II 

110TH CONGRESS 

1ST SESSION S. 1364 

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

State Children’s Health Insurance Program (SCHIP) and streamline 

enrollment under SCHIP and Medicaid, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MAY 10, 2007 

Mr. DURBIN introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To amend titles XIX and XXI of the Social Security Act 

to extend the State Children’s Health Insurance Program 

(SCHIP) and streamline enrollment under SCHIP and 

Medicaid, 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; TABLE OF CONTENTS. 

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

5 ‘‘Healthy Kids Act of 2007’’. 

6 (b) TABLE OF CONTENTS.—The table of contents for 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—EXTENSION OF SCHIP 


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Sec. 101. Extension of SCHIP program; increase in allotments to take into account growth in child population and health care costs. 

Sec. 102. 2-year initial availability of SCHIP allotments. 

Sec. 103. Redistribution of unused allotments to address State funding shortfalls. 

TITLE II—STATE OPTIONS FOR INCREASING COVERAGE OF CHILDREN AND PREGNANT WOMEN UNDER MEDICAID AND SCHIP 

Sec. 201. Bonus payments for States that implement administrative policies to 

streamline enrollment process. 

Sec. 202. State option to provide for ‘‘express lane’’ and simplified determinations of a child’s financial eligibility for medical assistance 

under Medicaid or child health assistance under SCHIP. 

Sec. 203. Information technology connections to improve health coverage determinations. 

Sec. 204. State option to expand or add coverage of certain pregnant women 

under Medicaid and SCHIP. 

Sec. 205. Optional coverage of legal immigrants under Medicaid and SCHIP. 

Sec. 206. Authorizing adjustment of SCHIP allotment due to increased outreach. 

Sec. 207. Model of Interstate coordinated enrollment and coverage process. 

Sec. 208. Authority for qualifying States to use portion of SCHIP allotment for 

any fiscal year for certain Medicaid expenditures. 

Sec. 209. Application of Medicaid outreach procedures to all pregnant women 

and children. 

Sec. 210. No impact on section 1115 waivers. 

Sec. 211. Elimination of counting Medicaid child presumptive eligibility costs 

against title XXI allotment. 

Sec. 212. Prohibiting limitations on enrollment. 

TITLE III—ELIMINATION OF CERTAIN BARRIERS TO COVERAGE 

Sec. 301. State option to require certain individuals to present satisfactory documentary evidence of proof of citizenship or nationality for 

purposes of eligibility for Medicaid. 

Sec. 302. Increased Federal matching rate for language services provided under 

Medicaid or SCHIP. 

TITLE IV—GRANTS TO PROMOTE INNOVATIVE OUTREACH AND 

ENROLLMENT UNDER MEDICAID AND SCHIP 

Sec. 401. Grants to promote innovative outreach and enrollment under Medicaid and SCHIP. 

TITLE V—IMPROVING THE QUALITY OF PEDIATRIC CARE 

Sec. 501. Requiring coverage of EPSDT services, including dental services, 

State option to provide supplemental coverage of dental services. 

Sec. 502. Pediatric quality and performance measures program. 

Sec. 503. Grants to States for demonstration projects transforming delivery of 

pediatric care. 

Sec. 504. Report by the comptroller general on design and implementation of 

a demonstration project evaluating existing quality and performance measures for children’s inpatient hospital services. 

Sec. 505. Medical home demonstration project. 


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Sec. 506. Disease prevention and treatment demonstration projects for ethnic 

and racial minority children. 

TITLE VI—COMMISSION ON CHILDREN’S HEALTH COVERAGE 

Sec. 601. Commission on Children’s Health Coverage. 

1 TITLE I—EXTENSION OF SCHIP 

2 SEC. 101. EXTENSION OF SCHIP PROGRAM; INCREASE IN 

3 ALLOTMENTS TO TAKE INTO ACCOUNT 

4 GROWTH IN CHILD POPULATION AND 

5 HEALTH CARE COSTS. 

6 (a) IN GENERAL.—Section 2104 of the Social Secu7 rity Act (42 U.S.C. 1397dd) is amended— 

8 (1) in subsection (a)— 

9 (A) by striking ‘‘and’’ at the end of para10 graph (9); 

11 (B) by striking the period at the end of 

12 paragraph (10) and inserting ‘‘; and’’; and 

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

14 paragraph: 

15 ‘‘(11) for each fiscal year 2008 and each subse16 quent fiscal year, $7,500,000,000 multiplied by the 

17 population and cost inflation factor for that fiscal 

18 year, as determined under subsection (i).’’; and 

19 (2) by adding at the end the following new sub20 section: 

21 ‘‘(i) POPULATION AND COST INFLATION FACTOR.— 

22 For purposes of subsection (a)(11), the population and 


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1 cost inflation factor for a fiscal year is equal to the prod2 uct of the following: 

3 ‘‘(1) CHILD POPULATION GROWTH FACTOR.— 

4 One plus the percentage increase in the population 

5 of children under 20 years of age in the United 

6 States from July 1, 2007, to July 1 during the fiscal 

7 year involved, as projected by the Secretary based on 

8 the most recent published estimates of the Bureau 

9 of the Census before the beginning of the fiscal year 

10 involved. 

11 ‘‘(2) PER CAPITA HEALTH CARE GROWTH FAC12 TOR.—One plus the percentage increase in the pro13 jected per capita amount of National Health Ex14 penditures from fiscal year 2007 to the fiscal year 

15 involved, as most recently published by the Secretary 

16 before the beginning of the fiscal year involved.’’. 

17 (b) ADDITIONAL ALLOTMENTS TO TERRITORIES.— 

18 Section 2104(c)(4)(B) of such Act (42 U.S.C. 

19 1397dd(c)(4)(B)) is amended by striking ‘‘and 

20 $40,000,000 for fiscal year 2007’’ and inserting 

21 ‘‘$40,000,000 for fiscal year 2007, and for each of fiscal 

22 years 2008 through 2017, the amount appropriated under 

23 this subparagraph for the preceding fiscal year increased 

24 by the population and cost inflation factor for that fiscal 

25 year, as determined under subsection (i)’’. 


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1 SEC. 102. 2-YEAR INITIAL AVAILABILITY OF SCHIP ALLOT2 MENTS. 

3 Section 2104(e) of the Social Security Act (42 U.S.C. 

4 1397dd(e)) is amended to read as follows: 

5 ‘‘(e) AVAILABILITY OF AMOUNTS ALLOTTED.— 

6 ‘‘(1) IN GENERAL.—Except as provided in para7 graphs (2) and (3), amounts allotted to a State pur8 suant to this section— 

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

10 2007, shall remain available for expenditure by 

11 the State through the end of the second suc12 ceeding fiscal year; and 

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

14 year thereafter, shall remain available for ex15 penditure by the State through the end of the 

16 succeeding fiscal year. 

17 ‘‘(2) AVAILABILITY OF AMOUNTS REALLOT18 TED.—Subject to paragraph (3), amounts reallotted 

19 to a State under subsection (f) shall be available for 

20 expenditure by the State through the end of the fis21 cal year in which they are reallotted. 

22 ‘‘(3) PERMANENT AVAILABILITY OF UNUSED

23 FUNDS.—Reallotted funds that are not used by the 

24 end of the fiscal year described in paragraph (2) 

25 shall be subject to reallotment under subsection (f) 

26 in subsequent fiscal years subject to such paragraph 


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1 and shall remain available for subsequent reallot2 ment until expended.’’. 

3 SEC. 103. REDISTRIBUTION OF UNUSED ALLOTMENTS TO 

4 ADDRESS STATE FUNDING SHORTFALLS. 

5 Section 2104(f) of the Social Security Act (42 U.S.C. 

6 1397dd(f)) is amended— 

7 (1) by striking ‘‘The Secretary’’ and inserting 

8 the following: 

9 ‘‘(1) IN GENERAL.—The Secretary’’; 

10 (2) by striking ‘‘States that have fully expended 

11 the amount of their allotments under this section’’ 

12 and inserting ‘‘States that the Secretary determines 

13 with respect to the fiscal year for which unused al14 lotments are available for redistribution under this 

15 subsection, are shortfall States described in para16 graph (2) for such fiscal year’’; and 

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

18 paragraph: 

19 ‘‘(2) SHORTFALL STATES DESCRIBED.— 

20 ‘‘(A) IN GENERAL.—For purposes of para21 graph (1), with respect to a fiscal year, a short22 fall State described in this subparagraph is a 

23 State with a State child health plan approved 

24 under this title for which the Secretary esti25 mates on the basis of the most recent data 


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1 available to the Secretary, that the projected ex2 penditures under such plan for the State for the 

3 fiscal year will exceed the sum of— 

4 ‘‘(i) the amount of the State’s allot5 ments for any preceding fiscal years that 

6 remain available for expenditure and that 

7 will not be expended by the end of the im8 mediately preceding fiscal year; and 

9 ‘‘(ii) the amount of the State’s allot10 ment for the fiscal year (taking into ac11 count any increase made in such allotment 

12 under section 2104(j), as added by section 

13 205(a) of the Healthy Kids Act of 2007). 

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

15 available for redistribution under paragraph (1) 

16 for a fiscal year are less than the total amounts 

17 of the estimated shortfalls determined for the 

18 year under subparagraph (A), the amount to be 

19 reallotted under such paragraph for each short20 fall State shall be reduced proportionally. 

21 ‘‘(C) RETROSPECTIVE ADJUSTMENT.—The 

22 Secretary may adjust the estimates and deter23 minations made under paragraph (1) and this 

24 paragraph with respect to a fiscal year as nec25 essary on the basis of the amounts reported by 


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1 States not later than November 30 of the suc2 ceeding fiscal year, as approved by the Sec3 retary.’’. 

4 TITLE II—STATE OPTIONS FOR 

5 INCREASING COVERAGE OF 

6 CHILDREN AND PREGNANT 

7 WOMEN UNDER MEDICAID 

8 AND SCHIP 

9 SEC. 201. BONUS PAYMENTS FOR STATES THAT IMPLE10 MENT ADMINISTRATIVE POLICIES TO 

11 STREAMLINE ENROLLMENT PROCESS. 

12 (a) BONUS IN FMAP AND ENHANCED FMAP FOR

13 APPLICATION OF STREAMLINE ENROLLMENT PROCE14 DURES UNDER MEDICAID AND SCHIP.—Section 2102 of 

15 the Social Security Act (42 U.S.C. 1397bb) is amended 

16 by adding at the end the following new subsection: 

17 ‘‘(d) STREAMLINE ENROLLMENT PROCEDURES.— 

18 ‘‘(1) INCREASE IN FEDERAL MATCHING

19 RATE.— 

20 ‘‘(A) IN GENERAL.—In the case of a State 

21 that meets the conditions described in subpara22 graph (B) (relating to agreeing to implement 

23 administrative enrollment policies under this 

24 title and title XIX) for a fiscal year, the Fed25 eral medical assistance percentage (for purposes 


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1 of title XIX only) and the enhanced FMAP (for 

2 purposes of this title, but determined without 

3 regard to the application of this subsection to 

4 the Federal medical assistance percentage 

5 under title XIX) otherwise computed for such 

6 fiscal year as applied to medical assistance for 

7 children and child health assistance, respec8 tively, shall be increased by such number of 

9 percentage points as the Secretary determines 

10 is necessary to provide an incentive for the 

11 State to satisfy the conditions described in sub12 paragraph (B) (but not to exceed such number 

13 of percentage points that would result in a Fed14 eral medical assistance percentage or enhanced 

15 FMAP for the State that would exceed 83 or 

16 85 percent, respectively). 

17 ‘‘(B) AGREEING TO REMOVE ENROLLMENT

18 AND ACCESS BARRIERS.—The conditions de19 scribed in this subparagraph, for a State for a 

20 fiscal year are that the State agrees to do the 

21 following: 

22 ‘‘(i) PRESUMPTIVE ELIGIBILITY FOR

23 CHILDREN.—The State agrees— 

24 ‘‘(I) to provide presumptive eligi25 bility for children under this title and 


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1 title XIX in accordance with section 

2 1920A; and 

3 ‘‘(II) to treat any items or serv4 ices that are provided to an uncovered 

5 child (as defined in section 

6 2110(c)(8)) who is determined ineli7 gible for medical assistance under title 

8 XIX as child health assistance for 

9 purposes of paying a provider of such 

10 items or services, so long as such 

11 items or services would be considered 

12 child health assistance for a targeted 

13 low-income child under this title. 

14 ‘‘(ii) 12-MONTH CONTINUOUS ELIGI15 BILITY.—The State agrees to provide that 

16 eligibility of children for assistance under 

17 this title and title XIX shall not be regu18 larly redetermined more often than once 

19 every year. 

20 ‘‘(iii) AUTOMATIC RENEWAL.—The 

21 State agrees to provide for the automatic 

22 renewal of the eligibility of children for as23 sistance under this title and under title 

24 XIX if the child’s family does not report 

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1 evant circumstances, subject to verification 

2 of information from databases available to 

3 the State for such purpose. 

4 ‘‘(iv) ELIMINATION OF ASSET TEST.— 

5 The State has amended its plans under 

6 this title and title XIX so that no asset or 

7 resource test is applied for eligibility under 

8 this title or title XIX with respect to chil9 dren. 

10 ‘‘(v) ADMINISTRATIVE VERIFICATION

11 OF INCOME.—The State agrees to permit 

12 the family of a child applying for child 

13 health assistance under this title or med14 ical assistance under title XIX to declare 

15 and certify, by signature under penalty of 

16 perjury, the family income for purposes of 

17 collecting financial eligibility information.’’. 

