II 

109TH CONGRESS 

1ST SESSION S. 338 

To provide for the establishment of a Bipartisan Commission on Medicaid. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 9, 2005 

Mr. SMITH (for himself, Mr. BINGAMAN, Ms. SNOWE, Mr. JEFFORDS, Mr. 

SANTORUM, Mr. KERRY, Mr. DEWINE, Mr. DURBIN, Mr. CHAFEE, Mrs. 

LINCOLN, Ms. COLLINS, Mr. NELSON of Nebraska, Mr. VOINOVICH, Mr. 

CORZINE, and Mr. COLEMAN) introduced the following bill; which was 

read twice and referred to the Committee on Finance 

A BILL 

To provide for the establishment of a Bipartisan Commission 

on Medicaid. 

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 ‘‘Bipartisan Commission 

5 on Medicaid Act of 2005’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 

8 (1) The medicaid program under title XIX of 

9 the Social Security Act (42 U.S.C. 1396 et seq.) (in 
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1 this Act referred to as ‘‘Medicaid’’) provides essen2 tial health care and long-term care coverage to low3 income children, pregnant women and families, indi4 viduals with disabilities, and senior citizens consti5 tuting 1 in 6 Americans. 

6 (2) State participation in Medicaid is voluntary, 

7 and all States have elected to participate, admin8 istering the program within broad Federal guide9 lines. 

10 (3) The Federal Government matches the costs 

11 of delivering covered services by participating pro12 viders to individuals entitled to benefits that are in13 curred by State Medicaid programs at rates ranging 

14 from 50 percent to 77 percent, depending upon a 

15 State’s per capita income. 

16 (4) Medicaid pays for health care services for 

over 1 17 ⁄4 of America’s children, including children who 

18 live in poverty. 

19 (5) Medicaid is America’s largest single purchaser of maternity care, paying for over 1 20 ⁄3 of all 

21 the births in the Nation each year. 

22 (6) Although low-income children and their parents make up 3 23 ⁄4 of the recipients of benefits under 

24 Medicaid, they account for only 30 percent of Med25 icaid spending. 
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1 (7) Medicaid is America’s single largest pur2 chaser of nursing home services and other long-term 

3 care, covering the majority of nursing home resi4 dents. 

5 (8) Medicaid is an essential supplement to the 

6 medicare program under title XVIII of the Social 

7 Security Act (42 U.S.C. 1395 et seq.) (in this Act 

8 referred to as ‘‘Medicare’’) for over 6,000,000 low9 income elderly and disabled Medicare beneficiaries, 

10 assisting them with their Medicare premiums and 

11 co-insurance and, in most cases, the costs of nursing 

12 home care that Medicare does not cover. 

13 (9) The elderly and individuals with disabilities 

comprise 1 14 ⁄4 of the recipients of benefits under Med15 icaid and 70 percent of Medicaid spending on serv16 ices. 

17 (10) States will be required, beginning in 2006, 

18 to contribute billions of dollars to the Federal Gov19 ernment to help finance the Medicare prescription 

20 drug benefit established under part D of title XVIII 

21 of the Social Security Act. 

22 (11) Medicaid pays for personal care and other 

23 supportive services necessary to enable individuals 

24 with disabilities to remain in the community, to 

25 work, and to maintain independence. 
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1 (12) Medicaid is the single largest source of 

2 revenue for the Nation’s safety net hospitals and 

3 health centers and is critical to the ability of these 

4 providers to continue to serve medicaid enrollees and 

5 uninsured Americans. 

6 (13) Medicaid is the single largest Federal 

7 grant-in-aid program to the States, accounting for 

8 over 40 percent of all Federal grants to States. 

9 (14) Medicaid serves a major role in ensuring 

10 that the number of Americans without health insur11 ance, approximately 45,000,000, is not substantially 

12 higher. 

13 (15) Medicaid finances services for many spe14 cial health care needs populations, providing health 

15 care for 55 percent of all individuals living with 

16 HIV/AIDS and 60 percent of all public mental 

17 health care for people with severe mental illnesses. 

18 (16) Medicaid’s multiple roles present financial 

19 challenges for Federal, and State governments that 

20 warrant a comprehensive review in light of the in21 creasing number of uninsured Americans and the in22 creasing number of low-income Americans in need of 

23 long-term care services. 
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1 SEC. 3. BIPARTISAN COMMISSION ON MEDICAID. 

