I 

110TH CONGRESS 

1ST SESSION H. R. 506 

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

coverage and access. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 17, 2007 

Ms. BALDWIN (for herself, Mr. PRICE of Georgia, Mr. TIERNEY, Mr. 

FORTUN ̃O, Mr. STARK, Mr. LINDER, Mr. CONYERS, Mr. WESTMORELAND, Mrs. CAPPS, Mr. SOUDER, Mr. ALLEN, Mr. MARCHANT, Mr. GENE

GREEN of Texas, Mr. GOHMERT, Mr. LARSON of Connecticut, Mr. BURTON of Indiana, Mr. WELCH of Vermont, Mr. GINGREY, Mr. HOLT, Mr. 

WAMP, Mr. COOPER, Mr. CANTOR, Mr. PAYNE, Mr. CARTER, Ms. JACKSON-LEE of Texas, Mr. AKIN, Ms. MOORE of Wisconsin, Mr. WU, and 

Mr. LANGEVIN) introduced the following bill; which was referred to the 

Committee on Energy and Commerce, and in addition to the Committee 

on Rules, for a period to be subsequently determined by the Speaker, in 

each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To provide for innovation in health care through State 

initiatives that expand coverage and access. 

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 Through Creative Federalism Act’’. 


frosa on PROD1PC71 with BILLS
2 

•HR 506 IH

1 SEC. 2. STATE HEALTH REFORM PROJECTS. 

2 (a) PURPOSES; ESTABLISHMENT OF STATE HEALTH

3 CARE EXPANSION AND IMPROVEMENT PROGRAM.— 

4 (1) PURPOSES.—The purposes of the programs 

5 approved under this section shall include, but not be 

6 limited to— 

7 (A) achieving the goals of increased health 

8 coverage and access; and 

9 (B) testing alternative reforms, such as 

10 building on the public or private health systems, 

11 or creating new systems, to achieve the objec12 tives of this Act. 

13 (2) INTENT OF CONGRESS.—It is the intent of 

14 Congress that— 

15 (A) the programs approved under this Act 

16 each comprise significant coverage expansions; 

17 (B) taken as a whole, such programs 

18 should be diverse and balanced in their ap19 proaches to covering the uninsured; and 

20 (C) each such program should be rigor21 ously and objectively evaluated, so that the 

22 State programs developed pursuant to this Act 

23 may guide the development of future State and 

24 national policy. 

25 (b) APPLICATIONS BY STATES AND LOCAL GOVERN26 MENTS.— 


frosa on PROD1PC71 with BILLS
3 

•HR 506 IH

1 (1) ENTITIES THAT MAY APPLY.— 

2 (A) IN GENERAL.—A State may apply for 

3 a State health care expansion and improvement 

4 program for the entire State (or for regions of 

5 the State) under paragraph (2). 

6 (B) REGIONAL AND SUB-STATE GROUPS.— 

7 A regional entity consisting of more than one 

8 State or one or more local governments within 

9 a State may apply for a multi-State or a sub10 state health care expansion and improvement 

11 program for the region or area involved. 

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

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

14 Columbia, and the Commonwealth of Puerto 

15 Rico. Such term shall include a regional entity 

16 described in subparagraph (B). 

17 (2) SUBMISSION OF APPLICATION.—In accord18 ance with this section, each State or regional entity 

19 desiring to implement a State health care expansion 

20 and improvement program may submit an applica21 tion to the State Health Coverage Innovation Com22 mission under subsection (c) (referred to in this sec23 tion as the ‘‘Commission’’) for approval. 

24 (3) LOCAL GOVERNMENT APPLICATIONS.— 

25 Where a State fails to submit an application under 


frosa on PROD1PC71 with BILLS
4 

•HR 506 IH

1 this section, a unit of local government of such 

2 State, or a consortium of such units of local govern3 ments, may submit an application directly to the 

4 Commission for programs or projects under this sub5 section. Such an application shall be subject to the 

6 requirements of this section. 

