indian 
     Tribes and Tribal Organizations with respect to populations 
     served by such Indian Tribes and Tribal Organizations.
       ``(j) Statute of Limitations.--The provisions of section 
     2415 of title 28, United States Code, shall apply to all 
     actions commenced under this section, and the references 
     therein to the United States are deemed to include Indian 
     Tribes, Tribal Organizations, and Urban Indian Organizations.
       ``(k) Savings.--Nothing in this section shall be construed 
     to limit any right of recovery available to the United 
     States, an Indian Tribe, or Tribal Organization under the 
     provisions of any applicable, Federal, State, or Tribal law, 
     including medical lien laws.

     ``SEC. 404. CREDITING OF REIMBURSEMENTS.

       ``(a) Use of Amounts.--
       ``(1) Retention by program.--Except as provided in section 
     202(f) (relating to the Catastrophic Health Emergency Fund) 
     and section 807 (relating to health services for ineligible 
     persons), all reimbursements received or recovered under any 
     of the programs described in paragraph (2), including under 
     section 807, by reason of the provision of health services by 
     the Service, by an Indian Tribe or Tribal Organization, or by 
     an Urban Indian Organization, shall be credited to the 
     Service, such Indian Tribe or Tribal Organization, or such 
     Urban Indian Organization, respectively, and may be used as 
     provided in section 401. In the case of such a service 
     provided by or through a Service Unit, such amounts shall be 
     credited to such unit and used for such purposes.
       ``(2) Programs covered.--The programs referred to in 
     paragraph (1) are the following:
       ``(A) Titles XVIII, XIX, and XXI of the Social Security 
     Act.
       ``(B) This Act, including section 807.
       ``(C) Public Law 87-693.
       ``(D) Any other provision of law.
       ``(b) No Offset of Amounts.--The Service may not offset or 
     limit any amount obligated to any Service Unit or entity 
     receiving funding from the Service because of the receipt of 
     reimbursements under subsection (a).

     ``SEC. 405. PURCHASING HEALTH CARE COVERAGE.

       ``(a) In General.--Insofar as amounts are made available 
     under law (including a provision of the Social Security Act, 
     the Indian Self-Determination and Education Assistance Act 
     (25 U.S.C. 450 et seq.), or other law, other than under 
     section 402) to Indian Tribes, Tribal Organizations, and 
     Urban Indian Organizations for health benefits for Service 
     beneficiaries, Indian Tribes, Tribal Organizations, and Urban 
     Indian Organizations may use such amounts to purchase health 
     benefits coverage for such beneficiaries in any manner, 
     including through--
       ``(1) a tribally owned and operated health care plan;
       ``(2) a State or locally authorized or licensed health care 
     plan;
       ``(3) a health insurance provider or managed care 
     organization; or
       ``(4) a self-insured plan.

     The purchase of such coverage by an Indian Tribe, Tribal 
     Organization, or Urban Indian Organization may be based on 
     the financial needs of such beneficiaries (as determined by 
     the Indian Tribe or Tribes being served based on a schedule 
     of income levels developed or implemented by such Indian 
     Tribe or Tribes).
       ``(b) Expenses for Self-Insured Plan.--In the case of a 
     self-insured plan under subsection (a)(4), the amounts may be 
     used for expenses of operating the plan, including 
     administration and insurance to limit the financial risks to 
     the entity offering the plan.
       ``(c) Construction.--Nothing in this section shall be 
     construed as affecting the use of any amounts not referred to 
     in subsection (a).

     ``SEC. 406. SHARING ARRANGEMENTS WITH FEDERAL AGENCIES.

       ``(a) Authority.--
       ``(1) In general.--The Secretary may enter into (or expand) 
     arrangements for the sharing of medical facilities and 
     services between the Service, Indian Tribes, and Tribal 
     Organizations and the Department of Veterans Affairs and the 
     Department of Defense.
       ``(2) Consultation by secretary required.--The Secretary 
     may not finalize any arrangement between the Service and a 
     Department described in paragraph (1) without first 
     consulting with the Indian Tribes which will be significantly 
     affected by the arrangement.
       ``(b) Limitations.--The Secretary shall not take any action 
     under this section or under subchapter IV of chapter 81 of 
     title 38, United States Code, which would impair--
       ``(1) the priority access of any Indian to health care 
     services provided through the Service and the eligibility of 
     any Indian to receive health services through the Service;
       ``(2) the quality of health care services provided to any 
     Indian through the Service;
       ``(3) the priority access of any veteran to health care 
     services provided by the Department of Veterans Affairs;
       ``(4) the quality of health care services provided by the 
     Department of Veterans Affairs or the Department of Defense; 
     or
       ``(5) the eligibility of any Indian who is a veteran to 
     receive health services through the Department of Veterans 
     Affairs.
       ``(c) Reimbursement.--The Service, Indian Tribe, or Tribal 
     Organization shall be reimbursed by the Department of 
     Veterans Affairs or the Department of Defense (as the case 
     may be) where services are provided through the Service, an 
     Indian Tribe, or a Tribal Organization to beneficiaries 
     eligible for services from either such Department, 
     notwithstanding any other provision of law.
       ``(d) Construction.--Nothing in this section may be 
     construed as creating any right of a non-Indian veteran to 
     obtain health services from the Service.

     ``SEC. 407. PAYOR OF LAST RESORT.

       ``Indian Health Programs and health care programs operated 
     by Urban Indian Organizations shall be the payor of last 
     resort for services provided to persons eligible for services 
     from Indian Health Programs and Urban Indian Organizations, 
     notwithstanding any Federal, State, or local law to the 
     contrary.

     ``SEC. 408. NONDISCRIMINATION UNDER FEDERAL HEALTH CARE 
                   PROGRAMS IN QUALIFICATIONS FOR REIMBURSEMENT 
                   FOR SERVICES.

       ``(a) Requirement To Satisfy Generally Applicable 
     Participation Requirements.--
       ``(1) In general.--A Federal health care program must 
     accept an entity that is operated by the Service, an Indian 
     Tribe, Tribal Organization, or Urban Indian Organization as a 
     provider eligible to receive payment under the program for 
     health care services furnished to an Indian on the same basis 
     as any other provider qualified to participate as a provider 
     of health care services under the program if the entity meets 
     generally applicable State or other requirements for 
     participation as a provider of health care services under the 
     program.
       ``(2) Satisfaction of state or local licensure or 
     recognition requirements.--Any requirement for participation 
     as a provider of health care services under a Federal

[[Page 21698]]

     health care program that an entity be licensed or recognized 
     under the State or local law where the entity is located to 
     furnish health care services shall be deemed to have been met 
     in the case of an entity operated by the Service, an Indian 
     Tribe, Tribal Organization, or Urban Indian Organization if 
     the entity meets all the applicable standards for such 
     licensure or recognition, regardless of whether the entity 
     obtains a license or other documentation under such State or 
     local law. In accordance with section 221, the absence of the 
     licensure of a health care professional employed by such an 
     entity under the State or local law where the entity is 
     located shall not be taken into account for purposes of 
     determining whether the entity meets such standards, if the 
     professional is licensed in another State.
       ``(b) Application of Exclusion From Participation in 
     Federal Health Care Programs.--
       ``(1) Excluded entities.--No entity operated by the 
     Service, an Indian Tribe, Tribal Organization, or Urban 
     Indian Organization that has been excluded from participation 
     in any Federal health care program or for which a license is 
     under suspension or has been revoked by the State where the 
     entity is located shall be eligible to receive payment or 
     reimbursement under any such program for health care services 
     furnished to an Indian.
       ``(2) Excluded individuals.--No individual who has been 
     excluded from participation in any Federal health care 
     program or whose State license is under suspension shall be 
     eligible to receive payment or reimbursement under any such 
     program for health care services furnished by that 
     individual, directly or through an entity that is otherwise 
     eligible to receive payment for health care services, to an 
     Indian.
       ``(3) Federal health care program defined.--In this 
     subsection, the term, `Federal health care program' has the 
     meaning given that term in section 1128B(f) of the Social 
     Security Act (42 U.S.C. 1320a-7b(f)), except that, for 
     purposes of this subsection, such term shall include the 
     health insurance program under chapter 89 of title 5, United 
     States Code.
       ``(c) Related Provisions.--For provisions related to 
     nondiscrimination against providers operated by the Service, 
     an Indian Tribe, Tribal Organization, or Urban Indian 
     Organization, see section 1139(c) of the Social Security Act 
     (42 U.S.C. 1320b-9(c)).

     ``SEC. 409. CONSULTATION.

       ``For provisions related to consultation with 
     representatives of Indian Health Programs and Urban Indian 
     Organizations with respect to the health care programs 
     established under titles XVIII, XIX, and XXI of the Social 
     Security Act, see section 1139(d) of the Social Security Act 
     (42 U.S.C. 1320b-9(d)).

     ``SEC. 410. STATE CHILDREN'S HEALTH INSURANCE PROGRAM 
                   (SCHIP).

       ``For provisions relating to--
       ``(1) outreach to families of Indian children likely to be 
     eligible for child health assistance under the State 
     children's health insurance program established under title 
     XXI of the Social Security Act, see sections 2105(c)(2)(C) 
     and 1139(a) of such Act (42 U.S.C. 1397ee(c)(2), 1320b-9); 
     and
       ``(2) ensuring that child health assistance is provided 
     under such program to targeted low-income children who are 
     Indians and that payments are made under such program to 
     Indian Health Programs and Urban Indian Organizations 
     operating in the State that provide such assistance, see 
     sections 2102(b)(3)(D) and 2105(c)(6)(B) of such Act (42 
     U.S.C. 1397bb(b)(3)(D), 1397ee(c)(6)(B)).

     ``SEC. 411. EXCLUSION WAIVER AUTHORITY FOR AFFECTED INDIAN 
                   HEALTH PROGRAMS AND SAFE HARBOR TRANSACTIONS 
                   UNDER THE SOCIAL SECURITY ACT.

       ``For provisions relating to--
       ``(1) exclusion waiver authority for affected Indian Health 
     Programs under the Social Security Act, see section 1128(k) 
     of the Social Security Act (42 U.S.C. 1320a-7(k)); and
       ``(2) certain transactions involving Indian Health Programs 
     deemed to be in safe harbors under that Act, see section 
     1128B(b)(4) of the Social Security Act (42 U.S.C. 1320a-
     7b(b)(4)).

     ``SEC. 412. PREMIUM AND COST SHARING PROTECTIONS AND 
                   ELIGIBILITY DETERMINATIONS UNDER MEDICAID AND 
                   SCHIP AND PROTECTION OF CERTAIN INDIAN PROPERTY 
                   FROM MEDICAID ESTATE RECOVERY.

       ``For provisions relating to--
       ``(1) premiums or cost sharing protections for Indians 
     furnished items or services directly by Indian Health 
     Programs or through referral under the contract health 
     service under the Medicaid program established under title 
     XIX of the Social Security Act, see sections 1916(j) and 
     1916A(a)(1) of the Social Security Act (42 U.S.C. 1396o(j), 
     1396o-1(a)(1));
       ``(2) rules regarding the treatment of certain property for 
     purposes of determining eligibility under such programs, see 
     sections 1902(e)(13) and 2107(e)(1)(B) of such Act (42 U.S.C. 
     1396a(e)(13), 1397gg(e)(1)(B)); and
       ``(3) the protection of certain property from estate 
     recovery provisions under the Medicaid program, see section 
     1917(b)(3)(B) of such Act (42 U.S.C. 1396p(b)(3)(B)).

     ``SEC. 413. TREATMENT UNDER MEDICAID AND SCHIP MANAGED CARE.

       ``For provisions relating to the treatment of Indians 
     enrolled in a managed care entity under the Medicaid program 
     under title XIX of the Social Security Act and Indian Health 
     Programs and Urban Indian Organizations that are providers of 
     items or services to such Indian enrollees, see sections 
     1932(h) and 2107(e)(1)(H) of the Social Security Act (42 
     U.S.C. 1396u-2(h), 1397gg(e)(1)(H)).

     ``SEC. 414. NAVAJO NATION MEDICAID AGENCY FEASIBILITY STUDY.

       ``(a) Study.--The Secretary shall conduct a study to 
     determine the feasibility of treating the Navajo Nation as a 
     State for the purposes of title XIX of the Social Security 
     Act, to provide services to Indians living within the 
     boundaries of the Navajo Nation through an entity established 
     having the same authority and performing the same functions 
     as single-State medicaid agencies responsible for the 
     administration of the State plan under title XIX of the 
     Social Security Act.
       ``(b) Considerations.--In conducting the study, the 
     Secretary shall consider the feasibility of--
       ``(1) assigning and paying all expenditures for the 
     provision of services and related administration funds, under 
     title XIX of the Social Security Act, to Indians living 
     within the boundaries of the Navajo Nation that are currently 
     paid to or would otherwise be paid to the State of Arizona, 
     New Mexico, or Utah;
       ``(2) providing assistance to the Navajo Nation in the 
     development and implementation of such entity for the 
     administration, eligibility, payment, and delivery of medical 
     assistance under title XIX of the Social Security Act;
       ``(3) providing an appropriate level of matching funds for 
     Federal medical assistance with respect to amounts such 
     entity expends for medical assistance for services and 
     related administrative costs; and
       ``(4) authorizing the Secretary, at the option of the 
     Navajo Nation, to treat the Navajo Nation as a State for the 
     purposes of title XIX of the Social Security Act (relating to 
     the State children's health insurance program) under terms 
     equivalent to those described in paragraphs (2) through (4).
       ``(c) Report.--Not later then 3 years after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2007, the Secretary shall submit to the 
     Committee on Indian Affairs and Committee on Finance of the 
     Senate and the Committee on Natural Resources and Committee 
     on Energy and Commerce of the House of Representatives a 
     report that includes--
       ``(1) the results of the study under this section;
       ``(2) a summary of any consultation that occurred between 
     the Secretary and the Navajo Nation, other Indian Tribes, the 
     States of Arizona, New Mexico, and Utah, counties which 
     include Navajo Lands, and other interested parties, in 
     conducting this study;
       ``(3) projected costs or savings associated with 
     establishment of such entity, and any estimated impact on 
     services provided as described in this section in relation to 
     probable costs or savings; and
       ``(4) legislative actions that would be required to 
     authorize the establishment of such entity if such entity is 
     determined by the Secretary to be feasible.

     ``SEC. 415. GENERAL EXCEPTIONS.

       ``The requirements of this title shall not apply to any 
     excepted benefits described in paragraph (1)(A) or (3) of 
     section 2791(c) of the Public Health Service Act (42 U.S.C. 
     300gg-91).

     ``SEC. 416. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2017 to 
     carry out this title.

              ``TITLE V--HEALTH SERVICES FOR URBAN INDIANS

     ``SEC. 501. PURPOSE.

       ``The purpose of this title is to establish and maintain 
     programs in Urban Centers to make health services more 
     accessible and available to Urban Indians.

     ``SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN INDIAN 
                   ORGANIZATIONS.

       ``Under authority of the Act of November 2, 1921 (25 U.S.C. 
     13) (commonly known as the `Snyder Act'), the Secretary, 
     acting through the Service, shall enter into contracts with, 
     or make grants to, Urban Indian Organizations to assist such 
     organizations in the establishment and administration, within 
     Urban Centers, of programs which meet the requirements set 
     forth in this title. Subject to section 506, the Secretary, 
     acting through the Service, shall include such conditions as 
     the Secretary considers necessary to effect the purpose of 
     this title in any contract into which the Secretary enters 
     with, or in any grant the Secretary makes to, any Urban 
     Indian Organization pursuant to this title.

     ``SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION OF HEALTH 
                   CARE AND REFERRAL SERVICES.

       ``(a) Requirements for Grants and Contracts.--Under 
     authority of the Act of November 2, 1921 (25 U.S.C. 13) 
     (commonly known as the `Snyder Act'), the Secretary, acting 
     through the Service, shall enter into contracts with, and 
     make grants to, Urban Indian Organizations for the provision 
     of health care and referral services for Urban Indians. Any 
     such contract or grant shall include requirements that the 
     Urban Indian Organization successfully undertake to--

[[Page 21699]]

       ``(1) estimate the population of Urban Indians residing in 
     the Urban Center or centers that the organization proposes to 
     serve who are or could be recipients of health care or 
     referral services;
       ``(2) estimate the current health status of Urban Indians 
     residing in such Urban Center or centers;
       ``(3) estimate the current health care needs of Urban 
     Indians residing in such Urban Center or centers;
       ``(4) provide basic health education, including health 
     promotion and disease prevention education, to Urban Indians;
       ``(5) make recommendations to the Secretary and Federal, 
     State, local, and other resource agencies on methods of 
     improving health service programs to meet the needs of Urban 
     Indians; and
       ``(6) where necessary, provide, or enter into contracts for 
     the provision of, health care services for Urban Indians.
       ``(b) Criteria.--The Secretary, acting through the Service, 
     shall, by regulation, prescribe the criteria for selecting 
     Urban Indian Organizations to enter into contracts or receive 
     grants under this section. Such criteria shall, among other 
     factors, include--
       ``(1) the extent of unmet health care needs of Urban 
     Indians in the Urban Center or centers involved;
       ``(2) the size of the Urban Indian population in the Urban 
     Center or centers involved;
       ``(3) the extent, if any, to which the activities set forth 
     in subsection (a) would duplicate any project funded under 
     this title, or under any current public health service 
     project funded in a manner other than pursuant to this title;
       ``(4) the capability of an Urban Indian Organization to 
     perform the activities set forth in subsection (a) and to 
     enter into a contract with the Secretary or to meet the 
     requirements for receiving a grant under this section;
       ``(5) the satisfactory performance and successful 
     completion by an Urban Indian Organization of other contracts 
     with the Secretary under this title;
       ``(6) the appropriateness and likely effectiveness of 
     conducting the activities set forth in subsection (a) in an 
     Urban Center or centers; and
       ``(7) the extent of existing or likely future participation 
     in the activities set forth in subsection (a) by appropriate 
     health and health-related Federal, State, local, and other 
     agencies.
       ``(c) Access to Health Promotion and Disease Prevention 
     Programs.--The Secretary, acting through the Service, shall 
     facilitate access to or provide health promotion and disease 
     prevention services for Urban Indians through grants made to 
     Urban Indian Organizations administering contracts entered 
     into or receiving grants under subsection (a).
       ``(d) Immunization Services.--
       ``(1) Access or services provided.--The Secretary, acting 
     through the Service, shall facilitate access to, or provide, 
     immunization services for Urban Indians through grants made 
     to Urban Indian Organizations administering contracts entered 
     into or receiving grants under this section.
       ``(2) Definition.--For purposes of this subsection, the 
     term `immunization services' means services to provide 
     without charge immunizations against vaccine-preventable 
     diseases.
       ``(e) Behavioral Health Services.--
       ``(1) Access or services provided.--The Secretary, acting 
     through the Service, shall facilitate access to, or provide, 
     behavioral health services for Urban Indians through grants 
     made to Urban Indian Organizations administering contracts 
     entered into or receiving grants under subsection (a).
       ``(2) Assessment required.--Except as provided by paragraph 
     (3)(A), a grant may not be made under this subsection to an 
     Urban Indian Organization until that organization has 
     prepared, and the Service has approved, an assessment of the 
     following:
       ``(A) The behavioral health needs of the Urban Indian 
     population concerned.
       ``(B) The behavioral health services and other related 
     resources available to that population.
       ``(C) The barriers to obtaining those services and 
     resources.
       ``(D) The needs that are unmet by such services and 
     resources.
       ``(3) Purposes of grants.--Grants may be made under this 
     subsection for the following:
       ``(A) To prepare assessments required under paragraph (2).
       ``(B) To provide outreach, educational, and referral 
     services to Urban Indians regarding the availability of 
     direct behavioral health services, to educate Urban Indians 
     about behavioral health issues and services, and effect 
     coordination with existing behavioral health providers in 
     order to improve services to Urban Indians.
       ``(C) To provide outpatient behavioral health services to 
     Urban Indians, including the identification and assessment of 
     illness, therapeutic treatments, case management, support 
     groups, family treatment, and other treatment.
       ``(D) To develop innovative behavioral health service 
     delivery models which incorporate Indian cultural support 
     systems and resources.
       ``(f) Prevention of Child Abuse.--
       ``(1) Access or services provided.--The Secretary, acting 
     through the Service, shall facilitate access to or provide 
     services for Urban Indians through grants to Urban Indian 
     Organizations administering contracts entered into or 
     receiving grants under subsection (a) to prevent and treat 
     child abuse (including sexual abuse) among Urban Indians.
       ``(2) Evaluation required.--Except as provided by paragraph 
     (3)(A), a grant may not be made under this subsection to an 
     Urban Indian Organization until that organization has 
     prepared, and the Service has approved, an assessment that 
     documents the prevalence of child abuse in the Urban Indian 
     population concerned and specifies the services and programs 
     (which may not duplicate existing services and programs) for 
     which the grant is requested.
       ``(3) Purposes of grants.--Grants may be made under this 
     subsection for the following:
       ``(A) To prepare assessments required under paragraph (2).
       ``(B) For the development of prevention, training, and 
     education programs for Urban Indians, including child 
     education, parent education, provider training on 
     identification and intervention, education on reporting 
     requirements, prevention campaigns, and establishing service 
     networks of all those involved in Indian child protection.
       ``(C) To provide direct outpatient treatment services 
     (including individual treatment, family treatment, group 
     therapy, and support groups) to Urban Indians who are child 
     victims of abuse (including sexual abuse) or adult survivors 
     of child sexual abuse, to the families of such child victims, 
     and to Urban Indian perpetrators of child abuse (including 
     sexual abuse).
       ``(4) Considerations when making grants.--In making grants 
     to carry out this subsection, the Secretary shall take into 
     consideration--
       ``(A) the support for the Urban Indian Organization 
     demonstrated by the child protection authorities in the area, 
     including committees or other services funded under the 
     Indian Child Welfare Act of 1978 (25 U.S.C. 1901 et seq.), if 
     any;
       ``(B) the capability and expertise demonstrated by the 
     Urban Indian Organization to address the complex problem of 
     child sexual abuse in the community; and
       ``(C) the assessment required under paragraph (2).
       ``(g) Other Grants.--The Secretary, acting through the 
     Service, may enter into a contract with or make grants to an 
     Urban Indian Organization that provides or arranges for the 
     provision of health care services (through satellite 
     facilities, provider networks, or otherwise) to Urban Indians 
     in more than 1 Urban Center.

     ``SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINATION OF 
                   UNMET HEALTH CARE NEEDS.

       ``(a) Grants and Contracts Authorized.--Under authority of 
     the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as 
     the `Snyder Act'), the Secretary, acting through the Service, 
     may enter into contracts with or make grants to Urban Indian 
     Organizations situated in Urban Centers for which contracts 
     have not been entered into or grants have not been made under 
     section 503.
       ``(b) Purpose.--The purpose of a contract or grant made 
     under this section shall be the determination of the matters 
     described in subsection (c)(1) in order to assist the 
     Secretary in assessing the health status and health care 
     needs of Urban Indians in the Urban Center involved and 
     determining whether the Secretary should enter into a 
     contract or make a grant under section 503 with respect to 
     the Urban Indian Organization which the Secretary has entered 
     into a contract with, or made a grant to, under this section.
       ``(c) Grant and Contract Requirements.--Any contract 
     entered into, or grant made, by the Secretary under this 
     section shall include requirements that--
       ``(1) the Urban Indian Organization successfully undertakes 
     to--
       ``(A) document the health care status and unmet health care 
     needs of Urban Indians in the Urban Center involved; and
       ``(B) with respect to Urban Indians in the Urban Center 
     involved, determine the matters described in paragraphs (2), 
     (3), (4), and (7) of section 503(b); and
       ``(2) the Urban Indian Organization complete performance of 
     the contract, or carry out the requirements of the grant, 
     within 1 year after the date on which the Secretary and such 
     organization enter into such contract, or within 1 year after 
     such organization receives such grant, whichever is 
     applicable.
       ``(d) No Renewals.--The Secretary may not renew any 
     contract entered into or grant made under this section.

     ``SEC. 505. EVALUATIONS; RENEWALS.

       ``(a) Procedures for Evaluations.--The Secretary, acting 
     through the Service, shall develop procedures to evaluate 
     compliance with grant requirements and compliance with and 
     performance of contracts entered into by Urban Indian 
     Organizations under this title. Such procedures shall include 
     provisions for carrying out the requirements of this section.
       ``(b) Evaluations.--The Secretary, acting through the 
     Service, shall evaluate the compliance of each Urban Indian 
     Organization

[[Page 21700]]

     which has entered into a contract or received a grant under 
     section 503 with the terms of such contract or grant. For 
     purposes of this evaluation, the Secretary shall--
       ``(1) acting through the Service, conduct an annual onsite 
     evaluation of the organization; or
       ``(2) accept in lieu of such onsite evaluation evidence of 
     the organization's provisional or full accreditation by a 
     private independent entity recognized by the Secretary for 
     purposes of conducting quality reviews of providers 
     participating in the Medicare program under title XVIII of 
     the Social Security Act.
       ``(c) Noncompliance; Unsatisfactory Performance.--If, as a 
     result of the evaluations conducted under this section, the 
     Secretary determines that an Urban Indian Organization has 
     not complied with the requirements of a grant or complied 
     with or satisfactorily performed a contract under section 
     503, the Secretary shall, prior to renewing such contract or 
     grant, attempt to resolve with the organization the areas of 
     noncompliance or unsatisfactory performance and modify the 
     contract or grant to prevent future occurrences of 
     noncompliance or unsatisfactory performance. If the Secretary 
     determines that the noncompliance or unsatisfactory 
     performance cannot be resolved and prevented in the future, 
     the Secretary shall not renew the contract or grant with the 
     organization and is authorized to enter into a contract or 
     make a grant under section 503 with another Urban Indian 
     Organization which is situated in the same Urban Center as 
     the Urban Indian Organization whose contract or grant is not 
     renewed under this section.
       ``(d) Considerations for Renewals.--In determining whether 
     to renew a contract or grant with an Urban Indian 
     Organization under section 503 which has completed 
     performance of a contract or grant under section 504, the 
     Secretary shall review the records of the Urban Indian 
     Organization, the reports submitted under section 507, and 
     shall consider the results of the onsite evaluations or 
     accreditations under subsection (b).

     ``SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS.

       ``(a) Procurement.--Contracts with Urban Indian 
     Organizations entered into pursuant to this title shall be in 
     accordance with all Federal contracting laws and regulations 
     relating to procurement except that in the discretion of the 
     Secretary, such contracts may be negotiated without 
     advertising and need not conform to the provisions of 
     sections 1304 and 3131 through 3133 of title 40, United 
     States Code.
       ``(b) Payments Under Contracts or Grants.--
       ``(1) In general.--Payments under any contracts or grants 
     pursuant to this title, notwithstanding any term or condition 
     of such contract or grant--
       ``(A) may be made in a single advance payment by the 
     Secretary to the Urban Indian Organization by no later than 
     the end of the first 30 days of the funding period with 
     respect to which the payments apply, unless the Secretary 
     determines through an evaluation under section 505 that the 
     organization is not capable of administering such a single 
     advance payment; and
       ``(B) if any portion thereof is unexpended by the Urban 
     Indian Organization during the funding period with respect to 
     which the payments initially apply, shall be carried forward 
     for expenditure with respect to allowable or reimbursable 
     costs incurred by the organization during 1 or more 
     subsequent funding periods without additional justification 
     or documentation by the organization as a condition of 
     carrying forward the availability for expenditure of such 
     funds.
       ``(2) Semiannual and quarterly payments and 
     reimbursements.--If the Secretary determines under paragraph 
     (1)(A) that an Urban Indian Organization is not capable of 
     administering an entire single advance payment, on request of 
     the Urban Indian Organization, the payments may be made--
       ``(A) in semiannual or quarterly payments by not later than 
     30 days after the date on which the funding period with 
     respect to which the payments apply begins; or
       ``(B) by way of reimbursement.
       ``(c) Revision or Amendment of Contracts.--Notwithstanding 
     any provision of law to the contrary, the Secretary may, at 
     the request and consent of an Urban Indian Organization, 
     revise or amend any contract entered into by the Secretary 
     with such organization under this title as necessary to carry 
     out the purposes of this title.
       ``(d) Fair and Uniform Services and Assistance.--Contracts 
     with or grants to Urban Indian Organizations and regulations 
     adopted pursuant to this title shall include provisions to 
     assure the fair and uniform provision to Urban Indians of 
     services and assistance under such contracts or grants by 
     such organizations.

     ``SEC. 507. REPORTS AND RECORDS.

       ``(a) Reports.--
       ``(1) In general.--For each fiscal year during which an 
     Urban Indian Organization receives or expends funds pursuant 
     to a contract entered into or a grant received pursuant to 
     this title, such Urban Indian Organization shall submit to 
     the Secretary not more frequently than every 6 months, a 
     report that includes the following:
       ``(A) In the case of a contract or grant under section 503, 
     recommendations pursuant to section 503(a)(5).
       ``(B) Information on activities conducted by the 
     organization pursuant to the contract or grant.
       ``(C) An accounting of the amounts and purpose for which 
     Federal funds were expended.
       ``(D) A minimum set of data, using uniformly defined 
     elements, as specified by the Secretary after consultation 
     with Urban Indian Organizations.
       ``(2) Health status and services.--
       ``(A) In general.--Not later than 18 months after the date 
     of enactment of the Indian Health Care Improvement Act 
     Amendments of 2007, the Secretary, acting through the Service 
     and working with a national membership-based consortium of 
     Urban Indian Organizations, shall submit to Congress a report 
     evaluating--
       ``(i) the health status of Urban Indians;
       ``(ii) the services provided to Indians pursuant to this 
     title; and
       ``(iii) areas of unmet needs in the delivery of health 
     services to Urban Indians, including unmet health care 
     facilities needs.
       ``(B) Consultation and contracts.--In preparing the report 
     under paragraph (1), the Secretary--
       ``(i) shall confer with Urban Indian Organizations; and
       ``(ii) may enter into a contract with a national 
     organization representing Urban Indian Organizations to 
     conduct any aspect of the report.
       ``(b) Audit.--The reports and records of the Urban Indian 
     Organization with respect to a contract or grant under this 
     title shall be subject to audit by the Secretary and the 
     Comptroller General of the United States.
       ``(c) Costs of Audits.--The Secretary shall allow as a cost 
     of any contract or grant entered into or awarded under 
     section 502 or 503 the cost of an annual independent 
     financial audit conducted by--
       ``(1) a certified public accountant; or
       ``(2) a certified public accounting firm qualified to 
     conduct Federal compliance audits.

     ``SEC. 508. LIMITATION ON CONTRACT AUTHORITY.

       ``The authority of the Secretary to enter into contracts or 
     to award grants under this title shall be to the extent, and 
     in an amount, provided for in appropriation Acts.

     ``SEC. 509. FACILITIES.

       ``(a) Grants.--The Secretary, acting through the Service, 
     may make grants to contractors or grant recipients under this 
     title for the lease, purchase, renovation, construction, or 
     expansion of facilities, including leased facilities, in 
     order to assist such contractors or grant recipients in 
     complying with applicable licensure or certification 
     requirements.
       ``(b) Loan Fund Study.--The Secretary, acting through the 
     Service, may carry out a study to determine the feasibility 
     of establishing a loan fund to provide to Urban Indian 
     Organizations direct loans or guarantees for loans for the 
     construction of health care facilities in a manner consistent 
     with section 309, including by submitting a report in 
     accordance with subsection (c) of that section.

     ``SEC. 510. DIVISION OF URBAN INDIAN HEALTH.

       ``There is established within the Service a Division of 
     Urban Indian Health, which shall be responsible for--
       ``(1) carrying out the provisions of this title;
       ``(2) providing central oversight of the programs and 
     services authorized under this title; and
       ``(3) providing technical assistance to Urban Indian 
     Organizations working with a national membership-based 
     consortium of Urban Indian Organizations.

     ``SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE-RELATED 
                   SERVICES.

       ``(a) Grants Authorized.--The Secretary, acting through the 
     Service, may make grants for the provision of health-related 
     services in prevention of, treatment of, rehabilitation of, 
     or school- and community-based education regarding, alcohol 
     and substance abuse, including fetal alcohol spectrum 
     disorders, in Urban Centers to those Urban Indian 
     Organizations with which the Secretary has entered into a 
     contract under this title or under section 201.
       ``(b) Goals.--Each grant made pursuant to subsection (a) 
     shall set forth the goals to be accomplished pursuant to the 
     grant. The goals shall be specific to each grant as agreed to 
     between the Secretary and the grantee.
       ``(c) Criteria.--The Secretary shall establish criteria for 
     the grants made under subsection (a), including criteria 
     relating to the following:
       ``(1) The size of the Urban Indian population.
       ``(2) Capability of the organization to adequately perform 
     the activities required under the grant.
       ``(3) Satisfactory performance standards for the 
     organization in meeting the goals set forth in such grant. 
     The standards shall be negotiated and agreed to between the 
     Secretary and the grantee on a grant-by-grant basis.
       ``(4) Identification of the need for services.

[[Page 21701]]

       ``(d) Allocation of Grants.--The Secretary shall develop a 
     methodology for allocating grants made pursuant to this 
     section based on the criteria established pursuant to 
     subsection (c).
       ``(e) Grants Subject to Criteria.--Any grant received by an 
     Urban Indian Organization under this Act for substance abuse 
     prevention, treatment, and rehabilitation shall be subject to 
     the criteria set forth in subsection (c).

     ``SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION PROJECTS.

       ``Notwithstanding any other provision of law, the Tulsa 
     Clinic and Oklahoma City Clinic demonstration projects 
     shall--
       ``(1) be permanent programs within the Service's direct 
     care program;
       ``(2) continue to be treated as Service Units and Operating 
     Units in the allocation of resources and coordination of 
     care; and
       ``(3) continue to meet the requirements and definitions of 
     an Urban Indian Organization in this Act, and shall not be 
     subject to the provisions of the Indian Self-Determination 
     and Education Assistance Act (25 U.S.C. 450 et seq.).

     ``SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS.

       ``(a) Grants and Contracts.--The Secretary, through the 
     Division of Urban Indian Health, shall make grants to, or 
     enter into contracts with, Urban Indian Organizations, to 
     take effect not later than September 30, 2010, for the 
     administration of Urban Indian alcohol programs that were 
     originally established under the National Institute on 
     Alcoholism and Alcohol Abuse (hereafter in this section 
     referred to as `NIAAA') and transferred to the Service.
       ``(b) Use of Funds.--Grants provided or contracts entered 
     into under this section shall be used to provide support for 
     the continuation of alcohol prevention and treatment services 
     for Urban Indian populations and such other objectives as are 
     agreed upon between the Service and a recipient of a grant or 
     contract under this section.
       ``(c) Eligibility.--Urban Indian Organizations that operate 
     Indian alcohol programs originally funded under the NIAAA and 
     subsequently transferred to the Service are eligible for 
     grants or contracts under this section.
       ``(d) Report.--The Secretary shall evaluate and report to 
     Congress on the activities of programs funded under this 
     section not less than every 5 years.

     ``SEC. 514. CONFERRING WITH URBAN INDIAN ORGANIZATIONS.

       ``(a) In General.--The Secretary shall ensure that the 
     Service confers or conferences, to the greatest extent 
     practicable, with Urban Indian Organizations.
       ``(b) Definition of Confer; Conference.--In this section, 
     the terms `confer' and `conference' mean an open and free 
     exchange of information and opinions that--
       ``(1) leads to mutual understanding and comprehension; and
       ``(2) emphasizes trust, respect, and shared responsibility.

     ``SEC. 515. URBAN YOUTH TREATMENT CENTER DEMONSTRATION.

       ``(a) Construction and Operation.--
       ``(1) In general.--The Secretary, acting through the 
     Service, through grant or contract, shall fund the 
     construction and operation of at least 1 residential 
     treatment center in each Service Area that meets the 
     eligibility requirements set forth in subsection (b) to 
     demonstrate the provision of alcohol and substance abuse 
     treatment services to Urban Indian youth in a culturally 
     competent residential setting.
       ``(2) Treatment.--Each residential treatment center 
     described in paragraph (1) shall be in addition to any 
     facilities constructed under section 707(b).
       ``(b) Eligibility Requirements.--To be eligible to obtain a 
     facility under subsection (a)(1), a Service Area shall meet 
     the following requirements:
       ``(1) There is an Urban Indian Organization in the Service 
     Area.
       ``(2) There reside in the Service Area Urban Indian youth 
     with need for alcohol and substance abuse treatment services 
     in a residential setting.
       ``(3) There is a significant shortage of culturally 
     competent residential treatment services for Urban Indian 
     youth in the Service Area.

     ``SEC. 516. GRANTS FOR DIABETES PREVENTION, TREATMENT, AND 
                   CONTROL.

       ``(a) Grants Authorized.--The Secretary may make grants to 
     those Urban Indian Organizations that have entered into a 
     contract or have received a grant under this title for the 
     provision of services for the prevention and treatment of, 
     and control of the complications resulting from, diabetes 
     among Urban Indians.
       ``(b) Goals.--Each grant made pursuant to subsection (a) 
     shall set forth the goals to be accomplished under the grant. 
     The goals shall be specific to each grant as agreed to 
     between the Secretary and the grantee.
       ``(c) Establishment of Criteria.--The Secretary shall 
     establish criteria for the grants made under subsection (a) 
     relating to--
       ``(1) the size and location of the Urban Indian population 
     to be served;
       ``(2) the need for prevention of and treatment of, and 
     control of the complications resulting from, diabetes among 
     the Urban Indian population to be served;
       ``(3) performance standards for the organization in meeting 
     the goals set forth in such grant that are negotiated and 
     agreed to by the Secretary and the grantee;
       ``(4) the capability of the organization to adequately 
     perform the activities required under the grant; and
       ``(5) the willingness of the organization to collaborate 
     with the registry, if any, established by the Secretary under 
     section 204(e) in the Area Office of the Service in which the 
     organization is located.
       ``(d) Funds Subject to Criteria.--Any funds received by an 
     Urban Indian Organization under this Act for the prevention, 
     treatment, and control of diabetes among Urban Indians shall 
     be subject to the criteria developed by the Secretary under 
     subsection (c).

     ``SEC. 517. COMMUNITY HEALTH REPRESENTATIVES.

       ``The Secretary, acting through the Service, may enter into 
     contracts with, and make grants to, Urban Indian 
     Organizations for the employment of Indians trained as health 
     service providers through the Community Health 
     Representatives Program under section 109 in the provision of 
     health care, health promotion, and disease prevention 
     services to Urban Indians.

     ``SEC. 518. EFFECTIVE DATE.

       ``The amendments made by the Indian Health Care Improvement 
     Act Amendments of 2007 to this title shall take effect 
     beginning on the date of enactment of that Act, regardless of 
     whether the Secretary has promulgated regulations 
     implementing such amendments.

     ``SEC. 519. ELIGIBILITY FOR SERVICES.

       ``Urban Indians shall be eligible for, and the ultimate 
     beneficiaries of, health care or referral services provided 
     pursuant to this title.

     ``SEC. 520. FURTHER AUTHORIZATIONS.

       ``The Secretary, acting through the Service, is authorized 
     to establish programs, including programs for the awarding of 
     grants, for Urban Indian Organizations that are identical to 
     any programs established pursuant to sections 126, 210, 212, 
     701, and 707(g).

     ``SEC. 521. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2017 to 
     carry out this title.

                ``TITLE VI--ORGANIZATIONAL IMPROVEMENTS

     ``SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERVICE AS AN 
                   AGENCY OF THE PUBLIC HEALTH SERVICE.

       ``(a) Establishment.--
       ``(1) In general.--In order to more effectively and 
     efficiently carry out the responsibilities, authorities, and 
     functions of the United States to provide health care 
     services to Indians and Indian Tribes, as are or may be 
     hereafter provided by Federal statute or treaties, there is 
     established within the Public Health Service of the 
     Department the Indian Health Service.
       ``(2) Assistant secretary for indian health.--The Service 
     shall be administered by an Assistant Secretary for Indian 
     Health, who shall be appointed by the President, by and with 
     the advice and consent of the Senate. The Assistant Secretary 
     shall report to the Secretary. Effective with respect to an 
     individual appointed by the President, by and with the advice 
     and consent of the Senate, after January 1, 2007, the term of 
     service of the Assistant Secretary shall be 4 years. An 
     Assistant Secretary may serve more than 1 term.
       ``(3) Incumbent.--The individual serving in the position of 
     Director of the Service on the day before the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2007 shall serve as Assistant Secretary.
       ``(4) Advocacy and consultation.--The position of Assistant 
     Secretary is established to, in a manner consistent with the 
     government-to-government relationship between the United 
     States and Indian Tribes--
       ``(A) facilitate advocacy for the development of 
     appropriate Indian health policy; and
       ``(B) promote consultation on matters relating to Indian 
     health.
       ``(b) Agency.--The Service shall be an agency within the 
     Public Health Service of the Department, and shall not be an 
     office, component, or unit of any other agency of the 
     Department.
       ``(c) Duties.--The Assistant Secretary shall--
       ``(1) perform all functions that were, on the day before 
     the date of enactment of the Indian Health Care Improvement 
     Act Amendments of 2007, carried out by or under the direction 
     of the individual serving as Director of the Service on that 
     day;
       ``(2) perform all functions of the Secretary relating to 
     the maintenance and operation of hospital and health 
     facilities for Indians and the planning for, and provision 
     and utilization of, health services for Indians;
       ``(3) administer all health programs under which health 
     care is provided to Indians based upon their status as 
     Indians which are administered by the Secretary, including 
     programs under--
       ``(A) this Act;
       ``(B) the Act of November 2, 1921 (25 U.S.C. 13);
       ``(C) the Act of August 5, 1954 (42 U.S.C. 2001 et seq.);

[[Page 21702]]

       ``(D) the Act of August 16, 1957 (42 U.S.C. 2005 et seq.); 
     and
       ``(E) the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450 et seq.);
       ``(4) administer all scholarship and loan functions carried 
     out under title I;
       ``(5) report directly to the Secretary concerning all 
     policy- and budget-related matters affecting Indian health;
       ``(6) collaborate with the Assistant Secretary for Health 
     concerning appropriate matters of Indian health that affect 
     the agencies of the Public Health Service;
       ``(7) advise each Assistant Secretary of the Department 
     concerning matters of Indian health with respect to which 
     that Assistant Secretary has authority and responsibility;
       ``(8) advise the heads of other agencies and programs of 
     the Department concerning matters of Indian health with 
     respect to which those heads have authority and 
     responsibility;
       ``(9) coordinate the activities of the Department 
     concerning matters of Indian health; and
       ``(10) perform such other functions as the Secretary may 
     designate.
       ``(d) Authority.--
       ``(1) In general.--The Secretary, acting through the 
     Assistant Secretary, shall have the authority--
       ``(A) except to the extent provided for in paragraph (2), 
     to appoint and compensate employees for the Service in 
     accordance with title 5, United States Code;
       ``(B) to enter into contracts for the procurement of goods 
     and services to carry out the functions of the Service; and
       ``(C) to manage, expend, and obligate all funds 
     appropriated for the Service.
       ``(2) Personnel actions.--Notwithstanding any other 
     provision of law, the provisions of section 12 of the Act of 
     June 18, 1934 (48 Stat. 986; 25 U.S.C. 472), shall apply to 
     all personnel actions taken with respect to new positions 
     created within the Service as a result of its establishment 
     under subsection (a).
       ``(e) References.--Any reference to the Director of the 
     Indian Health Service in any other Federal law, Executive 
     order, rule, regulation, or delegation of authority, or in 
     any document of or relating to the Director of the Indian 
     Health Service, shall be deemed to refer to the Assistant 
     Secretary.

     ``SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM.

       ``(a) Establishment.--
       ``(1) In general.--The Secretary shall establish an 
     automated management information system for the Service.
       ``(2) Requirements of system.--The information system 
     established under paragraph (1) shall include--
       ``(A) a financial management system;
       ``(B) a patient care information system for each area 
     served by the Service;
       ``(C) a privacy component that protects the privacy of 
     patient information held by, or on behalf of, the Service;
       ``(D) a services-based cost accounting component that 
     provides estimates of the costs associated with the provision 
     of specific medical treatments or services in each Area 
     office of the Service;
       ``(E) an interface mechanism for patient billing and 
     accounts receivable system; and
       ``(F) a training component.
       ``(b) Provision of Systems to Tribes and Organizations.--
     The Secretary shall provide each Tribal Health Program 
     automated management information systems which--
       ``(1) meet the management information needs of such Tribal 
     Health Program with respect to the treatment by the Tribal 
     Health Program of patients of the Service; and
       ``(2) meet the management information needs of the Service.
       ``(c) Access to Records.--Notwithstanding any other 
     provision of law, each patient shall have reasonable access 
     to the medical or health records of such patient which are 
     held by, or on behalf of, the Service.
       ``(d) Authority To Enhance Information Technology.--The 
     Secretary, acting through the Assistant Secretary, shall have 
     the authority to enter into contracts, agreements, or joint 
     ventures with other Federal agencies, States, private and 
     nonprofit organizations, for the purpose of enhancing 
     information technology in Indian Health Programs and 
     facilities.

     ``SEC. 603. AUTHORIZATION OF APPROPRIATIONS.

       ``There is authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2017 to 
     carry out this title.

                ``TITLE VII--BEHAVIORAL HEALTH PROGRAMS

     ``SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREATMENT 
                   SERVICES.

