I 

111TH CONGRESS 

1ST SESSION H. R. 542 

To amend titles XIX and XXI of the Social Security Act to permit States 

to rely on findings from an express plan agency to conduct simplified 

eligibility determinations under Medicaid and the State Children’s Health 

Insurance Program. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 14, 2009 

Mr. PUTNAM introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To amend titles XIX and XXI of the Social Security Act 

to permit States to rely on findings from an express 

plan agency to conduct simplified eligibility determinations under Medicaid and the State Children’s Health 

Insurance Program. 

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 ‘‘Healthy Kids One Stop 

5 Act’’. 


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1 SEC. 2. STATE OPTION TO RELY ON FINDINGS FROM AN EX2 PRESS LANE AGENCY TO CONDUCT SIM3 PLIFIED ELIGIBILITY DETERMINATIONS 

4 UNDER MEDICAID AND SCHIP. 

5 (a) APPLICATION UNDER MEDICAID AND SCHIP.— 

6 (1) MEDICAID.—Section 1902(e) of the Social 

7 Security Act (42 U.S.C. 1396a(e)) is amended by 

8 adding at the end the following: 

9 ‘‘(13) EXPRESS LANE OPTION.— 

10 ‘‘(A) IN GENERAL.— 

11 ‘‘(i) OPTION TO USE A FINDING FROM

12 AN EXPRESS LANE AGENCY.—At the op13 tion of the State, the State plan may pro14 vide that in determining eligibility under 

15 this title for a child (as defined in subpara16 graph (G)), the State may rely on a find17 ing made within a reasonable period (as 

18 determined by the State) from an Express 

19 Lane agency (as defined in subparagraph 

20 (F)) when it determines whether a child 

21 satisfies one or more components of eligi22 bility for medical assistance under this 

23 title. The State may rely on a finding from 

24 an Express Lane agency notwithstanding 

25 any differences in budget unit, disregard, 


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1 deeming, or other methodology, if the fol2 lowing requirements are met: 

3 ‘‘(I) PROHIBITION ON DETER4 MINING CHILDREN INELIGIBLE FOR

5 COVERAGE.—If a finding from an Ex6 press Lane agency would result in a 

7 determination that a child does not 

8 satisfy an eligibility requirement for 

9 medical assistance under this title and 

10 for child health assistance under title 

11 XXI, the State shall determine eligi12 bility for assistance using its regular 

13 procedures. 

14 ‘‘(II) NOTICE REQUIREMENT.— 

15 For any child who is found eligible for 

16 medical assistance under the State 

17 plan under this title or child health 

18 assistance under title XXI and who is 

19 subject to premiums based on an Ex20 press Lane agency’s finding of such 

21 child’s income level, the State shall 

22 provide notice that the child may 

23 qualify for lower premium payments if 

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1 ular policies and of the procedures for 

2 requesting such an evaluation. 

3 ‘‘(III) COMPLIANCE WITH

4 SCREEN AND ENROLL REQUIRE5 MENT.—The State shall satisfy the re6 quirements under subparagraphs (A) 

7 and (B) of section 2102(b)(3) (relat8 ing to screen and enroll) before enroll9 ing a child in child health assistance 

10 under title XXI. At its option, the 

11 State may fulfill such requirements in 

12 accordance with either option provided 

13 under subparagraph (C) of this para14 graph. 

15 ‘‘(IV) CODING.—The State meets 

16 the requirements of subparagraph 

17 (E). 

18 ‘‘(ii) OPTION TO APPLY TO RENEWALS

19 AND REDETERMINATIONS.—The State may 

20 apply the provisions of this paragraph 

21 when conducting initial determinations of 

22 eligibility, redeterminations of eligibility, or 

23 both, as described in the State plan. 

24 ‘‘(B) RULES OF CONSTRUCTION.—Nothing 

25 in this paragraph shall be construed— 


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1 ‘‘(i) to limit or prohibit a State from 

2 taking any actions otherwise permitted 

3 under this title or title XXI in determining 

4 eligibility for or enrolling children into 

5 medical assistance under this title or child 

6 health assistance under title XXI; 

7 ‘‘(ii) to modify the limitations in sec8 tion 1902(a)(5) concerning the agencies 

9 that may make a determination of eligi10 bility for medical assistance under this 

11 title; or 

12 ‘‘(iii) to modify the application of sec13 tions 1137(d), 1902(a)(46), 1903(i)(22), 

14 or 1903(x). 

