II 

113TH CONGRESS 

2D SESSION S. 1980 

To amend titles XIX and XXI of the Social Security Act to provide for 

12-month continuous enrollment under the Medicaid program and Children’s Health Insurance Program and to promote quality care. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 3, 2014 

Mr. ROCKEFELLER introduced the following bill; which was read twice and 

referred to the Committee on Finance 

A BILL 

To amend titles XIX and XXI of the Social Security Act 

to provide for 12-month continuous enrollment under 

the Medicaid program and Children’s Health Insurance 

Program and to promote quality care. 

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 ‘‘Medicaid and CHIP 

5 Continuous Quality Act of 2014’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) Every year millions of people are enrolled in 

2 Medicaid and the Children’s Health Insurance Pro3 gram (in this section referred to as ‘‘CHIP’’), but 

4 subsequently lose their coverage, despite still being 

5 eligible, because of inefficient and cumbersome pa6 perwork and logistical requirements. 

7 (2) Data show that the typical enrollee receives 

8 Medicaid coverage for about three-quarters of the 

9 year. Coverage periods are lower for non-elderly, 

10 non-disabled adults than for those with disabilities, 

11 seniors, and children. 

12 (3) Medicaid enrollees with coverage disruption 

13 are more likely to be hospitalized for illnesses like 

14 asthma, diabetes, or cardiovascular disease that can 

15 be effectively managed through ongoing primary 

16 medical care and medication, are less likely to be 

17 screened for breast cancer, and may have poorer 

18 cancer outcomes. 

19 (4) Children enrolled in CHIP also experience 

20 disruptions in health coverage and care. For exam21 ple, during just a one-year period, over one-third of 

22 CHIP enrollees were also enrolled in a State’s Med23 icaid program. Transitions between Medicaid and 

24 CHIP can cause disruptions in care because the 


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1 health care coverage and participating providers vary 

2 between the two programs. 

3 (5) Interruptions in coverage can impair the re4 ceipt of effective primary care and lead to expensive 

5 hospitalizations or emergency room visits. 

6 (6) Unnecessary enrollment, disenrollment and 

7 reenrollment in Medicaid and CHIP result in higher 

8 administrative expenses for reenrollment and result 

9 in more people uninsured at any given time. 

10 (7) Stable coverage under Medicaid and CHIP 

11 lowers average monthly medical costs. Continuous 

12 enrollment also permits better prevention and dis13 ease management, leading to fewer serious illnesses 

14 and hospitalizations. 

15 (8) Children with stable coverage are less likely 

16 to have unmet medical needs, allowing children to 

17 receive the preventive care that is necessary to help 

18 them grow into healthy adults. 

19 (9) For the majority of Medicaid enrollees who 

20 are served by Primary Care Case Management 

21 (PCCM) or fee-for-service arrangements, there are 

22 no Federal requirements for comparable quality 

23 monitoring or improvement. No structured oversight 

24 exists for Medicaid enrollees when they move be25 tween fee-for-service and capitated managed care 


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1 plans. Thus, there currently is no ability to make 

2 fair assessments across all modes of care for Med3 icaid enrollees. 

4 SEC. 3. 12-MONTH CONTINUOUS ENROLLMENT. 

5 (a) REQUIREMENT OF 12-MONTH CONTINUOUS EN6 ROLLMENT UNDER MEDICAID.— 

7 (1) IN GENERAL.—Section 1902(e)(12) of the 

8 Social Security Act (42 U.S.C. 1396a(e)), is amend9 ed to read as follows: 

10 ‘‘(12) 12-MONTH CONTINUOUS ENROLLMENT.— 

11 ‘‘(A) IN GENERAL.—Notwithstanding any 

12 other provision of this title, a State plan ap13 proved under this title (or under any waiver of 

14 such plan approved pursuant to section 1115 or 

15 section 1915), shall provide that an individual 

16 who is determined to be eligible for benefits 

17 under such plan (or waiver) shall remain eligi18 ble and enrolled for such benefits through the 

19 end of the month in which the 12-month period 

20 (beginning on the date of determination of eligi21 bility) ends. 

