[Congressional Record (Bound Edition), Volume 153 (2007), Part 18]
[House]
[Pages 25448-25521]
[From the U.S. Government Publishing Office, www.gpo.gov]




    CHILDREN'S HEALTH INSURANCE PROGRAM REAUTHORIZATION ACT OF 2007

  Mr. DINGELL. Mr. Speaker, pursuant to H. Res. 675, I call up from the 
Speaker's table the bill (H.R. 976) to amend the Internal Revenue Code 
of 1986 to provide tax relief for small businesses, and for other 
purposes, with Senate amendments thereto, and ask for its immediate 
consideration in the House.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore. The Clerk will designate the Senate 
amendments.
  The text of the Senate amendments is as follows:

       Senate amendments:
       Strike out all after the enacting clause and insert:

     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 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.
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.

      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.
Sec. 610. Support for injured servicemembers.
Sec. 611. Military family job protection.
Sec. 612. Sense of Senate regarding access to affordable and meaningful 
              health insurance coverage.
Sec. 613. Demonstraion projects relating to diabetes prevention.

[[Page 25449]]

Sec. 614. Outreach regarding health insurance options available to 
              children.

                     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 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

[[Page 25450]]

     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 subsection, 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 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;

[[Page 25451]]

       (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 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.

[[Page 25452]]

       ``(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.
       ``(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

[[Page 25453]]

       ``(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--

       ``(aa) the applicable percentage for the State under clause 
     (iii) was the enhanced FMAP for fiscal year 2009; and
       ``(bb) the State met either of the coverage benchmarks 
     described in subparagraph (B) or (C) of paragraph (3) for the 
     preceding fiscal year; or

       ``(II) the Federal medical assistance percentage (as so 
     determined) in the case of any State to which subclause (I) 
     does not apply.

     For purposes of subclause (I), the REMAP percentage is the 
     percentage which is the sum of such Federal medical 
     assistance percentage and a number of percentage points equal 
     to one-half of the difference between such Federal medical 
     assistance percentage and such enhanced FMAP.
       ``(v) No federal payments other than from block grant set 
     aside.--No payments shall be made to a State for expenditures 
     described in clause (ii) after the total amount set aside 
     under clause (i) for a fiscal year has been paid to the 
     State.
       ``(vi) No increase in income eligibility level for 
     parents.--No payments shall be made to a State from the 
     amount set aside under clause (i) for a fiscal year for 
     expenditures for providing child health assistance or health 
     benefits coverage to a parent of a targeted low-income child 
     whose family income exceeds the income eligibility level 
     applied under the applicable existing waiver to parents of 
     targeted low-income children on the date of enactment of the 
     Children's Health Insurance Program Reauthorization Act of 
     2007.
       ``(3) Outreach or coverage benchmarks.--For purposes of 
     paragraph (2), the outreach or coverage benchmarks described 
     in this paragraph are as follows:
       ``(A) Significant child outreach campaign.--The State--
       ``(i) was awarded a grant under section 2113 for fiscal 
     year 2009;
       ``(ii) implemented 1 or more of the 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 clause (ii) or (iii) of 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,

[[Page 25454]]

     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 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

[[Page 25455]]

     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 3-month period during 
     the fiscal year and such rate is at 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

[[Page 25456]]

     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 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--

[[Page 25457]]

       ``(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.--
       ``(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

[[Page 25458]]

     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.
       (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

[[Page 25459]]

      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.
       (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) 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 subsection (a)(46)(B)(ii), the 
     requirements of this subsection with respect to an individual 
     declaring to be a citizen or national of the United States 
     for purposes of establishing eligibility under this title, 
     are, in lieu of requiring the individual to present 
     satisfactory documentary evidence of citizenship or 
     nationality under section 1903(x) (if the individual is not 
     described in paragraph (2) of that section), as follows:
       ``(A) The State submits the name and social security number 
     of the individual to the Commissioner of Social Security as 
     part of the 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 a period of 90 days from 
     the date on which the notice required under clause (i) is 
     received by the individual to either present satisfactory 
     documentary evidence of citizenship or nationality (as 
     defined in section 1903(x)(3)) or cure the invalid 
     determination with the Commissioner of Social Security; 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

[[Page 25460]]

     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 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.--
       (A) In general.--Except as provided in subparagraph (B), 
     the amendments made by this section shall take effect on 
     October 1, 2008.
       (B) Technical amendments.--The amendments made by--
       (i) paragraphs (1), (2), and (3) of subsection (b) shall 
     take effect as if included in the enactment of section 6036 
     of the Deficit Reduction Act of 2005 (Public Law 109-171; 120 
     Stat. 80); and
       (ii) paragraph (4) of subsection (b) shall take effect as 
     if included in the enactment of section 405 of division B of 
     the Tax Relief and Health Care Act of 2006 (Public Law 109-
     432; 120 Stat. 2996).
       (2) Restoration of eligibility.--In the case of an 
     individual who, during the period that began on July 1, 2006, 
     and ends on October 1, 2008, was determined to be ineligible 
     for medical assistance under a State Medicaid plan, including 
     any waiver of such plan, solely as a result of the 
     application of subsections (i)(22) and (x) of section 1903 of 
     the Social Security Act (as in effect during such period), 
     but who would have been determined eligible for such 
     assistance if such subsections, as amended by subsection (b), 
     had applied to the individual, a State may deem the 
     individual to be eligible for such assistance as of the date 
     that the individual was determined to be ineligible for such 
     medical assistance on such basis.
       (3) Special transition rule for indians.--During the period 
     that begins on July 1, 2006, and ends on the effective date 
     of final regulations issued under subclause (II) of section 
     1903(x)(3)(B)(v) of the Social Security Act (42 U.S.C. 
     1396b(x)(3)(B)(v)) (as added by subsection (b)(1)(B)), an 
     individual who is a member of a federally-recognized Indian 
     tribe described in subclause (II) of that section who 
     presents a document described in subclause (I) of

[[Page 25461]]

     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 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 premium assistance waiver programs.--
     Nothing in this paragraph shall be construed as limiting the 
     authority of a State

[[Page 25462]]

     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.
       ``(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 developed in accordance with 
     section 701(f)(3)(B)(i)(II) of the Employee Retirement Income 
     Security Act of 1974 (29 U.S.C. 1181(f)(3)(B)(i)(II)).
       ``(II) Option to provide concurrent with provision of 
     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)(1)(C) of the Children's Health Insurance 
     Program Reauthorization Act of 2007, so as to permit the 
     State to make a determination (under paragraph (2)(B), (3), 
     or (10) of section 2105(c) of the Social Security Act or 
     otherwise) concerning the cost-effectiveness of the State 
     providing medical or child health assistance through premium 
     assistance for the purchase of coverage under such group 
     health plan and in order for the State to provide 
     supplemental benefits required under paragraph (10)(E) of 
     such section or other authority.''.
       (b) Conforming Amendments.--
       (1) Amendments to employee retirement income security 
     act.--
       (A) In general.--Section 701(f) of the Employee Retirement 
     Income Security Act of 1974 (29 U.S.C. 1181(f)) is amended by 
     adding at the end the following new paragraph:
       ``(3) Special rules for application in case of medicaid and 
     chip.--
       ``(A) In general.--A group health plan, and a health 
     insurance issuer offering group health insurance coverage in 
     connection with a group health plan, shall permit an employee 
     who is eligible, but not enrolled, for coverage under the 
     terms of the plan (or a dependent of such an employee if the 
     dependent is eligible, but not enrolled, for coverage under 
     such terms) to enroll for coverage under the terms of the 
     plan if either of the following conditions is met:
       ``(i) Termination of medicaid or chip coverage.--The 
     employee or dependent is covered under a Medicaid plan under 
     title XIX of the Social Security Act or under a State child 
     health plan under title XXI of such Act and coverage of the 
     employee or dependent under such a plan is terminated as a 
     result of loss of eligibility for such coverage and the 
     employee requests coverage under the group health plan (or 
     health insurance coverage) not later than 60 days after the 
     date of termination of such coverage.
       ``(ii) Eligibility for employment assistance under medicaid 
     or chip.--The employee or dependent becomes eligible for 
     assistance, with respect to coverage under the group health 
     plan or health insurance coverage, under such Medicaid plan 
     or State child health plan (including

[[Page 25463]]

     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)(1)(C) of the Children's Health Insurance 
     Program Reauthorization Act of 2007, so as to permit the 
     State to make a determination (under paragraph (2)(B), (3), 
     or (10) of section 2105(c) of the Social Security Act or 
     otherwise) concerning the cost-effectiveness of the State 
     providing medical or child health assistance through premium 
     assistance for the purchase of coverage under such group 
     health plan and in order for the State to provide 
     supplemental benefits required under paragraph (10)(E) of 
     such section or other authority.''.
       (B) Conforming amendment.--Section 102(b) of the Employee 
     Retirement Income Security Act of 1974 (29 U.S.C. 1022(b)) is 
     amended--
       (i) by striking ``and the remedies'' and inserting ``, the 
     remedies''; and
       (ii) by inserting before the period the following: ``, and 
     if the employer so elects for purposes of complying with 
     section 701(f)(3)(B)(i), the model notice applicable to the 
     State in which the participants and beneficiaries reside''.
       (C) Working group to develop model coverage coordination 
     disclosure form.--
       (i) Medicaid, chip, and employer-sponsored coverage 
     coordination working group.--

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

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

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

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

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

       (vi) Termination.--The Working Group shall terminate 30 
     days after the date of the issuance of its report under 
     clause (v).
       (D) Effective dates.--The Secretary of Labor and the 
     Secretary of Health and Human Services shall develop the 
     initial model notices under section 701(f)(3)(B)(i)(II) of 
     the Employee Retirement Income Security Act of 1974, and the 
     Secretary of Labor shall provide such notices to employers, 
     not later than the date that is 1 year after the date of 
     enactment of this Act, and each employer shall provide the 
     initial annual notices to such employer's employees beginning 
     with the first plan year that begins after the date on which 
     such initial model notices are first issued. The model 
     coverage coordination disclosure form developed under 
     subparagraph (C) shall apply with respect to requests made by 
     States beginning with the first plan year that begins after 
     the date on which such model coverage coordination disclosure 
     form is first issued.
       (E) Enforcement.--Section 502 of the Employee Retirement 
     Income Security Act of 1974 (29 U.S.C. 1132) is amended--
       (i) in subsection (a)(6), by striking ``or (8)'' and 
     inserting ``(8), or (9)''; and
       (ii) in subsection (c), by redesignating paragraph (9) as 
     paragraph (10), and by inserting after paragraph (8) the 
     following:
       ``(9)(A) The Secretary may assess a civil penalty against 
     any employer of up to $100 a day from the date of the 
     employer's failure to meet the notice requirement of section 
     701(f)(3)(B)(i)(I). For purposes of this subparagraph, each 
     violation with respect to any single employee shall be 
     treated as a separate violation.
       ``(B) The Secretary may assess a civil penalty against any 
     plan administrator of up to $100 a day from the date of the 
     plan administrator's failure to timely provide to any State 
     the information required to be disclosed under section 
     701(f)(3)(B)(ii). For purposes of this subparagraph, each 
     violation with respect to any single participant or 
     beneficiary shall be treated as a separate violation.''.
       (2) Amendments to public health service act.--Section 
     2701(f) of the Public Health Service Act (42 U.S.C. 300gg(f)) 
     is amended by adding at the end the following new paragraph:
       ``(3) Special rules for application in case of medicaid and 
     chip.--
       ``(A) In general.--A group health plan, and a health 
     insurance issuer offering group health insurance coverage in 
     connection with a group health plan, shall permit an employee 
     who is eligible, but not enrolled, for coverage under the 
     terms of the plan (or a dependent of such an employee if the 
     dependent is eligible, but not enrolled, for coverage under 
     such terms) to enroll

[[Page 25464]]

     for coverage under the terms of the plan if either of the 
     following conditions is met:
       ``(i) Termination of medicaid or chip coverage.--The 
     employee or dependent is covered under a Medicaid plan under 
     title XIX of the Social Security Act or under a State child 
     health plan under title XXI of such Act and coverage of the 
     employee or dependent under such a plan is terminated as a 
     result of loss of eligibility for such coverage and the 
     employee requests coverage under the group health plan (or 
     health insurance coverage) not later than 60 days after the 
     date of termination of such coverage.
       ``(ii) Eligibility for employment assistance under medicaid 
     or chip.--The employee or dependent becomes eligible for 
     assistance, with respect to coverage under the group health 
     plan or health insurance coverage, under such Medicaid plan 
     or State child health plan (including under any waiver or 
     demonstration project conducted under or in relation to such 
     a plan), if the employee requests coverage under the group 
     health plan or health insurance coverage not later than 60 
     days after the date the employee or dependent is determined 
     to be eligible for such assistance.
       ``(B) Coordination with medicaid and chip.--
       ``(i) Outreach to employees regarding availability of 
     medicaid and chip coverage.--

       ``(I) In general.--Each employer that maintains a group 
     health plan in a State that provides medical assistance under 
     a State Medicaid plan under title XIX of the Social Security 
     Act, or child health assistance under a State child health 
     plan under title XXI of such Act, in the form of premium 
     assistance for the purchase of coverage under a group health 
     plan, shall provide to each employee a written notice 
     informing the employee of potential opportunities then 
     currently available in the State in which the employee 
     resides for premium assistance under such plans for health 
     coverage of the employee or the employee's dependents. For 
     purposes of compliance with this subclause, the employer may 
     use any State-specific model notice developed in accordance 
     with section 701(f)(3)(B)(i)(II) of the Employee Retirement 
     Income Security Act of 1974 (29 U.S.C. 1181(f)(3)(B)(i)(II)).
       ``(II) Option to provide concurrent with provision of 
     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.

       ``(ii) Disclosure about group health plan benefits to 
     states for medicaid and chip eligible individuals.--In the 
     case of an enrollee in a group health plan who is covered 
     under a Medicaid plan of a State under title XIX of the 
     Social Security Act or under a State child health plan under 
     title XXI of such Act, the plan administrator of the group 
     health plan shall disclose to the State, upon request, 
     information about the benefits available under the group 
     health plan in sufficient specificity, as determined under 
     regulations of the Secretary of Health and Human Services in 
     consultation with the Secretary that require use of the model 
     coverage coordination disclosure form developed under section 
     411(b)(1)(C) of the Children's Health Insurance 
     Reauthorization Act of 2007, so as to permit the State to 
     make a determination (under paragraph (2)(B), (3), or (10) of 
     section 2105(c) of the Social Security Act or otherwise) 
     concerning the cost-effectiveness of the State providing 
     medical or child health assistance through premium assistance 
     for the purchase of coverage under such group health plan and 
     in order for the State to provide supplemental benefits 
     required under paragraph (10)(E) of such section or other 
     authority.''.

 TITLE 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

[[Page 25465]]

     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
       ``(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;

[[Page 25466]]

       ``(iii) training health professionals on how to identify 
     and treat obese and overweight individuals which may include 
     nutrition and physical activity counseling; and
       ``(iv) providing community education by a health 
     professional on good nutrition and physical activity to 
     develop a better understanding of the relationship between 
     diet, physical activity, and eating disorders, obesity, or 
     being overweight; and
       ``(D) provide, through qualified health professionals, 
     training and supervision for community health workers to--
       ``(i) educate families regarding the relationship between 
     nutrition, eating habits, physical activity, and obesity;
       ``(ii) educate families about effective strategies to 
     improve nutrition, establish healthy eating patterns, and 
     establish appropriate levels of physical activity; and
       ``(iii) educate and guide parents regarding the ability to 
     model and communicate positive health behaviors.
       ``(4) Priority.--In awarding grants under paragraph (1), 
     the Secretary shall give priority to awarding grants to 
     eligible entities--
       ``(A) that demonstrate that they have previously applied 
     successfully for funds to carry out activities that seek to 
     promote individual and community health and to prevent the 
     incidence of chronic disease and that can cite published and 
     peer-reviewed research demonstrating that the activities that 
     the entities propose to carry out with funds made available 
     under the grant are effective;
       ``(B) that will carry out programs or activities that seek 
     to accomplish a goal or goals set by the State in the Healthy 
     People 2010 plan of the State;
       ``(C) that provide non-Federal contributions, either in 
     cash or in-kind, to the costs of funding activities under the 
     grants;
       ``(D) that develop comprehensive plans that include a 
     strategy for extending program activities developed under 
     grants in the years following the fiscal years for which they 
     receive grants under this subsection;
       ``(E) located in communities that are medically 
     underserved, as determined by the Secretary;
       ``(F) located in areas in which the average poverty rate is 
     at least 150 percent or higher of the average poverty rate in 
     the State involved, as determined by the Secretary; and
       ``(G) that submit plans that exhibit multisectoral, 
     cooperative conduct that includes the involvement of a broad 
     range of stakeholders, including--
       ``(i) community-based organizations;
       ``(ii) local governments;
       ``(iii) local educational agencies;
       ``(iv) the private sector;
       ``(v) State or local departments of health;
       ``(vi) accredited colleges, universities, and community 
     colleges;
       ``(vii) health care providers;
       ``(viii) State and local departments of transportation and 
     city planning; and
       ``(ix) other entities determined appropriate by the 
     Secretary.
       ``(5) Program design.--
       ``(A) Initial design.--Not later than 1 year after the date 
     of enactment of the Children's Health Insurance Program 
     Reauthorization Act of 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

[[Page 25467]]

       (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 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.

[[Page 25468]]

       (e) Harmonization of MEQC and PERM.--
       (1) Reduction of redundancies.--The Secretary shall review 
     the Medicaid Eligibility Quality Control (in this subsection 
     referred to as the ``MEQC'') requirements with the PERM 
     requirements and coordinate consistent implementation of both 
     sets of requirements, while reducing redundancies.
       (2) State option to apply perm data.--A State may elect, 
     for purposes of determining the erroneous excess payments for 
     medical assistance ratio applicable to the State for a fiscal 
     year under section 1903(u) of the Social Security Act (42 
     U.S.C. 1396b(u)) to substitute data resulting from the 
     application of the PERM requirements to the State after the 
     final rule implementing such requirements is in effect for 
     all States for data obtained from the application of the MEQC 
     requirements to the State with respect to a fiscal year.
       (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 2111(b)(2)(B)(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--
       (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

[[Page 25469]]

       (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.

       (a) In General.--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 (f), 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--
       ``(A) the dental services (if any) covered under the State 
     child health plan; and
       ``(B) how the State intends to improve dental coverage and 
     services during fiscal years 2008 through 2012;
       ``(2) a detailed description of the programs and activities 
     proposed to be conducted with funds awarded under the grant;
       ``(3) quality and outcomes performance measures to evaluate 
     the effectiveness of such activities; and
       ``(4) 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) Use of Funds.--The programs and activities described 
     in subsection (a)(1) may include the provision of enhanced 
     dental coverage under the State child health plan.
       ``(d) 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.
       ``(e) 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)(4).
       ``(f) 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.''.
       (b) Improved Accessibility of Dental Provider Information 
     More Accessible to Enrollees Under Medicaid and CHIP.--The 
     Secretary shall--
       (1) work with States, pediatric dentists, and other dental 
     providers to include on the Insure Kids Now website (http://
www.insurekidsnow.gov/) and hotline (1-877-KIDS-NOW) a 
     current and accurate list of all dentists and other dental 
     providers within each State that provide dental services to 
     children enrolled in the State plan (or waiver) under 
     Medicaid or the State child health plan (or waiver) under 
     CHIP, and shall ensure that such list is updated at least 
     quarterly; and
       (2) work with States to include a description of the dental 
     services provided under each State plan (or waiver) under 
     Medicaid and each State child health plan (or waiver) under 
     CHIP on such Insure Kids Now website.
       (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.
       (d) Inclusion of Status of Efforts To Improve Dental Care 
     in Reports on the Quality of Children's Health Care Under 
     Medicaid and CHIP.--Section 1139A(a)(6)(ii), as added by 
     section 501(a), is amended by inserting ``dental care,'' 
     after ``preventive health services,''.

     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.

     SEC. 610. SUPPORT FOR INJURED SERVICEMEMBERS.

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

[[Page 25470]]

     leave under paragraph (1) during any other 12-month 
     period.''.
       (3) Requirements relating to leave.--
       (A) Schedule.--Section 102(b) of such Act (29 U.S.C. 
     2612(b)) is amended--
       (i) in paragraph (1), in the second sentence--

       (I) by striking ``section 103(b)(5)'' and inserting 
     ``subsection (b)(5) or (f) (as appropriate) of section 103''; 
     and
       (II) by inserting ``or under subsection (a)(3)'' after 
     ``subsection (a)(1)''; and

       (ii) in paragraph (2), by inserting ``or under subsection 
     (a)(3)'' after ``subsection (a)(1)''.
       (B) Substitution of paid leave.--Section 102(d) of such Act 
     (29 U.S.C. 2612(d)) is amended--
       (i) in paragraph (1)--

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

       (ii) in paragraph (2)(B), by adding at the end the 
     following: ``An eligible employee may elect, or an employer 
     may require the employee, to substitute any of the accrued 
     paid vacation leave, personal leave, family leave, or medical 
     or sick leave of the employee for leave provided under 
     subsection (a)(3) for any part of the 26-week period of such 
     leave under such subsection.''.
       (C) Notice.--Section 102(e)(2) of such Act (29 U.S.C. 
     2612(e)(2)) is amended by inserting ``or under subsection 
     (a)(3)'' after ``subsection (a)(1)''.
       (D) Spouses employed by same employer.--Section 102(f) of 
     such Act (29 U.S.C. 2612(f)) is amended--
       (i) by redesignating paragraphs (1) and (2) as 
     subparagraphs (A) and (B), and aligning the margins of the 
     subparagraphs with the margins of section 102(e)(2)(A);
       (ii) by striking ``In any'' and inserting the following:
       ``(1) In general.--In any''; and
       (iii) by adding at the end the following:
       ``(2) Servicemember family leave.--
       ``(A) In general.--The aggregate number of workweeks of 
     leave to which both that husband and wife may be entitled 
     under subsection (a) may be limited to 26 workweeks during 
     the single 12-month period described in subsection (a)(3) if 
     the leave is--
       ``(i) leave under subsection (a)(3); or
       ``(ii) a combination of leave under subsection (a)(3) and 
     leave described in paragraph (1).
       ``(B) Both limitations applicable.--If the leave taken by 
     the husband and wife includes leave described in paragraph 
     (1), the limitation in paragraph (1) shall apply to the leave 
     described in paragraph (1).''.
       (E) Certification.--Section 103 of such Act (29 U.S.C. 
     2613) is amended by adding at the end the following:
       ``(f) Certification for Servicemember Family Leave.--An 
     employer may require that a request for leave under section 
     102(a)(3) be supported by a certification issued at such time 
     and in such manner as the Secretary may by regulation 
     prescribe.''.
       (F) Failure to return.--Section 104(c) of such Act (29 
     U.S.C. 2614(c)) is amended--
       (i) in paragraph (2)(B)(i), by inserting ``or under section 
     102(a)(3)'' before the semicolon; and
       (ii) in paragraph (3)(A)--

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

       ``(iii) a certification issued by the health care provider 
     of the servicemember being cared for by the employee, in the 
     case of an employee unable to return to work because of a 
     condition specified in section 102(a)(3).''.
       (G) Enforcement.--Section 107 of such Act (29 U.S.C. 2617) 
     is amended, in subsection (a)(1)(A)(i)(II), by inserting 
     ``(or 26 weeks, in a case involving leave under section 
     102(a)(3))'' after ``12 weeks''.
       (H) Instructional employees.--Section 108 of such Act (29 
     U.S.C. 2618) is amended, in subsections (c)(1), (d)(2), and 
     (d)(3), by inserting ``or under section 102(a)(3)'' after 
     ``section 102(a)(1)''.
       (c) Servicemember Family Leave for Civil Service 
     Employees.--
       (1) Definitions.--Section 6381 of title 5, United States 
     Code, is amended--
       (A) in paragraph (5), by striking ``and'' at the end;
       (B) in paragraph (6), by striking the period and inserting 
     ``; and''; and
       (C) by adding at the end the following:
       ``(7) the term `active duty' means duty under a call or 
     order to active duty under a provision of law referred to in 
     section 101(a)(13)(B) of title 10, United States Code;
       ``(8) the term `covered servicemember' means a member of 
     the Armed Forces, including a member of the National Guard or 
     a Reserve, who is undergoing medical treatment, recuperation, 
     or therapy, is otherwise in medical hold or medical holdover 
     status, or is otherwise on the temporary disability retired 
     list, for a serious injury or illness;
       ``(9) the term `medical hold or medical holdover status' 
     means--
       ``(A) the status of a member of the Armed Forces, including 
     a member of the National Guard or a Reserve, assigned or 
     attached to a military hospital for medical care; and
       ``(B) the status of a member of a reserve component of the 
     Armed Forces who is separated, whether pre-deployment or 
     post-deployment, from the member's unit while in need of 
     health care based on a medical condition identified while the 
     member is on active duty in the Armed Forces;
       ``(10) the term `next of kin', used with respect to an 
     individual, means the nearest blood relative of that 
     individual; and
       ``(11) the term `serious injury or illness', in the case of 
     a member of the Armed Forces, means an injury or illness 
     incurred by the member in line of duty on active duty in the 
     Armed Forces that may render the member medically unfit to 
     perform the duties of the member's office, grade, rank, or 
     rating.''.
       (2) Entitlement to leave.--Section 6382(a) of such title is 
     amended by adding at the end the following:
       ``(3) Subject to section 6383, an employee who is the 
     spouse, son, daughter, parent, or next of kin of a covered 
     servicemember shall be entitled to a total of 26 
     administrative workweeks of leave during a 12-month period to 
     care for the servicemember. The leave described in this 
     paragraph shall only be available during a single 12-month 
     period.
       ``(4) During the single 12-month period described in 
     paragraph (3), an employee shall be entitled to a combined 
     total of 26 administrative workweeks of leave under 
     paragraphs (1) and (3). Nothing in this paragraph shall be 
     construed to limit the availability of leave under paragraph 
     (1) during any other 12-month period.''.
       (3) Requirements relating to leave.--
       (A) Schedule.--Section 6382(b) of such title is amended--
       (i) in paragraph (1), in the second sentence--

       (I) by striking ``section 6383(b)(5)'' and inserting 
     ``subsection (b)(5) or (f) (as appropriate) of section 
     6383''; and
       (II) by inserting ``or under subsection (a)(3)'' after 
     ``subsection (a)(1)''; and

       (ii) in paragraph (2), by inserting ``or under subsection 
     (a)(3)'' after ``subsection (a)(1)''.
       (B) Substitution of paid leave.--Section 6382(d) of such 
     title is amended by adding at the end the following: ``An 
     employee may elect to substitute for leave under subsection 
     (a)(3) any of the employee's accrued or accumulated annual or 
     sick leave under subchapter I for any part of the 26-week 
     period of leave under such subsection.''.
       (C) Notice.--Section 6382(e) of such title is amended by 
     inserting ``or under subsection (a)(3)'' after ``subsection 
     (a)(1)''.
       (D) Certification.--Section 6383 of such title is amended 
     by adding at the end the following:
       ``(f) An employing agency may require that a request for 
     leave under section 6382(a)(3) be supported by a 
     certification issued at such time and in such manner as the 
     Office of Personnel Management may by regulation 
     prescribe.''.

     SEC. 611. 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

[[Page 25471]]

     status, for an injury, illness, or disease incurred or 
     aggravated while on active duty in the Armed Forces.

     SEC. 612. SENSE OF SENATE REGARDING ACCESS TO AFFORDABLE AND 
                   MEANINGFUL HEALTH INSURANCE COVERAGE.

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

     SEC. 613. DEMONSTRATION PROJECTS RELATING TO DIABETES 
                   PREVENTION.

       There is authorized to be appropriated $15,000,000 during 
     the period of fiscal years 2008 through 2012 to fund 
     demonstration projects in up to 10 States over 3 years for 
     voluntary incentive programs to promote children's receipt of 
     relevant screenings and improvements in healthy eating and 
     physical activity with the aim of reducing the incidence of 
     type 2 diabetes. Such programs may involve reductions in 
     cost-sharing or premiums when children receive regular 
     screening and reach certain benchmarks in healthy eating and 
     physical activity. Under such programs, a State may also 
     provide financial bonuses for partnerships with entities, 
     such as schools, which increase their education and efforts 
     with respect to reducing the incidence of type 2 diabetes and 
     may also devise incentives for providers serving children 
     covered under this title and title XIX to perform relevant 
     screening and counseling regarding healthy eating and 
     physical activity. Upon completion of these demonstrations, 
     the Secretary shall provide a report to Congress on the 
     results of the State demonstration projects and the degree to 
     which they helped improve health outcomes related to type 2 
     diabetes in children in those States.''.

     SEC. 614. 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.

                     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 ``$3.00 per cigar''.
       (b) Cigarettes.--Section 5701(b) of such Code is amended--
       (1) by striking ``$19.50 per thousand ($17 per thousand on 
     cigarettes removed during 2000 or 2001)'' in paragraph (1) 
     and inserting ``$50.00 per thousand'', and
       (2) by striking ``$40.95 per thousand ($35.70 per thousand 
     on cigarettes removed during 2000 or 2001)'' in paragraph (2) 
     and inserting ``$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.--

[[Page 25472]]

       (A) Liability for tax.--A person holding tobacco products, 
     cigarette papers, or cigarette tubes on January 1, 2008, to 
     which any tax imposed by paragraph (1) applies shall be 
     liable for such tax.
       (B) Method of payment.--The tax imposed by paragraph (1) 
     shall be paid in such manner as the Secretary shall prescribe 
     by regulations.
       (C) Time for payment.--The tax imposed by paragraph (1) 
     shall be paid on or before April 1, 2008.
       (4) Articles in foreign trade zones.--Notwithstanding the 
     Act of June 18, 1934 (commonly known as the Foreign Trade 
     Zone Act, 48 Stat. 998, 19 U.S.C. 81a et seq.) or any other 
     provision of law, any article which is located in a foreign 
     trade zone on January 1, 2008, shall be subject to the tax 
     imposed by paragraph (1) if--
       (A) internal revenue taxes have been determined, or customs 
     duties liquidated, with respect to such article before such 
     date pursuant to a request made under the 1st proviso of 
     section 3(a) of such Act, or
       (B) such article is held on such date under the supervision 
     of an officer of the United States Customs and Border 
     Protection of the Department of Homeland Security pursuant to 
     the 2d proviso of such section 3(a).
       (5) Definitions.--For purposes of this subsection--
       (A) In general.--Any term used in this subsection which is 
     also used in section 5702 of the Internal Revenue Code of 
     1986 shall have the same meaning as such term has in such 
     section.
       (B) Secretary.--The term ``Secretary'' means the Secretary 
     of the Treasury or the Secretary's delegate.
       (6) Controlled groups.--Rules similar to the rules of 
     section 5061(e)(3) of such Code shall apply for purposes of 
     this subsection.
       (7) Other laws applicable.--All provisions of law, 
     including penalties, applicable with respect to the taxes 
     imposed by section 5701 of such Code shall, insofar as 
     applicable and not inconsistent with the provisions of this 
     subsection, apply to the floor stocks taxes imposed by 
     paragraph (1), to the same extent as if such taxes were 
     imposed by such section 5701. The Secretary may treat any 
     person who bore the ultimate burden of the tax imposed by 
     paragraph (1) as the person to whom a credit or refund under 
     such provisions may be allowed or made.
       (i) Effective Date.--The amendments made by this section 
     shall apply to articles removed (as defined in section 
     5702(j) of the Internal Revenue Code of 1986) after December 
     31, 2007.

     SEC. 702. ADMINISTRATIVE IMPROVEMENTS.

       (a) Permit, Report, and Record Requirements for 
     Manufacturers and Importers of Processed Tobacco.--
       (1) Permits.--
       (A) Application.--Section 5712 of the Internal Revenue Code 
     of 1986 is amended by inserting ``or processed tobacco'' 
     after ``tobacco products''.
       (B) Issuance.--Section 5713(a) of such Code is amended by 
     inserting ``or processed tobacco'' after ``tobacco 
     products''.
       (2) Inventories and reports.--
       (A) Inventories.--Section 5721 of such Code is amended by 
     inserting ``, processed tobacco,'' after ``tobacco 
     products''.
       (B) Reports.--Section 5722 of such Code is amended by 
     inserting ``, processed tobacco,'' after ``tobacco 
     products''.
       (3) Records.--Section 5741 of such Code is amended by 
     inserting ``, processed tobacco,'' after ``tobacco 
     products''.
       (4) Manufacturer of processed tobacco.--Section 5702 of 
     such Code is amended by adding at the end the following new 
     subsection:
       ``(p) Manufacturer of Processed Tobacco.--
       ``(1) In general.--The term `manufacturer of processed 
     tobacco' means any person who processes any tobacco other 
     than tobacco products.
       ``(2) Processed tobacco.--The processing of tobacco shall 
     not include the farming or growing of tobacco or the handling 
     of tobacco solely for sale, shipment, or delivery to a 
     manufacturer of tobacco products or processed tobacco.''.
       (5) Conforming amendment.--Section 5702(k) of such Code is 
     amended by inserting ``, or any processed tobacco,'' after 
     ``nontaxpaid tobacco products or cigarette papers or tubes''.
       (6) Effective date.--The amendments made by this subsection 
     shall take effect on January 1, 2008.
       (b) Basis for Denial, Suspension, or Revocation of 
     Permits.--
       (1) Denial.--Paragraph (3) of section 5712 of such Code is 
     amended to read as follows:
       ``(3) such person (including, in the case of a corporation, 
     any officer, director, or principal stockholder and, in the 
     case of a partnership, a partner)--
       ``(A) is, by reason of his business experience, financial 
     standing, or trade connections or by reason of previous or 
     current 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.


                     Motion Offered by Mr. Dingell

  Mr. DINGELL. Mr. Speaker, pursuant to H. Res. 675, I have a motion at 
the desk.
  The SPEAKER pro tempore. The Clerk will designate the motion.
  The text of the motion is as follows:
  Mr. Dingell moves that the House concur in each of the Senate 
amendments to H.R. 976 with the respective amendment printed in the 
report of the Committee on Rules accompanying H. Res. 675.

  The text of the House amendments to the Senate amendments is as 
follows:

       House amendments to Senate amendments:
       In lieu of the matter proposed to be inserted to the text 
     of the Act, insert the following:

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

       (a) Short Title.--This Act may be cited as ``Children's 
     Health Insurance Program Reauthorization Act of 2007''.

[[Page 25473]]

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

Sec. 1. Short title; amendments to Social Security Act; references; 
              table of contents.
Sec. 2.  Purpose.
Sec. 3. General effective date; exception for State legislation; 
              contingent effective date; reliance on law.

                           TITLE I--FINANCING

                          Subtitle A--Funding

Sec. 101. Extension of CHIP.
Sec. 102. Allotments for States and territories for fiscal years 2008 
              through 2012.
Sec. 103. Child Enrollment Contingency Fund.
Sec. 104. CHIP performance bonus payment to offset additional 
              enrollment costs resulting from enrollment and retention 
              efforts.
Sec. 105. 2-year initial availability of CHIP allotments.
Sec. 106. Redistribution of unused allotments to address State funding 
              shortfalls.
Sec. 107. Option for qualifying States to receive the enhanced portion 
              of the CHIP matching rate for Medicaid coverage of 
              certain children.
Sec. 108. One-time appropriation.
Sec. 109. Improving funding for the territories under CHIP and 
              Medicaid.

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

Sec. 111. State option to cover low-income pregnant women under CHIP 
              through a State plan amendment.
Sec. 112. Phase-Out of coverage for nonpregnant childless adults under 
              CHIP; conditions for coverage of parents.
Sec. 113. Elimination of counting Medicaid child presumptive 
              eligibility costs against Title XXI allotment.
Sec. 114. Limitation on matching rate for States that propose to cover 
              children with effective family income that exceeds 300 
              percent of the poverty line.
Sec. 115. State authority under Medicaid.
Sec. 116. Preventing substitution of CHIP coverage for private 
              coverage.

                   TITLE II--OUTREACH AND ENROLLMENT

             Subtitle A--Outreach and Enrollment Activities

Sec. 201. Grants and enhanced administrative funding for outreach and 
              enrollment.
Sec. 202. Increased outreach and enrollment of Indians.
Sec. 203. State option to rely on findings from an Express Lane agency 
              to conduct simplified eligibility determinations.

              Subtitle B--Reducing Barriers to Enrollment

Sec. 211. Verification of declaration of citizenship or nationality for 
              purposes of eligibility for Medicaid and CHIP.
Sec. 212. Reducing administrative barriers to enrollment.
Sec. 213. Model of Interstate coordinated enrollment and coverage 
              process.

      TITLE III--REDUCING BARRIERS TO PROVIDING PREMIUM ASSISTANCE

  Subtitle A--Additional State Option for Providing Premium Assistance

Sec. 301. Additional State option for providing premium assistance.
Sec. 302. Outreach, education, and enrollment assistance.

   Subtitle B--Coordinating Premium Assistance With Private Coverage

Sec. 311. Special enrollment period under group health plans in case of 
              termination of Medicaid or CHIP coverage or eligibility 
              for assistance in purchase of employment-based coverage; 
              coordination of coverage.

      TITLE IV--STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES

Sec. 401. Child health quality improvement activities for children 
              enrolled in Medicaid or CHIP.
Sec. 402. Improved availability of public information regarding 
              enrollment of children in CHIP and Medicaid.
Sec. 403. Application of certain managed care quality safeguards to 
              CHIP.

                 TITLE V--IMPROVING ACCESS TO BENEFITS

Sec. 501. Dental benefits.
Sec. 502. Mental health parity in CHIP plans.
Sec. 503. Application of prospective payment system for services 
              provided by Federally-Qualified Health Centers and rural 
              health clinics.
Sec. 504. Premium grace period.
Sec. 505. Demonstration projects relating to diabetes prevention.
Sec. 506. Clarification of coverage of services provided through 
              school-based health centers.

     TITLE VI--PROGRAM INTEGRITY AND OTHER MISCELLANEOUS PROVISIONS

           Subtitle A--Program Integrity and Data Collection

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

              Subtitle B--Miscellaneous Health Provisions

Sec. 611. Deficit Reduction Act technical corrections.
Sec. 612. References to title XXI.
Sec. 613. Prohibiting initiation of new health opportunity account 
              demonstration programs.
Sec. 614. County medicaid health insuring organizations; GAO report on 
              Medicaid managed care payment rates.
Sec. 615. Adjustment in computation of Medicaid FMAP to disregard an 
              extraordinary employer pension contribution.
Sec. 616. Moratorium on certain payment restrictions.
Sec. 617. Medicaid DSH allotments for Tennessee and Hawaii.
Sec. 618. Clarification treatment of regional medical center.
Sec. 619. Extension of SSI web-based asset demonstration project to the 
              Medicaid program.

                      Subtitle C--Other Provisions

Sec. 621. Support for injured servicemembers.
Sec. 622. Military family job protection.
Sec. 623. Outreach regarding health insurance options available to 
              children.
Sec. 624. Sense of Senate regarding access to affordable and meaningful 
              health insurance coverage.

                     TITLE VII--REVENUE PROVISIONS

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

     SEC. 2. PURPOSE.

       It is the purpose of this Act to provide dependable and 
     stable funding for children's health insurance under titles 
     XXI and XIX of the Social Security Act in order to enroll all 
     six million uninsured children who are eligible, but not 
     enrolled, for coverage today through such titles.

     SEC. 3. GENERAL EFFECTIVE DATE; EXCEPTION FOR STATE 
                   LEGISLATION; CONTINGENT EFFECTIVE DATE; 
                   RELIANCE ON LAW.

       (a) General Effective Date.--Unless otherwise provided in 
     this Act, subject to subsections (b) and (c), this Act (and 
     the amendments made by this Act) shall take effect on October 
     1, 2007, and shall apply to child health assistance and 
     medical assistance provided on or after that date without 
     regard to whether or not final regulations to carry out this 
     Act (or such amendments) have been promulgated by such date.
       (b) Exception for State Legislation.--In the case of a 
     State plan under title XIX or State child health plan under 
     XXI of the Social Security Act, which the Secretary of Health 
     and Human Services determines requires State legislation in 
     order for respective plan to meet one or more additional 
     requirements imposed by amendments made by this Act, the 
     respective State plan shall not be regarded as failing to 
     comply with the requirements of such title solely on the 
     basis of its failure to meet such an additional requirement 
     before the first day of the first calendar quarter beginning 
     after the close of the first regular session of the State 
     legislature that begins after the date of enactment of this 
     Act. For purposes of the previous sentence, in the case of a 
     State that has a 2-year legislative session, each year of the 
     session shall be considered to be a separate regular session 
     of the State legislature.
       (c) Contingent Effective Date for CHIP Funding for Fiscal 
     Year 2008.--Notwithstanding any other provision of law, if 
     funds are appropriated under any law (other than this Act) to 
     provide allotments to States under CHIP for all (or any 
     portion) of fiscal year 2008--
       (1) any amounts that are so appropriated that are not so 
     allotted and obligated before the date of the enactment of 
     this Act are rescinded; and

[[Page 25474]]

       (2) any amount provided for CHIP allotments to a State 
     under this Act (and the amendments made by this Act) for such 
     fiscal year shall be reduced by the amount of such 
     appropriations so allotted and obligated before such date.
       (d) Reliance on Law.--With respect to amendments made by 
     this Act (other than title VII) that become effective as of a 
     date--
       (1) such amendments are effective as of such date whether 
     or not regulations implementing such amendments have been 
     issued; and
       (2) Federal financial participation for medical assistance 
     or child health assistance furnished under title XIX or XXI, 
     respectively, of the Social Security Act on or after such 
     date by a State in good faith reliance on such amendments 
     before the date of promulgation of final regulations, if any, 
     to carry out such amendments (or before the date of guidance, 
     if any, regarding the implementation of such amendments) 
     shall not be denied on the basis of the State's failure to 
     comply with such regulations or guidance.

                           TITLE I--FINANCING

                          Subtitle A--Funding

     SEC. 101. EXTENSION OF CHIP.

       Section 2104(a) (42 U.S.C. 1397dd(a)) is amended--
       (1) in paragraph (9), by striking ``and'' at the end;
       (2) in paragraph (10), by striking the period at the end 
     and inserting a semicolon; and
       (3) by adding at the end the following new paragraphs:
       ``(11) for fiscal year 2008, $9,125,000,000;
       ``(12) for fiscal year 2009, $10,675,000,000;
       ``(13) for fiscal year 2010, $11,850,000,000;
       ``(14) for fiscal year 2011, $13,750,000,000; and
       ``(15) for fiscal year 2012, for purposes of making 2 semi-
     annual allotments--
       ``(A) $1,750,000,000 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 STATES AND TERRITORIES FOR FISCAL 
                   YEARS 2008 THROUGH 2012.