       ``(a) Purposes.--The purposes of this section are as 
     follows:
       ``(1) To authorize and direct the Secretary, acting through 
     the Service, Indian Tribes and Tribal Organizations to 
     develop a comprehensive behavioral health prevention and 
     treatment program which emphasizes collaboration among 
     alcohol and substance abuse, social services, and mental 
     health programs.
       ``(2) To provide information, direction, and guidance 
     relating to mental illness and dysfunction and self-
     destructive behavior, including child abuse and family 
     violence, to those Federal, tribal, State, and local agencies 
     responsible for programs in Indian communities in areas of 
     health care, education, social services, child and family 
     welfare, alcohol and substance abuse, law enforcement, and 
     judicial services.
       ``(3) To assist Indian Tribes to identify services and 
     resources available to address mental illness and 
     dysfunctional and self-destructive behavior.
       ``(4) To provide authority and opportunities for Indian 
     Tribes and Tribal Organizations to develop, implement, and 
     coordinate with community-based programs which include 
     identification, prevention, education, referral, and 
     treatment services, including through multidisciplinary 
     resource teams.
       ``(5) To ensure that Indians, as citizens of the United 
     States and of the States in which they reside, have the same 
     access to behavioral health services to which all citizens 
     have access.
       ``(6) To modify or supplement existing programs and 
     authorities in the areas identified in paragraph (2).
       ``(b) Plans.--
       ``(1) Development.--The Secretary, acting through the 
     Service, Indian Tribes, and Tribal Organizations, shall 
     encourage Indian Tribes and Tribal Organizations to develop 
     tribal plans and to participate in developing areawide plans 
     for Indian Behavioral Health Services. The plans shall 
     include, to the extent feasible, the following components:
       ``(A) An assessment of the scope of alcohol or other 
     substance abuse, mental illness, and dysfunctional and self-
     destructive behavior, including suicide, child abuse, and 
     family violence, among Indians, including--
       ``(i) the number of Indians served who are directly or 
     indirectly affected by such illness or behavior; or
       ``(ii) an estimate of the financial and human cost 
     attributable to such illness or behavior.
       ``(B) An assessment of the existing and additional 
     resources necessary for the prevention and treatment of such 
     illness and behavior, including an assessment of the progress 
     toward achieving the availability of the full continuum of 
     care described in subsection (c).
       ``(C) An estimate of the additional funding needed by the 
     Service, Indian Tribes, and Tribal Organizations to meet 
     their responsibilities under the plans.
       ``(2) Coordination with national clearinghouses and 
     information centers.--The Secretary, acting through the 
     Service, shall coordinate with existing national 
     clearinghouses and information centers to include at the 
     clearinghouses and centers plans and reports on the outcomes 
     of such plans developed by Indian Tribes, Tribal 
     Organizations, and Service Areas relating to behavioral 
     health. The Secretary shall ensure access to these plans and 
     outcomes by any Indian Tribe, Tribal Organization, or the 
     Service.
       ``(3) Technical assistance.--The Secretary shall provide 
     technical assistance to Indian Tribes and Tribal 
     Organizations in preparation of plans under this section and 
     in developing standards of care that may be used and adopted 
     locally.
       ``(c) Programs.--The Secretary, acting through the Service, 
     Indian Tribes, and Tribal Organizations, shall provide, to 
     the extent feasible and if funding is available, programs 
     including the following:
       ``(1) Comprehensive care.--A comprehensive continuum of 
     behavioral health care which provides--
       ``(A) community-based prevention, intervention, outpatient, 
     and behavioral health aftercare;
       ``(B) detoxification (social and medical);
       ``(C) acute hospitalization;
       ``(D) intensive outpatient/day treatment;
       ``(E) residential treatment;
       ``(F) transitional living for those needing a temporary, 
     stable living environment that is supportive of treatment and 
     recovery goals;
       ``(G) emergency shelter;
       ``(H) intensive case management; and
       ``(I) diagnostic services.
       ``(2) Child care.--Behavioral health services for Indians 
     from birth through age 17, including--
       ``(A) preschool and school age fetal alcohol spectrum 
     disorder services, including assessment and behavioral 
     intervention;
       ``(B) mental health and substance abuse services 
     (emotional, organic, alcohol, drug, inhalant, and tobacco);
       ``(C) identification and treatment of co-occurring 
     disorders and comorbidity;
       ``(D) prevention of alcohol, drug, inhalant, and tobacco 
     use;
       ``(E) early intervention, treatment, and aftercare;
       ``(F) promotion of healthy approaches to risk and safety 
     issues; and
       ``(G) identification and treatment of neglect and physical, 
     mental, and sexual abuse.
       ``(3) Adult care.--Behavioral health services for Indians 
     from age 18 through 55, including--
       ``(A) early intervention, treatment, and aftercare;
       ``(B) mental health and substance abuse services 
     (emotional, alcohol, drug, inhalant, and tobacco), including 
     sex specific services;
       ``(C) identification and treatment of co-occurring 
     disorders (dual diagnosis) and comorbidity;
       ``(D) promotion of healthy approaches for risk-related 
     behavior;

[[Page 21703]]

       ``(E) treatment services for women at risk of a fetal 
     alcohol-exposed pregnancy; and
       ``(F) sex specific treatment for sexual assault and 
     domestic violence.
       ``(4) Family care.--Behavioral health services for 
     families, including--
       ``(A) early intervention, treatment, and aftercare for 
     affected families;
       ``(B) treatment for sexual assault and domestic violence; 
     and
       ``(C) promotion of healthy approaches relating to 
     parenting, domestic violence, and other abuse issues.
       ``(5) Elder care.--Behavioral health services for Indians 
     56 years of age and older, including--
       ``(A) early intervention, treatment, and aftercare;
       ``(B) mental health and substance abuse services 
     (emotional, alcohol, drug, inhalant, and tobacco), including 
     sex specific services;
       ``(C) identification and treatment of co-occurring 
     disorders (dual diagnosis) and comorbidity;
       ``(D) promotion of healthy approaches to managing 
     conditions related to aging;
       ``(E) sex specific treatment for sexual assault, domestic 
     violence, neglect, physical and mental abuse and 
     exploitation; and
       ``(F) identification and treatment of dementias regardless 
     of cause.
       ``(d) Community Behavioral Health Plan.--
       ``(1) Establishment.--The governing body of any Indian 
     Tribe or Tribal Organization may adopt a resolution for the 
     establishment of a community behavioral health plan providing 
     for the identification and coordination of available 
     resources and programs to identify, prevent, or treat 
     substance abuse, mental illness, or dysfunctional and self-
     destructive behavior, including child abuse and family 
     violence, among its members or its service population. This 
     plan should include behavioral health services, social 
     services, intensive outpatient services, and continuing 
     aftercare.
       ``(2) Technical assistance.--At the request of an Indian 
     Tribe or Tribal Organization, the Bureau of Indian Affairs 
     and the Service shall cooperate with and provide technical 
     assistance to the Indian Tribe or Tribal Organization in the 
     development and implementation of such plan.
       ``(3) Funding.--The Secretary, acting through the Service, 
     may make funding available to Indian Tribes and Tribal 
     Organizations which adopt a resolution pursuant to paragraph 
     (1) to obtain technical assistance for the development of a 
     community behavioral health plan and to provide 
     administrative support in the implementation of such plan.
       ``(e) Coordination for Availability of Services.--The 
     Secretary, acting through the Service, Indian Tribes, and 
     Tribal Organizations, shall coordinate behavioral health 
     planning, to the extent feasible, with other Federal agencies 
     and with State agencies, to encourage comprehensive 
     behavioral health services for Indians regardless of their 
     place of residence.
       ``(f) Mental Health Care Need Assessment.--Not later than 1 
     year after the date of enactment of the Indian Health Care 
     Improvement Act Amendments of 2007, the Secretary, acting 
     through the Service, shall make an assessment of the need for 
     inpatient mental health care among Indians and the 
     availability and cost of inpatient mental health facilities 
     which can meet such need. In making such assessment, the 
     Secretary shall consider the possible conversion of existing, 
     underused Service hospital beds into psychiatric units to 
     meet such need.

     ``SEC. 702. MEMORANDA OF AGREEMENT WITH THE DEPARTMENT OF THE 
                   INTERIOR.

       ``(a) Contents.--Not later than 12 months after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2007, the Secretary, acting through the 
     Service, and the Secretary of the Interior shall develop and 
     enter into a memoranda of agreement, or review and update any 
     existing memoranda of agreement, as required by section 4205 
     of the Indian Alcohol and Substance Abuse Prevention and 
     Treatment Act of 1986 (25 U.S.C. 2411) under which the 
     Secretaries address the following:
       ``(1) The scope and nature of mental illness and 
     dysfunctional and self-destructive behavior, including child 
     abuse and family violence, among Indians.
       ``(2) The existing Federal, tribal, State, local, and 
     private services, resources, and programs available to 
     provide behavioral health services for Indians.
       ``(3) The unmet need for additional services, resources, 
     and programs necessary to meet the needs identified pursuant 
     to paragraph (1).
       ``(4)(A) The right of Indians, as citizens of the United 
     States and of the States in which they reside, to have access 
     to behavioral health services to which all citizens have 
     access.
       ``(B) The right of Indians to participate in, and receive 
     the benefit of, such services.
       ``(C) The actions necessary to protect the exercise of such 
     right.
       ``(5) The responsibilities of the Bureau of Indian Affairs 
     and the Service, including mental illness identification, 
     prevention, education, referral, and treatment services 
     (including services through multidisciplinary resource 
     teams), at the central, area, and agency and Service Unit, 
     Service Area, and headquarters levels to address the problems 
     identified in paragraph (1).
       ``(6) A strategy for the comprehensive coordination of the 
     behavioral health services provided by the Bureau of Indian 
     Affairs and the Service to meet the problems identified 
     pursuant to paragraph (1), including--
       ``(A) the coordination of alcohol and substance abuse 
     programs of the Service, the Bureau of Indian Affairs, and 
     Indian Tribes and Tribal Organizations (developed under the 
     Indian Alcohol and Substance Abuse Prevention and Treatment 
     Act of 1986 (25 U.S.C. 2401 et seq.)) with behavioral health 
     initiatives pursuant to this Act, particularly with respect 
     to the referral and treatment of dually diagnosed individuals 
     requiring behavioral health and substance abuse treatment; 
     and
       ``(B) ensuring that the Bureau of Indian Affairs and 
     Service programs and services (including multidisciplinary 
     resource teams) addressing child abuse and family violence 
     are coordinated with such non-Federal programs and services.
       ``(7) Directing appropriate officials of the Bureau of 
     Indian Affairs and the Service, particularly at the agency 
     and Service Unit levels, to cooperate fully with tribal 
     requests made pursuant to community behavioral health plans 
     adopted under section 701(c) and section 4206 of the Indian 
     Alcohol and Substance Abuse Prevention and Treatment Act of 
     1986 (25 U.S.C. 2412).
       ``(8) Providing for an annual review of such agreement by 
     the Secretaries which shall be provided to Congress and 
     Indian Tribes and Tribal Organizations.
       ``(b) Specific Provisions Required.--The memoranda of 
     agreement updated or entered into pursuant to subsection (a) 
     shall include specific provisions pursuant to which the 
     Service shall assume responsibility for--
       ``(1) the determination of the scope of the problem of 
     alcohol and substance abuse among Indians, including the 
     number of Indians within the jurisdiction of the Service who 
     are directly or indirectly affected by alcohol and substance 
     abuse and the financial and human cost;
       ``(2) an assessment of the existing and needed resources 
     necessary for the prevention of alcohol and substance abuse 
     and the treatment of Indians affected by alcohol and 
     substance abuse; and
       ``(3) an estimate of the funding necessary to adequately 
     support a program of prevention of alcohol and substance 
     abuse and treatment of Indians affected by alcohol and 
     substance abuse.
       ``(c) Publication.--Each memorandum of agreement entered 
     into or renewed (and amendments or modifications thereto) 
     under subsection (a) shall be published in the Federal 
     Register. At the same time as publication in the Federal 
     Register, the Secretary shall provide a copy of such 
     memoranda, amendment, or modification to each Indian Tribe, 
     Tribal Organization, and Urban Indian Organization.

     ``SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PREVENTION AND 
                   TREATMENT PROGRAM.

       ``(a) Establishment.--
       ``(1) In general.--The Secretary, acting through the 
     Service, Indian Tribes, and Tribal Organizations, shall 
     provide a program of comprehensive behavioral health, 
     prevention, treatment, and aftercare, which shall include--
       ``(A) prevention, through educational intervention, in 
     Indian communities;
       ``(B) acute detoxification, psychiatric hospitalization, 
     residential, and intensive outpatient treatment;
       ``(C) community-based rehabilitation and aftercare;
       ``(D) community education and involvement, including 
     extensive training of health care, educational, and 
     community-based personnel;
       ``(E) specialized residential treatment programs for high-
     risk populations, including pregnant and postpartum women and 
     their children; and
       ``(F) diagnostic services.
       ``(2) Target populations.--The target population of such 
     programs shall be members of Indian Tribes. Efforts to train 
     and educate key members of the Indian community shall also 
     target employees of health, education, judicial, law 
     enforcement, legal, and social service programs.
       ``(b) Contract Health Services.--
       ``(1) In general.--The Secretary, acting through the 
     Service, Indian Tribes, and Tribal Organizations, may enter 
     into contracts with public or private providers of behavioral 
     health treatment services for the purpose of carrying out the 
     program required under subsection (a).
       ``(2) Provision of assistance.--In carrying out this 
     subsection, the Secretary shall provide assistance to Indian 
     Tribes and Tribal Organizations to develop criteria for the 
     certification of behavioral health service providers and 
     accreditation of service facilities which meet minimum 
     standards for such services and facilities.

     ``SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM.

       ``(a) In General.--Under the authority of the Act of 
     November 2, 1921 (25 U.S.C. 13) (commonly known as the 
     `Snyder Act'), the Secretary shall establish and maintain a

[[Page 21704]]

     mental health technician program within the Service which--
       ``(1) provides for the training of Indians as mental health 
     technicians; and
       ``(2) employs such technicians in the provision of 
     community-based mental health care that includes 
     identification, prevention, education, referral, and 
     treatment services.
       ``(b) Paraprofessional Training.--In carrying out 
     subsection (a), the Secretary, acting through the Service, 
     Indian Tribes, and Tribal Organizations, shall provide high-
     standard paraprofessional training in mental health care 
     necessary to provide quality care to the Indian communities 
     to be served. Such training shall be based upon a curriculum 
     developed or approved by the Secretary which combines 
     education in the theory of mental health care with supervised 
     practical experience in the provision of such care.
       ``(c) Supervision and Evaluation of Technicians.--The 
     Secretary, acting through the Service, Indian Tribes, and 
     Tribal Organizations, shall supervise and evaluate the mental 
     health technicians in the training program.
       ``(d) Traditional Health Care Practices.--The Secretary, 
     acting through the Service, shall ensure that the program 
     established pursuant to this subsection involves the use and 
     promotion of the traditional health care practices of the 
     Indian Tribes to be served.

     ``SEC. 705. LICENSING REQUIREMENT FOR MENTAL HEALTH CARE 
                   WORKERS.

       ``(a) In General.--Subject to the provisions of section 
     221, and except as provided in subsection (b), any individual 
     employed as a psychologist, social worker, or marriage and 
     family therapist for the purpose of providing mental health 
     care services to Indians in a clinical setting under this Act 
     is required to be licensed as a psychologist, social worker, 
     or marriage and family therapist, respectively.
       ``(b) Trainees.--An individual may be employed as a trainee 
     in psychology, social work, or marriage and family therapy to 
     provide mental health care services described in subsection 
     (a) if such individual--
       ``(1) works under the direct supervision of a licensed 
     psychologist, social worker, or marriage and family 
     therapist, respectively;
       ``(2) is enrolled in or has completed at least 2 years of 
     course work at a post-secondary, accredited education program 
     for psychology, social work, marriage and family therapy, or 
     counseling; and
       ``(3) meets such other training, supervision, and quality 
     review requirements as the Secretary may establish.

     ``SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.

       ``(a) Grants.--The Secretary, consistent with section 701, 
     may make grants to Indian Tribes, Tribal Organizations, and 
     Urban Indian Organizations to develop and implement a 
     comprehensive behavioral health program of prevention, 
     intervention, treatment, and relapse prevention services that 
     specifically addresses the cultural, historical, social, and 
     child care needs of Indian women, regardless of age.
       ``(b) Use of Grant Funds.--A grant made pursuant to this 
     section may be used to--
       ``(1) develop and provide community training, education, 
     and prevention programs for Indian women relating to 
     behavioral health issues, including fetal alcohol spectrum 
     disorders;
       ``(2) identify and provide psychological services, 
     counseling, advocacy, support, and relapse prevention to 
     Indian women and their families; and
       ``(3) develop prevention and intervention models for Indian 
     women which incorporate traditional health care practices, 
     cultural values, and community and family involvement.
       ``(c) Criteria.--The Secretary, in consultation with Indian 
     Tribes and Tribal Organizations, shall establish criteria for 
     the review and approval of applications and proposals for 
     funding under this section.
       ``(d) Earmark of Certain Funds.--Twenty percent of the 
     funds appropriated pursuant to this section shall be used to 
     make grants to Urban Indian Organizations.

     ``SEC. 707. INDIAN YOUTH PROGRAM.

       ``(a) Detoxification and Rehabilitation.--The Secretary, 
     acting through the Service, consistent with section 701, 
     shall develop and implement a program for acute 
     detoxification and treatment for Indian youths, including 
     behavioral health services. The program shall include 
     regional treatment centers designed to include detoxification 
     and rehabilitation for both sexes on a referral basis and 
     programs developed and implemented by Indian Tribes or Tribal 
     Organizations at the local level under the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.). Regional centers shall be integrated with the intake 
     and rehabilitation programs based in the referring Indian 
     community.
       ``(b) Alcohol and Substance Abuse Treatment Centers or 
     Facilities.--
       ``(1) Establishment.--
       ``(A) In general.--The Secretary, acting through the 
     Service, Indian Tribes, and Tribal Organizations, shall 
     construct, renovate, or, as necessary, purchase, and 
     appropriately staff and operate, at least 1 youth regional 
     treatment center or treatment network in each area under the 
     jurisdiction of an Area Office.
       ``(B) Area office in california.--For the purposes of this 
     subsection, the Area Office in California shall be considered 
     to be 2 Area Offices, 1 office whose jurisdiction shall be 
     considered to encompass the northern area of the State of 
     California, and 1 office whose jurisdiction shall be 
     considered to encompass the remainder of the State of 
     California for the purpose of implementing California 
     treatment networks.
       ``(2) Funding.--For the purpose of staffing and operating 
     such centers or facilities, funding shall be pursuant to the 
     Act of November 2, 1921 (25 U.S.C. 13).
       ``(3) Location.--A youth treatment center constructed or 
     purchased under this subsection shall be constructed or 
     purchased at a location within the area described in 
     paragraph (1) agreed upon (by appropriate tribal resolution) 
     by a majority of the Indian Tribes to be served by such 
     center.
       ``(4) Specific provision of funds.--
       ``(A) In general.--Notwithstanding any other provision of 
     this title, the Secretary may, from amounts authorized to be 
     appropriated for the purposes of carrying out this section, 
     make funds available to--
       ``(i) the Tanana Chiefs Conference, Incorporated, for the 
     purpose of leasing, constructing, renovating, operating, and 
     maintaining a residential youth treatment facility in 
     Fairbanks, Alaska; and
       ``(ii) the Southeast Alaska Regional Health Corporation to 
     staff and operate a residential youth treatment facility 
     without regard to the proviso set forth in section 4(l) of 
     the Indian Self-Determination and Education Assistance Act 
     (25 U.S.C. 450b(l)).
       ``(B) Provision of services to eligible youths.--Until 
     additional residential youth treatment facilities are 
     established in Alaska pursuant to this section, the 
     facilities specified in subparagraph (A) shall make every 
     effort to provide services to all eligible Indian youths 
     residing in Alaska.
       ``(c) Intermediate Adolescent Behavioral Health Services.--
       ``(1) In general.--The Secretary, acting through the 
     Service, Indian Tribes, and Tribal Organizations, may provide 
     intermediate behavioral health services to Indian children 
     and adolescents, including--
       ``(A) pretreatment assistance;
       ``(B) inpatient, outpatient, and aftercare services;
       ``(C) emergency care;
       ``(D) suicide prevention and crisis intervention; and
       ``(E) prevention and treatment of mental illness and 
     dysfunctional and self-destructive behavior, including child 
     abuse and family violence.
       ``(2) Use of funds.--Funds provided under this subsection 
     may be used--
       ``(A) to construct or renovate an existing health facility 
     to provide intermediate behavioral health services;
       ``(B) to hire behavioral health professionals;
       ``(C) to staff, operate, and maintain an intermediate 
     mental health facility, group home, sober housing, 
     transitional housing or similar facilities, or youth shelter 
     where intermediate behavioral health services are being 
     provided;
       ``(D) to make renovations and hire appropriate staff to 
     convert existing hospital beds into adolescent psychiatric 
     units; and
       ``(E) for intensive home- and community-based services.
       ``(3) Criteria.--The Secretary, acting through the Service, 
     shall, in consultation with Indian Tribes and Tribal 
     Organizations, establish criteria for the review and approval 
     of applications or proposals for funding made available 
     pursuant to this subsection.
       ``(d) Federally-Owned Structures.--
       ``(1) In general.--The Secretary, in consultation with 
     Indian Tribes and Tribal Organizations, shall--
       ``(A) identify and use, where appropriate, federally-owned 
     structures suitable for local residential or regional 
     behavioral health treatment for Indian youths; and
       ``(B) establish guidelines for determining the suitability 
     of any such federally-owned structure to be used for local 
     residential or regional behavioral health treatment for 
     Indian youths.
       ``(2) Terms and conditions for use of structure.--Any 
     structure described in paragraph (1) may be used under such 
     terms and conditions as may be agreed upon by the Secretary 
     and the agency having responsibility for the structure and 
     any Indian Tribe or Tribal Organization operating the 
     program.
       ``(e) Rehabilitation and Aftercare Services.--
       ``(1) In general.--The Secretary, Indian Tribes, or Tribal 
     Organizations, in cooperation with the Secretary of the 
     Interior, shall develop and implement within each Service 
     Unit, community-based rehabilitation and follow-up services 
     for Indian youths who are having significant behavioral 
     health problems, and require long-term treatment, community 
     reintegration, and monitoring to support the Indian youths 
     after their return to their home community.
       ``(2) Administration.--Services under paragraph (1) shall 
     be provided by trained staff within the community who can 
     assist the Indian youths in their continuing development of 
     self-image, positive problem-solving

[[Page 21705]]

     skills, and nonalcohol or substance abusing behaviors. Such 
     staff may include alcohol and substance abuse counselors, 
     mental health professionals, and other health professionals 
     and paraprofessionals, including community health 
     representatives.
       ``(f) Inclusion of Family in Youth Treatment Program.--In 
     providing the treatment and other services to Indian youths 
     authorized by this section, the Secretary, acting through the 
     Service, Indian Tribes, and Tribal Organizations, shall 
     provide for the inclusion of family members of such youths in 
     the treatment programs or other services as may be 
     appropriate. Not less than 10 percent of the funds 
     appropriated for the purposes of carrying out subsection (e) 
     shall be used for outpatient care of adult family members 
     related to the treatment of an Indian youth under that 
     subsection.
       ``(g) Multidrug Abuse Program.--The Secretary, acting 
     through the Service, Indian Tribes, and Tribal Organizations, 
     shall provide, consistent with section 701, programs and 
     services to prevent and treat the abuse of multiple forms of 
     substances, including alcohol, drugs, inhalants, and tobacco, 
     among Indian youths residing in Indian communities, on or 
     near reservations, and in urban areas and provide appropriate 
     mental health services to address the incidence of mental 
     illness among such youths.
       ``(h) Indian Youth Mental Health.--The Secretary, acting 
     through the Service, shall collect data for the report under 
     section 801 with respect to--
       ``(1) the number of Indian youth who are being provided 
     mental health services through the Service and Tribal Health 
     Programs;
       ``(2) a description of, and costs associated with, the 
     mental health services provided for Indian youth through the 
     Service and Tribal Health Programs;
       ``(3) the number of youth referred to the Service or Tribal 
     Health Programs for mental health services;
       ``(4) the number of Indian youth provided residential 
     treatment for mental health and behavioral problems through 
     the Service and Tribal Health Programs, reported separately 
     for on- and off-reservation facilities; and
       ``(5) the costs of the services described in paragraph (4).

     ``SEC. 708. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRATION 
                   PROJECT.

       ``(a) Purpose.--The purpose of this section is to authorize 
     the Secretary to carry out a demonstration project to test 
     the use of telemental health services in suicide prevention, 
     intervention and treatment of Indian youth, including 
     through--
       ``(1) the use of psychotherapy, psychiatric assessments, 
     diagnostic interviews, therapies for mental health conditions 
     predisposing to suicide, and alcohol and substance abuse 
     treatment;
       ``(2) the provision of clinical expertise to, consultation 
     services with, and medical advice and training for frontline 
     health care providers working with Indian youth;
       ``(3) training and related support for community leaders, 
     family members and health and education workers who work with 
     Indian youth;
       ``(4) the development of culturally-relevant educational 
     materials on suicide; and
       ``(5) data collection and reporting.
       ``(b) Definitions.--For the purpose of this section, the 
     following definitions shall apply:
       ``(1) Demonstration project.--The term `demonstration 
     project' means the Indian youth telemental health 
     demonstration project authorized under subsection (c).
       ``(2) Telemental health.--The term `telemental health' 
     means the use of electronic information and 
     telecommunications technologies to support long distance 
     mental health care, patient and professional-related 
     education, public health, and health administration.
       ``(c) Authorization.--
       ``(1) In general.--The Secretary is authorized to award 
     grants under the demonstration project for the provision of 
     telemental health services to Indian youth who--
       ``(A) have expressed suicidal ideas;
       ``(B) have attempted suicide; or
       ``(C) have mental health conditions that increase or could 
     increase the risk of suicide.
       ``(2) Eligibility for grants.--Such grants shall be awarded 
     to Indian Tribes and Tribal Organizations that operate 1 or 
     more facilities--
       ``(A) located in Alaska and part of the Alaska Federal 
     Health Care Access Network;
       ``(B) reporting active clinical telehealth capabilities; or
       ``(C) offering school-based telemental health services 
     relating to psychiatry to Indian youth.
       ``(3) Grant period.--The Secretary shall award grants under 
     this section for a period of up to 4 years.
       ``(4) Awarding of grants.--Not more than 5 grants shall be 
     provided under paragraph (1), with priority consideration 
     given to Indian Tribes and Tribal Organizations that--
       ``(A) serve a particular community or geographic area where 
     there is a demonstrated need to address Indian youth suicide;
       ``(B) enter in to collaborative partnerships with Indian 
     Health Service or Tribal Health Programs or facilities to 
     provide services under this demonstration project;
       ``(C) serve an isolated community or geographic area which 
     has limited or no access to behavioral health services; or
       ``(D) operate a detention facility at which Indian youth 
     are detained.
       ``(d) Use of Funds.--
       ``(1) In general.--An Indian Tribe or Tribal Organization 
     shall use a grant received under subsection (c) for the 
     following purposes:
       ``(A) To provide telemental health services to Indian 
     youth, including the provision of--
       ``(i) psychotherapy;
       ``(ii) psychiatric assessments and diagnostic interviews, 
     therapies for mental health conditions predisposing to 
     suicide, and treatment; and
       ``(iii) alcohol and substance abuse treatment.
       ``(B) To provide clinician-interactive medical advice, 
     guidance and training, assistance in diagnosis and 
     interpretation, crisis counseling and intervention, and 
     related assistance to Service, tribal, or urban clinicians 
     and health services providers working with youth being served 
     under this demonstration project.
       ``(C) To assist, educate and train community leaders, 
     health education professionals and paraprofessionals, tribal 
     outreach workers, and family members who work with the youth 
     receiving telemental health services under this demonstration 
     project, including with identification of suicidal 
     tendencies, crisis intervention and suicide prevention, 
     emergency skill development, and building and expanding 
     networks among these individuals and with State and local 
     health services providers.
       ``(D) To develop and distribute culturally appropriate 
     community educational materials on--
       ``(i) suicide prevention;
       ``(ii) suicide education;
       ``(iii) suicide screening;
       ``(iv) suicide intervention; and
       ``(v) ways to mobilize communities with respect to the 
     identification of risk factors for suicide.
       ``(E) For data collection and reporting related to Indian 
     youth suicide prevention efforts.
       ``(2) Traditional health care practices.--In carrying out 
     the purposes described in paragraph (1), an Indian Tribe or 
     Tribal Organization may use and promote the traditional 
     health care practices of the Indian Tribes of the youth to be 
     served.
       ``(e) Applications.--To be eligible to receive a grant 
     under subsection (c), an Indian Tribe or Tribal Organization 
     shall prepare and submit to the Secretary an application, at 
     such time, in such manner, and containing such information as 
     the Secretary may require, including--
       ``(1) a description of the project that the Indian Tribe or 
     Tribal Organization will carry out using the funds provided 
     under the grant;
       ``(2) a description of the manner in which the project 
     funded under the grant would--
       ``(A) meet the telemental health care needs of the Indian 
     youth population to be served by the project; or
       ``(B) improve the access of the Indian youth population to 
     be served to suicide prevention and treatment services;
       ``(3) evidence of support for the project from the local 
     community to be served by the project;
       ``(4) a description of how the families and leadership of 
     the communities or populations to be served by the project 
     would be involved in the development and ongoing operations 
     of the project;
       ``(5) a plan to involve the tribal community of the youth 
     who are provided services by the project in planning and 
     evaluating the mental health care and suicide prevention 
     efforts provided, in order to ensure the integration of 
     community, clinical, environmental, and cultural components 
     of the treatment; and
       ``(6) a plan for sustaining the project after Federal 
     assistance for the demonstration project has terminated.
       ``(f) Collaboration; Reporting to National Clearinghouse.--
       ``(1) Collaboration.--The Secretary, acting through the 
     Service, shall encourage Indian Tribes and Tribal 
     Organizations receiving grants under this section to 
     collaborate to enable comparisons about best practices across 
     projects.
       ``(2) Reporting to national clearinghouse.--The Secretary, 
     acting through the Service, shall also encourage Indian 
     Tribes and Tribal Organizations receiving grants under this 
     section to submit relevant, declassified project information 
     to the national clearinghouse authorized under section 
     701(b)(2) in order to better facilitate program performance 
     and improve suicide prevention, intervention, and treatment 
     services.
       ``(g) Annual Report.--Each grant recipient shall submit to 
     the Secretary an annual report that--
       ``(1) describes the number of telemental health services 
     provided; and
       ``(2) includes any other information that the Secretary may 
     require.
       ``(h) Report to Congress.--Not later than 270 days after 
     the termination of the demonstration project, the Secretary 
     shall submit to the Committee on Indian Affairs of the Senate 
     and the Committee on Natural

[[Page 21706]]

     Resources and Committee on Energy and Commerce of the House 
     of Representatives a final report, based on the annual 
     reports provided by grant recipients under subsection (h), 
     that--
       ``(1) describes the results of the projects funded by 
     grants awarded under this section, including any data 
     available which indicates the number of attempted suicides;
       ``(2) evaluates the impact of the telemental health 
     services funded by the grants in reducing the number of 
     completed suicides among Indian youth;
       ``(3) evaluates whether the demonstration project should 
     be--
       ``(A) expanded to provide more than 5 grants; and
       ``(B) designated a permanent program; and
       ``(4) evaluates the benefits of expanding the demonstration 
     project to include Urban Indian Organizations.
       ``(i) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $1,500,000 for 
     each of fiscal years 2008 through 2011.

     ``SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL HEALTH 
                   FACILITIES DESIGN, CONSTRUCTION, AND STAFFING.

       ``Not later than 1 year after the date of enactment of the 
     Indian Health Care Improvement Act Amendments of 2007, the 
     Secretary, acting through the Service, Indian Tribes, and 
     Tribal Organizations, may provide, in each area of the 
     Service, not less than 1 inpatient mental health care 
     facility, or the equivalent, for Indians with behavioral 
     health problems. For the purposes of this subsection, 
     California shall be considered to be 2 Area Offices, 1 office 
     whose location shall be considered to encompass the northern 
     area of the State of California and 1 office whose 
     jurisdiction shall be considered to encompass the remainder 
     of the State of California. The Secretary shall consider the 
     possible conversion of existing, underused Service hospital 
     beds into psychiatric units to meet such need.

     ``SEC. 710. TRAINING AND COMMUNITY EDUCATION.

       ``(a) Program.--The Secretary, in cooperation with the 
     Secretary of the Interior, shall develop and implement or 
     assist Indian Tribes and Tribal Organizations to develop and 
     implement, within each Service Unit or tribal program, a 
     program of community education and involvement which shall be 
     designed to provide concise and timely information to the 
     community leadership of each tribal community. Such program 
     shall include education about behavioral health issues to 
     political leaders, Tribal judges, law enforcement personnel, 
     members of tribal health and education boards, health care 
     providers including traditional practitioners, and other 
     critical members of each tribal community. Such program may 
     also include community-based training to develop local 
     capacity and tribal community provider training for 
     prevention, intervention, treatment, and aftercare.
       ``(b) Instruction.--The Secretary, acting through the 
     Service, shall, either directly or through Indian Tribes and 
     Tribal Organizations, provide instruction in the area of 
     behavioral health issues, including instruction in crisis 
     intervention and family relations in the context of alcohol 
     and substance abuse, child sexual abuse, youth alcohol and 
     substance abuse, and the causes and effects of fetal alcohol 
     spectrum disorders to appropriate employees of the Bureau of 
     Indian Affairs and the Service, and to personnel in schools 
     or programs operated under any contract with the Bureau of 
     Indian Affairs or the Service, including supervisors of 
     emergency shelters and halfway houses described in section 
     4213 of the Indian Alcohol and Substance Abuse Prevention and 
     Treatment Act of 1986 (25 U.S.C. 2433).
       ``(c) Training Models.--In carrying out the education and 
     training programs required by this section, the Secretary, in 
     consultation with Indian Tribes, Tribal Organizations, Indian 
     behavioral health experts, and Indian alcohol and substance 
     abuse prevention experts, shall develop and provide 
     community-based training models. Such models shall address--
       ``(1) the elevated risk of alcohol and behavioral health 
     problems faced by children of alcoholics;
       ``(2) the cultural, spiritual, and multigenerational 
     aspects of behavioral health problem prevention and recovery; 
     and
       ``(3) community-based and multidisciplinary strategies for 
     preventing and treating behavioral health problems.

     ``SEC. 711. BEHAVIORAL HEALTH PROGRAM.

       ``(a) Innovative Programs.--The Secretary, acting through 
     the Service, Indian Tribes, and Tribal Organizations, 
     consistent with section 701, may plan, develop, implement, 
     and carry out programs to deliver innovative community-based 
     behavioral health services to Indians.
       ``(b) Awards; Criteria.--The Secretary may award a grant 
     for a project under subsection (a) to an Indian Tribe or 
     Tribal Organization and may consider the following criteria:
       ``(1) The project will address significant unmet behavioral 
     health needs among Indians.
       ``(2) The project will serve a significant number of 
     Indians.
       ``(3) The project has the potential to deliver services in 
     an efficient and effective manner.
       ``(4) The Indian Tribe or Tribal Organization has the 
     administrative and financial capability to administer the 
     project.
       ``(5) The project may deliver services in a manner 
     consistent with traditional health care practices.
       ``(6) The project is coordinated with, and avoids 
     duplication of, existing services.
       ``(c) Equitable Treatment.--For purposes of this 
     subsection, the Secretary shall, in evaluating project 
     applications or proposals, use the same criteria that the 
     Secretary uses in evaluating any other application or 
     proposal for such funding.

     ``SEC. 712. FETAL ALCOHOL SPECTRUM DISORDERS PROGRAMS.

       ``(a) Programs.--
       ``(1) Establishment.--The Secretary, consistent with 
     section 701, acting through the Service, Indian Tribes, and 
     Tribal Organizations, is authorized to establish and operate 
     fetal alcohol spectrum disorders programs as provided in this 
     section for the purposes of meeting the health status 
     objectives specified in section 3.
       ``(2) Use of funds.--
       ``(A) In general.--Funding provided pursuant to this 
     section shall be used for the following:
       ``(i) To develop and provide for Indians community and in-
     school training, education, and prevention programs relating 
     to fetal alcohol spectrum disorders.
       ``(ii) To identify and provide behavioral health treatment 
     to high-risk Indian women and high-risk women pregnant with 
     an Indian's child.
       ``(iii) To identify and provide appropriate psychological 
     services, educational and vocational support, counseling, 
     advocacy, and information to fetal alcohol spectrum 
     disorders-affected Indians and their families or caretakers.
       ``(iv) To develop and implement counseling and support 
     programs in schools for fetal alcohol spectrum disorders-
     affected Indian children.
       ``(v) To develop prevention and intervention models which 
     incorporate practitioners of traditional health care 
     practices, cultural values, and community involvement.
       ``(vi) To develop, print, and disseminate education and 
     prevention materials on fetal alcohol spectrum disorders.
       ``(vii) To develop and implement, in consultation with 
     Indian Tribes and Tribal Organizations, and in conference 
     with Urban Indian Organizations, culturally sensitive 
     assessment and diagnostic tools including dysmorphology 
     clinics and multidisciplinary fetal alcohol spectrum 
     disorders clinics for use in Indian communities and Urban 
     Centers.
       ``(B) Additional uses.--In addition to any purpose under 
     subparagraph (A), funding provided pursuant to this section 
     may be used for 1 or more of the following:
       ``(i) Early childhood intervention projects from birth on 
     to mitigate the effects of fetal alcohol spectrum disorders 
     among Indians.
       ``(ii) Community-based support services for Indians and 
     women pregnant with Indian children.
       ``(iii) Community-based housing for adult Indians with 
     fetal alcohol spectrum disorders.
       ``(3) Criteria for applications.--The Secretary shall 
     establish criteria for the review and approval of 
     applications for funding under this section.
       ``(b) Services.--The Secretary, acting through the Service, 
     Indian Tribes, and Tribal Organizations, shall--
       ``(1) develop and provide services for the prevention, 
     intervention, treatment, and aftercare for those affected by 
     fetal alcohol spectrum disorders in Indian communities; and
       ``(2) provide supportive services, including services to 
     meet the special educational, vocational, school-to-work 
     transition, and independent living needs of adolescent and 
     adult Indians with fetal alcohol spectrum disorders.
       ``(c) Task Force.--The Secretary shall establish a task 
     force to be known as the Fetal Alcohol Spectrum Disorders 
     Task Force to advise the Secretary in carrying out subsection 
     (b). Such task force shall be composed of representatives 
     from the following:
       ``(1) The National Institute on Drug Abuse.
       ``(2) The National Institute on Alcohol and Alcoholism.
       ``(3) The Office of Substance Abuse Prevention.
       ``(4) The National Institute of Mental Health.
       ``(5) The Service.
       ``(6) The Office of Minority Health of the Department of 
     Health and Human Services.
       ``(7) The Administration for Native Americans.
       ``(8) The National Institute of Child Health and Human 
     Development (NICHD).
       ``(9) The Centers for Disease Control and Prevention.
       ``(10) The Bureau of Indian Affairs.
       ``(11) Indian Tribes.
       ``(12) Tribal Organizations.
       ``(13) Urban Indian communities.
       ``(14) Indian fetal alcohol spectrum disorders experts.
       ``(d) Applied Research Projects.--The Secretary, acting 
     through the Substance

[[Page 21707]]

     Abuse and Mental Health Services Administration, shall make 
     grants to Indian Tribes, Tribal Organizations, and Urban 
     Indian Organizations for applied research projects which 
     propose to elevate the understanding of methods to prevent, 
     intervene, treat, or provide rehabilitation and behavioral 
     health aftercare for Indians and Urban Indians affected by 
     fetal alcohol spectrum disorders.
       ``(e) Funding for Urban Indian Organizations.--Ten percent 
     of the funds appropriated pursuant to this section shall be 
     used to make grants to Urban Indian Organizations funded 
     under title V.

     ``SEC. 713. CHILD SEXUAL ABUSE PREVENTION AND TREATMENT 
                   PROGRAMS.

       ``(a) Establishment.--The Secretary, acting through the 
     Service, and the Secretary of the Interior, Indian Tribes, 
     and Tribal Organizations, shall establish, consistent with 
     section 701, in every Service Area, programs involving 
     treatment for--
       ``(1) victims of sexual abuse who are Indian children or 
     children in an Indian household; and
       ``(2) perpetrators of child sexual abuse who are Indian or 
     members of an Indian household.
       ``(b) Use of Funds.--Funding provided pursuant to this 
     section shall be used for the following:
       ``(1) To develop and provide community education and 
     prevention programs related to sexual abuse of Indian 
     children or children in an Indian household.
       ``(2) To identify and provide behavioral health treatment 
     to victims of sexual abuse who are Indian children or 
     children in an Indian household, and to their family members 
     who are affected by sexual abuse.
       ``(3) To develop prevention and intervention models which 
     incorporate traditional health care practices, cultural 
     values, and community involvement.
       ``(4) To develop and implement culturally sensitive 
     assessment and diagnostic tools for use in Indian communities 
     and Urban Centers.
       ``(5) To identify and provide behavioral health treatment 
     to Indian perpetrators and perpetrators who are members of an 
     Indian household--
       ``(A) making efforts to begin offender and behavioral 
     health treatment while the perpetrator is incarcerated or at 
     the earliest possible date if the perpetrator is not 
     incarcerated; and
       ``(B) providing treatment after the perpetrator is 
     released, until it is determined that the perpetrator is not 
     a threat to children.
       ``(c) Coordination.--The programs established under 
     subsection (a) shall be carried out in coordination with 
     programs and services authorized under the Indian Child 
     Protection and Family Violence Prevention Act (25 U.S.C. 3201 
     et seq.).

     ``SEC. 714. DOMESTIC AND SEXUAL VIOLENCE PREVENTION AND 
                   TREATMENT.

       ``(a) In General.--The Secretary, in accordance with 
     section 701, is authorized to establish in each Service Area 
     programs involving the prevention and treatment of--
       ``(1) Indian victims of domestic violence or sexual abuse; 
     and
       ``(2) perpetrators of domestic violence or sexual abuse who 
     are Indian or members of an Indian household.
       ``(b) Use of Funds.--Funds made available to carry out this 
     section shall be used--
       ``(1) to develop and implement prevention programs and 
     community education programs relating to domestic violence 
     and sexual abuse;
       ``(2) to provide behavioral health services, including 
     victim support services, and medical treatment (including 
     examinations performed by sexual assault nurse examiners) to 
     Indian victims of domestic violence or sexual abuse;
       ``(3) to purchase rape kits,
       ``(4) to develop prevention and intervention models, which 
     may incorporate traditional health care practices; and
       ``(5) to identify and provide behavioral health treatment 
     to perpetrators who are Indian or members of an Indian 
     household.
       ``(c) Training and Certification.--
       ``(1) In general.--Not later than 1 year after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2007, the Secretary shall establish appropriate 
     protocols, policies, procedures, standards of practice, and, 
     if not available elsewhere, training curricula and training 
     and certification requirements for services for victims of 
     domestic violence and sexual abuse.
       ``(2) Report.--Not later than 18 months after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2007, the Secretary shall submit to the 
     Committee on Indian Affairs of the Senate and the Committee 
     on Natural Resources of the House of Representatives a report 
     that describes the means and extent to which the Secretary 
     has carried out paragraph (1).
       ``(d) Coordination.--
       ``(1) In general.--The Secretary, in coordination with the 
     Attorney General, Federal and tribal law enforcement 
     agencies, Indian Health Programs, and domestic violence or 
     sexual assault victim organizations, shall develop 
     appropriate victim services and victim advocate training 
     programs--
       ``(A) to improve domestic violence or sexual abuse 
     responses;
       ``(B) to improve forensic examinations and collection;
       ``(C) to identify problems or obstacles in the prosecution 
     of domestic violence or sexual abuse; and
       ``(D) to meet other needs or carry out other activities 
     required to prevent, treat, and improve prosecutions of 
     domestic violence and sexual abuse.
       ``(2) Report.--Not later than 2 years after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2007, the Secretary shall submit to the 
     Committee on Indian Affairs of the Senate and the Committee 
     on Natural Resources of the House of Representatives a report 
     that describes, with respect to the matters described in 
     paragraph (1), the improvements made and needed, problems or 
     obstacles identified, and costs necessary to address the 
     problems or obstacles, and any other recommendations that the 
     Secretary determines to be appropriate.

     ``SEC. 715. BEHAVIORAL HEALTH RESEARCH.

       ``The Secretary, in consultation with appropriate Federal 
     agencies, shall make grants to, or enter into contracts with, 
     Indian Tribes, Tribal Organizations, and Urban Indian 
     Organizations or enter into contracts with, or make grants to 
     appropriate institutions for, the conduct of research on the 
     incidence and prevalence of behavioral health problems among 
     Indians served by the Service, Indian Tribes, or Tribal 
     Organizations and among Indians in urban areas. Research 
     priorities under this section shall include--
       ``(1) the multifactorial causes of Indian youth suicide, 
     including--
       ``(A) protective and risk factors and scientific data that 
     identifies those factors; and
       ``(B) the effects of loss of cultural identity and the 
     development of scientific data on those effects;
       ``(2) the interrelationship and interdependence of 
     behavioral health problems with alcoholism and other 
     substance abuse, suicide, homicides, other injuries, and the 
     incidence of family violence; and
       ``(3) the development of models of prevention techniques.
     The effect of the interrelationships and interdependencies 
     referred to in paragraph (2) on children, and the development 
     of prevention techniques under paragraph (3) applicable to 
     children, shall be emphasized.

     ``SEC. 716. DEFINITIONS.

       ``For the purpose of this title, the following definitions 
     shall apply:
       ``(1) Assessment.--The term `assessment' means the 
     systematic collection, analysis, and dissemination of 
     information on health status, health needs, and health 
     problems.
       ``(2) Alcohol-related neurodevelop-
     mental disorders or arnd.--The term `alcohol-related 
     neurodevelopmental disorders' or `ARND' means any 1 of a 
     spectrum of effects that--
       ``(A) may occur when a woman drinks alcohol during 
     pregnancy; and
       ``(B) involves a central nervous system abnormality that 
     may be structural, neurological, or functional.
       ``(3) Behavioral health aftercare.--The term `behavioral 
     health aftercare' includes those activities and resources 
     used to support recovery following inpatient, residential, 
     intensive substance abuse, or mental health outpatient or 
     outpatient treatment. The purpose is to help prevent or deal 
     with relapse by ensuring that by the time a client or patient 
     is discharged from a level of care, such as outpatient 
     treatment, an aftercare plan has been developed with the 
     client. An aftercare plan may use such resources as a 
     community-based therapeutic group, transitional living 
     facilities, a 12-step sponsor, a local 12-step or other 
     related support group, and other community-based providers.
       ``(4) Dual diagnosis.--The term `dual diagnosis' means 
     coexisting substance abuse and mental illness conditions or 
     diagnosis. Such clients are sometimes referred to as mentally 
     ill chemical abusers (MICAs).
       ``(5) Fetal alcohol spectrum disorders.--
       ``(A) In general.--The term `fetal alcohol spectrum 
     disorders' includes a range of effects that can occur in an 
     individual whose mother drank alcohol during pregnancy, 
     including physical, mental, behavioral, and/or learning 
     disabilities with possible lifelong implications.
       ``(B) Inclusions.--The term `fetal alcohol spectrum 
     disorders' may include--
       ``(i) fetal alcohol syndrome (FAS);
       ``(ii) fetal alcohol effect (FAE);
       ``(iii) alcohol-related birth defects; and
       ``(iv) alcohol-related neurodevelopmental disorders (ARND).
       ``(6) Fetal alcohol syndrome or fas.--The term `fetal 
     alcohol syndrome' or `FAS' means any 1 of a spectrum of 
     effects that may occur when a woman drinks alcohol during 
     pregnancy, the diagnosis of which involves the confirmed 
     presence of the following 3 criteria:
       ``(A) Craniofacial abnormalities.
       ``(B) Growth deficits.
       ``(C) Central nervous system abnormalities.
       ``(7) Rehabilitation.--The term `rehabilitation' means to 
     restore the ability or capacity to engage in usual and 
     customary life activities through education and therapy.
       ``(8) Substance abuse.--The term `substance abuse' includes 
     inhalant abuse.

[[Page 21708]]



     ``SEC. 717. AUTHORIZATION OF APPROPRIATIONS.

       ``There is authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2017 to 
     carry out the provisions of this title.

                      ``TITLE VIII--MISCELLANEOUS

     ``SEC. 801. REPORTS.

       ``For each fiscal year following the date of enactment of 
     the Indian Health Care Improvement Act Amendments of 2007, 
     the Secretary shall transmit to Congress a report containing 
     the following:
       ``(1) A report on the progress made in meeting the 
     objectives of this Act, including a review of programs 
     established or assisted pursuant to this Act and assessments 
     and recommendations of additional programs or additional 
     assistance necessary to, at a minimum, provide health 
     services to Indians and ensure a health status for Indians, 
     which are at a parity with the health services available to 
     and the health status of the general population.
       ``(2) A report on whether, and to what extent, new national 
     health care programs, benefits, initiatives, or financing 
     systems have had an impact on the purposes of this Act and 
     any steps that the Secretary may have taken to consult with 
     Indian Tribes, Tribal Organizations, and Urban Indian 
     Organizations to address such impact, including a report on 
     proposed changes in allocation of funding pursuant to section 
     808.
       ``(3) A report on the use of health services by Indians--
       ``(A) on a national and area or other relevant geographical 
     basis;
       ``(B) by gender and age;
       ``(C) by source of payment and type of service;
       ``(D) comparing such rates of use with rates of use among 
     comparable non-Indian populations; and
       ``(E) provided under contracts.
       ``(4) A report of contractors to the Secretary on Health 
     Care Educational Loan Repayments every 6 months required by 
     section 110.
       ``(5) A general audit report of the Secretary on the Health 
     Care Educational Loan Repayment Program as required by 
     section 110(n).
       ``(6) A report of the findings and conclusions of 
     demonstration programs on development of educational 
     curricula for substance abuse counseling as required in 
     section 125(f).
       ``(7) A separate statement which specifies the amount of 
     funds requested to carry out the provisions of section 201.
       ``(8) A report of the evaluations of health promotion and 
     disease prevention as required in section 203(c).
       ``(9) A biennial report to Congress on infectious diseases 
     as required by section 212.
       ``(10) A report on environmental and nuclear health hazards 
     as required by section 215.
       ``(11) An annual report on the status of all health care 
     facilities needs as required by section 301(c)(2)(B) and 
     301(d).
       ``(12) Reports on safe water and sanitary waste disposal 
     facilities as required by section 302(h).
       ``(13) An annual report on the expenditure of non-Service 
     funds for renovation as required by sections 304(b)(2).
       ``(14) A report identifying the backlog of maintenance and 
     repair required at Service and tribal facilities required by 
     section 313(a).
       ``(15) A report providing an accounting of reimbursement 
     funds made available to the Secretary under titles XVIII, 
     XIX, and XXI of the Social Security Act.
       ``(16) A report on any arrangements for the sharing of 
     medical facilities or services, as authorized by section 406.
       ``(17) A report on evaluation and renewal of Urban Indian 
     programs under section 505.
       ``(18) A report on the evaluation of programs as required 
     by section 513(d).
       ``(19) A report on alcohol and substance abuse as required 
     by section 701(f).
       ``(20) A report on Indian youth mental health services as 
     required by section 707(h).
       ``(21) A report on the reallocation of base resources if 
     required by section 808.

     ``SEC. 802. REGULATIONS.

       ``(a) Deadlines.--
       ``(1) Procedures.--Not later than 90 days after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2007, the Secretary shall initiate procedures 
     under subchapter III of chapter 5 of title 5, United States 
     Code, to negotiate and promulgate such regulations or 
     amendments thereto that are necessary to carry out titles II 
     (except section 202) and VII, the sections of title III for 
     which negotiated rulemaking is specifically required, and 
     section 807. Unless otherwise required, the Secretary may 
     promulgate regulations to carry out titles I, III, IV, and V, 
     and section 202, using the procedures required by chapter V 
     of title 5, United States Code (commonly known as the 
     `Administrative Procedure Act').
       ``(2) Proposed regulations.--Proposed regulations to 
     implement this Act shall be published in the Federal Register 
     by the Secretary no later than 2 years after the date of 
     enactment of the Indian Health Care Improvement Act 
     Amendments of 2007 and shall have no less than a 120-day 
     comment period.
       ``(3) Final regulations.--The Secretary shall publish in 
     the Federal Register final regulations to implement this Act 
     by not later than 3 years after the date of enactment of the 
     Indian Health Care Improvement Act Amendments of 2007.
       ``(b) Committee.--A negotiated rulemaking committee 
     established pursuant to section 565 of title 5, United States 
     Code, to carry out this section shall have as its members 
     only representatives of the Federal Government and 
     representatives of Indian Tribes, and Tribal Organizations, a 
     majority of whom shall be nominated by and be representatives 
     of Indian Tribes and Tribal Organizations from each Service 
     Area.
       ``(c) Adaptation of Procedures.--The Secretary shall adapt 
     the negotiated rulemaking procedures to the unique context of 
     self-governance and the government-to-government relationship 
     between the United States and Indian Tribes.
       ``(d) Lack of Regulations.--The lack of promulgated 
     regulations shall not limit the effect of this Act.
       ``(e) Inconsistent Regulations.--The provisions of this Act 
     shall supersede any conflicting provisions of law in effect 
     on the day before the date of enactment of the Indian Health 
     Care Improvement Act Amendments of 2007, and the Secretary is 
     authorized to repeal any regulation inconsistent with the 
     provisions of this Act.

