I 

113TH CONGRESS 

2D SESSION H. R. 5364 

To amend title XXI of the Social Security Act to extend and improve the 

Children’s Health Insurance Program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 31, 2014 

Mr. PALLONE (for himself, Mr. WAXMAN, Ms. SCHAKOWSKY, Ms. CASTOR of 

Florida, Mrs. CAPPS, Mrs. CHRISTENSEN, Mr. GENE GREEN of Texas, 

Mr. DINGELL, Mr. BUTTERFIELD, Mr. SARBANES, Mr. ENGEL, and Mr. 

MATHESON) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on 

Ways and Means, 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 amend title XXI of the Social Security Act to extend 

and improve the Children’s Health Insurance Program, 

and for other purposes. 

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; AMENDMENTS TO SOCIAL SECU4 RITY ACT; REFERENCES; TABLE OF CON5 TENTS. 

6 (a) SHORT TITLE.—This Act may be cited as the 

7 ‘‘CHIP Extension and Improvement Act of 2014’’. 


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1 (b) REFERENCES TO CHIP; MEDICAID; SEC2 RETARY.—In this Act: 

3 (1) CHIP.—The term ‘‘CHIP’’ means the 

4 State Children’s Health Insurance Program estab5 lished under title XXI of the Social Security Act (42 

6 U.S.C. 1397aa et seq.) (whether implemented under 

7 title XIX, XXI, or both, of the Social Security Act). 

8 (2) MEDICAID.—The term ‘‘Medicaid’’ means 

9 the program for medical assistance established under 

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

11 et seq.). 

12 (3) SECRETARY.—The term ‘‘Secretary’’ means 

13 the Secretary of Health and Human Services. 

14 (c) TABLE OF CONTENTS.—The table of contents for 

15 this Act is as follows: 

Sec. 1. Short title; amendments to Social Security Act; references; table of contents. 

Sec. 2. General effective date; exception for State legislation; reliance on law. 

TITLE I—FINANCING 

Sec. 101. 4-year extension of CHIP funding. 

Sec. 102. Performance incentive program improvements. 

Sec. 103. Child enrollment contingency fund adjustment. 

TITLE II—COVERAGE STABILITY AND REDUCED BUREAUCRACY 

Sec. 201. Improving coverage stability. 

Sec. 202. Assuring care continuity during transitions among CHIP, Medicaid, 

and qualified health plans. 

Sec. 203. Continuous eligibility option for certain adults. 

Sec. 204. State flexibility to use administrative simplification policies for enrollment. 

Sec. 205. Outreach to targeted populations. 

TITLE III—BENEFITS AND AFFORDABILITY 

Sec. 301. Strengthened cost-sharing protections under CHIP. 


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Sec. 302. Ensuring coverage of preventive health services under Medicaid and 

CHIP. 

Sec. 303. Timely immunization coverage. 

Sec. 304. Payment parity for Medicaid primary care services. 

TITLE IV—ACCESS AND QUALITY 

Subtitle A—Pediatric Quality Measures 

Sec. 401. Extending the pediatric quality measures program. 

Sec. 402. Enhanced FMAP for activities related to pediatric quality measures. 

Sec. 403. Reporting of full set of pediatric quality measures. 

Sec. 404. Technical assistance to States for adopting and utilizing pediatric 

quality measures. 

Sec. 405. Improving the effectiveness of the pediatric quality measures. 

Sec. 406. Reports regarding State-specific quality of care measures applied 

under Medicaid or CHIP. 

Sec. 407. Advisory panel regarding pediatric quality. 

Sec. 408. Extending and expanding demonstration projects. 

Subtitle B—Continuing Delivery System Reform 

Sec. 411. Supporting evidence-based care coordination in communities. 

Sec. 412. Ensuring care coordination for children. 

Subtitle C—Miscellaneous 

Sec. 421. Assuring coverage continuity for former foster care children. 

Sec. 422. Definition of therapeutic foster care as medical assistance. 

Sec. 423. Technical correction. 

1 SEC. 2. GENERAL EFFECTIVE DATE; EXCEPTION FOR STATE 

2 LEGISLATION; RELIANCE ON LAW. 

3 (a) GENERAL EFFECTIVE DATE.—Unless otherwise 

4 provided in this Act, subject to subsections (b) and (c), 

5 this Act (and the amendments made by this Act) shall 

6 take effect on October 1, 2014, and shall apply to medical 

7 assistance and child health assistance furnished under ti8 tles XIX and XXI, respectively, of the Social Security Act 

9 on or after that date. 

10 (b) EXCEPTION FOR STATE LEGISLATION.—In the 

11 case of a State plan under title XIX of the Social Security 

12 Act (42 U.S.C. 1396 et seq.) or a State child health plan 


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1 under title XXI of such Act (42 U.S.C. 1397aa et seq.), 

2 which the Secretary determines requires State legislation 

3 in order for the respective plan to meet one or more addi4 tional requirements imposed by amendments made by this 

5 Act, the respective plan shall not be regarded as failing 

6 to comply with the requirements of such title solely on the 

7 basis of its failure to meet such an additional requirement 

8 before the first day of the first calendar quarter beginning 

9 after the close of the first regular session of the State leg10 islature that begins after the date of enactment of this 

11 Act. For purposes of the previous sentence, in the case 

12 of a State that has a 2-year legislative session, each year 

13 of the session shall be considered to be a separate regular 

14 session of the State legislature. 

15 (c) COORDINATION OF CHIP FUNDING FOR FISCAL

16 YEAR 2015.—Notwithstanding any other provision of law, 

17 insofar as funds have been appropriated under subsection 

18 (a)(18) or (m) of section 2104 of the Social Security Act 

19 (42 U.S.C. 1397dd), as such subsections are in effect on 

20 the day before the date of the enactment of this Act, to 

21 provide allotments to States under CHIP for fiscal year 

22 2015— 

23 (1) any amounts that are so appropriated that 

24 are not so allotted and obligated before April 1, 

25 2015, are rescinded; and 


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1 (2) any amount provided for CHIP allotments 

2 to a State under this Act (and the amendments 

3 made by this Act) for such fiscal year shall be re4 duced by the amount of such appropriations so allot5 ted and obligated before such date. 

6 (d) RELIANCE ON LAW.—With respect to amend7 ments made by this Act that become effective as of a 

8 date— 

9 (1) such amendments are effective as of such 

10 date whether or not regulations implementing such 

11 amendments have been issued; and 

12 (2) Federal financial participation for medical 

13 assistance or child health assistance furnished under 

14 title XIX or XXI, respectively, of the Social Security 

15 Act on or after such date by a State in good faith 

16 reliance on such amendments before the date of pro17 mulgation of final regulations, if any, to carry out 

18 such amendments (or before the date of guidance, if 

19 any, regarding the implementation of such amend20 ments) shall not be denied on the basis of the 

21 State’s failure to comply with such regulations or 

22 guidance. 


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1 TITLE I—FINANCING 

2 SEC. 101. 4-YEAR EXTENSION OF CHIP FUNDING. 

3 (a) FUNDING.—Section 2104(a) of the Social Secu4 rity Act (42 U.S.C. 1397dd(a)) is amended— 

5 (1) in paragraph (17), by striking ‘‘and’’ at the 

6 end; 

7 (2) by striking paragraph (18) and inserting 

8 the following new paragraph: 

9 ‘‘(18) for fiscal year 2015, $21,061,000,000;’’; 

10 and 

11 (3) by adding at the end the following new 

12 paragraphs: 

13 ‘‘(19) for fiscal year 2016, $19,300,000,000; 

14 ‘‘(20) for fiscal year 2017, $20,300,000,000; 

15 ‘‘(21) for fiscal year 2018, $21,300,000,000; 

16 and 

17 ‘‘(22) for fiscal year 2019, for purposes of mak18 ing 2 semi-annual allotments— 

19 ‘‘(A) $2,850,000,000 for the period begin20 ning on October 1, 2018, and ending on March 

21 31, 2019; and 

22 ‘‘(B) $2,850,000,000 for the period begin23 ning on April 1, 2019, and ending on Sep24 tember 30, 2019.’’. 

25 (b) ALLOTMENTS.— 


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1 (1) IN GENERAL.—Section 2104(m) of the So2 cial Security Act (42 U.S.C. 1397dd(m)) is amend3 ed— 

4 (A) in the subsection heading, by striking 

5 ‘‘2015’’ and inserting ‘‘2019’’; 

6 (B) in paragraph (2)— 

7 (i) in the paragraph heading, by strik8 ing ‘‘2014’’ and inserting ‘‘2018’’; and 

9 (ii) by striking subparagraph (B) and 

10 inserting the following new subparagraph: 

11 ‘‘(B) FISCAL YEAR 2013 AND EACH SUC12 CEEDING FISCAL YEAR.—Subject to paragraphs 

13 (4) and (6), from the amount made available 

14 under paragraphs (16) through (21) of sub15 section (a) for fiscal year 2013 and each suc16 ceeding fiscal year, respectively, the Secretary 

17 shall compute a State allotment for each State 

18 (including the District of Columbia and each 

19 commonwealth and territory) for each such fis20 cal year as follows: 

21 ‘‘(i) REBASING IN FISCAL YEAR 2013

22 AND EACH SUCCEEDING ODD-NUMBERED

23 FISCAL YEAR.—For fiscal year 2013 and 

24 each succeeding odd-numbered fiscal year, 

25 the allotment of the State is equal to the 


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1 Federal payments to the State that are at2 tributable to (and countable toward) the 

3 total amount of allotments available under 

4 this section to the State in the preceding 

5 fiscal year (including payments made to 

6 the State under subsection (n) for such 

7 preceding fiscal year as well as amounts 

8 redistributed to the State in such pre9 ceding fiscal year), multiplied by the allot10 ment increase factor under paragraph (5) 

11 for such odd-numbered fiscal year. 

