II 

109TH CONGRESS 

2D SESSION S. 2772 

To provide for innovation in health care through State initiatives that expand 

coverage and access and improve quality and efficiency in the health 

care system. 

IN THE SENATE OF THE UNITED STATES 

MAY 9, 2006 

Mr. VOINOVICH (for himself, Mr. BINGAMAN, Mr. DEWINE, and Mr. AKAKA) 

introduced the following bill; which was read twice and referred to the 

Committee on Health, Education, Labor, and Pensions 

A BILL 

To provide for innovation in health care through State initiatives that expand coverage and access and improve quality and efficiency in the health care system. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Health Partnership 

5 Act’’. 

6 SEC. 2. STATE HEALTH REFORM PROJECTS. 

7 (a) PURPOSE; ESTABLISHMENT OF STATE HEALTH

8 CARE EXPANSION AND IMPROVEMENT PROGRAM.—The 


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1 purposes of the programs approved under this section 

2 shall include, but not be limited to— 

3 (1) achieving the goals of increased health cov4 erage and access; 

5 (2) ensuring that patients receive high-quality, 

6 appropriate health care; 

7 (3) improving the efficiency of health care 

8 spending; and 

9 (4) testing alternative reforms, such as building 

10 on the public or private health systems, or creating 

11 new systems, to achieve the objectives of this Act. 

12 (b) APPLICATIONS BY STATES, LOCAL GOVERN13 MENTS, AND TRIBES.— 

14 (1) ENTITIES THAT MAY APPLY.— 

15 (A) IN GENERAL.—A State, in consultation 

16 with local governments, Indian tribes, and In17 dian organizations involved in the provision of 

18 health care, may apply for a State health care 

19 expansion and improvement program for the 

20 entire State (or for regions of the State) under 

21 paragraph (2). 

22 (B) REGIONAL GROUPS.—A regional entity 

23 consisting of more than one State may apply 

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1 provement program for the entire region in2 volved under paragraph (2). 

3 (C) DEFINITION.—In this Act, the term 

4 ‘‘State’’ means the 50 States, the District of 

5 Columbia, and the Commonwealth of Puerto 

6 Rico. Such term shall include a regional entity 

7 described in subparagraph (B). 

8 (2) SUBMISSION OF APPLICATION.—In accord9 ance with this section, each State desiring to imple10 ment a State health care expansion and improve11 ment program may submit an application to the 

12 State Health Innovation Commission under sub13 section (c) (referred to in this section as the ‘‘Com14 mission’’) for approval. 

15 (3) LOCAL GOVERNMENT APPLICATIONS.— 

16 (A) IN GENERAL.—Where a State declines 

17 to submit an application under this section, a 

18 unit of local government of such State, or a 

19 consortium of such units of local governments, 

20 may submit an application directly to the Com21 mission for programs or projects under this 

22 subsection. Such an application shall be subject 

23 to the requirements of this section. 

24 (B) OTHER APPLICATIONS.—Subject to 

25 such additional guidelines as the Secretary may 


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1 prescribe, a unit of local government, Indian 

2 tribe, or Indian health organization may submit 

3 an application under this section, whether or 

4 not the State submits such an application, if 

5 such unit of local government can demonstrate 

6 unique demographic needs or a significant pop7 ulation size that warrants a substate program 

8 under this subsection. 

9 (c) STATE HEALTH INNOVATION COMMISSION.— 

10 (1) IN GENERAL.—Within 90 days after the 

11 date of the enactment of this Act, the Secretary 

12 shall establish a State Health Innovation Commis13 sion that shall— 

14 (A) be comprised of— 

15 (i) the Secretary; 

16 (ii) four State governors to be ap17 pointed by the National Governors Associa18 tion on a bipartisan basis; 

19 (iii) two members of a State legisla20 ture to be appointed by the National Con21 ference of State Legislators on a bipartisan 

22 basis; 

23 (iv) two county officials to be ap24 pointed by the National Association of 

25 Counties on a bipartisan basis; 


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1 (v) two mayors to be appointed by the 

2 United States Conference of Mayors on a 

3 bipartisan basis; 

4 (vi) two individuals to be appointed by 

5 the Speaker of the House of Representa6 tives; 

