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[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 1564 Introduced in Senate (IS)]

110th CONGRESS
  1st Session
                                S. 1564

 To amend the Social Security Act to provide health insurance coverage 
 for children and pregnant and post-partum women throughout the United 
  States by combining the children and pregnant women health coverage 
 under Medicaid and SCHIP into a new All Healthy Children Program, and 
                          for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                              June 7, 2007

  Mr. Sanders introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL

 
 To amend the Social Security Act to provide health insurance coverage 
 for children and pregnant and post-partum women throughout the United 
  States by combining the children and pregnant women health coverage 
 under Medicaid and SCHIP into a new All Healthy Children Program, and 
                          for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS; FINDINGS; PURPOSE.

    (a) Short Title.--This Act may be cited as the ``All Healthy 
Children Act of 2007''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents; findings; purpose.
Sec. 2. Creation of new title XXII of the Social Security Act.
               ``TITLE XXII--ALL HEALTHY CHILDREN PROGRAM

        ``Sec. 2201. All Healthy Children Program.
        ``Sec. 2202. General contents of State all healthy children 
                            plan; eligibility; enrollment.
        ``Sec. 2203. Benefits; premiums; cost-sharing; provider payment 
                            rates.
        ``Sec. 2204. Payments to States.
        ``Sec. 2205. Application of SCHIP, Medicaid, and related SSA 
                            provisions; waivers; administration.
        ``Sec. 2206. Definitions.
        ``Sec. 2207. Effective dates; transition.
Sec. 3. Commission on Children's Health Coverage.
    (c) Findings.--Congress finds the following:
            (1) More than 9,000,000 children in the United States--one 
        in 9--have no health insurance coverage.
            (2) Every 46 seconds, another baby is born uninsured in the 
        United States.
            (3) Existing health care programs for low-income children 
        vary widely, with different standards for eligibility, cost 
        sharing, and benefits in each of the 50 States and the District 
        of Columbia.
            (4) The majority of uninsured children are eligible for 
        coverage under Medicaid or the State Children's Health 
        Insurance Program (SCHIP), but are not enrolled in existing 
        programs because of different eligibility and enrollment 
        barriers that make it difficult to obtain or keep coverage.
            (5) Millions more children are underinsured or at risk of 
        losing coverage if their parents change jobs or more employers 
        drop family coverage.
            (6) Uninsured children are almost 12 times as likely as 
        insured children to have an untreated medical need and are four 
        times as likely as insured children to have an unmet dental 
        need.
            (7) Uninsured children are more than 5 times as likely as 
        insured children to have gone more than 2 years without a 
        doctor visit.
            (8) The majority of uninsured children live in two-parent 
        households and almost 90 percent live in families where at 
        least 1 parent works.
            (9) An estimated \2/3\ of children and adolescents with 
        mental health needs are not getting the care they need and only 
        1 in 5 children with serious emotional disturbances receives 
        specialized treatment.
            (10) It costs less to provide health insurance coverage to 
        children than to any other group of people.
            (11) Increases in private health insurance costs are 
        dramatically outpacing increases in wages.
            (12) The United States spending on health care per person 
        is more than twice the average spent in industrialized 
        countries, yet the United States ranks near the bottom among 
        those countries in infant mortality rates.
            (13) Children enrolled in a health coverage program 
        experienced significant improvements in health after just 1 
        year and significant decreases of limitations in their daily 
        activities.
            (14) Enrollment in health insurance has been associated 
        with improvements in school.
            (15) When juvenile offenders arrested for minor offenses 
        had access to intensive and coordinated mental health services, 
        more than a \1/3\ fewer were re-arrested the following year, 
        compared to those who only had access to basic mental health 
        services.
    (d) Purpose.--It is the purpose of this Act to simplify and 
consolidate children's health coverage under Medicaid and SCHIP into a 
single program that guarantees children in all 50 States and the 
District of Columbia all medically necessary services.

SEC. 2. CREATION OF NEW TITLE XXII OF THE SOCIAL SECURITY ACT.

    (a) In General.--The Social Security Act is amended by adding at 
the end the following new title:

               ``TITLE XXII--ALL HEALTHY CHILDREN PROGRAM

``SEC. 2201. ALL HEALTHY CHILDREN PROGRAM.

    ``(a) In General.--There is established under this title a State-
operated program receiving Federal financial assistance to provide 
comprehensive health coverage for children and pregnant and post-partum 
women in place of benefits previously provided for children and 
pregnant and post-partum women under the Medicaid program under title 
XIX and the State Children's Health Insurance Program under title XXI.
    ``(b) State All Healthy Children Plan Required.--A State is not 
eligible for payment under section 2204 unless the State has submitted 
to the Secretary under section 2202 a plan that--
            ``(1) sets forth how the State intends to use the funds 
        provided under this title to provide all healthy children 
        assistance to uninsured children and pregnant and post-partum 
        women consistent with the provisions of this title, and
            ``(2) has been approved under section 2202.
    ``(c) State and Individual Entitlement.--This title constitutes 
budget authority in advance of appropriations Acts and represents the 
obligation of the Federal Government to provide for the payment to 
States of amounts provided under section 2204. Each individual who is 
an all healthy children eligible individual and who qualifies for 
benefits under this title has an entitlement to such benefits in 
accordance with this title.
    ``(d) Rule of Construction.--In construing the meaning, scope, and 
enforceability of the legal entitlement to assistance created by this 
title, it is the intent of Congress that existing judicial and other 
precedents or controlling law in effect on the date of enactment of 
this title relating to the construction of the meaning, scope, and 
enforceability of the legal entitlement of children and other 
individuals entitled to medical assistance under title XIX shall apply 
to the construction of the meaning, scope, and enforceability of the 
legal entitlement of individuals to all healthy children assistance 
under this title.
    ``(e) Private Right of Action.--
            ``(1) In general.--Any person aggrieved by a violation of 
        this title or a failure of an individual or entity, including a 
        State or Federal agency, to comply with the provisions of this 
        title, including any regulation promulgated pursuant to this 
        title, may bring a civil action in any Federal district court, 
        regardless of amount in controversy, or State court of 
        competent jurisdiction to enforce such person's rights.
            ``(2) No exclusion of other remedies.--The availability of 
        a private right of action under this subsection shall not be 
        construed to preclude the ability of any person aggrieved to 
        obtain relief for a violation of this title or a failure of an 
        individual or entity to comply with the provision of this 
        title, or any regulations promulgated pursuant to this title, 
        under any other applicable statute or other basis for relief.
            ``(3) Relief.--In an action under this subsection, the 
        court may award all relief allowed by law, including but not 
        limited to compensatory and exemplary damages and injunctive 
        relief, and attorneys' fees and court costs.
            ``(4) Person aggrieved defined.--In this subsection, the 
        term `person aggrieved' includes a child or individual entitled 
        to benefits under this title, the parent or guardian of such 
        child, a provider of services to children or other individuals 
        entitled to such benefits, or an association or other entity 
        whose mission is to ensure that children or pregnant and post-
        partum women receive adequate health care services.
    ``(f) Effective Date.--No State is eligible for payments under 
section 2204 for all healthy children assistance for coverage provided 
for periods beginning before October 1, 2008.