18 (b) CONFORMING MEDICAID AMENDMENTS.— 

19 (1) IN GENERAL.—Section 1905(b) of the So20 cial Security Act (42 U.S.C. 1396d(b)) is amended 

21 by inserting ‘‘and section 2102(d)(1)’’ after ‘‘section 

22 1933(d)’’. 

23 (2) INCREASE IN MEDICAID CAP FOR TERRI24 TORIES.—Section 1108(g) of such Act (42 U.S.C. 

25 1308(g)) is amended— 


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1 (A) in paragraph (2), by striking ‘‘para2 graph (3)’’ and inserting ‘‘paragraphs (3) and 

3 (4)’’; and 

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

5 paragraph: 

6 ‘‘(4) DISREGARD OF INCREASED EXPENDI7 TURES DIRECTLY ATTRIBUTABLE TO INCREASE IN

8 FMAP FOR APPLICATION OF STREAMLINED ENROLL9 MENT PROCEDURES.—The limitation of paragraph 

10 (2) shall not apply to payment under title XIX to a 

11 territory insofar as such payment is attributable to 

12 an increase in the Federal medical assistance per13 centage under subparagraph (A) of section 

14 2102(d)(1).’’. 

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

16 this section shall apply beginning with fiscal year 2007. 

17 SEC. 202. STATE OPTION TO PROVIDE FOR ‘‘EXPRESS LANE’’

18 AND SIMPLIFIED DETERMINATIONS OF A 

19 CHILD’S FINANCIAL ELIGIBILITY FOR MED20 ICAL ASSISTANCE UNDER MEDICAID OR 

21 CHILD HEALTH ASSISTANCE UNDER SCHIP. 

22 (a) MEDICAID.—Section 1902(e) of the Social Secu23 rity Act (42 U.S.C. 1396a(e)) is amended by adding at 

24 the end the following: 


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1 ‘‘(13)(A) At the option of the State, the plan may 

2 provide that eligibility requirements (including such re3 quirements applicable to redeterminations or renewals of 

4 eligibility) for medical assistance relating to income, assets 

5 (or resources), or citizenship status are met for a child 

6 who is under an age specified by the State (not to exceed 

7 21 years of age) by using a determination made within 

8 a reasonable period (as determined by the State) before 

9 its use for this purpose, of the child’s family or household 

10 income, or if applicable for purposes of determining eligi11 bility under this title or title XXI, assets or resources, or 

12 citizenship status, respectively, (notwithstanding any other 

13 provision of law, including sections 1902(a)(46)(B), 

14 1903(x), and 1137(d)), by a Federal or State agency, or 

15 a public or private entity making such determination on 

16 behalf of such agency, specified by the plan, including an 

17 agency administering the State program funded under 

18 part A of title IV, the Food Stamp Act of 1977, the Rich19 ard B. Russell National School Lunch Act, or the Child 

20 Nutrition Act of 1966, notwithstanding any differences in 

21 budget unit, disregard, deeming, or other methodology, 

22 but only if— 

23 ‘‘(i) the agency has fiscal liabilities or respon24 sibilities affected by such determination; and 


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

2 family— 

3 ‘‘(I) of the information which shall be dis4 closed in accordance with this subparagraph; 

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

6 used solely for purposes of determining eligi7 bility for medical assistance under this title or 

8 for child health assistance under title XXI; and 

9 ‘‘(III) that interagency agreements limit 

10 the use of such information to that purpose; 

11 and 

12 ‘‘(iii) the requirements of section 1939 are sat13 isfied. 

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

15 to relieve a State of the obligation to determine, on an16 other basis, eligibility for medical assistance under this 

17 title or for child health assistance under title XXI if a 

18 child is determined ineligible for such assistance on the 

19 basis of information furnished pursuant to this paragraph. 

20 ‘‘(C) If a State applies the eligibility process de21 scribed in subparagraph (A) to individuals eligible under 

22 this title and to individuals eligible under title XXI, the 

23 State may, at its option, implement its duties under sub24 paragraphs (A) and (B) of section 2102(b)(3) using either 

25 or both of the following approaches: 


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1 ‘‘(i) The State may— 

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

3 Federal poverty level (that shall exceed the in4 come eligibility level applicable for a population 

5 of individuals under this title by 30 percentage 

6 points (as a fraction of the Federal poverty 

7 level) or such other higher number of percent8 age points as the State determines reflects the 

9 typical application of income methodologies by 

10 the non-health program and the State plan 

11 under this title); and 

12 ‘‘(II) provide that, with respect to any in13 dividual within such population whom a non14 health agency determines has income that does 

15 not exceed such threshold percentage for such 

16 population, such individual is eligible for med17 ical assistance under this title (regardless of 

18 whether such individual would otherwise be de19 termined to be eligible to receive such assist20 ance). 

21 In exercising the approach under this clause, a State 

22 shall inform families whose children are enrolled in 

23 a State child health plan under title XXI based on 

24 having family income above the threshold described 

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


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

2 seek a regular eligibility determination for such as3 sistance for their child. 

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

5 provides for presumptive eligibility under section 

6 1920A, a State may provide presumptive eligibility 

7 under this title, consistent with subsection (e) of sec8 tion 1920A, to a child who, based on a determina9 tion by a non-health agency, would qualify for child 

10 health assistance under a State child health plan 

11 under title XXI. During such presumptive eligibility 

12 period, the State may determine the child’s eligibility 

13 for medical assistance under this title, pursuant to 

14 subparagraph (A) of section 2102(b)(3), based on 

15 telephone contact with family members, access to 

16 data available in electronic or paper form, and other 

17 means of gathering information that are less bur18 densome to the family than completing an applica19 tion form on behalf of the child. The procedures de20 scribed in the previous sentence may be used regard21 less of whether the State uses similar procedures 

22 under other circumstances for purposes of deter23 mining eligibility for medical assistance under this 

24 title. 


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1 ‘‘(D) At the option of a State, the eligibility process 

2 described in subparagraph (A) may apply to an individual 

3 who is not a child. 

4 ‘‘(E)(i) At the option of a State, an individual deter5 mined to be eligible for medical assistance or child health 

6 assistance pursuant to subparagraph (A), (C), or (D) or 

7 other procedures through which eligibility is determined 

8 based on data obtained from sources other than the indi9 vidual may receive medical assistance under this title if 

10 such individual (or, in the case of an individual under age 

11 19 (or if the State elects the option under subparagraph 

12 (A), age 20 or 21) who is not authorized to consent to 

13 medical care, the individual’s parent, guardian, or other 

14 caretaker relative) has acknowledged notice of such deter15 mination and has consented to such eligibility determina16 tion. The State (at its option) may waive any otherwise 

17 applicable requirements for signatures by or on behalf of 

18 an individual who has so consented. 

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

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

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

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

23 the individual’s parent, guardian, or other caretaker rel24 ative) about the significance of such enrollment, including 

25 appropriate methods to access covered services. 


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1 ‘‘(F) For purposes of this paragraph— 

2 ‘‘(i) the term ‘non-health agency’ means an 

3 agency or entity described in subparagraph (A); and 

4 ‘‘(ii) the term ‘non-health benefits’ means the 

5 benefits or assistance provided by a non-health agen6 cy.’’. 

7 (b) SCHIP.—Section 2107(e)(1) of such Act (42 

8 U.S.C. 1397gg(e)(1)) is amended by redesignating sub9 paragraphs (B) through (E) as subparagraphs (C) 

10 through (F) and by inserting after subparagraph (B) the 

11 following new subparagraph: 

12 ‘‘(C) Section 1902(e)(13) (relating to the 

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

14 eligibility for assistance on determinations made 

15 by a program providing nutrition or other pub16 lic assistance (except that the State option 

17 under subparagraph (D) of such section shall 

18 apply under this title only if an individual is 

19 pregnant)).’’. 

20 (c) PRESUMPTIVE ELIGIBILITY.—Section 1920A of 

21 such Act (42 U.S.C. 1396r–1a) is amended— 

22 (1) in subsection (b)(3)(A)(i), is amended by 

23 striking ‘‘or (IV)’’ and inserting ‘‘(IV) is an agency 

24 or entity described in section 1902(e)(13)(A), or 

25 (V)’’; and 


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

2 ‘‘(e) In the case of a State with a child health plan 

3 under title XXI that provides for presumptive eligibility 

4 under such plan for children, the State shall make a rea5 sonable effort to place each presumptively eligible child in 

6 the program under this title or title XXI for which the 

7 child appears most likely to qualify. During the child’s pe8 riod of presumptive eligibility, the State shall receive Fed9 eral matching funds under section 1903 or section 2105, 

10 depending on the program in which the child has been 

11 placed. If at the conclusion of such period, the child is 

12 found to qualify for, and is enrolled in, the program estab13 lished under this title or title XXI when the child was en14 rolled in the program under the other such title during 

15 such period, the State’s receipt of Federal matching funds 

16 shall be adjusted both retroactively and prospectively so 

17 that Federal matching funds are provided, both during 

18 and following such period of presumptive eligibility, based 

19 on the program in which the child is enrolled.’’. 

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

21 of such Act (42 U.S.C. 1396a(a)) is amended by adding 

22 at the end the following: ‘‘Notwithstanding any other pro23 vision of law, a signature under penalty of perjury shall 

24 not be required on an application form for medical assist25 ance as to any element of eligibility for which eligibility 


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1 is based on information received from a source other than 

2 applicant, rather than on representations from the appli3 cant. Notwithstanding any other provision of law, any sig4 nature requirement for an application for medical assist5 ance may be satisfied through an electronic signature, as 

6 defined in section 1710(1) of the Government Paperwork 

7 Elimination Act (44 U.S.C. 3504 note).’’. 

8 SEC. 203. INFORMATION TECHNOLOGY CONNECTIONS TO 

9 IMPROVE HEALTH COVERAGE DETERMINA10 TIONS. 

11 (a) ENHANCED FEDERAL FUNDING FOR IMPROVE12 MENTS RELATED TO IMPLEMENTATION OF CERTAIN

13 MODEL OUTREACH AND ENROLLMENT PRACTICES.— 

14 (1) IN GENERAL.—Section 1903(a)(3)(A) of the 

15 Social Security Act (42 U.S.C. 1396b(a)(3)(A)) is 

16 amended— 

17 (A) by striking ‘‘and’’ at the end of clause 

18 (i); and 

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

20 clause: 

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

22 expended during such quarter as are attrib23 utable to the design, development, or installa24 tion of such mechanized claims processing and 

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1 mentation of administrative systems and proc2 esses (including modification of eligibility com3 puter systems to permit the exchange of elec4 tronic information with other Federal or State 

5 programs) as the Secretary determines are di6 rectly related to the implementation of a model 

7 outreach and enrollment practice described in 

8 subparagraph (B), (C), (D), (E), or (F) of sec9 tion 1905(y)(3), and’’. 

10 (2) CONFORMING AMENDMENT TO ENSURE

11 AVAILABILITY FOR TERRITORIES.—Section 1108(g) 

12 of such Act (42 U.S.C. 1308(g)), as amended by 

13 section 201(b)(2)(B), is amended— 

14 (A) in paragraph (2), by striking ‘‘and 

15 (4)’’ and inserting ‘‘, (4), and (5)’’; and 

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

17 paragraph: 

18 ‘‘(5) ADDITIONAL INCREASE FOR CERTAIN EX19 PENDITURES.—With respect to fiscal year 2008 and 

20 each fiscal year thereafter, if Puerto Rico, the Virgin 

21 Islands, Guam, the Northern Mariana Islands, or 

22 American Samoa qualify for a payment under sec23 tion 1903(a)(3)(A)(iii) for a calendar quarter of 

24 such fiscal year, the additional Federal financial par25 ticipation under such section shall not be counted toVerDate Aug 31 2005 03:28 May 11, 2007 Jkt 059200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\S1364.IS S1364

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1 wards the limitation on expenditures under title XIX 

2 for such commonwealth or territory otherwise deter3 mined under subsection (f) and this subsection for 

4 such fiscal year.’’. 

5 (b) AUTHORIZATION OF INFORMATION DISCLO6 SURE.— 

7 (1) IN GENERAL.—Title XIX of such Act (42 

8 U.S.C. 1396 et seq.) is amended— 

9 (A) by redesignating section 1939 as sec10 tion 1940; and 

11 (B) by inserting after section 1938 the fol12 lowing: 

13 ‘‘AUTHORIZATION TO RECEIVE PERTINENT INFORMATION

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

15 other provision of law, a Federal or State agency or pri16 vate entity in possession of the sources of data potentially 

17 pertinent to eligibility determinations under this title or 

18 title XXI (including eligibility files maintained by pro19 grams described in section 1902(e)(13)(A), information 

20 described in paragraph (2) or (3) of section 1137(a), vital 

21 records information about births in any State, and infor22 mation described in sections 453(i) and 1902(a)(25)(I)) 

23 is authorized to convey such data or information to a State 

24 agency administering a State plan under this title or title 

25 XXI, if— 


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

2 establish or verify eligibility or provide coverage 

3 under this title or title XXI; and 

4 ‘‘(2) an interagency or other agreement, con5 sistent with standards developed by the Secretary, 

6 prevents the unauthorized use, disclosure, or modi7 fication of such data and otherwise meets applicable 

8 Federal requirements safeguarding privacy and data 

9 security. 

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

11 information may be conveyed pursuant to this section only 

12 if the following requirements are met: 

13 ‘‘(1) The individual whose circumstances are 

14 described in the data or information (or such indi15 vidual’s parent, guardian, caretaker relative, or au16 thorized representative) has either provided advance 

17 consent to disclosure or has not objected to disclo18 sure after receiving advance notice of disclosure and 

19 a reasonable opportunity to object. 