7 (vii) two individuals to be appointed 

8 by the Minority Leader of the House of 

9 Representatives; 

10 (viii) two individuals to be appointed 

11 by the Majority Leader of the Senate; 

12 (ix) two individuals to be appointed by 

13 the Minority Leader of the Senate; and 

14 (x) two individuals who are members 

15 of federally-recognized Indian tribes to be 

16 appointed on a bipartisan basis by the Na17 tional Congress of American Indians; 

(B) upon approval of 2 18 ⁄3 of the members of 

19 the Commission, provide the States with a vari20 ety of reform options for their applications, 

21 such as tax credit approaches, expansions of 

22 public programs such as medicaid and the State 

23 Children’s Health Insurance Program, the cre24 ation of purchasing pooling arrangements simi25 lar to the Federal Employees Health Benefits 


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1 Program, individual market purchasing options, 

2 single risk pool or single payer systems, health 

3 savings accounts, a combination of the options 

4 described in this clause, or other alternatives 

5 determined appropriate by the Commission, in6 cluding options suggested by States, Indian 

7 tribes, or the public; 

8 (C) establish, in collaboration with a quali9 fied and independent organization such as the 

10 Institute of Medicine, minimum performance 

11 measures and goals with respect to coverage, 

12 quality, and cost of State programs, as de13 scribed under subsection (d)(1); 

14 (D) conduct a thorough review of the grant 

15 application from a State and carry on a dia16 logue with all State applicants concerning pos17 sible modifications and adjustments; 

18 (E) submit the recommendations and legis19 lative proposal described in subsection 

20 (d)(4)(B); 

21 (F) be responsible for monitoring the sta22 tus and progress achieved under program or 

23 projects granted under this section; 

24 (G) report to the public concerning 

25 progress made by States with respect to the 


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1 performance measures and goals established 

2 under this Act, the periodic progress of the 

3 State relative to its State performance meas4 ures and goals, and the State program applica5 tion procedures, by region and State jurisdic6 tion; 

7 (H) promote information exchange between 

8 States and the Federal Government; and 

9 (I) be responsible for making recommenda10 tions to the Secretary and the Congress, using 

11 equivalency or minimum standards, for mini12 mizing the negative effect of State program on 

13 national employer groups, provider organiza14 tions, and insurers because of differing State 

15 requirements under the programs. 

16 (2) PERIOD OF APPOINTMENT; REPRESENTA17 TION REQUIREMENTS; VACANCIES.—Members shall 

18 be appointed for a term of 5 years. In appointing 

19 such members under paragraph (1)(A), the des20 ignated appointing individuals shall ensure the rep21 resentation of urban and rural areas and an appro22 priate geographic distribution of such members. Any 

23 vacancy in the Commission shall not affect its pow24 ers, but shall be filled in the same manner as the 

25 original appointment. 


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1 (3) CHAIRPERSON, MEETINGS.— 

2 (A) CHAIRPERSON.—The Commission shall 

3 select a Chairperson from among its members. 

4 (B) QUORUM.—A majority of the members 

5 of the Commission shall constitute a quorum, 

6 but a lesser number of members may hold hear7 ings. 

8 (C) MEETINGS.—Not later than 30 days 

9 after the date on which all members of the 

10 Commission have been appointed, the Commis11 sion shall hold its first meeting. The Commis12 sion shall meet at the call of the Chairperson. 

13 (4) POWERS OF THE COMMISSION.— 

14 (A) NEGOTIATIONS WITH STATES.—The 

15 Commission may conduct detailed discussions 

16 and negotiations with States submitting appli17 cations under this section, either individually or 

18 in groups, to facilitate a final set of rec19 ommendations for purposes of subsection 

20 (d)(4)(B). Such negotiations shall include con21 sultations with Indian tribes, and be conducted 

22 in a public forum. 

23 (B) HEARINGS.—The Commission may 

24 hold such hearings, sit and act at such times 

25 and places, take such testimony, and receive 


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1 such evidence as the Commission considers ad2 visable to carry out the purposes of this sub3 section. 

4 (C) MEETINGS.—In addition to other 

5 meetings the Commission may hold, the Com6 mission shall hold an annual meeting with the 

7 participating States under this section for the 

8 purpose of having States report progress to9 ward the purposes in subsection (a)(1) and for 

10 an exchange of information. 

