II 

Calendar No. 288 

110TH CONGRESS 

1ST SESSION S. 1893 

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

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

IN THE SENATE OF THE UNITED STATES 

JULY 27 (legislative day, JULY 26), 2007 

Mr. BAUCUS, from the Committee on Finance, reported the following original 

bill; which was read twice and placed on the calendar 

A BILL 

To amend title XXI of the Social Security Act to reauthorize 

the State Children’s Health Insurance Program, and for 

other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECU4 RITY ACT; REFERENCES; TABLE OF CON5 TENTS. 

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

7 ‘‘Children’s Health Insurance Program Reauthorization 

8 Act of 2007’’. 


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1 (b) AMENDMENTS TO SOCIAL SECURITY ACT.—Ex2 cept as otherwise specifically provided, whenever in this 

3 Act an amendment is expressed in terms of an amendment 

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

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

6 provision of the Social Security Act. 

7 (c) REFERENCES TO MEDICAID; CHIP; SEC8 RETARY.—In this Act: 

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

10 State Children’s Health Insurance Program estab11 lished under title XXI of the Social Security Act (42 

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

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

14 the program for medical assistance established under 

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

16 et seq.). 

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

18 the Secretary of Health and Human Services. 

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

20 this Act is as follows: 

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

TITLE I—FINANCING OF CHIP 

Sec. 101. Extension of CHIP. 

Sec. 102. Allotments for the 50 States and the District of Columbia. 

Sec. 103. One-time appropriation. 

Sec. 104. Improving funding for the territories under CHIP and Medicaid. 

Sec. 105. Incentive bonuses for States. 

Sec. 106. Phase-out of coverage for nonpregnant childless adults under CHIP; 

conditions for coverage of parents. 


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Sec. 107. State option to cover low-income pregnant women under CHIP 

through a State plan amendment. 

Sec. 108. CHIP Contingency fund. 

Sec. 109. Two-year availability of allotments; expenditures counted against oldest allotments. 

Sec. 110. Limitation on matching rate for States that propose to cover children 

with effective family income that exceeds 300 percent of the 

poverty line. 

Sec. 111. Option for qualifying States to receive the enhanced portion of the 

CHIP matching rate for Medicaid coverage of certain children. 

TITLE II—OUTREACH AND ENROLLMENT 

Sec. 201. Grants for outreach and enrollment. 

Sec. 202. Increased outreach and enrollment of Indians. 

Sec. 203. Demonstration project to permit States to rely on findings by an Express Lane agency to determine components of a child’s eligibility for Medicaid or CHIP. 

Sec. 204. Authorization of certain information disclosures to simplify health 

coverage determinations. 

TITLE III—REDUCING BARRIERS TO ENROLLMENT 

Sec. 301. Verification of declaration of citizenship or nationality for purposes 

of eligibility for Medicaid and CHIP. 

Sec. 302. Reducing administrative barriers to enrollment. 

TITLE IV—REDUCING BARRIERS TO PROVIDING PREMIUM 

ASSISTANCE 

Subtitle A—Additional State Option for Providing Premium Assistance 

Sec. 401. Additional State option for providing premium assistance. 

Sec. 402. Outreach, education, and enrollment assistance. 

Subtitle B—Coordinating Premium Assistance With Private Coverage 

Sec. 411. Special enrollment period under group health plans in case of termination of Medicaid or CHIP coverage or eligibility for assistance in purchase of employment-based coverage; coordination 

of coverage. 

TITLE V—STRENGTHENING QUALITY OF CARE AND HEALTH 

OUTCOMES OF CHILDREN 

Sec. 501. Child health quality improvement activities for children enrolled in 

Medicaid or CHIP. 

Sec. 502. Improved information regarding access to coverage under CHIP. 

Sec. 503. Application of certain managed care quality safeguards to CHIP. 

TITLE VI—MISCELLANEOUS 

Sec. 601. Technical correction regarding current State authority under Medicaid. 

Sec. 602. Payment error rate measurement (‘‘PERM’’). 

Sec. 603. Elimination of counting medicaid child presumptive eligibility costs 

against title XXI allotment. 

Sec. 604. Improving data collection. 


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Sec. 605. Deficit Reduction Act technical corrections. 

Sec. 606. Elimination of confusing program references. 

Sec. 607. Mental health parity in CHIP plans. 

Sec. 608. Dental health grants. 

Sec. 609. Application of prospective payment system for services provided by 

Federally-qualified health centers and rural health clinics. 

TITLE VII—REVENUE PROVISIONS 

Sec. 701. Increase in excise tax rate on tobacco products. 

Sec. 702. Administrative improvements. 

Sec. 703. Time for payment of corporate estimated taxes. 

TITLE VIII—EFFECTIVE DATE 

Sec. 801. Effective date. 

1 TITLE I—FINANCING OF CHIP 

2 SEC. 101. EXTENSION OF CHIP. 

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

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

5 end; 

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

7 the end and inserting a semicolon; and 

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

9 paragraphs: 

10 ‘‘(11) for fiscal year 2008, $9,125,000,000; 

11 ‘‘(12) for fiscal year 2009, $10,675,000,000; 

12 ‘‘(13) for fiscal year 2010, $11,850,000,000; 

13 ‘‘(14) for fiscal year 2011, $13,750,000,000; 

14 and 

15 ‘‘(15) for fiscal year 2012, for purposes of mak16 ing 2 semi-annual allotments— 


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1 ‘‘(A) $1,750,000,000 for the period begin2 ning on October 1, 2011, and ending on March 

3 31, 2012, and 

4 ‘‘(B) $1,750,000,000 for the period begin5 ning on April 1, 2012, and ending on Sep6 tember 30, 2012.’’. 

7 SEC. 102. ALLOTMENTS FOR THE 50 STATES AND THE DIS8 TRICT OF COLUMBIA. 

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

10 is amended by adding at the end the following new sub11 section: 

12 ‘‘(i) DETERMINATION OF ALLOTMENTS FOR THE 50 

13 STATES AND THE DISTRICT OF COLUMBIA FOR FISCAL

14 YEARS 2008 THROUGH 2012.— 

15 ‘‘(1) COMPUTATION OF ALLOTMENT.— 

16 ‘‘(A) IN GENERAL.—Subject to the suc17 ceeding paragraphs of this subsection, the Sec18 retary shall for each of fiscal years 2008 

19 through 2012 allot to each subsection (b) State 

20 from the available national allotment an 

21 amount equal to 110 percent of— 

22 ‘‘(i) in the case of fiscal year 2008, 

23 the highest of the amounts determined 

24 under paragraph (2); 


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1 ‘‘(ii) in the case of each of fiscal years 

2 2009 through 2011, the Federal share of 

3 the expenditures determined under sub4 paragraph (B) for the fiscal year; and 

5 ‘‘(iii) beginning with fiscal year 2012, 

6 subject to subparagraph (E), each semi-an7 nual allotment determined under subpara8 graph (D). 

9 ‘‘(B) PROJECTED STATE EXPENDITURES

10 FOR THE FISCAL YEAR.—For purposes of sub11 paragraphs (A)(ii) and (D), the expenditures 

12 determined under this subparagraph for a fiscal 

13 year are the projected expenditures under the 

14 State child health plan for the fiscal year (as 

15 certified by the State and submitted to the Sec16 retary by not later than August 31 of the pre17 ceding fiscal year). 

18 ‘‘(C) AVAILABLE NATIONAL ALLOT19 MENT.—For purposes of this subsection, the 

20 term ‘available national allotment’ means, with 

21 respect to any fiscal year, the amount available 

22 for allotment under subsection (a) for the fiscal 

23 year, reduced by the amount of the allotments 

24 made for the fiscal year under subsection (c). 

25 Subject to paragraph (3)(B), the available naVerDate Aug 31 2005 03:57 Jul 27, 2007 Jkt 059200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1893.PCS S1893

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1 tional allotment with respect to the amount 

2 available under subsection (a)(15)(A) for fiscal 

3 year 2012 shall be increased by the amount of 

4 the appropriation for the period beginning on 

5 October 1 and ending on March 31 of such fis6 cal year under section 103 of the Children’s 

7 Health Insurance Program Reauthorization Act 

8 of 2007. 

9 ‘‘(D) SEMI-ANNUAL ALLOTMENTS.—For 

10 purposes of subparagraph (A)(iii), the semi-an11 nual allotments determined under this para12 graph with respect to a fiscal year are as fol13 lows: 

14 ‘‘(i) For the period beginning on Oc15 tober 1 and ending on March 31 of the fis16 cal year, the Federal share of the portion 

17 of the expenditures determined under sub18 paragraph (B) for the fiscal year which are 

19 allocable to such period. 

20 ‘‘(ii) For the period beginning on 

21 April 1 and ending on September 30 of the 

22 fiscal year, the Federal share of the por23 tion of the expenditures determined under 

24 subparagraph (B) for the fiscal year which 

25 are allocable to such period. 


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1 ‘‘(E) AVAILABILITY.—Each semi-annual 

2 allotment made under subparagraph (A)(iii) 

3 shall remain available for expenditure under 

4 this title for periods after the period specified 

5 in subparagraph (D) for purposes of deter6 mining the allotment in the same manner as 

7 the allotment would have been available for ex8 penditure if made for an entire fiscal year. 

9 ‘‘(2) SPECIAL RULE FOR FISCAL YEAR 2008.— 

10 ‘‘(A) IN GENERAL.—For purposes of para11 graph (1)(A)(i), the amounts determined under 

12 this paragraph for fiscal year 2008 are as fol13 lows: 

14 ‘‘(i) The total Federal payments to 

15 the State under this title for fiscal year 

16 2007, multiplied by the annual adjustment 

17 determined under subparagraph (B) for 

18 fiscal year 2008. 

19 ‘‘(ii) The Federal share of the amount 

20 allotted to the State for fiscal year 2007 

21 under subsection (b), multiplied by the an22 nual adjustment determined under sub23 paragraph (B) for fiscal year 2008. 

24 ‘‘(iii) Only in the case of— 


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1 ‘‘(I) a State that received a pay2 ment, redistribution, or allotment 

3 under any of paragraphs (1), (2), or 

4 (4) of subsection (h), the amount of 

5 the projected total Federal payments 

6 to the State under this title for fiscal 

7 year 2007, as determined on the basis 

8 of the November 2006 estimates cer9 tified by the State to the Secretary; 

10 ‘‘(II) a State whose projected 

11 total Federal payments to the State 

12 under this title for fiscal year 2007, 

13 as determined on the basis of the May 

14 2006 estimates certified by the State 

15 to the Secretary, were at least 

16 $95,000,000 but not more than 

17 $96,000,000 higher than the projected 

18 total Federal payments to the State 

19 under this title for fiscal year 2007 on 

20 the basis of the November 2006 esti21 mates, the amount of the projected 

22 total Federal payments to the State 

23 under this title for fiscal year 2007 on 

24 the basis of the May 2006 estimates; 

25 or 


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1 ‘‘(III) a State whose projected 

2 total Federal payments under this 

3 title for fiscal year 2007, as deter4 mined on the basis of the November 

5 2006 estimates certified by the State 

6 to the Secretary, exceeded all amounts 

7 available to the State for expenditure 

8 for fiscal year 2007 (including any 

9 amounts paid, allotted, or redistrib10 uted to the State in prior fiscal 

11 years), the amount of the projected 

12 total Federal payments to the State 

13 under this title for fiscal year 2007, 

14 as determined on the basis of the No15 vember 2006 estimates certified by 

16 the State to the Secretary, 

17 multiplied by the annual adjustment deter18 mined under subparagraph (B) for fiscal 

19 year 2008. 

20 ‘‘(iv) The projected total Federal pay21 ments to the State under this title for fis22 cal year 2008, as determined on the basis 

23 of the August 2007 projections certified by 

24 the State to the Secretary by not later 

25 than September 30, 2007. 


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1 ‘‘(B) ANNUAL ADJUSTMENT FOR HEALTH

2 CARE COST GROWTH AND CHILD POPULATION

3 GROWTH.—The annual adjustment determined 

4 under this subparagraph for a fiscal year with 

5 respect to a State is equal to the product of the 

6 amounts determined under clauses (i) and (ii): 

7 ‘‘(i) PER CAPITA HEALTH CARE

8 GROWTH.—1 plus the percentage increase 

9 (if any) in the projected nominal per capita 

10 amount of National Health Expenditures 

11 for the calendar year that begins during 

12 the fiscal year involved over the preceding 

13 calendar year, as most recently published 

14 by the Secretary. 

15 ‘‘(ii) CHILD POPULATION GROWTH.— 

16 1.01 plus the percentage change in the 

17 population of children under 19 years of 

18 age in the State from July 1 of the fiscal 

19 year preceding the fiscal year involved to 

20 July 1 of the fiscal year involved, as deter21 mined by the Secretary based on the most 

22 timely and accurate published estimates of 

23 the Bureau of the Census. 