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

21 for the purposes of— 

22 ‘‘(A) identifying individuals who are eligi23 ble or potentially eligible for assistance under 

24 this title or title XXI and enrolling such indiVerDate Aug 31 2005 03:28 May 11, 2007 Jkt 059200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\S1364.IS S1364

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1 viduals in the State plans established under 

2 such titles; and 

3 ‘‘(B) verifying the eligibility of individuals 

4 for assistance under the State plans established 

5 under this title or title XXI. 

6 ‘‘(3) An interagency or other agreement, con7 sistent with standards developed by the Secretary— 

8 ‘‘(A) prevents the unauthorized use, disclo9 sure, or modification of such data and other10 wise meets applicable Federal requirements 

11 safeguarding privacy and data security; and 

12 ‘‘(B) requires the State agencies admin13 istering the State plans established under this 

14 title and title XXI to use the data and informa15 tion obtained under this section to seek to en16 roll individuals in such plans. 

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

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

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

20 Federal law, any information obtained under this section 

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

22 more than 1 year, or both for each such unauthorized ac23 tivity. 

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

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1 tion shall not be construed to prohibit the conveyance or 

2 disclosure of data or information otherwise permitted 

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

4 (2) CONFORMING AMENDMENT TO ASSURE AC5 CESS TO NATIONAL NEW HIRES DATABASE.—Section 

6 453(i)(1) of such Act (42 U.S.C. 653(i)(1)) is 

7 amended by striking ‘‘and programs funded under 

8 part A’’ and inserting ‘‘, programs funded under 

9 part A, and State plans approved under title XIX or 

10 XXI’’. 

11 (3) CONFORMING AMENDMENT TO PROVIDE

12 SCHIP PROGRAMS WITH ACCESS TO NATIONAL IN13 COME DATA.—Section 6103(l)(7)(D)(ii) of the Inter14 nal Revenue Code of 1986 is amended by inserting 

15 ‘‘or title XXI’’ after ‘‘title XIX’’. 

16 (4) CONFORMING AMENDMENT TO PROVIDE AC17 CESS TO DATA ABOUT ENROLLMENT IN INSURANCE

18 FOR PURPOSES OF EVALUATING APPLICATIONS AND

19 FOR SCHIP.—Section 1902(a)(25)(I)(i) of the Social 

20 Security Act (42 U.S.C. 1396a(a)(25)(I)(i)) is 

21 amended— 

22 (A) by inserting ‘‘(and, at State option, in23 dividuals who are potentially eligible or who 

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

25 are eligible’’; and 


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

2 State option, child health assistance under title 

3 XXI)’’ after ‘‘the State plan’’. 

4 SEC. 204. STATE OPTION TO EXPAND OR ADD COVERAGE 

5 OF CERTAIN PREGNANT WOMEN UNDER MED6 ICAID AND SCHIP. 

7 (a) MEDICAID.— 

8 (1) AUTHORITY TO EXPAND COVERAGE.—Sec9 tion 1902(l)(2)(A)(i) of the Social Security Act (42 

10 U.S.C. 1396a(l)(2)(A)(i)) is amended by inserting 

11 ‘‘(or such higher percentage as the State may elect 

12 for purposes of expenditures for medical assistance 

13 for pregnant women described in section 

14 1905(u)(4)(A))’’ after ‘‘185 percent’’. 

15 (2) ENHANCED MATCHING FUNDS AVAILABLE

16 IF CERTAIN CONDITIONS MET.—Section 1905 of 

17 such Act (42 U.S.C. 1396d) is amended— 

18 (A) in the fourth sentence of subsection 

19 (b), by striking ‘‘or subsection (u)(3)’’ and in20 serting ‘‘, (u)(3), or (u)(4)’’; and 

21 (B) in subsection (u)— 

22 (i) by redesignating paragraph (4) as 

23 paragraph (5); and 

24 (ii) by inserting after paragraph (3) 

25 the following new paragraph: 


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1 ‘‘(4) For purposes of the fourth sentence of sub2 section (b) and section 2105(a), the expenditures de3 scribed in this paragraph are the following: 

4 ‘‘(A) CERTAIN PREGNANT WOMEN.—If the con5 ditions described in subparagraph (B) are met, ex6 penditures for medical assistance for pregnant 

7 women described in subsection (n) or in section 

8 1902(l)(1)(A) in a family the income of which ex9 ceeds 185 percent of the poverty line, but does not 

10 exceed the income eligibility level established under 

11 title XXI for a targeted low-income child. 

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

13 in this subparagraph are the following: 

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

15 title XXI do not provide coverage for pregnant 

16 women described in subparagraph (A) with 

17 higher family income without covering such 

18 pregnant women with a lower family income. 

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

20 income level for pregnant women that is lower 

21 than the effective income level (expressed as a 

22 percent of the poverty line and considering ap23 plicable income disregards) specified under the 

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

25 or (l)(2)(A) of section 1902, on the date of enVerDate Aug 31 2005 03:28 May 11, 2007 Jkt 059200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\S1364.IS S1364

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1 actment of this paragraph to be eligible for 

2 medical assistance as a pregnant woman. 

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

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

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

6 (3) PAYMENT FROM TITLE XXI ALLOTMENT

7 FOR MEDICAID EXPANSION COSTS.—Section 

8 2105(a)(1) of such Act (42 U.S.C. 1397ee(a)(1)), as 

9 amended by section 211, is amended by striking sub10 paragraph (B) and inserting the following new sub11 paragraph: 

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

13 for expenditures described in section 

14 1905(u)(4)(A) that represents the additional 

15 amount paid for such expenditures as a result 

16 of the enhanced FMAP being substituted for 

17 the Federal medical assistance percentage of 

18 such expenditures;’’. 

19 (b) CHIP.— 

20 (1) COVERAGE.—Title XXI of such Act(42 

21 U.S.C. 1397aa et seq.) is amended by adding at the 

22 end the following new section: 


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1 ‘‘SEC. 2111. OPTIONAL COVERAGE OF TARGETED LOW-IN2 COME PREGNANT WOMEN. 

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

4 other provision of this title, a State may provide for cov5 erage, through an amendment to its State child health 

6 plan under section 2102, of pregnancy-related assistance 

7 for targeted low-income pregnant women in accordance 

8 with this section, but only if— 

9 ‘‘(1) the State has established an income eligi10 bility level for pregnant women under subsection 

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

12 at least 185 percent of the income official poverty 

13 line; and 

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

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

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

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

18 term ‘pregnancy-related assistance’ has the meaning 

19 given the term ‘child health assistance’ in section 

20 2110(a) as if any reference to targeted low-income 

21 children were a reference to targeted low-income 

22 pregnant women. 

23 ‘‘(2) TARGETED LOW-INCOME PREGNANT

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

25 woman’ means a woman— 


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1 ‘‘(A) during pregnancy and through the 

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

3 (beginning on the last day of her pregnancy) 

4 ends; 

5 ‘‘(B) whose family income exceeds the ef6 fective income level (expressed as a percent of 

7 the poverty line and considering applicable in8 come disregards) specified under subsection 

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

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

11 assistance as a pregnant woman under title 

12 XIX but does not exceed the income eligibility 

13 level established under the State child health 

14 plan under this title for a targeted low-income 

15 child; and 

16 ‘‘(C) who satisfies the requirements of 

17 paragraphs (1)(A), (1)(C), (2), and (3) of sec18 tion 2110(b) in the same manner as a child ap19 plying for child health assistance would have to 

20 satisfy such requirements. 

21 ‘‘(c) REFERENCES TO TERMS AND SPECIAL

22 RULES.—In the case of, and with respect to, a State pro23 viding for coverage of pregnancy-related assistance to tar24 geted low-income pregnant women under subsection (a), 

25 the following special rules apply: 


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

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

3 deemed to include a reference to a targeted low-in4 come pregnant woman. 

5 ‘‘(2) Any such reference to child health assist6 ance with respect to such women is deemed a ref7 erence to pregnancy-related assistance. 

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

9 reference to a woman during pregnancy and the pe10 riod described in subsection (b)(2)(A). 

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

12 reference to children found through screening to be 

13 eligible for medical assistance under the State Med14 icaid plan under title XIX is deemed a reference to 

15 pregnant women. 

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

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

18 preexisting condition and no waiting period (includ19 ing any waiting period imposed to carry out section 

20 2102(b)(3)(C)) shall apply. 

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

22 case of a pregnant woman provided coverage under 

23 this section, the limitation on total annual aggregate 

24 cost sharing shall be applied to such pregnant 

25 woman. 


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

2 section 1920A (relating to presumptive eligibility for 

3 children) is deemed a reference to section 1920 (re4 lating to presumptive eligibility for pregnant 

5 women). 

6 ‘‘(d) AUTOMATIC ENROLLMENT FOR CHILDREN

7 BORN TO WOMEN RECEIVING PREGNANCY-RELATED AS8 SISTANCE.—If a child is born to a targeted low-income 

9 pregnant woman who was receiving pregnancy-related as10 sistance under this section on the date of the child’s birth, 

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

12 assistance under the State child health plan and to have 

13 been found eligible for such assistance under such plan 

14 or to have applied for medical assistance under title XIX 

15 and to have been found eligible for such assistance under 

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

17 to remain eligible for such assistance until the child at18 tains 1 year of age. During the period in which a child 

19 is deemed under the preceding sentence to be eligible for 

20 child health or medical assistance, the child health or med21 ical assistance eligibility identification number of the 

22 mother shall also serve as the identification number of the 

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

24 such number (unless the State issues a separate identifica25 tion number for the child before such period expires).’’. 


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1 (2) ADDITIONAL CONFORMING AMENDMENTS.— 

2 (A) NO COST SHARING FOR PREGNANCY3 RELATED BENEFITS.—Section 2103(e)(2) (42 

4 U.S.C. 1397cc(e)(2)) is amended— 

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

6 PREGNANCY-RELATED SERVICES’’ after 

7 ‘‘PREVENTIVE SERVICES’’; and 

8 (ii) by inserting before the period at 

9 the end the following: ‘‘or for pregnancy10 related services’’. 

11 (B) NO WAITING PERIOD.—Section 

12 2102(b)(1)(B) (42 U.S.C. 1397bb(b)(1)(B)) is 

13 amended— 

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

15 the end and inserting a semicolon; 

16 (ii) in clause (ii), by striking the pe17 riod at the end and inserting ‘‘; and’’; and 

18 (iii) by adding at the end the fol19 lowing new clause: 

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

21 (including a waiting period to carry out 

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

23 low-income pregnant woman.’’. 

24 (c) OTHER AMENDMENTS TO MEDICAID.— 


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1 (1) ELIGIBILITY OF ANEWBORN.—Section 

2 1902(e)(4) (42 U.S.C. 1396a(e)(4)) is amended in 

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

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

5 woman remains (or would remain if pregnant) eligi6 ble for such assistance’’. 

7 (2) APPLICATION OF QUALIFIED ENTITIES TO

8 PRESUMPTIVE ELIGIBILITY FOR PREGNANT WOMEN

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

10 1396r–1(b)) is amended by adding after paragraph 

11 (2) the following new flush sentence: 

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

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

14 SEC. 205. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS 

15 UNDER MEDICAID AND SCHIP. 

16 (a) MEDICAID PROGRAM.—Section 1903(v) of the 

17 Social Security Act (42 U.S.C. 1396b(v)) is amended— 

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

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

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

21 paragraph: 

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

23 under this title) to provide medical assistance under this 

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

25 421 of the Personal Responsibility and Work Opportunity 


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1 Reconciliation Act of 1996, for aliens who are lawfully re2 siding in the United States (including battered aliens de3 scribed in section 431(c) of such Act) and who are other4 wise eligible for such assistance, within either or both of 

5 the following eligibility categories: 

6 ‘‘(i) PREGNANT WOMEN.—Women during preg7 nancy (and during the 60-day period beginning on 

8 the last day of the pregnancy). 

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

10 age, including optional targeted low-income children 

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

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

13 medical assistance to a category of aliens under subpara14 graph (A), no debt shall accrue under an affidavit of sup15 port against any sponsor of such an alien on the basis 

16 of provision of assistance to such category and the cost 

17 of such assistance shall not be considered as an unreim18 bursed cost.’’. 

19 (b) SCHIP.—Section 2107(e)(1) of such Act (42 

20 U.S.C. 1397gg(e)(1)), as amended by section 202(b), is 

21 amended by redesignating subparagraphs (D) and (E) as 

22 subparagraph (E) and (F), respectively, and by inserting 

23 after subparagraph (C) the following new subparagraph: 

24 ‘‘(D) Section 1903(v)(4) (relating to op25 tional coverage of categories of lawfully residing 


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•S 1364 IS

1 immigrant children), but only if the State has 

2 elected to apply such section to the category of 

3 children under title XIX.’’. 

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

5 this section take effect on October 1, 2007, and apply to 

6 medical assistance and child health assistance furnished 

7 on or after such date. 

8 (d) CONSTRUCTION.—Nothing in this section shall be 

9 construed as affecting eligibility of aliens who are not law10 fully residing in the United States to benefits under the 

11 Medicaid program under title XIX of the Social Security 

12 Act or under the State children’s health insurance pro13 gram (SCHIP) under title XXI of such Act. 

14 SEC. 206. AUTHORIZING ADJUSTMENT OF SCHIP ALLOT15 MENT DUE TO INCREASED OUTREACH. 

16 (a) IN GENERAL.—Section 2104 of the Social Secu17 rity Act (42 U.S.C. 1397dd), as amended by section 101, 

18 is further amended by adding at the end the following new 

19 subsection: 

20 ‘‘(j) AUTHORIZING ALLOTMENT ADJUSTMENT DUE

21 TO INCREASED OUTREACH.— 

22 ‘‘(1) IN GENERAL.—Notwithstanding the pre23 vious provisions of this section, if the Secretary de24 termines that— 


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•S 1364 IS

1 ‘‘(A) a State has an increase in the aver2 age number of children enrolled under its State 

3 child health plan in a fiscal year that exceeds 

4 the enrollment of children projected under para5 graph (2) for the State for such fiscal year, and 

6 ‘‘(B) the total Federal expenditures under 

7 the State child health plan (or waiver) under 

8 this title exceeds the amount of the allotment 

9 made available to the State for the fiscal year, 

10 the Secretary shall increase the allotment under this 

11 section for the State for the fiscal year by the 

12 amount specified in paragraph (3). There are hereby 

13 appropriated, out of any money in the Treasury not 

14 otherwise appropriated, such sums as may be nec15 essary to provide for such increase in allotment. 