     ``SEC. 803. PLAN OF IMPLEMENTATION.

       ``Not later than 9 months after the date of enactment of 
     the Indian Health Care Improvement Act Amendments of 2007, 
     the Secretary, in consultation with Indian Tribes and Tribal 
     Organizations, and in conference with Urban Indian 
     Organizations, shall submit to Congress a plan explaining the 
     manner and schedule, by title and section, by which the 
     Secretary will implement the provisions of this Act. This 
     consultation may be conducted jointly with the annual budget 
     consultation pursuant to the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450 et seq).

     ``SEC. 804. AVAILABILITY OF FUNDS.

       ``The funds appropriated pursuant to this Act shall remain 
     available until expended.

     ``SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED TO INDIAN 
                   HEALTH SERVICE.

       ``Any limitation on the use of funds contained in an Act 
     providing appropriations for the Department for a period with 
     respect to the performance of abortions shall apply for that 
     period with respect to the performance of abortions using 
     funds contained in an Act providing appropriations for the 
     Service.

     ``SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS.

       ``(a) In General.--The following California Indians shall 
     be eligible for health services provided by the Service:
       ``(1) Any member of a federally recognized Indian Tribe.
       ``(2) Any descendant of an Indian who was residing in 
     California on June 1, 1852, if such descendant--
       ``(A) is a member of the Indian community served by a local 
     program of the Service; and
       ``(B) is regarded as an Indian by the community in which 
     such descendant lives.
       ``(3) Any Indian who holds trust interests in public 
     domain, national forest, or reservation allotments in 
     California.
       ``(4) Any Indian in California who is listed on the plans 
     for distribution of the assets of rancherias and reservations 
     located within the State of California under the Act of 
     August 18, 1958 (72 Stat. 619), and any descendant of such an 
     Indian.
       ``(b) Clarification.--Nothing in this section may be 
     construed as expanding the eligibility of California Indians 
     for health services provided by the Service beyond the scope 
     of eligibility for such health services that applied on May 
     1, 1986.

     ``SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS.

       ``(a) Children.--Any individual who--
       ``(1) has not attained 19 years of age;
       ``(2) is the natural or adopted child, stepchild, foster 
     child, legal ward, or orphan of an eligible Indian; and
       ``(3) is not otherwise eligible for health services 
     provided by the Service,
     shall be eligible for all health services provided by the 
     Service on the same basis and subject to the same rules that 
     apply to eligible Indians until such individual attains 19 
     years of age. The existing and potential health needs of all 
     such individuals shall be taken into consideration by the 
     Service in determining the need for, or the allocation of, 
     the health resources of the Service. If such an individual 
     has been determined to be legally incompetent prior to 
     attaining 19 years of age, such individual shall remain 
     eligible for such services until 1 year after the date of a 
     determination of competency.
       ``(b) Spouses.--Any spouse of an eligible Indian who is not 
     an Indian, or who is of Indian descent but is not otherwise 
     eligible for the health services provided by the Service, 
     shall be eligible for such health services if all such 
     spouses or spouses who are married to members of each Indian 
     Tribe being served are made eligible, as a class, by an 
     appropriate resolution of the governing body of the Indian 
     Tribe or Tribal Organization providing such services. The 
     health needs of persons made eligible under this paragraph 
     shall not be taken into consideration by the Service in 
     determining the need for, or allocation of, its health 
     resources.
       ``(c) Provision of Services to Other Individuals.--

[[Page 21709]]

       ``(1) In general.--The Secretary is authorized to provide 
     health services under this subsection through health programs 
     operated directly by the Service to individuals who reside 
     within the Service Unit and who are not otherwise eligible 
     for such health services if--
       ``(A) the Indian Tribes served by such Service Unit request 
     such provision of health services to such individuals; and
       ``(B) the Secretary and the served Indian Tribes have 
     jointly determined that--
       ``(i) the provision of such health services will not result 
     in a denial or diminution of health services to eligible 
     Indians; and
       ``(ii) there is no reasonable alternative health facilities 
     or services, within or without the Service Unit, available to 
     meet the health needs of such individuals.
       ``(2) ISDEAA programs.--In the case of health programs and 
     facilities operated under a contract or compact entered into 
     under the Indian Self-Determination and Education Assistance 
     Act (25 U.S.C. 450 et seq.), the governing body of the Indian 
     Tribe or Tribal Organization providing health services under 
     such contract or compact is authorized to determine whether 
     health services should be provided under such contract to 
     individuals who are not eligible for such health services 
     under any other subsection of this section or under any other 
     provision of law. In making such determinations, the 
     governing body of the Indian Tribe or Tribal Organization 
     shall take into account the considerations described in 
     paragraph (1)(B).
       ``(3) Payment for services.--
       ``(A) In general.--Persons receiving health services 
     provided by the Service under this subsection shall be liable 
     for payment of such health services under a schedule of 
     charges prescribed by the Secretary which, in the judgment of 
     the Secretary, results in reimbursement in an amount not less 
     than the actual cost of providing the health services. 
     Notwithstanding section 404 of this Act or any other 
     provision of law, amounts collected under this subsection, 
     including Medicare, Medicaid, or SCHIP reimbursements under 
     titles XVIII, XIX, and XXI of the Social Security Act, shall 
     be credited to the account of the program providing the 
     service and shall be used for the purposes listed in section 
     401(d)(2) and amounts collected under this subsection shall 
     be available for expenditure within such program.
       ``(B) Indigent people.--Health services may be provided by 
     the Secretary through the Service under this subsection to an 
     indigent individual who would not be otherwise eligible for 
     such health services but for the provisions of paragraph (1) 
     only if an agreement has been entered into with a State or 
     local government under which the State or local government 
     agrees to reimburse the Service for the expenses incurred by 
     the Service in providing such health services to such 
     indigent individual.
       ``(4) Revocation of consent for services.--
       ``(A) Single tribe service area.--In the case of a Service 
     Area which serves only 1 Indian Tribe, the authority of the 
     Secretary to provide health services under paragraph (1) 
     shall terminate at the end of the fiscal year succeeding the 
     fiscal year in which the governing body of the Indian Tribe 
     revokes its concurrence to the provision of such health 
     services.
       ``(B) Multitribal service area.--In the case of a 
     multitribal Service Area, the authority of the Secretary to 
     provide health services under paragraph (1) shall terminate 
     at the end of the fiscal year succeeding the fiscal year in 
     which at least 51 percent of the number of Indian Tribes in 
     the Service Area revoke their concurrence to the provisions 
     of such health services.
       ``(d) Other Services.--The Service may provide health 
     services under this subsection to individuals who are not 
     eligible for health services provided by the Service under 
     any other provision of law in order to--
       ``(1) achieve stability in a medical emergency;
       ``(2) prevent the spread of a communicable disease or 
     otherwise deal with a public health hazard;
       ``(3) provide care to non-Indian women pregnant with an 
     eligible Indian's child for the duration of the pregnancy 
     through postpartum; or
       ``(4) provide care to immediate family members of an 
     eligible individual if such care is directly related to the 
     treatment of the eligible individual.
       ``(e) Hospital Privileges for Practitioners.--Hospital 
     privileges in health facilities operated and maintained by 
     the Service or operated under a contract or compact pursuant 
     to the Indian Self-Determination and Education Assistance Act 
     (25 U.S.C. 450 et seq.) may be extended to non-Service health 
     care practitioners who provide services to individuals 
     described in subsection (a), (b), (c), or (d). Such non-
     Service health care practitioners may, as part of the 
     privileging process, be designated as employees of the 
     Federal Government for purposes of section 1346(b) and 
     chapter 171 of title 28, United States Code (relating to 
     Federal tort claims) only with respect to acts or omissions 
     which occur in the course of providing services to eligible 
     individuals as a part of the conditions under which such 
     hospital privileges are extended.
       ``(f) Eligible Indian.--For purposes of this section, the 
     term `eligible Indian' means any Indian who is eligible for 
     health services provided by the Service without regard to the 
     provisions of this section.

     ``SEC. 808. REALLOCATION OF BASE RESOURCES.

       ``(a) Report Required.--Notwithstanding any other provision 
     of law, any allocation of Service funds for a fiscal year 
     that reduces by 5 percent or more from the previous fiscal 
     year the funding for any recurring program, project, or 
     activity of a Service Unit may be implemented only after the 
     Secretary has submitted to Congress, under section 801, a 
     report on the proposed change in allocation of funding, 
     including the reasons for the change and its likely effects.
       ``(b) Exception.--Subsection (a) shall not apply if the 
     total amount appropriated to the Service for a fiscal year is 
     at least 5 percent less than the amount appropriated to the 
     Service for the previous fiscal year.

     ``SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.

       ``The Secretary shall provide for the dissemination to 
     Indian Tribes, Tribal Organizations, and Urban Indian 
     Organizations of the findings and results of demonstration 
     projects conducted under this Act.

     ``SEC. 810. PROVISION OF SERVICES IN MONTANA.

       ``(a) Consistent With Court Decision.--The Secretary, 
     acting through the Service, shall provide services and 
     benefits for Indians in Montana in a manner consistent with 
     the decision of the United States Court of Appeals for the 
     Ninth Circuit in McNabb for McNabb v. Bowen, 829 F.2d 787 
     (9th Cir. 1987).
       ``(b) Clarification.--The provisions of subsection (a) 
     shall not be construed to be an expression of the sense of 
     Congress on the application of the decision described in 
     subsection (a) with respect to the provision of services or 
     benefits for Indians living in any State other than Montana.

     ``SEC. 811. MORATORIUM.

       ``During the period of the moratorium imposed on 
     implementation of the final rule published in the Federal 
     Register on September 16, 1987, by the Department of Health 
     and Human Services, relating to eligibility for the health 
     care services of the Indian Health Service, the Indian Health 
     Service shall provide services pursuant to the criteria for 
     eligibility for such services that were in effect on 
     September 15, 1987, subject to the provisions of sections 806 
     and 807, until the Service has submitted to the Committees on 
     Appropriations of the Senate and the House of Representatives 
     a budget request reflecting the increased costs associated 
     with the proposed final rule, and the request has been 
     included in an appropriations Act and enacted into law.

     ``SEC. 812. TRIBAL EMPLOYMENT.

       ``For purposes of section 2(2) of the Act of July 5, 1935 
     (49 Stat. 450, chapter 372), an Indian Tribe or Tribal 
     Organization carrying out a contract or compact pursuant to 
     the Indian Self-Determination and Education Assistance Act 
     (25 U.S.C. 450 et seq.) shall not be considered an 
     `employer'.

     ``SEC. 813. SEVERABILITY PROVISIONS.

       ``If any provision of this Act, any amendment made by the 
     Act, or the application of such provision or amendment to any 
     person or circumstances is held to be invalid, the remainder 
     of this Act, the remaining amendments made by this Act, and 
     the application of such provisions to persons or 
     circumstances other than those to which it is held invalid, 
     shall not be affected thereby.

     ``SEC. 814. ESTABLISHMENT OF NATIONAL BIPARTISAN COMMISSION 
                   ON INDIAN HEALTH CARE.

       ``(a) Establishment.--There is established the National 
     Bipartisan Indian Health Care Commission (the `Commission').
       ``(b) Duties of Commission.--The duties of the Commission 
     are the following:
       ``(1) To establish a study committee composed of those 
     members of the Commission appointed by the Director of the 
     Service and at least 4 members of Congress from among the 
     members of the Commission, the duties of which shall be the 
     following:
       ``(A) To the extent necessary to carry out its duties, 
     collect and compile data necessary to understand the extent 
     of Indian needs with regard to the provision of health 
     services, regardless of the location of Indians, including 
     holding hearings and soliciting the views of Indians, Indian 
     Tribes, Tribal Organizations, and Urban Indian Organizations, 
     which may include authorizing and making funds available for 
     feasibility studies of various models for providing and 
     funding health services for all Indian beneficiaries, 
     including those who live outside of a reservation, 
     temporarily or permanently.
       ``(B) To make legislative recommendations to the Commission 
     regarding the delivery of Federal health care services to 
     Indians. Such recommendations shall include those related to 
     issues of eligibility, benefits, the range of service 
     providers, the cost of such services, financing such 
     services, and the optimal manner in which to provide such 
     services.
       ``(C) To determine the effect of the enactment of such 
     recommendations on (i) the existing system of delivery of 
     health services for Indians, and (ii) the sovereign status of 
     Indian Tribes.

[[Page 21710]]

       ``(D) Not later than 12 months after the appointment of all 
     members of the Commission, to submit a written report of its 
     findings and recommendations to the full Commission. The 
     report shall include a statement of the minority and majority 
     position of the Committee and shall be disseminated, at a 
     minimum, to every Indian Tribe, Tribal Organization, and 
     Urban Indian Organization for comment to the Commission.
       ``(E) To report regularly to the full Commission regarding 
     the findings and recommendations developed by the study 
     committee in the course of carrying out its duties under this 
     section.
       ``(2) To review and analyze the recommendations of the 
     report of the study committee.
       ``(3) To make legislative recommendations to Congress 
     regarding the delivery of Federal health care services to 
     Indians. Such recommendations shall include those related to 
     issues of eligibility, benefits, the range of service 
     providers, the cost of such services, financing such 
     services, and the optimal manner in which to provide such 
     services.
       ``(4) Not later than 18 months following the date of 
     appointment of all members of the Commission, submit a 
     written report to Congress regarding the delivery of Federal 
     health care services to Indians. Such recommendations shall 
     include those related to issues of eligibility, benefits, the 
     range of service providers, the cost of such services, 
     financing such services, and the optimal manner in which to 
     provide such services.
       ``(c) Members.--
       ``(1) Appointment.--The Commission shall be composed of 25 
     members, appointed as follows:
       ``(A) Ten members of Congress, including 3 from the House 
     of Representatives and 2 from the Senate, appointed by their 
     respective majority leaders, and 3 from the House of 
     Representatives and 2 from the Senate, appointed by their 
     respective minority leaders, and who shall be members of the 
     standing committees of Congress that consider legislation 
     affecting health care to Indians.
       ``(B) Twelve persons chosen by the congressional members of 
     the Commission, 1 from each Service Area as currently 
     designated by the Director of the Service to be chosen from 
     among 3 nominees from each Service Area put forward by the 
     Indian Tribes within the area, with due regard being given to 
     the experience and expertise of the nominees in the provision 
     of health care to Indians and to a reasonable representation 
     on the commission of members who are familiar with various 
     health care delivery modes and who represent Indian Tribes of 
     various size populations.
       ``(C) Three persons appointed by the Director who are 
     knowledgeable about the provision of health care to Indians, 
     at least 1 of whom shall be appointed from among 3 nominees 
     put forward by those programs whose funds are provided in 
     whole or in part by the Service primarily or exclusively for 
     the benefit of Urban Indians.
       ``(D) All those persons chosen by the congressional members 
     of the Commission and by the Director shall be members of 
     federally recognized Indian Tribes.
       ``(2) Chair; vice chair.--The Chair and Vice Chair of the 
     Commission shall be selected by the congressional members of 
     the Commission.
       ``(3) Terms.--The terms of members of the Commission shall 
     be for the life of the Commission.
       ``(4) Deadline for appointments.--Congressional members of 
     the Commission shall be appointed not later than 180 days 
     after the date of enactment of the Indian Health Care 
     Improvement Act Amendments of 2007, and the remaining members 
     of the Commission shall be appointed not later than 60 days 
     following the appointment of the congressional members.
       ``(5) Vacancy.--A vacancy in the Commission shall be filled 
     in the manner in which the original appointment was made.
       ``(d) Compensation.--
       ``(1) Congressional members.--Each congressional member of 
     the Commission shall receive no additional pay, allowances, 
     or benefits by reason of their service on the Commission and 
     shall receive travel expenses and per diem in lieu of 
     subsistence in accordance with sections 5702 and 5703 of 
     title 5, United States Code.
       ``(2) Other members.--Remaining members of the Commission, 
     while serving on the business of the Commission (including 
     travel time), shall be entitled to receive compensation at 
     the per diem equivalent of the rate provided for level IV of 
     the Executive Schedule under section 5315 of title 5, United 
     States Code, and while so serving away from home and the 
     member's regular place of business, a member may be allowed 
     travel expenses, as authorized by the Chairman of the 
     Commission. For purpose of pay (other than pay of members of 
     the Commission) and employment benefits, rights, and 
     privileges, all personnel of the Commission shall be treated 
     as if they were employees of the United States Senate.
       ``(e) Meetings.--The Commission shall meet at the call of 
     the Chair.
       ``(f) Quorum.--A quorum of the Commission shall consist of 
     not less than 15 members, provided that no less than 6 of the 
     members of Congress who are Commission members are present 
     and no less than 9 of the members who are Indians are 
     present.
       ``(g) Executive Director; Staff; Facilities.--
       ``(1) Appointment; pay.--The Commission shall appoint an 
     executive director of the Commission. The executive director 
     shall be paid the rate of basic pay for level V of the 
     Executive Schedule.
       ``(2) Staff appointment.--With the approval of the 
     Commission, the executive director may appoint such personnel 
     as the executive director deems appropriate.
       ``(3) Staff pay.--The staff of the Commission shall be 
     appointed without regard to the provisions of title 5, United 
     States Code, governing appointments in the competitive 
     service, and shall be paid without regard to the provisions 
     of chapter 51 and subchapter III of chapter 53 of such title 
     (relating to classification and General Schedule pay rates).
       ``(4) Temporary services.--With the approval of the 
     Commission, the executive director may procure temporary and 
     intermittent services under section 3109(b) of title 5, 
     United States Code.
       ``(5) Facilities.--The Administrator of General Services 
     shall locate suitable office space for the operation of the 
     Commission. The facilities shall serve as the headquarters of 
     the Commission and shall include all necessary equipment and 
     incidentals required for the proper functioning of the 
     Commission.
       ``(h) Hearings.--(1) For the purpose of carrying out its 
     duties, the Commission may hold such hearings and undertake 
     such other activities as the Commission determines to be 
     necessary to carry out its duties, provided that at least 6 
     regional hearings are held in different areas of the United 
     States in which large numbers of Indians are present. Such 
     hearings are to be held to solicit the views of Indians 
     regarding the delivery of health care services to them. To 
     constitute a hearing under this subsection, at least 5 
     members of the Commission, including at least 1 member of 
     Congress, must be present. Hearings held by the study 
     committee established in this section may count toward the 
     number of regional hearings required by this subsection.
       ``(2)(A) The Director of the Congressional Budget Office or 
     the Chief Actuary of the Centers for Medicare & Medicaid 
     Services, or both, shall provide to the Commission, upon the 
     request of the Commission, such cost estimates as the 
     Commission determines to be necessary to carry out its 
     duties.
       ``(B) The Commission shall reimburse the Director of the 
     Congressional Budget Office for expenses relating to the 
     employment in the office of that Director of such additional 
     staff as may be necessary for the Director to comply with 
     requests by the Commission under subparagraph (A).
       ``(3) Upon the request of the Commission, the head of any 
     Federal agency is authorized to detail, without 
     reimbursement, any of the personnel of such agency to the 
     Commission to assist the Commission in carrying out its 
     duties. Any such detail shall not interrupt or otherwise 
     affect the civil service status or privileges of the Federal 
     employee.
       ``(4) Upon the request of the Commission, the head of a 
     Federal agency shall provide such technical assistance to the 
     Commission as the Commission determines to be necessary to 
     carry out its duties.
       ``(5) The Commission may use the United States mails in the 
     same manner and under the same conditions as Federal agencies 
     and shall, for purposes of the frank, be considered a 
     commission of Congress as described in section 3215 of title 
     39, United States Code.
       ``(6) The Commission may secure directly from any Federal 
     agency information necessary to enable it to carry out its 
     duties, if the information may be disclosed under section 552 
     of title 4, United States Code. Upon request of the Chairman 
     of the Commission, the head of such agency shall furnish such 
     information to the Commission.
       ``(7) Upon the request of the Commission, the Administrator 
     of General Services shall provide to the Commission on a 
     reimbursable basis such administrative support services as 
     the Commission may request.
       ``(8) For purposes of costs relating to printing and 
     binding, including the cost of personnel detailed from the 
     Government Printing Office, the Commission shall be deemed to 
     be a committee of Congress.
       ``(i) Authorization of Appropriations.--There is authorized 
     to be appropriated $4,000,000 to carry out the provisions of 
     this section, which sum shall not be deducted from or affect 
     any other appropriation for health care for Indian persons.
       ``(j) Nonapplicability of FACA.--The Federal Advisory 
     Committee Act (5 U.S.C. App.) shall not apply to the 
     Commission.

     ``SEC. 815. CONFIDENTIALITY OF MEDICAL QUALITY ASSURANCE 
                   RECORDS; QUALIFIED IMMUNITY FOR PARTICIPANTS.

       ``(a) Confidentiality of Records.--Medical quality 
     assurance records created by or for any Indian Health Program 
     or a health program of an Urban Indian Organization as part 
     of a medical quality assurance program are confidential and 
     privileged. Such records may not be disclosed to any person 
     or entity, except as provided in subsection (c).
       ``(b) Prohibition on Disclosure and Testimony.--

[[Page 21711]]

       ``(1) In general.--No part of any medical quality assurance 
     record described in subsection (a) may be subject to 
     discovery or admitted into evidence in any judicial or 
     administrative proceeding, except as provided in subsection 
     (c).
       ``(2) Testimony.--A person who reviews or creates medical 
     quality assurance records for any Indian Health Program or 
     Urban Indian Organization who participates in any proceeding 
     that reviews or creates such records may not be permitted or 
     required to testify in any judicial or administrative 
     proceeding with respect to such records or with respect to 
     any finding, recommendation, evaluation, opinion, or action 
     taken by such person or body in connection with such records 
     except as provided in this section.
       ``(c) Authorized Disclosure and Testimony.--
       ``(1) In general.--Subject to paragraph (2), a medical 
     quality assurance record described in subsection (a) may be 
     disclosed, and a person referred to in subsection (b) may 
     give testimony in connection with such a record, only as 
     follows:
       ``(A) To a Federal executive agency or private 
     organization, if such medical quality assurance record or 
     testimony is needed by such agency or organization to perform 
     licensing or accreditation functions related to any Indian 
     Health Program or to a health program of an Urban Indian 
     Organization to perform monitoring, required by law, of such 
     program or organization.
       ``(B) To an administrative or judicial proceeding commenced 
     by a present or former Indian Health Program or Urban Indian 
     Organization provider concerning the termination, suspension, 
     or limitation of clinical privileges of such health care 
     provider.
       ``(C) To a governmental board or agency or to a 
     professional health care society or organization, if such 
     medical quality assurance record or testimony is needed by 
     such board, agency, society, or organization to perform 
     licensing, credentialing, or the monitoring of professional 
     standards with respect to any health care provider who is or 
     was an employee of any Indian Health Program or Urban Indian 
     Organization.
       ``(D) To a hospital, medical center, or other institution 
     that provides health care services, if such medical quality 
     assurance record or testimony is needed by such institution 
     to assess the professional qualifications of any health care 
     provider who is or was an employee of any Indian Health 
     Program or Urban Indian Organization and who has applied for 
     or been granted authority or employment to provide health 
     care services in or on behalf of such program or 
     organization.
       ``(E) To an officer, employee, or contractor of the Indian 
     Health Program or Urban Indian Organization that created the 
     records or for which the records were created. If that 
     officer, employee, or contractor has a need for such record 
     or testimony to perform official duties.
       ``(F) To a criminal or civil law enforcement agency or 
     instrumentality charged under applicable law with the 
     protection of the public health or safety, if a qualified 
     representative of such agency or instrumentality makes a 
     written request that such record or testimony be provided for 
     a purpose authorized by law.
       ``(G) In an administrative or judicial proceeding commenced 
     by a criminal or civil law enforcement agency or 
     instrumentality referred to in subparagraph (F), but only 
     with respect to the subject of such proceeding.
       ``(2) Identity of participants.--With the exception of the 
     subject of a quality assurance action, the identity of any 
     person receiving health care services from any Indian Health 
     Program or Urban Indian Organization or the identity of any 
     other person associated with such program or organization for 
     purposes of a medical quality assurance program that is 
     disclosed in a medical quality assurance record described in 
     subsection (a) shall be deleted from that record or document 
     before any disclosure of such record is made outside such 
     program or organization. Such requirement does not apply to 
     the release of information pursuant to section 552a of title 
     5.
       ``(d) Disclosure for Certain Purposes.--
       ``(1) In general.--Nothing in this section shall be 
     construed as authorizing or requiring the withholding from 
     any person or entity aggregate statistical information 
     regarding the results of any Indian Health Program or Urban 
     Indian Organizations's medical quality assurance programs.
       ``(2) Withholding from congress.--Nothing in this section 
     shall be construed as authority to withhold any medical 
     quality assurance record from a committee of either House of 
     Congress, any joint committee of Congress, or the Government 
     Accountability Office if such record pertains to any matter 
     within their respective jurisdictions.
       ``(e) Prohibition on Disclosure of Record or Testimony.--A 
     person or entity having possession of or access to a record 
     or testimony described by this section may not disclose the 
     contents of such record or testimony in any manner or for any 
     purpose except as provided in this section.
       ``(f) Exemption From Freedom of Information Act.--Medical 
     quality assurance records described in subsection (a) may not 
     be made available to any person under section 552 of title 5.
       ``(g) Limitation on Civil Liability.--A person who 
     participates in or provides information to a person or body 
     that reviews or creates medical quality assurance records 
     described in subsection (a) shall not be civilly liable for 
     such participation or for providing such information if the 
     participation or provision of information was in good faith 
     based on prevailing professional standards at the time the 
     medical quality assurance program activity took place.
       ``(h) Application to Information in Certain Other 
     Records.--Nothing in this section shall be construed as 
     limiting access to the information in a record created and 
     maintained outside a medical quality assurance program, 
     including a patient's medical records, on the grounds that 
     the information was presented during meetings of a review 
     body that are part of a medical quality assurance program.
       ``(i) Regulations.--The Secretary, acting through the 
     Service, shall promulgate regulations pursuant to section 
     802.
       ``(j) Definitions.--In this section:
       ``(1) The term `health care provider' means any health care 
     professional, including community health aides and 
     practitioners certified under section 121, who are granted 
     clinical practice privileges or employed to provide health 
     care services in an Indian Health Program or health program 
     of an Urban Indian Organization, who is licensed or certified 
     to perform health care services by a governmental board or 
     agency or professional health care society or organization.
       ``(2) The term `medical quality assurance program' means 
     any activity carried out before, on, or after the date of 
     enactment of this Act by or for any Indian Health Program or 
     Urban Indian Organization to assess the quality of medical 
     care, including activities conducted by or on behalf of 
     individuals, Indian Health Program or Urban Indian 
     Organization medical or dental treatment review committees, 
     or other review bodies responsible for quality assurance, 
     credentials, infection control, patient safety, patient care 
     assessment (including treatment procedures, blood, drugs, and 
     therapeutics), medical records, health resources management 
     review and identification and prevention of medical or dental 
     incidents and risks.
       ``(3) The term `medical quality assurance record' means the 
     proceedings, records, minutes, and reports that emanate from 
     quality assurance program activities described in paragraph 
     (2) and are produced or compiled by or for an Indian Health 
     Program or Urban Indian Organization as part of a medical 
     quality assurance program.

     ``SEC. 816. APPROPRIATIONS; AVAILABILITY.

       ``Any new spending authority (described in subparagraph (A) 
     or (B) of section 401(c)(2) of the Congressional Budget Act 
     of 1974 (Public Law 93-344; 88 Stat. 317)) which is provided 
     under this Act shall be effective for any fiscal year only to 
     such extent or in such amounts as are provided in 
     appropriation Acts.

     ``SEC. 817. AUTHORIZATION OF APPROPRIATIONS.

       ``There are authorized to be appropriated such sums as may 
     be necessary for each fiscal year through fiscal year 2017 to 
     carry out this title.''.
       (b) Rate of Pay.--
       (1) Positions at level iv.--Section 5315 of title 5, United 
     States Code, is amended by striking ``Assistant Secretaries 
     of Health and Human Services (6).'' and inserting ``Assistant 
     Secretaries of Health and Human Services (7)''.
       (2) Positions at level v.--Section 5316 of title 5, United 
     States Code, is amended by striking ``Director, Indian Health 
     Service, Department of Health and Human Services''.
       (c) Amendments to Other Provisions of Law.--
       (1) Section 3307(b)(1)(C) of the Children's Health Act of 
     2000 (25 U.S.C. 1671 note; Public Law 106-310) is amended by 
     striking ``Director of the Indian Health Service'' and 
     inserting ``Assistant Secretary for Indian Health''.
       (2) The Indian Lands Open Dump Cleanup Act of 1994 is 
     amended--
       (A) in section 3 (25 U.S.C. 3902)--
       (i) by striking paragraph (2);
       (ii) by redesignating paragraphs (1), (3), (4), (5), and 
     (6) as paragraphs (4), (5), (2), (6), and (1), respectively, 
     and moving those paragraphs so as to appear in numerical 
     order; and
       (iii) by inserting before paragraph (4) (as redesignated by 
     subclause (II)) the following:
       ``(3) Assistant secretary.--The term `Assistant Secretary' 
     means the Assistant Secretary for Indian Health.'';
       (B) in section 5 (25 U.S.C. 3904), by striking the section 
     designation and heading and inserting the following:

     ``SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR INDIAN 
                   HEALTH.'';

       (C) in section 6(a) (25 U.S.C. 3905(a)), in the subsection 
     heading, by striking ``Director'' and inserting ``Assistant 
     Secretary'';
       (D) in section 9(a) (25 U.S.C. 3908(a)), in the subsection 
     heading, by striking ``Director'' and inserting ``Assistant 
     Secretary''; and
       (E) by striking ``Director'' each place it appears and 
     inserting ``Assistant Secretary''.
       (3) Section 5504(d)(2) of the Augustus F. Hawkins-Robert T. 
     Stafford Elementary and Secondary School Improvement 
     Amendments of 1988 (25 U.S.C. 2001 note; Public Law

[[Page 21712]]

     100-297) is amended by striking ``Director of the Indian 
     Health Service'' and inserting ``Assistant Secretary for 
     Indian Health''.
       (4) Section 203(a)(1) of the Rehabilitation Act of 1973 (29 
     U.S.C. 763(a)(1)) is amended by striking ``Director of the 
     Indian Health Service'' and inserting ``Assistant Secretary 
     for Indian Health''.
       (5) Subsections (b) and (e) of section 518 of the Federal 
     Water Pollution Control Act (33 U.S.C. 1377) are amended by 
     striking ``Director of the Indian Health Service'' each place 
     it appears and inserting ``Assistant Secretary for Indian 
     Health''.
       (6) Section 317M(b) of the Public Health Service Act (42 
     U.S.C. 247b-14(b)) is amended--
       (A) by striking ``Director of the Indian Health Service'' 
     each place it appears and inserting ``Assistant Secretary for 
     Indian Health''; and
       (B) in paragraph (2)(A), by striking ``the Directors 
     referred to in such paragraph'' and inserting ``the Director 
     of the Centers for Disease Control and Prevention and the 
     Assistant Secretary for Indian Health''.
       (7) Section 417C(b) of the Public Health Service Act (42 
     U.S.C. 285-9(b)) is amended by striking ``Director of the 
     Indian Health Service'' and inserting ``Assistant Secretary 
     for Indian Health''.
       (8) Section 1452(i) of the Safe Drinking Water Act (42 
     U.S.C. 300j-12(i)) is amended by striking ``Director of the 
     Indian Health Service'' each place it appears and inserting 
     ``Assistant Secretary for Indian Health''.
       (9) Section 803B(d)(1) of the Native American Programs Act 
     of 1974 (42 U.S.C. 2991b-2(d)(1)) is amended in the last 
     sentence by striking ``Director of the Indian Health 
     Service'' and inserting ``Assistant Secretary for Indian 
     Health''.
       (10) Section 203(b) of the Michigan Indian Land Claims 
     Settlement Act (Public Law 105-143; 111 Stat. 2666) is 
     amended by striking ``Director of the Indian Health Service'' 
     and inserting ``Assistant Secretary for Indian Health''.

     SEC. _12. SOBOBA SANITATION FACILITIES.

       The Act of December 17, 1970 (84 Stat. 1465), is amended by 
     adding at the end the following:
       ``Sec. 9.  Nothing in this Act shall preclude the Soboba 
     Band of Mission Indians and the Soboba Indian Reservation 
     from being provided with sanitation facilities and services 
     under the authority of section 7 of the Act of August 5, 1954 
     (68 Stat. 674), as amended by the Act of July 31, 1959 (73 
     Stat. 267).''.

     SEC. _13. NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION.

       (a) In General.--The Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450 et seq.) is amended 
     by adding at the end the following:

      ``TITLE VIII--NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION

     ``SEC. 801. DEFINITIONS.

       ``In this title:
       ``(1) Board.--The term `Board' means the Board of Directors 
     of the Foundation.
       ``(2) Committee.--The term `Committee' means the Committee 
     for the Establishment of Native American Health and Wellness 
     Foundation established under section 802(f).
       ``(3) Foundation.--The term `Foundation' means the Native 
     American Health and Wellness Foundation established under 
     section 802.
       ``(4) Secretary.--The term `Secretary' means the Secretary 
     of Health and Human Services.
       ``(5) Service.--The term `Service' means the Indian Health 
     Service of the Department of Health and Human Services.

     ``SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION.

       ``(a) Establishment.--
       ``(1) In general.--As soon as practicable after the date of 
     enactment of this title, the Secretary shall establish, under 
     the laws of the District of Columbia and in accordance with 
     this title, the Native American Health and Wellness 
     Foundation.
       ``(2) Funding determinations.--No funds, gift, property, or 
     other item of value (including any interest accrued on such 
     an item) acquired by the Foundation shall--
       ``(A) be taken into consideration for purposes of 
     determining Federal appropriations relating to the provision 
     of health care and services to Indians; or
       ``(B) otherwise limit, diminish, or affect the Federal 
     responsibility for the provision of health care and services 
     to Indians.
       ``(b) Perpetual Existence.--The Foundation shall have 
     perpetual existence.
       ``(c) Nature of Corporation.--The Foundation--
       ``(1) shall be a charitable and nonprofit federally 
     chartered corporation; and
       ``(2) shall not be an agency or instrumentality of the 
     United States.
       ``(d) Place of Incorporation and Domicile.--The Foundation 
     shall be incorporated and domiciled in the District of 
     Columbia.
       ``(e) Duties.--The Foundation shall--
       ``(1) encourage, accept, and administer private gifts of 
     real and personal property, and any income from or interest 
     in such gifts, for the benefit of, or in support of, the 
     mission of the Service;
       ``(2) undertake and conduct such other activities as will 
     further the health and wellness activities and opportunities 
     of Native Americans; and
       ``(3) participate with and assist Federal, State, and 
     tribal governments, agencies, entities, and individuals in 
     undertaking and conducting activities that will further the 
     health and wellness activities and opportunities of Native 
     Americans.
       ``(f) Committee for the Establishment of Native American 
     Health and Wellness Foundation.--
       ``(1) In general.--The Secretary shall establish the 
     Committee for the Establishment of Native American Health and 
     Wellness Foundation to assist the Secretary in establishing 
     the Foundation.
       ``(2) Duties.--Not later than 180 days after the date of 
     enactment of this section, the Committee shall--
       ``(A) carry out such activities as are necessary to 
     incorporate the Foundation under the laws of the District of 
     Columbia, including acting as incorporators of the 
     Foundation;
       ``(B) ensure that the Foundation qualifies for and 
     maintains the status required to carry out this section, 
     until the Board is established;
       ``(C) establish the constitution and initial bylaws of the 
     Foundation;
       ``(D) provide for the initial operation of the Foundation, 
     including providing for temporary or interim quarters, 
     equipment, and staff; and
       ``(E) appoint the initial members of the Board in 
     accordance with the constitution and initial bylaws of the 
     Foundation.
       ``(g) Board of Directors.--
       ``(1) In general.--The Board of Directors shall be the 
     governing body of the Foundation.
       ``(2) Powers.--The Board may exercise, or provide for the 
     exercise of, the powers of the Foundation.
       ``(3) Selection.--
       ``(A) In general.--Subject to subparagraph (B), the number 
     of members of the Board, the manner of selection of the 
     members (including the filling of vacancies), and the terms 
     of office of the members shall be as provided in the 
     constitution and bylaws of the Foundation.
       ``(B) Requirements.--
       ``(i) Number of members.--The Board shall have at least 11 
     members, who shall have staggered terms.
       ``(ii) Initial voting members.--The initial voting members 
     of the Board--

       ``(I) shall be appointed by the Committee not later than 
     180 days after the date on which the Foundation is 
     established; and
       ``(II) shall have staggered terms.

       ``(iii) Qualification.--The members of the Board shall be 
     United States citizens who are knowledgeable or experienced 
     in Native American health care and related matters.
       ``(C) Compensation.--A member of the Board shall not 
     receive compensation for service as a member, but shall be 
     reimbursed for actual and necessary travel and subsistence 
     expenses incurred in the performance of the duties of the 
     Foundation.
       ``(h) Officers.--
       ``(1) In general.--The officers of the Foundation shall 
     be--
       ``(A) a secretary, elected from among the members of the 
     Board; and
       ``(B) any other officers provided for in the constitution 
     and bylaws of the Foundation.
       ``(2) Chief operating officer.--The secretary of the 
     Foundation may serve, at the direction of the Board, as the 
     chief operating officer of the Foundation, or the Board may 
     appoint a chief operating officer, who shall serve at the 
     direction of the Board.
       ``(3) Election.--The manner of election, term of office, 
     and duties of the officers of the Foundation shall be as 
     provided in the constitution and bylaws of the Foundation.
       ``(i) Powers.--The Foundation--
       ``(1) shall adopt a constitution and bylaws for the 
     management of the property of the Foundation and the 
     regulation of the affairs of the Foundation;
       ``(2) may adopt and alter a corporate seal;
       ``(3) may enter into contracts;
       ``(4) may acquire (through a gift or otherwise), own, 
     lease, encumber, and transfer real or personal property as 
     necessary or convenient to carry out the purposes of the 
     Foundation;
       ``(5) may sue and be sued; and
       ``(6) may perform any other act necessary and proper to 
     carry out the purposes of the Foundation.
       ``(j) Principal Office.--
       ``(1) In general.--The principal office of the Foundation 
     shall be in the District of Columbia.
       ``(2) Activities; offices.--The activities of the 
     Foundation may be conducted, and offices may be maintained, 
     throughout the United States in accordance with the 
     constitution and bylaws of the Foundation.
       ``(k) Service of Process.--The Foundation shall comply with 
     the law on service of process of each State in which the 
     Foundation is incorporated and of each State in which the 
     Foundation carries on activities.
       ``(l) Liability of Officers, Employees, and Agents.--
       ``(1) In general.--The Foundation shall be liable for the 
     acts of the officers, employees, and agents of the Foundation 
     acting within the scope of their authority.

[[Page 21713]]

       ``(2) Personal liability.--A member of the Board shall be 
     personally liable only for gross negligence in the 
     performance of the duties of the member.
       ``(m) Restrictions.--
       ``(1) Limitation on spending.--Beginning with the fiscal 
     year following the first full fiscal year during which the 
     Foundation is in operation, the administrative costs of the 
     Foundation shall not exceed the percentage described in 
     paragraph (2) of the sum of--
       ``(A) the amounts transferred to the Foundation under 
     subsection (o) during the preceding fiscal year; and
       ``(B) donations received from private sources during the 
     preceding fiscal year.
       ``(2) Percentages.--The percentages referred to in 
     paragraph (1) are--
       ``(A) for the first fiscal year described in that 
     paragraph, 20 percent;
       ``(B) for the following fiscal year, 15 percent; and
       ``(C) for each fiscal year thereafter, 10 percent.
       ``(3) Appointment and hiring.--The appointment of officers 
     and employees of the Foundation shall be subject to the 
     availability of funds.
       ``(4) Status.--A member of the Board or officer, employee, 
     or agent of the Foundation shall not by reason of association 
     with the Foundation be considered to be an officer, employee, 
     or agent of the United States.
       ``(n) Audits.--The Foundation shall comply with section 
     10101 of title 36, United States Code, as if the Foundation 
     were a corporation under part B of subtitle II of that title.
       ``(o) Funding.--
       ``(1) Authorization of appropriations.--There is authorized 
     to be appropriated to carry out subsection (e)(1) $500,000 
     for each fiscal year, as adjusted to reflect changes in the 
     Consumer Price Index for all-urban consumers published by the 
     Department of Labor.
       ``(2) Transfer of donated funds.--The Secretary shall 
     transfer to the Foundation funds held by the Department of 
     Health and Human Services under the Act of August 5, 1954 (42 
     U.S.C. 2001 et seq.), if the transfer or use of the funds is 
     not prohibited by any term under which the funds were 
     donated.

     ``SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT.

       ``(a) Provision of Support by Secretary.--Subject to 
     subsection (b), during the 5-year period beginning on the 
     date on which the Foundation is established, the Secretary--
       ``(1) may provide personnel, facilities, and other 
     administrative support services to the Foundation;
       ``(2) may provide funds for initial operating costs and to 
     reimburse the travel expenses of the members of the Board; 
     and
       ``(3) shall require and accept reimbursements from the 
     Foundation for--
       ``(A) services provided under paragraph (1); and
       ``(B) funds provided under paragraph (2).
       ``(b) Reimbursement.--Reimbursements accepted under 
     subsection (a)(3)--
       ``(1) shall be deposited in the Treasury of the United 
     States to the credit of the applicable appropriations 
     account; and
       ``(2) shall be chargeable for the cost of providing 
     services described in subsection (a)(1) and travel expenses 
     described in subsection (a)(2).
       ``(c) Continuation of Certain Services.--The Secretary may 
     continue to provide facilities and necessary support services 
     to the Foundation after the termination of the 5-year period 
     specified in subsection (a) if the facilities and services--
       ``(1) are available; and
       ``(2) are provided on reimbursable cost basis.''.
       (b) Technical Amendments.--The Indian Self-Determination 
     and Education Assistance Act is amended--
       (1) by redesignating title V (25 U.S.C. 458bbb et seq.) as 
     title VII;
       (2) by redesignating sections 501, 502, and 503 (25 U.S.C. 
     458bbb, 458bbb-1, 458bbb-2) as sections 701, 702, and 703, 
     respectively; and
       (3) in subsection (a)(2) of section 702 and paragraph (2) 
     of section 703 (as redesignated by paragraph (2)), by 
     striking ``section 501'' and inserting ``section 701''.

Subtitle B--Improvement of Indian Health Care Provided Under the Social 
                              Security Act

     SEC. _21. EXPANSION OF PAYMENTS UNDER MEDICARE, MEDICAID, AND 
                   SCHIP FOR ALL COVERED SERVICES FURNISHED BY 
                   INDIAN HEALTH PROGRAMS.

       (a) Medicaid.--
       (1) Expansion to all covered services.--Section 1911 of the 
     Social Security Act (42 U.S.C. 1396j) is amended--
       (A) by amending the heading to read as follows:

     ``SEC. 1911. INDIAN HEALTH PROGRAMS.'';

     and
       (B) by amending subsection (a) to read as follows:
       ``(a) Eligibility for Payment for Medical Assistance.--The 
     Indian Health Service and an Indian Tribe, Tribal 
     Organization, or an Urban Indian Organization shall be 
     eligible for payment for medical assistance provided under a 
     State plan or under waiver authority with respect to items 
     and services furnished by the Indian Health Service, Indian 
     Tribe, Tribal Organization, or Urban Indian Organization if 
     the furnishing of such services meets all the conditions and 
     requirements which are applicable generally to the furnishing 
     of items and services under this title and under such plan or 
     waiver authority.''.
       (2) Compliance with conditions and requirements.--
     Subsection (b) of such section is amended to read as follows:
       ``(b) Compliance With Conditions and Requirements.--A 
     facility of the Indian Health Service or an Indian Tribe, 
     Tribal Organization, or an Urban Indian Organization which is 
     eligible for payment under subsection (a) with respect to the 
     furnishing of items and services, but which does not meet all 
     of the conditions and requirements of this title and under a 
     State plan or waiver authority which are applicable generally 
     to such facility, shall make such improvements as are 
     necessary to achieve or maintain compliance with such 
     conditions and requirements in accordance with a plan 
     submitted to and accepted by the Secretary for achieving or 
     maintaining compliance with such conditions and requirements, 
     and shall be deemed to meet such conditions and requirements 
     (and to be eligible for payment under this title), without 
     regard to the extent of its actual compliance with such 
     conditions and requirements, during the first 12 months after 
     the month in which such plan is submitted.''.
       (3) Revision of authority to enter into agreements.--
     Subsection (c) of such section is amended to read as follows:
       ``(c) Authority to Enter Into Agreements.--The Secretary 
     may enter into an agreement with a State for the purpose of 
     reimbursing the State for medical assistance provided by the 
     Indian Health Service, an Indian Tribe, Tribal Organization, 
     or an Urban Indian Organization (as so defined), directly, 
     through referral, or under contracts or other arrangements 
     between the Indian Health Service, an Indian Tribe, Tribal 
     Organization, or an Urban Indian Organization and another 
     health care provider to Indians who are eligible for medical 
     assistance under the State plan or under waiver authority.''.
       (4) Cross-references to special fund for improvement of ihs 
     facilities; direct billing option; definitions.--Such section 
     is further amended by striking subsection (d) and adding at 
     the end the following new subsections:
       ``(d) Special Fund for Improvement of IHS Facilities.--For 
     provisions relating to the authority of the Secretary to 
     place payments to which a facility of the Indian Health 
     Service is eligible for payment under this title into a 
     special fund established under section 401(c)(1) of the 
     Indian Health Care Improvement Act, and the requirement to 
     use amounts paid from such fund for making improvements in 
     accordance with subsection (b), see subparagraphs (A) and (B) 
     of section 401(c)(1) of such Act.
       ``(e) Direct Billing.--For provisions relating to the 
     authority of a Tribal Health Program or an Urban Indian 
     Organization to elect to directly bill for, and receive 
     payment for, health care items and services provided by such 
     Program or Organization for which payment is made under this 
     title, see section 401(d) of the Indian Health Care 
     Improvement Act.
       ``(f) Definitions.--In this section, the terms `Indian 
     Health Program', `Indian Tribe',`Tribal 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) Medicare.--
       (1) Expansion to all covered services.--Section 1880 of 
     such Act (42 U.S.C. 1395qq) is amended--
       (A) by amending the heading to read as follows:

     ``SEC. 1880. INDIAN HEALTH PROGRAMS.'';

     and
       (B) by amending subsection (a) to read as follows:
       ``(a) Eligibility for Payments.--Subject to subsection (e), 
     the Indian Health Service and an Indian Tribe, Tribal 
     Organization, or an Urban Indian Organization shall be 
     eligible for payments under this title with respect to items 
     and services furnished by the Indian Health Service, Indian 
     Tribe, Tribal Organization, or Urban Indian Organization if 
     the furnishing of such services meets all the conditions and 
     requirements which are applicable generally to the furnishing 
     of items and services under this title.''.
       (2) Compliance with conditions and requirements.--
     Subsection (b) of such section is amended to read as follows:
       ``(b) Compliance With Conditions and Requirements.--Subject 
     to subsection (e), a facility of the Indian Health Service or 
     an Indian Tribe, Tribal Organization, or an Urban Indian 
     Organization which is eligible for payment under subsection 
     (a) with respect to the furnishing of items and services, but 
     which does not meet all of the conditions and requirements of 
     this title which are applicable generally to such facility, 
     shall make such improvements as are necessary to achieve or 
     maintain compliance with such conditions and requirements in 
     accordance with a plan submitted to and accepted by the 
     Secretary for achieving or maintaining compliance with such 
     conditions and requirements, and shall be deemed to meet such 
     conditions and requirements (and to be eligible for payment 
     under this title), without regard to the extent of its actual 
     compliance

[[Page 21714]]

     with such conditions and requirements, during the first 12 
     months after the month in which such plan is submitted.''.
       (3) Cross-references to special fund for improvement of ihs 
     facilities; direct billing option; definitions.--
       (A) In general.--Such section is further amended by 
     striking subsections (c) and (d) and inserting the following 
     new subsections:
       ``(c) Special Fund for Improvement of IHS Facilities.--For 
     provisions relating to the authority of the Secretary to 
     place payments to which a facility of the Indian Health 
     Service is eligible for payment under this title into a 
     special fund established under section 401(c)(1) of the 
     Indian Health Care Improvement Act, and the requirement to 
     use amounts paid from such fund for making improvements in 
     accordance with subsection (b), see subparagraphs (A) and (B) 
     of section 401(c)(1) of such Act.
       ``(d) Direct Billing.--For provisions relating to the 
     authority of a Tribal Health Program or an Urban Indian 
     Organization to elect to directly bill for, and receive 
     payment for, health care items and services provided by such 
     Program or Organization for which payment is made under this 
     title, see section 401(d) of the Indian Health Care 
     Improvement Act.''.
       (B) Conforming amendment.--Paragraph (3) of section 1880(e) 
     of such Act (42 U.S.C. 1395qq(e)) is amended by inserting 
     ``and section 401(c)(1) of the Indian Health Care Improvement 
     Act'' after ``Subsection (c)''.
       (4) Definitions.--Such section is further amended by 
     amending subsection (f) to read as follows:
       ``(f) Definitions.--In this section, the terms `Indian 
     Health Program', `Indian Tribe', `Service Unit', `Tribal 
     Health Program', `Tribal Organization', and `Urban Indian 
     Organization' have the meanings given those terms in section 
     4 of the Indian Health Care Improvement Act.''.
       (c) Application to SCHIP.--Section 2107(e)(1) of the Social 
     Security Act (42 U.S.C. 1397gg(e)(1)) is amended--
       (1) by redesignating subparagraph (D) as subparagraph (E); 
     and
       (2) by inserting after subparagraph (C), the following new 
     subparagraph:
       ``(D) Section 1911 (relating to Indian Health Programs, 
     other than subsection (d) of such section).''.