24 ‘‘(C) DEFINITION.—For purposes of sub25 paragraph (B), the term ‘fiscal year involved’ 


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1 means the fiscal year for which an allotment 

2 under this subsection is being determined. 

3 ‘‘(D) PRORATION RULE.—If, after the ap4 plication of this paragraph without regard to 

5 this subparagraph, the sum of the State allot6 ments determined under this paragraph for fis7 cal year 2008 exceeds the available national al8 lotment for fiscal year 2008, the Secretary shall 

9 reduce each such allotment on a proportional 

10 basis. 

11 ‘‘(3) ALTERNATIVE ALLOTMENTS FOR FISCAL

12 YEARS 2009 THROUGH 2012.— 

13 ‘‘(A) IN GENERAL.—If the sum of the 

14 State allotments determined under paragraph 

15 (1)(A)(ii) for any of fiscal years 2009 through 

16 2011 exceeds the available national allotment 

17 for the fiscal year, the Secretary shall allot to 

18 each subsection (b) State from the available na19 tional allotment for the fiscal year an amount 

20 equal to the product of— 

21 ‘‘(i) the available national allotment 

22 for the fiscal year; and 

23 ‘‘(ii) the percentage equal to the sum 

24 of the State allotment factors for the fiscal 


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1 year determined under paragraph (4) with 

2 respect to the State. 

3 ‘‘(B) SPECIAL RULES BEGINNING IN FIS4 CAL YEAR 2012.—Beginning in fiscal year 

5 2012— 

6 ‘‘(i) this paragraph shall be applied 

7 separately with respect to each of the peri8 ods described in clauses (i) and (ii) of 

9 paragraph (1)(D) and the available na10 tional allotment for each such period shall 

11 be the amount appropriated for such pe12 riod (rather than the amount appropriated 

13 for the entire fiscal year), reduced by the 

14 amount of the allotments made for the fis15 cal year under subsection (c) for each such 

16 period, and 

17 ‘‘(ii) if— 

18 ‘‘(I) the sum of the State allot19 ments determined under paragraph 

20 (1)(A)(iii) for either such period ex21 ceeds the amount of such available 

22 national allotment for such period, the 

23 Secretary shall make the allotment for 

24 each State for such period in the 


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1 same manner as under subparagraph 

2 (A), and 

3 ‘‘(II) the amount of such avail4 able national allotment for either such 

5 period exceeds the sum of the State 

6 allotments determined under para7 graph (1)(A)(iii) for such period, the 

8 Secretary shall increase the allotment 

9 for each State for such period by the 

10 amount that bears the same ratio to 

11 such excess as the State’s allotment 

12 determined under paragraph 

13 (1)(A)(iii) for such period (without re14 gard to this subparagraph) bears to 

15 the sum of such allotments for all 

16 States. 

17 ‘‘(4) WEIGHTED FACTORS.— 

18 ‘‘(A) FACTORS DESCRIBED.—For purposes 

19 of paragraph (3), the factors described in this 

20 subparagraph are the following: 

21 ‘‘(i) PROJECTED STATE EXPENDI22 TURES FOR THE FISCAL YEAR.—The ratio 

23 of the projected expenditures under the 

24 State child health plan for the fiscal year 

25 (as certified by the State to the Secretary 


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1 by not later than August 31 of the pre2 ceding fiscal year) to the sum of the pro3 jected expenditures under all such plans 

4 for all subsection (b) States for the fiscal 

5 year, multiplied by the applicable percent6 age weight assigned under subparagraph 

7 (B). 

8 ‘‘(ii) NUMBER OF LOW-INCOME CHIL9 DREN IN THE STATE.—The ratio of the 

10 number of low-income children in the 

11 State, as determined on the basis of the 

12 most timely and accurate published esti13 mates of the Bureau of the Census, to the 

14 sum of the number of low-income children 

15 so determined for all subsection (b) States 

16 for such fiscal year, multiplied by the ap17 plicable percentage weight assigned under 

18 subparagraph (B). 

19 ‘‘(iii) PROJECTED STATE EXPENDI20 TURES FOR THE PRECEDING FISCAL

21 YEAR.—The ratio of the projected expendi22 tures under the State child health plan for 

23 the preceding fiscal year (as determined on 

24 the basis of the projections certified by the 

25 State to the Secretary for November of the 


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1 fiscal year), to the sum of the projected ex2 penditures under all such plans for all sub3 section (b) States for such preceding fiscal 

4 year (as so determined), multiplied by the 

5 applicable percentage weight assigned 

6 under subparagraph (B). 

7 ‘‘(iv) ACTUAL STATE EXPENDITURES

8 FOR THE SECOND PRECEDING FISCAL

9 YEAR.—The ratio of the actual expendi10 tures under the State child health plan for 

11 the second preceding fiscal year, as deter12 mined by the Secretary on the basis of ex13 penditure data reported by States on CMS 

14 Form 64 or CMS Form 21, to such sum 

15 of the actual expenditures under all such 

16 plans for all subsection (b) States for such 

17 second preceding fiscal year, multiplied by 

18 the applicable percentage weight assigned 

19 under subparagraph (B). 

20 ‘‘(B) ASSIGNMENT OF WEIGHTS.—For 

21 each of fiscal years 2009 through 2012, the ap22 plicable weights assigned under this subpara23 graph are the following: 


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1 ‘‘(i) With respect to the factor de2 scribed in subparagraph (A)(i), a weight of 

3 75 percent for each such fiscal year. 

4 ‘‘(ii) With respect to the factor de5 scribed in subparagraph (A)(ii), a weight 

of 121 6 ⁄2 percent for each such fiscal year. 

7 ‘‘(iii) With respect to the factor de8 scribed in subparagraph (A)(iii), a weight 

of 71 9 ⁄2 percent for each such fiscal year. 

10 ‘‘(iv) With respect to the factor de11 scribed in subparagraph (A)(iv), a weight 

12 of 5 percent for each such fiscal year. 

13 ‘‘(5) DEMONSTRATION OF NEED FOR IN14 CREASED ALLOTMENT BASED ON PROJECTED STATE

15 EXPENDITURES EXCEEDING 10 PERCENT OF THE

16 PRECEDING FISCAL YEAR ALLOTMENT.— 

17 ‘‘(A) IN GENERAL.—If the projected ex18 penditures under the State child health plan de19 scribed in paragraph (1)(B) for any of fiscal 

20 years 2009 through 2012 are at least 10 per21 cent more than the allotment determined for 

22 the State for the preceding fiscal year (deter23 mined without regard to paragraph (2)(D) or 

24 paragraph (3)), and, during the preceding fiscal 

25 year, the State did not receive approval for a 


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1 State plan amendment or waiver to expand cov2 erage under the State child health plan or did 

3 not receive a CHIP contingency fund payment 

4 under subsection (k)— 

5 ‘‘(i) the State shall submit to the Sec6 retary, by not later than August 31 of the 

7 preceding fiscal year, information relating 

8 to the factors that contributed to the need 

9 for the increase in the State’s allotment for 

10 the fiscal year, as well as any other addi11 tional information that the Secretary may 

12 require for the State to demonstrate the 

13 need for the increase in the State’s allot14 ment for the fiscal year; 

15 ‘‘(ii) the Secretary shall— 

16 ‘‘(I) review the information sub17 mitted under clause (i); 

18 ‘‘(II) notify the State in writing 

19 within 60 days after receipt of the in20 formation that— 

21 ‘‘(aa) the projected expendi22 tures under the State child 

23 health plan are approved or dis24 approved (and if disapproved, the 

25 reasons for disapproval); or 


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1 ‘‘(bb) specified additional in2 formation is needed; and 

3 ‘‘(III) if the Secretary dis4 approved the projected expenditures 

5 or determined additional information 

6 is needed, provide the State with a 

7 reasonable opportunity to submit ad8 ditional information to demonstrate 

9 the need for the increase in the 

10 State’s allotment for the fiscal year. 

11 ‘‘(B) PROVISIONAL AND FINAL ALLOT12 MENT.—In the case of a State described in sub13 paragraph (A) for which the Secretary has not 

14 determined by September 30 of a fiscal year 

15 whether the State has demonstrated the need 

16 for the increase in the State’s allotment for the 

17 succeeding fiscal year, the Secretary shall pro18 vide the State with a provisional allotment for 

19 the fiscal year equal to 110 percent of the allot20 ment determined for the State under this sub21 section for the preceding fiscal year (determined 

22 without regard to paragraph (2)(D) or para23 graph (3)), and may, not later than November 

24 30 of the fiscal year, adjust the State’s allot25 ment (and the allotments of other subsection 


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1 (b) States), as necessary (and, if applicable, 

2 subject to paragraph (3)), on the basis of infor3 mation submitted by the State in accordance 

4 with subparagraph (A). 

5 ‘‘(6) SPECIAL RULES.— 

6 ‘‘(A) DEADLINE AND DATA FOR DETER7 MINING FISCAL YEAR 2008 ALLOTMENTS.—In 

8 computing the amounts under paragraph (2)(A) 

9 and subsection (c)(5)(A) that determine the al10 lotments to subsection (b) States and territories 

11 for fiscal year 2008, the Secretary shall use the 

12 most recent data available to the Secretary be13 fore the start of that fiscal year. The Secretary 

14 may adjust such amounts and allotments, as 

15 necessary, on the basis of the expenditure data 

16 for the prior year reported by States on CMS 

17 Form 64 or CMS Form 21 not later than No18 vember 30, 2007, but in no case shall the Sec19 retary adjust the allotments provided under 

20 paragraph (2)(A) or subsection (c)(5)(A) for 

21 fiscal year 2008 after December 31, 2007. 

22 ‘‘(B) INCLUSION OF CERTAIN EXPENDI23 TURES.— 

24 ‘‘(i) PROJECTED EXPENDITURES OF

25 QUALIFYING STATES.—Payments made or 


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1 projected to be made to a qualifying State 

2 described in paragraph (2) of section 

3 2105(g) for expenditures described in 

4 paragraph (1)(B)(ii) or (4)(B) of that sec5 tion shall be included for purposes of de6 termining the projected expenditures de7 scribed in paragraph (1)(B) with respect to 

8 the allotments determined for each of fiscal 

9 years 2009 through 2012 and for purposes 

10 of determining the amounts described in 

11 clauses (i) and (iv) of paragraph (2)(A) 

12 with respect to the allotments determined 

13 for fiscal year 2008. 

14 ‘‘(ii) PROJECTED EXPENDITURES

15 UNDER BLOCK GRANT SET-ASIDES FOR

16 NONPREGNANT CHILDLESS ADULTS AND

17 PARENTS.—Payments projected to be made 

18 to a State under subsection (a) or (b) of 

19 section 2111 shall be included for purposes 

20 of determining the projected expenditures 

21 described in paragraph (1)(B) with respect 

22 to the allotments determined for each of 

23 fiscal years 2009 through 2012 (to the ex24 tent such payments are permitted under 

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1 locating such expenditures for purposes of 

2 clauses (i) and (ii) of paragraph (1)(D). 

3 ‘‘(7) SUBSECTION (b) STATE.—In this para4 graph, the term ‘subsection (b) State’ means 1 of 

5 the 50 States or the District of Columbia.’’. 

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

7 U.S.C. 1397dd) is amended— 

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

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

10 (2) in subsection (b)(1), by striking ‘‘subsection 

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

12 and 

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

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

15 SEC. 103. ONE-TIME APPROPRIATION. 

16 There is appropriated to the Secretary, out of any 

17 money in the Treasury not otherwise appropriated, 

18 $12,500,000,000 to accompany the allotment made for the 

19 period beginning on October 1, 2011, and ending on 

20 March 31, 2012, under section 2104(a)(15)(A) of the So21 cial Security Act (42 U.S.C. 1397dd(a)(15)(A)) (as added 

22 by section 101), to remain available until expended. Such 

23 amount shall be used to provide allotments to States under 

24 subsections (c)(5) and (i) of section 2104 of the Social 

25 Security Act (42 U.S.C. 1397dd) for the first 6 months 


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1 of fiscal year 2012 in the same manner as allotments are 

2 provided under subsection (a)(15)(A) of such section and 

3 subject to the same terms and conditions as apply to the 

4 allotments provided from such subsection (a)(15)(A). 