       Section 2104 (42 U.S.C. 1397dd) is amended--
       (1) in subsection (b)(1), by striking ``subsection (d)'' 
     and inserting ``subsections (d) and (i)'';
       (2) in subsection (c)(1), by striking ``subsection (d)'' 
     and inserting ``subsections (d) and (i)(4)''; and
       (3) by adding at the end the following new subsection:
       ``(i) Allotments for Fiscal Years 2008 Through 2012.--
       ``(1) For fiscal year 2008.--
       ``(A) For the 50 states and the district of columbia.--
     Subject to the succeeding provisions of this paragraph and 
     paragraph (4), the Secretary shall allot for fiscal year 2008 
     from the amount made available under subsection (a)(11), to 
     each of the 50 States and the District of Columbia 110 
     percent of the highest of the following amounts for such 
     State or District:
       ``(i) The total Federal payments to the State under this 
     title for fiscal year 2007, multiplied by the allotment 
     increase factor determined under paragraph (5) for fiscal 
     year 2008.
       ``(ii) The Federal share of the amount allotted to the 
     State for fiscal year 2007 under subsection (b), multiplied 
     by the allotment increase factor determined under paragraph 
     (5) for fiscal year 2008.
       ``(iii) Only in the case of--

       ``(I) a State that received a payment, redistribution, or 
     allotment under 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 allotment increase factor determined under 
     paragraph (5) for fiscal year 2008.
       ``(iv) The projected total Federal payments to the State 
     under this title for fiscal year 2008, as determined on the 
     basis of the August 2007 projections certified by the State 
     to the Secretary by not later than September 30, 2007.
       ``(B) For the commonwealths and territories.--Subject to 
     the succeeding provisions of this paragraph and paragraph 
     (4), the Secretary shall allot for fiscal year 2008 from the 
     amount made available under subsection (a)(11) to each of the 
     commonwealths and territories described in subsection (c)(3) 
     an amount equal to the highest amount of Federal payments to 
     the commonwealth or territory under this title for any fiscal 
     year occurring during the period of fiscal years 1998 through 
     2007, multiplied by the allotment increase factor determined 
     under paragraph (5) for fiscal year 2008, except that 
     subparagraph (B) thereof shall be applied by substituting 
     `the United States' for `the State'.
       ``(C) Deadline and data for determining fiscal year 2008 
     allotments.--In computing the amounts under subparagraphs (A) 
     and (B) that determine the allotments to States for fiscal 
     year 2008, the Secretary shall use the most recent data 
     available to the Secretary before the start of that fiscal 
     year. The Secretary may adjust such amounts and allotments, 
     as necessary, on the basis of the expenditure data for the 
     prior year reported by States on CMS Form 64 or CMS Form 21 
     not later than November 30, 2007, but in no case shall the 
     Secretary adjust the allotments provided under subparagraph 
     (A) or (B) for fiscal year 2008 after December 31, 2007.
       ``(D) Adjustment for qualifying states.--In the case of a 
     qualifying State described in paragraph (2) of section 
     2105(g), the Secretary shall permit the State to submit 
     revised projection described in subparagraph (A)(iv) in order 
     to take into account changes in such projections attributable 
     to the application of paragraph (4) of such section.
       ``(2) For fiscal years 2009 through 2011.--
       ``(A) In general.--Subject to paragraphs (4) and (6), from 
     the amount made available under paragraphs (12) through (14) 
     of subsection (a) for each of fiscal years 2009 through 2011, 
     respectively, the Secretary shall compute a State allotment 
     for each State (including the District of Columbia and each 
     commonwealth and territory) for each such fiscal year as 
     follows:
       ``(i) Growth factor update for fiscal year 2009.--For 
     fiscal year 2009, the allotment of the State is equal to the 
     sum of--

       ``(I) the amount of the State allotment under paragraph (1) 
     for fiscal year 2008; and
       ``(II) the amount of any payments made to the State under 
     subsection (j) for fiscal year 2008,

     multiplied by the allotment increase factor under paragraph 
     (5) for fiscal year 2009.
       ``(ii) Rebasing in fiscal year 2010.--For fiscal year 2010, 
     the allotment of a State is equal to the Federal payments to 
     the State that are attributable to (and countable towards) 
     the total amount of allotments available under this section 
     to the State in fiscal year 2009 (including payments made to 
     the State under subsection (j) for fiscal year 2009 as well 
     as amounts redistributed to the State in fiscal year 2009) 
     multiplied by the allotment increase factor under paragraph 
     (5) for fiscal year 2010.
       ``(iii) Growth factor update for fiscal year 2011.--For 
     fiscal year 2011, the allotment of the State is equal to the 
     sum of--

       ``(I) the amount of the State allotment under clause (ii) 
     for fiscal year 2010; and
       ``(II) the amount of any payments made to the State under 
     subsection (j) for fiscal year 2010,

     multiplied by the allotment increase factor under paragraph 
     (5) for fiscal year 2011.
       ``(3) For fiscal year 2012.--
       ``(A) First half.--Subject to paragraphs (4) and (6), from 
     the amount made available under subparagraph (A) of paragraph 
     (15) of subsection (a) for the semi-annual period described 
     in such paragraph, increased by the amount of the 
     appropriation for such period under section 108 of the 
     Children's Health Insurance Program Reauthorization Act of 
     2007, the Secretary shall compute a State allotment for each 
     State (including the District of Columbia and each 
     commonwealth and territory) for such semi-annual period in an 
     amount equal to the first half ratio (described in 
     subparagraph (D)) of the amount described in subparagraph 
     (C).
       ``(B) Second half.--Subject to paragraphs (4) and (6), from 
     the amount made available under subparagraph (B) of paragraph 
     (15) of subsection (a) for the semi-annual period described 
     in such paragraph, the Secretary shall compute a State 
     allotment for each State (including the District of Columbia 
     and each commonwealth and territory) for such semi-annual 
     period in an amount equal to the amount made available under 
     such subparagraph multiplied by the ratio of--
       ``(i) the amount of the allotment to such State under 
     subparagraph (A); to
       ``(ii) the total of the amount of all of the allotments 
     made available under such subparagraph.
       ``(C) Full year amount based on rebased amount.--The amount 
     described in this subparagraph for a State is equal to the 
     Federal payments to the State that are attributable to (and 
     countable towards) the total amount of allotments available 
     under this section to the State in fiscal year 2011 
     (including payments made to the State under subsection (j)

[[Page 25475]]

     for fiscal year 2011 as well as amounts redistributed to the 
     State in fiscal year 2011) multiplied by the allotment 
     increase factor under paragraph (5) for fiscal year 2012.
       ``(D) First half ratio.--The first half ratio described in 
     this subparagraph is the ratio of--
       ``(i) the sum of--

       ``(I) the amount made available under subsection 
     (a)(15)(A); and
       ``(II) the amount of the appropriation for such period 
     under section 108 of the Children's Health Insurance Program 
     Reauthorization Act of 2007; to

       ``(ii) the sum of the--

       ``(I) amount described in clause (i); and
       ``(II) the amount made available under subsection 
     (a)(15)(B).

       ``(4) Proration rule.--If, after the application of this 
     subsection without regard to this paragraph, the sum of the 
     allotments determined under paragraph (1), (2), or (3) for a 
     fiscal year (or, in the case of fiscal year 2012, for a semi-
     annual period in such fiscal year) exceeds the amount 
     available under subsection (a) for such fiscal year or 
     period, the Secretary shall reduce each allotment for any 
     State under such paragraph for such fiscal year or period on 
     a proportional basis.
       ``(5) Allotment increase factor.--The allotment increase 
     factor under this paragraph for a fiscal year is equal to the 
     product of the following:
       ``(A) Per capita health care growth factor.--1 plus the 
     percentage increase in the projected per capita amount of 
     National Health Expenditures from the calendar year in which 
     the previous fiscal year ends to the calendar year in which 
     the fiscal year involved ends, as most recently published by 
     the Secretary before the beginning of the fiscal year.
       ``(B) Child population growth factor.--1 plus the 
     percentage increase (if any) in the population of children in 
     the State from July 1 in the previous fiscal year to July 1 
     in the fiscal year involved, as determined by the Secretary 
     based on the most recent published estimates of the Bureau of 
     the Census before the beginning of the fiscal year involved, 
     plus 1 percentage point.
       ``(6) Increase in allotment to account for approved program 
     expansions.--In the case of one of the 50 States or the 
     District of Columbia that--
       ``(A) has submitted to the Secretary, and has approved by 
     the Secretary, a State plan amendment or waiver request 
     relating to an expansion of eligibility for children or 
     benefits under this title that becomes effective for a fiscal 
     year (beginning with fiscal year 2009 and ending with fiscal 
     year 2012); and
       ``(B) has submitted to the Secretary, before the August 31 
     preceding the beginning of the fiscal year, a request for an 
     expansion allotment adjustment under this paragraph for such 
     fiscal year that specifies--
       ``(i) the additional expenditures that are attributable to 
     the eligibility or benefit expansion provided under the 
     amendment or waiver described in subparagraph (A), as 
     certified by the State and submitted to the Secretary by not 
     later than August 31 preceding the beginning of the fiscal 
     year; and
       ``(ii) the extent to which such additional expenditures are 
     projected to exceed the allotment of the State or District 
     for the year,

     subject to paragraph (4), the amount of the allotment of the 
     State or District under this subsection for such fiscal year 
     shall be increased by the excess amount described in 
     subparagraph (B)(i). A State or District may only obtain an 
     increase under this paragraph for an allotment for fiscal 
     year 2009 or fiscal year 2011.
       ``(7) Availability of amounts for semi-annual periods in 
     fiscal year 2012.--Each semi-annual allotment made under 
     paragraph (3) for a period in fiscal year 2012 shall remain 
     available for expenditure under this title for periods after 
     the end of such fiscal year in the same manner as if the 
     allotment had been made available for the entire fiscal 
     year.''.

     SEC. 103. CHILD ENROLLMENT CONTINGENCY FUND.

       Section 2104 (42 U.S.C. 1397dd), as amended by section 102, 
     is amended by adding at the end the following new subsection:
       ``(j) Child Enrollment Contingency Fund.--
       ``(1) Establishment.--There is hereby established in the 
     Treasury of the United States a fund which shall be known as 
     the `Child Enrollment Contingency Fund' (in this subsection 
     referred to as the `Fund'). Amounts in the Fund shall be 
     available without further appropriations for payments under 
     this subsection.
       ``(2) Deposits into fund.--
       ``(A) Initial and subsequent appropriations.--Subject to 
     subparagraphs (B) and (D), out of any money in the Treasury 
     of the United States not otherwise appropriated, there are 
     appropriated to the Fund--
       ``(i) for fiscal year 2008, an amount equal to 20 percent 
     of the amount made available under paragraph (11) of 
     subsection (a) for the fiscal year; and
       ``(ii) for each of fiscal years 2009 through 2011 (and for 
     each of the semi-annual allotment periods for fiscal year 
     2012) , such sums as are necessary for making payments to 
     eligible States for such fiscal year or period, but not in 
     excess of the aggregate cap described in subparagraph (B).
       ``(B) Aggregate cap.--The total amount available for 
     payment from the Fund for each of fiscal years 2009 through 
     2011 (and for each of the semi-annual allotment periods for 
     fiscal year 2012), taking into account deposits made under 
     subparagraph (C), shall not exceed 20 percent of the amount 
     made available under subsection (a) for the fiscal year or 
     period.
       ``(C) Investment of fund.--The Secretary of the Treasury 
     shall invest, in interest bearing securities of the United 
     States, such currently available portions of the Fund as are 
     not immediately required for payments from the Fund. The 
     income derived from these investments constitutes a part of 
     the Fund.
       ``(D) Availability of excess funds for performance 
     bonuses.--Any amounts in excess of the aggregate cap 
     described in subparagraph (B) for a fiscal year or period 
     shall be made available for purposes of carrying out section 
     2105(a)(3) for any succeeding fiscal year and the Secretary 
     of the Treasury shall reduce the amount in the Fund by the 
     amount so made available.
       ``(3) Child enrollment contingency fund payments.--
       ``(A) In general.--If a State's expenditures under this 
     title in fiscal year 2008, fiscal year 2009, fiscal year 
     2010, fiscal year 2011, or a semi-annual allotment period for 
     fiscal year 2012, exceed the total amount of allotments 
     available under this section to the State in the fiscal year 
     or period (determined without regard to any redistribution it 
     receives under subsection (f) that is available for 
     expenditure during such fiscal year or period, but including 
     any carryover from a previous fiscal year) and if the average 
     monthly unduplicated number of children enrolled under the 
     State plan under this title (including children receiving 
     health care coverage through funds under this title pursuant 
     to a waiver under section 1115) during such fiscal year or 
     period exceeds its target average number of such enrollees 
     (as determined under subparagraph (B)) for that fiscal year 
     or period, subject to subparagraph (D), the Secretary shall 
     pay to the State from the Fund an amount equal to the product 
     of--
       ``(i) the amount by which such average monthly caseload 
     exceeds such target number of enrollees; and
       ``(ii) the projected per capita expenditures under the 
     State child health plan (as determined under subparagraph (C) 
     for the fiscal year), multiplied by the enhanced FMAP (as 
     defined in section 2105(b)) for the State and fiscal year 
     involved (or in which the period occurs).
       ``(B) Target average number of child enrollees.--In this 
     paragraph, the target average number of child enrollees for a 
     State--
       ``(i) for fiscal year 2008 is equal to the monthly average 
     unduplicated number of children enrolled in the State child 
     health plan under this title (including such children 
     receiving health care coverage through funds under this title 
     pursuant to a waiver under section 1115) during fiscal year 
     2007 increased by the population growth for children in that 
     State for the year ending on June 30, 2006 (as estimated by 
     the Bureau of the Census) plus 1 percentage point; or
       ``(ii) for a subsequent fiscal year (or semi-annual period 
     occurring in a fiscal year) is equal to the target average 
     number of child enrollees for the State for the previous 
     fiscal year increased by the child population growth factor 
     described in subsection (i)(5)(B) for the State for the prior 
     fiscal year.
       ``(C) Projected per capita expenditures.--For purposes of 
     subparagraph (A)(ii), the projected per capita expenditures 
     under a State child health plan--
       ``(i) for fiscal year 2008 is equal to the average per 
     capita expenditures (including both State and Federal 
     financial participation) under such plan for the targeted 
     low-income children counted in the average monthly caseload 
     for purposes of this paragraph during fiscal year 2007, 
     increased by the annual percentage increase in the projected 
     per capita amount of National Health Expenditures (as 
     estimated by the Secretary) for 2008; or
       ``(ii) for a subsequent fiscal year (or semi-annual period 
     occurring in a fiscal year) is equal to the projected per 
     capita expenditures under such plan for the previous fiscal 
     year (as determined under clause (i) or this clause) 
     increased by the annual percentage increase in the projected 
     per capita amount of National Health Expenditures (as 
     estimated by the Secretary) for the year in which such 
     subsequent fiscal year ends.
       ``(D) Proration rule.--If the amounts available for payment 
     from the Fund for a fiscal year or period are less than the 
     total amount of payments determined under subparagraph (A) 
     for the fiscal year or period, the amount to be paid under 
     such subparagraph to each eligible State shall be reduced 
     proportionally.
       ``(E) Timely payment; reconciliation.--Payment under this 
     paragraph for a fiscal year or period shall be made before 
     the end of the fiscal year or period based upon the most 
     recent data for expenditures and enrollment and the 
     provisions of subsection (e) of section 2105 shall apply to 
     payments under this subsection in the same manner as they 
     apply to payments under such section.
       ``(F) Continued reporting.--For purposes of this paragraph 
     and subsection (f), the

[[Page 25476]]

     State shall submit to the Secretary the State's projected 
     Federal expenditures, even if the amount of such expenditures 
     exceeds the total amount of allotments available to the State 
     in such fiscal year or period.
       ``(G) Application to commonwealths and territories.--No 
     payment shall be made under this paragraph to a commonwealth 
     or territory described in subsection (c)(3) until such time 
     as the Secretary determines that there are in effect methods, 
     satisfactory to the Secretary, for the collection and 
     reporting of reliable data regarding the enrollment of 
     children described in subparagraphs (A) and (B) in order to 
     accurately determine the commonwealth's or territory's 
     eligibility for, and amount of payment, under this 
     paragraph.''.

     SEC. 104. CHIP PERFORMANCE BONUS PAYMENT TO OFFSET ADDITIONAL 
                   ENROLLMENT COSTS RESULTING FROM ENROLLMENT AND 
                   RETENTION EFFORTS.

       Section 2105(a) (42 U.S.C. 1397ee(a)) is amended by adding 
     at the end the following new paragraphs:
       ``(3) Performance bonus payment to offset additional 
     medicaid and chip child enrollment costs resulting from 
     enrollment and retention efforts.--
       ``(A) In general.--In addition to the payments made under 
     paragraph (1), for each fiscal year (beginning with fiscal 
     year 2008 and ending with fiscal year 2012) the Secretary 
     shall pay from amounts made available under subparagraph (E), 
     to each State that meets the condition under paragraph (4) 
     for the fiscal year, an amount equal to the amount described 
     in subparagraph (B) for the State and fiscal year. The 
     payment under this paragraph shall be made, to a State for a 
     fiscal year, as a single payment not later than the last day 
     of the first calendar quarter of the following fiscal year.
       ``(B) Amount.--Subject to subparagraph (E), the amount 
     described in this subparagraph for a State for a fiscal year 
     is equal to the sum of the following amounts:
       ``(i) For above baseline medicaid child enrollment costs.--

       ``(I) First tier above baseline medicaid enrollees.--An 
     amount equal to the number of first tier above baseline child 
     enrollees (as determined under subparagraph (C)(i)) under 
     title XIX for the State and fiscal year multiplied by 15 
     percent of the projected per capita State Medicaid 
     expenditures (as determined under subparagraph (D)(i)) for 
     the State and fiscal year under title XIX.
       ``(II) Second tier above baseline medicaid enrollees.--An 
     amount equal to the number of second tier above baseline 
     child enrollees (as determined under subparagraph (C)(ii)) 
     under title XIX for the State and fiscal year multiplied by 
     60 percent of the projected per capita State Medicaid 
     expenditures (as determined under subparagraph (D)(i)) for 
     the State and fiscal year under title XIX.

       ``(ii) For above baseline chip enrollment costs.--

       ``(I) First tier above baseline chip enrollees.--An amount 
     equal to the number of first tier above baseline child 
     enrollees under this title (as determined under subparagraph 
     (C)(i)) for the State and fiscal year multiplied by 10 
     percent of the projected per capita State CHIP expenditures 
     (as determined under subparagraph (D)(ii)) for the State and 
     fiscal year under this title.
       ``(II) Second tier above baseline chip enrollees.--An 
     amount equal to the number of second tier above baseline 
     child enrollees under this title (as determined under 
     subparagraph (C)(ii)) for the State and fiscal year 
     multiplied by 40 percent of the projected per capita State 
     CHIP expenditures (as determined under subparagraph (D)(ii)) 
     for the State and fiscal year under this title.

       ``(C) Number of first and second tier above baseline child 
     enrollees; baseline number of child enrollees.--For purposes 
     of this paragraph:
       ``(i) First tier above baseline child enrollees.--The 
     number of first tier above baseline child enrollees for a 
     State for a fiscal year under this title or title XIX is 
     equal to the number (if any, as determined by the Secretary) 
     by which--

       ``(I) the monthly average unduplicated number of qualifying 
     children (as defined in subparagraph (F)) enrolled during the 
     fiscal year under the State child health plan under this 
     title or under the State plan under title XIX, respectively; 
     exceeds
       ``(II) the baseline number of enrollees described in clause 
     (iii) for the State and fiscal year under this title or title 
     XIX, respectively;

     but not to exceed 3 percent (in the case of title XIX) or 7.5 
     percent (in the case of this title) of the baseline number of 
     enrollees described in subclause (II).
       ``(ii) Second tier above baseline child enrollees.--The 
     number of second tier above baseline child enrollees for a 
     State for a fiscal year under this title or title XIX is 
     equal to the number (if any, as determined by the Secretary) 
     by which--

       ``(I) the monthly average unduplicated number of qualifying 
     children (as defined in subparagraph (F)) enrolled during the 
     fiscal year under this title or under title XIX, 
     respectively, as described in clause (i)(I); exceeds
       ``(II) the sum of the baseline number of child enrollees 
     described in clause (iii) for the State and fiscal year under 
     this title or title XIX, respectively, as described in clause 
     (i)(II), and the maximum number of first tier above baseline 
     child enrollees for the State and fiscal year under this 
     title or title XIX, respectively, as determined under clause 
     (i).

       ``(iii) Baseline number of child enrollees.--Subject to 
     subparagraph (H), the baseline number of child enrollees for 
     a State under this title or title XIX--

       ``(I) for fiscal year 2008 is equal to the monthly average 
     unduplicated number of qualifying children enrolled in the 
     State child health plan under this title or in the State plan 
     under title XIX, respectively, during fiscal year 2007 
     increased by the population growth for children in that State 
     for the year ending on June 30, 2006 (as estimated by the 
     Bureau of the Census) plus 1 percentage point; or
       ``(II) for a subsequent fiscal year is equal to the 
     baseline number of child enrollees for the State for the 
     previous fiscal year under this title or title XIX, 
     respectively, increased by the population growth for children 
     in that State for the year ending on June 30 before the 
     beginning of the fiscal year (as estimated by the Bureau of 
     the Census) plus 1 percentage point.

       ``(D) Projected per capita state expenditures.--For 
     purposes of subparagraph (B)--
       ``(i) Projected per capita state medicaid expenditures.--
     The projected per capita State Medicaid expenditures for a 
     State and fiscal year under title XIX is equal to the average 
     per capita expenditures (including both State and Federal 
     financial participation) for children under the State plan 
     under such title, including under waivers but not including 
     such children eligible for assistance by virtue of the 
     receipt of benefits under title XVI, for the most recent 
     fiscal year for which actual data are available (as 
     determined by the Secretary), increased (for each subsequent 
     fiscal year up to and including the fiscal year involved) by 
     the annual percentage increase in per capita amount of 
     National Health Expenditures (as estimated by the Secretary) 
     for the calendar year in which the respective subsequent 
     fiscal year ends and multiplied by a State matching 
     percentage equal to 100 percent minus the Federal medical 
     assistance percentage (as defined in section 1905(b)) for the 
     fiscal year involved.
       ``(ii) Projected per capita state chip expenditures.--The 
     projected per capita State CHIP expenditures for a State and 
     fiscal year under this title is equal to the average per 
     capita expenditures (including both State and Federal 
     financial participation) for children under the State child 
     health plan under this title, including under waivers, for 
     the most recent fiscal year for which actual data are 
     available (as determined by the Secretary), increased (for 
     each subsequent fiscal year up to and including the fiscal 
     year involved) by the annual percentage increase in per 
     capita amount of National Health Expenditures (as estimated 
     by the Secretary) for the calendar year in which the 
     respective subsequent fiscal year ends and multiplied by a 
     State matching percentage equal to 100 percent minus the 
     enhanced FMAP (as defined in section 2105(b)) for the fiscal 
     year involved.
       ``(E) Amounts available for payments.--
       ``(i) Initial appropriation.--Out of any money in the 
     Treasury not otherwise appropriated, there are appropriated 
     $3,000,000,000 for fiscal year 2008 for making payments under 
     this paragraph, to be available until expended.
       ``(ii) Transfers.--Notwithstanding any other provision of 
     this title, the following amounts shall also be available, 
     without fiscal year limitation, for making payments under 
     this paragraph:

       ``(I) Unobligated national allotment.--

       ``(aa) Fiscal years 2008 through 2011.--As of December 31 
     of fiscal year 2008, and as of December 31 of each succeeding 
     fiscal year through fiscal year 2011, the portion, if any, of 
     the amount appropriated under subsection (a) for such fiscal 
     year that is unobligated for allotment to a State under 
     subsection (i) for such fiscal year or set aside under 
     subsection (a)(3) or (b)(2) of section 2111 for such fiscal 
     year.
       ``(bb) First half of fiscal year 2012.--As of December 31 
     of fiscal year 2012, the portion, if any, of the sum of the 
     amounts appropriated under subsection (a)(15)(A) and under 
     section 108 of the Children's Health Insurance 
     Reauthorization Act of 2007 for the period beginning on 
     October 1, 2011, and ending on March 31, 2012, that is 
     unobligated for allotment to a State under subsection (i) for 
     such fiscal year or set aside under subsection (b)(2) of 
     section 2111 for such fiscal year.
       ``(cc) Second half of fiscal year 2012.--As of June 30 of 
     fiscal year 2012, the portion, if any, of the amount 
     appropriated under subsection (a)(15)(B) for the period 
     beginning on April 1, 2012, and ending on September 30, 2012, 
     that is unobligated for allotment to a State under subsection 
     (i) for such fiscal year or set aside under subsection (b)(2) 
     of section 2111 for such fiscal year.

       ``(II) Unexpended allotments not used for redistribution.--
     As of November 15 of each of fiscal years 2009 through 2012, 
     the total amount of allotments made to States under section 
     2104 for the second preceding fiscal year (third preceding 
     fiscal year in the case of the fiscal year 2006 and 2007 
     allotments) that is not expended or redistributed

[[Page 25477]]

     under section 2104(f) during the period in which such 
     allotments are available for obligation.
       ``(III) Excess child enrollment contingency funds.--As of 
     October 1 of each of fiscal years 2009 through 2012, any 
     amount in excess of the aggregate cap applicable to the Child 
     Enrollment Contingency Fund for the fiscal year under section 
     2104(j).
       ``(IV) Unexpended transitional coverage block grant for 
     nonpregnant childless adults.--As of October 1, 2009, any 
     amounts set aside under section 2111(a)(3) that are not 
     expended by September 30, 2009.

       ``(iii) Proportional reduction.--If the sum of the amounts 
     otherwise payable under this paragraph for a fiscal year 
     exceeds the amount available for the fiscal year under this 
     subparagraph, the amount to be paid under this paragraph to 
     each State shall be reduced proportionally.
       ``(F) Qualifying children defined.--For purposes of this 
     subsection, the term `qualifying children' means, with 
     respect to this title or title XIX, children who meet the 
     eligibility criteria (including income, categorical 
     eligibility, age, and immigration status criteria) in effect 
     as of July 1, 2007, for enrollment under this title or title 
     XIX, respectively, taking into account criteria applied as of 
     such date under this title or title XIX, respectively, 
     pursuant to a waiver under section 1115.
       ``(G) Application to commonwealths and territories.--The 
     provisions of subparagraph (H) of section 2104(j)(3) shall 
     apply with respect to payments under this paragraph in the 
     same manner as such provisions apply to payment under such 
     section.
       ``(H)  Application to states that implement a medicaid 
     expansion for children after fiscal year 2007.--In the case 
     of a State that provides coverage under paragraph (1) or (2) 
     of section 115(b) of the Children's Health Insurance Program 
     Reauthorization Act of 2007 for any fiscal year after fiscal 
     year 2007--
       ``(i) any child enrolled in the State plan under title XIX 
     through the application of such an election shall be 
     disregarded from the determination for the State of the 
     monthly average unduplicated number of qualifying children 
     enrolled in such plan during the first 3 fiscal years in 
     which such an election is in effect; and
       ``(ii) in determining the baseline number of child 
     enrollees for the State for any fiscal year subsequent to 
     such first 3 fiscal years, the baseline number of child 
     enrollees for the State under this title or title XIX for the 
     third of such fiscal years shall be the monthly average 
     unduplicated number of qualifying children enrolled in the 
     State child health plan under this title or in the State plan 
     under title XIX, respectively, for such third fiscal year.
       ``(4) Enrollment and retention provisions for children.--
     For purposes of paragraph (3)(A), a State meets the condition 
     of this paragraph for a fiscal year if it is implementing at 
     least 4 of the following enrollment and retention provisions 
     (treating each subparagraph as a separate enrollment and 
     retention provision) throughout the entire fiscal year:
       ``(A) Continuous eligibility.--The State has elected the 
     option of continuous eligibility for a full 12 months for all 
     children described in section 1902(e)(12) under title XIX 
     under 19 years of age, as well as applying such policy under 
     its State child health plan under this title.
       ``(B) Liberalization of asset requirements.--The State 
     meets the requirement specified in either of the following 
     clauses:
       ``(i) Elimination of asset test.--The State does not apply 
     any asset or resource test for eligibility for children under 
     title XIX or this title.
       ``(ii) Administrative verification of assets.--The State--

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

       ``(C) Elimination of in-person interview requirement.--The 
     State does not require an application of a child for medical 
     assistance under title XIX (or for child health assistance 
     under this title), including an application for renewal of 
     such assistance, to be made in person nor does the State 
     require a face-to-face interview, unless there are 
     discrepancies or individual circumstances justifying an in-
     person application or face-to-face interview.
       ``(D) Use of joint application for medicaid and chip.--The 
     application form and supplemental forms (if any) and 
     information verification process is the same for purposes of 
     establishing and renewing eligibility for children for 
     medical assistance under title XIX and child health 
     assistance under this title.
       ``(E) Automatic renewal (use of administrative renewal).--
       ``(i) In general.--The State provides, in the case of 
     renewal of a child's eligibility for medical assistance under 
     title XIX or child health assistance under this title, a pre-
     printed form completed by the State based on the information 
     available to the State and notice to the parent or caretaker 
     relative of the child that eligibility of the child will be 
     renewed and continued based on such information unless the 
     State is provided other information. Nothing in this clause 
     shall be construed as preventing a State from verifying, 
     through electronic and other means, the information so 
     provided.
       ``(ii) Satisfaction through demonstrated use of ex parte 
     process.--A State shall be treated as satisfying the 
     requirement of clause (i) if renewal of eligibility of 
     children under title XIX or this title is determined without 
     any requirement for an in-person interview, unless sufficient 
     information is not in the State's possession and cannot be 
     acquired from other sources (including other State agencies) 
     without the participation of the applicant or the applicant's 
     parent or caretaker relative.
       ``(F) Presumptive eligibility for children.--The State is 
     implementing section 1920A under title XIX as well as, 
     pursuant to section 2107(e)(1), under this title.
       ``(G) Express lane.--The State is implementing the option 
     described in section 1902(e)(13) under title XIX as well as, 
     pursuant to section 2107(e)(1), under this title.''.

     SEC. 105. 2-YEAR INITIAL AVAILABILITY OF CHIP ALLOTMENTS.

       Section 2104(e) (42 U.S.C. 1397dd(e)) is amended to read as 
     follows:
       ``(e) Availability of Amounts Allotted.--
       ``(1) In general.--Except as provided in paragraph (2), 
     amounts allotted to a State pursuant to this section--
       ``(A) for each of fiscal years 1998 through 2007, shall 
     remain available for expenditure by the State through the end 
     of the second succeeding fiscal year; and
       ``(B) for fiscal year 2008 and each fiscal year thereafter, 
     shall remain available for expenditure by the State through 
     the end of the succeeding fiscal year.
       ``(2) Availability of amounts redistributed.--Amounts 
     redistributed to a State under subsection (f) shall be 
     available for expenditure by the State through the end of the 
     fiscal year in which they are redistributed.''.

     SEC. 106. REDISTRIBUTION OF UNUSED ALLOTMENTS TO ADDRESS 
                   STATE FUNDING SHORTFALLS.

       (a) Fiscal Year 2005 Allotments.--
       (1) In general.--Notwithstanding section 2104(f) of the 
     Social Security Act (42 U.S.C. 1397dd(f)), subject to 
     paragraph (2), 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)(1)(A) of the Social Security 
     Act, as added by section 102, 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).
       (2) Contingency.--Paragraph (1) shall not apply if the 
     redistribution described in such paragraph has occurred as of 
     the date of the enactment of this Act.
       (b) Allotments for Subsequent Fiscal Years.--Section 
     2104(f) (42 U.S.C. 1397dd(f)) is amended--
       (1) by striking ``The Secretary'' and inserting the 
     following:
       ``(1) In general.--The Secretary'';
       (2) by striking ``States that have fully expended the 
     amount of their allotments under this section.'' and 
     inserting ``States that the Secretary determines with respect 
     to the fiscal year for which unused allotments are available 
     for redistribution under this subsection, are shortfall 
     States described in paragraph (2) for such fiscal year, but 
     not to exceed the amount of the shortfall described in 
     paragraph (2)(A) for each such State (as may be adjusted 
     under paragraph (2)(C)).''; and
       (3) by adding at the end the following new paragraph:
       ``(2) Shortfall states described.--
       ``(A) In general.--For purposes of paragraph (1), with 
     respect to a fiscal year, a shortfall State described in this 
     subparagraph is a State with a State child health plan 
     approved under this title for which the Secretary estimates 
     on the basis of the most recent data available to the 
     Secretary, that the projected expenditures under such plan 
     for the State for the fiscal year will exceed the sum of--
       ``(i) the amount of the State's allotments for any 
     preceding fiscal years that remains available for expenditure 
     and that will not be expended by the end of the immediately 
     preceding fiscal year;
       ``(ii) the amount (if any) of the child enrollment 
     contingency fund payment under subsection (j); and
       ``(iii) the amount of the State's allotment for the fiscal 
     year.
       ``(B) Proration rule.--If the amounts available for 
     redistribution under paragraph

[[Page 25478]]

     (1) for a fiscal year are less than the total amounts of the 
     estimated shortfalls determined for the year under 
     subparagraph (A), the amount to be redistributed under such 
     paragraph for each shortfall State shall be reduced 
     proportionally.
       ``(C) Retrospective adjustment.--The Secretary may adjust 
     the estimates and determinations made under paragraph (1) and 
     this paragraph with respect to a fiscal year as necessary on 
     the basis of the amounts reported by States not later than 
     November 30 of the succeeding fiscal year, as approved by the 
     Secretary.''.

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

       Section 2105(g) (42 U.S.C. 1397ee(g)) is amended--
       (1) in paragraph (1)(A), 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.''.

     SEC. 108. 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 until expended. Such amount shall be used to 
     provide allotments to States under paragraph (3) of section 
     2104(i) of the Social Security Act (42 U.S.C. 1397dd(i)), as 
     added by section 102, for the first 6 months of fiscal year 
     2012 in the same manner as allotments are provided under 
     subsection (a)(15)(A) of such section 2104 and subject to the 
     same terms and conditions as apply to the allotments provided 
     from such subsection (a)(15)(A).

     SEC. 109. IMPROVING FUNDING FOR THE TERRITORIES UNDER CHIP 
                   AND MEDICAID.

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

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

     SEC. 111. STATE OPTION TO COVER LOW-INCOME PREGNANT WOMEN 
                   UNDER CHIP THROUGH A STATE PLAN AMENDMENT.

       (a) In General.--Title XXI (42 U.S.C. 1397aa et seq.), as 
     amended by section 112(a), is amended by adding at the end 
     the following new section:

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

       ``(a) In General.--Subject to the succeeding provisions of 
     this section, a State may elect through an amendment to its 
     State child health plan under section 2102 to provide 
     pregnancy-related assistance under such plan for targeted 
     low-income pregnant women.
       ``(b) Conditions.--A State may only elect the option under 
     subsection (a) if the following conditions are satisfied:
       ``(1) Minimum income eligibility levels for pregnant women 
     and children.--The State has established an income 
     eligibility level--
       ``(A) for pregnant women under subsection 
     (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or (l)(1)(A) of 
     section 1902 that is at least 185 percent (or such higher 
     percent as the State has in effect with regard to pregnant 
     women under this title) of the poverty line applicable to a 
     family of the size involved, but in no case lower than the 
     percent in effect under any such subsection as of July 1, 
     2007; and
       ``(B) for children under 19 years of age under this title 
     (or title XIX) that is at least 200 percent of the poverty 
     line applicable to a family of the size involved.
       ``(2) No chip income eligibility level for pregnant women 
     lower than the state's medicaid level.--The State does not 
     apply an effective income level for pregnant women under the 
     State plan amendment that is lower than the effective income 
     level (expressed as a percent of the poverty line and 
     considering applicable income disregards) specified under 
     subsection (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or 
     (l)(1)(A) of section 1902, on the date of enactment of this 
     paragraph to be eligible for medical assistance as a pregnant 
     woman.
       ``(3) No coverage for higher income pregnant women without 
     covering lower income pregnant women.--The State does not 
     provide coverage for pregnant women with higher family income 
     without covering pregnant women with a lower family income.
       ``(4) Application of requirements for coverage of targeted 
     low-income children.--The State provides pregnancy-related 
     assistance for targeted low-income pregnant women in the same 
     manner, and subject to the same requirements, as the State 
     provides child health assistance for targeted low-income 
     children under the State child health plan, and in addition 
     to providing child health assistance for such women.
       ``(5) No preexisting condition exclusion or waiting 
     period.--The State does not apply any exclusion of benefits 
     for pregnancy-related assistance based on any preexisting 
     condition or any waiting period (including any waiting period 
     imposed to carry out section 2102(b)(3)(C)) for receipt of 
     such assistance.
       ``(6) Application of cost-sharing protection.--The State 
     provides pregnancy-related assistance to a targeted low-
     income woman consistent with the cost-sharing protections 
     under section 2103(e) and applies the limitation on total 
     annual aggregate cost sharing imposed under paragraph (3)(B) 
     of such section to the family of such a woman.
       ``(7) No waiting list for children.--The State does not 
     impose, with respect to the enrollment under the State child 
     health plan of targeted low-income children during the 
     quarter, any enrollment cap or other numerical limitation on 
     enrollment, any waiting list, any procedures designed to 
     delay the consideration of applications for enrollment, or 
     similar limitation with respect to enrollment.
       ``(c) Option To Provide Presumptive Eligibility.--A State 
     that elects the option under subsection (a) and satisfies the 
     conditions described in subsection (b) may elect to apply 
     section 1920 (relating to presumptive eligibility for 
     pregnant women) to the State child health plan in the same 
     manner as such section applies to the State plan under title 
     XIX.
       ``(d) Definitions.--For purposes of this section:
       ``(1) Pregnancy-related assistance.--The term `pregnancy-
     related assistance' has the meaning given the term `child 
     health assistance' in section 2110(a) and includes any

[[Page 25479]]

     medical assistance that the State would provide for a 
     pregnant woman under the State plan under title XIX during 
     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 exceeds 185 percent (or, if 
     higher, the percent applied under subsection (b)(1)(A)) of 
     the poverty line applicable to a family of the size involved, 
     but does not exceed the income eligibility level established 
     under the State child health plan under this title for a 
     targeted low-income child; and
       ``(C) who satisfies the requirements of paragraphs (1)(A), 
     (1)(C), (2), and (3) of section 2110(b) in the same manner as 
     a child applying for child health assistance would have to 
     satisfy such requirements.
       ``(e) Automatic Enrollment for Children Born to Women 
     Receiving Pregnancy-Related Assistance.--If a child is born 
     to a targeted low-income pregnant woman who was receiving 
     pregnancy-related assistance under this section on the date 
     of the child's birth, the child shall be deemed to have 
     applied for child health assistance under the State child 
     health plan and to have been found eligible for such 
     assistance under such plan or to have applied for medical 
     assistance under title XIX and to have been found eligible 
     for such assistance under such title, as appropriate, on the 
     date of such birth and to remain eligible for such assistance 
     until the child attains 1 year of age. During the period in 
     which a child is deemed under the preceding sentence to be 
     eligible for child health or medical assistance, the child 
     health or medical assistance eligibility identification 
     number of the mother shall also serve as the identification 
     number of the child, and all claims shall be submitted and 
     paid under such number (unless the State issues a separate 
     identification number for the child before such period 
     expires).
       ``(f) States Providing Assistance Through Other Options.--
       ``(1) Continuation of other options for providing 
     assistance.--The option to provide assistance in accordance 
     with the preceding subsections of this section shall not 
     limit any other option for a State to provide--
       ``(A) child health assistance through the application of 
     sections 457.10, 457.350(b)(2), 457.622(c)(5), and 
     457.626(a)(3) of title 42, Code of Federal Regulations (as in 
     effect after the final rule adopted by the Secretary and set 
     forth at 67 Fed. Reg. 61956-61974 (October 2, 2002)), or
       ``(B) pregnancy-related services through the application of 
     any waiver authority (as in effect on June 1, 2007).
       ``(2) Clarification of authority to provide postpartum 
     services.--Any State that provides child health assistance 
     under any authority described in paragraph (1) may continue 
     to provide such assistance, as well as postpartum services, 
     through the end of the month in which the 60-day period 
     (beginning on the last day of the pregnancy) ends, in the 
     same manner as such assistance and postpartum services would 
     be provided if provided under the State plan under title XIX, 
     but only if the mother would otherwise satisfy the 
     eligibility requirements that apply under the State child 
     health plan (other than with respect to age) during such 
     period.
       ``(3) No inference.--Nothing in this subsection shall be 
     construed--
       ``(A) to infer congressional intent regarding the legality 
     or illegality of the content of the sections specified in 
     paragraph (1)(A); or
       ``(B) to modify the authority to provide pregnancy-related 
     services under a waiver specified in paragraph (1)(B).''.
       (b) Additional Conforming Amendments.--
       (1) No cost sharing for pregnancy-related benefits.--
     Section 2103(e)(2) (42 U.S.C. 1397cc(e)(2)) is amended--
       (A) in the heading, by inserting ``OR PREGNANCY-RELATED 
     ASSISTANCE'' after ``PREVENTIVE SERVICES''; and
       (B) by inserting before the period at the end the 
     following: ``or for pregnancy-related assistance''.
       (2) No waiting period.--Section 2102(b)(1)(B) (42 U.S.C. 
     1397bb(b)(1)(B)) is amended--
       (A) in clause (i), by striking ``, and'' at the end and 
     inserting a semicolon;
       (B) in clause (ii), by striking the period at the end and 
     inserting ``; and''; and
       (C) by adding at the end the following new clause:
       ``(iii) may not apply a waiting period (including a waiting 
     period to carry out paragraph (3)(C)) in the case of a 
     targeted low-income pregnant woman provided pregnancy-related 
     assistance under section 2112.''.

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

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

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

       ``(a) Termination of Coverage for Nonpregnant Childless 
     Adults.--
       ``(1) No new chip waivers; automatic extensions at state 
     option through 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.
       ``(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)(5)(A). The Secretary may 
     adjust the amount set aside under the preceding sentence, as 
     necessary, on the basis of the expenditure data for fiscal 
     year 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

[[Page 25480]]

     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 
     subparagraphs (A) and (B) of section 2104(a)(15) and any 
     reduction in the allotment for either such period under 
     section 2104(i)(4) shall be allocated on a pro rata basis to 
     such set aside.
       ``(ii) Payments from block grant.--The Secretary shall pay 
     the State from the amount set aside under clause (i) for the 
     fiscal year, an amount for each quarter of such fiscal year 
     equal to the applicable percentage determined under clause 
     (iii) or (iv) for expenditures in the quarter for providing 
     child health assistance or other health benefits coverage to 
     a parent of a targeted low-income child.
       ``(iii) Enhanced fmap only in fiscal year 2010 for states 
     with significant child outreach or that achieve child 
     coverage benchmarks; fmap for any other states.--For purposes 
     of clause (ii), the applicable percentage for any quarter of 
     fiscal year 2010 is equal to--

       ``(I) the enhanced FMAP determined under section 2105(b) in 
     the case of a State that meets the outreach or coverage 
     benchmarks described in any of 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--

       ``(aa) the applicable percentage for the State under clause 
     (iii) was the enhanced FMAP for fiscal year 2009; and
       ``(bb) the State met either of the coverage benchmarks 
     described in subparagraph (B) or (C) of paragraph (3) for the 
     preceding fiscal year; or

       ``(II) the Federal medical assistance percentage (as so 
     determined) in the case of any State to which subclause (I) 
     does not apply.

     For purposes of subclause (I), the REMAP percentage is the 
     percentage which is the sum of such Federal medical 
     assistance percentage and a number of percentage points equal 
     to one-half of the difference between such Federal medical 
     assistance percentage and such enhanced FMAP.
       ``(v) No federal payments other than from block grant set 
     aside.--No payments shall be made to a State for expenditures 
     described in clause (ii) after the total amount set aside 
     under clause (i) for a fiscal year has been paid to the 
     State.
       ``(vi) No increase in income eligibility level for 
     parents.--No payments shall be made to a State from the 
     amount set aside under clause (i) for a fiscal year for 
     expenditures for providing child health assistance or health 
     benefits coverage to a parent of a targeted low-income child 
     whose family income exceeds the income eligibility level 
     applied under the applicable existing waiver to parents of 
     targeted low-income children on the date of enactment of the 
     Children's Health Insurance Program Reauthorization Act of 
     2007.
       ``(3) Outreach or coverage benchmarks.--For purposes of 
     paragraph (2), the outreach or coverage benchmarks described 
     in this paragraph are as follows:
       ``(A) Significant child outreach campaign.--The State--
       ``(i) was awarded a grant under section 2113 for fiscal 
     year 2009;
       ``(ii) implemented 1 or more of the enrollment and 
     retention provisions described in section 2105(a)(4) for such 
     fiscal year; or
       ``(iii) has submitted a specific plan for outreach for such 
     fiscal year.
       ``(B) High-performing state.--The State, on the basis of 
     the most timely and accurate published estimates of the 
     Bureau of the Census, ranks in the lowest \1/3\ of States in 
     terms of the State's percentage of low-income children 
     without health insurance.
       ``(C) State increasing enrollment of low-income children.--
     The State qualified for a performance bonus payment under 
     section 2105(a)(3)(B) for the most recent fiscal year 
     applicable under such section.
       ``(4) Rules of construction.--Nothing in this subsection 
     shall be construed as prohibiting a State from submitting an 
     application to the Secretary for a waiver under section 1115 
     of the State plan under title XIX to provide medical 
     assistance to a parent of a targeted low-income child that 
     was provided child health assistance or health benefits 
     coverage under an applicable existing waiver.
       ``(c) Applicable Existing Waiver.--For purposes of this 
     section--
       ``(1) In general.--The term `applicable existing waiver' 
     means a waiver, experimental, pilot, or demonstration project 
     under section 1115, grandfathered under section 6102(c)(3) of 
     the Deficit Reduction Act of 2005, or otherwise conducted 
     under authority that--
       ``(A) would allow funds made available under this title to 
     be used to provide child health assistance or other health 
     benefits coverage to--
       ``(i) a parent of a targeted low-income child;
       ``(ii) a nonpregnant childless adult; or
       ``(iii) individuals described in both clauses (i) and (ii); 
     and
       ``(B) was in effect 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--

[[Page 25481]]

       (i) by striking ``, the Secretary'' and inserting ``:
       ``(1) The Secretary'';
       (ii) in the first sentence, by inserting ``or a parent (as 
     defined in section 2111(c)(2)(A)), who is not pregnant, of a 
     targeted low-income child'' before the period;
       (iii) by striking the second sentence; and
       (iv) by adding at the end the following new paragraph:
       ``(2) The Secretary may not approve, extend, renew, or 
     amend a waiver, experimental, pilot, or demonstration project 
     with respect to a State after the date of enactment of the 
     Children's Health Insurance Program Reauthorization Act of 
     2007 that would waive or modify the requirements of section 
     2111.''.
       (B) Section 6102(c) of the Deficit Reduction Act of 2005 
     (Public Law 109-171; 120 Stat. 131) is amended by striking 
     ``Nothing'' and inserting ``Subject to section 2111 of the 
     Social Security Act, as added by section 112 of the 
     Children's Health Insurance Program Reauthorization Act of 
     2007, nothing''.
       (b) GAO Study and Report.--
       (1) In general.--The Comptroller General of the United 
     States shall conduct a study of whether--
       (A) the coverage of a parent, a caretaker relative (as such 
     term is used in carrying out section 1931), or a legal 
     guardian of a targeted low-income child under a State health 
     plan under title XXI of the Social Security Act increases the 
     enrollment of, or the quality of care for, children, and
       (B) such parents, relatives, and legal guardians who enroll 
     in such a plan are more likely to enroll their children in 
     such a plan or in a State plan under title XIX of such Act.
       (2) Report.--Not later than 2 years after the date of the 
     enactment of this Act, the Comptroller General shall report 
     the results of the study to the Committee on Finance of the 
     Senate and the Committee on Energy and Commerce of the House 
     of Representatives, including recommendations (if any) for 
     changes in legislation.

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

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

     ``The term `qualified provider' also includes a qualified 
     entity, as defined in section 1920A(b)(3).''.

