# Children's Health Insurance Program Reauthorization Act of 2009/Title VI/Subtitle B
### 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. 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, 2009, 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. 615. 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. 616. EXTENSION OF MEDICAID DSH ALLOTMENTS FOR TENNESSEE AND HAWAII.

Section 1923(f)(6) (42 U.S.C. 1396r-4(f)(6)), as amended by section 202 of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110-275) is amended—
       (1) in the paragraph heading, by striking ‘‘2009 AND THE FIRST CALENDAR QUARTER OF FISCAL YEAR 2010’’ and inserting ‘‘2011 AND THE FIRST CALENDAR QUARTER OF FISCAL YEAR 2012’’;
       (2) in subparagraph (A)—
          (A) in clause (i)—
             (i) in the second sentence—
                (I) by striking ‘‘and 2009’’ and inserting ‘‘, 2009, 2010, and 2011’’; and
                (II) by striking ‘‘such portion of’’; and
             (ii) in the third sentence, by striking ‘‘2010 for the period ending on December 31, 2009’’ and inserting ‘‘2012 for the period ending on December 31, 2011’’;
          (B) in clause (ii), by striking ‘‘or for a period in fiscal year 2010’’ and inserting ‘‘2010, 2011, or for period in fiscal year 2012’’; and
          (C) in clause (iv)—
             (i) in the clause heading, by striking ‘‘2009 AND THE FIRST CALENDAR QUARTER OF FISCAL YEAR 2010’’ and inserting ‘‘2011 AND THE FIRST CALENDAR QUARTER OF FISCAL YEAR 2012’’; and
             (ii) in each of subclauses (I) and (II), by striking ‘‘ or for a period in fiscal year 2010’’ and inserting ‘‘2010, 2011, or for a period in fiscal year 2012’’; and
       (3) in subparagraph (B)—
          (A) in clause (i)—
             (i) in the first sentence, by striking ‘‘2009’’ and inserting ‘‘2011’’; and
             (ii) in the second sentence, by striking ‘‘2010 for the period ending on December 31, 2009’’ and inserting ‘‘2012 for the period ending on December 31, 2011’’.