11 (D) INFORMATION.—The Commission may 

12 secure directly from any Federal department or 

13 agency such information as the Commission 

14 considers necessary to carry out the provisions 

15 of this subsection. Upon request of the Chair16 person of the Commission, the head of such de17 partment or agency shall furnish such informa18 tion to the Commission if the head of the de19 partment or agency involved determines it ap20 propriate. 

21 (E) POSTAL SERVICES.—The Commission 

22 may use the United States mails in the same 

23 manner and under the same conditions as other 

24 departments and agencies of the Federal Gov25 ernment. 


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1 (5) PERSONNEL MATTERS.— 

2 (A) COMPENSATION.—Each member of the 

3 Commission who is not an officer or employee 

4 of the Federal Government or of a State or 

5 local government shall be compensated at a rate 

6 equal to the daily equivalent of the annual rate 

7 of basic pay prescribed for level IV of the Exec8 utive Schedule under section 5315 of title 5, 

9 United States Code, for each day (including 

10 travel time) during which such member is en11 gaged in the performance of the duties of the 

12 Commission. All members of the Commission 

13 who are officers or employees of the United 

14 States shall serve without compensation in addi15 tion to that received for their services as offi16 cers or employees of the United States. 

17 (B) TRAVEL EXPENSES.—The members of 

18 the Commission shall be allowed travel ex19 penses, including per diem in lieu of subsist20 ence, at rates authorized for employees of agen21 cies under subchapter I of chapter 57 of title 5, 

22 United States Code, while away from their 

23 homes or regular places of business in the per24 formance of services for the Commission. 


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1 (C) STAFF.—The Chairperson of the Com2 mission may, without regard to the civil service 

3 laws and regulations, appoint and terminate an 

4 executive director and such other additional 

5 personnel as may be necessary to enable the 

6 Commission to perform its duties. The employ7 ment of an executive director shall be subject to 

8 confirmation by the Commission. 

9 (D) DETAIL OF GOVERNMENT EMPLOY10 EES.—Any Federal Government employee may 

11 be detailed to the Commission without reim12 bursement, and such detail shall be without 

13 interruption or loss of civil service status or 

14 privilege. 

15 (E) TEMPORARY AND INTERMITTENT

16 SERVICES.—The Chairperson of the Commis17 sion may procure temporary and intermittent 

18 services under section 3109(b) of title 5, United 

19 States Code, at rates for individuals which do 

20 not exceed the daily equivalent of the annual 

21 rate of basic pay prescribed for level V of the 

22 Executive Schedule under section 5316 of such 

23 title. 

24 (6) FUNDING.—For the purpose of carrying out 

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1 priated $3,000,000 for fiscal year 2006 and each fis2 cal year thereafter. 

3 (d) REQUIREMENTS FOR PROGRAMS.— 

4 (1) STATE PLAN.—A State that seeks to receive 

5 a grant under subsection (f) to operate a program 

6 under this section shall prepare and submit to the 

7 Commission, as part of the application under sub8 section (b), a State health care plan that shall have 

9 as its goal improvements in coverage, quality and 

10 costs. To achieve such goal, the State plan shall 

11 comply with the following: 

12 (A) COVERAGE.—With respect to coverage, 

13 the State plan shall— 

14 (i) provide and describe the manner in 

15 which the State will ensure that an in16 creased number of individuals residing 

17 within the State will have expanded access 

18 to health care coverage with a specific 5- 

19 year target for reduction in the number of 

20 uninsured individuals through either pri21 vate or public program expansion, or both, 

22 in accordance with the options established 

23 by the Commission; 

24 (ii) describe the number and percent25 age of current uninsured individuals who 


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1 will achieve coverage under the State 

2 health program; 

3 (iii) describe the minimum benefits 

4 package that will be provided to all classes 

5 of beneficiaries under the State health pro6 gram; 

7 (iv) identify Federal, State, or local 

8 and private programs that currently pro9 vide health care services in the State and 

10 describe how such programs could be co11 ordinated with the State health program, 

12 to the extent practicable; and 

13 (v) provide for improvements in the 

14 availability of appropriate health care serv15 ices that will increase access to care in 

16 urban, rural, and frontier areas of the 

17 State with medically underserved popu18 lations or where there is an inadequate 

19 supply of health care providers. 