     SEC. 114. 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) Rule of Construction.--Nothing in the amendments made 
     by this section shall be construed as--
       (1) changing any income eligibility level for children 
     under title XXI of the Social Security Act; or
       (2) changing the flexibility provided States under such 
     title to establish the income eligibility level for targeted 
     low-income children under a State child health plan and the 
     methodologies used by the State to determine income or assets 
     under such plan.

     SEC. 115. STATE AUTHORITY UNDER MEDICAID.

       (a) State Authority to Expand Income or Resource 
     Eligibility Levels for Children.--Nothing in this Act, the 
     amendments made by this Act, or title XIX of the Social 
     Security Act, including paragraph (2)(B) of section 1905(u) 
     of such Act, shall be construed as limiting the flexibility 
     afforded States under such title to increase the income or 
     resource eligibility levels for children under a State plan 
     or waiver under such title.
       (b) State Authority to Receive Payments Under Medicaid for 
     Providing Medical Assistance to Children Eligible as a Result 
     of an Income or Resource Eligibility Level Expansion.--A 
     State may, notwithstanding the fourth sentence of subsection 
     (b) of section 1905 of the Social Security Act (42 U.S.C. 
     1396d) or subsection (u) of such section--
       (1) cover individuals described in section 
     1902(a)(10)(A)(ii)(IX) of the Social Security Act and thereby 
     receive Federal financial participation for medical 
     assistance for such individuals under title XIX of the Social 
     Security Act; or
       (2) receive Federal financial participation for 
     expenditures for medical assistance under Medicaid for 
     children described in paragraph (2)(B) or (3) of section 
     1905(u) of such Act based on the Federal medical assistance 
     percentage, as otherwise determined based on the first and 
     third sentences of subsection (b) of section 1905 of the 
     Social Security Act, rather than on the basis of an enhanced 
     FMAP (as defined in section 2105(b) of such Act).

     SEC. 116. PREVENTING SUBSTITUTION OF CHIP COVERAGE FOR 
                   PRIVATE COVERAGE.

       (a) Findings.--
       (1) Congress agrees with the President that low-income 
     children should be the first priority of all States in 
     providing child health assistance under CHIP.
       (2) Congress agrees with the President and the 
     Congressional Budget Office that the substitution of CHIP 
     coverage for private coverage occurs more frequently for 
     children in families at higher income levels.
       (3) Congress agrees with the President that it is 
     appropriate that States that expand CHIP eligibility to 
     children at higher income levels should have achieved a high 
     level of health benefits coverage for low-income children and 
     should implement strategies to address such substitution.
       (4) Congress concludes that the policies specified in this 
     section (and the amendments made by this section) are the 
     appropriate policies to address these issues.
       (b) Analyses of Best Practices and Methodology in 
     Addressing Crowd-Out.--
       (1) GAO report.--Not later than 18 months after the date of 
     the enactment of this Act, the Comptroller General of the 
     United States shall submit to the Committee on Finance of the 
     Senate and the Committee on Energy and Commerce of the House 
     of Representatives and the Secretary a report describing the 
     best practices by States in addressing the issue of CHIP 
     crowd-out. Such report shall include analyses of--
       (A) the impact of different geographic areas, including 
     urban and rural areas, on CHIP crowd-out;
       (B) the impact of different State labor markets on CHIP 
     crowd-out;
       (C) the impact of different strategies for addressing CHIP 
     crowd-out;
       (D) the incidence of crowd-out for children with different 
     levels of family income; and
       (E) the relationship (if any) between changes in the 
     availability and affordability of dependent coverage under 
     employer-sponsored health insurance and CHIP crowd-out.
       (2) IOM report on methodology.--The Secretary shall enter 
     into an arrangement with the Institute of Medicine under 
     which the Institute submits to the Committee on Finance of 
     the Senate and the Committee on Energy and Commerce of the 
     House of Representatives and the Secretary, not later than 18 
     months after the date of the enactment of this Act, a report 
     on--
       (A) the most accurate, reliable, and timely way to 
     measure--
       (i) on a State-by-State basis, the rate of public and 
     private health benefits coverage among low-income children 
     with family income that does not exceed 200 percent of the 
     poverty line; and
       (ii) CHIP crowd-out, including in the case of children with 
     family income that exceeds 200 percent of the poverty line; 
     and
       (B) the least burdensome way to gather the necessary data 
     to conduct the measurements described in subparagraph (A).

     Out of any money in the Treasury not otherwise appropriated, 
     there are hereby appropriated $2,000,000 to carry out this 
     paragraph for the period ending September 30, 2009.
       (3) Incorporation of definitions.--In this section, the 
     terms ``CHIP crowd-out'', ``children'', ``poverty line'', and 
     ``State'' have the meanings given such terms for purposes of 
     CHIP.

[[Page 25482]]

       (4) Definition of chip crowd-out.--Section 2110(c) (42 
     U.S.C. 1397jj(c)) is amended by adding at the end the 
     following:
       ``(9) CHIP crowd-out.--The term `CHIP crowd-out' means the 
     substitution of--
       ``(A) health benefits coverage for a child under this 
     title, for
       ``(B) health benefits coverage for the child other than 
     under this title or title XIX.''.
       (c) Development of Best Practice Recommendations.--Section 
     2107 (42 U.S.C. 1397gg) is amended by adding at the end the 
     following:
       ``(g) Development of Best Practice Recommendations.--Within 
     6 months after the date of receipt of the reports under 
     subsections (a) and (b) of section 116 of the Children's 
     Health Insurance Program Reauthorization Act of 2007, the 
     Secretary, in consultation with States, including Medicaid 
     and CHIP directors in States, shall publish in the Federal 
     Register, and post on the public website for the Department 
     of Health and Human Services--
       ``(1) recommendations regarding best practices for States 
     to use to address CHIP crowd-out; and
       ``(2) uniform standards for data collection by States to 
     measure and report--
       ``(A) health benefits coverage for children with family 
     income below 200 percent of the poverty line; and
       ``(B) on CHIP crowd-out, including for children with family 
     income that exceeds 200 percent of the poverty line.

     The Secretary, in consultation with States, including 
     Medicaid and CHIP directors in States, may from time to time 
     update the best practice recommendations and uniform 
     standards set published under paragraphs (1) and (2) and 
     shall provide for publication and posting of such updated 
     recommendations and standards.''.
       (d) Requirement to Address CHIP Crowd-Out; Secretarial 
     Review.--Section 2106 (42 U.S.C. 1397ff) is amended by adding 
     at the end the following:
       ``(f) Requirement to Address CHIP Crowd-Out; Secretarial 
     Review.--
       ``(1) In general.--Each State that, on or after the best 
     practice application date described in paragraph (3), submits 
     a plan amendment (or waiver request) to provide for 
     eligibility for child health assistance under the State child 
     health plan for higher income children described in section 
     2105(c)(9)(D) (relating to children whose effective family 
     income exceeds 300 percent of the poverty line) shall include 
     with such plan amendment or request a description of how the 
     State--
       ``(A) will address CHIP crowd-out for such children; and
       ``(B) will incorporate recommended best practices referred 
     to in such paragraph.
       ``(2) Application to certain states.--Each State that, as 
     of the best practice application date described in paragraph 
     (3), has a State child health plan that provides (whether 
     under the plan or through a waiver) for eligibility for child 
     health assistance for children referred to in paragraph (1) 
     shall submit to the Secretary, not later than 6 months after 
     the date of such application, a State plan amendment 
     describing how the State--
       ``(A) will address CHIP crowd-out for such children; and
       ``(B) will incorporate recommended best practices referred 
     to in such paragraph.
       ``(3) Best practice application date.--The best practice 
     application date described in this paragraph is the date that 
     is 6 months after the date of publication of recommendations 
     regarding best practices under section 2107(g)(1).
       ``(4) Secretarial review.--The Secretary shall--
       ``(A) review each State plan amendment or waiver request 
     submitted under paragraph (1) or (2);
       ``(B) determine whether the amendment or request 
     incorporates recommended best practices referred to in 
     paragraph (3);
       ``(C) determine whether the State meets the enrollment 
     targets required under reference section 2105(c)(9)(C); and
       ``(D) notify the State of such determinations.''.
       (e) Limitation on Payments for States Covering Higher 
     Income Children.--Section 2105(c) (42 U.S.C. 1397ee(c)), as 
     amended by section 114(a), is amended by adding at the end 
     the following new subsection:
       ``(9) Limitation on payments for states covering higher 
     income children.--
       ``(A) Determinations.--
       ``(i) In general.--The Secretary shall determine, for each 
     State that is a higher income eligibility State as of April 1 
     of 2010 and each subsequent year, whether the State meets the 
     target rate of coverage of low-income children required under 
     subparagraph (C) and shall notify the State in that month of 
     such determination.
       ``(ii) Determination of failure.--If the Secretary 
     determines in such month that a higher income eligibility 
     State does not meet such target rate of coverage, subject to 
     subparagraph (E), no payment shall be made as of October 1 of 
     such year on or after October 1, 2010, under this section for 
     child health assistance provided for higher-income children 
     (as defined in subparagraph (D)) under the State child health 
     plan unless and until the State establishes it is in 
     compliance with such requirement.
       ``(B) Higher income eligibility state.--A higher income 
     eligibility State described in this clause is a State that--
       ``(i) applies under its State child health plan an 
     eligibility income standard for targeted low-income children 
     that exceeds 300 percent of the poverty line; or
       ``(ii) because of the application of a general exclusion of 
     a block of income that is not determined by type of expense 
     or type of income, applies an effective income standard under 
     the State child health plan for such children that exceeds 
     300 percent of the poverty line. 
       ``(C) Requirement for target rate of coverage of low-income 
     children.--
       ``(i) In general.--The requirement of this subparagraph for 
     a State is that the rate of health benefits coverage (both 
     private and public) for low-income children in the State is 
     not statistically significantly (at a p=0.05 level) less than 
     the target rate of coverage specified in clause (ii).
       ``(ii) Target rate.--The target rate of coverage specified 
     in this clause is the average rate (determined by the 
     Secretary) of health benefits coverage (both private and 
     public) as of January 1, 2010, among the 10 of the 50 States 
     and the District of Columbia with the highest percentage of 
     health benefits coverage (both private and public) for low-
     income children.
       ``(iii) Standards for data.-- In applying this 
     subparagraph, rates of health benefits coverage for States 
     shall be determined using the uniform standards identified by 
     the Secretary under section 2107(g)(2).
       ``(D) Higher-income child.--For purposes of this paragraph, 
     the term `higher income child' means, with respect to a State 
     child health plan, a targeted low-income child whose family 
     income--
       ``(i) exceeds 300 percent of the poverty line; or
       ``(ii) would exceed 300 percent of the poverty line if 
     there were not taken into account any general exclusion 
     described in subparagraph (B)(ii).
       ``(E) Notice and opportunity to comply with target rate.--
     If the Secretary makes a determination described in 
     subparagraph (A)(ii) in April of a year, the Secretary--
       ``(i) shall provide the State with the opportunity to 
     submit and implement a corrective action plan for the State 
     to come into compliance with the requirement of subparagraph 
     (C) before October 1 of such year;
       ``(ii) shall not effect a denial of payment under 
     subparagraph (A) on the basis of such determination before 
     October 1 of such year; and
       ``(iii) shall not effect such a denial if the Secretary 
     determines that there is a reasonable likelihood that the 
     implementation of such a correction action plan will bring 
     the State into compliance with the requirement of 
     subparagraph (C).''.
       (f) Treatment of Medical Support Orders.--Section 2102(b) 
     (42 U.S.C. 1397bb(c)) is amended by adding at the end the 
     following::
       ``(5) Treatment of medical support orders.--
       ``(A) In general.--Nothing in this title shall be construed 
     to allow the Secretary to require that a State deny 
     eligibility for child health assistance to a child who is 
     otherwise eligible on the basis of the existence of a valid 
     medical support order being in effect.
       ``(B) State election.--A State may elect to limit 
     eligibility for child health assistance to a targeted low-
     income child on the basis of the existence of a valid medical 
     support order on the child's behalf, but only if the State 
     does not deny such eligibility for a child on such basis if 
     the child asserts that the order is not being complied with 
     for any of the reasons described in subparagraph (C) unless 
     the State demonstrates that none of such reasons applies in 
     the case involved.
       ``(C) Reasons for noncompliance.--The reasons described in 
     this subparagraph for noncompliance with a medical support 
     order with respect to a child are that the child is not being 
     provided health benefits coverage pursuant to such order 
     because--
       ``(i) of failure of the noncustodial parent to comply with 
     the order;
       ``(ii) of the failure of an employer, group health plan or 
     health insurance issuer to comply with such order; or
       ``(iii) the child resides in a geographic area in which 
     benefits under the health benefits coverage are generally 
     unavailable.''.
       (g) Effective Date of Amendments; Consistency of 
     Policies.--The amendments made by this section shall take 
     effect as if enacted on August 16, 2007. The Secretary may 
     not impose (or continue in effect) any requirement, prevent 
     the implementation of any provision, or condition the 
     approval of any provision under any State child health plan, 
     State plan amendment, or waiver request on the basis of any 
     policy or interpretation relating to CHIP crowd-out or 
     medical support order other than under the amendments made by 
     this section.

                   TITLE II--OUTREACH AND ENROLLMENT

             Subtitle A--Outreach and Enrollment Activities

     SEC. 201. GRANTS AND ENHANCED ADMINISTRATIVE FUNDING FOR 
                   OUTREACH AND ENROLLMENT.

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

[[Page 25483]]



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

       ``(a) Outreach and Enrollment Grants; National Campaign.--
       ``(1) In general.--From the amounts appropriated under 
     subsection (g), subject to paragraph (2), the Secretary shall 
     award grants to eligible entities during the period of fiscal 
     years 2008 through 2012 to conduct outreach and enrollment 
     efforts that are designed to increase the enrollment and 
     participation of eligible children under this title and title 
     XIX.
       ``(2) Ten percent set aside for national enrollment 
     campaign.--An amount equal to 10 percent of such amounts 
     shall be used by the Secretary for expenditures during such 
     period to carry out a national enrollment campaign in 
     accordance with subsection (h).
       ``(b) Priority for Award of Grants.--
       ``(1) In general.--In awarding grants under subsection (a), 
     the Secretary shall give priority to eligible entities that--
       ``(A) propose to target geographic areas with high rates 
     of--
       ``(i) eligible but unenrolled children, including such 
     children who reside in rural areas; or
       ``(ii) racial and ethnic minorities and health disparity 
     populations, including those proposals that address cultural 
     and linguistic barriers to enrollment; and
       ``(B) submit the most demonstrable evidence required under 
     paragraphs (1) and (2) of subsection (c).
       ``(2) Ten percent set aside for outreach to indian 
     children.--An amount equal to 10 percent of the funds 
     appropriated under subsection (g) shall be used by the 
     Secretary to award grants to Indian Health Service providers 
     and urban Indian organizations receiving funds under title V 
     of the Indian Health Care Improvement Act (25 U.S.C. 1651 et 
     seq.) for outreach to, and enrollment of, children who are 
     Indians.
       ``(c) Application.--An eligible entity that desires to 
     receive a grant under subsection (a) shall submit an 
     application to the Secretary in such form and manner, and 
     containing such information, as the Secretary may decide. 
     Such application shall include--
       ``(1) evidence demonstrating that the entity includes 
     members who have access to, and credibility with, ethnic or 
     low-income populations in the communities in which activities 
     funded under the grant are to be conducted;
       ``(2) evidence demonstrating that the entity has the 
     ability to address barriers to enrollment, such as lack of 
     awareness of eligibility, stigma concerns and punitive fears 
     associated with receipt of benefits, and other cultural 
     barriers to applying for and receiving child health 
     assistance or medical assistance;
       ``(3) specific quality or outcomes performance measures to 
     evaluate the effectiveness of activities funded by a grant 
     awarded under this section; and
       ``(4) an assurance that the eligible entity shall--
       ``(A) conduct an assessment of the effectiveness of such 
     activities against the performance measures;
       ``(B) cooperate with the collection and reporting of 
     enrollment data and other information in order for the 
     Secretary to conduct such assessments; and
       ``(C) in the case of an eligible entity that is not the 
     State, provide the State with enrollment data and other 
     information as necessary for the State to make necessary 
     projections of eligible children and pregnant women.
       ``(d) Dissemination of Enrollment Data and Information 
     Determined From Effectiveness Assessments; Annual Report.--
     The Secretary shall--
       ``(1) make publicly available the enrollment data and 
     information collected and reported in accordance with 
     subsection (c)(4)(B); and
       ``(2) submit an annual report to Congress on the outreach 
     and enrollment activities conducted with funds appropriated 
     under this section.
       ``(e) Maintenance of Effort for States Awarded Grants; No 
     State Match Required.--In the case of a State that is awarded 
     a grant under this section--
       ``(1) the State share of funds expended for outreach and 
     enrollment activities under the State child health plan shall 
     not be less than the State share of such funds expended in 
     the fiscal year preceding the first fiscal year for which the 
     grant is awarded; and
       ``(2) no State matching funds shall be required for the 
     State to receive a grant under this section.
       ``(f) Definitions.--In this section:
       ``(1) Eligible entity.--The term `eligible entity' means 
     any of the following:
       ``(A) A State with an approved child health plan under this 
     title.
       ``(B) A local government.
       ``(C) An Indian tribe or tribal consortium, a tribal 
     organization, an urban Indian organization receiving funds 
     under title V of the Indian Health Care Improvement Act (25 
     U.S.C. 1651 et seq.), or an Indian Health Service provider.
       ``(D) A Federal health safety net organization.
       ``(E) A national, State, local, or community-based public 
     or nonprofit private organization, including organizations 
     that use community health workers or community-based doula 
     programs.
       ``(F) A faith-based organization or consortia, to the 
     extent that a grant awarded to such an entity is consistent 
     with the requirements of section 1955 of the Public Health 
     Service Act (42 U.S.C. 300x-65) relating to a grant award to 
     nongovernmental entities.
       ``(G) An elementary or secondary school.
       ``(2) Federal health safety net organization.--The term 
     `Federal health safety net organization' means--
       ``(A) a Federally-qualified health center (as defined in 
     section 1905(l)(2)(B));
       ``(B) a hospital defined as a disproportionate share 
     hospital for purposes of section 1923;
       ``(C) a covered entity described in section 340B(a)(4) of 
     the Public Health Service Act (42 U.S.C. 256b(a)(4)); and
       ``(D) any other entity or consortium that serves children 
     under a federally funded program, including the special 
     supplemental nutrition program for women, infants, and 
     children (WIC) established under section 17 of the Child 
     Nutrition Act of 1966 (42 U.S.C. 1786), the Head Start and 
     Early Head Start programs under the Head Start Act (42 U.S.C. 
     9801 et seq.), the school lunch program established under the 
     Richard B. Russell National School Lunch Act, and an 
     elementary or secondary school.
       ``(3) Indians; indian tribe; tribal organization; urban 
     indian organization.--The terms `Indian', `Indian tribe', 
     `tribal organization', and `urban Indian organization' have 
     the meanings given such terms in section 4 of the Indian 
     Health Care Improvement Act (25 U.S.C. 1603).
       ``(4) Community health worker.--The term `community health 
     worker' means an individual who promotes health or nutrition 
     within the community in which the individual resides--
       ``(A) by serving as a liaison between communities and 
     health care agencies;
       ``(B) by providing guidance and social assistance to 
     community residents;
       ``(C) by enhancing community residents' ability to 
     effectively communicate with health care providers;
       ``(D) by providing culturally and linguistically 
     appropriate health or nutrition education;
       ``(E) by advocating for individual and community health or 
     nutrition needs; and
       ``(F) by providing referral and followup services.
       ``(g) Appropriation.--There is appropriated, out of any 
     money in the Treasury not otherwise appropriated, 
     $100,000,000 for the period of fiscal years 2008 through 
     2012, for the purpose of awarding grants under this section. 
     Amounts appropriated and paid under the authority of this 
     section shall be in addition to amounts appropriated under 
     section 2104 and paid to States in accordance with section 
     2105, including with respect to expenditures for outreach 
     activities in accordance with subsections (a)(1)(D)(iii) and 
     (c)(2)(C) of that section.
       ``(h) National Enrollment Campaign.--From the amounts made 
     available under subsection (a)(2), the Secretary shall 
     develop and implement a national enrollment campaign to 
     improve the enrollment of underserved child populations in 
     the programs established under this title and title XIX. Such 
     campaign may include--
       ``(1) the establishment of partnerships with the Secretary 
     of Education and the Secretary of Agriculture to develop 
     national campaigns to link the eligibility and enrollment 
     systems for the assistance programs each Secretary 
     administers that often serve the same children;
       ``(2) the integration of information about the programs 
     established under this title and title XIX in public health 
     awareness campaigns administered by the Secretary;
       ``(3) increased financial and technical support for 
     enrollment hotlines maintained by the Secretary to ensure 
     that all States participate in such hotlines;
       ``(4) the establishment of joint public awareness outreach 
     initiatives with the Secretary of Education and the Secretary 
     of Labor regarding the importance of health insurance to 
     building strong communities and the economy;
       ``(5) the development of special outreach materials for 
     Native Americans or for individuals with limited English 
     proficiency; and
       ``(6) such other outreach initiatives as the Secretary 
     determines would increase public awareness of the programs 
     under this title and title XIX.''.
       (b) Enhanced Administrative Funding for Translation or 
     Interpretation Services Under CHIP and Medicaid.--
       (1) CHIP.--Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)), as 
     amended by section 113, is amended--
       (A) in the matter preceding subparagraph (A), by inserting 
     ``(or, in the case of expenditures described in subparagraph 
     (D)(iv), the higher of 75 percent or the sum of the enhanced 
     FMAP plus 5 percentage points)'' after ``enhanced FMAP''; and
       (B) in subparagraph (D)--
       (i) in clause (iii), by striking ``and'' at the end;
       (ii) by redesignating clause (iv) as clause (v); and
       (iii) by inserting after clause (iii) the following new 
     clause:

[[Page 25484]]

       ``(iv) for translation or interpretation services in 
     connection with the enrollment of, retention of, and use of 
     services under this title by, individuals for whom English is 
     not their primary language (as found necessary by the 
     Secretary for the proper and efficient administration of the 
     State plan); and''.
       (2) Medicaid.--
       (A) Use of medicaid funds.--Section 1903(a)(2) (42 U.S.C. 
     1396b(a)(2)) is amended by adding at the end the following 
     new subparagraph:
       ``(E) an amount equal to 75 percent of so much of the sums 
     expended during such quarter (as found necessary by the 
     Secretary for the proper and efficient administration of the 
     State plan) as are attributable to translation or 
     interpretation services in connection with the enrollment of, 
     retention of, and use of services under this title by, 
     children of families for whom English is not the primary 
     language; plus''.
       (B) Use of community health workers for outreach 
     activities.--
       (i) In general.--Section 2102(c)(1) of such Act (42 U.S.C. 
     1397bb(c)(1)) is amended by inserting ``(through community 
     health workers and others)'' after ``Outreach''.
       (ii) In federal evaluation.--Section 2108(c)(3)(B) of such 
     Act (42 U.S.C. 1397hh(c)(3)(B)) is amended by inserting 
     ``(such as through community health workers and others)'' 
     after ``including practices''.

     SEC. 202. INCREASED OUTREACH AND ENROLLMENT OF INDIANS.

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

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

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

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

       (a) Application Under Medicaid and CHIP Programs.--
       (1) Medicaid.--Section 1902(e) (42 U.S.C. 1396a(e)) is 
     amended by adding at the end the following:
       ``(13) Express Lane Option.--
       ``(A) In general.--
       ``(i) Option to use a finding from an express lane 
     agency.--At the option of the State, the State plan may 
     provide that in determining eligibility under this title for 
     a child (as defined in subparagraph (G)), the State may rely 
     on a finding made within a reasonable period (as determined 
     by the State) from an Express Lane agency (as defined in 
     subparagraph (F)) when it determines whether a child 
     satisfies one or more components of eligibility for medical 
     assistance under this title. The State may rely on a finding 
     from an Express Lane agency notwithstanding sections 
     1902(a)(46)(B) and 1137(d) and any differences in budget 
     unit, disregard, deeming or other methodology, if the 
     following requirements are met:
       ``(I) Prohibition on determining children ineligible for 
     coverage.--If a finding from an Express Lane agency would 
     result in a determination that a child does not satisfy an 
     eligibility requirement for medical assistance under this 
     title and for child health assistance under title XXI, the 
     State shall determine eligibility for assistance using its 
     regular procedures.
       ``(II) Notice requirement.--For any child who is found 
     eligible for medical assistance under the State plan under 
     this title or child health assistance under title XXI and who 
     is subject to premiums based on an Express Lane agency's 
     finding of such child's income level, the State shall provide 
     notice that the child may qualify for lower premium payments 
     if evaluated by the State using its regular policies and of 
     the procedures for requesting such an evaluation.
       ``(III) Compliance with screen and enroll requirement.--The 
     State shall satisfy the requirements under (A) and (B) of 
     section 2102(b)(3) (relating to screen and enroll) before 
     enrolling a child in child health assistance under title XXI. 
     At its option, the State may fulfill such requirements in 
     accordance with either option provided under subparagraph (C) 
     of this paragraph.
       ``(IV) Verification of citizenship or nationality status.--
     The State shall satisfy the requirements of section 
     1902(a)(46)(B) or 2105(c)(10), as applicable for 
     verifications of citizenship or nationality status.
       ``(V) Coding.--The State meets the requirements of 
     subparagraph (E).
       ``(ii) Option to apply to renewals and redeterminations.--
     The State may apply the provisions of this paragraph when 
     conducting initial determinations of eligibility, 
     redeterminations of eligibility, or both, as described in the 
     State plan.
       ``(B) Rules of construction.--Nothing in this paragraph 
     shall be construed--
       ``(i) to limit or prohibit a State from taking any actions 
     otherwise permitted under this title or title XXI in 
     determining eligibility for or enrolling children into 
     medical assistance under this title or child health 
     assistance under title XXI; or
       ``(ii) to modify the limitations in section 1902(a)(5) 
     concerning the agencies that may make a determination of 
     eligibility for medical assistance under this title.
       ``(C) Options for satisfying the screen and enroll 
     requirement.--
       ``(i) In general.--With respect to a child whose 
     eligibility for medical assistance under this title or for 
     child health assistance under title XXI has been evaluated by 
     a State agency using an income finding from an Express Lane 
     agency, a State may carry out its duties under subparagraphs 
     (A) and (B) of section 2102(b)(3) (relating to screen and 
     enroll) in accordance with either clause (ii) or clause 
     (iii).
       ``(ii) Establishing a screening threshold.--
       ``(I) In general.--Under this clause, the State establishes 
     a screening threshold set as a percentage of the Federal 
     poverty level that exceeds the highest income threshold 
     applicable under this title to the child by a minimum of 30 
     percentage points or, at State option, a higher number of 
     percentage points that reflects the value (as determined by 
     the State and described in the State plan) of any differences 
     between income methodologies used by the program administered 
     by the Express Lane agency and the methodologies used by the 
     State in determining eligibility for medical assistance under 
     this title.
       ``(II) Children with income not above threshold.--If the 
     income of a child does not exceed the screening threshold, 
     the child is deemed to satisfy the income eligibility 
     criteria for medical assistance under this title regardless 
     of whether such child would otherwise satisfy such criteria.
       ``(III) Children with income above threshold.--If the 
     income of a child exceeds the screening threshold, the child 
     shall be considered to have an income above the Medicaid 
     applicable income level described in section 2110(b)(4) and 
     to satisfy the requirement under section 2110(b)(1)(C) 
     (relating to the requirement that CHIP matching funds be used 
     only for children not eligible for Medicaid). If such a child 
     is enrolled in child health assistance under title XXI, the 
     State shall provide the parent, guardian, or custodial 
     relative with the following:

       ``(aa) Notice that the child may be eligible to receive 
     medical assistance under the State plan under this title if 
     evaluated for such assistance under the State's regular 
     procedures and notice of the process through which a parent, 
     guardian, or custodial relative can request that the State 
     evaluate the child's eligibility for medical assistance under 
     this title using such regular procedures.
       ``(bb) A description of differences between the medical 
     assistance provided under this title and child health 
     assistance under title

[[Page 25485]]

     XXI, including differences in cost-sharing requirements and 
     covered benefits.

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

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

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

       ``(aa) The temporary assistance for needy families program 
     funded under part A of title IV.
       ``(bb) A State program funded under part D of title IV.
       ``(cc) The State Medicaid plan.
       ``(dd) The State CHIP plan.
       ``(ee) The Food Stamp Act of 1977 (7 U.S.C. 2011 et seq.).
       ``(ff) The Head Start Act (42 U.S.C. 9801 et seq.).
       ``(gg) The Richard B. Russell National School Lunch Act (42 
     U.S.C. 1751 et seq.).
       ``(hh) The Child Nutrition Act of 1966 (42 U.S.C. 1771 et 
     seq.).
       ``(ii) The Child Care and Development Block Grant Act of 
     1990 (42 U.S.C. 9858 et seq.).
       ``(jj) The Stewart B. McKinney Homeless Assistance Act (42 
     U.S.C. 11301 et seq.).
       ``(kk) The United States Housing Act of 1937 (42 U.S.C. 
     1437 et seq.).
       ``(ll) The Native American Housing Assistance and Self-
     Determination Act of 1996 (25 U.S.C. 4101 et seq.).

       ``(II) A State-specified governmental agency that has 
     fiscal liability or legal responsibility for the accuracy of 
     the eligibility determination findings relied on by the 
     State.
       ``(III) A public agency that is subject to an interagency 
     agreement limiting the disclosure and use of the information 
     disclosed for purposes of determining eligibility under the 
     State Medicaid plan or the State CHIP plan.
       ``(iii) Exclusions.--Such term does not include an agency 
     that determines eligibility for a program established under 
     the Social Services Block Grant established under title XX or 
     a private, for-profit organization.
       ``(iv) Rules of construction.--Nothing in this paragraph 
     shall be construed as--
       ``(I) exempting a State Medicaid agency from complying with 
     the requirements of section 1902(a)(4) relating to merit-
     based personnel standards for employees of the State Medicaid 
     agency and safeguards against conflicts of interest); or
       ``(II) authorizing a State Medicaid agency that elects to 
     use Express Lane agencies under this subparagraph to use the 
     Express Lane option to avoid complying with such requirements 
     for purposes of making eligibility determinations under the 
     State Medicaid plan.
       ``(v) Additional definitions.--In this paragraph:
       ``(I) State.--The term  `State' means 1 of the 50 States or 
     the District of Columbia.
       ``(II) State chip agency.--The term `State CHIP agency' 
     means the State agency responsible for administering the 
     State CHIP plan.
       ``(III) State chip plan.--The term  `State CHIP plan' means 
     the State child health plan established under title XXI and 
     includes any waiver of such plan.
       ``(IV) State medicaid agency.--The term `State Medicaid 
     agency' means the State agency responsible for administering 
     the State Medicaid plan.

[[Page 25486]]

       ``(V) State medicaid plan.--The term  `State Medicaid plan' 
     means the State plan established under title XIX and includes 
     any waiver of such plan.
       ``(G) Child defined.--For purposes of this paragraph, the 
     term `child' means an individual under 19 years of age, or, 
     at the option of a State, such higher age, not to exceed 21 
     years of age, as the State may elect.
       ``(H) Application.--This paragraph shall not apply to with 
     respect to eligibility determinations made after September 
     30, 2012.''.
       (2) CHIP.--Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)) is 
     amended by redesignating subparagraphs (B), (C), and (D) as 
     subparagraphs (C), (D), and (E), respectively, and by 
     inserting after subparagraph (A) the following new 
     subparagraph:
       ``(B) Section 1902(e)(13) (relating to the State option to 
     rely on findings from an Express Lane agency to help evaluate 
     a child's eligibility for medical assistance).''.
       (b) Evaluation and Report.--
       (1) Evaluation.--The Secretary shall conduct, by grant, 
     contract, or interagency agreement, a comprehensive, 
     independent evaluation of the option provided under the 
     amendments made by subsection (a). Such evaluation shall 
     include an analysis of the effectiveness of the option, and 
     shall include--
       (A) obtaining a statistically valid sample of the children 
     who were enrolled in the State Medicaid plan or the State 
     CHIP plan through reliance on a finding made by an Express 
     Lane agency and determining the percentage of children who 
     were erroneously enrolled in such plans;
       (B) determining whether enrolling children in such plans 
     through reliance on a finding made by an Express Lane agency 
     improves the ability of a State to identify and enroll low-
     income, uninsured children who are eligible but not enrolled 
     in such plans;
       (C) evaluating the administrative costs or savings related 
     to identifying and enrolling children in such plans through 
     reliance on such findings, and the extent to which such costs 
     differ from the costs that the State otherwise would have 
     incurred to identify and enroll low-income, uninsured 
     children who are eligible but not enrolled in such plans; and
       (D) any recommendations for legislative or administrative 
     changes that would improve the effectiveness of enrolling 
     children in such plans through reliance on such findings.
       (2) Report to congress.--Not later than September 30, 2011, 
     the Secretary shall submit a report to Congress on the 
     results of the evaluation under paragraph (1).
       (3) Funding.--
       (A) In general.--Out of any funds in the Treasury not 
     otherwise appropriated, there is appropriated to the 
     Secretary to carry out the evaluation under this subsection 
     $5,000,000 for the period of fiscal years 2008 through 2011.
       (B) Budget authority.--Subparagraph (A) constitutes budget 
     authority in advance of appropriations Act and represents the 
     obligation of the Federal Government to provide for the 
     payment of such amount to conduct the evaluation under this 
     subsection.
       (c) Electronic Transmission of Information.--Section 1902 
     (42 U.S.C. 1396a) is amended by adding at the end the 
     following new subsection:
       ``(dd) Electronic Transmission of Information.--If the 
     State agency determining eligibility for medical assistance 
     under this title or child health assistance under title XXI 
     verifies an element of eligibility based on information from 
     an Express Lane Agency (as defined in subsection (e)(13)(F)), 
     or from another public agency, then the applicant's signature 
     under penalty of perjury shall not be required as to such 
     element. Any signature requirement for an application for 
     medical assistance may be satisfied through an electronic 
     signature, as defined in section 1710(1) of the Government 
     Paperwork Elimination Act (44 U.S.C. 3504 note). The 
     requirements of subparagraphs (A) and (B) of section 
     1137(d)(2) may be met through evidence in digital or 
     electronic form.''.
       (d) Authorization of Information Disclosure.--
       (1) In general.--Title XIX is amended--
       (A) by redesignating section 1939 as section 1940; and
       (B) by inserting after section 1938 the following new 
     section:

     ``SEC. 1939. AUTHORIZATION TO RECEIVE RELEVANT INFORMATION.

       ``(a) In General.--Notwithstanding any other provision of 
     law, a Federal or State agency or private entity in 
     possession of the sources of data directly relevant to 
     eligibility determinations under this title (including 
     eligibility files maintained by Express Lane agencies 
     described in section 1902(e)(13)(F), information described in 
     paragraph (2) or (3) of section 1137(a), vital records 
     information about births in any State, and information 
     described in sections 453(i) and 1902(a)(25)(I)) is 
     authorized to convey such data or information to the State 
     agency administering the State plan under this title, to the 
     extent such conveyance meets the requirements of subsection 
     (b).
       ``(b) Requirements for Conveyance.--Data or information may 
     be conveyed pursuant to subsection (a) only if the following 
     requirements are met:
       ``(1) The individual whose circumstances are described in 
     the data or information (or such individual's parent, 
     guardian, caretaker relative, or authorized representative) 
     has either provided advance consent to disclosure or has not 
     objected to disclosure after receiving advance notice of 
     disclosure and a reasonable opportunity to object.
       ``(2) Such data or information are used solely for the 
     purposes of--
       ``(A) identifying individuals who are eligible or 
     potentially eligible for medical assistance under this title 
     and enrolling or attempting to enroll such individuals in the 
     State plan; and
       ``(B) verifying the eligibility of individuals for medical 
     assistance under the State plan.
       ``(3) An interagency or other agreement, consistent with 
     standards developed by the Secretary--
       ``(A) prevents the unauthorized use, disclosure, or 
     modification of such data and otherwise meets applicable 
     Federal requirements safeguarding privacy and data security; 
     and
       ``(B) requires the State agency administering the State 
     plan to use the data and information obtained under this 
     section to seek to enroll individuals in the plan.
       ``(c) Penalties for Improper Disclosure.--
       ``(1) Civil money penalty.--A private entity described in 
     the subsection (a) that publishes, discloses, or makes known 
     in any manner, or to any extent not authorized by Federal 
     law, any information obtained under this section is subject 
     to a civil money penalty in an amount equal to $10,000 for 
     each such unauthorized publication or disclosure. The 
     provisions of section 1128A (other than subsections (a) and 
     (b) and the second sentence of subsection (f)) shall apply to 
     a civil money penalty under this paragraph in the same manner 
     as such provisions apply to a penalty or proceeding under 
     section 1128A(a).
       ``(2) Criminal penalty.--A private entity described in the 
     subsection (a) that willfully publishes, discloses, or makes 
     known in any manner, or to any extent not authorized by 
     Federal law, any information obtained under this section 
     shall be fined not more than $10,000 or imprisoned not more 
     than 1 year, or both, for each such unauthorized publication 
     or disclosure.
       ``(d) Rule of Construction.--The limitations and 
     requirements that apply to disclosure pursuant to this 
     section shall not be construed to prohibit the conveyance or 
     disclosure of data or information otherwise permitted under 
     Federal law (without regard to this section).''.
       (2) Conforming amendment to title xxi.--Section 2107(e)(1) 
     (42 U.S.C. 1397gg(e)(1)), as amended by subsection (a)(2), is 
     amended by adding at the end the following new subparagraph:
       ``(F) Section 1939 (relating to authorization to receive 
     data directly relevant to eligibility determinations).''.
       (3) Conforming amendment to provide access to data about 
     enrollment in insurance for purposes of evaluating 
     applications and for chip.--Section 1902(a)(25)(I)(i) (42 
     U.S.C. 1396a(a)(25)(I)(i)) is amended--
       (A) by inserting ``(and, at State option, individuals who 
     apply or whose eligibility for medical assistance is being 
     evaluated in accordance with section 1902(e)(13)(D))'' after 
     ``with respect to individuals who are eligible''; and
       (B) by inserting ``under this title (and, at State option, 
     child health assistance under title XXI)'' after ``the State 
     plan''.
       (e) Authorization for States Electing Express Lane Option 
     To Receive Certain Data Directly Relevant To Determining 
     Eligibility and Correct Amount of Assistance.--The Secretary 
     shall enter into such agreements as are necessary to permit a 
     State that elects the Express Lane option under section 
     1902(e)(13) of the Social Security Act to receive data 
     directly relevant to eligibility determinations and 
     determining the correct amount of benefits under a State 
     child health plan under CHIP or a State plan under Medicaid 
     from the following:
       (1) The National Directory of New Hires established under 
     section 453(i) of the Social Security Act (42 U.S.C. 653(i)).
       (2) Data regarding enrollment in insurance that may help to 
     facilitate outreach and enrollment under the State Medicaid 
     plan, the State CHIP plan, and such other programs as the 
     Secretary may specify.
       (f) Effective Date.--The amendments made by this section 
     are effective on January 1, 2008.

              Subtitle B--Reducing Barriers to Enrollment

     SEC. 211. VERIFICATION OF DECLARATION OF CITIZENSHIP OR 
                   NATIONALITY FOR PURPOSES OF ELIGIBILITY FOR 
                   MEDICAID AND CHIP.

       (a) 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), as amended 
     by section 203(c), is amended--
       (i) in subsection (a)(46)--

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

       ``(B) provide, with respect to an individual declaring to 
     be a citizen or national of the

[[Page 25487]]

     United States for purposes of establishing eligibility under 
     this title, that the State shall satisfy the requirements 
     of--
       ``(i) section 1903(x); or
       ``(ii) subsection (ee);''; and
       (ii) by adding at the end the following new subsection:
       ``(ee)(1) For purposes of subsection (a)(46)(B)(ii), the 
     requirements of this subsection with respect to an individual 
     declaring to be a citizen or national of the United States 
     for purposes of establishing eligibility under this title, 
     are, in lieu of requiring the individual to present 
     satisfactory documentary evidence of citizenship or 
     nationality under section 1903(x) (if the individual is not 
     described in paragraph (2) of that section), as follows:
       ``(A) The State submits the name and social security number 
     of the individual to the Commissioner of Social Security as 
     part of the program established under paragraph (2).
       ``(B) If the State receives notice from the Commissioner of 
     Social Security that the name or social security number of 
     the individual is invalid--
       ``(i) the State makes a reasonable effort to identify and 
     address the causes of such invalid match, including through 
     typographical or other clerical errors, by contacting the 
     individual to confirm the accuracy of the name or social 
     security number, respectively, submitted, and by taking such 
     additional actions as the Secretary, through regulation or 
     other guidance, or the State may identify, and continues to 
     provide the individual with medical assistance while making 
     such effort; and
       ``(ii) in the case that the name or social security number 
     of the individual remains invalid after such reasonable 
     efforts, the State--
       ``(I) notifies the individual of such fact;
       ``(II) provides the individual with a period of 90 days 
     from the date on which the notice required under subclause 
     (I) is received by the individual to either present 
     satisfactory documentary evidence of citizenship or 
     nationality (as defined in section 1903(x)(3)) or cure the 
     invalid determination with the Commissioner of Social 
     Security (and continues to provide the individual with 
     medical assistance during such 90-day period); and
       ``(III) disenrolls the individual from the State plan under 
     this title within 30 days after the end of such 90-day period 
     if no such documentary evidence is presented or if such 
     invalid determination is not cured.
       ``(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 newly 
     enrolled in the State plan under this title that month who is 
     not described in section 1903(x)(2).
       ``(B) In establishing the State program under this 
     paragraph, the State may enter into an agreement with the 
     Commissioner of Social Security--
       ``(i) to provide for the electronic submission and 
     verification, through an on-line system or otherwise, of the 
     name and social security number of an individual enrolled in 
     the State plan under this title;
       ``(ii) to submit to the Commissioner the names and social 
     security numbers of such individuals on a batch basis, 
     provided that such batches are submitted at least on a 
     monthly basis; or
       ``(iii) to provide for the verification of the names and 
     social security numbers of such individuals through such 
     other method as agreed to by the State and the Commissioner 
     and approved by the Secretary, provided that such method is 
     no more burdensome for individuals to comply with than any 
     burdens that may apply under a method described in clause (i) 
     or (ii).
       ``(C) The program established under this paragraph shall 
     provide that, in the case of any individual who is required 
     to submit a social security number to the State under 
     subparagraph (A) and who is unable to provide the State with 
     such number, shall be provided with at least the reasonable 
     opportunity to present satisfactory documentary evidence of 
     citizenship or nationality (as defined in section 1903(x)(3)) 
     as is provided under clauses (i) and (ii) of section 
     1137(d)(4)(A) to an individual for the submittal to the State 
     of evidence indicating a satisfactory immigration status.
       ``(3)(A) The State agency implementing the plan approved 
     under this title shall, at such times and in such form as the 
     Secretary may specify, provide information on the percentage 
     each month that the invalid names and numbers submitted bears 
     to the total submitted for verification. For purposes of the 
     previous sentence, a name or social security number of an 
     individual shall be treated as invalid and included in the 
     determination of such percentage only if--
       ``(i) the name or social security number, respectively, 
     submitted by the individual does not match Social Security 
     Administration records;
       ``(ii) the inconsistency between the name or number, 
     respectively, so submitted and the Social Security 
     Administration records could not be resolved by the State;
       ``(iii) the individual was provided with a reasonable 
     period of time to resolve the inconsistency with the Social 
     Security Administration or provide satisfactory documentation 
     of citizenship and did not successfully resolve such 
     inconsistency; and
       ``(iv) payment has been made for an item or service 
     furnished to the individual under this title.
       ``(B) If, for any fiscal year, the average monthly 
     percentage determined under subparagraph (A) is greater than 
     3 percent--
       ``(i) the State shall develop and adopt a corrective plan 
     to review its procedures for verifying the identities of 
     individuals seeking to enroll in the State plan under this 
     title and to identify and implement changes in such 
     procedures to improve their accuracy; and
       ``(ii) pay to the Secretary an amount equal to the amount 
     which bears the same ratio to the total payments under the 
     State plan for the fiscal year for providing medical 
     assistance to individuals who provided invalid information as 
     the number of individuals with invalid information in excess 
     of 3 percent of 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(ee) (including a system described 
     in paragraph (2)(B) thereof), and
       ``(ii) 75 percent of the sums expended during the quarter 
     as are attributable to the operation of systems to which 
     clause (i) applies, plus''.
       (2) Limitation on waiver authority.--Notwithstanding any 
     provision of section 1115 of the Social Security Act (42 
     U.S.C. 1315), or any other provision of law, the Secretary 
     may not waive the requirements of section 1902(a)(46)(B) of 
     such Act (42 U.S.C. 1396a(a)(46)(B)) with respect to a State.
       (3) Conforming amendments.--Section 1903 (42 U.S.C. 1396b) 
     is amended--
       (A) in subsection (i)(22), by striking ``subsection (x)'' 
     and inserting ``section 1902(a)(46)(B)''; and
       (B) in subsection (x)(1), by striking ``subsection 
     (i)(22)'' and inserting ``section 1902(a)(46)(B)(i)''.
       (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.--

[[Page 25488]]

       (A) Clarification of rules.--Section 1903(x) (42 U.S.C. 
     1396b(x)), as amended by paragraph (2), is amended--
       (i) in paragraph (2)--

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

       ``(D) pursuant to the application of section 1902(e)(4) 
     (and, in the case of an individual who is eligible for 
     medical assistance on such basis, the individual shall be 
     deemed to have provided satisfactory documentary evidence of 
     citizenship or nationality and shall not be required to 
     provide further documentary evidence on any date that occurs 
     during or after the period in which the individual is 
     eligible for medical assistance on such basis); or''; and
       (ii) by adding at the end the following new paragraph:
       ``(5) Nothing in subparagraph (A) or (B) of section 
     1902(a)(46), the preceding paragraphs of this subsection, or 
     the Deficit Reduction Act of 2005, including section 6036 of 
     such Act, shall be construed as changing the requirement of 
     section 1902(e)(4) that a child born in the United States to 
     an alien mother for whom medical assistance for the delivery 
     of such child is available as treatment of an emergency 
     medical condition pursuant to subsection (v) shall be deemed 
     eligible for medical assistance during the first year of such 
     child's life.''.
       (B) State requirement to issue separate identification 
     number.--Section 1902(e)(4) (42 U.S.C. 1396a(e)(4)) is 
     amended by adding at the end the following new sentence: 
     ``Notwithstanding the preceding sentence, in the case of a 
     child who is born in the United States to an alien mother for 
     whom medical assistance for the delivery of the child is made 
     available pursuant to section 1903(v), the State immediately 
     shall issue a separate identification number for the child 
     upon notification by the facility at which such delivery 
     occurred of the child's birth.''.
       (4) Technical amendments.--Section 1903(x)(2) (42 U.S.C. 
     1396b(x)) is amended--
       (A) in subparagraph (B)--
       (i) by realigning the left margin of the matter preceding 
     clause (i) 2 ems to the left; and
       (ii) by realigning the left margins of clauses (i) and 
     (ii), respectively, 2 ems to the left; and
       (B) in subparagraph (C)--
       (i) by realigning the left margin of the matter preceding 
     clause (i) 2 ems to the left; and
       (ii) by realigning the left margins of clauses (i) and 
     (ii), respectively, 2 ems to the left.
       (c) Application of Documentation System to CHIP.--
       (1) In general.--Section 2105(c) (42 U.S.C. 1397ee(c)), as 
     amended by sections 114(a) and 116(c), is amended by adding 
     at the end the following new paragraph:
       ``(10) Citizenship documentation requirements.--
       ``(A) In general.--No payment may be made under this 
     section with respect to an individual who has, or is, 
     declared to be a citizen or national of the United States for 
     purposes of establishing eligibility under this title unless 
     the State meets the requirements of section 1902(a)(46)(B) 
     with respect to the individual.
       ``(B) Enhanced payments.--Notwithstanding subsection (b), 
     the enhanced FMAP with respect to payments under subsection 
     (a) for expenditures described in clause (i) or (ii) of 
     section 1903(a)(3)(F) necessary to comply with subparagraph 
     (A) shall in no event be less than 90 percent and 75 percent, 
     respectively.''.
       (2) Nonapplication of administrative expenditures cap.--
     Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)(C)), as amended 
     by section 202(b), is amended by adding at the end the 
     following:
       ``(ii) Expenditures to comply with citizenship or 
     nationality verification requirements.--Expenditures 
     necessary for the State to comply with paragraph (9)(A).''.
       (d) Effective Date.--
       (1) In general.--
       (A) In general.--Except as provided in subparagraph (B), 
     the amendments made by this section shall take effect on 
     October 1, 2008.
       (B) Technical amendments.--The amendments made by--
       (i) paragraphs (1), (2), and (3) of subsection (b) shall 
     take effect as if included in the enactment of section 6036 
     of the Deficit Reduction Act of 2005 (Public Law 109-171; 120 
     Stat. 80); and
       (ii) paragraph (4) of subsection (b) shall take effect as 
     if included in the enactment of section 405 of division B of 
     the Tax Relief and Health Care Act of 2006 (Public Law 109-
     432; 120 Stat. 2996).
       (2) Restoration of eligibility.--In the case of an 
     individual who, during the period that began on July 1, 2006, 
     and ends on October 1, 2008, was determined to be ineligible 
     for medical assistance under a State Medicaid plan, including 
     any waiver of such plan, solely as a result of the 
     application of subsections (i)(22) and (x) of section 1903 of 
     the Social Security Act (as in effect during such period), 
     but who would have been determined eligible for such 
     assistance if such subsections, as amended by subsection (b), 
     had applied to the individual, a State may deem the 
     individual to be eligible for such assistance as of the date 
     that the individual was determined to be ineligible for such 
     medical assistance on such basis.
       (3) Special transition rule for indians.--During the period 
     that begins on July 1, 2006, and ends on the effective date 
     of final regulations issued under subclause (II) of section 
     1903(x)(3)(B)(v) of the Social Security Act (42 U.S.C. 
     1396b(x)(3)(B)(v)) (as added by subsection (b)(1)(B)), an 
     individual who is a member of a federally-recognized Indian 
     tribe described in subclause (II) of that section who 
     presents a document described in subclause (I) of such 
     section that is issued by such Indian tribe, shall be deemed 
     to have presented satisfactory evidence of citizenship or 
     nationality for purposes of satisfying the requirement of 
     subsection (x) of section 1903 of such Act.

