II 

110TH CONGRESS 

1ST SESSION S. 1224 

To amend title XXI of the Social Security Act to reauthorize the State 

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

IN THE SENATE OF THE UNITED STATES 

APRIL 25, 2007 

Mr. ROCKEFELLER (for himself, Ms. SNOWE, and Mr. KENNEDY) introduced 

the following bill; which was read twice and referred to the Committee 

on Finance 

A BILL 

To amend title XXI of the Social Security Act to reauthorize 

the State 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; TABLE OF CONTENTS. 

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

6 ‘‘Children’s Health Insurance Program (CHIP) Reauthor7 ization Act of 2007’’. 

8 (b) AMENDMENTS TO SOCIAL SECURITY ACT.—Ex9 cept as otherwise specifically provided, whenever in this 


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1 Act an amendment is expressed in terms of an amendment 

2 to or repeal of a section or other provision, the reference 

3 shall be considered to be made to that section or other 

4 provision of the Social Security Act. 

5 (c) MEDICAID; CHIP; SECRETARY.—In this Act: 

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

7 State Children’s Health Insurance Program estab8 lished under title XXI of the Social Security Act (42 

9 U.S.C. 1397aa et seq.). 

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

11 the program for medical assistance established under 

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

13 et seq,). 

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

15 the Secretary of Health and Human Services. 

16 (d) TABLE OF CONTENTS.—The table of contents for 

17 this Act is as follows: 

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

Sec. 2. Findings. 

TITLE I—MAKING CHILDREN’S HEALTH COVERAGE A NATIONAL 

PRIORITY 

Sec. 101. Providing necessary funding for CHIP. 

TITLE II—IMPROVING CHIP FINANCING 

Sec. 201. State CHIP allotments that are responsive to health care costs, population growth, and the needs of low-income uninsured children. 

Sec. 202. 2-year initial availability of CHIP allotments for all States and territories. 

Sec. 203. Establishment of timely and responsive redistribution process. 

Sec. 204. Improving funding for the territories under CHIP and Medicaid. 

Sec. 205. Extension of authority for qualifying States to use CHIP allotments 

for certain Medicaid expenditures. 


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Sec. 206. State option to expand coverage of children under CHIP up to 300 

percent of the poverty line. 

Sec. 207. Requiring responsible CHIP enrollment growth. 

TITLE III—ENROLLING UNINSURED CHILDREN ELIGIBLE FOR 

CHIP AND MEDICAID 

Sec. 301. ‘‘Express Lane’’ option for States to determine components of a 

child’s eligibility for Medicaid or CHIP. 

Sec. 302. Information technology connections to simplify health coverage determinations. 

Sec. 303. Enhanced administrative funding for translation or interpretation 

services. 

Sec. 304. Enhanced assistance with coverage costs for States with increasing or 

high coverage rates among children. 

Sec. 305. Elimination of counting Medicaid child presumptive eligibility costs 

against title XXI allotment. 

Sec. 306. State option to require certain individuals to present satisfactory documentary evidence of proof of citizenship or nationality for 

purposes of eligibility for Medicaid. 

TITLE IV—START HEALTHY, STAY HEALTHY 

Sec. 401. State option to expand or add coverage of certain pregnant women 

under Medicaid and CHIP. 

Sec. 402. Coordination with the maternal and child health program. 

Sec. 403. Optional coverage of legal immigrants under Medicaid and CHIP. 

Sec. 404. Improving benchmark coverage options. 

Sec. 405. Requiring coverage of dental and mental health services. 

Sec. 406. Clarification of requirement to provide EPSDT services for all children in benchmark benefit packages under Medicaid. 

Sec. 407. Childhood obesity demonstration project. 

TITLE V—IMPROVING ACCESS TO HEALTH CARE FOR CHILDREN 

Sec. 501. Promoting children’s access to covered health services. 

Sec. 502. Institute of Medicine study and report on children’s access to health 

care. 

TITLE VI—STRENGTHENING QUALITY OF CARE AND HEALTH 

OUTCOMES OF CHILDREN 

Sec. 601. Strengthening child health quality improvement activities. 

Sec. 602. Application of certain managed care quality safeguards to CHIP. 

TITLE VII—OTHER IMPROVEMENTS 

Sec. 701. Strengthening premium assistance programs. 

Sec. 702. Permitting coverage of children of State employees. 

Sec. 703. Improving data collection. 

Sec. 704. Moratorium on application of PERM requirements related to eligibility reviews during period of independent study and report. 

Sec. 705. Elimination of confusing program references. 

TITLE VIII—EFFECTIVE DATE 

Sec. 801. Effective date. 


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1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) THE STATE CHILDREN’S HEALTH INSUR4 ANCE PROGRAM (CHIP) AND MEDICAID HAVE GREAT5 LY IMPROVED CHILDREN’S COVERAGE RATES AND

6 ACCESS TO NEEDED HEALTH CARE SERVICES.— 

7 (A) CHIP and Medicaid serve as the crit8 ical health care safety net for 34,000,000 chil9 dren over the course of a year, with 28,000,000 

10 children enrolled in Medicaid and more than 

11 6,000,000 children enrolled in CHIP. 

12 (B) CHIP and Medicaid have accounted 

for a 1 13 ⁄3 decline in the rate of uninsured low14 income children since 1997. 

15 (C) During the recent economic downturn, 

16 and as the number of uninsured people has 

17 climbed to the highest number ever recorded in 

18 the United States, CHIP and Medicaid offset 

19 losses in employer-sponsored coverage that af20 fected children and parents alike. 

21 (D) While the number of children living in 

22 low-income families increased between 2000 and 

23 2005, the number of uninsured children fell due 

24 to Medicaid and CHIP. 

25 (E) Children enrolled in CHIP or Medicaid 

26 are much more likely to have a usual source of 


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1 care than uninsured children, and are much 

2 more likely than uninsured children to receive 

3 well-child care, see a doctor during the year, 

4 and get dental care. Studies have found that 

5 children enrolled in public insurance programs 

6 experienced significant improvement in meas7 ures of school performance. 

8 (F) Since CHIP was created, coverage 

9 rates have increased significantly among chil10 dren of all ethnic and racial groups. 

11 (G) According to one Federal evaluation of 

12 CHIP, uninsured children who gained coverage 

13 through the program received more preventive 

14 care, and their parents reported better access to 

15 providers and improved communications with 

16 their children’s doctors. 

17 (2) EVEN WITH THE SUCCESS OF CHIP AND

18 MEDICAID, MORE NEEDS TO BE DONE TO IMPROVE

19 THE HEALTH STATUS OF OUR NATION’S CHIL20 DREN.— 

21 (A) There are currently 9,000,000 unin22 sured children under age 19, accounting for 

23 nearly 20 percent of our Nation’s uninsured. 


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1 (B) Approximately 7 out of every 10 unin2 sured children are eligible for CHIP or Med3 icaid. 

4 (C) The cost of unmet health needs among 

5 children extends beyond measurable health sys6 tem costs. For example, problems that could be 

7 prevented, managed, or treated with regular ac8 cess to care can become more serious, resulting 

9 in lower school attendance and increased health 

10 care costs. 

11 (D) Reducing the number of uninsured 

12 children in our country is an essential first step 

13 to improve health status. CHIP reauthorization 

14 presents an opportunity to secure health care 

15 coverage for more children who are eligible for 

16 CHIP or Medicaid but not yet enrolled. 

17 (3) WE MUST MAINTAIN COVERAGE FOR THE

18 CHILDREN CURRENTLY ENROLLED IN CHIP.— 

19 (A) When CHIP was created in 1997, 

20 Congress allocated $40,000,000,000 for the 10- 

21 year authorization. 

22 (B) At current funding levels, nearly 

23 2,000,000 children are at risk of losing their 

24 CHIP coverage over the next 5 years because 

25 the current CHIP financing structure is inadVerDate Aug 31 2005 23:27 Apr 26, 2007 Jkt 059200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1224.IS S1224

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1 equate and States are facing CHIP funding 

2 shortfalls. 

3 (C) We must eliminate Federal funding 

4 shortfalls by providing States with significant 

5 new Federal resources for children’s health cov6 erage. 

7 (D) CHIP reauthorization offers an oppor8 tunity to increase CHIP funding and to provide 

9 stable, predictable Federal funding so that 

10 States not only have the ability to maintain 

11 their current caseloads but also to expand cov12 erage to currently unenrolled children. 

13 (4) WE MUST REACH THE UNINSURED CHIL14 DREN WHO ARE ALREADY ELIGIBLE FOR CHIP OR

15 MEDICAID BUT UNENROLLED.— 

16 (A) More than 6,000,000 uninsured chil17 dren are eligible for CHIP or Medicaid at any 

18 point during the year. 

19 (B) In some States, it is estimated that up 

20 to 50 percent of children covered through CHIP 

21 do not remain in the program due to reenroll22 ment barriers. 

23 (C) Difficult renewal policies and reenroll24 ment barriers make seamless coverage in CHIP 

25 unattainable. Studies indicate that as many as 


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1 67 percent of children who were eligible but not 

2 enrolled in CHIP or Medicaid had applied for 

3 coverage but were denied eligibility due to pro4 cedural issues. 

5 (D) States have tools at their disposal to 

6 streamline enrollment procedures, but further 

7 Federal changes would help States reach more 

8 children. 

9 (E) Insuring parents is an effective way to 

10 increase children’s participation in public pro11 grams and to increase children’s access to 

12 health care services. 

13 (F) To reduce the number of uninsured 

14 children, improve our children’s health, and 

15 continue our progress in reducing health dis16 parities, the reauthorization of CHIP should 

17 provide States with the tools and resources nec18 essary to identify, enroll, and maintain coverage 

19 for children who are eligible for CHIP or Med20 icaid. 

21 (5) WE MUST SUPPORT AND ENCOURAGE

22 STATES THAT ARE LEADING THE WAY WITH INITIA23 TIVES TO COVER MORE CHILDREN.— 

24 (A) States in every region of the country 

25 are seeking to move forward in covering more 


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1 children, either by reaching already eligible chil2 dren or further expanding eligibility. 

3 (B) The Federal government should serve 

4 as a partner in these efforts by providing suffi5 cient funding to solidify and strengthen this 

6 momentum. 

7 (6) WE MUST PROMOTE HIGH-QUALITY HEALTH

8 CARE THAT PROMOTES CHILDREN’S HEALTHY DE9 VELOPMENT.— 

10 (A) Children and adolescents deserve bet11 ter quality care than what they currently re12 ceive. 

13 (B) Most States report using some kind of 

14 measure to evaluate and improve the quality of 

15 care children receive through their CHIP and 

16 Medicaid programs. However, State efforts are 

17 often hampered by budget constraints, limita18 tions on information technology systems, and a 

19 need for improved measurement tools and per20 formance measurement standards. 

21 (C) As we improve access to health cov22 erage as part of CHIP reauthorization, Con23 gress also has an opportunity to enhance qual24 ity by improving and standardizing data collec25 tion efforts. 


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1 (7) WE MUST SUPPORT POLICIES THAT

2 STRENGTHEN AND EXPAND HEALTH INSURANCE

3 COVERAGE.— 

4 (A) There are more than 46,000,000 unin5 sured Americans today. 

6 (B) No one who is currently covered 

7 should lose coverage because of changes to 

8 CHIP or Medicaid as part of the reauthoriza9 tion of CHIP. 

10 (C) Coverage of parents through family 

11 coverage waivers furthers the objectives of 

12 CHIP in that it promotes children’s enrollment, 

13 positively impacts children’s utilization of serv14 ices, and improves family well-being. 

15 (D) Coverage of parents through family 

16 coverage waivers is also consistent with long17 standing CHIP policy—the explicit authoriza18 tion in the CHIP statute for the Secretary to 

19 grant waivers that are consistent with the ob20 jectives of CHIP, the parent waiver guidelines 

21 for CHIP issued by the Secretary, and the flexi22 bility broadly accorded states through CHIP. 

23 (E) Parent coverage waivers have been 

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1 ment to cover children first and then to use 

2 funding to cover low-income parents. 

3 (F) Research indicates that having an un4 insured parent not only decreases the likelihood 

5 that a child will have a well-child visit, it also 

6 decreases the likelihood that a child will see any 

7 medical provider at all. 

8 (G) We strongly support maintaining the 

9 current flexibility under CHIP that permits 

10 family coverage through waivers to cover par11 ents, while assuring that children remain the 

12 primary focus of CHIP. 

13 TITLE I—MAKING CHILDREN’S 

14 HEALTH COVERAGE A NA15 TIONAL PRIORITY 

16 SEC. 101. PROVIDING NECESSARY FUNDING FOR CHIP. 

17 Section 2104(a) (42 U.S.C. 1397dd(a)) is amended— 

18 (1) in paragraph (9), by striking ‘‘and’’ at the 

19 end; 

20 (2) in paragraph (10), by striking the period at 

21 the end and inserting a semicolon; and 

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

23 paragraphs: 

24 ‘‘(11) for fiscal year 2008, $8,525,000,000; 

25 ‘‘(12) for fiscal year 2009, $10,075,000,000; 


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1 ‘‘(13) for fiscal year 2010, $11,250,000,000; 

2 ‘‘(14) for fiscal year 2011, $13,150,000,000; 

3 ‘‘(15) for fiscal year 2012, $15,400,000,000; 

4 and 

5 ‘‘(16) for fiscal year 2013 and each fiscal year 

6 thereafter, the total allotment amount appropriated 

7 under this subsection for the preceding fiscal year, 

8 multiplied by the adjustment determined for such 

9 fiscal year under subsection (i)(2)(C).’’. 

10 TITLE II—IMPROVING CHIP 

11 FINANCING 

12 SEC. 201. STATE CHIP ALLOTMENTS THAT ARE RESPON13 SIVE TO HEALTH CARE COSTS, POPULATION 

14 GROWTH, AND THE NEEDS OF LOW-INCOME 

15 UNINSURED CHILDREN. 

16 (a) IN GENERAL.—Section 2104 (42 U.S.C. 1397dd) 

17 is amended by adding at the end the following new sub18 section: 

19 ‘‘(i) ANNUAL ALLOTMENTS FOR STATES OTHER

20 THAN TERRITORIES BEGINNING WITH FISCAL YEAR

21 2008.— 

22 ‘‘(1) IN GENERAL.—Subject to paragraph (4), 

23 of the total allotment amount appropriated under 

24 subsection (a) for a fiscal year beginning with fiscal 

25 year 2008 and remaining available after the applicaVerDate Aug 31 2005 23:27 Apr 26, 2007 Jkt 059200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S1224.IS S1224

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1 tion of subsection (j) and subsection (c)(5), the Sec2 retary shall allot to each State (as defined for pur3 poses of this subsection in paragraph (5)) the sum 

4 of the following: 

5 ‘‘(A) The coverage factor, as determined 

6 under paragraph (2), based on the State’s prior 

7 spending adjusted for health care cost growth 

8 and child population growth. 

9 ‘‘(B) The uninsured children factor, as de10 termined under paragraph (3), based on the 

11 number of low-income children without health 

12 insurance in the State, adjusted for geographic 

13 variation in health care costs. 

14 ‘‘(2) COVERAGE FACTOR.— 

15 ‘‘(A) IN GENERAL.—For purposes of para16 graph (1)(A), subject to subparagraphs (B) and 

17 (D), the coverage factor determined for a State 

18 is equal to the following: 

19 ‘‘(i) FISCAL YEAR 2008.—For fiscal 

20 year 2008, the higher of the following: 

21 ‘‘(I) The total Federal payments 

22 to the State under this title for fiscal 

23 year 2007 multiplied by the annual 

24 adjustment determined under sub25 paragraph (C) for that fiscal year. 


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1 ‘‘(II) The amount allotted to the 

2 State for fiscal year 2007 under sub3 section (b), multiplied by the annual 

4 adjustment determined under sub5 paragraph (C) for that fiscal year. 

6 ‘‘(III) The projected total Fed7 eral payments to the State under this 

8 title for fiscal year 2007, as reported 

9 by the State to the Secretary by the 

10 State as of November 2006 (or the 

11 projected total Federal payments to 

12 the State under this title for fiscal 

13 year 2007 as reported by the State to 

14 the Secretary as of May 2006 if the 

15 projected total Federal payments to 

16 the State under this title for such fis17 cal year were at least $95,000,000 

18 higher than such projected payments 

19 as of November 2006), multiplied by 

20 the annual adjustment determined 

21 under subparagraph (C) for that fis22 cal year. 

23 ‘‘(IV) The projected total Federal 

24 payments to the State under this title 

25 for fiscal year 2008, as reported by 


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1 the State to the Secretary by the 

2 State as of February 2007. 

3 ‘‘(ii) FISCAL YEAR 2009.—For fiscal 

4 year 2009, the amount determined under 

5 clause (i), multiplied by the annual adjust6 ment determined under subparagraph (C) 

7 for that fiscal year. 

8 ‘‘(iii) FISCAL YEAR 2010 AND EACH

9 SECOND SUCCEEDING FISCAL YEAR; PRO10 VIDING FOR REBASING.—Subject to sub11 paragraphs (B) and (D), for fiscal year 

12 2010 and each second succeeding fiscal 

13 year, the total Federal payments to the 

14 State under this title for the previous fiscal 

15 year attributable to any allotments avail16 able to the State in such fiscal year under 

17 paragraph (1) and subsection (b) multi18 plied by the annual adjustment determined 

19 under subparagraph (C) for that fiscal 

20 year. 

21 ‘‘(iv) FISCAL YEAR 2011 AND EACH

22 SECOND SUCCEEDING FISCAL YEAR.—For 

23 fiscal year 2011 and each second suc24 ceeding fiscal year, the amount determined 

25 under clause (iii) for the preceding fiscal 


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1 year, multiplied by the annual adjustment 

2 determined under subparagraph (C) for 

3 the State for that fiscal year. 