``SEC. 2202. GENERAL CONTENTS OF STATE ALL HEALTHY CHILDREN PLAN; 
              ELIGIBILITY; ENROLLMENT.

    ``(a) General Contents.--A State all healthy children plan shall 
include a description, consistent with the requirements of this title, 
of--
            ``(1) the all healthy children assistance provided under 
        the plan for all healthy children eligible individuals, 
        including the proposed methods of delivery and utilization 
        control systems;
            ``(2) eligibility standards consistent with subsection (b);
            ``(3) enrollment and outreach activities consistent with 
        subsection (c); and
            ``(4) methods (including monitoring) used--
                    ``(A) to assure the quality and appropriateness of 
                care, particularly with respect to pre-natal care, 
                well-baby care, well-child care, and immunizations 
                provided under the plan, and
                    ``(B) to assure access to all medically necessary 
                health care services, including emergency services.
    ``(b) Eligibility Standards and Methodology.--
            ``(1) In general.--The all healthy children plan for a 
        State shall provide that all of the following are all healthy 
        children eligible individuals if they are residents:
                    ``(A) Full subsidy individuals.--
                            ``(i) All children under age 19 whose 
                        family income does not exceed 300 percent of 
                        the poverty line (as defined in section 
                        2110(c)(5)).
                            ``(ii) All pregnant and post-partum women 
                        whose family income does not exceed 300 percent 
                        of the poverty line.
                            ``(iii) All children under age 19 and 
                        pregnant and post-partum women who would have 
                        qualified for medical assistance under title 
                        XIX (as applied in the State as of October 1, 
                        2005).
                            ``(iv) All children who meet the 
                        requirements of subparagraphs (A) and (B) of 
                        section 1905(w)(1) (relating to independent 
                        foster care adolescents).
                    ``(B) Transitional assistance.--An individual who 
                loses eligibility as an individual described in 
                subparagraph (A) because of an increase in family 
                income, but only during the 3-month period beginning 
                with the first month in which such eligibility is lost. 
                Cost-sharing for transition coverage may not exceed the 
                amounts the State plan charged for such individual 
                before receiving transitional assistance.
                    ``(C) Buy-in eligible individuals.--Individuals 
                who, but for the amount of family income, would be an 
                individual described in subparagraph (A) and who are 
                not described in subparagraph (B) if they meet such 
                terms and conditions as the Secretary determines 
                appropriate.
            ``(2) Residency requirement.--For purposes of this title, 
        an individual is a resident of a State if the individual is 
        present in the State with intent to remain, and includes any 
        individual who would be treated as such a resident under title 
        XIX (as in effect as of January 1, 2007).
            ``(3) Post-partum woman defined.--In this title, the term 
        `post-partum woman' means a woman during the period beginning 
        on the date of completion of pregnancy and ending on the last 
        day of the first month that ends at least 60 days after such 
        date.
            ``(4) Income methodology.--The methodology for determining 
        income under a State all healthy children plan shall not be 
        more restrictive than the income methodology described in 
        section 1931(b)(1)(B), to the extent such methodology is 
        consistent with the requirements of section 1902(a)(17).
            ``(5) No asset test.--The State plan may not impose any 
        asset or resource test for eligibility.
            ``(6) Construction.--Nothing in this title shall be 
        construed as preventing a State from covering individuals (such 
        as individuals who are 19 or 20 years of age) who are not all 
        healthy children eligible individuals under title XIX.
            ``(7) Exclusion of public benefit definition.--The benefits 
        provided under this title shall not be deemed to constitute a 
        Federal or State public benefit within the meaning of title IV 
        of the Personal Responsibility and Work Opportunity 
        Reconciliation Act of 1996 (Public Law 104-193) nor shall any 
        documentation of citizenship be required for the purpose of 
        securing benefits under this title.
            ``(8) Special rules for territories.--In the case of States 
        that are not one of the 50 states or the District of Columbia, 
        the Secretary may, by regulation, adjust the income eligibility 
        levels set forth in this title, taking into account factors 
        such as average income, costs of living, and availability of 
        health care coverage in a manner that assures equitable access 
        to health coverage for children and pregnant and post-partum 
        women residing in such States.
    ``(c) Enrollment.--
            ``(1) Streamlined enrollment system.--Each State plan shall 
        provide for a system of streamlined enrollment that includes 
        the following (as specified by the Secretary):
                    ``(A) A simple, short application form translated 
                into multiple languages.
                    ``(B) Applicant self-attestation of eligibility, 
                subject to verification, random audits, or both.
                    ``(C) The option for applications to be submitted 
                in-person, on-line, by mail, or as part of applications 
                for other programs.
                    ``(D) Automatic enrollment, as provided under 
                paragraph (2).
                    ``(E) 12-month continuous eligibility for children.
                    ``(F) Presumptive eligibility during an interim 
                period of coverage for individuals who appear to 
                qualify for assistance under this title, on the basis 
                of preliminary information.
                    ``(G) A determination of continued eligibility at 
                the end of an individual's eligibility period, based on 
                all data available to the State. If such determination 
                cannot be made, the individual or family shall be 
                contacted for additional information, but only to the 
                extent such information is not available to State 
                officials from other sources. The family shall be 
                notified of all determinations and findings and given 
                an opportunity to contest and appeal them. An 
                individual's eligibility shall continue until the 
                redetermination process is complete.
            ``(2) Automatic enrollment procedures.--
                    ``(A) In general.--The automatic enrollment 
                procedures under this paragraph shall include 
                enrollment of any all healthy children eligible 
                individual at the following points, unless the 
                individual (or parent or guardian on the individual's 
                behalf) affirmatively declines such enrollment:
                            ``(i) Unless the individual otherwise 
                        establishes enrollment in health benefits plan 
                        or coverage, at the point of a final 
                        determination--
                                    ``(I) of individual's eligibility 
                                to participate in any federally-funded, 
                                means-tested program, regardless of any 
                                differences between the program's 
                                eligibility or income methodology and 
                                those otherwise used under this title, 
                                or
                                    ``(II) that, based on the income 
                                determinations made as part of such 
                                eligibility determination, the 
                                individual is eligible to participate 
                                under this title.
                            ``(ii) Birth of a child in the United 
                        States.
                            ``(iii) Assignment of a social security 
                        account number for a child.
                            ``(iv) A visit with any health care 
                        provider eligible to participate in the program 
                        established under this title.
                            ``(v) Enrollment in any public elementary 
                        or secondary school within the State or any 
                        other elementary or secondary school subject to 
                        mandatory immunization requirements.
                            ``(vi) Enrollment in a publicly-subsidized 
                        child care program.
                            ``(vii) Upon discharge of a child from a 
                        public institution or other institution where 
                        the child has been confined.
                            ``(viii) Such other points of enrollment as 
                        the State or Secretary may establish.