7 (c) STATE HEALTH COVERAGE INNOVATION COM8 MISSION.— 

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

10 date of the enactment of this Act, the Secretary of 

11 Health and Human Services (in this section referred 

12 to as the ‘‘Secretary’’) shall establish a State Health 

13 Coverage Innovation Commission that— 

14 (A) shall 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, on a joint and bipar21 tisan basis, by the National Conference of 

22 State Legislators and the American Legis23 lative Exchange Council; 


frosa on PROD1PC71 with BILLS
5 

•HR 506 IH

1 (iv) two county officials to be ap2 pointed by the National Association of 

3 Counties on a bipartisan basis; 

4 (v) two mayors to be appointed, on a 

5 joint and bipartisan basis, by the National 

6 League of Cities and by the United States 

7 Conference of Mayors; 

8 (vi) two individuals to be appointed by 

9 the Speaker of the House of Representa10 tives; 

11 (vii) two individuals to be appointed 

12 by the Minority Leader of the House of 

13 Representatives; 

14 (viii) two individuals to be appointed 

15 by the Majority Leader of the Senate; and 

16 (ix) two individuals to be appointed by 

17 the Minority Leader of the Senate; 

18 (B) shall request States to submit pro19 posals, which may include a variety of reform 

20 options such as tax credit approaches, expan21 sions of public programs such as Medicaid and 

22 the State Children’s Health Insurance Pro23 gram, the creation of purchasing pooling ar24 rangements similar to the Federal Employees 

25 Health Benefits Program, individual market 


frosa on PROD1PC71 with BILLS
6 

•HR 506 IH

1 purchasing options, single risk pool or single 

2 payer systems, health savings accounts, a com3 bination of the options described in this sub4 paragraph, or other alternatives determined ap5 propriate by the Commission, including options 

6 suggested by States or the public, and nothing 

7 in this subparagraph shall be construed to pre8 vent the Commission from approving a reform 

9 proposal not included in this subparagraph; 

10 (C) shall conduct a thorough review of the 

11 grant application from a State and carry on a 

12 dialogue with all State applicants concerning 

13 possible modifications and adjustments; 

14 (D) shall submit the recommendations and 

15 legislative proposal described in subsection 

16 (d)(4)(C); 

17 (E) shall be responsible for receiving infor18 mation to determine the status and progress 

19 achieved under program or projects granted 

20 under this section; 

21 (F) shall report to the public concerning 

22 progress made by States with respect to the 

23 performance measures and goals established 

24 under this Act, the periodic progress of the 

25 State relative to its State performance measVerDate Aug 31 2005 21:54 Jan 18, 2007 Jkt 059200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H506.IH H506

frosa on PROD1PC71 with BILLS
7 

•HR 506 IH

1 ures and goals, and the State program applica2 tion procedures, by region and State jurisdic3 tion; 

4 (G) shall promote information exchange 

5 between States and the Federal Government; 

6 (H) shall be responsible for making rec7 ommendations to the Secretary and the Con8 gress, using equivalency or minimum standards, 

9 for minimizing the negative effect of State pro10 gram on national employer groups, provider or11 ganizations, and insurers because of differing 

12 State requirements under the programs; and 

13 (I) may require States to submit additional 

14 information or reports concerning the status 

15 and progress achieved under health care expan16 sion and improvement programs granted under 

17 this section, as needed. 

18 (2) PERIOD OF APPOINTMENT; REPRESENTA19 TION REQUIREMENTS; VACANCIES.—Members shall 

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

21 such members under paragraph (1)(A), the des22 ignated appointing individuals shall ensure the rep23 resentation of urban and rural areas and an appro24 priate geographic distribution of such members. Any 

25 vacancy in the Commission shall not affect its powVerDate Aug 31 2005 21:54 Jan 18, 2007 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H506.IH H506

frosa on PROD1PC71 with BILLS
8 

•HR 506 IH

1 ers, but shall be filled in the same manner as the 

2 original appointment. 

3 (3) CHAIRPERSON, MEETINGS.— 

4 (A) CHAIRPERSON.—The Commission shall 

5 select a Chairperson from among its members. 