15 ‘‘(C) OPTIONS FOR SATISFYING THE

16 SCREEN AND ENROLL REQUIREMENT.— 

17 ‘‘(i) IN GENERAL.—With respect to a 

18 child whose eligibility for medical assist19 ance under this title or for child health as20 sistance under title XXI has been evalu21 ated by a State agency using an income 

22 finding from an Express Lane agency, a 

23 State may carry out its duties under sub24 paragraphs (A) and (B) of section 

25 2102(b)(3) (relating to screen and enroll) 


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1 in accordance with either clause (ii) or 

2 clause (iii). 

3 ‘‘(ii) ESTABLISHING A SCREENING

4 THRESHOLD.— 

5 ‘‘(I) IN GENERAL.—Under this 

6 clause, the State establishes a screen7 ing threshold set as a percentage of 

8 the Federal poverty level that exceeds 

9 the highest income threshold applica10 ble under this title to the child by a 

11 minimum of 30 percentage points or, 

12 at State option, a higher number of 

13 percentage points that reflects the 

14 value (as determined by the State and 

15 described in the State plan) of any 

16 differences between income methodolo17 gies used by the program adminis18 tered by the Express Lane agency and 

19 the methodologies used by the State 

20 in determining eligibility for medical 

21 assistance under this title. 

22 ‘‘(II) CHILDREN WITH INCOME

23 NOT ABOVE THRESHOLD.—If the in24 come of a child does not exceed the 

25 screening threshold, the child is 


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1 deemed to satisfy the income eligi2 bility criteria for medical assistance 

3 under this title regardless of whether 

4 such child would otherwise satisfy 

5 such criteria. 

6 ‘‘(III) CHILDREN WITH INCOME

7 ABOVE THRESHOLD.—If the income of 

8 a child exceeds the screening thresh9 old, the child shall be considered to 

10 have an income above the Medicaid 

11 applicable income level described in 

12 section 2110(b)(4) and to satisfy the 

13 requirement under section 

14 2110(b)(1)(C) (relating to the re15 quirement that CHIP matching funds 

16 be used only for children not eligible 

17 for Medicaid). If such a child is en18 rolled in child health assistance under 

19 title XXI, the State shall provide the 

20 parent, guardian, or custodial relative 

21 with the following: 

22 ‘‘(aa) Notice that the child 

23 may be eligible to receive medical 

24 assistance under the State plan 

25 under this title if evaluated for 


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1 such assistance under the State’s 

2 regular procedures and notice of 

3 the process through which a par4 ent, guardian, or custodial rel5 ative can request that the State 

6 evaluate the child’s eligibility for 

7 medical assistance under this 

8 title using such regular proce9 dures. 

10 ‘‘(bb) A description of dif11 ferences between the medical as12 sistance provided under this title 

13 and child health assistance under 

14 title XXI, including differences in 

15 cost-sharing requirements and 

16 covered benefits. 

17 ‘‘(iii) TEMPORARY ENROLLMENT IN

18 CHIP PENDING SCREEN AND ENROLL.— 

19 ‘‘(I) IN GENERAL.—Under this 

20 clause, a State enrolls a child in child 

21 health assistance under title XXI for 

22 a temporary period if the child ap23 pears eligible for such assistance 

24 based on an income finding by an Ex25 press Lane agency. 


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1 ‘‘(II) DETERMINATION OF ELIGI2 BILITY.—During such temporary en3 rollment period, the State shall deter4 mine the child’s eligibility for child 

5 health assistance under title XXI or 

6 for medical assistance under this title 

7 in accordance with this clause. 

8 ‘‘(III) PROMPT FOLLOW UP.—In 

9 making such a determination, the 

10 State shall take prompt action to de11 termine whether the child should be 

12 enrolled in medical assistance under 

13 this title or child health assistance 

14 under title XXI pursuant to subpara15 graphs (A) and (B) of section 

16 2102(b)(3) (relating to screen and en17 roll). 