     SEC. 212. REDUCING ADMINISTRATIVE BARRIERS TO ENROLLMENT.

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

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

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

      TITLE III--REDUCING BARRIERS TO PROVIDING PREMIUM ASSISTANCE

  Subtitle A--Additional State Option for Providing Premium Assistance

     SEC. 301. ADDITIONAL STATE OPTION FOR PROVIDING PREMIUM 
                   ASSISTANCE.

       (a) CHIP.--
       (1) In general.--Section 2105(c) (42 U.S.C. 1397ee(c)), as 
     amended by sections 114(a), 116(c), and 211(c), is amended by 
     adding at the end the following:
       ``(11) State option to offer premium assistance.--
       ``(A) In general.--A State may elect to offer a premium 
     assistance subsidy (as defined in subparagraph (C)) for 
     qualified employer-sponsored coverage (as defined in 
     subparagraph (B)) to all targeted low-income children who are 
     eligible for child health assistance under the plan and have 
     access to such coverage in accordance with the requirements 
     of this paragraph. No subsidy shall be provided to a targeted 
     low-income child under this paragraph unless the child (or 
     the child's parent) voluntarily elects to receive such a 
     subsidy. A State may not require such an election as a 
     condition of receipt of child health assistance.
       ``(B) Qualified employer-sponsored coverage.--
       ``(i) In general.--Subject to clause (ii), in this 
     paragraph, the term `qualified employer-sponsored coverage' 
     means a group health plan or health insurance coverage 
     offered through an employer--

       ``(I) that qualifies as creditable coverage as a group 
     health plan under section 2701(c)(1) of the Public Health 
     Service Act;

[[Page 25489]]

       ``(II) for which the employer contribution toward any 
     premium for such coverage is at least 40 percent; and
       ``(III) that is offered to all individuals in a manner that 
     would be considered a nondiscriminatory eligibility 
     classification for purposes of paragraph (3)(A)(ii) of 
     section 105(h) of the Internal Revenue Code of 1986 (but 
     determined without regard to clause (i) of subparagraph (B) 
     of such paragraph).

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

       ``(I) benefits provided under a health flexible spending 
     arrangement (as defined in section 106(c)(2) of the Internal 
     Revenue Code of 1986); or
       ``(II) a high deductible health plan (as defined in section 
     223(c)(2) of such Code), without regard to whether the plan 
     is purchased in conjunction with a health savings account (as 
     defined under section 223(d) of such Code).

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

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

       ``(ii) Record keeping requirements.--For purposes of 
     carrying out clause (i), a State may elect to directly pay 
     out-of-pocket expenditures for cost-sharing imposed under the 
     qualified employer-sponsored coverage and collect or not 
     collect all or any portion of such expenditures from the 
     parent of the child.
       ``(F) Application of waiting period imposed under the 
     state.--Any waiting period imposed under the State child 
     health plan prior to the provision of child health assistance 
     to a targeted low-income child under the State plan shall 
     apply to the same extent to the provision of a premium 
     assistance subsidy for the child under this paragraph.
       ``(G) Opt-out permitted for any month.--A State shall 
     establish a process for permitting the parent of a targeted 
     low-income child receiving a premium assistance subsidy to 
     disenroll the child from the qualified employer-sponsored 
     coverage and enroll the child in, and receive child health 
     assistance under, the State child health plan, effective on 
     the first day of any month for which the child is eligible 
     for such assistance and in a manner that ensures continuity 
     of coverage for the child.
       ``(H) Application to parents.--If a State provides child 
     health assistance or health benefits coverage to parents of a 
     targeted low-income child in accordance with section 2111(b), 
     the State may elect to offer a premium assistance subsidy to 
     a parent of a targeted low-income child who is eligible for 
     such a subsidy under this paragraph in the same manner as the 
     State offers such a subsidy for the enrollment of the child 
     in qualified employer-sponsored coverage, except that--
       ``(i) the amount of the premium assistance subsidy shall be 
     increased to take into account the cost of the enrollment of 
     the parent in the qualified employer-sponsored coverage or, 
     at the option of the State if the State determines it cost-
     effective, the cost of the enrollment of the child's family 
     in such coverage; and
       ``(ii) any reference in this paragraph to a child is deemed 
     to include a reference to the parent or, if applicable under 
     clause (i), the family of the child.
       ``(I) Additional state option for providing premium 
     assistance.--
       ``(i) In general.--A State may establish an employer-family 
     premium assistance purchasing pool for employers with less 
     than 250 employees who have at least 1 employee who is a 
     pregnant woman eligible for assistance under the State child 
     health plan (including through the application of an option 
     described in section 2112(f)) or a member of a family with at 
     least 1 targeted low-income child and to provide a premium 
     assistance subsidy under this paragraph for enrollment in 
     coverage made available through such pool.
       ``(ii) Access to choice of coverage.--A State that elects 
     the option under clause (i) shall identify and offer access 
     to not less than 2 private health plans that are health 
     benefits coverage that is equivalent to the benefits coverage 
     in a benchmark benefit package described in section 2103(b) 
     or benchmark-equivalent coverage that meets the requirements 
     of section 2103(a)(2) for employees described in clause (i).
       ``(iii) Clarification of payment for administrative 
     expenditures.--Nothing in this subparagraph shall be 
     construed as permitting payment under this section for 
     administrative expenditures attributable to the establishment 
     or operation of such pool, except to the extent that such 
     payment would otherwise be permitted under this title.
       ``(J) No effect on premium assistance waiver programs.--
     Nothing in this paragraph shall be construed as limiting the 
     authority of a State to offer premium assistance under 
     section 1906 or 1906A, a waiver described in paragraph (2)(B) 
     or (3), a waiver approved under section 1115, or other 
     authority in effect prior to the date of enactment of the 
     Children's Health Insurance Program Reauthorization Act of 
     2007.
       ``(K) Notice of availability.--If a State elects to provide 
     premium assistance subsidies in accordance with this 
     paragraph, the State shall--
       ``(i) include on any application or enrollment form for 
     child health assistance a notice of the availability of 
     premium assistance subsidies for the enrollment of targeted 
     low-income children in qualified employer-sponsored coverage;
       ``(ii) provide, as part of the application and enrollment 
     process under the State child health plan, information 
     describing the availability of such subsidies and how to 
     elect to obtain such a subsidy; and
       ``(iii) establish such other procedures as the State 
     determines necessary to ensure that parents are fully 
     informed of the choices for receiving child health assistance 
     under the State child health plan or through the receipt of 
     premium assistance subsidies.
       ``(L) Application to qualified employer-sponsored benchmark 
     coverage.--If a group health plan or health insurance 
     coverage offered through an employer is certified by an 
     actuary as health benefits coverage that is equivalent to the 
     benefits coverage in a benchmark benefit package described in 
     section 2103(b) or benchmark-equivalent coverage that meets 
     the requirements of section 2103(a)(2), the State may provide 
     premium assistance subsidies for enrollment of targeted low-
     income children in such group health plan or health insurance 
     coverage in the same manner as such subsidies are provided 
     under this paragraph for enrollment in qualified employer-
     sponsored coverage, but without regard to the requirement to 
     provide supplemental coverage for benefits and cost-sharing 
     protection provided under the State child health plan under 
     subparagraph (E).
       ``(M) Satisfaction of cost-effectiveness test.--Premium 
     assistance subsidies for qualified employer-sponsored 
     coverage offered under this paragraph shall be deemed to meet 
     the requirement of subparagraph (A) of paragraph (3).''.
       (2) Determination of cost-effectiveness for premium 
     assistance or purchase of family coverage.--
       (A) In general.--Section 2105(c)(3)(A) (42 U.S.C. 
     1397ee(c)(3)(A)) is amended by striking ``relative to'' and 
     all that follows through the comma and inserting ``relative 
     to
       ``(i) the amount of expenditures under the State child 
     health plan, including administrative expenditures, that the 
     State would have made to provide comparable coverage of the 
     targeted low-income child involved or the family involved (as 
     applicable); or
       ``(ii) the aggregate amount of expenditures that the State 
     would have made under the State child health plan, including 
     administrative expenditures, for providing coverage under 
     such plan for all such children or families.''.
       (B) Nonapplication to previously approved coverage.--The 
     amendment made by subparagraph (A) shall not apply to 
     coverage the purchase of which has been approved by the 
     Secretary under section 2105(c)(3) of the Social Security Act 
     prior to the date of enactment of this Act.

[[Page 25490]]

       (b) Medicaid.--Title XIX is amended by inserting after 
     section 1906 the following new section:


                ``PREMIUM ASSISTANCE OPTION FOR CHILDREN

       ``Sec. 1906A.  (a) In General.--A State may elect to offer 
     a premium assistance subsidy (as defined in subsection (c)) 
     for qualified employer-sponsored coverage (as defined in 
     subsection (b)) to all individuals under age 19 who are 
     entitled to medical assistance under this title (and to the 
     parent of such an individual) who have access to such 
     coverage if the State meets the requirements of this section.
       ``(b) Qualified Employer-Sponsored Coverage.--
       ``(1) In general.--Subject to paragraph (2)), in this 
     paragraph, the term `qualified employer-sponsored coverage' 
     means a group health plan or health insurance coverage 
     offered through an employer--
       ``(A) that qualifies as creditable coverage as a group 
     health plan under section 2701(c)(1) of the Public Health 
     Service Act;
       ``(B) for which the employer contribution toward any 
     premium for such coverage is at least 40 percent; and
       ``(C) that is offered to all individuals in a manner that 
     would be considered a nondiscriminatory eligibility 
     classification for purposes of paragraph (3)(A)(ii) of 
     section 105(h) of the Internal Revenue Code of 1986 (but 
     determined without regard to clause (i) of subparagraph (B) 
     of such paragraph).
       ``(2) Exception.--Such term does not include coverage 
     consisting of--
       ``(A) benefits provided under a health flexible spending 
     arrangement (as defined in section 106(c)(2) of the Internal 
     Revenue Code of 1986); or
       ``(B) a high deductible health plan (as defined in section 
     223(c)(2) of such Code), without regard to whether the plan 
     is purchased in conjunction with a health savings account (as 
     defined under section 223(d) of such Code).
       ``(3) Treatment as third party liability.--The State shall 
     treat the coverage provided under qualified employer-
     sponsored coverage as a third party liability under section 
     1902(a)(25).
       ``(c) Premium Assistance Subsidy.--In this section, the 
     term `premium assistance subsidy' means the amount of the 
     employee contribution for enrollment in the qualified 
     employer-sponsored coverage by the individual under age 19 or 
     by the individual's family. Premium assistance subsidies 
     under this section shall be considered, for purposes of 
     section 1903(a), to be a payment for medical assistance.
       ``(d) Voluntary Participation.--
       ``(1) Employers.--Participation by an employer in a premium 
     assistance subsidy offered by a State under this section 
     shall be voluntary. An employer may notify a State that it 
     elects to opt-out of being directly paid a premium assistance 
     subsidy on behalf of an employee.
       ``(2) Beneficiaries.--No subsidy shall be provided to an 
     individual under age 19 under this section unless the 
     individual (or the individual's parent) voluntarily elects to 
     receive such a subsidy. A State may not require such an 
     election as a condition of receipt of medical assistance. 
     State may not require, as a condition of an individual under 
     age 19 (or the individual's parent) being or remaining 
     eligible for medical assistance under this title, apply for 
     enrollment in qualified employer-sponsored coverage under 
     this section.
       ``(3) Opt-out permitted for any month.--A State shall 
     establish a process for permitting the parent of an 
     individual under age 19 receiving a premium assistance 
     subsidy to disenroll the individual from the qualified 
     employer-sponsored coverage.
       ``(e) Requirement to Pay Premiums and Cost-Sharing and 
     Provide Supplemental Coverage.--In the case of the 
     participation of an individual under age 19 (or the 
     individual's parent) in a premium assistance subsidy under 
     this section for qualified employer-sponsored coverage, the 
     State shall provide for payment of all enrollee premiums for 
     enrollment in such coverage and all deductibles, coinsurance, 
     and other cost-sharing obligations for items and services 
     otherwise covered under the State plan under this title 
     (exceeding the amount otherwise permitted under section 1916 
     or, if applicable, section 1916A). The fact that an 
     individual under age 19 (or a parent) elects to enroll in 
     qualified employer-sponsored coverage under this section 
     shall not change the individual's (or parent's) eligibility 
     for medical assistance under the State plan, except insofar 
     as section 1902(a)(25) provides that payments for such 
     assistance shall first be made under such coverage.''.
       (c) GAO Study and Report.--Not later than January 1, 2009, 
     the Comptroller General of the United States shall study cost 
     and coverage issues relating to any State premium assistance 
     programs for which Federal matching payments are made under 
     title XIX or XXI of the Social Security Act, including under 
     waiver authority, and shall submit a report to the Committee 
     on Finance of the Senate and the Committee on Energy and 
     Commerce of the House of Representatives on the results of 
     such study.

     SEC. 302. OUTREACH, EDUCATION, AND ENROLLMENT ASSISTANCE.

       (a) Requirement To Include Description of Outreach, 
     Education, and Enrollment Efforts Related to Premium 
     Assistance Subsidies in State Child Health Plan.--Section 
     2102(c) (42 U.S.C. 1397bb(c)) is amended by adding at the end 
     the following new paragraph:
       ``(3) Premium assistance subsidies.--In the case of a State 
     that provides for premium assistance subsidies under the 
     State child health plan in accordance with paragraphs (2)(B), 
     (3), or (10) of section 2105(c), or a waiver approved under 
     section 1115, outreach, education, and enrollment assistance 
     for families of children likely to be eligible for such 
     subsidies, to inform such families of the availability of, 
     and to assist them in enrolling their children in, such 
     subsidies, and for employers likely to provide coverage that 
     is eligible for such subsidies, including the specific, 
     significant resources the State intends to apply to educate 
     employers about the availability of premium assistance 
     subsidies under the State child health plan.''.
       (b) Nonapplication of 10 Percent Limit on Outreach and 
     Certain Other Expenditures.--Section 2105(c)(2)(C) (42 U.S.C. 
     1397ee(c)(2)(C)), as amended by section 301(c)(2), is amended 
     by adding at the end the following new clause:
       ``(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), 
     but not to exceed an amount equal to 1.25 percent of the 
     maximum amount permitted to be expended under subparagraph 
     (A) for items described in subsection (a)(1)(D).''.

   Subtitle B--Coordinating Premium Assistance With Private Coverage

     SEC. 311. SPECIAL ENROLLMENT PERIOD UNDER GROUP HEALTH PLANS 
                   IN CASE OF TERMINATION OF MEDICAID OR CHIP 
                   COVERAGE OR ELIGIBILITY FOR ASSISTANCE IN 
                   PURCHASE OF EMPLOYMENT-BASED COVERAGE; 
                   COORDINATION OF COVERAGE.

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

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

[[Page 25491]]

     connection with an open season or election process conducted 
     under the plan, or concurrent with the furnishing of the 
     summary plan description as provided in section 104(b) of the 
     Employee Retirement Income Security Act of 1974 (29 U.S.C. 
     1024).

       ``(ii) Disclosure about group health plan benefits to 
     states for medicaid and chip eligible individuals.--In the 
     case of a participant or beneficiary of a group health plan 
     who is covered under a Medicaid plan of a State under title 
     XIX of the Social Security Act or under a State child health 
     plan under title XXI of such Act, the plan administrator of 
     the group health plan shall disclose to the State, upon 
     request, information about the benefits available under the 
     group health plan in sufficient specificity, as determined 
     under regulations of the Secretary of Health and Human 
     Services in consultation with the Secretary that require use 
     of the model coverage coordination disclosure form developed 
     under section 311(b)(1)(C) of the Children's Health Insurance 
     Program Reauthorization Act of 2007, so as to permit the 
     State to make a determination (under paragraph (2)(B), (3), 
     or (10) of section 2105(c) of the Social Security Act or 
     otherwise) concerning the cost-effectiveness of the State 
     providing medical or child health assistance through premium 
     assistance for the purchase of coverage under such group 
     health plan and in order for the State to provide 
     supplemental benefits required under paragraph (10)(E) of 
     such section or other authority.''.
       (b) Conforming Amendments.--
       (1) Amendments to employee retirement income security 
     act.--
       (A) In general.--Section 701(f) of the Employee Retirement 
     Income Security Act of 1974 (29 U.S.C. 1181(f)) is amended by 
     adding at the end the following new paragraph:
       ``(3) Special rules for application in case of medicaid and 
     chip.--
       ``(A) In general.--A group health plan, and a health 
     insurance issuer offering group health insurance coverage in 
     connection with a group health plan, shall permit an employee 
     who is eligible, but not enrolled, for coverage under the 
     terms of the plan (or a dependent of such an employee if the 
     dependent is eligible, but not enrolled, for coverage under 
     such terms) to enroll for coverage under the terms of the 
     plan if either of the following conditions is met:
       ``(i) Termination of medicaid or chip coverage.--The 
     employee or dependent is covered under a Medicaid plan under 
     title XIX of the Social Security Act or under a State child 
     health plan under title XXI of such Act and coverage of the 
     employee or dependent under such a plan is terminated as a 
     result of loss of eligibility for such coverage and the 
     employee requests coverage under the group health plan (or 
     health insurance coverage) not later than 60 days after the 
     date of termination of such coverage.
       ``(ii) Eligibility for employment assistance under medicaid 
     or chip.--The employee or dependent becomes eligible for 
     assistance, with respect to coverage under the group health 
     plan or health insurance coverage, under such Medicaid plan 
     or State child health plan (including under any waiver or 
     demonstration project conducted under or in relation to such 
     a plan), if the employee requests coverage under the group 
     health plan or health insurance coverage not later than 60 
     days after the date the employee or dependent is determined 
     to be eligible for such assistance.
       ``(B) Coordination with medicaid and chip.--
       ``(i) Outreach to employees regarding availability of 
     medicaid and chip coverage.--

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

       ``(ii) Disclosure about group health plan benefits to 
     states for medicaid and chip eligible individuals.--In the 
     case of a participant or beneficiary of a group health plan 
     who is covered under a Medicaid plan of a State under title 
     XIX of the Social Security Act or under a State child health 
     plan under title XXI of such Act, the plan administrator of 
     the group health plan shall disclose to the State, upon 
     request, information about the benefits available under the 
     group health plan in sufficient specificity, as determined 
     under regulations of the Secretary of Health and Human 
     Services in consultation with the Secretary that require use 
     of the model coverage coordination disclosure form developed 
     under section 311(b)(1)(C) of the Children's Health Insurance 
     Program Reauthorization Act of 2007, so as to permit the 
     State to make a determination (under paragraph (2)(B), (3), 
     or (10) of section 2105(c) of the Social Security Act or 
     otherwise) concerning the cost-effectiveness of the State 
     providing medical or child health assistance through premium 
     assistance for the purchase of coverage under such group 
     health plan and in order for the State to provide 
     supplemental benefits required under paragraph (10)(E) of 
     such section or other authority.''.
       (B) Conforming amendment.--Section 102(b) of the Employee 
     Retirement Income Security Act of 1974 (29 U.S.C. 1022(b)) is 
     amended--
       (i) by striking ``and the remedies'' and inserting ``, the 
     remedies''; and
       (ii) by inserting before the period the following: ``, and 
     if the employer so elects for purposes of complying with 
     section 701(f)(3)(B)(i), the model notice applicable to the 
     State in which the participants and beneficiaries reside''.
       (C) Working group to develop model coverage coordination 
     disclosure form.--
       (i) Medicaid, chip, and employer-sponsored coverage 
     coordination working group.--

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

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

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

[[Page 25492]]

     or other health benefits coverage under title XXI of such 
     Act.

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

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

       (vi) Termination.--The Working Group shall terminate 30 
     days after the date of the issuance of its report under 
     clause (v).
       (D) Effective dates.--The Secretary of Labor and the 
     Secretary of Health and Human Services shall develop the 
     initial model notices under section 701(f)(3)(B)(i)(II) of 
     the Employee Retirement Income Security Act of 1974, and the 
     Secretary of Labor shall provide such notices to employers, 
     not later than the date that is 1 year after the date of 
     enactment of this Act, and each employer shall provide the 
     initial annual notices to such employer's employees beginning 
     with the first plan year that begins after the date on which 
     such initial model notices are first issued. The model 
     coverage coordination disclosure form developed under 
     subparagraph (C) shall apply with respect to requests made by 
     States beginning with the first plan year that begins after 
     the date on which such model coverage coordination disclosure 
     form is first issued.
       (E) Enforcement.--Section 502 of the Employee Retirement 
     Income Security Act of 1974 (29 U.S.C. 1132) is amended--
       (i) in subsection (a)(6), by striking ``or (8)'' and 
     inserting ``(8), or (9)''; and
       (ii) in subsection (c), by redesignating paragraph (9) as 
     paragraph (10), and by inserting after paragraph (8) the 
     following:
       ``(9)(A) The Secretary may assess a civil penalty against 
     any employer of up to $100 a day from the date of the 
     employer's failure to meet the notice requirement of section 
     701(f)(3)(B)(i)(I). For purposes of this subparagraph, each 
     violation with respect to any single employee shall be 
     treated as a separate violation.
       ``(B) The Secretary may assess a civil penalty against any 
     plan administrator of up to $100 a day from the date of the 
     plan administrator's failure to timely provide to any State 
     the information required to be disclosed under section 
     701(f)(3)(B)(ii). For purposes of this subparagraph, each 
     violation with respect to any single participant or 
     beneficiary shall be treated as a separate violation.''.
       (2) Amendments to public health service act.--Section 
     2701(f) of the Public Health Service Act (42 U.S.C. 300gg(f)) 
     is amended by adding at the end the following new paragraph:
       ``(3) Special rules for application in case of medicaid and 
     chip.--
       ``(A) In general.--A group health plan, and a health 
     insurance issuer offering group health insurance coverage in 
     connection with a group health plan, shall permit an employee 
     who is eligible, but not enrolled, for coverage under the 
     terms of the plan (or a dependent of such an employee if the 
     dependent is eligible, but not enrolled, for coverage under 
     such terms) to enroll for coverage under the terms of the 
     plan if either of the following conditions is met:
       ``(i) Termination of medicaid or chip coverage.--The 
     employee or dependent is covered under a Medicaid plan under 
     title XIX of the Social Security Act or under a State child 
     health plan under title XXI of such Act and coverage of the 
     employee or dependent under such a plan is terminated as a 
     result of loss of eligibility for such coverage and the 
     employee requests coverage under the group health plan (or 
     health insurance coverage) not later than 60 days after the 
     date of termination of such coverage.
       ``(ii) Eligibility for employment assistance under medicaid 
     or chip.--The employee or dependent becomes eligible for 
     assistance, with respect to coverage under the group health 
     plan or health insurance coverage, under such Medicaid plan 
     or State child health plan (including under any waiver or 
     demonstration project conducted under or in relation to such 
     a plan), if the employee requests coverage under the group 
     health plan or health insurance coverage not later than 60 
     days after the date the employee or dependent is determined 
     to be eligible for such assistance.
       ``(B) Coordination with medicaid and chip.--
       ``(i) Outreach to employees regarding availability of 
     medicaid and chip coverage.--

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

       ``(ii) Disclosure about group health plan benefits to 
     states for medicaid and chip eligible individuals.--In the 
     case of an enrollee in a group health plan who is covered 
     under a Medicaid plan of a State under title XIX of the 
     Social Security Act or under a State child health plan under 
     title XXI of such Act, the plan administrator of the group 
     health plan shall disclose to the State, upon request, 
     information about the benefits available under the group 
     health plan in sufficient specificity, as determined under 
     regulations of the Secretary of Health and Human Services in 
     consultation with the Secretary that require use of the model 
     coverage coordination disclosure form developed under section 
     311(b)(1)(C) of the Children's Health Insurance 
     Reauthorization Act of 2007, so as to permit the State to 
     make a determination (under paragraph (2)(B), (3), or (10) of 
     section 2105(c) of the Social Security Act or otherwise) 
     concerning the cost-effectiveness of the State providing 
     medical or child health assistance through premium assistance 
     for the purchase of coverage under such group health plan and 
     in order for the State to provide supplemental benefits 
     required under paragraph (10)(E) of such section or other 
     authority.''.

      TITLE IV--STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES

     SEC. 401. CHILD HEALTH QUALITY IMPROVEMENT ACTIVITIES FOR 
                   CHILDREN ENROLLED IN MEDICAID OR CHIP.

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

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

       ``(a) Development of an Initial Core Set of Health Care 
     Quality Measures for Children Enrolled in Medicaid or Chip.--
       ``(1) In general.--Not later than January 1, 2009, the 
     Secretary shall identify and publish for general comment an 
     initial, recommended core set of child health quality 
     measures for use by State programs administered under titles 
     XIX and XXI, health insurance issuers and managed care 
     entities that enter into contracts with such programs, and 
     providers of items and services under such programs.
       ``(2) Identification of initial core measures.--In 
     consultation with the individuals and entities described in 
     subsection (b)(3), the Secretary shall identify existing 
     quality of care measures for children that are in use under 
     public and privately sponsored health care coverage 
     arrangements, or that are part of reporting systems that 
     measure both the presence and duration of health insurance 
     coverage over time.
       ``(3) Recommendations and dissemination.--Based on such 
     existing and identified measures, the Secretary shall publish 
     an initial core set of child health quality measures that 
     includes (but is not limited to) the following:
       ``(A) The duration of children's health insurance coverage 
     over a 12-month time period.
       ``(B) The availability and effectiveness of a full range 
     of--
       ``(i) preventive services, treatments, and services for 
     acute conditions, including services to promote healthy 
     birth, prevent and treat premature birth, and detect the 
     presence or risk of physical or mental conditions that could 
     adversely affect growth and development; and

[[Page 25493]]

       ``(ii) treatments to correct or ameliorate the effects of 
     physical and mental conditions, including chronic conditions, 
     in infants, young children, school-age children, and 
     adolescents.
       ``(C) The availability of care in a range of ambulatory and 
     inpatient health care settings in which such care is 
     furnished.
       ``(D) The types of measures that, taken together, can be 
     used to estimate the overall national quality of health care 
     for children, including children with special needs, and to 
     perform comparative analyses of pediatric health care quality 
     and racial, ethnic, and socioeconomic disparities in child 
     health and health care for children.
       ``(4) Encourage voluntary and standardized reporting.--Not 
     later than 2 years after the date of enactment of the 
     Children's Health Insurance Program Reauthorization Act of 
     2007, the Secretary, in consultation with States, shall 
     develop a standardized format for reporting information and 
     procedures and approaches that encourage States to use the 
     initial core measurement set to voluntarily report 
     information regarding the quality of pediatric health care 
     under titles XIX and XXI.
       ``(5) Adoption of best practices in implementing quality 
     programs.--The Secretary shall disseminate information to 
     States regarding best practices among States with respect to 
     measuring and reporting on the quality of health care for 
     children, and shall facilitate the adoption of such best 
     practices. In developing best practices approaches, the 
     Secretary shall give particular attention to State 
     measurement techniques that ensure the timeliness and 
     accuracy of provider reporting, encourage provider reporting 
     compliance, encourage successful quality improvement 
     strategies, and improve efficiency in data collection using 
     health information technology.
       ``(6) Reports to congress.--Not later than January 1, 2010, 
     and every 3 years thereafter, the Secretary shall report to 
     Congress on--
       ``(A) the status of the Secretary's efforts to improve--
       ``(i) quality related to the duration and stability of 
     health insurance coverage for children under titles XIX and 
     XXI;
       ``(ii) the quality of children's health care under such 
     titles, including preventive health services, health care for 
     acute conditions, chronic health care, and health services to 
     ameliorate the effects of physical and mental conditions and 
     to aid in growth and development of infants, young children, 
     school-age children, and adolescents with special health care 
     needs; and
       ``(iii) the quality of children's health care under such 
     titles across the domains of quality, including clinical 
     quality, health care safety, family experience with health 
     care, health care in the most integrated setting, and 
     elimination of racial, ethnic, and socioeconomic disparities 
     in health and health care;
       ``(B) the status of voluntary reporting by States under 
     titles XIX and XXI, utilizing the initial core quality 
     measurement set; and
       ``(C) any recommendations for legislative changes needed to 
     improve the quality of care provided to children under titles 
     XIX and XXI, including recommendations for quality reporting 
     by States.
       ``(7) Technical assistance.--The Secretary shall provide 
     technical assistance to States to assist them in adopting and 
     utilizing core child health quality measures in administering 
     the State plans under titles XIX and XXI.
       ``(8) Definition of core set.--In this section, the term 
     `core set' means a group of valid, reliable, and evidence-
     based quality measures that, taken together--
       ``(A) provide information regarding the quality of health 
     coverage and health care for children;
       ``(B) address the needs of children throughout the 
     developmental age span; and
       ``(C) allow purchasers, families, and health care providers 
     to understand the quality of care in relation to the 
     preventive needs of children, treatments aimed at managing 
     and resolving acute conditions, and diagnostic and treatment 
     services whose purpose is to correct or ameliorate physical, 
     mental, or developmental conditions that could, if untreated 
     or poorly treated, become chronic.
       ``(b) Advancing and Improving Pediatric Quality Measures.--
       ``(1) Establishment of pediatric quality measures 
     program.--Not later than January 1, 2010, the Secretary shall 
     establish a pediatric quality measures program to--
       ``(A) improve and strengthen the initial core child health 
     care quality measures established by the Secretary under 
     subsection (a);
       ``(B) expand on existing pediatric quality measures used by 
     public and private health care purchasers and advance the 
     development of such new and emerging quality measures; and
       ``(C) increase the portfolio of evidence-based, consensus 
     pediatric quality measures available to public and private 
     purchasers of children's health care services, providers, and 
     consumers.
       ``(2) Evidence-based measures.--The measures developed 
     under the pediatric quality measures program shall, at a 
     minimum, be--
       ``(A) evidence-based and, where appropriate, risk adjusted;
       ``(B) designed to identify and eliminate racial and ethnic 
     disparities in child health and the provision of health care;
       ``(C) designed to ensure that the data required for such 
     measures is collected and reported in a standard format that 
     permits comparison of quality and data at a State, plan, and 
     provider level;
       ``(D) periodically updated; and
       ``(E) responsive to the child health needs, services, and 
     domains of health care quality described in clauses (i), 
     (ii), and (iii) of subsection (a)(6)(A).
       ``(3) Process for pediatric quality measures program.--In 
     identifying gaps in existing pediatric quality measures and 
     establishing priorities for development and advancement of 
     such measures, the Secretary shall consult with--
       ``(A) States;
       ``(B) pediatricians, children's hospitals, and other 
     primary and specialized pediatric health care professionals 
     (including members of the allied health professions) who 
     specialize in the care and treatment of children, 
     particularly children with special physical, mental, and 
     developmental health care needs;
       ``(C) dental professionals, including pediatric dental 
     professionals;
       ``(D) health care providers that furnish primary health 
     care to children and families who live in urban and rural 
     medically underserved communities or who are members of 
     distinct population sub-groups at heightened risk for poor 
     health outcomes;
       ``(E) national organizations representing children, 
     including children with disabilities and children with 
     chronic conditions;
       ``(F) national organizations representing consumers and 
     purchasers of children's health care;
       ``(G) national organizations and individuals with expertise 
     in pediatric health quality measurement; and
       ``(H) voluntary consensus standards setting organizations 
     and other organizations involved in the advancement of 
     evidence-based measures of health care.
       ``(4) Developing, validating, and testing a portfolio of 
     pediatric quality measures.--As part of the program to 
     advance pediatric quality measures, the Secretary shall--
       ``(A) award grants and contracts for the development, 
     testing, and validation of new, emerging, and innovative 
     evidence-based measures for children's health care services 
     across the domains of quality described in clauses (i), (ii), 
     and (iii) of subsection (a)(6)(A); and
       ``(B) award grants and contracts for--
       ``(i) the development of consensus on evidence-based 
     measures for children's health care services;
       ``(ii) the dissemination of such measures to public and 
     private purchasers of health care for children; and
       ``(iii) the updating of such measures as necessary.
       ``(5) Revising, strengthening, and improving initial core 
     measures.--Beginning no later than January 1, 2012, and 
     annually thereafter, the Secretary shall publish recommended 
     changes to the core measures described in subsection (a) that 
     shall reflect the testing, validation, and consensus process 
     for the development of pediatric quality measures described 
     in subsection paragraphs (1) through (4).
       ``(6) Definition of pediatric quality measure.--In this 
     subsection, the term `pediatric quality measure' means a 
     measurement of clinical care that is capable of being 
     examined through the collection and analysis of relevant 
     information, that is developed in order to assess 1 or more 
     aspects of pediatric health care quality in various 
     institutional and ambulatory health care settings, including 
     the structure of the clinical care system, the process of 
     care, the outcome of care, or patient experiences in care.
       ``(7) Construction.--Nothing in this section shall be 
     construed as supporting the restriction of coverage, under 
     title XIX or XXI or otherwise, to only those services that 
     are evidence-based.
       ``(c) Annual State Reports Regarding State-Specific Quality 
     of Care Measures Applied Under Medicaid or Chip.--
       ``(1) Annual state reports.--Each State with a State plan 
     approved under title XIX or a State child health plan 
     approved under title XXI shall annually report to the 
     Secretary on the--
       ``(A) State-specific child health quality measures applied 
     by the States under such plans, including measures described 
     in subparagraphs (A) and (B) of subsection (a)(6); and
       ``(B) State-specific information on the quality of health 
     care furnished to children under such plans, including 
     information collected through external quality reviews of 
     managed care organizations under section 1932 of the Social 
     Security Act (42 U.S.C. 1396u-4) and benchmark plans under 
     sections 1937 and 2103 of such Act (42 U.S.C. 1396u-7, 
     1397cc).
       ``(2) Publication.--Not later than September 30, 2009, and 
     annually thereafter, the Secretary shall collect, analyze, 
     and make publicly available the information reported by 
     States under paragraph (1).

[[Page 25494]]

       ``(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;
       ``(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

[[Page 25495]]

     to be appropriate, on the design, conduct, and evaluation of 
     the demonstration.
       ``(B) Number and project areas.--Not later than 2 years 
     after the date of enactment of the Children's Health 
     Insurance Program Reauthorization Act of 2007, the Secretary 
     shall award 1 grant that is specifically designed to 
     determine whether programs similar to programs to be 
     conducted by other grantees under this subsection should be 
     implemented with respect to the general population of 
     children who are eligible for child health assistance under 
     State child health plans under title XXI in order to reduce 
     the incidence of childhood obesity among such population.
       ``(6) Report to congress.--Not later than 3 years after the 
     date the Secretary implements the demonstration project under 
     this subsection, the Secretary shall submit to Congress a 
     report that describes the project, evaluates the 
     effectiveness and cost effectiveness of the project, 
     evaluates the beneficiary satisfaction under the project, and 
     includes any such other information as the Secretary 
     determines to be appropriate.
       ``(7) Definitions.--In this subsection:
       ``(A) Federally-qualified health center.--The term 
     `Federally-qualified health center' has the meaning given 
     that term in section 1905(l)(2)(B).
       ``(B) Indian tribe.--The term `Indian tribe' has the 
     meaning given that term in section 4 of the Indian Health 
     Care Improvement Act (25 U.S.C. 1603).
       ``(C) Self-assessment.--The term `self-assessment' means a 
     form that--
       ``(i) includes questions regarding--

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

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

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

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

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

       (a) Inclusion of Process and Access Measures in Annual 
     State Reports.--Section 2108 (42 U.S.C. 1397hh) is amended--
       (1) in subsection (a), in the matter preceding paragraph 
     (1), by striking ``The State'' and inserting ``Subject to 
     subsection (e), the State''; and
       (2) by adding at the end the following new subsection:
       ``(e) Information Required for Inclusion in State Annual 
     Report.--The State shall include the following information in 
     the annual report required under subsection (a):
       ``(1) Eligibility criteria, enrollment, and retention data 
     (including data with respect to continuity of coverage or 
     duration of benefits).
       ``(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.

[[Page 25496]]

       ``(6) To the extent applicable, a description of any State 
     activities that are designed to reduce the number of 
     uncovered children in the State, including through a State 
     health insurance connector program or support for innovative 
     private health coverage initiatives.''.
       (b) Standardized Reporting Format.--
       (1) In general.--Not later than 1 year after the date of 
     enactment of this Act, the Secretary shall specify a 
     standardized format for States to use for reporting the 
     information required under section 2108(e) of the Social 
     Security Act, as added by subsection (a)(2).
       (2) Transition period for states.--Each State that is 
     required to submit a report under subsection (a) of section 
     2108 of the Social Security Act that includes the information 
     required under subsection (e) of such section may use up to 3 
     reporting periods to transition to the reporting of such 
     information in accordance with the standardized format 
     specified by the Secretary under paragraph (1).
       (c) Additional Funding for the Secretary To Improve 
     Timeliness of Data Reporting and Analysis for Purposes of 
     Determining Enrollment Increases Under Medicaid and CHIP.--
       (1) Appropriation.--There is appropriated, out of any money 
     in the Treasury not otherwise appropriated, $5,000,000 to the 
     Secretary for fiscal year 2008 for the purpose of improving 
     the timeliness of the data reported and analyzed from the 
     Medicaid Statistical Information System (MSIS) for purposes 
     of providing more timely data on enrollment and eligibility 
     of children under Medicaid and CHIP and to provide guidance 
     to States with respect to any new reporting requirements 
     related to such improvements. Amounts appropriated under this 
     paragraph shall remain available until expended.
       (2) Requirements.--The improvements made by the Secretary 
     under paragraph (1) shall be designed and implemented 
     (including with respect to any necessary guidance for States 
     to report such information in a complete and expeditious 
     manner) so that, beginning no later than October 1, 2008, 
     data regarding the enrollment of low-income children (as 
     defined in section 2110(c)(4) of the Social Security Act (42 
     U.S.C. 1397jj(c)(4)) of a State enrolled in the State plan 
     under Medicaid or the State child health plan under CHIP with 
     respect to a fiscal year shall be collected and analyzed by 
     the Secretary within 6 months of submission.
       (d) GAO Study and Report on Access to Primary and 
     Speciality Services.--
       (1) In general.--The Comptroller General of the United 
     States shall conduct a study of children's access to primary 
     and specialty services under Medicaid and CHIP, including--
       (A) the extent to which providers are willing to treat 
     children eligible for such programs;
       (B) information on such children's access to networks of 
     care;
       (C) geographic availability of primary and specialty 
     services under such programs;
       (D) the extent to which care coordination is provided for 
     children's care under Medicaid and CHIP; and
       (E) as appropriate, information on the degree of 
     availability of services for children under such programs.
       (2) Report.--Not later than 2 years after the date of 
     enactment of this Act, the Comptroller General shall submit a 
     report to the Committee on Finance of the Senate and the 
     Committee on Energy and Commerce of the House of 
     Representatives on the study conducted under paragraph (1) 
     that includes recommendations for such Federal and State 
     legislative and administrative changes as the Comptroller 
     General determines are necessary to address any barriers to 
     access to children's care under Medicaid and CHIP that may 
     exist.

     SEC. 403. APPLICATION OF CERTAIN MANAGED CARE QUALITY 
                   SAFEGUARDS TO CHIP.

       (a) In General.--Section 2103(f) of Social Security Act (42 
     U.S.C. 1397bb(f)) is amended by adding at the end the 
     following new paragraph:
       ``(3) Compliance with managed care requirements.--The State 
     child health plan shall provide for the application of 
     subsections (a)(4), (a)(5), (b), (c), (d), and (e) of section 
     1932 (relating to requirements for managed care) to coverage, 
     State agencies, enrollment brokers, managed care entities, 
     and managed care organizations under this title in the same 
     manner as such subsections apply to coverage and such 
     entities and organizations under title XIX.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to contract years for health plans beginning on 
     or after July 1, 2008.

                 TITLE V--IMPROVING ACCESS TO BENEFITS

     SEC. 501. DENTAL BENEFITS.