                For purposes of this subparagraph, the term `federally-
                funded, means-tested program' includes the National 
                School Lunch Program under the Richard B. Russell 
                National School Lunch Act (42 U.S.C. 1751 et seq.), the 
                Food Stamp Program under the Food Stamp Act of 1977, 
                the special supplemental nutrition program for women, 
                infants, and children (WIC) under section 17 of the 
                Child Nutrition Act of 1966 (42 U.S.C. 1786), 
                subsidized child care under the Child Care Development 
                Block Grant Act of 1990 (42 U.S.C. 9858 et seq.), 
                programs carried out under the Head Start Act (42 
                U.S.C. 9831 et seq.), and other means-tested programs 
                designated by the Secretary.
                    ``(B) Operation of automatic enrollment.--
                            ``(i) In general.--In the case of automatic 
                        enrollment under subparagraph (A)--
                                    ``(I) the enrolled individual (or 
                                parents or guardians of such 
                                individual) shall be advised of the 
                                level of premiums and cost-sharing 
                                applicable consistent with section 2203 
                                and the fact that enrollment is 
                                conditioned upon payment of any 
                                applicable premiums; and
                                    ``(II) the failure to pay any 
                                initial applicable premiums shall be 
                                treated as an affirmative rejection of 
                                coverage.
                            ``(ii) Notice.--The State plan shall 
                        implement effective procedures, consistent with 
                        the Secretary's guidelines, for ensuring that--
                                    ``(I) auto-enrolled individuals (or 
                                their parents or guardians) understand 
                                their right to decline the coverage 
                                made available through auto-enrollment; 
                                and
                                    ``(II) after enrollment, they 
                                receive confirmation of coverage and 
                                information on benefits.
                            ``(iii) Equal treatment.--A State plan 
                        shall implement effective procedures to ensure 
                        that individuals covered through auto-
                        enrollment do not receive fewer services, on 
                        average, than do similar individuals enrolled 
                        through other means.
                            ``(iv) Information sharing.--Each State 
                        shall develop the information technology 
                        infrastructure needed for automated 
                        transmission and analysis of data involving 
                        means-tested programs referred to in 
                        subparagraph (A) and other sources of data 
                        pertinent to eligibility under this title, 
                        including State and Federal income tax records 
                        and information contained in the National 
                        Directory of New Hires. Consistent with 
                        standards developed by the Secretary, the State 
                        shall implement effective safeguards that 
                        protect the confidentiality of such data and 
                        limit its use to the effective administration 
                        of this title, including an identification of 
                        potentially eligible individuals not enrolled 
                        in the State plan as well as eligibility 
                        verification.
            ``(3) Outreach.--Each State plan shall provide for a system 
        for culturally and linguistically competent outreach to 
        families of potentially eligible individuals, which shall--
                    ``(A) be fully accessible to those whose ability to 
                communicate is affected by disability; and
                    ``(B) incorporate proactive communication (via 
                telephone or in-person visits) to such families, 
                consumer education, a preliminary or final eligibility 
                determination, and enrollment completed within a single 
                encounter, whenever possible, and proactive follow-up, 
                when necessary.
    ``(d) Avoiding Crowd-Out and Coordination With Other Health 
Coverage Programs.--
            ``(1) In general.--The State plan shall include a 
        description of procedures, consistent with this subsection, to 
        be used to ensure--
                    ``(A) that benefits provided under the State all 
                healthy children plan do not substitute for coverage 
                under group health plans;
                    ``(B) the provision of all healthy children 
                assistance to all healthy children eligible individuals 
                in the State who are Indians (as defined in section 
                4(c) of the Indian Health Care Improvement Act, 25 
                U.S.C. 1603(c)); and
                    ``(C) coordination with other public and private 
                programs providing creditable coverage for low-income 
                children and pregnant and post-partum women.
            ``(2) Group health plan coverage permitted.--
        Notwithstanding paragraph (1)(A), a State plan may not deny 
        enrollment under this title in the case of any of the following 
        individuals or circumstances:
                    ``(A) The individual would have qualified for 
                medical assistance under title XIX under State law as 
                in effect on October 1, 2005.
                    ``(B) The individual has family income that does 
                not exceed 150 percent of the poverty line.
                    ``(C) The individual's enrollment under a group 
                health plan--
                            ``(i) ended more than four months before 
                        applying for enrollment under this title; or
                            ``(ii) was involuntarily terminated because 
                        of the death of a parent, job loss, or other 
                        circumstance.
                    ``(D) Other than for the subsidies described in 
                section 2203(b)(2)(B) (in the case of all healthy 
                children eligible individuals with family income that 
                exceeds 300 percent of the poverty line), the failure 
                of a parent or other individual (other than the 
                enrollee) to enroll the all healthy children eligible 
                individual in an available group health plan.
            ``(3) Supplemental coverage.--
                    ``(A) In general.--In the case of an all healthy 
                children eligible individual who is enrolled in a group 
                health plan, the State plan--
                            ``(i) must provide full supplemental 
                        coverage (described in subparagraph (B)) if--
                                    ``(I) the individual would have 
                                qualified for supplemental coverage 
                                under title XIX under State law as in 
                                effect on October 1, 2005; or
                                    ``(II) the individual is disabled 
                                (as defined for purposes of the 
                                supplemental security income program 
                                under title XVI); and
                            ``(ii) may provide some or all of such 
                        coverage to other all healthy children eligible 
                        individuals (or to reasonable classifications 
                        of such individuals, as specified under the 
                        State plan).
                    ``(B) Full supplemental coverage described.--Full 
                supplemental coverage described in this subparagraph 
                includes the following:
                            ``(i) Benefits covered by the State plan 
                        that are outside the scope of benefits offered 
                        under the group health plan.
                            ``(ii) Reimbursement of families' premium 
                        payments under the group health plan for all 
                        healthy children eligible individuals so that 
                        costs do not exceed levels otherwise permitted 
                        by the State plan.
                            ``(iii) Coverage of out-of-pocket costs 
                        incurred under the group health plan where such 
                        coverage prevents those costs from exceeding 
                        the levels otherwise permitted under the State 
                        plan.
    ``(e) Assistance for Children Who Age Out of Assistance.--The State 
plan shall provide assistance in obtaining health benefits to 
individuals who lose eligibility under this title because of age.
    ``(f) Emergency Coverage.--When an all healthy children eligible 
individual enrolled in a State plan in one State moves to another State 
because of natural disaster or other reasons, the individual shall 
receive immediate and automatic presumptive eligibility under this 
title in the State to which the individual moves.