2 (a) ESTABLISHMENT.—There is established a com3 mission to be known as the Bipartisan Commission on 

4 Medicaid (in this section referred to as the ‘‘Commis5 sion’’). The Commission shall locate its headquarters in 

6 the District of Columbia. 

7 (b) MEMBERSHIP.— 

8 (1) APPOINTMENT.—The Commission shall be 

9 composed of 23 members to be appointed as follows: 

10 (A) One member shall be appointed by the 

11 President. 

12 (B) Three members shall be appointed by 

13 the majority leader of the Senate of whom— 

14 (i) one shall be a Member or former 

15 Member of Congress; 

16 (ii) one shall be an advocate for popu17 lations who are served by Medicaid; and 

18 (iii) one shall be a health care pro19 vider that provides a disproportionate 

20 share of care to recipients of benefits 

21 under Medicaid or a representative of an 

22 organization that represent such providers. 

23 (C) Three members shall be appointed by 

24 the minority leader of the Senate of whom— 

25 (i) one shall be a Member or former 

26 Member of Congress; 
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1 (ii) one shall be an advocate for popu2 lations who are served by Medicaid; and 

3 (iii) one shall be a health care pro4 vider that provides a disproportionate 

5 share of care to recipients of benefits 

6 under Medicaid or a representative of an 

7 organization that represent such providers. 

8 (D) Three members shall be appointed by 

9 the Speaker of the House of Representatives of 

10 whom— 

11 (i) one shall be a Member or former 

12 Member of Congress; 

13 (ii) one shall be an advocate for popu14 lations who are served by Medicaid; and 

15 (iii) one shall be a health care pro16 vider that provides a disproportionate 

17 share of care to recipients of benefits 

18 under Medicaid or a representative of an 

19 organization that represent such providers. 

20 (E) Three members shall be appointed by 

21 the minority leader of the House of Representa22 tives of whom— 

23 (i) one shall be a Member or former 

24 Member of Congress; 
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1 (ii) one shall be an advocate for popu2 lations who are served by Medicaid; and 

3 (iii) one shall be a health care pro4 vider that provides a disproportionate 

5 share of care to recipients of benefits 

6 under Medicaid or a representative of an 

7 organization that represent such providers. 

8 (F) Two members shall be appointed by 

9 the National Governors Association and shall be 

10 chief executive officers of a State who are not 

11 of the same political party. 

12 (G) Two members shall be appointed by 

13 the National Conference of State Legislatures 

14 and shall be members of a State legislature who 

15 are not of the same political party. 

16 (H) Two members shall be appointed by 

17 the National Association of State Medicaid Di18 rectors and shall be chief officials responsible 

19 for administering Medicaid in a State who are 

20 not of the same political party. 

21 (I) Two members shall be appointed by the 

22 National Association of Counties and shall be 

23 officials of a local government involved in Med24 icaid financing or that directly provides medical 

25 services to Medicaid beneficiaries and uninsured 
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1 individuals who are not of the same political 

2 party. 

3 (J) Two members shall be appointed by 

4 the Comptroller General of the United States 

5 and shall be health policy experts with special 

6 expertise regarding Medicaid or the populations 

7 served by Medicaid who are not of the same po8 litical party. 

9 (2) QUALIFICATIONS.—The members of the 

10 Commission appointed under paragraph (1), shall 

11 reflect— 

12 (A) a broad geographic representation; and 

13 (B) a balance between urban and rural 

14 representation. 

15 (3) DEADLINE FOR APPOINTMENT.—Members 

16 of the Commission shall be appointed by not later 

17 than the 60th day after the date of enactment of 

18 this Act. 