20 (B) QUALITY.—With respect to quality, 

21 the State plan shall— 

22 (i) provide a plan to improve health 

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1 tient focused, equity while reducing health 

2 disparities, and medical errors; and 

3 (ii) contain appropriate results-based 

4 quality indicators established by the Com5 mission that will be addressed by the State 

6 as well as State-specific quality indicators. 

7 (C) COSTS.—With respect to costs, the 

8 State plan shall— 

9 (i) provide that the State will develop 

10 and implement systems to improve the effi11 ciency of health care, including a specific 

12 5-year target for reducing administrative 

13 costs (including paperwork burdens); 

14 (ii) describe the public and private 

15 sector financing to be provided for the 

16 State health program; 

17 (iii) estimate the amount of Federal, 

18 State, and local expenditures, as well as, 

19 the costs to business and individuals under 

20 the State health program; 

21 (iv) describe how the State plan will 

22 ensure the financial solvency of the State 

23 health program; and 

24 (v) provide that the State will prepare 

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1 mission such reports as the Secretary or 

2 Commission may require to carry out pro3 gram evaluations. 

4 (D) HEALTH INFORMATION TECH5 NOLOGY.—With respect to health information 

6 technology, the State plan shall provide method7 ology for the appropriate use of health informa8 tion technology to improve infrastructure, such 

9 as improving the availability of evidence-based 

10 medical and outcomes data to providers and pa11 tients, as well as other health information (such 

12 as electronic health records, electronic billing, 

13 and electronic prescribing). 

14 (2) TECHNICAL ASSISTANCE.—The Secretary 

15 shall, if requested, provide technical assistance to 

16 States to assist such States in developing applica17 tions and plans under this section, including tech18 nical assistance by private sector entities if deter19 mined appropriate by the Commission. 

20 (3) INITIAL REVIEW.—With respect to a State 

21 application for a grant under subsection (b), the 

22 Secretary and the Commission shall complete an ini23 tial review of such State application within 60 days 

24 of the receipt of such application, analyze the scope 

25 of the proposal, and determine whether additional 


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1 information is needed from the State. The Commis2 sion shall advise the State within such period of the 

3 need to submit additional information. 

4 (4) FINAL DETERMINATION.— 

5 (A) IN GENERAL.—Not later than 90 days 

6 after completion of the initial review under 

7 paragraph (3), the Commission shall determine 

8 whether to submit a State proposal to Congress 

9 for approval. 

10 (B) VOTING.— 

11 (i) IN GENERAL.—The determination 

12 to submit a State proposal to Congress 

13 under subparagraph (A) shall be approved 

by 2 14 ⁄3 of the members of the Commission 

15 who are eligible to participate in such de16 termination subject to clause (ii). 

17 (ii) ELIGIBILITY.—A member of the 

18 Commission shall not participate in a de19 termination under subparagraph (A) if— 

20 (I) in the case of a member who 

21 is a Governor, such determination re22 lates to the State of which the mem23 ber is the Governor; or 

24 (II) in the case of member not 

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1 mination relates to the geographic 

2 area of a State of which such member 

3 serves as a State or local official. 

4 (C) SUBMISSION.—Not later than 90 days 

5 prior to October 1 of each fiscal year, the Com6 mission shall submit to Congress a list, in the 

7 form of a legislative proposal, of the State ap8 plications that the Commission recommends for 

9 approval under this section. 

10 (D) APPROVAL.—With respect to a fiscal 

11 year, a State proposal that has been rec12 ommended under subparagraph (B) shall be 

13 deemed to be approved, and subject to the 

14 availability of appropriations, Federal funds 

15 shall be provided to such program, unless a 

16 joint resolution has been enacted disapproving 

17 such proposal as provided for in subsection (e). 

18 Nothing in the preceding sentence shall be con19 strued to include the approval of State pro20 posals that involve waivers or modifications in 

21 applicable Federal law. 

22 (5) PROGRAM OR PROJECT PERIOD.—A State 

23 program or project may be approved for a period of 

24 5 years and may be extended for subsequent 5-year 

25 periods upon approval by the Commission and the 


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1 Secretary, based upon achievement of targets, except 

2 that a shorter period may be requested by a State 

3 and granted by the Secretary. 