16 ‘‘(2) PROJECTED ENROLLMENT OF CHIL17 DREN.—The projected enrollment of children for a 

18 State under this paragraph for a fiscal year is equal 

19 to the average number of children enrolled under the 

20 State child health plan in fiscal year 2007 increased, 

21 for each subsequent fiscal year through the fiscal 

22 year involved, by a factor equal to the population 

23 growth of children in the State for such fiscal year, 

24 as projected by the Secretary before the beginning of 

25 the fiscal year involved. 


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1 ‘‘(3) AMOUNT OF ALLOTMENT INCREASE.— 

2 ‘‘(A) IN GENERAL.—Subject to subpara3 graph (B), the amount of the allotment increase 

4 under this subsection for a State for a fiscal 

5 year shall be an amount equal to the product 

6 of— 

7 ‘‘(i) the number by which the average 

8 number of children enrolled under the 

9 State child health plan in the fiscal year 

10 exceeds the enrollment of children pro11 jected under paragraph (2) for such State 

12 for such fiscal year; and 

13 ‘‘(ii) the per capita expenditures for 

14 children under the State child health plan 

15 for the previous year, increased by the av16 erage annual rate of increase (for the three 

17 previous fiscal years) in the amount of 

18 such per capita expenditures. 

19 The amount of the allotment increase under 

20 this subsection shall not be subject to adminis21 trative or judicial review. 

22 ‘‘(B) LIMITATION.— 

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

24 (ii), in no case shall the sum of the allot25 ment increases for all States under this 


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•S 1364 IS

1 subsection for a fiscal year exceed an 

2 amount equal to 20 percent of the total 

3 Federal payments to all of the States oth4 erwise made under this title for the fiscal 

5 year. If such sum exceeds such amount, 

6 subject to clause (ii), the allotment in7 crease for each State under this subsection 

8 for the fiscal year shall be reduced in a pro 

9 rata manner in order that such sum does 

10 not exceed such amount. 

11 ‘‘(ii) CONGRESSIONAL APPROVAL OF

12 ADDITIONAL AMOUNTS.—If the Secretary 

13 estimates that the allotment increases that 

14 should be provided under this subsection, 

15 but for clause (i), would exceed the limita16 tion established under such clause, the 

17 Secretary shall submit to Congress a re18 quest for supplemental appropriations for 

19 the purpose of meeting such shortfall. 

20 ‘‘(4) CLARIFICATION.—An adjustment in an al21 lotment shall not be made under this subsection due 

22 to excess State expenditures resulting from a growth 

23 in per capita costs, increased reimbursement to pro24 viders, or other factors not directly related to outVerDate Aug 31 2005 03:28 May 11, 2007 Jkt 059200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 E:\BILLS\S1364.IS S1364

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1 reach to eligible, but previously unenrolled chil2 dren.’’. 

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

4 subsection (a) shall take effect beginning with allotments 

5 for fiscal year 2008. 

6 SEC. 207. MODEL OF INTERSTATE COORDINATED ENROLL7 MENT AND COVERAGE PROCESS. 

8 In order to assure continuity of coverage of low-in9 come children under the Medicaid program and the State 

10 Children’s Health Insurance Program (SCHIP), the Sec11 retary of Health and Human Services, in consultation with 

12 State Medicaid and SCHIP directors, shall develop and 

13 disseminate a model process for the coordination of the 

14 enrollment and coverage under such programs of children 

15 who, because of migration of families, emergency evacu16 ations, educational needs, or otherwise, frequently change 

17 their State of residency or otherwise are temporarily 

18 present outside of the State of their residency. 

19 SEC. 208. AUTHORITY FOR QUALIFYING STATES TO USE 

20 PORTION OF SCHIP ALLOTMENT FOR ANY 

21 FISCAL YEAR FOR CERTAIN MEDICAID EX22 PENDITURES. 

23 Section 2105(g)(1)(A) of the Social Security Act (42 

24 U.S.C. 1397ee(g)(1)(A)), as amended by section 201(b) 

25 of the National Institutes of Health Reform Act of 2006 


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1 (Public Law 109–482) is amended by striking ‘‘fiscal year 

2 1998, 1999, 2000, 2001, 2004, 2005, 2006, or 2007’’ and 

3 inserting ‘‘a fiscal year’’. 

4 SEC. 209. APPLICATION OF MEDICAID OUTREACH PROCE5 DURES TO ALL PREGNANT WOMEN AND CHIL6 DREN. 

7 (a) IN GENERAL.—Section 1902(a)(55) of the Social 

8 Security Act (42 U.S.C. 1396a(a)(55)) is amended by 

9 striking ‘‘individuals for medical assistance under sub10 section (a)(10)(A)(i)(IV), (a)(10)(A)(i)(VI), 

11 (a)(10)(A)(i)(VII), or (a)(10)(A)(ii)(IX)’’ and inserting 

12 ‘‘child and pregnant women for medical assistance (includ13 ing under clauses (i)(IV), (i)(VI), (i)(VII), and (ii)(IX) of 

14 paragraph (10)(A))’’. 

15 (b) EFFECTIVE DATE.— 

16 (1) IN GENERAL.— 

17 (2) EXCEPTION FOR STATE LEGISLATION.—In 

18 the case of a State plan under title XIX of the So19 cial Security Act, which the Secretary of Health and 

20 Human Services determines requires State legisla21 tion in order for the plan to meet the additional re22 quirements imposed by the amendment made by 

23 subsection (a), the State plan shall not be regarded 

24 as failing to comply with the requirements of such 

25 Act solely on the basis of its failure to meet these 


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•S 1364 IS

1 additional requirements before the first day of the 

2 first calendar quarter beginning after the close of 

3 the first regular session of the State legislature that 

4 begins after the date of enactment of this Act. For 

5 purposes of the previous sentence, in the case of a 

6 State that has a 2-year legislative session, each year 

7 of the session shall be considered to be a separate 

8 regular session of the State legislature. 

9 SEC. 210. NO IMPACT ON SECTION 1115 WAIVERS. 

10 Nothing in this Act shall be construed to affect State 

11 flexibility on eligibility and waivers approved by the Fed12 eral government under section 1115 of the Social Security 

13 Act (42 U.S.C. 1315). 

14 SEC. 211. ELIMINATION OF COUNTING MEDICAID CHILD 

15 PRESUMPTIVE ELIGIBILITY COSTS AGAINST 

16 TITLE XXI ALLOTMENT. 

17 Section 2105(a)(1) of the Social Security Act (42 

18 U.S.C. 1397ee(a)(1)) is amended— 

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

20 by striking ‘‘(or, in the case of expenditures de21 scribed in subparagraph (B), the Federal medical 

22 assistance percentage (as defined in the first sen23 tence of section 1905(b)))’’; and 

24 (2) by amending subparagraph (B) to read as 

25 follows: 


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•S 1364 IS

1 ‘‘(B) [reserved]’’. 

2 SEC. 212. PROHIBITING LIMITATIONS ON ENROLLMENT. 

3 (a) IN GENERAL.—Section 2102(b)(3)(B) of the So4 cial Security Act (42 U.S.C. 1397bb(b)(3)(B)) is amend5 ed— 

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

7 (2) by striking the period at the end of clause 

8 (ii) and inserting ‘‘; and’’; and 

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

10 clause: 

11 ‘‘(iii) shall not impose, with respect to 

12 enrollment of targeted low-income children 

13 under the State child health plan, any en14 rollment cap or other numerical limitation 

15 on enrollment, any waiting list, any proce16 dures designed to delay the consideration 

17 of applications for enrollment, or similar 

18 limitation with respect to enrollment.’’. 

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

20 subsection (a) shall apply to State child health plans as 

21 of October 1, 2007. 


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1 TITLE III—ELIMINATION OF 

2 CERTAIN BARRIERS TO COV3 ERAGE 

4 SEC. 301. STATE OPTION TO REQUIRE CERTAIN INDIVID5 UALS TO PRESENT SATISFACTORY DOCUMEN6 TARY EVIDENCE OF PROOF OF CITIZENSHIP 

7 OR NATIONALITY FOR PURPOSES OF ELIGI8 BILITY FOR MEDICAID. 

9 (a) IN GENERAL.—Section 1902(a)(46) of the Social 

10 Security Act (42 U.S.C. 1396a(a)(46)) is amended— 

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

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

13 (3) by adding at the end the following new sub14 paragraph: 

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

16 section 1903(x), require that, with respect to an in17 dividual (other than an individual described in sec18 tion 1903(x)(1)) who declares to be a citizen or na19 tional of the United States for purposes of estab20 lishing initial eligibility for medical assistance under 

21 this title (or, at State option, for purposes of renew22 ing or redetermining such eligibility to the extent 

23 that such satisfactory documentary evidence of citi24 zenship or nationality has not yet been presented), 

25 there is presented satisfactory documentary evidence 


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•S 1364 IS

1 of citizenship or nationality of the individual (using 

2 criteria determined by the State, which shall be no 

3 more restrictive than the criteria used by the Social 

4 Security Administration to determine citizenship, 

5 and which shall accept as such evidence a document 

6 issued by a federally recognized Indian tribe evidenc7 ing membership or enrollment in, or affiliation with, 

8 such tribe (such as a tribal enrollment card or cer9 tificate of degree of Indian blood, and, with respect 

10 to those federally recognized Indian tribes located 

11 within States having an international border whose 

12 membership includes individuals who are not citizens 

13 of the United States, such other forms of docu14 mentation (including tribal documentation, if appro15 priate) that the Secretary, after consulting with such 

16 tribes, determines to be satisfactory documentary 

17 evidence of citizenship or nationality for purposes of 

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

19 (b) LIMITATION ON WAIVER AUTHORITY.—Notwith20 standing any provision of section 1115 of the Social Secu21 rity Act (42 U.S.C. 1315), or any other provision of law, 

22 the Secretary may not waive the requirements of section 

23 1902(a)(46)(B) of such Act (42 U.S.C. 1396a(a)(46)(B)) 

24 with respect to a State. 


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1 (c) CONFORMING AMENDMENTS.—Section 1903 of 

2 such Act (42 U.S.C. 1396b) is amended— 

3 (1) in subsection (i)— 

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

5 after the semicolon; 

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

7 and inserting a period; and 

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

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

10 405(c)(1)(A) of division B of the Tax Relief and 

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

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

13 (B) by redesignating paragraph (2) as 

14 paragraph (1); 

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

16 by striking ‘‘paragraph (1)’’ and inserting ‘‘sec17 tion 1902(a)(46)(B)’’; and 

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

19 paragraphs: 

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

21 citizen or national of the United States with respect to 

22 whom a State requires the presentation of satisfactory 

23 documentary evidence of citizenship or nationality under 

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

25 at least the reasonable opportunity to present satisfactory 


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1 documentary evidence of citizenship or nationality under 

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

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

4 to the State of evidence indicating a satisfactory immigra5 tion status. 

6 ‘‘(3)(A) In addition to the criteria established by the 

7 State for purposes of section 1902(a)(46)(B), a State shall 

8 deem presentation of the following documents to be ‘satis9 factory documentary evidence of citizenship or nationality’ 

10 (and shall not favor presentation of 1 type of document 

11 described over another): 

12 ‘‘(i) Any document described in subparagraph 

13 (B). 

14 ‘‘(ii) Any document described in subparagraph 

15 (C) when presented with any document described in 

16 subparagraph (D). 

17 ‘‘(iii) Any document described in subparagraph 

18 (E) if the requirements of that subparagraph are 

19 met. 

20 ‘‘(B) The following are documents described in this 

21 subparagraph: 

22 ‘‘(i) A United States passport. 

23 ‘‘(ii) Form N–550 or N–570 (Certificate of 

24 Naturalization). 


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1 ‘‘(iii) Form N–560 or N–561 (Certificate of 

2 United States Citizenship). 

3 ‘‘(iv) A valid State-issued driver’s license or 

4 other identity document described in section 

5 274A(b)(1)(D) of the Immigration and Nationality 

6 Act, but only if the State issuing the license or such 

7 document requires proof of United States citizenship 

8 before issuance of such license or document or ob9 tains a social security number from the applicant 

10 and verifies before certification that such number is 

11 valid and assigned to the applicant who is a citizen. 

12 ‘‘(v) Such other document as the Secretary may 

13 specify, by regulation, that provides proof of United 

14 States citizenship or nationality and that provides a 

15 reliable means of documentation of personal identity. 

16 ‘‘(C) The following are documents described in this 

17 subparagraph: 

18 ‘‘(i) A certificate of birth in the United States. 

19 ‘‘(ii) Form FS–545 or Form DS–1350 (Certifi20 cation of Birth Abroad). 

21 ‘‘(iii) Form I–197 (United States Citizen Iden22 tification Card). 

23 ‘‘(iv) Form FS–240 (Report of Birth Abroad of 

24 a Citizen of the United States). 