4 ‘‘(B) LIMITATION AND MINIMUMS.— 

5 ‘‘(i) IN GENERAL.—Subject to clause 

6 (ii), if the total of the coverage factors de7 termined under subparagraph (A) for all 

8 States exceed in any fiscal year the total 

9 allotment amount under subsection (a) for 

10 a fiscal year beginning with fiscal year 

11 2008 remaining available after the applica12 tion of subsections (c)(5) and (j)(2)(C), 

13 each State’s coverage factor shall be equal 

14 to the total allotment amount under sub15 section (a) for a fiscal year remaining 

16 available after application of such sub17 sections, multiplied by the ratio of— 

18 ‘‘(I) the amount of the State’s 

19 coverage factor determined under sub20 paragraph (A); to 

21 ‘‘(II) the total of such coverage 

22 factors for all States for such fiscal 

23 year. 

24 ‘‘(ii) MIMIMUM COVERAGE FACTOR.— 

25 At a minimum, the coverage factor for a 


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1 State for a fiscal year shall not be less 

2 than the lesser of— 

3 ‘‘(I) the State’s total Federal 

4 payments attributable to any allot5 ments available to the State in the 

6 prior fiscal year under paragraph (1) 

7 and subsection (b), multiplied by the 

8 annual adjustment determined under 

9 subparagraph (C) for that fiscal year; 

10 and 

11 ‘‘(II) the total allotment for the 

12 State under paragraph (1) for the 

13 prior fiscal year, multiplied by the an14 nual adjustment determined under 

15 subparagraph (C) for that fiscal year. 

16 ‘‘(C) ANNUAL ADJUSTMENT FOR HEALTH

17 CARE COST GROWTH AND CHILD POPULATION

18 GROWTH.—The annual adjustment with respect 

19 to a State for any fiscal year is equal to the 

20 product of the amounts determined under 

21 clauses (i) and (ii): 

22 ‘‘(i) PER CAPITA HEALTH CARE

23 GROWTH.—1 plus the percentage increase 

24 (if any) in the projected nominal per capita 

25 amount of National Health Expenditures 


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1 for such fiscal year over the preceding fis2 cal year, as most recently published by the 

3 Secretary before the beginning of the fiscal 

4 year involved. 

5 ‘‘(ii) CHILD POPULATION GROWTH.— 

6 1.01 plus the percentage increase in the 

7 population of children under 19 years of 

8 age in the United States from July 1 of 

9 the previous fiscal year to July 1 of the fis10 cal year involved, as determined by the 

11 Secretary based on the most recent pub12 lished estimates of the Bureau of the Cen13 sus before the beginning of the fiscal year 

14 involved. 

15 ‘‘(D) REBASING RULE FOR FISCAL YEAR

16 2010 AND EACH SECOND SUCCEEDING FISCAL

17 YEAR FOR CERTAIN STATES.— 

18 ‘‘(i) IN GENERAL.—For fiscal year 

19 2010 and each second succeeding fiscal 

20 year, a State receiving reallocated funds 

21 under subsection (j) in the prior fiscal year 

22 shall receive an additional spending 

23 amount equal to the proportion (deter24 mined under clause (ii)) of the total allot25 ment amount under subsection (a) for such 


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1 fiscal year remaining available after the 

2 application of subsections (c)(5) and 

3 (j)(2)(C), and subparagraphs (A) and (B), 

4 if any, multiplied by the ratio of— 

5 ‘‘(I) the total Federal payments 

6 to the State under this title for the 

7 previous fiscal year attributable to any 

8 funds made available to the State in 

9 the previous fiscal year under sub10 section (j), multiplied by the annual 

11 adjustment determined under sub12 paragraph (C) for the fiscal year; to 

13 ‘‘(II) the total of such payments 

14 for all States for the previous fiscal 

15 year. 

16 ‘‘(ii) PROPORTION.—For purposes of 

17 clause (i), the proportion shall equal— 

18 ‘‘(I) for fiscal year 2010, 20 per19 cent; and 

20 ‘‘(II) for fiscal year 2012 and 

21 each second succeeding fiscal year, 40 

22 percent. 

23 ‘‘(3) UNINSURED CHILDREN FACTOR.— 

24 ‘‘(A) IN GENERAL.—For purposes of para25 graph (1)(B), subject to subparagraph (B), the 


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1 uninsured children factor for a State is equal to 

2 the total allotment amount under subsection (a) 

3 for a fiscal year beginning with fiscal year 

4 2008, remaining available after application of 

5 subsections (c)(5) and (j)(2)(C) and paragraph 

6 (2), multiplied by the following: 

7 ‘‘(i) FISCAL YEAR 2008 AND EACH

8 SECOND SUCCEEDING FISCAL YEAR.—In 

9 the case of fiscal year 2008, and each sec10 ond succeeding fiscal year, the ratio of— 

11 ‘‘(I) the uninsured children ad12 justment for the State determined 

13 under subparagraph (B); to 

14 ‘‘(II) the sum of the uninsured 

15 children adjustments for all States de16 termined under subparagraph (B). 

17 ‘‘(ii) FISCAL YEAR 2009 AND EACH

18 SECOND SUCCEEDING FISCAL YEAR.—In 

19 the case of fiscal year 2009, and each sec20 ond succeeding fiscal year, the ratio deter21 mined under clause (i) for the previous fis22 cal year. 

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1 termined under this subparagraph for a State is 

2 equal to the product of the following: 

3 ‘‘(i) NUMBER OF LOW-INCOME CHIL4 DREN WITHOUT HEALTH INSURANCE.— 

5 The average of the number of low-income 

6 children under 19 years of age in the State 

7 with no health insurance for a fiscal year, 

8 as reported and defined in the 2 most re9 cent March supplement to the Current 

10 Population Survey of the Bureau of the 

11 Census available prior to the beginning of 

12 such fiscal year. 

13 ‘‘(ii) GEOGRAPHIC VARIATION IN

14 HEALTH CARE COSTS.—The adjustment 

15 for geographic variation in health care 

16 costs, as determined under subsection 

17 (b)(3). 

18 ‘‘(4) DATA.—In computing the amounts under 

19 paragraphs (2) and (3) and subsection (c)(5) that 

20 determine the allotments to States for each fiscal 

21 year, the Secretary shall use the most recent expend22 iture data for the prior year available to the Sec23 retary before the start of each fiscal year. The Sec24 retary may adjust such amounts and allotments, as 

25 necessary, on the basis of the expenditure data for 


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1 the prior year reported by States on CMS Form 64 

2 or CMS Form 21 not later than November 30 of 

3 each fiscal year but in no case shall the Secretary 

4 adjust the allotments provided under this subsection 

5 or subsection (c)(5) for a fiscal year after December 

6 31 of such year. 

7 ‘‘(5) STATE DEFINED.—In this subsection, the 

8 term ‘State’ means one of the 50 States or the Dis9 trict of Columbia.’’. 

10 (b) CONFORMING AMENDMENTS.—Section 2104 (42 

11 U.S.C. 1397dd) is amended— 

12 (1) in subsection (a), by striking ‘‘subsection 

13 (d)’’ and inserting ‘‘subsections (d), (h), and (i)’’; 

14 (2) in subsection (b)— 

15 (A) in paragraph (1), by striking ‘‘sub16 section (d)’’ and inserting ‘‘subsections (d), (h), 

17 and (i)’’; and 

18 (B) in paragraph (3)(A), by inserting ‘‘and 

19 subsection (i)(3)(D)(ii)’’ after ‘‘paragraph 

20 (1)(A)(ii)’’; and 

21 (3) in subsection (c)(1), by striking ‘‘subsection 

22 (d)’’ and inserting ‘‘subsections (d), (h), and (i)’’. 


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1 SEC. 202. 2-YEAR INITIAL AVAILABILITY OF CHIP ALLOT2 MENTS FOR ALL STATES AND TERRITORIES. 

3 Section 2104(e) (42 U.S.C. 1397dd(e)) is amended 

4 to read as follows: 

5 ‘‘(e) AVAILABILITY OF AMOUNTS ALLOTTED.—Sub6 ject to paragraphs (3) and (4) of subsection (j), amounts 

7 allotted to a State pursuant to subsections (b), (c), or 

8 (i)— 

9 ‘‘(1) for each of fiscal years 1998 through 

10 2007, shall remain available for expenditure by the 

11 State through the end of the second succeeding fis12 cal year; and 

13 ‘‘(2) for fiscal year 2008 and each fiscal year 

14 thereafter, shall remain available for expenditure by 

15 the State through the end of the succeeding fiscal 

16 year.’’. 

17 SEC. 203. ESTABLISHMENT OF TIMELY AND RESPONSIVE 

18 REDISTRIBUTION PROCESS. 

19 (a) IN GENERAL.—Section 2104 (42 U.S.C. 

20 1397dd), as amended by section 201, is amended by add21 ing at the end the following new subsection: 

22 ‘‘(j) TIMELY AND RESPONSIVE REDISTRIBUTIONS

23 BEGINNING WITH FISCAL YEAR 2008.— 

24 ‘‘(1) REALLOCATION TO STATES FACING FED25 ERAL FUNDING SHORTFALLS.— 


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1 ‘‘(A) IN GENERAL.—Notwithstanding sub2 section (f), in each fiscal year quarter of fiscal 

3 year 2008 and each subsequent fiscal year, the 

4 Secretary shall reallocate to a shortfall State 

5 described in subparagraph (D) from the funds 

6 available under paragraph (2) an amount equal 

7 to the projected amount of the shortfall for the 

8 fiscal year. The Secretary shall only make such 

9 a reallocation under this paragraph to the ex10 tent that there are amounts available under 

11 paragraph (2). 

12 ‘‘(B) PRORATION RULE.—If the amounts 

13 available under paragraph (2) for any fiscal 

14 year quarter for reallocation under subpara15 graph (A) are less than the total shortfall 

16 amounts for the fiscal year determined under 

17 subparagraph (A), the reallocated amount to 

18 each shortfall State shall be reduced proportion19 ally. 

20 ‘‘(C) AVAILABILITY OF REALLOCATED

21 FUNDS.—Any funds made available to a short22 fall State described in subparagraph (D) shall 

23 remain available to such State through the end 

24 of the fiscal year in which such funds are re25 allocated. 


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1 ‘‘(D) SHORTFALL STATE DESCRIBED.— 

2 For purposes of subparagraph (A), a shortfall 

3 State is a State (as defined in subsection (i)(5)) 

4 that has a State child health plan approved 

5 under this title (or waiver of such title approved 

6 by the Secretary) for which the Secretary esti7 mates on a quarterly basis using the most re8 cent data available to the Secretary as of such 

9 quarter, that the projected expenditures under 

10 such plan (or waiver) for the State for the fiscal 

11 year will exceed the sum of— 

12 ‘‘(i) the amount of the allotments pro13 vided under subsection (b) or (i) in fiscal 

14 years preceding such fiscal year that re15 main available to the State; 

16 ‘‘(ii) the amount of the allotment 

17 under subsection (i) for such fiscal year to 

18 the State; and 

19 ‘‘(iii) the amount of any reallocated 

20 funds made available under subparagraph 

21 (A) in previous quarters of such fiscal year 

22 to the State. 

23 ‘‘(2) AMOUNTS AVAILABLE FOR REALLOCA24 TION.—Amounts available for reallocation in any fisVerDate Aug 31 2005 23:27 Apr 26, 2007 Jkt 059200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\S1224.IS S1224

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1 cal year under this subsection shall equal the sum of 

2 the following: 

3 ‘‘(A) Any allotments remaining unex4 pended after the period of availability under 

5 subsection (e). 

6 ‘‘(B) Any amounts available for realloca7 tion and remaining unexpended at the end of 

8 the previous fiscal year under paragraph (3). 

9 ‘‘(C) Subject to paragraph (4), 5 percent 

10 of the total amount available under subsection 

11 (a) for such fiscal year. 

12 ‘‘(3) CONTINUED AVAILABILITY OF UNEX13 PENDED REALLOCATED FUNDS.—Any unexpended 

14 amounts reallocated to a shortfall State remaining 

15 available after the period of availability under para16 graph (1)(C) and any amounts available for redis17 tribution in a fiscal year that are not reallocated to 

18 a shortfall State because the total amount available 

19 for reallocation exceeds the total of all reallocated 

20 amounts under paragraph (1)(A) shall remain avail21 able for reallocation until expended. 

22 ‘‘(4) LIMITS ON WITHHOLDING FROM TOTAL

23 ALLOTMENTS FOR PURPOSES OF REALLOCATION.—If 

24 the Secretary determines that the total amounts 

25 available for reallocation under paragraph (2) for a 


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1 fiscal year exceeds 10 percent of the total amount 

2 available under subsection (a) for that fiscal year, 

3 the Secretary shall reduce the percentage under 

4 paragraph (2)(C) accordingly so that the total 

5 amount available for reallocation under paragraph 

6 (2) for the fiscal year does not exceed 10 percent of 

7 the total amount available under subsection (a) for 

8 such fiscal year.’’. 

9 SEC. 204. IMPROVING FUNDING FOR THE TERRITORIES 

10 UNDER CHIP AND MEDICAID. 

11 (a) UPDATE OF CHIP ALLOTMENTS.—Section 

12 2104(c) (42 U.S.C. 1397dd(c)) is amended— 

13 (1) in paragraph (1), by inserting ‘‘and para14 graphs (5) and (6)’’ after ‘‘subsection (d)’’; and 

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

16 paragraphs: 

17 ‘‘(5) ANNUAL ALLOTMENTS FOR TERRITORIES

18 BEGINNING WITH FISCAL YEAR 2008.—Of the total 

19 allotment amount appropriated under subsection (a) 

20 for a fiscal year beginning with fiscal year 2008 and 

21 remaining available after the application of sub22 section (j), the Secretary shall allot to each of the 

23 commonwealths and territories described in para24 graph (3) the following: 


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1 ‘‘(A) FISCAL YEAR 2008.—For fiscal year 

2 2008, the highest amount of Federal payments 

3 to the commonwealth or territory under this 

4 title for any fiscal year occurring during the pe5 riod of fiscal years 1998 through 2007, multi6 plied by the annual adjustment determined 

7 under subsection (i)(2)(C) for the fiscal year. 

8 ‘‘(B) FISCAL YEAR 2009 AND SUCCEEDING

9 FISCAL YEARS.—For fiscal year 2009 and each 

10 succeeding fiscal year, the amount determined 

11 under clause (i), multiplied by the annual ad12 justment determined under subsection (i)(2)(C) 

13 for the fiscal year. 

14 ‘‘(6) REDISTRIBUTIONS FOR TERRITORIES FAC15 ING FEDERAL FUNDING SHORTFALLS.—Notwith16 standing subsection (f), the Secretary shall deter17 mine an appropriate procedure for reallocating to 

18 each commonwealth or territory described in para19 graph (3) that would, with respect to each fiscal 

20 year quarter of fiscal year 2008 be a shortfall State 

21 described in subsection (j)(1)(D) if such subsection 

22 applied to such commonwealth or territory, from the 

23 funds available under subsection (j)(2) for such fis24 cal year, the same proportion as the proportion of 

25 the commonwealth’s or territory’s allotment under 


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1 paragraph (2 ) to such percentage (not to exceed 

2 1.05 percent) as the Secretary determines appro3 priate of such funds.’’. 

4 (b) REMOVAL OF FEDERAL MATCHING PAYMENTS

5 FOR DATA REPORTING SYSTEMS FROM THE OVERALL

6 LIMIT ON PAYMENTS TO TERRITORIES UNDER TITLE

7 XIX.—Section 1108(g) (42 U.S.C. 1308(g)) is amended 

8 by adding at the end the following new paragraph: 

9 ‘‘(4) EXCLUSION OF CERTAIN EXPENDITURES

10 FROM PAYMENT LIMITS.—With respect to fiscal year 

11 2008 and each fiscal year thereafter, if Puerto Rico, 

12 the Virgin Islands, Guam, the Northern Mariana Is13 lands, or American Samoa qualify for a payment 

14 under subparagraph (A)(i), (A) (iii), (A)(iv), or (B) 

15 of section 1903(a)(3) for a calendar quarter of such 

16 fiscal year, the limitation on expenditures under title 

17 XIX for such commonwealth or territory otherwise 

18 determined under subsection (f) and this subsection 

19 for such fiscal year shall be determined without re20 gard to such payment.’’. 

21 (c) GAO STUDY AND REPORT.—Not later than Sep22 tember 30, 2009, the Comptroller General of the United 

23 States shall submit a report to Congress regarding Fed24 eral funding under Medicaid and the State Children’s 

25 Health Insurance Program for Puerto Rico, the United 


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1 States Virgin Islands, Guam, American Samoa, and the 

2 Northern Mariana Islands. The report shall include the 

3 following: 

4 (1) An analysis of all relevant factors with re5 spect to— 

6 (A) eligible Medicaid and CHIP popu7 lations in such commonwealths and territories; 

8 (B) historical and projected spending needs 

9 of such commonwealths and territories and the 

10 ability of capped funding streams to respond to 

11 those spending needs; 

12 (C) the extent to which Federal poverty 

13 guidelines are used by such commonwealths and 

14 territories to determine Medicaid and CHIP eli15 gibility; and 

16 (D) the extent to which such common17 wealths and territories participate in data col18 lection and reporting related to Medicaid and 

19 CHIP, including an analysis of territory partici20 pation in the Current Population Survey versus 

21 the American Community Survey. 

22 (2) Recommendations for improving Federal 

23 funding under Medicaid and the State Children’s 

24 Health Insurance Program for such commonwealths 

25 and territories. 


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1 SEC. 205. EXTENSION OF AUTHORITY FOR QUALIFYING 

2 STATES TO USE CHIP ALLOTMENTS FOR CER3 TAIN MEDICAID EXPENDITURES. 

4 Section 2105(g)(1)(A) (42 U.S.C. 1397ee(g)(1)(A)), 

5 as amended by section 201(b) of the National Institutes 

6 of Health Reform Act of 2006 (Public Law 109–482) is 

7 amended by striking ‘‘not more than 20 percent of any 

8 allotment under section 2104 for fiscal year 1998, 1999, 

9 2000, 2001, 2004, 2005, 2006, or 2007’’ and inserting 

10 ‘‘any allotment under subsection (b) or (i) of section 2104 

11 for a fiscal year’’. 

