II 

110TH CONGRESS 

1ST SESSION S. 325 

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 

JANUARY 17, 2007 

Mr. BINGAMAN (for himself and Mr. VOINOVICH) 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 

24 for a multi-State health care expansion and imVerDate Aug 31 2005 00:33 Jan 19, 2007 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S325.IS S325

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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 and 

3 the National League of Cities on a joint 

4 and bipartisan basis; 

5 (vi) two individuals to be appointed by 

6 the Speaker of the House of Representa7 tives; 

8 (vii) two individuals to be appointed 

9 by the minority leader of the House of 

10 Representatives; 

11 (viii) two individuals to be appointed 

12 by the majority leader of the Senate; 

13 (ix) two individuals to be appointed by 

14 the minority leader of the Senate; and 

15 (x) two individuals who are members 

16 of federally-recognized Indian tribes to be 

17 appointed on a bipartisan basis by the Na18 tional Congress of American Indians; 

(B) upon approval of 2 19 ⁄3 of the members of 

20 the Commission, provide the States with a vari21 ety of reform options for their applications, 

22 such as tax credit approaches, expansions of 

23 public programs such as medicaid and the State 

24 Children’s Health Insurance Program, the cre25 ation of purchasing pooling arrangements simiVerDate Aug 31 2005 00:33 Jan 19, 2007 Jkt 059200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S325.IS S325

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1 lar to the Federal Employees Health Benefits 

2 Program, individual market purchasing options, 

3 single risk pool or single payer systems, health 

4 savings accounts, a combination of the options 

5 described in this clause, or other alternatives 

6 determined appropriate by the Commission, in7 cluding options suggested by States, Indian 

8 tribes, or the public; 

9 (C) establish, in collaboration with a quali10 fied and independent organization such as the 

11 Institute of Medicine, minimum performance 

12 measures and goals with respect to coverage, 

13 quality, and cost of State programs, as de14 scribed under subsection (d)(1); 

15 (D) conduct a thorough review of the grant 

16 application from a State and carry on a dia17 logue with all State applicants concerning pos18 sible modifications and adjustments; 

19 (E) submit the recommendations and legis20 lative proposal described in subsection 

21 (d)(4)(B); 

22 (F) be responsible for monitoring the sta23 tus and progress achieved under program or 

24 projects granted under this section; 


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1 (G) report to the public concerning 

2 progress made by States with respect to the 

3 performance measures and goals established 

4 under this Act, the periodic progress of the 

5 State relative to its State performance meas6 ures and goals, and the State program applica7 tion procedures, by region and State jurisdic8 tion; 

9 (H) promote information exchange between 

10 States and the Federal Government; and 

11 (I) be responsible for making recommenda12 tions to the Secretary and the Congress, using 

13 equivalency or minimum standards, for mini14 mizing the negative effect of State program on 

15 national employer groups, provider organiza16 tions, and insurers because of differing State 

17 requirements under the programs. 

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 00:33 Jan 19, 2007 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S325.IS S325

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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.—A majority 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)(B). Such negotiations shall include con23 sultations with Indian tribes, and be conducted 

24 in a public forum. 


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1 (B) HEARINGS.—The Commission may 

2 hold such hearings, sit and act at such times 

3 and places, take such testimony, and receive 

4 such evidence as the Commission considers ad5 visable to carry out the purposes of this sub6 section. 

7 (C) MEETINGS.—In addition to other 

8 meetings the Commission may hold, the Com9 mission shall hold an annual meeting with the 

10 participating States under this section for the 

11 purpose of having States report progress to12 ward the purposes in subsection (a)(1) and for 

13 an exchange of information. 

14 (D) INFORMATION.—The Commission may 

15 secure directly from any Federal department or 

16 agency such information as the Commission 

17 considers necessary to carry out the provisions 

18 of this subsection. Upon request of the Chair19 person of the Commission, the head of such de20 partment or agency shall furnish such informa21 tion to the Commission if the head of the de22 partment or agency involved determines it ap23 propriate. 

24 (E) POSTAL SERVICES.—The Commission 

25 may use the United States mails in the same 


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1 manner and under the same conditions as other 

2 departments and agencies of the Federal Gov3 ernment. 