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1 ‘‘(v) Such other document (not described in 

2 subparagraph (B)(iv)) as the Secretary may specify 

3 that provides proof of United States citizenship or 

4 nationality. 

5 ‘‘(D) The following are documents described in this 

6 subparagraph: 

7 ‘‘(i) Any identity document described in section 

8 274A(b)(1)(D) of the Immigration and Nationality 

9 Act. 

10 ‘‘(ii) Any other documentation of personal iden11 tity of such other type as the Secretary finds, by 

12 regulation, provides a reliable means of identifica13 tion. 

14 ‘‘(E) A document described in this subparagraph is 

15 an affidavit of citizenship or identity, or both, which need 

16 not be notarized or witnessed, but only if the individual 

17 has been unable to acquire other satisfactory documentary 

18 evidence within the reasonable opportunity period estab19 lished by the State, despite a good faith effort to do so. 

20 An individual shall be deemed unable to acquire such doc21 umentary evidence— 

22 ‘‘(i) if there is good reason to believe that such 

23 documentary evidence does not exist; 

24 ‘‘(ii) if, after a timely request for such docu25 mentary evidence, it has not been received by the 


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1 State or the individual within the reasonable oppor2 tunity period established by the State; 

3 ‘‘(iii) if such documentary evidence cannot be 

4 acquired at a nominal cost to the individual; or 

5 ‘‘(iv) in such additional situations as the Sec6 retary may describe. 

7 ‘‘(F)(i) A reference in this paragraph to a form in8 cludes a reference to any successor form. 

9 ‘‘(ii) Any legible copy of a form described in this 

10 paragraph shall be accepted as if it were the original of 

11 such form.’’. 

12 (d) CLARIFICATION OF RULES FOR CHILDREN BORN

13 IN THE UNITED STATES TO MOTHERS ELIGIBLE FOR

14 MEDICAID.—Section 1903(x) of such Act (42 U.S.C. 

15 1396b(x)), as amended by subsection (c)(2), is amended— 

16 (1) in paragraph (1)— 

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

18 at the end; 

19 (B) by redesignating subparagraph (D) as 

20 subparagraph (E); and 

21 (C) by inserting after subparagraph (C) 

22 the following new subparagraph: 

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

24 1902(e)(4) (and, in the case of an individual who is 

25 eligible for medical assistance on such basis, the inVerDate Aug 31 2005 03:28 May 11, 2007 Jkt 059200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\S1364.IS S1364

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1 dividual shall be deemed to have provided satisfac2 tory documentary evidence of citizenship or nation3 ality and shall not be required to provide further 

4 documentary evidence on any date that occurs dur5 ing or after the period in which the individual is eli6 gible for medical assistance on such basis); or’’; and 

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

8 paragraph: 

9 ‘‘(4) Nothing in subparagraph (A) or (B) of section 

10 1902(a)(46), the preceding paragraphs of this subsection, 

11 or the Deficit Reduction Act of 2005, including section 

12 6036 of such Act, shall be construed as changing the re13 quirement of section 1902(e)(4) that a child born in the 

14 United States to an alien mother for whom medical assist15 ance for the delivery of such child is available as treatment 

16 of an emergency medical condition pursuant to subsection 

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

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

19 (e) EFFECTIVE DATE.— 

20 (1) RETROACTIVE APPLICATION.—The amend21 ments made by this section shall take effect as if in22 cluded in the enactment of the Deficit Reduction Act 

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

24 (2) RESTORATION OF ELIGIBILITY.—In the 

25 case of an individual who, during the period that 


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1 began on July 1, 2006, and ends on the date of en2 actment of this Act, was determined to be ineligible 

3 for medical assistance under a State Medicaid pro4 gram solely as a result of the application of sub5 sections (i)(22) and (x) of section 1903 of the Social 

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

7 who would have been determined eligible for such as8 sistance if such subsections, as amended by this sec9 tion, had applied to the individual, a State may 

10 deem the individual to be eligible for such assistance 

11 as of the date that the individual was determined to 

12 be ineligible for such medical assistance on such 

13 basis. 

14 SEC. 302. INCREASED FEDERAL MATCHING RATE FOR LAN15 GUAGE SERVICES PROVIDED UNDER MED16 ICAID OR SCHIP. 

17 (a) IN GENERAL.—Section 1903(a)(3) of the Social 

18 Security Act (42 U.S.C. 1396b(a)(3)) is amended— 

19 (1) in subparagraph (E)(ii), by striking ‘‘plus’’ 

20 at the end; and 

21 (2) by adding at the end the following: 

22 ‘‘(3) 85 percent of the sums expended with re23 spect to costs incurred during such quarter as are 

24 attributable to the provision of language services on 

25 behalf of individuals with limited English proficiency 


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1 who apply for or receive medical assistance under 

2 the State plan (including any provisions of the plan 

3 implemented pursuant to any waiver authority of the 

4 Secretary) or child health assistance under title 

5 XXI; plus’’. 

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

7 subsection (a) take effect on October 1, 2007, and apply 

8 to language services provided on or after that date. 

9 TITLE IV—GRANTS TO PROMOTE 

10 INNOVATIVE OUTREACH AND 

11 ENROLLMENT UNDER MED12 ICAID AND SCHIP 

13 SEC. 401. GRANTS TO PROMOTE INNOVATIVE OUTREACH 

14 AND ENROLLMENT UNDER MEDICAID AND 

15 SCHIP. 

16 Title XXI of the Social Security Act (42 U.S.C. 

17 1397aa et seq.), as amended by section 204(b), is amend18 ed by adding at the end the following: 

19 ‘‘SEC. 2112. EXPANDED OUTREACH AND ENROLLMENT AC20 TIVITIES. 

21 ‘‘(a) GRANTS TO CONDUCT INNOVATIVE OUTREACH

22 AND ENROLLMENT EFFORTS.— 

23 ‘‘(1) IN GENERAL.—The Secretary shall award 

24 grants to eligible entities to— 


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1 ‘‘(A) conduct innovative outreach and en2 rollment efforts that are designed to increase 

3 the enrollment and participation of eligible chil4 dren under this title and title XIX; and 

5 ‘‘(B) promote understanding of the impor6 tance of health insurance coverage for prenatal 

7 care and children. 

8 ‘‘(2) PERFORMANCE BONUSES.—The Secretary 

9 may reserve a portion of the funds appropriated 

10 under subsection (g) for a fiscal year for the purpose 

11 of awarding performance bonuses during the suc12 ceeding fiscal year to eligible entities that meet en13 rollment goals or other criteria established by the 

14 Secretary. 

15 ‘‘(b) PRIORITY FOR AWARD OF GRANTS.— 

16 ‘‘(1) IN GENERAL.—In making grants under 

17 subsection (a)(1), the Secretary shall give priority 

18 to— 

19 ‘‘(A) eligible entities that propose to target 

20 geographic areas with high rates of— 

21 ‘‘(i) eligible but unenrolled children, 

22 including such children who reside in rural 

23 areas; or 

24 ‘‘(ii) racial and ethnic minorities and 

25 health disparity populations, including 


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1 those proposals that address cultural and 

2 linguistic barriers to enrollment; and 

3 ‘‘(B) eligible entities that plan to engage in 

4 outreach efforts with respect to individuals de5 scribed in subparagraph (A) and that are— 

6 ‘‘(i) Federal health safety net organi7 zations; or 

8 ‘‘(ii) faith-based organizations or con9 sortia. 

10 ‘‘(2) 10 PERCENT SET ASIDE FOR OUTREACH

11 TO INDIAN CHILDREN.—An amount equal to 10 per12 cent of the funds appropriated under subsection (g) 

13 for a fiscal year shall be used by the Secretary to 

14 award grants to Indian Health Service providers and 

15 urban Indian organizations receiving funds under 

16 title V of the Indian Health Care Improvement Act 

17 (25 U.S.C. 1651 et seq.) for outreach to, and enroll18 ment of, children who are Indians. 

19 ‘‘(c) APPLICATION.—An eligible entity that desires to 

20 receive a grant under subsection (a)(1) shall submit an 

21 application to the Secretary in such form and manner, and 

22 containing such information, as the Secretary may decide. 

23 Such application shall include— 

24 ‘‘(1) quality and outcomes performance meas25 ures to evaluate the effectiveness of activities funded 


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1 by a grant awarded under this section to ensure that 

2 the activities are meeting their goals; and 

3 ‘‘(2) an assurance that the entity shall— 

4 ‘‘(A) conduct an assessment of the effec5 tiveness of such activities against such perform6 ance measures; and 

7 ‘‘(B) cooperate with the collection and re8 porting of enrollment data and other informa9 tion determined as a result of conducting such 

10 assessments to the Secretary, in such form and 

11 manner as the Secretary shall require. 

12 ‘‘(d) DISSEMINATION OF ENROLLMENT DATA AND

13 INFORMATION DETERMINED FROM EFFECTIVENESS AS14 SESSMENTS; ANNUAL REPORT.—The Secretary shall— 

15 ‘‘(1) disseminate to eligible entities and make 

16 publicly available the enrollment data and informa17 tion collected and reported in accordance with sub18 section (c)(2)(B); and 

19 ‘‘(2) submit an annual report to Congress on 

20 the outreach activities funded by grants awarded 

21 under this section. 

22 ‘‘(e) SUPPLEMENT, NOT SUPPLANT.—Federal funds 

23 awarded under this section shall be used to supplement, 

24 not supplant, non-Federal funds that are otherwise avail25 able for activities funded under this section. 


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1 ‘‘(f) DEFINITIONS.—In this section: 

2 ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en3 tity’ means any of the following: 

4 ‘‘(A) A State or local government. 

5 ‘‘(B) A Federal health safety net organiza6 tion. 

7 ‘‘(C) A national, local, or community-based 

8 public or nonprofit private organization, includ9 ing organizations that use community health 

10 workers or community-based doula programs. 

11 ‘‘(D) A faith-based organization or con12 sortia, to the extent that a grant awarded to 

13 such an entity is consistent with the require14 ments of section 1955 of the Public Health 

15 Service Act (42 U.S.C. 300x–65) relating to a 

16 grant award to non-governmental entities. 

17 ‘‘(E) An elementary or secondary school. 

18 ‘‘(2) FEDERAL HEALTH SAFETY NET ORGANI19 ZATION.—The term ‘Federal health safety net orga20 nization’ means— 

21 ‘‘(A) an Indian tribe, tribal organization, 

22 or an urban Indian organization receiving funds 

23 under title V of the Indian Health Care Im24 provement Act (25 U.S.C. 1651 et seq.), or an 

25 Indian Health Service provider; 


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1 ‘‘(B) a Federally-qualified health center 

2 (as defined in section 1905(l)(2)(B)); 

3 ‘‘(C) a hospital defined as a dispropor4 tionate share hospital for purposes of section 

5 1923; 

6 ‘‘(D) a covered entity described in section 

7 340B(a)(4) of the Public Health Service Act 

8 (42 U.S.C. 256b(a)(4)); and 

9 ‘‘(E) any other entity or a consortium that 

10 serves children under a federally-funded pro11 gram, including the special supplemental nutri12 tion program for women, infants, and children 

13 (WIC) established under section 17 of the Child 

14 Nutrition Act of 1966 (42 U.S.C. 1786), the 

15 head start and early head start programs under 

16 the Head Start Act (42 U.S.C. 9801 et seq.), 

17 the school lunch program established under the 

18 Richard B. Russell National School Lunch Act, 

19 and an elementary or secondary school. 

20 ‘‘(3) INDIANS; INDIAN TRIBE; TRIBAL ORGANI21 ZATION; URBAN INDIAN ORGANIZATION.—The terms 

22 ‘Indian’, ‘Indian tribe’, ‘tribal organization’, and 

23 ‘urban Indian organization’ have the meanings given 

24 such terms in section 4 of the Indian Health Care 

25 Improvement Act (25 U.S.C. 1603). 


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1 ‘‘(g) APPROPRIATION.—There is appropriated, out of 

2 any money in the Treasury not otherwise appropriated, 

3 $50,000,000 for each of fiscal years 2008 through 2012 

4 for the purpose of awarding grants under this section. 

5 Amounts appropriated and paid under the authority of 

6 this section shall be in addition to amounts appropriated 

7 under section 2104 and paid to States in accordance with 

8 section 2105, including with respect to expenditures for 

9 outreach activities in accordance with subsection 

10 (a)(1)(D)(iii) of such section.’’. 

11 TITLE V—IMPROVING THE 

12 QUALITY OF PEDIATRIC CARE 

13 SEC. 501. REQUIRING COVERAGE OF EPSDT SERVICES, IN14 CLUDING DENTAL SERVICES; STATE OPTION 

15 TO PROVIDE SUPPLEMENTAL COVERAGE OF 

16 DENTAL SERVICES. 

17 (a) ADDITIONAL REQUIRED SERVICES.— 

18 (1) REQUIRED COVERAGE OF EPSDT SERVICES, 

19 INCLUDING DENTAL SERVICES.—Section 2103(c) of 

20 the Social Security Act (42 U.S.C. 1397cc(c)) is 

21 amended— 

22 (A) by redesignating paragraph (5) as 

23 paragraph (6); and 

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

25 following: 


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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 early and periodic 

4 screening, diagnostic, and treatment services de5 scribed in subsections (a)(4)(B) and (r) of section 

6 1905 and provided in accordance with section 

7 1903(a)(43) (including dental services that are nec8 essary to prevent disease and promote oral health, 

9 restore oral structures to health and function, and 

10 treat emergency conditions).’’. 

11 (2) STATE CHILD HEALTH PLAN REQUIRE12 MENT.—Section 2102(a)(7)(B) of such Act (42 

13 U.S.C. 1397bb(c)(2)) is amended by inserting ‘‘and 

14 services described in section 2103(c)(5)’’ after 

15 ‘‘emergency services’’. 