``SEC. 2203. BENEFITS; PREMIUMS; COST-SHARING; PROVIDER PAYMENT RATES.

    ``(a) Benefits.--
            ``(1) In general.--The all healthy children assistance 
        under this title shall include benefits for all medically 
        necessary health care, including early and periodic screening, 
        diagnostic, and treatment services (as defined in section 
        1905(r)) consistent with the requirements of section 
        1902(a)(43).
            ``(2) Benefit protections.--The State plan shall provide 
        for all benefit protections for all healthy children eligible 
        individuals that would otherwise have applied under title XIX 
        if such individuals were entitled to medical assistance under 
        such title, including the application of no preexisting 
        exclusion.
    ``(b) Premiums.--Subject to subsection (d)--
            ``(1) No premium for lower-income individuals.--For all 
        healthy children eligible individuals described in subparagraph 
        (A) or (B) of section 2202(b)(1), there shall be no premium 
        imposed for coverage under this title.
            ``(2) Required premiums for buy-in eligible individuals.--
                    ``(A) In general.--Except as provided in this 
                paragraph, in the case of all healthy children eligible 
                individuals described in section 2202(b)(1)(C), the 
                premium for coverage under this title shall be the 
                applicable percentage specified in subparagraph (D) of 
                such premium (as estimated under a methodology 
                specified by the Secretary) as is equal to the full 
                average per capita cost of benefits for all healthy 
                children eligible individuals under the State all 
                healthy children plan.
                    ``(B) Aggregate limit.--
                            ``(i) In general.--Subject to clause (ii), 
                        in no case shall the premium for coverage under 
                        this title exceed (taking into account any 
                        private coverage in which the all healthy 
                        children eligible individual is enrolled as 
                        well as supplemental coverage purchased under 
                        this title)--
                                    ``(I) 5 percent of the family 
                                income; or
                                    ``(II) in the case of multiple 
                                eligible individuals within the same 
                                family, 10 percent of family income.
                            ``(ii) Limitation.--Clause (i) shall not 
                        apply for an all healthy children eligible 
                        individual in a family if--
                                    ``(I) the individual could be 
                                covered under a group health plan for 
                                which the employer (or other plan 
                                sponsor) provides for payment of at 
                                least 50 percent of the premium for 
                                coverage of such individual; and
                                    ``(II) the individual is not so 
                                covered because of a rejection of such 
                                coverage option.
                    ``(C) Optional subsidies.--A State plan may reduce 
                premiums otherwise imposed for reasonable 
                classifications of all healthy children eligible 
                individuals described in section 2202(b)(1)(C). Such 
                classifications may include--
                            ``(i) all healthy children eligible 
                        individuals with family income within specific 
                        income ranges;
                            ``(ii) all healthy children eligible 
                        individuals with special health care needs; and
                            ``(iii) all healthy children eligible 
                        individuals who could have qualified for 
                        medical assistance under an optional 
                        eligibility category under title XIX (as in 
                        effect as of January 1, 2007).
                    ``(D) Applicable percentage specified.--For 
                purposes of subparagraph (A)(i), with respect to all 
                healthy children eligible individuals described in 
                section 2202(b)(1)(C), the applicable percentage 
                specified in this subparagraph is as follows:
                            ``(i) In the case of such all healthy 
                        children eligible individuals whose income 
                        exceeds 300, but does not exceed 320 percent of 
                        the poverty line, 25 percent.
                            ``(ii) In the case of such all healthy 
                        children eligible individuals whose income 
                        exceeds 320, but does not exceed 340 percent of 
                        the poverty line, 35 percent.
                            ``(iii) In the case of such all healthy 
                        children eligible individuals whose income 
                        exceeds 340, but does not exceed 360 percent of 
                        the poverty line, 45 percent.
                            ``(iv) In the case of such all healthy 
                        children eligible individuals whose income 
                        exceeds 360, but does not exceed 380 percent of 
                        the poverty line, 55 percent.
                            ``(v) In the case of such all healthy 
                        children eligible individuals whose income 
                        exceeds 380, but does not exceed 400 percent of 
                        the poverty line, 65 percent.
                            ``(vi) In the case of such all healthy 
                        children eligible individuals whose income 
                        exceeds 400, but does not exceed 425 percent of 
                        the poverty line, 80 percent.
                            ``(vii) In the case of such all healthy 
                        children eligible individuals whose income 
                        exceeds 425, but does not exceed 450 percent of 
                        the poverty line, 90 percent.
                            ``(viii) In the case of such all healthy 
                        children eligible individuals whose income 
                        exceeds 450 percent of the poverty line, 100 
                        percent.
            ``(3) Premium payments.--
                    ``(A) In general.--The State all healthy children 
                plan shall provide effective measures, consistent with 
                standards established by the Secretary, to make premium 
                payment simple and convenient to parents (or other 
                payers) and to preserve continuity of coverage. Such 
                measures shall include--
                            ``(i) discounts to encourage the payment of 
                        quarterly or annual premiums in advance;
                            ``(ii) options to make premium payments 
                        automatically by credit card, debit account 
                        payments, electronic fund transfers, payroll 
                        withholding, or otherwise; and
                            ``(iii) payment opportunities at multiple, 
                        convenient community locations.
                    ``(B) Promoting continuity of coverage.--In the 
                case of all healthy children eligible individuals for 
                whom premium payments are required under the State 
                plan, the plan shall have effective procedures to 
                prevent premium non-payment from interrupting 
                continuity of coverage. If there is a default on 
                premium payments, the State plan shall provide 
                reasonable opportunities to cure such default, 
                including at least a 60-day period, following notice of 
                default, during which overdue premium payments may be 
                made without interrupting coverage or incurring 
                interest charges, late fees, or other costs.
    ``(c) Cost-Sharing.--
            ``(1) Limitations.--Subject to subsection (d), for all 
        healthy children eligible individuals with a family income 
        that--
                    ``(A) does not exceed 200 percent of the poverty 
                line, there shall be no out-of-pocket cost-sharing 
                imposed;
                    ``(B) does exceed 200 percent, but does not exceed 
                300 percent, of the poverty line, only nominal out-of-
                pocket cost-sharing may be imposed; or
                    ``(C) exceeds 300 percent of the poverty line, out-
                of-pocket cost-sharing charged may not exceed levels 
                the Secretary finds to be consistent with charges under 
                employer-based health insurance for the majority of 
                employees enrolled in such coverage nationally.
        In no case shall an all healthy children eligible individual 
        described in subparagraph (A) or (B) of section 2202(b)(1) be 
        denied services under this title because of failure to pay out-
        of-pocket cost-sharing.
            ``(2) Waiver.--A state may elect to waive or reduce out-of-
        pocket cost-sharing otherwise authorized under this subsection.
    ``(d) Limitations on Out-of-Pocket Costs.--
            ``(1) Current medicaid.--For each all healthy children 
        eligible individual, premiums and out-of-pocket cost-sharing 
        may not exceed the levels that would have been charged for that 
        individual under State Medicaid and SCHIP law as of October 1, 
        2005, updated in a manner specified by the Secretary based on 
        changes, after that date, to average earnings among families 
        with incomes that do not exceed 200 percent of the poverty 
        line.
            ``(2) Affordability.--The State plan shall provide 
        effective measures, consistent with standards established by 
        the Secretary, to further limit out-of-pocket cost-sharing 
        (taking into account all premiums and cost-sharing) of all 
        healthy children eligible individuals to affordable levels, for 
        all individual health care services and total family costs. 
        Such measures may include coding of each individual's 
        enrollment card. Such measures may not include a requirement 
        that households track incurred costs.
    ``(e) Choice of Plans.--To the extent feasible, a State plan must 
provide, insofar as the plan provides for benefits through enrollment 
in specific health benefits plans, for each enrollee to have a choice 
of at least two health plan options, consistent with the requirements 
of section 1932.
    ``(f) Reimbursement Rates.--The State shall establish under the 
State plan, in consultation with appropriate child health providers and 
experts--
            ``(1) payment rates for providers that are--
                    ``(A) not less than 80 percent of the average of 
                payment rates for similar services for providers under 
                private health insurance plans within that State; and
                    ``(B) sufficient in amount to ensure that enrolled 
                all healthy children eligible individuals have adequate 
                access to all services covered under this title; and
            ``(2) payments rates to capitated plans that are 
        actuarially sound, based on comprehensive encounter data.

``SEC. 2204. PAYMENTS TO STATES.