22 ‘‘(B) PROMOTING RETENTION OF ELIGI23 BLE AND ENROLLED PERSONS BEYOND 12

24 MONTHS.—The Secretary shall— 


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1 ‘‘(i) identify methods that promote the 

2 retention of individuals who are enrolled 

3 under the State plan and who remain eligi4 ble for medical assistance beyond the 12- 

5 month period described in subparagraph 

6 (A); and 

7 ‘‘(ii) actively promote the adoption of 

8 such enrollment retention methods by 

9 States, which should include but not be 

10 limited to issuing guidance and developing 

11 resources on State best practices. 

12 ‘‘(C) ENROLLMENT AND RETENTION RE13 PORTING.— 

14 ‘‘(i) IN GENERAL.—Not later than 

15 September 30, 2014, the Secretary shall 

16 publish the procedures that States are ex17 pected to use to provide annual enrollment 

18 and retention reports beginning September 

19 30, 2015. 

20 ‘‘(ii) STATE REPORTING REQUIRE21 MENTS.—At a minimum, such reporting 

22 procedures shall include a description of 

23 State eligibility criteria and enrollment 

24 procedures under this title, and data re25 garding enrollment and retention using 


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1 standardized reporting formats determined 

2 by the Secretary. 

3 ‘‘(iii) SECRETARY REPORT AND PUB4 LICATION.—The Secretary shall annually 

5 publish enrollment and retention perform6 ance results for all States beginning not 

7 later than June 30, 2016. 

8 ‘‘(iv) Each such annual report shall 

9 include estimates of Medicaid enrollment 

10 continuity ratios for each State. In this 

11 clause, the term ‘enrollment continuity 

12 ratio’ means, for a given group, the ratio 

13 of the average monthly enrollment of that 

14 group in the fiscal year divided by the total 

15 unduplicated enrollment for that group in 

16 the fiscal year, expressed as a percentage. 

17 ‘‘(v) For purposes of such reports, the 

18 Secretary shall develop both overall ratios 

19 for all enrollees and separate ratios for the 

20 following categories: 

21 ‘‘(I) Children. 

22 ‘‘(II) Individuals whose eligibility 

23 category is related to being equal to 

24 or over the age of 65. 


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1 ‘‘(III) Individuals whose eligi2 bility category is related to disability 

3 or blindness. 

4 ‘‘(IV) Individuals whose eligibility 

5 category is related to their status as 

6 parents and caretaker relatives of chil7 dren under 19 or who are otherwise 

8 not elderly, blind or disabled adults.’’. 

9 (b) REQUIREMENT OF 12-MONTH CONTINUOUS EN10 ROLLMENT UNDER CHIP.— 

11 (1) IN GENERAL.—Section 2102(b) of the So12 cial Security Act (42 U.S.C. 1397bb(b)) is amended 

13 by adding at the end the following new paragraph: 

14 ‘‘(6) REQUIREMENT FOR 12-MONTH CONTIN15 UOUS ENROLLMENT.—Notwithstanding any other 

16 provision of this title, a State child health plan that 

17 provides child health assistance under this title 

18 through a means other than described in section 

19 2101(a)(2), shall provide that an individual who is 

20 determined to be eligible for benefits under such 

21 plan shall remain eligible and enrolled for such bene22 fits through the end of the month in which the 12- 

23 month period (beginning on the date of determina24 tion of eligibility) ends.’’. 


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1 (2) CONFORMING AMENDMENT.—Section 

2 2105(a)(4)(A) of the Social Security Act (42 U.S.C. 

3 1397ee(a)(4)(A)) is amended— 

4 (A) by striking ‘‘has elected the option of’’ 

5 and inserting ‘‘is in compliance with the re6 quirement for’’; and 

7 (B) by striking ‘‘applying such policy 

8 under its State child health plan under this 

9 title’’ and inserting ‘‘in compliance with section 

10 2102(b)’’. 

11 (c) EFFECTIVE DATE.— 

12 (1) IN GENERAL.—Except as provided in para13 graph (2) or (3), the amendments made by sub14 sections (a) and (b) shall apply to determinations 

15 (and redeterminations) of eligibility made on or after 

16 the date that is 18 months after the date of the en17 actment of this Act. 