12 ‘‘(ii) GROWTH FACTOR UPDATE FOR

13 FISCAL YEAR 2014 AND EACH SUCCEEDING

14 EVEN-NUMBERED FISCAL YEAR.—For fis15 cal year 2014 and each succeeding even16 numbered fiscal year, the allotment of the 

17 State is equal to the sum of— 

18 ‘‘(I) the amount of the State al19 lotment under clause (i) for the pre20 ceding fiscal year; and 

21 ‘‘(II) the amount of any pay22 ments made to the State under sub23 section (n) for such preceding fiscal 

24 year, 


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1 multiplied by the allotment increase factor 

2 under paragraph (5) for such even-num3 bered fiscal year.’’; 

4 (C) in paragraph (3)— 

5 (i) in the heading, by striking ‘‘2015’’ 

6 and inserting ‘‘2019’’; 

7 (ii) in subparagraph (A), by striking 

8 ‘‘paragraph (18)’’ and inserting ‘‘para9 graph (22)’’; 

10 (iii) in subparagraph (B), by striking 

11 ‘‘paragraph (18)’’ and inserting ‘‘para12 graph (22)’’; 

13 (iv) in subparagraph (C)— 

14 (I) by striking ‘‘2014’’ each place 

15 it appears and inserting ‘‘2018’’; and 

16 (II) by striking ‘‘2015’’ and in17 serting ‘‘2019’’; and 

18 (v) in subparagraph (D)— 

19 (I) in clause (i)— 

20 (aa) in subclause (I), by 

21 striking ‘‘subsection (a)(18)(A)’’ 

22 and inserting ‘‘subsection 

23 (a)(22)(A)’’; and 

24 (bb) in subclause (II), by 

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1 dren’s Health Insurance Program 

2 Reauthorization Act of 2009’’ 

3 and inserting ‘‘section 101(b)(2) 

4 of the CHIP Extension and Im5 provement Act of 2014’’; and 

6 (II) in clause (ii)(II), by striking 

7 ‘‘subsection (a)(18)(B)’’ and inserting 

8 ‘‘subsection (a)(22)(B)’’; 

9 (D) in paragraph (4), by striking ‘‘2015’’ 

10 and inserting ‘‘2019’’; 

11 (E) in paragraph (6)— 

12 (i) in subparagraph (A), by striking 

13 ‘‘2015’’ and inserting ‘‘2019’’; and 

14 (ii) in the second sentence, by striking 

15 ‘‘or fiscal year 2014’’ and inserting ‘‘fiscal 

16 year 2014, fiscal year 2016, or fiscal year 

17 2018’’; and 

18 (F) in paragraph (8)— 

19 (i) in the paragraph heading, by strik20 ing ‘‘2015’’ and inserting ‘‘2019’’; and 

21 (ii) by striking ‘‘for a period in fiscal 

22 year 2015’’ and inserting ‘‘for a period in 

23 fiscal year 2019’’. 

24 (2) SUPPLEMENTAL APPROPRIATION FOR FIS25 CAL YEAR 2019.—There is appropriated to the SecVerDate Mar 15 2010 03:49 Aug 15, 2014 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H5364.IH H5364

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1 retary, out of any money in the Treasury not other2 wise appropriated, $16,700,000,000 to accompany 

3 the allotment made for the period beginning on Oc4 tober 1, 2018, and ending on March 31, 2019, 

5 under section 2104(a)(22)(A) of the Social Security 

6 Act (42 U.S.C. 1397dd(a)(22)(A)) (as added by sub7 section (a)), to remain available until expended. 

8 Such amount shall be used to provide allotments to 

9 States under paragraph (3) of section 2104(m) of 

10 such Act (42 U.S.C. 1397dd(m)) (as amended by 

11 paragraph (1)(C)) for the first 6 months of fiscal 

12 year 2019 in the same manner as allotments are 

13 provided under subsection (a)(22)(A) of such section 

14 2104 and subject to the same terms and conditions 

15 as apply to the allotments provided from such sub16 section (a)(22)(A). 

17 (c) EXTENSION OF QUALIFYING STATES OPTION.— 

18 Section 2105(g)(4) of the Social Security Act (42 U.S.C. 

19 1397ee(g)(4)) is amended— 

20 (1) in the paragraph heading, by striking 

21 ‘‘2015’’ and inserting ‘‘2019’’; and 

22 (2) in subparagraph (A), by striking ‘‘2015’’ 

23 and inserting ‘‘2019’’. 


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1 SEC. 102. PERFORMANCE INCENTIVE PROGRAM IMPROVE2 MENTS. 

3 (a) EXTENSION THROUGH FISCAL YEAR 2019.—Sec4 tion 2105(a)(3) of the Social Security Act (42 U.S.C. 

5 1397ee(a)(3)) is amended— 

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

7 and inserting ‘‘2019’’; 

8 (2) in subparagraph (E)— 

9 (A) in clause (ii)— 

10 (i) in the matter preceding subclause 

11 (I), by inserting ‘‘after the application of 

12 section 2104(n)(3)(D)(ii) with respect to 

13 such amounts,’’ after ‘‘limitation,’’; 

14 (ii) by striking subclause (I) and in15 serting the following new subclause: 

16 ‘‘(I) UNOBLIGATED NATIONAL

17 ALLOTMENT FOR FISCAL YEARS 2009

18 THROUGH 2015.—As of December 31 

19 of fiscal year 2009, and as of Decem20 ber 31 of each succeeding fiscal year 

21 through fiscal year 2015, the portion, 

22 if any, of the amount appropriated 

23 under section 2104(a) for such fiscal 

24 year that is unobligated for allotment 

25 to a State under section 2104(m) for 

26 such fiscal year or set aside under 


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1 subsection (a)(3) or (b)(2) of section 

2 2111 for such fiscal year.’’; 

3 (iii) in subclause (II), by striking 

4 ‘‘2013’’ and inserting ‘‘2015’’; and 

5 (iv) in subclause (III), by striking 

6 ‘‘2013’’ and inserting ‘‘2015’’; 

7 (B) by redesignating clause (iii) as clause 

8 (iv); and 

9 (C) by inserting after clause (ii), the fol10 lowing new clause: 

11 ‘‘(iii) APPROPRIATION FOR FISCAL

12 YEARS 2016 THROUGH 2019.—Out of any 

13 money in the Treasury not otherwise ap14 propriated, there are appropriated 

15 $500,000,000 for each of fiscal years 2016 

16 through 2019 for making payments under 

17 this paragraph. Amounts appropriated for 

18 a fiscal year under this clause shall remain 

19 available for making payments under this 

20 paragraph until January 1 of the following 

21 fiscal year. Any amounts of such appro22 priations that remain unexpended or unob23 ligated as of such date shall be transferred 

24 and made available for making payments 

25 under section 2104(n).’’; and 


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

2 ‘‘2013’’ and inserting ‘‘2019’’. 

3 (b) UPDATED PERFORMANCE INCENTIVE CRITERIA

4 FOR FISCAL YEARS 2015 THROUGH 2019.—Section 

5 2105(a) of the Social Security Act (42 U.S.C. 1397ee(a)) 

6 is amended— 

7 (1) in paragraph (3)(A), by inserting ‘‘or (5)’’ 

8 after ‘‘paragraph (4)’’; 

9 (2) in paragraph (4)— 

10 (A) in the heading, by inserting ‘‘FISCAL

11 YEARS 2009 THROUGH 2014’’ after ‘‘FOR CHIL12 DREN’’; and 

13 (B) in the matter preceding subparagraph 

14 (A), by striking ‘‘for a fiscal year if’’ and in15 serting ‘‘for fiscal years 2009 through 2014 if’’; 

16 and 

17 (3) by adding at the end the following new 

18 paragraph: 

19 ‘‘(5) ENROLLMENT AND RETENTION PROVI20 SIONS FOR CHILDREN FOR FISCAL YEAR 2015 AND

21 SUCCEEDING FISCAL YEARS.— 

22 ‘‘(A) IN GENERAL.—For purposes of para23 graph (3)(A), a State meets the condition of 

24 this paragraph for fiscal year 2015 and any 

25 succeeding fiscal year if it is implementing at 


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1 least 5 of the enrollment and retention provi2 sions specified in subparagraph (B) (treating 

3 each clause as a separate enrollment and reten4 tion provision) throughout the entire fiscal year. 