12 SEC. 206. STATE OPTION TO EXPAND COVERAGE OF CHIL13 DREN UNDER CHIP UP TO 300 PERCENT OF 

14 THE POVERTY LINE. 

15 Section 2110(b)(1)(B) (42 U.S.C. 1397jj(b)(1)(B)) is 

16 amended— 

17 (1) in clause (i), by striking ‘‘, or’’ at the end 

18 and inserting a semicolon; 

19 (2) in clause (ii)(III), by striking ‘‘and’’ at the 

20 end and inserting ‘‘or’’; and 

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

22 clause: 

23 ‘‘(iii) is a child— 

24 ‘‘(I) whose family income (as deter25 mined under the State child health plan) 


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1 does not exceed 300 percent of the poverty 

2 line for a family of the size involved; or 

3 ‘‘(II) whose family income exceeds 

4 300 percent of the poverty line but does 

5 not exceed 50 percentage points above the 

6 effective income level (expressed as a per7 cent of the poverty line and considering ap8 plicable income disregards) applied under 

9 the State child health plan on the date of 

10 enactment of this clause; and’’. 

11 SEC. 207. REQUIRING RESPONSIBLE CHIP ENROLLMENT 

12 GROWTH. 

13 (a) LIMITATION ON APPROVAL OF PROPOSED PLAN

14 AMENDMENTS.—Section 2106(b)(3)(B) (42 U.S.C. 

15 1397ff(b)(3)(B)) is amended by adding at the end the fol16 lowing new clause: 

17 ‘‘(iii) AMENDMENTS TO EXPAND ELI18 GIBILITY BEYOND HIGHEST INCOME ELIGI19 BILITY PERMITTED.—Any plan amendment 

20 that would allow funds made available 

21 under this title to be used to provide child 

22 health assistance or other health benefits 

23 coverage for a child whose family income 

24 exceeds the highest income eligibility level 

25 permitted under section 2110(b)(1)(B)(iii) 


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1 (in this clause referred to as an ‘expansion 

2 amendment’) may not take effect, and 

3 shall not remain in effect, unless the Sec4 retary determines that the following condi5 tions are met: 

6 ‘‘(I) UNINSURED RATE FOR LOW7 INCOME CHILDREN IS BELOW THE NA8 TIONAL AVERAGE.—With respect to 

9 each fiscal year in which the expan10 sion amendment is in effect, the per11 centage of low-income children with12 out private health coverage who are 

13 uninsured is below the national aver14 age percentage of such children, for 

15 the most recent year for which such 

16 data is available (as determined by 

17 the Secretary on the basis of the 2 

18 most recent Annual Social and Eco19 nomic Supplements of the Current 

20 Population Survey of the Bureau of 

21 the Census). 

22 ‘‘(II) OPEN ENROLLMENT; MAIN23 TENANCE OF ELIGIBILITY STAND24 ARDS.—The State does not impose 

25 any numerical limitation, waiting list, 


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1 or similar limitation on eligibility for 

2 targeted low-income children described 

3 in section 2110(b)(1)(B)(iii) under 

4 the State child health plan, or to 

5 make more restrictive the eligibility 

6 standards for such children, while the 

7 expansion amendment is in effect. 

8 ‘‘(III) IMPLEMENTATION OF SIM9 PLIFIED OUTREACH AND ENROLL10 MENT PROCEDURES.—The State sub11 mitting the expansion amendment has 

12 implemented procedures to effectively 

13 enroll and retain children eligible for 

14 medical assistance under title XIX 

15 and children eligible for child health 

16 assistance under this title by adopting 

17 and effectively implementing with re18 spect to such children at least 3 of the 

19 following policies and procedures 

20 under title XIX and this title: 

21 ‘‘(aa) JOINT APPLICATION

22 AND RENEWAL PROCESS THAT

23 PERMITS APPLICATION OTHER

24 THAN IN PERSON.—The applica25 tion and renewal forms and supVerDate Aug 31 2005 23:27 Apr 26, 2007 Jkt 059200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\S1224.IS S1224

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1 plemental forms (if any) and in2 formation verification process is 

3 the same for purposes of estab4 lishing and renewing eligibility 

5 for children for medical assist6 ance under title XIX and child 

7 health assistance under this title, 

8 and such process does not require 

9 an application to be made in per10 son or a face-to-face interview. 

11 ‘‘(bb) NO ASSETS TEST.— 

12 The State does not apply any as13 sets test for eligibility under title 

14 XIX and this title with respect to 

15 children. 

16 ‘‘(cc) 12-MONTHS CONTIN17 UOUS ELIGIBILITY.—The State 

18 has elected the option of contin19 uous eligibility for a full 12 

20 months for children described in 

21 section 1902(e)(12) under title 

22 XIX, and applies such option 

23 under this title. 

24 ‘‘(dd) PRESUMPTIVE ELIGI25 BILITY FOR CHILDREN.—The 


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1 State has implemented the op2 tion, for purposes of title XIX 

3 and this title, of applying pre4 sumptive eligibility for children in 

5 accordance with sections 1920A 

6 and 2107(e)(1)(F). 

7 ‘‘(IV) ANNUAL REPORTING OF

8 MEASURES OF QUALITY OF HEALTH

9 CARE FOR CHILDREN.—The State sat10 isfies the requirements of section 

11 1905(y)(2)(B)(iv) (relating to annual 

12 reporting of measures of quality of 

13 health care for children under title 

14 XIX and this title).’’. 

15 (b) APPLICATION TO WAIVERS.—Section 2107(f) (42 

16 U.S.C. 1397gg(f)) is amended— 

17 (1) by striking ‘‘, the Secretary’’ and inserting 

18 ‘‘: 

19 ‘‘(1) The Secretary’’; and 

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

21 paragraph: 

22 ‘‘(2) The Secretary may not approve a waiver, 

23 experimental, pilot, or demonstration project with re24 spect to a State that would allow funds made avail25 able under this title to be used to provide child 


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1 health assistance or other health benefits coverage 

2 for a child whose family income exceeds the highest 

3 income eligibility level permitted under section 

4 2110(b)(1)(B)(iii) (in this paragraph referred to as 

5 an ‘expansion waiver’) unless the Secretary deter6 mines that the conditions described in each of sub7 clauses (I) through (IV) of section 2106(b)(3)(B)(iii) 

8 are met (and determines on an ongoing basis, that 

9 such conditions continue to be met while the expan10 sion waiver is in effect).’’. 

11 TITLE III—ENROLLING UNIN12 SURED CHILDREN ELIGIBLE 

13 FOR CHIP AND MEDICAID 

14 SEC. 301. ‘‘EXPRESS LANE’’ OPTION FOR STATES TO DETER15 MINE COMPONENTS OF A CHILD’S ELIGI16 BILITY FOR MEDICAID OR CHIP. 

17 (a) MEDICAID.—Section 1902(e) (42 U.S.C. 

18 1396a(e)) is amended by adding at the end the following 

19 new paragraph: 

20 ‘‘(13)(A)(i) At the option of the State, notwith21 standing any other provision of law, including subsection 

22 (a)(46)(B) and sections 1137(d) and 1903(x), the State 

23 may rely on a determination made within a reasonable pe24 riod (as determined by the State) by an Express Lane 

25 agency (as defined in subparagraph (F)(i)) to determine 


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1 whether an individual has met the income, assets or re2 sources, or citizenship status criteria for eligibility for 

3 medical assistance under this title (including under a 

4 waiver of the requirements of this title). 

5 ‘‘(ii) The option under clause (i) shall apply to rede6 terminations or renewals of eligibility for medical assist7 ance, as well as to initial applications for such assistance. 

8 ‘‘(iii) The option under clause (i) shall apply to a 

9 child who is under an age specified by the State (not to 

10 exceed 21 years of age) and, at State option, may also 

11 apply to an individual who is not a child. 

12 ‘‘(B) Nothing in this paragraph shall be construed 

13 to relieve a State of the obligation to determine eligibility 

14 for medical assistance under this title if an individual is 

15 determined ineligible for such assistance on the basis of 

16 information furnished pursuant to this paragraph. 

17 ‘‘(C) A State shall inform an individual (or, in the 

18 case of a child, the family of the child) enrolled in the 

19 State plan under this title and required to pay premiums 

20 for such enrollment based on an income determination fur21 nished to the State pursuant to this paragraph that the 

22 individual or family may qualify for lower premium pay23 ments if directly evaluated for eligibility by the State Med24 icaid agency. 


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1 ‘‘(D) If a State applies the eligibility process de2 scribed in subparagraph (A) to individuals eligible for 

3 medical assistance under this title, the State may, at its 

4 option, implement its duties under subparagraphs (A) and 

5 (B) of section 2102(b)(3) using either or both of the fol6 lowing approaches: 

7 ‘‘(i) The State may— 

8 ‘‘(I) establish a threshold percentage of the 

9 Federal poverty level (that shall exceed the in10 come eligibility level applicable for a population 

11 of individuals under this title by 30 percentage 

12 points (as a fraction of the Federal poverty 

13 level) or such other higher number of percent14 age points as the State determines reflects the 

15 typical application of income methodologies by 

16 the program administered by the Express Lane 

17 agency and the State plan under this title); and 

18 ‘‘(II) provide that, with respect to any in19 dividual within such population whom an Ex20 press Lane agency determines has income that 

21 does not exceed such threshold percentage for 

22 such population, such individual is eligible for 

23 medical assistance under this title (regardless of 

24 whether such individual would otherwise be deVerDate Aug 31 2005 23:27 Apr 26, 2007 Jkt 059200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 E:\BILLS\S1224.IS S1224

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1 termined to be eligible to receive such assist2 ance). 

3 In exercising the approach under this clause, a State 

4 shall inform families whose children are enrolled in 

5 a State child health plan under title XXI based on 

6 having family income above the threshold described 

7 in subclause (I) that they may qualify for medical 

8 assistance under this title and, at their option, can 

9 seek a regular eligibility determination for such as10 sistance for their child, and that if their child is de11 termined to be eligible for such assistance, the child 

12 may receive health benefits coverage that is more af13 fordable and comprehensive than the coverage that 

14 would be provided to the child under the State child 

15 health plan. 

16 ‘‘(ii) Regardless of whether a State otherwise 

17 provides for presumptive eligibility under section 

18 1920A, a State may provide presumptive eligibility 

19 under this title, consistent with subsection (e) of sec20 tion 1920A, to a child who, based on a determina21 tion by an Express Lane agency, would qualify for 

22 child health assistance under a State child health 

23 plan under title XXI. During such presumptive eligi24 bility period, the State may determine the child’s eli25 gibility for medical assistance under this title, pursuVerDate Aug 31 2005 23:27 Apr 26, 2007 Jkt 059200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\S1224.IS S1224

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1 ant to subparagraph (A) of section 2102(b)(3), 

2 based on telephone contact with family members, ac3 cess to data available in electronic or paper form, 

4 and other means of gathering information that are 

5 less burdensome to the family than completing an 

6 application form on behalf of the child. The proce7 dures described in the previous sentence may be 

8 used regardless of whether the State uses similar 

9 procedures under other circumstances for purposes 

10 of determining eligibility for medical assistance 

11 under this title. 

12 ‘‘(E)(i) At the option of a State, an individual deter13 mined to be eligible for medical assistance pursuant to 

14 subparagraph (A), (C), or (D) or other procedures 

15 through which eligibility is determined based on data ob16 tained from sources other than the individual, may receive 

17 medical assistance under this title if such individual (or, 

18 in the case of an individual under age 19 (or if the State 

19 elects the option under subparagraph (A), age 20 or 21) 

20 who is not authorized to consent to medical care, the indi21 vidual’s parent, guardian, or other caretaker relative) has 

22 acknowledged notice of such determination and has con23 sented to being enrolled in the State plan under this title. 

24 The State (at its option) may waive any otherwise applicaVerDate Aug 31 2005 23:27 Apr 26, 2007 Jkt 059200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\S1224.IS S1224

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1 ble requirements for signatures by or on behalf of an indi2 vidual who has so consented. 

3 ‘‘(ii) In the case of an individual enrolled pursuant 

4 to clause (i), the State shall inform the individual (or, in 

5 the case of an individual under age 19 (or if the State 

6 elects the option under subparagraph (A), age 20 or 21), 

7 the individual’s parent, guardian, or other caretaker rel8 ative) about the significance of such enrollment, including 

9 appropriate methods to access covered services. 

10 ‘‘(F) In this paragraph, the term ‘Express Lane 

11 agency’ means a Federal or State agency, or a public or 

12 private entity making such determination on behalf of 

13 such agency, specified by the plan, including an agency 

14 administering the State program funded under part A of 

15 title IV, the State child health plan under title XXI, the 

16 Food Stamp Act of 1977, the Richard B. Russell National 

17 School Lunch Act, or the Child Nutrition Act of 1966, 

18 notwithstanding any differences in budget unit, disregard, 

19 deeming, or other methodology, but only if— 

20 ‘‘(i) the agency or entity has fiscal liabilities or 

21 responsibilities affected by such determination; 

22 ‘‘(ii) the agency or entity notifies the child’s 

23 family— 

24 ‘‘(I) of the information which shall be dis25 closed in accordance with this paragraph; 


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1 ‘‘(II) that the information disclosed will be 

2 used solely for purposes of determining eligi3 bility for medical assistance under this title or 

4 for child health assistance under title XXI; 

5 ‘‘(III) that interagency agreements limit 

6 the use of such information to such purposes; 

7 and 

8 ‘‘(IV) that the family may elect to not have 

9 the information disclosed for such purposes; 

10 and 

11 ‘‘(iii) the requirements of section 1939 are sat12 isfied.’’. 

13 (b) CHIP.—Section 2107(e)(1) (42 U.S.C. 

14 1397gg(e)(1)) is amended by redesignating subparagraphs 

15 (B) through (D) as subparagraphs (C) through (E), re16 spectively, and by inserting after subparagraph (A) the 

17 following new subparagraph: 

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

19 State option to base a determination of a child’s 

20 eligibility for assistance on determinations made 

21 by an agency other than the State Medicaid 

22 agency).’’. 

23 (c) PRESUMPTIVE ELIGIBILITY.—Section 

24 1920A(b)(3)(A)(i) (42 U.S.C. 1396r–1a(b)(3)(A)(i)) is 

25 amended by striking ‘‘or (IV)’’ and inserting ‘‘(IV) is an 


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1 agency or entity described in section 1902(e)(13)(F), or 

2 (V)’’. 

3 (d) SIGNATURE REQUIREMENTS.—Section 1902(a) 

4 (42 U.S.C. 1396a(a)) is amended by adding at the end 

5 the following new sentence: ‘‘Notwithstanding any other 

6 provision of law, a signature under penalty of perjury shall 

7 not be required on an application form for medical assist8 ance as to any element of eligibility for which eligibility 

9 is based on information received from a source other than 

10 an applicant, rather than on representations from the ap11 plicant. Notwithstanding any other provision of law, any 

12 signature requirement for an application for medical as13 sistance may be satisfied through an electronic signature, 

14 as defined in section 1710(1) of the Government Paper15 work Elimination Act (44 U.S.C. 3504 note).’’. 

16 SEC. 302. INFORMATION TECHNOLOGY CONNECTIONS TO 

17 SIMPLIFY HEALTH COVERAGE DETERMINA18 TIONS. 

19 (a) ENHANCED ADMINISTRATIVE FUNDING FOR IN20 FORMATION TECHNOLOGY USED TO SIMPLIFY ELIGI21 BILITY DETERMINATIONS.—Section 1903(a)(3)(A) (42 

22 U.S.C. 1396b(a)(3)(A)) is amended— 

23 (1) by striking ‘‘and’’ at the end of clause (i); 

24 and 


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

2 clause: 

3 ‘‘(iii) 75 percent of so much of the sums 

4 expended during such quarter as are attrib5 utable to information technology needed to con6 duct data matches or for the exchange of elec7 tronic information with an Express Lane agen8 cy (as defined in 1902(e)(13)(F)) as the Sec9 retary determines is directly related to reducing 

10 the need for an individual undergoing an eligi11 bility determination for medical assistance 

12 under this title or child health assistance under 

13 title XXI (including a determination of a re14 newal of eligibility for such assistance) to pro15 vide information previously submitted by or on 

16 behalf of the individual to such agency, and’’. 

17 (b) AUTHORIZATION OF INFORMATION DISCLO18 SURE.— 

19 (1) IN GENERAL.—Title XIX (42 U.S.C. 1396 

20 et seq.) is amended— 

21 (A) by redesignating section 1939 as sec22 tion 1940; and 

23 (B) by inserting after section 1938 the fol24 lowing new section: 


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1 ‘‘AUTHORIZATION TO RECEIVE PERTINENT INFORMATION

2 ‘‘SEC. 1939. (a) IN GENERAL.—Notwithstanding any 

3 other provision of law, a Federal or State agency or pri4 vate entity in possession of the sources of data potentially 

5 pertinent to eligibility determinations under this title (in6 cluding eligibility files maintained by Express Lane agen7 cies described in section 1902(e)(13)(F), information de8 scribed in paragraph (2) or (3) of section 1137(a), vital 

9 records information about births in any State, and infor10 mation described in sections 453(i) and 1902(a)(25)(I)) 

11 is authorized to convey such data or information to the 

12 State agency administering the State plan under this title, 

13 if— 

14 ‘‘(1) such data or information are used only to 

15 establish or verify eligibility or provide coverage 

16 under this title; and 

17 ‘‘(2) an interagency or other agreement, con18 sistent with standards developed by the Secretary, 

19 prevents the unauthorized use, disclosure, or modi20 fication of such data and otherwise meets applicable 

21 Federal requirements safeguarding privacy and data 

22 security. 