6 (B) QUORUM.—Two-thirds of the members 

7 of the Commission shall constitute a quorum, 

8 but a lesser number of members may hold hear9 ings. 

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

11 after the date on which all members of the 

12 Commission have been appointed, the Commis13 sion shall hold its first meeting. The Commis14 sion shall meet at the call of the Chairperson. 

15 (4) POWERS OF THE COMMISSION.— 

16 (A) NEGOTIATIONS WITH STATES.—The 

17 Commission may conduct detailed discussions 

18 and negotiations with States submitting appli19 cations under this section, either individually or 

20 in groups, to facilitate a final set of rec21 ommendations for purposes of subsection 

22 (d)(4)(C). 

23 (B) HEARINGS.—The Commission may 

24 hold such hearings, sit and act at such times 

25 and places, take such testimony, and receive 


frosa on PROD1PC71 with BILLS
9 

•HR 506 IH

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) and for an 

10 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. 


frosa on PROD1PC71 with BILLS
10 

•HR 506 IH

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. 


frosa on PROD1PC71 with BILLS
11 

•HR 506 IH

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 

25 this subsection, there are authorized to be approVerDate Aug 31 2005 21:54 Jan 18, 2007 Jkt 059200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H506.IH H506

frosa on PROD1PC71 with BILLS
12 

•HR 506 IH

1 priated $3,000,000 for fiscal year 2008 and each fis2 cal year thereafter. 

3 (d) REQUIREMENTS FOR PROGRAMS.— 

4 (1) STATE PLAN.—A State that seeks to oper5 ate a program under this section shall prepare and 

6 submit to the Commission, as part of the application 

7 under subsection (b), a State health care plan that 

8 shall have as its goal increased coverage, and in 

9 service of that goal such additional goals as improve10 ments in quality, efficiency, cost-effectiveness, and 

11 the appropriate use of information technology. To 

12 achieve such goal, the State plan shall comply with 

13 the following: 

14 (A) COVERAGE.— 

15 (i) IN GENERAL.—With respect to 

16 coverage, the State plan shall— 

17 (I) provide and describe the man18 ner in which the State will ensure that 

19 an increased number of individuals re20 siding within the State will have ex21 panded access to health care coverage 

22 with a specific 5-year target for reduc23 tion in the number or proportion of 

24 uninsured individuals through either 

25 private or public program expansion, 


frosa on PROD1PC71 with BILLS
13 

•HR 506 IH

1 or both, in accordance with or in addi2 tion to the options established by the 

3 Commission; 

4 (II) describe the number and per5 centage of current uninsured individ6 uals who will achieve coverage under a 

7 State health program; 

8 (III) describe the coverage that 

9 will be provided to beneficiaries under 

10 a State health program; 

11 (IV) identify Federal, State, or 

12 local and private programs that cur13 rently provide health care services in 

14 the State and describe how such pro15 grams could be coordinated with a 

16 State health program, to the extent 

17 practicable; and 

18 (V) provide for improvements in 

19 the availability of appropriate health 

20 care coverage that will increase access 

21 to care in urban, suburban, rural, and 

22 frontier areas of the State with medi23 cally underserved populations or 

24 where there may be an inadequate 

25 supply of health care providers. 


frosa on PROD1PC71 with BILLS
14 

•HR 506 IH

1 (ii) COVERAGE OPTIONS.—The cov2 erage under the State plan may be— 

3 (I) health insurance coverage 

4 that meets the aggregate actuarial 

5 value requirement of section 

6 2103(a)(2)(B) of the Social Security 

7 Act (42 U.S.C. 1397cc(a)(2)(B)); 

8 (II) a combination of health in9 surance coverage and a consumer-di10 rected health care spending account, if 

11 the actuarial value of such coverage 

12 plus the amount of annual deposits 

13 into such account from sources other 

14 than the beneficiary is not less than 

15 the actuarial value amount described 

16 in subclause (I); or 

17 (III) health care access not less 

18 on average than that provided 

19 through coverage described in sub20 clause (I). 