18 ‘‘(IV) REQUIREMENT FOR SIM19 PLIFIED DETERMINATION.—In mak20 ing such a determination, the State 

21 shall use procedures that, to the max22 imum feasible extent, reduce the bur23 den imposed on the individual of such 

24 determination. Such procedures may 

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1 ian, or custodial relative to provide or 

2 verify information that already has 

3 been provided to the State agency by 

4 an Express Lane agency or another 

5 source of information unless the State 

6 agency has reason to believe the infor7 mation is erroneous. 

8 ‘‘(V) AVAILABILITY OF CHIP

9 MATCHING FUNDS DURING TEM10 PORARY ENROLLMENT PERIOD.—Med11 ical assistance for items and services 

12 that are provided to a child enrolled in 

13 title XXI during a temporary enroll14 ment period under this clause shall be 

15 treated as child health assistance 

16 under such title. 

17 ‘‘(D) OPTION FOR AUTOMATIC ENROLL18 MENT.— 

19 ‘‘(i) IN GENERAL.—The State may 

20 initiate and determine eligibility for med21 ical assistance under the State Medicaid 

22 plan or for child health assistance under 

23 the State CHIP plan without a program 

24 application from, or on behalf of, the child 

25 based on data obtained from sources other 


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1 than the child (or the child’s family), but 

2 a child can only be automatically enrolled 

3 in the State Medicaid plan or the State 

4 CHIP plan if the child or the family af5 firmatively consents to being enrolled 

6 through affirmation and signature on an 

7 Express Lane agency application, if the re8 quirement of clause (ii) is met. 

9 ‘‘(ii) INFORMATION REQUIREMENT.— 

10 The requirement of this clause is that the 

11 State informs the parent, guardian, or cus12 todial relative of the child of the services 

13 that will be covered, appropriate methods 

14 for using such services, premium or other 

15 cost sharing charges (if any) that apply, 

16 medical support obligations (under section 

17 1912(a)) created by enrollment (if applica18 ble), and the actions the parent, guardian, 

19 or relative must take to maintain enroll20 ment and renew coverage. 

21 ‘‘(E) CODING; APPLICATION TO ENROLL22 MENT ERROR RATES.— 

23 ‘‘(i) IN GENERAL.—For purposes of 

24 subparagraph (A)(iv), the requirement of 


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1 this subparagraph for a State is that the 

2 State agrees to— 

3 ‘‘(I) assign such codes as the 

4 Secretary shall require to the children 

5 who are enrolled in the State Med6 icaid plan or the State CHIP plan 

7 through reliance on a finding made by 

8 an Express Lane agency for the dura9 tion of the State’s election under this 

10 paragraph; 

11 ‘‘(II) annually provide the Sec12 retary with a statistically valid sample 

13 (that is approved by Secretary) of the 

14 children enrolled in such plans 

15 through reliance on such a finding by 

16 conducting a full Medicaid eligibility 

17 review of the children identified for 

18 such sample for purposes of deter19 mining an eligibility error rate (as de20 scribed in clause (iv)) with respect to 

21 the enrollment of such children (and 

22 shall not include such children in any 

23 data or samples used for purposes of 

24 complying with a Medicaid Eligibility 

25 Quality Control (MEQC) review or a 


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1 payment error rate measurement 

2 (PERM) requirement); 

3 ‘‘(III) submit the error rate de4 termined under subclause (II) to the 

5 Secretary; 

6 ‘‘(IV) if such error rate exceeds 3 

7 percent for either of the first 2 fiscal 

8 years in which the State elects to 

9 apply this paragraph, demonstrate to 

10 the satisfaction of the Secretary the 

11 specific corrective actions implemented 

12 by the State to improve upon such 

13 error rate; and 

14 ‘‘(V) if such error rate exceeds 3 

15 percent for any fiscal year in which 

16 the State elects to apply this para17 graph, a reduction in the amount oth18 erwise payable to the State under sec19 tion 1903(a) for quarters for that fis20 cal year, equal to the total amount of 

21 erroneous excess payments determined 

22 for the fiscal year only with respect to 

23 the children included in the sample 

24 for the fiscal year that are in excess 


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1 of a 3 percent error rate with respect 

2 to such children. 