4 (5) PERSONNEL MATTERS.— 

5 (A) COMPENSATION.—Each member of the 

6 Commission who is not an officer or employee 

7 of the Federal Government or of a State or 

8 local government shall be compensated at a rate 

9 equal to the daily equivalent of the annual rate 

10 of basic pay prescribed for level IV of the Exec11 utive Schedule under section 5315 of title 5, 

12 United States Code, for each day (including 

13 travel time) during which such member is en14 gaged in the performance of the duties of the 

15 Commission. All members of the Commission 

16 who are officers or employees of the United 

17 States shall serve without compensation in addi18 tion to that received for their services as offi19 cers or employees of the United States. 

20 (B) TRAVEL EXPENSES.—The members of 

21 the Commission shall be allowed travel ex22 penses, including per diem in lieu of subsist23 ence, at rates authorized for employees of agen24 cies under subchapter I of chapter 57 of title 5, 

25 United States Code, while away from their 


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1 homes or regular places of business in the per2 formance of services for the Commission. 

3 (C) STAFF.—The Chairperson of the Com4 mission may, without regard to the civil service 

5 laws and regulations, appoint and terminate an 

6 executive director and such other additional 

7 personnel as may be necessary to enable the 

8 Commission to perform its duties. The employ9 ment of an executive director shall be subject to 

10 confirmation by the Commission. 

11 (D) DETAIL OF GOVERNMENT EMPLOY12 EES.—Any Federal Government employee may 

13 be detailed to the Commission without reim14 bursement, and such detail shall be without 

15 interruption or loss of civil service status or 

16 privilege. 

17 (E) TEMPORARY AND INTERMITTENT

18 SERVICES.—The Chairperson of the Commis19 sion may procure temporary and intermittent 

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

21 States Code, at rates for individuals which do 

22 not exceed the daily equivalent of the annual 

23 rate of basic pay prescribed for level V of the 

24 Executive Schedule under section 5316 of such 

25 title. 


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

2 this subsection, there are authorized to be appro3 priated $3,000,000 for fiscal year 2007 and each fis4 cal year thereafter. 

5 (d) REQUIREMENTS FOR PROGRAMS.— 

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

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

8 under this section shall prepare and submit to the 

9 Commission, as part of the application under sub10 section (b), a State health care plan that shall have 

11 as its goal improvements in coverage, quality and 

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

13 comply with the following: 

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

15 the State plan shall— 

16 (i) provide and describe the manner in 

17 which the State will ensure that an in18 creased number of individuals residing 

19 within the State will have expanded access 

20 to health care coverage with a specific 5- 

21 year target for reduction in the number of 

22 uninsured individuals through either pri23 vate or public program expansion, or both, 

24 in accordance with the options established 

25 by the Commission; 


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1 (ii) describe the number and percent2 age of current uninsured individuals who 

3 will achieve coverage under the State 

4 health program; 

5 (iii) describe the minimum benefits 

6 package that will be provided to all classes 

7 of beneficiaries under the State health pro8 gram; 

9 (iv) identify Federal, State, or local 

10 and private programs that currently pro11 vide health care services in the State and 

12 describe how such programs could be co13 ordinated with the State health program, 

14 to the extent practicable; and 

15 (v) provide for improvements in the 

16 availability of appropriate health care serv17 ices that will increase access to care in 

18 urban, rural, and frontier areas of the 

19 State with medically underserved popu20 lations or where there is an inadequate 

21 supply of health care providers. 

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

23 the State plan shall— 

24 (i) provide a plan to improve health 

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1 ing effectiveness, efficiency, timeliness, pa2 tient focused, equity while reducing health 

3 disparities, and medical errors; and 

4 (ii) contain appropriate results-based 

5 quality indicators established by the Com6 mission that will be addressed by the State 

7 as well as State-specific quality indicators. 

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

9 State plan shall— 

10 (i) provide that the State will develop 

11 and implement systems to improve the effi12 ciency of health care, including a specific 

13 5-year target for reducing administrative 

14 costs (including paperwork burdens); 

15 (ii) describe the public and private 

16 sector financing to be provided for the 

17 State health program; 

18 (iii) estimate the amount of Federal, 

19 State, and local expenditures, as well as, 

20 the costs to business and individuals under 

21 the State health program; 

22 (iv) describe how the State plan will 

23 ensure the financial solvency of the State 

24 health program; and 


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1 (v) provide that the State will prepare 

2 and submit to the Secretary and the Com3 mission such reports as the Secretary or 

4 Commission may require to carry out pro5 gram evaluations. 

6 (D) HEALTH INFORMATION TECH7 NOLOGY.—With respect to health information 

8 technology, the State plan shall provide method9 ology for the appropriate use of health informa10 tion technology to improve infrastructure, such 

11 as improving the availability of evidence-based 

12 medical and outcomes data to providers and pa13 tients, as well as other health information (such 

14 as electronic health records, electronic billing, 

15 and electronic prescribing). 