5 SEC. 104. IMPROVING FUNDING FOR THE TERRITORIES 

6 UNDER CHIP AND MEDICAID. 

7 (a) UPDATE OF CHIP ALLOTMENTS.—Section 

8 2104(c) (42 U.S.C. 1397dd(c)) is amended— 

9 (1) in paragraph (1), by inserting ‘‘and para10 graphs (5) and (6)’’ after ‘‘and (i)’’; and 

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

12 paragraphs: 

13 ‘‘(5) ANNUAL ALLOTMENTS FOR TERRITORIES

14 BEGINNING WITH FISCAL YEAR 2008.—Of the total 

15 allotment amount appropriated under subsection (a) 

16 for a fiscal year beginning with fiscal year 2008, the 

17 Secretary shall allot to each of the commonwealths 

18 and territories described in paragraph (3) the fol19 lowing: 

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

21 2008, the highest amount of Federal payments 

22 to the commonwealth or territory under this 

23 title for any fiscal year occurring during the pe24 riod of fiscal years 1998 through 2007, multi25 plied by the annual adjustment determined 


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1 under subsection (i)(2)(B) for fiscal year 2008, 

2 except that clause (ii) thereof shall be applied 

3 by substituting ‘the United States’ for ‘the 

4 State’. 

5 ‘‘(B) FISCAL YEARS 2009 THROUGH 2012.— 

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

7 years 2009 through 2012, except as pro8 vided in clause (ii), the amount determined 

9 under this paragraph for the preceding fis10 cal year multiplied by the annual adjust11 ment determined under subsection 

12 (i)(2)(B) for the fiscal year, except that 

13 clause (ii) thereof shall be applied by sub14 stituting ‘the United States’ for ‘the 

15 State’. 

16 ‘‘(ii) SPECIAL RULE FOR FISCAL YEAR

17 2012.—In the case of fiscal year 2012— 

18 ‘‘(I) 89 percent of the amount al19 located to the commonwealth or terri20 tory for such fiscal year (without re21 gard to this subclause) shall be allo22 cated for the period beginning on Oc23 tober 1, 2011, and ending on March 

24 31, 2012, and 


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•S 1893 PCS

1 ‘‘(II) 11 percent of such amount 

2 shall be allocated for the period begin3 ning on April 1, 2012, and ending on 

4 September 30, 2012.’’. 

5 (b) REMOVAL OF FEDERAL MATCHING PAYMENTS

6 FOR DATA REPORTING SYSTEMS FROM THE OVERALL

7 LIMIT ON PAYMENTS TO TERRITORIES UNDER TITLE

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

9 by adding at the end the following new paragraph: 

10 ‘‘(4) EXCLUSION OF CERTAIN EXPENDITURES

11 FROM PAYMENT LIMITS.—With respect to fiscal 

12 years beginning with fiscal year 2008, if Puerto 

13 Rico, the Virgin Islands, Guam, the Northern Mar14 iana Islands, or American Samoa qualify for a pay15 ment under subparagraph (A)(i), (B), or (F) of sec16 tion 1903(a)(3) for a calendar quarter of such fiscal 

17 year, the payment shall not be taken into account in 

18 applying subsection (f) (as increased in accordance 

19 with paragraphs (1), (2), and (3) of this subsection) 

20 to such commonwealth or territory for such fiscal 

21 year.’’. 

22 (c) GAO STUDY AND REPORT.—Not later than Sep23 tember 30, 2009, the Comptroller General of the United 

24 States shall submit a report to the appropriate committees 

25 of Congress regarding Federal funding under Medicaid 


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•S 1893 PCS

1 and CHIP for Puerto Rico, the United States Virgin Is2 lands, Guam, American Samoa, and the Northern Mar3 iana Islands. The report shall include the following: 

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

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

8 (B) historical and projected spending needs 

9 of such commonwealths and territories and the 

10 ability of capped funding streams to respond to 

11 those spending needs; 

12 (C) the extent to which Federal poverty 

13 guidelines are used by such commonwealths and 

14 territories to determine Medicaid and CHIP eli15 gibility; and 

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

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

21 the American Community Survey. 

22 (2) Recommendations for improving Federal 

23 funding under Medicaid and CHIP for such com24 monwealths and territories. 


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•S 1893 PCS

1 SEC. 105. INCENTIVE BONUSES FOR STATES. 

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

3 1397dd), as amended by section 102, is amended by add4 ing at the end the following new subsection: 

5 ‘‘(j) INCENTIVE BONUSES.— 

6 ‘‘(1) ESTABLISHMENT OF INCENTIVE POOL

7 FROM UNOBLIGATED NATIONAL ALLOTMENT AND

8 UNEXPENDED STATE ALLOTMENTS.— 

9 ‘‘(A) IN GENERAL.—There is hereby estab10 lished in the Treasury of the United States a 

11 fund which shall be known as the ‘CHIP Incen12 tive Bonuses Pool’ (in this subsection referred 

13 to as the ‘Incentive Pool’). Amounts in the In14 centive Pool are authorized to be appropriated 

15 for payments under this subsection and shall 

16 remain available until expended. 

17 ‘‘(B) DEPOSITS THROUGH INITIAL APPRO18 PRIATION AND TRANSFERS OF FUNDS.— 

19 ‘‘(i) INITIAL APPROPRIATION.—There 

20 is appropriated to the Incentive Pool, out 

21 of any money in the Treasury not other22 wise appropriated, $3,000,000,000 for fis23 cal year 2008. 

24 ‘‘(ii) TRANSFERS.—Notwithstanding 

25 any other provision of law, the following 

26 amounts are hereby appropriated or transVerDate Aug 31 2005 03:57 Jul 27, 2007 Jkt 059200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\S1893.PCS S1893

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•S 1893 PCS

1 ferred to, deposited in, and made available 

2 for expenditure from the Incentive Pool on 

3 the following dates: 

4 ‘‘(I) UNEXPENDED FISCAL YEAR

5 2006 AND 2007 ALLOTMENTS.—On De6 cember 31, 2007, the sum for all 

7 States of the excess (if any) for each 

8 State of— 

9 ‘‘(aa) the aggregate allot10 ments provided for the State 

11 under subsection (b) or (c) for 

12 fiscal years 2006 and 2007 that 

13 are not expended by September 

14 30, 2007, over 

15 ‘‘(bb) an amount equal to 50 

16 percent of the allotment provided 

17 for the State under subsection (c) 

18 or (i) for fiscal year 2008 (as de19 termined in accordance with sub20 section (i)(6)). 

21 ‘‘(II) UNOBLIGATED NATIONAL

22 ALLOTMENT.— 

23 ‘‘(aa) FISCAL YEARS 2008

24 THROUGH 2011.—On December 

25 31 of fiscal year 2008, and on 


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•S 1893 PCS

1 December 31 of each succeeding 

2 fiscal year through fiscal year 

3 2011, the portion, if any, of the 

4 amount appropriated under sub5 section (a) for such fiscal year 

6 that is unobligated for allotment 

7 to a State under subsection (c) or 

8 (i) for such fiscal year or set 

9 aside under subsection (a)(3) or 

10 (b)(2) of section 2111 for such 

11 fiscal year. 

12 ‘‘(bb) FIRST HALF OF FIS13 CAL YEAR 2012.—On December 

14 31 of fiscal year 2012, the por15 tion, if any, of the sum of the 

16 amounts appropriated under sub17 section (a)(15)(A) and under sec18 tion 103 of the Children’s Health 

19 Insurance Program Reauthoriza20 tion Act of 2007 for the period 

21 beginning on October 1, 2011, 

22 and ending on March 31, 2012, 

23 that is unobligated for allotment 

24 to a State under subsection (c) or 

25 (i) for such fiscal year or set 


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•S 1893 PCS

1 aside under subsection (b)(2) of 

2 section 2111 for such fiscal year. 

3 ‘‘(cc) SECOND HALF OF FIS4 CAL YEAR 2012.—On June 30 of 

5 fiscal year 2012, the portion, if 

6 any, of the amount appropriated 

7 under subsection (a)(15)(B) for 

8 the period beginning on April 1, 

9 2012, and ending on September 

10 30, 2012, that is unobligated for 

11 allotment to a State under sub12 section (c) or (i) for such fiscal 

13 year or set aside under sub14 section (b)(2) of section 2111 for 

15 such fiscal year. 

16 ‘‘(III) PERCENTAGE OF STATE

17 ALLOTMENTS THAT ARE UNEX18 PENDED BY THE END OF THE FIRST

19 YEAR OF AVAILABILITY BEGINNING

20 WITH THE FISCAL YEAR 2009 ALLOT21 MENTS.—On October 1 of each of fis22 cal years 2009 through 2012, the sum 

23 for all States for such fiscal year (the 

24 ‘current fiscal year’) of the excess (if 

25 any) for each State of— 


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•S 1893 PCS

1 ‘‘(aa) the allotment made for 

2 the State under subsection (b), 

3 (c), or (i) for the fiscal year pre4 ceding the current fiscal year (re5 duced by any amounts set aside 

6 under section 2111(a)(3)) that is 

7 not expended by the end of such 

8 preceding fiscal year, over 

9 ‘‘(bb) an amount equal to 

10 the applicable percentage (for the 

11 fiscal year) of the allotment made 

12 for the State under subsection 

13 (b), (c), or (i) (as so reduced) for 

14 such preceding fiscal year. 

15 For purposes of item (bb), the appli16 cable percentage is 20 percent for fis17 cal year 2009, and 10 percent for 

18 each of fiscal years 2010, 2011, and 

19 2012. 

20 ‘‘(IV) REMAINDER OF STATE AL21 LOTMENTS THAT ARE UNEXPENDED

22 BY THE END OF THE PERIOD OF

23 AVAILABILITY BEGINNING WITH THE

24 FISCAL YEAR 2006 ALLOTMENTS.—On 

25 October 1 of each of fiscal years 2009 


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1 through 2012, the total amount of al2 lotments made to States under sub3 section (b), (c), or (i) for the second 

4 preceding fiscal year (third preceding 

5 fiscal year in the case of the fiscal 

6 year 2006 allotments) and remaining 

7 after the application of subclause (III) 

8 that are not expended by September 

9 30 of the preceding fiscal year. 

10 ‘‘(V) UNEXPENDED TRANSI11 TIONAL COVERAGE BLOCK GRANT FOR

12 NONPREGNANT CHILDLESS ADULTS.— 

13 On October 1, 2009, any amounts set 

14 aside under section 2111(a)(3) that 

15 are not expended by September 30, 

16 2009. 

17 ‘‘(VI) EXCESS CHIP CONTIN18 GENCY FUNDS.— 

19 ‘‘(aa) AMOUNTS IN EXCESS

20 OF THE AGGREGATE CAP.—On 

21 October 1 of each of fiscal years 

22 2010 through 2012, any amount 

23 in excess of the aggregate cap 

24 applicable to the CHIP ContinVerDate Aug 31 2005 03:57 Jul 27, 2007 Jkt 059200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\S1893.PCS S1893

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•S 1893 PCS

1 gency Fund for the fiscal year 

2 under subsection (k)(2)(B). 

3 ‘‘(bb) UNEXPENDED CHIP

4 CONTINGENCY FUND PAY5 MENTS.—On October 1 of each 

6 of fiscal years 2010 through 

7 2012, any portion of a CHIP 

8 Contingency Fund payment made 

9 to a State that remains unex10 pended at the end of the period 

11 for which the payment is avail12 able for expenditure under sub13 section (e)(3). 

14 ‘‘(VII) EXTENSION OF AVAIL15 ABILITY FOR PORTION OF UNEX16 PENDED STATE ALLOTMENTS.—The 

17 portion of the allotment made to a 

18 State for a fiscal year that is not 

19 transferred to the Incentive Pool 

20 under subclause (I) or (III) shall re21 main available for expenditure by the 

22 State only during the fiscal year in 

23 which such transfer occurs, in accord24 ance with subclause (IV) and sub25 section (e)(4). 


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1 ‘‘(C) INVESTMENT OF FUND.—The Sec2 retary of the Treasury shall invest, in interest 

3 bearing securities of the United States, such 

4 currently available portions of the Incentive 

5 Pool as are not immediately required for pay6 ments from the Pool. The income derived from 

7 these investments constitutes a part of the In8 centive Pool. 

9 ‘‘(2) PAYMENTS TO STATES INCREASING EN10 ROLLMENT.— 

11 ‘‘(A) IN GENERAL.—Subject to paragraph 

12 (3)(D), with respect to each of fiscal years 

13 2009 through 2012, the Secretary shall make 

14 payments to States from the Incentive Pool de15 termined under subparagraph (B). 

16 ‘‘(B) DETERMINATION OF PAYMENTS.—If, 

17 for any coverage period ending in a fiscal year 

18 ending after September 30, 2008, the average 

19 monthly enrollment of children in the State 

20 plan under title XIX exceeds the baseline 

21 monthly average for such period, the payment 

22 made for the fiscal year shall be equal to the 

23 applicable amount determined under subpara24 graph (C). 


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•S 1893 PCS

1 ‘‘(C) APPLICABLE AMOUNT.—For purposes 

2 of subparagraph (B), the applicable amount is 

3 the product determined in accordance with the 

4 following: 

5 ‘‘(i) If such excess with respect to the 

6 number of individuals who are enrolled in 

7 the State plan under title XIX does not ex8 ceed 2 percent, the product of $75 and the 

9 number of such individuals included in 

10 such excess. 

11 ‘‘(ii) If such excess with respect to the 

12 number of individuals who are enrolled in 

13 the State plan under title XIX exceeds 2, 

14 but does not exceed 5 percent, the product 

15 of $300 and the number of such individ16 uals included in such excess, less the 

17 amount of such excess calculated in clause 

18 (i). 