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

24 information may be conveyed pursuant to this section only 

25 if the following requirements are met: 


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1 ‘‘(1) The individual whose circumstances are 

2 described in the data or information (or such indi3 vidual’s parent, guardian, caretaker relative, or au4 thorized representative) has either provided advance 

5 consent to disclosure or has not objected to disclo6 sure after receiving advance notice of disclosure and 

7 a reasonable opportunity to object. 

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

9 for the purposes of— 

10 ‘‘(A) identifying individuals who are eligi11 ble or potentially eligible for medical assistance 

12 under this title and enrolling such individuals in 

13 the State plan; and 

14 ‘‘(B) verifying the eligibility of individuals 

15 for medical assistance under the State plan. 

16 ‘‘(3) An interagency or other agreement, con17 sistent with standards developed by the Secretary— 

18 ‘‘(A) prevents the unauthorized use, disclo19 sure, or modification of such data and other20 wise meets applicable Federal requirements 

21 safeguarding privacy and data security; and 

22 ‘‘(B) requires the State agency admin23 istering the State plan to use the data and in24 formation obtained under this section to seek to 

25 enroll individuals in the plan. 


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1 ‘‘(c) CRIMINAL PENALTY.—A person described in the 

2 subsection (a) who publishes, divulges, discloses, or makes 

3 known in any manner, or to any extent not authorized by 

4 Federal law, any information obtained under this section 

5 shall be fined not more than $1,000 or imprisoned not 

6 more than 1 year, or both, for each such unauthorized 

7 activity. 

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

9 requirements that apply to disclosure pursuant to this sec10 tion shall not be construed to prohibit the conveyance or 

11 disclosure of data or information otherwise permitted 

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

13 (2) CONFORMING AMENDMENT TO TITLE XXI.— 

14 Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)), as 

15 amended by section 301(b), is amended by adding at 

16 the end the following new subparagraph: 

17 ‘‘(F) Section 1939 (relating to authoriza18 tion to receive data potentially pertinent to eli19 gibility determinations).’’. 

20 (3) CONFORMING AMENDMENT TO ASSURE AC21 CESS TO NATIONAL NEW HIRES DATABASE.—Section 

22 453(i)(1) (42 U.S.C. 653(i)(1)) is amended by strik23 ing ‘‘and programs funded under part A’’ and in24 serting ‘‘, programs funded under part A, and State 

25 plans approved under title XIX or XXI’’. 


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1 (4) CONFORMING AMENDMENT TO PROVIDE

2 CHIP PROGRAMS WITH ACCESS TO NATIONAL INCOME

3 DATA.—Section 6103(l)(7)(D)(ii) of the Internal 

4 Revenue Code of 1986 is amended by inserting ‘‘or 

5 title XXI’’ after ‘‘title XIX’’. 

6 (5) CONFORMING AMENDMENT TO PROVIDE AC7 CESS TO DATA ABOUT ENROLLMENT IN INSURANCE

8 FOR PURPOSES OF EVALUATING APPLICATIONS AND

9 FOR CHIP.—Section 1902(a)(25)(I)(i) (42 U.S.C. 

10 1396a(a)(25)(I)(i)) is amended— 

11 (A) by inserting ‘‘(and, at State option, in12 dividuals who are potentially eligible or who 

13 apply)’’ after ‘‘with respect to individuals who 

14 are eligible’’; and 

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

16 State option, child health assistance under title 

17 XXI)’’ after ‘‘the State plan’’. 

18 SEC. 303. ENHANCED ADMINISTRATIVE FUNDING FOR 

19 TRANSLATION OR INTERPRETATION SERV20 ICES. 

21 Section 1903(a)(2) (42 U.S.C. 1396b(a)(2)) is 

22 amended by adding at the end the following new subpara23 graph: 

24 ‘‘(E) an amount equal to 75 percent of so much 

25 of the sums expended during such quarter (as found 


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•S 1224 IS

1 necessary by the Secretary for the proper and effi2 cient administration of the State plan) as are attrib3 utable to translation or interpretation services in 

4 connection with the enrollment and use of services 

5 under this title by individuals for whom English is 

6 not their primary language; plus’’. 

7 SEC. 304. ENHANCED ASSISTANCE WITH COVERAGE COSTS 

8 FOR STATES WITH INCREASING OR HIGH 

9 COVERAGE RATES AMONG CHILDREN. 

10 Section 1905 (42 U.S.C. 1396d) is amended— 

11 (1) in subsection (b), in the first sentence— 

12 (A) by striking ‘‘and (4)’’ and inserting 

13 ‘‘(4)’’; and 

14 (B) by inserting ‘‘, and (5) the Federal 

15 medical assistance percentage with respect to 

16 medical assistance provided to individuals who 

17 have not attained age 19 for a fiscal year shall 

18 be increased, notwithstanding the previous 

19 clauses of this sentence, in the case of a State 

20 that meets the conditions described in subpara21 graph (A) of subsection (y)(1) in the preceding 

22 fiscal year by the number of percentage points 

23 determined under subparagraph (B) of that 

24 subsection, in the case of a State that is de25 scribed in subparagraph (A) of subsection 


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•S 1224 IS

1 (y)(2) in the preceding fiscal year, by the num2 ber of percentage points determined under sub3 paragraph (D) of that subsection, and, in the 

4 case of a State described in both such subpara5 graphs in the preceding fiscal year, by the 

6 greater of the number of percentage points de7 termined under paragraph (1)(B) or (2)(D) of 

8 subsection (y)’’ before the period; and 

9 (2) by adding at the end the following new sub10 section: 

11 ‘‘(y) DETERMINATION OF INCREASE IN FMAP FOR

12 MEDICAL ASSISTANCE FOR CHILDREN FOR CERTAIN

13 STATES.— 

14 ‘‘(1) FOR STATES SIGNIFICANTLY INCREASING

15 ENROLLMENT OF ELIGIBLE CHILDREN.— 

16 ‘‘(A) SIGNIFICANT INCREASE IN ENROLL17 MENT OF ELIGIBLE CHILDREN.— 

18 ‘‘(i) IN GENERAL.—For purposes of 

19 clause (5) of the first sentence of sub20 section (b), a State described in this para21 graph is a State that satisfies the report22 ing requirements described in clause (iii) 

23 and has a percentage increase in the child 

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1 tial reference year that exceeds the bench2 mark rate of growth. 

3 ‘‘(ii) DEFINITIONS.—For purposes of 

4 clause (i): 

5 ‘‘(I) CHILD CASELOAD.—The 

6 term ‘child caseload’ means the aver7 age monthly enrollment of individuals 

8 under age 19 in the State plan under 

9 this title or under a waiver of such 

10 title, as determined by the Secretary. 

11 ‘‘(II) INITIAL REFERENCE

12 YEAR.—The term ‘initial reference 

13 year’ means the 12-month period pre14 ceding August 1, 2007. 

15 ‘‘(III) REFERENCE YEAR.—The 

16 term ‘reference year’ means, with re17 spect to a fiscal year, the 12-month 

18 period preceding August 1 of such fis19 cal year. 

20 ‘‘(IV) BENCHMARK RATE OF

21 GROWTH.—The term ‘benchmark rate 

22 of growth’ means, with respect to a 

23 fiscal year, the product of the pro24 jected rate of growth of children in 

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1 plied by the number of fiscal years 

2 that have elapsed since the initial ref3 erence year. 

4 ‘‘(V) PROJECTED RATE OF

5 GROWTH OF CHILDREN IN MEDICAID

6 AT TIME OF ENACTMENT.—The term 

7 ‘projected rate of growth of children 

8 in Medicaid at time of enactment’ 

9 means the average annual rate of 

10 growth for children enrolled in all 

11 State plans under this title (or under 

12 waivers of such title) during the pe13 riod beginning with fiscal year 2007 

14 and ending with fiscal year 2010, as 

15 projected in March 2007 by the Direc16 tor of the Congressional Budget Of17 fice. 

18 ‘‘(iii) STATE REPORTING REQUIRE19 MENTS.—The State shall submit to the 

20 Secretary such data relating to the average 

21 monthly enrollment of individuals who have 

22 not attained age 19 under this title and 

23 title XXI (including under waivers of such 

24 titles) as the Secretary shall specify for the 

25 purpose of increasing under clause (5) of 


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1 subsection (b) the Federal medical assist2 ance percentage for a State for a fiscal 

3 year in accordance with this subsection. 

4 ‘‘(B) DETERMINATION OF INCREASE.— 

5 ‘‘(i) IN GENERAL.—Subject to clause 

6 (ii), for purposes of clause (5) of the first 

7 sentence of subsection (b), in the case of a 

8 State described in subparagraph (A), the 

9 number of percentage points determined 

10 under this subparagraph is equal to the 

11 percentage increase in the State child case12 load determined for purposes of subpara13 graph (A)(i). 

14 ‘‘(ii) LIMITATION ON INCREASE.—In 

15 no event may the Federal medical assist16 ance percentage for a State for a fiscal 

17 year exceed 85 percent as a result of an in18 crease under this paragraph. 

19 ‘‘(C) SECRETARIAL RESPONSIBILITIES.— 

20 ‘‘(i) REVIEW AND VERIFICATION OF

21 CHILD CASELOAD DATA.—The Secretary 

22 shall review the child caseload data pro23 vided by States for purposes of this para24 graph and shall conduct data matches on 


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•S 1224 IS

1 a periodic basis to verify the child case2 loads determined for States. 

3 ‘‘(ii) NOTICE TO STATES.—Not later 

4 than September 30 of each fiscal year be5 ginning with fiscal year 2008, the Sec6 retary shall inform each State on the ex7 tent to which the child caseload in the 

8 most recent reference year exceeds or does 

9 not exceed the benchmark rate of growth 

10 for such fiscal year. 

11 ‘‘(2) FOR STATES THAT HAVE ACHIEVED AT

12 LEAST A HIGH PARTICIPATION RATE FOR COVERAGE

13 OF UNINSURED LOW-INCOME CHILDREN.— 

14 ‘‘(A) IN GENERAL.—For purposes of 

15 clause (5) of the first sentence of subsection 

16 (b), a State described in this paragraph is a 

17 State— 

18 ‘‘(i) for which the percentage of low19 income children without private health cov20 erage who are uninsured (as determined 

21 under subparagraph (D)) is at least 90 

22 percent; and 

23 ‘‘(ii) that satisfies the conditions de24 scribed in subparagraph (B) (with respect 


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1 to coverage of children under this title and 

2 title XXI) and paragraph (1)(A)(iii). 

3 ‘‘(B) CONDITIONS DESCRIBED.—The con4 ditions described in this subparagraph are the 

5 following: 

6 ‘‘(i) CONTINUOUS ELIGIBILITY RE7 QUIREMENT.—The State has elected the 

8 option of continuous eligibility for a full 12 

9 months for children described in section 

10 1902(e)(12) under this title, as well as ap11 plying such policy under its State child 

12 health plan under title XXI. 

13 ‘‘(ii) NO WAITING LIST FOR TITLE

14 XXI.—The State does not impose any nu15 merical limitation, waiting list, or similar 

16 limitation on eligibility for assistance under 

17 title XXI and has not imposed any such 

18 limitation or list within the preceding 3 

19 years. 

20 ‘‘(iii) NO ASSETS TEST.—The State 

21 does not apply any assets test for eligibility 

22 under this title or title XXI with respect to 

23 children. 

24 ‘‘(iv) ANNUAL REPORTING OF MEAS25 URES OF QUALITY OF HEALTH CARE FOR


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1 CHILDREN.—The State annually reports 

2 on the measures required under section 

3 601 of the Children’s Health Insurance 

4 Program (CHIP) Reauthorization Act of 

5 2007 with respect to the quality of health 

6 care for children under the State plan 

7 under this title and the State child health 

8 plan under title XXI or is otherwise deter9 mined by the Secretary to have imple10 mented a comprehensive system for gath11 ering information and reporting on the 

12 quality of health care for children enrolled 

13 under such plans. 

14 ‘‘(C) DETERMINATION OF INCREASE.— 

15 ‘‘(i) IN GENERAL.—Subject to clause 

16 (ii), for purposes of clause (5) of the first 

17 sentence of subsection (b), in the case of a 

18 State described in subparagraph (A), the 

19 number of percentage points determined 

20 under this subparagraph is equal to the 

21 number of percentage points by which the 

22 percentage described in subparagraph 

23 (A)(i) exceeds 90 percent. 

24 ‘‘(ii) LIMITATION ON INCREASE.—In 

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1 ance percentage for a State for a fiscal 

2 year exceed 85 percent as a result of an in3 crease under this paragraph. 

4 ‘‘(D) SECRETARIAL RESPONSIBILITIES.— 

5 ‘‘(i) DETERMINATION OF STATE

6 RATES.—The rates described in subpara7 graph (A)(i) shall be determined by the 

8 Secretary on the basis of the 2 most recent 

9 Annual Social and Economic Supplements 

10 of the Current Population Survey of the 

11 Bureau of the Census. 

12 ‘‘(ii) NOTICE TO STATES.—Not later 

13 than September 30 of each fiscal year be14 ginning with fiscal year 2008, the Sec15 retary shall inform each State on the ex16 tent to which the State’s participation rate 

17 among uninsured low-income children ex18 ceeds or does not exceed 90 percent. 

19 ‘‘(3) INCREASE IN CAP ON PAYMENTS TO TER20 RITORIES.—If Puerto Rico, the Virgin Islands, 

21 Guam, the Northern Mariana Islands, or American 

22 Samoa qualify for an increase in the Federal medical 

23 assistance percentage under subsection (b)(5) for a 

24 fiscal year, the additional Federal financial partici25 pation under this title that results from such inVerDate Aug 31 2005 23:27 Apr 26, 2007 Jkt 059200 PO 00000 Frm 00058 Fmt 6652 Sfmt 6201 E:\BILLS\S1224.IS S1224

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1 crease shall not be counted towards the limitation on 

2 total payments under this title for such common3 wealth or territory otherwise determined under sub4 sections (f) and (g) of section 1108. 

5 ‘‘(4) SCOPE OF APPLICATION.—The increase in 

6 the Federal medical assistance percentage under 

7 subsection (b)(5) shall only apply for purposes of 

8 payments under section 1903 with respect to med9 ical assistance provided to individuals who have not 

10 attained age 19 and shall not apply with respect 

11 to— 

12 ‘‘(A) disproportionate share hospital pay13 ments described in section 1923; 

14 ‘‘(B) payments under title IV or XXI; or 

15 ‘‘(C) any payments under this title that 

16 are based on the enhanced FMAP described in 

17 section 2105(b).’’. 

18 SEC. 305. ELIMINATION OF COUNTING MEDICAID CHILD 

19 PRESUMPTIVE ELIGIBILITY COSTS AGAINST 

20 TITLE XXI ALLOTMENT. 

21 Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)) is 

22 amended— 

23 (1) in the matter preceding subparagraph (A), 

24 by striking ‘‘(or, in the case of expenditures de25 scribed in subparagraph (B), the Federal medical 


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1 assistance percentage (as defined in the first sen2 tence of section 1905(b)))’’; and 

3 (2) by striking subparagraph (B) and inserting 

4 the following new subparagraph: 

5 ‘‘(B) [reserved]’’. 

6 SEC. 306. STATE OPTION TO REQUIRE CERTAIN INDIVID7 UALS TO PRESENT SATISFACTORY DOCUMEN8 TARY EVIDENCE OF PROOF OF CITIZENSHIP 

9 OR NATIONALITY FOR PURPOSES OF ELIGI10 BILITY FOR MEDICAID. 

11 (a) IN GENERAL.—Section 1902(a)(46) (42 U.S.C. 

12 1396a(a)(46)) is amended— 

13 (1) by inserting ‘‘(A)’’ after ‘‘(46)’’; 

14 (2) by adding ‘‘and’’ after the semicolon; and 

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

17 ‘‘(B) at the option of the State and subject to 

18 section 1903(x), require that, with respect to an in19 dividual (other than an individual described in sec20 tion 1903(x)(1)) who declares to be a citizen or na21 tional of the United States for purposes of estab22 lishing initial eligibility for medical assistance under 

23 this title (or, at State option, for purposes of renew24 ing or redetermining such eligibility to the extent 

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1 zenship or nationality has not yet been presented), 

2 there is presented satisfactory documentary evidence 

3 of citizenship or nationality of the individual (using 

4 criteria determined by the State, which shall be no 

5 more restrictive than the criteria used by the Social 

6 Security Administration to determine citizenship, 

7 and which shall accept as such evidence a document 

8 issued by a federally recognized Indian tribe evidenc9 ing membership or enrollment in, or affiliation with, 

10 such tribe (such as a tribal enrollment card or cer11 tificate of degree of Indian blood, and, with respect 

12 to those federally recognized Indian tribes located 

13 within States having an international border whose 

14 membership includes individuals who are not citizens 

15 of the United States, such other forms of docu16 mentation (including tribal documentation, if appro17 priate) that the Secretary, after consulting with such 

18 tribes, determines to be satisfactory documentary 

19 evidence of citizenship or nationality for purposes of 

20 satisfying the requirement of this subparagraph));’’. 

21 (b) LIMITATION ON WAIVER AUTHORITY.—Notwith22 standing any provision of section 1115 of the Social Secu23 rity Act (42 U.S.C. 1315), or any other provision of law, 

24 the Secretary may not waive the requirements of section 


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1 1902(a)(46)(B) of such Act (42 U.S.C. 1396a(a)(46)(B)) 

2 with respect to a State. 