16 (2) TECHNICAL ASSISTANCE.—The Secretary 

17 shall, if requested, provide technical assistance to 

18 States to assist such States in developing applica19 tions and plans under this section, including tech20 nical assistance by private sector entities if deter21 mined appropriate by the Commission. 

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

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

24 Secretary and the Commission shall complete an ini25 tial review of such State application within 60 days 


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1 of the receipt of such application, analyze the scope 

2 of the proposal, and determine whether additional 

3 information is needed from the State. The Commis4 sion shall advise the State within such period of the 

5 need to submit additional information. 

6 (4) FINAL DETERMINATION.— 

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

8 after completion of the initial review under 

9 paragraph (3), the Commission shall determine 

10 whether to submit a State proposal to Congress 

11 for approval. 

12 (B) VOTING.— 

13 (i) IN GENERAL.—The determination 

14 to submit a State proposal to Congress 

15 under subparagraph (A) shall be approved 

by 2 16 ⁄3 of the members of the Commission 

17 who are eligible to participate in such de18 termination subject to clause (ii). 

19 (ii) ELIGIBILITY.—A member of the 

20 Commission shall not participate in a de21 termination under subparagraph (A) if— 

22 (I) in the case of a member who 

23 is a Governor, such determination re24 lates to the State of which the mem25 ber is the Governor; or 


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1 (II) in the case of member not 

2 described in subclause (I), such deter3 mination relates to the geographic 

4 area of a State of which such member 

5 serves as a State or local official. 

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

7 prior to October 1 of each fiscal year, the Com8 mission shall submit to Congress a list, in the 

9 form of a legislative proposal, of the State ap10 plications that the Commission recommends for 

11 approval under this section. 

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

13 year, a State proposal that has been rec14 ommended under subparagraph (B) shall be 

15 deemed to be approved, and subject to the 

16 availability of appropriations, Federal funds 

17 shall be provided to such program, unless a 

18 joint resolution has been enacted disapproving 

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

20 Nothing in the preceding sentence shall be con21 strued to include the approval of State pro22 posals that involve waivers or modifications in 

23 applicable Federal law. 

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

25 program or project may be approved for a period of 


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1 5 years and may be extended for subsequent 5-year 

2 periods upon approval by the Commission and the 

3 Secretary, based upon achievement of targets, except 

4 that a shorter period may be requested by a State 

5 and granted by the Secretary. 

6 (e) EXPEDITED CONGRESSIONAL CONSIDERATION.— 

7 (1) INTRODUCTION AND COMMITTEE CONSIDER8 ATION.— 

9 (A) INTRODUCTION.—The legislative pro10 posal submitted pursuant to subsection 

11 (d)(4)(B) shall be in the form of a joint resolu12 tion (in this subsection referred to as the ‘‘reso13 lution’’). Such resolution shall be introduced in 

14 the House of Representatives by the Speaker, 

15 and in the Senate, by the majority leader, im16 mediately upon receipt of the language and 

17 shall be referred to the appropriate committee 

18 of Congress. If the resolution is not introduced 

19 in accordance with the preceding sentence, the 

20 resolution may be introduced in either House of 

21 Congress by any member thereof. 

22 (B) COMMITTEE CONSIDERATION.—A reso23 lution introduced in the House of Representa24 tives shall be referred to the Committee on 

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1 tives. A resolution introduced in the Senate 

2 shall be referred to the Committee on Finance 

3 of the Senate. Not later than 15 calendar days 

4 after the introduction of the resolution, the 

5 committee of Congress to which the resolution 

6 was referred shall report the resolution or a 

7 committee amendment thereto. If the committee 

8 has not reported such resolution (or an iden9 tical resolution) at the end of 15 calendar days 

10 after its introduction or at the end of the first 

11 day after there has been reported to the House 

12 involved a resolution, whichever is earlier, such 

13 committee shall be deemed to be discharged 

14 from further consideration of such reform bill 

15 and such reform bill shall be placed on the ap16 propriate calendar of the House involved. 

