[Congressional Record (Bound Edition), Volume 155 (2009), Part 2]
[Senate]
[Pages 1786-1788]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 74. Mr. BUNNING submitted an amendment intended to be proposed by 
him to the bill H.R. 2, to amend title XXI of the Social Security Act 
to extend and improve the Children's Health Insurance Program, and for 
other purposes; which was ordered to lie on the table; as follows:

       Beginning on page 75, strike line 18 and all that follows 
     through page 76, line 2, and insert the following:
       ``(B) Increased funding for outreach and enrollment 
     grants.--
       ``(i) Appropriation.--In addition to amounts appropriated 
     under subsection (g) of section 2113 for the period of fiscal 
     years 2009 through 2013, there is appropriated, out of any 
     money in the Treasury not otherwise appropriated, the amount 
     described in clause (ii), for the purpose of the Secretary 
     awarding grants under that section.
       ``(ii) Amount described.--The amount described in this 
     clause is the amount equal to the amount of additional 
     Federal funds that the Director of the Congressional Budget 
     Office certifies would have been expended for the period 
     beginning April 1, 2009, and ending September 30, 2013, if 
     subparagraph (A) did not apply to any State that, on the date 
     of enactment of the Children's Health Insurance Program 
     Reauthorization Act of 2009, has an approved State plan 
     amendment or waiver to provide, or has enacted a State law to 
     submit a State plan amendment to provide, expenditures 
     described in such subparagraph under the State child health 
     plan.''.
                                 ______
                                 
  SA 75. Mr. ROBERTS (for himself, Mr. Hatch, and Ms. Collins) 
submitted an amendment intended to be proposed by him to the bill H.R. 
2, to amend title XXI of the Social Security Act to extend and improve 
the Children's Health Insurance Program, and for other purposes; as 
follows:

       Strike section 114 and insert the following:

     SEC. 114. LIMITATION ON FEDERAL MATCHING PAYMENTS.

       (a) Denial of Federal Matching Payments for Coverage of 
     Higher Income Children.--Section 2105(c) (42 U.S.C. 
     1397ee(c)) is amended by adding at the end the following new 
     paragraph:
       ``(8) Denial of payments for expenditures for child health 
     assistance for higher income children.--
       ``(A) In general.--No payment may be made under this 
     section for any expenditures for providing child health 
     assistance or health benefits coverage under a State child 
     health plan under this title, including under a waiver under 
     section 1115, with respect to any child whose gross family 
     income (as defined by the Secretary) exceeds the lower of--
       ``(i) $65,000; or
       ``(ii) the median State income (as determined by the 
     Secretary).
       ``(B) No payments from allotments under this title if 
     medicaid income eligibility level for children is greater.--
     No payment may be made under this section from an allotment 
     of a State for any expenditures for a fiscal year quarter for 
     providing child health assistance or health benefits coverage 
     under the State child health plan under this title to any 
     individual if the income eligibility level (expressed as a 
     percentage of the poverty line) for children who are eligible 
     for medical assistance under the State plan under title XIX 
     under any category specified in subparagraph (A) or (C) of 
     section 1902(a)(10) in effect during such quarter is greater 
     than the income eligibility level (as so expressed) for 
     children in effect during such quarter under the State child 
     health plan under this title.''.
                                 ______
                                 
  SA 76. Mr. ROBERTS (for himself and Mr. Hatch) submitted an amendment 
intended to be proposed by him to the bill H.R. 2, to amend title XXI 
of the Social Security Act to extend and improve the Children's Health 
Insurance Program, and for other purposes; which was ordered to lie on 
the table; as follows:

       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. CHILDREN'S HEALTH INSURANCE PROGRAM 
                   REAUTHORIZATION ACT OF 2007 (CHIPRA II).