       (a) Coverage.--
       (1) In general.--Section 2103 (42 U.S.C. 1397cc) is 
     amended--
       (A) in subsection (a)--
       (i) in the matter before paragraph (1), by striking 
     ``subsection (c)(5)'' and inserting ``paragraphs (5) and (7) 
     of subsection (c)''; and
       (ii) in paragraph (1), by inserting ``at least'' after 
     ``that is''; and
       (B) in subsection (c)--
       (i) by redesignating paragraph (5) as paragraph (7); and
       (ii) by inserting after paragraph (4), the following:
       ``(5) Dental benefits.--
       ``(A) In general.--The child health assistance provided to 
     a targeted low-income child shall include coverage of dental 
     services necessary to prevent disease and promote oral 
     health, restore oral structures to health and function, and 
     treat emergency conditions.
       ``(B) Permitting use of dental benchmark plans by certain 
     states.--A State may elect to meet the requirement of 
     subparagraph (A) through dental coverage that is equivalent 
     to a benchmark dental benefit package described in 
     subparagraph (C).
       ``(C) Benchmark dental benefit packages.--The benchmark 
     dental benefit packages are as follows:
       ``(i) FEHBP children's dental coverage.--A dental benefits 
     plan under chapter 89A of title 5, United States Code, that 
     has been selected most frequently by employees seeking 
     dependent coverage, among such plans that provide such 
     dependent coverage, in either of the previous 2 plan years.
       ``(ii) State employee dependent dental coverage.--A dental 
     benefits plan that is offered and generally available to 
     State employees in the State involved and that has been 
     selected most frequently by employees seeking dependent 
     coverage, among such plans that provide such dependent 
     coverage, in either of the previous 2 plan years.
       ``(iii) Coverage offered through commercial dental plan.--A 
     dental benefits plan that has the largest insured commercial, 
     non-medicaid enrollment of dependent covered lives of such 
     plans that is offered in the State involved.''.
       (2) Assuring access to care.--Section 2102(a)(7)(B) (42 
     U.S.C. 1397bb(c)(2)) is amended by inserting ``and services 
     described in section 2103(c)(5)'' after ``emergency 
     services''.
       (3) Effective date.--The amendments made by paragraph (1) 
     shall apply to coverage of items and services furnished on or 
     after October 1, 2008.
       (b) Dental Education for Parents of Newborns.--The 
     Secretary shall develop and implement, through entities that 
     fund or provide perinatal care services to targeted low-
     income children under a State child health plan under title 
     XXI of the Social Security Act, a program to deliver oral 
     health educational materials that inform new parents about 
     risks for, and prevention of, early childhood caries and the 
     need for a dental visit within their newborn's first year of 
     life.
       (c) Provision of Dental Services Through FQHCs.--
       (1) Medicaid.--Section 1902(a) (42 U.S.C. 1396a(a)) is 
     amended--
       (A) by striking ``and'' at the end of paragraph (69);
       (B) by striking the period at the end of paragraph (70) and 
     inserting ``; and''; and
       (C) by inserting after paragraph (70) the following new 
     paragraph:
       ``(71) provide that the State will not prevent a Federally-
     qualified health center from entering into contractual 
     relationships with private practice dental providers in the 
     provision of Federally-qualified health center services.''.
       (2) CHIP.--Section 2107(e)(1) (42 U.S.C. 1397g(e)(1)), as 
     amended by subsections (a)(2) and (d)(2) of section 203, is 
     amended by inserting after subparagraph (B) the following new 
     subparagraph (and redesignating the succeeding subparagraphs 
     accordingly):
       ``(C) Section 1902(a)(71) (relating to limiting FQHC 
     contracting for provision of dental services).''.
       (3) Effective date.--The amendments made by this subsection 
     shall take effect on January 1, 2008.
       (d) Reporting Information on Dental Health.--
       (1) Medicaid.--Section 1902(a)(43)(D)(iii) (42 U.S.C. 
     1396a(a)(43)(D)(iii)) is amended by inserting ``and other 
     information relating to the provision of dental services to 
     such children described in section 2108(e)'' after 
     ``receiving dental services,''.
       (2) CHIP.--Section 2108 (42 U.S.C. 1397hh) is amended by 
     adding at the end the following new subsection:
       ``(e) Information on Dental Care for Children.--
       ``(1) In general.--Each annual report under subsection (a) 
     shall include the following information with respect to care 
     and services described in section 1905(r)(3) provided to 
     targeted low-income children enrolled in the State child 
     health plan under this title at any time during the year 
     involved:
       ``(A) The number of enrolled children by age grouping used 
     for reporting purposes under section 1902(a)(43).
       ``(B) For children within each such age grouping, 
     information of the type contained in questions 12(a)-(c) of 
     CMS Form 416 (that consists of the number of enrolled 
     targeted low income children who receive any, preventive, or 
     restorative dental care under the State plan).
       ``(C) For the age grouping that includes children 8 years 
     of age, the number of such children who have received a 
     protective sealant on at least one permanent molar tooth.

[[Page 25497]]

       ``(2) Inclusion of information on enrollees in managed care 
     plans.--The information under paragraph (1) shall include 
     information on children who are enrolled in managed care 
     plans and other private health plans and contracts with such 
     plans under this title shall provide for the reporting of 
     such information by such plans to the State.''.
       (3) Effective date.--The amendments made by this subsection 
     shall be effective for annual reports submitted for years 
     beginning after date of enactment.
       (e) Improved Accessibility of Dental Provider Information 
     to Enrollees Under Medicaid and CHIP.--The Secretary shall--
       (1) work with States, pediatric dentists, and other dental 
     providers (including providers that are, or are affiliated 
     with, a school of dentistry) to include, not later than 6 
     months after the date of the enactment of this Act, on the 
     Insure Kids Now website (http://www.insurekidsnow.gov/) and 
     hotline (1-877-KIDS-NOW) (or on any successor websites or 
     hotlines) a current and accurate list of all such dentists 
     and providers within each State that provide dental services 
     to children enrolled in the State plan (or waiver) under 
     Medicaid or the State child health plan (or waiver) under 
     CHIP, and shall ensure that such list is updated at least 
     quarterly; and
       (2) work with States to include, not later than 6 months 
     after the date of the enactment of this Act, a description of 
     the dental services provided under each State plan (or 
     waiver) under Medicaid and each State child health plan (or 
     waiver) under CHIP on such Insure Kids Now website, and shall 
     ensure that such list is updated at least annually.
       (f) Inclusion of Status of Efforts To Improve Dental Care 
     in Reports on the Quality of Children's Health Care Under 
     Medicaid and CHIP.--Section 1139A(a), as added by section 
     401(a), is amended--
       (1) in paragraph (3)(B)(ii), by inserting ``and, with 
     respect to dental care, conditions requiring the restoration 
     of teeth, relief of pain and infection, and maintenance of 
     dental health'' after ``chronic conditions''; and
       (2) in paragraph (6)(A)(ii), by inserting ``dental care,'' 
     after ``preventive health services,''.
       (g) GAO Study and Report.--
       (1) Study.--The Comptroller General of the United States 
     shall provide for a study that examines--
       (A) access to dental services by children in underserved 
     areas;
       (B) children's access to oral health care, including 
     preventive and restorative services, under Medicaid and CHIP, 
     including--
       (i) the extent to which dental providers are willing to 
     treat children eligible for such programs;
       (ii) information on such children's access to networks of 
     care, including such networks that serve special needs 
     children; and
       (iii) geographic availability of oral health care, 
     including preventive and restorative services, under such 
     programs; and
       (C) the feasibility and appropriateness of using qualified 
     mid-level dental health providers, in coordination with 
     dentists, to improve access for children to oral health 
     services and public health overall.
       (2) Report.--Not later than 18 months year after the date 
     of the enactment of this Act, the Comptroller General shall 
     submit to Congress a report on the study conducted under 
     paragraph (1). The report shall include recommendations for 
     such Federal and State legislative and administrative changes 
     as the Comptroller General determines are necessary to 
     address any barriers to access to oral health care, including 
     preventive and restorative services, under Medicaid and CHIP 
     that may exist.

     SEC. 502. MENTAL HEALTH PARITY IN CHIP PLANS.

       (a) Assurance of Parity.--Section 2103(c) (42 U.S.C. 
     1397cc(c)), as amended by section 501(a)(1)(B), is amended by 
     inserting after paragraph (5), the following:
       ``(6) Mental health services parity.--
       ``(A) In general.--In the case of a State child health plan 
     that provides both medical and surgical benefits and mental 
     health or substance abuse benefits, such plan shall ensure 
     that the financial requirements and treatment limitations 
     applicable to such mental health or substance abuse benefits 
     are no more restrictive than the financial requirements and 
     treatment limitations applied to substantially all medical 
     and surgical benefits covered by the plan.
       ``(B) Deemed compliance.--To the extent that a State child 
     health plan includes coverage with respect to an individual 
     described in section 1905(a)(4)(B) and covered under the 
     State plan under section 1902(a)(10)(A) of the services 
     described in section 1905(a)(4)(B) (relating to early and 
     periodic screening, diagnostic, and treatment services 
     defined in section 1905(r)) and provided in accordance with 
     section 1902(a)(43), such plan shall be deemed to satisfy the 
     requirements of subparagraph (A).''.
       (b) Conforming Amendments.--Section 2103 (42 U.S.C. 1397cc) 
     is amended--
       (1) in subsection (a), as amended by section 
     501(a)(1)(A)(i), in the matter preceding paragraph (1), by 
     inserting ``, (6),'' after ``(5)''; and
       (2) in subsection (c)(2), by striking subparagraph (B) and 
     redesignating subparagraphs (C) and (D) as subparagraphs (B) 
     and (C), respectively.

     SEC. 503. APPLICATION OF PROSPECTIVE PAYMENT SYSTEM FOR 
                   SERVICES PROVIDED BY FEDERALLY-QUALIFIED HEALTH 
                   CENTERS AND RURAL HEALTH CLINICS.

       (a) Application of Prospective Payment System.--
       (1) In general.--Section 2107(e)(1) (42 U.S.C. 
     1397gg(e)(1)), as amended by section 501(c)(2) is amended by 
     inserting after subparagraph (C) the following new 
     subparagraph (and redesignating the succeeding subparagraphs 
     accordingly):
       ``(D) Section 1902(bb) (relating to payment for services 
     provided by Federally-qualified health centers and rural 
     health clinics).''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall apply to services provided on or after October 1, 2008.
       (b) Transition Grants.--
       (1) Appropriation.--Out of any funds in the Treasury not 
     otherwise appropriated, there is appropriated to the 
     Secretary for fiscal year 2008, $5,000,000, to remain 
     available until expended, for the purpose of awarding grants 
     to States with State child health plans under CHIP that are 
     operated separately from the State Medicaid plan under title 
     XIX of the Social Security Act (including any waiver of such 
     plan), or in combination with the State Medicaid plan, for 
     expenditures related to transitioning to compliance with the 
     requirement of section 2107(e)(1)(D) of the Social Security 
     Act (as added by subsection (a)) to apply the prospective 
     payment system established under section 1902(bb) of the such 
     Act (42 U.S.C. 1396a(bb)) to services provided by Federally-
     qualified health centers and rural health clinics.
       (2) Monitoring and report.--The Secretary shall monitor the 
     impact of the application of such prospective payment system 
     on the States described in paragraph (1) and, not later than 
     October 1, 2010, shall report to Congress on any effect on 
     access to benefits, provider payment rates, or scope of 
     benefits offered by such States as a result of the 
     application of such payment system.

     SEC. 504. PREMIUM GRACE PERIOD.

       (a) In General.--Section 2103(e)(3) (42 U.S.C. 
     1397cc(e)(3)) is amended by adding at the end the following 
     new subparagraph:
       ``(C) Premium grace period.--The State child health plan--
       ``(i) shall afford individuals enrolled under the plan a 
     grace period of at least 30 days from the beginning of a new 
     coverage period to make premium payments before the 
     individual's coverage under the plan may be terminated; and
       ``(ii) shall provide to such an individual, not later than 
     7 days after the first day of such grace period, notice--

       ``(I) that failure to make a premium payment within the 
     grace period will result in termination of coverage under the 
     State child health plan; and
       ``(II) of the individual's right to challenge the proposed 
     termination pursuant to the applicable Federal regulations.

     For purposes of clause (i), the term `new coverage period' 
     means the month immediately following the last month for 
     which the premium has been paid.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to new coverage periods beginning on or after 
     January 1, 2009.

     SEC. 505. DEMONSTRATION PROJECTS RELATING TO DIABETES 
                   PREVENTION.

       There is authorized to be appropriated $15,000,000 during 
     the period of fiscal years 2008 through 2012 to fund 
     demonstration projects in up to 10 States over 3 years for 
     voluntary incentive programs to promote children's receipt of 
     relevant screenings and improvements in healthy eating and 
     physical activity with the aim of reducing the incidence of 
     type 2 diabetes. Such programs may involve reductions in 
     cost-sharing or premiums when children receive regular 
     screening and reach certain benchmarks in healthy eating and 
     physical activity. Under such programs, a State may also 
     provide financial bonuses for partnerships with entities, 
     such as schools, which increase their education and efforts 
     with respect to reducing the incidence of type 2 diabetes and 
     may also devise incentives for providers serving children 
     covered under this title and title XIX to perform relevant 
     screening and counseling regarding healthy eating and 
     physical activity. Upon completion of these demonstrations, 
     the Secretary shall provide a report to Congress on the 
     results of the State demonstration projects and the degree to 
     which they helped improve health outcomes related to type 2 
     diabetes in children in those States.

     SEC. 506. CLARIFICATION OF COVERAGE OF SERVICES PROVIDED 
                   THROUGH SCHOOL-BASED HEALTH CENTERS.

       Section 2103(c) (42 U.S.C. 1397cc(c)), as amended by 
     section 501(a)(1)(B), is amended by adding at the end the 
     following new paragraph:
       ``(8) Availability of coverage for items and services 
     furnished through school-based health centers.--Nothing in 
     this title shall be construed as limiting a State's ability 
     to provide child health assistance for covered items and 
     services that are furnished through school-based health 
     centers.''.

[[Page 25498]]



     TITLE VI--PROGRAM INTEGRITY AND OTHER MISCELLANEOUS PROVISIONS

           Subtitle A--Program Integrity and Data Collection

     SEC. 601. PAYMENT ERROR RATE MEASUREMENT (``PERM'').

       (a) Expenditures Related to Compliance With Requirements.--
       (1) Enhanced payments.--Section 2105(c) (42 U.S.C. 
     1397ee(c)), as amended by section 301(a), is amended by 
     adding at the end the following new paragraph:
       ``(12) Enhanced payments.--Notwithstanding subsection (b), 
     the enhanced FMAP with respect to payments under subsection 
     (a) for expenditures related to the administration of the 
     payment error rate measurement (PERM) requirements applicable 
     to the State child health plan in accordance with the 
     Improper Payments Information Act of 2002 and parts 431 and 
     457 of title 42, Code of Federal Regulations (or any related 
     or successor guidance or regulations) shall in no event be 
     less than 90 percent.''.
       (2) Exclusion of from cap on administrative expenditures.--
     Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)C)), as amended 
     by section 302(b)), is amended by adding at the end the 
     following:
       ``(iv) Payment error rate measurement (perm) 
     expenditures.--Expenditures related to the administration of 
     the payment error rate measurement (PERM) requirements 
     applicable to the State child health plan in accordance with 
     the Improper Payments Information Act of 2002 and parts 431 
     and 457 of title 42, Code of Federal Regulations (or any 
     related or successor guidance or regulations).''.
       (b) Final Rule Required To Be in Effect for All States.--
     Notwithstanding parts 431 and 457 of title 42, Code of 
     Federal Regulations (as in effect on the date of enactment of 
     this Act), the Secretary shall not calculate or publish any 
     national or State-specific error rate based on the 
     application of the payment error rate measurement (in this 
     section referred to as ``PERM'') requirements to CHIP until 
     after the date that is 6 months after the date on which a 
     final rule implementing such requirements in accordance with 
     the requirements of subsection (c) is in effect for all 
     States. Any calculation of a national error rate or a State 
     specific error rate after such final rule in effect for all 
     States may only be inclusive of errors, as defined in such 
     final rule or in guidance issued within a reasonable time 
     frame after the effective date for such final rule that 
     includes detailed guidance for the specific methodology for 
     error determinations.
       (c) Requirements for Final Rule.--For purposes of 
     subsection (b), the requirements of this subsection are that 
     the final rule implementing the PERM requirements shall--
       (1) include--
       (A) clearly defined criteria for errors for both States and 
     providers;
       (B) a clearly defined process for appealing error 
     determinations by--
       (i) review contractors; or
       (ii) the agency and personnel described in section 
     431.974(a)(2) of title 42, Code of Federal Regulations, as in 
     effect on September 1, 2007, responsible for the development, 
     direction, implementation, and evaluation of eligibility 
     reviews and associated activities; and
       (C) clearly defined responsibilities and deadlines for 
     States in implementing any corrective action plans; and
       (2) provide that the payment error rate determined for a 
     State shall not take into account payment errors resulting 
     from the State's verification of an applicant's self-
     declaration or self-certification of eligibility for, and the 
     correct amount of, medical assistance or child health 
     assistance, if the State process for verifying an applicant's 
     self-declaration or self-certification satisfies the 
     requirements for such process applicable under regulations 
     promulgated by the Secretary or otherwise approved by the 
     Secretary.
       (d) Option for Application of Data for States in First 
     Application Cycle Under the Interim Final Rule.--After the 
     final rule implementing the PERM requirements in accordance 
     with the requirements of subsection (c) is in effect for all 
     States, a State for which the PERM requirements were first in 
     effect under an interim final rule for fiscal year 2007 may 
     elect to accept any payment error rate determined in whole or 
     in part for the State on the basis of data for that fiscal 
     year or may elect to not have any payment error rate 
     determined on the basis of such data and, instead, shall be 
     treated as if fiscal year 2010 were the first fiscal year for 
     which the PERM requirements apply to the State.
       (e) Harmonization of MEQC and PERM.--
       (1) Reduction of redundancies.--The Secretary shall review 
     the Medicaid Eligibility Quality Control (in this subsection 
     referred to as the ``MEQC'') requirements with the PERM 
     requirements and coordinate consistent implementation of both 
     sets of requirements, while reducing redundancies.
       (2) State option to apply perm data.--A State may elect, 
     for purposes of determining the erroneous excess payments for 
     medical assistance ratio applicable to the State for a fiscal 
     year under section 1903(u) of the Social Security Act (42 
     U.S.C. 1396b(u)) to substitute data resulting from the 
     application of the PERM requirements to the State after the 
     final rule implementing such requirements is in effect for 
     all States for data obtained from the application of the MEQC 
     requirements to the State with respect to a fiscal year.
       (3) State option to apply meqc data.--For purposes of 
     satisfying the requirements of subpart Q of part 431 of title 
     42, Code of Federal Regulations, as in effect on September 1, 
     2007, relating to Medicaid eligibility reviews, a State may 
     elect to substitute data obtained through MEQC reviews 
     conducted in accordance with section 1903(u) of the Social 
     Security Act (42 U.S.C. 1396b(u)) for data required for 
     purposes of PERM requirements, but only if the State MEQC 
     reviews are based on a broad, representative sample of 
     Medicaid applicants or enrollees in the States.
       (f) Identification of Improved State-Specific Sample 
     Sizes.--The Secretary shall establish State-specific sample 
     sizes for application of the PERM requirements with respect 
     to State child health plans for fiscal years beginning with 
     fiscal year 2009, on the basis of such information as the 
     Secretary determines appropriate. In establishing such sample 
     sizes, the Secretary shall, to the greatest extent 
     practicable--
       (1) minimize the administrative cost burden on States under 
     Medicaid and CHIP; and
       (2) maintain State flexibility to manage such programs.

     SEC. 602. IMPROVING DATA COLLECTION.

       (a) Increased Appropriation.--Section 2109(b)(2) (42 U.S.C. 
     1397ii(b)(2)) is amended by striking ``$10,000,000 for fiscal 
     year 2000'' and inserting ``$20,000,000 for fiscal year 
     2008''.
       (b) Use of Additional Funds.--Section 2109(b) (42 U.S.C. 
     1397ii(b)), as amended by subsection (a), is amended--
       (1) by redesignating paragraph (2) as paragraph (4); and
       (2) by inserting after paragraph (1), the following new 
     paragraphs:
       ``(2) Additional requirements.--In addition to making the 
     adjustments required to produce the data described in 
     paragraph (1), with respect to data collection occurring for 
     fiscal years beginning with fiscal year 2008, in appropriate 
     consultation with the Secretary of Health and Human Services, 
     the Secretary of Commerce shall do the following:
       ``(A) Make appropriate adjustments to the Current 
     Population Survey to develop more accurate State-specific 
     estimates of the number of children enrolled in health 
     coverage under title XIX or this title.
       ``(B) Make appropriate adjustments to the Current 
     Population Survey to improve the survey estimates used to 
     determine the child population growth factor under section 
     2104(i)(5)(B) and any other data necessary for carrying out 
     this title.
       ``(C) Include health insurance survey information in the 
     American Community Survey related to children.
       ``(D) Assess whether American Community Survey estimates, 
     once such survey data are first available, produce more 
     reliable estimates than the Current Population Survey with 
     respect to the purposes described in subparagraph (B).
       ``(E) On the basis of the assessment required under 
     subparagraph (D), recommend to the Secretary of Health and 
     Human Services whether American Community Survey estimates 
     should be used in lieu of, or in some combination with, 
     Current Population Survey estimates for the purposes 
     described in subparagraph (B).
       ``(F) Continue making the adjustments described in the last 
     sentence of paragraph (1) with respect to expansion of the 
     sample size used in State sampling units, the number of 
     sampling units in a State, and using an appropriate 
     verification element.
       ``(3) Authority for the secretary of health and human 
     services to transition to the use of all, or some combination 
     of, acs estimates upon recommendation of the secretary of 
     commerce.--If, on the basis of the assessment required under 
     paragraph (2)(D), the Secretary of Commerce recommends to the 
     Secretary of Health and Human Services that American 
     Community Survey estimates should be used in lieu of, or in 
     some combination with, Current Population Survey estimates 
     for the purposes described in paragraph (2)(B), the Secretary 
     of Health and Human Services, in consultation with the 
     States, may provide for a period during which the Secretary 
     may transition from carrying out such purposes through the 
     use of Current Population Survey estimates to the use of 
     American Community Survey estimates (in lieu of, or in 
     combination with the Current Population Survey estimates, as 
     recommended), provided that any such transition is 
     implemented in a manner that is designed to avoid adverse 
     impacts upon States with approved State child health plans 
     under this title.''.

     SEC. 603. UPDATED FEDERAL EVALUATION OF CHIP.

       Section 2108(c) (42 U.S.C. 1397hh(c)) is amended by 
     striking paragraph (5) and inserting the following:
       ``(5) Subsequent evaluation using updated information.--
       ``(A) In general.--The Secretary, directly or through 
     contracts or interagency agreements, shall conduct an 
     independent subsequent evaluation of 10 States with approved 
     child health plans.

[[Page 25499]]

       ``(B) Selection of states and matters included.--Paragraphs 
     (2) and (3) shall apply to such subsequent evaluation in the 
     same manner as such provisions apply to the evaluation 
     conducted under paragraph (1).
       ``(C) Submission to congress.--Not later than December 31, 
     2010, the Secretary shall submit to Congress the results of 
     the evaluation conducted under this paragraph.
       ``(D) Funding.--Out of any money in the Treasury of the 
     United States not otherwise appropriated, there are 
     appropriated $10,000,000 for fiscal year 2009 for the purpose 
     of conducting the evaluation authorized under this paragraph. 
     Amounts appropriated under this subparagraph shall remain 
     available for expenditure through fiscal year 2011.''.

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

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

     SEC. 605. NO FEDERAL FUNDING FOR ILLEGAL ALIENS.

       Nothing in this Act allows Federal payment for individuals 
     who are not legal residents.

              Subtitle B--Miscellaneous Health Provisions

     SEC. 611. DEFICIT REDUCTION ACT TECHNICAL CORRECTIONS.

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

     SEC. 612. REFERENCES TO TITLE XXI.

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

     SEC. 613. PROHIBITING INITIATION OF NEW HEALTH OPPORTUNITY 
                   ACCOUNT DEMONSTRATION PROGRAMS.

       After the date of the enactment of this Act, the Secretary 
     of Health and Human Services may not approve any new 
     demonstration programs under section 1938 of the Social 
     Security Act (42 U.S.C. 1396u-8).

     SEC. 614. COUNTY MEDICAID HEALTH INSURING ORGANIZATIONS; GAO 
                   REPORT ON MEDICAID MANAGED CARE PAYMENT RATES.

       (a) In General.--Section 9517(c)(3) of the Consolidated 
     Omnibus Budget Reconciliation Act of 1985 (42 U.S.C. 1396b 
     note), as added by section 4734 of the Omnibus Budget 
     Reconciliation Act of 1990 and as amended by section 704 of 
     the Medicare, Medicaid, and SCHIP Benefits Improvement and 
     Protection Act of 2000, is amended--
       (1) in subparagraph (A), by inserting ``, in the case of 
     any health insuring organization described in such 
     subparagraph that is operated by a public entity established 
     by Ventura County, and in the case of any health insuring 
     organization described in such subparagraph that is operated 
     by a public entity established by Merced County'' after 
     ``described in subparagraph (B)''; and
       (2) in subparagraph (C), by striking ``14 percent'' and 
     inserting ``16 percent''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall take effect on the date of the enactment of this Act.
       (c) GAO Report on Actuarial Soundness of Medicaid Managed 
     Care Payment Rates.--Not later than 18 months after the date 
     of the enactment of this Act, the Comptroller General of the 
     United States shall submit a report to the Committee on 
     Finance of the Senate and the Committee on Energy and 
     Commerce of the House of Representatives analyzing the extent 
     to which State payment rates for medicaid managed care 
     organizations under title XIX of the Social Security Act are 
     actuarially sound.

     SEC. 615. ADJUSTMENT IN COMPUTATION OF MEDICAID FMAP TO 
                   DISREGARD AN EXTRAORDINARY EMPLOYER PENSION 
                   CONTRIBUTION.

       (a) In General.--Only for purposes of computing the FMAP 
     (as defined in subsection (e)) for a State for a fiscal year 
     (beginning with fiscal year 2006) and applying the FMAP under 
     title XIX of the Social Security Act, any significantly 
     disproportionate employer pension or insurance fund 
     contribution described in subsection (b) shall be disregarded 
     in computing the per capita income of such State, but shall 
     not be disregarded in computing the per capita income for the 
     continental United States (and Alaska) and Hawaii.
       (b) Significantly Disproportionate Employer Pension and 
     Insurance Fund Contribution.--
       (1) In general.--For purposes of this section, a 
     significantly disproportionate employer pension and insurance 
     fund contribution described in this subsection with respect 
     to a State is any identifiable employer contribution towards 
     pension or other employee insurance funds that is estimated 
     to accrue to residents of such State for a calendar year 
     (beginning with calendar year 2003) if the increase in the 
     amount so estimated exceeds 25 percent of the total increase 
     in personal income in that State for the year involved.
       (2) Data to be used.--For estimating and adjustment a FMAP 
     already calculated as of the date of the enactment of this 
     Act for a State with a significantly disproportionate 
     employer pension and insurance fund contribution, the 
     Secretary shall use the personal income data set originally 
     used in calculating such FMAP.
       (3) Special adjustment for negative growth.--If in any 
     calendar year the total personal income growth in a State is 
     negative, an employer pension and insurance fund contribution 
     for the purposes of calculating the State's FMAP for a 
     calendar year shall not exceed 125 percent of the amount of 
     such contribution for the previous calendar year for the 
     State.
       (c) Hold Harmless.--No State shall have its FMAP for a 
     fiscal year reduced as a result of the application of this 
     section.
       (d) Report.--Not later than May 15, 2008, the Secretary 
     shall submit to the Congress a report on the problems 
     presented by the current treatment of pension and insurance 
     fund contributions in the use of Bureau of Economic Affairs 
     calculations for the FMAP and for Medicaid and on possible 
     alternative methodologies to mitigate such problems.

[[Page 25500]]

       (e) FMAP Defined.--For purposes of this section, the term 
     ``FMAP'' means the Federal medical assistance percentage, as 
     defined in section 1905(b) of the Social Security Act (42 
     U.S.C. 1396(d)).

     SEC. 616. MORATORIUM ON CERTAIN PAYMENT RESTRICTIONS.

       Notwithstanding any other provision of law, the Secretary 
     of Health and Human Services shall not, prior to May 28, 
     2008, take any action (through promulgation of regulation, 
     issuance of regulatory guidance, use of federal payment audit 
     procedures, or other administrative action, policy, or 
     practice, including a Medical Assistance Manual transmittal 
     or letter to State Medicaid directors) to restrict coverage 
     or payment under title XIX of the Social Security Act for 
     rehabilitation services, or school-based administration, 
     transportation, or medical services if such restrictions are 
     more restrictive in any aspect than those applied to such 
     coverage or payment as of July 1, 2007.

     SEC. 617. MEDICAID DSH ALLOTMENTS FOR TENNESSEE AND HAWAII.

       (a) Tennessee.--The DSH allotments for Tennessee for each 
     fiscal year beginning with fiscal year 2008 under subsection 
     (f)(3) of section 1923 of the Social Security Act (42 U.S.C. 
     1396r-4) are deemed to be $30,000,000. The Secretary of 
     Health and Human Services may impose a limitation on the 
     total amount of payments made to hospitals under the TennCare 
     Section 1115 waiver only to the extent that such limitation 
     is necessary to ensure that a hospital does not receive 
     payment in excess of the amounts described in subsection (f) 
     of such section or as necessary to ensure that the waiver 
     remains budget neutral.
       (b) Hawaii.--Section 1923(f)(6) (42 U.S.C. 1396r-4(f)(6)) 
     is amended--
       (1) in the paragraph heading, by striking ``for fiscal year 
     2007''; and
       (2) in subparagraph (B)--
       (A) in clause (i), by striking ``Only with respect to 
     fiscal year 2007'' and inserting ``With respect to each of 
     fiscal years 2007 and 2008'';
       (B) by redesignating clause (ii) as clause (iv); and
       (C) by inserting after clause (i), the following new 
     clauses:
       ``(ii) Treatment as a low-dsh state.--With respect to 
     fiscal year 2009 and each fiscal year thereafter, 
     notwithstanding the table set forth in paragraph (2), the DSH 
     allotment for Hawaii shall be increased in the same manner as 
     allotments for low DSH States are increased for such fiscal 
     year under clauses (ii) and (iii) of paragraph (5)(B).
       ``(iii) Certain hospital payments.--The Secretary may not 
     impose a limitation on the total amount of payments made to 
     hospitals under the QUEST section 1115 Demonstration Project 
     except to the extent that such limitation is necessary to 
     ensure that a hospital does not receive payments in excess of 
     the amounts described in subsection (g), or as necessary to 
     ensure that such payments under the waiver and such payments 
     pursuant to the allotment provided in this section do not, in 
     the aggregate in any year, exceed the amount that the 
     Secretary determines is equal to the Federal medical 
     assistance percentage component attributable to 
     disproportionate share hospital payment adjustments for such 
     year that is reflected in the budget neutrality provision of 
     the QUEST Demonstration Project.''.

     SEC. 618. CLARIFICATION TREATMENT OF REGIONAL MEDICAL CENTER.

       (a) In General.--Nothing in section 1903(w) of the Social 
     Security Act (42 U.S.C. 1396b(w)) shall be construed by the 
     Secretary of Health and Human Services as prohibiting a 
     State's use of funds as the non-Federal share of expenditures 
     under title XIX of such Act where such funds are transferred 
     from or certified by a publicly-owned regional medical center 
     located in another State and described in subsection (b), so 
     long as the Secretary determines that such use of funds is 
     proper and in the interest of the program under title XIX.
       (b) Center Described.--A center described in this 
     subsection is a publicly-owned regional medical center that--
       (1) provides level 1 trauma and burn care services;
       (2) provides level 3 neonatal care services;
       (3) is obligated to serve all patients, regardless of 
     ability to pay;
       (4) is located within a Standard Metropolitan Statistical 
     Area (SMSA) that includes at least 3 States;
       (5) provides services as a tertiary care provider for 
     patients residing within a 125-mile radius; and
       (6) meets the criteria for a disproportionate share 
     hospital under section 1923 of such Act (42 U.S.C. 1396r-4) 
     in at least one State other than the State in which the 
     center is located.

     SEC. 619. EXTENSION OF SSI WEB-BASED ASSET DEMONSTRATION 
                   PROJECT TO THE MEDICAID PROGRAM.

       (a) In General.--Beginning on October 1, 2012, the 
     Secretary of Health and Human Services shall provide for the 
     application to asset eligibility determinations under the 
     Medicaid program under title XIX of the Social Security Act 
     of the automated, secure, web-based asset verification 
     request and response process being applied for determining 
     eligibility for benefits under the Supplemental Security 
     Income (SSI) program under title XVI of such Act under a 
     demonstration project conducted under the authority of 
     section 1631(e)(1)(B)(ii) of such Act (42 U.S.C. 
     1383(e)(1)(B)(ii)).
       (b) Limitation.--Such application shall only extend to 
     those States in which such demonstration project is operating 
     and only for the period in which such project is otherwise 
     provided.
       (c) Rules of Application.--For purposes of carrying out 
     subsection (a), notwithstanding any other provision of law, 
     information obtained from a financial institution that is 
     used for purposes of eligibility determinations under such 
     demonstration project with respect to the Secretary of Health 
     and Human Services under the SSI program may also be shared 
     and used by States for purposes of eligibility determinations 
     under the Medicaid program. In applying section 
     1631(e)(1)(B)(ii) of the Social Security Act under this 
     subsection, references to the Commissioner of Social Security 
     and benefits under title XVI of such Act shall be treated as 
     including a reference to a State described in subsection (b) 
     and medical assistance under title XIX of such Act provided 
     by such a State.

                      Subtitle C--Other Provisions

     SEC. 621. SUPPORT FOR INJURED SERVICEMEMBERS.

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

       (I) by striking ``section 103(b)(5)'' and inserting 
     ``subsection (b)(5) or (f) (as appropriate) of section 103''; 
     and
       (II) by inserting ``or under subsection (a)(3)'' after 
     ``subsection (a)(1)''; and

       (ii) in paragraph (2), by inserting ``or under subsection 
     (a)(3)'' after ``subsection (a)(1)''.
       (B) Substitution of paid leave.--Section 102(d) of such Act 
     (29 U.S.C. 2612(d)) is amended--
       (i) in paragraph (1)--

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

       (ii) in paragraph (2)(B), by adding at the end the 
     following: ``An eligible employee may elect, or an employer 
     may require the employee, to substitute any of the accrued

[[Page 25501]]

     paid vacation leave, personal leave, family leave, or medical 
     or sick leave of the employee for leave provided under 
     subsection (a)(3) for any part of the 26-week period of such 
     leave under such subsection.''.
       (C) Notice.--Section 102(e)(2) of such Act (29 U.S.C. 
     2612(e)(2)) is amended by inserting ``or under subsection 
     (a)(3)'' after ``subsection (a)(1)''.
       (D) Spouses employed by same employer.--Section 102(f) of 
     such Act (29 U.S.C. 2612(f)) is amended--
       (i) by redesignating paragraphs (1) and (2) as 
     subparagraphs (A) and (B), and aligning the margins of the 
     subparagraphs with the margins of section 102(e)(2)(A);
       (ii) by striking ``In any'' and inserting the following:
       ``(1) In general.--In any''; and
       (iii) by adding at the end the following:
       ``(2) Servicemember family leave.--
       ``(A) In general.--The aggregate number of workweeks of 
     leave to which both that husband and wife may be entitled 
     under subsection (a) may be limited to 26 workweeks during 
     the single 12-month period described in subsection (a)(3) if 
     the leave is--
       ``(i) leave under subsection (a)(3); or
       ``(ii) a combination of leave under subsection (a)(3) and 
     leave described in paragraph (1).
       ``(B) Both limitations applicable.--If the leave taken by 
     the husband and wife includes leave described in paragraph 
     (1), the limitation in paragraph (1) shall apply to the leave 
     described in paragraph (1).''.
       (E) Certification.--Section 103 of such Act (29 U.S.C. 
     2613) is amended by adding at the end the following:
       ``(f) Certification for Servicemember Family Leave.--An 
     employer may require that a request for leave under section 
     102(a)(3) be supported by a certification issued at such time 
     and in such manner as the Secretary may by regulation 
     prescribe.''.
       (F) Failure to return.--Section 104(c) of such Act (29 
     U.S.C. 2614(c)) is amended--
       (i) in paragraph (2)(B)(i), by inserting ``or under section 
     102(a)(3)'' before the semicolon; and
       (ii) in paragraph (3)(A)--

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

       ``(iii) a certification issued by the health care provider 
     of the servicemember being cared for by the employee, in the 
     case of an employee unable to return to work because of a 
     condition specified in section 102(a)(3).''.
       (G) Enforcement.--Section 107 of such Act (29 U.S.C. 2617) 
     is amended, in subsection (a)(1)(A)(i)(II), by inserting 
     ``(or 26 weeks, in a case involving leave under section 
     102(a)(3))'' after ``12 weeks''.
       (H) Instructional employees.--Section 108 of such Act (29 
     U.S.C. 2618) is amended, in subsections (c)(1), (d)(2), and 
     (d)(3), by inserting ``or under section 102(a)(3)'' after 
     ``section 102(a)(1)''.
       (c) Servicemember Family Leave for Civil Service 
     Employees.--
       (1) Definitions.--Section 6381 of title 5, United States 
     Code, is amended--
       (A) in paragraph (5), by striking ``and'' at the end;
       (B) in paragraph (6), by striking the period and inserting 
     ``; and''; and
       (C) by adding at the end the following:
       ``(7) the term `active duty' means duty under a call or 
     order to active duty under a provision of law referred to in 
     section 101(a)(13)(B) of title 10, United States Code;
       ``(8) the term `covered servicemember' means a member of 
     the Armed Forces, including a member of the National Guard or 
     a Reserve, who is undergoing medical treatment, recuperation, 
     or therapy, is otherwise in medical hold or medical holdover 
     status, or is otherwise on the temporary disability retired 
     list, for a serious injury or illness;
       ``(9) the term `medical hold or medical holdover status' 
     means--
       ``(A) the status of a member of the Armed Forces, including 
     a member of the National Guard or a Reserve, assigned or 
     attached to a military hospital for medical care; and
       ``(B) the status of a member of a reserve component of the 
     Armed Forces who is separated, whether pre-deployment or 
     post-deployment, from the member's unit while in need of 
     health care based on a medical condition identified while the 
     member is on active duty in the Armed Forces;
       ``(10) the term `next of kin', used with respect to an 
     individual, means the nearest blood relative of that 
     individual; and
       ``(11) the term `serious injury or illness', in the case of 
     a member of the Armed Forces, means an injury or illness 
     incurred by the member in line of duty on active duty in the 
     Armed Forces that may render the member medically unfit to 
     perform the duties of the member's office, grade, rank, or 
     rating.''.
       (2) Entitlement to leave.--Section 6382(a) of such title is 
     amended by adding at the end the following:
       ``(3) Subject to section 6383, an employee who is the 
     spouse, son, daughter, parent, or next of kin of a covered 
     servicemember shall be entitled to a total of 26 
     administrative workweeks of leave during a 12-month period to 
     care for the servicemember. The leave described in this 
     paragraph shall only be available during a single 12-month 
     period.
       ``(4) During the single 12-month period described in 
     paragraph (3), an employee shall be entitled to a combined 
     total of 26 administrative workweeks of leave under 
     paragraphs (1) and (3). Nothing in this paragraph shall be 
     construed to limit the availability of leave under paragraph 
     (1) during any other 12-month period.''.
       (3) Requirements relating to leave.--
       (A) Schedule.--Section 6382(b) of such title is amended--
       (i) in paragraph (1), in the second sentence--

       (I) by striking ``section 6383(b)(5)'' and inserting 
     ``subsection (b)(5) or (f) (as appropriate) of section 
     6383''; and
       (II) by inserting ``or under subsection (a)(3)'' after 
     ``subsection (a)(1)''; and

       (ii) in paragraph (2), by inserting ``or under subsection 
     (a)(3)'' after ``subsection (a)(1)''.
       (B) Substitution of paid leave.--Section 6382(d) of such 
     title is amended by adding at the end the following: ``An 
     employee may elect to substitute for leave under subsection 
     (a)(3) any of the employee's accrued or accumulated annual or 
     sick leave under subchapter I for any part of the 26-week 
     period of leave under such subsection.''.
       (C) Notice.--Section 6382(e) of such title is amended by 
     inserting ``or under subsection (a)(3)'' after ``subsection 
     (a)(1)''.
       (D) Certification.--Section 6383 of such title is amended 
     by adding at the end the following:
       ``(f) An employing agency may require that a request for 
     leave under section 6382(a)(3) be supported by a 
     certification issued at such time and in such manner as the 
     Office of Personnel Management may by regulation 
     prescribe.''.

     SEC. 622. 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.

     SEC. 623. 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.);

[[Page 25502]]

       (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.

     SEC. 624. SENSE OF SENATE REGARDING ACCESS TO AFFORDABLE AND 
                   MEANINGFUL HEALTH INSURANCE COVERAGE.

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

                     TITLE VII--REVENUE PROVISIONS

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

       (a) Cigars.--Section 5701(a) of the Internal Revenue Code 
     of 1986 is amended--
       (1) by striking ``$1.828 cents per thousand ($1.594 cents 
     per thousand on cigars removed during 2000 or 2001)'' in 
     paragraph (1) and inserting ``$50.00 per thousand'',
       (2) by striking ``20.719 percent (18.063 percent on cigars 
     removed during 2000 or 2001)'' in paragraph (2) and inserting 
     ``52.988 percent'', and
       (3) by striking ``$48.75 per thousand ($42.50 per thousand 
     on cigars removed during 2000 or 2001)'' in paragraph (2) and 
     inserting ``$3.00 per cigar''.
       (b) Cigarettes.--Section 5701(b) of such Code is amended--
       (1) by striking ``$19.50 per thousand ($17 per thousand on 
     cigarettes removed during 2000 or 2001)'' in paragraph (1) 
     and inserting ``$50.00 per thousand'', and
       (2) by striking ``$40.95 per thousand ($35.70 per thousand 
     on cigarettes removed during 2000 or 2001)'' in paragraph (2) 
     and inserting ``$105.00 per thousand''.
       (c) Cigarette Papers.--Section 5701(c) of such Code is 
     amended by striking ``1.22 cents (1.06 cents on cigarette 
     papers removed during 2000 or 2001)'' and inserting ``3.13 
     cents''.
       (d) Cigarette Tubes.--Section 5701(d) of such Code is 
     amended by striking ``2.44 cents (2.13 cents on cigarette 
     tubes removed during 2000 or 2001)'' and inserting ``6.26 
     cents''.
       (e) Smokeless Tobacco.--Section 5701(e) of such Code is 
     amended--
       (1) by striking ``58.5 cents (51 cents on snuff removed 
     during 2000 or 2001)'' in paragraph (1) and inserting 
     ``$1.50'', and
       (2) by striking ``19.5 cents (17 cents on chewing tobacco 
     removed during 2000 or 2001)'' in paragraph (2) and inserting 
     ``50 cents''.
       (f) Pipe Tobacco.--Section 5701(f) of such Code is amended 
     by striking ``$1.0969 cents (95.67 cents on pipe tobacco 
     removed during 2000 or 2001)'' and inserting ``$2.8126 
     cents''.
       (g) Roll-Your-Own Tobacco.--Section 5701(g) of such Code is 
     amended by striking ``$1.0969 cents (95.67 cents on roll-
     your-own tobacco removed during 2000 or 2001)'' and inserting 
     ``$8.8889 cents''.
       (h) Floor Stocks Taxes.--
       (1) Imposition of tax.--On tobacco products (other than 
     cigars described in section 5701(a)(2) of the Internal 
     Revenue Code of 1986) and cigarette papers and tubes 
     manufactured in or imported into the United States which are 
     removed before January 1, 2008, and held on such date for 
     sale by any person, there is hereby imposed a tax in an 
     amount equal to the excess of--
       (A) the tax which would be imposed under section 5701 of 
     such Code on the article if the article had been removed on 
     such date, over
       (B) the prior tax (if any) imposed under section 5701 of 
     such Code on such article.
       (2) Credit against tax.--Each person shall be allowed as a 
     credit against the taxes imposed by paragraph (1) an amount 
     equal to $500. Such credit shall not exceed the amount of 
     taxes imposed by paragraph (1) on January 1, 2008, for which 
     such person is liable.
       (3) Liability for tax and method of payment.--
       (A) Liability for tax.--A person holding tobacco products, 
     cigarette papers, or cigarette tubes on January 1, 2008, to 
     which any tax imposed by paragraph (1) applies shall be 
     liable for such tax.
       (B) Method of payment.--The tax imposed by paragraph (1) 
     shall be paid in such manner as the Secretary shall prescribe 
     by regulations.
       (C) Time for payment.--The tax imposed by paragraph (1) 
     shall be paid on or before April 1, 2008.
       (4) Articles in foreign trade zones.--Notwithstanding the 
     Act of June 18, 1934 (commonly known as the Foreign Trade 
     Zone Act, 48 Stat. 998, 19 U.S.C. 81a et seq.) or any other 
     provision of law, any article which is located in a foreign 
     trade zone on January 1, 2008, shall be subject to the tax 
     imposed by paragraph (1) if--
       (A) internal revenue taxes have been determined, or customs 
     duties liquidated, with respect to such article before such 
     date pursuant to a request made under the 1st proviso of 
     section 3(a) of such Act, or
       (B) such article is held on such date under the supervision 
     of an officer of the United

[[Page 25503]]

     States Customs and Border Protection of the Department of 
     Homeland Security pursuant to the 2d proviso of such section 
     3(a).
       (5) Definitions.--For purposes of this subsection--
       (A) In general.--Any term used in this subsection which is 
     also used in section 5702 of the Internal Revenue Code of 
     1986 shall have the same meaning as such term has in such 
     section.
       (B) Secretary.--The term ``Secretary'' means the Secretary 
     of the Treasury or the Secretary's delegate.
       (6) Controlled groups.--Rules similar to the rules of 
     section 5061(e)(3) of such Code shall apply for purposes of 
     this subsection.
       (7) Other laws applicable.--All provisions of law, 
     including penalties, applicable with respect to the taxes 
     imposed by section 5701 of such Code shall, insofar as 
     applicable and not inconsistent with the provisions of this 
     subsection, apply to the floor stocks taxes imposed by 
     paragraph (1), to the same extent as if such taxes were 
     imposed by such section 5701. The Secretary may treat any 
     person who bore the ultimate burden of the tax imposed by 
     paragraph (1) as the person to whom a credit or refund under 
     such provisions may be allowed or made.
       (i) Effective Date.--The amendments made by this section 
     shall apply to articles removed (as defined in section 
     5702(j) of the Internal Revenue Code of 1986) after December 
     31, 2007.