18 (2) EXTENSION OF EFFECTIVE DATE FOR

19 STATE LAW AMENDMENT.—In the case of a State 

20 plan under title XIX or State child health plan 

21 under title XXI of the Social Security Act (42 

22 U.S.C. 1396 et seq., 42 U.S.C. 1397aa et seq.) 

23 which the Secretary of Health and Human Services 

24 determines requires State legislation (other than leg25 islation appropriating funds) in order for the respecVerDate Mar 15 2010 00:36 Feb 13, 2014 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1980.IS S1980

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1 tive plan to meet the additional requirement imposed 

2 by the amendment made by subsection (a) or (b), re3 spectively, the respective plan shall not be regarded 

4 as failing to comply with the requirements of such 

5 title solely on the basis of its failure to meet such 

6 applicable additional requirement before the first 

7 day of the first calendar quarter beginning after the 

8 close of the first regular session of the State legisla9 ture that begins after the date of enactment of this 

10 Act. For purposes of the previous sentence, in the 

11 case of a State that has a 2-year legislative session, 

12 each year of the session is considered to be a sepa13 rate regular session of the State legislature. 

14 (3) OPTION TO IMPLEMENT 12-MONTH CONTIN15 UOUS ELIGIBILITY PRIOR TO EFFECTIVE DATE.—A 

16 State may elect through a State plan amendment 

17 under title XIX or XXI of the Social Security Act 

18 (42 U.S.C. 1396 et seq., 42 U.S.C. 1397aa et seq.) 

19 to apply the amendment made by subsection (a) or 

20 (b), respectively, on any date prior to the 18-month 

21 date specified in paragraph (1), but not sooner than 

22 the date of the enactment of this Act. 


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1 SEC. 4. PREVENTING THE APPLICATION UNDER CHIP OF 

2 COVERAGE WAITING PERIODS. 

3 (a) IN GENERAL.—Section 2102(b)(1)(B) of the So4 cial Security Act (42 U.S.C. 1397bb(b)(1)(B)) is amend5 ed— 

6 (1) in clause (iii)— 

7 (A) by striking ‘‘in the case of’’ and insert8 ing ‘‘in the case of a targeted low-income child 

9 (including a child provided dental-only supple10 mental coverage under section 2110(b)(5)) or in 

11 the case of’’; and 

12 (B) by adding ‘‘and’’ after the semicolon; 

13 (2) by striking clause (iv); and 

14 (3) by redesignating clause (v) as clause (iv). 

15 (b) CONFORMING AMENDMENTS.—Section 

16 2105(c)(10) of the Social Security Act (42 U.S.C. 

17 1397ee(c)(10)) is amended by striking subparagraph (F) 

18 and redesignating subparagraphs (G) through (M) as sub19 paragraphs (F) through (L), respectively. 

20 (c) EFFECTIVE DATE.—The amendments made by 

21 this section shall take effect on the date of enactment of 

22 this Act. 


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1 SEC. 5. PERFORMANCE BONUSES FOR ENROLLMENT AND 

2 RETENTION IMPROVEMENTS FOR CERTAIN 

3 INDIVIDUALS. 

4 (a) MEDICAID.—Section 1903 of the Social Security 

5 Act (42 U.S.C. 1396b) is amended by adding at the end 

6 the following new subsection: 

7 ‘‘(aa) PERFORMANCE BONUSES FOR ENROLLMENT

8 AND RETENTION OF LOW-INCOME INDIVIDUALS.— 

9 ‘‘(1) IN GENERAL.—In addition to performance 

10 bonuses for enrollment and retention described in 

11 section 2105(a) (related to children), a State may 

12 qualify for 1 or more performance bonuses related to 

13 the enrollment and retention of individuals described 

14 in section 1902(e)(12)(C)(iii)(III). For purposes of 

15 this paragraph, a State meets the condition of this 

16 paragraph for such individuals if, for each category 

17 of individuals specified in section 

18 1902(e)(12)(C)(iii)(III) and selected by the State for 

19 additional enrollment and retention provisions, the 

20 State is implementing at least 3 of the following en21 rollment and retention provisions (treating each sub22 paragraph as a separate enrollment and retention 

23 provision) throughout the entire fiscal year: 

24 ‘‘(A) ALIGNING TREATMENT OF INCOME

25 UNDER MEDICAID WITH THAT OF OTHER IN26 SURANCE AFFORDABILITY PROGRAMS.—The 


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1 State implements policies, including prorating 

2 income over annual periods, so as to align its 

3 treatment of income for purposes of a deter4 mination of eligibility for medical assistance 

5 with that of other affordability insurance pro6 grams with the goal of eliminating inconsistent 

7 determinations among these programs. 