       The text of the Children's Health Insurance Program 
     Reauthorization Act of 2007 (H.R. 3963, 110th Congress) as 
     passed by the Senate on November 1, 2007, is hereby 
     incorporated by reference.
                                 ______
                                 
  SA 77. Ms. MURKOWSKI (for herself, Mr. Specter, Mr. Johanns, and Ms. 
Collins) submitted an amendment intended to be proposed by her to the 
bill H.R. 2, to amend title XXI of the Social Security Act to extend 
and improve the Children's Health Insurance Program, and for other 
purposes; as follows:

       At the appropriate place, insert the following:

     SEC. __. DEVELOPMENT OF BEST PRACTICE RECOMMENDATIONS AND 
                   COVERAGE OF LOW INCOME CHILDREN.

       (a) 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.--Not 
     later than 12 months after the date of enactment of this Act, 
     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.''.
       (b) Limitation on Payments for States Covering Higher 
     Income Children.--
       (1) In general.--Section 2105(c) (42 U.S.C. 1397ee(c)), as 
     amended by section 601(a), is further amended by adding at 
     the end the following new paragraph:
       ``(12) 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 October 
     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, no payment 
     shall be made as of April 30 of the following year, 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 Secretary 
     establishes that the State is in compliance with such 
     requirement, but in no case more than 12 months.
       ``(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.--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 80 
     percent of the low-income children who reside in the State 
     and are eligible for child health assistance under the State 
     child health plan.
       ``(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).''.
       (2) Construction.--Nothing in the amendment made by 
     paragraph (1) or this section this shall be construed as 
     authorizing the Secretary of Health and Human Services to 
     limit payments under title XXI of the Social Security Act in 
     the case of a State that is not a higher income eligibility 
     State (as defined in section 2105(c)(12)(B) of such Act, as 
     added by paragraph (1)).
                                 ______
                                 
  SA 78. Mr. MARTINEZ submitted an amendment intended to be proposed by 
him to the bill H.R. 2, to amend title XXI of the Social Security Act 
to extend and improve the Children's Health

[[Page 1787]]

Insurance Program, and for other purposes; which was ordered to lie on 
the table; as follows:

       On page 43, between lines 11 and 12, and insert the 
     following:
       ``(3) Exception.--
       ``(A) In general.--Notwithstanding paragraph (1)(B), if a 
     State submits, by not later than 18 months after the date of 
     enactment of this paragraph, a plan to the Secretary that the 
     Secretary determines is likely to reduce the levels of 
     improper payments for the State under the Medicaid program 
     under title XIX and the program under this title, such 
     paragraph shall be applied with respect to such State by 
     substituting `second succeeding fiscal year' for `succeeding 
     fiscal year'.
       ``(B) Determination.--In making the determination under 
     subparagraph (A), the Secretary shall take into account the 
     results of the study conducted under paragraph (4).
       ``(4) GAO study and report on improper payments under the 
     medicaid and chip programs and ways to reduce such improper 
     payments.--
       ``(A) Study.--The Comptroller General of the United States 
     shall conduct a study on--
       ``(i) the mechanisms that States are currently using to 
     reduce improper payments under the Medicaid program under 
     title XIX the program under this title;
       ``(ii) the levels of such improper payments for each State; 
     and
       ``(iii) the mechanisms that States should implement in 
     order to reduce such improper payments.
       ``(B) Report.--Not later than 12 months after the date of 
     enactment of this paragraph, the Comptroller General of the 
     United States shall submit a report to Congress on the study 
     conducted under subsection (a) together with such 
     recommendations as the Comptroller General determines 
     appropriate.''.
                                 ______
                                 
  SA 79. Mr. BROWN submitted an amendment intended to be proposed by 
him to the bill H.R. 2, to amend title XXI of the Social Security Act 
to extend and improve the Children's Health Insurance Program, and for 
other purposes; which was ordered to lie on the table; as follows:

       After section 622 insert the following:

     SEC. 623. ONE-TIME PROCESS FOR HOSPITAL WAGE INDEX 
                   RECLASSIFICATION IN ECONOMICALLY-DISTRESSED 
                   AREAS.