    ``(a) Payment.--Subject to the succeeding provisions of this 
section, the Secretary shall pay to each State with a plan approved 
under this title, an amount for each quarter equal to the Federal all 
healthy children matching rate for the State (as determined under 
subsection (b)) of the total expenditures under the plan for the 
quarter, except that the matching rate for the development and 
operation of information technology shall be the same as the Federal 
matching percentage in effect for such technology under subparagraphs 
(A) and (B) of section 1903(a)(3).
    ``(b) Computation of Federal All Healthy Children Matching Rate.--
            ``(1) In general.--Subject to paragraph (3), the Federal 
        all healthy children matching rate under this subsection for a 
        State for a calendar quarter in a fiscal year is equal to the 
        ratio of--
                    ``(A) the total expenditures under the State plan 
                under this title for the quarter that are attributable 
                to required populations and services, less the State 
                share of basic expenditures described in paragraph (2), 
                to
                    ``(B) the total expenditures referred to in 
                subparagraph (A).
            ``(2) State share for basic expenditures.--
                    ``(A) In general.--The State share of expenditures 
                attributable to required populations and services under 
                this title for a quarter in a fiscal year is equal to 
                \1/4\ of the product of the following:
                            ``(i) Base amount.--The base FY 2006 amount 
                        (specified in subparagraph (B) for the State).
                            ``(ii) Child increase factor.--One plus the 
                        percentage increase in the number of children 
                        residing in the State, as estimated by the 
                        Secretary, from fiscal year 2006 to the fiscal 
                        year involved.
                            ``(iii) Cost increase factor.--One plus the 
                        percentage increase in the medical care 
                        component of the consumer price index for all 
                        urban consumers (U.S. city average), as 
                        estimated by the Secretary, from fiscal year 
                        2006 to the fiscal year involved.
                    ``(B) Base fy 2006 amount.--For purposes of this 
                paragraph, the `base FY 2006 amount' for a State is 
                equal to the sum of--
                            ``(i) the total amount of expenditures made 
                        by the State during calendar quarters in fiscal 
                        year 2006 under title XIX (including under any 
                        waiver under section 1115) that are 
                        attributable to coverage of individuals who 
                        meet the requirement to be all healthy children 
                        eligible individuals, including an appropriate 
                        portion of administrative expenses, reduced by 
                        the amount of Federal financial participation 
                        provided with respect to such expenditures; and
                            ``(ii) the total amount of expenditures 
                        made by the State during calendar quarters in 
                        fiscal year 2006 under title XXI (including 
                        under any waiver under section 1115), reduced 
                        by the amount of payment received by the State 
                        under such title for such quarters.
            ``(3) Counter-cyclical reduction.--The Secretary shall 
        establish a formula for providing, in addition to the base 
        Federal matching amounts, automatic supplemental assistance to 
        States that experience a sustained economic downturn, based 
        upon State's quarterly unemployment rate exceeding the State's 
        average of such rates during a period of previous calendar 
        quarters (in such number as the Secretary shall specify) and by 
        a percentage to be determined by the Secretary and in an amount 
        calculated on the basis of the relationship between changes in 
        unemployment and anticipated increases in providing services 
        under this title. The supplemental assistance shall be 
        distributed quarterly through a supplement to the State's 
        Federal payment and shall be for such duration as the Secretary 
        determines appropriate.
    ``(c) Bonus for Meeting Enrollment Targets.--The Secretary is 
authorized to establish a system for providing additional bonus 
payments for States that meet or exceed enrollment targets established 
for each State by the Secretary, taking into account the circumstances 
in each State.
    ``(d) Advance Payment; Retrospective Adjustment.--The Secretary may 
make payments under this section for each quarter on the basis of 
advance estimates of expenditures submitted by the State and such other 
investigation as the Secretary may find necessary, and may reduce or 
increase the payments as necessary to adjust for any overpayment or 
underpayment for prior quarters.
    ``(e) Treatment of Territories.--In the case of States that are not 
one of the 50 States or the District of Columbia, the Secretary shall 
by regulation establish an equitable formula for allocating funds to 
provide services to all healthy children eligible individuals residing 
in such States.

``SEC. 2205. APPLICATION OF SCHIP, MEDICAID, AND RELATED SSA 
              PROVISIONS; WAIVERS; ADMINISTRATION.

    ``(a) SCHIP Provisions Relating to Plan Submission, Strategic 
Objectives and Performance Goals, and Audits.--Except to the extent 
inconsistent with the provisions of this title, sections 2106, 2107, 
and 2108(d) shall apply with respect to State plans under this title in 
the same manner as they applied with respect to State plans under title 
XXI.
    ``(b) Medicaid Provisions.--Except to the extent inconsistent with 
the provisions of this title, the provisions of title XIX (and the 
provisions of title XI, including section 1115, insofar as they are 
applicable to title XIX) shall apply to activities under this title.
    ``(c) Limitation on Waivers.--No waiver shall be granted under 
section 1115 with respect to this title if it is likely to result in--
            ``(1) an increase in health care or health premium costs 
        for all healthy children eligible individuals under this title; 
        or
            ``(2) a reduction in benefits, eligibility, guaranteed 
        eligibility, health care access, or health care quality for 
        such individuals under this title.
    ``(d) Annual Reports.--The Secretary shall present annual reports 
to Congress describing implementation of this title. Such reports shall 
include a description of--
            ``(1) optional coverage chosen by States; and
            ``(2) for each category of coverage and method of 
        enrollment, nationwide and State-specific data showing the 
        number and characteristics of all healthy children eligible 
        individuals receiving coverage, services provided, categories 
        and amounts of expenditures.

``SEC. 2206. DEFINITIONS.

    ``(a) In General.--For purposes of this title:
            ``(1) All healthy children eligible individual.--The term 
        `all healthy children eligible individual' means individuals 
        described in section 2202(b)(1).
            ``(2) All healthy children assistance.--The term `all 
        healthy children assistance' means payment under this title for 
        part or all of the cost of health benefits coverage for all 
        healthy children eligible individual.
            ``(3) Child, group health plan, and poverty line.--The 
        terms `child', `group health plan', and `poverty line' have the 
        meanings given such terms in section 2110(c).
            ``(4) State all healthy children plan; state plan.--The 
        terms `State all healthy children plan' and `State plan' mean 
        such a plan as approved under this title.
            ``(5) State.--The term `State' has the meaning given such 
        term for purposes of titles XIX and XXI.

``SEC. 2207. EFFECTIVE DATES; TRANSITION.