19 (c) DUTIES OF COMMISSION.— 

20 (1) IN GENERAL.—The Commission shall— 

21 (A) review and make recommendations 

22 with respect to each of Medicaid’s major func23 tional responsibilities, including being— 
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1 (i) a source of coverage for low-income 

2 children, pregnant women, and some par3 ents; 

4 (ii) a payer for a complex range of 

5 acute and long-term care services for the 

6 frail elderly and individuals with disabil7 ities, including the medically needy; 

8 (iii) the source of wrap-around cov9 erage or assistance for low-income seniors 

10 and individuals with disabilities on Medi11 care, including coverage of additional bene12 fits and assistance with Medicare pre13 miums and copayments; and 

14 (iv) the primary source of funding to 

15 safety net providers that serve both Med16 icaid patients and the 45,000,000 unin17 sured; 

18 (B) review and make recommendations for 

19 a clearer delineation of— 

20 (i) the Federal and State roles and re21 sponsibilities under Medicaid; and 

22 (ii) the interaction of Medicaid with 

23 Medicare and other Federal health pro24 grams; 
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1 (C) review and identify issues that either 

2 threaten or could improve the long-term finan3 cial condition of Medicaid, including forth4 coming demographic changes, Federal and 

5 State revenue options, private sector health cov6 erage, and health care information; 

7 (D) review the Federal matching payments 

8 and requirements under Medicaid, and issues 

9 related to such payments and requirements, and 

10 make recommendations on how to make such 

11 payments more equitable with respect to the 

12 populations served and the States, and on how 

13 to improve the program’s responsiveness to 

14 changes in economic conditions; 

15 (E) review and make recommendations 

16 with respect to health care for individuals du17 ally eligible for both Medicare and Medicaid, in18 cluding issues related to Federal, State, pro19 vider, and beneficiary responsibilities, coordina20 tion, and outcomes; 

21 (F) review research and data with respect 

22 to health disparities for populations served by 

23 Medicaid, particularly with respect to individ24 uals with disabilities or special health care 

25 needs, and make recommendations on how to 
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1 improve health quality, coordination of services 

2 and providers, and access to health care for vul3 nerable populations, including the implementa4 tion of managed care protections for Medicaid 

5 enrollees with special health care needs; 

6 (G) review Federal and State policies for 

7 enrollment (including enrollment sites), income 

8 eligibility (including methodology and length of 

9 eligibility periods), outreach, and documentation 

10 with respect to Medicaid and Medicare and 

11 make recommendations on how to simplify such 

12 policies and improve enrollment and retention 

13 in such programs and coordination with other 

14 Federal and State programs to improve service 

15 delivery and coverage; 

16 (H) review the operation and effectiveness 

17 of Medicaid premium assistance programs, in18 cluding the payment of premiums under section 

19 1906(a)(3) of the Social Security Act (42 

20 U.S.C. 1396e(a)(3)) and payment waivers 

21 under section 1115 of such Act (42 U.S.C. 

22 1315), and the adequacy of covered benefits, af23 fordability of cost-sharing and premiums, and 

24 access to care under such programs; 
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1 (I) review and make recommendations re2 garding payment policies under Medicaid, in3 cluding the adequacy of such policies with re4 spect to— 

5 (i) managed care plans (including 

6 payment policies for single benefit man7 aged care arrangements, such as managed 

8 behavioral health and dental care); 

9 (ii) providers in managed care, fee10 for-service, long-term care, and primary 

11 care case management settings; and 

12 (iii) measures to assure and reward 

13 quality and access to care for Medicaid en14 rollees; 

15 (J) review how Medicare payment policies 

16 impact Medicaid and make recommendations on 

17 ways to address specific payment problems that 

18 such policies may create in service delivery to 

19 populations typically not covered by Medicare, 

20 such as children and pregnant women; 

21 (K) review payments to safety net pro22 viders, including a review of— 

23 (i) the adjustments to payments under 

24 Medicaid— 
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1 (I) under section 1923 of the So2 cial Security Act (42 U.S.C. 1396r–4) 

3 for inpatient hospital services fur4 nished by disproportionate share hos5 pitals; and 

6 (II) under section 1902(bb) of 

7 such Act (42 U.S.C. 1396a(bb)) for 

8 payments to federally-qualified health 

9 centers and rural health clinics; and 

10 (ii) other payments that impact the 

11 capacity of the health care safety net to 

12 care for uninsured individuals, recipients of 

13 benefits under Medicaid, and other vulner14 able populations; 

15 (L) review interstate payment, enrollment, 

16 access, and quality concerns with respect to re17 cipients of benefits under Medicaid that are 

18 served by interstate providers, and make rec19 ommendations on ways to improve interstate 

20 health care delivery; 

21 (M) review and make recommendations 

22 with respect to financing and other issues im23 pacting Commonwealth and territorial programs 

24 as compared to other States; and 
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1 (N) review and make recommendations on 

2 such other matters related to Medicaid as the 

3 Commission deems appropriate. 

4 (2) ANALYSIS OF EFFECT OF EACH REC5 OMMENDATION.—Each recommendation required 

6 under paragraph (1) shall include an analysis of the 

7 effect of the recommendation under Medicaid and, if 

8 applicable, Medicare and other Federal health pro9 grams, on— 

10 (A) Federal and State expenditures; 

11 (B) provider payment rates; 

12 (C) beneficiary out-of-pocket expenditures; 

13 (D) beneficiary access to covered items and 

14 services; and 

15 (E) coverage of items and services. 