       (a) Reclassifications.--
       (1) Notwithstanding any other provision of law, effective 
     for discharges occurring on or after April 1, 2009, and 
     before March 31, 2012, for purposes of making payments under 
     section 1886(d) of the Social Security Act (42 U.S.C. 
     1395ww(d)) to St. Vincent Mercy Medical Center (provider 
     number 36-0112), such hospital is deemed to be located in the 
     Ann Arbor, MI metropolitan statistical area.
       (2) Notwithstanding any other provision of law, effective 
     for discharges occurring on or after April 1, 2009 and before 
     March 31, 2012, for purposes of making payments under section 
     1886(d) of the Social Security Act (42 U.S.C. 1395ww(d)) to 
     St. Elizabeth Health Center (provider number 36-0064), 
     Northside Medical Center (provider number 36-3307), St. 
     Joseph Health Center (provider number 36-0161), and St. 
     Elizabeth Boardman Health Center (provider number 36-0276), 
     such hospitals are deemed to be located in the Cleveland-
     Elyria-Mentor metropolitan statistical area.
       (b) Rules.--
       (1) Except as provided in paragraph (2), any 
     reclassification made under subsection (a) shall be treated 
     as a decision of the Medicare Geographic Classification 
     Review Board under section 1886(d)(10) of the Social Security 
     Act (42 U.S.C. 1395ww(d)(10)).
       (2) Section 1886(d)(10)(D)(v) of the Social Security Act 
     (42 U.S.C. 1395ww(d)(10)(D)(v)), as it relates to 
     reclassification being effective for 3 fiscal years, shall 
     not apply with respect to a reclassification made under 
     subsection (a).

     SEC. 624. TREATMENT OF CERTAIN CANCER HOSPITALS.

       (a) In General.--
       (1) Treatment.--Section 1886(d)(1)(B)(v) of the Social 
     Security Act (42 U.S.C. 1395ww(d)(1)(B)(v)) is amended--
       (A) in subclause (II), by striking ``or'' at the end;
       (B) in subclause (III), by striking the semicolon at the 
     end and inserting ``, or''; and
       (C) by inserting after subclause (III) the following new 
     subclause:

       ``(IV) a hospital--

       ``(aa) that the Secretary has determined to be, at any time 
     on or before December 31, 2011, a hospital involved 
     extensively in treatment for, or research on, cancer,
       ``(bb) that is a free standing hospital, the construction 
     of which had commenced as of December 31, 2008; and
       ``(cc) whose current or predecessor provider entity is 
     University Hospitals of Cleveland (provider number 36-
     0137).''.
       (2) Initial determination.--
       (A) A hospital described in subclause (IV) of section 
     1886(d)(1)(B)(v) of the Social Security Act, as inserted by 
     subsection (a), shall not qualify as a hospital described in 
     such subclause unless the hospital petitions the Secretary of 
     Health and Human Services for a determination of such 
     qualification on or before December 31, 2011.
       (B) The Secretary of Health and Human Services shall, not 
     later than 30 days after the date of a petition under 
     subparagraph (A), determine that the petitioning hospital 
     qualifies as a hospital described in such subclause (IV) if 
     not less than 50 percent of the hospital's total discharges 
     since its commencement of operations have a principal finding 
     of neoplastic disease (as defined in section 1886(d)(1)(E) of 
     such Act (42 U.S.C. 1395ww(d)(1)(E))).
       (b) Application.--
       (1) Inapplicability of certain requirements.--The 
     provisions of section 412.22(e) of title 42, Code of Federal 
     Regulations, shall not apply to a hospital described in 
     subclause (IV) of section 1886(d)(1)(B)(v) of the Social 
     Security Act, as inserted by subsection (a).
       (2) Application to cost reporting periods.--If the 
     Secretary makes a determination that a hospital is described 
     in subclause (IV) of section 1886(d)(1)(B)(v) of the Social 
     Security Act, as inserted by subsection (a), such 
     determination shall apply as of the first full 12-month cost 
     reporting period beginning on January 1 immediately following 
     the date of such determination.
       (3) Base period.--Notwithstanding the provisions of section 
     1886(b)(3)(E) of the Social Security Act (42 U.S.C. 
     1395ww(b)(3)(E)) or any other provision of law, the base cost 
     reporting period for purposes of determining the target 
     amount for any hospital for which such a determination has 
     been made shall be the first full 12-month cost reporting 
     period beginning on or after the date of such determination.
       (4) Requirement.--A hospital described in subclause (IV) of 
     section 1886(d)(1)(B)(v) of the Social Security Act, as 
     inserted by subsection (a), shall not qualify as a hospital 
     described in such subclause for any cost reporting period in 
     which less than 50 percent of its total discharges have a 
     principal finding of neoplastic disease (as defined in 
     section 1886(d)(1)(E) of such Act (42 U.S.C. 
     1395ww(d)(1)(E))).