21 (iii) CONSTRUCTION.—Nothing in this 

22 clause shall be construed to limit in any 

23 way the authority of the Secretary of 

24 Health and Human Services to issue waivVerDate Aug 31 2005 21:54 Jan 18, 2007 Jkt 059200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H506.IH H506

frosa on PROD1PC71 with BILLS
15 

•HR 506 IH

1 ers under section 1115 of the Social Secu2 rity Act. 

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

4 the State plan may describe efforts to improve 

5 health care quality in the State, including an 

6 explanation of how such efforts would change 

7 (if at all) under the State plan. 

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

9 State plan shall— 

10 (i) describe such steps as the State 

11 may undertake to improve the efficiency of 

12 health care; 

13 (ii) describe the public and private 

14 sector financing to be provided for the 

15 State health program; 

16 (iii) estimate the amount of Federal, 

17 State, and local expenditures, as well as, 

18 the costs to business and individuals under 

19 the State health program; and 

20 (iv) describe how the State plan will 

21 ensure the financial solvency of the State 

22 health program. 

23 (D) HEALTH INFORMATION TECH24 NOLOGY.—With respect to health information 

25 technology, the State plan may describe efforts 


frosa on PROD1PC71 with BILLS
16 

•HR 506 IH

1 to improve the appropriate use of health infor2 mation technology, including an explanation of 

3 how such efforts would change (if at all) under 

4 the State plan. 

5 (E) EXCEPTIONS TO FEDERAL POLICIES.— 

6 The State plan shall describe the exceptions to 

7 otherwise applicable Federal statutes, regula8 tions, and policies that would apply within the 

9 geographic area and time period governed by 

10 the plan. 

11 (2) TECHNICAL ASSISTANCE.—The Secretary 

12 shall, if requested, provide technical assistance to 

13 States to assist such States in developing applica14 tions and plans under this section, including tech15 nical assistance by private sector entities if deter16 mined appropriate by the Commission. 

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

18 application under subsection (b), the Secretary and 

19 the Commission shall complete an initial review of 

20 such State application within 60 days of the receipt 

21 of such application, analyze the scope of the pro22 posal, and determine whether additional information 

23 is needed from the State. The Commission shall ad24 vise the State within such period of the need to sub25 mit additional information. 


frosa on PROD1PC71 with BILLS
17 

•HR 506 IH

1 (4) FINAL DETERMINATION.— 

2 (A) IN GENERAL.—In a timely manner 

3 consistent with subparagraph (C), the Commis4 sion shall determine whether to submit a State 

5 proposal to Congress for approval. 

6 (B) VOTING.— 

7 (i) IN GENERAL.—The determination 

8 to submit a State proposal to Congress 

9 under subparagraph (A) shall be approved 

by 2 10 ⁄3 of the members of the Commission 

11 who are present and eligible to vote and a 

12 majority of the entire Commission. 

13 (ii) ELIGIBILITY.—A member of the 

14 Commission shall not participate in a de15 termination under subparagraph (A) if— 

16 (I) in the case of a member who 

17 is a Governor, such determination re18 lates to the State of which the mem19 ber is the Governor; or 

20 (II) in the case of member not 

21 described in subclause (I), such deter22 mination relates to the geographic 

23 area of a State of which such member 

24 serves as a State or local official or as 

25 a Member of Congress. 


frosa on PROD1PC71 with BILLS
18 

•HR 506 IH

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

2 prior to October 1 of each fiscal year, the Com3 mission may submit to Congress a list, in the 

4 form of a legislative proposal, of the State ap5 plications that the Commission recommends for 

6 approval under this section. 

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

8 program or project may be approved for a period of 

9 5 years and may be extended for a subsequent pe10 riod of time upon approval by the Commission, 

11 based upon achievement of targets. 