8 ‘‘(B) MAINTAINING COVERAGE FOR INDI9 VIDUALS DURING PERIODS OF TRANSITION.— 

10 ‘‘(i) IN GENERAL.—Upon determina11 tion that an individual is no longer eligible 

12 for medical assistance, the State imple13 ments policies to maintain eligibility for 

14 medical assistance, including enrollment in 

15 the managed care organization in which 

16 the individual was enrolled at the time of 

17 the determination of ineligibility, during 

18 the period of time in which— 

19 ‘‘(I) eligibility-related information 

20 is transmitted to the other insurance 

21 affordability programs; 

22 ‘‘(II) a determination is made as 

23 to for which other insurance afford24 ability program the individual is eligi25 ble; and 


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1 ‘‘(III) coverage in such program 

2 and any related managed care organi3 zation becomes effective. 

4 ‘‘(ii) MANAGED CARE ORGANIZATION

5 CONTINUITY.—The State shall also imple6 ment policies to enroll the individual in the 

7 managed care organization in which the in8 dividual was a member prior to the loss of 

9 medical assistance eligibility, if such man10 aged care organization participates in the 

11 other insurance affordability program, un12 less the individual voluntarily selects a sep13 arate managed care organization. 

14 ‘‘(C) ENHANCED DATA-SHARING BETWEEN

15 AGENCIES.—The State utilizes findings from an 

16 American Health Benefit Exchange, an Express 

17 Lane Agency (as identified by the State and as 

18 described in section 1902(e)(13)(F)) or the So19 cial Security Administration or other agencies 

20 administering employment, educational, or so21 cial services programs as identified by the 

22 State, to document income, assets, residency, 

23 age or other relevant information in deter24 mining or renewing eligibility. 


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1 ‘‘(D) ELIGIBILITY BASED ON PENDING

2 STATUS.—The State maintains eligibility for 

3 enrollees whose renewal status has not yet been 

4 determined and for whom eligibility based on 

5 alternative eligibility criteria has not yet been 

6 ruled out. 

7 ‘‘(E) DEFAULT REENROLLMENT IN MAN8 AGED CARE ORGANIZATION.—In the case of in9 dividuals who are determined to be eligible for 

10 medical assistance under this title after the loss 

11 of eligibility for fewer than 6 months, and who 

12 previously had been members of a managed 

13 care organization, the State re-enrolls the indi14 vidual in the managed care organization in 

15 which the individual was a member prior to the 

16 loss of eligibility, unless the individual volun17 tarily selects a separate managed care organiza18 tion. 

19 ‘‘(2) PERFORMANCE BONUS PAYMENT TO OFF20 SET COSTS RESULTING FROM 12-MONTH CONTIN21 UOUS ENROLLMENT FOR MEDICAID ENROLLEES.— 

22 ‘‘(A) AUTHORITY TO MAKE BONUS PAY23 MENTS.— 

24 ‘‘(i) IN GENERAL.—In addition to the 

25 payments provided under section 2105(a) 


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1 of the Social Security Act, subject to sub2 paragraph (C) the Secretary shall make 

3 payments to a State (beginning with fiscal 

4 year 2016) that satisfies the requirements 

5 of subparagraph (B). 

6 ‘‘(ii) REGULATIONS.—Payments to 

7 States shall be allocated annually among 

8 States in accordance with regulations pro9 mulgated by the Secretary not later than 

10 July 1, 2015. 

11 ‘‘(iii) TIMING.—The payment under 

12 this paragraph shall be made, to a State 

13 for a fiscal year, as a single payment not 

14 later than the last day of the first calendar 

15 quarter of the following fiscal year to 

16 which the performance payment applies. 