19 ‘‘(iii) If such excess with respect to 

20 the number of individuals who are enrolled 

21 in the State plan under title XIX exceeds 

22 5 percent, the product of $625 and the 

23 number of such individuals included in 

24 such excess, less the sum of the amount of 


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•S 1893 PCS

1 such excess calculated in clauses (i) and 

2 (ii). 

3 ‘‘(D) INDEXING OF DOLLAR AMOUNTS.— 

4 For each coverage period ending in a fiscal year 

5 ending after September 30, 2009, the dollar 

6 amounts specified in subparagraph (C) shall be 

7 increased by the percentage increase (if any) in 

8 the projected nominal per capita amount of Na9 tional Health Expenditures for the calendar 

10 year beginning on January 1 of the coverage 

11 period over the preceding coverage period, as 

12 most recently published by the Secretary before 

13 the beginning of the coverage period involved. 

14 ‘‘(3) RULES RELATING TO ENROLLMENT IN15 CREASES.—For purposes of paragraph (2)(B)— 

16 ‘‘(A) BASELINE MONTHLY AVERAGE.—Ex17 cept as provided in subparagraph (C), the base18 line monthly average for any fiscal year for a 

19 State is equal to— 

20 ‘‘(i) the baseline monthly average for 

21 the preceding fiscal year; multiplied by 

22 ‘‘(ii) the sum of 1 plus the sum of— 

23 ‘‘(I) 0.01; and 

24 ‘‘(II) the percentage increase in 

25 the population of low-income children 


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•S 1893 PCS

1 in the State from the preceding fiscal 

2 year to the fiscal year involved, as de3 termined by the Secretary based on 

4 the most timely and accurate pub5 lished estimates of the Bureau of the 

6 Census before the beginning of the 

7 fiscal year involved. 

8 ‘‘(B) COVERAGE PERIOD.—Except as pro9 vided in subparagraph (C), the coverage period 

10 for any fiscal year consists of the last 2 quar11 ters of the preceding fiscal year and the first 2 

12 quarters of the fiscal year. 

13 ‘‘(C) SPECIAL RULES FOR FISCAL YEAR

14 2009.—With respect to fiscal year 2009— 

15 ‘‘(i) the coverage period for that fiscal 

16 year shall be based on the first 2 quarters 

17 of fiscal year 2009; and 

18 ‘‘(ii) the baseline monthly average 

19 shall be— 

20 ‘‘(I) the average monthly enroll21 ment of low-income children enrolled 

22 in the State’s plan under title XIX for 

23 the first 2 quarters of fiscal year 2007 

24 (as determined over a 6-month period 

25 on the basis of the most recent inforVerDate Aug 31 2005 03:57 Jul 27, 2007 Jkt 059200 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 E:\BILLS\S1893.PCS S1893

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•S 1893 PCS

1 mation reported through the Medicaid 

2 Statistical Information System 

3 (MSIS)); multiplied by 

4 ‘‘(II) the sum of 1 plus the sum 

5 of— 

6 ‘‘(aa) 0.02; and 

7 ‘‘(bb) the percentage in8 crease in the population of low9 income children in the State from 

10 fiscal year 2007 to fiscal year 

11 2009, as determined by the Sec12 retary based on the most timely 

13 and accurate published estimates 

14 of the Bureau of the Census be15 fore the beginning of the fiscal 

16 year involved. 

17 ‘‘(D) ADDITIONAL REQUIREMENT FOR ELI18 GIBILITY FOR PAYMENT.—For purposes of sub19 paragraphs (B) and (C), the average monthly 

20 enrollment shall be determined without regard 

21 to children who do not meet the income eligi22 bility criteria in effect on July 19, 2007, for en23 rollment under the State plan under title XIX 

24 or under a waiver of such plan. 


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•S 1893 PCS

1 ‘‘(4) TIME OF PAYMENT.—Payments under 

2 paragraph (2) for any fiscal year shall be made dur3 ing the last quarter of such year. 

4 ‘‘(5) USE OF PAYMENTS.—Payments made to a 

5 State from the Incentive Pool shall be used for any 

6 purpose that the State determines is likely to reduce 

7 the percentage of low-income children in the State 

8 without health insurance. 

9 ‘‘(6) PRORATION RULE.—If the amount avail10 able for payment from the Incentive Pool is less 

11 than the total amount of payments to be made for 

12 such fiscal year, the Secretary shall reduce the pay13 ments described in paragraph (2) on a proportional 

14 basis. 

15 ‘‘(7) REFERENCES.—With respect to a State 

16 plan under title XIX, any references to a child in 

17 this subsection shall include a reference to any indi18 vidual provided medical assistance under the plan 

19 who has not attained age 19 (or, if a State has so 

20 elected under such State plan, age 20 or 21).’’. 

21 (b) REDISTRIBUTION OF UNEXPENDED FISCAL

22 YEAR 2005 ALLOTMENTS.—Notwithstanding section 

23 2104(f) of the Social Security Act (42 U.S.C. 1397dd(f)), 

24 with respect to fiscal year 2008, the Secretary shall pro25 vide for a redistribution under such section from the allotVerDate Aug 31 2005 03:57 Jul 27, 2007 Jkt 059200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 E:\BILLS\S1893.PCS S1893

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•S 1893 PCS

1 ments for fiscal year 2005 under subsection (b) and (c) 

2 of such section that are not expended by the end of fiscal 

3 year 2007, to each State described in clause (iii) of section 

4 2104(i)(2)(A) of the Social Security Act, as added by sec5 tion 102(a), of an amount that bears the same ratio to 

6 such unexpended fiscal year 2005 allotments as the ratio 

7 of the fiscal year 2007 allotment determined for each such 

8 State under subsection (b) of section 2104 of such Act 

9 for fiscal year 2007 (without regard to any amounts paid, 

10 allotted, or redistributed to the State under section 2104 

11 for any preceding fiscal year) bears to the total amount 

12 of the fiscal year 2007 allotments for all such States (as 

13 so determined). 

14 (c) CONFORMING AMENDMENT ELIMINATING RULES

15 FOR REDISTRIBUTION OF UNEXPENDED ALLOTMENTS

16 FOR FISCAL YEARS AFTER 2005.—Effective January 1, 

17 2008, section 2104(f) (42 U.S.C. 1397dd(f)) is amended 

18 to read as follows: 

19 ‘‘(f) UNALLOCATED PORTION OF NATIONAL ALLOT20 MENT AND UNUSED ALLOTMENTS.—For provisions relat21 ing to the distribution of portions of the unallocated na22 tional allotment under subsection (a) for fiscal years be23 ginning with fiscal year 2008, and unexpended allotments 

24 for fiscal years beginning with fiscal year 2006, see sub25 section (j).’’. 


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•S 1893 PCS

1 (d) ADDITIONAL FUNDING FOR THE SECRETARY TO

2 IMPROVE TIMELINESS OF DATA REPORTING AND ANAL3 YSIS FOR PURPOSES OF DETERMINING ENROLLMENT IN4 CREASES UNDER MEDICAID AND CHIP.— 

5 (1) APPROPRIATION.—There is appropriated, 

6 out of any money in the Treasury not otherwise ap7 propriated, $5,000,000 to the Secretary for fiscal 

8 year 2008 for the purpose of improving the timeli9 ness of the data reported and analyzed from the 

10 Medicaid Statistical Information System (MSIS) for 

11 purposes of carrying out section 2104(j)(2)(B) of 

12 the Social Security Act (as added by subsection (a)) 

13 and to provide guidance to States with respect to 

14 any new reporting requirements related to such im15 provements. Amounts appropriated under this para16 graph shall remain available until expended. 

17 (2) REQUIREMENTS.—The improvements made 

18 by the Secretary under paragraph (1) shall be de19 signed and implemented (including with respect to 

20 any necessary guidance for States) so that, begin21 ning no later than October 1, 2008, data regarding 

22 the enrollment of low-income children (as defined in 

23 section 2110(c)(4) of the Social Security Act (42 

24 U.S.C. 1397jj(c)(4)) of a State enrolled in the State 

25 plan under Medicaid or the State child health plan 


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•S 1893 PCS

1 under CHIP with respect to a fiscal year shall be 

2 collected and analyzed by the Secretary within 6 

3 months of submission. 

4 SEC. 106. PHASE-OUT OF COVERAGE FOR NONPREGNANT 

5 CHILDLESS ADULTS UNDER CHIP; CONDI6 TIONS FOR COVERAGE OF PARENTS. 

7 (a) PHASE-OUT RULES.— 

8 (1) IN GENERAL.—Title XXI (42 U.S.C. 

9 1397aa et seq.) is amended by adding at the end the 

10 following new section: 

11 ‘‘SEC. 2111. PHASE-OUT OF COVERAGE FOR NONPREGNANT 

12 CHILDLESS ADULTS; CONDITIONS FOR COV13 ERAGE OF PARENTS. 

14 ‘‘(a) TERMINATION OF COVERAGE FOR NONPREG15 NANT CHILDLESS ADULTS.— 

16 ‘‘(1) NO NEW CHIP WAIVERS; AUTOMATIC EX17 TENSIONS AT STATE OPTION THROUGH FISCAL YEAR

18 2008.—Notwithstanding section 1115 or any other 

19 provision of this title, except as provided in this sub20 section— 

21 ‘‘(A) the Secretary shall not on or after the 

22 date of the enactment of the Children’s Health 

23 Insurance Program Reauthorization Act of 

24 2007, approve or renew a waiver, experimental, 

25 pilot, or demonstration project that would allow 


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•S 1893 PCS

1 funds made available under this title to be used 

2 to provide child health assistance or other 

3 health benefits coverage to a nonpregnant child4 less adult; and 

5 ‘‘(B) notwithstanding the terms and condi6 tions of an applicable existing waiver, the provi7 sions of paragraphs (2) and (3) shall apply for 

8 purposes of any fiscal year beginning on or 

9 after October 1, 2008, in determining the pe10 riod to which the waiver applies, the individuals 

11 eligible to be covered by the waiver, and the 

12 amount of the Federal payment under this title. 

13 ‘‘(2) TERMINATION OF CHIP COVERAGE UNDER

14 APPLICABLE EXISTING WAIVERS AT THE END OF

15 FISCAL YEAR 2008.— 

16 ‘‘(A) IN GENERAL.—No funds shall be 

17 available under this title for child health assist18 ance or other health benefits coverage that is 

19 provided to a nonpregnant childless adult under 

20 an applicable existing waiver after September 

21 30, 2008. 

22 ‘‘(B) EXTENSION UPON STATE RE23 QUEST.—If an applicable existing waiver de24 scribed in subparagraph (A) would otherwise 

25 expire before October 1, 2008, and the State 


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•S 1893 PCS

1 requests an extension of such waiver, the Sec2 retary shall grant such an extension, but only 

3 through September 30, 2008. 

4 ‘‘(C) APPLICATION OF ENHANCED FMAP.— 

5 The enhanced FMAP determined under section 

6 2105(b) shall apply to expenditures under an 

7 applicable existing waiver for the provision of 

8 child health assistance or other health benefits 

9 coverage to a nonpregnant childless adult dur10 ing fiscal year 2008. 

11 ‘‘(3) OPTIONAL 1-YEAR TRANSITIONAL COV12 ERAGE BLOCK GRANT FUNDED FROM STATE ALLOT13 MENT.—Subject to paragraph (4)(B), each State for 

14 which coverage under an applicable existing waiver 

15 is terminated under paragraph (2)(A) may elect to 

16 provide nonpregnant childless adults who were pro17 vided child health assistance or health benefits cov18 erage under the applicable existing waiver at any 

19 time during fiscal year 2008 with such assistance or 

20 coverage during fiscal year 2009, as if the authority 

21 to provide such assistance or coverage under an ap22 plicable existing waiver was extended through that 

23 fiscal year, but subject to the following terms and 

24 conditions: 


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•S 1893 PCS

1 ‘‘(A) BLOCK GRANT SET ASIDE FROM

2 STATE ALLOTMENT.—The Secretary shall set 

3 aside for the State an amount equal to the Fed4 eral share of the State’s projected expenditures 

5 under the applicable existing waiver for pro6 viding child health assistance or health benefits 

7 coverage to all nonpregnant childless adults 

8 under such waiver for fiscal year 2008 (as cer9 tified by the State and submitted to the Sec10 retary by not later than August 31, 2008, and 

11 without regard to whether any such individual 

12 lost coverage during fiscal year 2008 and was 

13 later provided child health assistance or other 

14 health benefits coverage under the waiver in 

15 that fiscal year), increased by the annual ad16 justment for fiscal year 2009 determined under 

17 section 2104(i)(2)(B)(i). The Secretary may ad18 just the amount set aside under the preceding 

19 sentence, as necessary, on the basis of the ex20 penditure data for fiscal year 2008 reported by 

21 States on CMS Form 64 or CMS Form 21 not 

22 later than November 30, 2008, but in no case 

23 shall the Secretary adjust such amount after 

24 December 31, 2008. 


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•S 1893 PCS

1 ‘‘(B) NO COVERAGE FOR NONPREGNANT

2 CHILDLESS ADULTS WHO WERE NOT COVERED

3 DURING FISCAL YEAR 2008.— 

4 ‘‘(i) FMAP APPLIED TO EXPENDI5 TURES.—The Secretary shall pay the State 

6 for each quarter of fiscal year 2009, from 

7 the amount set aside under subparagraph 

8 (A), an amount equal to the Federal med9 ical assistance percentage (as determined 

10 under section 1905(b) without regard to 

11 clause (4) of such section) of expenditures 

12 in the quarter for providing child health 

13 assistance or other health benefits coverage 

14 to a nonpregnant childless adult but only 

15 if such adult was enrolled in the State pro16 gram under this title during fiscal year 

17 2008 (without regard to whether the indi18 vidual lost coverage during fiscal year 

19 2008 and was reenrolled in that fiscal year 

20 or in fiscal year 2009). 