12 (e) EXPEDITED CONGRESSIONAL CONSIDERATION.— 

13 (1) INTRODUCTION AND EXPEDITED CONSIDER14 ATION IN THE HOUSE OF REPRESENTATIVES.— 

15 (A) INTRODUCTION IN HOUSE OF REP16 RESENTATIVES.—The legislative proposal sub17 mitted pursuant to subsection (d)(4)(C) shall be 

18 in the form of a joint resolution (in this sub19 section referred to as the ‘‘resolution’’). Such 

20 resolution shall be introduced in the House of 

21 Representatives by the Speaker immediately 

22 upon receipt of the language and shall be re23 ferred non-sequentially to the appropriate com24 mittee (or committees) of House of Representa25 tives. If the resolution is not introduced in acVerDate Aug 31 2005 21:54 Jan 18, 2007 Jkt 059200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H506.IH H506

frosa on PROD1PC71 with BILLS
19 

•HR 506 IH

1 cordance with the preceding sentence, the reso2 lution may be introduced by any member of the 

3 House of Representatives. 

4 (B) COMMITTEE CONSIDERATION.—Not 

5 later than 15 calendar days after the introduc6 tion of the resolution described in subparagraph 

7 (A), each committee of House of Representa8 tives to which the resolution was referred shall 

9 report the resolution. The report may include, 

10 at the committee’s discretion, a recommenda11 tion for action by the House. If a committee 

12 has not reported such resolution (or an iden13 tical resolution) at the end of 15 calendar days 

14 after its introduction or at the end of the first 

15 day after there has been reported to the House 

16 a resolution, whichever is earlier, such com17 mittee shall be deemed to be discharged from 

18 further consideration of such resolution and 

19 such resolution shall be placed on the appro20 priate calendar of the House of Representatives. 

21 (C) EXPEDITED PROCEDURE IN HOUSE.— 

22 Not later than 5 legislative days after the date 

23 on which all committees have been discharged 

24 from consideration of a resolution, the Speaker 

25 of the House of Representatives, or the SpeakVerDate Aug 31 2005 21:54 Jan 18, 2007 Jkt 059200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H506.IH H506

frosa on PROD1PC71 with BILLS
20 

•HR 506 IH

1 er’s designee, shall move to proceed to the con2 sideration of the resolution. It shall also be in 

3 order for any member of the House of Rep4 resentatives to move to proceed to the consider5 ation of the resolution at any time after the 

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

7 order against the resolution (and against con8 sideration of the resolution) are waived. A mo9 tion to proceed to the consideration of the reso10 lution is highly privileged in the House of Rep11 resentatives and is not debatable. The motion is 

12 not subject to amendment, to a motion to post13 pone consideration of the resolution, or to a mo14 tion to proceed to the consideration of other 

15 business. A motion to reconsider the vote by 

16 which the motion to proceed is agreed to or not 

17 agreed to shall not be in order. If the motion 

18 to proceed is agreed to, the House of Rep19 resentatives shall immediately proceed to con20 sideration of the resolution without intervening 

21 motion, order, or other business, and the reso22 lution shall remain the unfinished business of 

23 the House of Representatives until disposed of. 

24 A motion to recommit the resolution shall not 

25 be in order. Upon its passage in the House, the 


frosa on PROD1PC71 with BILLS
21 

•HR 506 IH

1 clerk of the House shall provide for its imme2 diate transmittal to the Senate. 

3 (2) EXPEDITED CONSIDERATION IN THE SEN4 ATE.— 

5 (A) REFERRAL TO COMMITTEE.—If the 

6 resolution is agreed to by the House of Rep7 resentatives, upon its receipt in the Senate the 

8 Majority Leader of the Senate, or the Leader’s 

9 designee, the resolution shall be referred to the 

10 appropriate committee of Senate. 

11 (B) COMMITTEE CONSIDERATION.—Not 

12 later than 15 calendar days after the referral of 

13 the resolution under subparagraph (A), the 

14 committee of the Senate to which the resolution 

15 was referred shall report the resolution. The re16 port may include, at the committee’s discretion, 

17 a recommendation for action by the Senate. If 

18 a committee has not reported such resolution 

19 (or an identical resolution) at the end of 15 cal20 endar days after its referral or at the end of the 

21 first day after there has been reported to the 

22 Senate a resolution, whichever is earlier, such 

23 committee shall be deemed to be discharged 

24 from further consideration of such resolution 


frosa on PROD1PC71 with BILLS
22 

•HR 506 IH

1 and such resolution shall be placed on the ap2 propriate calendar of the Senate. 