4 (e) EXPEDITED CONGRESSIONAL CONSIDERATION.— 

5 (1) INTRODUCTION AND COMMITTEE CONSIDER6 ATION.— 

7 (A) INTRODUCTION.—The legislative pro8 posal submitted pursuant to subsection 

9 (d)(4)(B) shall be in the form of a joint resolu10 tion (in this subsection referred to as the ‘‘reso11 lution’’). Such resolution shall be introduced in 

12 the House of Representatives by the Speaker, 

13 and in the Senate, by the Majority Leader, im14 mediately upon receipt of the language and 

15 shall be referred to the appropriate committee 

16 of Congress. If the resolution is not introduced 

17 in accordance with the preceding sentence, the 

18 resolution may be introduced in either House of 

19 Congress by any member thereof. 

20 (B) COMMITTEE CONSIDERATION.—A reso21 lution introduced in the House of Representa22 tives shall be referred to the Committee on 

23 Ways and Means of the House of Representa24 tives. A resolution introduced in the Senate 

25 shall be referred to the Committee on Finance 


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1 of the Senate. Not later than 15 calendar days 

2 after the introduction of the resolution, the 

3 committee of Congress to which the resolution 

4 was referred shall report the resolution or a 

5 committee amendment thereto. If the committee 

6 has not reported such resolution (or an iden7 tical resolution) at the end of 15 calendar days 

8 after its introduction or at the end of the first 

9 day after there has been reported to the House 

10 involved a resolution, whichever is earlier, such 

11 committee shall be deemed to be discharged 

12 from further consideration of such reform bill 

13 and such reform bill shall be placed on the ap14 propriate calendar of the House involved. 

15 (2) EXPEDITED PROCEDURE.— 

16 (A) CONSIDERATION.—Not later than 5 

17 days after the date on which a committee has 

18 been discharged from consideration of a resolu19 tion, the Speaker of the House of Representa20 tives, or the Speaker’s designee, or the Majority 

21 Leader of the Senate, or the Leader’s designee, 

22 shall move to proceed to the consideration of 

23 the committee amendment to the resolution, 

24 and if there is no such amendment, to the reso25 lution. It shall also be in order for any member 


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1 of the House of Representatives or the Senate, 

2 respectively, to move to proceed to the consider3 ation of the resolution at any time after the 

4 conclusion of such 5-day period. All points of 

5 order against the resolution (and against con6 sideration of the resolution) are waived. A mo7 tion to proceed to the consideration of the reso8 lution is highly privileged in the House of Rep9 resentatives and is privileged in the Senate and 

10 is not debatable. The motion is not subject to 

11 amendment, to a motion to postpone consider12 ation of the resolution, or to a motion to pro13 ceed to the consideration of other business. A 

14 motion to reconsider the vote by which the mo15 tion to proceed is agreed to or not agreed to 

16 shall not be in order. If the motion to proceed 

17 is agreed to, the House of Representatives or 

18 the Senate, as the case may be, shall imme19 diately proceed to consideration of the resolu20 tion without intervening motion, order, or other 

21 business, and the resolution shall remain the 

22 unfinished business of the House of Represent23 atives or the Senate, as the case may be, until 

24 disposed of. 


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1 (B) CONSIDERATION BY OTHER HOUSE.— 

2 If, before the passage by one House of the reso3 lution that was introduced in such House, such 

4 House receives from the other House a resolu5 tion as passed by such other House— 

6 (i) the resolution of the other House 

7 shall not be referred to a committee and 

8 may only be considered for final passage in 

9 the House that receives it under clause 

10 (iii); 

11 (ii) the procedure in the House in re12 ceipt of the resolution of the other House, 

13 with respect to the resolution that was in14 troduced in the House in receipt of the res15 olution of the other House, shall be the 

16 same as if no resolution had been received 

17 from the other House; and 

18 (iii) notwithstanding clause (ii), the 

19 vote on final passage shall be on the re20 form bill of the other House. 

21 Upon disposition of a resolution that is received 

22 by one House from the other House, it shall no 

23 longer be in order to consider the resolution bill 

24 that was introduced in the receiving House. 