5 ‘‘(B) ENROLLMENT AND RETENTION PRO6 VISIONS.—The enrollment and retention provi7 sions specified in this subparagraph are the fol8 lowing: 

9 ‘‘(i) CONTINUOUS ELIGIBILITY.—The 

10 State has elected the option of continuous 

11 eligibility for a full 12 months for all chil12 dren (as defined in section 

13 1902(e)(13)(G)), as well as applying such 

14 policy under its State child health plan 

15 under this title. 

16 ‘‘(ii) EXPRESS LANE ELIGIBILITY.— 

17 The State is implementing the option de18 scribed in section 1902(e)(13) under title 

19 XIX as well as, pursuant to section 

20 2107(e)(1), under this title. 

21 ‘‘(iii) PRESUMPTIVE ELIGIBILITY.— 

22 The State is implementing section 1920A 

23 under title XIX as well as, pursuant to 

24 section 2107(e)(1), under this title. 


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1 ‘‘(iv) PREMIUM ASSISTANCE FOR EM2 PLOYER-SPONSORED PLANS.—The State is 

3 implementing section 1906A under title 

4 XIX or the option described in section 

5 2105(c)(10) under this title. 

6 ‘‘(v) SEAMLESS COVERAGE OP7 TIONS.—In the case of a State that pro8 vides medical assistance under the State 

9 plan under title XIX through managed 

10 care entities (as defined in section 

11 1932(a)(1)(B)) or health benefits coverage 

12 under the State child health plan through 

13 such entities, the State shall ensure that at 

14 least one such entity offers a qualified 

15 health plan through the Exchange estab16 lished under title I of the Patient Protec17 tion and Affordable Care Act in the State. 

18 ‘‘(vi) RETROACTIVE COVERAGE REIN19 STATEMENT UPON PREMIUM PAYMENT.— 

20 The State child health plan, in the case of 

21 an individual whose coverage under the 

22 plan has been terminated for failure to 

23 make premium payments, provides assist24 ance to such individual for purposes of the 

25 immediate reenrollment of the individual 


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1 upon payment of outstanding premiums, 

2 with coverage retroactive to the beginning 

3 of the most recent month for which an out4 standing premium has been paid, and shall 

5 not impose any waiting period or fee as a 

6 condition of such reenrollment. 

7 ‘‘(vii) EFFECTIVE TRANSITION TO

8 THE COMMUNITY FOR VULNERABLE

9 YOUTH.— 

10 ‘‘(I) IN GENERAL.—Subject to 

11 the subdivision (A) following para12 graph (29) of section 1905(a), the 

13 State, before the date of the release of 

14 an eligible juvenile from any public in15 stitution, and notwithstanding that 

16 the juvenile is an inmate of a public 

17 institution— 

18 ‘‘(aa) screens for eligibility 

19 for and processes any application 

20 for medical assistance submitted 

21 by, or on behalf of, such an eligi22 ble juvenile; and 

23 ‘‘(bb) refers such juvenile to 

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1 scribed in section 1905(a)(4)(B) 

2 (relating to early and periodic 

3 screening, diagnostic, and treat4 ment services defined in section 

5 1905(r)). 

6 ‘‘(II) ELIGIBLE JUVENILE.—For 

7 purposes of subclause (I), the term 

8 ‘eligible juvenile’ means an individual 

9 who— 

10 ‘‘(aa) is under 19 years of 

11 age (or such higher age as the 

12 State has elected under section 

13 475(8)(B)(iii)); and 

14 ‘‘(bb) is an inmate of a pub15 lic institution. 

16 ‘‘(III) INMATE OF A PUBLIC IN17 STITUTION.—For purposes of this 

18 clause, the term ‘inmate of a public 

19 institution’ has the meaning given 

20 such term for purposes of applying 

21 the subdivision (A) following para22 graph (29) of section 1905(a), taking 

23 into account the exception in such 

24 subdivision for a patient of a medical 

25 institution.’’. 


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1 SEC. 103. CHILD ENROLLMENT CONTINGENCY FUND AD2 JUSTMENT. 

3 (a) IN GENERAL.—Section 2104(n) of the Social Se4 curity Act (42 U.S.C. 1397dd(n)) is amended— 

5 (1) in paragraph (2)— 

6 (A) by striking ‘‘2014’’ and inserting 

7 ‘‘2018’’ each place it appears in subparagraphs 

8 (A)(ii) and (B); and 

9 (B) by striking ‘‘2015’’ and inserting 

10 ‘‘2019’’ each place it appears in subparagraphs 

11 (A)(ii) and (B); 

12 (2) in paragraph (3)— 

13 (A) in subparagraph (A)— 

14 (i) in the heading, by striking ‘‘IN

15 GENERAL’’ and inserting ‘‘FISCAL YEARS

16 2009 THROUGH 2015’’; 

17 (ii) in the matter preceding clause 

18 (i)— 

19 (I) by striking ‘‘a semi-annual al20 lotment period for’’; and 

21 (II) by striking ‘‘(determined 

22 without regard to any redistribution it 

23 receives under subsection (f) that is 

24 available for expenditure during such 

25 fiscal year or period, but including 


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1 any carryover from a previous fiscal 

2 year)’’; 

3 (iii) by striking ‘‘or period’’ each place 

4 it appears; and 

5 (iv) in clause (ii), by striking ‘‘(or in 

6 which the period occurs)’’; 

7 (B) in subparagraph (B)(ii), by striking 

8 ‘‘(or semi-annual period occurring in a fiscal 

9 year)’’; 

10 (C) in subparagraph (C)(ii), by striking 

11 ‘‘(or semi-annual period occurring in a fiscal 

12 year)’’; 

13 (D) by redesignating subparagraphs (D), 

14 (E), (F), and (G) as subparagraphs (E), (F), 

15 (G), and (H), respectively; 

16 (E) by inserting after subparagraph (C) 

17 the following new subparagraph: 

18 ‘‘(D) FISCAL YEARS 2016 THROUGH 2019.— 

19 ‘‘(i) IN GENERAL.—For each of fiscal 

20 years 2016 through 2018 and each semi21 annual allotment period for fiscal year 

22 2019, if the Secretary determines that a 

23 State is a shortfall State described in sub24 paragraph (I) for that fiscal year or pe25 riod, the Secretary shall pay the State 


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1 from the Fund, in addition to any other 

2 payments made to a State under this title 

3 for the fiscal year or period an amount 

4 equal to the amount of projected expendi5 tures for the State under this title for the 

6 fiscal year or period that exceeds the sum 

7 determined under subparagraph (I) for the 

8 State and fiscal year or period. 

9 ‘‘(ii) TRANSFERS.—Notwithstanding 

10 any other provision of this title, the fol11 lowing amounts shall also be available, 

12 without fiscal year limitation, for making 

13 payments from the Fund: 

14 ‘‘(I) UNOBLIGATED NATIONAL

15 ALLOTMENT FOR FISCAL YEARS BE16 GINNING WITH FISCAL YEAR 2016.— 

17 As of December 31 of fiscal year 

18 2016, and as of December 31 of each 

19 succeeding fiscal year, the portion, if 

20 any, of the amount appropriated 

21 under subsection (a) for such fiscal 

22 year that is unobligated for allotment 

23 to a State under subsection (m) for 

24 such fiscal year. 


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1 ‘‘(II) UNEXPENDED ALLOT2 MENTS NOT USED FOR REDISTRIBU3 TION.—As of November 15 of fiscal 

4 year 2016 and each succeeding fiscal 

5 year, the total amount of allotments 

6 made to States under subsection (a) 

7 for the second preceding fiscal year 

8 that is not expended or redistributed 

9 under subsection (f) during the period 

10 in which such allotments are available 

11 for obligation. 

12 ‘‘(III) UNEXPENDED PERFORM13 ANCE INCENTIVE FUNDS.—As of Sep14 tember 1, 2017, and as of September 

15 1 of each succeeding calendar year, 

16 the portion, if any, of the amount ap17 propriated under subparagraph 

18 (E)(iii) of section 2105(a)(3) for the 

19 preceding fiscal year that is not ex20 pended or obligated under such sec21 tion. 