3 (C) EXPEDITED FLOOR CONSIDERATION.— 

4 Not later than 5 legislative days after the date 

5 on which all committees have been discharged 

6 from consideration of a resolution, the Majority 

7 Leader of the Senate, or the Majority Leader’s 

8 designee, shall move to proceed to the consider9 ation of the resolution. It shall also be in order 

10 for any member of the Senate to move to pro11 ceed to the consideration of the resolution at 

12 any time after the conclusion of such 5-day pe13 riod. All points of order against the resolution 

14 (and against consideration of the resolution) 

15 are waived. A motion to proceed to the consid16 eration of the resolution in the Senate is privi17 leged and is not debatable. The motion is not 

18 subject to amendment, to a motion to postpone 

19 consideration of the resolution, or to a motion 

20 to proceed to the consideration of other busi21 ness. A motion to reconsider the vote by which 

22 the motion to proceed is agreed to or not 

23 agreed to shall not be in order. If the motion 

24 to proceed is agreed to, the Senate shall imme25 diately proceed to consideration of the resoluVerDate Aug 31 2005 21:54 Jan 18, 2007 Jkt 059200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\H506.IH H506

frosa on PROD1PC71 with BILLS
23 

•HR 506 IH

1 tion without intervening motion, order, or other 

2 business, and the resolution shall remain the 

3 unfinished business of the Senate until disposed 

4 of. 

5 (3) RULES OF THE SENATE AND HOUSE OF

6 REPRESENTATIVES.—This subsection is enacted by 

7 Congress— 

8 (A) as an exercise of the rulemaking power 

9 of the Senate and House of Representatives, re10 spectively, and is deemed to be part of the rules 

11 of each House, respectively, but applicable only 

12 with respect to the procedure to be followed in 

13 that House in the case of a resolution under 

14 this subsection, and it supersedes other rules 

15 only to the extent that it is inconsistent with 

16 such rules; and 

17 (B) with full recognition of the constitu18 tional right of either House to change the rules 

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

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

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

22 rule of that House. 

23 (4) FEDERAL BUDGET NEUTRALITY.—Except 

24 insofar as it allots appropriations made pursuant to 

25 subsection (k), the legislative proposal submitted 


frosa on PROD1PC71 with BILLS
24 

•HR 506 IH

1 pursuant to subsection (d)(4)(C) may not increase 

2 the cumulative, net Federal budget deficit during the 

3 multi-year operation of all the State applications 

4 contained therein, taking into account such applica5 tions’ impact on Federal mandatory and discre6 tionary spending, Federal revenue, and Federal tax 

7 expenditures. 

8 (f) FUNDING.— 

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

10 a grant to a State that has an application approved 

11 under subsection (e) to enable such State to carry 

12 out an innovative State health program in the State, 

13 to the extent that such a grant is included in the 

14 recommendation of the Commission. 

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

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

17 be determined based upon the recommendations of 

18 the Commission, subject to the amount appropriated 

19 under subsection (k). 

20 (3) PERFORMANCE-BASED FUNDING ALLOCA21 TION.—In awarding grants under paragraph (1), the 

22 Commission shall direct the Secretary to— 

23 (A) fund a balanced diversity of ap24 proaches as provided for by the Commission in 

25 subsection (c)(1)(B); and 


frosa on PROD1PC71 with BILLS
25 

•HR 506 IH

1 (B) link allocations to the State to the 

2 meeting of the goals and performance measures 

3 relating to health care coverage and health care 

4 costs established under this Act through the 

5 State project application process. 

6 (4) REPORT.—One year prior to the end of the 

7 5-year period beginning on the date on which the 

8 first State begins to implement a plan approved 

9 under subsection (e), the Commission shall prepare 

10 and submit to the appropriate committees of Con11 gress, a report on the progress made by States in 

12 meeting the goals of expanded coverage and cost 

13 containment through performance measures estab14 lished during the 5-year period of the State plan. 