16 (3) CONFORMING AMENDMENT.—Section 

17 2103(a) of such Act (42 U.S.C. 1397cc(a)) is 

18 amended, in the matter preceding paragraph (1), by 

19 striking ‘‘subsection (c)(5)’’ and inserting ‘‘para20 graphs (5) and (6) of subsection (c)’’. 

21 (b) STATE OPTION TO PROVIDE SUPPLEMENTAL

22 COVERAGE OF DENTAL SERVICES UNDER SCHIP TO

23 CHILDREN WITH OTHER HEALTH COVERAGE.— 


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1 (1) IN GENERAL.—Section 2110(b) of the So2 cial Security Act (42 U.S.C. 1397jj(b)) is amend3 ed— 

4 (A) in paragraph (1)(C), by inserting ‘‘, 

5 subject to paragraph (5),’’ after ‘‘under title 

6 XIX or’’; and 

7 (B) by adding at the end the following: 

8 ‘‘(5) STATE OPTION TO PROVIDE SUPPLE9 MENTAL COVERAGE OF DENTAL SERVICES TO CHIL10 DREN WITH OTHER HEALTH COVERAGE.— 

11 ‘‘(A) IN GENERAL.—A State may waive 

12 the requirement of paragraph (1)(C) that a tar13 geted low-income child may not be covered 

14 under a group health plan or under health in15 surance coverage in order to provide dental 

16 services that are not covered, or are only par17 tially covered, under such plan or coverage. 

18 Nothing in subsection (c)(5) of section 2103 

19 shall be construed as prohibiting a State from 

20 limiting the supplemental coverage of dental 

21 services provided in accordance with this para22 graph and nothing in paragraph (2) or (3) of 

23 subsection (e) of such section shall be construed 

24 as prohibiting a State from imposing premiums, 

25 deductibles, cost-sharing, or similar charges for 


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1 such coverage without regard to the require2 ments of either such paragraph. 

3 ‘‘(B) ELIGIBILITY.—In waiving such re4 quirement, a State may limit the application of 

5 the waiver to children whose family income does 

6 not exceed a level specified by the State, which 

7 may not exceed the maximum income level oth8 erwise established for other children under the 

9 State child health plan. 

10 ‘‘(C) CONTINUED APPLICATION OF DUTY

11 TO PREVENT SUBSTITUTION OF EXISTING COV12 ERAGE.—Nothing in this paragraph shall be 

13 construed as modifying the application of sec14 tion 2102(b)(3)(C) to a State.’’. 

15 (2) APPLICATION OF ENHANCED MATCH UNDER

16 MEDICAID.—Section 1905 of such Act (42 U.S.C. 

17 1396d) is amended— 

18 (A) in subsection (b), in the fourth sen19 tence, by striking ‘‘subsection (u)(3)’’ and in20 serting ‘‘(u)(3), or (u)(4)’’; and 

21 (B) in subsection (u), by redesignating 

22 paragraph (4) as paragraph (5) and by insert23 ing after paragraph (3) the following: 

24 ‘‘(4) For purposes of subsection (b), the expenditures 

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1 mental coverage of dental services for children described 

2 in section 2110(b)(5).’’. 

3 (3) APPLICATION OF SECONDARY PAYOR PROVI4 SIONS.—Section 2107(e)(1) of such Act (42 U.S.C. 

5 1397gg(e)(1)) is amended— 

6 (A) by redesignating subparagraphs (B) 

7 through (D) as subparagraphs (C) through (E), 

8 respectively; and 

9 (B) by inserting after subparagraph (A) 

10 the following new subparagraph: 

11 ‘‘(B) Section 1902(a)(25) (relating to co12 ordination of benefits and secondary payor pro13 visions) with respect to children provided sup14 plemental coverage of dental services under a 

15 waiver described in section 2110(b)(5).’’. 

16 SEC. 502. PEDIATRIC QUALITY AND PERFORMANCE MEAS17 URES PROGRAM. 

18 Title XIX of the Social Security Act (42 U.S.C. 1396 

19 et seq.) is amended— 

20 (1) by redesignating section 1939 as section 

21 1941; and 

22 (2) by inserting after section 1938 the fol23 lowing: 


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1 ‘‘PEDIATRIC QUALITY AND PERFORMANCE MEASURES

2 PROGRAM

3 ‘‘SEC. 1939. (a) ESTABLISHMENT.—The Secretary, 

4 acting through the Administrator of the Centers for Medi5 care & Medicaid Services and in consultation with the Di6 rector of the Agency for Healthcare Research and Quality, 

7 shall establish a program to encourage and support the 

8 development of new and emerging quality and perform9 ance measures for providers of pediatric care through the 

10 activities described in subsection (c). In establishing the 

11 program, gaps in existing evidence-based measures and 

12 priority areas for advancement shall be identified. 

13 ‘‘(b) PURPOSE.—The purpose of the program is to 

14 ensure that— 

15 ‘‘(1) evidence-based pediatric quality and per16 formance measures are developed; and 

17 ‘‘(2) such measures are available for States, 

18 other purchasers of pediatric health care services, 

19 health care providers, and consumers to use. 

20 ‘‘(c) PROGRAM ACTIVITIES.— 

21 ‘‘(1) IDENTIFYING QUALITY AND PERFORMANCE

22 MEASURES FOR PROVIDERS OF PEDIATRIC SERVICES

23 AND OPPORTUNITIES FOR NEW MEASURES.—Not 

24 later than 3 months after the date of enactment of 

25 this section, the Secretary shall identify quality and 


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1 performance measures for providers of pediatric 

2 services and opportunities for the development of 

3 new measures, taking into consideration existing evi4 dence-based measures. In conducting this review, the 

5 Secretary shall— 

6 ‘‘(A) ensure the inclusion of at least 1 

7 measure related to children’s dental and oral 

8 health; and 

9 ‘‘(B) convene and consult with representa10 tives of— 

11 ‘‘(i) States; 

12 ‘‘(ii) pediatric hospitals, pediatricians, 

13 and other pediatric health professionals; 

14 ‘‘(iii) national organizations rep15 resenting— 

16 ‘‘(I) consumers of children’s 

17 health care; and 

18 ‘‘(II) purchasers of children’s 

19 health care; 

20 ‘‘(iv) experts in pediatric quality and 

21 performance measurement; and 

22 ‘‘(v) a voluntary consensus standards 

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1 sensus on evidence-based measures of 

2 health care. 

3 ‘‘(2) DEVELOPING, VALIDATING, AND TESTING

4 NEW MEASURES.—The Secretary shall award grants 

5 or contracts to eligible entities (as defined in sub6 section (d)(1)) for the development, validation, and 

7 testing of new and emerging quality and perform8 ance measures, including at least 1 measure related 

9 to children’s dental and oral health, for providers of 

10 pediatric services. Such measures shall— 

11 ‘‘(A) provide consumers and purchasers 

12 (including States and beneficiaries under the 

13 program under this title and title XXI) with in14 formation about provider performance and qual15 ity; and 

16 ‘‘(B) assist health care providers in im17 proving the quality of the items and services 

18 they provide and their performance with respect 

19 to the provision of such items and services. 

20 ‘‘(3) ACHIEVING CONSENSUS ON EVIDENCE21 BASED MEASURES.—The Secretary shall award 

22 grants or contracts to eligible consensus entities (as 

23 defined in subsection (d)(2)) for the development of 

24 consensus on evidence-based measures for pediatric 

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1 dren’s dental and oral health, that have broad ac2 ceptability in the health care industry. 

3 ‘‘(d) ELIGIBLE ENTITIES.— 

4 ‘‘(1) DEVELOPMENT, VALIDATION, AND TEST5 ING.—For purposes of paragraph (2) of subsection 

6 (c), the term ‘eligible entity’ means— 

7 ‘‘(A) organizations with demonstrated ex8 pertise and capacity in the development and 

9 evaluation of pediatric quality and performance 

10 measures; 

11 ‘‘(B) an organization or association of 

12 health care providers with demonstrated experi13 ence in working with accrediting organizations 

14 in developing pediatric quality and performance 

15 measures; and 

16 ‘‘(C) a collaboration of national pediatric 

17 organizations working to improve pediatric 

18 quality and performance measures. 

19 ‘‘(2) ACHIEVEMENT OF CONSENSUS.—For pur20 poses of paragraph (3) of such subsection, the term 

21 ‘eligible consensus entity’ means an organization, in22 cluding a voluntary consensus standards setting or23 ganization involved in the advancement of consensus 

24 on evidence-based measures of health care. 


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1 ‘‘(e) ONGOING AUTHORITY TO UPDATE AND ADJUST

2 PEDIATRIC MEASURES.—The Secretary may update and 

3 adjust measures developed and advanced under the pro4 gram under this section in accordance with— 

5 ‘‘(1) any changes that a voluntary consensus 

6 standards setting organization determines should be 

7 made with respect to such measures; or 

8 ‘‘(2) new evidence indicating the need for 

9 changes with respect to such measures. 

10 ‘‘(f) ADDITION OF PEDIATRIC CONSUMER ASSESS11 MENT MEASURES TO CAHPS HOSPITAL SURVEY CON12 DUCTED BY AHRQ.—The Director of the Agency for 

13 Healthcare Research and Quality shall ensure that con14 sumer assessment measures for hospital services for chil15 dren are added to the Consumer Assessment of Healthcare 

16 Providers and Systems (CAHPS) Hospital survey con17 ducted by such Agency. 

18 ‘‘(g) APPROPRIATION.—There are authorized to be 

19 appropriated and there are appropriated, for the purpose 

20 of carrying out this section, $10,000,000, for each of fiscal 

21 years 2008 through 2012, to remain available until ex22 pended.’’. 


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1 SEC. 503. GRANTS TO STATES FOR DEMONSTRATION 

2 PROJECTS TRANSFORMING DELIVERY OF PE3 DIATRIC CARE. 

4 Title XIX of the Social Security Act (42 U.S.C. 1396 

5 et seq.), as amended by section 502, is amended by insert6 ing after section 1939 the following: 

7 ‘‘GRANTS TO STATES FOR DEMONSTRATION PROJECTS

8 TRANSFORMING DELIVERY OF PEDIATRIC CARE

9 ‘‘SEC. 1940. (a) ESTABLISHMENT.—The Secretary, 

10 acting through the Administrator of the Centers for Medi11 care & Medicaid Services, shall establish demonstration 

12 projects, including demonstration projects in each of the 

13 4 categories described in subsection (d), to award grants 

14 to States to improve the delivery of health care services 

15 provided to children under this title and title XXI. 

16 ‘‘(b) DURATION.—The demonstration projects shall 

17 be conducted for a period of 4 years. 

18 ‘‘(c) ELIGIBILITY.—A State shall not be eligible to 

19 receive a grant under this section unless the State has 

20 demonstrated experience or commitment to the concept of 

21 transformation in the delivery of pediatric care. 

22 ‘‘(d) CATEGORIES OF PROJECTS.—The following cat23 egories of projects are described in this subsection: 

24 ‘‘(1) HEALTH INFORMATION TECHNOLOGY SYS25 TEMS.—Projects for developing health information 

26 technology systems, including technology acquisition, 


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1 electronic health record development, data standards 

2 development, and software development, for pediatric 

3 hospital and physician services and other commu4 nity-based services; implementing model systems; 

5 and evaluating their impact on the quality, safety, 

6 and costs of care. 

7 ‘‘(2) DISEASE MANAGEMENT.—Projects for pro8 viding provider-based care disease management for 

9 children with chronic conditions (including physical, 

10 developmental, behavioral, and psychological condi11 tions), demonstrating the effectiveness of provider12 based management models in promoting better care, 

13 reducing adverse health outcomes, and preventing 

14 avoidable hospitalizations. 

15 ‘‘(3) EVIDENCE-BASED QUALITY IMPROVE16 MENTS.—Projects for implementing evidence-based 

17 approaches to improving efficiency, safety, and effec18 tiveness in the delivery of hospital care for children 

19 across hospital services, evaluating the translation of 

20 successful models of such evidence-based approaches 

21 to other institutions, and the impact of such changes 

22 on the quality, safety, and costs of care. 

23 ‘‘(4) QUALITY AND PERFORMANCE MEASURES

24 FOR PROVIDERS OF CHILDREN’S HEALTH CARE

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1 diatric quality and performance measures for inpa2 tient hospital services, physician services, or services 

3 of other health professionals, determining the reli4 ability, feasibility, and validity of such measures, 

5 and evaluating their potential impact on improving 

6 the quality and delivery of children’s health care. To 

7 the extent feasible, such measures shall have been 

8 approved by consensus standards setting organiza9 tions. 

10 ‘‘(e) UNIFORM METRICS.—The Secretary shall estab11 lish uniform metrics (adjusted, as appropriate, for patient 

12 acuity), collect data, and conduct evaluations with respect 

13 to each demonstration project category described in sub14 section (d). In establishing such metrics, collecting such 

15 data, and conducting such evaluations, the Secretary shall 

16 consult with— 

17 ‘‘(1) experts in each such demonstration project 

18 category; 

19 ‘‘(2) participating States; 

20 ‘‘(3) national pediatric provider organizations; 

21 ‘‘(4) health care consumers; and 

22 ‘‘(5) such other entities or individuals with rel23 evant expertise as the Secretary determines appro24 priate. 