22 ‘‘(iii) INVESTMENT OF FUND.—The 

23 Secretary of the Treasury shall invest, in 

24 interest bearing securities of the United 

25 States, such currently available portions of 


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1 the Fund as are not immediately required 

2 for payments from the Fund. The income 

3 derived from these investments constitutes 

4 a part of the Fund.’’; 

5 (F) in subparagraph (E) (as so redesig6 nated), by inserting ‘‘or (D)’’ after ‘‘subpara7 graph (A)’’; and 

8 (G) in subparagraph (H) (as so redesig9 nated), by inserting ‘‘and regarding the expend10 itures under the State child health plan’’ after 

11 ‘‘subparagraphs (A) and (B)’’; and 

12 (3) by adding at the end the following new sub13 paragraph: 

14 ‘‘(I) SHORTFALL STATES DESCRIBED.— 

15 For purposes of subparagraph (D), with respect 

16 to a fiscal year or semi-annual allotment period, 

17 a shortfall State is a State for which the Sec18 retary estimates, on the basis of the most re19 cent data available to the Secretary, that the 

20 projected expenditures for the State for the fis21 cal year or period under this title (including in 

22 the form of coverage described in paragraph (1) 

23 or (2) of section 2101, or both) will exceed the 

24 sum of— 


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1 ‘‘(i) the amount of the State’s allot2 ments for any preceding fiscal year or pe3 riod that remains available for expenditure 

4 and that will not be expended by the end 

5 of the immediately preceding fiscal year; 

6 ‘‘(ii) the amount (if any) that will be 

7 redistributed to the State under subsection 

8 (f) for the fiscal year or period; 

9 ‘‘(iii) the portion, if any, of the 

10 amount appropriated under subparagraph 

11 (E)(iii) of section 2105(a)(3) for the pre12 ceding fiscal year or period that is not ex13 pended or obligated under such section; 

14 and 

15 ‘‘(iv) the amount of the State’s allot16 ment for the fiscal year or period.’’. 

17 (b) CONFORMING AMENDMENTS.—Section 

18 2104(f)(2)(A) of the Social Security Act (42 U.S.C. 

19 13957dd(f)(2)(A)) is amended— 

20 (1) in clause (i), by inserting ‘‘and’’ at the end; 

21 (2) by striking clause (ii); and 

22 (3) by redesignating clause (iii) as clause (ii). 


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1 TITLE II—COVERAGE STABILITY 

2 AND REDUCED BUREAUCRACY 

3 SEC. 201. IMPROVING COVERAGE STABILITY. 

4 (a) IN GENERAL.—Section 2102(b)(1)(B) of the So5 cial Security Act (42 U.S.C. 1397bb(b)(1)(B)) is amend6 ed— 

7 (1) in clause (iii), by striking ‘‘in the case of a 

8 targeted low-income pregnant woman provided preg9 nancy-related assistance under section 2112’’; and 

10 (2) in clause (iv), by striking ‘‘at State op11 tion,’’. 

12 (b) CONFORMING AMENDMENTS.— 

13 (1) Section 2105(c)(10) of the Social Security 

14 Act (42 U.S.C. 1397(ee)(10)) is amended— 

15 (A) by striking subparagraph (F); and 

16 (B) by redesignating subparagraphs (G) 

17 through (M) as subparagraphs (F) through (L), 

18 respectively. 

19 (2) Section 2112(b)(5) of the Social Security 

20 Act (42 U.S.C. 1397ll(b)(5)) is amended— 

21 (A) in the heading, by striking ‘‘OR WAIT22 ING PERIOD’’; and 

23 (B) by striking ‘‘or any waiting period’’ 

24 and all that follows through ‘‘receipt of such as25 sistance’’. 


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

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

3 this Act. 

4 SEC. 202. ASSURING CARE CONTINUITY DURING TRANSI5 TIONS AMONG CHIP, MEDICAID, AND QUALI6 FIED HEALTH PLANS. 

7 (a) MINIMUM ESSENTIAL COVERAGE.— 

8 (1) IN GENERAL.—Section 5000A(f) of the In9 ternal Revenue Code of 1986 is amended by adding 

10 at the end the following: 

11 ‘‘(6) PREGNANCY-RELATED ASSISTANCE UNDER

12 CHIP.—With respect to a targeted low-income preg13 nant woman (as defined in section 2112(d)(2) of the 

14 Social Security Act (42 U.S.C. 1397ll(d)(2))), not15 withstanding paragraph (1)(A)(iii), the term ‘min16 imum essential coverage’, at the option of such a 

17 woman, shall not include pregnancy-related assist18 ance (as defined in section 2112(d)(1) of the Social 

19 Security Act (42 U.S.C. 1397ll(d)(1))).’’. 

20 (2) EFFECTIVE DATE.—The amendment made 

21 by this subsection applies to taxable years beginning 

22 after December 31, 2014. 

23 (b) CONTINUITY OF CARE.—The Secretary of Health 

24 and Human Services shall issue regulations for purposes 

25 of ensuring continuity of care for children who— 


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1 (1) are undergoing an active course of treat2 ment; and 

3 (2) involuntarily change coverage under health 

4 insurance, the State plan under the Medicaid pro5 gram under title XIX of the Social Security Act, or 

6 the State child health plan under title XXI of such 

7 Act during such course of treatment for any reason, 

8 including a reason related to a change in income, 

9 health plan termination, or a material change or 

10 changes to the plan’s health benefits coverage. 

11 (c) ENSURING COMPARABILITY OF COVERAGE.— 

12 (1) IN GENERAL.—Not later than 18 months 

13 after the date of the enactment of the CHIP Exten14 sion and Improvement Act of 2014, the Secretary of 

15 Health and Human Services shall review, with re16 spect to a State, the benefits (by each benefit class) 

17 offered for children and the cost-sharing imposed 

18 with respect to such benefits by qualified health 

19 plans offered through an Exchange established 

20 under title I of the Patient Protection and Afford21 able Care Act in the State. The Secretary shall 

22 make the findings of such review available on the 

23 public Internet site of the Department of Health and 

24 Human Services. 


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1 (2) REGULATIONS REQUIRED.—If, following 

2 such review, the Secretary determines that benefits 

3 and cost-sharing protections referred to in para4 graph (1) are not comparable to the benefits (by 

5 each benefit class) offered and cost-sharing protec6 tions provided under the State child health plan 

7 under title XXI of the Social Security Act (42 

8 U.S.C. 1397aa et seq.) in the State, the Secretary, 

9 not later than January 1, 2017, shall issue a rule, 

10 to apply with respect to plan years beginning in 

11 2019, establishing requirements designed to ensure 

12 that such qualified health plans offer benefits and 

13 cost-sharing protections that are comparable to the 

14 benefits and cost-sharing protections provided under 

15 such State child health plan for plan year 2019. 

16 SEC. 203. STATE FLEXIBILITY TO PROVIDE FOR CONTIN17 UOUS ELIGIBILITY. 

18 Section 1902(e)(12) of the Social Security Act (42 

19 U.S.C. 1396a(e)(12)) is amended to read as follows: 

20 ‘‘(12) CONTINUOUS ELIGIBILITY OPTION.— 

21 ‘‘(A) CHILDREN.—At the option of the 

22 State, the plan may provide that a child (as de23 fined in paragraph (13)(G)) who is determined 

24 to be eligible for benefits under a State plan ap25 proved under this title under subsection 


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1 (a)(10)(A) shall remain eligible for those bene2 fits until the earlier of— 

3 ‘‘(i) the end of a period (not to exceed 

4 12 months) following the determination; or 

5 ‘‘(ii) the time that the child exceeds 

6 the age specified in such paragraph 

7 (13)(G). 

8 ‘‘(B) CERTAIN NONELDERLY ADULTS.— 

9 ‘‘(i) IN GENERAL.—At the option of 

10 the State, the plan may provide that in the 

11 case of an eligible adult who is determined 

12 to be eligible for benefits under a State 

13 plan approved under this title (or a waiver 

14 of such plan), the eligible adult shall re15 main eligible for those benefits until the 

16 end of a period (not to exceed 12 months) 

17 following the determination. 

18 ‘‘(ii) ELIGIBLE ADULT DEFINED.—In 

19 this subparagraph, the term ‘eligible adult’ 

20 means— 

21 ‘‘(I) an individual (other than a 

22 child) whose income eligibility under 

23 the State plan or under a waiver of 

24 the plan for medical assistance is de25 termined under paragraph (14); and 


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1 ‘‘(II) an individual included in 

2 any other group of individuals the 

3 Secretary determines appropriate.’’. 

4 SEC. 204. STATE FLEXIBILITY TO USE ADMINISTRATIVE 

5 SIMPLIFICATION POLICIES FOR ENROLL6 MENT. 

7 (a) PERMANENT EXTENSION OF MEDICAID AND

8 CHIP EXPRESS LANE OPTION.—Section 1902(e)(13) of 

9 the Social Security Act (42 U.S.C. 1396a(e)(13)) is 

10 amended by striking subparagraph (I). 

11 (b) EXTENDING EXPRESS LANE ELIGIBILITY TO

12 ADULTS.—Section 1902(e)(13)(A) of the Social Security 

13 Act (42 U.S.C. 1396a(e)(13)(A)) is amended by adding 

14 at the end the following new clause: 

15 ‘‘(iii) STATE OPTION TO EXTEND EXPRESS

16 LANE ELIGIBILITY TO ADULTS.— 

17 ‘‘(I) IN GENERAL.—At the option of 

18 the State, the State may apply the provi19 sions of this paragraph with respect to de20 termining eligibility under this title for an 

21 eligible individual (as defined in subclause 

22 (II)). In applying this paragraph in the 

23 case of a State making such an option, any 

24 reference in this paragraph to a child with 

25 respect to this title (other than a reference 


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1 to child health assistance) shall be deemed 

2 to be a reference to an eligible individual. 