17 ‘‘(B) STATE ELIGIBILITY FOR BONUS PAY18 MENTS.—A State shall be eligible for bonus 

19 payments under this subsection if— 

20 ‘‘(i) the State has adopted at least 3 

21 of the 5 policies described in subpara22 graphs (A) through (E) of paragraph (1); 

23 and 

24 ‘‘(ii) the State is able to demonstrate 

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1 ment by aged, blind, and disabled and 

2 adult populations, compared to its baseline 

3 performance in fiscal year 2013. 

4 ‘‘(C) AMOUNTS AVAILABLE FOR PAY5 MENTS.— 

6 ‘‘(i) IN GENERAL.—The total amount 

7 of payments under paragraphs (1) and (2) 

8 of this section shall be equal to 

9 $500,000,000 for fiscal year 2016 for 

10 making payments under this paragraph, to 

11 be available until expended. 

12 ‘‘(ii) BUDGET AUTHORITY.—This sub13 section constitutes budget authority in ad14 vance of appropriations Acts and rep15 resents the obligation of the Secretary to 

16 provide for the payment of amounts pro17 vided under this subsection. 

18 ‘‘(D) USES OF ENROLLMENT AND RETEN19 TION PERFORMANCE BONUSES.—Nothing in 

20 this section shall prohibit a State from estab21 lishing criteria which would permit the State to 

22 distribute a portion of the proceeds of any per23 formance bonuses received pursuant to this sec24 tion to financially support providers who have 

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1 tion activities. For purposes of allocation of En2 rollment and Retention Performance Bonuses 

3 the definition of provider shall have the mean4 ing given to it in a State Plan.’’. 

5 (b) EXTENSION OF CHIP PERFORMANCE BONUS TO

6 ALIGN WITH REAUTHORIZATION OF STATE ALLOT7 MENTS.—Section 2105(a)(3) of the Social Security Act 

8 (42 U.S.C. 1397ee(a)(3)) is amended— 

9 (1) in subparagraph (A), by striking ‘‘2013’’ 

10 and inserting ‘‘2015’’; 

11 (2) in subparagraph (E)(ii)— 

12 (A) in the heading for subclause (I)(aa), by 

13 striking ‘‘2012’’ and inserting ‘‘2014’’; 

14 (B) in subclause (I)(aa)— 

15 (i) by striking ‘‘2012’’ and inserting 

16 ‘‘2014’’; 

17 (ii) by striking ‘‘subsection (a)’’ and 

18 inserting ‘‘section 2104(a)’’; and 

19 (iii) by striking ‘‘subsection (m)’’ and 

20 inserting ‘‘section 2104(m)’’; 

21 (C) in the heading for subclause (I)(bb), 

22 by striking ‘‘2013’’ and inserting ‘‘2015’’; 

23 (D) in subclause (I)(bb)— 

24 (i) by striking ‘‘fiscal year 2013’’ and 

25 inserting ‘‘fiscal year 2015’’; 


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1 (ii) by striking ‘‘subsection 

2 (a)(16)(A)’’ and inserting ‘‘section 

3 2104(a)(18)(A)’’; 

4 (iii) by striking ‘‘October 1, 2012, and 

5 ending on March 31, 2013’’ and inserting 

6 ‘‘October 1, 2014, and ending on March 

7 31, 2015’’; 

8 (iv) by striking ‘‘subsection (m)’’ and 

9 inserting ‘‘section 2104(m)’’; and 

10 (v) by striking ‘‘or set aside under 

11 subsection (b)(2) of section 2111 for such 

12 fiscal year’’; 

13 (E) in the heading for subclause (I)(cc), by 

14 striking ‘‘2013’’ and inserting ‘‘2015’’; 

15 (F) in subclause (I)(cc)— 

16 (i) by striking ‘‘2013’’ each place it 

17 appears and inserting ‘‘2015’’; 

18 (ii) by striking ‘‘subsection 

19 (a)(16)(B)’’ and inserting ‘‘section 

20 2104(a)(18)(B)’’; 

21 (iii) by striking ‘‘subsection (m)’’ and 

22 inserting ‘‘section 2104(m)’’; and 

23 (iv) by striking ‘‘or set aside under 

24 subsection (b)(2) of section 2111 for such 

25 fiscal year’’; 


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1 (G) in subclause (II), by striking ‘‘2013’’ 

2 and inserting ‘‘2015’’; and 

3 (H) in subclause (III), by striking ‘‘2013’’ 

4 and inserting ‘‘2015’’; and 

5 (3) in subparagraph (F)(iii), by striking 

6 ‘‘2013’’ and inserting ‘‘2015’’. 