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1 ‘‘(f) EVALUATION AND REPORT.—The Secretary 

2 shall evaluate the demonstration projects conducted under 

3 this section and submit a report to Congress not later than 

4 3 months before the completion of each demonstration 

5 project that includes the findings of the evaluation and 

6 recommendations with respect to— 

7 ‘‘(1) expansion of the demonstration project to 

8 additional States and sites; and 

9 ‘‘(2) the broader implementation of approaches 

10 identified as being successful in advancing quality 

11 and performance in the delivery of medical assist12 ance provided to children under this title and title 

13 XXI. 

14 ‘‘(g) WAIVER.—The Secretary may waive the require15 ments of this title and title XXI to the extent necessary 

16 to carry out the demonstration projects under this section. 

17 ‘‘(h) AMOUNTS PAID TO A STATE.—Amounts paid to 

18 a State under this section— 

19 ‘‘(1) shall be in addition to Federal payments 

20 made to the State under section 1903(a); 

21 ‘‘(2) shall not be used for the State share of 

22 any expenditures claimed for payment under such 

23 section; and 

24 ‘‘(3) shall be used only for expenditures of the 

25 State for participating in the demonstration 


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1 projects, or for expenditures of providers in partici2 pating in the demonstration projects, including— 

3 ‘‘(A) administrative costs of States and 

4 participating providers (such as costs associated 

5 with the design and evaluation of, and data col6 lection under, the demonstration projects); and 

7 ‘‘(B) such other expenditures that are not 

8 otherwise eligible for reimbursement under this 

9 title or title XXI as the Secretary may deter10 mine appropriate. 

11 ‘‘(i) APPROPRIATION.—There are authorized to be 

12 appropriated and there are appropriated, for the purpose 

13 of carrying out this section, to remain available until ex14 pended $10,000,000 for each of fiscal years 2008 through 

15 2012.’’. 

16 SEC. 504. REPORT BY THE COMPTROLLER GENERAL ON DE17 SIGN AND IMPLEMENTATION OF A DEM18 ONSTRATION PROJECT EVALUATING EXIST19 ING QUALITY AND PERFORMANCE MEASURES 

20 FOR CHILDREN’S INPATIENT HOSPITAL 

21 SERVICES. 

22 (a) IN GENERAL.—Not later than 12 months after 

23 the date of enactment of this Act, the Comptroller General 

24 of the United States (in this section referred to as the 

25 ‘‘Comptroller General’’) shall submit a report to Congress 


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1 containing recommendations for the design and implemen2 tation of a demonstration project to evaluate the suit3 ability of existing quality and performance measures for 

4 children’s inpatient hospital services for public reporting, 

5 differentiating quality, identifying best practices, and pro6 viding a basis for payment rewards. 

7 (b) DEVELOPMENT OF RECOMMENDATIONS.—In de8 veloping the recommendations submitted under subsection 

9 (a), the Comptroller General shall accomplish the fol10 lowing: 

11 (1) Consider which agency within the Depart12 ment of Health and Human Services should have 

13 primary responsibility and oversight for such a dem14 onstration project. 

15 (2) Determine a sufficient number of partici16 pating hospitals and volume of children’s cases, 

17 given existing measures that might be chosen for 

18 evaluation under such a demonstration project. 

19 (3) Determine the number of States and variety 

20 of geographic locations that may be required to con21 duct such a demonstration project. 

22 (4) Describe alternatives for administering and 

23 directing funding for such a demonstration project, 

24 taking into consideration the potential involvement 

25 of multiple States, State plans under title XIX of 


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1 the Social Security Act (42 U.S.C. 1396 et seq.), 

2 and State child health plans under title XXI of such 

3 Act (42 U.S.C. 1397aa et seq.). Such description 

4 shall be included in the recommendations submitted 

5 under subsection (a). 

6 (5) Determine requirements for consistency in 

7 measures, metrics, and risk adjustment for such a 

8 demonstration project, across hospitals and across 

9 State lines. 

10 (6) Consider the infrastructure requirements in11 volved in public reporting of quality and perform12 ance measures for children’s inpatient hospital serv13 ices at the national and State levels, including the 

14 requirements involved with respect to maintaining 

15 such measures and data. 

16 (7) Estimate the cost of undertaking such a 

17 demonstration project. 

18 (c) SUGGESTION OF EXISTING MEASURES FOR EVAL19 UATION UNDER THE DEMONSTRATION PROJECT.— 

20 (1) IN GENERAL.—The report submitted under 

21 subsection (a) shall include suggestions for existing 

22 measures to be evaluated under the demonstration 

23 project recommended in such report, including, to 

24 the extent feasible, measures with respect to— 


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1 (A) high volume pediatric inpatient condi2 tions; 

3 (B) high cost pediatric inpatient services; 

4 (C) pediatric conditions with predicted 

5 high morbidities; and 

6 (D) pediatric cases at high risk of patient 

7 safety failures. 

8 (2) SUGGESTED MEASURES.—The measures 

9 suggested under paragraph (1) shall be measures 

10 representing process, structure, patient outcomes, or 

11 patient and family experience— 

12 (A) that are evidence-based; 

13 (B) that are feasible to collect and report; 

14 (C) that include a mechanism for risk ad15 justment when necessary; and 

16 (D) for which there is a consensus within 

17 the pediatric hospital community or a consensus 

18 determined by a voluntary consensus standards 

19 setting organization involved in the advance20 ment of evidence-based measures of health care. 

21 (3) CONSULTATION.—In determining the exist22 ing measures suggested under paragraph (1), the 

23 Comptroller General shall consult with representa24 tives of the following: 


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1 (A) National associations of pediatric hos2 pitals and pediatric health professionals. 

3 (B) Experts in pediatric quality and per4 formance measurement. 

5 (C) Voluntary consensus standards setting 

6 organizations and other organizations involved 

7 in the advancement of consensus on evidence8 based measures. 

9 (D) The Department of Health and 

10 Human Services, States, and other purchasers 

11 of health care items and services. 

12 SEC. 505. MEDICAL HOME DEMONSTRATION PROJECT. 

13 (a) ESTABLISHMENT.— 

14 (1) IN GENERAL.—The Secretary of Health and 

15 Human Services (in this section referred to as the 

16 ‘‘Secretary’’) shall establish a medical home dem17 onstration project (in this section referred to as the 

18 ‘‘project’’) under titles XIX and XXI of the Social 

19 Security Act (42 U.S.C. 1396 et seq.; 1397aa et 

20 seq.) to redesign the health care delivery system by 

21 providing targeted, accessible, continuous, coordi22 nated, and family-centered care to eligible individ23 uals. 


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1 (2) ELIGIBLE INDIVIDUALS DEFINED.—In this 

2 section, the term ‘‘eligible individual’’ means an indi3 vidual who— 

4 (A) is receiving child health assistance 

5 under a State child health plan implemented 

6 under title XXI of the Social Security Act (42 

7 U.S.C. 1397aa et seq.), title XIX of such Act 

8 (42 U.S.C. 1396 et seq.), or both such titles; 

9 and 

10 (B) is a member of a high need population 

11 (as determined by the Secretary). 

12 (3) PROJECT GOALS.—The project shall be de13 signed in order to determine whether, and if so, the 

14 extent to which, medical homes accomplish the fol15 lowing: 

16 (A) Increase— 

17 (i) cost efficiencies of health care de18 livery; 

19 (ii) access to appropriate health care 

20 services; 

21 (iii) patient satisfaction; 

22 (iv) school attendance; and 

23 (v) the quality of health care services 

24 provided, as determined based on measures 

25 of quality the Secretary determines are 


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1 broadly accepted in the health care com2 munity. 

3 (B) Decrease— 

4 (i) inappropriate emergency room uti5 lization; and 

6 (ii) duplication of health care services 

7 provided. 

8 (C) Provide appropriate— 

9 (i) preventive care; and 

10 (ii) referrals to multidisciplinary serv11 ices. 

12 (b) PROJECT DESIGN.— 

13 (1) DURATION.—The project shall be conducted 

14 for a 5 year period. 

15 (2) SITES.— 

16 (A) IN GENERAL.—The project shall be 

17 conducted in 8 States on a State-wide basis. 

18 (B) APPLICATION.—A State seeking to 

19 participate in the project shall submit an appli20 cation to the Secretary at such time, in such 

21 manner, and containing such information as the 

22 Secretary may require. 

23 (3) CONDUCT OF PROJECT.— 

24 (A) AGREEMENTS WITH ACADEMIC INSTI25 TUTIONS.—A participating State may enter into 


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1 an agreement with an academic institution in 

2 order to have the institution conduct the 

3 project, provide technical assistance and moni4 toring, and to participate in the evaluation of 

5 the project under subsection (e)(1). 

6 (B) CHOICE OF PARTICIPATING PHYSICIAN

7 PRACTICES.— 

8 (i) IN GENERAL.—A participating 

9 State shall establish procedures for physi10 cian practices to participate in the project 

11 by providing coordinated care to eligible in12 dividuals. Such participation shall be on a 

13 voluntary basis. 

14 (ii) STANDARDS FOR PARTICIPATING

15 PHYSICIAN PRACTICES.—The procedures 

16 established under clause (i) shall encourage 

17 physician practices participating in the 

18 project to demonstrate that they have— 

19 (I) identified care coordinators, 

20 family resource guides, family advi21 sors, and a family advisory committee; 

22 (II) developed care plans for eli23 gible individuals; and 

24 (III) taken such other actions as 

25 the State determines appropriate in 


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1 order to provide coordinated care to 

2 eligible individuals. 

3 (c) PROJECT REQUIREMENTS.—Each participating 

4 State shall establish procedures in order to ensure that 

5 the following requirements are met: 

6 (1) Each eligible individual in the State who is 

7 enrolled in the project is provided a medical home 

8 with access to appropriate medical care. 

9 (2) Each medical home in the State that is par10 ticipating in the project— 

11 (A) provides for physician-directed care co12 ordination; 

13 (B) uses health information technology (in14 cluding patient registry systems, clinical deci15 sion support tools, remote monitoring, and elec16 tronic medical record systems); 

17 (C) communicates with physician practices 

18 participating in the project, eligible individuals 

19 receiving health care through the medical home, 

20 and other health care providers (as appropriate) 

21 with respect to health matters, including 

22 through electronic mail and telephone consulta23 tions; 

24 (D) makes arrangements with teams of 

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1 dinators, and facilitates linkages to community 

2 resources to extend access to the full spectrum 

3 of health care services that eligible individuals 

4 require; 

5 (E) establishes networks with community 

6 practices, hospitals, and community health care 

7 providers to facilitate the exchange of ideas and 

8 resources in order to improve project outcomes; 

9 and 

10 (F) acts as a facilitator in order to ensure 

11 that eligible individuals enrolled in the medical 

12 home under the project receive high-quality care 

13 at the appropriate time and place in a cost-ef14 fective manner. 

15 (3) The State provides payment (in accordance 

16 with subsection (d)) and appropriate support for 

17 physician-directed care coordination services pro18 vided to eligible individuals under the project. 

19 (d) PAYMENT.— 

20 (1) IN GENERAL.—The Secretary shall establish 

21 a structure for payments to participating States for 

22 the cost of services provided under the project. Such 

23 structure shall provide payments based on the per24 formance of medical homes located in the State in 


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1 achieving quality and efficiency goals (as defined by 

2 the Secretary). 

3 (2) PAYMENTS FOR HEALTH INFORMATION

4 TECHNOLOGY.— 

5 (A) IN GENERAL.—The Secretary shall es6 tablish a prospective, bundled, and risk ad7 justed structural practice payment to cover 

8 health information technology expenses incurred 

9 by medical homes under the project. 

10 (B) IN GENERAL.—Such payments shall 

11 take into account any expenses the medical 

12 home incurs in order to acquire and utilize 

13 health information technology, such as clinical 

14 decision support tools, patient registries, and 

15 electronic medical records. 

16 (3) PAYMENTS FOR PHYSICIAN WORK OUTSIDE

17 OF OFFICE VISITS.—The Secretary shall establish a 

18 prospective, bundled, and risk adjusted structural 

19 care coordination payment that represents the value 

20 of physician work provided to eligible individuals 

21 under the project that is done outside of any office 

22 visits. 

23 (e) EVALUATION AND REPORT.— 

24 (1) EVALUATION.—The Secretary, in consulta25 tion with appropriate pediatric medical associations, 


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1 shall evaluate the project in order to determine the 

2 effectiveness of medical homes in terms of quality 

3 improvement, patient and provider satisfaction, and 

4 the improvement of health outcomes. 

5 (2) REPORT.—Not later than 12 months after 

6 completion of the project, the Secretary shall submit 

7 to Congress a report on the project containing the 

8 results of the evaluation conducted under paragraph 

9 (1), together with recommendations for such legisla10 tion and administrative action as the Secretary de11 termines to be appropriate. 

12 (f) FUNDING.— 

13 (1) IN GENERAL.—There are authorized to be 

14 appropriated, such sums as may be necessary to 

15 carry out this section. 

16 (2) PROHIBITION.—Amounts paid to a State 

17 under the project shall not be used for purposes of 

18 claiming a Federal matching payment under section 

19 1903(a) or 2105(a) of the Social Security Act (42 

20 U.S.C. 1396b(a); 1397ee(a)). 

21 (g) WAIVER.—The Secretary shall waive compliance 

22 with such requirements of titles XIX and XXI of the So23 cial Security Act (42 U.S.C. 1396 et seq.; 1397aa et seq.) 

24 to the extent and for the period the Secretary finds nec25 essary to conduct the project. 


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1 SEC. 506. DISEASE PREVENTION AND TREATMENT DEM2 ONSTRATION PROJECTS FOR ETHNIC AND 

3 RACIAL MINORITY CHILDREN. 

4 (a) DEFINITIONS.—In this section: 

5 (1) CHILD.—The term ‘‘child’’ has the meaning 

6 given such term in section 2110(c)(1) of the Social 

7 Security Act (42 U.S.C. 1397jj(c)(1)). 

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

9 the program established under title XIX of the So10 cial Security Act (42 U.S.C. 1396 et seq.). 