3 ‘‘(II) ELIGIBLE INDIVIDUAL DE4 FINED.—In this clause, the term ‘eligible 

5 individual’ means— 

6 ‘‘(aa) any individual (other than 

7 a child) whose income eligibility under 

8 the State plan or under a waiver of 

9 the plan for medical assistance is de10 termined under paragraph (14); and 

11 ‘‘(bb) an individual included in 

12 any other group of individuals the 

13 Secretary determines appropriate.’’. 

14 SEC. 205. OUTREACH TO TARGETED POPULATIONS. 

15 (a) OUTREACH AND ENROLLMENT GRANTS.—Sec16 tion 2113 of the Social Security Act (42 U.S.C. 1397mm) 

17 is amended— 

18 (1) in subsection (a)— 

19 (A) in paragraph (1), by striking ‘‘during 

20 the period of fiscal years 2009 through 2015’’; 

21 and 

22 (B) in paragraph (2)— 

23 (i) in the heading, by striking ‘‘TEN

24 PERCENT SET ASIDE’’ and inserting ‘‘SET

25 ASIDE’’; and 


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1 (ii) by striking ‘‘10 percent’’ and in2 serting ‘‘15 percent’’; and 

3 (2) in subsection (g), by inserting ‘‘and 

4 $40,000,000 for each fiscal year thereafter, to re5 main available until expended’’ after ‘‘2015,’’. 

6 (b) REQUIREMENT THAT MANAGED CARE ORGANI7 ZATIONS PROVIDE LANGUAGE SERVICES TO ENROLL8 EES.—Section 1932(b) of the Social Security Act (42 

9 U.S.C. 1396u–2(b)) is amended by adding at the end the 

10 following new paragraph: 

11 ‘‘(9) LANGUAGE SERVICES.—Each contract 

12 with a managed care entity under section 1903(m) 

13 or under section 1905(t)(3) shall require the entity 

14 to provide and pay for language services, including 

15 oral interpretation and written translation services, 

16 for an individual and the parent or guardian of such 

17 individual who is eligible for medical assistance 

18 under the State plan under this title and is enrolled 

19 with the entity and is limited English proficient 

20 when interacting with the entity or with any pro21 vider receiving payment from the entity. Such lan22 guage services shall be provided in conjunction with 

23 all covered items and services that are available to 

24 such individuals under the contract.’’. 


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1 (c) MEDICAID HEALTH CARE DISPARITIES.—Section 

2 1946 of the Social Security Act (42 U.S.C. 1396w–5) is 

3 amended by adding at the end the following new sub4 section: 

5 ‘‘(d) APPROPRIATION.—Out of any funds in the 

6 Treasury not otherwise appropriated, there are appro7 priated to carry out this section $20,000,000, to remain 

8 available until expended.’’. 

9 (d) EFFECTIVE DATE.—The amendments made by 

10 this section take effect on the date of enactment of this 

11 Act. 

12 TITLE III—BENEFITS AND 

13 AFFORDABILITY 

14 SEC. 301. STRENGTHENED COST-SHARING PROTECTIONS 

15 UNDER CHIP. 

16 Section 2103(e) of the Social Security Act (42 U.S.C. 

17 1397cc(e)) is amended— 

18 (1) in paragraph (3)(B)— 

19 (A) by inserting ‘‘, including with respect 

20 to benefits for dental services,’’ after ‘‘State 

21 child health plan’’; 

22 (B) by striking ‘‘annual aggregate cost23 sharing’’ and inserting ‘‘aggregate cost-shar24 ing’’; and 


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1 (C) by striking ‘‘for the year involved’’ and 

2 inserting ‘‘, as applied on a quarterly or month3 ly basis (as specified by the State)’’; and 

4 (2) by adding at the end the following new 

5 paragraph: 

6 ‘‘(5) ADDITIONAL REQUIREMENTS.— 

7 ‘‘(A) TRACKING OF EXPENSES; NOTICE.— 

8 Except as provided in subparagraph (B), in the 

9 case of a State child health plan that imposes 

10 premiums, deductibles, cost sharing, or similar 

11 charges that could (as determined by the Sec12 retary) cause families that include a targeted 

13 low-income child or a targeted low-income preg14 nant woman to have out-of-pocket expenses that 

15 exceed the limit imposed under paragraph 

16 (3)(B) for a month or quarter (as applicable 

17 under the State plan), the State child health 

18 plan shall— 

19 ‘‘(i) establish an electronic process for 

20 tracking such expenses that does not rely 

21 on documentation provided by the targeted 

22 low-income child, the targeted low-income 

23 pregnant woman, or the family; and 

24 ‘‘(ii) notify each such family— 


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1 ‘‘(I) of the aggregate monthly or 

2 quarterly limits on out-of-pocket ex3 penses applicable to the family im4 posed under paragraph (3)(B); and 

5 ‘‘(II) that no premiums, 

6 deductibles, cost sharing, or similar 

7 charges shall be imposed on any tar8 geted low-income child or targeted 

9 low-income pregnant woman in the 

10 family for the remainder of any month 

11 or quarter with respect to which the 

12 family has reached the aggregate 

13 monthly or quarterly family limit im14 posed under such paragraph applica15 ble to the family. 

16 ‘‘(B) MANAGED CARE ENTITIES OR ORGA17 NIZATIONS.—In the case of a State child health 

18 plan that provides child health assistance 

19 through managed care entities or organizations, 

20 the entities or organizations shall, with respect 

21 to families described in subparagraph (A)— 

22 ‘‘(i) establish an electronic process de23 scribed in subparagraph (A)(i); and 

24 ‘‘(ii) coordinate with the State agency 

25 responsible for implementing the State 


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1 child health plan under this title to ensure 

2 that any premiums, deductibles, cost shar3 ing, or similar charges imposed on such a 

4 family are included in the aggregate limit 

5 applicable to the family under paragraph 

6 (3)(B).’’. 

7 SEC. 302. ENSURING COVERAGE OF PREVENTIVE HEALTH 

8 SERVICES UNDER MEDICAID AND CHIP. 

9 (a) MEDICAID.— 

10 (1) CLARIFYING PREVENTIVE COVERAGE.—Sec11 tion 1905(a)(13) of the Social Security Act (42 

12 U.S.C. 1396d(a)(13)) is amended— 

13 (A) by striking subparagraphs (A) and 

14 (B); 

15 (B) by redesignating subparagraph (C) as 

16 subparagraph (B); and 

17 (C) by inserting before subparagraph (B) 

18 (as so redesignated) the following new subpara19 graph: 

20 ‘‘(A) the items and services described in 

21 paragraphs (1) through (5) of section 2713(a) 

22 of the Public Health Service Act; and’’. 

23 (2) CONFORMING AMENDMENT.—Section 

24 1902(a)(10)(A) of the Social Security Act (42 

25 U.S.C. 1396a(a)(10)(A)) is amended in the matter 


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1 preceding clause (i), by inserting ‘‘, (13)(A)’’ before 

2 ‘‘, (17)’’. 

3 (b) CHIP.—Section 2103(c)(1)(D) of the Social Se4 curity Act (42 U.S.C. 1397cc(c)(1)(D)) is amended by 

5 striking ‘‘Well-baby’’ and inserting ‘‘Items and services 

6 described in paragraphs (1) through (5) of section 2713(a) 

7 of the Public Health Service Act, including well-baby’’. 

8 (c) COST-SHARING PROHIBITIONS.— 

9 (1) IN GENERAL.—Section 1916 of the Social 

10 Security Act (42 U.S.C. 1396(o)) is amended— 

11 (A) in subsection (a)(2)— 

12 (i) in subparagraph (D), by striking 

13 ‘‘or’’ at the end; 

14 (ii) in subparagraph (E), by striking 

15 ‘‘hospice care (as defined in section 

16 1905(o)); and’’ at the end and inserting 

17 ‘‘hospice care (as defined in section 

18 1905(o)), or’’; and 

19 (iii) by adding at the end the fol20 lowing new subparagraph: 

21 ‘‘(F) items and services described in sec22 tion 1905(a)(13)(A); and’’; and 

23 (B) in subsection (b)(2)— 

24 (i) in subparagraph (D), by striking 

25 ‘‘or’’ at the end; 


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1 (ii) in subparagraph (E), by striking 

2 ‘‘hospice care (as defined in section 

3 1905(o)); and’’ at the end and inserting 

4 ‘‘hospice care (as defined in section 

5 1905(o)), or’’; and 

6 (iii) by adding at the end the fol7 lowing new subparagraph: 

8 ‘‘(F) items and services described in sec9 tion 1905(a)(13)(A); and’’. 

10 (2) STATE OPTION.—Section 1916A(b)(3)(B) of 

11 the Social Security Act (42 U.S.C. 1396o– 

12 1(b)(3)(B)) is amended by adding at the end the fol13 lowing new clause: 

14 ‘‘(xi) Items and services described in 

15 section 1905(a)(13)(A).’’. 