    ``(a) Effective Date.--Benefits and payments to States shall first 
be available under this title for items and services furnished on or 
after October 1, 2008 (in this section referred to as the `All Healthy 
Children Program effective date').
    ``(b) Transition Provisions.--
            ``(1) In general.--Any child under 19 years of age, any 
        pregnant or post-partum woman, or any independent foster care 
        adolescent (as defined in section 1905(w)(1)) who, as of the 
        day before the All Healthy Children Program effective date, is 
        enrolled under title XIX or XXI shall, as of such effective 
        date, automatically qualify for and be enrolled in the State 
        plan under this title, with the benefits based on the family 
        income of the individual as most recently determined for 
        purposes of the title under which the individual was enrolled.
            ``(2) Treatment of schip adults.--In the case of an 
        individual not described in paragraph (1) who, as of the day 
        before the All Healthy Children Program effective date, was 
        enrolled under title XXI through a program waiver, during the 
        remainder of such program waiver period, so long as the 
        individual continues to meet the conditions for eligibility 
        under such program waiver, shall be eligible for medical 
        assistance under the State plan under title XIX and, with 
        respect to medical assistance to such individuals, the enhanced 
        FMAP under title XXI shall be substituted for the Federal 
        medical assistance percentage (FMAP) for purposes of section 
        1903(a)(1).
            ``(3) Guidance.--The Secretary shall provide guidance and 
        assistance to the States in carrying out this section.
    ``(c) Medicaid; SCHIP Transition.--Notwithstanding any other 
provision of law, as of the All Healthy Children Program effective 
date, any all healthy children eligible individual shall not be 
eligible for medical assistance under title XIX or child health 
assistance under title XXI and no Federal financial participation shall 
be available under either such title with respect to such 
individuals.''.

SEC. 3. COMMISSION ON CHILDREN'S HEALTH COVERAGE.