21 ‘‘(ii) FEDERAL PAYMENTS LIMITED

22 TO AMOUNT OF BLOCK GRANT SET23 ASIDE.—No payments shall be made to a 

24 State for expenditures described in this 

25 subparagraph after the total amount set 


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•S 1893 PCS

1 aside under subparagraph (A) for fiscal 

2 year 2009 has been paid to the State. 

3 ‘‘(4) STATE OPTION TO APPLY FOR MEDICAID

4 WAIVER TO CONTINUE COVERAGE FOR NONPREG5 NANT CHILDLESS ADULTS.— 

6 ‘‘(A) IN GENERAL.—Each State for which 

7 coverage under an applicable existing waiver is 

8 terminated under paragraph (2)(A) may sub9 mit, not later than June 30, 2009, an applica10 tion to the Secretary for a waiver under section 

11 1115 of the State plan under title XIX to pro12 vide medical assistance to a nonpregnant child13 less adult whose coverage is so terminated (in 

14 this subsection referred to as a ‘Medicaid non15 pregnant childless adults waiver’). 

16 ‘‘(B) DEADLINE FOR APPROVAL.—The 

17 Secretary shall make a decision to approve or 

18 deny an application for a Medicaid nonpregnant 

19 childless adults waiver submitted under sub20 paragraph (A) within 90 days of the date of the 

21 submission of the application. If no decision has 

22 been made by the Secretary as of September 

23 30, 2009, on the application of a State for a 

24 Medicaid nonpregnant childless adults waiver 

25 that was submitted to the Secretary by June 


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•S 1893 PCS

1 30, 2009, the application shall be deemed ap2 proved. 

3 ‘‘(C) STANDARD FOR BUDGET NEU4 TRALITY.—The budget neutrality requirement 

5 applicable with respect to expenditures for med6 ical assistance under a Medicaid nonpregnant 

7 childless adults waiver shall— 

8 ‘‘(i) in the case of fiscal year 2010, 

9 allow expenditures for medical assistance 

10 under title XIX for all such adults to not 

11 exceed the total amount of payments made 

12 to the State under paragraph (3)(B) for 

13 fiscal year 2009, increased by the percent14 age increase (if any) in the projected nomi15 nal per capita amount of National Health 

16 Expenditures for calendar year 2010 over 

17 calendar year 2009, as most recently pub18 lished by the Secretary; and 

19 ‘‘(ii) in the case of any succeeding fis20 cal year, allow such expenditures to not ex21 ceed the amount in effect under this sub22 paragraph for the preceding fiscal year, in23 creased by the percentage increase (if any) 

24 in the projected nominal per capita amount 

25 of National Health Expenditures for the 


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1 calendar year that begins during the fiscal 

2 year involved over the preceding calendar 

3 year, as most recently published by the 

4 Secretary. 

5 ‘‘(b) RULES AND CONDITIONS FOR COVERAGE OF

6 PARENTS OF TARGETED LOW-INCOME CHILDREN.— 

7 ‘‘(1) TWO-YEAR TRANSITION PERIOD; AUTO8 MATIC EXTENSION AT STATE OPTION THROUGH FIS9 CAL YEAR 2009.— 

10 ‘‘(A) NO NEW CHIP WAIVERS.—Notwith11 standing section 1115 or any other provision of 

12 this title, except as provided in this sub13 section— 

14 ‘‘(i) the Secretary shall not on or after 

15 the date of the enactment of the Children’s 

16 Health Insurance Program Reauthoriza17 tion Act of 2007 approve or renew a waiv18 er, experimental, pilot, or demonstration 

19 project that would allow funds made avail20 able under this title to be used to provide 

21 child health assistance or other health ben22 efits coverage to a parent of a targeted 

23 low-income child; and 

24 ‘‘(ii) notwithstanding the terms and 

25 conditions of an applicable existing waiver, 


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1 the provisions of paragraphs (2) and (3) 

2 shall apply for purposes of any fiscal year 

3 beginning on or after October 1, 2009, in 

4 determining the period to which the waiver 

5 applies, the individuals eligible to be cov6 ered by the waiver, and the amount of the 

7 Federal payment under this title. 

8 ‘‘(B) EXTENSION UPON STATE RE9 QUEST.—If an applicable existing waiver de10 scribed in subparagraph (A) would otherwise 

11 expire before October 1, 2009, and the State 

12 requests an extension of such waiver, the Sec13 retary shall grant such an extension, but only, 

14 subject to paragraph (2)(A), through Sep15 tember 30, 2009. 

16 ‘‘(C) APPLICATION OF ENHANCED FMAP.— 

17 The enhanced FMAP determined under section 

18 2105(b) shall apply to expenditures under an 

19 applicable existing waiver for the provision of 

20 child health assistance or other health benefits 

21 coverage to a parent of a targeted low-income 

22 child during fiscal years 2008 and 2009. 

23 ‘‘(2) RULES FOR FISCAL YEARS 2010 THROUGH

24 2012.— 


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1 ‘‘(A) PAYMENTS FOR COVERAGE LIMITED

2 TO BLOCK GRANT FUNDED FROM STATE ALLOT3 MENT.—Any State that provides child health 

4 assistance or health benefits coverage under an 

5 applicable existing waiver for a parent of a tar6 geted low-income child may elect to continue to 

7 provide such assistance or coverage through fis8 cal year 2010, 2011, or 2012, subject to the 

9 same terms and conditions that applied under 

10 the applicable existing waiver, unless otherwise 

11 modified in subparagraph (B). 

12 ‘‘(B) TERMS AND CONDITIONS.— 

13 ‘‘(i) BLOCK GRANT SET ASIDE FROM

14 STATE ALLOTMENT.—If the State makes 

15 an election under subparagraph (A), the 

16 Secretary shall set aside for the State for 

17 each such fiscal year an amount equal to 

18 the Federal share of 110 percent of the 

19 State’s projected expenditures under the 

20 applicable existing waiver for providing 

21 child health assistance or health benefits 

22 coverage to all parents of targeted low-in23 come children enrolled under such waiver 

24 for the fiscal year (as certified by the State 

25 and submitted to the Secretary by not 


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1 later than August 31 of the preceding fis2 cal year). In the case of fiscal year 2012, 

3 the set aside for any State shall be com4 puted separately for each period described 

5 in clauses (i) and (ii) of subsection 

6 (i))(1)(D) and any increase or reduction in 

7 the allotment for either such period under 

8 subsection (i)(3)(B)(ii) shall be allocated 

9 on a pro rata basis to such set aside. 

10 ‘‘(ii) PAYMENTS FROM BLOCK

11 GRANT.—The Secretary shall pay the State 

12 from the amount set aside under clause (i) 

13 for the fiscal year, an amount for each 

14 quarter of such fiscal year equal to the ap15 plicable percentage determined under 

16 clause (iii) or (iv) for expenditures in the 

17 quarter for providing child health assist18 ance or other health benefits coverage to a 

19 parent of a targeted low-income child. 

20 ‘‘(iii) ENHANCED FMAP ONLY IN FIS21 CAL YEAR 2010 FOR STATES WITH SIGNIFI22 CANT CHILD OUTREACH OR THAT ACHIEVE

23 CHILD COVERAGE BENCHMARKS; FMAP

24 FOR ANY OTHER STATES.—For purposes 

25 of clause (ii), the applicable percentage for 


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•S 1893 PCS

1 any quarter of fiscal year 2010 is equal 

2 to— 

3 ‘‘(I) the enhanced FMAP deter4 mined under section 2105(b) in the 

5 case of a State that meets the out6 reach or coverage benchmarks de7 scribed in any of subparagraphs (A), 

8 (B), or (C) of paragraph (3) for fiscal 

9 year 2009; or 

10 ‘‘(II) the Federal medical assist11 ance percentage (as determined under 

12 section 1905(b) without regard to 

13 clause (4) of such section) in the case 

14 of any other State. 

15 ‘‘(iv) AMOUNT OF FEDERAL MATCH16 ING PAYMENT IN 2011 OR 2012.—For pur17 poses of clause (ii), the applicable percent18 age for any quarter of fiscal year 2011 or 

19 2012 is equal to— 

20 ‘‘(I) the REMAP percentage if 

21 the State met either of the coverage 

22 benchmarks described in subpara23 graph (B) or (C) of paragraph (3) for 

24 the preceding fiscal year; or 


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•S 1893 PCS

1 ‘‘(II) the Federal medical assist2 ance percentage (as so determined) in 

3 the case of any State to which sub4 clause (I) does not apply. 

5 For purposes of subclause (I), the REMAP 

6 percentage is the percentage which is the 

7 sum of such Federal medical assistance 

8 percentage and a number of percentage 

9 points equal to one-half of the difference 

10 between such Federal medical assistance 

11 percentage and such enhanced FMAP. 

12 ‘‘(v) NO FEDERAL PAYMENTS OTHER

13 THAN FROM BLOCK GRANT SET ASIDE.— 

14 No payments shall be made to a State for 

15 expenditures described in clause (ii) after 

16 the total amount set aside under clause (i) 

17 for a fiscal year has been paid to the 

18 State. 

19 ‘‘(vi) NO INCREASE IN INCOME ELIGI20 BILITY LEVEL FOR PARENTS.—No pay21 ments shall be made to a State from the 

22 amount set aside under clause (i) for a fis23 cal year for expenditures for providing 

24 child health assistance or health benefits 

25 coverage to a parent of a targeted low-inVerDate Aug 31 2005 03:57 Jul 27, 2007 Jkt 059200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\S1893.PCS S1893

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1 come child whose family income exceeds 

2 the income eligibility level applied under 

3 the applicable existing waiver to parents of 

4 targeted low-income children on the date of 

5 enactment of the Children’s Health Insur6 ance Program Reauthorization Act of 

7 2007. 

8 ‘‘(3) OUTREACH OR COVERAGE BENCH9 MARKS.—For purposes of paragraph (2), the out10 reach or coverage benchmarks described in this 

11 paragraph are as follows: 

12 ‘‘(A) SIGNIFICANT CHILD OUTREACH CAM13 PAIGN.—The State— 

14 ‘‘(i) was awarded a grant under sec15 tion 2113 for fiscal year 2009; 

16 ‘‘(ii) implemented 1 or more of the 

17 process measures described in section 

18 2104(j)(3)(A)(i) for such fiscal year; or 

19 ‘‘(iii) has submitted a specific plan for 

20 outreach for such fiscal year. 

21 ‘‘(B) HIGH-PERFORMING STATE.—The 

22 State, on the basis of the most timely and accu23 rate published estimates of the Bureau of the 

Census, ranks in the lowest 1 24 ⁄3 of States in 


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•S 1893 PCS

1 terms of the State’s percentage of low-income 

2 children without health insurance. 

3 ‘‘(C) STATE INCREASING ENROLLMENT OF

4 LOW-INCOME CHILDREN.—The State qualified 

5 for a payment from the Incentive Fund under 

6 paragraph (2)(C) of section 2104(j) for the 

7 most recent coverage period applicable under 

8 such section. 

9 ‘‘(4) RULES OF CONSTRUCTION.—Nothing in 

10 this subsection shall be construed as prohibiting a 

11 State from submitting an application to the Sec12 retary for a waiver under section 1115 of the State 

13 plan under title XIX to provide medical assistance to 

14 a parent of a targeted low-income child that was 

15 provided child health assistance or health benefits 

16 coverage under an applicable existing waiver. 