     SEC. 702. ADMINISTRATIVE IMPROVEMENTS.

       (a) Permit, Report, and Record Requirements for 
     Manufacturers and Importers of Processed Tobacco.--
       (1) Permits.--
       (A) Application.--Section 5712 of the Internal Revenue Code 
     of 1986 is amended by inserting ``or processed tobacco'' 
     after ``tobacco products''.
       (B) Issuance.--Section 5713(a) of such Code is amended by 
     inserting ``or processed tobacco'' after ``tobacco 
     products''.
       (2) Inventories and reports.--
       (A) Inventories.--Section 5721 of such Code is amended by 
     inserting ``, processed tobacco,'' after ``tobacco 
     products''.
       (B) Reports.--Section 5722 of such Code is amended by 
     inserting ``, processed tobacco,'' after ``tobacco 
     products''.
       (3) Records.--Section 5741 of such Code is amended by 
     inserting ``, processed tobacco,'' after ``tobacco 
     products''.
       (4) Manufacturer of processed tobacco.--Section 5702 of 
     such Code is amended by adding at the end the following new 
     subsection:
       ``(p) Manufacturer of Processed Tobacco.--
       ``(1) In general.--The term `manufacturer of processed 
     tobacco' means any person who processes any tobacco other 
     than tobacco products.
       ``(2) Processed tobacco.--The processing of tobacco shall 
     not include the farming or growing of tobacco or the handling 
     of tobacco solely for sale, shipment, or delivery to a 
     manufacturer of tobacco products or processed tobacco.''.
       (5) Conforming amendment.--Section 5702(k) of such Code is 
     amended by inserting ``, or any processed tobacco,'' after 
     ``nontaxpaid tobacco products or cigarette papers or tubes''.
       (6) Effective date.--The amendments made by this subsection 
     shall take effect on January 1, 2008.
       (b) Basis for Denial, Suspension, or Revocation of 
     Permits.--
       (1) Denial.--Paragraph (3) of section 5712 of such Code is 
     amended to read as follows:
       ``(3) such person (including, in the case of a corporation, 
     any officer, director, or principal stockholder and, in the 
     case of a partnership, a partner)--
       ``(A) is, by reason of his business experience, financial 
     standing, or trade connections or by reason of previous or 
     current legal proceedings involving a felony violation of any 
     other provision of Federal criminal law relating to tobacco 
     products, cigarette paper, or cigarette tubes, not likely to 
     maintain operations in compliance with this chapter,
       ``(B) has been convicted of a felony violation of any 
     provision of Federal or State criminal law relating to 
     tobacco products, cigarette paper, or cigarette tubes, or
       ``(C) has failed to disclose any material information 
     required or made any material false statement in the 
     application therefor.''.
       (2) Suspension or revocation.--Subsection (b) of section 
     5713 of such Code is amended to read as follows:
       ``(b) Suspension or Revocation.--
       ``(1) Show cause hearing.--If the Secretary has reason to 
     believe that any person holding a permit--
       ``(A) has not in good faith complied with this chapter, or 
     with any other provision of this title involving intent to 
     defraud,
       ``(B) has violated the conditions of such permit,
       ``(C) has failed to disclose any material information 
     required or made any material false statement in the 
     application for such permit,
       ``(D) has failed to maintain his premises in such manner as 
     to protect the revenue,
       ``(E) is, by reason of previous or current legal 
     proceedings involving a felony violation of any other 
     provision of Federal criminal law relating to tobacco 
     products, cigarette paper, or cigarette tubes, not likely to 
     maintain operations in compliance with this chapter, or
       ``(F) has been convicted of a felony violation of any 
     provision of Federal or State criminal law relating to 
     tobacco products, cigarette paper, or cigarette tubes,

     the Secretary shall issue an order, stating the facts 
     charged, citing such person to show cause why his permit 
     should not be suspended or revoked.
       ``(2) Action following hearing.--If, after hearing, the 
     Secretary finds that such person has not shown cause why his 
     permit should not be suspended or revoked, such permit shall 
     be suspended for such period as the Secretary deems proper or 
     shall be revoked.''.
       (3) Effective date.--The amendments made by this subsection 
     shall take effect on the date of the enactment of this Act.
       (c) Application of Internal Revenue Code Statute of 
     Limitations for Alcohol and Tobacco Excise Taxes.--
       (1) In general.--Section 514(a) of the Tariff Act of 1930 
     (19 U.S.C. 1514(a)) is amended by striking ``and section 520 
     (relating to refunds)'' and inserting ``section 520 (relating 
     to refunds), and section 6501 of the Internal Revenue Code of 
     1986 (but only with respect to taxes imposed under chapters 
     51 and 52 of such Code)''.
       (2) Effective date.--The amendment made by this subsection 
     shall apply to articles imported after the date of the 
     enactment of this Act.
       (d) Expansion of Definition of Roll-Your-Own Tobacco.--
       (1) In general.--Section 5702(o) of the Internal Revenue 
     Code of 1986 is amended by inserting ``or cigars, or for use 
     as wrappers thereof'' before the period at the end.
       (2) Effective date.--The amendment made by this subsection 
     shall apply to articles removed (as defined in section 
     5702(j) of the Internal Revenue Code of 1986) after December 
     31, 2007.
       (e) Time of Tax for Unlawfully Manufactured Tobacco 
     Products.--
       (1) In general.--Section 5703(b)(2) of such Code is amended 
     by adding at the end the following new subparagraph:
       ``(F) Special rule for unlawfully manufactured tobacco 
     products.--In the case of any tobacco products, cigarette 
     paper, or cigarette tubes produced in the United States at 
     any place other than the premises of a manufacturer of 
     tobacco products, cigarette paper, or cigarette tubes that 
     has filed the bond and obtained the permit required under 
     this chapter, tax shall be due and payable immediately upon 
     manufacture.''.
       (2) Effective date.--The amendment made by this subsection 
     shall take effect on the date of the enactment of this Act.

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

       Subparagraph (B) of section 401(1) of the Tax Increase 
     Prevention and Reconciliation Act of 2005 is amended by 
     striking ``114.75 percent'' and inserting ``113.75 percent''.
       In lieu of the matter proposed to be inserted to the title 
     of the Act, insert the following: ``An Act to amend title XXI 
     of the Social Security Act to extend and improve the 
     Children's Health Insurance Program, and for other 
     purposes.''.

  The SPEAKER pro tempore. Pursuant to House Resolution 675, the 
gentleman from Michigan (Mr. Dingell), the gentleman from Texas (Mr. 
Barton), the gentleman from New York (Mr. Rangel), and the gentleman 
from Louisiana (Mr. McCrery) each will control 15 minutes.
  The Chair recognizes the gentleman from Michigan.


                             General Leave

  Mr. DINGELL. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days to revise and extend their remarks and 
include therein extraneous matter on the bill under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Michigan?
  There was no objection.
  Mr. DINGELL. Mr. Speaker, I yield myself 2 minutes.
  Mr. Speaker, I rise in support of H.R. 976, the Children's Health 
Insurance Program Reauthorization Act of 2007.
  Ten years ago a Republican Congress and a Democratic President passed 
a landmark program to reach children who had fallen through the cracks 
of the health care system. These kids weren't poor enough to qualify 
for Medicaid, and their parents, most of whom worked, couldn't afford 
health insurance on their own.
  Today this program provides health care for 6 million children across 
the Nation. Those 6 million kids today are in jeopardy because this 
successful program will expire September 30. The legislation before us 
will continue helping these 6 million of our children and extend health 
care to 4 million more of our young people.
  This bill is for parents like Ms. Molina, a mother of 2 children who

[[Page 25504]]

worked 2 part-time jobs but still could not afford health insurance. 
CHIP got her kids treatment for dental work, 2 sprained ankles, 1 
broken arm, and a severe burn.
  It's for parents like Ms. Mingeldorff, the mother of a child born 25 
weeks prematurely who would have had to turn down a job without health 
insurance because it would have made her ineligible for Medicaid.
  This bill is for every child who needs a vaccination, a cavity 
filled, chemotherapy, insulin, antidepressants, or other life-
sustaining health care.
  I urge my colleagues to vote for the children in your district and to 
remember this legislation will provide health care for 6 million who 
are now deriving that and 4 million more. The issue here is are you for 
or against health care for the kids under the SCHIP program?
  Mr. Speaker, I reserve the balance of my time.
  Mr. DEAL of Georgia. Mr. Speaker, on behalf of the House Energy and 
Commerce Committee, I reserve the balance of my time at this point.
  Mr. RANGEL. Mr. Speaker, I yield myself 3 minutes.
  My friends, this is almost an historic occasion because, like the 
President of the United States said, it is our intention to extend 
health care to cover 10 million kids.
  I don't care how you cut it. You can call it socialized medicine. You 
can say it's outside of the budget. But when you go home, the question 
basically is going to be were you with the kids or were you not? It is 
not just the human and right thing to do, but from a fiscal point of 
view, how many billions of dollars do we save by providing preventative 
care to these youngsters? And certainly from a tax writer's point of 
view, how many of these kids are going to grow to be productive workers 
so that they can pay taxes and make a contribution to this great 
Republic?

                              {time}  1845

  I don't know how you're going to explain how the kids can go to 
emergency wards if they get ill, as the President of the United States 
has indicated; but I know one thing, those of us who have kids and 
grandkids want the very best for them, and we do have this occasion 
now.
  Now, there are a lot of complaints from the other side that they did 
not participate in the writing of this bill. Having been in the 
minority for so long, let me say that every one of you on the 
Republican side that did not participate, that complained, you have 
good cause. You were not involved. And I might heartily add, neither 
were Members on the Democratic side involved.
  If you really want to find out who called the shots on this bill, 
which is not the House bill, it's those people on the other side of the 
Capitol that believe that everything that has to pass the Senate, that 
you need 60 votes for. And that's the long and the short of it. So, you 
may call it the Democratic majority, as I once did, but they're being 
held hostage by the Republican minority.
  And so I participated in terms of seeing what they wanted to do. And 
believe me, what they said to the House of Representatives, Republicans 
and Democrats alike, take it or leave it. And so if you want to join 
with me in looking for someone to criticize, after the debate we can 
meet in the lobby and talk about it.
  But you had an opportunity to vote for a better bill; it was here. 
And for those who are concerned that legal immigrants can't get 
services, I hope you voted for the House bill because it was in there. 
But if you really want to complain about it being un-American, walk 
with me to the other side, and we'll find the culprits who did it, and 
they're not Democrats.
  Mr. Speaker, I reserve the balance of my time.


                Announcement By the Speaker Pro Tempore

  The SPEAKER pro tempore. Members are reminded to address their 
remarks to the Chair.
  Mr. McCRERY. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, the debate this evening should not be about who is for 
insurance for children and who is against health insurance for 
children. The fact is that all of us, Democrats and Republicans alike, 
want SCHIP to be reauthorized. We will vote tomorrow, I believe, for a 
temporary extension of the program, and I predict that there will be a 
huge bipartisan vote in favor of extending the program to give this 
House more time to develop a true bipartisan reauthorization, long-term 
reauthorization of the SCHIP program.
  I do expect, Mr. Speaker, this bill to pass tonight, but I also 
expect the President to veto this bill, and I expect his veto to be 
sustained by this House. At that point, I'm very hopeful that, for the 
first time in this process, the minority in this House will be included 
in discussions about how we should reauthorize the SCHIP program, 
because to this point, frankly, we have not been included at all. We 
have not been asked for our recommendations for a reauthorization; we 
were not even given a substitute when this matter came to the floor 
originally here in the House of Representatives.
  So perhaps after the President vetoes and we sustain the veto, then 
maybe we will be brought into the room and we will have a chance to 
discuss with the majority what we think is the appropriate level of 
reauthorization for funding for this program and perhaps some of our 
ideas with respect to limiting those eligible for this program to the 
universe of people who were originally intended to be helped by the 
program, that is, low-income children whose family incomes are too high 
to qualify for Medicaid but too low to buy a policy in the individual 
market outside of the workplace.
  So, Mr. Speaker, this evening I suggest that, rather than point 
fingers and say you're against kids and we're for kids, you're for 
tobacco, we're against tobacco, that we get through this debate and 
then get through the next step of the process, which I hope will be 
more bipartisan and more cooperative, to allow us to get a real 
reauthorization that we can all support as we did in the mid-1990s when 
we created this program.
  Now, we only got this bill, this so-called compromise, last night, so 
we've been diligently going through it all night and all day today. 
We're not sure of everything that's in this bill, but I can enumerate a 
number of things that we believe to be facts and I think are important 
in this debate for this particular bill.
  First of all is the matter of funding. This bill is not even close to 
being fully funded. Budget gimmicks are replete. The proposal assumes 
that funding will drop to about one-fourth of the funding in the year 
2013, and then another $5 million cut after that. We all know that's 
not going to happen. But that was done, and I understand, just to make 
the budget numbers work; but Members ought to know what they're voting 
for.
  Another thing that we're told by the Congressional Budget Office, a 
nonpartisan arm of the House and the Senate, is that under this 
proposal 2 million children will move from private health insurance to 
government health insurance. Now, surely that's not what we want. We 
don't want the SCHIP program, do we, to move children from private 
insurance into government insurance? That wasn't the intent of this 
program when it started.
  And on the tax side, on the pay-for side, this bill proposes that we 
pay for a program with clearly growing requirements, growing needs with 
a funding source that is going to be declining, depleting, the tobacco 
tax. As you raise the tax on tobacco, you exacerbate the trend that has 
been evident in this country for a number of years of declining use of 
tobacco.
  So to propose funding a growing program with a declining revenue 
source is, I would submit, irresponsible fiscal policy.
  I have a few other speakers who are going to talk about some of the 
other weaknesses in this legislation.
  At this time, I would reserve the balance of my time.
  Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from New Jersey, the chairman of the subcommittee, Mr. 
Pallone.
  Mr. PALLONE. I want to thank my chairman, Mr. Dingell, Mr. Rangel,

[[Page 25505]]

Mr. Stark, and all who worked, including on the Senate side, to put 
this bill together.
  It does pain me a great deal, though, to hear my Republican 
colleagues, and specifically the ranking member of the Ways and Means 
Committee, basically advocate for the President's veto of this 
legislation. And I say that because I know that 10 years ago, when we 
established the SCHIP program, it was bipartisan, President Clinton, 
Speaker Gingrich. And the fact of the matter is it was done for 
practical reasons because we knew there were kids, as was said by the 
gentleman from Louisiana, who were not getting health care on the job, 
but whose incomes, because their parents were working, were too high to 
be eligible for Medicaid.
  Now, all we're doing today is being as practical as we were 10 years 
ago. We know that there are 6 million kids, almost twice who were 
enrolled in the program, who are eligible for this program under the 
same eligibility requirements as 10 years ago who are not enrolled in 
the program because we don't have enough money to pay for it and we 
haven't had enough outreach to get them enrolled.
  There is nothing new here. This is the same block grant that Speaker 
Gingrich and President Clinton advocated 10 years ago. But practically 
speaking, we know that for the first time in the last 2 years the 
number of uninsured kids is now going up instead of going down, so we 
have to do something about it. And we sat down with the Republicans in 
the Senate, with the Democrats in the Senate and the Democrats here in 
the House, and we came up with a solution, which was the tobacco tax. 
Now, this is fully funded. And the tobacco tax is a great way to pay 
for it because if you tax people who are smoking and they smoke less, 
then we have less health problems, and it's directly related to trying 
to provide health insurance. So don't tell me it's not paid for. It is 
paid for. It's paid for in a good way. There is no change in 
eligibility here. We are simply trying to cover the same kids that are 
eligible but not enrolled.
  And if you go along with the President's veto of this legislation, 
what you're saying is that not only the kids that are not enrolled, but 
even those who are now in the program won't be able to get their health 
insurance. Shame on you for that.
  Mr. DEAL of Georgia. Mr. Speaker, I yield myself 3\1/2\ minutes.
  We're debating the reauthorization of a bill that has been in place 
for 10 years. It would seem to me that, in doing so, we should learn 
from the mistakes that were made in the initial legislation and attempt 
to correct them. I believe the legislation before us tonight overlooks 
that opportunity.
  We have seen the House version that passed here earlier, and we have 
now seen a Senate version; and the one before us tonight is very 
similar to the Senate version of this legislation. But it appears to me 
that we have some questions to ask about that. CBO says that there are 
300,000 fewer uninsured low-income children who will be enrolled under 
the bill before us today than would have been enrolled under the 
original Senate bill, and yet the amount of money that is being spent 
is almost exactly the same, an additional $35 billion over the next 5 
years. When you couple that $35 billion with the baseline budgeting and 
the amount of money that States will have to put into the program, we 
find that we're going to be spending about $60 billion over the next 5 
years for a program that for the first 10 years was only a $40 billion 
program. And when you do include that State funding into the mix, it 
will be $200 billion over the next 10 years.
  Now, who are we going to insure by putting this substantial amount of 
new money into the program? Once again, the Congressional Budget Office 
attempts to answer that question. They say that there will be an 
additional 800,000 children, currently SCHIP eligible, being enrolled 
in the program by the year 2012. And if that is truly the focus, which 
it should be the focus of the program, then what are we getting by 
spending an additional $60 billion? If you divide $60 billion by the 
additional 800,000 children, that means that this bill is going to 
require that we spend $74,000 per child. Now, I know the government can 
throw money away, but I believe that is certainly an excessive amount 
of money.
  Now, who are these children that are going to be the new enrollees? 
Once again, CBO tells us that, of the additional children who are going 
to be potentially enrolled, that about half of them are children who 
already have private health insurance, a 50 percent crowd-out of the 
existing insurance market.
  Now, they also tell us that we ought to be concerned about the fact 
that if there are potentially going to be as many as 2 million children 
who will have been moved out of their private insurance into this 
government-subsidized program, we're also told that Medicaid and also 
SCHIP generally pay less than the private insurance market pays, that 
means that the health care providers, the doctors and the hospitals, 
are going to have to absorb another 2 million patients who are going to 
be reimbursing them at a lower rate. Another error in the original 
program, it was for children, and yet we know that four States 
currently have more adults than children in their program.
  Under this bill before us, CBO estimates that in the next 5 years 
there will still be 780,000 adults enrolled in the Children's Health 
Care Program.
  Mr. Speaker, I reserve the balance of my time.


                         Parliamentary Inquiry

  Mr. RANGEL. I have a parliamentary inquiry, Mr. Speaker.
  The SPEAKER pro tempore. The gentleman will state his inquiry.
  Mr. RANGEL. Does it violate any of the House rules if I refer to the 
bill before this House as the ``Republican-controlled Senate'' bill?
  The SPEAKER pro tempore. The gentleman is not stating a parliamentary 
inquiry.
  Mr. RANGEL. Well, does it violate any of the House rules if I refer 
to this bill as a bill that is a Senate bill controlled by the 
Republicans on the other side of the House? I want to make it clear 
it's not a House bill.
  The SPEAKER pro tempore. If a point of order is made against the 
gentleman's referring to the bill in that manner, the Speaker will rule 
on the matter.

                              {time}  1900

  Mr. RANGEL. Mr. Speaker, I yield myself such time as I may consume 
because I want to share a lot of complaints about what those 
Republicans did to a good, decent House bill. So if you want to join 
with me with your criticism, don't criticize anyone here. It is not my 
fault that your leaders were excluded from the so-called 
``conference.'' We had no conference.
  I know how it feels to have been in the minority, having been there 
for a decade. So I share with you why you were left out. But had I been 
in charge, and not the Senate, I would have wanted you there, your 
judgment. Even if it was just to read the bill over and over and over, 
at least you would have been participating.
  I yield to the chairman of the Health Subcommittee. No one is in a 
better position to let you know that this is not the House bill. As 
hard as he worked to reform Medicare, to make certain that we preserved 
it, to reform that bill, to get $5 billion for the people in the rural 
areas, to help the aged poor, and really to help the doctors that work 
hard every day and deserve a decent reimbursement, that, my friends, 
was in the House bill. But our friends on the other side, the 
Republicans said, ``No, take it or leave it.''
  Mr. Speaker, I yield 2 minutes to the gentleman that worked hard for 
the House bill, the gentleman from California (Mr. Stark).
  Mr. STARK. Mr. Speaker, as my distinguished chairman has suggested, 
this is a modest proposal, with all due respect to Mr. Swift. I am not 
proud of the bill or the process. I would say to my distinguished 
ranking member from the Ways and Means Committee that they were 
accorded every opportunity at every point to participate in this bill, 
and they know it. They were not excluded until they decided they did 
not want to help us pass the CHAMP bill, which was a far better bill.

[[Page 25506]]

  At this point, I have to thank my colleagues on both sides of the 
aisle who have helped us pass a bill that would have added a million 
additional children. It was a far better bill for children. It would 
have expanded coverage to legal immigrant children. It was better also 
for senior citizens. But I also have to thank our leadership and the 
commitment of Speaker Pelosi to suggest that when we come back, after, 
as we expect this bill will be vetoed, we will remember that there were 
a tremendous number of proposals in here which would have helped not 
only children, but seniors, financial help for low-income seniors, 
mental health parity for Medicare, improved Medicare benefits and 
health benefits, preventive care, rural health parity, consumer 
protections in part D, improved dialysis procedures, protection of 
Medicare from privatization, and the preservation of the Medicare 
system by doing away with the excessive spending in Medicare Advantage.
  The allegiance of groups like AARP, the AMA, Families USA, the 
Alliance for Retired Americans, the National Committee to Preserve 
Medicare and Social Security, the AHA, all of whom helped us pass 
CHAMP, all have been ignored in the bill before us today.
  I want to make it perfectly clear, I had no part in backing away from 
not only my commitments, the commitments of many of my colleagues, to 
these groups or to America's seniors. I know the Speaker will help us 
return to that commitment and pass those procedures in the future.
  Mr. Speaker, I rise in support of H.R. 976, the Children's Health 
Insurance Program Reauthorization Act.
  As many of my colleagues have made clear, this bill is far better 
than what President Bush prefers. It will provide $35 billion in new 
funds for the CHIP program, which will enable 6.6 million children to 
keep their health care at the end of the month and provide coverage to 
nearly 4 million currently uninsured children.
  President Bush proclaims to want a ``clean extension'' of the CHIP 
program, but don't believe him on this any more than you did on weapons 
of mass destruction, ``mission accomplished'' or take your pick of lies 
he's told. He knows full well that his proposal would mean taking 
health care away from needy children.
  The CHIP program is a block grant so it provides a capped amount of 
funding to States each year. The existing program is broken. We've 
already had to pass legislation this year to provide additional funds 
to keep more than 13 States from dropping children from their CHIP 
roles. If the President has his way, those States will soon have to 
take away their health coverage anyway.
  That's why I'll vote for this bill today. It is better than the 
status quo--and far better than the direction President Bush wants to 
take us all with regard to health coverage.
  But, I am not proud of this bill or this process.
  On August 1st, we passed a far better bill through the House of 
Representatives.
  First, the Children's Health Insurance and Medicare Protection Act, 
CHAMP, was better for children. It invested $50 billion into the 
program and covered more than a million children. CHAMP also allowed 
States to use Federal funds to appropriately expand coverage to legal 
immigrant children and corrected a misguided regulation issued by the 
Bush administration on citizenship documentation that forced thousands 
of American children to lose their health coverage through Medicaid.
  However, not only was the CHAMP Act better for children, it also 
provided overdue and much needed improvements to senior citizens and 
people with disabilities on Medicare. In the House, we combined 
children with seniors and created a bill that improved the health of 
our youngest and most needy and our oldest.
  Unfortunately, Senate Republicans refused to allow our bills to go to 
conference. They refused to even consider attaching any Medicare 
provisions to the CHIP reauthorization. As a result, we are here today 
with a reduced CHIP package that cedes most of the House CHIP 
reauthorization bill to the Senate's preferred language.
  I'm also not certain about whether we will really take up Medicare 
later this year and adopt the important Medicare improvements we passed 
in the House.
  All of the following provisions from the CHAMP Act are now at risk: 
financial help for low-income seniors, Medicare mental health parity, 
improved Medicare preventive health benefits, prevention of the pending 
physician payment cuts, rural health parity, consumer protections in 
Part D, improved dialysis procedures, protection of Medicare from 
privatization through massive overpayments to private plans, and 
preservation of the Medicare system.
  In my opinion, the allegiance of groups like AARP, the AMA, Families 
USA, the Alliance for Retired Americans, the National Committee to 
Preserve Medicare, and Social Security and the AHA--which helped us 
pass CHAMP--have been ignored in the bill before us today.
  I want to close by making it perfectly clear that I had no part in 
backing away from my commitments to any Members of Congress, these 
groups, or to America's seniors in requesting your support for our 
broader CHAMP Act. I will do everything I can to see all sections of 
CHAMP become law. I urge my colleagues in the House and advocates 
across the country to urge leaders in both the House and the Senate to 
do the same.
  Mr. McCRERY. Mr. Speaker, at this time, I yield 2 minutes to the 
gentleman from Michigan (Mr. Camp), the distinguished member of the 
Ways and Means Committee, the ranking member of the Health 
Subcommittee.
  Mr. CAMP of Michigan. Mr. Speaker, I thank the gentleman for 
yielding.
  Mr. Speaker, this bill clearly isn't about helping low-income 
children. If it were, it would have support from both parties and the 
President would be eagerly waiting to sign it into law. This is a 
missed opportunity. Virtually everyone supports providing health 
insurance to low-income children. But when a Federal health program for 
children starts covering not only families, but childless adults making 
three and four times the poverty level, it has clearly lost its focus.
  It is clear that Democrats want taxpayers to fund, and the Federal 
Government to directly provide, health care benefits to millions of 
more Americans, even for those families making over $80,000 a year. 
They are using SCHIP as a vehicle and the children it is intended to 
cover as a shield to get one step closer to total Government control 
over our health care system. The current plan to expand SCHIP is in 
dire need of a second opinion. Instead of moving further and further 
away from the core mission, we should be reforming the program to 
ensure it is truly helping America's uninsured children.
  The nonpartisan Congressional Budget Office stipulates that the 
proposed expansion would cover an additional 5.8 million Americans at a 
cost of $35 billion. Alarmingly, more than one out of every three 
individuals already has private insurance. The bill before us does 
little more than move children and upper-income families from private 
insurance plans to taxpayer-funded plans. That is a prescription for 
the type of government largess that stifles economies and unduly 
burdens taxpayers. It is not a prescription for reducing the number of 
uninsured Americans.
  State's and children's advocates should take a second look at this 
bill. Because of shoddy funding sources, this bill is likely to harm 
more States and health care programs than it helps. A Heritage 
Foundation study showed that as many as 28 States, including Michigan, 
stand to have a net loss of $10 to $700 million in revenue.
  This bill is designed poorly, funded poorly, and will do little to 
help lower-income Americans obtain health coverage. The President 
should veto this bill. Congress should work in a bipartisan fashion, as 
we did nearly 10 years ago when the program was created, to make 
certain that children in America have access to a health care system.
  Mr. DINGELL. Mr. Speaker, I yield to the distinguished gentlewoman 
from California (Ms. Eshoo) 1 minute.
  Ms. ESHOO. Mr. Speaker, I thank the chairman of the Energy and 
Commerce Committee for his devotion to this issue during his entire 
career in the Congress. I don't think that this is a complicated 
question that is here before us today. I think that it is very clear. 
It is very clear in terms of the values of the American people. Why 
wouldn't a Congress, any Congress, offer health insurance for its most 
vulnerable citizens, the little ones, of our country?
  That is what is on the floor today. That is what is on the floor. 
They are smart, and they are grinning. Grinning. But do you know what? 
There are going to be the votes for this bill, and

[[Page 25507]]

the bill is going to pass. And imagine the person that stands at the 
doctor's door and not allow children to go through: the President of 
the United States.
  This is a bipartisan effort. The people of our country want us to 
come together for the families of this country, for the betterment of 
our country, to make an investment. Yes, through taxing tobacco. I 
would rather tax tobacco and protect the children of our country than 
to blow $10 billion a month in Iraq. I am proud of the Democrats. I am 
proud of the Republicans that support it. We should pass this and say a 
prayer that the President will come out of his cloud and sign the bill.
  The SPEAKER pro tempore. Without objection, the gentleman from Texas 
will claim the time controlled previously by the gentleman from 
Georgia.
  There was no objection.
  Mr. BARTON of Texas. Mr. Speaker, I would like to recognize a member 
of the committee, the gentleman from Arizona (Mr. Shadegg), for 2 
minutes.
  Mr. SHADEGG. I thank the gentleman for yielding.
  Mr. Speaker, I rise in strong support of health care for America's 
poor and near-poor children. I also rise in equally strong opposition 
to this bill.
  For more than a decade, I have introduced into the United States 
Congress every single year a bill that would give every single child 
covered by this bill health insurance. Indeed, it would provide to 
every family covered by this bill a source of money, tax funds, to them 
and their family, to buy the health insurance they need for them and 
their children. But make no mistake about it. This bill is a fraud. The 
American people are smart. They know it is a fraud. This bill is 
Congress playing fast and loose with the facts. If we are going to have 
a debate about covering every single American, let's have that debate. 
But let's not hide it in a debate about children's health care.
  The American people are generous to a fault. They want to cover poor 
children. They want to cover children who are uninsured. The SCHIP 
program we have was supposed to do just that. But this program is a 
fraud. It doesn't cover just poor and near-poor. It covers middle-class 
families. Some will say, ``Oh, it is capped at 300 percent of the 
Federal poverty level.'' But under the law and the language in the 
bill, States can define income any way they want. Therefore, there is 
no cap on income. It doesn't just cover uninsured children. It covers 
more children who are insured already than those who are uninsured. CBO 
says that if we pass this bill, 2 million children currently covered by 
insurance, getting better coverage than they will get under this bill, 
will lose that coverage and go on SCHIP. Be proud of reducing the 
quality of the care they get. In fact, this bill isn't even limited to 
children. Indeed, this bill will cover adults. In Wisconsin today, 75 
percent of the SCHIP money is used to cover adults. In Minnesota, it is 
61 percent. In Arizona, we do the same.
  Mr. Speaker, if we want to have a debate about universal care, I am 
for that debate. I have got that bill. But don't have a bill that is a 
fraud. We must be honest in this debate. This bill will hurt children's 
health care in America.
  Mr. RANGEL. Mr. Speaker, I am going to act as if I didn't hear that 
gentleman call this bill a fraud four times. I was in that back room 
with Senator Grassley, Senator Reid and our dear friend Orrin Hatch. 
It's their bill. So you call it what you want. But please don't call it 
a fraud, because it is a Senate bill. And they are very sensitive over 
there. So I just want to make that clear.
  Mr. Speaker, it is my pleasure to give 1 minute to the gentleman from 
Illinois (Mr. LaHood). I cannot think of a Member of this House that 
has worked harder in trying to bring civility, no matter what the issue 
was. I heard he wasn't going to run for reelection. I just want him to 
know publicly that both sides of the aisle will miss him.
  Mr. LaHOOD. Mr. Speaker, this is a bill about children and about 
health care. Now, all of us in this Chamber have the very best health 
care insurance in the world, bar none. We should be willing to share 
those kinds of resources with kids in this country. Why should children 
have to go to an emergency room when they have the flu? Why should 
children have to go to an emergency room when they have a cold? Why 
should children have to go to emergency rooms when they are sick? They 
shouldn't. Not in America. Not where we have the very best health care 
in the world. My friends, we should give to our children the access to 
health care that we have, those of us that serve in the House and the 
Senate.
  This is a bipartisan compromise. This is an opportunity to take a 
Republican initiative, share it, move on and give the opportunity to 
children. I encourage Members to do that, to play on the Republican 
initiative that was started years ago and to say, we have a bipartisan 
opportunity to give good health care to children.
  Mr. Speaker, I urge my colleagues, particularly on the Republican 
side, to vote for this proposal.
  I thank the chairman for the time.
  The debate about whether or not to reauthorize and expand the State 
Children's Health Insurance Program should be easy. This legislation is 
the product of a bipartisan group that worked to produce a compromise 
that should be acceptable to all of us. With the shortfall we have seen 
in several states over the past year, reauthorization of the program at 
current funding levels is unacceptable. Earlier this year, Illinois 
faced a $247 million SCHIP shortfall. Many other states were a similar 
situation before the shortfalls were addressed with new appropriations. 
By passing this bill today, we may be able to prevent future shortfalls 
which jeopardize those state programs designed to cover the costs for 
low income families who can't afford adequate health insurance for 
their children.
  Of the estimated six million low-income children who are not eligible 
for Medicaid, more than 250,000 children were covered by All Kids, 
Illinois' successful children's insurance program. More than half of 
those children live in working and middle class families that make too 
much to qualify for Medicaid but can't afford private insurance. In 
2005, more than 25% of all uninsured children in Illinois fell into the 
$25,000-$35,000 income level range, having nearly doubled from 13% in 
2002. At that rate of growth, we must continue to see this program 
through. With passage of this legislation today, it is estimated that 
an additional 154,000 Illinois children will be afforded health 
insurance. An additional 3.8 million children nationwide will be 
covered.
  I urge my colleagues to support this vital piece of legislation. It 
is imperative that we continue to look out for the future health and 
well-being of this Nation, and that starts with our children today.

                              {time}  1915

  Mr. McCRERY. Mr. Speaker, before I recognize our next speaker, I 
yield myself such time as I may consume.
  Mr. Speaker, I agree with the gentleman that children ought not have 
to go to emergency rooms to get care, that children ought to be able to 
go to their family doctor; but there's a good way and a not-so-good way 
to provide that.
  This bill provides a government healthcare program for that. We would 
much rather provide a private health insurance plan for that. I would 
submit that there is a vast difference in those approaches.
  Mr. Speaker, at this time I would yield 2 minutes to the 
distinguished gentleman from Texas (Mr. Sam Johnson), a member of the 
Ways and Means Committee and ranking member of the Social Security 
Subcommittee.
  Mr. SAM JOHNSON of Texas. Mr. Speaker, I must oppose this bill today, 
but I have got to make it clear that I do support children's health 
insurance. I believe this bill flat misses the mark. While well-
intentioned, this legislation is a massive expansion of a government-
run healthcare program that takes resources away from the very children 
it was meant to help.
  As ranking member of the Social Security Subcommittee on Ways and 
Means, I am deeply disturbed by the part of this bill that makes it 
easier for illegal immigrants to be covered under this program. In the 
last Congress, Republicans worked hard to ensure that everyone in this 
children's health program are really U.S. citizens. Because of that 
effort, States now require applicants to show documents like birth 
certificates, driver's licenses or passports in order to prove U.S. 
citizenship.

[[Page 25508]]

  This new legislation weakens this standard. All applicants would 
simply be asked to provide a Social Security number and a name that 
would then be verified by the Social Security Administration. This 
process is ripe for massive fraud and abuse that will leave American 
tax dollars paying for healthcare for illegal immigrants.
  In addition, we have the responsibility here in Congress to spend the 
taxpayer dollar wisely. I know my constituents don't want the Federal 
Government doling out billions of dollars to pay for illegal 
immigrants' health care.
  Congress should just pass a responsible extension of this important 
program before it expires, not play politics with our kids' health 
care. Americans deserve, want, and need for our children to have good 
health care, and we need to do it today.
  Mr. DINGELL. Mr. Speaker, with affection and respect for my good 
friend from Texas, I would observe that none of the abuses that he 
points out have been found in the years in which this legislation has 
been in place, and there are none of the abuses that he would find here 
going to come forward.
  Mr. Speaker, I am delighted to yield 1 minute to my friend, the 
distinguished gentlewoman from California (Mrs. Capps), a real expert 
in the field of health care and a caring and concerned practitioner as 
a nurse. We are grateful that she is with us.
  Mrs. CAPPS. Thank you, Chairman Dingell, for your leadership.
  Mr. Speaker, I rise today in strong support of this bill and in 
support of America's children. We have two choices today: We can vote 
for this excellent bipartisan bill, which Senator Hatch appropriately 
called ``an honest compromise which improves a program that works,'' or 
we can vote against this bill and not only deny millions of children 
the chance to finally access health care, but strip it away from 
children who are already covered.
  Trust me: as a nurse, I know the power and prudence of providing this 
health care coverage for our kids. It is indeed an accomplishment that 
Congress can be proud of.
  This bill is responsible, and it's the right thing to do. Make no 
mistake, it is a compromise bill. But if we fail to pass this bill and 
even one child loses health coverage, we have failed our most important 
constituents, our children.
  I urge my colleagues, I strongly urge my colleagues to join me in 
supporting this legislation. Vote ``yes'' to protect children's health. 
``Suffer the little children.''
  Mr. BARTON of Texas. Mr. Speaker, I would yield myself 2 minutes.
  Mr. Speaker, we have spent most of today actually trying to read the 
bill. I have the bill in front of me. In this 2-minute period, I want 
to discuss section 605 of the bill. Section 605 of the bill has the 
title: ``No Federal funding for illegal aliens.'' It is a very brief 
section, two lines: ``Nothing in this act allows Federal payment for 
individuals who are not legal residents.'' That is it.
  So the title of section 605 would have you believe there's going to 
be no Federal funding for illegal aliens. When you specifically read 
the section, it just says nothing in the act allows payment. It doesn't 
prohibit it.
  Now, if the authors of section 605 really don't want illegal aliens 
to receive funding under this bill, this section ought to read 
something like this: ``This act prohibits Federal payments for 
individuals who are not legal residents or citizens.''
  Mr. Speaker, I would ask unanimous consent to substitute the language 
that I just read: ``This act prohibits Federal payments for individuals 
who are not legal residents or citizens.''
  Mr. DINGELL. Reserving the right to object, will the gentleman 
restate his unanimous consent request?
  Mr. BARTON of Texas. Mr. Speaker, my unanimous consent request is to 
substitute for what is in the bill: ``Nothing in this act allows 
Federal payment for individuals who are not legal residents,'' that is 
in the bill, I ask unanimous consent to substitute: ``This act 
prohibits Federal payments for individuals who are not legal residents 
or citizens.''
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  Mr. DINGELL. Mr. Speaker, that would contravene the understandings we 
had with our good friends in the Senate who insisted on this language. 
I have to object.
  The SPEAKER pro tempore. Objection is heard.
  Mr. BARTON of Texas. The gentleman from Michigan has objected, and I 
respect that objection. But what that means is that they want illegal 
residents of the United States of America to get these benefits. That 
is what the objection means. So for that reason alone, I would ask that 
we vote against this bill.
  Mr. Speaker, I reserve the balance of my time.
  Mr. RANGEL. Let me tell you what it means, distinguished ranking 
member. Distinguished ranking member, what it means is that the deal 
that we cut, if we change anything over here, the Republicans on the 
other side are going to drop everything. So we are trying to cooperate 
with this Republican Senate bill. So even if the distinguished 
gentlemen here would want to agree, we can't do it. We are held hostage 
by the other side.
  Let us put down our arguments and march over there and correct this 
thing. But I agree with you, that language should have been corrected 
with both Houses, but the Republicans objected to any changes or any 
additions.
  Mr. Speaker, I yield 1 minute to the distinguished gentleman from 
Illinois (Mr. Emanuel), a member of the Ways and Means Committee who is 
a leader in the Democratic Party, a leader in our Congress, and a 
leader in our country. We are proud to have him on this bill.
  Mr. EMANUEL. Last week the President asked for $200 billion more for 
the war in Iraq. In the same week, the White House said that the 
bipartisan plan to give 10 million children health care included 
``excessive spending'' and threatened to veto it.
  I agree we have excessive spending. In Iraq. For 41 days of the war 
in Iraq, 10 million U.S. children would get health care; 41 days of the 
war in Iraq, where we have been at war for over 4\1/2\ years.
  Make no mistakes, this debate is not about spending. It is about 
priorities. So it is no surprise that the President finds himself 
increasingly isolated from Republicans here on Capitol Hill, in the 
Senate, in the House, and Republicans in the State capitals around 
America.
  This President is isolated from where the American people are. They 
would like to see 10 million children get their health care.
  Just listen to what Republicans have been saying. Senate Republican 
Orrin Hatch: ``We're talking about kids who basically don't have 
coverage. I think the President's had some pretty bad advice.''
  Senator Charles Grassley, another Republican, said that the 
bipartisan plan ``breaks the legislative impasse and should have strong 
support from both Democrats and Republicans.''
  From minimum wage, to lobbying reform, to veterans health care, to 
college education, we have passed bipartisan solutions to problems 
facing America. That is what this bill does.
  Thank you for the Republican support for this Democrat initiative. It 
is right for America's children. It is time to put them first, 10 
million kids.
  Mr. McCRERY. Mr. Speaker, I yield 3 minutes to the gentleman from 
Wisconsin (Mr. Ryan), another distinguished member of the Ways and 
Means Committee.
  Mr. RYAN of Wisconsin. I thank the gentleman for yielding.
  Mr. Speaker, a couple of things: number one, we are not dedicating 
enough time to this debate. A half-hour is not enough time to debate 
what this is really all about. This is not just about health care, 
health insurance for low-income children. If that is all this was 
about, then we could pass this with 2 minutes of debate, unanimous 
consent, voice vote, everyone would agree.
  That is not what this debate is about. This debate goes far beyond 
that, and the American people deserve to have a much more honest, much 
more thorough debate about what really is being discussed here.

[[Page 25509]]

  This is a misleading bill. This is a misleading debate. This is 
misleading, number one, because this is really all about whether or not 
the Federal Government should run health care for most Americans or 
not.
  All of us in this room, Republicans and Democrats, believe that 
Americans ought to have access to affordable health insurance. All 
Americans. We all believe that. The question is, should the government 
run it, or should health care be a decision between patients and their 
doctors? Let's have a debate about that.
  The reason this is a misleading debate is because this bill takes 
more health insurance away from children with private insurance than it 
gives to children without insurance. We are taking more people off of 
private insurance than we are giving to uninsured children. If we 
wanted to just give uninsured children health insurance, let's do it.
  This bill is misleading because it gives children health insurance 
for 5 years, and then it pushes them off a cliff. I call it the 
majority's ``bait and switch SCHIP funding.'' It says 5 million 
children get it now; 5 million children 6 months into 2012 get nothing. 
$41 billion is hidden out of this bill. Who believes that that is going 
to happen? In order to contort their way into their PAYGO rule, they 
are giving on the one hand and taking out with the other.
  But what this debate is really about is putting the government in the 
middle of that decision between the patient and their doctor. I don't 
want a bureaucrat running health care. I don't want an HMO bureaucrat 
running health care, and I don't want a government bureaucrat running 
health care. I want patients running health care with their doctors.
  That is what this debate is really about. This debate is about 
getting more and more and more government in the middle of the health 
care decisions between patients and their doctors. This is a debate 
about getting us on that path toward government-run health care. That 
is a big debate. It deserves more than a half-hour of debate.
  And, unfortunately, the majority is misleading the American people by 
saying this is only about low-income children, when they are bringing 
us a bill that displaces kids off of private health insurance, goes to 
virtually to anybody of any income if a State wants to, and goes way 
beyond the idea of insuring low-income children.
  Let's give low-income children health insurance, and let's have a big 
debate on whether the government ought to be running health care in 
America or not.
  Mr. DINGELL. Mr. Speaker, I would observe an interesting point, and 
that is the Congressional Budget Office says that we are taking care of 
4 million additional kids who are identical in all particulars to those 
we now care for under SCHIP. There is no vast increase in socialized 
medicine or anything of that sort, as we hear from the other side.
  Mr. Speaker, I yield 1 minute to the distinguished gentlewoman from 
California (Ms. Solis).
  Ms. SOLIS. I thank our chairman of the Energy and Commerce Committee 
for allowing me to speak this evening.
  Mr. Speaker, I rise with a very heavy heart today in support of this 
so-called Children's Health Insurance Program because I can't afford 
not to have our children covered. That is what SCHIP has been about for 
the last 10 years. We need to continue that service to those kids who 
are covered. It hopefully will not be dropped off, and we can continue 
to expand the program.
  I will tell you that I do have differences with our party, and 
especially the Republican Senate Members that refused to allow for 
coverage of legal permanent resident children and pregnant women.
  We passed a good bill, the CHAMP Act. We worked very hard, and I 
thank our leaders of our committee and our Members for allowing us the 
opportunity to provide interpretive services for hard-to-reach 
populations, to go out and do the right thing and to get more children 
enrolled.