17 (2) EXPEDITED PROCEDURE.— 

18 (A) CONSIDERATION.—Not later than 5 

19 days after the date on which a committee has 

20 been discharged from consideration of a resolu21 tion, the Speaker of the House of Representa22 tives, or the Speaker’s designee, or the majority 

23 leader of the Senate, or the leader’s designee, 

24 shall move to proceed to the consideration of 

25 the committee amendment to the resolution, 


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1 and if there is no such amendment, to the reso2 lution. It shall also be in order for any member 

3 of the House of Representatives or the Senate, 

4 respectively, 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 privileged in the Senate and 

12 is not debatable. The motion is not subject to 

13 amendment, to a motion to postpone consider14 ation of the resolution, or to a motion to pro15 ceed to the consideration of other business. A 

16 motion to reconsider the vote by which the mo17 tion to proceed is agreed to or not agreed to 

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

19 is agreed to, the House of Representatives or 

20 the Senate, as the case may be, shall imme21 diately proceed to consideration of the resolu22 tion without intervening motion, order, or other 

23 business, and the resolution shall remain the 

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1 atives or the Senate, as the case may be, until 

2 disposed of. 

3 (B) CONSIDERATION BY OTHER HOUSE.— 

4 If, before the passage by one House of the reso5 lution that was introduced in such House, such 

6 House receives from the other House a resolu7 tion as passed by such other House— 

8 (i) the resolution of the other House 

9 shall not be referred to a committee and 

10 may only be considered for final passage in 

11 the House that receives it under clause 

12 (iii); 

13 (ii) the procedure in the House in re14 ceipt of the resolution of the other House, 

15 with respect to the resolution that was in16 troduced in the House in receipt of the res17 olution of the other House, shall be the 

18 same as if no resolution had been received 

19 from the other House; and 

20 (iii) notwithstanding clause (ii), the 

21 vote on final passage shall be on the re22 form bill of the other House. 

23 Upon disposition of a resolution that is received 

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


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1 longer be in order to consider the resolution bill 

2 that was introduced in the receiving House. 

3 (C) CONSIDERATION IN CONFERENCE.— 

4 Immediately upon a final passage of the resolu5 tion that results in a disagreement between the 

6 two Houses of Congress with respect to the res7 olution, conferees shall be appointed and a con8 ference convened. Not later than 10 days after 

9 the date on which conferees are appointed, the 

10 conferees shall file a report with the House of 

11 Representatives and the Senate resolving the 

12 differences between the Houses on the resolu13 tion. Notwithstanding any other rule of the 

14 House of Representatives or the Senate, it shall 

15 be in order to immediately consider a report of 

16 a committee of conference on the resolution 

17 filed in accordance with this subclause. Debate 

18 in the House of Representatives and the Senate 

19 on the conference report shall be limited to 10 

20 hours, equally divided and controlled by the 

21 Speaker of the House of Representatives and 

22 the minority leader of the House of Representa23 tives or their designees and the majority and 

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1 ference report shall occur immediately at the 

2 conclusion or yielding back of all time for de3 bate on the conference report. 

4 (3) RULES OF THE SENATE AND HOUSE OF

5 REPRESENTATIVES.—This subsection is enacted by 

6 Congress— 

7 (A) as an exercise of the rulemaking power 

8 of the Senate and House of Representatives, re9 spectively, and is deemed to be part of the rules 

10 of each House, respectively, but applicable only 

11 with respect to the procedure to be followed in 

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

13 supersedes other rules only to the extent that it 

14 is inconsistent with such rules; and 

15 (B) with full recognition of the constitu16 tional right of either House to change the rules 

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

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

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

20 rule of that House. 

21 (4) LIMITATION.—The amount of Federal 

22 funds provided with respect to any State proposal 

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

24 shall not exceed the cost provided for such proposals 


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1 within the concurrent resolution on the budget as 

2 enacted by Congress for the fiscal year involved. 

3 (f) FUNDING.— 

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

5 a grant to a State that has an application approved 

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

7 out an innovative State health program in the State. 

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

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

10 be determined based upon the recommendations of 

11 the Commission, subject to the amount appropriated 

12 under subsection (k). 

13 (3) PERFORMANCE-BASED FUNDING ALLOCA14 TION AND PRIORITIZATION.—In awarding grants 

15 under paragraph (1), the Secretary shall— 

16 (A) fund a diversity of approaches as pro17 vided for by the Commission in subsection 

18 (c)(1)(B); 

19 (B) give priority to those State programs 

20 that the Commission determines have the great21 est opportunity to succeed in providing ex22 panded health insurance coverage and in pro23 viding children, youth, and other vulnerable 

24 populations with improved access to health care 

25 items and services; and 


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1 (C) link allocations to the State to the 

2 meeting of the goals and performance measures 

3 relating to health care coverage, quality, and 

4 health care costs established under this Act 

5 through the State project application process. 