3 ‘‘(ii) NO PUNITIVE ACTION BASED ON

4 ERROR RATE.—The Secretary shall not 

5 apply the error rate derived from the sam6 ple under clause (i) to the entire popu7 lation of children enrolled in the State 

8 Medicaid plan or the State CHIP plan 

9 through reliance on a finding made by an 

10 Express Lane agency, or to the population 

11 of children enrolled in such plans on the 

12 basis of the State’s regular procedures for 

13 determining eligibility, or penalize the 

14 State on the basis of such error rate in any 

15 manner other than the reduction of pay16 ments provided for under clause (i)(V). 

17 ‘‘(iii) RULE OF CONSTRUCTION.— 

18 Nothing in this paragraph shall be con19 strued as relieving a State that elects to 

20 apply this paragraph from being subject to 

21 a penalty under section 1903(u), for pay22 ments made under the State Medicaid plan 

23 with respect to ineligible individuals and 

24 families that are determined to exceed the 

25 error rate permitted under that section (as 


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1 determined without regard to the error 

2 rate determined under clause (i)(II)). 

3 ‘‘(iv) ERROR RATE DEFINED.—In this 

4 subparagraph, the term ‘error rate’ means 

5 the rate of erroneous excess payments for 

6 medical assistance (as defined in section 

7 1903(u)(1)(D)) for the period involved, ex8 cept that such payments shall be limited to 

9 individuals for which eligibility determina10 tions are made under this paragraph and 

11 except that in applying this paragraph 

12 under title XXI, there shall be substituted 

13 for references to provisions of this title cor14 responding provisions within title XXI. 

15 ‘‘(F) EXPRESS LANE AGENCY.— 

16 ‘‘(i) IN GENERAL.—In this paragraph, 

17 the term ‘Express Lane agency’ means a 

18 public agency that— 

19 ‘‘(I) is determined by the State 

20 Medicaid agency or the State CHIP 

21 agency (as applicable) to be capable of 

22 making the determinations of one or 

23 more eligibility requirements described 

24 in subparagraph (A)(i); 


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1 ‘‘(II) is identified in the State 

2 Medicaid plan or the State CHIP 

3 plan; and 

4 ‘‘(III) notifies the child’s fam5 ily— 

6 ‘‘(aa) of the information 

7 which shall be disclosed in ac8 cordance with this paragraph; 

9 ‘‘(bb) that the information 

10 disclosed will be used solely for 

11 purposes of determining eligi12 bility for medical assistance 

13 under the State Medicaid plan or 

14 for child health assistance under 

15 the State CHIP plan; and 

16 ‘‘(cc) that the family may 

17 elect to not have the information 

18 disclosed for such purposes; and 

19 ‘‘(IV) enters into, or is subject 

20 to, an interagency agreement to limit 

21 the disclosure and use of the informa22 tion disclosed. 

23 ‘‘(ii) INCLUSION OF SPECIFIC PUBLIC

24 AGENCIES.—Such term includes the fol25 lowing: 


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1 ‘‘(I) A public agency that deter2 mines eligibility for assistance under 

3 any of the following: 

4 ‘‘(aa) The temporary assist5 ance for needy families program 

6 funded under part A of title IV. 

7 ‘‘(bb) A State program 

8 funded under part D of title IV. 

9 ‘‘(cc) The State Medicaid 

10 plan. 

11 ‘‘(dd) The State CHIP plan. 

12 ‘‘(ee) The supplemental nu13 trition assistance program under 

14 the Food and Nutrition Act of 

15 2008 (7 U.S.C. 2011 et seq.). 

16 ‘‘(ff) The Head Start Act 

17 (42 U.S.C. 9801 et seq.). 

18 ‘‘(gg) The Richard B. Rus19 sell National School Lunch Act 

20 (42 U.S.C. 1751 et seq.). 

21 ‘‘(hh) The Child Nutrition 

22 Act of 1966 (42 U.S.C. 1771 et 

23 seq.). 


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1 ‘‘(ii) The Child Care and 

2 Development Block Grant Act of 

3 1990 (42 U.S.C. 9858 et seq.). 

4 ‘‘(jj) The Stewart B. McKin5 ney Homeless Assistance Act (42 

6 U.S.C. 11301 et seq.). 

7 ‘‘(kk) The United States 

8 Housing Act of 1937 (42 U.S.C. 

9 1437 et seq.). 

10 ‘‘(ll) The Native American 

11 Housing Assistance and Self-De12 termination Act of 1996 (25 

13 U.S.C. 4101 et seq.). 

14 ‘‘(II) A State-specified govern15 mental agency that has fiscal liability 

16 or legal responsibility for the accuracy 

17 of the eligibility determination find18 ings relied on by the State. 