15 Such report may contain the recommendation of the 

16 Commission concerning any future action that Con17 gress should take concerning health care reform, in18 cluding whether or not to extend the program estab19 lished under this subsection. 

20 (g) MONITORING AND EVALUATION.— 

21 (1) ANNUAL REPORTS AND PARTICIPATION BY

22 STATES.—Each State that has received a program 

23 approval shall— 

24 (A) submit to the Commission an annual 

25 report based on the period representing the reVerDate Aug 31 2005 21:54 Jan 18, 2007 Jkt 059200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\H506.IH H506

frosa on PROD1PC71 with BILLS
26 

•HR 506 IH

1 spective State’s fiscal year, detailing compliance 

2 with the requirements established by the Com3 mission and the Secretary in the approval and 

4 in this section; and 

5 (B) participate in the annual meeting 

6 under subsection (c)(4)(C). 

7 (2) EVALUATIONS BY COMMISSION.—The Com8 mission shall prepare and submit to the Congress 

9 annual reports that shall contain— 

10 (A) a description of the effects of the re11 forms undertaken in States receiving approvals 

12 under this section; 

13 (B) a description of the recommendations 

14 of the Commission and actions taken based on 

15 these recommendations; 

16 (C) an independent evaluation of the effec17 tiveness of such reforms in— 

18 (i) expanding health care coverage for 

19 State residents; and 

20 (ii) reducing or containing health care 

21 costs in the States, 

22 as well as other relevant or significant findings; 

23 (D) recommendations regarding the advis24 ability of increasing Federal financial assistance 

25 for State ongoing or future health program iniVerDate Aug 31 2005 21:54 Jan 18, 2007 Jkt 059200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\H506.IH H506

frosa on PROD1PC71 with BILLS
27 

•HR 506 IH

1 tiatives, including the amount and source of 

2 such assistance; and 

3 (E) as required by the Commission or the 

4 Secretary under this section, a periodic, inde5 pendent evaluation of the program. 

6 (h) NONCOMPLIANCE.— 

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

8 not in compliance with a requirement of this section, 

9 the Commission, on recommendation of the Sec10 retary, shall develop a corrective action plan for such 

11 State. 

12 (2) TERMINATION.—The Commission, on rec13 ommendation of the Secretary, may revoke any pro14 gram granted under this section. Such decisions 

15 shall be subject to a petition for reconsideration and 

16 appeal pursuant to regulations established by the 

17 Secretary. 

18 (i) RELATIONSHIP TO FEDERAL PROGRAMS.— 

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

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

21 1315) shall be construed as authorizing the Sec22 retary, the Commission, a State, or any other person 

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

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

25 or the regulations implementing such title. 


frosa on PROD1PC71 with BILLS
28 

•HR 506 IH

1 (2) MAINTENANCE OF EFFORT.—No payment 

2 may be made under subsection (f)(1) if the State 

3 adopts criteria for benefits or criteria for standards 

4 and methodologies for purposes of determining an 

5 individual’s eligibility for medical assistance under 

6 the State plan under title XIX that are more restric7 tive than those required under Federal law and ap8 plied as of the date of enactment of this Act. 

9 (j) MISCELLANEOUS PROVISIONS.— 

10 (1) APPLICATION OF CERTAIN REQUIRE11 MENTS.— 

12 (A) RESTRICTION ON APPLICATION OF

13 PREEXISTING CONDITION EXCLUSIONS.— 

14 (i) IN GENERAL.—Subject to subpara15 graph (B), a State shall not permit the im16 position of any preexisting condition exclu17 sion for covered benefits under a program 

18 or project under this section. 