    (a) Establishment.--There is hereby established a Commission on 
Children's Health Coverage (in this section referred to as the 
``Commission'').
    (b) Composition.--
            (1) In general.--The Commission shall be composed of the 
        following:
                    (A) Four members one each appointed by the majority 
                and minority leaders of the House of Representatives 
                and the majority and minority leaders of the Senate.
                    (B) One member appointed by the Secretary of Health 
                and Human Services.
                    (C) Two members one each appointed by the American 
                Academy of Pediatrics and by the Institute of Medicine 
                of the National Academies of Science.
                    (D) One member appointed by the Secretary of Health 
                and Human Services who is a representative of parents 
                of children with special health care needs.
                    (E) One member appointed by the Secretary of Health 
                and Human Services who is a representative of a 
                children's advocacy group.
                    (F) Two non-voting advisory members appointed by 
                the National Governors Association.
        Appointment of members of the Commission shall first be made 
        not later than 60 days after the date of the enactment of this 
        Act.
            (2) Terms.--The term of each member of the Commission shall 
        be for 2 years. A vacancy shall be filled in the same manner as 
        the original appointment but the member so appointed shall 
        serve for the remainder of the term of the vacating member.
            (3) Compensation.--Members of the Commission who are not 
        Federal officers or employees shall be entitled to 
        compensation, including travel time, at a per diem rate 
        equivalent of rate for level IV of Executive Schedule under 
        section 5315 of title 5, United States Code, and for travel 
        expense reimbursement, at rates authorized for employees of 
        agencies under such title.
            (4) Chair.--The Secretary shall designate a member to serve 
        as Chair of the Commission.
            (5) Meetings.--The Commission shall meet at the call of the 
        Chair.
            (6) Use of committees.--The Commission may establish 
        committees if necessary to carry out its duties.
    (c) Supermajority Requirement for Actions.--Commission actions must 
be approved by at least six of the members described in subparagraphs 
(A) through (E) of subsection (b)(1).
    (d) Administration.--
            (1) Powers.--
                    (A) Hearings.--The Commission may hold such 
                hearings, sit and act at such times and places, take 
                such testimony, and receive such evidence as the 
                Commission considers advisable to carry out this 
                section.
                    (B) Information from federal agencies.--The 
                Commission may secure directly from any Federal 
                department or agency such information as the Commission 
                considers necessary to carry out this section. Upon 
                request of the Chairperson of the Commission, the head 
                of such department or agency shall furnish such 
                information to the Commission.
                    (C) Postal services.--The Commission may use the 
                United States mails in the same manner and under the 
                same conditions as other departments and agencies of 
                the Federal Government.
                    (D) Gifts.--The Commission may accept, use, and 
                dispose of gifts or donations of services or property.
            (2) Compensation.--While serving on the business of the 
        Commission (including travel time), a member of the Commission 
        who is not a Federal officer or employee shall be entitled to 
        compensation at the per diem equivalent of the rate provided 
        for level IV of the Executive Schedule under section 5315 of 
        title 5, United States Code, and while so serving away from 
        home and the member's regular place of business, any member may 
        be allowed travel expenses, as authorized by the chairperson of 
        the Commission. All members of the Commission who are officers 
        or employees of the United States shall serve without 
        compensation in addition to that received for their services as 
        officers or employees of the United States.
            (3) Staff.--
                    (A) In general.--The Chair of the Commission may, 
                without regard to the civil service laws and 
                regulations, appoint and terminate an executive 
                director and such other additional personnel as may be 
                necessary to enable the Commission to perform its 
                duties. The employment of an executive director shall 
                be subject to confirmation by the Commission.
                    (B) Staff compensation.--The Chair of the 
                Commission may fix the compensation of the executive 
                director and other personnel without regard to chapter 
                51 and subchapter III of chapter 53 of title 5, United 
                States Code, relating to classification of positions 
                and General Schedule pay rates, except that the rate of 
                pay for the executive director and other personnel may 
                not exceed the rate payable for level V of the 
                Executive Schedule under section 5316 of such title.
                    (C) Detail of government employees.--Any Federal 
                Government employee may be detailed to the Commission 
                without reimbursement, and such detail shall be without 
                interruption or loss of civil service status or 
                privilege.
                    (D) Procurement of temporary and intermittent 
                services.--The Chair of the Commission may procure 
                temporary and intermittent services under section 
                3109(b) of title 5, United States Code, at rates for 
                individuals which do not exceed the daily equivalent of 
                the annual rate of basic pay prescribed for level V of 
                the Executive Schedule under section 5316 of such 
                title.
    (e) Reimbursement of Costs.--The Secretary shall provide, from 
general operating funds of the Department of Health and Human Services, 
the Commission with such funds and support as may be necessary to 
support its activities.
    (f) Annual Reports.--Beginning one year after the All Healthy 
Children Program effective date, the Commission shall transmit to 
Congress an annual report that evaluates the status of children's 
health coverage in the United States, including an evaluation of the 
implementation of title XXII of the Social Security Act and 
recommendations for policy improvements at the State and national 
levels and in the private sector to improve such coverage. Each such 
report shall include an evaluation of the improvements in the quality 
of children's health by assessing outcome measures achieved by 
providers of care, especially at Federally-qualified health centers (as 
defined in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 
1396d(l)(2)(B)).
    (g) Submission of Legislative Proposal for Universal Coverage of 
Children.--Not later than three years after the date of the enactment 
of this Act, the Commission shall submit to Congress a report that 
contains a legislative proposal that would assure health benefits 
coverage for all children in the United States. Such proposal may 