17 ‘‘(c) APPLICABLE EXISTING WAIVER.—For purposes 

18 of this section— 

19 ‘‘(1) IN GENERAL.—The term ‘applicable exist20 ing waiver’ means a waiver, experimental, pilot, or 

21 demonstration project under section 1115, grand22 fathered under section 6102(c)(3) of the Deficit Re23 duction Act of 2005, or otherwise conducted under 

24 authority that— 


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1 ‘‘(A) would allow funds made available 

2 under this title to be used to provide child 

3 health assistance or other health benefits cov4 erage to— 

5 ‘‘(i) a parent of a targeted low-income 

6 child; 

7 ‘‘(ii) a nonpregnant childless adult; or 

8 ‘‘(iii) individuals described in both 

9 clauses (i) and (ii); and 

10 ‘‘(B) was in effect during fiscal year 2007. 

11 ‘‘(2) DEFINITIONS.— 

12 ‘‘(A) PARENT.—The term ‘parent’ includes 

13 a caretaker relative (as such term is used in 

14 carrying out section 1931) and a legal guard15 ian. 

16 ‘‘(B) NONPREGNANT CHILDLESS ADULT.— 

17 The term ‘nonpregnant childless adult’ has the 

18 meaning given such term by section 2107(f).’’. 

19 (2) CONFORMING AMENDMENTS.— 

20 (A) Section 2107(f) (42 U.S.C. 1397gg(f)) 

21 is amended— 

22 (i) by striking ‘‘, the Secretary’’ and 

23 inserting ‘‘: 

24 ‘‘(1) The Secretary’’; 


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•S 1893 PCS

1 (ii) in the first sentence, by inserting 

2 ‘‘or a parent (as defined in section 

3 2111(c)(2)(A)), who is not pregnant, of a 

4 targeted low-income child’’ before the pe5 riod; 

6 (iii) by striking the second sentence; 

7 and 

8 (iv) by adding at the end the following 

9 new paragraph: 

10 ‘‘(2) The Secretary may not approve, extend, 

11 renew, or amend a waiver, experimental, pilot, or 

12 demonstration project with respect to a State after 

13 the date of enactment of the Children’s Health In14 surance Program Reauthorization Act of 2007 that 

15 would waive or modify the requirements of section 

16 2111.’’. 

17 (B) Section 6102(c) of the Deficit Reduc18 tion Act of 2005 (Public Law 109–171; 120 

19 Stat. 131) is amended by striking ‘‘Nothing’’ 

20 and inserting ‘‘Subject to section 2111 of the 

21 Social Security Act, as added by section 

22 106(a)(1) of the Children’s Health Insurance 

23 Program Reauthorization Act of 2007, noth24 ing’’. 

25 (b) GAO STUDY AND REPORT.— 


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1 (1) IN GENERAL.—The Comptroller General of 

2 the United States shall conduct a study of wheth3 er— 

4 (A) the coverage of a parent, a caretaker 

5 relative (as such term is used in carrying out 

6 section 1931), or a legal guardian of a targeted 

7 low-income child under a State health plan 

8 under title XXI of the Social Security Act in9 creases the enrollment of, or the quality of care 

10 for, children, and 

11 (B) such parents, relatives, and legal 

12 guardians who enroll in such a plan are more 

13 likely to enroll their children in such a plan or 

14 in a State plan under title XIX of such Act. 

15 (2) REPORT.—Not later than 2 years after the 

16 date of the enactment of this Act, the Comptroller 

17 General shall report the results of the study to the 

18 appropriate committees of Congress, including rec19 ommendations (if any) for changes in legislation. 

20 SEC. 107. STATE OPTION TO COVER LOW-INCOME PREG21 NANT WOMEN UNDER CHIP THROUGH A 

22 STATE PLAN AMENDMENT. 

23 (a) IN GENERAL.—Title XXI (42 U.S.C. 1397aa et 

24 seq.), as amended by section 106(a), is amended by adding 

25 at the end the following new section: 


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1 ‘‘SEC. 2112. OPTIONAL COVERAGE OF TARGETED LOW-IN2 COME PREGNANT WOMEN THROUGH A STATE 

3 PLAN AMENDMENT. 

4 ‘‘(a) IN GENERAL.—Subject to the succeeding provi5 sions of this section, a State may elect through an amend6 ment to its State child health plan under section 2102 to 

7 provide pregnancy-related assistance under such plan for 

8 targeted low-income pregnant women. 

9 ‘‘(b) CONDITIONS.—A State may only elect the option 

10 under subsection (a) if the following conditions are satis11 fied: 

12 ‘‘(1) MEDICAID INCOME ELIGIBILITY LEVEL

13 FOR PREGNANT WOMEN OF AT LEAST 185 PERCENT

14 OF POVERTY.—The State has established an income 

15 eligibility level for pregnant women under subsection 

16 (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or (l)(1)(A) of 

17 section 1902 that is at least 185 percent of the in18 come official poverty line. 

19 ‘‘(2) NO CHIP INCOME ELIGIBILITY LEVEL FOR

20 PREGNANT WOMEN LOWER THAN THE STATE’S MED21 ICAID LEVEL.—The State does not apply an effective 

22 income level for pregnant women under the State 

23 plan amendment that is lower than the effective in24 come level (expressed as a percent of the poverty line 

25 and considering applicable income disregards) speci26 fied under subsection (a)(10)(A)(i)(III), 


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•S 1893 PCS

1 (a)(10)(A)(i)(IV), or (l)(1)(A) of section 1902, on 

2 the date of enactment of this paragraph to be eligi3 ble for medical assistance as a pregnant woman. 

4 ‘‘(3) NO COVERAGE FOR HIGHER INCOME PREG5 NANT WOMEN WITHOUT COVERING LOWER INCOME

6 PREGNANT WOMEN.—The State does not provide 

7 coverage for pregnant women with higher family in8 come without covering pregnant women with a lower 

9 family income. 

10 ‘‘(4) APPLICATION OF REQUIREMENTS FOR

11 COVERAGE OF TARGETED LOW-INCOME CHILDREN.— 

12 The State provides pregnancy-related assistance for 

13 targeted low-income pregnant women in the same 

14 manner, and subject to the same requirements, as 

15 the State provides child health assistance for tar16 geted low-income children under the State child 

17 health plan, and in addition to providing child health 

18 assistance for such women. 

19 ‘‘(5) NO PREEXISTING CONDITION EXCLUSION

20 OR WAITING PERIOD.—The State does not apply any 

21 exclusion of benefits for pregnancy-related assistance 

22 based on any preexisting condition or any waiting 

23 period (including any waiting period imposed to 

24 carry out section 2102(b)(3)(C)) for receipt of such 

25 assistance. 


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1 ‘‘(6) APPLICATION OF COST-SHARING PROTEC2 TION.—The State provides pregnancy-related assist3 ance to a targeted low-income woman consistent 

4 with the cost-sharing protections under section 

5 2103(e) and applies the limitation on total annual 

6 aggregate cost sharing imposed under paragraph 

7 (3)(B) of such section to the family of such a 

8 woman. 

9 ‘‘(c) OPTION TO PROVIDE PRESUMPTIVE ELIGI10 BILITY.—A State that elects the option under subsection 

11 (a) and satisfies the conditions described in subsection (b) 

12 may elect to apply section 1920 (relating to presumptive 

13 eligibility for pregnant women) to the State child health 

14 plan in the same manner as such section applies to the 

15 State plan under title XIX. 

16 ‘‘(d) DEFINITIONS.—For purposes of this section: 

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) and includes any medical assistance that 

21 the State would provide for a pregnant woman 

22 under the State plan under title XIX during preg23 nancy and the period described in paragraph (2)(A). 


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1 ‘‘(2) TARGETED LOW-INCOME PREGNANT

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

3 woman’ means a woman— 

4 ‘‘(A) during pregnancy and through the 

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

6 (beginning on the last day of her pregnancy) 

7 ends; 

8 ‘‘(B) whose family income does not exceed 

9 the income eligibility level established under the 

10 State child health plan under this title for a 

11 targeted low-income child; and 

12 ‘‘(C) who satisfies the requirements of 

13 paragraphs (1)(A), (1)(C), (2), and (3) of sec14 tion 2110(b) in the same manner as a child ap15 plying for child health assistance would have to 

16 satisfy such requirements. 

17 ‘‘(e) AUTOMATIC ENROLLMENT FOR CHILDREN

18 BORN TO WOMEN RECEIVING PREGNANCY-RELATED AS19 SISTANCE.—If a child is born to a targeted low-income 

20 pregnant woman who was receiving pregnancy-related as21 sistance under this section on the date of the child’s birth, 

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

23 assistance under the State child health plan and to have 

24 been found eligible for such assistance under such plan 

25 or to have applied for medical assistance under title XIX 


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•S 1893 PCS

1 and to have been found eligible for such assistance under 

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

3 to remain eligible for such assistance until the child at4 tains 1 year of age. During the period in which a child 

5 is deemed under the preceding sentence to be eligible for 

6 child health or medical assistance, the child health or med7 ical assistance eligibility identification number of the 

8 mother shall also serve as the identification number of the 

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

10 such number (unless the State issues a separate identifica11 tion number for the child before such period expires). 

12 ‘‘(f) STATES PROVIDING ASSISTANCE THROUGH

13 OTHER OPTIONS.— 

14 ‘‘(1) CONTINUATION OF OTHER OPTIONS FOR

15 PROVIDING ASSISTANCE.—The option to provide as16 sistance in accordance with the preceding sub17 sections of this section shall not limit any other op18 tion for a State to provide— 

19 ‘‘(A) child health assistance through the 

20 application of sections 457.10, 457.350(b)(2), 

21 457.622(c)(5), and 457.626(a)(3) of title 42, 

22 Code of Federal Regulations (as in effect after 

23 the final rule adopted by the Secretary and set 

24 forth at 67 Fed. Reg. 61956–61974 (October 2, 

25 2002)), or 


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•S 1893 PCS

1 ‘‘(B) pregnancy-related services through 

2 the application of any waiver authority (as in 

3 effect on June 1, 2007). 

4 ‘‘(2) CLARIFICATION OF AUTHORITY TO PRO5 VIDE POSTPARTUM SERVICES.—Any State that pro6 vides child health assistance under any authority de7 scribed in paragraph (1) may continue to provide 

8 such assistance, as well as postpartum services, 

9 through the end of the month in which the 60-day 

10 period (beginning on the last day of the pregnancy) 

11 ends, in the same manner as such assistance and 

12 postpartum services would be provided if provided 

13 under the State plan under title XIX, but only if the 

14 mother would otherwise satisfy the eligibility re15 quirements that apply under the State child health 

16 plan (other than with respect to age) during such 

17 period. 

18 ‘‘(3) NO INFERENCE.—Nothing in this sub19 section shall be construed— 

20 ‘‘(A) to infer congressional intent regard21 ing the legality or illegality of the content of the 

22 sections specified in paragraph (1)(A); or 

23 ‘‘(B) to modify the authority to provide 

24 pregnancy-related services under a waiver speci25 fied in paragraph (1)(B).’’. 


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1 (b) ADDITIONAL CONFORMING AMENDMENTS.— 

2 (1) NO COST SHARING FOR PREGNANCY-RE3 LATED BENEFITS.—Section 2103(e)(2) (42 U.S.C. 

4 1397cc(e)(2)) is amended— 

5 (A) in the heading, by inserting ‘‘OR PREG6 NANCY-RELATED ASSISTANCE’’ after ‘‘PREVEN7 TIVE SERVICES’’; and 

8 (B) by inserting before the period at the 

9 end the following: ‘‘or for pregnancy-related as10 sistance’’. 

11 (2) NO WAITING PERIOD.—Section 

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

13 amended— 

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

15 end and inserting a semicolon; 

16 (B) in clause (ii), by striking the period at 

17 the end and inserting ‘‘; and’’; and 

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

19 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 provided preg24 nancy-related assistance under section 

25 2112.’’. 


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1 SEC. 108. CHIP CONTINGENCY FUND. 

2 Section 2104 (42 U.S.C. 1397dd), as amended by 

3 section 105, is amended by adding at the end the following 

4 new subsection: 

5 ‘‘(k) CHIP CONTINGENCY FUND.— 

6 ‘‘(1) ESTABLISHMENT.—There is hereby estab7 lished in the Treasury of the United States a fund 

8 which shall be known as the ‘CHIP Contingency 

9 Fund’ (in this subsection referred to as the ‘Fund’). 

10 Amounts in the Fund are authorized to be appro11 priated for payments under this subsection. 

12 ‘‘(2) DEPOSITS INTO FUND.— 

13 ‘‘(A) INITIAL AND SUBSEQUENT APPRO14 PRIATIONS.—Subject to subparagraphs (B) and 

15 (E), out of any money in the Treasury of the 

16 United States not otherwise appropriated, there 

17 are appropriated to the Fund— 

18 ‘‘(i) for fiscal year 2009, an amount 

19 equal to 12.5 percent of the available na20 tional allotment under subsection (i)(1)(C) 

21 for the fiscal year; and 

22 ‘‘(ii) for each of fiscal years 2010 

23 through 2012, such sums as are necessary 

24 for making payments to eligible States for 

25 such fiscal year, but not in excess of the 


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•S 1893 PCS

1 aggregate cap described in subparagraph 

2 (B). 