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1 (C) CONSIDERATION IN CONFERENCE.— 

2 Immediately upon a final passage of the resolu3 tion that results in a disagreement between the 

4 two Houses of Congress with respect to the res5 olution, conferees shall be appointed and a con6 ference convened. Not later than 10 days after 

7 the date on which conferees are appointed, the 

8 conferees shall file a report with the House of 

9 Representatives and the Senate resolving the 

10 differences between the Houses on the resolu11 tion. Notwithstanding any other rule of the 

12 House of Representatives or the Senate, it shall 

13 be in order to immediately consider a report of 

14 a committee of conference on the resolution 

15 filed in accordance with this subclause. Debate 

16 in the House of Representatives and the Senate 

17 on the conference report shall be limited to 10 

18 hours, equally divided and controlled by the 

19 Speaker of the House of Representatives and 

20 the Minority Leader of the House of Represent21 atives or their designees and the Majority and 

22 Minority Leaders of the Senate or their des23 ignees. A vote on final passage of the con24 ference report shall occur immediately at the 


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1 conclusion or yielding back of all time for de2 bate on the conference report. 

3 (3) RULES OF THE SENATE AND HOUSE OF

4 REPRESENTATIVES.—This subsection is enacted by 

5 Congress— 

6 (A) as an exercise of the rulemaking power 

7 of the Senate and House of Representatives, re8 spectively, and is deemed to be part of the rules 

9 of each House, respectively, but applicable only 

10 with respect to the procedure to be followed in 

11 that House in the case of a resolution, and it 

12 supersedes other rules only to the extent that it 

13 is inconsistent with such rules; and 

14 (B) with full recognition of the constitu15 tional right of either House to change the rules 

16 (so far as they relate to the procedure of that 

17 House) at any time, in the same manner, and 

18 to the same extent as in the case of any other 

19 rule of that House. 

20 (4) LIMITATION.—The amount of Federal 

21 funds provided with respect to any State proposal 

22 that is deemed approved under subsection (d)(3) 

23 shall not exceed the cost provided for such proposals 

24 within the concurrent resolution on the budget as 

25 enacted by Congress for the fiscal year involved. 


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1 (f) FUNDING.— 

2 (1) IN GENERAL.—The Secretary shall provide 

3 a grant to a State that has an application approved 

4 under subsection (b) to enable such State to carry 

5 out an innovative State health program in the State. 

6 (2) AMOUNT OF GRANT.—The amount of a 

7 grant provided to a State under paragraph (1) shall 

8 be determined based upon the recommendations of 

9 the Commission, subject to the amount appropriated 

10 under subsection (k). 

11 (3) PERFORMANCE-BASED FUNDING ALLOCA12 TION AND PRIORITIZATION.—In awarding grants 

13 under paragraph (1), the Secretary shall— 

14 (A) fund a diversity of approaches as pro15 vided for by the Commission in subsection 

16 (c)(1)(B); 

17 (B) give priority to those State programs 

18 that the Commission determines have the great19 est opportunity to succeed in providing ex20 panded health insurance coverage and in pro21 viding children, youth, and other vulnerable 

22 populations with improved access to health care 

23 items and services; and 

24 (C) link allocations to the State to the 

25 meeting of the goals and performance measures 


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1 relating to health care coverage, quality, and 

2 health care costs established under this Act 

3 through the State project application process. 

4 (4) MAINTENANCE OF EFFORT.—A State, in 

5 utilizing the proceeds of a grant received under 

6 paragraph (1), shall maintain the expenditures of 

7 the State for health care coverage purposes for the 

8 support of direct health care delivery at a level equal 

9 to not less than the level of such expenditures main10 tained by the State for the fiscal year preceding the 

11 fiscal year for which the grant is received. 

12 (5) REPORT.—At the end of the 5-year period 

13 beginning on the date on which the Secretary 

14 awards the first grant under paragraph (1), the 

15 State Health Innovation Advisory Commission estab16 lished under subsection (c) shall prepare and submit 

17 to the appropriate committees of Congress, a report 

18 on the progress made by States receiving grants 

19 under paragraph (1) in meeting the goals of ex20 panded coverage, improved quality, and cost contain21 ment through performance measures established 

22 during the 5-year period of the grant. Such report 

23 shall contain the recommendation of the Commission 

24 concerning any future action that Congress should 

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1 er or not to extend the program established under 

2 this subsection. 