16 (3) EXPERT ADVICE.—The Comptroller General 

17 of the United States and the Director of the Con18 gressional Research Service shall advise the Commis19 sion on the methodology to be used in identifying 

20 problems and analyzing potential solutions in ac21 cordance with the duties of the Commission de22 scribed in paragraph (1). 

23 (d) GENERAL ADMINISTRATIVE PROVISIONS.— 
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1 (1) TERMS OF APPOINTMENT.—The members 

2 of the Commission shall be appointed for the life of 

3 the Commission. 

4 (2) VACANCIES.—A vacancy on the Commission 

5 shall be filled, not later than 30 days after the date 

6 on which the Commission is given notice of the va7 cancy, in the same manner in which the original ap8 pointment was made. 

9 (3) CHAIRPERSON AND VICE CHAIRPERSON.— 

10 The Commission shall designate 2 of its members to 

11 serve as the chairperson and vice chairperson of the 

12 Commission. 

13 (4) MEETINGS.—The Commission shall meet at 

14 the call of the chairperson of the Commission. 

15 (5) QUORUM.—Twelve members of the Commis16 sion shall constitute a quorum for purposes of vot17 ing, but a lesser number of members may meet and 

18 hold hearings. 

19 (6) COMPENSATION AND EXPENSES.— 

20 (A) COMPENSATION.—Except as provided 

21 in subparagraph (B), members of the Commis22 sion shall receive no additional pay, allowances, 

23 or benefits by reason of their service on the 

24 Commission. 
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1 (B) EXPENSES.—While away from their 

2 homes or regular places of business in the per3 formance of services for the Commission, mem4 bers of the Commission shall be allowed travel 

5 expenses, including per diem in lieu of subsist6 ence, at rates authorized for employees of agen7 cies under subchapter I of chapter 57 of title 5, 

8 United States Code. 

9 (7) ETHICAL DISCLOSURE.—The Comptroller 

10 General of the United States shall establish and im11 plement a system for public disclosure of financial 

12 and other potential conflicts of interest by members 

13 of the Commission. 

14 (e) STAFF AND SUPPORT SERVICES.— 

15 (1) EXECUTIVE DIRECTOR.—The chairperson 

16 and vice-chair shall appoint an executive director of 

17 the Commission. 

18 (2) STAFF.—With the approval of the Commis19 sion, the executive director may appoint such per20 sonnel as the executive director determines to be ap21 propriate. 

22 (3) APPLICABILITY OF CIVIL SERVICE LAW; 

23 ETC.—The executive director and staff of the Com24 mission shall be appointed without regard to the 

25 provisions of title 5, United States Code, governing 
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1 appointment in the competitive service, and shall be 

2 paid without regard to chapter 51 and subchapter 

3 III of chapter 53 of title 5, United States Code, re4 lating to classification of positions and General 

5 Schedule pay rates, except that the rate of pay for 

6 the executive director and other personnel may not 

7 exceed the rate payable for level V of the Executive 

8 Schedule under section 5316 of such title. 

9 (4) EXPERTS AND CONSULTANTS.—With the 

10 approval of the Commission, the executive director 

11 may procure temporary and intermittent services 

12 under section 3109(b) of title 5, United States Code. 

13 (5) FEDERAL AGENCIES.— 

14 (A) STAFF OF OTHER FEDERAL AGEN15 CIES.—Upon the request of the Commission, 

16 the head of any Federal agency may detail, 

17 without reimbursement, any of the personnel of 

18 such agency to the Commission to assist in car19 rying out the duties of the Commission. Any 

20 such detail shall not interrupt or otherwise af21 fect the civil service status or privileges of the 

22 Federal employee. 

23 (B) TECHNICAL ASSISTANCE.—Upon the 

24 request of the Commission, the head of a Fed25 eral agency shall provide such technical assist-
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1 ance to the Commission as the Commission de2 termines to be necessary to carry out its duties. 