3 (c) CONFORMING AMENDMENTS.—Section 1903 (42 

4 U.S.C. 1396b) is amended— 

5 (1) in subsection (i)— 

6 (A) in paragraph (20), by adding ‘‘or’’ 

7 after the semicolon; 

8 (B) in paragraph (21), by striking ‘‘; or’’ 

9 and inserting a period; and 

10 (C) by striking paragraph (22); and 

11 (2) in subsection (x) (as amended by section 

12 405(c)(1)(A) of division B of the Tax Relief and 

13 Health Care Act of 2006 (Public Law 109–432))— 

14 (A) by striking paragraphs (1) and (3); 

15 (B) by redesignating paragraph (2) as 

16 paragraph (1); 

17 (C) in paragraph (1), as so redesignated, 

18 by striking ‘‘paragraph (1)’’ and inserting ‘‘sec19 tion 1902(a)(46)(B)’’; and 

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

21 paragraph: 

22 ‘‘(2) In the case of an individual declaring to be a 

23 citizen or national of the United States with respect to 

24 whom a State requires the presentation of satisfactory 

25 documentary evidence of citizenship or nationality under 


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1 section 1902(a)(46)(B), the individual shall be provided 

2 at least the reasonable opportunity to present satisfactory 

3 documentary evidence of citizenship or nationality under 

4 this subsection as is provided under clauses (i) and (ii) 

5 of section 1137(d)(4)(A) to an individual for the submittal 

6 to the State of evidence indicating a satisfactory immigra7 tion status.’’. 

8 (d) CLARIFICATION OF RULES FOR CHILDREN BORN

9 IN THE UNITED STATES TO MOTHERS ELIGIBLE FOR

10 MEDICAID.—Section 1903(x) (42 U.S.C. 1396b(x)), as 

11 amended by subsection (c)(2), is amended— 

12 (1) in paragraph (1)— 

13 (A) in subparagraph (C), by striking ‘‘or’’ 

14 at the end; 

15 (B) by redesignating subparagraph (D) as 

16 subparagraph (E); and 

17 (C) by inserting after subparagraph (C) 

18 the following new subparagraph: 

19 ‘‘(D) pursuant to the application of section 

20 1902(e)(4) (and, in the case of an individual who is 

21 eligible for medical assistance on such basis, the in22 dividual shall be deemed to have provided satisfac23 tory documentary evidence of citizenship or nation24 ality and shall not be required to provide further 

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1 ing or after the period in which the individual is eli2 gible for medical assistance on such basis); or’’; and 

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

4 paragraph: 

5 ‘‘(3) Nothing in subparagraph (A) or (B) of section 

6 1902(a)(46), the preceding paragraphs of this subsection, 

7 or the Deficit Reduction Act of 2005, including section 

8 6036 of such Act, shall be construed as changing the re9 quirement of section 1902(e)(4) that a child born in the 

10 United States to an alien mother for whom medical assist11 ance for the delivery of such child is available as treatment 

12 of an emergency medical condition pursuant to subsection 

13 (v) shall be deemed eligible for medical assistance during 

14 the first year of such child’s life.’’. 

15 (e) EFFECTIVE DATE.— 

16 (1) RETROACTIVE APPLICATION.—The amend17 ments made by this section shall take effect as if in18 cluded in the enactment of the Deficit Reduction Act 

19 of 2005 (Public Law 109–171; 120 Stat. 4). 

20 (2) RESTORATION OF ELIGIBILITY.—In the 

21 case of an individual who, during the period that 

22 began on July 1, 2006, and ends on the date of en23 actment of this Act, was determined to be ineligible 

24 for medical assistance under a State Medicaid pro25 gram solely as a result of the application of subVerDate Aug 31 2005 23:27 Apr 26, 2007 Jkt 059200 PO 00000 Frm 00064 Fmt 6652 Sfmt 6201 E:\BILLS\S1224.IS S1224

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1 sections (i)(22) and (x) of section 1903 of the Social 

2 Security Act (as in effect during such period), but 

3 who would have been determined eligible for such as4 sistance if such subsections, as amended by this sec5 tion, had applied to the individual, a State may 

6 deem the individual to be eligible for such assistance 

7 as of the date that the individual was determined to 

8 be ineligible for such medical assistance on such 

9 basis. 

10 TITLE IV—START HEALTHY, 

11 STAY HEALTHY 

12 SEC. 401. STATE OPTION TO EXPAND OR ADD COVERAGE 

13 OF CERTAIN PREGNANT WOMEN UNDER MED14 ICAID AND CHIP. 

15 (a) MEDICAID.— 

16 (1) AUTHORITY TO EXPAND COVERAGE.—Sec17 tion 1902(l)(2)(A)(i) (42 U.S.C. 1396a(l)(2)(A)(i)) 

18 is amended by inserting ‘‘(or such higher percentage 

19 as the State may elect for purposes of expenditures 

20 for medical assistance for pregnant women described 

21 in section 1905(u)(4)(A))’’ after ‘‘185 percent’’. 

22 (2) ENHANCED MATCHING FUNDS AVAILABLE

23 IF CERTAIN CONDITIONS MET.—Section 1905 (42 

24 U.S.C. 1396d) is amended— 


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1 (A) in the fourth sentence of subsection 

2 (b), by striking ‘‘or subsection (u)(3)’’ and in3 serting ‘‘, (u)(3), or (u)(4)’’; and 

4 (B) in subsection (u)— 

5 (i) by redesignating paragraph (4) as 

6 paragraph (5); and 

7 (ii) by inserting after paragraph (3) 

8 the following new paragraph: 

9 ‘‘(4) For purposes of the fourth sentence of sub10 section (b) and section 2105(a), the expenditures de11 scribed in this paragraph are the following: 

12 ‘‘(A) CERTAIN PREGNANT WOMEN.—If the con13 ditions described in subparagraph (B) are met, ex14 penditures for medical assistance for pregnant 

15 women described in subsection (n) or in section 

16 1902(l)(1)(A) in a family the income of which ex17 ceeds 185 percent of the poverty line, but does not 

18 exceed the income eligibility level established under 

19 title XXI for a targeted low-income child. 

20 ‘‘(B) CONDITIONS.—The conditions described 

21 in this subparagraph are the following: 

22 ‘‘(i) The State plans under this title and 

23 title XXI do not provide coverage for pregnant 

24 women described in subparagraph (A) with 


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1 higher family income without covering such 

2 pregnant women with a lower family income. 

3 ‘‘(ii) The State does not apply an effective 

4 income level for pregnant women that is lower 

5 than the effective income level (expressed as a 

6 percent of the poverty line and considering ap7 plicable income disregards) specified under the 

8 State plan under subsection (a)(10)(A)(i)(III) 

9 or (l)(2)(A) of section 1902, on the date of en10 actment of this paragraph to be eligible for 

11 medical assistance as a pregnant woman. 

12 ‘‘(C) DEFINITION OF POVERTY LINE.—In this 

13 subsection, the term ‘poverty line’ has the meaning 

14 given such term in section 2110(c)(5).’’. 

15 (3) PAYMENT FROM TITLE XXI ALLOTMENT

16 FOR MEDICAID EXPANSION COSTS.—Section 

17 2105(a)(1) (42 U.S.C. 1397ee(a)(1)), as amended 

18 by section 305, is amended by striking subparagraph 

19 (B) and inserting the following new subparagraph: 

20 ‘‘(B) for the portion of the payments made 

21 for expenditures described in section 

22 1905(u)(4)(A) that represents the additional 

23 amount paid for such expenditures as a result 

24 of the enhanced FMAP being substituted for 


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1 the Federal medical assistance percentage of 

2 such expenditures;’’. 

3 (b) CHIP.— 

4 (1) COVERAGE.—Title XXI (42 U.S.C. 1397aa 

5 et seq.) is amended by adding at the end the fol6 lowing new section: 

7 ‘‘SEC. 2111. OPTIONAL COVERAGE OF TARGETED LOW-IN8 COME PREGNANT WOMEN. 

9 ‘‘(a) OPTIONAL COVERAGE.—Notwithstanding any 

10 other provision of this title, a State may provide for cov11 erage, through an amendment to its State child health 

12 plan under section 2102, of pregnancy-related assistance 

13 for targeted low-income pregnant women in accordance 

14 with this section, but only if— 

15 ‘‘(1) the State has established an income eligi16 bility level for pregnant women under subsection 

17 (a)(10)(A)(i)(III) or (l)(2)(A) of section 1902 that is 

18 at least 185 percent of the income official poverty 

19 line; and 

20 ‘‘(2) the State meets the conditions described in 

21 section 1905(u)(4)(B). 

22 ‘‘(b) DEFINITIONS.—For purposes of this title: 

23 ‘‘(1) PREGNANCY-RELATED ASSISTANCE.—The 

24 term ‘pregnancy-related assistance’ has the meaning 

25 given the term ‘child health assistance’ in section 


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1 2110(a) as if any reference to targeted low-income 

2 children were a reference to targeted low-income 

3 pregnant women. 

4 ‘‘(2) TARGETED LOW-INCOME PREGNANT

5 WOMAN.—The term ‘targeted low-income pregnant 

6 woman’ means a woman— 

7 ‘‘(A) during pregnancy and through the 

8 end of the month in which the 60-day period 

9 (beginning on the last day of her pregnancy) 

10 ends; 

11 ‘‘(B) whose family income exceeds the ef12 fective income level (expressed as a percent of 

13 the poverty line and considering applicable in14 come disregards) specified under subsection 

15 (a)(10)(A)(i)(III) or (l)(2)(A) of section 1902, 

16 on January 1, 2008, to be eligible for medical 

17 assistance as a pregnant woman under title 

18 XIX but does not exceed the income eligibility 

19 level established under the State child health 

20 plan under this title for a targeted low-income 

21 child; and 

22 ‘‘(C) who satisfies the requirements of 

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1 plying for child health assistance would have to 

2 satisfy such requirements. 

3 ‘‘(c) REFERENCES TO TERMS AND SPECIAL

4 RULES.—In the case of, and with respect to, a State pro5 viding for coverage of pregnancy-related assistance to tar6 geted low-income pregnant women under subsection (a), 

7 the following special rules apply: 

8 ‘‘(1) Any reference in this title (other than in 

9 subsection (b)) to a targeted low-income child is 

10 deemed to include a reference to a targeted low-in11 come pregnant woman. 

12 ‘‘(2) Any such reference to child health assist13 ance with respect to such women is deemed a ref14 erence to pregnancy-related assistance. 

15 ‘‘(3) Any such reference to a child is deemed a 

16 reference to a woman during pregnancy and the pe17 riod described in subsection (b)(2)(A). 

18 ‘‘(4) In applying section 2102(b)(3)(B), any 

19 reference to children found through screening to be 

20 eligible for medical assistance under the State Med21 icaid plan under title XIX is deemed a reference to 

22 pregnant women. 

23 ‘‘(5) There shall be no exclusion of benefits for 

24 services described in subsection (b)(1) based on any 

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1 ing any waiting period imposed to carry out section 

2 2102(b)(3)(C)) shall apply. 

3 ‘‘(6) In applying section 2103(e)(3)(B) in the 

4 case of a pregnant woman provided coverage under 

5 this section, the limitation on total annual aggregate 

6 cost sharing shall be applied to such pregnant 

7 woman. 

8 ‘‘(7) The reference in section 2107(e)(1)(F) to 

9 section 1920A (relating to presumptive eligibility for 

10 children) is deemed a reference to section 1920 (re11 lating to presumptive eligibility for pregnant 

12 women). 

13 ‘‘(d) AUTOMATIC ENROLLMENT FOR CHILDREN

14 BORN TO WOMEN RECEIVING PREGNANCY-RELATED AS15 SISTANCE.—If a child is born to a targeted low-income 

16 pregnant woman who was receiving pregnancy-related as17 sistance under this section on the date of the child’s birth, 

18 the child shall be deemed to have applied for child health 

19 assistance under the State child health plan and to have 

20 been found eligible for such assistance under such plan 

21 or to have applied for medical assistance under title XIX 

22 and to have been found eligible for such assistance under 

23 such title, as appropriate, on the date of such birth and 

24 to remain eligible for such assistance until the child at25 tains 1 year of age. During the period in which a child 


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1 is deemed under the preceding sentence to be eligible for 

2 child health or medical assistance, the child health or med3 ical assistance eligibility identification number of the 

4 mother shall also serve as the identification number of the 

5 child, and all claims shall be submitted and paid under 

6 such number (unless the State issues a separate identifica7 tion number for the child before such period expires).’’. 

8 (2) ADDITIONAL CONFORMING AMENDMENTS.— 

9 (A) NO COST SHARING FOR PREGNANCY10 RELATED BENEFITS.—Section 2103(e)(2) (42 

11 U.S.C. 1397cc(e)(2)) is amended— 

12 (i) in the heading, by inserting ‘‘OR

13 PREGNANCY-RELATED SERVICES’’ after 

14 ‘‘PREVENTIVE SERVICES’’; and 

15 (ii) by inserting before the period at 

16 the end the following: ‘‘or for pregnancy17 related services’’. 

18 (B) NO WAITING PERIOD.—Section 

19 2102(b)(1)(B) (42 U.S.C. 1397bb(b)(1)(B)) is 

20 amended— 

21 (i) in clause (i), by striking ‘‘, and’’ at 

22 the end and inserting a semicolon; 

23 (ii) in clause (ii), by striking the pe24 riod at the end and inserting ‘‘; and’’; and 


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1 (iii) by adding at the end the fol2 lowing new clause: 

3 ‘‘(iii) may not apply a waiting period 

4 (including a waiting period to carry out 

5 paragraph (3)(C)) in the case of a targeted 

6 low-income pregnant woman.’’. 

7 (c) OTHER AMENDMENTS TO MEDICAID.— 

8 (1) ELIGIBILITY OF A NEWBORN.—Section 

9 1902(e)(4) (42 U.S.C. 1396a(e)(4)) is amended in 

10 the first sentence by striking ‘‘so long as the child 

11 is a member of the woman’s household and the 

12 woman remains (or would remain if pregnant) eligi13 ble for such assistance’’. 

14 (2) APPLICATION OF QUALIFIED ENTITIES TO

15 PRESUMPTIVE ELIGIBILITY FOR PREGNANT WOMEN

16 UNDER MEDICAID.—Section 1920(b) (42 U.S.C. 

17 1396r–1(b)) is amended by adding after paragraph 

18 (2) the following new flush sentence: 

19 ‘‘The term ‘qualified provider’ includes a qualified entity 

20 as defined in section 1920A(b)(3).’’. 

21 SEC. 402. COORDINATION WITH THE MATERNAL AND CHILD 

22 HEALTH PROGRAM. 

23 (a) IN GENERAL.—Section 2102(b)(3) (42 U.S.C. 

24 1397bb(b)(3)) is amended— 


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

2 the end; 

3 (2) in subparagraph (E), by striking the period 

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

5 (3) by adding at the end the following new sub6 paragraph: 

7 ‘‘(F) that operations and activities under 

8 this title are developed and implemented in con9 sultation and coordination with the program op10 erated by the State under title V in areas in11 cluding outreach and enrollment, benefits and 

12 services, service delivery standards, public 

13 health and social service agency relationships, 

14 and quality assurance and data reporting.’’. 

15 (b) CONFORMING MEDICAID AMENDMENT.—Section 

16 1902(a)(11) (42 U.S.C. 1396a(a)(11)) is amended— 

17 (1) by striking ‘‘and’’ before ‘‘(C)’’; and 

18 (2) by inserting before the semicolon at the end 

19 the following: ‘‘, and (D) provide that operations and 

20 activities under this title are developed and imple21 mented in consultation and coordination with the 

22 program operated by the State under title V in areas 

23 including outreach and enrollment, benefits and 

24 services, service delivery standards, public health 


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1 and social service agency relationships, and quality 

2 assurance and data reporting’’. 

3 SEC. 403. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS 

4 UNDER MEDICAID AND CHIP. 

5 (a) MEDICAID PROGRAM.—Section 1903(v) (42 

6 U.S.C. 1396b(v)) is amended— 

7 (1) in paragraph (1), by striking ‘‘paragraph 

8 (2)’’ and inserting ‘‘paragraphs (2) and (4)’’; and 

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

10 paragraph: 

11 ‘‘(4)(A) A State may elect (in a plan amendment 

12 under this title) to provide medical assistance under this 

13 title, notwithstanding sections 401(a), 402(b), 403, and 

14 421 of the Personal Responsibility and Work Opportunity 

15 Reconciliation Act of 1996, for aliens who are lawfully re16 siding in the United States (including battered aliens de17 scribed in section 431(c) of such Act) and who are other18 wise eligible for such assistance, within either or both of 

19 the following eligibility categories: 

20 ‘‘(i) PREGNANT WOMEN.—Women during preg21 nancy (and during the 60-day period beginning on 

22 the last day of the pregnancy). 

23 ‘‘(ii) CHILDREN.—Individuals under 21 years of 

24 age, including optional targeted low-income children 

25 described in section 1905(u)(2)(B). 


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1 ‘‘(B) In the case of a State that has elected to provide 

2 medical assistance to a category of aliens under subpara3 graph (A), no debt shall accrue under an affidavit of sup4 port against any sponsor of such an alien on the basis 

5 of provision of assistance to such category and the cost 

6 of such assistance shall not be considered as an unreim7 bursed cost.’’. 

8 (b) CHIP.—Section 2107(e)(1) (42 U.S.C. 

9 1397gg(e)(1)), as amended by sections 301(b) and 

10 302(b)(2), is amended by redesignating subparagraphs 

11 (D), (E), and (F) as subparagraphs (E), (F), and (G), 

12 respectively, and by inserting after subparagraph (B) the 

13 following new subparagraph: 

14 ‘‘(C) Section 1903(v)(4) (relating to op15 tional coverage of categories of lawfully residing 

16 immigrant children), but only if the State has 

17 elected to apply such section to the category of 

18 children under title XIX.’’. 

19 SEC. 404. IMPROVING BENCHMARK COVERAGE OPTIONS. 

20 (a) LIMITATION ON USE OF SECRETARY-APPROVED

21 COVERAGE.—Section 2103(a)(4) (42 U.S.C. 

22 1397cc(a)(4)) is amended by striking the period at the end 

23 and inserting ‘‘, but only if such determination was made 

24 before March 1, 2007.’’. 