7 SEC. 6. MEASURING AND REPORTING ON COMPARABLE 

8 HEALTH CARE QUALITY MEASURES FOR ALL 

9 PERSONS ENROLLED IN MEDICAID. 

10 (a) QUALITY ASSURANCE STANDARDS.—Section 

11 1932(c)(1) of the Social Security Act (42 U.S.C. 1396u– 

12 2(c)(1)) is amended in subparagraph (A), by inserting 

13 after ‘‘1903(m)’’ the following: ‘‘or comparable primary 

14 care case management services providers described in sec15 tion 1905(t) as well as health care services furnished in 

16 fee-for-service settings’’. 

17 (b) ADULT HEALTH QUALITY MEASURES.—Title XI 

18 of the Social Security Act (42 U.S.C. 1301 et seq.), as 

19 amended by section 2701 of the Patient Protection and 

20 Affordable Care Act (Public Law 111–148), is amended 

21 at section 1139B (42 U.S.C. 1320b–9b)— 

22 (1) by adding after (b)(3) the following: 

23 ‘‘(4) QUALITY REPORTING FOR MEDICAID ELI24 GIBLE ADULTS.—Beginning January 1, 2016, the 

25 Secretary shall require States to use the measures 


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1 and approaches identified in paragraph (3) of this 

2 subsection to report on the initial core set of quality 

3 measures for Medicaid eligible adults identified in 

4 paragraph (2), subject to revisions made by (5)(B) 

5 of this subsection.’’; 

6 (2) by redesignating subsection (b)(4) as (b)(5) 

7 and (b)(5) as (b)(6); 

8 (3) in subsection (d)(1)(B) inserting after ‘‘Sec9 tion 1937 of this title’’ the following: ‘‘or comparable 

10 primary care case management services providers 

11 described in section 1905(t) as well as health care 

12 services furnished in fee-for-service settings’’; and 

13 (4) in subsection (d)(2) by inserting after ‘‘(1)’’ 

14 the following: ‘‘including analysis of comparable 

15 quality measures for Medicaid eligible adults who re16 ceive their health services through managed care, 

17 primary care case management, and fee-for-service 

18 settings’’. 

19 (c) PEDIATRIC HEALTH CARE MEASURES.— 

20 (1) IN GENERAL.—Title XI of the Social Secu21 rity Act, is amended at section 1139A(a) (42 U.S.C. 

22 1320b–9a(a)) by— 

23 (A) inserting after paragraph (4) as if it 

24 were included upon enactment: 


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1 ‘‘(5) REPORTING OF PEDIATRIC HEALTH CARE

2 MEASURES.—Not later than five years after the date 

3 of enactment of the Medicaid Continuous Quality 

4 Act of 2012, States shall use the procedures and ap5 proaches identified in paragraph (4) to report infor6 mation on the initial core measurement set regard7 ing the quality of pediatric health care under titles 

8 XIX and XXI.’’; 

9 (B) redesignating paragraphs (5), (6), (7) 

10 and (8) as (6), (7), (8) and (9), respectively; 

11 and 

12 (C) in subsection (c)(1)(B), inserting after 

13 ‘‘section 2103 of such Act’’ the following: ‘‘or 

14 comparable primary care case management 

15 services providers described in section 1905(t) 

16 as well as health care services furnished in fee17 for-service settings’’. 