include a requirement that parents obtain coverage for their children 
or that employers fund coverage for children of their workers. The 
proposal shall provide for the following:
            (1) Coverage shall include all medically necessary care for 
        all children.
            (2) Enrollment shall be simple and seamless.
            (3) Unnecessary costs shall be avoided.
            (4) Quality, access and continuity of care shall be 
        promoted.
    (h) Expedited Congressional Consideration of Legislative 
Proposal.--
            (1) Bill introduction.--
                    (A) In general.--Any legislative proposal described 
                in subsection (f) may be introduced as a bill by 
                request in the following manner:
                            (i) House of representatives.--In the House 
                        of Representatives, by the majority leader and 
                        the minority leader not later than 10 days 
                        after receipt of the legislative proposal.
                            (ii) Senate.--In the Senate, by the 
                        majority leader and the minority leader not 
                        later than 10 days after receipt of the 
                        legislative proposal.
                    (B) Alternative by administration.--The President 
                may submit a legislative proposal based on the 
                recommendations of the Commission and such legislative 
                proposal may be introduced in the manner described in 
                subparagraph (A).
            (2) Committee consideration.--
                    (A) In general.--Any legislative proposal submitted 
                pursuant to subparagraph (A) or (B) of paragraph (1) 
                (in this subsection referred to as ``implementing 
                legislation'') shall be referred to the appropriate 
                committees of the House of Representatives and the 
                Senate.
                    (B) Committee reporting.--If, not later than 150 
                days after the date on which the implementing 
                legislation is referred to a committee under 
                subparagraph (A), the committee has reported the 
                implementing legislation or has reported an original 
                bill whose subject is related to universal health 
                benefits coverage of children, or to providing access 
                to affordable health care coverage for all children, 
                the regular rules of the applicable House of Congress 
                shall apply to such legislation.
                    (C) Discharge from committees.--
                            (i) Senate.--
                                    (I) In general.--If the 
                                implementing legislation or an original 
                                bill described in paragraph (1) has not 
                                been reported by a committee of the 
                                Senate within 180 days after the date 
                                on which such legislation was referred 
                                to committee under subparagraph (A), it 
                                shall be in order for any Senator to 
                                move to discharge the committee from 
                                further consideration of such 
                                implementing legislation.
                                    (II) Sequential referrals.--Should 
                                a sequential referral of the 
                                implementing legislation be made, the 
                                additional committee has 30 days for 
                                consideration of implementing 
                                legislation before the discharge motion 
                                described in subclause (I) would be in 
                                order.
                                    (III) Procedure.--The motion 
                                described in subclause (I) shall not be 
                                in order after the implementing 
                                legislation has been placed on the 
                                calendar. While the motion described in 
                                subclause (I) is pending, no other 
                                motions related to the motion described 
                                in subclause (I) shall be in order. 
                                Debate on a motion to discharge shall 
                                be limited to not more than 10 hours, 
                                equally divided and controlled by the 
                                majority leader and the minority 
                                leader, or their designees. An 
                                amendment to the motion shall not be in 
                                order, nor shall it be in order to move 
                                to reconsider the vote by which the 
                                motion is agreed or disagreed to.
                                    (IV) Exception.--If implementing 
                                language is submitted on a date later 
                                than May 1 of the second session of a 
                                Congress, the committee shall have 90 
                                days to consider the implementing 
                                legislation before a motion to 
                                discharge under this clause would be in 
                                order.
                            (ii) House of representatives.--If the 
                        implementing legislation or an original bill 
                        described in paragraph (1) has not been 
                        reported out of a committee of the House of 
                        Representatives within 180 days after the date 
                        on which such legislation was referred to 
                        committee under subparagraph (A), then on any 
                        day on which the call of the calendar for 
                        motions to discharge committees is in order, 
                        any member of the House of Representatives may 
                        move that the committee be discharged from 
                        consideration of the implementing legislation, 
                        and this motion shall be considered under the 
                        same terms and conditions, and if adopted the 
                        House of Representatives shall follow the 
                        procedure described in subparagraph (4)(A).
            (3) Floor consideration.--
                    (A) Motion to proceed.--If a motion to discharge 
                made pursuant to paragraph (3)(B)(ii)(I) or 
                (3)(B)(ii)(II) is adopted, then, not earlier than 5 
                legislative days after the date on which the motion to 
                discharge is adopted, a motion may be made to proceed 
                to the bill.
                    (B) Failure of motion.--If the motion to discharge 
                made pursuant to either such paragraph fails, such 
                motion may be made not more than 2 additional times, 
                but in no case more frequently than within 30 days of 
                the previous motion. Debate on each of such motions 
                shall be limited to 5 hours, equally divided.
                    (C) Applicable rules.--Once the Senate is debating 
                the implementing legislation the regular rules of the 
                Senate shall apply.
                                 <all>
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