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1 (b) STATE EMPLOYEE COVERAGE BENCHMARK.— 

2 Section 2103(b)(2) (42 U.S.C. 1397(b)(2)) is amended— 

3 (1) by striking ‘‘A health benefits coverage 

4 plan’’ and inserting ‘‘The health benefits coverage 

5 plan’’; and 

6 (2) by inserting ‘‘and that has the largest en7 rollment among such employees with dependent cov8 erage in either of the previous 2 plan years’’ before 

9 the period. 

10 SEC. 405. REQUIRING COVERAGE OF DENTAL AND MENTAL 

11 HEALTH SERVICES. 

12 (a) REQUIRED COVERAGE OF DENTAL AND MENTAL

13 HEALTH SERVICES.—Section 2103 (42 U.S.C. 1397cc(c)) 

14 is amended— 

15 (1) in subsection (a), in the matter preceding 

16 paragraph (1), by striking ‘‘subsection (c)(5)’’ and 

17 inserting ‘‘paragraphs (5) and (6) of subsection (c)’’; 

18 and 

19 (2) in subsection (c)— 

20 (A) by redesignating paragraph (5) as 

21 paragraph (6); and 

22 (B) by inserting after paragraph (4), the 

23 following new paragraph: 


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1 ‘‘(5) OTHER REQUIRED SERVICES.—The child 

2 health assistance provided to a targeted low-income 

3 child shall include coverage of the following: 

4 ‘‘(A) DENTAL SERVICES.—Dental services 

5 described in section 1905(r)(3) and provided in 

6 accordance with section 1902(a)(43). 

7 ‘‘(B) MENTAL HEALTH SERVICES.—Mental 

8 health services.’’. 

9 (b) STATE CHILD HEALTH PLAN REQUIREMENT.— 

10 Section 2102(a)(7)(B) (42 U.S.C. 1397bb(c)(2)) is 

11 amended by inserting ‘‘and services described in section 

12 2103(c)(5)’’ after ‘‘emergency services’’ 

13 (c) CONFORMING AMENDMENTS.—Section 

14 2103(c)(2) (42 U.S.C. 1397cc(c)(2)) is amended— 

15 (1) by striking subparagraph (B); and 

16 (2) by redesignating subparagraphs (C) and 

17 (D) as subparagraphs (B) and (C), respectively. 

18 SEC. 406. CLARIFICATION OF REQUIREMENT TO PROVIDE 

19 EPSDT SERVICES FOR ALL CHILDREN IN 

20 BENCHMARK BENEFIT PACKAGES UNDER 

21 MEDICAID. 

22 (a) IN GENERAL.—Section 1937(a)(1), as inserted by 

23 section 6044(a) of the Deficit Reduction Act of 2005, is 

24 amended— 

25 (1) in subparagraph (A)— 


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1 (A) in the matter before clause (i), by 

2 striking ‘‘Notwithstanding any other provision 

3 of this title’’ and inserting ‘‘Subject to subpara4 graph (E)’’; and 

5 (B) by striking ‘‘enrollment in coverage 

6 that provides’’ and all that follows and inserting 

7 ‘‘benchmark coverage described in subsection 

8 (b)(1) or benchmark equivalent coverage de9 scribed in subsection (b)(2).’’; 

10 (2) by striking subparagraph (C) and inserting 

11 the following new subparagraph: 

12 ‘‘(C) STATE OPTION TO PROVIDE ADDI13 TIONAL BENEFITS.—A State, at its option, may 

14 provide such additional benefits to benchmark 

15 coverage described in subsection (b)(1) or 

16 benchmark equivalent coverage described in 

17 subsection (b)(2) as the State may specify.’’; 

18 and 

19 (3) by adding at the end the following new sub20 paragraph: 

21 ‘‘(E) REQUIRING COVERAGE OF EPSDT

22 SERVICES.—Nothing in this paragraph shall be 

23 construed as affecting a child’s entitlement to 

24 care and services described in subsections 

25 (a)(4)(B) and (r) of section 1905 and provided 


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1 in accordance with section 1903(a)(43) whether 

2 provided through benchmark coverage, bench3 mark equivalent coverage, or otherwise.’’. 

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

5 this subsection shall take effect as if included in the 

6 amendment made by section 6044(a) of the Deficit Reduc7 tion Act of 2005. 

8 SEC. 407. CHILDHOOD OBESITY DEMONSTRATION 

9 PROJECT. 

10 (a) AUTHORITY TO CONDUCT DEMONSTRATION.— 

11 The Secretary, in consultation with the Administrator of 

12 the Centers for Medicare & Medicaid Services, shall con13 duct a demonstration project to develop a comprehensive 

14 and systematic model for reducing childhood obesity by 

15 awarding grants to eligible entities to carry out such 

16 project. Such model shall— 

17 (1) identify, through self-assessment, behavioral 

18 risk factors for obesity among children; 

19 (2) identify, through self-assessment, needed 

20 clinical preventive and screening benefits among 

21 those children identified as target individuals on the 

22 basis of such risk factors; 

23 (3) provide ongoing support to such target indi24 viduals and their families to reduce risk factors and 


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1 promote the appropriate use of preventive and 

2 screening benefits; and 

3 (4) be designed to improve health outcomes, 

4 satisfaction, quality of life, and appropriate use of 

5 items and services for which medical assistance is 

6 available under title XIX of the Social Security Act 

7 or child health assistance is available under title 

8 XXI of such Act among such target individuals. 

9 (b) ELIGIBILITY ENTITIES.—For purposes of this 

10 section, an eligible entity is any of the following: 

11 (1) A city, county, or Indian tribe. 

12 (2) A local or tribal educational agency. 

13 (3) An accredited university, college, or commu14 nity college. 

15 (4) A federally-qualified health center. 

16 (5) A local health department. 

17 (6) A health care provider. 

18 (7) A community-based organization. 

19 (8) Any other entity determined appropriate by 

20 the Secretary, including a consortia or partnership 

21 of entities described in any of paragraphs (1) 

22 through (7). 

23 (c) USE OF FUNDS.—An eligible entity awarded a 

24 grant under this section shall use the funds made available 

25 under the grant to— 


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1 (1) carry out community-based activities related 

2 to reducing childhood obesity, including by— 

3 (A) forming partnerships with entities, in4 cluding schools and other facilities providing 

5 recreational services, to establish programs for 

6 after school and weekend community activities 

7 that are designed to reduce childhood obesity; 

8 (B) forming partnerships with daycare fa9 cilities to establish programs that promote 

10 healthy eating behaviors and physical activity; 

11 and 

12 (C) developing and evaluating community 

13 educational activities targeting good nutrition 

14 and promoting healthy eating behaviors; 

15 (2) carry out age-appropriate school-based ac16 tivities that are designed to reduce childhood obesity, 

17 including by— 

18 (A) developing and testing educational cur19 ricula and intervention programs designed to 

20 promote healthy eating behaviors and habits in 

21 youth, which may include— 

22 (i) after hours physical activity pro23 grams; and 

24 (ii) science-based interventions with 

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1 orders including nutritional content, under2 standing and responding to hunger and sa3 tiety, positive body image development, 

4 positive self-esteem development, and 

5 learning life skills (such as stress manage6 ment, communication skills, problem-solv7 ing and decisionmaking skills), as well as 

8 consideration of cultural and develop9 mental issues, and the role of family, 

10 school, and community; 

11 (B) providing education and training to 

12 educational professionals regarding how to pro13 mote a healthy lifestyle and a healthy school en14 vironment for children; 

15 (C) planning and implementing a healthy 

16 lifestyle curriculum or program with an empha17 sis on healthy eating behaviors and physical ac18 tivity; and 

19 (D) planning and implementing healthy 

20 lifestyle classes or programs for parents or 

21 guardians, with an emphasis on healthy eating 

22 behaviors and physical activity for children; 

23 (3) carry out activities through the local health 

24 care delivery systems including by— 


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1 (A) promoting healthy eating behaviors 

2 and physical activity services to treat or prevent 

3 eating disorders, being overweight, and obesity; 

4 (B) providing patient education and coun5 seling to increase physical activity and promote 

6 healthy eating behaviors; 

7 (C) training health professionals on how to 

8 identify and treat obese and overweight individ9 uals which may include nutrition and physical 

10 activity counseling; and 

11 (D) providing community education by a 

12 health professional on good nutrition and phys13 ical activity to develop a better understanding 

14 of the relationship between diet, physical activ15 ity, and eating disorders, obesity, or being over16 weight; and 

17 (4) provide, through qualified health profes18 sionals, training and supervision for community 

19 health workers to— 

20 (A) educate families regarding the relation21 ship between nutrition, eating habits, physical 

22 activity, and obesity; 

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1 ing patterns, and establish appropriate levels of 

2 physical activity; and 

3 (C) educate and guide parents regarding 

4 the ability to model and communicate positive 

5 health behaviors. 

6 (d) PRIORITY.—In awarding grants under subsection 

7 (a), the Secretary shall give priority to awarding grants 

8 to eligible entities— 

9 (1) that demonstrate that they have previously 

10 applied successfully for funds to carry out activities 

11 that seek to promote individual and community 

12 health and to prevent the incidence of chronic dis13 ease and that can cite published and peer-reviewed 

14 research demonstrating that the activities that the 

15 entities propose to carry out with funds made avail16 able under the grant are effective; 

17 (2) that will carry out programs or activities 

18 that seek to accomplish a goal or goals set by the 

19 State in the Healthy People 2010 plan of the State; 

20 (3) that provide non-Federal contributions, ei21 ther in cash or inkind, to the costs of funding activi22 ties under the grants; 

23 (4) that develop comprehensive plans that in24 clude a strategy for extending program activities de25 veloped under grants in the years following the fiscal 


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1 years for which they receive grants under this sec2 tion; 

3 (5) located in communities that are medically 

4 underserved, as determined by the Secretary; 

5 (6) located in areas in which the average pov6 erty rate is at least 150 percent or higher of the av7 erage poverty rate in the State involved, as deter8 mined by the Secretary; and 

9 (7) that submit plans that exhibit multisectoral, 

10 cooperative conduct that includes the involvement of 

11 a broad range of stakeholders, including— 

12 (A) community-based organizations; 

13 (B) local governments; 

14 (C) local educational agencies; 

15 (D) the private sector; 

16 (E) State or local departments of health; 

17 (F) accredited colleges, universities, and 

18 community colleges; 

19 (G) health care providers; 

20 (H) State and local departments of trans21 portation and city planning; and 

22 (I) other entities determined appropriate 

23 by the Secretary. 

24 (e) PROGRAM DESIGN.— 


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1 (1) INITIAL DESIGN.—Not later than 1 year 

2 after the date of enactment of this Act, the Sec3 retary shall design the demonstration project. The 

4 demonstration should draw upon promising, innova5 tive models and incentives to reduce behavioral risk 

6 factors. The Administrator of the Centers for Medi7 care & Medicaid Services shall consult with the Di8 rector of the Centers for Disease Control and Pre9 vention, the Director of the Office of Minority 

10 Health, the heads of other agencies in the Depart11 ment of Health and Human Services, and such pro12 fessional organizations, as the Secretary determines 

13 to be appropriate, on the design, conduct, and eval14 uation of the demonstration. 

15 (2) NUMBER AND PROJECT AREAS.—Not later 

16 than 2 years after the date of enactment of this Act, 

17 the Secretary shall award 1 grant that is specifically 

18 designed to determine whether programs similar to 

19 programs to be conducted by other grantees under 

20 this section should be implemented with respect to 

21 the general population of children who are eligible 

22 for child health assistance under State child health 

23 plans under title XXI of the Social Security Act in 

24 order to reduce the incidence of childhood obesity 

25 among such population. 


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1 (f) REPORT TO CONGRESS.—Not later than 3 years 

2 after the date the Secretary implements the demonstration 

3 project under this section, the Secretary shall submit to 

4 Congress a report that describes the project, evaluates the 

5 effectiveness and cost effectiveness of the project, evalu6 ates the beneficiary satisfaction under the project, and in7 cludes any such other information as the Secretary deter8 mines to be appropriate. 

9 (g) DEFINITIONS.—In this section: 

10 (1) FEDERALLY-QUALIFIED HEALTH CEN11 TER.—The term ‘‘Federally-qualified health center’’ 

12 has the meaning given that term in section 

13 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 

14 1396d(l)(2)(B)). 

15 (2) INDIAN TRIBE.—The term ‘‘Indian tribe’’ 

16 has the meaning given that term in section 4 of the 

17 Indian Health Care Improvement Act (25 U.S.C. 

18 1603). 

19 (3) SELF-ASSESSMENT.—The term ‘‘self-assess20 ment’’ means a form that— 

21 (A) includes questions regarding— 

22 (i) behavioral risk factors; 

23 (ii) needed preventive and screening 

24 services; and 


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1 (iii) target individuals’ preferences for 

2 receiving follow-up information; 

3 (B) is assessed using such computer gen4 erated assessment programs; and 

5 (C) allows for the provision of such ongo6 ing support to the individual as the Secretary 

7 determines appropriate. 

8 (4) ONGOING SUPPORT.—The term ‘‘ongoing 

9 support’’ means— 

10 (A) to provide any target individual with 

11 information, feedback, health coaching, and rec12 ommendations regarding— 

13 (i) the results of a self-assessment 

14 given to the individual; 

15 (ii) behavior modification based on the 

16 self-assessment; and 

17 (iii) any need for clinical preventive 

18 and screening services or treatment includ19 ing medical nutrition therapy; 

20 (B) to provide any target individual with 

21 referrals to community resources and programs 

22 available to assist the target individual in re23 ducing health risks; and 

24 (C) to provide the information described in 

25 subparagraph (A) to a health care provider, if 


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1 designated by the target individual to receive 

2 such information. 

3 (h) AUTHORIZATION OF APPROPRIATIONS.—There is 

4 authorized to be appropriated to carry out this section, 

5 $25,000,000 for each of fiscal years 2008 through 2012. 

6 TITLE V—IMPROVING ACCESS 

7 TO HEALTH CARE FOR CHIL8 DREN 

9 SEC. 501. PROMOTING CHILDREN’S ACCESS TO COVERED 

10 HEALTH SERVICES. 

11 (a) MEDICAID AND CHIP PAYMENT AND ACCESS

12 COMMISSION.—Title XIX (42 U.S.C. 1396 et seq.) is 

13 amended by inserting before section 1901 the following 

14 new section: 

15 ‘‘MEDICAID AND CHIP PAYMENT AND ACCESS

16 COMMISSION

17 ‘‘SEC. 1900. (a) ESTABLISHMENT.—There is hereby 

18 established the Medicaid and CHIP Payment and Access 

19 Commission (in this section referred to as ‘MACPAC’). 

20 ‘‘(b) DUTIES.— 

21 ‘‘(1) REVIEW OF ACCESS POLICIES AND AN22 NUAL REPORTS.—MACPAC shall— 

23 ‘‘(A) review policies of the Medicaid pro24 gram established under this title (in this section 

25 referred to as ‘Medicaid’) and the State Chil26 dren’s Health Insurance Program established 


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1 under title XXI (in this section referred to as 

2 ‘CHIP’) affecting children’s access to covered 

3 items and services, including topics described in 

4 paragraph (2); 

5 ‘‘(B) make recommendations to Congress 

6 concerning such access policies; 

7 ‘‘(C) by not later than March 1 of each 

8 year (beginning with 2009), submit a report to 

9 Congress containing the results of such reviews 

10 and MACPAC’s recommendations concerning 

11 such policies; and 

12 ‘‘(D) by not later than June 1 of each year 

13 (beginning with 2009), submit a report to Con14 gress containing an examination of issues af15 fecting Medicaid and CHIP, including the im16 plications of changes in health care delivery in 

17 the United States and in the market for health 

18 care services on such programs. 

19 ‘‘(2) SPECIFIC TOPICS TO BE REVIEWED.—Spe20 cifically, MACPAC shall review and assess the fol21 lowing: 

22 ‘‘(A) MEDICAID AND CHIP PAYMENT POLI23 CIES.—Payment policies under Medicaid and 

24 CHIP, including— 


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1 ‘‘(i) the factors affecting expenditures 

2 for items and services in different sectors, 

3 including the process for updating hospital, 

4 skilled nursing facility, physician, Feder5 ally-qualified health center, rural health 

6 center, and other fees; 

7 ‘‘(ii) payment methodologies; and 

8 ‘‘(iii) the relationship of such factors 

9 and methodologies to access and quality of 

10 care for Medicaid and CHIP beneficiaries. 

11 ‘‘(B) INTERACTION OF MEDICAID AND

12 CHIP PAYMENT POLICIES WITH HEALTH CARE

13 DELIVERY GENERALLY.—The effect of Medicaid 

14 and CHIP payment policies on access to items 

15 and services for children and other Medicaid 

16 and CHIP populations other than under this 

17 title or title XXI and the implications of 

18 changes in health care delivery in the United 

19 States and in the general market for health 

20 care items and services on Medicaid and CHIP. 

21 ‘‘(C) OTHER ACCESS POLICIES.—The ef22 fect of other Medicaid and CHIP policies on ac23 cess to covered items and services, including 

24 policies relating to transportation and language 

25 barriers. 


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1 ‘‘(3) CREATION OF EARLY-WARNING SYSTEM.— 

2 MACPAC shall create an early-warning system to 

3 identify provider shortage areas or any other prob4 lems that threaten access to care or the health care 

5 status of Medicaid and CHIP beneficiaries. 

6 ‘‘(4) COMMENTS ON CERTAIN SECRETARIAL RE7 PORTS.—If the Secretary submits to Congress (or a 

8 committee of Congress) a report that is required by 

9 law and that relates to access policies, including with 

10 respect to payment policies, under Medicaid or 

11 CHIP, the Secretary shall transmit a copy of the re12 port to MACPAC. MACPAC shall review the report 

13 and, not later than 6 months after the date of sub14 mittal of the Secretary’s report to Congress, shall 

15 submit to the appropriate committees of Congress 

16 written comments on such report. Such comments 

17 may include such recommendations as MACPAC 

18 deems appropriate. 