11 (3) PROJECTS.—The term ‘‘projects’’ means 

12 the demonstration projects established under sub13 section (b)(1). 

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

15 the Secretary of Health and Human Services. 

16 (5) SCHIP.—The term ‘‘SCHIP’’ means the 

17 State Children’s Health Insurance Program estab18 lished under title XXI of the Social Security Act (42 

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

20 (6) TARGET INDIVIDUAL.— 

21 (A) IN GENERAL.—The term ‘‘target indi22 vidual’’ means a child— 

23 (i) who is a member of a racial and 

24 ethnic minority group; and 


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1 (ii) who is enrolled in a State Med2 icaid program or a State child health plan 

3 under SCHIP. 

4 (B) RACIAL AND ETHNIC MINORITY

5 GROUP.—The term ‘‘racial and ethnic minority 

6 group’’ has the meaning given such term in sec7 tion 1707(g)(1) of the Public Health Service 

8 Act (42 U.S.C. 300u–6(1)). 

9 (b) DEMONSTRATION PROJECTS.— 

10 (1) ESTABLISHMENT.—The Secretary shall es11 tablish demonstration projects for the purpose of de12 veloping models and evaluating methods that— 

13 (A) improve the quality of medical assist14 ance and child health assistance provided to 

15 target individuals under Medicaid and SCHIP 

16 in order to reduce disparities in the provision of 

17 health care services; 

18 (B) improve clinical outcomes, satisfaction, 

19 quality of life, and the appropriate use of serv20 ices covered and referral patterns under Med21 icaid and SCHIP among target individuals; 

22 (C) eliminate disparities in the rate of pre23 ventive measures, such as well child visits and 

24 immunizations, among target individuals; and 


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1 (D) promote collaboration with community2 based organizations to ensure cultural com3 petency of health care professionals and lin4 guistic access for persons with limited English 

5 proficiency. 

6 (2) DESIGN.— 

7 (A) INITIAL DESIGN.—Not later than 1 

8 year after the date of enactment of this Act, the 

9 Secretary shall— 

10 (i) evaluate best practices in the pri11 vate sector, community programs, and aca12 demic research with respect to methods for 

13 reducing health care disparities among tar14 get individuals; and 

15 (ii) design the projects based on such 

16 evaluation. 

17 (B) NUMBER AND PROJECT AREAS.— 

18 (i) IN GENERAL.—Not later than 2 

19 years after the date of enactment of this 

20 Act, the Secretary shall implement not less 

21 than 9 projects, including the following: 

22 (I) Two projects for each of the 

23 4 following racial and ethnic minority 

24 groups: 


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1 (aa) American Indians, in2 cluding Alaskan Natives, Eski3 mos, and Aleuts. 

4 (bb) Asian Americans and 

5 Pacific Islanders. 

6 (cc) Blacks. 

7 (dd) Hispanics (as defined 

8 in section 1707(g)(2) of the Pub9 lic Health Service Act (42 U.S.C. 

10 300u–6(g)(2)). 

11 (II) One project within Puerto 

12 Rico. 

13 (ii) SUBPOPULATIONS.—The 2 

14 projects implemented for the groups de15 scribed in clause (i)(I) shall each target 

16 different ethnic subpopulations within such 

17 groups. 

18 (iii) RURAL AND INNER-CITY

19 AREAS.—Not less than 1 of the projects 

20 implemented under clause (i)(I) shall be 

21 conducted in a rural area and not less than 

22 1 of such projects shall be conducted in an 

23 inner-city area. 

24 (c) REPORTS TO CONGRESS.— 


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1 (1) IN GENERAL.—Not later than 2 years after 

2 the date on which the Secretary initially implements 

3 the projects, and biannually thereafter for the dura4 tion of the projects, the Secretary shall submit to 

5 Congress a report on the projects. 

6 (2) CONTENTS OF REPORT.—Each report sub7 mitted under paragraph (1) shall include the fol8 lowing: 

9 (A) A description of the projects. 

10 (B) An evaluation of— 

11 (i) the cost and benefits of the 

12 projects, including whether the projects 

13 have reduced expenditures under Medicaid 

14 and SCHIP; 

15 (ii) the quality of the health care serv16 ices provided to target individuals under 

17 the projects, including whether the projects 

18 have reduced racial and ethnic health dis19 parities in the quality of health care serv20 ices provided to such individuals; 

21 (iii) beneficiary and health care pro22 vider satisfaction under the projects; and 

23 (iv) whether, based on the factors 

24 evaluated under clauses (i) through (iii), 


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1 the projects should be continued or con2 ducted on an expanded basis. 

3 (C) Any other information with respect to 

4 the projects the Secretary determines appro5 priate. 

6 (3) EXPANSION OF PROJECTS; IMPLEMENTA7 TION OF RESULTS.—If the initial report submitted 

8 under paragraph (1) includes an evaluation under 

9 paragraph (2)(B)(iv) that the projects initially es10 tablished under subsection (b)(1) should be contin11 ued or conducted on an expanded basis, the Sec12 retary— 

13 (A) shall continue to conduct such 

14 projects; and 

15 (B) may conduct such additional projects 

16 as the Secretary determines appropriate. 

17 (d) FUNDING FOR PROJECTS.— 

18 (1) IN GENERAL.—There are authorized to be 

19 appropriated, such sums as may be necessary to 

20 carry out projects under this section. 

21 (2) PROHIBITION.—Amounts paid to a State or 

22 territory under the projects shall not be used for 

23 purposes of claiming a Federal matching payment 

24 under section 1903(a) or 2105(a) of the Social Secu25 rity Act (42 U.S.C. 1396b(a); 1397ee(a)). 


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1 (e) WAIVER.—The Secretary shall waive compliance 

2 with such requirements of titles XIX and XXI of the So3 cial Security Act (42 U.S.C. 1396 et seq.; 1397aa et seq.) 

4 to the extent and for the period the Secretary finds nec5 essary to conduct the projects. 

6 TITLE VI—COMMISSION ON 

7 CHILDREN’S HEALTH COVERAGE 

8 SEC. 601. COMMISSION ON CHILDREN’S HEALTH COV9 ERAGE. 

10 (a) ESTABLISHMENT OF COMMISSION.— 

11 (1) ESTABLISHMENT.—There is established a 

12 commission to be known as the ‘‘Commission on 

13 Children’s Health Coverage’’ (referred to in this sec14 tion as the ‘‘Commission’’). 

15 (2) MEMBERSHIP.— 

16 (A) IN GENERAL.—The Committee shall be 

17 composed of 10 members with academic train18 ing and practical experience in— 

19 (i) the areas of— 

20 (I) child health and development; 

21 (II) maternal health and develop22 ment; 

23 (III) pediatric care; 

24 (IV) health care financing; 


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1 (V) community-based 

2 participatory research; 

3 (VI) public health; 

4 (VII) data collection, analysis, 

5 and reporting; and 

6 (VIII) health and health care dis7 parities; and 

8 (ii) such other areas as the Secretary 

9 of Health and Human Services (in this 

10 section referred to as the ‘‘Secretary’’) de11 termines appropriate. 

12 (B) SELECTION.—The Secretary shall ap13 point members of the Committee. No candidate 

14 for appointment on the Committee shall be 

15 asked to provide non-relevant information, such 

16 as voting record, political party affiliation, or 

17 position on particular policies. 

18 (3) TERM; VACANCIES.— 

19 (A) TERM.—A member shall be appointed 

20 for the life of the Commission. 

21 (B) VACANCIES.—A vacancy on the Com22 mission— 

23 (i) shall not affect the powers of the 

24 Commission; and 


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1 (ii) shall be filled in the same manner 

2 as the original appointment was made. 

3 (4) MEETINGS.—The Commission shall meet at 

4 the call of the Chairperson. 

5 (5) QUORUM.—A majority of the members of 

6 the Commission shall constitute a quorum, but a 

7 lesser number of members may hold hearings. 

8 (6) CHAIRPERSON AND VICE CHAIRPERSON.— 

9 The Commission shall select a Chairperson from 

10 among the members of the Commission. 

11 (b) DUTIES.— 

12 (1) STUDY.—The Commission shall conduct a 

13 study of all matters relating to children’s health cov14 erage. 

15 (2) RECOMMENDATIONS.—The Commission 

16 shall develop recommendations on policy improve17 ments at the State and national levels, and in the 

18 private sector, with respect to children’s health cov19 erage. 

20 (3) REPORT.— 

21 (A) ANNUAL REPORTS.—During the 2 year 

22 period beginning on the date of enactment of 

23 this Act, the Commission shall submit to the 

24 President and Congress annual reports evalu25 ating the status of children’s health coverage, 


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1 together with recommendations for such legisla2 tion and administrative administrative actions 

3 as the Commission determines would result in 

4 improvements in such health coverage at the 

5 State and national levels, and in the private 

6 sector. 

7 (B) FINAL REPORT.—Not later than 3 

8 years after such date of enactment, the Com9 mission shall submit to the President and Con10 gress a report that contains the recommenda11 tions of the Commission for such legislation and 

12 administrative actions as the Commission deter13 mines would result in comprehensive health cov14 erage of all children in the United States. 

15 (c) POWERS.— 

16 (1) HEARINGS.—The Commission may hold 

17 such hearings, meet and act at such times and 

18 places, take such testimony, and receive such evi19 dence as the Commission considers advisable to 

20 carry out this Act. 

21 (2) INFORMATION FROM FEDERAL AGENCIES.— 

22 (A) IN GENERAL.—The Commission may 

23 secure directly from a Federal agency such in24 formation as the Commission considers nec25 essary to carry out this Act. 


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1 (B) PROVISION OF INFORMATION.—On re2 quest of the Chairperson of the Commission, 

3 the head of the agency shall provide the infor4 mation to the Commission. 

5 (3) POSTAL SERVICES.—The Commission may 

6 use the United States mails in the same manner and 

7 under the same conditions as other agencies of the 

8 Federal Government. 

9 (4) GIFTS.—The Commission may accept, use, 

10 and dispose of gifts or donations of services or prop11 erty. 

12 (d) COMMISSION PERSONNEL MATTERS.— 

13 (1) COMPENSATION OF MEMBERS.— 

14 (A) NON-FEDERAL EMPLOYEES.—A mem15 ber of the Commission who is not an officer or 

16 employee of the Federal Government shall be 

17 compensated at a rate equal to the daily equiva18 lent of the annual rate of basic pay prescribed 

19 for level IV of the Executive Schedule under 

20 section 5315 of title 5, United States Code, for 

21 each day (including travel time) during which 

22 the member is engaged in the performance of 

23 the duties of the Commission. 

24 (B) FEDERAL EMPLOYEES.—A member of 

25 the Commission who is an officer or employee 


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1 of the Federal Government shall serve without 

2 compensation in addition to the compensation 

3 received for the services of the member as an 

4 officer or employee of the Federal Government. 

5 (2) TRAVEL EXPENSES.—A member of the 

6 Commission shall be allowed travel expenses, includ7 ing per diem in lieu of subsistence, at rates author8 ized for an employee of an agency under subchapter 

9 I of chapter 57 of title 5, United States Code, while 

10 away from the home or regular place of business of 

11 the member in the performance of the duties of the 

12 Commission. 

13 (3) STAFF.— 

14 (A) IN GENERAL.—The Chairperson of the 

15 Commission may, without regard to the civil 

16 service laws (including regulations), appoint 

17 and terminate an executive director and such 

18 other additional personnel as are necessary to 

19 enable the Commission to perform the duties of 

20 the Commission. 

21 (B) CONFIRMATION OF EXECUTIVE DIREC22 TOR.—The employment of an executive director 

23 shall be subject to confirmation by the Commis24 sion. 

25 (C) COMPENSATION.— 


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1 (i) IN GENERAL.—Except as provided 

2 in subparagraph (B), the Chairperson of 

3 the Commission may fix the compensation 

4 of the executive director and other per5 sonnel without regard to the provisions of 

6 chapter 51 and subchapter III of chapter 

7 53 of title 5, United States Code, relating 

8 to classification of positions and General 

9 Schedule pay rates. 

10 (ii) MAXIMUM RATE OF PAY.—The 

11 rate of pay for the executive director and 

12 other personnel shall not exceed the rate 

13 payable for level V of the Executive Sched14 ule under section 5316 of title 5, United 

15 States Code. 

16 (4) DETAIL OF FEDERAL GOVERNMENT EM17 PLOYEES.— 

18 (A) IN GENERAL.—An employee of the 

19 Federal Government may be detailed to the 

20 Commission without reimbursement. 

21 (B) CIVIL SERVICE STATUS.—The detail of 

22 the employee shall be without interruption or 

23 loss of civil service status or privilege. 

24 (5) PROCUREMENT OF TEMPORARY AND INTER25 MITTENT SERVICES.—The Chairperson of the ComVerDate Aug 31 2005 03:28 May 11, 2007 Jkt 059200 PO 00000 Frm 00097 Fmt 6652 Sfmt 6201 E:\BILLS\S1364.IS S1364

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1 mission may procure temporary and intermittent 

2 services in accordance with section 3109(b) of title 

3 5, United States Code, at rates for individuals that 

4 do not exceed the daily equivalent of the annual rate 

5 of basic pay prescribed for level V of the Executive 

6 Schedule under section 5316 of that title. 

7 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

8 are authorized to be appropriated such sums as are nec9 essary to carry out this section. 

10 (f) TERMINATION OF COMMISSION.—The Commis11 sion shall terminate 90 days after the date on which the 

12 Commission submits the final report of the Commission 

13 under subsection (b)(3)(B). 

Æ 


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