3 ‘‘(B) AGGREGATE CAP.—Subject to sub4 paragraph (E), the total amount available for 

5 payment from the Fund for each of fiscal years 

6 2009 through 2012 (taking into account depos7 its made under subparagraph (C)), shall not ex8 ceed 12.5 percent of the available national allot9 ment under subsection (i)(1)(C) for the fiscal 

10 year. 

11 ‘‘(C) INVESTMENT OF FUND.—The Sec12 retary of the Treasury shall invest, in interest 

13 bearing securities of the United States, such 

14 currently available portions of the Fund as are 

15 not immediately required for payments from the 

16 Fund. The income derived from these invest17 ments constitutes a part of the Fund. 

18 ‘‘(D) TRANSFER OF EXCESS FUNDS TO

19 THE INCENTIVE FUND.—The Secretary of the 

20 Treasury shall transfer to, and deposit in, the 

21 CHIP Incentive Bonuses Pool established under 

22 subsection (j) any amounts in excess of the ag23 gregate cap described in subparagraph (B) for 

24 a fiscal year. 


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1 ‘‘(E) SPECIAL RULES FOR AMOUNTS SET

2 ASIDE FOR PARENTS AND CHILDLESS

3 ADULTS.—For purposes of subparagraphs (A) 

4 and (B)— 

5 ‘‘(i) the available national allotment 

6 under subsection (i)(1)(C) shall be reduced 

7 by any amount set aside under section 

8 2111(a)(3) for block grant payments for 

9 transitional coverage for childless adults; 

10 and 

11 ‘‘(ii) the Secretary shall establish a 

12 separate account in the Fund for the por13 tion of any amount appropriated to the 

14 Fund for any fiscal year which is allocable 

15 to the portion of the available national al16 lotment under subsection (i)(1)(C) which is 

17 set aside for the fiscal year under section 

18 2111(b)(2)(B)(i) for coverage of parents of 

19 low-income children. 

20 The Secretary shall include in the account es21 tablished under clause (ii) any income derived 

22 under subparagraph (C) which is allocable to 

23 amounts in such account. 

24 ‘‘(3) CHIP CONTINGENCY FUND PAYMENTS.— 

25 ‘‘(A) PAYMENTS.— 


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1 ‘‘(i) IN GENERAL.—Subject to clauses 

2 (ii) and (iii) and the succeeding subpara3 graphs of this paragraph, the Secretary 

4 shall pay from the Fund to a State that is 

5 an eligible State for a month of a fiscal 

6 year a CHIP contingency fund payment 

7 equal to the Federal share of the shortfall 

8 determined under subparagraph (D). In 

9 the case of an eligible State under sub10 paragraph (D)(i), the Secretary shall not 

11 make the payment under this subpara12 graph until the State makes, and submits 

13 to the Secretary, a projection of the 

14 amount of the shortfall. 

15 ‘‘(ii) SEPARATE DETERMINATIONS OF

16 SHORTFALLS.—The Secretary shall sepa17 rately compute the shortfall under sub18 paragraph (D) for expenditures for eligible 

19 individuals other than nonpregnant child20 less adults and parents with respect to 

21 whom amounts are set aside under section 

22 2111, for expenditures for such childless 

23 adults, and for expenditures for such par24 ents. 

25 ‘‘(iii) PAYMENTS.— 


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•S 1893 PCS

1 ‘‘(I) NONPREGNANT CHILDLESS

2 ADULTS.—No payments shall be made 

3 from the Fund for nonpregnant child4 less adults with respect to whom 

5 amounts are set aside under section 

6 2111(a)(3). 

7 ‘‘(II) PARENTS.—Any payments 

8 with respect to any shortfall for par9 ents who are paid from amounts set 

10 aside under section 2111(b)(2)(B)(i) 

11 shall be made only from the account 

12 established under paragraph (2)(E)(ii) 

13 and not from any other amounts in 

14 the Fund. No other payments may be 

15 made from such account. 

16 ‘‘(iv) SPECIAL RULES.—Subpara17 graphs (B) and (C) shall be applied sepa18 rately with respect to shortfalls described 

19 in clause (ii). 

20 ‘‘(B) USE OF FUNDS.—Amounts paid to 

21 an eligible State from the Fund shall be used 

22 only to eliminate the Federal share of a short23 fall in the State’s allotment under subsection (i) 

24 for a fiscal year. 


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•S 1893 PCS

1 ‘‘(C) PRORATION RULE.—If the amounts 

2 available for payment from the Fund for a fis3 cal year are less than the total amount of pay4 ments determined under subparagraph (A) for 

5 the fiscal year, the amount to be paid under 

6 such subparagraph to each eligible State shall 

7 be reduced proportionally. 

8 ‘‘(D) ELIGIBLE STATE.— 

9 ‘‘(i) IN GENERAL.—A State is an eli10 gible State for a month if the State is a 

11 subsection (b) State (as defined in sub12 section (i)(7)), the State requests access to 

13 the Fund for the month, and it is de14 scribed in clause (ii) or (iii). 

15 ‘‘(ii) SHORTFALL OF FEDERAL ALLOT16 MENT FUNDING OF NOT MORE THAN 5

17 PERCENT.—The Secretary estimates, on 

18 the basis of the most recent data available 

19 to the Secretary or requested from the 

20 State by the Secretary, that the State’s al21 lotment for the fiscal year is at least 95 

22 percent, but less than 100 percent, of the 

23 projected expenditures under the State 

24 child health plan for the State for the fis25 cal year determined under subsection (i) 


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•S 1893 PCS

1 (without regard to incentive bonuses or 

2 payments for which the State is eligible for 

3 under subsection (j)(2) for the fiscal year). 

4 ‘‘(iii) SHORTFALL OF FEDERAL AL5 LOTMENT FUNDING OF MORE THAN 5 PER6 CENT CAUSED BY SPECIFIC EVENTS.—The 

7 Secretary estimates, on the basis of the 

8 most recent data available to the Secretary 

9 or requested from the State by the Sec10 retary, that the State’s allotment for the 

11 fiscal year is less than 95 percent of the 

12 projected expenditures under the State 

13 child health plan for the State for the fis14 cal year determined under subsection (i) 

15 (without regard to incentive bonuses or 

16 payments for which the State is eligible for 

17 under subsection (j)(2) for the fiscal year) 

18 and that such shortfall is attributable to 1 

19 or more of the following events: 

20 ‘‘(I) STAFFORD ACT OR PUBLIC

21 HEALTH EMERGENCY.—The State 

22 has— 

23 ‘‘(aa) 1 or more parishes or 

24 counties for which a major dis25 aster has been declared in acVerDate Aug 31 2005 03:57 Jul 27, 2007 Jkt 059200 PO 00000 Frm 00073 Fmt 6652 Sfmt 6201 E:\BILLS\S1893.PCS S1893

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1 cordance with section 401 of the 

2 Robert T. Stafford Disaster Re3 lief and Emergency Assistance 

4 Act (42 U.S.C. 5170) and which 

5 the President has determined 

6 warrants individual and public 

7 assistance from the Federal Gov8 ernment under such Act; or 

9 ‘‘(bb) a public health emer10 gency declared by the Secretary 

11 under section 319 of the Public 

12 Health Service Act. 

13 ‘‘(II) STATE ECONOMIC DOWN14 TURN.—The State unemployment rate 

15 is at least 5.5 percent during any 13- 

16 consecutive week period during the 

17 fiscal year and such rate is at least 

18 120 percent of the State unemploy19 ment rate for the same period as aver20 aged over the last 3 fiscal years. 

21 ‘‘(III) EVENT RESULTING IN

22 RISE IN PERCENTAGE OF LOW-INCOME

23 CHILDREN WITHOUT HEALTH INSUR24 ANCE.—The State experienced a re25 cent event that resulted in an increase 


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1 in the percentage of low-income chil2 dren in the State without health in3 surance (as determined on the basis of 

4 the most timely and accurate pub5 lished estimates of the Bureau of the 

6 Census) that was outside the control 

7 of the State and warrants granting 

8 the State access to the Fund (as de9 termined by the Secretary). 

10 ‘‘(E) PAYMENTS MADE TO ALL ELIGIBLE

11 STATES ON A MONTHLY BASIS; AUTHORITY FOR

12 PRO RATA PAYMENTS.—The Secretary shall 

13 make monthly payments from the Fund to all 

14 States that are determined to be eligible States 

15 with respect to a month. If the sum of the pay16 ments to be made from the Fund for a month 

17 exceed the amount in the Fund, the Secretary 

18 shall reduce each such payment on a propor19 tional basis. 

20 ‘‘(F) PAYMENTS LIMITED TO FISCAL YEAR

21 OF ELIGIBILITY DETERMINATION UNLESS NEW

22 ELIGIBILITY BASIS DETERMINED.—No State 

23 shall receive a CHIP contingency fund payment 

24 under this section for a month beginning after 

25 September 30 of the fiscal year in which the 


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1 State is determined to be an eligible State 

2 under this subsection, except that in the case of 

3 an event described in subclause (I) or (III) of 

4 subparagraph (D)(iii) that occurred after July 

5 1 of the fiscal year, any such payment with re6 spect to such event shall remain available until 

7 September 30 of the subsequent fiscal year. 

8 Nothing in the preceding sentence shall be con9 strued as prohibiting a State from being deter10 mined to be an eligible State under this sub11 section for any fiscal year occurring after a fis12 cal year in which such a determination is made. 

13 ‘‘(G) EXEMPTION FROM DETERMINATION

14 OF PERCENTAGE OF ALLOTMENT RETAINED

15 AFTER FIRST YEAR OF AVAILABILITY.—In no 

16 event shall payments made to a State under 

17 this subsection be treated as part of the allot18 ment determined for a State for a fiscal year 

19 under subsection (i) for purposes of subsection 

20 (j)(1)(B)(ii)(III). 

21 ‘‘(H) APPLICATION OF ALLOTMENT RE22 PORTING RULES.—Rules applicable to States 

23 for purposes of receiving payments from an al24 lotment determined under subsection (c) or (i) 

25 shall apply in the same manner to an eligible 


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1 State for purposes of receiving a CHIP contin2 gency fund payment under this subsection. 

3 ‘‘(4) ANNUAL REPORTS.—The Secretary shall 

4 annually report to the Congress on the amounts in 

5 the Fund, the specific events that caused States to 

6 apply for payments from the Fund, and the pay7 ments made from the Fund.’’. 

8 SEC. 109. TWO-YEAR AVAILABILITY OF ALLOTMENTS; EX9 PENDITURES COUNTED AGAINST OLDEST AL10 LOTMENTS. 

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

12 to read as follows: 

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

14 ‘‘(1) IN GENERAL.—Except as provided in sub15 section (j)(1)(B)(ii)(III), amounts allotted to a State 

16 pursuant to this section— 

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

18 2006, shall remain available for expenditure by 

19 the State through the end of the second suc20 ceeding fiscal year; and 

21 ‘‘(B) for each of fiscal years 2007 through 

22 2012, shall remain available for expenditure by 

23 the State only through the end of the suc24 ceeding fiscal year for which such amounts are 

25 allotted. 


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1 ‘‘(2) INCENTIVE BONUSES.—Incentive bonuses 

2 paid to a State under subsection (j)(2) for a fiscal 

3 year shall remain available for expenditure by the 

4 State without limitation. 

5 ‘‘(3) CHIP CONTINGENCY FUND PAYMENTS.— 

6 Except as provided in paragraph (3)(F) of sub7 section (k), CHIP Contingency Fund payments 

8 made to a State under such subsection for a month 

9 of a fiscal year shall remain available for expendi10 ture by the State through the end of the fiscal year. 

11 ‘‘(4) RULE FOR COUNTING EXPENDITURES

12 AGAINST CHIP CONTINGENCY FUND PAYMENTS, FIS13 CAL YEAR ALLOTMENTS, AND INCENTIVE BO14 NUSES.— 

15 ‘‘(A) IN GENERAL.—Expenditures under 

16 the State child health plan made on or after 

17 October 1, 2007, shall be counted against— 

18 ‘‘(i) first, any CHIP Contingency 

19 Fund payment made to the State under 

20 subsection (k) for the earliest month of the 

21 earliest fiscal year for which the payment 

22 remains available for expenditure; and 

23 ‘‘(ii) second, amounts allotted to the 

24 State for the earliest fiscal year for which 

25 amounts remain available for expenditure. 


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1 ‘‘(B) INCENTIVE BONUSES.—A State may 

2 elect, but is not required, to count expenditures 

3 under the State child health plan against any 

4 incentive bonuses paid to the State under sub5 section (j)(2) for a fiscal year. 