18 SEC. 7. PERFORMANCE BONUSES FOR SIGNIFICANT 

19 ACHIEVEMENT IN MEDICAID QUALITY PER20 FORMANCE. 

21 Section 1932(c)(1) of the Social Security Act (42 

22 U.S.C. 1396u–2(c)(1)) is amended by adding at the end 

23 the following new subparagraph: 

24 ‘‘(F) PERFORMANCE BONUS FOR QUALITY

25 PERFORMANCE ACHIEVEMENT.— 


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1 ‘‘(i) IN GENERAL.—The Secretary 

2 shall establish a Medicaid Quality Perform3 ance Bonus fund for awarding perform4 ance bonuses to States for high attainment 

5 and improvement on a core set of quality 

6 measures related to the goals and purposes 

7 of the Medicaid program. 

8 ‘‘(ii) QUALITY PERFORMANCE BONUS

9 METHODOLOGY.—Not later than three 

10 years after the date of enactment of this 

11 Act, the Secretary shall establish a meth12 odology for awarding Medicaid Quality 

13 Performance bonuses to States not less 

14 than annually which will be based on the 

15 annual State reports required under sec16 tion 1138B of title XI of the Social Secu17 rity Act, in accordance with regulations 

18 promulgated by the Secretary. 

19 ‘‘(iii) QUALITY PERFORMANCE MEAS20 UREMENT BONUSES.—Medicaid Quality 

21 Performance Bonus funds will be awarded 

22 to up to 10 States that meet thresholds es23 tablished by the Secretary for— 


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1 ‘‘(I) the top five States achieving 

2 the designation of superior quality 

3 performing State; or 

4 ‘‘(II) five States demonstrating 

5 the greatest relative level of annual 

6 improvement in quality performance. 

7 ‘‘(iv) INITIAL APPROPRIATION.—The 

8 total amount of payments under this sub9 paragraph shall be equal to $500,000,000 

10 for making payments under this subpara11 graph, to be available until expended. 

12 This subparagraph constitutes budget authority 

13 in advance of appropriations Acts and rep14 resents the obligation of the Secretary to pro15 vide for the payment of amounts provided 

16 under this subparagraph. 

17 ‘‘(v) USES OF QUALITY PERFORMANCE

18 BONUS FUNDS.— 

19 ‘‘(I) DESIGNATION FOR QUALITY

20 IMPROVEMENT ACTIVITIES.—As a 

21 condition of receiving a bonus fund 

22 award under clause (iii), a State shall 

23 agree to designate at least 75 percent 

24 of the performance bonus funds for 

25 the development and operation of 


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1 quality-related initiatives that will di2 rectly benefit providers, including— 

3 ‘‘(aa) provider pay-for-per4 formance programs; 

5 ‘‘(bb) provider collaboration 

6 initiatives that have been dem7 onstrated to improve performance 

8 on quality; 

9 ‘‘(cc) provider quality im10 provement initiatives, including 

11 those aimed at improving care 

12 for special and hard-to-reach 

13 populations; and 

14 ‘‘(dd) Secretary-approved 

15 activities and initiatives that a 

16 State may pursue to encourage 

17 quality improvement and patient18 focused high value care. 

19 Nothing in this subparagraph shall pro20 hibit a State from establishing criteria for 

21 the State provider performance program 

22 that limits the award to a particular pro23 vider type(s), that limits application to a 

24 specific geographic area, or that directs in25 centive programs for quality-related activiVerDate Mar 15 2010 00:36 Feb 13, 2014 Jkt 039200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\S1980.IS S1980

rfrederick on DSK6VPTVN1PROD with BILLS
25 

•S 1980 IS

1 ties for specific populations, including indi2 viduals eligible under this title and title 

3 XVIII of the Social Security Act, hard-to4 reach populations. 

5 ‘‘(II) REMAINING BONUS

6 FUNDS.—States may designate up to 

7 25 percent of the quality performance 

8 bonus award for activities related to 

9 the goals and purposes of the pro10 gram. 

11 ‘‘(vi) DEFINITION OF PROVIDERS.— 

12 For purposes of allocation of Medicaid 

13 Quality Performance Bonuses the defini14 tion of provider shall have the meaning 

15 given to it in a State Plan. Nothing in this 

16 section shall prohibit a State from invest17 ing bonus funds into quality improvement 

18 activities for managed care entities.’’. 

Æ 


rfrederick on DSK6VPTVN1PROD with BILLS