19 ‘‘(III) A public agency that is 

20 subject to an interagency agreement 

21 limiting the disclosure and use of the 

22 information disclosed for purposes of 

23 determining eligibility under the State 

24 Medicaid plan or the State CHIP 

25 plan. 


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1 ‘‘(iii) EXCLUSIONS.—Such term does 

2 not include an agency that determines eli3 gibility for a program established under 

4 the Social Services Block Grant established 

5 under title XX or a private, for-profit or6 ganization. 

7 ‘‘(iv) RULES OF CONSTRUCTION.— 

8 Nothing in this paragraph shall be con9 strued as— 

10 ‘‘(I) exempting a State Medicaid 

11 agency from complying with the re12 quirements of section 1902(a)(4) re13 lating to merit-based personnel stand14 ards for employees of the State Med15 icaid agency and safeguards against 

16 conflicts of interest); or 

17 ‘‘(II) authorizing a State Med18 icaid agency that elects to use Ex19 press Lane agencies under this sub20 paragraph to use the Express Lane 

21 option to avoid complying with such 

22 requirements for purposes of making 

23 eligibility determinations under the 

24 State Medicaid plan. 


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1 ‘‘(v) ADDITIONAL DEFINITIONS.—In 

2 this paragraph: 

3 ‘‘(I) STATE.—The term ‘State’ 

4 means 1 of the 50 States or the Dis5 trict of Columbia. 

6 ‘‘(II) STATE CHIP AGENCY.—The 

7 term ‘State CHIP agency’ means the 

8 State agency responsible for admin9 istering the State CHIP plan. 

10 ‘‘(III) STATE CHIP PLAN.—The 

11 term ‘State CHIP plan’ means the 

12 State child health plan established 

13 under title XXI and includes any 

14 waiver of such plan. 

15 ‘‘(IV) STATE MEDICAID AGEN16 CY.—The term ‘State Medicaid agen17 cy’ means the State agency respon18 sible for administering the State Med19 icaid plan. 

20 ‘‘(V) STATE MEDICAID PLAN.— 

21 The term ‘State Medicaid plan’ means 

22 the State plan established under title 

23 XIX and includes any waiver of such 

24 plan. 


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1 ‘‘(G) CHILD DEFINED.—For purposes of 

2 this paragraph, the term ‘child’ means an indi3 vidual under 19 years of age, or, at the option 

4 of a State, such higher age, not to exceed 21 

5 years of age, as the State may elect. 

6 ‘‘(H) APPLICATION.—This paragraph shall 

7 not apply to with respect to eligibility deter8 minations made after September 30, 2014. 

9 ‘‘(I) CONTINUED APPLICATION.—’’. 

10 (2) CHIP.—Section 2107(e)(1) of such Act (42 

11 U.S.C. 1397gg(e)(1)) is amended by redesignating 

12 subparagraphs (B), (C), and (D) as subparagraphs 

13 (C), (D), and (E), respectively, and by inserting 

14 after subparagraph (A) the following new subpara15 graph: 

16 ‘‘(B) Section 1902(e)(13) (relating to the 

17 State option to rely on findings from an Ex18 press Lane agency to help evaluate a child’s eli19 gibility for medical assistance).’’. 

20 (b) EVALUATION AND REPORT.— 

21 (1) EVALUATION.—The Secretary shall con22 duct, by grant, contract, or interagency agreement, 

23 a comprehensive, independent evaluation of the op24 tion provided under the amendments made by subVerDate Nov 24 2008 01:54 Jan 21, 2009 Jkt 079200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\H542.IH H542

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1 section (a). Such evaluation shall include an analysis 

2 of the effectiveness of the option, and shall include— 

3 (A) obtaining a statistically valid sample of 

4 the children who were enrolled in the State 

5 Medicaid plan or the State CHIP plan through 

6 reliance on a finding made by an Express Lane 

7 agency and determining the percentage of chil8 dren who were erroneously enrolled in such 

9 plans; 

10 (B) determining whether enrolling children 

11 in such plans through reliance on a finding 

12 made by an Express Lane agency improves the 

13 ability of a State to identify and enroll low-in14 come, uninsured children who are eligible but 

15 not enrolled in such plans; 

16 (C) evaluating the administrative costs or 

17 savings related to identifying and enrolling chil18 dren in such plans through reliance on such 

19 findings, and the extent to which such costs dif20 fer from the costs that the State otherwise 

21 would have incurred to identify and enroll low22 income, uninsured children who are eligible but 

23 not enrolled in such plans; and 

24 (D) any recommendations for legislative or 

25 administrative changes that would improve the 


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1 effectiveness of enrolling children in such plans 

2 through reliance on such findings. 