16 SEC. 303. TIMELY IMMUNIZATION COVERAGE. 

17 (a) COVERAGE FOR NEWLY APPROVED VACCINES

18 WITHIN 30 DAYS.— 

19 (1) IN GENERAL.—Section 1928(e) of the So20 cial Security Act (42 U.S.C. 1396s(e)) is amended 

21 by adding at the end the following new sentence: 

22 ‘‘Each revision of the list established by such Advi23 sory Committee shall apply to the purchase, delivery, 

24 and administration of pediatric vaccines under this 


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1 section not later than 30 days after the date such 

2 Advisory Committee approves the revision.’’. 

3 (2) CONFORMING AMENDMENT.—Section 

4 2103(c)(1)(D) of the Social Security Act (42 U.S.C. 

5 1397cc(c)(1)(D)) is amended by inserting ‘‘, admin6 istered in accordance with the schedule referred to 

7 in section 1928(c)(2)(B)(i) for pediatric vaccines’’ 

8 after ‘‘immunizations’’. 

9 (b) TREATMENT OF CHIP-ELIGIBLE CHILDREN AS

10 FEDERALLY VACCINE-ELIGIBLE CHILDREN.—Section 

11 1928(b)(2) of the Social Security Act (42 U.S.C. 

12 1396s(b)(2)) is amended— 

13 (1) in subparagraph (A)(i), by inserting ‘‘or 

14 CHIP-eligible’’ after ‘‘medicaid-eligible’’; and 

15 (2) in subparagraph (B), by striking clause (i) 

16 and inserting the following: 

17 ‘‘(i) The term ‘medicaid-eligible or 

18 CHIP-eligible child’ means, with respect to 

19 a child, a child who is entitled to medical 

20 assistance under a State plan approved 

21 under this title or a waiver of such plan, 

22 or who is eligible for child health assist23 ance under a State child health plan ap24 proved under title XXI.’’. 


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

2 this section take effect on the date of enactment of this 

3 Act. 

4 SEC. 304. PAYMENT PARITY FOR MEDICAID PRIMARY CARE 

5 SERVICES. 

6 (a) IN GENERAL.—Section 1902(a)(13)(C) of the So7 cial Security Act (42 U.S.C. 1396a(a)(13)(C)) is amend8 ed— 

9 (1) by striking ‘‘2013 and 2014’’ and inserting 

10 ‘‘calendar years 2014 through 2019’’; 

11 (2) by striking ‘‘, general internal medicine’’ 

12 and inserting ‘‘, general internal medicine, neu13 rology, psychiatry, obstetrics and gynecology’’; 

14 (3) by inserting ‘‘or a health care practitioner 

15 who is a nurse practitioner, physician assistant, or 

16 clinical nurse specialist (as such terms are defined in 

17 section 1861(aa)(5)) or a certified nurse midwife (as 

18 defined in section 1861(gg)(2))’’ after ‘‘pediatric 

19 medicine’’; and 

20 (4) by striking ‘‘such services and physician’’ 

21 and inserting ‘‘such services and physician or health 

22 care practitioner’’. 

23 (b) EFFECTIVE DATE.—The amendments made by 

24 this section shall apply to items and services furnished on 


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1 or after the first day of the first calendar quarter that 

2 begins after the date of the enactment of this Act. 

3 TITLE IV—ACCESS AND QUALITY 

4 Subtitle A—Pediatric Quality 

5 Measures 

6 SEC. 401. EXTENDING THE PEDIATRIC QUALITY MEASURES 

7 PROGRAM. 

8 Section 1139A(i) of the Social Security Act (42 

9 U.S.C. 1320b–9a(i)) is amended by inserting ‘‘, and for 

10 each of fiscal years 2015 through 2019, $50,000,000,’’ 

11 after ‘‘$45,000,000’’. 

12 SEC. 402. ENHANCED FMAP FOR ACTIVITIES RELATED TO 

13 PEDIATRIC QUALITY MEASURES. 

14 Section 1903(a)(3)(A)(iii) of the Social Security Act 

15 (42 U.S.C. 1396b(a)(3)(A)(iii)) is amended to read as fol16 lows: 

17 ‘‘(iii) 95 percent of so much of the sums 

18 expended during any such quarter in fiscal 

19 years 2015, 2016, and 2017, 90 percent of so 

20 much of the sums expended during any such 

21 quarter in fiscal years 2018 and 2019, and the 

22 higher of an amount equal to the Federal med23 ical assistance percentage (as defined in section 

24 1905(b)) or 75 percent of so much of the sums 

25 expended during any such quarter in any fiscal 


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1 year thereafter (as found necessary by the Sec2 retary for the proper and efficient administra3 tion of the State plan) as are attributable to 

4 such developments or modifications of systems 

5 of the type described in clause (i) as are nec6 essary for the efficient collection and reporting 

7 on the core set of child health quality measures 

8 under subsections (a), (b), (c), and (f) of sec9 tion 1139A; and’’. 

10 SEC. 403. REPORTING OF FULL SET OF PEDIATRIC QUALITY 

11 MEASURES. 

12 Section 1139A(a)(4) of the Social Security Act (42 

13 U.S.C. 1320b–9a(a)(4)) is amended— 

14 (1) in the heading, by striking ‘‘ENCOURAGE

15 VOLUNTARY AND STANDARDIZED’’ and inserting 

16 ‘‘STANDARDIZED’’; 

17 (2) by striking ‘‘Not later than’’ and inserting 

18 the following: 

19 ‘‘(A) ENCOURAGING VOLUNTARY REPORT20 ING.—Not later than’’; and 

21 (3) by adding at the end the following new sub22 paragraph: 

23 ‘‘(B) OTHER REPORTING.—Not later than 

24 five years after the date of the enactment of the 

25 CHIP Extension and Improvement Act of 2014, 


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1 the Secretary shall require that each State sub2 mit information on the core set of child health 

3 quality measures (as in effect on such date of 

4 enactment), as updated under subsection 

5 (b)(5).’’. 

6 SEC. 404. TECHNICAL ASSISTANCE TO STATES FOR ADOPT7 ING AND UTILIZING PEDIATRIC QUALITY 

8 MEASURES. 

9 Section 1139A(a)(7) of the Social Security Act (42 

10 U.S.C. 1320b–9a(a)(7)) is amended to read as follows: 

11 ‘‘(7) TECHNICAL ASSISTANCE.— 

12 ‘‘(A) IN GENERAL.—The Secretary shall 

13 provide technical assistance to States to assist 

14 them in adopting and utilizing the core set of 

15 child health measures in administering the 

16 State plans under titles XIX and XXI, includ17 ing by assisting States in building their data 

18 collection infrastructures. 

19 ‘‘(B) FUNDING.—$5,000,000 of the 

20 amount appropriated under subsection (i) for a 

21 fiscal year shall be used to carry out this para22 graph.’’. 


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1 SEC. 405. IMPROVING THE EFFECTIVENESS OF THE PEDI2 ATRIC QUALITY MEASURES. 

3 Section 1139A(b) of the Social Security Act (42 

4 U.S.C. 1320b–9a(b)) is amended— 

5 (1) in paragraph (4)— 

6 (A) by striking the paragraph heading and 

7 inserting the following: ‘‘ENSURING THE DE8 VELOPMENT, MAINTENANCE, AND REPORTING

9 OF A PORTFOLIO OF PEDIATRIC QUALITY MEAS10 URES’’; 

11 (B) in subparagraph (A), by striking 

12 ‘‘and’’ at the end; 

13 (C) in subparagraph (B)(iii)— 

14 (i) by inserting ‘‘establishment of a 

15 sustainable mechanism for maintaining 

16 and’’ before ‘‘updating’’; and 

17 (ii) by striking ‘‘as necessary.’’ and 

18 inserting ‘‘in alignment with the most re19 cent version of the ‘Blueprint for the 

20 Measures Management System’ published 

21 by the Centers for Medicare & Medicaid 

22 Services, as necessary; and’’; and 

23 (D) by adding at the end the following new 

24 subparagraph: 

25 ‘‘(C) award grants or contracts to continue 

26 and enhance the pediatric quality measures proVerDate Mar 15 2010 00:56 Aug 15, 2014 Jkt 039200 PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 E:\BILLS\H5364.IH H5364

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1 gram, which shall include awarding grants and 

2 contracts with a particular emphasis on— 

3 ‘‘(i) patient and family experience or 

4 coordination of care; 

5 ‘‘(ii) pediatric populations that are 

6 small in size and may be most effectively 

7 addressed by aggregating data across mul8 tiple States, including pediatric populations 

9 with medical complexity and pediatric pop10 ulations with rare conditions; 

11 ‘‘(iii) the impacts of changes in life 

12 events over various stages of child and ad13 olescent development, including changes in 

14 morbidity and mortality, dependence sta15 tus, and developmental stages, and the im16 pacts of such changes on subsequent 

17 health and health care quality; and 

18 ‘‘(iv) establishing a sustainable mech19 anism for identifying and assisting States 

20 in developing a standardized data infra21 structure for the collection and national re22 porting of pediatric quality measures, in23 cluding developing precise data element 

24 definitions and utilizing consistent data 

25 collection methods.’’; 


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1 (2) by striking paragraph (5) and inserting the 

2 following new paragraph: 

3 ‘‘(5) REVISING, STRENGTHENING, AND IMPROV4 ING INITIAL CORE MEASURES.— 

5 ‘‘(A) IN GENERAL.—The Secretary shall 

6 annually issue a rule (in accordance with sec7 tion 553 of title 5, United States Code) to 

8 amend the core set of child health quality meas9 ures described in subsection (a) so that such 

10 core set— 

11 ‘‘(i) is consistent with the purposes of 

12 the pediatric quality measures program es13 tablished under paragraph (1); 

14 ‘‘(ii) meets the conditions specified in 

15 paragraph (2); 

16 ‘‘(iii) includes measures that— 

17 ‘‘(I) were developed by the Sec18 retary in consultation with the entities 

19 specified in subparagraphs (A) 

20 through (H) of paragraph (3); 

21 ‘‘(II) were developed, validated, 

22 tested, or maintained through a grant 

23 or contract awarded under paragraph 

24 (4); and 


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1 ‘‘(III) were submitted to the Sec2 retary for consideration that were not 

3 developed under such a grant or con4 tract; and 

5 ‘‘(iv) takes into account the reports 

6 and demonstration projects described in 

7 subparagraphs (c), (d), (e), and (f) of this 

8 section. 