3 (g) MONITORING AND EVALUATION.— 

4 (1) ANNUAL REPORTS AND PARTICIPATION BY

5 STATES.—Each State that has received a program 

6 approval shall— 

7 (A) submit to the Commission an annual 

8 report based on the period representing the re9 spective State’s fiscal year, detailing compliance 

10 with the requirements established by the Com11 mission and the Secretary in the approval and 

12 in this section; and 

13 (B) participate in the annual meeting 

14 under subsection (c)(4)(B). 

15 (2) EVALUATIONS BY COMMISSION.—The Com16 mission, in consultation with a qualified and inde17 pendent organization such as the Institute of Medi18 cine, shall prepare and submit to the Committee on 

19 Finance and the Committee on Health, Education, 

20 Labor, and Pensions of the Senate and the Com21 mittee on Energy and Commerce, the Committee on 

22 Education and the Workforce, and the Committee 

23 on Ways and Means of the House of Representatives 

24 annual reports that shall contain— 


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•S 2772 IS 

1 (A) a description of the effects of the re2 forms undertaken in States receiving approvals 

3 under this section; 

4 (B) a description of the recommendations 

5 of the Commission and actions taken based on 

6 these recommendations; 

7 (C) an evaluation of the effectiveness of 

8 such reforms in— 

9 (i) expanding health care coverage for 

10 State residents; 

11 (ii) improving the quality of health 

12 care provided in the States; and 

13 (iii) reducing or containing health 

14 care costs in the States; 

15 (D) recommendations regarding the advis16 ability of increasing Federal financial assistance 

17 for State ongoing or future health program ini18 tiatives, including the amount and source of 

19 such assistance; and 

20 (E) as required by the Commission or the 

21 Secretary under subsection (f)(5), a periodic, 

22 independent evaluation of the program. 

23 (h) NONCOMPLIANCE.— 

24 (1) CORRECTIVE ACTION PLANS.—If a State is 

25 not in compliance with a requirements of this secVerDate Aug 31 2005 21:59 May 10, 2006 Jkt 049200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\S2772.IS S2772

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•S 2772 IS 

1 tion, the Secretary shall develop a corrective action 

2 plan for such State. 

3 (2) TERMINATION.—For good cause and in con4 sultation with the Commission, the Secretary may 

5 revoke any program granted under this section. 

6 Such decisions shall be subject to a petition for re7 consideration and appeal pursuant to regulations es8 tablished by the Secretary. 

9 (i) RELATIONSHIP TO FEDERAL PROGRAMS.— 

10 (1) IN GENERAL.—Nothing in this Act, or in 

11 section 1115 of the Social Security Act (42 U.S.C. 

12 1315) shall be construed as authorizing the Sec13 retary, the Commission, a State, or any other person 

14 or entity to alter or affect in any way the provisions 

15 of title XIX of such Act (42 U.S.C. 1396 et seq.) 

16 or the regulations implementing such title. 

17 (2) MAINTENANCE OF EFFORT.—No payment 

18 may be made under this section if the State adopts 

19 criteria for benefits, income, and resource standards 

20 and methodologies for purposes of determining an 

21 individual’s eligibility for medical assistance under 

22 the State plan under title XIX that are more restric23 tive than those applied as of the date of enactment 

24 of this Act. 

25 (j) MISCELLANEOUS PROVISIONS.— 


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•S 2772 IS 

1 (1) APPLICATION OF CERTAIN REQUIRE2 MENTS.— 

3 (A) RESTRICTION ON APPLICATION OF

4 PREEXISTING CONDITION EXCLUSIONS.— 

5 (i) IN GENERAL.—Subject to subpara6 graph (B), a State shall not permit the im7 position of any preexisting condition exclu8 sion for covered benefits under a program 

9 or project under this section. 

10 (ii) GROUP HEALTH PLANS AND

11 GROUP HEALTH INSURANCE COVERAGE.— 

12 If the State program or project provides 

13 for benefits through payment for, or a con14 tract with, a group health plan or group 

15 health insurance coverage, the program or 

16 project may permit the imposition of a pre17 existing condition exclusion but only inso18 far and to the extent that such exclusion is 

19 permitted under the applicable provisions 

20 of part 7 of subtitle B of title I of the Em21 ployee Retirement Income Security Act of 

22 1974 and title XXVII of the Public Health 

23 Service Act. 

24 (B) COMPLIANCE WITH OTHER REQUIRE25 MENTS.—Coverage offered under the program 


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•S 2772 IS 

1 or project shall comply with the requirements of 

2 subpart 2 of part A of title XXVII of the Public 

3 Health Service Act insofar as such require4 ments apply with respect to a health insurance 

5 issuer that offers group health insurance cov6 erage. 

