[House Report 110-346]
[From the U.S. Government Publishing Office]
110th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 110-346
======================================================================
PROVIDING FOR THE CONSIDERATION OF THE SENATE AMENDMENTS TO THE BILL
(H.R. 976) TO AMEND THE INTERNAL REVENUE CODE OF 1986 TO PROVIDE TAX
RELIEF FOR SMALL BUSINESSES, AND FOR OTHER PURPOSES
_______
September 24, 2007.--Referred to the House Calendar and ordered to be
printed
_______
Mr. McGovern, from the Committee on Rules, submitted the following
R E P O R T
[To accompany H. Res. 675]
The Committee on Rules, having had under consideration
House Resolution 675, by a record vote of 8 to 4, report the
same to the House with the recommendation that the resolution
be adopted.
SUMMARY OF PROVISIONS OF THE RESOLUTION
The resolution provides for consideration of the Senate
amendments to the bill, H.R. 976, to amend the Internal Revenue
Code of 1986 to provide tax relief for small businesses, and
for other purposes. The resolution provides that it is in order
for the chairman of the Committee on Energy and Commerce to
make a motion that the House concur in each of the Senate
amendments to H.R. 976 with the respective amendment printed in
this report.
The resolution waives all points of order against the
motion except those arising under clause 10 of rule XXI. The
resolution provides that the Senate amendments and the motion
shall be considered as read. It further provides that the
motion shall be debatable for one hour equally divided among
and controlled by the chairman and ranking minority member of
the Committee on Energy and Commerce and the chairman and
ranking minority member of the Committee on Ways and Means.
EXPLANATION OF WAIVERS
Although the rule waives all points of order against the
motion (except those arising under clause 10 of rule XXI), the
Committee is not aware of any points of order against the
motion. The waiver of all points of order against the motion is
prophylactic in nature.
COMMITTEE VOTES
The results of each record vote on an amendment or motion
to report, together with the names of those voting for and
against, are printed below:
Rules Committee record vote No. 310
Date: September 24, 2007.
Measure: Senate amendment to H.R. 976.
Motion by: Mr. Dreier.
Summary of motion: To amend the rule and provide for an
amendment to the motion to concur to be offered by Rep. Barton
of Texas and to be debatable by a proponent and an opponent for
ten minutes each.
Results: Defeated 4-8.
Vote by Members: Hastings (FL)--Nay; Matsui--Nay; Cardoza--
Nay; Welch--Nay; Castor--Nay; Arcuri--Nay; Sutton--Nay;
Dreier--Yea; Diaz-Balart--Yea; Hastings (WA)--Yea; Sessions--
Yea; Slaughter--Nay.
Rules Committee record vote No. 311
Date: September 24, 2007.
Measure: Senate amendment to H.R. 976.
Motion by: Mr. Dreier.
Summary of motion: To make in order and provide appropriate
waivers for an amendment by Rep. Barton of Texas, an amendment
in the nature of a substitute that would reauthorize and fully
fund the existing SCHIP program for an additional 18 months to
be debated by a proponent and an opponent for 20 minutes each.
Results: Defeated 4-8.
Vote by Members: Hastings (FL)--Nay; Matsui--Nay; Cardoza--
Nay; Welch--Nay; Castor--Nay; Arcuri--Nay; Sutton--Nay;
Dreier--Yea; Diaz-Balart--Yea; Hastings (WA)--Yea; Sessions--
Yea; Slaughter--Nay.
Rules Committee record vote No. 312
Date: September 24, 2007.
Measure: Senate amendment to H.R. 976.
Motion by: Mr. Diaz-Balart.
Summary of motion: To make in order and provide appropriate
waivers for an amendment by Rep. Diaz-Balart that would allow
states the option to provide Medicaid and SCHIP coverage to all
eligible, legally present, children and pregnant women.
Results: Defeated 4-8.
Vote by Members: Hastings (FL)--Nay; Matsui--Nay; Cardoza--
Nay; Welch--Nay; Castor--Nay; Arcuri--Nay; Sutton--Nay;
Dreier--Yea; Diaz-Balart--Yea; Hastings (WA)--Yea; Sessions--
Yea; Slaughter--Nay.
Rules Committee record vote No. 313
Date: September 24, 2007.
Measure: Senate amendment to H.R. 976.
Motion by: Mr. Sessions.
Summary of motion: To amend the rule to waive all points of
order against the motion except those arising under clause 9
and 10 of rule XXI.
Results: Defeated 4-8.
Vote by Members: Hastings (FL)--Nay; Matsui--Nay; Cardoza--
Nay; Welch--Nay; Castor--Nay; Arcuri--Nay; Sutton--Nay;
Dreier--Yea; Diaz-Balart--Yea; Hastings (WA)--Yea; Sessions--
Yea; Slaughter--Nay.
Rules Committee record vote No. 314
Date: September 24, 2007.
Measure: Senate amendment to H.R. 976.
Motion by: Mr. Hastings (FL).
Summary of motion: To grant the rule.
Results: Adopted 8-4.
Vote by Members: Hastings (FL)--Yea; Matsui--Yea; Cardoza--
Yea; Welch--Yea; Castor--Yea; Arcuri--Yea; Sutton--Yea;
Dreier--Nay; Diaz-Balart--Nay; Hastings (WA)--Nay; Sessions--
Nay; Slaughter--Yea.
SUMMARY OF THE HOUSE AMENDMENTS TO THE SENATE AMENDMENTS TO H.R. 976
The amendment reauthorizes the Children's Health Insurance
Program, investing an additional $35 billion over five years
for CHIP's financing and health insurance coverage for low-
income children. The amendment provides that dental coverage
should be available to children enrolled in CHIP. The amendment
provides coverage to pregnant women as a new state option as
well as preserving the options to cover them through a state
waiver or through regulation. The amendment prohibits new
waivers to cover parents in the CHIP program. States that have
received waivers to cover low-income parents under CHIP will be
allowed to transition parents into a separate block grant.
The amendment retains the current law prohibition of
waivers to allow coverage of childless adults. Currently
covered childless adults will transition off CHIP. For states
that have received CHIP waivers to cover childless adults, the
amendment terminates those waivers after a one-year period,
provides temporary Medicaid funding for already-enrolled
adults, and allows states to apply for a Medicaid waiver for
coverage.
Under the financing structure, states that face a funding
shortfall and meet enrollment goals will receive an adjustment
payment to ensure that no child who is eligible for Medicaid or
CHIP is denied coverage or placed on a waiting list. The
formula also sets in place new overall caps on federal funding
to ensure the program's expenditures do not exceed the amounts
authorized.
The amendment provides $100 million in grants for new
outreach activities to states, local governments, schools,
community-based organizations, safety-net providers and others.
The amendment establishes a new quality child health initiative
to develop and implement quality measures and improve state
reporting of quality data. Finally, the amendment allows states
to offer a premium assistance subsidy for qualified, cost-
effective employer-sponsored coverage to children eligible for
CHIP and who have access to such coverage.
TEXT OF THE HOUSE AMENDMENTS TO THE SENATE AMENDMENTS TO H.R. 976
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''.
(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
(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) 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 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 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
(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 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 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--
(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.
(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:
``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:
``(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 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.
``(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 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.--
(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;
``(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.
(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 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 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.
``(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
``(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).
``(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 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.
``(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.
``(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.''.
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.
``(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.
(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 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.);
(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
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.''.