19 ‘‘(5) AGENDA AND ADDITIONAL REVIEWS.— 

20 MACPAC shall consult periodically with the chair21 men and ranking minority members of the appro22 priate committees of Congress regarding MACPAC’s 

23 agenda and progress towards achieving the agenda. 

24 MACPAC may conduct additional reviews, and sub25 mit additional reports to the appropriate committees 


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1 of Congress, from time to time on such topics relat2 ing to the program under this title or title XXI as 

3 may be requested by such chairmen and members 

4 and as MACPAC deems appropriate. 

5 ‘‘(6) AVAILABILITY OF REPORTS.—MACPAC 

6 shall transmit to the Secretary a copy of each report 

7 submitted under this subsection and shall make such 

8 reports available to the public. 

9 ‘‘(7) APPROPRIATE COMMITTEE OF CON10 GRESS.—For purposes of this section, the term ‘ap11 propriate committees of Congress’ means the Com12 mittee on Energy and Commerce of the House of 

13 Representatives and the Committee on Finance of 

14 the Senate. 

15 ‘‘(8) VOTING AND REPORTING REQUIRE16 MENTS.—With respect to each recommendation con17 tained in a report submitted under paragraph (1), 

18 each member of MACPAC shall vote on the rec19 ommendation, and MACPAC shall include, by mem20 ber, the results of that vote in the report containing 

21 the recommendation. 

22 ‘‘(9) EXAMINATION OF BUDGET CON23 SEQUENCES.—Before making any recommendations, 

24 MACPAC shall examine the budget consequences of 


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1 such recommendations, directly or through consulta2 tion with appropriate expert entities. 

3 ‘‘(c) MEMBERSHIP.— 

4 ‘‘(1) NUMBER AND APPOINTMENT.—MACPAC 

5 shall be composed of 17 members appointed by the 

6 Comptroller General of the United States. 

7 ‘‘(2) QUALIFICATIONS.— 

8 ‘‘(A) IN GENERAL.—The membership of 

9 MACPAC shall include individuals who have 

10 had direct experience as enrollees or parents of 

11 enrollees in Medicaid or CHIP and individuals 

12 with national recognition for their expertise in 

13 Federal safety net health programs, health fi14 nance and economics, actuarial science, health 

15 facility management, health plans and inte16 grated delivery systems, reimbursement of 

17 health facilities, health information technology, 

18 pediatric physicians, dentists, and other pro19 viders of health services, and other related 

20 fields, who provide a mix of different profes21 sionals, broad geographic representation, and a 

22 balance between urban and rural representa23 tives. 

24 ‘‘(B) INCLUSION.—The membership of 

25 MACPAC shall include (but not be limited to) 


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1 physicians and other health professionals, em2 ployers, third-party payers, and individuals with 

3 expertise in the delivery of health services. Such 

4 membership shall also include consumers rep5 resenting children, pregnant women, the elderly, 

6 and individuals with disabilities, current or 

7 former representatives of State agencies respon8 sible for administering Medicaid, and current or 

9 former representatives of State agencies respon10 sible for administering CHIP. 

11 ‘‘(C) MAJORITY NONPROVIDERS.—Individ12 uals who are directly involved in the provision, 

13 or management of the delivery, of items and 

14 services covered under Medicaid or CHIP shall 

15 not constitute a majority of the membership of 

16 MACPAC. 

17 ‘‘(D) ETHICAL DISCLOSURE.—The Comp18 troller General of the United States shall estab19 lish a system for public disclosure by members 

20 of MACPAC of financial and other potential 

21 conflicts of interest relating to such members. 

22 Members of MACPAC shall be treated as em23 ployees of Congress for purposes of applying 

24 title I of the Ethics in Government Act of 1978 

25 (Public Law 95–521). 


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1 ‘‘(3) TERMS.— 

2 ‘‘(A) IN GENERAL.—The terms of mem3 bers of MACPAC shall be for 3 years except 

4 that the Comptroller General of the United 

5 States shall designate staggered terms for the 

6 members first appointed. 

7 ‘‘(B) VACANCIES.—Any member appointed 

8 to fill a vacancy occurring before the expiration 

9 of the term for which the member’s predecessor 

10 was appointed shall be appointed only for the 

11 remainder of that term. A member may serve 

12 after the expiration of that member’s term until 

13 a successor has taken office. A vacancy in 

14 MACPAC shall be filled in the manner in which 

15 the original appointment was made. 

16 ‘‘(4) COMPENSATION.—While serving on the 

17 business of MACPAC (including travel time), a 

18 member of MACPAC shall be entitled to compensa19 tion at the per diem equivalent of the rate provided 

20 for level IV of the Executive Schedule under section 

21 5315 of title 5, United States Code; and while so 

22 serving away from home and the member’s regular 

23 place of business, a member may be allowed travel 

24 expenses, as authorized by the Chairman of 

25 MACPAC. Physicians serving as personnel of 


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1 MACPAC may be provided a physician comparability 

2 allowance by MACPAC in the same manner as Gov3 ernment physicians may be provided such an allow4 ance by an agency under section 5948 of title 5, 

5 United States Code, and for such purpose subsection 

6 (i) of such section shall apply to MACPAC in the 

7 same manner as it applies to the Tennessee Valley 

8 Authority. For purposes of pay (other than pay of 

9 members of MACPAC) and employment benefits, 

10 rights, and privileges, all personnel of MACPAC 

11 shall be treated as if they were employees of the 

12 United States Senate. 

13 ‘‘(5) CHAIRMAN; VICE CHAIRMAN.—The Comp14 troller General of the United States shall designate 

15 a member of MACPAC, at the time of appointment 

16 of the member as Chairman and a member as Vice 

17 Chairman for that term of appointment, except that 

18 in the case of vacancy of the Chairmanship or Vice 

19 Chairmanship, the Comptroller General of the 

20 United States may designate another member for 

21 the remainder of that member’s term. 

22 ‘‘(6) MEETINGS.—MACPAC shall meet at the 

23 call of the Chairman. 

24 ‘‘(d) DIRECTOR AND STAFF; EXPERTS AND CON25 SULTANTS.—Subject to such review as the Comptroller 


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1 General of the United States deems necessary to assure 

2 the efficient administration of MACPAC, MACPAC 

3 may— 

4 ‘‘(1) employ and fix the compensation of an Ex5 ecutive Director (subject to the approval of the 

6 Comptroller General of the United States) and such 

7 other personnel as may be necessary to carry out its 

8 duties (without regard to the provisions of title 5, 

9 United States Code, governing appointments in the 

10 competitive service); 

11 ‘‘(2) seek such assistance and support as may 

12 be required in the performance of its duties from ap13 propriate Federal departments and agencies; 

14 ‘‘(3) enter into contracts or make other ar15 rangements, as may be necessary for the conduct of 

16 the work of MACPAC (without regard to section 

17 3709 of the Revised Statutes (41 U.S.C. 5)); 

18 ‘‘(4) make advance, progress, and other pay19 ments which relate to the work of MACPAC; 

20 ‘‘(5) provide transportation and subsistence for 

21 persons serving without compensation; and 

22 ‘‘(6) prescribe such rules and regulations as it 

23 deems necessary with respect to the internal organi24 zation and operation of MACPAC. 

25 ‘‘(e) POWERS.— 


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1 ‘‘(1) OBTAINING OFFICIAL DATA.—MACPAC 

2 may secure directly from any department or agency 

3 of the United States information necessary to enable 

4 it to carry out this section. Upon request of the 

5 Chairman, the head of that department or agency 

6 shall furnish that information to MACPAC on an 

7 agreed upon schedule. 

8 ‘‘(2) DATA COLLECTION.—In order to carry out 

9 its functions, MACPAC shall— 

10 ‘‘(A) utilize existing information, both pub11 lished and unpublished, where possible, collected 

12 and assessed either by its own staff or under 

13 other arrangements made in accordance with 

14 this section; 

15 ‘‘(B) carry out, or award grants or con16 tracts for, original research and experimen17 tation, where existing information is inad18 equate; and 

19 ‘‘(C) adopt procedures allowing any inter20 ested party to submit information for 

21 MACPAC’s use in making reports and rec22 ommendations. 

23 ‘‘(3) ACCESS OF GAO TO INFORMATION.—The 

24 Comptroller General of the United States shall have 

25 unrestricted access to all deliberations, records, and 


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1 nonproprietary data of MACPAC, immediately upon 

2 request. 

3 ‘‘(4) PERIODIC AUDIT.—MACPAC shall be sub4 ject to periodic audit by the Comptroller General of 

5 the United States. 

6 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.— 

7 ‘‘(1) REQUEST FOR APPROPRIATIONS.— 

8 MACPAC shall submit requests for appropriations 

9 in the same manner as the Comptroller General of 

10 the United States submits requests for appropria11 tions, but amounts appropriated for MACPAC shall 

12 be separate from amounts appropriated for the 

13 Comptroller General of the United States. 

14 ‘‘(2) AUTHORIZATION.—There are authorized to 

15 be appropriated such sums as may be necessary to 

16 carry out the provisions of this section.’’. 

17 (b) DEADLINE FOR INITIAL APPOINTMENTS.—Not 

18 later than January 1, 2008, the Comptroller General of 

19 the United States shall appoint the initial members of the 

20 Medicaid and CHIP Payment and Access Commission es21 tablished under section 1900 of the Social Security Act 

22 (as added by subsection (a)). 

23 SEC. 502. INSTITUTE OF MEDICINE STUDY AND REPORT ON 

24 CHILDREN’S ACCESS TO HEALTH CARE. 

25 (a) STUDY.— 


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1 (1) IN GENERAL.—The Secretary shall enter 

2 into a contract with the Institute of Medicine of the 

3 National Academy of Sciences (in this section re4 ferred to as the ‘‘Institute’’), to update the data and 

5 analyses of the June 1998 report of the Institute en6 titled, ‘‘America’s Children: Health Insurance and 

7 Access to Care’’. Specifically, the Institute shall— 

8 (A) examine the extent of health insurance 

9 coverage for children in the United States; and 

10 (B) analyze the extent to which there is 

11 evidence of the relationship between health in12 surance coverage and children’s access to health 

13 care. 

14 (2) REQUIREMENT.—In carrying out the study 

15 required under paragraph (1), the Institute shall 

16 focus on a broad range of providers that offer health 

17 care services to children, including (but not limited 

18 to) providers of oral health care services and mental 

19 health care services. 

20 (3) SUPPORT.—The Secretary shall provide to 

21 the Institute any relevant data available to the Sec22 retary during the period in which the study required 

23 under paragraph (1) is conducted. 

24 (b) REPORT.—Not later than 18 months after the 

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1 tute shall submit a report to Congress on the results of 

2 the study conducted under subsection (a). 

3 (c) APPROPRIATIONS.—Out of any funds in the 

4 Treasury not otherwise appropriated, there is appro5 priated for fiscal year 2008 such sums as may be nec6 essary for the purpose of carrying out this section, not 

7 to exceed $1,000,000. Funds appropriated under this sub8 section shall remain available until expended. 

9 TITLE VI—STRENGTHENING 

10 QUALITY OF CARE AND 

11 HEALTH OUTCOMES OF CHIL12 DREN 

13 SEC. 601. STRENGTHENING CHILD HEALTH QUALITY IM14 PROVEMENT ACTIVITIES. 

15 (a) UPDATING AND ENHANCEMENT OF QUALITY OF

16 CARE MEASURES FOR CHILDREN.— 

17 (1) IN GENERAL.—Not later than January 1, 

18 2009, the Secretary shall do the following: 

19 (A) UPDATE AND ENHANCE QUALITY

20 MEASURES.—In consultation with States, pro21 viders, and child health experts, update and en22 hance the HEDIS measures and other meas23 ures that the Secretary recommends States use 

24 to annually report on the quality of health care 

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1 clude additional and more comprehensive infor2 mation with respect to health care delivered to 

3 children in both ambulatory and inpatient care 

4 settings, that can be used to develop national 

5 quality measures and perform comparative 

6 analyses. 

7 (B) ENCOURAGE VOLUNTARY REPORT8 ING.—In consultation with States, develop pro9 cedures to encourage States to voluntarily re10 port the same set of measures with respect to 

11 the quality of health care for children under 

12 Medicaid and CHIP. 

13 (C) ADOPTION OF BEST PRACTICES.—De14 velop programs to identify best practices with 

15 respect to the quality of health care for children 

16 and facilitate the adoption of such best prac17 tices, including in areas such as provider re18 porting compliance, successful quality improve19 ment strategies, and improved efficiency in data 

20 collection using health information technology. 

21 (D) TECHNICAL ASSISTANCE.—Provide 

22 technical assistance to States to help them com23 ply with the measures updated in accordance 

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1 tices identified in accordance with subparagraph 

2 (C). 

3 (b) DISSEMINATION OF HEALTH QUALITY INFORMA4 TION.— 

5 (1) STATE-SPECIFIC REPORT ON CHILD

6 HEALTH QUALITY MEASURES.—Not later than Janu7 ary 1, 2008, and annually thereafter, the Secretary 

8 shall collect, analyze, and make publicly available 

9 State-specific data on child health quality measures, 

10 including State-specific data collected on external 

11 quality review activities related to managed care or12 ganizations under Medicaid and CHIP. 

13 (2) REPORTS TO CONGRESS.—Not later than 

14 January 1, 2008, and every 3 years thereafter, the 

15 Secretary shall report to Congress on— 

16 (A) the status of the Secretary’s efforts to 

17 improve— 

18 (i) children’s health care, including 

19 children’s needs with respect to preventive, 

20 acute, and chronic health care; and 

21 (ii) all domains of quality, including 

22 safety, family experience of care, and elimi23 nation of disparities; and 

24 (B) the quality of care furnished to amelio25 rate at least 1 type of physical, mental, or deVerDate Aug 31 2005 23:27 Apr 26, 2007 Jkt 059200 PO 00000 Frm 00105 Fmt 6652 Sfmt 6201 E:\BILLS\S1224.IS S1224

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1 velopmental condition recognized as having an 

2 effect on growth and development in children 

3 and adolescents. 

4 (c) DEVELOPMENT, ENDORSEMENT, AND UPDATING

5 OF CHILD-SPECIFIC HEALTH QUALITY MEASURES.— 

6 (1) IN GENERAL.—Not later than January 1, 

7 2009, the Secretary shall establish a program to 

8 support the development of quality measures for 

9 children’s health care services. 

10 (2) AUTHORITY TO AWARD GRANTS AND CON11 TRACTS.—As part of such program, the Secretary 

12 shall award grants and contracts for the— 

13 (A) development of new child health qual14 ity measures to supplement or replace, as ap15 propriate, the HEDIS measures updated and 

16 enhanced in accordance with subsection 

17 (a)(1)(A); 

18 (B) advancement (through validation and 

19 consensus among the entities described in para20 graph (3)) of such new measures and of child 

21 health quality measures used as of the date of 

22 enactment of this Act; and 

23 (C) updating of such measures as nec24 essary. 


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1 (3) CONSULTATION REQUIRED.—In carrying 

2 out the program required under this subsection, the 

3 Secretary shall consult with the following: 

4 (A) ESTABLISHMENT OF AREAS OF NEED

5 AND PRIORITIES.—For purposes of identifying 

6 gaps in child health quality measures used as of 

7 the date of enactment of this Act and estab8 lishing priorities for development: 

9 (i) States. 

10 (ii) National pediatric organizations. 

11 (iii) Consumers. 

12 (iv) Other entities with expertise in 

13 pediatric quality measures, such as quality 

14 improvement organizations. 

15 (B) ESTABLISHMENT OF PORTFOLIO OF

16 MEASURES.—For purposes of developing a port17 folio of child health quality measures for use by 

18 States, other purchasers, and providers, an or19 ganization involved in the advancement of con20 sensus on evidence-based measures of health 

21 care, such as the National Quality Forum. 

22 (C) ESTABLISHMENT OF MEDICAID AND

23 CHIP CORE PEDIATRIC QUALITY MEASURES.— 

24 For purposes of identifying a core pediatric 

25 data set that includes specific quality measures 


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1 for Medicaid and CHIP, States, health care 

2 providers, consumers, purchasers, child health 

3 experts, and public and private organizations 

4 with experience and expertise in the outreach 

5 and enrollment of children in public and private 

6 health insurance programs. 

7 (4) SPECIFIC REQUIREMENTS FOR MEDICAID

8 AND CHIP PEDIATRIC QUALITY MEASURES.— 

9 (A) CORE PEDIATRIC DATA SET.—The core 

10 pediatric data set identified under paragraph 

11 (3)(C) shall include specific quality measures 

12 for Medicaid and CHIP, including with respect 

13 to at least the following: 

14 (i) State-specific quality measures for 

15 Medicaid and CHIP (including State-spe16 cific data on enrollment and retention of 

17 eligible children; coordination of Medicaid 

18 and CHIP children’s coverage; measures of 

19 children’s access to preventive, acute and 

20 chronic care, including the availability of 

21 providers and adequacy of provider pay22 ments relative to private coverage). 

23 (ii) Quality measures and data for 

24 health plans and providers at the State, 

25 plan, and provider levels of care. 