7 (2) PREVENTION OF DUPLICATIVE PAY8 MENTS.— 

9 (A) OTHER HEALTH PLANS.—No payment 

10 shall be made to a State under this section for 

11 expenditures for health assistance provided for 

12 an individual to the extent that a private in13 surer (as defined by the Secretary by regulation 

14 and including a group health plan (as defined 

15 in section 607(1) of the Employee Retirement 

16 Income Security Act of 1974), a service benefit 

17 plan, and a health maintenance organization) 

18 would have been obligated to provide such as19 sistance but for a provision of its insurance con20 tract which has the effect of limiting or exclud21 ing such obligation because the individual is eli22 gible for or is provided health assistance under 

23 the plan. 

24 (B) OTHER FEDERAL GOVERNMENTAL

25 PROGRAMS.—Except as provided in any other 


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•S 2772 IS 

1 provision of law, no payment shall be made to 

2 a State under this section for expenditures for 

3 health assistance provided for an individual to 

4 the extent that payment has been made or can 

5 reasonably be expected to be made promptly (as 

6 determined in accordance with regulations) 

7 under any other federally operated or financed 

8 health care insurance program, other than an 

9 insurance program operated or financed by the 

10 Indian Health Service, as identified by the Sec11 retary. For purposes of this paragraph, rules 

12 similar to the rules for overpayments under sec13 tion 1903(d)(2) of the Social Security Act shall 

14 apply. 

15 (3) APPLICATION OF CERTAIN GENERAL PROVI16 SIONS.—The following sections of the Social Security 

17 Act shall apply to States under this section in the 

18 same manner as they apply to a State under such 

19 title XIX: 

20 (A) TITLE XIX PROVISIONS.— 

21 (i) Section 1902(a)(4)(C) (relating to 

22 conflict of interest standards). 

23 (ii) Paragraphs (2), (16), and (17) of 

24 section 1903(i) (relating to limitations on 

25 payment). 


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•S 2772 IS 

1 (iii) Section 1903(w) (relating to limi2 tations on provider taxes and donations). 

3 (iv) Section 1920A (relating to pre4 sumptive eligibility for children). 

5 (B) TITLE XI PROVISIONS.— 

6 (i) Section 1116 (relating to adminis7 trative and judicial review), but only inso8 far as consistent with this title. 

9 (ii) Section 1124 (relating to disclo10 sure of ownership and related informa11 tion). 

12 (iii) Section 1126 (relating to disclo13 sure of information about certain convicted 

14 individuals). 

15 (iv) Section 1128A (relating to civil 

16 monetary penalties). 

17 (v) Section 1128B(d) (relating to 

18 criminal penalties for certain additional 

19 charges). 

20 (vi) Section 1132 (relating to periods 

21 within which claims must be filed). 

22 (4) RELATION TO OTHER LAWS.— 

23 (A) HIPAA.—Health benefits coverage 

24 provided under a State program or project 

25 under this section shall be treated as creditable 


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•S 2772 IS 

1 coverage for purposes of part 7 of subtitle B of 

2 title I of the Employee Retirement Income Se3 curity Act of 1974, title XXVII of the Public 

4 Health Service Act, and subtitle K of the Inter5 nal Revenue Code of 1986. 

6 (B) ERISA.—Nothing in this section shall 

7 be construed as affecting or modifying section 

8 514 of the Employee Retirement Income Secu9 rity Act of 1974 (29 U.S.C. 1144) with respect 

10 to a group health plan (as defined in section 

11 2791(a)(1) of the Public Health Service Act (42 

12 U.S.C. 300gg–91(a)(1))). 

13 (k) AUTHORIZATION OF APPROPRIATIONS.—There is 

14 authorized to be appropriated to carry out this section, 

15 such sums as may be necessary in each fiscal year. 

16 Amounts appropriated for a fiscal year under this sub17 section and not expended may be used in subsequent fiscal 

18 years to carry out this section. 

Æ 


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