3 (6) OTHER RESOURCES.—The Commission 

4 shall have reasonable access to materials, resources, 

5 statistical data, and other information from the Li6 brary of Congress and agencies and elected rep7 resentatives of the executive and legislative branches 

8 of the Federal Government. The chairperson or vice9 chair of the Commission shall make requests for 

10 such access in writing when necessary. 

11 (7) GAO SERVICES.— 

12 (A) PHYSICAL FACILITIES.—The Adminis13 trator of General Services shall locate suitable 

14 office space for the operation of the Commis15 sion. The facilities shall serve as the head16 quarters of the Commission and shall include 

17 all necessary equipment and incidentals re18 quired for the proper functioning of the Com19 mission. 

20 (B) ADMINISTRATIVE SUPPORT SERV21 ICES.—Upon the request of the Commission, 

22 the Administrator of General Services shall pro23 vide to the Commission, on a reimbursable 

24 basis, such administrative support services as 

25 the Commission may request. 
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1 (f) POWERS OF THE COMMISSION.— 

2 (1) HEARINGS.—The Commission shall conduct 

3 public hearings or forums at the discretion of the 

4 Commission, at any time and place the Commission 

5 is able to secure facilities and witnesses, for the pur6 pose of carrying out the duties of the Commission. 

7 (2) STUDIES OR INVESTIGATIONS.—Upon the 

8 request of the Commission, the Comptroller General 

9 of the United States, the Medicare Payment Advi10 sory Commission, or the Director of the Congres11 sional Research Service shall conduct such studies or 

12 investigations as the Commission determines to be 

13 necessary to carry out its duties. 

14 (3) COST ESTIMATES.—The Director of the 

15 Congressional Budget Office, the Chief Actuary of 

16 the Centers for Medicare & Medicaid Services, the 

17 Medicare Payment Advisory Commission, or all 

18 three, shall provide to the Commission, upon the re19 quest of the Commission and without reimburse20 ment, such cost estimates as the Commission deter21 mines to be necessary to carry out its duties. 

22 (4) GIFTS.—The Commission may accept, use, 

23 and dispose of gifts or donations of services or prop24 erty. 
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1 (5) MAILS.—The Commission may use the 

2 United States mails in the same manner and under 

3 the same conditions as Federal agencies. 

4 (g) REPORT.— 

5 (1) IN GENERAL.—Not later than 14 months 

6 after the date of enactment of this Act, the Commis7 sion shall prepare and submit a report that contains 

8 a detailed statement of the recommendations, find9 ings, and conclusions of the Commission (as deter10 mined in accordance with paragraph (3)) to each of 

11 the following: 

12 (A) The President. 

13 (B) The Committee on Finance of the Sen14 ate. 

15 (C) The Committee on Energy and Com16 merce of the House of Representatives. 

17 (D) The chief executive officer of each 

18 State. 

19 (2) AVAILABILITY.—The report shall be made 

20 available to the public. 

21 (3) RECOMMENDATIONS, FINDINGS, AND CON22 CLUSIONS.—The recommendations, findings, and 

23 conclusions of the Commission shall be included in 

24 the report under paragraph (1) only if— 
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1 (A) each member of the Commission has 

2 had an opportunity to vote on such rec3 ommendation, finding, or conclusion; 

4 (B) the results of the vote are printed in 

5 the report, including a record of how each mem6 ber voted; and 

7 (C) at least 14 of the 23 members of the 

8 Commission voted in favor of such rec9 ommendation, finding, or conclusion. 

10 (h) AUTHORIZATION OF APPROPRIATIONS.—There is 

11 authorized to be appropriated to the Commission such 

12 sums as may be necessary to carry out this section. 

13 (i) DEFINITION OF STATE.—In this Act, the term 

14 ‘‘State’’ has the meaning given such term for purposes of 

15 title XIX of the Social Security Act (42 U.S.C. 1396 et 

16 seq.). 

17 (j) TERMINATION.—The Commission shall terminate 

18 on the date that is 30 days after the date on which the 

19 Commission submits the report under subsection (g) to the 

20 President, Congress, and the chief executive officer of each 

21 State. 

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