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

7 utilizing the proceeds of a grant received under 

8 paragraph (1), shall maintain the expenditures of 

9 the State for health care coverage purposes for the 

10 support of direct health care delivery at a level equal 

11 to not less than the level of such expenditures main12 tained by the State for the fiscal year preceding the 

13 fiscal year for which the grant is received. 

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

15 beginning on the date on which the Secretary 

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

17 State Health Innovation Advisory Commission estab18 lished under subsection (c) shall prepare and submit 

19 to the appropriate committees of Congress, a report 

20 on the progress made by States receiving grants 

21 under paragraph (1) in meeting the goals of ex22 panded coverage, improved quality, and cost contain23 ment through performance measures established 

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

25 shall contain the recommendation of the Commission 


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1 concerning any future action that Congress should 

2 take concerning health care reform, including wheth3 er or not to extend the program established under 

4 this subsection. 

5 (g) MONITORING AND EVALUATION.— 

6 (1) ANNUAL REPORTS AND PARTICIPATION BY

7 STATES.—Each State that has received a program 

8 approval shall— 

9 (A) submit to the Commission an annual 

10 report based on the period representing the re11 spective State’s fiscal year, detailing compliance 

12 with the requirements established by the Com13 mission and the Secretary in the approval and 

14 in this section; and 

15 (B) participate in the annual meeting 

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

17 (2) EVALUATIONS BY COMMISSION.—The Com18 mission, in consultation with a qualified and inde19 pendent organization such as the Institute of Medi20 cine, shall prepare and submit to the Committee on 

21 Finance and the Committee on Health, Education, 

22 Labor, and Pensions of the Senate and the Com23 mittee on Energy and Commerce, the Committee on 

24 Education and Labor, and the Committee on Ways 


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1 and Means of the House of Representatives annual 

2 reports that shall contain— 

3 (A) a description of the effects of the re4 forms undertaken in States receiving approvals 

5 under this section; 

6 (B) a description of the recommendations 

7 of the Commission and actions taken based on 

8 these recommendations; 

9 (C) an evaluation of the effectiveness of 

10 such reforms in— 

11 (i) expanding health care coverage for 

12 State residents; 

13 (ii) improving the quality of health 

14 care provided in the States; and 

15 (iii) reducing or containing health 

16 care costs in the States; 

17 (D) recommendations regarding the advis18 ability of increasing Federal financial assistance 

19 for State ongoing or future health program ini20 tiatives, including the amount and source of 

21 such assistance; and 

22 (E) as required by the Commission or the 

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

24 independent evaluation of the program. 

25 (h) NONCOMPLIANCE.— 


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

2 not in compliance with a requirement of this section, 

3 the Secretary shall develop a corrective action plan 

4 for such State. 

5 (2) TERMINATION.—For good cause and in con6 sultation with the Commission, the Secretary may 

7 revoke any program granted under this section. 

8 Such decisions shall be subject to a petition for re9 consideration and appeal pursuant to regulations es10 tablished by the Secretary. 

11 (i) RELATIONSHIP TO FEDERAL PROGRAMS.— 

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

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

14 1315) shall be construed as authorizing the Sec15 retary, the Commission, a State, or any other person 

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

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

18 or the regulations implementing such title. 

19 (2) MAINTENANCE OF EFFORT.—No payment 

20 may be made under this section if the State adopts 

21 criteria for benefits, income, and resource standards 

22 and methodologies for purposes of determining an 

23 individual’s eligibility for medical assistance under 

24 the State plan under title XIX that are more restricVerDate Aug 31 2005 00:33 Jan 19, 2007 Jkt 059200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\S325.IS S325

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1 tive than those applied as of the date of enactment 

2 of this Act. 

3 (j) MISCELLANEOUS PROVISIONS.— 

4 (1) APPLICATION OF CERTAIN REQUIRE5 MENTS.— 

6 (A) RESTRICTION ON APPLICATION OF

7 PREEXISTING CONDITION EXCLUSIONS.— 

8 (i) IN GENERAL.—Subject to subpara9 graph (B), a State shall not permit the im10 position of any preexisting condition exclu11 sion for covered benefits under a program 

12 or project under this section. 