                              {time}  1930

  This is not the expansion that many of us envisioned that are sitting 
here tonight, but it is the best we can do. I can tell you, we had a 
meeting earlier with Speaker Pelosi. She has made a commitment to 
continue the discussion with us, and we will make that a priority for 
the people that we represent here in America.
  If we can send troops, send our soldiers to defend our country and 
yet not cover their families and their children, then we have moral 
corruption going on in this Congress. I support this bill. Again, I say 
I have a heavy heart.
  Mr. BARTON of Texas. Mr. Speaker, I yield myself 1 minute.
  Mr. Speaker, I want to acknowledge my good friend, Mr. Rangel, the 
distinguished chairman of the Ways and Means Committee. I now know who 
the problem is; it is those big, bad bully Republicans in the Senate. I 
didn't realize that.
  Mr. RANGEL. I can discuss it in some detail.
  Mr. BARTON of Texas. It is my time.
  The SPEAKER pro tempore (Mr. Schiff). The gentleman from Texas 
controls the time.
  Mr. BARTON of Texas. Now that I know what the problem is, I am going 
to call over there. They are good friends of mine, Mr. Hatch and Mr. 
Grassley. And tell them that now that we have identified the problem, 
will they accept the language that Mr. Dingell objected to, and when we 
are here next week on the House floor when this bill is vetoed by the 
President, I would expect my good friend from New York to accept that 
change in the language.
  Mr. RANGEL. If we can get them to open up this, we can do business.
  Mr. BARTON of Texas. I know we can. I think my time has expired, but 
I just want to commend him because now I know where the problem is. It 
is those big bad bully Republicans and these two wily negotiators, Mr. 
Rangel and Mr. Dingell, who are two of the most distinguished, able 
legislators in the history of the Congress, have been buffaloed by a 
couple of scallywags over in the Senate.
  Mr. RANGEL. Mr. Speaker, it is my pleasure to yield 1 minute to the 
gentlewoman from Pennsylvania (Ms. Schwartz) who is an outstanding 
member of the Ways and Means Committee.
  Ms. SCHWARTZ. Mr. Speaker, as one of the original architects of CHIP 
in Pennsylvania, I have seen firsthand that it is possible to bring 
together public and private stakeholders and expand health coverage to 
millions of children, children of working families who cannot afford 
the increasing cost of coverage.
  As the September 30 deadline to reauthorize CHIP quickly approaches, 
American families are counting on us to ensure health coverage for 
millions of American children.
  The Democratic majority understands the needs of working families and 
has negotiated for weeks to craft a commonsense compromise legislation 
before us. This plan has a broad-based coalition of supporters ranging 
from our Nation's seniors and unions and businesses, insurance 
companies and health care providers, all of whom have come together to 
support CHIP.
  American families expect action, and 10 million uninsured American 
children are depending on us. It is time to put children ahead of 
politics. Vote ``yes.'' Vote for America's children. Tell the President 
to end his veto threats and vote to make health coverage available and 
affordable to 10 million American children.
  Mr. McCRERY. Mr. Speaker, due to the imbalance of time remaining, I 
would at this time withhold calling on a speaker, and I reserve the 
balance of my time.
  Mr. BARTON of Texas. Mr. Speaker, I yield 1 minute to the gentleman 
from Georgia (Mr. Kingston).
  Mr. KINGSTON. Mr. Speaker, I thank the gentleman for yielding, and I 
rise to oppose this bill.
  As much as anything, I want to say the children's health care bill, 
you would think would get a little more dignity in the process around 
here. This is a 299-page bill which we received, ``we,'' minority 
Republicans, received at 6 p.m. last night, or maybe even later than 
that. That doesn't give

[[Page 25510]]

you a lot of time to work on a bill and have any kind of bipartisan 
deliberations.
  Plus, there is no motion to recommit. Now I know that is inside-the-
Beltway stuff, but this is important if you are talking children's 
health care.
  What I do know is that in the bill, adults are still allowed to be 
covered by it. Adults can push poor children out of the way because 
States are going to politically favor them and let them have the 
opportunity to be insured.
  I know there is a massive tax increase. I know there is very little 
sympathy for smokers these days, but it is still a tax increase on the 
backs of the smokers. And in order to get enough money to pay for this, 
it would require 22 million new smokers in the United States of 
America.
  Now, maybe the Democrat Party is planning to pass out cigarettes at 
the schools and say to the kids: Hey, look, start smoking so you can 
finance your own insurance company. And you'll probably be needing it, 
by the way, wink-wink. But in the meantime, the government gets to 
grow. The bureaucracy gets to grow. The nanny-state, more like the 
Nurse Ratchet states, continues to grow at the expense of children. I 
urge a ``no'' vote on this.
  Mr. RANGEL. Mr. Speaker, I think my time along with Mr. McCrery's is 
short. If you can give us the amount of time, I think I am going to 
pass right now.
  The SPEAKER pro tempore. The gentleman from New York has 4\1/2\ 
minutes remaining. The gentleman from Louisiana has 2\1/2\ minutes 
remaining. The gentleman from Texas has 5\1/2\ minutes remaining. The 
gentleman from Michigan has 7\1/2\ minutes remaining.
  Mr. RANGEL. Mr. Speaker, I reserve the balance of my time.
  Mr. DINGELL. Mr. Speaker, I am delighted to yield 1 minute to a very 
able member of our committee, the gentlewoman from Oregon (Ms. Hooley).
  Ms. HOOLEY. Mr. Speaker, I rise today in strong support of H.R. 976. 
In Oregon alone, 37,000 new children will receive access to health care 
under this bill. Those children are counting on us to act today before 
this critical program expires.
  Although many speakers before me have focused on the big picture by 
citing the number of children impacted by this legislation, I implore 
my colleagues to not lose sight of the small picture: the impact SCHIP 
has on the life of a single child.
  The core purpose of this legislation is to ensure that a single child 
with the flu can go to the doctor or that a single child with cancer 
can receive chemotherapy. SCHIP simply allows the interaction between 
health care providers and the child to occur millions of times over.
  I hope the House will put aside petty partisan differences and show 
strong bipartisan support for H.R. 976, that the President will stand 
alone if he vetoes this critical piece of legislation.
  I can give the President 10 million reasons why he should put down 
his veto pen once we pass this bill, H.R. 976: the 10 million children 
who will otherwise go without access to health care if we do not pass 
this bill. I urge a ``yes'' vote on H.R. 976.
  Mr. BARTON of Texas. Mr. Speaker, I yield 1 minute to the gentleman 
from Indiana (Mr. Pence).
  Mr. PENCE. Mr. Speaker, I thank the gentleman for yielding.
  I rise in opposition to this SCHIP proposal. I see this as a bad deal 
for America, which is not to say that I oppose a reauthorization of 
this program or its essential elements. And in the continuing 
resolution this week, we will see to it that this program does not 
lapse as a virtue of my vote.
  But beyond the budget gimmickry, beyond increasing taxpayer liability 
for illegal immigrants, this compromise is no deal the American people 
should accept.
  It is interesting that a health insurance program for poor kids 
doesn't require your kids to be poor. Families with incomes of up to 
$83,000 a year could be entitled to assistance in health insurance in 
this program. Also, a State program to provide health insurance for 
children doesn't require families to have children to participate. This 
program allows childless adults to continue to receive SCHIP through 
2012.
  Also, it pays for all of this by raising taxes 61 cents per pack and 
more on cigars. The headline ought to read, ``Smokers in America to pay 
for middle class welfare.''
  Congress should reject this SCHIP program, continue this program, and 
reject all of the bad elements of this bad deal.
  Mr. RANGEL. Mr. Speaker, I yield 1 minute to Mr. Jason Altmire, a 
distinguished gentleman from Pennsylvania.
  Mr. ALTMIRE. Mr. Speaker, there has been a lot of conversation about 
how this is a Federal Government program and how this is a move to 
expand Government's role in health care, so I thought I would take a 
moment, a minute, to talk about what is really in this bill.
  This is an expansion of an existing program created 10 years ago in a 
Republican Congress. It is a capped block grant. The amount of money is 
capped. It flows through the States, and almost every State in the 
country administers the program through the private health insurance 
market. Through the private market.
  This could not be anything further from a big, government-run 
program. It is administered by the States and contracted out to the 
private market.
  And yes, these are families that have income. They are families that 
work hard and play by the rules, and they are families that can't 
afford health care for their children. Is there any better cause in 
this country that we can work on in this Congress than that issue? I 
ask my colleagues to support this bill.
  Mr. BARTON of Texas. Mr. Speaker, I yield myself 2 minutes.
  Mr. Speaker, since we have not had a markup and since we have not had 
a legislative hearing, and I know it is cumbersome to actually refer to 
specific sections of the bill on the floor, especially of what is 
portrayed to be a conference report, which this is not, which is not 
amendable, but I want to go back and talk about this eligibility.
  There is a section in the bill, section 203: ``State option to rely 
on findings from an express lane agency to conduct simplified 
eligibility determinations.'' On the face of it, that would seem to be 
a good thing. This section is very complicated. It is 10 to 15 pages 
long.
  But it does say in this section that a parent of a child that might 
be eligible can self-verify. If you are approached by one of these 
express lane agencies, it is up to the parent of the child to self-
determine, to self-certify that they are indeed eligible. That would 
appear to be something that we need to work on.
  Then it goes on when it defines the actual express lane agencies on 
page 123 of the bill, in subparagraph (F), it goes through and lists 
the kind of public agencies that are express lane agencies. They 
apparently include Medicare part D, Medicaid, Food Stamp Act, Head 
Start Act, National School Lunch Act, Child Nutrition Act, Stewart B. 
McKinney Homeless Assistance Act, United States Housing Act, Native 
American Housing Assistance Act, and so on and so on.
  Again on the face of it, those are all agencies that might be of some 
assistance, but I doubt that their requirements are the same as the 
requirements for the base bill for SCHIP in terms of income eligibility 
and age determination. For example, I doubt that the Stewart B. 
McKinney Homeless Assistance Act has an age requirement at all.
  So again, when the President vetoes this bill and we are back working 
together on a bipartisan basis, these are the kinds of things I hope to 
clarify and tighten up.
  Mr. DINGELL. Mr. Speaker, it is a pleasure and a privilege for me to 
yield time to a distinguished member of the Committee on Energy and 
Commerce, the respected gentlewoman from New Mexico, a very valuable 
member of our committee (Mrs. Wilson).

                              {time}  1945

  Mrs. WILSON of New Mexico. Mr. Speaker, my colleague from New York, 
Mr. Rangel, says this is not a House bill; and he's right, it isn't.

[[Page 25511]]

  When the House first passed its version of this bill, I opposed it, 
particularly because it funded that House version of the bill through 
reductions in Medicare spending. This bill is a compromise. It is a 
much better bill. It's not a great bill, but it's a good bill.
  I was a cabinet secretary in New Mexico for children at the time 
SCHIP was initially implemented. It was established by a Republican 
Congress and a Democrat President and it works. It gets kids health 
insurance that they need.
  We have big challenges in health care, but this isn't one of them. 
Don't let the perfect be the enemy of the good. I would ask my 
colleagues to join together and to support this bill tonight for the 
good of all of us.
  Mr. BARTON of Texas. Mr. Speaker, I yield 1 minute to a distinguished 
Member from Texas (Mr. Hensarling).
  Mr. McCRERY. Mr. Speaker, I yield 30 seconds to the gentleman from 
Texas (Mr. Hensarling).
  Mr. HENSARLING. I thank the gentleman for yielding.
  Mr. Speaker, let nobody make a mistake about it. I know the Democrats 
are trying to cast this as a debate about insuring poor children. 
That's false. We have Medicaid. We could reauthorize the current SCHIP 
program now in the snap of a finger, but that's not what this is about.
  Instead, this is a debate about who will control health care in 
America. Will it be families and doctors, or will it be government 
bureaucrats? This is a proxy fight for the Democrats to take that first 
step towards socialized, government-run health care in America. That's 
what this is all about, and there should be no mistake about it.
  We've got a program for children that insures adults. We've got a 
program ostensibly to help the poor that can subsidize people making 
$82,000 a year, and they're going to do all this with a huge tax 
increase on smokers, and we're going to need 22 million new smokers in 
10 years just to pay for it.
  If this bill passes not today not tomorrow but at some time, the 
children of America will suffer. If this program passes, and I hope all 
the mothers of America are paying very careful attention to this, 
because if this passes, in the years to come they won't wait minutes or 
hours to see a doctor of their choice. They will wait weeks and months 
to see a doctor chosen by a government bureaucrat, and that doctor will 
not be the doctor of today. It will be somebody who is less competent, 
less able to take care of their child, and that's what this is all 
about.
  If you care about the children, reject this bill tonight.
  Mr. RANGEL. Mr. Speaker, it's my pleasure to yield 1 minute to Dr. 
Steve Kagen, who would share his views with us.
  Mr. KAGEN. Mr. Speaker, the vote we will cast today will ask a simple 
question: Whose side are you on? Are you on the side of the millions of 
children who lack access to health care? Are you on the side of 
families who are working hard, but still cannot afford the cost of 
health insurance today in America? Are you on the side of the American 
people who demand, who demand that this Congress find a solution to the 
impossible costs for health care across the country? Or are you on the 
side of powerful special interests?
  The bill before us will cover nearly 38,000 additional uninsured 
children in Wisconsin, and I'm on their side. Whose side are you on? 
The American people will remember tonight, how you cast your vote. That 
question tonight will be answered in your vote, and tonight will answer 
the needs of those who need us the most, and that's our Nation's 
children, for they are our future.
  Vote ``yes.''
  Mr. McCRERY. Mr. Speaker, I only have one speaker left to close, so I 
would reserve the balance of my time.
  Mr. BARTON of Texas. Mr. Speaker, I also only have one speaker, 
that's myself, to close. What is the order of closure?
  The SPEAKER pro tempore. The Chair will recognize Members to close in 
the reverse order of opening: Mr. McCrery, Mr. Rangel, Mr. Barton, and 
lastly Mr. Dingell.
  Mr. RANGEL. Mr. Speaker, I have two speakers so I think I will 
reserve my time at this time until we can get a little equality in the 
time. I think I only have 2\1/2\ minutes.
  Mr. DINGELL. Mr. Speaker, I yield to the distinguished gentleman from 
Washington (Mr. Inslee) 1 minute.
  Mr. INSLEE. Mr. Speaker, 10 million low-income American children will 
get health care coverage under this bill to renew SCHIP. Some of us 
think that is not such a bad thing.
  This legislation is especially important to my home State of 
Washington because it will cut in half the number of uninsured kids in 
Washington State. It does that by fixing a long-standing inequity that 
punished Washington and 10 other States because we provided coverage 
for kids just above the poverty line, and we fix that long-standing 
inequity tonight.
  If you're a Member from the State of Washington, Wisconsin, New 
Mexico, Connecticut, Wisconsin, Rhode Island, Minnesota, Maryland, New 
Hampshire, Vermont and Tennessee, vote for this bill and you can go 
home telling your constituents we fixed this long-term unfairness.
  I'd like to thank Chairman Dingell for including a 100 percent 
permanent fix in the House SCHIP bill that we passed in early August. 
I'm grateful that we retained that fix, and I hope we'll make sure that 
we do this on a permanent basis ultimately.
  So we need to pass this bill tonight, extend coverage and fix that 
inequity.
  Mr. DINGELL. Mr. Speaker, I yield to the distinguished gentlewoman 
from California (Ms. Roybal-Allard) 1 minute.
  Ms. ROYBAL-ALLARD. Mr. Speaker, I hoped I would rise today in strong 
support of this SCHIP conference agreement that ensures millions of 
additional children access to health care.
  While I am pleased that we are increasing our investment in 
children's health, I'm deeply disappointed that final product denies 
health care to legal immigrant children.
  The Senate Republicans' failure to include the House-passed Immigrant 
Children's Health Improvement Act in the conference agreement is a 
tragically missed opportunity to address existing health disparities 
among vulnerable legal immigrant children and pregnant women.
  More than 20 States, including California, have recognized that 
increasing access to care for legal immigrant children and pregnant 
women is good public health policy and cost-effective care.
  Unfortunately, this bill ignores that fact.
  This debate is not about immigration. This debate is about health 
care and our moral imperative to value the life of every child and to 
ensure that race and income do not determine the health status of any 
child in our wealthy Nation.
  Mr. RANGEL. Mr. Speaker, I yield 1 minute to an outstanding member of 
the Ways and Means Committee from the sovereign State of New Jersey 
(Mr. Pascrell).
  Mr. PASCRELL. Mr. Speaker, 90 million Americans, nearly one-third of 
our Nation's population, had no health insurance for some or all of the 
past 2 years. Please let it sink in.
  It is shameful that roughly 10 million of these uninsured are 
children. Ninety percent of those kids live in working households and a 
majority in two-parent families who simply cannot afford health 
coverage. Six million children are in imminent danger of losing their 
coverage if Congress fails to reauthorize SCHIP now.
  We've heard many things this evening and that is, you've stooped to 
conquer. You accuse the Republicans and Democrats who support this 
legislation of wanting to do this for illegals. Then you accuse the 
Republicans and Democrats who support this legislation of supporting 
socialized medicine. And that wasn't bad enough. You went to the next 
thing. You accused Democrats and Republicans of encouraging smoking, 
and then you said that we want to aid the rich and comfort the rich.
  Read the legislation. This is good legislation for America. Help the 
children for a change. Let's come together and vote for this 
legislation.
  Mr. DINGELL. Mr. Speaker, at this time I yield myself 2 minutes.

[[Page 25512]]

  We have here before us a bill which gives $35 billion to strengthen 
and improve children's health coverage. It protects 6 million children 
today covered by SCHIP. It adds an additional 4 million. It is the 
largest investment in children's health since the passage of the 
original Children's Health Insurance Program in 1997.
  It provides $300 million in outreach grants for the States, community 
organizations, tribal organizations, and national initiatives. It 
provides a new express lane initiative for one-stop enrollment. It 
facilitates enrollments for newborns so coverage starts immediately. It 
does more than this. It revises the current SCHIP program formula to 
more accurately attract State need in that it follows the House 
provisions.
  It provides the children enrollment program contingencies adjustment 
allotments to States to succeed in reaching the eligible but the 
unenrolled.
  It does more. It provides dental coverage for CHIP children. It also 
provides mental health coverage for children. It provides grant money 
for diabetes clarification and prevention. It clarifies the coverage of 
school-based clinic services through the CHIP program. It creates a new 
option for CHIP programs to subsidize employer options and employer 
coverage for children whose parents may already have access to 
coverage.
  It does not do any of the things that were charged on the other side 
because it does not change the law that CHIP now has in place. It just 
offers additional benefits to children under the SCHIP program.
  It is a program which will cover 4 million more kids. It has to be 
passed by the first of the next month or else all of these kids are 
going to lose their coverage.
  I was at the Governors' meeting in northern Michigan, and the one 
thing that the Governors were unanimous on is that we need to pass this 
SCHIP because it is an essential program and an essential part of their 
program for the care of our kids.
  It is a piece of legislation that will make this country better. Take 
care of our kids. See to it that we do the job that we should in making 
health care available for all of our kids.
  I yield back the balance of my time, excepting I'm going to save time 
to yield to my dear friend, the majority leader, to close.
  The SPEAKER pro tempore. The gentleman reserves the balance of his 
time.
  Mr. McCRERY. Mr. Speaker, I believe all of the controllers of time 
are ready to close.
  Mr. Speaker, the gentleman that spoke right before me, the 
distinguished chairman of the Energy and Commerce Committee, said that 
this bill provides $35 billion for children. This bill actually 
provides a lot more than that. It's $35 billion in new, additional 
spending on top of the $25 billion that the program as currently 
structured spends. So we're more than doubling on paper the cost of 
this program. And when you consider that there's another, oh, 
approximately $30 billion that the tax increase in this bill does not 
cover, we're getting up to tripling, quadrupling the size of this 
program.
  Now, the gentleman earlier said that no abuses such as illegal 
immigrants gaining benefits have ever been identified. Well, I would 
refer the gentleman to the 2005 HHS Inspector General report in which 
the Inspector General says that 47 States allowed self-declaration in 
the United States citizenship for Medicaid and he asked for those 
States to give him an audit.
  Only one State did that, the State of Oregon. The Secretary of State 
provided an audit, and in that audit he found out of 812 individuals 
sampled, who were Medicaid beneficiaries in that State, 25 of them were 
noneligible noncitizens.
  So, Mr. Speaker, under the provisions in this bill, which liberalize 
the current law treatment of qualification of individuals for this 
program, we indeed expect to see abuses of this.
  So, Mr. Speaker, I urge all of us to vote ``no'' on this so that we 
can sustain the President's veto if the bill passes and then get 
together for a true bipartisan compromise on this important program.
  The SPEAKER pro tempore. The time of the gentleman has expired.

                              {time}  2000

  Mr. RANGEL. Mr. Speaker, when Congresswoman Nancy Pelosi shattered 
the glass ceiling and made history as the first woman to become Speaker 
in the history of the United States Congress, the one picture that 
remained to commemorate this great event was the children that were 
there when she was sworn in. It wasn't a symbol of the war or the 
deficit or the Republicans or Democrats; it was this Congress sharing 
with the rest of the country our deep commitment to the children of our 
country. And that is our investment.
  Whether you are liberal, conservative, Republican, or Democrat, no 
one can challenge that our most precious human beings are those who 
cannot protect themselves. We have this opportunity to join with the 
Speaker as she closes this argument to set aside the partisanship and 
to be able to say, no matter what our differences, it was the children, 
it was the children that prevailed, and I voted with them.
  I yield the balance of my time to the Speaker of the House of 
Representatives, Congresswoman Nancy Pelosi.
  Ms. PELOSI. Mr. Speaker, I thank the gentleman for yielding, and I 
thank the distinguished chairman for recalling to mind that opening day 
here when I accepted the gavel on behalf of the children of America, 
all of the children of America. And when we had this debate before in 
Congress, we talked about perhaps the children listening to this 
debate, hearing what Members of Congress were saying. And I expressed 
my hope that they would consider this the children's Congress.
  I thank the chairman of the Ways and Means Committee, Mr. Rangel, for 
his leadership, and Mr. Stark, the Chair of the Health Subcommittee for 
helping to make this the children's Congress with this legislation. I 
thank the distinguished chairman of the Energy and Commerce Committee 
for his tremendous leadership.
  Mr. Rangel and Mr. Dingell went into the conversations with the 
Republican leadership in the Senate on this bill, true champions of 
America's children, knowing the facts and figures, the provisions, 
every provision of the bill with such authority as they argued on 
behalf of America's children so effectively that this legislation 
before us reflects many of the provisions that were in the House bill. 
We had to agree to the Senate language in terms of the $35 billion and 
the pay-for with the tax on tobacco. We had hoped that we could do more 
in terms of the money allocated for this purpose so that we could cover 
more children.
  As I praise Mr. Dingell, I also want to acknowledge the fabulous 
leadership of Mr. Pallone, Chairman Pallone of the Subcommittee on 
Health in the Energy and Commerce Committee. Because of their 
leadership, we were able to join Senator Reid, Chairman Baucus, 
Chairman Rockefeller, Ranking Member Grassley, and Ranking Member Hatch 
in having a very bipartisan conversation on this subject. The people 
who were in the room that evening cared about passing a serious piece 
of legislation to expand health care for America's children. Not to 
expand the eligibility, as some on the other side of this House would 
have you believe, but to expand the number of kids who could be served 
if they met the eligibility. I, myself, had hoped that we could go 
beyond that and have eligible children in America who were legal 
immigrants. I was told that that would not fly in the Senate; that is a 
fight we will hold for another day.
  But I am pleased as one who represents a minority majority district 
from a majority minority State, where our State is blessed with a 
beautiful diversity, that of the additional children, nearly 4 million 
additional children covered, 67 percent of those children are minority 
children. Two-thirds of those children are children from families who 
are working hard, playing by the rules, lifting themselves out of 
poverty. They are the working poor in America. They are those who have 
aspired to the middle class to change

[[Page 25513]]

that status and want to stay there. They simply don't make enough money 
to afford the private health insurance that this SCHIP initiative 
enables them to do. In fact, 72 percent, my colleagues might be 
interested to know that 72 percent of the children on this SCHIP 
program get their health coverage from private health insurance.
  There are many misrepresentations, and I think they are probably 
unwitting because I assume that every person in this Congress cares 
about insuring as many children in our country as possible. How could 
it not be so? It is a deeply held value in our country that our 
children, as President Kennedy said, are our greatest resource and our 
best hope for the future. We must invest in them. We have a moral 
responsibility to do so.
  When we had the debate on this bill and it first came to the floor, I 
was delighted in quoting a poem from my youth from Longfellow when he 
said, ``Between the dark and the daylight, when the night is beginning 
to lower, comes a pause in the day's occupation that is known as the 
children's hour.'' This is the children's hour for us in the Congress 
of the United States.
  I quoted Longfellow then, I am reminded of the Bible tonight, and I 
speak with all of the sincerity and all of the hope to President Bush 
in the hope that he will change his mind to dig deeply into his heart 
and think about the children in America who don't have health care. 
Because, if not, I think that the President is giving new meaning to 
the words ``suffer, little children.'' Suffer, little children, if your 
parents can't afford health insurance, but they are working hard and 
they are not on Medicaid, but you will suffer because they are 
struggling to give you the best possible future. Suffer, little 
children, if your family has played by the rules and they have come to 
this country and you are here as a legal immigrant, because if you are 
sick, you will not get health care unless your parents can afford 
private insurance. Suffer, little children, if you are sick because you 
haven't had the proper nutrition, the proper prevention, the proper 
early intervention to your affliction, that you should go directly to 
the emergency room. But until you can get into that emergency room with 
enough of a serious illness, you will suffer. That is just not right.
  I would hope that the President would have had a change of heart and 
mind since he was Governor of Texas. When he was Governor of Texas, the 
SCHIP program there, in meeting the needs of the children of Texas, 
ranked 49th in the country; 49th in the country. Forty-eight States 
were doing better in meeting the health needs of their children as 
reflected in the outreach of the SCHIP program. Does that mean that 
Texas is the 49th wealthiest State in the Union, that the children in 
that State can all afford private health care? I don't think so, 
especially since that State, as with mine, is blessed with beautiful 
diversity and people, again, families who come to America, families who 
are part of our country, who are struggling to make ends meet to build 
a better future for their children. And building that better future is 
what our country is all about, and those newcomers make America more 
American. I heard the President say that.
  We also heard him say that in this term of office that he would 
enroll every child who is eligible. I am sure our distinguished 
majority leader will bring that to the attention of this body.
  What is interesting about this is that the President, if he persists 
in vetoing this bill, and by the way, you don't have to be a Latin 
scholar to know that ``veto'' means ``I forbid.'' With that pen, the 
President says, I forbid struggling families in America to have health 
care for their children. I forbid every child to be treated the same if 
they have an ailment.
  How did any one of us decide that we were going to choose, you will 
have health care and you will not, in a country as great as ours when 
we are talking about our children? We are talking about our children.
  So that is why the Conference of Mayors, the U.S. Conference of 
Mayors, a bipartisan organization, has overwhelmingly supported this 
legislation. That is why 43 Governors sent us a letter in July urging 
us to come to bipartisan agreement on legislation that would 
reauthorize SCHIP to care for many more children in our country. So 
when I hear the President say that we don't want to help children, we 
just want to do politics, I don't think he means that. So I hope he 
doesn't mean that he is going to veto the bill.
  Senator Grassley said of the President: The President's understanding 
of our bill is wrong. I urge him to reconsider his veto message based 
on our bill, not something that someone on his staff told him wrongly 
is in the bill. Actually, he said, ``in my bill,'' Senator Grassley 
said. And Senator Hatch said: We are talking about kids who basically 
don't have coverage. I think the President has some pretty bad advice 
on this.
  And I want to also commend Representative Ray LaHood and join you, 
Mr. Chairman, in saying what a privilege it is to call him 
``colleague'' and to serve with him in the Congress, and thank him for 
his leadership in making a distinction between what is about the 
children and what is about politics in this House.
  I talked about the mayors; I talked about the Governors. Nearly 300 
organizations in our country, alphabetically from AARP to YMCA and 
everything alphabetically in between, Families USA.
  I heard someone say the doctors should be making the decisions. The 
American Medical Association firmly supports this bill. The President 
of the AMA stood with us in a press conference today to support this 
legislation. The Society of Pediatrics. Everyone who has anything to do 
or cares about children in our country knows that this bill is the way 
to go. It is not everything I want, believe me, it is not the bill I 
would have written. I would have been far more generous and it would 
have been paid for in perhaps a different way, but it would have been 
paid for; because in terms of bringing benefits to our children, we 
have absolutely no intention of heaping debt onto them.
  The Catholic Hospitals Association, again, the list goes on and on 
about who supports this bill. It is a long list; it is a comprehensive 
list. And I might include in it that, across the country, 
overwhelmingly, the American people know and respect the value of 
taking care of America's children, all of America's children. Two-
thirds, two-thirds of those polled among Republican voters, 2-1, they 
support passing this legislation and having it signed into law.
  Why does the President want to isolate himself from caring for 
America's children? Let's hope and let's pray that a very big, strong 
bipartisan vote tonight will send him a message to rethink his 
position.
  I see a child in the Chamber. Our constant inspiration of what we do 
here is supposed to be about the future, and the future demands that we 
invest in health, the education, and the well-being of our children.
  So, my colleagues, vote as if the children are watching. Please vote 
as if the children are watching, and please send them a message that 
this is the children's Congress.

                              {time}  2015

  Mr. BARTON of Texas. Mr. Speaker, may I inquire as to how much time I 
have.
  The SPEAKER pro tempore. The gentleman from Texas has 1\1/2\ minutes 
remaining. The gentleman from Michigan has 1 minute remaining.
  Mr. BARTON of Texas. Mr. Speaker, I yield myself the balance of the 
time.
  And since I really have a real minute and a half, I'm going to try to 
go through this as quickly as possible.
  Republicans want to reauthorize the SCHIP program. We do want to 
refocus it on the original intent of the program, which was near-low-
income children in families between 100 and 200 percent of poverty. We 
understand that in the 10 years of the program's existence that waivers 
have been given and there are some States that cover up to 350 percent 
of poverty, and some States cover adults.
  But as our distinguished Speaker just said, Republicans are for the 
children,

[[Page 25514]]

and we want to focus the SCHIP funds on those children and those 
families that don't have private insurance and aren't covered by 
Medicaid; and we believe that that is children in families somewhere 
between 100 percent of poverty and 200 percent of poverty.
  And when the President rightfully vetoes this bill, and when the 
House of Representatives rightfully sustains the President's veto, it 
is my hope that we will get with the other body and the Democratic 
leadership at the leadership level and Chairman Dingell and Chairman 
Rangel, and we will work out a bipartisan compromise that does cover 
the health care needs of the needy children of America that currently, 
in spite of our best efforts, do not have the health insurance and the 
health coverage that they need.
  To make that possible, we have to defeat this bill, or at least get 
enough votes to sustain the President's veto of this bill, and then 
work together in the near future to do some of the things that we have 
talked about on the floor this evening.
  Vote ``no'' on the SCHIP bill this evening.
  Mr. DINGELL. Mr. Speaker, at this time I yield to the distinguished 
majority leader the balance of my time for purposes of closing.
  Mr. HOYER. Mr. Speaker, for those of us who have served in this body 
for some period of time, all of us know that the gentleman from 
Michigan (Mr. Dingell) has been as focused on health care for all 
Americans as anybody who's served in this body, with the sole 
exception, perhaps, of his father. For over half a century, the 
Dingells have focused on making sure that Americans in the richest land 
on the face of the Earth had access to health care.
  I want to congratulate my friend, Mr. Dingell, and I want to 
congratulate his partner, Charlie Rangel, one of the senior Members of 
this House, chairman of the Ways and Means Committee, who has worked 
collaboratively with Jim McCrery, and I want to congratulate Jim 
McCrery; I'll congratulate him again while he's listening; who has 
worked, I think, positively with the chairman, and I thank him for 
that.
  I rise in support of this legislation. Today the Members of this body 
must answer this fundamental question: Will you stand with millions of 
American children who, through no fault of their own, but they live in 
families of limited means, have no health insurance? Or will you stand 
with the few, including at least now President Bush, although I hope he 
changes his mind, who are ideologically opposed to this legislation, 
and thus being willing to leave millions of American children stranded 
without the health insurance coverage they need and that they deserve?
  Mr. Speaker, the bottom line is this: We must not sacrifice the 
health of our children on the altar of a conservative ideology. We must 
pass this bill.
  The fact is, President Bush himself stated on the campaign trail in 
2004, in fact, it was at the Republican Convention, and I would hope 
all my Republican colleagues would listen to the President's quote, if 
you haven't already seen it and read it. He said this as he addressed 
the American people asking them for their vote for a second term, which 
they gave him. He said this: ``In a new term, we will lead an 
aggressive effort to enroll millions of children who are eligible but 
not signed up for government health insurance programs.''
  President Bush said that as he appealed to the American public for 
their support for a second term, that he would aggressively pursue a 
program of adding millions of children, eligible but not included, in 
the health insurance program.
  ``We will not allow a lack of attention or information to stand 
between these children and the health care they need.'' That is what 
President Bush said to the American public from the convention floor in 
2004. We, tonight, are going to give him the opportunity to fulfill 
that promise to the American public.
  Unfortunately, the President is threatening to renege on his campaign 
promise and to veto this legislation. Let's be clear: this fiscally 
responsible legislation will ensure that some 10 million children will 
receive health insurance coverage. That's approximately 4 million more 
than are covered under the Children's Health Insurance Program today. 
And so what we consider today is not young Master Snyder, who was on 
this floor, or Gemma Frost, with whom we met earlier today. Gemma Frost 
will be covered. Luckily, Master Snyder's father is covered, as all of 
us are, under a Federal Employee Health Benefit Plan to which our 
employer contributes. Gemma Frost was not so lucky.
  The truth is, those 4 million additional children are eligible under 
existing guidelines, not new guidelines that we've created. They are 
the children that were eligible that President Bush talked about in 
2004 that he wanted to vigorously assume inclusion in the program. 
Millions, he referred to.
  This legislation does not change eligibility guidelines. It simply 
strengthens CHIP's financing, increases coverage for low-income 
children, and improves the quality of care they will receive.
  In contrast, under the President's proposal, and I hope my friends 
would put this fact in juxtaposition to the President's representation 
in 2004 on the floor of the national convention that you held as your 
party, his proposal would decrease, by 800,000 children, the numbers 
that would be covered under CHIP in the future. Now, that's included in 
the 4 million, so actually it's a net 4 million difference between the 
proposals.
  Ladies and gentlemen, we ought not to retreat from our children's 
health. We ought not to retreat from working families concerned about 
the inclusion of their children.
  And I suggest to my friends concerned about cost, we ought not to 
give the answer, they can go to the emergency room. Why not? Because 
all of us know that is the most expensive intervention in the health 
care system in America. And so not only do we put our children at risk, 
but we compound our costs.
  It's no wonder, Mr. Speaker, that this legislation has received 
strong support from Members of both sides of the aisle, as well as a 
wide range of health care providers, including private insurers, 
doctors and hospitals.
  For example, Senator Hatch has already been quoted, but it bears 
repeating. He said: ``We're talking about kids who basically don't have 
coverage. I think the President had some pretty bad advice on this.''
  Don't take that bad advice. Let us join hands; let us be together on 
this issue. You voted on a prescription drug program far more expensive 
than this one, and unpaid for.
  Senator Grassley stated: ``The President's understanding of our bill 
is wrong.''
  That's the former chairman of the Finance Committee, Republican, 
senior Member of the United States Senate. He says, ``The President's 
wrong.'' He urges him, he says, ``I urge him to reconsider his veto 
message.''
  Every one of us, as we vote tonight, can send a strong message that 
will perhaps help him to reconsider that position.
  Now, let me say, those who complain that this bill will induce people 
with private insurance to drop their coverage and enroll in the CHIP 
program are simply grasping at straws. Why do I say that? The fact is, 
even America's health insurance lobbying group supports this bill.
  Finally, let me mention 2 other points. First, I am very pleased that 
this legislation includes a comprehensive dental benefit that will give 
low-income children the dental care they need and will provide States 
with flexibility in how they provide such care.
  Why do I bring that up?
  Dental care is important. A 12-year-old child who lived approximately 
8 miles from this Chamber, Deamonte Driver was his name, he was 12 
years of age. He had 3 siblings. He got a toothache. His mother did not 
have coverage and tried to get coverage, tried to get dental care, and 
she could not get dental care, and that toothache became an infection 
in the brain, and Deamonte Driver died just months ago, just 9 or 10 
miles from where we stand. That is

[[Page 25515]]

one of the reasons, one of the four million reasons that I stand here 
to say that we need to pass this legislation.
  Secondly, I'm very disappointed that the Senate Republicans insisted 
that we remove the House-passed provision on Medicare, as well as our 
provision that would have allowed legal immigrants who pay taxes to be 
eligible.
  Why is that of concern?
  Because my granddaughter, 5 years of age, who just started 
kindergarten, she may sit next to one of those children in her 
kindergarten class, and that child who is legally in the United States 
may get sick. But if that child cannot access health care and sits next 
to my granddaughter, my granddaughter is at risk.
  We want everybody in this country to be healthy so that the rest of 
us can be assured that we operate in a healthy environment. That is why 
we want that provision.
  Ladies and gentlemen of this House, Speaker Pelosi was right: I don't 
believe there's a person in this House that doesn't care about their 
own children, about their neighbor's children, and about the children 
of our country. All of us care. We need to come together, however, and 
see how that care can be transformed into meaningful, tangible help.
  Mr. Speaker, we have a rare and wonderful opportunity tonight to do 
the right thing, to put aside partisanship, to elevate the practical, 
responsible, and moral solution above the ideological.
  Mr. Speaker, I urge my colleagues on both sides of the aisle, let's 
seize this opportunity. Let's do the right thing. Let's stand with 
America's children. Let us pass this historic legislation.
  Ms. HIRONO. Mr. Speaker, I rise today in support of H.R. 976, the 
reauthorization of the Children's Health Insurance Program (CHIP).
  I believe our nation must show true compassion for the most 
vulnerable among us, and CHIP is a program that helps millions of low-
income American children to receive health care so they can grow up in 
good health.
  Since its creation in 1997, CHIP has been successful in providing 
vital health care coverage for children in families who cannot afford 
private insurance yet earn too much to qualify for Medicaid.
  There are now 6.6 million children emolled in the program.
  Unless we act now, they are in danger of losing their health 
coverage, as CHIP expires on September 30th.
  Leaders in the House and Senate have worked hard to bring this 
conference bill to the floor.
  In supporting the conference bill, I want to note that the bill 
passed by the House earlier is a stronger bill in its coverage of more 
children in need and in eliminating the automatic cuts to Medicare 
reimbursements set to take effect in 2008 and 2009. Eliminating these 
automatic cuts was at the top of the list of needed legislation by 
medical and health care groups.
  I am hopeful that we will address their concerns through another bill 
before the cuts go into effect.
  I am also deeply disappointed that Senate Republicans insisted on the 
removal of provisions providing coverage for the children of legal 
immigrants. Such discrimination based on immigrant status should have 
no place in a bill providing health care to children.
  While work remains to be done, I also want to point out that under 
this bill we would preserve the coverage of more than 20,000 children 
in Hawai`i, and in addition 12,000 children in Hawai`i who currently 
are uninsured would gain coverage.
  We would preserve coverage for the 6.6 million children nationwide 
currently covered by CHIP and extend coverage to an additional 3.8 
million children who are eligible for coverage but not enrolled. Thus 
passing this bill would provide health care coverage for more than 10 
million American children.
  A new report by Families USA indicates that during a 2-year period 
almost 35 percent of Americans under age 65 lacked healthcare 
insurance. Hawai'i is better than average in this regard, but 29 
percent of our state's residents under age 65 still lacked insurance at 
some point during the past 2 years.
  I support providing all Americans with high quality, affordable 
health care, and I hope that Congress will continue to move in that 
direction. But until we reach that goal, we should take steps that help 
our most vulnerable populations, including low-income children. This is 
precisely the group that CHIP will help, if we can get it reauthorized 
and signed into law.
  I support CHIP because it is the compassionate, just, moral and the 
right thing to do. In fact, it is also highly cost-effective. It costs 
less than $3.50 a day to cover a child through CHIP. It would be far 
more expensive for taxpayers to leave these children uninsured and 
having to pick up the tab for indigent care in emergency rooms.
  I urge my colleagues to vote for this bill.
  Ms. WOOLSEY. Mr. Speaker, I rise in support of H.R. 976, the 
Children's Health and Medicare Protection Act. While the bill is not as 
strong as the House passed version, it has several good provisions that 
deserve our support. This bill invests $35 billion in our children, 
providing health insurance for an additional four million children and 
bringing the total number of children covered by SCHIP to ten million. 
This bill will also help states provide millions of children with the 
dental and mental health services they so desperately need.
  While this is a very good bill, it is not perfect and I hope it will 
serve as a starting point in a larger conversation about how we find a 
way to ensure coverage for everyone, but particularly for children and 
low income seniors, the most vulnerable amongst us. I look forward to 
working with my colleagues in the House and Senate to come to an 
agreement on how to increase coverage to the level the House bill 
provided. Additionally, I would like to join my colleagues in covering 
legal immigrant children and pregnant women, which the House bill 
ensured. Finally, I hope that the House and Senate will agree upon a 
strong Medicare bill that rolls back payment cuts and addresses 
payments based solely upon where a physician practices. This has made 
it incredibly difficult for physicians in Sonoma County to continue to 
see Medicare patients. The House bill addressed the geographic inequity 
and is a great starting point for a conversation about how to address 
this serious issue.
  Additionally, as the Chairwoman of the House Subcommittee on 
Workforce Protections, I am proud to support the language in this bill 
that will provide military families with the protections they need in 
the workplace. For the first time since Congress passed the Family and 
Medical Leave Act (FMLA) fourteen years ago, this bill will amend FMLA 
to provide the spouse, child, parent, and closest blood relative of an 
injured service member with six months of unpaid, job protected leave 
to care for their injured loved ones. Congressman George Miller and I 
worked closely with Senators Christopher Dodd and Hillary Rodham 
Clinton to ensure that the provisions of H.R. 3481, the Support for 
Injured Servicemembers Act, were included as part of the final 
compromise reached between the House and Senate, and I commend the 
Democratic Leadership for their strong support for our Nation's wounded 
warriors and their families. Military families should never have to 
risk losing their jobs in order to meet the needs of their loved ones, 
and with this bill, we are one step closer to fulfilling our promise to 
them.
  Passing this bill will mean a real investment for our children and I 
hope that we consider it a starting point for a conversation about 
covering every child.
  Ms. SCHAKOWSKY. Mr. Speaker, I want to start by thanking Chairman 
Dingell as well as the Democratic leadership for working so hard to 
bring the Children's Health Insurance Program reauthorization bill 
before us today. H.R. 976 is not a compromise that was easily come by, 
and it's important to recognize the hard work that has gone into it.
  Let's be clear, today each of us is either voting for providing 
healthcare to more uninsured children, or voting against covering more 
uninsured kids.
  This bill is not the bill that I would have written, nor is it as 
good as the bill that passed the House. But it will cover the 6.6 
million children currently covered by CHIP and will reach an additional 
4 million kids. It also provides children with dental coverage and 
finally puts mental health services on par with other medical benefits 
covered under the program. This bill will also improve quality 
improvement, outreach, and enrollment efforts under CHIP, and will 
target those most in need. It is a good bill that we think will get to 
the President's desk. Thus, I think the commitment this bill makes to 
our children should be celebrated.
  Yet, we need to push further and pass several provisions that were in 
the house bill, including meaningful improvements in access to basic 
health services, including granting access to our legal immigrant 
children, more affordable prescription drug costs and benefits for 
senior citizens and people with disabilities, and adequate 
reimbursements for physicians that provide critical care to the 
Medicare population.
  Incredibly, President Bush has pledged to veto this compromise, 
bipartisan, bicameral