19 (ii) GROUP HEALTH PLANS AND

20 GROUP HEALTH INSURANCE COVERAGE.— 

21 If the State program or project provides 

22 for benefits through payment for, or a con23 tract with, a group health plan or group 

24 health insurance coverage, the program or 

25 project may permit the imposition of a preVerDate Aug 31 2005 21:54 Jan 18, 2007 Jkt 059200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\H506.IH H506

frosa on PROD1PC71 with BILLS
29 

•HR 506 IH

1 existing condition exclusion but only inso2 far and to the extent that such exclusion is 

3 permitted under the applicable provisions 

4 of part 7 of subtitle B of title I of the Em5 ployee Retirement Income Security Act of 

6 1974 and title XXVII of the Public Health 

7 Service Act. 

8 (B) COMPLIANCE WITH OTHER REQUIRE9 MENTS.—Coverage offered under the program 

10 or project shall comply with the requirements of 

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

12 Health Service Act insofar as such require13 ments apply with respect to a health insurance 

14 issuer that offers group health insurance cov15 erage. 

16 (2) PREVENTION OF DUPLICATIVE PAY17 MENTS.— 

18 (A) OTHER HEALTH PLANS.—No payment 

19 shall be made to a State under subsection (f)(1) 

20 for expenditures for health assistance provided 

21 for an individual to the extent that a private in22 surer (as defined by the Secretary by regulation 

23 and including a group health plan (as defined 

24 in section 607(1) of the Employee Retirement 

25 Income Security Act of 1974), a service benefit 


frosa on PROD1PC71 with BILLS
30 

•HR 506 IH

1 plan, and a health maintenance organization) 

2 would have been obligated to provide such as3 sistance but for a provision of its insurance con4 tract which has the effect of limiting or exclud5 ing such obligation because the individual is eli6 gible for or is provided health assistance under 

7 the plan. 

8 (B) OTHER FEDERAL GOVERNMENTAL

9 PROGRAMS.—Except as provided in any other 

10 provision of law, no payment shall be made to 

11 a State under subsection (f)(1) for expenditures 

12 for health assistance provided for an individual 

13 to the extent that payment has been made or 

14 can reasonably be expected to be made prompt15 ly (as determined in accordance with regula16 tions) under any other federally operated or fi17 nanced health care insurance program. For 

18 purposes of this paragraph, rules similar to the 

19 rules for overpayments under section 

20 1903(d)(2) of the Social Security Act shall 

21 apply. 

22 (3) APPLICATION OF CERTAIN GENERAL PROVI23 SIONS.—The following provisions of the Social Secu24 rity Act shall apply to States under subsection (f)(1) 


frosa on PROD1PC71 with BILLS
31 

•HR 506 IH

1 in the same manner as they apply to a State under 

2 such title XIX: 

3 (A) TITLE XIX PROVISIONS.— 

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

5 conflict of interest standards). 

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

7 section 1903(i) (relating to limitations on 

8 payment). 

9 (iii) Section 1903(w) (relating to limi10 tations on provider taxes and donations). 

11 (iv) Section 1920A (relating to pre12 sumptive eligibility for children). 

13 (B) TITLE XI PROVISIONS.— 

14 (i) Section 1116 (relating to adminis15 trative and judicial review), but only inso16 far as consistent with this title. 

17 (ii) Section 1124 (relating to disclo18 sure of ownership and related informa19 tion). 

20 (iii) Section 1126 (relating to disclo21 sure of information about certain convicted 

22 individuals). 

23 (iv) Section 1128A (relating to civil 

24 monetary penalties). 


frosa on PROD1PC71 with BILLS
32 

•HR 506 IH

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

2 criminal penalties for certain additional 

3 charges). 

4 (vi) Section 1132 (relating to periods 

5 within which claims must be filed). 

6 (4) RELATION TO HIPAA.—Health benefits cov7 erage provided under a State program or project 

8 under this section shall be treated as creditable cov9 erage for purposes of part 7 of subtitle B of title I 

10 of the Employee Retirement Income Security Act of 

11 1974, title XXVII of the Public Health Service Act, 

12 and subtitle K of the Internal Revenue Code of 

13 1986. 

14 (k) AUTHORIZATION OF APPROPRIATIONS.—There is 

15 authorized to be appropriated to carry out this section, 

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

17 Amounts appropriated for a fiscal year under this sub18 section and not expended may be used in subsequent fiscal 

19 years to carry out this section. 

Æ 


frosa on PROD1PC71 with BILLS