9 ‘‘(B) ADDITIONAL CHANGES.—Beginning 

10 not later than one year after the date of the en11 actment of the CHIP Extension and Improve12 ment Act of 2014, the amendments made to the 

13 core set of measures under subparagraph (A) 

14 shall include changes— 

15 ‘‘(i) to measure the type of children’s 

16 health insurance coverage or other health 

17 benefits coverage available over time, in 

18 addition to the presence, stability, and du19 ration of such health insurance coverage or 

20 such health benefits coverage over time, for 

21 purposes of examining enrollment changes 

22 of a child from one type of coverage to an23 other; 

24 ‘‘(ii) to ensure that the measures re25 flect the care provided to the diverse pediVerDate Mar 15 2010 00:56 Aug 15, 2014 Jkt 039200 PO 00000 Frm 00047 Fmt 6652 Sfmt 6201 E:\BILLS\H5364.IH H5364

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1 atric population, including adolescents and 

2 children with special health care needs and 

3 the management of acute and chronic con4 ditions; 

5 ‘‘(iii) to ensure that the measures re6 flect care provided in all health care set7 tings in which an individual enrolled in the 

8 State plan under title XIX receives care; 

9 and 

10 ‘‘(iv) to encourage the adoption of pe11 diatric quality measures at the State, plan, 

12 community, facility, and provider level at13 tribution, as well as across different health 

14 care delivery and coverage systems, includ15 ing coverage provided through the Ex16 changes established under title I of the Pa17 tient Protection and Affordable Care Act.’’; 

18 (3) in paragraph (6)— 

19 (A) by striking ‘‘clinical care’’ and insert20 ing ‘‘clinical effectiveness, patient safety, popu21 lation and public health, patient and family en22 gagement, care coordination, or efficiency’’; and 

23 (B) by striking ‘‘in various institutional 

24 and ambulatory health care settings’’; and 


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1 (4) by adding at the end the following new 

2 paragraph: 

3 ‘‘(8) FUNDING.—$20,000,000 of the amount 

4 appropriated under subsection (i) for a fiscal year 

5 shall be used to carry out this subsection.’’. 

6 SEC. 406. REPORTS REGARDING STATE-SPECIFIC QUALITY 

7 OF CARE MEASURES APPLIED UNDER MED8 ICAID OR CHIP. 

9 Section 1139A(c)(1) of the Social Security Act (42 

10 U.S.C. 1320b–9a(c)) is amended— 

11 (1) in subparagraph (A), by striking ‘‘and’’ at 

12 the end; 

13 (2) in subparagraph (B), by striking the period 

14 at the end and inserting a semicolon; and 

15 (3) by adding at the end the following new sub16 paragraphs: 

17 ‘‘(C) State-specific information on the an18 nual progress toward, and efforts to overcome 

19 barriers to, reporting on all quality measures 

20 within the core set of child health quality meas21 ures, as updated under subsection (b)(5); and 

22 ‘‘(D) beginning not later than 5 years after 

23 the date of the enactment of this subparagraph, 

24 State-specific information on all quality measVerDate Mar 15 2010 03:49 Aug 15, 2014 Jkt 039200 PO 00000 Frm 00049 Fmt 6652 Sfmt 6201 E:\BILLS\H5364.IH H5364

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1 ures within the core set of child health quality 

2 measures, as updated under subsection (b)(5).’’. 

3 SEC. 407. ADVISORY PANEL REGARDING PEDIATRIC QUAL4 ITY. 

5 (a) IN GENERAL.—Section 1139A(g) of the Social 

6 Security Act (42 U.S.C. 1320b–9a(g)) is amended— 

7 (1) in the heading, by striking ‘‘STUDY OF’’ and 

8 inserting ‘‘STAKEHOLDER INPUT AND REPORTS

9 ON’’; 

10 (2) by redesignating paragraph (2) as para11 graph (3); and 

12 (3) by inserting after paragraph (1) the fol13 lowing new paragraph: 

14 ‘‘(2) PEDIATRIC QUALITY MEASUREMENT.—Not 

15 later than 18 months after the date of the enact16 ment of this paragraph, the Secretary, in consulta17 tion with representatives of State agencies respon18 sible for administering the Medicaid program under 

19 title XIX and the Children’s Health Insurance Pro20 gram under title XXI and representatives of relevant 

21 provider organizations, shall submit (and periodically 

22 update) to the Committee on Energy and Commerce 

23 of the House of Representatives and the Committee 

24 on Finance of the Senate a report that takes into 

25 account the priorities and goals to be established 


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1 pursuant to section 1890(b)(7)(E). Such report shall 

2 include— 

3 ‘‘(A) strategic and detailed operational 

4 plans to address and overcome barriers to State 

5 collection of, and reporting of, all quality meas6 ures within the core set of child health quality 

7 measures, as updated under subsection (b)(5); 

8 ‘‘(B) an analysis of the types of incentives, 

9 including Federal funding and any associated 

10 amounts necessary for States to collect and re11 port on all quality measures within the core set 

12 of child health quality measures, as updated 

13 under subsection (b)(5); and 

14 ‘‘(C) a standardized format and plan for 

15 States to collect and report on all quality meas16 ures within the core set of child health quality 

17 measures, as updated under subsection (b)(5).’’. 

18 (b) INCLUSION OF CHILD AND ADULT HEALTH

19 QUALITY MEASURES FOR MULTI-STAKEHOLDER GROUP

20 INPUT.—Section 1890(b)(7) of the Social Security Act 

21 (42 U.S.C. 1395aaa(b)(7)) is amended— 

22 (1) in subparagraph (B)(i)(I), by inserting 

23 ‘‘1139A(a), 1139B,’’ after ‘‘sections’’; and 

24 (2) by adding at the end the following new sub25 paragraph: 


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1 ‘‘(E) PEDIATRIC QUALITY MEASURE2 MENT.—With respect to quality and efficiency 

3 measures for use pursuant to section 1139A(a), 

4 the entity shall convene a panel, composed of 

5 health experts (including experts employed by 

6 the Federal Government and experts not so em7 ployed) to establish priorities and goals for 

8 child health to— 

9 ‘‘(i) advise and make recommenda10 tions to the Secretary regarding changes 

11 that may be made to the core set of child 

12 health quality measures, as updated under 

13 section 1139A(b)(5); 

14 ‘‘(ii) establish standards for the time15 liness and accuracy of data collected and 

16 reported for purposes of such measures; 

17 and 

18 ‘‘(iii) review and make recommenda19 tions, at least annually, for strategies to 

20 enhance the timeliness, accuracy, and util21 ity of such measures.’’. 

22 SEC. 408. EXTENDING AND EXPANDING DEMONSTRATION 

23 PROJECTS. 

24 (a) STRENGTHENING DEMONSTRATION PROJECTS

25 FOR IMPROVING THE QUALITY OF CHILDREN’S HEALTH


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1 CARE AND THE USE OF HEALTH INFORMATION TECH2 NOLOGY.—Section 1139A(d) of the Social Security Act 

3 (42 U.S.C. 1320b–9a(d)) is amended— 

4 (1) in paragraph (1)— 

5 (A) in the matter preceding subparagraph 

6 (A)— 

7 (i) by striking ‘‘2009 through 2013, 

8 the Secretary shall award not more than 

9 10 grants’’ and inserting ‘‘2015 through 

10 2019, the Secretary shall award not fewer 

11 than 10 grants,’’; and 

12 (ii) by inserting ‘‘(including oral 

13 care)’’ after ‘‘health care’’; 

14 (B) in subparagraph (C), by striking ‘‘or’’ 

15 at the end; 

16 (C) in subparagraph (D), by striking the 

17 period at the end and inserting a semicolon; 

18 and 

19 (D) by adding at the end the following new 

20 subparagraphs: 

21 ‘‘(E) examine and address barriers to ef22 fective delivery of perinatal care and its impact 

23 on birth outcomes and subsequent pregnancies 

24 and children’s health; 


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1 ‘‘(F) implement and expand pediatric and 