[[Page 25516]]

measure. The President and the Congressional Republican leadership say 
that we cannot afford it. We can't afford to cover children, but we can 
afford the war in Iraq. The bill to provide health care to children 
will cost $35 billion over the next 5 years--but we will spend over $50 
billion in the next 5 months in Iraq.
  While this bill could have been so much more to so many of our 
constituents, it does bring us a necessary, moderate expansion of the 
Children's Health Insurance Program and I urge my colleagues to support 
it.
  Mr. MARKEY. Mr. Speaker, I rise today in strong support of this 
compromise legislation which will provide healthcare for 10 million 
low-income American children.
  This bill will give 4 million currently uninsured children a healthy 
start in life.
  Yet in a confirmation of the White House's pitiless priorities, 
President Bush is threatening to veto this bill if we spend any more 
than $5 billion dollars over 5 years to help poor American children get 
health care.
  This year alone, the President requested 40 times that amount--$200 
billion dollars--for the wars in Iraq and Afghanistan, yet he has 
threatened to veto SCHIP on the basis that it spends too much money on 
American children.
  The President constantly chooses Corporations over Children, spending 
billions on tax cuts for millionaires and subsidies for his friends in 
big oil without batting an eyelash. But when it comes to giving our 
country's poor children health care, he can't find the heart to come up 
with the money.
  Today's debate is a major moment in the history of health care, and a 
veto will place the President firmly on the wrong side of history.
  By vetoing this bill, President Bush will expose himself as a 
Compassionless Conservative.
  By vetoing SCHIP, the President will dash hopes of millions of 
working families who dreamed that they would be able to provide health 
care for their sick children.
  I urge you to stand with those working families and help their 
children get the health care they need. Vote yes on this critical 
legislation.
  Mr. UDALL of Colorado. Mr. Speaker, I rise in support of this bill.
  Dr. Martin Luther King, Jr. said ``Of all the forms of inequality, 
injustice in health care is the most shocking and inhumane.'' H.R. 976 
does not end health care inequality, but it will provide continued 
coverage for children not covered by Medicare but whose parents cannot 
afford to buy insurance and whose employers do not provide it.
  These children--currently 6 million of them--are now eligible for 
coverage under the Children's Health Insurance Program (CHIP)--but that 
program is set to expire at the end of this month. If Congress does not 
act, these six million will no longer have access to quality, 
affordable health insurance. This bill responds to that urgent need.
  This legislation would assure continued coverage for those now 
enrolled and would provide coverage for an additional four million 
children who currently qualify, but who are not yet enrolled under 
CHIP.
  I believe that health care should be a right, not a privilege, and 
this act is a step in the right direction toward that goal. So, I will 
support it although I wish it went further.
  Despite claims by some, this bill does not change the basic nature of 
the CHIP program. Instead, it maintains current eligibility 
requirements for CHIP. The majority of uninsured children are currently 
eligible for coverage--but better outreach and adequate funding are 
needed to identify and enroll them. This bill gives states the tools 
and incentives necessary to reach millions of uninsured children who 
are eligible for, but not enrolled in, the program.
  Earlier this year, I vote for the ``CHAMP'' bill to extend CHIP. The 
House of Representatives passed that bill, and I had hoped the Senate 
would follow suit. It would have increased funding for the CHIP program 
to $50 million, instead of the lesser amount provided by this bill. The 
CHAMP bill would have also addressed major health care issues, first by 
protecting traditional Medicare and second by addressing the 
catastrophic 10 percent payment cuts to physicians who serve Medicare 
patients.
  However, the bill before us represents a compromise between the House 
and the Senate and deserves support today. It will pay for continued 
CHIP coverage by raising the federal tax by $0.61 per pack of 
cigarettes and similar amounts on other tobacco products. According to 
the American Cancer Society, this means that youth smoking will be 
reduced by seven percent while overall smoking will be reduced by four 
percent, with the potential that 900,000 lives will be saved.
  H.R. 976 has the support of the American Medical Association, 
American Association of Retired Persons, Catholic Health Association, 
Healthcare Leadership Council, National Association of Children's 
Hospitals, American Nurses Association, US Conference of Mayors, NAACP, 
American Cancer Society Cancer Action Network, and United Way of 
America.
  I am proud to vote for this bill that seeks to protect those that are 
most vulnerable in our society by increasing health insurance coverage 
for low-income children. I hope that we have the opportunity to take up 
the other important Medicare issues addressed in the CHAMP bill soon.
  Mr. RAMSTAD. Mr. Speaker, I rise in strong support of H.R. 976, which 
extends and expands the State Children's Health Insurance Program 
(SCHIP).
  We have a moral obligation to cover all our children so every child 
in America can grow up healthy. It's the right thing to do; it's also 
the cost-effective thing to do.
  The great Minnesotan Hubert H. Humphrey once said that a key moral 
test of government is how we treat those who are in the dawn of life, 
the children. We must not flunk this moral test!
  My home state of Minnesota started covering children through its 
medical assistance program even before SCHIP was created, but we still 
have far too many children without coverage--73,000 kids.
  That's why I strongly support extending and expanding SCHIP. I also 
hope we can work together to provide greater access to private 
insurance coverage for America's children and other uninsured 
Americans.
  This SCHIP legislation also avoids cutting any of the payments to 
Medicare Advantage and other critical programs, as it is financed 
primarily by a cigarette tax increase. So this bill will cover our 
children without cutting benefits for our seniors.
  I urge my colleagues to support this bill. With an expiration of this 
crucial program looming on September 30, we cannot afford to wait any 
longer. It's time to break down the barriers to health care for our 
kids. It's time to reauthorize SCHIP. It's time that all kids have a 
chance to grow up healthy.
  Like the U.S. Senate, we should pass this SCHIP reauthorization with 
a strong bipartisan vote.
  Let's put children's health first and do the right thing. Let's pass 
this reauthorization of SCHIP and reduce the number of uninsured 
children by at least 70 percent.
  There is no better investment than to invest in the health and well-
being of America's children.
  Mr. BACA. Mr. Speaker, I ask unanimous consent to revise and extend 
my remarks. I support the Children's Health Insurance Program Act.
  It's a shame that we live in the richest country of the world, yet 
3.8 million children are uninsured. 33,000 of these children are in my 
District.
  This bill is not about politics, it's about helping hardworking 
families and the poorest among us.
  Leaving children uninsured is unacceptable. With health care costs 
going up, working families are on the edge. Expanding coverage is the 
only solution.
  I am disappointed that this bill does not cover pregnant women and 
children who are legal permanent residents. This is a health care 
issue, not an immigration issue.
  A simple pre-natal exam can detect future complications and prevent 
costly visits to the emergency room. This would save tax payers 
millions of dollars in the end.
  No mother who is working here legally and paying taxes should have to 
choose between buying baby formula and taking her infant to the doctor.
  No child should die from a sore throat or be denied access to 
lifesaving treatments. It costs less than $3.50 a day to cover a child 
through SCHIP.
  This is not the time to play politics, our children must come first. 
I urge my colleagues to support this bill.
  Mr. WELDON of Florida. Mr. Speaker, I rise as a supporter of the 
State Children Health Insurance Program (SCHIP), which focuses on 
covering children in families at or below 200 percent of the poverty 
level ($41,000 per year). I have voted to extend this program and to 
provide additional resources to ensure that those living in families 
below 200 percent of the poverty level ($41,000) have access to 
affordable health insurance through the SCHIP program.
  What I cannot support is the Democrat's SCHIP bill, because their 
bill: 1. Fails to place a priority on first enrolling uninsured 
children in households earning less than $41,000 per year (200 percent 
of the federal poverty level); 2. Expands government subsidies to those 
making nearly $80,000 per year; 3. Spends half of the additional SCHIP 
dollars to enroll children in the government SCHIP program

[[Page 25517]]

who were otherwise enrolled in private insurance; and 4. Virtually 
eliminates all funding for SCHIP beyond 2012 because they have no way 
to sustain funding for SCHIP beyond that date.
  It is fiscally irresponsible to expand this program by enticing 
millions of children in families earning as much as $82,000 per year to 
drop private coverage and enroll in the SCHIP program that cannot be 
sustained. In August, House Democrat leaders forced an earlier version 
of SCHIP through the House that cut over $150 billion from Medicare and 
moved that money into SCHIP so that they would have a way to pay for 
millions of new SCHIP enrollees over the next ten years, including 
millions of currently insured children from middle and upper middle 
class families.
  Their plan to cut Medicare was rejected not only by Republicans, but 
by the U.S. Senate, and most importantly by the public at large. But 
now the bill before us is simply a bait and switch. They have brought a 
bill before us today that nearly triples the size of SCHIP over the 
next five years--including enrolling millions of children currently 
ensured by private plans--only this time they have chosen to hide from 
the public how they plan to pay for the program for the next ten years. 
They ramp up the annual budget of SCHIP to nearly $14 billion a year, 
and then they simply leave it to a future Congress to find a way to 
continue paying for the massively expanded SCHIP program. It turns out 
that their nearly tripling of the federal cigarette taxes still leaves 
them tens of billions of dollars short. Americans should be on notice 
that in 2012 the Democrats will ask for another $180 billion to 
continue SCHIP for another ten years.
  Particularly troubling is that by significantly expanding SCHIP 
enrollment eligibility those in families making upwards of $80,000 per 
year, the Congressional Budget Office (CBO) estimates that millions of 
new SCHIP enrollees will be children that move from private coverage to 
the SCHIP program. By moving children from private insurance onto the 
government program, this bill essentially enrolls five uninsured 
children for the price of ten. Enticing millions of children to drop 
private coverage and sign up for SCHIP is short-sighted and fiscally 
irresponsible, particularly given that it goes bankrupt in 2012.
  What we should be doing is focusing this program on enrolling 
uninsured children in households earning less than $41,000 per year. 
Mr. Chairman, our children and the American taxpayers deserve better 
that what the Democrat leadership has put before us today.
  In February of this year, states that had overspent their SCHIP 
funding grants came to Congress begging for more money to ``insure 
uninsured poor children.'' The root problem in many of these states was 
the fact that they had use their federal grant to enroll children in 
the SCHIP program who were neither poor nor uninsured. New Jersey, for 
example had used their grant to enroll children in families with 
incomes of more than $72,000, even though there were and still are over 
150,000 children in New Jersey in households earning less than $41,000 
who are uninsured.
  I offered an amendment in February that would have refocus SCHIP to 
make sure that children in families under 200 percent of the poverty 
level were covered first. My amendment was rejected by the liberal 
majority on the Committee, who stated that they had no intent to 
refocus SCHIP on lower income children. Rather, they planned to 
continue expanding the program to those well above the poverty level--
to include adults and illegal immigrants--as a step toward universal 
government-run health care. In today's Washington Post, liberal 
columnist E.J. Dionne Jr., removes any doubt of this goal by writing: 
``This battle [over SCHIP] is central to the long-term goal of 
universal coverage.''
  While the press releases about today's bill focus on uninsured low-
income children, the language in the bill is about much more than 
uninsured low-income children. If the bill before us was focused on 
low-income uninsured children, I would be voting for it. The bill 
before us does the opposite. It repeals recent rules requiring states 
to ensure that at least 95 percent of those under 200 percent of the 
poverty level are insured under their state SCHIP programs. Democrats 
leaders in Congress have responded to the rule by arguing that there is 
no way to ensure a 95 percent enrollment rate of uninsured children in 
households earning less than $41,000 per year. They argue that since 
they cannot achieve the goal we should simply expand the program to 
those in households earning more than $80,000 or more a year.
  They use budget gimmicks to say that their bill is balance and paid 
for through higher cigarette taxes. The Heritage Foundation has 
estimated that the amount of money Democrats estimate they will raise 
from higher cigarette taxes comes up billions of dollars short and that 
over the next 10 years they will have to find 22 million new smokers to 
bring in the amount of cigarette tax revenue they hope to raise. (It is 
also noteworthy that lower-income Americans pay a higher percentage of 
cigarette taxes, but it is middle-income Americans that will receive 
most of the expanded SCHIP benefits under this bill.)
  I am also concerned over provisions included in the bill that repeal 
the requirement that individuals must prove citizenship in order to 
enroll in Medicaid and SCHIP. This opens the program to fraud and the 
enrollment of illegal immigrants. In 2006, the Inspector General (IG) 
of the Department of Health and Human Services found that 46 states 
allowed anyone seeking Medicaid or SCHIP to simply state they were 
citizens. The IG found that 27 states never sought to verify that 
enrollees were indeed citizens. The Congressional Budget Office (CBO) 
estimates that repealing this requirement will cost $1.9 billion.
  And finally from a Florida perspective, Florida taxpayers come up 
short. Florida taxpayer will send $700 million more to Washington than 
we will receive back in SCHIP allocations. Where will Florida taxpayer 
dollars end up going? Residents of California, New York, Texas, New 
Mexico, Arizona and New Jersey will be the biggest recipients of 
Florida tax dollars. Yet, Florida has a higher rate of uninsured 
children that several of these.
  Florida voters will also be asked to foot part of the bill for a $1.2 
billion earmark inserted into the 300-page bill at the last minute by 
the powerful chairman of the committee for his home state of Michigan.
  Mr. BARTON of Texas. Mr. Speaker, here we are again.
  Once again, we are being forced by the Democratic Leadership of the 
House to vote on a bill of vital importance to millions of our 
constituents without the ability to actually analyze its contents.
  Once again, Mr. Speaker, we are being forced by the Democratic 
Leadership to vote less than 24 hours after they introduced a bill that 
is hundreds of pages long and spends hundreds of billions of the 
taxpayers' dollars.
  Once again, Mr. Speaker, we are being forced to vote on a bill that 
was concocted in secret and unveiled in the middle of the night.
  When this sort of thing happens, everybody wonders what the Majority 
is trying to hide, and why they need to hide anything.
  I truly hope that the Democratic Leadership does not expect me to 
vote in favor of a 299-page bill that Republicans saw for the first 
time at 6:36 p.m. yesterday evening. I believe in faith, but not in 
blind faith.
  I challenge the supporters of this bill to come to the floor of this 
House, look people in the eye, and say that they understand all of the 
provisions that are actually in this bill. Because I have some 
questions for you.
  Mr. Speaker, it would be a compliment to say that the so-called 
process which produced this bill is an abuse of our democratic system 
of government. It was so much worse than garden-variety abuse. It was a 
travesty and an abomination, and it was pathetic. Yet, I'm sure that 
some will show up here with a handful of talking points from the staff 
who actually wrote this legislation, and explain to us that it is not a 
pathetic abomination, but a wondrous triumph of bipartisanship.
  I challenge any Member that would claim that this bill is bipartisan 
to give me the name of one Republican in the entire House of 
Representatives who directly participated in these discussions. Name 
just one.
  I know that the authors of this bill certainly did not consult with 
either Mr. Deal or myself; I know that they have not included any 
Members of the Republican Leadership in the House; and I'm not aware of 
a single Republican Member of the Energy and Commerce Committee or the 
Ways and Means Committee being invited to participate in this process.
  Now we have not had time to analyze this product that the Democrats 
are going to bring to the floor today but the Congressional Budget 
Office has. Yesterday at the Rules Committee, it was stated that this 
bill would put 4.4 million new people on to SCHIP. However, according 
to the CBO close to a million of those children were already enrolled 
in Medicaid and over 1.5 million of those newly enrolled in SCHIP were 
already enrolled in private coverage.
  It was also stated last night at the Rules Committee that this bill 
does not expand eligibility under SCHIP. If that is the case then why 
does the CBO estimate 1.2 million of the newly enrolled people in SCHIP 
come from expanding the populations that are eligible for the program? 
Now those comments last night could have been misstatements because 
people just really do not know what is in this bill. It is difficult to 
know what is in a bill that no one has seen.

[[Page 25518]]

  Mr. Speaker, I wonder if someone can explain to me why the Democratic 
Leadership has decided to wait until just days before SCHIP expires to 
bring their reauthorization to the House floor. We have known for well 
over 10 years that the current SCHIP authorization would expire on 
September 30, 2007, and the Democratic Leadership in the House and the 
Senate have known since early November that they would be in charge of 
actually producing a bill to reauthorize this vital health care program 
for low-income, uninsured children. Yet, here they are, a full 10 
months later, jamming a bill through the House with fewer than three 
legislative days before the entire program expires and children's 
health care stops.
  Well, Mr. Speaker, I was not sent here by the 6th District of Texas 
to be quiet and do what the gentle lady from San Francisco instructs me 
to do. I was sent here to represent my constituents' best interests and 
I demand the ability to do what I have sworn to do.
  We all know that the President has promised to veto this version of 
the bill, so why are we wasting precious time on a bill that we all 
know doesn't stand a chance of ever becoming law?
  While we are down here on the floor participating in this Theatre of 
the Absurd, the Democratic Leadership is in the back rooms trying to 
figure how they will extend the SCHIP program for another 6 months or a 
year. We all know this to be a fact, but I guess the Democrats want to 
pick a fight with the president so they can pretend that he is against 
children, and only then will they permit everybody to do the right 
thing and extend SCHIP.
  Mr. Speaker, I'm sorry it's come to this. The pettiness of this 
transparent political strategy to damage and weaken the president is a 
new low. I regret that the state of political strategy has come to 
this.
  I'd hoped that we would not engage in this game, and it's still not 
too late to stop it. We could start debating how to best extend the 
SCHIP program so that we can actually do the job people sent us here to 
do. We still have a chance to write a responsible, long-term 
reauthorization of the SCHIP program. Now, it's true that writing a 
solid, bipartisan bill will not give the president a black eye, but 
that's the price that Democrats will have to pay. Given that millions 
of needy children are depending on us, it doesn't seem like a big 
price.
  Mr. VAN HOLLEN. Mr. Speaker, I rise in strong support of the 
bipartisan, bicameral Children's Health Insurance Program (CHIP) 
Reauthorization Act of 2007.
  The CHIP Reauthorization Act will reauthorize and improve the very 
successful Children's Health Insurance Program, CHIP, for 5 years. This 
bipartisan bill will preserve coverage for the 6 million children 
currently enrolled who otherwise would have no access to health 
insurance while, according to the non-partisan Congressional Budget 
Office (CBO), extending coverage to 3.8 million children who are not 
enrolled in the program. By reauthorizing this very important program, 
we will strengthen CHIP's financing, improve the quality of health care 
children receive, and increase health insurance coverage for low-income 
children.
  I am pleased that this bill maintains the guaranteed dental coverage 
and mental health parity provisions that were in the CHAMP Act. Good 
oral health care is important to the overall health of children. No 
family should have to suffer the loss of a child because they lack the 
access to care, as happened in the tragic case of Deamonte Driver, a 
12-year-old Marylander who died earlier this year when an infection 
from an untreated abscessed tooth spread to his brain.
  This legislation increases the tobacco tax by 61 cents to a total of 
one dollar. Increasing the tobacco tax will save billions in health 
costs and is one of the most effective ways to reduce tobacco use, 
especially among young children. The 2000 U.S. Surgeon General's report 
found that increasing the price of tobacco products will decrease the 
prevalence of tobacco use, particularly among kids and young adults. In 
short, raising the tobacco tax will prevent thousands of children from 
starting to smoke and the proceeds of the tax will be used to provide 
health coverage for children. That is a win-win result.
  The President has said that he will veto this bipartisan bill. Not so 
long ago in a September 2004 speech, he promised to expand coverage of 
CHIP to include eligible children who are not yet enrolled in the 
program.
  Now the President has reversed course. In his July 2007 speech in 
Cleveland, Ohio, he forgot his 2004 pledge and stated, ``I mean, people 
have access to health care in America. After all, you just go to an 
emergency room.'' I am disappointed that he will wield his veto pen on 
such promising legislation. I hope he will reconsider his position and 
help Congress provide health insurance to millions of America's 
children.
  Mr. Speaker, I urge my colleagues to vote for this much needed 
bipartisan legislation.
  Mr. HONDA. Mr. Speaker, I rise today in support of the Children's 
Health Insurance Program Reauthorization Act of 2007 and to express my 
dismay over one particular matter not addressed by today's conference 
agreement.
  Since its creation in 1997, the CHIP's flexibility, in combination 
with existing Medicaid programs, has proven highly effective in 
reducing the number of children who are uninsured in the United States. 
The bill before us today will invest $35 billion in the program over 
the next 5 years, ensuring that 6.6 million children currently enrolled 
will continue to have a health program and allowing for the growth in 
the program predicted over the next 10 years.
  I am glad that the bill will allow California and other innovative 
states to continue to cover families--the health of children is 
inextricably entwined with that of the family as a whole. I am 
especially pleased that this bill includes full dental coverage and 
mental health parity, recognizing that physical health care is only one 
part of effective health coverage.
  Despite the desperately needed reforms contained in this legislation, 
I am deeply disappointed that the conferees did not include language 
from the House-passed Children's Health and Medicare Protection, CHAMP, 
Act that would have given states the option of choosing to waive the 
five year waiting period for Medicaid and CHIP imposed on pregnant 
women and children who are legally present in the United States. It is 
unconscionable that Congress will make pregnant women and innocent 
children pawns in a raucous and frequently misleading immigration 
debate. I was proud that the House included language that would allow 
states to make their own decision on this matter and I am saddened that 
Congress bowed to reactionary anti-immigrant voices on this particular 
matter and excluded it from this conference agreement.
  Despite my concern, I support this legislation, as I believe that it 
is too important to allow to lapse. I hope that House leadership will 
take note of my and others' concerns about the denial of coverage to 
legally present, otherwise eligible, immigrant children and pregnant 
women and will work with us to bring this matter to resolution in as 
swift a manner as possible.
  I am glad that the Democratic and Republican leadership have been so 
active in ensuring that we get this bill to the President before the 
program expires on September 30th, 2007. With passage of this bill, the 
health of millions of American children will depend on the stroke of 
the President's pen. I am sure that I express the sentiments of 
millions of Americans when I say that I hope the President will make 
the morally correct choice not to veto healthcare for children when 
this agreement reaches his desk.
  Mr. LEVIN. Mr. Speaker, I rise in strong support of the State 
Children's Health Insurance Reauthorization Act of 2007. This 
legislation renews and strengthens a program that provides health 
insurance to children whose families cannot afford it on the private 
market.
  The legislation we are voting on today will extend children's health 
insurance to enroll almost 4 million kids that are currently eligible 
for the program and not yet enrolled. That's in addition to the 6 
million low-income children already receiving health care under the 
SCHIP program nationwide, including 55,000 kids in my home state of 
Michigan.
  I regret that many of the provisions the House included this summer 
did not make it into the compromise bill. I'm hopeful that we will work 
with the Senate to approve legislation before the year's end in order 
to ensure Medicare beneficiary access to physicians and stop the 
further erosion of Medicare solvency. Nonetheless, I support this 
legislation and urge my colleagues to vote in support of the compromise 
bill.
  Providing health care for children should not be a partisan issue. 
The legislation has the support of a large majority of state governors, 
Republicans and Democrats alike. The bill has broad bipartisan support 
in the Senate; unfortunately, most of the Republican minority in the 
House has failed to join us in crafting this compromise and the 
President has threatened to veto this important legislation. So it 
comes down to this: Clearly, a majority of the House will vote for the 
SCHIP bill today; the only real question is whether the House will pass 
this bill with enough votes to discourage a Presidential veto. Do we 
stand with the President or with kids who need health care coverage?
  Instead of working with Congress to expand health care coverage for 
children, the President's proposal would actually cause 840,000 kids 
that are currently covered under SCHIP to lose their benefits, not to 
mention leave hanging the 4 million children that Congress' bill would 
bring into the program.

[[Page 25519]]

  The American people want the children of America covered by health 
insurance. A bipartisan majority of House and Senate Members are 
committed to carrying this out. The question remains as to whether or 
not the Bush Administration will get on board.
  Mr. DINGELL. Mr. Speaker, I insert these remarks into the Record in 
response to some unfortunate remarks made on the House floor regarding 
a provision in the Children's Health Insurance Program Reauthorization 
Act, H.R. 976. A statement was made suggesting that a certain provision 
had been inserted in the bill to solely benefit my home State of 
Michigan, a statement that could not be further from the truth. The 
provision for which this accusation was made in reality would ensure 
that all States would not be penalized due to factors in Medicaid 
funding that are beyond their control.
  The Medicaid Federal Medical Assistance Percentage, FMAP, is the 
formula used to calculate the amount of Federal funding distributed to 
States to offset Medicaid expenses. The Federal Government's share of a 
State's Medicaid funding is based on the State's per capita income. Put 
simply, States with lower per capita incomes receive more Federal 
Medicaid funding; States with higher per capita incomes receive lower 
Federal Medicaid funding.
  Due to recent changes to accounting rules, the current FMAP formula 
needs to be updated. Accounting rules that require employers to pre-
fund employee pension and insurance funds may cause a State's per 
capita income to be calculated far higher than it really is. To comply 
with the rules, employers may occasionally have to make large transfers 
to a pension or insurance fund. This money is counted in the 
calculation of a State's per capita income in the year of the transfer, 
even though it may not be paid out for years. When this occurs, a State 
then appears wealthier than it is, causing the State to lose Medicaid 
funding.
  The FMAP adjustment included in the CHIP Reauthorization Act corrects 
this unfair penalty. It simply ensures that when an employer makes a 
significantly disproportionate pension or insurance contribution, the 
State is not denied much-needed Medicaid funding.
  This adjustment provision is not limited to any single State. In fact 
it now applies to three States, Michigan, Indiana and Ohio. It may well 
be that many more States will have cause to complain about this soon, 
unless it is corrected. It would apply to any State in any instance 
where there is a significantly disproportionate employer pension or 
insurance fund contribution that exceeds 25 percent of a State's 
increase in personal income for a year.
  Mr. ETHERIDGE. Mr. Speaker, I rise reluctantly in opposition to H.R. 
976. There is no doubt that the State Children's Health Insurance 
Program, or SCHIP, which expires at the end of this fiscal year, needs 
to be reauthorized. Millions of children across the country, including 
120,000 in North Carolina's Health Choice, depend on SCHIP to provide 
cost-effective and high-quality health services. This health care makes 
a difference to the development of at-risk children and to their 
leading healthy adult lives. Unfortunately, in its current form, this 
legislation will excessively burden the Second Congressional District 
of North Carolina.
  By singling out tobacco for a huge tax increase, the provisions of 
this bill will cost North Carolina's citizens a great deal in direct 
cost increases. Researchers at North Carolina State University estimate 
that North Carolina's economy would lose at least $540 million a year 
through the tax's indirect impact as well. North Carolina's tobacco 
farmers grow a legal crop. These hard-working farm families have 
suffered greatly from transformations in the global economy. Because my 
district is the second largest tobacco producing district in the 
country, this bill disproportionately affects my constituents who work 
hard to be able to pay their bills and provide a better life for their 
children. This just doesn't pass the fairness test.
  I have been a long-time supporter of SCHIP. As a member of the House 
Budget Committee, I am proud that we provided for an increase of $50 
billion for SCHIP, not just the $35 billion reflected in the compromise 
we are considering today. I support reauthorizing and strengthening 
SCHIP, but North Carolina's citizens pay more than their share for the 
benefits they receive in this bill.
  Mr. Speaker, I want children to receive the health care they need. 
However, as the bill stands, I must vote no today, and hope that we can 
come up with a better, more balanced plan in the future.
  Mr. MORAN of Virginia. Mr. Speaker, I rise today in strong support of 
the Children's Health Insurance Program Reauthorization Act of 2007. 
Truly, we face a health care crisis in this country--in the richest 
country on Earth, 46 million Americans do not have health insurance, 
including 9 million children. Today's bipartisan, bicameral compromise 
is not a perfect solution to that problem, but is a decisive, strong 
step towards covering uninsured kids and fulfilling our moral 
obligation to our children.
  In my home State of Virginia, the CHIP program, known as FAMIS or 
Family Access to Medical Insurance Security, currently provides 
coverage to 137,642 low-income children each year. The current 
population survey estimates that 171,642 children in Virginia remain 
uninsured, and the CHIP Reauthorization Act will help us cover 74,200 
of these children in Fiscal Year 2008. The CHIP Reauthorization Act 
will ensure that these children have access to high quality health 
insurance, including the preventative services that children need to be 
healthy and successful in school and later in life. This bill will 
provide dental and mental health benefits on par with medical and 
surgical services--truly ensuring that the whole child's health is 
provided for.
  The CHIP Reauthorization Act does not increase the deficit, through a 
61-cent-per-pack increase in the Federal excise tax on cigarettes. In 
my view as chairman of the Congressional Prevention Caucus, an increase 
in the Federal tobacco tax is sound public health policy. On the one 
hand, it provides a reliable revenue source to offset the costs of 
expanding coverage to low-income children. On the other, given that 70 
percent of health care spending in the U.S. can be attributed to 
chronic diseases, many of which are linked to smoking, measures which 
reduce tobacco use, particularly among young people, are responsible 
ways to improve public health and reduce the overall costs of our 
healthcare system.
  The CHIP Reauthorization Act also addresses a serious problem arising 
from the implementation of the Deficit Reduction Act of 2005. Opponents 
of this responsible, common-sense, humane adjustment claim that 
language in the 2005 Deficit Reduction Act (DRA) that imposed harsher 
citizenship verification requirements on State Medicaid programs is the 
only barrier protecting taxpayer dollars from being spent on healthcare 
for illegal immigrants. Empirical evidence from the first 9 months of 
the implementation of this rule demonstrates, in fact, that nothing 
could be further from the truth.
  First and foremost, existing Federal law and provisions in the CHIP 
Reauthorization Act prevent Federal funds from being spent to provide 
benefits for illegal immigrants. Section 605 specifically states that 
``nothing in this act allows Federal payment for individuals who are 
not legal immigrants.'' Illegal immigrants have never been eligible for 
Medicaid, and nothing in the CHIP Reauthorization Act would change that 
fact.
  Secondly, the DRA requirements have overwhelmingly failed to meet 
their objective--producing cost savings for the Medicaid program. 
Instead, they have imposed substantial additional costs on taxpayers 
while reducing health care benefits available to poor children. Wait 
times have skyrocketed, and measures to streamline the application 
process have been rendered impossible. In the first 9 months of the 
implementation of this requirement, 6 States spent a combined $16.6 
million in State and Federal dollars, and found just 8 undocumented 
immigrants out of a pool of 3.6 million Medicaid applicants. The DRA 
requirements have effectively led States and the Federal Government to 
spend millions of dollars in additional administrative expenses, funds 
which have ultimately been put to use denying care to tens of thousands 
of otherwise eligible American children.
  Third, these draconian requirements, which are far stricter than 
those employed by other government programs, have caused tens of 
thousands of U.S. citizen children to lose health insurance coverage. 
In Virginia, there was a net decline of more than 11,000 children 
enrolled in Medicaid during the first 9 months of implementation. Had 
growth in enrollment continued at the same rate it had during the 
previous 2 years, the State would have seen an increase of 9,000 poor 
children in the program during this same time period. Kansas has seen a 
net decline of 14,000 children.
The Virginia State Medicaid Office has identified a total of two 
undocumented immigrants during this period; meanwhile, 20,000 poor 
children have gone without health insurance. Data from the Center on 
Budget and Policy Priorities suggests that these children are 
overwhelmingly African American, hardly the demographic results we'd 
expect if our colleagues were correct in suggesting that tens of 
thousands of illegal immigrant children were being denied coverage.
  The debate about reauthorizing SCHIP should be about the public 
health and improving the health of our children. In a recent survey, 90 
percent of parents applying for Medicaid for their children indicated 
that they have

[[Page 25520]]

no other health coverage available. Allowing state flexibility in 
citizenship verification is sound public health policy that would 
enable thousands of American children access to vital health services 
to help them live better, healthier, and more productive lives. Because 
Medicaid is now the single largest cost to state taxpayers, we ought to 
make a concerted effort to support state flexibility. Twenty-four 
Senators signed letters to Chairman Baucus asking him to include this 
measure in the Senate's bipartisan SCHIP bill, and 51 other House 
Members joined me in requesting that Chairman Dingell include this 
provision in the House version. I thank the Committees for including 
this important provision in this landmark legislation.
  Reauthorizing SCHIP is sound public health policy--research shows 
that children who have access to health insurance are substantially 
more likely to access key preventative services, miss fewer days of 
school due to illness, get better grades, and continue to have superior 
outcomes later in life. Moreover, the financial benefits of covering 
children vastly outweigh the costs--one need only compare the cost of a 
visit to a primary care provider to the cost of a night spent in the 
emergency room. But above all, covering all our children is a moral 
imperative--it is the only possible humane, responsible course of 
action. I urge a yes vote on the underlying bill, and furthermore, 
would urge the President, in the strongest possible terms, not to veto 
this vitally needed, responsible legislation to cover the most 
vulnerable members of our society: our children.
  Mr. ELLISON. Mr. Speaker, I rise today in strong support of the SCHIP 
bill that will provide millions of children in America with health 
coverage. The bill passed Tuesday, 265-159.
  The bi-partisan compromise will include $35 billion more for the 
SCHIP program allowing Congress to cover 4 million more additional 
children, bringing the total number of children covered to 10 million. 
Next year alone, this new SCHIP bill will provide Minnesota with $50 
million in additional dollars to help insure Minnesota's children.
  This compromise reauthorizing SCHIP is supported by 43 Governors, 16 
of them Republican, including Republican Governors Arnold 
Schwarzenegger and my home state Governor Tim Pawlenty.
  But unfortunately, Mr. Speaker, it has been widely reported that the 
President has promised to veto this bill to provide children with 
health care.
  Last February, I spoke on the floor of the House to criticize the 
budget cuts contained in the President's budget. Like the budget, we 
could easily look at the SCHIP bill and say, this is all about numbers, 
it is just a plan and it is an impersonal thing. But, in fact, Madam 
Speaker, this bill is a moral statement about who matters in our 
society.
  This bill is a reflection of our own humanity. It talks about who 
counts, who doesn't, who matters, who doesn't, and what are our 
priorities.
  As the late Senator and former Vice President Hubert Humphrey from my 
State of Minnesota stated so eloquently:
  ``The moral test of any government is how it treats those in the dawn 
of life, the children; those in the dusk of life, the elderly; and 
those in the shadow of life, the disadvantaged.''
  The SCHIP bill brought to the House floor today clearly shows the 
priorities of this Congress.
  We are for children having access to health insurance.
  We are for providing health care for 4 million additional children.
  We are for families not having to worry about the health care for 
their children.
  This SCHIP bill is a clear measure that Congress values the 
hardworking energy, the blood, sweat and tears of Minnesotans or 
Americans.
  Mr. President, let's not play politics with the health care of our 
nation's children. Step up to plate and truly leave no children behind 
by signing this SCHIP bill into law.
  Mr. McHUGH. Mr. Speaker, I rise today in support of H.R. 976, the 
Children's Health Insurance Program Reauthorization Act of 2007. As a 
strong supporter of the State Children's Health Insurance Program 
(SCHIP), I am pleased that the House is working to extend SCHIP beyond 
its upcoming September 30, 2007 expiration.
  Importantly, the bill before the House today (H.R. 976) does not 
include many of the Medicare provisions that were included in H.R. 
3162. Those provisions would have markedly reduced funding for my 
constituent seniors, hospitals, skilled nursing facilities, and home 
health agencies. Accordingly, I was compelled to vote against H.R. 
3162, even though I have long supported the SCHIP program and its 
expansion.
  H.R. 976 takes the approach set forth in legislation (H.R. 3269) 
introduced by the gentlewoman from New Mexico, Mrs. Wilson, which I 
cosponsored. Significantly, under this approach, approximately 4 
million additional children will have access to health insurance 
through SCHIP and their coverage will not come at the expense of my 
constituent seniors and health care providers.
  Ms. CORRINE BROWN of Florida. Mr. Speaker, today, I rise in strong 
support of the State Children's Health Insurance Program (SCHIP) 
reauthorization bill. This is a landmark piece of bipartisan 
legislation that will progress further than any other program to cover 
uninsured children.
  Currently, I am ashamed to say that there are 10 million children 
without health insurance. But, this bill would provide continued health 
insurance to 6 million children already covered and add an additional 
four million children who currently lack health insurance nationwide. 
It will improve health benefits for children by providing dental 
coverage, mental health services and surgical benefits. The bill will 
also improve access by providing states with incentives to lower the 
rate of uninsured low income children and distributing grants for new 
outreach activities to states, local governments and schools.
  Unfortunately President Bush has threatened to veto this bipartisan 
bill and deny 10 million low-income kids the health care they need and 
deserve. The President has instead expressed support for his own CHIP 
proposal--which would result in 840,000 low-income kids losing their 
health care coverage, according to the Congressional Budget Office.
  The President has no idea what it might be like to go without health 
insurance. I saw a quote from him in July when he said ``I mean, people 
have access to health care in America. After all, just go to an 
emergency room . . .''
  An emergency room, Mr. President? That is the best kind of health 
care you want to provide to our children? Shame, shame, shame.
  Mr. President, this bill is going to get the children out the 
emergency room and make sure they don't delay health care needs until 
the last minute, give them regular checkups and preventative care. That 
is what health care is really about.
  Poor children cannot contribute to campaigns, but their right to 
medical care is no less than that of the children of members of 
Congress. This bill is the right thing to do and it pays for itself. I 
urge all my colleagues to have some compassionate conservatism and 
support this bill.
  Mr. RODRIGUEZ. Mr. Speaker, I am proud to support the State 
Children's Health Insurance Program Reauthorization bill. At a time 
when there are over 46 million uninsured individuals in this country, 
and over 5 million uninsured people in Texas alone, it is time that 
Congress stepped up and improved access to healthcare for children--our 
most vulnerable population. This legislation will go a long way in 
providing care to children of low-income families, some of our most 
disadvantaged individuals.
  Without this important legislation, SCHIP will expire at the end of 
the month. Since its inception ten years ago, SCHIP has been a highly 
successful program. There are currently 6.6 million children enrolled 
in SCHIP, but millions more are eligible for the program and continue 
to lack health insurance. Approximately two-thirds of uninsured 
children are eligible for SCHIP or Medicaid and it is our 
responsibility to ensure that these children receive health benefits. 
Without healthcare coverage under SCHIP many children of the working 
poor are forced to replace regular visits to primary care physicians 
with costly trips to the emergency room.
  Today's expansion will provide states with the resources to start 
covering more of these eligible children. This legislation will expand 
the Children's Health Insurance Program by $35 billion over the next 5 
years, allowing states to cover an estimated 3.8 million more children. 
In Texas alone, an additional 440,000 children will receive coverage. 
Texas has the unpleasant distinction of being the state with the most 
uninsured residents. With 5 million uninsured Texans, providing 
healthcare coverage for another half million children is a critical 
first step for the state of Texas.
  I am proud to support this important SCHIP expansion that will 
improve healthcare access for children in Texas and across the Nation.
  Ms. McCOLLUM of Minnesota. Mr. Speaker, I rise today to express my 
strong support for the State Children's Health Insurance Program 
Reauthorization Act to provide health care coverage for an additional 
3.8 million children.
  The Children's Health Insurance Program (CHIP) plays an important 
role in providing quality, cost-effective health care coverage for 
millions of lower-income children around the

[[Page 25521]]

country. It costs less than $3.50 a day to provide health care for a 
child through CHIP. This small investment keeps kids and families 
healthy and saves money in the long-run. However, without action from 
Congress, the law authorizing funding for this important program will 
expire at the end of September. For this reason, it is essential for 
Congress and the President to put politics aside to renew this 
critical, bi-partisan program.
  This legislation reauthorizes CHIP and includes an additional $35 
billion for children's health care. This funding is to enroll children 
throughout our nation who are eligible, but not currently enrolled in 
CHIP or Medicaid, and to improve the benefits available by adding a 
guaranteed dental benefit for all children enrolled in CHIP and parity 
for mental health coverage.
  Investing in our children's health care must be a priority for 
Congress. All Americans--Republicans, Democrats, and Independents--
should be able to agree that our children deserve access to quality 
health care. It is morally right, it is the right thing for our economy 
and in the richest country in the world--it is possible. I urge my 
colleagues to join me in voting for this important bill.

                              {time}  2030

  The SPEAKER pro tempore. All time for debate has expired.
  Pursuant to House Resolution 675, the previous question is ordered.
  The question is on the motion offered by the gentleman from Michigan 
(Mr. Dingell).
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.
  Mr. RANGEL. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, this 15-
minute vote on agreeing to the motion will be followed by a 5-minute 
vote on suspending the rules and agreeing to House Resolution 590.
  The vote was taken by electronic device, and there were--yeas 265, 
nays 159, answered ``present'' 1, not voting 8, as follows:

                             [Roll No. 906]

                               YEAS--265

     Abercrombie
     Ackerman
     Allen
     Altmire
     Andrews
     Arcuri
     Baca
     Baird
     Baldwin
     Barrow
     Bean
     Becerra
     Berkley
     Berman
     Berry
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Bono
     Boswell
     Boucher
     Boyd (FL)
     Boyda (KS)
     Brady (PA)
     Braley (IA)
     Brown, Corrine
     Buchanan
     Butterfield
     Capito
     Capps
     Capuano
     Cardoza
     Carnahan
     Carney
     Castle
     Chandler
     Clarke
     Clay
     Cleaver
     Clyburn
     Cohen
     Conyers
     Cooper
     Costa
     Costello
     Courtney
     Cramer
     Crowley
     Cuellar
     Cummings
     Davis (AL)
     Davis (CA)
     Davis (IL)
     Davis, Lincoln
     Davis, Tom
     DeFazio
     DeGette
     DeLauro
     Dent
     Dicks
     Dingell
     Doggett
     Donnelly
     Doyle
     Edwards
     Ehlers
     Ellison
     Ellsworth
     Emanuel
     Emerson
     Engel
     English (PA)
     Eshoo
     Farr
     Fattah
     Ferguson
     Filner
     Fossella
     Frank (MA)
     Gerlach
     Giffords
     Gilchrest
     Gillibrand
     Gonzalez
     Gordon
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Hall (NY)
     Hare
     Harman
     Hastings (FL)
     Herseth Sandlin
     Higgins
     Hinchey
     Hinojosa
     Hirono
     Hobson
     Hodes
     Holden
     Holt
     Honda
     Hooley
     Hoyer
     Inslee
     Israel
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     Johnson (GA)
     Jones (OH)
     Kagen
     Kanjorski
     Kaptur
     Kennedy
     Kildee
     Kilpatrick
     Kind
     King (NY)
     Kirk
     Klein (FL)
     LaHood
     Lampson
     Langevin
     Lantos
     Larsen (WA)
     Larson (CT)
     Latham
     LaTourette
     Lee
     Levin
     Lewis (GA)
     Lipinski
     LoBiondo
     Loebsack
     Lofgren, Zoe
     Lowey
     Lynch
     Mahoney (FL)
     Maloney (NY)
     Markey
     Matheson
     Matsui
     McCarthy (NY)
     McCollum (MN)
     McDermott
     McGovern
     McHugh
     McMorris Rodgers
     McNerney
     McNulty
     Meek (FL)
     Meeks (NY)
     Melancon
     Michaud
     Miller (MI)
     Miller (NC)
     Miller, George
     Mitchell
     Mollohan
     Moore (KS)
     Moore (WI)
     Moran (KS)
     Moran (VA)
     Murphy (CT)
     Murphy, Patrick
     Murphy, Tim
     Murtha
     Nadler
     Napolitano
     Neal (MA)
     Oberstar
     Obey
     Olver
     Ortiz
     Pallone
     Pascrell
     Pastor
     Payne
     Pelosi
     Perlmutter
     Peterson (MN)
     Petri
     Platts
     Pomeroy
     Porter
     Price (NC)
     Pryce (OH)
     Rahall
     Ramstad
     Rangel
     Regula
     Rehberg
     Reichert
     Renzi
     Reyes
     Richardson
     Rodriguez
     Ross
     Rothman
     Roybal-Allard
     Ruppersberger
     Rush
     Ryan (OH)
     Salazar
     Sanchez, Linda T.
     Sanchez, Loretta
     Sarbanes
     Schakowsky
     Schiff
     Schwartz
     Scott (GA)
     Scott (VA)
     Serrano
     Sestak
     Shays
     Shea-Porter
     Sherman
     Shuler
     Simpson
     Sires
     Skelton
     Slaughter
     Smith (NJ)
     Smith (WA)
     Snyder
     Solis
     Space
     Spratt
     Stark
     Stupak
     Sutton
     Tanner
     Tauscher
     Thompson (CA)
     Thompson (MS)
     Tiberi
     Tierney
     Towns
     Turner
     Udall (CO)
     Udall (NM)
     Upton
     Van Hollen
     Velazquez
     Visclosky
     Walsh (NY)
     Walz (MN)
     Wasserman Schultz
     Waters
     Watt
     Waxman
     Weiner
     Welch (VT)
     Wexler
     Wilson (NM)
     Wilson (OH)
     Wolf
     Woolsey
     Wu
     Wynn
     Yarmuth
     Young (AK)
     Young (FL)

                               NAYS--159

     Aderholt
     Akin
     Alexander
     Bachmann
     Bachus
     Baker
     Barrett (SC)
     Bartlett (MD)
     Barton (TX)
     Biggert
     Bilbray
     Bilirakis
     Bishop (UT)
     Blackburn
     Blunt
     Boehner
     Bonner
     Boozman
     Boren
     Boustany
     Brady (TX)
     Broun (GA)
     Brown (SC)
     Brown-Waite, Ginny
     Burgess
     Burton (IN)
     Buyer
     Calvert
     Camp (MI)
     Campbell (CA)
     Cannon
     Cantor
     Carter
     Castor
     Chabot
     Coble
     Cole (OK)
     Conaway
     Crenshaw
     Culberson
     Davis (KY)
     Davis, David
     Deal (GA)
     Diaz-Balart, L.
     Diaz-Balart, M.
     Doolittle
     Drake
     Dreier
     Duncan
     Etheridge
     Everett
     Fallin
     Feeney
     Flake
     Forbes
     Fortenberry
     Foxx
     Franks (AZ)
     Frelinghuysen
     Gallegly
     Garrett (NJ)
     Gingrey
     Gohmert
     Goode
     Goodlatte
     Granger
     Graves
     Hall (TX)
     Hastert
     Hastings (WA)
     Hayes
     Heller
     Hensarling
     Hill
     Hoekstra
     Hulshof
     Hunter
     Inglis (SC)
     Issa
     Johnson (IL)
     Johnson, Sam
     Jones (NC)
     Jordan
     Keller
     King (IA)
     Kingston
     Kline (MN)
     Knollenberg
     Kucinich
     Kuhl (NY)
     Lamborn
     Lewis (CA)
     Lewis (KY)
     Linder
     Lucas
     Lungren, Daniel E.
     Mack
     Manzullo
     Marchant
     Marshall
     McCarthy (CA)
     McCaul (TX)
     McCotter
     McCrery
     McHenry
     McIntyre
     McKeon
     Mica
     Miller (FL)
     Miller, Gary
     Musgrave
     Myrick
     Neugebauer
     Nunes
     Paul
     Pearce
     Pence
     Peterson (PA)
     Pickering
     Pitts
     Price (GA)
     Putnam
     Radanovich
     Reynolds
     Rogers (AL)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Ros-Lehtinen
     Roskam
     Royce
     Ryan (WI)
     Sali
     Saxton
     Schmidt
     Sensenbrenner
     Sessions
     Shadegg
     Shimkus
     Shuster
     Smith (NE)
     Smith (TX)
     Souder
     Stearns
     Sullivan
     Tancredo
     Taylor
     Terry
     Thornberry
     Tiahrt
     Walberg
     Walden (OR)
     Wamp
     Weldon (FL)
     Weller
     Westmoreland
     Whitfield
     Wicker
     Wilson (SC)

                        ANSWERED ``PRESENT''--1

       
     Watson
       

                             NOT VOTING--8

     Carson
     Cubin
     Davis, Jo Ann
     Delahunt
     Herger
     Jindal
     Johnson, E. B.
     Poe


                Announcement By the Speaker Pro Tempore

  The SPEAKER pro tempore (during the vote). Members have 2 minutes 
remaining to cast their votes.

                              {time}  2053

  Messrs. PASTOR, ORTIZ, GRIJALVA, GUTIERREZ and MEEK of Florida 
changed their vote from ``nay'' to ``yea.''
  Mr. REYES and Mrs. NAPOLITANO changed their vote from ``present'' to 
``yea.''
  So the motion was agreed to.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.

                          ____________________