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1 (B) QUALITY MEASURES.—In identifying 

2 quality measures for Medicaid and CHIP, the 

3 Secretary shall— 

4 (i) identify measures specific to man5 aged care plans and providers of primary 

6 care case management services; 

7 (ii) build on the core set of quality 

8 measures reported by States as of the date 

9 of enactment of this Act, including the 

10 HEDIS measures and evidence-based 

11 measures (to the extent such measures are 

12 available); 

13 (iii) assure that the measures identi14 fied are selected from measures that have 

15 been approved through an independent 

16 process that includes a broad consensus 

17 determined by a voluntary, standard set18 ting organization, with broad participation 

19 by providers, patient advocates, health 

20 plans, and purchasers; 

21 (iv) assure that the measures place an 

22 emphasis on physical and mental condi23 tions for which amelioration is necessary to 

24 promote growth and development; 


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1 (v) assure that the measures are evi2 dence-based and risk adjusted; 

3 (vi) assure that the measures are de4 signed to identify and eliminate racial and 

5 ethnic disparities in the provision of care; 

6 (vii) assure that the data required for 

7 such measures is collected and reported in 

8 a standard format that permits comparison 

9 of quality and data at a State, plan, and 

10 provider level; and 

11 (viii) periodically update such meas12 ures. 

13 (d) DEMONSTRATION PROJECTS FOR IMPROVING

14 THE QUALITY OF CHILDREN’S HEALTH CARE AND THE

15 USE OF HEALTH INFORMATION TECHNOLOGY.— 

16 (1) IN GENERAL.—The Secretary shall award 

17 grants to States and child health providers to con18 duct demonstration projects to evaluate promising 

19 ideas for improving the quality of children’s health 

20 care, including projects to— 

21 (A) experiment with, and evaluate the use 

22 of, new measures of the quality of children’s 

23 health care (including testing the validity and 

24 suitability for reporting of such measures); 


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1 (B) promote the use of health information 

2 technology in care delivery for children; or 

3 (C) evaluate value-based purchasing of 

4 health care services for children. 

5 (2) AUTHORITY FOR MULTI-STATE

6 PROJECTS.—A demonstration project conducted with 

7 a grant awarded under this subsection may be con8 ducted on a multi-State basis, as needed. 

9 (e) INCREASED MATCHING RATE FOR COLLECTING

10 AND REPORTING ON CHILD HEALTH MEASURES.—Sec11 tion 1903(a)(3)(A) (42 U.S.C. 1396b(a)(3)(A)), as 

12 amended by section 302, is amended— 

13 (1) by striking ‘‘and’’ at the end of clause (ii); 

14 and 

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

16 clause: 

17 ‘‘(iv) an amount equal to 75 percent of so 

18 much of the sums expended during such quar19 ter (as found necessary by the Secretary for the 

20 proper and efficient administration of the State 

21 plan) as are attributable to such developments 

22 or modifications of systems of the type de23 scribed in clause (i) as are necessary for the ef24 ficient collection and reporting on child health 

25 measures; and’’. 


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1 (f) DEVELOPMENT OF MODEL ELECTRONIC HEALTH

2 RECORD FOR CHILDREN.—Not later than January 1, 

3 2009, the Secretary shall establish a program to encour4 age the development and dissemination of a model elec5 tronic health record for children. Such model electronic 

6 health record should be— 

7 (1) subject to State laws, accessible to parents 

8 and other consumers for the sole purpose of dem9 onstrating compliance with school or leisure activity 

10 requirements, such as appropriate immunizations or 

11 physicals; and 

12 (2) designed to allow interoperable exchanges 

13 that conform with Federal and State privacy and se14 curity requirements. 

15 (g) DEFINITION OF HEDIS MEASURES.—In this sec16 tion, the term ‘‘HEDIS measures’’ means the Health Plan 

17 Employer Data and Information Set (HEDIS) measures 

18 established by the National Committee for Quality Assur19 ance (NCQA). 

20 (h) APPROPRIATIONS.—Out of any funds in the 

21 Treasury not otherwise appropriated, there is appro22 priated for each of fiscal years 2008 through 2012, 

23 $20,000,000 for the purpose of carrying out this section. 

24 Funds appropriated under this subsection shall remain 

25 available until expended. 


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1 SEC. 602. APPLICATION OF CERTAIN MANAGED CARE 

2 QUALITY SAFEGUARDS TO CHIP. 

3 Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)), as 

4 amended by sections 301(b), 302(b)(2), and 403(b), is 

5 amended by redesignating subparagraph (G) as subpara6 graph (H), and by inserting after subparagraph (F) the 

7 following new subparagraph: 

8 ‘‘(G) Subsections (a)(5), (b), (c), (d), and 

9 (e) of section 1932 (relating to requirements for 

10 managed care).’’. 

11 TITLE VII—OTHER 

12 IMPROVEMENTS 

13 SEC. 701. STRENGTHENING PREMIUM ASSISTANCE PRO14 GRAMS. 

15 (a) IMPROVING THE COST-EFFECTIVENESS STAND16 ARD.—Section 2105(c)(3) (42 U.S.C. 1397ee(c)(3)) is 

17 amended— 

18 (1) by redesignating subparagraphs (A) and 

19 (B) as clauses (i) and (ii) and indenting appro20 priately; 

21 (2) by striking ‘‘Payment may be made’’ and 

22 inserting the following: 

23 ‘‘(A) IN GENERAL.—Subject to the suc24 ceeding provisions of this paragraph, payment 

25 may be made’’; and 


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1 (3) by adding at the end the following new sub2 paragraph: 

3 ‘‘(B) IMPROVEMENTS IN COST-EFFECTIVE4 NESS MEASURE.— 

5 ‘‘(i) APPLICATION OF FAMILY-BASED

6 TEST.—Coverage described in subpara7 graph (A) shall be deemed cost-effective if 

8 the State establishes to the satisfaction of 

9 the Secretary that the cost of such cov10 erage is less than the expenditures that the 

11 State would have made to enroll the family 

12 in the State child health plan. 

13 ‘‘(ii) AGGREGATE PROGRAM OPER14 ATIONAL COSTS DO NOT EXCEED THE

15 COST OF PROVIDING COVERAGE UNDER

16 THE STATE CHILD HEALTH PLAN.—In the 

17 case of a State that does not establish 

18 cost-effectiveness under clause (i), payment 

19 may not be made under subsection (a)(1) 

20 for the purchase of any coverage described 

21 in subparagraph (A) for a family unless 

22 the State establishes to the satisfaction of 

23 the Secretary that the aggregate amount 

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1 ministrative expenditures) does not exceed 

2 the aggregate amount of expenditures that 

3 the State would have made for providing 

4 coverage under the State child health plan 

5 for all such families.’’. 

6 (b) DISCLOSURE OF GROUP HEALTH PLAN BENE7 FITS.—Section 2105(c)(3) (42 U.S.C. 1397ee(c)(3)), as 

8 amended by subsections (a) and (b), is amended by adding 

9 at the end the following new subparagraph: 

10 ‘‘(D) DISCLOSURE OF GROUP HEALTH

11 PLAN BENEFITS.—Notwithstanding any other 

12 provision of law, the plan administrator of a 

13 group health plan in which participants or 

14 beneficiaries are covered under a State plan 

15 under title XIX or this title, shall disclose to 

16 the State, upon request, information about the 

17 benefits available under the group health plan 

18 in sufficient specificity so that the State may 

19 determine— 

20 ‘‘(i) whether purchasing coverage for 

21 the participant or beneficiary under the 

22 group health plan meets the cost-effective23 ness standard applied under subparagraph 

24 (B); and 


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1 ‘‘(ii) what additional benefits and 

2 cost-sharing assistance must be provided to 

3 ensure that the participant or beneficiary 

4 receives through the provision of additional 

5 benefits by the State, benefits that are 

6 equivalent to the coverage that would be 

7 provided to such participant or beneficiary 

8 under such State plan.’’. 

9 (c) APPROVAL OF SECTION 1115 WAIVERS FOR PRE10 MIUM ASSISTANCE.—Section 1115 (42 U.S.C. 1315) is 

11 amended by inserting after subsection (c), the following 

12 new subsection: 

13 ‘‘(d) In approving a request by a State for an experi14 mental, pilot, or demonstration project under this section 

15 with respect to the purchase of private insurance for indi16 viduals eligible for assistance under title XIX or XXI, the 

17 Secretary shall not waive compliance with requirements of 

18 such titles or treat expenditures under the project as ex19 penditures under the State plans approved under such ti20 tles unless the State demonstrates both of the following: 

21 ‘‘(1) The fact that an individual is enrolled in 

22 a group health plan or an insurance plan purchased 

23 on the individual market shall not change the indi24 vidual’s eligibility for assistance under the such 

25 State plans. 


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1 ‘‘(2) The cost to the Federal Government and 

2 State of purchasing private insurance for the indi3 vidual (including administrative costs), as well as 

4 any additional costs incurred in providing items and 

5 services covered under such State plans but not 

6 through the private insurance for such individual, 

7 does not exceed, on an average per individual basis, 

8 the cost of providing coverage to the individual di9 rectly under such State plans.’’. 

10 (d) GAO STUDY AND REPORT.—Not later than Jan11 uary 1, 2009, the Comptroller General of the United 

12 States shall study cost and coverage issues relating to 

13 State premium assistance programs for which Federal 

14 matching payments are made under title XIX or XXI of 

15 the Social Security Act and submit a report to Congress 

16 on the results of such study. 

17 SEC. 702. PERMITTING COVERAGE OF CHILDREN OF EM18 PLOYEES OF A PUBLIC AGENCY IN THE 

19 STATE. 

20 Section 2110(b) (42 U.S.C. 1397jj(b)) is amended— 

21 (1) in paragraph (2)(B), by inserting ‘‘except as 

22 provided in paragraph (5),’’ before ‘‘a child’’; and 

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

24 paragraph: 


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1 ‘‘(5) EXCEPTIONS TO EXCLUSION OF CHILDREN

2 OF EMPLOYEES OF A PUBLIC AGENCY IN THE

3 STATE.— 

4 ‘‘(A) IN GENERAL.—A child shall not be 

5 considered to be described in paragraph (2)(B) 

6 if— 

7 ‘‘(i) the public agency that employs a 

8 member of the child’s family to which such 

9 paragraph applies satisfies subparagraph 

10 (B); or 

11 ‘‘(ii) subparagraph (C) applies to such 

12 child. 

13 ‘‘(B) MAINTENANCE OF EFFORT WITH RE14 SPECT TO PER PERSON AGENCY CONTRIBUTION

15 FOR FAMILY COVERAGE.—For purposes of sub16 paragraph (A)(i), a public agency satisfies this 

17 subparagraph if the amount of annual agency 

18 expenditures made on behalf of each employee 

19 enrolled in health coverage paid for by the 

20 agency that includes dependent coverage for the 

21 most recent State fiscal year is not less than 

22 the amount of such expenditures made by the 

23 agency for the 1997 State fiscal year, increased 

24 by the percentage increase in the medical care 

25 expenditure category of the Consumer Price 


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1 Index for All-Urban Consumers (all items: U.S. 

2 City Average) for such preceding fiscal year. 

3 ‘‘(C) HARDSHIP EXCEPTION.—For pur4 poses of subparagraph (A)(ii), this subpara5 graph applies to a child if the State determines, 

6 on a case-by-case basis, that the annual aggre7 gate amount of premiums and cost-sharing im8 posed for coverage of the family of the child 

9 would exceed 5 percent of such family’s income 

10 for the year involved.’’. 

11 SEC. 703. IMPROVING DATA COLLECTION. 

12 (a) INCREASED APPROPRIATION.—Section 

13 2109(b)(2) (42 U.S.C. 1397ii(b)(2)) is amended by strik14 ing ‘‘$10,000,000 for fiscal year 2000’’ and inserting 

15 ‘‘$20,000,000 for fiscal year 2008’’. 

16 (b) USE OF ADDITIONAL FUNDS.—Section 2109(b) 

17 (42 U.S.C. 1397ii(b)), as amended by subsection (a), is 

18 amended— 

19 (1) by redesignating paragraph (2) as para20 graph (3); and 

21 (2) by inserting after paragraph (1), the fol22 lowing new paragraph: 

23 ‘‘(2) ADDITIONAL REQUIREMENTS.—In addition 

24 to making the adjustments required to produce the 

25 data described in paragraph (1), with respect to 


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1 data collection occurring for fiscal years beginning 

2 with fiscal year 2008, in appropriate consultation 

3 with the Secretary of Health and Human Services, 

4 the Secretary of Commerce shall do the following: 

5 ‘‘(A) Make appropriate adjustments to the 

6 Current Population Survey to develop more ac7 curate State-specific estimates of the number of 

8 children enrolled in health coverage under title 

9 XIX or this title. 

10 ‘‘(B) Make appropriate adjustments to the 

11 Current Population Survey to improve the sur12 vey estimates used to compile the State-specific 

13 and national number of low-income children 

14 without health insurance for purposes of sec15 tions 1905(y)(2)(A)(i), 2106(b)(3)(B)(iii)(I), 

16 and 2104(i)(3)(D)(i). 

17 ‘‘(C) Assist in the incorporation of health 

18 insurance survey information in the American 

19 Community Survey related to children. 

20 ‘‘(D) Assess whether American Community 

21 Survey estimates, once such survey data are 

22 first available, produce more reliable estimates 

23 than the Current Population Survey for pur24 poses of section 2104(i)(3)(D)(i). 


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1 ‘‘(E) Recommend to the Secretary of 

2 Health and Human Services whether American 

3 Community Survey estimates should be used for 

4 purposes of 2104(i)(3)(D)(i). 

5 ‘‘(F) Continue making the adjustments de6 scribed in the last sentence of paragraph (1) 

7 with respect to expansion of the sample size 

8 used in State sampling units, the number of 

9 sampling units in a State, and using an appro10 priate verification element.’’. 

11 SEC. 704. MORATORIUM ON APPLICATION OF PERM RE12 QUIREMENTS RELATED TO ELIGIBILITY RE13 VIEWS DURING PERIOD OF INDEPENDENT 

14 STUDY AND REPORT. 

15 (a) MORATORIUM.—Notwithstanding parts 431 and 

16 457 of title 42, Code of Federal Regulations, or any other 

17 provision of law, except as provided in paragraph (2), dur18 ing the period that begins on the date of enactment of 

19 this Act and ends on the final effective date for the regula20 tions required under subsection (c), the Secretary shall not 

21 apply the payment error rate measurement (PERM) re22 quirements related to eligibility reviews imposed under 

23 such parts with respect to Medicaid or CHIP. 

24 (b) STUDY AND REPORT.— 


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1 (1) INSTITUTE OF MEDICINE STUDY.—The Sec2 retary shall enter into a contract with the Institute 

3 of Medicine of the National Academy of Sciences (in 

4 this section referred to as the ‘‘Institute’’) to con5 duct an independent study of the payment error rate 

6 measurement (PERM) requirements related to eligi7 bility reviews imposed under parts 431 and 457 of 

8 title 42, Code of Federal Regulations with respect to 

9 Medicaid and CHIP and established in accordance 

10 with the Improper Payments Information Act of 

11 2002 (Public Law 107–300). Such study shall exam12 ine and develop recommendations for modifying such 

13 requirements in order to— 

14 (A) minimize the administrative cost bur15 den on States under Medicaid and CHIP; 

16 (B) avoid inadvertent error findings with 

17 respect to such programs despite compliance 

18 with Federal and State policies and procedures 

19 in effect as of the date of the submission of the 

20 claim or action that led to such finding; 

21 (C) maintain State flexibility to manage 

22 such programs; and 

23 (D) ensure that such requirements do not 

24 interfere with State efforts to simplify applica25 tion and renewal procedures that increase enVerDate Aug 31 2005 23:27 Apr 26, 2007 Jkt 059200 PO 00000 Frm 00122 Fmt 6652 Sfmt 6201 E:\BILLS\S1224.IS S1224

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1 rollment in Medicaid and CHIP and do not re2 duce beneficiary participation in such programs. 

3 (2) SUPPORT.—The Secretary shall provide the 

4 Institute with any relevant data available to the Sec5 retary during the period in which the study required 

6 under paragraph (1) is conducted. 

7 (3) REPORT.—Not later than the date that is 

8 18 months after the date of enactment of this Act, 

9 the Institute shall submit to the Secretary and Con10 gress a report on the results of the study conducted 

11 under this subsection. 

12 (c) REGULATIONS.—Not later than 6 months after 

13 the date on which the report required under subsection 

14 (b)(3) has been submitted to the Secretary, the Secretary, 

15 after taking into consideration the recommendations con16 tained in the report, shall promulgate such regulations re17 vising the PERM requirements as the Secretary deter18 mines are appropriate. 

19 (d) APPROPRIATIONS.—Out of any funds in the 

20 Treasury not otherwise appropriated, there is appro21 priated for fiscal year 2008 such sums as may be nec22 essary for the purpose of carrying out this section, not 

23 to exceed $1,000,000. Funds appropriated under this sub24 section shall remain available until expended. 


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1 SEC. 705. ELIMINATION OF CONFUSING PROGRAM REF2 ERENCES. 

3 Section 704 of the Medicare, Medicaid, and SCHIP 

4 Balanced Budget Refinement Act of 1999, as enacted into 

5 law by division B of Public Law 106–113 (113 Stat. 

6 1501A–402) is repealed. 

7 TITLE VIII—EFFECTIVE DATE 

8 SEC. 801. EFFECTIVE DATE. 

9 (a) IN GENERAL.—Unless otherwise provided, sub10 ject to subsection (b), the amendments made by this Act 

11 shall take effect on October 1, 2007, and shall apply to 

12 child health assistance and medical assistance provided on 

13 or after that date without regard to whether or not final 

14 regulations to carry out such amendments have been pro15 mulgated by such date. 

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

17 case of a State plan under title XIX or XXI of the Social 

18 Security Act, which the Secretary determines requires 

19 State legislation in order for the plan to meet the addi20 tional requirements imposed by an amendment made by 

21 this Act, the State plan shall not be regarded as failing 

22 to comply with the requirements of such Act solely on the 

23 basis of its failure to meet these additional requirements 

24 before the first day of the first calendar quarter beginning 

25 after the close of the first regular session of the State leg26 islature that begins after the date of enactment of this 


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1 Act. For purposes of the preceding sentence, in the case 

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

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

4 session of the State legislature. 

Æ 


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