     SEC. _22. INCREASED OUTREACH TO INDIANS UNDER MEDICAID AND 
                   SCHIP AND IMPROVED COOPERATION IN THE PROVISION 
                   OF ITEMS AND SERVICES TO INDIANS UNDER SOCIAL 
                   SECURITY ACT HEALTH BENEFIT PROGRAMS.

       Section 1139 of the Social Security Act (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 XVIII, XIX, AND XXI.

       ``(a) Agreements With States for Medicaid and SCHIP 
     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 subparagraph (A) 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 XVIII, 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.''.

     SEC. _23. ADDITIONAL PROVISIONS TO INCREASE OUTREACH TO, AND 
                   ENROLLMENT OF, INDIANS IN SCHIP AND MEDICAID.

       (a) Nonapplication of 10 Percent Limit on Outreach and 
     Certain Other Expenditures.--Section 2105(c)(2) of the Social 
     Security Act (42 U.S.C. 1397ee(c)(2)) is amended by adding at 
     the end the following new subparagraph:
       ``(C) Nonapplication to expenditures for outreach to 
     increase the enrollment of indian children under this title 
     and title xix.--The limitation under subparagraph (A) on 
     expenditures for items described in subsection (a)(1)(D) 
     shall not apply in the case of 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).''.
       (b) Assurance of Payments to Indian Health Care Providers 
     for Child Health Assistance.--Section 2102(b)(3)(D) of such 
     Act (42 U.S.C. 1397bb(b)(3)(D)) is amended by striking ``(as 
     defined in section 4(c) of the Indian Health Care Improvement 
     Act, 25 U.S.C. 1603(c))'' and inserting ``, including how the 
     State will ensure that payments are made to Indian Health 
     Programs and Urban Indian Organizations operating in the 
     State for the provision of such assistance''.
       (c) Inclusion of Other Indian Financed Health Care Programs 
     in Exemption From Prohibition on Certain Payments.--Section 
     2105(c)(6)(B) of such Act (42 U.S.C. 1397ee(c)(6)(B)) is 
     amended by striking ``insurance program, other than an 
     insurance program operated or financed by the Indian Health 
     Service'' and inserting ``program, other than a health care 
     program operated or financed by the Indian Health Service or 
     by an Indian Tribe, Tribal Organization, or Urban Indian 
     Organization''.
       (d) Satisfaction of Medicaid Documentation Requirements.--
       (1) In general.--Section 1903(x)(3)(B) of the Social 
     Security Act (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.
       ``(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) Transition rule.--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 paragraph (1)), 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.
       (e) Definitions.--Section 2110(c) of such Act (42 U.S.C. 
     1397jj(c)) is amended by adding at the end the following new 
     paragraph:
       ``(9) Indian; indian health program; indian tribe; etc.--
     The terms `Indian', `Indian Health Program', `Indian Tribe', 
     `Tribal Organization', and `Urban Indian Organization' have 
     the meanings given those terms in section 4 of the Indian 
     Health Care Improvement Act.''.

     SEC. _24. PREMIUMS AND COST SHARING PROTECTIONS UNDER 
                   MEDICAID, ELIGIBILITY DETERMINATIONS UNDER 
                   MEDICAID AND SCHIP, AND PROTECTION OF CERTAIN 
                   INDIAN PROPERTY FROM MEDICAID ESTATE RECOVERY.

       (a) Premiums and Cost Sharing Protection Under Medicaid.--
       (1) In general.--Section 1916 of the Social Security Act 
     (42 U.S.C. 1396o) is amended--
       (A) in subsection (a), in the matter preceding paragraph 
     (1), by striking ``and (i)'' and inserting ``, (i), and 
     (j)''; and
       (B) by adding at the end the following new subsection:
       ``(j) No Premiums or Cost Sharing for Indians Furnished 
     Items or Services Directly by Indian Health Programs or 
     Through Referral Under the Contract Health Service.--
       ``(1) No cost sharing for items or services furnished to 
     indians through indian health programs.--
       ``(A) In general.--No enrollment fee, premium, or similar 
     charge, and no deduction, copayment, cost sharing, or similar 
     charge shall be imposed against an Indian who is furnished an 
     item or service directly by the Indian Health Service, an 
     Indian Tribe, Tribal Organization, or Urban Indian 
     Organization or through referral under the contract health 
     service for which payment may be made under this title.
       ``(B) No reduction in amount of payment to indian health 
     providers.--Payment due under this title to the Indian Health 
     Service, an Indian Tribe, Tribal Organization, or Urban 
     Indian Organization, or a health care

[[Page 21715]]

     provider through referral under the contract health service 
     for the furnishing of an item or service to an Indian who is 
     eligible for assistance under such title, may not be reduced 
     by the amount of any enrollment fee, premium, or similar 
     charge, or any deduction, copayment, cost sharing, or similar 
     charge that would be due from the Indian but for the 
     operation of subparagraph (A).
       ``(2) Rule of construction.--Nothing in this subsection 
     shall be construed as restricting the application of any 
     other limitations on the imposition of premiums or cost 
     sharing that may apply to an individual receiving medical 
     assistance under this title who is an Indian.
       ``(3) Definitions.--In this subsection, the terms `contract 
     health service', `Indian', `Indian Tribe', `Tribal 
     Organization', and `Urban Indian Organization' have the 
     meanings given those terms in section 4 of the Indian Health 
     Care Improvement Act.''.
       (2) Conforming amendment.--Section 1916A (a)(1) of such Act 
     (42 U.S.C. 1396o- 1(a)(1)) is amended by striking ``section 
     1916(g)'' and inserting ``subsections (g), (i), or (j) of 
     section 1916''.
       (b) Treatment of Certain Property for Medicaid and SCHIP 
     Eligibility.--
       (1) Medicaid.--Section 1902(e) of the Social Security Act 
     (42 U.S.C. 1396a) is amended by adding at the end the 
     following new paragraph:
       ``(13) Notwithstanding any other requirement of this title 
     or any other provision of Federal or State law, a State shall 
     disregard the following property for purposes of determining 
     the eligibility of an individual who is an Indian (as defined 
     in section 4 of the Indian Health Care Improvement Act) for 
     medical assistance under this title:
       ``(A) Property, including real property and improvements, 
     that is held in trust, subject to Federal restrictions, or 
     otherwise under the supervision of the Secretary of the 
     Interior, located on a reservation, including any federally 
     recognized Indian Tribe's reservation, pueblo, or colony, 
     including former reservations in Oklahoma, Alaska Native 
     regions established by the Alaska Native Claims Settlement 
     Act, and Indian allotments on or near a reservation as 
     designated and approved by the Bureau of Indian Affairs of 
     the Department of the Interior.
       ``(B) For any federally recognized Tribe not described in 
     subparagraph (A), property located within the most recent 
     boundaries of a prior Federal reservation.
       ``(C) Ownership interests in rents, leases, royalties, or 
     usage rights related to natural resources (including 
     extraction of natural resources or harvesting of timber, 
     other plants and plant products, animals, fish, and 
     shellfish) resulting from the exercise of federally protected 
     rights.
       ``(D) Ownership interests in or usage rights to items not 
     covered by subparagraphs (A) through (C) that have unique 
     religious, spiritual, traditional, or cultural significance 
     or rights that support subsistence or a traditional lifestyle 
     according to applicable tribal law or custom.''.
       (2) Application to schip.--Section 2107(e)(1) of such Act 
     (42 U.S.C. 1397gg(e)(1)) is amended--
       (A) by redesignating subparagraphs (B) through (E), as 
     subparagraphs (C) through (F), respectively; and
       (B) by inserting after subparagraph (A), the following new 
     subparagraph:
       ``(B) Section 1902(e)(13) (relating to disregard of certain 
     property for purposes of making eligibility 
     determinations).''.
       (c) Continuation of Current Law Protections of Certain 
     Indian Property From Medicaid Estate Recovery.--Section 
     1917(b)(3) of the Social Security Act (42 U.S.C. 1396p(b)(3)) 
     is amended--
       (1) by inserting ``(A)'' after ``(3)''; and
       (2) by adding at the end the following new subparagraph:
       ``(B) The standards specified by the Secretary under 
     subparagraph (A) shall require that the procedures 
     established by the State agency under subparagraph (A) exempt 
     income, resources, and property that are exempt from the 
     application of this subsection as of April 1, 2003, under 
     manual instructions issued to carry out this subsection (as 
     in effect on such date) because of the Federal responsibility 
     for Indian Tribes and Alaska Native Villages. Nothing in this 
     subparagraph shall be construed as preventing the Secretary 
     from providing additional estate recovery exemptions under 
     this title for Indians.''.

     SEC. _25. NONDISCRIMINATION IN QUALIFICATIONS FOR PAYMENT FOR 
                   SERVICES UNDER FEDERAL HEALTH CARE PROGRAMS.

       Section 1139 of the Social Security Act (42 U.S.C. 1320b-
     9), as amended by section _22, is amended by redesignating 
     subsection (c) as subsection (d), and inserting after 
     subsection (b) the following new subsection:
       ``(c) Nondiscrimination in Qualifications for Payment for 
     Services Under Federal Health Care Programs.--
       ``(1) Requirement to satisfy generally applicable 
     participation requirements.--
       ``(A) In general.--A Federal health care program must 
     accept an entity that is operated by the Indian Health 
     Service, an Indian Tribe, Tribal Organization, or Urban 
     Indian Organization as a provider eligible to receive payment 
     under the program for health care services furnished to an 
     Indian on the same basis as any other provider qualified to 
     participate as a provider of health care services under the 
     program if the entity meets generally applicable State or 
     other requirements for participation as a provider of health 
     care services under the program.
       ``(B) Satisfaction of state or local licensure or 
     recognition requirements.--Any requirement for participation 
     as a provider of health care services under a Federal health 
     care program that an entity be licensed or recognized under 
     the State or local law where the entity is located to furnish 
     health care services shall be deemed to have been met in the 
     case of an entity operated by the Indian Health Service, an 
     Indian Tribe, Tribal Organization, or Urban Indian 
     Organization if the entity meets all the applicable standards 
     for such licensure or recognition, regardless of whether the 
     entity obtains a license or other documentation under such 
     State or local law. In accordance with section 221 of the 
     Indian Health Care Improvement Act, the absence of the 
     licensure of a health care professional employed by such an 
     entity under the State or local law where the entity is 
     located shall not be taken into account for purposes of 
     determining whether the entity meets such standards, if the 
     professional is licensed in another State.
       ``(2) Prohibition on federal payments to entities or 
     individuals excluded from participation in federal health 
     care programs or whose state licenses are under suspension or 
     have been revoked.--
       ``(A) Excluded entities.--No entity operated by the Indian 
     Health Service, an Indian Tribe, Tribal Organization, or 
     Urban Indian Organization that has been excluded from 
     participation in any Federal health care program or for which 
     a license is under suspension or has been revoked by the 
     State where the entity is located shall be eligible to 
     receive payment under any such program for health care 
     services furnished to an Indian.
       ``(B) Excluded individuals.--No individual who has been 
     excluded from participation in any Federal health care 
     program or whose State license is under suspension or has 
     been revoked shall be eligible to receive payment under any 
     such program for health care services furnished by that 
     individual, directly or through an entity that is otherwise 
     eligible to receive payment for health care services, to an 
     Indian.
       ``(C) Federal health care program defined.--In this 
     subsection, the term, `Federal health care program' has the 
     meaning given that term in section 1128B(f), except that, for 
     purposes of this subsection, such term shall include the 
     health insurance program under chapter 89 of title 5, United 
     States Code.''.

     SEC. _26. CONSULTATION ON MEDICAID, SCHIP, AND OTHER HEALTH 
                   CARE PROGRAMS FUNDED UNDER THE SOCIAL SECURITY 
                   ACT INVOLVING INDIAN HEALTH PROGRAMS AND URBAN 
                   INDIAN ORGANIZATIONS.

       (a) In General.--Section 1139 of the Social Security Act 
     (42 U.S.C. 1320b-9), as amended by sections 202 and 205, is 
     amended by redesignating subsection (d) as subsection (e), 
     and inserting after subsection (c) the following new 
     subsection:
       ``(d) Consultation With Tribal Technical Advisory Group 
     (TTAG).--The Secretary shall maintain within the Centers for 
     Medicaid & Medicare Services (CMS) a Tribal Technical 
     Advisory Group, established in accordance with requirements 
     of the charter dated September 30, 2003, and in such group 
     shall include a representative of the Service.''.
       (b) Solicitation of Advice Under Medicaid and SCHIP.--
       (1) Medicaid state plan amendment.--Section 1902(a) of the 
     Social Security Act (42 U.S.C. 1396a(a)) is amended--
       (A) in paragraph (69), by striking ``and'' at the end;
       (B) in paragraph (70)(B)(iv), by striking the period at the 
     end and inserting ``; and''; and
       (C) by inserting after paragraph (70)(B)(iv), the following 
     new paragraph:
       ``(71) in the case of any State in which the Indian Health 
     Service operates or funds health care programs, or in which 1 
     or more Indian Health Programs or Urban Indian Organizations 
     (as such terms are defined in section 4 of the Indian Health 
     Care Improvement Act) provide health care in the State for 
     which medical assistance is available under such title, 
     provide for a process under which the State seeks advice on a 
     regular, ongoing basis from designees of such Indian Health 
     Programs and Urban Indian Organizations on matters relating 
     to the application of this title that are likely to have a 
     direct effect on such Indian Health Programs and Urban Indian 
     Organizations and that--
       ``(A) shall include solicitation of advice prior to 
     submission of any plan amendments, waiver requests, and 
     proposals for demonstration projects likely to have a direct 
     effect on Indians, Indian Health Programs, or Urban Indian 
     Organizations; and
       ``(B) may include appointment of an advisory committee and 
     of a designee of such Indian Health Programs and Urban Indian 
     Organizations to the medical care advisory committee advising 
     the State on its State plan under this title.''.
       (2) Application to schip.--Section 2107(e)(1) of such Act 
     (42 U.S.C. 1397gg(e)(1)), as amended by section _24(b)(2), is 
     amended--

[[Page 21716]]

       (A) by redesignating subparagraphs (B) through (F) as 
     subparagraphs (C) through (G), respectively; and
       (B) by inserting after subparagraph (A), the following new 
     subparagraph:
       ``(B) Section 1902(a)(71) (relating to the option of 
     certain States to seek advice from designees of Indian Health 
     Programs and Urban Indian Organizations).''.
       (c) Rule of Construction.--Nothing in the amendments made 
     by this section shall be construed as superseding existing 
     advisory committees, working groups, guidance, or other 
     advisory procedures established by the Secretary of Health 
     and Human Services or by any State with respect to the 
     provision of health care to Indians.

     SEC. _27. EXCLUSION WAIVER AUTHORITY FOR AFFECTED INDIAN 
                   HEALTH PROGRAMS AND SAFE HARBOR TRANSACTIONS 
                   UNDER THE SOCIAL SECURITY ACT.

       (a) Exclusion Waiver Authority.--Section 1128 of the Social 
     Security Act (42 U.S.C. 1320a-7) is amended by adding at the 
     end the following new subsection:
       ``(k) Additional Exclusion Waiver Authority for Affected 
     Indian Health Programs.--In addition to the authority granted 
     the Secretary under subsections (c)(3)(B) and (d)(3)(B) to 
     waive an exclusion under subsection (a)(1), (a)(3), (a)(4), 
     or (b), the Secretary may, in the case of an Indian Health 
     Program, waive such an exclusion upon the request of the 
     administrator of an affected Indian Health Program (as 
     defined in section 4 of the Indian Health Care Improvement 
     Act) who determines that the exclusion would impose a 
     hardship on individuals entitled to benefits under or 
     enrolled in a Federal health care program.''.
       (b) Certain Transactions Involving Indian Health Care 
     Programs Deemed to Be in Safe Harbors.--Section 1128B(b) of 
     the Social Security Act (42 U.S.C. 1320a-7b(b)) is amended by 
     adding at the end the following new paragraph:
       ``(4) Subject to such conditions as the Secretary may 
     promulgate from time to time as necessary to prevent fraud 
     and abuse, for purposes of paragraphs (1) and (2) and section 
     1128A(a), the following transfers shall not be treated as 
     remuneration:
       ``(A) Transfers between indian health programs, indian 
     tribes, tribal organizations, and urban indian 
     organizations.--Transfers of anything of value between or 
     among an Indian Health Program, Indian Tribe, Tribal 
     Organization, or Urban Indian Organization, that are made for 
     the purpose of providing necessary health care items and 
     services to any patient served by such Program, Tribe, or 
     Organization and that consist of--
       ``(i) services in connection with the collection, 
     transport, analysis, or interpretation of diagnostic 
     specimens or test data;
       ``(ii) inventory or supplies;
       ``(iii) staff; or
       ``(iv) a waiver of all or part of premiums or cost sharing.
       ``(B) Transfers between indian health programs, indian 
     tribes, tribal organizations, or urban indian organizations 
     and patients.--Transfers of anything of value between an 
     Indian Health Program, Indian Tribe, Tribal Organization, or 
     Urban Indian Organization and any patient served or eligible 
     for service from an Indian Health Program, Indian Tribe, 
     Tribal Organization, or Urban Indian Organization, including 
     any patient served or eligible for service pursuant to 
     section 807 of the Indian Health Care Improvement Act, but 
     only if such transfers--
       ``(i) consist of expenditures related to providing 
     transportation for the patient for the provision of necessary 
     health care items or services, provided that the provision of 
     such transportation is not advertised, nor an incentive of 
     which the value is disproportionately large in relationship 
     to the value of the health care item or service (with respect 
     to the value of the item or service itself or, for 
     preventative items or services, the future health care costs 
     reasonably expected to be avoided);
       ``(ii) consist of expenditures related to providing housing 
     to the patient (including a pregnant patient) and immediate 
     family members or an escort necessary to assuring the timely 
     provision of health care items and services to the patient, 
     provided that the provision of such housing is not advertised 
     nor an incentive of which the value is disproportionately 
     large in relationship to the value of the health care item or 
     service (with respect to the value of the item or service 
     itself or, for preventative items or services, the future 
     health care costs reasonably expected to be avoided); or
       ``(iii) are for the purpose of paying premiums or cost 
     sharing on behalf of such a patient, provided that the making 
     of such payment is not subject to conditions other than 
     conditions agreed to under a contract for the delivery of 
     contract health services.
       ``(C) Contract health services.--A transfer of anything of 
     value negotiated as part of a contract entered into between 
     an Indian Health Program, Indian Tribe, Tribal Organization, 
     Urban Indian Organization, or the Indian Health Service and a 
     contract care provider for the delivery of contract health 
     services authorized by the Indian Health Service, provided 
     that--
       ``(i) such a transfer is not tied to volume or value of 
     referrals or other business generated by the parties; and
       ``(ii) any such transfer is limited to the fair market 
     value of the health care items or services provided or, in 
     the case of a transfer of items or services related to 
     preventative care, the value of the future health care costs 
     reasonably expected to be avoided.
       ``(D) Other transfers.--Any other transfer of anything of 
     value involving an Indian Health Program, Indian Tribe, 
     Tribal Organization, or Urban Indian Organization, or a 
     patient served or eligible for service from an Indian Health 
     Program, Indian Tribe, Tribal Organization, or Urban Indian 
     Organization, that the Secretary, in consultation with the 
     Attorney General, determines is appropriate, taking into 
     account the special circumstances of such Indian Health 
     Programs, Indian Tribes, Tribal Organizations, and Urban 
     Indian Organizations, and of patients served by such 
     Programs, Tribes, and Organizations.''.

     SEC. _28. RULES APPLICABLE UNDER MEDICAID AND SCHIP TO 
                   MANAGED CARE ENTITIES WITH RESPECT TO INDIAN 
                   ENROLLEES AND INDIAN HEALTH CARE PROVIDERS AND 
                   INDIAN MANAGED CARE ENTITIES.

       (a) In General.--Section 1932 of the Social Security Act 
     (42 U.S.C. 1396u-2) is amended by adding at the end the 
     following new subsection:
       ``(h) Special Rules With Respect to Indian Enrollees, 
     Indian Health Care Providers, and Indian Managed Care 
     Entities.--
       ``(1) Enrollee option to select an indian health care 
     provider as primary care provider.--In the case of a non-
     Indian Medicaid managed care entity that--
       ``(A) has an Indian enrolled with the entity; and
       ``(B) has an Indian health care provider that is 
     participating as a primary care provider within the network 
     of the entity,

     insofar as the Indian is otherwise eligible to receive 
     services from such Indian health care provider and the Indian 
     health care provider has the capacity to provide primary care 
     services to such Indian, the contract with the entity under 
     section 1903(m) or under section 1905(t)(3) shall require, as 
     a condition of receiving payment under such contract, that 
     the Indian shall be allowed to choose such Indian health care 
     provider as the Indian's primary care provider under the 
     entity.
       ``(2) Assurance of payment to indian health care providers 
     for provision of covered services.--Each contract with a 
     managed care entity under section 1903(m) or under section 
     1905(t)(3) shall require any such entity that has a 
     significant percentage of Indian enrollees (as determined by 
     the Secretary), as a condition of receiving payment under 
     such contract to satisfy the following requirements:
       ``(A) Demonstration of participating indian health care 
     providers or application of alternative payment 
     arrangements.--Subject to subparagraph (E), to--
       ``(i) demonstrate that the number of Indian health care 
     providers that are participating providers with respect to 
     such entity are sufficient to ensure timely access to covered 
     Medicaid managed care services for those enrollees who are 
     eligible to receive services from such providers; or
       ``(ii) agree to pay Indian health care providers who are 
     not participating providers with the entity for covered 
     Medicaid managed care services provided to those enrollees 
     who are eligible to receive services from such providers at a 
     rate equal to the rate negotiated between such entity and the 
     provider involved or, if such a rate has not been negotiated, 
     at a rate that is not less than the level and amount of 
     payment which the entity would make for the services if the 
     services were furnished by a participating provider which is 
     not an Indian health care provider.
       ``(B) Prompt payment.--To agree to make prompt payment (in 
     accordance with rules applicable to managed care entities) to 
     Indian health care providers that are participating providers 
     with respect to such entity or, in the case of an entity to 
     which subparagraph (A)(ii) or (E) applies, that the entity is 
     required to pay in accordance with that subparagraph.
       ``(C) Satisfaction of claim requirement.--To deem any 
     requirement for the submission of a claim or other 
     documentation for services covered under subparagraph (A) by 
     the enrollee to be satisfied through the submission of a 
     claim or other documentation by an Indian health care 
     provider that is consistent with section 403(h) of the Indian 
     Health Care Improvement Act.
       ``(D) Compliance with generally applicable requirements.--
       ``(i) In general.--Subject to clause (ii), as a condition 
     of payment under subparagraph (A), an Indian health care 
     provider shall comply with the generally applicable 
     requirements of this title, the State plan, and such entity 
     with respect to covered Medicaid managed care services 
     provided by the Indian health care provider to the same 
     extent that non-Indian providers participating with the 
     entity must comply with such requirements.
       ``(ii) Limitations on compliance with managed care entity 
     generally applicable requirements.--An Indian health care 
     provider--

[[Page 21717]]

       ``(I) shall not be required to comply with a generally 
     applicable requirement of a managed care entity described in 
     clause (i) as a condition of payment under subparagraph (A) 
     if such compliance would conflict with any other statutory or 
     regulatory requirements applicable to the Indian health care 
     provider; and
       ``(II) shall only need to comply with those generally 
     applicable requirements of a managed care entity described in 
     clause (i) as a condition of payment under subparagraph (A) 
     that are necessary for the entity's compliance with the State 
     plan, such as those related to care management, quality 
     assurance, and utilization management.

       ``(E) Application of special payment requirements for 
     federally-qualified health centers and encounter rate for 
     services provided by certain indian health care providers.--
       ``(i) Federally-qualified health centers.--

       ``(I) Managed care entity payment requirement.--To agree to 
     pay any Indian health care provider that is a Federally-
     qualified health center but not a participating provider with 
     respect to the entity, for the provision of covered Medicaid 
     managed care services by such provider to an Indian enrollee 
     of the entity at a rate equal to the amount of payment that 
     the entity would pay a Federally-qualified health center that 
     is a participating provider with respect to the entity but is 
     not an Indian health care provider for such services.
       ``(II) Continued application of state requirement to make 
     supplemental payment.--Nothing in subclause (I) or 
     subparagraph (A) or (B) shall be construed as waiving the 
     application of section 1902(bb)(5) regarding the State plan 
     requirement to make any supplemental payment due under such 
     section to a Federally-qualified health center for services 
     furnished by such center to an enrollee of a managed care 
     entity (regardless of whether the Federally-qualified health 
     center is or is not a participating provider with the 
     entity).

       ``(ii) Continued application of encounter rate for services 
     provided by certain indian health care providers.--If the 
     amount paid by a managed care entity to an Indian health care 
     provider that is not a Federally-qualified health center and 
     that has elected to receive payment under this title as an 
     Indian Health Service provider under the July 11, 1996, 
     Memorandum of Agreement between the Health Care Financing 
     Administration (now the Centers for Medicare & Medicaid 
     Services) and the Indian Health Service for services provided 
     by such provider to an Indian enrollee with the managed care 
     entity is less than the encounter rate that applies to the 
     provision of such services under such memorandum, the State 
     plan shall provide for payment to the Indian health care 
     provider of the difference between the applicable encounter 
     rate under such memorandum and the amount paid by the managed 
     care entity to the provider for such services.
       ``(F) Construction.--Nothing in this paragraph shall be 
     construed as waiving the application of section 
     1902(a)(30)(A) (relating to application of standards to 
     assure that payments are consistent with efficiency, economy, 
     and quality of care).
       ``(3) Offering of managed care through indian medicaid 
     managed care entities.--If--
       ``(A) a State elects to provide services through Medicaid 
     managed care entities under its Medicaid managed care 
     program; and
       ``(B) an Indian health care provider that is funded in 
     whole or in part by the Indian Health Service, or a 
     consortium composed of 1 or more Tribes, Tribal 
     Organizations, or Urban Indian Organizations, and which also 
     may include the Indian Health Service, has established an 
     Indian Medicaid managed care entity in the State that meets 
     generally applicable standards required of such an entity 
     under such Medicaid managed care program,

     the State shall offer to enter into an agreement with the 
     entity to serve as a Medicaid managed care entity with 
     respect to eligible Indians served by such entity under such 
     program.
       ``(4) Special rules for indian managed care entities.--The 
     following are special rules regarding the application of a 
     Medicaid managed care program to Indian Medicaid managed care 
     entities:
       ``(A) Enrollment.--
       ``(i) Limitation to indians.--An Indian Medicaid managed 
     care entity may restrict enrollment under such program to 
     Indians and to members of specific Tribes in the same manner 
     as Indian Health Programs may restrict the delivery of 
     services to such Indians and tribal members.
       ``(ii) No less choice of plans.--Under such program the 
     State may not limit the choice of an Indian among Medicaid 
     managed care entities only to Indian Medicaid managed care 
     entities or to be more restrictive than the choice of managed 
     care entities offered to individuals who are not Indians.
       ``(iii) Default enrollment.--

       ``(I) In general.--If such program of a State requires the 
     enrollment of Indians in a Medicaid managed care entity in 
     order to receive benefits, the State, taking into 
     consideration the criteria specified in subsection 
     (a)(4)(D)(ii)(I), shall provide for the enrollment of Indians 
     described in subclause (II) who are not otherwise enrolled 
     with such an entity in an Indian Medicaid managed care entity 
     described in such clause.
       ``(II) Indian described.--An Indian described in this 
     subclause, with respect to an Indian Medicaid managed care 
     entity, is an Indian who, based upon the service area and 
     capacity of the entity, is eligible to be enrolled with the 
     entity consistent with subparagraph (A).

       ``(iv) Exception to state lock-in.--A request by an Indian 
     who is enrolled under such program with a non-Indian Medicaid 
     managed care entity to change enrollment with that entity to 
     enrollment with an Indian Medicaid managed care entity shall 
     be considered cause for granting such request under 
     procedures specified by the Secretary.
       ``(B) Flexibility in application of solvency.--In applying 
     section 1903(m)(1) to an Indian Medicaid managed care 
     entity--
       ``(i) any reference to a `State' in subparagraph (A)(ii) of 
     that section shall be deemed to be a reference to the 
     `Secretary'; and
       ``(ii) the entity shall be deemed to be a public entity 
     described in subparagraph (C)(ii) of that section.
       ``(C) Exceptions to advance directives.--The Secretary may 
     modify or waive the requirements of section 1902(w) (relating 
     to provision of written materials on advance directives) 
     insofar as the Secretary finds that the requirements 
     otherwise imposed are not an appropriate or effective way of 
     communicating the information to Indians.
       ``(D) Flexibility in information and marketing.--
       ``(i) Materials.--The Secretary may modify requirements 
     under subsection (a)(5) to ensure that information described 
     in that subsection is provided to enrollees and potential 
     enrollees of Indian Medicaid managed care entities in a 
     culturally appropriate and understandable manner that clearly 
     communicates to such enrollees and potential enrollees their 
     rights, protections, and benefits.
       ``(ii) Distribution of marketing materials.--The provisions 
     of subsection (d)(2)(B) requiring the distribution of 
     marketing materials to an entire service area shall be deemed 
     satisfied in the case of an Indian Medicaid managed care 
     entity that distributes appropriate materials only to those 
     Indians who are potentially eligible to enroll with the 
     entity in the service area.
       ``(5) Malpractice insurance.--Insofar as, under a Medicaid 
     managed care program, a health care provider is required to 
     have medical malpractice insurance coverage as a condition of 
     contracting as a provider with a Medicaid managed care 
     entity, an Indian health care provider that is--
       ``(A) a Federally-qualified health center that is covered 
     under the Federal Tort Claims Act (28 U.S.C. 1346(b), 2671 et 
     seq.);
       ``(B) providing health care services pursuant to a contract 
     or compact under the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450 et seq.) that are covered under 
     the Federal Tort Claims Act (28 U.S.C. 1346(b), 2671 et 
     seq.); or
       ``(C) the Indian Health Service providing health care 
     services that are covered under the Federal Tort Claims Act 
     (28 U.S.C. 1346(b), 2671 et seq.);

     are deemed to satisfy such requirement.
       ``(6) Definitions.--For purposes of this subsection:
       ``(A) Indian health care provider.--The term `Indian health 
     care provider' means an Indian Health Program or an Urban 
     Indian Organization.
       ``(B) Indian; indian health program; service; tribe; tribal 
     organization; urban indian organization.--The terms `Indian', 
     `Indian Health Program', `Service', `Tribe', `tribal 
     organization', `Urban Indian Organization' have the meanings 
     given such terms in section 4 of the Indian Health Care 
     Improvement Act.
       ``(C) Indian medicaid managed care entity.--The term 
     `Indian Medicaid managed care entity' means a managed care 
     entity that is controlled (within the meaning of the last 
     sentence of section 1903(m)(1)(C)) by the Indian Health 
     Service, a Tribe, Tribal Organization, or Urban Indian 
     Organization, or a consortium, which may be composed of 1 or 
     more Tribes, Tribal Organizations, or Urban Indian 
     Organizations, and which also may include the Service.
       ``(D) Non-indian medicaid managed care entity.--The term 
     `non-Indian Medicaid managed care entity' means a managed 
     care entity that is not an Indian Medicaid managed care 
     entity.
       ``(E) Covered medicaid managed care services.--The term 
     `covered Medicaid managed care services' means, with respect 
     to an individual enrolled with a managed care entity, items 
     and services that are within the scope of items and services 
     for which benefits are available with respect to the 
     individual under the contract between the entity and the 
     State involved.
       ``(F) Medicaid managed care program.--The term `Medicaid 
     managed care program' means a program under sections 1903(m) 
     and 1932 and includes a managed care program operating under 
     a waiver under section 1915(b) or 1115 or otherwise.''.
       (b) Application to SCHIP.--Section 2107(e)(1) of such Act 
     (42 U.S.C. 1397gg(1)), as amended by section _26(b)(2), is 
     amended by

[[Page 21718]]

     adding at the end the following new subparagraph:
       ``(H) Subsections (a)(2)(C) and (h) of section 1932.''.

     SEC. _29. ANNUAL REPORT ON INDIANS SERVED BY SOCIAL SECURITY 
                   ACT HEALTH BENEFIT PROGRAMS.

       Section 1139 of the Social Security Act (42 U.S.C. 1320b-
     9), as amended by the sections 202, 205, and 206, is amended 
     by redesignating subsection (e) as subsection (f), and 
     inserting after subsection (d) the following new subsection:
       ``(e) Annual Report on Indians Served by Health Benefit 
     Programs Funded Under This Act.--Beginning January 1, 2008, 
     and annually thereafter, the Secretary, acting through the 
     Administrator of the Centers for Medicare & Medicaid Services 
     and the Director of the Indian Health Service, shall submit a 
     report to Congress regarding the enrollment and health status 
     of Indians receiving items or services under health benefit 
     programs funded under this Act during the preceding year. 
     Each such report shall include the following:
       ``(1) The total number of Indians enrolled in, or receiving 
     items or services under, such programs, disaggregated with 
     respect to each such program.
       ``(2) The number of Indians described in paragraph (1) that 
     also received health benefits under programs funded by the 
     Indian Health Service.
       ``(3) General information regarding the health status of 
     the Indians described in paragraph (1), disaggregated with 
     respect to specific diseases or conditions and presented in a 
     manner that is consistent with protections for privacy of 
     individually identifiable health information under section 
     264(c) of the Health Insurance Portability and Accountability 
     Act of 1996.
       ``(4) A detailed statement of the status of facilities of 
     the Indian Health Service or an Indian Tribe, Tribal 
     Organization, or an Urban Indian Organization with respect to 
     such facilities' compliance with the applicable conditions 
     and requirements of titles XVIII, XIX, and XXI, and, in the 
     case of title XIX or XXI, under a State plan under such title 
     or under waiver authority, and of the progress being made by 
     such facilities (under plans submitted under section 1880(b), 
     1911(b) or otherwise) toward the achievement and maintenance 
     of such compliance.
       ``(5) Such other information as the Secretary determines is 
     appropriate.''.
                                 ______
                                 
  SA 2535. Mr. ALLARD submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the appropriate place, insert the following:

     SEC. __. TREATMENT OF UNBORN CHILDREN.

       (a) Codification of Current Regulations.--Section 
     2110(c)(1) (42 U.S.C. 1397jj(c)(1)) is amended by striking 
     the period at the end and inserting the following: ``, and 
     includes, at the option of a State, an unborn child. For 
     purposes of the previous sentence, the term `unborn child' 
     means a member of the species Homo sapiens, at any stage of 
     development, who is carried in the womb.''.
       (b) Clarifications Regarding Coverage of Mothers.--Section 
     2103 (42 U.S.C. 1397cc) is amended by adding at the end the 
     following new subsection:
       ``(g) Clarifications Regarding Authority to Provide 
     Postpartum Services and Maternal Health Care.--Any State that 
     provides child health assistance to an unborn child under the 
     option described in section 2110(c)(1) may--
       ``(1) continue to provide such assistance to the mother, as 
     well as postpartum services, through the end of the month in 
     which the 60-day period (beginning on the last day of 
     pregnancy) ends; and
       ``(2) in the interest of the child to be born, have 
     flexibility in defining and providing services to benefit 
     either the mother or unborn child consistent with the health 
     of both.''.
                                 ______
                                 
  SA 2536. Mr. ALLARD submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; as follows:

       At the end of title I, add the following:

     SEC. __. STANDARDIZATION OF DETERMINATION OF FAMILY INCOME.

       (a) Eligibility Based on Gross Income.--
       (1) In general.--Section 2110 (42 U.S.C. 1397jj) is amended 
     by adding at the end the following new subsection:
       ``(d) Standardization of Determination of Family Income.--A 
     State shall determine family income for purposes of 
     determining income eligibility for child health assistance or 
     other health benefits coverage under the State child health 
     plan (or under a waiver of such plan under section 1115) 
     solely on the basis of the gross income (as defined by the 
     Secretary) of the family.''.
       (2) Prohibition on waiver of requirements.--Section 2107(f) 
     (42 U.S.C. 1397gg(f)), as amended by section 106(a)(2)(A), is 
     amended by adding at the end the following new paragraph:
       ``(3) The Secretary may not approve a waiver, experimental, 
     pilot, or demonstration project with respect to a State after 
     the date of enactment of the Children's Health Insurance 
     Program Reauthorization Act of 2007 that would waive or 
     modify the requirements of section 2110(d) (relating to 
     determining income eligibility on the basis of gross income) 
     and regulations promulgated to carry out such 
     requirements.''.
       (b) Regulations.--Not later than 90 days after the date of 
     enactment of this Act, the Secretary shall promulgate interim 
     final regulations defining gross income for purposes of 
     section 2110(d) of the Social Security Act, as added by 
     subsection (a)(1).
       (c) Application to Current Enrollees.--The interim final 
     regulations promulgated under subsection (b) shall not be 
     used to determine the income eligibility of any individual 
     enrolled in a State child health plan under title XXI of the 
     Social Security Act on the date of enactment of this Act 
     before the date on which such eligibility of the individual 
     is required to be redetermined under the plan as in effect on 
     such date. In the case of any individual enrolled in such 
     plan on such date who, solely as a result of the application 
     of subsection (d) of section 2110 of the Social Security Act 
     (as added by subsection (a)(1))) and the regulations 
     promulgated under subsection (b), is determined to be 
     ineligible for child health assistance under the State child 
     health plan, a State may elect, subject to substitution of 
     the Federal medical assistance percentage for the enhanced 
     FMAP under section 2105(a)(1) of the Social Security Act, to 
     continue to provide the individual with such assistance for 
     so long as the individual otherwise would be eligible for 
     such assistance and the individual's family income, if 
     determined under the income and resource standards and 
     methodologies applicable under the State child health plan on 
     September 30, 2007, would not exceed the income eligibility 
     level applicable to the individual under the State child 
     health plan.
                                 ______
                                 
  SA 2537. Mr. KYL submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the end, add the following:

     SEC. __. DELAY IN EFFECTIVE DATE.

       Notwithstanding any other provision of this Act, this Act 
     and the amendments made by this Act shall not take effect 
     until the day after the date on which the Director of the 
     Congressional Budget Office certifies that this Act and the 
     amendments made by the Act, will not result in a reduction of 
     private health insurance coverage greater than 20 percent.
                                 ______
                                 
  SA 2538. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; as follows:

       At the appropriate place, insert the following:

     SEC. _. DISEASE PREVENTION AND TREATMENT RESEARCH TRUST FUND.

       (a) In General.--Subchapter A of chapter 98 of the Internal 
     Revenue Code of 1986 (relating to establishment of trust 
     funds) is amended by adding at the end the following new 
     section:

     ``SEC. 9511. DISEASE PREVENTION AND TREATMENT RESEARCH TRUST 
                   FUND.

       ``(a) Creation of Trust Fund.--There is established in the 
     Treasury of the United States a trust fund to be known as the 
     `Disease Prevention and Treatment Research Trust Fund', 
     consisting of such amounts as may be appropriated or credited 
     to the Disease Prevention and Treatment Research Trust Fund.
       ``(b) Transfer to Disease Prevention and Treatment Research 
     Trust Fund of Amounts Equivalent to Certain Taxes.--There are 
     hereby appropriated to the Disease Prevention and Treatment 
     Research Trust Fund amounts equivalent to the taxes received 
     in the Treasury attributable to the amendments made by 
     section 701 of the Children's Health Insurance Program 
     Reauthorization Act of 2007.
       ``(c) Expenditures From Trust Fund.--
       ``(1) In general.--Amounts in the Disease Prevention and 
     Treatment Research Trust Fund shall be available, as provided 
     by appropriation Acts, for the purposes of funding the 
     disease prevention and treatment research activities of the 
     National Institutes

[[Page 21719]]

     of Health. Amounts appropriated from the Disease Prevention 
     and Treatment Research Trust Fund shall be in addition to any 
     other funds provided by appropriation Acts for the National 
     Institutes of Health.
       ``(2) Disease prevention and treatment research 
     activities.--Disease prevention and treatment research 
     activities shall include activities relating to:
       ``(A) Cancer.--Disease prevention and treatment research in 
     this category shall include activities relating to pediatric, 
     lung, breast, ovarian, uterine, prostate, colon, rectal, 
     oral, skin, bone, kidney, liver, stomach, bladder, thyroid, 
     pancreatic, brain and nervous system, and blood-related 
     cancers, including leukemia and lymphoma. Priority in this 
     category shall be given to disease prevention and treatment 
     research into pediatric cancers.
       ``(B) Respiratory diseases.--Disease prevention and 
     treatment research in this category shall include activities 
     relating to chronic obstructive pulmonary disease, 
     tuberculosis, bronchitis, asthma, and emphysema.
       ``(C) Cardiovascular diseases.--Disease prevention and 
     treatment research in this category shall include activities 
     relating to peripheral arterial disease, heart disease, valve 
     disease, stroke, and hypertension.
       ``(D) Other diseases, conditions, and disorders.--Disease 
     prevention and treatment research in this category shall 
     include activities relating to autism, diabetes (including 
     type I diabetes, also known as juvenile diabetes, and type II 
     diabetes), muscular dystrophy, Alzheimer's disease, 
     Parkinson's disease, multiple sclerosis, amyotrophic lateral 
     sclerosis, cerebral palsy, cystic fibrosis, spinal muscular 
     atrophy, osteoporosis, human immunodeficiency virus (HIV) and 
     acquired immunodeficiency syndrome (AIDS), depression and 
     other mental health disorders, infertility, arthritis, 
     anaphylaxis, lymphedema, psoriasis, eczema, lupus, cleft lip 
     and palate, fibromyalgia, chronic fatigue and immune 
     dysfunction syndrome, alopecia areata, and sepsis.''.
       (b) Clerical Amendment.--The table of sections for 
     subchapter A of chapter 98 of the Internal Revenue Code of 
     1986 is amended by adding at the end the following new item:

``Sec. 9511. Disease Prevention and Treatment Research Trust Fund.''.
                                 ______
                                 
  SA 2539. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       Strike section 106 and insert the following:

     SEC. 106. ELIMINATION OF COVERAGE FOR NONPREGNANT ADULTS.

       (a) Elimination of Coverage.--Title XXI (42 U.S.C. 1397aa 
     et seq.) is amended by adding at the end the following new 
     section:

     ``SEC. 2111. ELIMINATION OF COVERAGE FOR NONPREGNANT ADULTS.

       ``(a) No Coverage for Nonpregnant Childless Adults and 
     Nonpregnant Parents.--
       ``(1) Termination of coverage under applicable existing 
     waivers.--No funds shall be available under this title for 
     child health assistance or other health benefits coverage 
     that is provided for any other adult other than a pregnant 
     woman after September 30, 2007.
       ``(2) No new waivers.--Notwithstanding section 1115 or any 
     other provision of this title the Secretary shall not on or 
     after the date of the enactment of the Children's Health 
     Insurance Program Reauthorization Act of 2007, approve or 
     renew a waiver, experimental, pilot, or demonstration project 
     that would allow funds made available under this title to be 
     used to provide child health assistance or other health 
     benefits coverage for any other adult other than a pregnant 
     woman.
       ``(b) Increased Outreach and Coverage of Low-Income 
     Children.--A State that, but for the application of 
     subsections (a) and (b), would have expended funds for child 
     health assistance or other health benefits coverage for an 
     adult other than a pregnant woman after fiscal year 2007 
     shall use the funds that would have been expended for such 
     assistance or coverage to conduct outreach to, and provide 
     child health assistance for, low-income children who are 
     eligible for such assistance under the State child health 
     plan.
       ``(c) Nonapplication.--Beginning with fiscal year 2008, 
     this title shall be applied without regard to any provision 
     of this title that would be contrary to the prohibition on 
     providing child health assistance or health benefits coverage 
     for an adult other than a pregnant woman established under 
     this section.''.
       (b) Conforming Amendments.--
       (1) Section 2107(f) (42 U.S.C. 1397gg(f)) is amended--
       (A) by striking ``, the Secretary'' and inserting ``:
       ``(1) The Secretary'';
       (B) in the first sentence, by inserting ``or a nonpregnant 
     parent (as defined in section 2111(d)(2)) of a targeted low-
     income child'' before the period;
       (C) by striking the second sentence; and
       (D) by adding at the end the following new paragraph:
       ``(2) The Secretary may not approve, extend, renew, or 
     amend a waiver, experimental, pilot, or demonstration project 
     with respect to a State after the date of enactment of the 
     Children's Health Insurance Program Reauthorization Act of 
     2007 that would waive or modify the requirements of section 
     2111.''.
       (2) Section 6102(c) of the Deficit Reduction Act of 2005 
     (Public Law 109-171; 120 Stat. 131) is amended by striking 
     ``Nothing'' and inserting ``Subject to section 2111 of the 
     Social Security Act, as added by section 106(a)(1) of the 
     Children's Health Insurance Program Reauthorization Act of 
     2007, nothing''.
                                 ______
                                 
  SA 2540. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 58, between lines 16 and 17, insert the following:
       ``(d) Cover Kids First Implementation Requirement.--
     Notwithstanding the preceding subsections of this section, no 
     funds shall be available under this title for child health 
     assistance or other health benefits coverage that is provided 
     for any other adult other than a pregnant woman, and this 
     title shall be applied with respect to a State without regard 
     to such subsections, for each fiscal year quarter that begins 
     prior to the date on which the State demonstrates to the 
     Secretary that the State has enrolled in the State child 
     health plan at least 95 percent of the targeted low-income 
     children who reside in the State.''.
                                 ______
                                 
  SA 2541. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the end of title I, add the following:

     SEC. 112. COVER LOW-INCOME KIDS FIRST.

       Section 2105(c) (42 U.S.C. 1397ee(c)), as amended by 
     section 602, is amended by adding at the end the following 
     new paragraph:
       ``(12) No payments for expenditures for child health 
     assistance or health benefits coverage for individuals whose 
     gross family income exceeds 200 percent of the poverty line 
     unless at least 95 percent of eligible low-income children 
     enrolled.--Notwithstanding any other provision of this title, 
     for fiscal years beginning with fiscal year 2008, no payments 
     shall be made to a State under subsection (a)(1), or any 
     other provision of this title, for any fiscal year quarter 
     that begins prior to the date on which the State demonstrates 
     to the Secretary that the State has enrolled in the State 
     child health plan at least 95 percent of the low-income 
     children who reside in the State and are eligible for child 
     health assistance under this State child health plan with 
     respect to any expenditures for providing child health 
     assistance or health benefits coverage for any individual 
     whose gross family income exceeds 200 percent of the poverty 
     line.''.
                                 ______
                                 
  SA 2542. Mr. ENSIGN submitted an amendment intended to be proposed to 
the amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. 
Grassley, Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to 
amend the Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the end of title I, add the following:

     SEC. 112. REMOVING THE INCENTIVE TO COVER CHILDREN AT HIGHER 
                   INCOME LEVELS RATHER THAN LOWER INCOME LEVELS.