3 (2) REPORT TO CONGRESS.—Not later than 

4 September 30, 2013, the Secretary shall submit a 

5 report to Congress on the results of the evaluation 

6 under paragraph (1). 

7 (3) FUNDING.— 

8 (A) IN GENERAL.—Out of any funds in the 

9 Treasury not otherwise appropriated, there is 

10 appropriated to the Secretary to carry out the 

11 evaluation under this subsection $5,000,000 for 

12 the period of fiscal years 2010 through 2013. 

13 (B) BUDGET AUTHORITY.—Subparagraph 

14 (A) constitutes budget authority in advance of 

15 appropriations Act and represents the obliga16 tion of the Federal Government to provide for 

17 the payment of such amount to conduct the 

18 evaluation under this subsection. 

19 (c) ELECTRONIC TRANSMISSION OF INFORMATION.— 

20 Section 1902 of such Act (42 U.S.C. 1396a) is amended 

21 by adding at the end the following new subsection: 

22 ‘‘(dd) ELECTRONIC TRANSMISSION OF INFORMA23 TION.—If the State agency determining eligibility for med24 ical assistance under this title or child health assistance 

25 under title XXI verifies an element of eligibility based on 


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1 information from an Express Lane Agency (as defined in 

2 subsection (e)(13)(F)), or from another public agency, 

3 then the applicant’s signature under penalty of perjury 

4 shall not be required as to such element. Any signature 

5 requirement for an application for medical assistance may 

6 be satisfied through an electronic signature, as defined in 

7 section 1710(1) of the Government Paperwork Elimi8 nation Act (44 U.S.C. 3504 note). The requirements of 

9 subparagraphs (A) and (B) of section 1137(d)(2) may be 

10 met through evidence in digital or electronic form.’’. 

11 (d) AUTHORIZATION OF INFORMATION DISCLO12 SURE.— 

13 (1) IN GENERAL.—Title XIX of the Social Se14 curity Act is amended by adding at the end the fol15 lowing new section: 

16 ‘‘SEC. 1942. AUTHORIZATION TO RECEIVE RELEVANT IN17 FORMATION. 

18 ‘‘(a) IN GENERAL.—Notwithstanding any other pro19 vision of law, a Federal or State agency or private entity 

20 in possession of the sources of data directly relevant to 

21 eligibility determinations under this title (including eligi22 bility files maintained by Express Lane agencies described 

23 in section 1902(e)(13)(F), information described in para24 graph (2) or (3) of section 1137(a), vital records informa25 tion about births in any State, and information described 


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1 in sections 453(i) and 1902(a)(25)(I)) is authorized to 

2 convey such data or information to the State agency ad3 ministering the State plan under this title, to the extent 

4 such conveyance meets the requirements of subsection (b). 

5 ‘‘(b) REQUIREMENTS FOR CONVEYANCE.—Data or 

6 information may be conveyed pursuant to subsection (a) 

7 only if the following requirements are met: 

8 ‘‘(1) The individual whose circumstances are 

9 described in the data or information (or such indi10 vidual’s parent, guardian, caretaker relative, or au11 thorized representative) has either provided advance 

12 consent to disclosure or has not objected to disclo13 sure after receiving advance notice of disclosure and 

14 a reasonable opportunity to object. 

15 ‘‘(2) Such data or information are used solely 

16 for the purposes of— 

17 ‘‘(A) identifying individuals who are eligi18 ble or potentially eligible for medical assistance 

19 under this title and enrolling or attempting to 

20 enroll such individuals in the State plan; and 

21 ‘‘(B) verifying the eligibility of individuals 

22 for medical assistance under the State plan. 