     SEC. 625. RECONCILIATION AND RECOVERY OF ALL SERVICE-
                   CONCLUDED MEDICARE FEE-FOR-SERVICE DISEASE 
                   MANAGEMENT PROGRAM FUNDING.

       Notwithstanding any other provision of law, the Secretary 
     of Health and Human Services shall provide for the immediate 
     reconciliation and recovery of all service-concluded Medicare 
     fee-for-service disease management program funding.
                                 ______
                                 
  SA 80. HATCH (for himself, Mr. Vitter, Mr. Brownback, Mr. Thune, Mr. 
Bennett of Utah, Mr. Johanns, Mr. DeMint, Mr. Roberts, Mr. Risch, Mr. 
Inhofe, Mr. Barrasso, Mr. Gregg, Mr. Ensign, Mr. Grassley, Mr. 
Martinez, Mr. McCain, Mr. Enzi, Mr. Crapo, Mr. Corker, Mr. Kyl, Mr. 
Graham, Mr. Coburn, and Mr. Cornyn) submitted an amendment intended to 
be proposed by him to the bill H.R. 2, to amend title XXI of the Social 
Security Act to extend and improve the Children's Health Insurance 
Program, and for other purposes; which was ordered to lie on the table; 
as follows:

       On page 76, after line 23, add the following:

     SEC. 116. TREATMENT OF UNBORN CHILDREN.

       (a) Codification of Current Regulations.--Section 
     2110(c)(1) (42 U.S.C. 1397jj(c)(1)) is amended by striking 
     the period at the end and inserting the following: ``, and 
     includes, at the option of a State, an unborn child. For 
     purposes of the previous sentence, the term `unborn child' 
     means a member of the species Homo sapiens, at any stage of 
     development, who is carried in the womb.''.
       (b) Clarifications Regarding Coverage of Mothers.--Section 
     2103 (42 U.S.C. 1397cc) is amended by adding at the end the 
     following new subsection:
       ``(g) Clarifications Regarding Authority to Provide 
     Postpartum Services and Maternal Health Care.--Any State that 
     provides child health assistance to an unborn child under the 
     option described in section 2110(c)(1) may--
       ``(1) continue to provide such assistance to the mother, as 
     well as postpartum services, through the end of the month in 
     which the 60-day period (beginning on the last day of 
     pregnancy) ends; and
       ``(2) in the interest of the child to be born, have 
     flexibility in defining and providing services to benefit 
     either the mother or unborn child consistent with the health 
     of both.''.
                                 ______
                                 
  SA 81. Mr. BUNNING submitted an amendment intended to be proposed by 
him to the bill H.R. 2, to amend title XXI of the Social Security Act 
to extend and improve the Children's Health Insurance Program, and for 
other purposes; which was ordered to lie on the table; as follows:

       Beginning on page 273, line 8, strike ``inserting 
     ``$24.78''.'' and all that follows through page 276, line 9, 
     and insert ``inserting ``$2.8311 cents''.''.

[[Page 1788]]



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