       (a) Elimination of Enhanced FMAP.--Section 2105 (42 U.S.C. 
     1397ee) is amended--
       (1) in subsection (a)(1), in the matter preceding 
     subparagraph (A), by striking ``enhanced FMAP (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 inserting ``Federal 
     medical assistance percentage'';
       (2) in subparagraph (A), by striking ``on the basis of an 
     enhanced FMAP'';
       (3) by striking subsection (b) and inserting the following:
       ``(b) Federal Medical Assistance Percentage.--The term 
     `Federal medical assistance percentage' has the meaning given 
     such term in the first sentence of section 1905(b).'';
       (4) in subsection (d)(B)(ii), by striking ``an enhanced 
     FMAP'' and inserting ``payments''; and
       (5) in subsection (g)(1)(B)(i), by striking ``the 
     additional amount'' and all that follows

[[Page 21720]]

     through the period and inserting ``the Federal medical 
     assistance percentage with respect to expenditures described 
     in clause (ii).''.
       (b) Conforming Amendments to Title XIX.--Section 1905 (42 
     U.S.C. 1396d)) is amended--
       (1) in subsection (b)--
       (A) in the first sentence by striking ``and (4)'' and all 
     that follows up to the period;
       (B) in the last sentence--
       (i) by inserting ``the Federal medical assistance 
     percentage shall apply only'' after ``Notwithstanding the 
     first sentence of this subsection,''; and
       (ii) by striking ``section 2104'' and all that follows 
     through the period and inserting ``section 2104.''; and
       (2) in subsection (u)(4), by striking ``an enhanced FMAP 
     described in section 2105(b)'' and inserting ``this 
     subsection''.
       (c) Conforming Amendments to Title XXI and the Amendments 
     Made by Other Provisions of This Act.--
       (1) Subsections (a)(2) and (b)(1) of section 2111, as added 
     by section 106(a), are each amended by striking subparagraph 
     (C).
       (2) Section 2111(b)(2)(B), as so added, is amended--
       (A) in clause (ii), by striking ``applicable percentage 
     determined under clause (iii) or (iv) for'' and inserting 
     ``Federal medical assistance percentage of'';
       (B) by striking clauses (iii) and (iv); and
       (C) by redesignating clauses (v) and (vi) as clauses (iii) 
     and (iv), respectively.
       (3) This Act shall be applied without regard to the 
     amendment to section 2105(c) made by section 110.
       (4) Section 2105(g)(4)(A), as added by section 111, is 
     amended by striking ``the additional amount'' and all that 
     follows through the period and inserting ``the Federal 
     medical assistance percentage with respect to expenditures 
     described in subparagraph (B).''.
       (5) The amendment made by paragraph (1) of section 201(b) 
     of this Act is amended to read as follows:
       ``(1) in the matter preceding subparagraph (A) (as amended 
     by section 112(a)(1)(A)), by inserting `(or, in the case of 
     expenditures described in subparagraph (D)(iv), 75 percent )' 
     after `Federal medical assistance percentage'; and''.
       (6) Section 2105(c)(9), as added by section 301(c)(1), is 
     amended by striking ``enhanced FMAP'' and inserting ``Federal 
     medical assistance percentage''.
       (7) Section 601(a)(2) of this Act is amended by striking 
     ``, rather than on the basis of an enhanced FMAP (as defined 
     in section 2105(b) of such Act)''.
       (8) Section 2105(c)(11), as added by section 602(a)(1), is 
     amended by striking ``enhanced FMAP'' and inserting ``Federal 
     medical assistance percentage''.
                                 ______
                                 
  SA 2543. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the end of title VI, add the following:

     SEC. 610. PERSONAL EMPOWERMENT THROUGH INDIVIDUAL 
                   RESPONSIBILITY.

       Section 2103(e) (42 U.S.C. 1397cc(e)) is amended by adding 
     at the end the following new paragraph:
       ``(5) Personal empowerment through individual 
     responsibility.--Notwithstanding the preceding provisions of 
     this subsection or any other provision of this title, for 
     fiscal years beginning with fiscal year 2008, a State shall 
     not be considered to have an approved State child health plan 
     unless the State has submitted a State plan amendment to the 
     Secretary specifying how the State will impose premiums, 
     deductibles, coinsurance, and other cost-sharing under the 
     State child health plan (regardless of whether such plan is 
     implemented under this title, title XIX, or both) for 
     populations of individuals whose family income exceeds the 
     effective income eligibility level applicable under the State 
     child health plan for that population on the date of the 
     enactment of the Children's Health Insurance Program 
     Reauthorization Act of 2007, in a manner that is consistent 
     with the authority and limitations for imposed cost-sharing 
     under section 1916A.''.
                                 ______
                                 
  SA 2544. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       Beginning on page 134, strike line 23 and all that follows 
     through page 135, line 10, and insert the following:
       (ii) Inclusion of high deductible health plans; exclusion 
     of flexible spending arrangements.--Such term--

       (I) includes coverage consisting of a high deductible 
     health plan (as defined in section 223(c)(2) of such Code) 
     purchased in conjunction with a health savings account (as 
     defined under section 223(d) of such Code); but
       (II) does not include coverage consisting of benefits 
     provided under a health flexible spending arrangement (as 
     defined in section 106(c)(2) of the Internal Revenue Code of 
     1986).

                                 ______
                                 
  SA 2545. Mr. ENSIGN (for himself and Mr. DeMint) submitted an 
amendment intended to be proposed to amendment SA 2530 proposed by Mr. 
Baucus (for himself, Mr. Grassley, Mr. Rockefeller, and Mr. Hatch) to 
the bill H.R. 976, to amend the Internal Revenue Code of 1986 to 
provide tax relief for small businesses, and for other purposes; which 
was ordered to lie on the table; as follows:

       On page 217, after line 25, insert the following:

     SEC. _. USE OF HEALTH SAVINGS ACCOUNTS FOR NON-GROUP HIGH 
                   DEDUCTIBLE HEALTH PLAN PREMIUMS.

       (a) In General.--Section 223(d)(2)(C) of the Internal 
     Revenue Code of 1986 (relating to exceptions) is amended by 
     striking ``or'' at the end of clause (iii), by striking the 
     period at the end of clause (iv) and inserting ``, or'', and 
     by adding at the end the following new clause:
       ``(v) a high deductible health plan, other than a group 
     health plan (as defined in section 5000(b)(1)).''.
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years beginning after December 31, 
     2007.
                                 ______
                                 
  SA 2546. Mr. ENSIGN submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 217, after line 25, add the following:

     SEC. ___. REPEAL OF EXCISE TAX ON TELEPHONE AND OTHER 
                   COMMUNICATIONS SERVICES.

       (a) In General.--Chapter 33 of the Internal Revenue Code of 
     1986 (relating to facilities and services) is amended by 
     striking subchapter B.
       (b) Conforming Amendments.--
       (1) Section 4293 of such Code is amended by striking 
     ``chapter 32 (other than the taxes imposed by sections 4064 
     and 4121) and subchapter B of chapter 33,'' and inserting 
     ``and chapter 32 (other than the taxes imposed by sections 
     4064 and 4121),''.
       (2)(A) Paragraph (1) of section 6302(e) of such Code is 
     amended by striking ``section 4251 or''.
       (B) Paragraph (2) of section 6302(e) of such Code is 
     amended--
       (i) by striking ``imposed by--'' and all that follows 
     through ``with respect to'' and inserting ``imposed by 
     section 4261 or 4271 with respect to'', and
       (ii) by striking ``bills rendered or''.
       (C) The subsection heading for section 6302(e) of such Code 
     is amended by striking ``Communications Services and''.
       (3) Section 6415 of such Code is amended by striking 
     ``4251, 4261, or 4271'' each place it appears and inserting 
     ``4261 or 4271''.
       (4) Paragraph (2) of section 7871(a) of such Code is 
     amended by inserting ``or'' at the end of subparagraph (B), 
     by striking subparagraph (C), and by redesignating 
     subparagraph (D) as subparagraph (C).
       (5) The table of subchapters for chapter 33 of such Code is 
     amended by striking the item relating to subchapter B.
       (c) Effective Date.--The amendments made by this section 
     shall apply to amounts paid pursuant to bills first rendered 
     more than 90 days after the date of the enactment of this 
     Act.
                                 ______
                                 
  SA 2547. Mr. BUNNING submitted an amendment intended to be proposed 
to amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; as follows:

       Beginning on page 79, strike line 21 and all that follows 
     through page 81, line 6, and insert the following:
       (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.--For 
     fiscal years beginning with fiscal year 2008, the Federal 
     medical assistance percentage (as determined under section 
     1905(b) without regard to clause (4) of such section) shall 
     be substituted for the enhanced FMAP under subsection (a)(1) 
     with respect to any expenditures for providing child health 
     assistance or health benefits

[[Page 21721]]

     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) Conforming Amendment.--Section 2105(a)(1) ( 42 U.S.C. 
     1397dd(a)(1)) is amended, in the matter preceding 
     subparagraph (A), by inserting ``or subsection (c)(8)'' after 
     ``subparagraph (B)''.
       (c) Application of Savings to Grants for Outreach and 
     Enrollment.--
       (1) In general.--Notwithstanding the dollar amount 
     specified in section 2113(g) of the Social Security Act, as 
     added by section 201(a), the dollar amount specified in such 
     section shall be increased by the amount appropriated under 
     paragraph (2).
       (2) Appropriation.--Out of any funds in the Treasury not 
     otherwise appropriated, there is appropriated such amount as 
     the Secretary determines is equal to the amount of additional 
     Federal expenditures for the period of fiscal years 2008 
     through 2012 that would have been made if the enhanced FMAP 
     (as defined in section 2105(b) of the Social Security Act) 
     applied to expenditures for providing child health assistance 
     to targeted low-income children residing in a State that, on 
     the date of enactment of the Children's Health Insurance 
     Program Reauthorization Act of 2007, has an approved State 
     plan amendment or waiver to provide, or has enacted a State 
     law to submit a State plan amendment to provide, expenditures 
     described in section 2105(c)(8) of such Act (as added by 
     subsection (a)). The preceding sentence 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 States awarded grants under section 
     2113 of the Social Security Act.
                                 ______
                                 
  SA 2548. Mr. BURR (for himself, Mr. Corker, Mr. Coburn, Mr. Martinez, 
and Mrs. Dole) submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other puuposes; which was ordered to lie on the 
table; as follows:

       At the end, add the following:

                TITLE __--EVERY AMERICAN HEALTH INSURED

   Subtitle A--Refundable and Advanceable Credit for Certain Health 
                           Insurance Coverage

     SEC. __00. REFERENCE.

       Except as otherwise expressly provided, whenever in this 
     subtitle an amendment or repeal 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 a section or 
     other provision of the Internal Revenue Code of 1986.

     SEC. __01. REFUNDABLE AND ADVANCEABLE CREDIT FOR CERTAIN 
                   HEALTH INSURANCE COVERAGE.

       (a) Advanceable Credit.--Subpart A of part IV of subchapter 
     A of chapter 1 (relating to nonrefundable personal credits) 
     is amended by adding at the end the following new section:

     ``SEC. 25E. QUALIFIED HEALTH INSURANCE CREDIT.

       ``(a) Allowance of Credit.--In the case of an individual, 
     there shall be allowed as a credit against the tax imposed by 
     this chapter for the taxable year the sum of the monthly 
     limitations determined under subsection (b) for the taxpayer 
     and the taxpayer's spouse and dependents.
       ``(b) Monthly Limitation.--
       ``(1) In general.--The monthly limitation for each month 
     during the taxable year for an eligible individual is \1/
     12\th of--
       ``(A) the applicable adult amount, in the case that the 
     eligible individual is the taxpayer or the taxpayer's spouse,
       ``(B) the applicable adult amount, in the case that the 
     eligible individual is an adult dependent, and
       ``(C) the applicable child amount, in the case that the 
     eligible individual is a child dependent.
       ``(2) Limitation on aggregate amount.--Notwithstanding 
     paragraph (1), the aggregate monthly limitations for the 
     taxpayer and the taxpayer's spouse and dependents for any 
     month shall not exceed \1/12\th of the applicable aggregate 
     amount.
       ``(3) Applicable amount.--For purposes of this section--

 
                    Applicable adult  Applicable child     Applicable
 ``Calendar year         amount            amount       aggregate amount
 
          2009             $2,160             $1,620            $5,400
          2010             $2,220             $1,670            $5,550
          2011             $2,290             $1,710            $5,710
          2012             $2,350             $1,760            $5,880
          2013             $2,420             $1,810            $6,050
          2014             $2,490             $1,870            $6,220
          2015             $2,560             $1,920            $6,400
          2016             $2,640             $1,980            $6,590
          2017             $2,710             $2,030            $6,780
 

       ``(4) No credit for ineligible months.--With respect to any 
     individual, the monthly limitation shall be zero for any 
     month for which such individual is not an eligible 
     individual.
       ``(c) Limitation Based on Amount of Tax.--In the case of a 
     taxable year to which section 26(a)(2) does not apply, the 
     credit allowed under subsection (a) for the taxable year 
     shall not exceed the excess of--
       ``(1) the sum of the regular tax liability (as defined in 
     section 26(b)) plus the tax imposed by section 55, over
       ``(2) the sum of the credits allowable under this subpart 
     (other than this section) and section 27 for the taxable 
     year.
       ``(d) Excess Credit Refundable to Certain Tax-Favored 
     Accounts.--If--
       ``(1) the credit which would be allowable under subsection 
     (a) if only qualified refund eligible health insurance were 
     taken into account under this section, exceeds
       ``(2) the limitation imposed by section 26 or subsection 
     (c) for the taxable year,
     such excess shall be paid by the Secretary into the 
     designated account of the taxpayer.
       ``(e) Eligible Individual.--For purposes of this section--
       ``(1) In general.--The term `eligible individual' means, 
     with respect to any month, an individual who--
       ``(A) is the taxpayer, the taxpayer's spouse, or the 
     taxpayer's dependent, and
       ``(B) is covered under qualified health insurance as of the 
     1st day of such month.
       ``(2) Coverage under medicare, medicaid, schip, military 
     coverage.--The term `eligible individual' shall not include 
     any individual who for any month is--
       ``(A) entitled to benefits under part A of title XVIII of 
     the Social Security Act or enrolled under part B of such 
     title, and the individual is not a participant or beneficiary 
     in a group health plan or large group health plan that is a 
     primary plan (as defined in section 1862(b)(2)(A) of such 
     Act),
       ``(B) enrolled in the program under title XIX or XXI of 
     such Act (other than under section 1928 of such Act), or
       ``(C) entitled to benefits under chapter 55 of title 10, 
     United States Code, including under the TRICARE program (as 
     defined in section 1072(7) of such title).
       ``(3) Identification requirements.--The term `eligible 
     individual' shall not include any individual for any month 
     unless the policy number associated with the qualified health 
     insurance and the TIN of each eligible individual covered 
     under such health insurance for such month are included on 
     the return of tax for the taxable year in which such month 
     occurs.
       ``(4) Prisoners.--The term `eligible individual' shall not 
     include any individual for a month if, as of the first day of 
     such month, such individual is imprisoned under Federal, 
     State, or local authority.
       ``(5) Aliens.--The term `eligible individual' shall not 
     include any alien individual who is not a lawful permanent 
     resident of the United States.
       ``(f) Health Insurance.--For purposes of this section--
       ``(1) Qualified health insurance.--The term `qualified 
     health insurance' means any insurance constituting medical 
     care which (as determined under regulations prescribed by the 
     Secretary)--
       ``(A) has a reasonable annual and lifetime benefit maximum, 
     and
       ``(B) provides coverage for inpatient and outpatient care, 
     emergency benefits, and physician care.

     Such term does not include any insurance substantially all of 
     the coverage of which is coverage described in section 
     223(c)(1)(B).
       ``(2) Qualified refund eligible health insurance.--The term 
     `qualified refund eligible health insurance' means any 
     qualified health insurance which is--
       ``(A) coverage under a group health plan (as defined in 
     section 5000(b)(1)), or
       ``(B) coverage offered in a State which has been deemed by 
     the Secretary of Health and Human Services to meet the 
     refundability requirements of section 2201 of the Social 
     Security Act.
       ``(g) Designated Accounts.--
       ``(1) Designated account.--For purposes of this section, 
     the term `designated account' means any specified account 
     established and maintained by the provider of the taxpayer's 
     qualified refund eligible health insurance--
       ``(A) which is designated by the taxpayer (in such form and 
     manner as the Secretary may provide) on the return of tax for 
     the taxable year, and
       ``(B) which, under the terms of the account, accepts the 
     payment described in subparagraph (A) on behalf of the 
     taxpayer.
       ``(2) Specified account.--For purposes of this paragraph, 
     the term `specified account' means--
       ``(A) any health savings account under section 223 or 
     Archer MSA under section 220, or
       ``(B) any health insurance reserve account.
       ``(3) Health insurance reserve account.--For purposes of 
     this subsection, the term `health insurance reserve account' 
     means a trust created or organized in the United States as a 
     health insurance reserve account exclusively for the purpose 
     of paying the qualified medical expenses (within the meaning 
     of section 223(d)(2)) of the account beneficiary (as defined 
     in section 223(d)(3)), but only if the written governing 
     instrument creating the trust meets the requirements 
     described in subparagraphs (B), (C), (D), and (E) of section 
     223(d)(1). Rules similar to the rules under subsections (g) 
     and (h) of section

[[Page 21722]]

     408 shall apply for purposes of this subparagraph.
       ``(4) Treatment of payment.--Any payment under subsection 
     (d) to a designated account shall--
       ``(A) not be taken into account with respect to any dollar 
     limitation which applies with respect to contributions to 
     such account (or to tax benefits with respect to such 
     contributions),
       ``(B) be includible in the gross income of the taxpayer for 
     the taxable year in which the payment is made (except as 
     provided in subparagraph (C)), and
       ``(C) be taken into account in determining any deduction or 
     exclusion from gross income in the same manner as if such 
     contribution were made by the taxpayer.
       ``(h) Other Definitions.--For purposes of this section--
       ``(1) Dependent.--The term `dependent' has the meaning 
     given such term by section 152 (determined without regard to 
     subsections (b)(1), (b)(2), and (d)(1)(B) thereof). An 
     individual who is a child to whom section 152(e) applies 
     shall be treated as a dependent of the custodial parent for a 
     coverage month unless the custodial and noncustodial parent 
     provide otherwise.
       ``(2) Adult.--The term `adult' means an individual who is 
     not a child.
       ``(3) Child.--The term `child' means a qualifying child (as 
     defined in section 152(c).
       ``(i) Special Rules.--
       ``(1) Coordination with medical deduction, etc.--Any amount 
     paid by a taxpayer for insurance to which subsection (a) 
     applies shall not be taken into account in computing the 
     amount allowable to the taxpayer as a credit under section 35 
     or as a deduction under section 213(a).
       ``(2) Medical and health savings accounts.--The credit 
     allowed under subsection (a) for any taxable year shall be 
     reduced by the aggregate amount distributed from Archer MSAs 
     (as defined in section 220(d)) and health savings accounts 
     (as defined in section 223(d)) which are excludable from 
     gross income for such taxable years by reason of being used 
     to pay premiums for coverage of an eligible individual under 
     qualified health insurance for any month.
       ``(3) Denial of credit to dependents.--No credit shall be 
     allowed under this section to any individual with respect to 
     whom a deduction under section 151 is allowable to another 
     taxpayer for a taxable year beginning in the calendar year in 
     which such individual's taxable year begins.
       ``(4) Married couples must file joint return.--
       ``(A) In general.--If the taxpayer is married at the close 
     of the taxable year, the credit shall be allowed under 
     subsection (a) only if the taxpayer and his spouse file a 
     joint return for the taxable year.
       ``(B) Marital status; certain married individuals living 
     apart.--Rules similar to the rules of paragraphs (3) and (4) 
     of section 21(e) shall apply for purposes of this paragraph.
       ``(5) Verification of coverage, etc.--No credit shall be 
     allowed under this section with respect to any individual 
     unless such individual's coverage (and such related 
     information as the Secretary may require) is verified in such 
     manner as the Secretary may prescribe.
       ``(6) Insurance which covers other individuals; treatment 
     of payments.--Rules similar to the rules of paragraphs (7) 
     and (8) of section 35(g) shall apply for purposes of this 
     section.
       ``(j) Coordination With Advance Payments.--
       ``(1) Reduction in credit for advance payments.--With 
     respect to any taxable year, the amount which would (but for 
     this subsection) be allowed as a credit to the taxpayer under 
     subsection (a) shall be reduced (but not below zero) by the 
     aggregate amount paid on behalf of such taxpayer under 
     section 7527A for months beginning in such taxable year.
       ``(2) Recapture of excess advance payments.--If the 
     aggregate amount paid on behalf of the taxpayer under section 
     7527A for months beginning in the taxable year exceeds the 
     sum of the monthly limitations determined under subsection 
     (b) for the taxpayer and the taxpayer's spouse and dependents 
     for such months, then the tax imposed by this chapter for 
     such taxable year shall be increased by the sum of--
       ``(A) such excess, plus
       ``(B) interest on such excess determined at the 
     underpayment rate established under section 6621 for the 
     period from the date of the payment under section 7527A to 
     the date such excess is paid.

     For purposes of subparagraph (B), an equal part of the 
     aggregate amount of the excess shall be deemed to be 
     attributable to payments made under section 7527A on the 
     first day of each month beginning in such taxable year, 
     unless the taxpayer establishes the date on which each such 
     payment giving rise to such excess occurred, in which case 
     subparagraph (B) shall be applied with respect to each date 
     so established.
       ``(k) Cost-of-Living Adjustments.--
       ``(1) In general.--In the case of any taxable year 
     beginning in a calendar year after 2017, each of the dollar 
     amounts contained in the last row of the table under 
     subsection (b)(3) shall be increased by an amount equal to 
     such dollar amount multiplied by the blended cost-of-living 
     adjustment.
       ``(2) Blended cost-of-living adjustment.--For purposes of 
     paragraph (1), the blended cost-of-living adjustment means 
     one-half of the sum of--
       ``(A) the cost-of-living adjustment determined under 
     section 1(f)(3) for the calendar year in which the taxable 
     year begins by substituting `calendar year 2016' for 
     `calendar year 1992' in subparagraph (B) thereof, plus
       ``(B) the cost-of-living adjustment determined under 
     section 213(d)(10)(B)(ii) for the calendar year in which the 
     taxable year begins by substituting `2016' for `1996' in 
     subclause (II) thereof.
       ``(3) Rounding.--Any increase determined under paragraph 
     (2) shall be rounded to the nearest multiple of $10.''.
       (b) Advance Payment of Credit.--Chapter 77 (relating to 
     miscellaneous provisions) is amended by inserting after 
     section 7527 the following new section:

     ``SEC. 7527A. ADVANCE PAYMENT OF CREDIT FOR QUALIFIED REFUND 
                   ELIGIBLE HEALTH INSURANCE.

       ``(a) In General.--The Secretary shall establish a program 
     for making payments on behalf of individuals to providers of 
     qualified refund eligible health insurance (as defined in 
     section 25E(f)(2)) for such individuals.
       ``(b) Limitation.--The Secretary may make payments under 
     subsection (a) only to the extent that the Secretary 
     determines that the amount of such payments made on behalf of 
     any taxpayer for any month does not exceed the sum of the 
     monthly limitations determined under section 25E(b) for the 
     taxpayer and taxpayer's spouse and dependents for such 
     month.''.
       (c) Information Reporting.--
       (1) In general.--Subpart B of part III of subchapter A of 
     chapter 61 (relating to information concerning transactions 
     with other persons) is amended by inserting after section 
     6050V the following new section:

     ``SEC. 6050W. RETURNS RELATING TO CREDIT FOR QUALIFIED REFUND 
                   ELIGIBLE HEALTH INSURANCE.

       ``(a) Requirement of Reporting.--Every person who is 
     entitled to receive payments for any month of any calendar 
     year under section 7527A (relating to advance payment of 
     credit for qualified refund eligible health insurance) with 
     respect to any individual shall, at such time as the 
     Secretary may prescribe, make the return described in 
     subsection (b) with respect to each such individual.
       ``(b) Form and Manner of Returns.--A return is described in 
     this subsection if such return--
       ``(1) is in such form as the Secretary may prescribe, and
       ``(2) contains, with respect to each individual referred to 
     in subsection (a)--
       ``(A) the name, address, and TIN of each such individual,
       ``(B) the months for which amounts payments under section 
     7527A were received,
       ``(C) the amount of each such payment,
       ``(D) the type of insurance coverage provide by such person 
     with respect to such individual and the policy number 
     associated with such coverage,
       ``(E) the name, address, and TIN of the spouse and each 
     dependent covered under such coverage, and
       ``(F) such other information as the Secretary may 
     prescribe.
       ``(c) Statements to Be Furnished to Individuals With 
     Respect to Whom Information Is Required.--Every person 
     required to make a return under subsection (a) shall furnish 
     to each individual whose name is required to be set forth in 
     such return a written statement showing--
       ``(1) the name and address of the person required to make 
     such return and the phone number of the information contact 
     for such person, and
       ``(2) the information required to be shown on the return 
     with respect to such individual.

     The written statement required under the preceding sentence 
     shall be furnished on or before January 31 of the year 
     following the calendar year for which the return under 
     subsection (a) is required to be made.
       ``(d) Returns Which Would Be Required to Be Made by 2 or 
     More Persons.--Except to the extent provided in regulations 
     prescribed by the Secretary, in the case of any amount 
     received by any person on behalf of another person, only the 
     person first receiving such amount shall be required to make 
     the return under subsection (a).''.
       (2) Assessable penalties.--
       (A) Subparagraph (B) of section 6724(d)(1) (relating to 
     definitions) is amended by redesignating clauses (xv) through 
     (xxi) as clauses (xvi) through (xxii), respectively, and by 
     inserting after clause (xiv) the following new clause:
       ``(xv) section 6050W (relating to returns relating to 
     credit for qualified refund eligible health insurance),''.
       (B) Paragraph (2) of section 6724(d) is amended by striking 
     the period at the end of subparagraph (CC) and inserting ``, 
     or'' and by inserting after subparagraph (CC) the following 
     new subparagraph:
       ``(DD) section 6050W (relating to returns relating to 
     credit for qualified refund eligible health insurance).''.
       (d) Conforming Amendments.--

[[Page 21723]]

       (1) Paragraph (2) of section 1324(b) of title 31, United 
     States Code, is amended by inserting ``or 25E'' after 
     ``section 35''.
       (2)(A) Section 23(b)(4)(B) is amended by inserting ``and 
     section 25D'' after ``this section''.
       (B) Section 24(b)(3)(B) is amended by striking ``and 25B'' 
     and inserting ``, 25B, and 25D''.
       (C) Section 25B(g)(2) is amended by striking ``section 23'' 
     and inserting ``sections 23 and 25D''.
       (D) Section 26(a)(1) is amended by striking ``and 25B'' and 
     inserting ``25B, and 25D''.
       (3) The table of sections for subpart A of part IV of 
     subchapter A of chapter 1 is amended by inserting after the 
     item relating to section 25D the following new item:

``Sec. 25E. Qualified health insurance credit.''.
       (4) The table of sections for chapter 77 is amended by 
     inserting after the item relating to section 7527 the 
     following new item:

``Sec. 7527A. Advance payment of credit for qualified refund eligible 
              health insurance.''.
       (5) The table of sections for subpart B of part III of 
     subchapter A of chapter 61 is amended by adding at the end 
     the following new item:

``Sec. 6050W. Returns relating to credit for qualified refund eligible 
              health insurance.''.
       (e) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2008.

     SEC. __02. CHANGES TO EXISTING TAX PREFERENCES FOR MEDICAL 
                   COVERAGE, ETC., FOR INDIVIDUALS ELIGIBLE FOR 
                   QUALIFIED HEALTH INSURANCE CREDIT OR STANDARD 
                   DEDUCTION.

       (a) Exclusion for Contributions by Employer to Accident and 
     Health Plans.--
       (1) In general.--Section 106 (relating to contributions by 
     employer to accident and health plans) is amended by adding 
     at the end the following new subsection:
       ``(f) No Exclusion for Individuals Eligible for Qualified 
     Health Insurance Credit.--Subsection (a) shall not apply with 
     respect to any employer-provided coverage under an accident 
     or health plan for any individual for any month unless such 
     individual is described in paragraph (2) or (5) of section 
     25E(e) for such month. The amount includible in gross income 
     by reason of this subsection shall be determined under rules 
     similar to the rules of section 4980B(f)(4).''.
       (2) Conforming amendments.--
       (A) Section 106(b)(1) is amended--
       (i) by inserting ``gross income does not include'' before 
     ``amounts contributed'', and
       (ii) by striking ``shall be treated as employer-provided 
     coverage for medical expenses under an accident or health 
     plan''.
       (B) Section 106(d)(1) is amended--
       (i) by inserting ``gross income does not include'' before 
     ``amounts contributed'', and
       (ii) by striking ``shall be treated as employer-provided 
     coverage for medical expenses under an accident or health 
     plan''.
       (b) Amounts Received Under Accident and Health Plans.--
     Section 105 (relating to amounts received under accident and 
     health plans) is amended by adding at the end the following 
     new subsection:
       ``(f) No Exclusion for Individuals Eligible for Qualified 
     Health Insurance Credit.--Subsection (b) shall not apply with 
     respect to any employer-provided coverage under an accident 
     or health plan for any individual for any month unless such 
     individual is described in paragraph (2) or (5) of section 
     25E(e) for such month.''.
       (c) Special Rules for Health Insurance Costs of Self-
     Employed Individuals.--Subsection (l) of section 162 
     (relating to special rules for health insurance costs of 
     self-employed individuals) is amended by adding at the end 
     the following new paragraph:
       ``(6) No deduction to individuals eligible for qualified 
     health insurance.--Paragraph (1) shall not apply for any 
     individual for any month unless such individual is described 
     in paragraph (2) or (5) of section 25E(e) for such month.''.
       (d) Earned Income Credit Unaffected by Repealed 
     Exclusions.--Subparagraph (B) of section 32(c)(2) is amended 
     by redesignating clauses (v) and (vi) as clauses (vi) and 
     (vii), respectively, and by inserting after clause (iv) the 
     following new clause:
       ``(v) the earned income of an individual shall be computed 
     without regard to sections 105(f) and 106(f),''.
       (e) Modification of Deduction for Medical Expenses.--
     Subsection (d) of section 213 is amended by adding at the end 
     the following new paragraph:
       ``(12) Premiums for qualified health insurance.--The term 
     `medical care' does not include any amount paid as a premium 
     for coverage of an eligible individual (as defined in section 
     25E(e)) under qualified health insurance (as defined in 
     section 25E(f)) for any month.''.
       (f)  Definition of Wages for Employment Tax Purposes.--
       (1) Federal insurance contributions act.--Subsection (a) of 
     section 3121 is amended--
       (A) by striking ``sickness or'' each place it appears in 
     paragraph (2), and
       (B) by inserting after paragraph (2) the following new 
     paragraph:
       ``(3) any payment made to or for the benefit of an employee 
     if at the time of such payment it is reasonable to believe 
     that the employee will be able to exclude such payment from 
     income under section 104, 105, or 106;''.
       (2) Railroad retirement tax.--Subsection (e) of section 
     3231 is amended--
       (A) by striking ``sickness or'' each place it appears in 
     paragraph (1), and
       (B) by adding at the end the following new paragraph:
       ``(13) The term `compensation' shall not include any 
     payment made to or for the benefit of an employee if at the 
     time of such payment it is reasonable to believe that the 
     employee will be able to exclude such payment from income 
     under section 104, 105, or 106.''.
       (3) Unemployment tax.--Subsection (b) of section 3306 is 
     amended--
       (A) by striking ``sickness or'' each place it appears in 
     paragraph (2), and
       (B) by inserting after paragraph (2) the following new 
     paragraph:
       ``(3) any payment made to or for the benefit of an employee 
     if at the time of such payment it is reasonable to believe 
     that the employee will be able to exclude such payment from 
     income under section 104, 105, or 106;''.
       (g) Reporting Requirement.--Subsection (a) of section 6051 
     is amended by striking ``and'' at the end of paragraph (12), 
     by striking the period at the end of paragraph (13) and 
     inserting ``and'', and by inserting after paragraph (13) the 
     following new paragraph:
       ``(14) the total amount of employer-provided coverage under 
     an accident or health plan which is includible in gross 
     income by reason of sections 105(f) and 106(f).''.
       (h) Retired Public Safety Officers.--Section 402(l)(4)(D) 
     is amended by adding at the end the following: ``Such term 
     shall not include any premium for coverage by an accident or 
     health insurance plan for any month unless such individual is 
     described in paragraph (2) or (5) of section 25E(e) for such 
     month.''.
       (i) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2008.

Subtitle B--Improving Private Health Insurance Access and Affordability

     SEC. __11. IMPROVING PRIVATE HEALTH INSURANCE ACCESS AND 
                   AFFORDABILITY.

       The Social Security Act is amended by adding at the end the 
     following new title:

 ``TITLE XXII--REFUNDABILITY DEEMING; STATE HEALTH INSURANCE EXCHANGES

                  ``Subtitle A--Refundability Deeming

     ``SEC. 2201. REFUNDABILITY DEEMING.

       ``(a) In General.--For purposes of section 25E of the 
     Internal Revenue Code of 1986, the Secretary shall deem 
     whether a State (as defined for purposes of title XIX) has 
     taken efforts to provide its citizens with greater access to 
     affordable private health insurance. Those efforts may 
     include, but are not limited to, the following initiatives:
       ``(1) The establishment of a State health insurance 
     exchange.
       ``(2) The establishment of a high risk solution, such as a 
     high risk pool, reinsurance mechanism, or other State-
     designed high risk solution.
       ``(3) The availability of affordable coverage (as defined 
     in section 2212(b)(2), determined without regard to whether 
     such coverage is qualified exchange-based health insurance 
     coverage (as defined in section 2214).
       ``(b) More Individuals Covered.--A State shall demonstrate 
     to the Secretary that an initiative under subsection (a) is 
     reasonably designed to operate in a manner so as to result, 
     in combination with the qualified health insurance tax 
     credit, in a reduction in the number of eligible individuals 
     (as defined in section 2213) in the State who do not have 
     health insurance coverage, as measured by the Secretary based 
     upon information obtained in the Current Population Survey.
       ``(c) Reference to Refundability Requirement for 
     Application of Refundability of Qualified Health Insurance 
     Tax Credit.--For rules relating to limitations on the 
     refundability of the qualified health insurance credit under 
     section 25E of the Internal Revenue Code of 1986 in relation 
     to initiatives described in subsection (a), see section 
     25E(d). In this title, the term `qualified health insurance 
     tax credit' means the tax credit provided under such section.

             ``Subtitle B--State Health Insurance Exchanges

     ``SEC. 2211. STATE HEALTH INSURANCE EXCHANGES.

       ``(a) In General.--The Secretary shall provide a process 
     for the review and certification of applications of each 
     State of a State-based program as a certified health 
     insurance exchange for the State (each in this subtitle 
     referred to as a `certified State health insurance exchange' 
     or an `exchange'). A program shall not be treated as a 
     certified State health insurance exchange unless the 
     Secretary, in consultation with the Secretary of the 
     Treasury, determines that the program meets the requirements 
     for an exchange under this subtitle.
       ``(b) Continued Certification.--Upon certification of a 
     program under subsection (a), the program shall remain so 
     certified unless the Secretary determines that the program 
     has failed to meet any of the requirements for an exchange 
     under this subtitle.

     ``SEC. 2212. REQUIREMENTS FOR EXCHANGE CERTIFICATION.

       ``(a) General Requirements.--

[[Page 21724]]

       ``(1) In general.--The exchange shall be a means to pool 
     individual consumers purchasing private health insurance, to 
     provide them with greater negotiating leverage, and to 
     provide a market where private health insurance plans can 
     compete to offer coverage for these individuals.
       ``(2) Administration.--Nothing in this subtitle shall 
     prohibit a State from either directly contracting with the 
     health insurance plans participating in the exchange or a 
     third party administrator to operate the exchange.
       ``(3) Plan participation.--No State may restrict or 
     otherwise limit the ability of health insurance plans to 
     participate in and offer health insurance products through an 
     exchange, so long as the providers of these plans are duly 
     licensed under State insurance laws applicable to all health 
     insurance providers in the State and comply with the 
     requirements under this subtitle.
       ``(4) Benefits.--A State shall not impose requirements that 
     health insurance plans participating in the exchange provide 
     any benefits, beyond those requirements that the State 
     imposes upon all licensed health insurance providers 
     operating in the State.
       ``(5) Pricing.--A State shall not set prices for any 
     products offered through the exchange.
       ``(6) Premiums collection method.--A State shall ensure the 
     existence of an effective and efficient method for the 
     collection of premiums owed for qualified exchange-based 
     health insurance coverage.
       ``(7) Multi-state pooling arrangements.--Nothing in this 
     subtitle shall prohibit State health insurance exchanges from 
     organizing into a multi-state pooling arrangement.
       ``(b) Offering of Affordable Qualified Exchange-Based 
     Health Insurance Coverage to Eligible Individuals.--
       ``(1) Affordable and benchmark coverage.--The exchange must 
     have one or more health insurance plans participating in the 
     offering to each eligible individual (as defined in section 
     2213(a)) of qualified exchange-based health insurance 
     coverage (as defined in section 2214)--
       ``(A) at least one of which is affordable as determined 
     under paragraph (2); and
       ``(B) at least one of which provides benchmark benefits 
     coverage described in section 2113(b).

     Private health insurance providers, duly licensed in the 
     State, may enter into agreements with the exchange to provide 
     qualified exchange-based health insurance coverage and 
     increase the choices available to eligible individuals.
       ``(2) Affordable coverage.--
       ``(A) In general.--Subject to subparagraph (B), a State 
     through an exchange shall meet the requirement under 
     paragraph (1)(A) in a year by using its funds to supplement 
     the premiums of the lowest cost plan participating in the 
     exchange (as determined by a methodology to be specified by 
     the Secretary), so that the average premium for individuals 
     enrolling in the plan will not exceed 6 percent of the 
     State's median income.
       ``(B) Exception.--A State is not required under 
     subparagraph (A) to provide any supplemental payments if 
     there is at least one plan available in all areas of the 
     State with average premiums that are below 6 percent of the 
     State's median income.
       ``(C) No use of price fixing.--The implementation of this 
     paragraph shall comply with subsection (a)(5).
       ``(D) Application.--
       ``(i) Disregarding late enrollment penalties and related 
     premium disincentives.--The amount of premium under 
     subparagraph (A) shall not take into account any increase in 
     premium resulting from the State's application of methods 
     permitted under subsection (a)(6).
       ``(ii) Application to sub-state areas.--A State may apply 
     subparagraph (A) separately for different areas within the 
     State.
       ``(c) Enrollment of Eligible Individuals.--
       ``(1) Enrollment mechanisms.--Health insurance plans 
     participating in the exchange in State shall have uniform 
     mechanisms designed to encourage and facilitate the 
     enrollment of all eligible individuals in qualified exchange-
     based health insurance coverage.
       ``(2) Enrollment opportunities.--
       ``(A) In general.--Health insurance plans participating in 
     the exchange in a State shall permit the enrollment and 
     changes of enrollment of individuals at the time they become 
     eligible individuals in the State, such as through loss of 
     group-based qualifying health insurance coverage, changes in 
     residency or family composition, and other circumstances 
     specified by the Secretary.
       ``(B) Annual open enrollment periods.--Health insurance 
     plans participating in the exchange in a State shall permit 
     eligible individuals to change enrollment among such plans in 
     an annual manner, subject to subparagraph (A).
       ``(3) Limitation on preexisting condition exclusions.--
     Qualified exchange-based health insurance coverage shall meet 
     the requirements of section 9801 of the Internal Revenue Code 
     of 1986 in the same manner as if it were a group health plan.
       ``(d) Pathway for Enrollment by Medicaid and SCHIP 
     Beneficiaries.--A State through an exchange shall include a 
     pathway for eligible individuals who are enrolled (or 
     eligible to enroll) under title XIX or XXI in such State to 
     enroll in qualified exchange-based health insurance coverage. 
     A State may use the program under section 1938 in developing 
     such a pathway.
       ``(e) Methods to Reduce Adverse Selection.--Health 
     insurance plans participating in the exchange in a State 
     shall have a mechanism to reduce adverse selection in the 
     enrollment of eligible individuals. This mechanism shall be 
     uniform for all such plans and may include waiting periods 
     and premium surcharges for late enrollees (or individuals who 
     otherwise do not have periods of creditable coverage before 
     enrolling through the exchange) and other devices reasonably 
     designed to reduce adverse selection in the enrollment of 
     eligible individuals consistent with the requirements of 
     subpart 1 of part B of title XXVII of the Public Health 
     Service Act (relating to portability, access, and 
     renewability requirements for health insurance coverage in 
     the individual market).
       ``(f) Reinsurance or Other Risk Redistribution Mechanism.--
     Health insurance plans participating in the exchange in a 
     State may have a uniform mechanism that protects entities 
     offering qualified exchange-based health insurance coverage 
     to manage risk. Such a mechanism may include reinsurance, a 
     high risk pool, or other mechanism approved by the Secretary.
       ``(g) Dissemination of Coverage Information.--Health 
     insurance plans participating in the exchange in a State 
     shall ensure that there is wide dissemination of information 
     about health insurance coverage options, including the plans 
     offered and premiums and benefits for such plans, to eligible 
     individuals and to employers that provide financial 
     assistance in purchasing such coverage.
       ``(h) Information Coordination.--Health insurance plans 
     participating in the exchange in a State shall report to the 
     Secretary of the Treasury such information as is required 
     under the Internal Revenue Code of 1986 to carry out the 
     qualified health insurance tax credit.

     ``SEC. 2213. ELIGIBLE INDIVIDUAL.

       ``(a) Eligible Individual.--In this subtitle--
       ``(1) In general.--The term `eligible individual' means, 
     with respect to a State and a month, an individual who, as of 
     the first day of the month--
       ``(A) is a resident of the State (as determined in 
     accordance with guidelines specified by the Secretary);
       ``(B) is citizen or national of the United States, an alien 
     lawfully admitted to the United States for permanent 
     residence or otherwise residing in the United States under 
     color of law, or an alien otherwise lawfully residing in the 
     United States under color of law for such period as the 
     Secretary shall specify; and
       ``(C) is not covered under group-based qualifying health 
     insurance coverage.
       ``(2) Group-based qualifying health insurance coverage.--
     The term `group-based qualifying health insurance coverage' 
     means any of the following::
       ``(A) Group health plan coverage.--
       ``(i) In general.--Subject to clause (ii), coverage under a 
     group health plan (as defined in section 9832(a) of the 
     Internal Revenue Code of 1986).
       ``(ii) Exception.--Clause (i) shall not include--

       ``(I) a health plan if substantially all of its coverage is 
     coverage described in section 223(c)(1)(B) of the Internal 
     Revenue Code of 1986; or
       ``(II) coverage under a group health plan insofar as the 
     plan benefits consist (other than coverage described in 
     subclause (I)) of contribution towards a qualified exchange-
     based health insurance coverage.

       ``(B) Medicare.--
       ``(i) In general.--Subject to clause (ii), coverage under 
     any part of the Medicare program under title XVIII.
       ``(ii) Exception.--Clause (i) shall not apply if all the 
     coverage under Medicare is, through the direct or indirect 
     application of section 1862(b), secondary to coverage under a 
     group health plan.
       ``(C) Military health care.--Coverage under the military 
     health program under chapter 55 of title 10, United States 
     Code, including under the TRICARE program (as defined in 
     section 1072(7) of such title).
       ``(D) FEHBP.--Coverage under the Federal employees health 
     benefit program under chapter 89 of title 5, United States 
     Code.
       ``(E) Full veterans coverage.--Coverage through the 
     Department of Veterans Affairs if such coverage is based on 
     enrollment of an individual who is described in paragraph (1) 
     of section 1705(a) of title 38, United States Code (relating 
     to veterans with service-connected disabilities rated 50 
     percent or greater).
       ``(b) Relation to Medicaid/SCHIP.--Except as a State may 
     otherwise provide, an individual is not disqualified from 
     being an eligible individual merely because the individual is 
     enrolled under title XIX or XXI.

     ``SEC. 2214. QUALIFIED EXCHANGE-BASED HEALTH INSURANCE 
                   COVERAGE.

       ``In this subtitle, the term `qualified exchange-based 
     health insurance coverage' means qualified health insurance 
     (as defined in section 25E(f)(1) of the Internal Revenue Code 
     of 1986) offered by a private entity through an exchange.

[[Page 21725]]



     ``SEC. 2215. FLEXIBILITY IN APPLICATION TO LOWER-INCOME 
                   INDIVIDUALS.

       ``(a) State Supplementation.--Nothing in this subtitle 
     shall be construed as preventing a State from providing, 
     under a certified State health insurance exchange and at the 
     State's own expense, additional assistance to eligible 
     individuals with respect to subsidizing premium and cost-
     sharing costs for qualified exchange-based health insurance 
     coverage.
       ``(b) Treatment of Certain Medicaid and SCHIP 
     Beneficiaries.--Nothing in this subtitle shall be construed 
     as preventing a State Medicaid or children's health insurance 
     program under title XIX or XXI from permitting individuals 
     eligible for medical assistance or child health assistance 
     under the respective titles from obtaining such assistance 
     through enrollment in qualified exchange-based health 
     insurance coverage.''.

     SEC. __12. EXPANSION OF MEDICAID HEALTH OPPORTUNITY ACCOUNTS 
                   TO ALL STATES.

       Section 1938 of the Social Security Act (42 U.S.C. 1396u-8) 
     is amended--
       (1) in subsection (a)--
       (A) by striking paragraph (1) and inserting the following:
       ``(1) In general.--Notwithstanding any other provision of 
     this title, the Secretary shall establish a program under 
     which States may provide under their State plans under this 
     title (including such a plan operating under a statewide 
     waiver under section 1115) in accordance with this section 
     for the provision of alternative benefits consistent with 
     subsection (c) for eligible population groups in one or more 
     geographic areas of the State specified by the State. An 
     amendment under the previous sentence is referred to in this 
     section as a `State health opportunity accounts program'.''; 
     and
       (B) in paragraph (2)--
       (i) by striking the paragraph heading and inserting 
     ``Implementation.--'';
       (ii) by striking subparagraph (A) and inserting the 
     following:
       ``(A) In general.--The program established under this 
     section shall begin on January 1, 2008.''; and
       (iii) in subparagraph (B)--

       (I) by striking clause (i) and inserting the following:

       ``(i) In general.--Not later than March 31, 2013, the 
     Comptroller General of the United States shall submit a 
     report to Congress evaluating the programs conducted under 
     this section .''; and

       (II) in clause (ii), by striking ``2010'' and inserting 
     ``2013''; and

       (C) in paragraph (3)(E), by inserting ``that include plan 
     comparison information in language that is easily 
     understood'' before the period;
       (2) in subsection (b)--
       (A) in paragraph (1) , by striking ``consistent with 
     paragraphs (2) and (3)'';
       (B) by striking paragraphs (2) through (4) and inserting 
     the following:
       ``(2) Limitation on enrollees in medicaid managed care 
     organizations.--Insofar as the State provides for eligibility 
     of individuals who are enrolled in Medicaid managed care 
     organizations, such individuals may participate in the State 
     health opportunity account program only if the State provides 
     assurances satisfactory to the Secretary that the following 
     conditions are met with respect to any such organization:
       ``(A) In no case may the number of such individuals 
     enrolled in the organization who participate in the program 
     exceed 5 percent of the total number of individuals enrolled 
     in such organization.
       ``(B) The proportion of enrollees in the organization who 
     so participate is not significantly disproportionate to the 
     proportion of such enrollees in other such organizations who 
     participate.
       ``(C) The State has provided for an appropriate adjustment 
     in the per capita payments to the organization to account for 
     such participation, taking into account differences in the 
     likely use of health services between enrollees who so 
     participate and enrollees who do not so participate.''; and
       (C) by redesignating paragraphs (5) and (6) as paragraphs 
     (3) and (4), respectively;
       (3) in subsection (d)--
       (A) in paragraph (2)(C)(i)--
       (i) in subclause (II), by striking ``and'' at the end;
       (ii) in subclause (III), by striking the period at the end 
     and inserting ``; and''; and
       (iii) by adding at the end the following:

       ``(IV) shall provide contributions into such an account on 
     a sliding-scale based on income.''; and

       (B) in paragraph (3)(B)(ii)--
       (i) in subclause (I), by striking ``and'' at the end;
       (ii) by redesignating subclause (II) as subclause (III); 
     and
       (iii) by inserting after subclause (I), the following:

       ``(II) may be transferred into a health savings account 
     established under section 223 of the Internal Revenue Code of 
     1986 and such transfer shall be treated as a rollover 
     contribution described in section 223(f) of the Internal 
     Revenue Code of 1986; and''; and

       (4) by striking ``State demonstration program'' each place 
     it appears and inserting ``State health opportunity accounts 
     program''.
                                 ______
                                 
  SA 2549. Mr. LOTT submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 217, after line 25, insert the following:

     SEC. 61_. ESTIMATED TAX SAFE HARBOR FOR ALTERNATIVE MINIMUM 
                   TAX LIABILITY.

       (a) In General.--Section 6654 of the Internal Revenue Code 
     of 1986 (relating to failure by individual to pay estimated 
     income tax) is amended by redesignating subsection (m) as 
     subsection (n) and by inserting after subsection (l) the 
     following new subsection:
       ``(m) Safe Harbor for Certain Alternative Minimum Tax 
     Payers.--In the case of any individual with respect to whom 
     there was no liability for the tax imposed under section 55 
     for the preceding taxable year--
       ``(1) any required payment calculated under subsection 
     (d)(1)(B)(i) shall be determined without regard to any tax 
     imposed under section 55,
       ``(2) any annualized income installment calculated under 
     subsection (d)(2)(B) shall determined without regard to 
     alternative minimum taxable income, and
       ``(3) the determination of the amount of the tax for the 
     taxable year for purposes of subsection (e)(1) shall not 
     include the amount of any tax imposed under section 55.''.
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years ending after the date of the 
     enactment of this Act.
                                 ______
                                 
  SA 2550. Mr. LOTT submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 217, after line 25, add the following:

     SEC. ___. PERMANENT REPEAL OF ALTERNATIVE MINIMUM TAX.