2 perinatal learning and quality improvement 

3 collaboratives on the quality of children’s and 

4 pregnant women’s health care, including im5 proving patient outcomes, reducing health costs, 

6 and addressing health disparities; 

7 ‘‘(G) encourage and evaluate the use at the 

8 State level of payment reform and related policy 

9 proposals for purposes of promoting higher 

10 quality of care for children, including the 

11 shared savings program established under sec12 tion 1899 and other methods of encouraging in13 tegrated care models; or 

14 ‘‘(H) with respect to the model electronic 

15 health record format for children developed and 

16 disseminated under subsection (f)— 

17 ‘‘(i) assess the extent to which the 

18 format has been incorporated into widely 

19 used electronic health record formats; 

20 ‘‘(ii) implement standards and activi21 ties that result in increased use of such 

22 format; and 

23 ‘‘(iii) evaluate the impact of the in24 creased use of such format.’’; 

25 (2) in paragraph (2)— 


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1 (A) in subparagraph (A), by striking 

2 ‘‘and’’ at the end; 

3 (B) in subparagraph (B), by striking the 

4 period at the end and inserting ‘‘; and’’; and 

5 (C) by adding at the end the following new 

6 subparagraph: 

7 ‘‘(C) with respect to grants awarded for 

8 projects described in paragraph (1)(F)— 

9 ‘‘(i) give priority to collaboratives that 

10 would demonstrate substantial impacts on 

11 the pediatric population by— 

12 ‘‘(I) affecting a large percentage 

13 of such population or by substantially 

14 improving outcomes in a smaller pop15 ulation; 

16 ‘‘(II) reducing the cost of, and 

17 other barriers to access to, health care 

18 for children, including children with 

19 medically complex illnesses or chronic 

20 conditions; 

21 ‘‘(III) having a high likelihood to 

22 reduce disparities in health status; or 

23 ‘‘(IV) potentially having long24 term health impacts by addressing 


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1 childhood precursors to adult condi2 tions; and 

3 ‘‘(ii) encourage coordination with 

4 other sources of funding in the expansion 

5 of pediatric learning collaboratives, includ6 ing by coordinating care and utilizing com7 munity health workers (as defined in sec8 tion 399V(k) of the Public Health Service 

9 Act (42 U.S.C. 280g–11(k))).’’; and 

10 (3) in paragraph (4)— 

11 (A) by inserting ‘‘For each of fiscal years 

12 2009 through 2013,’’ before ‘‘$20,000,000’’; 

13 and 

14 (B) by adding at the end the following new 

15 sentence: ‘‘For each of fiscal years 2015 

16 through 2019, $25,000,000 of the amount ap17 propriated under subsection (i) for a fiscal year 

18 shall be used to carry out this subsection.’’. 

19 (b) EXTENDING FUNDING FOR CHILDHOOD OBESITY

20 DEMONSTRATION PROJECTS.—Section 1139A(e)(8) of the 

21 Social Security Act (42 U.S.C. 1320b–9a(e)(8)) is amend22 ed by inserting ‘‘, and for the period of fiscal years 2015 

23 through 2019, $25,000,000’’ after ‘‘2014’’. 


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1 Subtitle B—Continuing Delivery 

2 System Reform 

3 SEC. 411. SUPPORTING EVIDENCE-BASED CARE COORDINA4 TION IN COMMUNITIES. 

5 (a) IN GENERAL.—Section 511(j)(1) of the Social Se6 curity Act (42 U.S.C. 711(j)(1)) is amended— 

7 (1) in subparagraph (D), by inserting ‘‘and’’ at 

8 the end; 

9 (2) in subparagraph (E), by striking ‘‘fiscal 

10 year 2014; and’’ and inserting ‘‘each of fiscal years 

11 2014 through 2019.’’; and 

12 (3) by striking subparagraph (F). 

13 (b) EFFECTIVE DATE.—The amendments made by 

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

15 this Act. 

16 SEC. 412. ENSURING CARE COORDINATION FOR CHILDREN. 

17 Section 2706 of the Patient Protection and Afford18 able Care Act (42 U.S.C. 1396a note) is amended— 

19 (1) in subsection (a)(2), by striking ‘‘2016’’ and 

20 inserting ‘‘2019’’; and 

21 (2) in subsection (e), by striking ‘‘appro22 priated’’ and all that follows through the period at 

23 the end and inserting the following: ‘‘appropriated to 

24 carry out this section— 


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1 ‘‘(1) for fiscal year 2014, such sums as are nec2 essary; 

3 ‘‘(2) for each of fiscal years 2015 through 

4 2019, $100,000,000; and 

5 ‘‘(3) for the period beginning on October 1, 

6 2019, and ending on December 31, 2019, 

7 $25,000,000.’’. 

8 Subtitle C—Miscellaneous 

9 SEC. 421. ASSURING COVERAGE CONTINUITY FOR FORMER 

10 FOSTER CARE CHILDREN. 

11 (a) IN GENERAL.—Section 1902(a)(10)(A)(i)(IX) of 

12 the Social Security Act (42 U.S.C. 

13 1396a(a)(10)(A)(i)(IX)) is amended— 

14 (1) in item (bb), by striking ‘‘are not described 

15 in or enrolled under’’ and inserting ‘‘are not de16 scribed in and are not enrolled under’’; 

17 (2) in item (cc), by striking ‘‘responsibility of 

18 the State’’ and inserting ‘‘responsibility of a State’’; 

19 and 

20 (3) in item (dd), by striking ‘‘the State plan 

21 under this title or under a waiver of the’’ and insert22 ing ‘‘a State plan under this title or under a waiver 

23 of such a’’. 

24 (b) EFFECTIVE DATE.—The amendments made by 

25 this section shall take effect on July 1, 2015. 


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1 SEC. 422. DEFINITION OF THERAPEUTIC FOSTER CARE AS 

2 MEDICAL ASSISTANCE. 

3 (a) IN GENERAL.—Section 1905 of the Social Secu4 rity Act (42 U.S.C. 1396d) is amended— 

5 (1) in subsection (a)— 

6 (A) in paragraph (28), by striking ‘‘and’’ 

7 at the end; 

8 (B) by redesignating paragraph (29) as 

9 paragraph (30); and 

10 (C) by inserting after paragraph (28) the 

11 following new paragraph: 

12 ‘‘(29) therapeutic foster care services described 

13 in subsection (ee); and’’; and 

14 (2) by adding at the end the following new sub15 section: 

16 ‘‘(ee)(1) For purposes of subsection (a)(29), subject 

17 to subparagraph (C), therapeutic foster care services de18 scribed in this subsection are services provided for children 

19 who have not attained age 21, and who, as a result of 

20 mental illness, other emotional or behavioral disorders, 

21 medically fragile conditions, or developmental disabilities, 

22 need the level of care provided in an institution (including 

23 a psychiatric residential treatment facility) or nursing fa24 cility the cost of which could be reimbursed under the 

25 State plan but who can be cared for or maintained in a 


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1 community placement, through a qualified therapeutic fos2 ter care program described in paragraph (2). 

3 ‘‘(2) A qualified therapeutic foster care program de4 scribed in this paragraph is a program that— 

5 ‘‘(A) is licensed by the State and accredited by 

6 the Joint Commission on Accreditation of 

7 Healthcare Organizations, the Commission on Ac8 creditation of Rehabilitation Facilities, the Council 

9 on Accreditation, or by another equivalent accredita10 tion agency (or agencies) as the Secretary may rec11 ognize; 

12 ‘‘(B) provides structured daily activities, includ13 ing the development, improvement, monitoring, and 

14 reinforcing of age-appropriate social, communication 

15 and behavioral skills, trauma-informed and gender16 responsive services, crisis intervention and crisis sup17 port services, medication monitoring, counseling, and 

18 case management, and may furnish other intensive 

19 community services; and 

20 ‘‘(C) provides foster care parents with special21 ized training and consultation in the management of 

22 children with mental illness, trauma, other emotional 

23 or behavioral disorders, medically fragile conditions, 

24 or developmental disabilities, and specific additional 


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1 training on the needs of each child provided such 

2 services. 

3 ‘‘(3) In making coverage determinations under para4 graph (1), a State may employ medical necessity criteria 

5 that are similar to the medical necessity criteria applied 

6 to coverage determinations for other services and supports 

7 under this title. 

8 ‘‘(4) The services described in this subsection do not 

9 include the training referred to in paragraph (2)(C).’’. 

10 (b) EFFECTIVE DATE.—The amendments made by 

11 subsection (a) shall apply to calendar quarters beginning 

12 on or after the date of enactment of this Act. 

13 SEC. 423. TECHNICAL CORRECTION. 

14 (a) IN GENERAL.—Section 1917(d)(4)(A) of the So15 cial Security Act (42 U.S.C. 1396p(d)(4)(A)) is amended 

16 by inserting ‘‘the individual,’’ after ‘‘for the benefit of such 

17 individual by’’. 

18 (b) EFFECTIVE DATE.—The amendment made by 

19 subsection (a) shall apply to trusts established on or after 

20 the date of the enactment of this Act. 

Æ 


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