13 (ii) GROUP HEALTH PLANS AND

14 GROUP HEALTH INSURANCE COVERAGE.— 

15 If the State program or project provides 

16 for benefits through payment for, or a con17 tract with, a group health plan or group 

18 health insurance coverage, the program or 

19 project may permit the imposition of a pre20 existing condition exclusion but only inso21 far and to the extent that such exclusion is 

22 permitted under the applicable provisions 

23 of part 7 of subtitle B of title I of the Em24 ployee Retirement Income Security Act of 


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1 1974 and title XXVII of the Public Health 

2 Service Act. 

3 (B) COMPLIANCE WITH OTHER REQUIRE4 MENTS.—Coverage offered under the program 

5 or project shall comply with the requirements of 

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

7 Health Service Act insofar as such require8 ments apply with respect to a health insurance 

9 issuer that offers group health insurance cov10 erage. 

11 (2) PREVENTION OF DUPLICATIVE PAY12 MENTS.— 

13 (A) OTHER HEALTH PLANS.—No payment 

14 shall be made to a State under this section for 

15 expenditures for health assistance provided for 

16 an individual to the extent that a private in17 surer (as defined by the Secretary by regulation 

18 and including a group health plan (as defined 

19 in section 607(1) of the Employee Retirement 

20 Income Security Act of 1974), a service benefit 

21 plan, and a health maintenance organization) 

22 would have been obligated to provide such as23 sistance but for a provision of its insurance con24 tract which has the effect of limiting or exclud25 ing such obligation because the individual is eliVerDate Aug 31 2005 00:33 Jan 19, 2007 Jkt 059200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\S325.IS S325

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1 gible for or is provided health assistance under 

2 the plan. 

3 (B) OTHER FEDERAL GOVERNMENTAL

4 PROGRAMS.—Except as provided in any other 

5 provision of law, no payment shall be made to 

6 a State under this section for expenditures for 

7 health assistance provided for an individual to 

8 the extent that payment has been made or can 

9 reasonably be expected to be made promptly (as 

10 determined in accordance with regulations) 

11 under any other federally operated or financed 

12 health care insurance program, other than an 

13 insurance program operated or financed by the 

14 Indian Health Service, as identified by the Sec15 retary. For purposes of this paragraph, rules 

16 similar to the rules for overpayments under sec17 tion 1903(d)(2) of the Social Security Act shall 

18 apply. 

19 (3) APPLICATION OF CERTAIN GENERAL PROVI20 SIONS.—The following sections of the Social Security 

21 Act shall apply to States under this section in the 

22 same manner as they apply to a State under such 

23 title XIX: 

24 (A) TITLE xix PROVISIONS.— 


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

2 conflict of interest standards). 

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

4 section 1903(i) (relating to limitations on 

5 payment). 

6 (iii) Section 1903(w) (relating to limi7 tations on provider taxes and donations). 

8 (iv) Section 1920A (relating to pre9 sumptive eligibility for children). 

10 (B) TITLE xi PROVISIONS.— 

11 (i) Section 1116 (relating to adminis12 trative and judicial review), but only inso13 far as consistent with this title. 

14 (ii) Section 1124 (relating to disclo15 sure of ownership and related informa16 tion). 

17 (iii) Section 1126 (relating to disclo18 sure of information about certain convicted 

19 individuals). 

20 (iv) Section 1128A (relating to civil 

21 monetary penalties). 

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

23 criminal penalties for certain additional 

24 charges). 


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1 (vi) Section 1132 (relating to periods 

2 within which claims must be filed). 

3 (4) RELATION TO OTHER LAWS.— 

4 (A) HIPAA.—Health benefits coverage 

5 provided under a State program or project 

6 under this section shall be treated as creditable 

7 coverage for purposes of part 7 of subtitle B of 

8 title I of the Employee Retirement Income Se9 curity Act of 1974, title XXVII of the Public 

10 Health Service Act, and subtitle K of the Inter11 nal Revenue Code of 1986. 

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

13 be construed as affecting or modifying section 

14 514 of the Employee Retirement Income Secu15 rity Act of 1974 (29 U.S.C. 1144) with respect 

16 to a group health plan (as defined in section 

17 2791(a)(1) of the Public Health Service Act (42 

18 U.S.C. 300gg–91(a)(1))). 

19 (k) AUTHORIZATION OF APPROPRIATIONS.—There is 

20 authorized to be appropriated to carry out this section, 

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

22 Amounts appropriated for a fiscal year under this sub23 section and not expended may be used in subsequent fiscal 

24 years to carry out this section. 

Æ 


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