       (a) In General.--Section 55(a) of the Internal Revenue Code 
     of 1986 (relating to alternative minimum tax imposed) is 
     amended by adding at the end the following new flush 
     sentence:

     ``For purposes of this title, the tentative minimum tax on 
     any taxpayer for any taxable year beginning after December 
     31, 2006, shall be zero.''.
       (b) Modification of Limitation on Use of Credit for Prior 
     Year Minimum Tax Liability.--Subsection (c) of section 53 of 
     the Internal Revenue Code of 1986 (relating to credit for 
     prior year minimum tax liability) is amended to read as 
     follows:
       ``(c) Limitation.--
       ``(1) In general.--Except as provided in paragraph (2), the 
     credit allowable under subsection (a) for any taxable year 
     shall not exceed the excess (if any) of--
       ``(A) the regular tax liability of the taxpayer for such 
     taxable year reduced by the sum of the credits allowable 
     under subparts A, B, D, E, and F of this part, over
       ``(B) the tentative minimum tax for the taxable year.
       ``(2) Taxable years beginning after 2006.--In the case of 
     any taxable year beginning after December 31, 2006, the 
     credit allowable under subsection (a) to a taxpayer other 
     than a corporation for any taxable year shall not exceed 90 
     percent of the regular tax liability of the taxpayer for such 
     taxable year reduced by the sum of the credits allowable 
     under subparts A, B, D, E, and F of this part.''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2006.
                                 ______
                                 
  SA 2551. Mr. BROWN (for himself and Mr. Voinovich) submitted an 
amendment intended to be proposed to amendment SA 2530 proposed by Mr. 
Baucus (for himself, Mr. Grassley, Mr. Rockefeller, and Mr. Hatch) to 
the bill H.R. 976, to amend the Internal Revenue Code of 1986 to 
provide tax relief for small businesses, and for other purposes; which 
was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. LIMITING TO CLASS II NARCOTICS THE REQUIRED USE OF 
                   TAMPER-RESISTANT PRESCRIPTION PADS UNDER 
                   MEDICAID.

       (a) In General.--Effective as if included in the enactment 
     of section 1903(i)(23) (42 U.S.C. 1396b(i)(23)), as added by 
     section 7002(b) of the U.S. Troop Readiness, Veterans' Care, 
     Katrina Recovery, and Iraq Accountability Appropriations Act, 
     2007 (Public Law 110-28), such section is amended by 
     inserting ``which

[[Page 21726]]

     are narcotic drugs included in schedule II of section 202 of 
     the Controlled Substances Act (21 U.S.C. 812) and'' after 
     ``1927(k)(2))''.
       (b) Delay in Effective Date for Requirement.--Effective as 
     if included in the enactment of section 7002(b) of the U.S. 
     Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq 
     Accountability Appropriations Act, 2007 (Public Law 110-28), 
     paragraph (2) of such section is amended by striking 
     ``September 30, 2007'' and inserting ``March 31, 2009''.
                                 ______
                                 
  SA 2552. Mr. SMITH (for himself and Mr. Kohl) submitted an amendment 
intended to be proposed to amendment SA 2530 proposed by Mr. Baucus 
(for himself, Mr. Grassley, Mr. Rockefeller, and Mr. Hatch) to the bill 
H.R. 976, to amend the Internal Revenue Code of 1986 to provide tax 
relief for small businesses, and for other purposes; which was ordered 
to lie on the table; as follows:

       At the end, insert the following:
       (_) SSI Extensions for Humanitarian Immigrants; Collection 
     of Unemployment Compensation Debts Resulting From Fraud.--
       (1) SSI extensions for humanitarian immigrants.--Section 
     402(a)(2) of the Personal Responsibility and Work Opportunity 
     Reconciliation Act of 1996 (8 U.S.C. 1612(a)(2)) is amended 
     by adding at the end the following:
       ``(M) SSI extensions through fiscal year 2010.--
       ``(i) Two-year extension.--

       ``(I) In general.--Except as provided in clause (ii), with 
     respect to eligibility for benefits for the specified Federal 
     program described in paragraph (3)(A), the 7-year period 
     described in subparagraph (A) shall be deemed to be a 9-year 
     period during fiscal years 2008 through 2010.
       ``(II) Aliens whose benefits ceased in prior fiscal 
     years.--

       ``(aa) In general.--Beginning on the date of the enactment 
     of the SSI Extension for Elderly and Disabled Refugees Act, 
     any qualified alien rendered ineligible for the specified 
     Federal program described in paragraph (3)(A) during fiscal 
     years prior to fiscal year 2008 solely by reason of the 
     termination of the 7-year period described in subparagraph 
     (A) shall be eligible for such program for an additional 2-
     year period in accordance with this clause, if such alien 
     meets all other eligibility factors under title XVI of the 
     Social Security Act.
       ``(bb) Payment of benefits.--Benefits paid under item (aa) 
     shall be paid prospectively over the duration of the 
     qualified alien's renewed eligibility.
       ``(ii) Pending naturalization application.--With respect to 
     eligibility for benefits for the specified program described 
     in paragraph (3)(A), subsection (a)(1) shall not apply during 
     fiscal years 2008 through 2010 to an alien described in one 
     of clauses (i) through (v) of subparagraph (A), if the alien 
     has submitted an application for naturalization that is 
     pending before the Secretary of Homeland Security, and such 
     submission is verified by the Commissioner of Social Security 
     either by receiving a receipt number from the alien for such 
     submitted application or by receiving confirmation from the 
     Secretary of Homeland Security.''.
       (2) Collection of unemployment compensation debts resulting 
     from fraud.--
       (A) In general.--Section 6402 of the Internal Revenue Code 
     (relating to authority to make credits or refunds) is amended 
     by redesignating subsections (f) through (k) as subsections 
     (g) through (l), respectively, and by inserting after 
     subsection (e) the following new subsection:
       ``(f) Collection of Unemployment Compensation Debts 
     Resulting From Fraud.--
       ``(1) In general.--Upon receiving notice from any State 
     that a named person owes a covered unemployment compensation 
     debt to such State, the Secretary shall, under such 
     conditions as may be prescribed by the Secretary--
       ``(A) reduce the amount of any overpayment payable to such 
     person by the amount of such covered unemployment 
     compensation debt;
       ``(B) pay the amount by which such overpayment is reduced 
     under subparagraph (A) to such State and notify such State of 
     such person's name, taxpayer identification number, address, 
     and the amount collected; and
       ``(C) notify the person making such overpayment that the 
     overpayment has been reduced by an amount necessary to 
     satisfy a covered unemployment compensation debt.
     If an offset is made pursuant to a joint return, the notice 
     under subparagraph (B) shall include the names, taxpayer 
     identification numbers, and addresses of each person filing 
     such return and the notice under subparagraph (C) shall 
     include information related to the rights of a spouse of a 
     person subject to such an offset.
       ``(2) Priorities for offset.--Any overpayment by a person 
     shall be reduced pursuant to this subsection--
       ``(A) after such overpayment is reduced pursuant to--
       ``(i) subsection (a) with respect to any liability for any 
     internal revenue tax on the part of the person who made the 
     overpayment;
       ``(ii) subsection (c) with respect to past-due support; and
       ``(iii) subsection (d) with respect to any past-due, 
     legally enforceable debt owed to a Federal agency; and
       ``(B) before such overpayment is credited to the future 
     liability for any Federal internal revenue tax of such person 
     pursuant to subsection (b).

     If the Secretary receives notice from a State or States of 
     more than one debt subject to paragraph (1) or subsection (e) 
     that is owed by a person to such State or States, any 
     overpayment by such person shall be applied against such 
     debts in the order in which such debts accrued.
       ``(3) Notice; consideration of evidence.--No State may take 
     action under this subsection until such State--
       ``(A) notifies the person owing the covered unemployment 
     compensation debt that the State proposes to take action 
     pursuant to this section;
       ``(B) provides such person at least 60 days to present 
     evidence that all or part of such liability is not legally 
     enforceable or due to fraud;
       ``(C) considers any evidence presented by such person and 
     determines that an amount of such debt is legally enforceable 
     and due to fraud; and
       ``(D) satisfies such other conditions as the Secretary may 
     prescribe to ensure that the determination made under 
     subparagraph (C) is valid and that the State has made 
     reasonable efforts to obtain payment of such covered 
     unemployment compensation debt.
       ``(4) Covered unemployment compensation debt.--For purposes 
     of this subsection, the term `covered unemployment 
     compensation debt' means--
       ``(A) a past-due debt for erroneous payment of unemployment 
     compensation due to fraud which has become final under the 
     law of a State certified by the Secretary of Labor pursuant 
     to section 3304 and which remains uncollected;
       ``(B) contributions due to the unemployment fund of a State 
     for which the State has determined the person to be liable 
     due to fraud; and
       ``(C) any penalties and interest assessed on such debt.
       ``(5) Regulations.--
       ``(A) In general.--The Secretary may issue regulations 
     prescribing the time and manner in which States must submit 
     notices of covered unemployment compensation debt and the 
     necessary information that must be contained in or accompany 
     such notices. The regulations may specify the minimum amount 
     of debt to which the reduction procedure established by 
     paragraph (1) may be applied.
       ``(B) Fee payable to secretary.--The regulations may 
     require States to pay a fee to the Secretary, which may be 
     deducted from amounts collected, to reimburse the Secretary 
     for the cost of applying such procedure. Any fee paid to the 
     Secretary pursuant to the preceding sentence shall be used to 
     reimburse appropriations which bore all or part of the cost 
     of applying such procedure.
       ``(C) Submission of notices through secretary of labor.--
     The regulations may include a requirement that States submit 
     notices of covered unemployment compensation debt to the 
     Secretary via the Secretary of Labor in accordance with 
     procedures established by the Secretary of Labor. Such 
     procedures may require States to pay a fee to the Secretary 
     of Labor to reimburse the Secretary of Labor for the costs of 
     applying this subsection. Any such fee shall be established 
     in consultation with the Secretary of the Treasury. Any fee 
     paid to the Secretary of Labor may be deducted from amounts 
     collected and shall be used to reimburse the appropriation 
     account which bore all or part of the cost of applying this 
     subsection.
       ``(6) Erroneous payment to state.--Any State receiving 
     notice from the Secretary that an erroneous payment has been 
     made to such State under paragraph (1) shall pay promptly to 
     the Secretary, in accordance with such regulations as the 
     Secretary may prescribe, an amount equal to the amount of 
     such erroneous payment (without regard to whether any other 
     amounts payable to such State under such paragraph have been 
     paid to such State).''.
       (B) Disclosure of certain information to states requesting 
     refund offsets for legally enforceable state unemployment 
     compensation debt resulting from fraud.--
       (i) General rule.--Paragraph (3) of section 6103(a) of such 
     Code is amended by inserting ``(10),'' after ``(6),''.
       (ii) Disclosure to department of labor and its agent.--
     Paragraph (10) of section 6103(l) of such Code is amended--

       (I) by striking ``(c), (d), or (e)'' each place it appears 
     in the heading and text and inserting ``(c), (d), (e), or 
     (f)'',
       (II) in subparagraph (A) by inserting ``, to officers and 
     employees of the Department of Labor and its agent for 
     purposes of facilitating the exchange of data in connection 
     with a request made under subsection (f)(5) of section 
     6402,'' after ``section 6402'', and
       (III) in subparagraph (B) by inserting ``, and any agents 
     of the Department of Labor,'' after ``agency'' the first 
     place it appears.

       (iii) Safeguards.--Paragraph (4) of section 6103(p) of such 
     Code is amended--

[[Page 21727]]

       (I) in the matter preceding subparagraph (A), by striking 
     ``(l)(16),'' and inserting ``(l)(10), (16),'';
       (II) in subparagraph (F)(i), by striking ``(l)(16),'' and 
     inserting ``(l)(10), (16),''; and
       (III) in the matter following subparagraph (F)(iii)--

       (aa) in each of the first two places it appears, by 
     striking ``(l)(16),'' and inserting ``(l)(10), (16),'';
       (bb) by inserting ``(10),'' after ``paragraph (6)(A),''; 
     and
       (cc) in each of the last two places it appears, by striking 
     ``(l)(16)'' and inserting ``(l)(10) or (16)''.
       (C) Expenditures from state fund.--Section 3304(a)(4) of 
     such Code is amended--
       (i) in subparagraph (E), by striking ``and'' after the 
     semicolon;
       (ii) in subparagraph (F), by inserting ``and'' after the 
     semicolon; and
       (iii) by adding at the end the following new subparagraph:
       ``(G) with respect to amounts of covered unemployment 
     compensation debt (as defined in section 6402(f)(4)) 
     collected under section 6402(f)--
       ``(i) amounts may be deducted to pay any fees authorized 
     under such section; and
       ``(ii) the penalties and interest described in section 
     6402(f)(4)(B) may be transferred to the appropriate State 
     fund into which the State would have deposited such amounts 
     had the person owing the debt paid such amounts directly to 
     the State;''.
       (D) Conforming amendments.--
       (i) Subsection (a) of section 6402 of such Code is amended 
     by striking ``(c), (d), and (e),'' and inserting ``(c), (d), 
     (e), and (f)''.
       (ii) Paragraph (2) of section 6402(d) of such Code is 
     amended by striking ``and before such overpayment is reduced 
     pursuant to subsection (e)'' and inserting ``and before such 
     overpayment is reduced pursuant to subsections (e) and (f)''.
       (iii) Paragraph (3) of section 6402(e) of such Code is 
     amended in the last sentence by inserting ``or subsection 
     (f)'' after ``paragraph (1)''.
       (iv) Subsection (g) of section 6402 of such Code, as 
     redesignated by subsection (a), is amended by striking ``(c), 
     (d), or (e)'' and inserting ``(c), (d), (e), or (f)''.
       (v) Subsection (i) of section 6402 of such Code, as 
     redesignated by subsection (a), is amended by striking 
     ``subsection (c) or (e)'' and inserting ``subsection (c), 
     (e), or (f)''.
       (E) Effective date.--The amendments made by this paragraph 
     shall apply to refunds payable under section 6402 of the 
     Internal Revenue Code of 1986 on or after the date of 
     enactment of this Act.
                                 ______
                                 
  SA 2553. Mr. SMITH submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 217, after line 25, insert the following:

     SEC. _. MODIFICATIONS TO SOCIAL SECURITY ACT TO ENCOURAGE THE 
                   INCLUSION OF INDIVIDUALS WITH DISABILITIES IN 
                   WORK PROGRAMS.

       (a) Authorization of Modified Employability Plan for 
     Individuals With Disabilities.--
       (1) In general.--Section 407(c)(2) of the Social Security 
     Act (42 U.S.C. 607(c)(2)) is amended by adding at the end the 
     following new subparagraph:
       ``(E) Individuals with disabilities complying with a 
     modified employability plan deemed to be meeting work 
     participation requirements.--
       ``(i) Modified employability plan.--A State may develop a 
     modified employability plan for an adult or minor child head 
     of household recipient of assistance who has been determined 
     by a qualified medical, mental health, addiction, or social 
     services professional (as determined by the State) to have a 
     disability, or who is caring for a family member with a 
     disability (as so determined). The modified employability 
     plan shall--

       ``(I) include a determination that, because of the 
     disability of the recipient or the individual for whom the 
     recipient is caring, reasonable modification of work 
     activities, hourly participation requirements, or both, is 
     needed in order for the recipient to participate in work 
     activities;
       ``(II) set forth the modified work activities in which the 
     recipient is required to participate;
       ``(III) set forth the number of hours per week for which 
     the recipient is required to participate in such modified 
     work activities based on the State's evaluation of the 
     family's circumstances;
       ``(IV) set forth the services, supports, and modifications 
     that the State will provide to the recipient or the 
     recipient's family;
       ``(V) be developed in cooperation with the recipient; and
       ``(VI) be reviewed not less than every 6 months.

       ``(ii) Inclusion in monthly participation rates.--For the 
     purpose of determining monthly participation rates under 
     subsection (b)(1)(B)(i), and notwithstanding paragraphs (1), 
     (2)(A), (2)(B), (2)(C), and (2)(D) of this subsection and 
     subsection (d) of this section, a recipient is deemed to be 
     engaged in work for a month in a fiscal year if--

       ``(I) the State has determined that the recipient is in 
     substantial compliance with activities and hourly 
     participation requirements set forth in a modified 
     employability plan that meets the requirements set forth in 
     clause (i); and
       ``(II) the State complies with the reporting requirement 
     set forth in clause (iii) for the fiscal year in which the 
     month occurs.

       ``(iii) Reports.--

       ``(I) Report by state.--With respect to any fiscal year for 
     which a State counts a recipient as engaged in work pursuant 
     to a modified employability plan, the State shall submit a 
     report entitled `Annual State Report on TANF Recipients 
     Participating in Work Activities Pursuant to Modified 
     Employability Plans Due to Disability' to the Secretary not 
     later than March 31 of the succeeding fiscal year. The report 
     shall provide the following information:

       ``(aa) The aggregate number of recipients with modified 
     employability plans due to a disability.
       ``(bb) The percentage of all recipients with modified 
     employability plans who substantially complied with 
     activities set forth in the plans each month of the fiscal 
     year.
       ``(cc) Information regarding the most prevalent types of 
     physical and mental impairments that provided the basis for 
     the disability determinations.
       ``(dd) The percentage of cases with a modified 
     employability plan in which the recipient had a disability, 
     was caring for a child with a disability, or was caring for 
     another family member with a disability.
       ``(ee) A description of the most prevalent types of 
     modification in work activities or hours of participation 
     that were included in the modified employability plans.
       ``(ff) A description of the qualifications of the staff who 
     determined whether individuals had a disability, of the staff 
     who determined that individuals needed modifications to their 
     work requirements, and of the staff who developed the 
     modified employability plans.

       ``(II) Report by secretary.--The Secretary shall submit an 
     annual report to Congress entitled `Efforts in State TANF 
     Programs to Promote and Support Employment for Individuals 
     with Disabilities' not later than July 31 of each fiscal year 
     that includes information on State efforts to engage 
     individuals with disabilities in work activities for the 
     preceding fiscal year. The report shall include the 
     following:

       ``(aa) The number of individuals for whom each State has 
     developed a modified employability plan.
       ``(bb) The types of physical and mental impairments that 
     provided the basis for the disability determination, and 
     whether the individual with the disability was an adult 
     recipient or minor child head of household, a child, or a 
     non-recipient family member.
       ``(cc) The types of modifications that States have included 
     in modified employability plans.
       ``(dd) The extent to which individuals with a modified 
     employability plan are participating in work activities.
       ``(ee) An analysis of the extent to which the option to 
     establish such modified employability plans was a factor in 
     States' achieving or not achieving the minimum participation 
     rates under subsection (a) for the fiscal year.
       ``(iv) Definitions.--

       ``(I) Disability.--For purposes of this subparagraph, the 
     term `disability' means a mental or physical impairment, 
     including substance abuse or addiction, that--

       ``(aa) constitutes or results in a substantial impediment 
     to employment; or
       ``(bb) substantially limits 1 or more major life 
     activities.

       ``(II) Modified work activities.--For purposes of this 
     subparagraph, the term `modified work activities' means 
     activities the State has determined will help the recipient 
     become employable and which are not subject to and do not 
     count against the limitations and requirements under the 
     preceding provisions of this subsection and of subsection 
     (d).''.

       (2) Effective date.--The amendments made by this subsection 
     shall take effect on October 1, 2007.
       (b) State Option to Exclude SSI Applicants in Work 
     Participation Rate.--
       (1) In general.--Section 407(b)(5) of the Social Security 
     Act (42 U.S.C. 607(b)(5)) is amended by striking ``at its 
     option, not require an individual'' and all that follows and 
     inserting ``at its option--
       ``(A) not require an individual who is a single custodial 
     parent caring for a child who has not attained 12 months of 
     age to engage in work, and may disregard such an individual 
     in determining the participation rates under subsection (a) 
     of this section for not more than 12 months;
       ``(B) disregard for purposes of determining such rates for 
     any month, on a case-by-case basis, an individual who is an 
     applicant for or a recipient of supplemental security income 
     benefits under title XVI or of social security disability 
     insurance benefits under title II, if--

[[Page 21728]]

       ``(i) the State has determined that an application for such 
     benefits has been filed by or on behalf of the individual;
       ``(ii) the State has determined that there is a reasonable 
     basis to conclude that the individual meets the disability or 
     blindness criteria applied under title II or XVI;
       ``(iii) there has been no final decision (including a 
     decision for which no appeal is pending at the administrative 
     or judicial level or for which the time period for filing 
     such an appeal has expired) denying benefits; and
       ``(iv) not less than every 6 months, the State reviews the 
     status of such application and determines that there is a 
     reasonable basis to conclude that the individual continues to 
     meet the disability or blindness criteria under title II or 
     XVI; and
       ``(C) disregard for purposes of determining such rates for 
     any month, on a case-by-case basis, an individual who the 
     State has determined would meet the disability criteria for 
     supplemental security income benefits under title XVI or 
     social security disability insurance benefits under title II 
     but for the requirement that the disability has lasted or is 
     expected to last for a continuous period of not less than 12 
     months.''.
       (2) Effective date.--The amendments made by this subsection 
     shall take effect on October 1, 2007.
                                 ______
                                 
  SA 2554. Mrs. DOLE submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 217, after line 25, add the following:

     SEC. __. BUDGET POINT OF ORDER AGAINST LEGISLATION THAT 
                   RAISES EXCISE TAX RATES.

       Title III of the Congressional Budget Act of 1974 is 
     amended by adding at the end the following:


          ``POINT OF ORDER AGAINST RAISES IN EXCISE TAX RATES

       ``Sec. 316.  (a) In General.--It shall not be in order in 
     the Senate to consider any bill, resolution, amendment, 
     amendment between Houses, motion, or conference report that 
     includes a Federal excise tax rate increase which 
     disproportionately affects taxpayers with earned income of 
     less than 200 percent of the Federal poverty level, as 
     determined by the Joint Committee on Taxation. In this 
     subsection, the term `Federal excise tax rate increase' means 
     any amendment to any section in subtitle D or E of the 
     Internal Revenue Code of 1986, that imposes a new percentage 
     or amount as a rate of tax and thereby increases the amount 
     of tax imposed by any such section.
       ``(b) Supermajority Waiver and Appeal.--
       ``(1) Waiver.--This section may be waived or suspended in 
     the Senate only by an affirmative vote of three-fifths of the 
     Members, duly chosen and sworn.
       ``(2) Appeal.--An affirmative vote of three-fifths of the 
     Members of the Senate, duly chosen and sworn, shall be 
     required in the Senate to sustain an appeal of the ruling of 
     the Chair on a point of order raised under this section.''.
                                 ______
                                 
  SA 2555. Mrs. DOLE submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 217, after line 25, insert the following:

     SEC. 61_. CREDIT FOR TRANSPORTATION OF FOOD FOR CHARITABLE 
                   PURPOSES.

       (a) In General.--Subpart B of part IV of subchapter A of 
     chapter 1 of the Internal Revenue Code of 1986 is amended by 
     adding at the end the following new section:

     ``SEC. 30D. CREDIT FOR TRANSPORTATION OF FOOD FOR CHARITABLE 
                   PURPOSES.

       ``(a) Allowance of Credit.--There shall be allowed as a 
     credit against the tax imposed by this chapter for the 
     taxable year an amount equal to 25 cents for each mile for 
     which the taxpayer uses a qualified truck for a qualified 
     charitable purpose during the taxable year.
       ``(b) Qualified Charitable Purpose.--For purposes of this 
     section, the term `qualified charitable purpose' means the 
     transportation of food in connection with the hunger relief 
     efforts of an organization which is described in section 
     501(c)(3) and is exempt from taxation under section 501(a) 
     (other than a private foundation, as defined in section 
     509(a), which is not an operating foundation, as defined in 
     section 4942(j)(3)).
       ``(c) Qualified Truck.--For purposes of this section, the 
     term `qualified truck' means a truck which--
       ``(1) has a capacity of not less than 1,760 cubic square 
     feet,
       ``(2) is owned, leased, or operated by the taxpayer, and
       ``(3) is ordinarily used for hauling property in the course 
     of a business.
       ``(d) Other Rules.--
       ``(1) Denial of double benefit.--No credit shall be allowed 
     under this section with respect to any amount for which a 
     deduction is allowed under any other provision of this 
     chapter.
       ``(2) No credit where taxpayer is compensated.--No credit 
     shall be allowed under this section if the taxpayer receives 
     compensation in connection with the use of the qualified 
     truck for the qualified charitable purpose.
       ``(3) Capacity requirement.--No credit shall be allowed 
     under this section unless at least 50 percent of the hauling 
     capacity of the qualified truck (measured in cubic square 
     feet) is used for the qualified charitable purpose.''.
       (b) Conforming Amendment.--The table of sections for 
     subpart B of part IV of subchapter A of chapter 1 of the 
     Internal Revenue Code of 1986 is amended by adding at the end 
     the following new item:

``Sec. 30D. Credit for transportation of food for charitable 
              purposes.''.

       (c) Effective Date.--The amendments made by this section 
     shall apply to taxable years ending after December 31, 2007.
                                 ______
                                 
  SA 2556. Mrs. CLINTON (for herself, Mrs. Dole, Ms. Mikulski, Mr. 
Graham, Mr. Brown, and Mrs. Boxer) submitted an amendment intended to 
be proposed to amendment SA 2530 proposed by Mr. Baucus (for himself, 
Mr. Grassley, Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to 
amend the Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the end of title VI, insert the following:

     SEC. __. MILITARY FAMILY AND MEDICAL LEAVE ACT.

       (a) Short Title.--This section may be cited as the 
     ``Military Family and Medical Leave Act''.
       (b) Definitions.--Section 101 of the Family and Medical 
     Leave Act of 1993 (29 U.S.C. 2611) is amended by adding at 
     the end the following:
       ``(14) Active duty.--The term `active duty' means duty 
     under a call or order to active duty under a provision of law 
     referred to in section 101(a)(13)(B) of title 10, United 
     States Code.
       ``(15) Covered servicemember.--The term `covered 
     servicemember' means a member of the Armed Forces, including 
     a member of the National Guard or a Reserve, who is 
     undergoing medical treatment, recuperation, or therapy, or is 
     otherwise in medical hold or medical holdover status, for a 
     serious injury or illness.
       ``(16) Medical hold or medical holdover status.--The term 
     `medical hold or medical holdover status' means--
       ``(A) the status of a member of the Armed Forces, including 
     a member of the National Guard or a Reserve, assigned or 
     attached to a military hospital for medical care; and
       ``(B) the status of a member of a reserve component of the 
     Armed Forces who is separated, whether pre-deployment or 
     post-deployment, from the member's unit while in need of 
     health care based on a medical condition identified while the 
     member is on active duty in the Armed Forces.
       ``(17) Serious injury or illness.--The term `serious injury 
     or illness', in the case of a member of the Armed Forces, 
     means an injury or illness incurred by the member in line of 
     duty on active duty in the Armed Forces that may render the 
     member medically unfit to perform the duties of the member's 
     office, grade, rank, or rating.''.
       (c) Military Family and Medical Leave.--
       (1) Entitlement to leave.--Section 102(a) of such Act (29 
     U.S.C. 2612(a)) is amended by adding at the end the 
     following:
       ``(3) Military family and medical leave.--Subject to 
     section 103, an eligible employee shall be entitled to a 
     total of 26 workweeks of leave during a 12-month period to 
     care for a covered servicemember who is the spouse, son, 
     daughter, or parent of the employee. The leave described in 
     this paragraph shall only be available during a single 12-
     month period.
       ``(4) Combined leave total.--During the single 12-month 
     period described in paragraph (3), an eligible employee shall 
     be entitled to a combined total of 26 workweeks of leave 
     under paragraphs (1) and (3). Nothing in this paragraph shall 
     be construed to limit the availability of leave under 
     paragraph (1) during any other 12-month period.''.
       (2) Schedule.--Section 102(b) of such Act (29 U.S.C. 
     2612(b)) is amended--
       (A) in paragraph (1), in the second sentence--
       (i) by striking ``section 103(b)(5)'' and inserting 
     ``subsection (b)(5) or (f) (as appropriate) of section 103''; 
     and
       (ii) by inserting ``or under subsection (a)(3)'' after 
     ``subsection (a)(1)''; and
       (B) in paragraph (2), by inserting ``or under subsection 
     (a)(3)'' after ``subsection (a)(1)''.
       (3) Substitution of paid leave.--Section 102(d) of such Act 
     (29 U.S.C. 2612(d)) is amended--

[[Page 21729]]

       (A) in paragraph (1)--
       (i) by inserting ``(or 26 workweeks in the case of leave 
     provided under subsection (a)(3))'' after ``12 workweeks'' 
     the first place it appears; and
       (ii) by inserting ``(or 26 workweeks, as appropriate)'' 
     after ``12 workweeks'' the second place it appears; and
       (B) in paragraph (2)--
       (i) in subparagraph (A), by adding at the end the 
     following: ``An eligible employee may elect, or an employer 
     may require the employee, to substitute any of the accrued 
     paid vacation leave, personal leave, or family leave of the 
     employee for leave provided under subsection (a)(3) for any 
     part of the 26-week period of such leave under such 
     subsection.''; and
       (ii) in subparagraph (B), by adding at the end the 
     following: ``An eligible employee may elect, or an employer 
     may require the employee, to substitute any of the accrued 
     paid vacation leave, personal leave, or medical or sick leave 
     of the employee for leave provided under subsection (a)(3) 
     for any part of the 26-week period of such leave under such 
     subsection.''.
       (4) Notice.--Section 102(e)(2) of such Act (29 U.S.C. 
     2612(e)(2)) is amended by inserting ``or under subsection 
     (a)(3)'' after ``subsection (a)(1)''.
       (5) Spouses employed by same employer.--Section 102(f) of 
     such Act (29 U.S.C. 2612(f)) is amended--
       (A) by redesignating paragraphs (1) and (2) as 
     subparagraphs (A) and (B), and aligning the margins of the 
     subparagraphs with the margins of section 102(e)(2)(A);
       (B) by striking ``In any'' and inserting the following:
       ``(1) In general.--In any''; and
       (C) by adding at the end the following:
       ``(2) Military family and medical leave.--
       ``(A) In general.--The aggregate number of workweeks of 
     leave to which both that husband and wife may be entitled 
     under subsection (a) may be limited to 26 workweeks during 
     the single 12-month period described in subsection (a)(3) if 
     the leave is--
       ``(i) leave under subsection (a)(3); or
       ``(ii) a combination of leave under subsection (a)(3) and 
     leave described in paragraph (1).
       ``(B) Both limitations applicable.--If the leave taken by 
     the husband and wife includes leave described in paragraph 
     (1), the limitation in paragraph (1) shall apply to the leave 
     described in paragraph (1).''.
       (d) Certification.--Section 103 of such Act (29 U.S.C. 
     2613) is amended by adding at the end the following:
       ``(f) Certification for Military Family and Medical 
     Leave.--An employer may require that a request for leave 
     under section 102(a)(3) be supported by a certification 
     issued at such time and in such manner as the Secretary may 
     by regulation prescribe.''.
       (e) Failure to Return.--Section 104(c) of such Act (29 
     U.S.C. 2614(c)) is amended--
       (1) in paragraph (2)(B)(i), by inserting ``or under section 
     102(a)(3)'' before the semicolon; and
       (2) in paragraph (3)(A)--
       (A) in clause (i), by striking ``or'' at the end;
       (B) in clause (ii), by striking the period and inserting 
     ``; or''; and
       (C) by adding at the end the following:
       ``(iii) a certification issued by the health care provider 
     of the son, daughter, spouse, or parent of the employee, as 
     appropriate, in the case of an employee unable to return to 
     work because of a condition specified in section 
     102(a)(3).''.
       (f) Enforcement.--Section 107 of such Act (29 U.S.C. 2617) 
     is amended, in subsection (a)(1)(A)(i)(II), by inserting 
     ``(or 26 weeks, in a case involving leave under section 
     102(a)(3))'' after ``12 weeks''.
       (g) Instructional Employees.--Section 108 of such Act (29 
     U.S.C. 2618) is amended, in subsections (c)(1), (d)(2), and 
     (d)(3), by inserting ``or under section 102(a)(3)'' after 
     ``section 102(a)(1)''.
                                 ______
                                 
  SA 2557. Mr. SPECTER submitted an amendment intended to be proposed 
to amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 217, after line 25, insert the following:

     SEC. 61_. REDUCTION IN RATE OF TENTATIVE MINIMUM TAX FOR 
                   NONCORPORATE TAXPAYERS.

       (a) In General.--Clause (i) of section 55(b)(1)(A) of the 
     Internal Revenue Code of 1986 (relating to noncorporate 
     taxpayers) is amended to read as follows:
       ``(i) In general.--In the case of a taxpayer other than a 
     corporation, the tentative minimum tax for the taxable year 
     is--

       ``(I) 24 percent of the taxable excess, reduced by
       ``(II) the alternative minimum tax foreign tax credit for 
     the taxable year.''.

       (b) Conforming Amendment.--Subparagraph (A) of section 
     55(b)(1) of such Code is amended by striking clause (iii).
       (c) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2006.
                                 ______
                                 
  SA 2558. Mr. GRAHAM submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       Beginning on page 218, strike line 5 and all that follows 
     through page 220, line 2, and insert the following:
       (a) Cigars.--Section 5701(a) of the Internal Revenue Code 
     of 1986 is amended--
       (1) by striking ``($1.594 cents per thousand on cigars 
     removed during 2000 or 2001)'' in paragraph (1) and inserting 
     ``($50.00 per thousand on cigars removed after December 31, 
     2007, and before October 1, 2012)'',
       (2) by striking ``(18.063 percent on cigars removed during 
     2000 or 2001)'' in paragraph (2) and inserting ``(53.13 
     percent on cigars removed after December 31, 2007, and before 
     October 1, 2012)'', and
       (3) by striking ``($42.50 per thousand on cigars removed 
     during 2000 or 2001)'' in paragraph (2) and inserting 
     ``($10.00 per thousand on cigars removed after December 31, 
     2007, and before October 1, 2012)''.
       (b) Cigarettes.--Section 5701(b) of such Code is amended--
       (1) by striking ``($17 per thousand on cigarettes removed 
     during 2000 or 2001)'' in paragraph (1) and inserting 
     ``($50.00 per thousand on cigarettes removed after December 
     31, 2007, and before October 1, 2012)'', and
       (2) by striking ``($35.70 per thousand on cigarettes 
     removed during 2000 or 2001)'' in paragraph (2) and inserting 
     ``($104.9999 per thousand on cigarettes removed after 
     December 31, 2007, and before October 1, 2012)''.
       (c) Cigarette Papers.--Section 5701(c) of such Code is 
     amended by striking ``(1.06 cents on cigarette papers removed 
     during 2000 or 2001)'' and inserting ``(3.13 cents on 
     cigarette papers removed after December 31, 2007, and before 
     October 1, 2012)''.
       (d) Cigarette Tubes.--Section 5701(d) of such Code is 
     amended by striking ``(2.13 cents on cigarette tubes removed 
     during 2000 or 2001)'' and inserting ``(6.26 cents on 
     cigarette tubes removed after December 31, 2007, and before 
     October 1, 2012)''.
       (e) Smokeless Tobacco.--Section 5701(e) of such Code is 
     amended--
       (1) by striking ``(51 cents on snuff removed during 2000 or 
     2001)'' in paragraph (1) and inserting ``($1.50 on snuff 
     removed after December 31, 2007, and before October 1, 
     2012)'', and
       (2) by striking ``(17 cents on chewing tobacco removed 
     during 2000 or 2001)'' in paragraph (2) and inserting ``(50 
     cents on chewing tobacco removed after December 31, 2007, and 
     before October 1, 2012)''.
       (f) Pipe Tobacco.--Section 5701(f) of such Code is amended 
     by striking ``(95.67 cents on pipe tobacco removed during 
     2000 or 2001)'' and inserting ``($2.8126 on pipe tobacco 
     removed after December 31, 2007, and before October 1, 
     2012)''.
       (g) Roll-Your-Own Tobacco.--Section 5701(g) of such Code is 
     amended by striking ``(95.67 cents on roll-your-own tobacco 
     removed during 2000 or 2001)'' and inserting ``($8.8889 on 
     roll-your-own tobacco removed after December 31, 2007, and 
     before October 1, 2012)''.
                                 ______
                                 
  SA 2559. Mr. GRAHAM submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 217, after line 25, insert the following:

     SEC. __. EXTENSION OF ELECTION TO INCLUDE COMBAT PAY AS 
                   INCOME FOR PURPOSES OF THE EARNED INCOME TAX 
                   CREDIT.

       Paragraph (2)(B)(vi) of section 32(c) of the Internal 
     Revenue Code of 1986 (relating to earned income) is amended 
     by striking ``ending--'' and all that follows through the 
     period and inserting ``ending after the date of the enactment 
     of this clause, a taxpayer may elect to treat amounts 
     excluded from gross income by reason of section 112 as earned 
     income.''.
                                 ______
                                 
  SA 2560. Mr. DODD submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the end of title VI, add the following:

     SEC. 610. FAMILY LEAVE FOR CAREGIVERS OF MEMBERS OF THE ARMED 
                   FORCES WITH COMBAT-RELATED INJURIES.

       (a) Servicemember Family Leave.--
       (1) Definitions.--Section 101 of the Family and Medical 
     Leave Act of 1993 (29 U.S.C. 2611)

[[Page 21730]]

     is amended by adding at the end the following:
       ``(14) Combat-related injury.--The term `combat-related 
     injury' means an injury or illness that was incurred (as 
     determined under criteria prescribed by the Secretary of 
     Defense)--
       ``(A) as a direct result of armed conflict;
       ``(B) while an individual was engaged in hazardous service;
       ``(C) in the performance of duty under conditions 
     simulating war; or
       ``(D) through an instrumentality of war.
       ``(15) Servicemember.--The term `servicemember' means a 
     member of the Armed Forces.''.
       (2) Entitlement to leave.--Section 102(a) of such Act (29 
     U.S.C. 2612(a)) is amended by adding at the end the 
     following:
       ``(3) Servicemember family leave.--Subject to section 103, 
     an eligible employee who is the primary caregiver for a 
     servicemember with a combat-related injury shall be entitled 
     to a total of 26 workweeks of leave during any 12-month 
     period to care for the servicemember.
       ``(4) Combined leave total.--An eligible employee shall be 
     entitled to a combined total of 26 workweeks of leave under 
     paragraphs (1) and (3).''.
       (3) Requirements relating to leave.--
       (A) Schedule.--Section 102(b) of such Act (29 U.S.C. 
     2612(b)) is amended--
       (i) in paragraph (1), by inserting after the second 
     sentence the following: ``Subject to paragraph (2), leave 
     under subsection (a)(3) may be taken intermittently or on a 
     reduced leave schedule''; and
       (ii) in paragraph (2), by inserting ``or subsection 
     (a)(3)'' after ``subsection (a)(1)''.
       (B) Substitution of paid leave.--Section 102(d) of such Act 
     (29 U.S.C. 2612(d)) is amended--
       (i) in paragraph (1)--

       (I) by inserting ``(or 26 workweeks in the case of leave 
     provided under subsection (a)(3))'' after ``12 workweeks'' 
     the first place it appears; and
       (II) by inserting ``(or 26 workweeks, as appropriate)'' 
     after ``12 workweeks'' the second place it appears; and

       (ii) in paragraph (2)(B), by adding at the end the 
     following: ``An eligible employee may elect, or an employer 
     may require the employee, to substitute any of the accrued 
     paid vacation leave, personal leave, family leave, or medical 
     or sick leave of the employee for leave provided under 
     subsection (a)(3) for any part of the 26-week period of such 
     leave under such subsection.''.
       (C) Notice.--Section 102(e) of such Act (29 U.S.C. 2612(e)) 
     is amended by adding at the end the following:
       ``(3) Notice for servicemember family leave.--In any case 
     in which an employee seeks leave under subsection (a)(3), the 
     employee shall provide such notice as is practicable.''.
       (D) Certification.--Section 103 of such Act (29 U.S.C. 
     2613) is amended by adding at the end the following:
       ``(f) Certification for Servicemember Family Leave.--An 
     employer may require that a request for leave under section 
     102(a)(3) be supported by a certification issued at such time 
     and in such manner as the Secretary may by regulation 
     prescribe.''.
       (E) Failure to return.--Section 104(c) of such Act (29 
     U.S.C. 2614(c)) is amended--
       (i) in paragraph (2)(B)(i), by inserting ``or section 
     102(a)(3)'' before the semicolon; and
       (ii) in paragraph (3)(A)--

       (I) in clause (i), by striking ``or'' at the end;
       (II) in clause (ii), by striking the period and inserting 
     ``; or''; and
       (III) by adding at the end the following:

       ``(iii) a certification issued by the health care provider 
     of the person for whom the employee is the primary caregiver, 
     in the case of an employee unable to return to work because 
     of a condition specified in section 102(a)(3).''.
       (F) Enforcement.--Section 107 of such Act (29 U.S.C. 2617) 
     is amended, in subsection (a)(1)(A)(i)(II), by inserting 
     ``(or 26 weeks, in a case involving leave under section 
     102(a)(3))'' after ``12 weeks''.
       (G) Instructional employees.--Section 108 of such Act (29 
     U.S.C. 2618) is amended, in subsections (c)(1), (d)(2), and 
     (d)(3), by inserting ``or section 102(a)(3)'' after ``section 
     102(a)(1)''.
       (b) Servicemember Family Leave for Civil Service 
     Employees.--
       (1) Definitions.--Section 6381 of title 5, United States 
     Code, is amended--
       (A) in paragraph (5), by striking ``and'' at the end;
       (B) in paragraph (6), by striking the period and inserting 
     ``; and''; and
       (C) by adding at the end the following:
       ``(7) the term `combat-related injury' means an injury or 
     illness that was incurred (as determined under criteria 
     prescribed by the Secretary of Defense)--
       ``(A) as a direct result of armed conflict;
       ``(B) while an individual was engaged in hazardous service;
       ``(C) in the performance of duty under conditions 
     simulating war; or
       ``(D) through an instrumentality of war; and
       ``(8) the term `servicemember' means a member of the Armed 
     Forces.''.
       (2) Entitlement to leave.--Section 6382(a) of such title is 
     amended by adding at the end the following:
       ``(3) Subject to section 6383, an employee who is the 
     primary caregiver for a servicemember with a combat-related 
     injury shall be entitled to a total of 26 administrative 
     workweeks of leave during any 12-month period to care for the 
     servicemember.
       ``(4) An employee shall be entitled to a combined total of 
     26 administrative workweeks of leave under paragraphs (1) and 
     (3).''.
       (3) Requirements relating to leave.--
       (A) Schedule.--Section 6382(b) of such title is amended--
       (i) in paragraph (1), by inserting after the second 
     sentence the following: ``Subject to paragraph (2), leave 
     under subsection (a)(3) may be taken intermittently or on a 
     reduced leave schedule.''; and
       (ii) in paragraph (2), by inserting ``or subsection 
     (a)(3)'' after ``subsection (a)(1)''.
       (B) Substitution of paid leave.--Section 6382(d) of such 
     title is amended by adding at the end the following: ``An 
     employee may elect to substitute for leave under subsection 
     (a)(3) any of the employee's accrued or accumulated annual or 
     sick leave under subchapter I for any part of the 26-week 
     period of leave under such subsection.''.
       (C) Notice.--Section 6382(e) of such title is amended by 
     adding at the end the following:
       ``(3) In any case in which an employee seeks leave under 
     subsection (a)(3), the employee shall provide such notice as 
     is practicable.''.
       (D) Certification.--Section 6383 of such title is amended 
     by adding at the end the following:
       ``(f) An employing agency may require that a request for 
     leave under section 6382(a)(3) be supported by a 
     certification issued at such time and in such manner as the 
     Office of Personnel Management may by regulation 
     prescribe.''.
                                 ______
                                 
  SA 2561. Mr. SMITH (for himself and Mrs. Clinton) submitted an 
amendment intended to be proposed to amendment SA 2530 proposed by Mr. 
Baucus (for himself, Mr. Grassley, Mr. Rockefeller, and Mr. Hatch) to 
the bill H.R. 976, to amend the Internal Revenue Code of 1986 to 
provide tax relief for small businesses, and for other purposes; which 
was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. DEMONSTRATION PROJECT REGARDING MEDICAID COVERAGE OF 
                   LOW-INCOME HIV-INFECTED INDIVIDUALS.

       (a) Requirement To Conduct Demonstration Project.--
       (1) In general.--The Secretary shall establish a 
     demonstration project under which a State may apply under 
     section 1115 of the Social Security Act (42 U.S.C. 1315) to 
     provide medical assistance under a State medicaid program to 
     HIV-infected individuals described in subsection (b) in 
     accordance with the provisions of this section.
       (2) Limitation on number of approved applications.--The 
     Secretary shall only approve as many State applications to 
     provide medical assistance in accordance with this section as 
     will not exceed the limitation on aggregate payments under 
     subsection (d)(2)(A).
       (3) Authority to waive restrictions on payments to 
     territories.--The Secretary shall waive the limitations on 
     payment under subsections (f) and (g) of section 1108 of the 
     Social Security Act (42 U.S.C. 1308) in the case of a State 
     that is subject to such limitations and submits an approved 
     application to provide medical assistance in accordance with 
     this section.
       (b) HIV-Infected Individuals Described.--For purposes of 
     subsection (a), HIV-infected individuals described in this 
     subsection are individuals who are not described in section 
     1902(a)(10)(A)(i) of the Social Security Act (42 U.S.C. 
     1396a(a)(10)(A)(i))--
       (1) who have HIV infection;
       (2) whose income (as determined under the State Medicaid 
     plan with respect to disabled individuals) does not exceed 
     200 percent of the poverty line (as defined in section 
     2110(c)(5) of the Social Security Act (42 U.S.C. 
     1397jj(c)(5)); and
       (3) whose resources (as determined under the State Medicaid 
     plan with respect to disabled individuals) do not exceed the 
     maximum amount of resources a disabled individual described 
     in section 1902(a)(10)(A)(i) of such Act may have and obtain 
     medical assistance under such plan.
       (c) Length of Period for Provision of Medical Assistance.--
     A State shall not be approved to provide medical assistance 
     to an HIV-infected individual in accordance with the 
     demonstration project established under this section for a 
     period of more than 5 consecutive years.
       (d) Limitations on Federal Funding.--
       (1) Appropriation.--
       (A) In general.--Out of any funds in the Treasury not 
     otherwise appropriated, there is appropriated to carry out 
     this section, $500,000,000 for the period of fiscal years 
     2008 through 2012.
       (B) Budget authority.--Subparagraph (A) constitutes budget 
     authority in advance of

[[Page 21731]]

     appropriations Act and represents the obligation of the 
     Federal Government to provide for the payment of the amounts 
     appropriated under that subparagraph.
       (2) Limitation on payments.--In no case may--
       (A) the aggregate amount of payments made by the Secretary 
     to eligible States under this section exceed $500,000,000; or
       (B) payments be provided by the Secretary under this 
     section after September 30, 2012.
       (3) Funds allocated to states.--The Secretary shall 
     allocate funds to States with approved applications under 
     this section based on their applications and the availability 
     of funds.
       (4) Payments to states.--The Secretary shall pay to each 
     State, from its allocation under paragraph (3), an amount 
     each quarter equal to the enhanced FMAP described in section 
     2105(b) of the Social Security Act (42 U.S.C. 1397ee(b)) of 
     expenditures in the quarter for medical assistance provided 
     to HIV-infected individuals who are eligible for such 
     assistance under a State Medicaid program in accordance with 
     the demonstration project established under this section.
       (e) Evaluation and Report.--
       (1) Evaluation.--The Secretary shall conduct an evaluation 
     of the demonstration project established under this section. 
     Such evaluation shall include an analysis of the cost-
     effectiveness of the project and the impact of the project on 
     the Medicare, Medicaid, and Supplemental Security Income 
     programs established under titles XVIII, XIX, and XVI, 
     respectively, of the Social Security Act (42 U.S.C. 1395 et 
     seq., 1396 et seq., 1381 et seq.).
       (2) Report to congress.--Not later than December 31, 2012, 
     the Secretary shall submit a report to Congress on the 
     results of the evaluation of the demonstration project 
     established under this section.
                                 ______
                                 
  SA 2562. Mr. KYL submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 217, after line 25, insert the following:

     SEC. 61_. EXTENSION AND MODIFICATION OF 15-YEAR STRAIGHT-LINE 
                   COST RECOVERY FOR QUALIFIED LEASEHOLD 
                   IMPROVEMENTS AND QUALIFIED RESTAURANT 
                   IMPROVEMENTS; 15-YEAR STRAIGHT-LINE COST 
                   RECOVERY FOR CERTAIN IMPROVEMENTS TO RETAIL 
                   SPACE.