23 ‘‘(3) An interagency or other agreement, con24 sistent with standards developed by the Secretary— 


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1 ‘‘(A) prevents the unauthorized use, disclo2 sure, or modification of such data and other3 wise meets applicable Federal requirements 

4 safeguarding privacy and data security; and 

5 ‘‘(B) requires the State agency admin6 istering the State plan to use the data and in7 formation obtained under this section to seek to 

8 enroll individuals in the plan. 

9 ‘‘(c) PENALTIES FOR IMPROPER DISCLOSURE.— 

10 ‘‘(1) CIVIL MONEY PENALTY.—A private entity 

11 described in the subsection (a) that publishes, dis12 closes, or makes known in any manner, or to any ex13 tent not authorized by Federal law, any information 

14 obtained under this section is subject to a civil 

15 money penalty in an amount equal to $10,000 for 

16 each such unauthorized publication or disclosure. 

17 The provisions of section 1128A (other than sub18 sections (a) and (b) and the second sentence of sub19 section (f)) shall apply to a civil money penalty 

20 under this paragraph in the same manner as such 

21 provisions apply to a penalty or proceeding under 

22 section 1128A(a). 

23 ‘‘(2) CRIMINAL PENALTY.—A private entity de24 scribed in the subsection (a) that willfully publishes, 

25 discloses, or makes known in any manner, or to any 


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1 extent not authorized by Federal law, any informa2 tion obtained under this section shall be fined not 

3 more than $10,000 or imprisoned not more than 1 

4 year, or both, for each such unauthorized publication 

5 or disclosure. 

6 ‘‘(d) RULE OF CONSTRUCTION.—The limitations and 

7 requirements that apply to disclosure pursuant to this sec8 tion shall not be construed to prohibit the conveyance or 

9 disclosure of data or information otherwise permitted 

10 under Federal law (without regard to this section).’’. 

11 (2) CONFORMING AMENDMENT TO TITLE XXI.— 

12 Section 2107(e)(1) of such Act (42 U.S.C. 

13 1397gg(e)(1)), as amended by subsection (a)(2), is 

14 amended by adding at the end the following new 

15 subparagraph: 

16 ‘‘(F) Section 1942 (relating to authoriza17 tion to receive data directly relevant to eligi18 bility determinations).’’. 

19 (3) CONFORMING AMENDMENT TO PROVIDE AC20 CESS TO DATA ABOUT ENROLLMENT IN INSURANCE

21 FOR PURPOSES OF EVALUATING APPLICATIONS AND

22 FOR CHIP.—Section 1902(a)(25)(I)(i) of such Act 

23 (42 U.S.C. 1396a(a)(25)(I)(i)) is amended— 

24 (A) by inserting ‘‘(and, at State option, in25 dividuals who apply or whose eligibility for medVerDate Nov 24 2008 04:53 Jan 16, 2009 Jkt 079200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\H542.IH H542

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1 ical assistance is being evaluated in accordance 

2 with section 1902(e)(13)(D))’’ after ‘‘with re3 spect to individuals who are eligible’’; and 

4 (B) by inserting ‘‘under this title (and, at 

5 State option, child health assistance under title 

6 XXI)’’ after ‘‘the State plan’’. 

7 (e) AUTHORIZATION FOR STATES ELECTING EX8 PRESS LANE OPTION TO RECEIVE CERTAIN DATA DI9 RECTLY RELEVANT TO DETERMINING ELIGIBILITY AND

10 CORRECT AMOUNT OF ASSISTANCE.—The Secretary of 

11 Health and Human Services shall enter into such agree12 ments as are necessary to permit a State that elects the 

13 Express Lane option under section 1902(e)(13) of the So14 cial Security Act to receive data directly relevant to eligi15 bility determinations and determining the correct amount 

16 of benefits under a State child health plan under title XXI 

17 of the Social Security Act or a State plan under title XIX 

18 of such Act from the following: 

19 (1) The National Directory of New Hires estab20 lished under section 453(i) of the Social Security 

21 Act (42 U.S.C. 653(i)). 

22 (2) Data regarding enrollment in insurance that 

23 may help to facilitate outreach and enrollment under 

24 the State Medicaid plan, the State child health plan, 


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1 and such other programs as the Secretary may 

2 specify. 

3 (f) EFFECTIVE DATE.—The amendments made by 

4 this section are effective on January 1, 2010. 

Æ 


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