       (a) Extension of Leasehold and Restaurant Improvements.--
       (1) In general.--Clauses (iv) and (v) of section 
     168(e)(3)(E) of the Internal Revenue Code of 1986 (relating 
     to 15-year property) are each amended by striking ``January 
     1, 2008'' and inserting ``January 1, 2009''.
       (2) Effective date.--The amendment made by this subsection 
     shall apply to property placed in service after December 31, 
     2007.
       (b) Modification of Treatment of Qualified Restaurant 
     Property as 15-Year Property for Purposes of Depreciation 
     Deduction.--
       (1) Treatment to include new construction.--Paragraph (7) 
     of section 168(e) of the Internal Revenue Code of 1986 
     (relating to classification of property) is amended to read 
     as follows:
       ``(7) Qualified restaurant property.--The term `qualified 
     restaurant property' means any section 1250 property which is 
     a building (or its structural components) or an improvement 
     to such building if more than 50 percent of such building's 
     square footage is devoted to preparation of, and seating for 
     on-premises consumption of, prepared meals.''.
       (2) Effective date.--The amendment made by this subsection 
     shall apply to any property placed in service after the date 
     of the enactment of this Act, the original use of which 
     begins with the taxpayer after such date.
       (c) Recovery Period for Depreciation of Certain 
     Improvements to Retail Space.--
       (1) 15-year recovery period.--Section 168(e)(3)(E) of the 
     Internal Revenue Code of 1986 (relating to 15-year property) 
     is amended by striking ``and'' at the end of clause (vii), by 
     striking the period at the end of clause (viii) and inserting 
     ``, and'', and by adding at the end the following new clause:
       ``(ix) any qualified retail improvement property placed in 
     service before January 1, 2009.''.
       (2) Qualified retail improvement property.--Section 168(e) 
     of such Code is amended by adding at the end the following 
     new paragraph:
       ``(8) Qualified retail improvement property.--
       ``(A) In general.--The term `qualified retail improvement 
     property' means any improvement to an interior portion of a 
     building which is nonresidential real property if--
       ``(i) such portion is open to the general public and is 
     used in the retail trade or business of selling tangible 
     personal property to the general public, and
       ``(ii) such improvement is placed in service more than 3 
     years after the date the building was first placed in 
     service.
       ``(B) Improvements made by owner.--In the case of an 
     improvement made by the owner of such improvement, such 
     improvement shall be qualified retail improvement property 
     (if at all) only so long as such improvement is held by such 
     owner. Rules similar to the rules under paragraph (6)(B) 
     shall apply for purposes of the preceding sentence.
       ``(C) Certain improvements not included.--Such term shall 
     not include any improvement for which the expenditure is 
     attributable to--
       ``(i) the enlargement of the building,
       ``(ii) any elevator or escalator,
       ``(iii) any structural component benefitting a common area, 
     or
       ``(iv) the internal structural framework of the 
     building.''.
       (3) Requirement to use straight line method.--Section 
     168(b)(3) of such Code is amended by adding at the end the 
     following new subparagraph:
       ``(I) Qualified retail improvement property described in 
     subsection (e)(8).''.
       (4) Alternative system.--The table contained in section 
     168(g)(3)(B) of such Code is amended by inserting after the 
     item relating to subparagraph (E)(viii) the following new 
     item:

(E)(ix)...........................................................39''.

       (5) Effective date.--The amendments made by this subsection 
     shall apply to property placed in service after the date of 
     the enactment of this Act.
                                 ______
                                 
  SA 2563. Mr. KYL submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 217, after line 25, add the following:

     SEC. ___. PERMANENT EXTENSION OF EXPENSING FOR SMALL 
                   BUSINESSES.

       (a) Dollar Limitation.--Paragraph (1) of section 179(b) of 
     the Internal Revenue Code of 1986 is amended by striking 
     ``$25,000 ($125,000 in the case of taxable years beginning 
     after 2006 and before 2011)'' and inserting ``$125,000''.
       (b) Reduction in Limitation.--Paragraph (2) of section 
     179(b) of the Internal Revenue Code of 1986 is amended by 
     striking ``$200,000 ($500,000 in the case of taxable years 
     beginning after 2006 and before 2011)'' and inserting 
     ``$500,000''.
       (c) Inflation Adjustments.--Subparagraph (A) of section 
     179(b)(5) of the Internal Revenue Code of 1986 is amended by 
     striking ``and before 2011''.
       (d) Election.--Paragraph (2) of section 179(c) of the 
     Internal Revenue Code of 1986 is amended by striking ``and 
     before 2011''.
       (e) Computer Software.--Clause (ii) of section 179(d)(1)(A) 
     of the Internal Revenue Code of 1986 is amended by striking 
     ``and before 2011''.
                                 ______
                                 
  SA 2564. Mr. CARDIN submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 196, between lines 18 and 19, insert the following:
       (c) GAO Study and Report on Access to Oral Health Care, 
     Including Preventive and Restorative Services.--
       (1) In general.--The Comptroller General of the United 
     States shall conduct a study of children's access to oral 
     health care, including preventive and restorative services, 
     under Medicaid and CHIP, including--
       (A) the extent to which providers are willing to treat 
     children eligible for such programs;
       (B) information on such children's access to networks of 
     care;
       (C) geographic availability of oral health care, including 
     preventive and restorative services, under such programs; and
       (D) as appropriate, information on the degree of 
     availability of oral health care, including preventive and 
     restorative services, for children under such programs.
       (2) Report.--Not later than 2 years after the date of 
     enactment of this Act, the Comptroller General shall submit a 
     report to the appropriate committees of Congress on the study 
     conducted under paragraph (1) that includes recommendations 
     for such Federal and State legislative and administrative 
     changes as the Comptroller General determines are necessary 
     to address any barriers to access to oral health care, 
     including preventive and restorative services, under Medicaid 
     and CHIP that may exist.
                                 ______
                                 
  SA 2565. Mr. CARDIN submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,

[[Page 21732]]

Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 85, between lines 2 and 3, insert the following:
       ``(3) Five percent set aside for outreach to and enrollment 
     of children in undeserved communities.--An amount equal to 5 
     percent of the funds appropriated under subsection (g) shall 
     be used by the Secretary to award grants to school-based 
     health centers for outreach to and enrollment of children in 
     undeserved communities.
                                 ______
                                 
  SA 2566. Mr. CARDIN submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 168, line 22, insert ``dental care,'' after 
     ``health services,''.
                                 ______
                                 
  SA 2567. Mr. CARDIN submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the end of title II, add the following:

     SEC. ____. ESTABLISHMENT OF STATE TELEPHONE HOTLINES FOR 
                   ACCESS TO DENTAL PROVIDERS.

       The Secretary shall work with States to establish telephone 
     hotlines for individuals enrolled in a State plan under title 
     XIX of the Social Security Act or a State child health plan 
     under title XXI of such Act, or any waiver of such plans, who 
     have dental coverage under such a plan or waiver in order to 
     identify participating dental providers who are willing to 
     accept such individuals as patients under such a plan or 
     waiver.
                                 ______
                                 
  SA 2568. Mr. AKAKA (for himself, Mr. Alexander, Mr. Inouye, and Mr. 
Corker) submitted an amendment intended to be proposed to amendment SA 
2530 proposed by Mr. Baucus (for himself, Mr. Grassley, Mr. 
Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the Internal 
Revenue Code of 1986 to provide tax relief for small businesses, and 
for other purposes; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. MEDICAID DSH ALLOTMENTS FOR TENNESSEE AND HAWAII.

       (a) Tennessee.--The DSH allotments for Tennessee for each 
     fiscal year beginning with fiscal year 2008 under subsection 
     (f)(3) of section 1923 of the Social Security Act (42 U.S.C. 
     13961396r-4) are deemed to be $30,000,000. The Secretary of 
     Health and Human Services may impose a limitation on the 
     total amount of payments made to hospitals under the TennCare 
     Section 1115 waiver only to the extent that such limitation 
     is necessary to ensure that a hospital does not receive 
     payment in excess of the amounts described in subsection (f) 
     of such section or as necessary to ensure that the waiver 
     remains budget neutral.
       (b) Hawaii.--Section 1923(f)(6) (42 U.S.C. 1396r-4(f)(6)) 
     is amended--
       (1) in the paragraph heading, by striking ``for fiscal year 
     2007''; and
       (2) in subparagraph (B)--
       (A) in clause (i), by striking ``Only with respect to 
     fiscal year 2007'' and inserting ``With respect to each of 
     fiscal years 2007 and 2008'';
       (B) by redesignating clause (ii) as clause (iv); and
       (C) by inserting after clause (i), the following new 
     clauses:
       ``(ii) Treatment as a low-dsh state.--With respect to 
     fiscal year 2009 and each fiscal year thereafter, 
     notwithstanding the table set forth in paragraph (2), the DSH 
     allotment for Hawaii shall be increased in the same manner as 
     allotments for low DSH States are increased for such fiscal 
     year under clauses (ii) and (iii) of paragraph (5)(B).
       ``(iii) Certain hospital payments.--The Secretary may not 
     impose a limitation on the total amount of payments made to 
     hospitals under the QUEST section 1115 Demonstration Project 
     except to the extent that such limitation is necessary to 
     ensure that a hospital does not receive payments in excess of 
     the amounts described in subsection (g), or as necessary to 
     ensure that such payments under the waiver and such payments 
     pursuant to the allotment provided in this section do not, in 
     the aggregate in any year, exceed the amount that the 
     Secretary determines is equal to the Federal medical 
     assistance percentage component attributable to 
     disproportionate share hospital payment adjustments for such 
     year that is reflected in the budget neutrality provision of 
     the QUEST Demonstration Project.''.
                                 ______
                                 
  SA 2569. Mr. MENENDEZ submitted an amendment intended to be proposed 
to amendment SA 2547 submitted by Mr. Bunning to the amendment SA 2530 
proposed by Mr. Baucus (for himself, Mr. Grassley, Mr. Rockefeller, and 
Mr. Hatch) to the bill H.R. 976, to amend the Internal Revenue Code of 
1986 to provide tax relief for small businesses, and for other 
purposes; which was ordered to lie on the table; as follows:

       At the end of the matter proposed to be inserted, add the 
     following:
       (d) Exclusion of Federally Elected Officials With Incomes 
     Over 300 Percent of the Federal Poverty Line From Benefits 
     Under FEHBP.--Notwithstanding any other provision of law, on 
     and after October 1, 2007, any federally elected official, 
     including a Member of Congress and the President, whose 
     income exceeds 300 percent of the Federal poverty line shall 
     not be eligible for benefits under the Federal Employees 
     Health Benefits Program (FEHBP) under chapter 89 of title 5, 
     United States Code.
                                 ______
                                 
  SA 2570. Mr. WYDEN submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 39, line 8, after the period, insert the following: 
     ``In addition, States may use up to 1 percent of any payments 
     received from the Incentive Pool to fund voluntary incentive 
     programs to promote children's receipt of relevant screenings 
     and improvements in healthy eating and physical activity with 
     the aim of reducing the incidence of type 2 diabetes. Such 
     programs may involve reductions in cost-sharing or premiums 
     when children receive regular screening and reach certain 
     benchmarks in healthy eating and physical activity. Under 
     such programs, a State may also provide financial bonuses for 
     partnerships with entities, such as schools, which increase 
     their education and efforts with respect to reducing the 
     incidence of type 2 diabetes and childhood obesity and may 
     also devise incentives for providers serving children covered 
     under this title and title XIX to perform relevant screening 
     and counseling regarding healthy eating and physical 
     activity.''.

       On page 195, between lines 15 and 16, insert the following 
     new paragraph:
       ``(7) To the extent applicable, a description of any 
     efforts to address type 2 diabetes and childhood obesity that 
     are funded under the program under this title (and the 
     program under title XIX, as appropriate).''.
                                 ______
                                 
  SA 2571. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the end of title I, insert the following:

     SEC. __. INCENTIVE PROGRAM FOR STATE HEALTH ACCESS 
                   INNOVATIONS.

       Section 2104, as amended by section 108, is amended by 
     adding at the end the following new subsection:
       ``(l) Incentive Program for State Health Access 
     Innovations.--
       ``(1) Establishment of state health access innovations 
     incentive pool.--
       ``(A) In general.--There is hereby established in the 
     Treasury of the United States a fund which shall be known as 
     the `CHIP State Health Access Innovations Pool' (in this 
     subsection referred to as the `SHAI Pool''). Amounts in the 
     SHAI Pool are authorized to be appropriated for payments 
     under this subsection and shall remain available until 
     expended.
       ``(B) Transfer of funds.--Notwithstanding subsection 
     (j)(1)(B)(i), from the amount appropriated for fiscal year 
     2008 under such subsection, $250,000,000 of such amount is 
     hereby transferred to the SHAI Pool and made available for 
     expenditure from such pool for the period of fiscal years 
     2008 through 2012.
       ``(2) Award of grants.--
       ``(A) In general.--The Secretary shall award grants to 
     eligible States from amounts in the SHAI Pool in accordance 
     with this subsection.
       ``(B) Eligible state.--For purposes of this subsection, an 
     eligible State is a State--
       ``(i) for which the percentage of low-income children 
     without health insurance (as determined by the Secretary on 
     the basis of the most recent data available) is less than 10 
     percent; and

[[Page 21733]]

       ``(ii) that submits an application for a grant from the 
     SHAI Pool for the purpose of carrying out programs and 
     activities that are designed to expand access to health 
     providers and health services for low-income children who are 
     eligible for medical assistance under the State plan under 
     title XIX (or a waiver of such plan) or child health 
     assistance under the State child health plan under this 
     title.
       ``(3) Requirements.--
       ``(A) Priority in awarding of grants.--In awarding grants 
     under this subsection, the Secretary shall give preference to 
     grant applications that--
       ``(i) propose innovative approaches to increasing the 
     availability of health care providers and services;
       ``(ii) create longer-term improvements in health care 
     infrastructure;
       ``(iii) have potential application in other States;
       ``(iv) seek to remedy shortages of health care providers; 
     or
       ``(v) result in the direct provision of health services.
       ``(B) Prohibitions.--The Secretary shall not--
       ``(i) award a grant to carry out programs or activities 
     which the Secretary determines would substitute for services 
     or funds provided by a State or the Federal Government; or
       ``(ii) disapprove any grant application on the basis that 
     programs or activities to be conducted with funds provided 
     under the grant would be provided through or by an entity 
     that otherwise receives Federal or State funding, such as a 
     Federally-qualified health center.
       ``(C) Term, amount, and number of grants per eligible 
     states.--
       ``(i) Term.--A grant awarded under this subsection may be 
     renewed each year for a period of up to 5 years, but in no 
     case later than fiscal year 2012.
       ``(ii) Amount.--No grant awarded under this subsection may 
     exceed $2,000,000 for any fiscal year.
       ``(iii) No limit on number of grants per state.--Nothing in 
     this subsection shall be construed as limiting the number of 
     grants that an eligible State may be awarded under this 
     subsection.
       ``(D) Annual aggregate limit.--The aggregate amount of all 
     grants awarded from the SHAI pool shall not exceed--
       ``(i) $50,000,000 in fiscal year 2008;
       ``(ii) $100,000,000 in fiscal year 2009;
       ``(iii) $150,000,000 in fiscal year 2010;
       ``(iv) $200,000,000 in fiscal year 2011; and
       ``(v) $250,000,000 in fiscal year 2012.''.
                                 ______
                                 
  SA 2572. Mr. SANDERS submitted an amendment intended to be proposed 
to the bill H.R. 976, to amend the Internal Revenue Code of 1986 to 
provide tax relief for small businesses, and for other purposes; which 
was ordered to lie on the table; as follows:

       At the end appropriate place, add the following:

     SEC. ___. IMPROVMENTS TO MEDICARE COVERAGE OF AND PAYMENT FOR 
                   FQHC SERVICES.

       (a) Coverage for FQHC Ambulatory Services.--Section 
     1861(aa)(3) of the Social Security Act (42 U.S.C. 
     1395x(aa)(3)) is amended to read as follows:
       ``(3) The term `Federally qualified health center services' 
     means--
       ``(A) services of the type described in subparagraphs (A) 
     through (C) of paragraph (1), and such other services 
     furnished by a Federally qualified health center for which 
     payment may otherwise be made under this title if such 
     services were furnished by a health care provider or health 
     care professional other than a Federally qualified health 
     center; and
       ``(B) preventive primary health services that a center is 
     required to provide under section 330 of the Public Health 
     Service Act;

     when furnished to an individual as a patient of a Federally 
     qualified health center.''.
       (b) Per Visit Payment Requirements for FQHCs.--Section 
     1833(a)(3)(A) of the Social Security Act (42 U.S.C. 
     1395l(a)(3)(A)), is amended by adding ``(which regulations 
     may not limit the per visit payment amount, or a component of 
     such amount, for services described in section 
     1832(a)(2)(D)(ii))'' after ``the Secretary may prescribe in 
     regulations''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to services provided on or after January 1, 2008.
                                 ______
                                 
  SA 2573. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the end of title VI, add the following:

     SEC. ___. SENSE OF THE SENATE REGARDING MEDICARE PAYMENT FOR 
                   FEDERALLY QUALIFIED HEALTH CENTER SERVICES.

       It is the sense of the Senate that title XVIII of the 
     Social Security Act, regarding per visit Medicare payment 
     requirements for Federally qualified health centers (FQHCs), 
     should be amended by adding that regulations may not limit 
     the per visit payment amount or a component of such amount.
                                 ______
                                 
  SA 2574. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the appropriate place, insert the following:

     SEC. __. PREVENTING THE CARRYING OUT OF A PROPOSED RULE.

       The Secretary shall not take any action to finalize (or 
     otherwise implement) provisions contained in the proposed 
     rule published on May 3, 2007, on pages 24680 through 25135 
     of volume 72, Federal Register, insofar as such provisions 
     propose--
       (1) to alter payments for services under the hospital 
     inpatient prospective payment system under section 1886(d) of 
     the Social Security Act (42 U.S.C. 1395ww(d)) based on use of 
     a Medicare severity diagnosis related group (MS-DRG) system; 
     or
       (2) to implement a prospective behavioral offset in 
     response to the implementation of such a Medicare Severity 
     Diagnosis Related Group (MS-DRG) system for purposes of such 
     hospital inpatient prospective payment system.
                                 ______
                                 
  SA 2575. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the appropriate place, insert the following:

     SEC. __. SENSE OF THE SENATE.

       It is the sense of the Senate that the Secretary should not 
     take any action to finalize (or otherwise implement) 
     provisions contained in the proposed rule published on May 3, 
     2007, on pages 24680 through 25135 of volume 72, Federal 
     Register, insofar as such provisions propose--
       (1) to alter payments for services under the hospital 
     inpatient prospective payment system under section 1886(d) of 
     the Social Security Act (42 U.S.C. 1395ww(d)) based on use of 
     a Medicare severity diagnosis related group (MS-DRG) system; 
     or
       (2) to implement a prospective behavioral offset in 
     response to the implementation of such a Medicare Severity 
     Diagnosis Related Group (MS-DRG) system for purposes of such 
     hospital inpatient prospective payment system.
                                 ______
                                 
  SA 2576. Mr. DeMINT submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       On page 217, after line 25, insert the following:

     SEC. _. REPEAL OF MEDICINE AND DRUGS LIMITATION ON DEDUCTION 
                   FOR MEDICAL CARE.

       (a) In General.--Section 213 of the Internal Revenue Code 
     of 1986 (relating to medical, dental, etc., expenses) is 
     amended by striking subsection (b).
       (b) Conforming Amendment.--Section 213(d) of such Code is 
     amended by striking paragraph (3).
       (c) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after the date of the 
     enactment of this Act.
                                 ______
                                 
  SA 2577. Mr. DeMINT submitted an amendment intended to be proposed by 
him to the bill H.R. 976, to amend the Internal Revenue Code of 1986 to 
provide tax relief for small businesses, and for other purposes; which 
was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

                      TITLE __--HEALTH CARE CHOICE

     SEC. _01. SHORT TITLE.

       This title may be cited as ``Health Care Choice Act of 
     2007''.

     SEC. _02. SPECIFICATION OF CONSTITUTIONAL AUTHORITY FOR 
                   ENACTMENT OF LAW.

       This title is enacted pursuant to the power granted 
     Congress under article I, section 8, clause 3, of the United 
     States Constitution.

     SEC. _03. FINDINGS.

       Congress finds the following:
       (1) The application of numerous and significant variations 
     in State law impacts the

[[Page 21734]]

     ability of insurers to offer, and individuals to obtain, 
     affordable individual health insurance coverage, thereby 
     impeding commerce in individual health insurance coverage.
       (2) Individual health insurance coverage is increasingly 
     offered through the Internet, other electronic means, and by 
     mail, all of which are inherently part of interstate 
     commerce.
       (3) In response to these issues, it is appropriate to 
     encourage increased efficiency in the offering of individual 
     health insurance coverage through a collaborative approach by 
     the States in regulating this coverage.
       (4) The establishment of risk-retention groups has provided 
     a successful model for the sale of insurance across State 
     lines, as the acts establishing those groups allow insurance 
     to be sold in multiple States but regulated by a single 
     State.

     SEC. _04. COOPERATIVE GOVERNING OF INDIVIDUAL HEALTH 
                   INSURANCE COVERAGE.

       (a) In General.--Title XXVII of the Public Health Service 
     Act (42 U.S.C. 300gg et seq.) is amended by adding at the end 
     the following new part:

``PART D--COOPERATIVE GOVERNING OF INDIVIDUAL HEALTH INSURANCE COVERAGE

     ``SEC. 2795. DEFINITIONS.

       ``In this part:
       ``(1) Primary state.--The term `primary State' means, with 
     respect to individual health insurance coverage offered by a 
     health insurance issuer, the State designated by the issuer 
     as the State whose covered laws shall govern the health 
     insurance issuer in the sale of such coverage under this 
     part. An issuer, with respect to a particular policy, may 
     only designate one such State as its primary State with 
     respect to all such coverage it offers. Such an issuer may 
     not change the designated primary State with respect to 
     individual health insurance coverage once the policy is 
     issued, except that such a change may be made upon renewal of 
     the policy. With respect to such designated State, the issuer 
     is deemed to be doing business in that State.
       ``(2) Secondary state.--The term `secondary State' means, 
     with respect to individual health insurance coverage offered 
     by a health insurance issuer, any State that is not the 
     primary State. In the case of a health insurance issuer that 
     is selling a policy in, or to a resident of, a secondary 
     State, the issuer is deemed to be doing business in that 
     secondary State.
       ``(3) Health insurance issuer.--The term `health insurance 
     issuer' has the meaning given such term in section 
     2791(b)(2), except that such an issuer must be licensed in 
     the primary State and be qualified to sell individual health 
     insurance coverage in that State.
       ``(4) Individual health insurance coverage.--The term 
     `individual health insurance coverage' means health insurance 
     coverage offered in the individual market, as defined in 
     section 2791(e)(1).
       ``(5) Applicable state authority.--The term `applicable 
     State authority' means, with respect to a health insurance 
     issuer in a State, the State insurance commissioner or 
     official or officials designated by the State to enforce the 
     requirements of this title for the State with respect to the 
     issuer.
       ``(6) Hazardous financial condition.--The term `hazardous 
     financial condition' means that, based on its present or 
     reasonably anticipated financial condition, a health 
     insurance issuer is unlikely to be able--
       ``(A) to meet obligations to policyholders with respect to 
     known claims and reasonably anticipated claims; or
       ``(B) to pay other obligations in the normal course of 
     business.
       ``(7) Covered laws.--The term `covered laws' means the 
     laws, rules, regulations, agreements, and orders governing 
     the insurance business pertaining to--
       ``(A) individual health insurance coverage issued by a 
     health insurance issuer;
       ``(B) the offer, sale, and issuance of individual health 
     insurance coverage to an individual; and
       ``(C) the provision to an individual in relation to 
     individual health insurance coverage of--
       ``(i) health care and insurance related services;
       ``(ii) management, operations, and investment activities of 
     a health insurance issuer; and
       ``(iii) loss control and claims administration for a health 
     insurance issuer with respect to liability for which the 
     issuer provides insurance.
       ``(8) State.--The term `State' means only the 50 States and 
     the District of Columbia.
       ``(9) Unfair claims settlement practices.--The term `unfair 
     claims settlement practices' means only the following 
     practices:
       ``(A) Knowingly misrepresenting to claimants and insured 
     individuals relevant facts or policy provisions relating to 
     coverage at issue.
       ``(B) Failing to acknowledge with reasonable promptness 
     pertinent communications with respect to claims arising under 
     policies.
       ``(C) Failing to adopt and implement reasonable standards 
     for the prompt investigation and settlement of claims arising 
     under policies.
       ``(D) Failing to effectuate prompt, fair, and equitable 
     settlement of claims submitted in which liability has become 
     reasonably clear.
       ``(E) Refusing to pay claims without conducting a 
     reasonable investigation.
       ``(F) Failing to affirm or deny coverage of claims within a 
     reasonable period of time after having completed an 
     investigation related to those claims.
       ``(10) Fraud and abuse.--The term `fraud and abuse' means 
     an act or omission committed by a person who, knowingly and 
     with intent to defraud, commits, or conceals any material 
     information concerning, one or more of the following:
       ``(A) Presenting, causing to be presented or preparing with 
     knowledge or belief that it will be presented to or by an 
     insurer, a reinsurer, broker or its agent, false information 
     as part of, in support of or concerning a fact material to 
     one or more of the following:
       ``(i) An application for the issuance or renewal of an 
     insurance policy or reinsurance contract.
       ``(ii) The rating of an insurance policy or reinsurance 
     contract.
       ``(iii) A claim for payment or benefit pursuant to an 
     insurance policy or reinsurance contract.
       ``(iv) Premiums paid on an insurance policy or reinsurance 
     contract.
       ``(v) Payments made in accordance with the terms of an 
     insurance policy or reinsurance contract.
       ``(vi) A document filed with the commissioner or the chief 
     insurance regulatory official of another jurisdiction.
       ``(vii) The financial condition of an insurer or reinsurer.
       ``(viii) The formation, acquisition, merger, 
     reconsolidation, dissolution or withdrawal from one or more 
     lines of insurance or reinsurance in all or part of a State 
     by an insurer or reinsurer.
       ``(ix) The issuance of written evidence of insurance.
       ``(x) The reinstatement of an insurance policy.
       ``(B) Solicitation or acceptance of new or renewal 
     insurance risks on behalf of an insurer reinsurer or other 
     person engaged in the business of insurance by a person who 
     knows or should know that the insurer or other person 
     responsible for the risk is insolvent at the time of the 
     transaction.
       ``(C) Transaction of the business of insurance in violation 
     of laws requiring a license, certificate of authority or 
     other legal authority for the transaction of the business of 
     insurance.
       ``(D) Attempt to commit, aiding or abetting in the 
     commission of, or conspiracy to commit the acts or omissions 
     specified in this paragraph.

     ``SEC. 2796. APPLICATION OF LAW.

       ``(a) In General.--The covered laws of the primary State 
     shall apply to individual health insurance coverage offered 
     by a health insurance issuer in the primary State and in any 
     secondary State, but only if the coverage and issuer comply 
     with the conditions of this section with respect to the 
     offering of coverage in any secondary State.
       ``(b) Exemptions From Covered Laws in a Secondary State.--
     Except as provided in this section, a health insurance issuer 
     with respect to its offer, sale, renewal, and issuance of 
     individual health insurance coverage in any secondary State 
     is exempt from any covered laws of the secondary State (and 
     any rules, regulations, agreements, or orders sought or 
     issued by such State under or related to such covered laws) 
     to the extent that such laws would--
       ``(1) make unlawful, or regulate, directly or indirectly, 
     the operation of the health insurance issuer operating in the 
     secondary State, except that any secondary State may require 
     such an issuer--
       ``(A) to pay, on a nondiscriminatory basis, applicable 
     premium and other taxes (including high risk pool 
     assessments) which are levied on insurers and surplus lines 
     insurers, brokers, or policyholders under the laws of the 
     State;
       ``(B) to register with and designate the State insurance 
     commissioner as its agent solely for the purpose of receiving 
     service of legal documents or process;
       ``(C) to submit to an examination of its financial 
     condition by the State insurance commissioner in any State in 
     which the issuer is doing business to determine the issuer's 
     financial condition, if--
       ``(i) the State insurance commissioner of the primary State 
     has not done an examination within the period recommended by 
     the National Association of Insurance Commissioners; and
       ``(ii) any such examination is conducted in accordance with 
     the examiners' handbook of the National Association of 
     Insurance Commissioners and is coordinated to avoid 
     unjustified duplication and unjustified repetition;
       ``(D) to comply with a lawful order issued--
       ``(i) in a delinquency proceeding commenced by the State 
     insurance commissioner if there has been a finding of 
     financial impairment under subparagraph (C); or
       ``(ii) in a voluntary dissolution proceeding;
       ``(E) to comply with an injunction issued by a court of 
     competent jurisdiction, upon a petition by the State 
     insurance commissioner alleging that the issuer is in 
     hazardous financial condition;

[[Page 21735]]

       ``(F) to participate, on a nondiscriminatory basis, in any 
     insurance insolvency guaranty association or similar 
     association to which a health insurance issuer in the State 
     is required to belong;
       ``(G) to comply with any State law regarding fraud and 
     abuse (as defined in section 2795(10)), except that if the 
     State seeks an injunction regarding the conduct described in 
     this subparagraph, such injunction must be obtained from a 
     court of competent jurisdiction; or
       ``(H) to comply with any State law regarding unfair claims 
     settlement practices (as defined in section 2795(9));
       ``(2) require any individual health insurance coverage 
     issued by the issuer to be countersigned by an insurance 
     agent or broker residing in that Secondary State; or
       ``(3) otherwise discriminate against the issuer issuing 
     insurance in both the primary State and in any secondary 
     State.
       ``(c) Clear and Conspicuous Disclosure.--A health insurance 
     issuer shall provide the following notice, in 12-point bold 
     type, in any insurance coverage offered in a secondary State 
     under this part by such a health insurance issuer and at 
     renewal of the policy, with the 5 blank spaces therein being 
     appropriately filled with the name of the health insurance 
     issuer, the name of primary State, the name of the secondary 
     State, the name of the secondary State, and the name of the 
     secondary State, respectively, for the coverage concerned:
     `This policy is issued by _____ and is governed by the laws 
     and regulations of the State of _____, and it has met all the 
     laws of that State as determined by that State's Department 
     of Insurance. This policy may be less expensive than others 
     because it is not subject to all of the insurance laws and 
     regulations of the State of _____, including coverage of some 
     services or benefits mandated by the law of the State of 
     _____. Additionally, this policy is not subject to all of the 
     consumer protection laws or restrictions on rate changes of 
     the State of _____. As with all insurance products, before 
     purchasing this policy, you should carefully review the 
     policy and determine what health care services the policy 
     covers and what benefits it provides, including any 
     exclusions, limitations, or conditions for such services or 
     benefits.'.
       ``(d) Prohibition on Certain Reclassifications and Premium 
     Increases.--
       ``(1) In general.--For purposes of this section, a health 
     insurance issuer that provides individual health insurance 
     coverage to an individual under this part in a primary or 
     secondary State may not upon renewal--
       ``(A) move or reclassify the individual insured under the 
     health insurance coverage from the class such individual is 
     in at the time of issue of the contract based on the health-
     status related factors of the individual; or
       ``(B) increase the premiums assessed the individual for 
     such coverage based on a health status-related factor or 
     change of a health status-related factor or the past or 
     prospective claim experience of the insured individual.
       ``(2) Construction.--Nothing in paragraph (1) shall be 
     construed to prohibit a health insurance issuer--
       ``(A) from terminating or discontinuing coverage or a class 
     of coverage in accordance with subsections (b) and (c) of 
     section 2742;
       ``(B) from raising premium rates for all policy holders 
     within a class based on claims experience;
       ``(C) from changing premiums or offering discounted 
     premiums to individuals who engage in wellness activities at 
     intervals prescribed by the issuer, if such premium changes 
     or incentives--
       ``(i) are disclosed to the consumer in the insurance 
     contract;
       ``(ii) are based on specific wellness activities that are 
     not applicable to all individuals; and
       ``(iii) are not obtainable by all individuals to whom 
     coverage is offered;
       ``(D) from reinstating lapsed coverage; or
       ``(E) from retroactively adjusting the rates charged an 
     individual insured individual if the initial rates were set 
     based on material misrepresentation by the individual at the 
     time of issue.
       ``(e) Prior Offering of Policy in Primary State.--A health 
     insurance issuer may not offer for sale individual health 
     insurance coverage in a secondary State unless that coverage 
     is currently offered for sale in the primary State.
       ``(f) Licensing of Agents or Brokers for Health Insurance 
     Issuers.--Any State may require that a person acting, or 
     offering to act, as an agent or broker for a health insurance 
     issuer with respect to the offering of individual health 
     insurance coverage obtain a license from that State, except 
     that a State many not impose any qualification or requirement 
     which discriminates against a nonresident agent or broker.
       ``(g) Documents for Submission to State Insurance 
     Commissioner.--Each health insurance issuer issuing 
     individual health insurance coverage in both primary and 
     secondary States shall submit--
       ``(1) to the insurance commissioner of each State in which 
     it intends to offer such coverage, before it may offer 
     individual health insurance coverage in such State--
       ``(A) a copy of the plan of operation or feasibility study 
     or any similar statement of the policy being offered and its 
     coverage (which shall include the name of its primary State 
     and its principal place of business);
       ``(B) written notice of any change in its designation of 
     its primary State; and
       ``(C) written notice from the issuer of the issuer's 
     compliance with all the laws of the primary State; and
       ``(2) to the insurance commissioner of each secondary State 
     in which it offers individual health insurance coverage, a 
     copy of the issuer's quarterly financial statement submitted 
     to the primary State, which statement shall be certified by 
     an independent public accountant and contain a statement of 
     opinion on loss and loss adjustment expense reserves made 
     by--
       ``(A) a member of the American Academy of Actuaries; or
       ``(B) a qualified loss reserve specialist.
       ``(h) Power of Courts To Enjoin Conduct.--Nothing in this 
     section shall be construed to affect the authority of any 
     Federal or State court to enjoin--
       ``(1) the solicitation or sale of individual health 
     insurance coverage by a health insurance issuer to any person 
     or group who is not eligible for such insurance; or
       ``(2) the solicitation or sale of individual health 
     insurance coverage by, or operation of, a health insurance 
     issuer that is in hazardous financial condition.
       ``(i) State Powers To Enforce State Laws.--
       ``(1) In general.--Subject to the provisions of subsection 
     (b)(1)(G) (relating to injunctions) and paragraph (2), 
     nothing in this section shall be construed to affect the 
     authority of any State to make use of any of its powers to 
     enforce the laws of such State with respect to which a health 
     insurance issuer is not exempt under subsection (b).
       ``(2) Courts of competent jurisdiction.--If a State seeks 
     an injunction regarding the conduct described in paragraphs 
     (1) and (2) of subsection (h), such injunction must be 
     obtained from a Federal or State court of competent 
     jurisdiction.
       ``(j) States' Authority To Sue.--Nothing in this section 
     shall affect the authority of any State to bring action in 
     any Federal or State court.
       ``(k) Generally Applicable Laws.--Nothing in this section 
     shall be construed to affect the applicability of State laws 
     generally applicable to persons or corporations.

     ``SEC. 2797. PRIMARY STATE MUST MEET FEDERAL FLOOR BEFORE 
                   ISSUER MAY SELL INTO SECONDARY STATES.

       ``A health insurance issuer may not offer, sell, or issue 
     individual health insurance coverage in a secondary State if 
     the primary State does not meet the following requirements:
       ``(1) The State insurance commissioner must use a risk-
     based capital formula for the determination of capital and 
     surplus requirements for all health insurance issuers.
       ``(2) The State must have legislation or regulations in 
     place establishing an independent review process for 
     individuals who are covered by individual health insurance 
     coverage unless the issuer provides an independent review 
     mechanism functionally equivalent (as determined by the 
     primary State insurance commissioner or official) to that 
     prescribed in the `Health Carrier External Review Model Act' 
     of the National Association of Insurance Commissioners for 
     all individuals who purchase insurance coverage under the 
     terms of this part.

     ``SEC. 2798. ENFORCEMENT.

       ``(a) In General.--Subject to subsection (b), with respect 
     to specific individual health insurance coverage the primary 
     State for such coverage has sole jurisdiction to enforce the 
     primary State's covered laws in the primary State and any 
     secondary State.
       ``(b) Secondary State's Authority.--Nothing in subsection 
     (a) shall be construed to affect the authority of a secondary 
     State to enforce its laws as set forth in the exception 
     specified in section 2796(b)(1).
       ``(c) Court Interpretation.--In reviewing action initiated 
     by the applicable secondary State authority, the court of 
     competent jurisdiction shall apply the covered laws of the 
     primary State.
       ``(d) Notice of Compliance Failure.--In the case of 
     individual health insurance coverage offered in a secondary 
     State that fails to comply with the covered laws of the 
     primary State, the applicable State authority of the 
     secondary State may notify the applicable State authority of 
     the primary State.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to individual health insurance coverage offered, 
     issued, or sold after the date of the enactment of this Act.

     SEC. _05. SEVERABILITY.

       If any provision of the title or the application of such 
     provision to any person or circumstance is held to be 
     unconstitutional, the remainder of this title and the 
     application of the provisions of such to any other person or 
     circumstance shall not be affected.
                                 ______
                                 
  SA 2578. Mr. VITTER submitted an amendment intended to be proposed to 
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal

[[Page 21736]]

Revenue Code of 1986 to provide tax relief for small businesses, and 
for other purposes; which was ordered to lie on the table; as follows:

       At the end of title VI, insert the following:

     SEC. ___. TREATMENT OF CERTAIN HOSPITALS IN DETERMINING THE 
                   APPROVED FTE RESIDENT AMOUNT FOR PAYMENTS FOR 
                   DIRECT GRADUATE MEDICAL EDUCATION COSTS UNDER 
                   THE MEDICARE PROGRAM.

       (a) Treatment.--
       (1) In general.--For purposes of subparagraph (F) of 
     section 1886(h)(2) of the Social Security Act (42 U.S.C. 
     1395ww(h)(2)), and any regulations implementing such section, 
     in the case of an eligible hospital, the approved FTE 
     resident amount for the hospital's first cost reporting 
     period for which it has an approved medical residency 
     training program and is participating under title XVIII of 
     such Act, subject to paragraph (2), shall be based on the 
     hospital's actual costs incurred in connection with the 
     Graduate Medical Education program for the hospital's first 
     cost reporting period in which residents were on duty during 
     the first month of the cost reporting period.
       (2) Limit.--The approved FTE resident amount for such first 
     cost reporting period may not exceed 140 percent of the 
     locality adjusted national average per resident amount 
     computed under subparagraph (E) of such section 1886(h)(2) 
     for the area in which the hospital is located and for the 
     period.
       (b) Eligible Hospital Defined.--In this section, the term 
     ``eligible hospital'' means a hospital that--
       (1) did not have an approved medical residency training 
     program (as defined in section 1886(h)(5)(A) of the Social 
     Security Act (42 U.S.C. 1395ww(h)(5)(A)) in 1984;
       (2) began such a program in a cost reporting period 
     beginning on or after July 1, 2005 and ending before 
     September 30, 2011; and
       (3) is located within 150 miles of the Medical Center of 
     Louisiana at New Orleans.
                                 ______
                                 
  SA 2579. Mr. THUNE (for himself, Mr. Lott, Mr. Cornyn, and Mr. 
DeMint) submitted an amendment intended to be proposed to amendment SA 
2530 proposed by Mr. Baucus (for himself, Mr. Grassley, Mr. 
Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the Internal 
Revenue Code of 1986 to provide tax relief for small businesses, and 
for other purposes; which was ordered to lie on the table; as follows:

       At the end of title VI, add the following:

     SEC. ___. EXCLUSION OF INDIVIDUALS WITH ALTERNATIVE MINIMUM 
                   TAX LIABILITY FROM ELIGIBILITY FOR SCHIP 
                   COVERAGE.

       (a) In General.--Section 2102(b), as amended by this Act, 
     is amended by adding at the end the following new paragraph:
       ``(6) Exclusion of individuals with alternative minimum tax 
     liability.--Notwithstanding any other provision of this 
     title, no individual whose income is subject to tax liability 
     imposed under section 55 of the Internal Revenue Code of 1986 
     for the taxable year shall be eligible for assistance under a 
     State plan under this title for the fiscal year following 
     such taxable year.''.
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years beginning after the date of the 
     enactment of this Act.
                                 ______
                                 
  SA 2580. Mr. BINGAMAN (for himself, Mr. Levin, Ms. Stabenow, and Mr. 
Feingold) submitted an amendment intended to be proposed to amendment 
SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, Mr. 
Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the Internal 
Revenue Code of 1986 to provide tax relief for small businesses, and 
for other purposes; which was ordered to lie on the table; as follows:

       At the end of title I, add the following:

     SEC. __. ONE-YEAR DELAY IN PROVISIONS RELATING TO PHASE-OUT 
                   FOR COVERAGE OF NONPREGNANT CHILDLESS ADULTS.

       (a) One-Year Delay.--Notwithstanding section 2111(a) of the 
     Social Security Act (as added by section 106), or any other 
     provision of title XXI of such Act, as amended by this Act, 
     each date specified in such section and title relating to the 
     phase-out for coverage of nonpregnant childless adults under 
     an applicable existing waiver (as defined in section 2111(c) 
     of such Act) shall be applied as if such date were 1 year 
     later.
       (b) Increase in Basic Rebate for Single Source Drugs and 
     Innovator Multiple Source Drugs.--
       (1) In general.--Section 1927(c) (42 U.S.C. 1396r-8(c)) is 
     amended--
       (A) in paragraph (1)(B)(i)--
       (i) in subclause (IV), by striking ``and'' after the 
     semicolon;
       (ii) in subclause (V)--

       (I) by inserting ``and before January 1, 2008,'' after 
     ``1995,''; and
       (II) by striking the period and inserting ``; and''; and

       (iii) by adding at the end the following:

       ``(VI) after December 31, 2007, is 20.1 percent.''; and

       (B) in paragraph (3)(B)--
       (i) in clause (i), by striking ``and'' at the end;
       (ii) in clause (ii)--

       (I) by inserting ``and before January 1, 2008,'' after 
     ``1993,''; and
       (II) by striking the period and inserting ``; and''; and
       (III) by adding at the end the following new clause:

       ``(iii) after December 31, 2007, is 16 percent.''.
       (2) Effective date.--The amendments made by this subsection 
     take effect on the date of enactment of this Act and apply to 
     rebate agreements entered into or renewed under section 1927 
     of the Social Security Act (42 U.S.C. 1396r-8) on or after 
     such date.
       (c) Extension of Prescription Drug Discounts to Enrollees 
     of Medicaid Managed Care Organizations.--
       (1) In general.--Section 1903(m)(2)(A) (42 U.S.C. 
     1396b(m)(2)(A)) is amended--
       (A) in clause (xi), by striking ``and'' at the end;
       (B) in clause (xii), by striking the period at the end and 
     inserting ``; and''; and
       (C) by adding at the end the following:
       ``(xiii) such contract provides that (I) payment for 
     covered outpatient drugs dispensed to individuals eligible 
     for medical assistance who are enrolled with the entity shall 
     be subject to the same rebate required by the agreement 
     entered into under section 1927 as the State is subject to 
     and that the State shall allow the entity to collect such 
     rebates from manufacturers, and (II) capitation rates paid to 
     the entity shall be based on actual cost experience related 
     to rebates and subject to the Federal regulations requiring 
     actuarially sound rates.''.
       (2) Conforming amendments.--Section 1927 (42 U.S.C. 1396r-
     8) is amended--
       (A) in subsection (d)--
       (i) in paragraph (1), by adding at the end the following:
       ``(C) Notwithstanding subparagraphs (A) and (B)--
       ``(i) a medicaid managed care organization with a contract 
     under section 1903(m) may exclude or otherwise restrict 
     coverage of a covered outpatient drug on the basis of 
     policies or practices of the organization, such as those 
     affecting utilization management, formulary adherence, and 
     cost sharing or dispute resolution, in lieu of any State 
     policies or practices relating to the exclusion or 
     restriction of coverage of such drugs; and
       ``(ii) nothing in this section or paragraph (2)(A)(xiii) of 
     section 1903(m) shall be construed as requiring a medicaid 
     managed care organization with a contract under such section 
     to maintain the same such polices and practices as those 
     established by the State for purposes of individuals who 
     receive medical assistance for covered outpatient drugs on a 
     fee-for service basis.''; and
       (ii) in paragraph (4), by inserting after subparagraph (E) 
     the following:
       ``(F) Notwithstanding the preceding subparagraphs of this 
     paragraph, any formulary established by medicaid managed care 
     organization with a contract under section 1903(m) may be 
     based on positive inclusion of drugs selected by a formulary 
     committee consisting of physicians, pharmacists, and other 
     individuals with appropriate clinical experience as long as 
     drugs excluded from the formulary are available through prior 
     authorization, as described in paragraph (5).''; and
       (B) in subsection (j), by striking paragraph (1) and 
     inserting the following:
       ``(1) Covered outpatients drugs are not subject to the 
     requirements of this section if such drugs are--
       ``(A) dispensed by a health maintenance organization other 
     than a medicaid managed care organization with a contract 
     under section 1903(m); and
       ``(B) subject to discounts under section 340B of the Public 
     Health Service Act.''.
       (3) Effective date.--The amendments made by this subsection 
     take effect on the date of enactment of this Act and apply to 
     rebate agreements entered into or renewed under section 1927 
     of the Social Security Act (42 U.S.C. 1396r-8) on or after 
     such date.
                                 ______
                                 
  SA 2581. Mr. BINGAMAN (for himself, Mr. Kerry, and Mr. Johnson) 
submitted an amendment intended to be proposed by him to the bill H.R. 
976, to amend the Internal Revenue Code of 1986 to provide tax relief 
for small businesses, and for other purposes; which was ordered to lie 
on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. INCLUDING COSTS INCURRED BY THE INDIAN HEALTH 
                   SERVICE, A FEDERALLY QUALIFIED HEALTH CENTER, 
                   AN AIDS DRUG ASSISTANCE PROGRAM, CERTAIN 
                   HOSPITALS, OR A PHARMACEUTICAL MANUFACTURER 
                   PATIENT ASSISTANCE PROGRAM IN PROVIDING 
                   PRESCRIPTION DRUGS TOWARD THE ANNUAL OUT OF 
                   POCKET THRESHOLD UNDER PART D.

       (a) Including Costs Incurred.--
       (1) In general.--Section 1860D-2(b)(4)(C) (42 U.S.C. 1395w-
     102(b)(4)(C)) is amended--
       (A) in clause (i), by striking ``and'' at the end;
       (B) in clause (ii)--

[[Page 21737]]

       (i) by striking ``such costs shall be treated as incurred 
     only if'' and inserting ``subject to clause (iii), such costs 
     shall be treated as incurred if'';
       (ii) by striking ``, under section 1860D-14, or under a 
     State Pharmaceutical Assistance Program'';
       (iii) by striking ``(other than under such section or such 
     a Program)''; and
       (iv) by striking the period at the end and inserting ``; 
     and''; and
       (C) by inserting after clause (ii) the following new 
     clause:
       ``(iii) such costs shall be treated as incurred and shall 
     not be considered to be reimbursed under clause (ii) if such 
     costs are borne or paid--

       ``(I) under section 1860D-14;
       ``(II) under a State Pharmaceutical Assistance Program;
       ``(III) by the Indian Health Service, an Indian tribe or 
     tribal organization, or an urban Indian organization (as 
     defined in section 4 of the Indian Health Care Improvement 
     Act);
       ``(IV) by a Federally qualified health center (as defined 
     in section 1861(aa)(4));
       ``(V) under an AIDS Drug Assistance Program under part B of 
     title XXVI of the Public Health Service Act;
       ``(VI) by a subsection (d) hospital (as defined in section 
     1886(d)(1)(B)) that meets the requirements of clauses (i) and 
     (ii) of section 340B(a)(4)(L) of the Public Health Service 
     Act; or
       ``(VII) by a pharmaceutical manufacturer patient assistance 
     program, either directly or through the distribution or 
     donation of covered part D drugs, which shall be valued at 
     the negotiated price of such covered part D drug under the 
     enrollee's prescription drug plan or MA-PD plan as of the 
     date that the drug was distributed or donated.''.

       (2) Effective date.--The amendments made by paragraph (1) 
     shall apply to costs incurred on or after January 1, 2008.
       (b) Increase in Basic Rebate for Single Source Drugs and 
     Innovator Multiple Source Drugs.--
       (1) In general.--Section 1927(c) (42 U.S.C. 1396r-8(c)) is 
     amended--
       (A) in paragraph (1)(B)(i)--
       (i) in subclause (IV), by striking ``and'' after the 
     semicolon;
       (ii) in subclause (V)--

       (I) by inserting ``and before January 1, 2008,'' after 
     ``1995,''; and
       (II) by striking the period and inserting ``; and''; and

       (iii) by adding at the end the following:

       ``(VI) after December 31, 2007, is 20.1 percent.''; and

       (B) in paragraph (3)(B)--
       (i) in clause (i), by striking ``and'' at the end;
       (ii) in clause (ii)--

       (I) by inserting ``and before January 1, 2008,'' after 
     ``1993,''; and
       (II) by striking the period and inserting ``; and''; and
       (III) by adding at the end the following new clause:

       ``(iii) after December 31, 2007, is 16 percent.''.
       (2) Effective date.--The amendments made by this subsection 
     take effect on the date of enactment of this Act and apply to 
     rebate agreements entered into or renewed under section 1927 
     of the Social Security Act (42 U.S.C. 1396r-8) on or after 
     such date.
                                 ______
                                 
  SA 2582. Mr. BINGAMAN (for himself, Mr. Kerry, and Mrs. Lincoln) 
submitted an amendment intended to be proposed by him to the bill H.R. 
976, to amend the Internal Revenue Code of 1986 to provide tax relief 
for small businesses, and for other purposes; which was ordered to lie 
on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. EXTENSION OF MORATORIUM ON SECRETARIAL AUTHORITY.

       (a) Extension.--Effective as if included in the enactment 
     of section 7002 of the U.S. Troop Readiness, Veterans' Care, 
     Katrina Recovery, and Iraq Accountability Appropriations Act, 
     2007 (Public Law 110-28), subsection (a)(1) of such section 
     is amended, in the matter preceding subparagraph (A), by 
     striking ``1 year'' and inserting ``2 years''.
       (b) Increase in Basic Rebate for Single Source Drugs and 
     Innovator Multiple Source Drugs.--
       (1) In general.--Section 1927(c) (42 U.S.C. 1396r-8(c)) is 
     amended--
       (A) in paragraph (1)(B)(i)--
       (i) in subclause (IV), by striking ``and'' after the 
     semicolon;
       (ii) in subclause (V)--

       (I) by inserting ``and before January 1, 2008,'' after 
     ``1995,''; and
       (II) by striking the period and inserting ``; and''; and

       (iii) by adding at the end the following:

       ``(VI) after December 31, 2007, is 20.1 percent.''; and

       (B) in paragraph (3) (B)--
       (i) in clause (i), by striking ``and'' at the end;
       (ii) in clause (ii)--

       (I) by inserting ``and before January 1, 2008,'' after 
     ``1993,''; and
       (II) by striking the period and inserting ``; and''; and
       (III) by adding at the end the following new clause:

       ``(iii) after December 31, 2007, is 16 percent.''.
       (2) Effective date.--The amendments made by this subsection 
     take effect on the date of enactment of this Act and apply to 
     rebate agreements entered into or renewed under section 1927 
     of the Social Security Act (42 U.S.C. 1396r-8) on or after 
     such date.
                                 ______
                                 
  SA 2583. Mr. BINGAMAN (for himself and Mr. Kerry) submitted an 
amendment intended to be proposed to amendment SA 2530 proposed by Mr. 
Baucus (for himself and Mr. Grassley, Mr. Rockefeller, and Mr. Hatch) 
to the bill H.R. 976, to amend the Internal Revenue Code of 1986 to 
provide tax relief for small businesses, and for other purposes; which 
was ordered to lie on the table; as follows:

       At the end of title VI, add the following:

     SEC. ___. IMPROVEMENTS TO THE MEDICARE SAVINGS PROGRAM.

       (a) Increasing SLMB Eligibility Income Level to 135 Percent 
     of Poverty.--Section 1902(a)(10)(E)(iii) (42 U.S.C. 
     1396a(a)(10)(E)(iii)) is amended by striking ``and 120 
     percent in 1995 and years thereafter'' and inserting ``, 120 
     percent in 1995 through 2007, and 135 percent in 2008 and 
     years thereafter''.
       (b) Improving the Assets Test for the Medicare Savings 
     Program.--Section 1905(p)(1)(C) (42 U.S.C. 1396d(p)(1)(C)) is 
     amended to read as follows:
       ``(C) whose resources (as determined under section 1613 for 
     purposes of the supplemental security income program) do not 
     exceed--
       ``(i) for years before 2008, twice the maximum amount of 
     resources that an individual may have and obtain benefits 
     under that program; and
       ``(ii) for 2008 and subsequent years, the resource 
     limitation established under this clause (or clause (i)) for 
     the previous year increased by the annual percentage increase 
     in the consumer price index (all items; U.S. city average) as 
     of September of such previous year.''.
       (c) Effective Date.--The amendments made by subsections (a) 
     and (b) shall apply to eligibility determinations for 
     medicare cost-sharing furnished for periods beginning on or 
     after January 1, 2008.
       (d) Increase in Basic Rebate for Single Source Drugs and 
     Innovator Multiple Source Drugs.--
       (1) In general.--Section 1927(c) (42 U.S.C. 1396r-8(c)) is 
     amended--
       (A) in paragraph (1)(B)(i)--
       (i) in subclause (IV), by striking ``and'' after the 
     semicolon;
       (ii) in subclause (V)--

       (I) by inserting ``and before January 1, 2008,'' after 
     ``1995,''; and
       (II) by striking the period and inserting ``; and''; and

       (iii) by adding at the end the following:

       ``(VI) after December 31, 2007, is 20.1 percent.''; and

       (B) in paragraph (3) (B)--
       (i) in clause (i), by striking ``and'' at the end;
       (ii) in clause (ii)--

       (I) by inserting ``and before January 1, 2008,'' after 
     ``1993,''; and
       (II) by striking the period and inserting ``; and''; and
       (III) by adding at the end the following new clause:

       ``(iii) after December 31, 2007, is 16 percent.''.
       (2) Effective date.--The amendments made by this subsection 
     take effect on the date of enactment of this Act and apply to 
     rebate agreements entered into or renewed under section 1927 
     of the Social Security Act (42 U.S.C. 1396r-8) on or after 
     such date.
       (e) Extension of Prescription Drug Discounts to Enrollees 
     of Medicaid Managed Care Organizations.--
       (1) In general.--Section 1903(m)(2)(A) (42 U.S.C. 
     1396b(m)(2)(A)) is amended--
       (A) in clause (xi), by striking ``and'' at the end;
       (B) in clause (xii), by striking the period at the end and 
     inserting ``; and''; and
       (C) by adding at the end the following:
       ``(xiii) such contract provides that (I) payment for 
     covered outpatient drugs dispensed to individuals eligible 
     for medical assistance who are enrolled with the entity shall 
     be subject to the same rebate required by the agreement 
     entered into under section 1927 as the State is subject to 
     and that the State shall allow the entity to collect such 
     rebates from manufacturers, and (II) capitation rates paid to 
     the entity shall be based on actual cost experience related 
     to rebates and subject to the Federal regulations requiring 
     actuarially sound rates.''.
       (2) Conforming amendments.--Section 1927 (42 U.S.C. 1396r-
     8) is amended--
       (A) in subsection (d)--
       (i) in paragraph (1), by adding at the end the following:
       ``(C) Notwithstanding subparagraphs (A) and (B)--
       ``(i) a medicaid managed care organization with a contract 
     under section 1903(m) may exclude or otherwise restrict 
     coverage of a covered outpatient drug on the basis of 
     policies or practices of the organization, such as

[[Page 21738]]

     those affecting utilization management, formulary adherence, 
     and cost sharing or dispute resolution, in lieu of any State 
     policies or practices relating to the exclusion or 
     restriction of coverage of such drugs; and
       ``(ii) nothing in this section or paragraph (2)(A)(xiii) of 
     section 1903(m) shall be construed as requiring a medicaid 
     managed care organization with a contract under such section 
     to maintain the same such polices and practices as those 
     established by the State for purposes of individuals who 
     receive medical assistance for covered outpatient drugs on a 
     fee-for service basis.''; and
       (ii) in paragraph (4), by inserting after subparagraph (E) 
     the following:
       ``(F) Notwithstanding the preceding subparagraphs of this 
     paragraph, any formulary established by medicaid managed care 
     organization with a contract under section 1903(m) may be 
     based on positive inclusion of drugs selected by a formulary 
     committee consisting of physicians, pharmacists, and other 
     individuals with appropriate clinical experience as long as 
     drugs excluded from the formulary are available through prior 
     authorization, as described in paragraph (5).''; and
       (B) in subsection (j), by striking paragraph (1) and 
     inserting the following:
       ``(1) Covered outpatients drugs are not subject to the 
     requirements of this section if such drugs are--
       ``(A) dispensed by a health maintenance organization other 
     than a medicaid managed care organization with a contract 
     under section 1903(m); and
       ``(B) subject to discounts under section 340B of the Public 
     Health Service Act.''.
       (3) Effective date.--The amendments made by this subsection 
     take effect on the date of enactment of this Act and apply to 
     rebate agreements entered into or renewed under section 1927 
     of the Social Security Act (42 U.S.C. 1396r-8) on or after 
     such date.
                                 ______
                                 
  SA 2584. Mr. BINGAMAN (for himself, Mr. Kerry and Mr. Feingold) 
submitted an amendment intended to be proposed to amendment SA 2530 
proposed by Mr. Baucus (for himself and Mr. Grassley, Mr. Rockefeller, 
and Mr. Hatch) to the bill H.R. 976, to amend the Internal Revenue Code 
of 1986 to provide tax relief for small businesses, and for other 
purposes; which was ordered to lie on the table; as follows:

       Strike section 301 and insert the following:

     SEC. 301. STATE OPTION TO REQUIRE CERTAIN INDIVIDUALS TO 
                   PRESENT SATISFACTORY DOCUMENTARY EVIDENCE OF 
                   PROOF OF CITIZENSHIP OR NATIONALITY FOR 
                   PURPOSES OF ELIGIBILITY FOR MEDICAID.

       (a) State Plan Amendment.--
       (1) In general.--Section 1902(a)(46) (42 U.S.C. 
     1396a(a)(46)) is amended--
       (A) by inserting ``(A)'' after ``(46)'';
       (B) by adding ``and'' after the semicolon; and
       (C) by adding at the end the following new subparagraph:
       ``(B) at the option of the State and subject to section 
     1903(x), require that, with respect to an individual (other 
     than an individual described in section 1903(x)(1)) who 
     declares to be a citizen or national of the United States for 
     purposes of establishing initial eligibility for medical 
     assistance under this title (or, at State option, for 
     purposes of renewing or redetermining such eligibility to the 
     extent that such satisfactory documentary evidence of 
     citizenship or nationality has not yet been presented), there 
     is presented satisfactory documentary evidence of citizenship 
     or nationality of the individual (using criteria determined 
     by the State, which shall be no more restrictive than the 
     criteria used by the Social Security Administration to 
     determine citizenship, and which shall accept as such 
     evidence 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, and, 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, such other forms of documentation (including tribal 
     documentation, if appropriate) that the Secretary, after 
     consulting with such tribes, determines to be satisfactory 
     documentary evidence of citizenship or nationality for 
     purposes of satisfying the requirement of this 
     subparagraph));''.
       (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 of 
     Health and Human Services 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)--
       (i) in paragraph (20), by adding ``or'' after the 
     semicolon;
       (ii) in paragraph (21), by striking ``; or'' and inserting 
     a period; and
       (iii) by striking paragraph (22); and
       (B) in subsection (x) (as amended by section 405(c)(1)(A) 
     of division B of the Tax Relief and Health Care Act of 2006 
     (Public Law 109-432))--
       (i) by striking paragraphs (1) and (3);
       (ii) by redesignating paragraph (2) as paragraph (1);
       (iii) in paragraph (1), as so redesignated, by striking 
     ``paragraph (1)'' and inserting ``section 1902(a)(46)(B)''; 
     and
       (iv) by adding at the end the following new paragraph:
       ``(2) 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), 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.''.
       (b) Clarification of Rules for Children Born in the United 
     States to Mothers Eligible for Medicaid.--Section 1903(x) (42 
     U.S.C. 1396b(x)), as amended by subsection a(3)(B), is 
     amended--
       (1) in paragraph (1)--
       (A) in subparagraph (C), by striking ``or'' at the end;
       (B) by redesignating subparagraph (D) as subparagraph (E); 
     and
       (C) 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
       (2) by adding at the end the following new paragraph:
       ``(3) 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.''.
       (c) Effective Date.--
       (1) Retroactive application.--The amendments made by this 
     section shall take effect as if included in the enactment of 
     the Deficit Reduction Act of 2005 (Public Law 109-171; 120 
     Stat. 4).
       (2) Restoration of eligibility.--In the case of an 
     individual who, during the period that began on July 1, 2006, 
     and ends on the date of enactment of this Act, was determined 
     to be ineligible for medical assistance under a State 
     Medicaid program 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 subsections (a) and (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.
       (d) Increase in Basic Rebate for Single Source Drugs and 
     Innovator Multiple Source Drugs.--
       (1) In general.--Section 1927(c) (42 U.S.C. 1396r-8(c)) is 
     amended--
       (A) in paragraph (1)(B)(i)--
       (i) in subclause (IV), by striking ``and'' after the 
     semicolon;
       (ii) in subclause (V)--

       (I) by inserting ``and before January 1, 2008,'' after 
     ``1995,''; and
       (II) by striking the period and inserting ``; and''; and

       (iii) by adding at the end the following:

       ``(VI) after December 31, 2007, is 20.1 percent.''; and

       (B) in paragraph (3)(B)--
       (i) in clause (i), by striking ``and'' at the end;
       (ii) in clause (ii)--

       (I) by inserting ``and before January 1, 2008,'' after 
     ``1993,''; and
       (II) by striking the period and inserting ``; and''; and
       (III) by adding at the end the following new clause:

       ``(iii) after December 31, 2007, is 16 percent.''.
       (2) Effective date.--The amendments made by this subsection 
     take effect on the date of enactment of this Act and apply to 
     rebate agreements entered into or renewed under section 1927 
     of the Social Security Act (42 U.S.C. 1396r-8) on or after 
     such date.
       (e) Extension of Prescription Drug Discounts to Enrollees 
     of Medicaid Managed Care Organizations.--
       (1) In general.--Section 1903(m)(2)(A) (42 U.S.C. 
     1396b(m)(2)(A)) is amended--
       (A) in clause (xi), by striking ``and'' at the end;

[[Page 21739]]

       (B) in clause (xii), by striking the period at the end and 
     inserting ``; and''; and
       (C) by adding at the end the following:
       ``(xiii) such contract provides that (I) payment for 
     covered outpatient drugs dispensed to individuals eligible 
     for medical assistance who are enrolled with the entity shall 
     be subject to the same rebate required by the agreement 
     entered into under section 1927 as the State is subject to 
     and that the State shall allow the entity to collect such 
     rebates from manufacturers, and (II) capitation rates paid to 
     the entity shall be based on actual cost experience related 
     to rebates and subject to the Federal regulations requiring 
     actuarially sound rates.''.
       (2) Conforming amendments.--Section 1927 (42 U.S.C. 1396r-
     8) is amended--
       (A) in subsection (d)--
       (i) in paragraph (1), by adding at the end the following:
       ``(C) Notwithstanding subparagraphs (A) and (B)--
       ``(i) a medicaid managed care organization with a contract 
     under section 1903(m) may exclude or otherwise restrict 
     coverage of a covered outpatient drug on the basis of 
     policies or practices of the organization, such as those 
     affecting utilization management, formulary adherence, and 
     cost sharing or dispute resolution, in lieu of any State 
     policies or practices relating to the exclusion or 
     restriction of coverage of such drugs; and
       ``(ii) nothing in this section or paragraph (2)(A)(xiii) of 
     section 1903(m) shall be construed as requiring a medicaid 
     managed care organization with a contract under such section 
     to maintain the same such polices and practices as those 
     established by the State for purposes of individuals who 
     receive medical assistance for covered outpatient drugs on a 
     fee-for service basis.''; and
       (ii) in paragraph (4), by inserting after subparagraph (E) 
     the following:
       ``(F) Notwithstanding the preceding subparagraphs of this 
     paragraph, any formulary established by medicaid managed care 
     organization with a contract under section 1903(m) may be 
     based on positive inclusion of drugs selected by a formulary 
     committee consisting of physicians, pharmacists, and other 
     individuals with appropriate clinical experience as long as 
     drugs excluded from the formulary are available through prior 
     authorization, as described in paragraph (5).''; and
       (B) in subsection (j), by striking paragraph (1) and 
     inserting the following:
       ``(1) Covered outpatients drugs are not subject to the 
     requirements of this section if such drugs are--
       ``(A) dispensed by a health maintenance organization other 
     than a medicaid managed care organization with a contract 
     under section 1903(m); and
       ``(B) subject to discounts under section 340B of the Public 
     Health Service Act.''.
       (3) Effective date.--The amendments made by this subsection 
     take effect on the date of enactment of this Act and apply to 
     rebate agreements entered into or renewed under section 1927 
     of the Social Security Act (42 U.S.C. 1396r-8) on or after 
     such date.
                                 ______
                                 
  SA 2585. Mr. BINGAMAN (for himself and Mr. Levin, Mr. Kerry, Mr. 
Feingold, Mr. Durbin, and Mrs. Lincoln) submitted an amendment intended 
to be proposed by him to the bill H.R. 976, to to amend the Internal 
Revenue Code of 1986 to provide tax relief for small businesses, and 
for other purposes; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. INSTITUTE OF MEDICINE STUDY AND REPORT RELATING TO 
                   CHIP COVERAGE OF ADULT POPULATIONS.

       Not later than July 1, 2009, the Institute of Medicine 
     shall conduct a study and submit a report to Congress 
     regarding coverage of adult populations in CHIP. Such study 
     and report shall include the following:
       (1) Quantification of the total Federal and State 
     expenditures made for providing coverage of adult populations 
     under--
       (A) section 1115 waivers approved before the date of 
     enactment of this Act with respect to the provision of such 
     coverage under State child health plans; and
       (B) the amendments made by this Act.
       (2) An analysis of the impact of providing coverage for 
     parents under CHIP on the access of children to health 
     insurance and the access of children to health services.
       (3) An analysis of the overall cost of providing coverage 
     to pregnant women enrolled in State child health plans under 
     CHIP. Such analysis shall include the long-term cost-savings 
     to Federal and State governments associated with the 
     provision of prenatal care, including the increase in Federal 
     and State health care expenditures that would be associated 
     with the mother and newborn child (over the mother's lifetime 
     and the child's lifetime) if such prenatal care had not been 
     provided.
                                 ______
                                 
  SA 2586. Mr. BINGAMAN (for himself and Mr. Kerry) submitted an 
amendment intended to be proposed by him to the bill H.R. 976, to amend 
the Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the appropriate place, insert the following:

     SEC. __. EXPEDITING LOW-INCOME SUBSIDIES AND REVISING THE 
                   RESOURCE STANDARDS UNDER THE MEDICARE 
                   PRESCRIPTION DRUG PROGRAM.

       (a) Expediting Low-Income Subsidies.--
       (1) In general.--Section 1860D-14 (42 U.S.C. 1395w-114) is 
     amended by adding at the end the following new subsection:
       ``(e) Expedited Application and Eligibility Process.--
       ``(1) Expedited process.--
       ``(A) In general.--The Commissioner of Social Security 
     shall provide for an expedited process under this subsection 
     for the qualification for low-income assistance under this 
     section through a request to the Secretary of the Treasury as 
     provided in subparagraphs (B) and (C) for information 
     described in section 6103(l)(21) of the Internal Revenue Code 
     of 1986. Such process shall be conducted in cooperation with 
     the Secretary.
       ``(B) Opt in for newly eligible individuals.--Not later 
     than 60 days after the date of the enactment of this 
     subsection, the Secretary shall ensure that, as part of the 
     Medicare enrollment process, enrolling individuals--
       ``(i) receive information describing the low-income subsidy 
     provided under this section; and
       ``(ii) are provided the opportunity to opt-in to the 
     expedited process described in this subsection by requesting 
     that the Commissioner of Social Security screen the 
     individual involved for eligibility for such subsidy through 
     a request to the Secretary of the Treasury under section 
     6103(l)(21) of the Internal Revenue Code of 1986.
       ``(C) Currently eligible individuals.--The Commissioner of 
     Social Security shall, as soon as practicable after 
     implementation of subparagraph (A), screen any part D 
     eligible individual to which subparagraph (B) did not apply 
     at the time of such individual's enrollment for eligibility 
     for the low-income subsidy provided under this section 
     through a request to the Secretary of the Treasury under 
     section 6103(l)(21) of the Internal Revenue Code of 1986.
       ``(2) Notification of potentially eligible individuals.--
     Under such process, in the case of each individual identified 
     under paragraph (1) who has not otherwise applied for, or 
     been determined eligible for, benefits under this section (or 
     who has applied for and been determined ineligible for such 
     benefits based only on excess resources), the Commissioner of 
     Social Security shall send a notification that the individual 
     is likely eligible for low-income subsidies under this 
     section. Such notification shall include the following:
       ``(A) Application information.--Information on how to apply 
     for such low-income subsidies.
       ``(B) Description of the lis benefit.--A description of the 
     low-income subsidies available under this section.
       ``(C) Information on state health insurance programs.--
     Information on--
       ``(i) the State Health Insurance Assistance Program for the 
     State in which the individual is located; and
       ``(ii) how the individual may contact such Program in order 
     to obtain assistance regarding enrollment and benefits under 
     this part.
       ``(D) Attestation.--An application form that provides for a 
     signed attestation, under penalty of law, as to the amount of 
     income and assets of the individual and constitutes an 
     application for the low-income subsidies under this section. 
     Such form--
       ``(i) shall not require the submittal of additional 
     documentation regarding income or assets;
       ``(ii) shall permit the appointment of a personal 
     representative described in paragraph (4); and
       ``(iii) shall allow for the specification of a language 
     (other than English) that is preferred by the individual for 
     subsequent communications with respect to the individual 
     under this part.

     If a State is doing its own outreach to low-income seniors 
     regarding enrollment and low-income subsidies under this 
     part, such process shall be coordinated with the State's 
     outreach effort.
       ``(3) Hold-harmless.--Under such process, if an individual 
     in good faith and in the absence of fraud executes an 
     attestation described in paragraph (2)(D) and is provided 
     low-income subsidies under this section on the basis of such 
     attestation, if the individual is subsequently found not 
     eligible for such subsidies, there shall be no recovery made 
     against the individual because of such subsidies improperly 
     paid.
       ``(4) Use of authorized representative.--Under such 
     process, with proper authorization (which may be part of the 
     attestation form described in paragraph (2)(D)), an 
     individual may authorize another individual to act as the 
     individual's personal representative with respect to 
     communications under this part and the enrollment of the 
     individual under a prescription drug plan (or MA-PD plan) and 
     for low-income subsidies under this section.
       ``(5) Use of preferred language in subsequent 
     communications.--In the case where

[[Page 21740]]

     an attestation described in paragraph (2)(D) is completed and 
     in which a language other than English is specified under 
     clause (iii) of such paragraph, the Commissioner of Social 
     Security shall provide that subsequent communications to the 
     individual under this part shall be in such language.
       ``(6) Construction.--Nothing in this subsection shall be 
     construed as precluding the Commissioner of Social Security 
     or the Secretary from taking additional outreach efforts to 
     enroll eligible individuals under this part and to provide 
     low-income subsidies to eligible individuals.''.
       (2) Prescription drug plans required to provide expedited 
     low-income subsidy opt-in as part of applications.--
       (A) In general.--Section 1860D-1(b)(1)(B)(vi) (42 U.S.C. 
     1395w-101(b)(1)(B)(vi)) is amended by inserting before the 
     period at the end the following: ``, except that any 
     application form distributed by a sponsor of a prescription 
     drug plan, or an organization offering an MA-PD plan, shall 
     contain an option for a part D eligible individual to opt-in 
     to the expedited process under section 1860D-14(e) for low-
     income assistance subsidies under such section by requesting 
     that the individual be screened for eligibility for such 
     subsidy through a request to the Secretary of the Treasury 
     under section 6103(l)(21) of the Internal Revenue Code of 
     1986''.
       (B) Effective date.--The amendment made by subparagraph (A) 
     shall apply to application forms for plan years beginning 
     with 2008.
       (3) Disclosure of return information for purposes of 
     determining individuals eligible for subsidies under medicare 
     part d.--
       (A) In general.--Subsection (l) of section 6103 of the 
     Internal Revenue Code of 1986 is amended by adding at the end 
     the following new paragraph:
       ``(21) Disclosure of return information to carry out 
     medicare part d subsidies.--
       ``(A) In general.--The Secretary shall, upon written 
     request from the Commissioner of Social Security under 
     section 1860D-14(e)(1) of the Social Security Act, disclose 
     to officers and employees of the Social Security 
     Administration return information of a taxpayer who 
     (according to the records of the Secretary) may be eligible 
     for a subsidy under section 1860D-14 of the Social Security 
     Act. Such return information shall be limited to--
       ``(i) taxpayer identity information with respect to such 
     taxpayer,
       ``(ii) the filing status of such taxpayer,
       ``(iii) the gross income of such taxpayer,
       ``(iv) such other information relating to the liability of 
     the taxpayer as is prescribed by the Secretary by regulation 
     as might indicate the eligibility of such taxpayer for a 
     subsidy under section 1860D-14 of the Social Security Act, 
     and
       ``(v) the taxable year with respect to which the preceding 
     information relates.
       ``(B) Restriction on use of disclosed information.--Return 
     information disclosed under this paragraph may be used by 
     officers and employees of the Social Security Administration 
     only for the purposes of identifying eligible individuals 
     for, and, if applicable, administering--
       ``(i) low-income subsidies under section 1860D-14 of the 
     Social Security Act, and
       ``(ii) the Medicare Savings Program implemented under 
     clauses (i), (iii), and (iv) of section 1902(a)(10)(E) of 
     such Act.
       ``(C) Termination.--Return information may not be disclosed 
     under this paragraph after the date that is one year after 
     the date of the enactment of this paragraph.''.
       (B) Conforming amendments.--Paragraph (4) of section 
     6103(p) of the Internal Revenue Code of 1986 is amended--
       (i) by striking ``(14) or (17)'' in the matter preceding 
     subparagraph (A) and inserting ``(14), (17), or (21)''; and
       (ii) by striking ``(15) or (17)'' in subparagraph (F)(ii) 
     and inserting ``(15), (17), or (21)''.
       (b) Modification of Resource Standards for Determination of 
     Eligibility for Low-Income Subsidy.--
       (1) Increasing the resource standard applied to full low-
     income subsidy.--Subparagraph (D) of section 1860D-14(a)(3) 
     (42 U.S.C. 1395w-114(a)(3)) is amended--
       (A) in the heading, by striking ``three times'';
       (B) in clause (i), by striking ``and'' at the end;
       (C) in clause (ii)--
       (i) by striking ``a subsequent year'' and inserting 
     ``2007'';
       (ii) by striking ``this clause for the previous year'' and 
     inserting ``clause (i) for 2006''; and
       (iii) by inserting ``(or clause (i))'' after ``this 
     clause''; and
       (iv) by striking the period at the end and inserting a 
     semicolon;
       (D) by adding at the end the following new clauses:
       ``(iii) for 2008, six times the maximum amount of resources 
     that an individual may have and obtain benefits under such 
     supplemental security income program; and
       ``(iv) for a subsequent year the resource limitation 
     established under this clause (or clause (iii)) for the 
     previous year increased by the annual percentage increase in 
     the consumer price index (all items; U.S. city average) as of 
     September of such previous year.''; and
       (E) in the last sentence, by inserting ``or (iv)'' after 
     ``clause (ii)''.
       (2) Increasing the alternate resource standard.--
     Subparagraph (E)(i) of such section is amended--
       (A) by striking ``and'' at the end of subclause (I);
       (B) in subclause (II)--
       (i) by striking ``a subsequent year'' and inserting 
     ``2007'';
       (ii) by striking ``in this subclause (or subclause (I)) for 
     the previous year'' and inserting ``in subclause (I) for 
     2006''; and
       (iii) by striking the period at the end and inserting a 
     semicolon;
       (C) by inserting after subclause (II) the following new 
     subclauses:

       ``(III) for 2008, $27,500 (or $55,000 in the case of the 
     combined value of the individual's assets or resources and 
     the assets or resources of the individual's spouse); and
       ``(IV) for a subsequent year the dollar amounts specified 
     in this subclause (or subclause (III)) for the previous year 
     increased by the annual percentage increase in the consumer 
     price index (all items; U.S. city average) as of September of 
     such previous year.''; and

       (D) in the last sentence, by inserting ``or (IV)'' after 
     ``subclause (II)''.
       (3) Exemptions from resources.--Section 1860D-14(a)(3) (42 
     U.S.C. 1395w-114(a)(3)) is amended--
       (A) in subparagraph (D), in the matter preceding clause 
     (i), by inserting ``, subject to the additional exclusions 
     provided under subparagraph (G)'' before ``)'';
       (B) in subparagraph (E)(i), in the matter preceding 
     subclause (I), by inserting ``,subject to the additional 
     exclusions provided under subparagraph (G)'' before ``)''; 
     and
       (C) by adding at the end the following new subparagraph:
       ``(G) Additional exclusions.--In determining the resources 
     of an individual (and their eligible spouse, if any) under 
     section 1613 for purposes of subparagraphs (D) and (E) the 
     following additional exclusions shall apply:
       ``(i) Life insurance policy.--No part of the value of any 
     life insurance policy shall be taken into account.
       ``(ii) In-kind contributions.--No in-kind contribution 
     shall be taken into account.
       ``(iii) Pension or retirement plan.--No balance in any 
     pension or retirement plan shall be taken into account.''.
       (4) Effective date.--The amendments made by this subsection 
     shall take effect on the date of enactment of this Act.
       (c) Indexing Deductible and Cost-Sharing Above Annual Out-
     of-Pocket Threshold for Individuals With Income Below 150 
     Percent of Poverty Line.--
       (1) Indexing deductible.--Section 1860D-14(a)(4)(B) (42 
     U.S.C. 1395w-114(a)(4)(B)) is amended--
       (A) in clause (i), by striking ``or'';
       (B) in clause (ii)--
       (i) by striking ``a subsequent year'' and inserting 
     ``2008'';
       (ii) by striking ``this clause (or clause (i)) for the 
     previous year'' and inserting ``clause (i) for 2007''; and
       (iii) by striking ``involved.'' and inserting ``involved; 
     and'';
       (C) by adding after clause (ii) the following new clause:
       ``(iii) for 2008 and each succeeding year, the amount 
     determined under this subparagraph for the previous year 
     increased by the annual percentage increase in the consumer 
     price index (all items; U.S. city average) as of September of 
     such previous year.''; and
       (D) in the flush sentence at the end, by striking ``clause 
     (i) or (ii)'' and inserting ``clause (i), (ii), or (iii)''.
       (2) Indexing cost-sharing.--Section 1860D-14(a) (42 U.S.C. 
     1395w-114(a)) is amended-
       (A) in paragraph (1)(D)(iii), by striking ``exceed the 
     copayment amount'' and all that follows through the period at 
     the end and inserting ``exceed--

       ``(I) for 2006 and 2007, the copayment amount specified 
     under section 1860D-2(b)(4)(A)(i)(I) for the drug and year 
     involved; and
       ``(II) for 2008 and each succeeding year, the amount 
     determined under this subparagraph for the previous year 
     increased by the annual percentage increase in the consumer 
     price index (all items; U.S. city average) as of September of 
     such previous year.''; and

       (B) in paragraph (2)(E), by striking ``exceed the copayment 
     or coinsurance amount'' and all that follows through the 
     period at the end and inserting ``exceed--
       ``(i) for 2006 and 2007, the copayment or coinsurance 
     amount specified under section 1860D-2(b)(4)(A)(i)(I) for the 
     drug and year involved; and
       ``(ii) for 2008 and each succeeding year, the amount 
     determined under this clause for the previous year increased 
     by the annual percentage increase in the consumer price index 
     (all items; U.S. city average) as of September of such 
     previous year.''.
       (d) No Impact on Eligibility for Benefits Under Other 
     Programs.--
       (1) In general.--Section 1860D-14(a)(3) (42 U.S.C. 1395w-
     114(a)(3)), as amended by subsection b(3), is amended--
       (A) in subparagraph (A), in the matter preceding clause 
     (i), by striking ``subparagraph (F)'' and inserting 
     ``subparagraphs (F) and (H)''; and

[[Page 21741]]

       (B) by adding at the end the following new subparagraph:
       ``(H) No impact on eligibility for benefits under other 
     programs.--The availability of premium and cost-sharing 
     subsidies under this section shall not be treated as benefits 
     or otherwise taken into account in determining an 
     individual's eligibility for, or the amount of benefits 
     under, any other Federal program.''.
       (2) Effective date.--The amendments made by this subsection 
     shall take effect on the date of enactment of this Act.
       (e) Extension of Prescription Drug Discounts to Enrollees 
     of Medicaid Managed Care Organizations.--
       (1) In general.--Section 1903(m)(2)(A) (42 U.S.C. 
     1396b(m)(2)(A)) is amended--
       (A) in clause (xi), by striking ``and'' at the end;
       (B) in clause (xii), by striking the period at the end and 
     inserting ``; and''; and
       (C) by adding at the end the following:
       ``(xiii) such contract provides that (I) payment for 
     covered outpatient drugs dispensed to individuals eligible 
     for medical assistance who are enrolled with the entity shall 
     be subject to the same rebate required by the agreement 
     entered into under section 1927 as the State is subject to 
     and that the State shall allow the entity to collect such 
     rebates from manufacturers, and (II) capitation rates paid to 
     the entity shall be based on actual cost experience related 
     to rebates and subject to the Federal regulations requiring 
     actuarially sound rates.''.
       (2) Conforming amendments.--Section 1927 (42 U.S.C. 1396r-
     8) is amended--
       (A) in subsection (d)--
       (i) in paragraph (1), by adding at the end the following:
       ``(C) Notwithstanding subparagraphs (A) and (B)--
       ``(i) a medicaid managed care organization with a contract 
     under section 1903(m) may exclude or otherwise restrict 
     coverage of a covered outpatient drug on the basis of 
     policies or practices of the organization, such as those 
     affecting utilization management, formulary adherence, and 
     cost sharing or dispute resolution, in lieu of any State 
     policies or practices relating to the exclusion or 
     restriction of coverage of such drugs; and
       ``(ii) nothing in this section or paragraph (2)(A)(xiii) of 
     section 1903(m) shall be construed as requiring a medicaid 
     managed care organization with a contract under such section 
     to maintain the same such polices and practices as those 
     established by the State for purposes of individuals who 
     receive medical assistance for covered outpatient drugs on a 
     fee-for service basis.''; and
       (ii) in paragraph (4), by inserting after subparagraph (E) 
     the following:
       ``(F) Notwithstanding the preceding subparagraphs of this 
     paragraph, any formulary established by medicaid managed care 
     organization with a contract under section 1903(m) may be 
     based on positive inclusion of drugs selected by a formulary 
     committee consisting of physicians, pharmacists, and other 
     individuals with appropriate clinical experience as long as 
     drugs excluded from the formulary are available through prior 
     authorization, as described in paragraph (5).''; and
       (B) in subsection (j), by striking paragraph (1) and 
     inserting the following:
       ``(1) Covered outpatients drugs are not subject to the 
     requirements of this section if such drugs are--
       ``(A) dispensed by a health maintenance organization other 
     than a medicaid managed care organization with a contract 
     under section 1903(m); and
       ``(B) subject to discounts under section 340B of the Public 
     Health Service Act.''.
       (3) Effective date.--The amendments made by this subsection 
     take effect on the date of enactment of this Act and apply to 
     rebate agreements entered into or renewed under section 1927 
     of the Social Security Act (42 U.S.C. 1396r-8) on or after 
     such date.
       (f) Increase in Basic Rebate for Single Source Drugs and 
     Innovator Multiple Source Drugs.--
       (1) In general.--Section 1927(c) (42 U.S.C. 1396r-8(c)) is 
     amended--
       (A) in paragraph (1)(B)(i)--
       (i) in subclause (IV), by striking ``and'' after the 
     semicolon;
       (ii) in subclause (V)--

       (I) by inserting ``and before January 1, 2008,'' after 
     ``1995,''; and
       (II) by striking the period and inserting ``; and''; and

       (iii) by adding at the end the following:

       ``(VI) after December 31, 2007, is 20.1 percent.''; and

       (B) in paragraph (3) (B)--
       (i) in clause (i), by striking ``and'' at the end;
       (ii) in clause (ii)--

       (I) by inserting ``and before January 1, 2008,'' after 
     ``1993,''; and
       (II) by striking the period and inserting ``; and''; and
       (III) by adding at the end the following new clause:

       ``(iii) after December 31, 2007, is 16 percent.''.
       (2) Effective date.--The amendments made by this subsection 
     take effect on the date of enactment of this Act and apply to 
     rebate agreements entered into or renewed under section 1927 
     of the Social Security Act (42 U.S.C. 1396r-8) on or after 
     such date.
                                 ______
                                 
  SA 2587. Mr. GREGG proposed an amendment to amendment SA 2530 
proposed by Mr. Baucus (for himself, Mr. Grassley, Mr. Rockefeller, and 
Mr. Hatch) to the bill H.R. 976, to amend the Internal Revenue Code of 
1986 to provide tax relief for small businesses, and for other 
purposes; as follows:

       Beginning on page 42, strike line 4 and all that follows 
     through page 66, line 25, and insert the following:

     SEC. 106. LIMITATIONS ON MATCHING RATES FOR POPULATIONS OTHER 
                   THAN LOW-INCOME CHILDREN OR PREGNANT WOMEN 
                   COVERED THROUGH A SECTION 1115 WAIVER.

       (a) Limitation on Payments.--Section 2105(c) of the Social 
     Security Act (42 U.S.C. 1397ee(c)) is amended by adding at 
     the end the following new paragraph:
       ``(8) Limitations on matching rate for populations other 
     than targeted low-income children or pregnant women covered 
     through a section 1115 waiver.--For child health assistance 
     or health benefits coverage furnished in any fiscal year 
     beginning with fiscal year 2008:
       ``(A) FMAP applied to payments only for nonpregnant 
     childless adults and parents and caretaker relatives enrolled 
     under a section 1115 waiver on the date of enactment of the 
     state children's health insurance program reauthorization of 
     2007.--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 payments for child 
     health assistance or health benefits coverage provided under 
     the State child health plan for any of the following:
       ``(i) Parents or caretaker relatives enrolled under a 
     waiver on the date of enactment of the state children's 
     health insurance program reauthorization of 2007.--A 
     nonpregnant parent or a nonpregnant caretaker relative of a 
     targeted low-income child who is enrolled in the State child 
     health plan under a waiver, experimental, pilot, or 
     demonstration project on the date of enactment of the 
     Children's Health Insurance Program Reauthorization Act of 
     2007 and whose family income does not exceed the income 
     eligibility applied under such waiver with respect to that 
     population on such date.
       ``(ii) Nonpregnant childless adults enrolled under a waiver 
     on such date.--A nonpregnant childless adult enrolled in the 
     State child health plan under a waiver, experimental, pilot, 
     or demonstration project described in section 6102(c)(3) of 
     the Deficit Reduction Act of 2005 (42 U.S.C. 1397gg note) on 
     the date of enactment of the Children's Health Insurance 
     Program Reauthorization Act of 2007 and whose family income 
     does not exceed the income eligibility applied under such 
     waiver with respect to that population on such date.
       ``(iii) No replacement enrollees.--Nothing in clauses (i) 
     or (ii) shall be construed as authorizing a State to provide 
     child health assistance or health benefits coverage under a 
     waiver described in either such clause to a nonpregnant 
     parent or a nonpregnant caretaker relative of a targeted low-
     income child, or a nonpregnant childless adult, who is not 
     enrolled under the waiver on the date of enactment of the 
     Children's Health Insurance Program Reauthorization Act of 
     2007.
       ``(B) No federal payment for any new nonpregnant adult 
     enrollees or for such enrollees who no longer satisfy income 
     eligibility requirements.--Payment shall not be made under 
     this section for child health assistance or other health 
     benefits coverage provided under the State child health plan 
     or under a waiver under section 1115 for any of the 
     following:
       ``(i) Parents or caretaker relatives under a section 1115 
     waiver approved after the date of enactment of the state 
     children's health insurance program reauthorization of 
     2007.--A nonpregnant parent or a nonpregnant caretaker 
     relative of a targeted low-income child under a waiver, 
     experimental, pilot, or demonstration project that is 
     approved on or after the date of enactment of the Children's 
     Health Insurance Program Reauthorization Act of 2007.
       ``(ii) Parents, caretaker relatives, and nonpregnant 
     childless adults whose family income exceeds the income 
     eligibility level specified under a section 1115 waiver 
     approved prior to the state children's health insurance 
     program reauthorization of 2007.--Any nonpregnant parent or a 
     nonpregnant caretaker relative of a targeted low-income child 
     whose family income exceeds the income eligibility level 
     referred to in subparagraph (B)(i), and any nonpregnant 
     childless adult whose family income exceeds the income 
     eligibility level referred to in subparagraph (B)(ii).
       ``(iii) Nonpregnant childless adults, parents, or caretaker 
     relatives not enrolled under a section 1115 waiver on the 
     date of enactment of the state children's health insurance 
     program reauthorization of 2007.--Any nonpregnant parent or a 
     nonpregnant caretaker relative of a targeted low-income child 
     who is not enrolled in the State child health plan under a 
     section 1115 waiver, experimental, pilot, or demonstration 
     project referred to in subparagraph

[[Page 21742]]

     (B)(i) on the date of enactment of the Children's Health 
     Insurance Program Reauthorization Act of 2007, and any 
     nonpregnant childless adult who is not enrolled in the State 
     child health plan under a section 1115 waiver, experimental, 
     pilot, or demonstration project referred to in subparagraph 
     (B)(ii)(I) on such date.
       ``(C) Definition of caretaker relative.--In this 
     subparagraph, the term `caretaker relative' has the meaning 
     given that term for purposes of carrying out section 1931.
       ``(D) Rule of construction.--Nothing in this paragraph 
     shall be construed as implying that payments for coverage of 
     populations for which the Federal medical assistance 
     percentage (as so determined) is to be substituted for the 
     enhanced FMAP under subsection (a)(1) in accordance with this 
     paragraph are to be made from funds other than the allotments 
     determined for a State under section 2104.''.
       (b) Conforming Amendment.--Section 2105(a)(1) ( 42 U.S.C. 
     1397dd(a)(1)) is amended, in the matter preceding 
     subparagraph (A), by inserting ``or subsection (c)(8)'' after 
     ``subparagraph (B)''.
       (c) Nonapplication of Certain References.--Subsections (e), 
     (i), (j), and (k) of section 2104 (42 U.S.C. 1397dd), as 
     added by this Act, shall be applied without regard to any 
     reference to section 2111.

     SEC. 107. PROHIBITION ON NEW SECTION 1115 WAIVERS FOR 
                   COVERAGE OF ADULTS OTHER THAN PREGNANT WOMEN.

       (a) In General.--Section 2107(f) (42 U.S.C. 1397gg(f)) is 
     amended--
       (1) by striking ``, the Secretary'' and inserting ``:
       ``(1) The Secretary''; and
       (2) by adding at the end the following new paragraphs:
       ``(2) The Secretary may not approve, extend, renew, or 
     amend a waiver, experimental, pilot, or demonstration project 
     with respect to a State after the date of enactment of the 
     Children's Health Insurance Program Reauthorization Act of 
     2007 that would allow funds made available under this title 
     to be used to provide child health assistance or other health 
     benefits coverage for any other adult other than a pregnant 
     woman whose family income does not exceed the income 
     eligibility level specified for a targeted low-income child 
     in that State under a waiver or project approved as of such 
     date.
       ``(3) The Secretary may not approve, extend, renew, or 
     amend a waiver, experimental, pilot, or demonstration project 
     with respect to a State after the date of enactment of the 
     Children's Health Insurance Program Reauthorization Act of 
     2007 that would waive or modify the requirements of section 
     2105(c)(8).''.
       (b) Clarification of Authority for Coverage of Pregnant 
     Women.--Section 2106 (42 U.S.C. 1397ff) is amended by adding 
     at the end the following new subsection:
       ``(f) No Authority to Cover Pregnant Women Through State 
     Plan.--For purposes of this title, a State may provide 
     assistance to a pregnant woman under the State child health 
     plan only--
       ``(1) by virtue of a waiver under section 1115; or
       ``(2) 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 on the date of 
     enactment of the Children's Health Insurance Program 
     Reauthorization Act of 2007.''.
       (c) Assurance of Notice to Affected Enrollees.--The 
     Secretary of Health and Human Services shall establish 
     procedures to ensure that States provide adequate public 
     notice for parents, caretaker relatives, and nonpregnant 
     childless adults whose eligibility for child health 
     assistance or health benefits coverage under a waiver under 
     section 1115 of the Social Security Act will be terminated as 
     a result of the amendments made by subsection (a), and that 
     States otherwise adhere to regulations of the Secretary 
     relating to procedures for terminating waivers under section 
     1115 of the Social Security Act.
                                 ______
                                 
  SA 2588. Mr. OBAMA (for himself, Mrs. McCaskill, Mr. Harkin, Mr. 
Kerry, and Ms. Landrieu) submitted an amendment intended to be proposed 
to amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, 
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the 
Internal Revenue Code of 1986 to provide tax relief for small 
businesses, and for other purposes; which was ordered to lie on the 
table; as follows:

       At the end of title VI, insert the following:

     SEC. ___. MILITARY FAMILY JOB PROTECTION.

       (a) Short Title.--This section may be cited as the 
     ``Military Family Job Protection Act''.
       (b) Prohibition on Discrimination in Employment Against 
     Certain Family Members Caring for Recovering Members of the 
     Armed Forces.--A family member of a recovering servicemember 
     described in subsection (c) shall not be denied retention in 
     employment, promotion, or any benefit of employment by an 
     employer on the basis of the family member's absence from 
     employment as described in that subsection, for a period of 
     not more than 52 workweeks.
       (c) Covered Family Members.--A family member described in 
     this subsection is a family member of a recovering 
     servicemember who is--
       (1) on invitational orders while caring for the recovering 
     servicemember;
       (2) a non-medical attendee caring for the recovering 
     servicemember; or
       (3) receiving per diem payments from the Department of 
     Defense while caring for the recovering servicemember.
       (d) Treatment of Actions.--An employer shall be considered 
     to have engaged in an action prohibited by subsection (b) 
     with respect to a person described in that subsection if the 
     absence from employment of the person as described in that 
     subsection is a motivating factor in the employer's action, 
     unless the employer can prove that the action would have been 
     taken in the absence of the absence of employment of the 
     person.
       (e) Definitions.--In this section:
       (1) Benefit of employment.--The term ``benefit of 
     employment'' has the meaning given such term in section 4303 
     of title 38, United States Code.
       (2) Caring for.--The term ``caring for'', used with respect 
     to a recovering servicemember, means providing personal, 
     medical, or convalescent care to the recovering 
     servicemember, under circumstances that substantially 
     interfere with an employee's ability to work.
       (3) Employer.--The term ``employer'' has the meaning given 
     such term in section 4303 of title 38, United States Code, 
     except that the term does not include any person who is not 
     considered to be an employer under title I of the Family and 
     Medical Leave Act of 1993 (29 U.S.C. 2611 et seq.) because 
     the person does not meet the requirements of section 
     101(4)(A)(i) of such Act (29 U.S.C. 2611(4)(A)(i)).
       (4) Family member.--The term ``family member'', with 
     respect to a recovering servicemember, has the meaning given 
     that term in section 411h(b) of title 37, United States Code.
       (5) Recovering servicemember.--The term ``recovering 
     servicemember'' means a member of the Armed Forces, including 
     a member of the National Guard or a Reserve, who is 
     undergoing medical treatment, recuperation, or therapy, or is 
     otherwise in medical hold or medical holdover status, for an 
     injury, illness, or disease incurred or aggravated while on 
     active duty in the Armed Forces.
                                 ______
                                 
  SA 2589. Mr. REID proposed an amendment to the bill S. 1, to provide 
greater transparency in the legislative process; as follows:

       At the end of the amendment add the following:
       This section shall take effect 3 days after date of 
     enactment.
                                 ______
                                 
  SA 2590. Mr. REID proposed an amendment to amendment SA 2589 proposed 
by Mr. REID to the bill S. 1, to provide greater transparency in the 
legislative process; as follows:

       In the amendment strike 3 and insert 1.
                                 ______
                                 
  SA 2591. Mr. TESTER (for Mr. Biden) proposed an amendment to the 
resolution S. Res. 276, calling for the urgent deployment of a robust 
and effective multinational peacekeeping mission with sufficient size, 
resources, leadership, and mandate to protect civilians in Darfur, 
Sudan, and for efforts to strengthen the renewal of a just and 
inclusive peace process; as follows:

       On page 8, line 9, strike ``and'',
       On page 8, between lines 9 and 10, insert the following:
       (5) urges all participants in the conflict in Darfur, 
     including the leaders of rebel movements that were not 
     signatories to the Darfur Peace Agreement, to participate 
     fully in all meetings, conferences, and discussions within a 
     political process led by the United Nations and African Union 
     in order to return peace and security to the people of 
     Darfur;
       (6) regards failure to participate in such meetings, 
     conferences, and discussions, as requested by the African 
     Union and United Nations, as an obstruction of the political 
     process and its goals that may be worthy of international 
     sanctions; and
       On page 8, line 10, strike ``(5)'' and insert ``(7)''.
                                 ______
                                 
  SA 2592. Mr. TESTER (for Mr. Biden) proposed an amendment to the 
resolution S. Res. 276, calling for the urgent deployment of a robust 
and effective multinational peacekeeping mission with sufficient size, 
resources, leadership, and mandate to protect civilians in Darfur, 
Sudan, and for efforts to strengthen the renewal of a just and 
inclusive peace process; as follows:

       In the twelfth whereas clause, insert ``and members of his 
     administration'' after ``al-Bashir''.
       Strike the seventeenth whereas clause and insert the 
     following:
       Whereas the United Nations and African Union have invited 
     leaders of the rebel movements in Darfur to participate in a 
     political process led by the United Nations and

[[Page 21743]]

     African Union to return peace and stability to the people of 
     Darfur;
       Whereas deliberately targeting civilians and people 
     providing humanitarian assistance during an armed conflict is 
     a flagrant violation of international humanitarian law, and 
     those who commit such violations must be held accountable; 
     and

                          ____________________