6 ‘‘(C) BLOCK GRANT SET-ASIDES.—Expend7 itures for coverage of— 

8 ‘‘(i) nonpregnant childless adults for 

9 fiscal year 2009 shall be counted only 

10 against the amount set aside for such cov11 erage under section 2111(a)(3); and 

12 ‘‘(ii) parents of targeted low-income 

13 children for each of fiscal years 2010 

14 through 2012, shall be counted only 

15 against the amount set aside for such cov16 erage under section 2111(b)(2)(B)(i).’’. 

17 SEC. 110. LIMITATION ON MATCHING RATE FOR STATES 

18 THAT PROPOSE TO COVER CHILDREN WITH 

19 EFFECTIVE FAMILY INCOME THAT EXCEEDS 

20 300 PERCENT OF THE POVERTY LINE. 

21 (a) FMAP APPLIED TO EXPENDITURES.—Section 

22 2105(c) (42 U.S.C. 1397ee(c)) is amended by adding at 

23 the end the following new paragraph: 

24 ‘‘(8) LIMITATION ON MATCHING RATE FOR EX25 PENDITURES FOR CHILD HEALTH ASSISTANCE PROVerDate Aug 31 2005 03:57 Jul 27, 2007 Jkt 059200 PO 00000 Frm 00079 Fmt 6652 Sfmt 6201 E:\BILLS\S1893.PCS S1893

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1 VIDED TO CHILDREN WHOSE EFFECTIVE FAMILY IN2 COME EXCEEDS 300 PERCENT OF THE POVERTY

3 LINE.— 

4 ‘‘(A) FMAP APPLIED TO EXPENDI5 TURES.—Except as provided in subparagraph 

6 (B), for fiscal years beginning with fiscal year 

7 2008, the Federal medical assistance percent8 age (as determined under section 1905(b) with9 out regard to clause (4) of such section) shall 

10 be substituted for the enhanced FMAP under 

11 subsection (a)(1) with respect to any expendi12 tures for providing child health assistance or 

13 health benefits coverage for a targeted low-in14 come child whose effective family income would 

15 exceed 300 percent of the poverty line but for 

16 the application of a general exclusion of a block 

17 of income that is not determined by type of ex18 pense or type of income. 

19 ‘‘(B) EXCEPTION.—Subparagraph (A) 

20 shall not apply to any State that, on the date 

21 of enactment of the Children’s Health Insur22 ance Program Reauthorization Act of 2007, has 

23 an approved State plan amendment or waiver to 

24 provide, or has enacted a State law to submit 

25 a State plan amendment to provide, expendiVerDate Aug 31 2005 03:57 Jul 27, 2007 Jkt 059200 PO 00000 Frm 00080 Fmt 6652 Sfmt 6201 E:\BILLS\S1893.PCS S1893

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1 tures described in such subparagraph under the 

2 State child health plan.’’. 

3 (b) CONFORMING AMENDMENT.—Section 2105(a)(1) 

4 ( 42 U.S.C. 1397dd(a)(1)) is amended, in the matter pre5 ceding subparagraph (A), by inserting ‘‘or subsection 

6 (c)(8)’’ after ‘‘subparagraph (B)’’. 

7 SEC. 111. OPTION FOR QUALIFYING STATES TO RECEIVE 

8 THE ENHANCED PORTION OF THE CHIP 

9 MATCHING RATE FOR MEDICAID COVERAGE 

10 OF CERTAIN CHILDREN. 

11 Section 2105(g) (42 U.S.C. 1397ee(g)) is amended— 

12 (1) in paragraph (1)(A), by inserting ‘‘subject 

13 to paragraph (4),’’ after ‘‘Notwithstanding any other 

14 provision of law,’’; and 

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

16 paragraph: 

17 ‘‘(4) OPTION FOR ALLOTMENTS FOR FISCAL

18 YEARS 2008 THROUGH 2012.— 

19 ‘‘(A) PAYMENT OF ENHANCED PORTION OF

20 MATCHING RATE FOR CERTAIN EXPENDI21 TURES.—In the case of expenditures described 

22 in subparagraph (B), a qualifying State (as de23 fined in paragraph (2)) may elect to be paid 

24 from the State’s allotment made under section 

25 2104 for any of fiscal years 2008 through 2012 


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1 (insofar as the allotment is available to the 

2 State under subsections (e) and (i) of such sec3 tion) an amount each quarter equal to the addi4 tional amount that would have been paid to the 

5 State under title XIX with respect to such ex6 penditures if the enhanced FMAP (as deter7 mined under subsection (b)) had been sub8 stituted for the Federal medical assistance per9 centage (as defined in section 1905(b)). 

10 ‘‘(B) EXPENDITURES DESCRIBED.—For 

11 purposes of subparagraph (A), the expenditures 

12 described in this subparagraph are expenditures 

13 made after the date of the enactment of this 

14 paragraph and during the period in which funds 

15 are available to the qualifying State for use 

16 under subparagraph (A), for the provision of 

17 medical assistance to individuals residing in the 

18 State who are eligible for medical assistance 

19 under the State plan under title XIX or under 

20 a waiver of such plan and who have not at21 tained age 19 (or, if a State has so elected 

22 under the State plan under title XIX, age 20 

23 or 21), and whose family income equals or ex24 ceeds 133 percent of the poverty line but does 


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1 not exceed the Medicaid applicable income 

2 level.’’. 

3 TITLE II—OUTREACH AND 

4 ENROLLMENT 

5 SEC. 201. GRANTS FOR OUTREACH AND ENROLLMENT. 

6 (a) GRANTS.—Title XXI (42 U.S.C. 1397aa et seq.), 

7 as amended by section 107, is amended by adding at the 

8 end the following: 

9 ‘‘SEC. 2113. GRANTS TO IMPROVE OUTREACH AND ENROLL10 MENT. 

11 ‘‘(a) OUTREACH AND ENROLLMENT GRANTS; NA12 TIONAL CAMPAIGN.— 

13 ‘‘(1) IN GENERAL.—From the amounts appro14 priated under subsection (g), subject to paragraph 

15 (2), the Secretary shall award grants to eligible enti16 ties during the period of fiscal years 2008 through 

17 2012 to conduct outreach and enrollment efforts 

18 that are designed to increase the enrollment and 

19 participation of eligible children under this title and 

20 title XIX. 

21 ‘‘(2) TEN PERCENT SET ASIDE FOR NATIONAL

22 ENROLLMENT CAMPAIGN.—An amount equal to 10 

23 percent of such amounts shall be used by the Sec24 retary for expenditures during such period to carry 


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1 out a national enrollment campaign in accordance 

2 with subsection (h). 

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

4 ‘‘(1) IN GENERAL.—In awarding grants under 

5 subsection (a), the Secretary shall give priority to el6 igible entities that— 

7 ‘‘(A) propose to target geographic areas 

8 with high rates of— 

9 ‘‘(i) eligible but unenrolled children, 

10 including such children who reside in rural 

11 areas; or 

12 ‘‘(ii) racial and ethnic minorities and 

13 health disparity populations, including 

14 those proposals that address cultural and 

15 linguistic barriers to enrollment; and 

16 ‘‘(B) submit the most demonstrable evi17 dence required under paragraphs (1) and (2) of 

18 subsection (c). 

19 ‘‘(2) TEN PERCENT SET ASIDE FOR OUTREACH

20 TO INDIAN CHILDREN.—An amount equal to 10 per21 cent of the funds appropriated under subsection (g) 

22 shall be used by the Secretary to award grants to 

23 Indian Health Service providers and urban Indian 

24 organizations receiving funds under title V of the In25 dian Health Care Improvement Act (25 U.S.C. 1651 


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1 et seq.) for outreach to, and enrollment of, children 

2 who are Indians. 

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

4 receive a grant under subsection (a) shall submit an appli5 cation to the Secretary in such form and manner, and con6 taining such information, as the Secretary may decide. 

7 Such application shall include— 

8 ‘‘(1) evidence demonstrating that the entity in9 cludes members who have access to, and credibility 

10 with, ethnic or low-income populations in the com11 munities in which activities funded under the grant 

12 are to be conducted; 

13 ‘‘(2) evidence demonstrating that the entity has 

14 the ability to address barriers to enrollment, such as 

15 lack of awareness of eligibility, stigma concerns and 

16 punitive fears associated with receipt of benefits, 

17 and other cultural barriers to applying for and re18 ceiving child health assistance or medical assistance; 

19 ‘‘(3) specific quality or outcomes performance 

20 measures to evaluate the effectiveness of activities 

21 funded by a grant awarded under this section; and 

22 ‘‘(4) an assurance that the eligible entity 

23 shall— 


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1 ‘‘(A) conduct an assessment of the effec2 tiveness of such activities against the perform3 ance measures; 

4 ‘‘(B) cooperate with the collection and re5 porting of enrollment data and other informa6 tion in order for the Secretary to conduct such 

7 assessments; and 

8 ‘‘(C) in the case of an eligible entity that 

9 is not the State, provide the State with enroll10 ment data and other information as necessary 

11 for the State to make necessary projections of 

12 eligible children and pregnant women. 

13 ‘‘(d) DISSEMINATION OF ENROLLMENT DATA AND

14 INFORMATION DETERMINED FROM EFFECTIVENESS AS15 SESSMENTS; ANNUAL REPORT.—The Secretary shall— 

16 ‘‘(1) make publicly available the enrollment 

17 data and information collected and reported in ac18 cordance with subsection (c)(4)(B); and 

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

20 the outreach and enrollment activities conducted 

21 with funds appropriated under this section. 

22 ‘‘(e) MAINTENANCE OF EFFORT FOR STATES

23 AWARDED GRANTS; NO STATE MATCH REQUIRED.—In 

24 the case of a State that is awarded a grant under this 

25 section— 


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1 ‘‘(1) the State share of funds expended for out2 reach and enrollment activities under the State child 

3 health plan shall not be less than the State share of 

4 such funds expended in the fiscal year preceding the 

5 first fiscal year for which the grant is awarded; and 

6 ‘‘(2) no State matching funds shall be required 

7 for the State to receive a grant under this section. 

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

9 ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en10 tity’ means any of the following: 

11 ‘‘(A) A State with an approved child health 

12 plan under this title. 

13 ‘‘(B) A local government. 

14 ‘‘(C) An Indian tribe or tribal consortium, 

15 a tribal organization, an urban Indian organiza16 tion receiving funds under title V of the Indian 

17 Health Care Improvement Act (25 U.S.C. 1651 

18 et seq.), or an Indian Health Service provider. 

19 ‘‘(D) A Federal health safety net organiza20 tion. 

21 ‘‘(E) A national, State, local, or commu22 nity-based public or nonprofit private organiza23 tion, including organizations that use commu24 nity health workers or community-based doula 

25 programs. 


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1 ‘‘(F) A faith-based organization or con2 sortia, to the extent that a grant awarded to 

3 such an entity is consistent with the require4 ments of section 1955 of the Public Health 

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

6 grant award to nongovernmental entities. 

7 ‘‘(G) An elementary or secondary school. 

8 ‘‘(2) FEDERAL HEALTH SAFETY NET ORGANI9 ZATION.—The term ‘Federal health safety net orga10 nization’ means— 

11 ‘‘(A) a Federally-qualified health center (as 

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

13 ‘‘(B) a hospital defined as a dispropor14 tionate share hospital for purposes of section 

15 1923; 

16 ‘‘(C) a covered entity described in section 

17 340B(a)(4) of the Public Health Service Act 

18 (42 U.S.C. 256b(a)(4)); and 

19 ‘‘(D) any other entity or consortium that 

20 serves children under a federally funded pro21 gram, including the special supplemental nutri22 tion program for women, infants, and children 

23 (WIC) established under section 17 of the Child 

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

25 Head Start and Early Head Start programs 


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1 under the Head Start Act (42 U.S.C. 9801 et 

2 seq.), the school lunch program established 

3 under the Richard B. Russell National School 

4 Lunch Act, and an elementary or secondary 

5 school. 

6 ‘‘(3) INDIANS; INDIAN TRIBE; TRIBAL ORGANI7 ZATION; URBAN INDIAN ORGANIZATION.—The terms 

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

9 ‘urban Indian organization’ have the meanings given 

10 such terms in section 4 of the Indian Health Care 

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

12 ‘‘(4) COMMUNITY HEALTH WORKER.—The term 

13 ‘community health worker’ means an individual who 

14 promotes health or nutrition within the community 

15 in which the individual resides— 

16 ‘‘(A) by serving as a liaison between com17 munities and health care agencies; 

18 ‘‘(B) by providing guidance and social as19 sistance to community residents; 

20 ‘‘(C) by enhancing community residents’ 

21 ability to effectively communicate with health 

22 care providers; 

23 ‘‘(D) by providing culturally and linguis24 tically appropriate health or nutrition edu25 cation; 


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1 ‘‘(E) by advocating for individual and com2 munity health or nutrition needs; and 

3 ‘‘(F) by providing referral and followup 

4 services. 

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

6 any money in the Treasury not otherwise appropriated, 

7 $100,000,000 for the period of fiscal years 2008 through 

8 2012, to remain available until expended, for the purpose 

9 of awarding grants under this section. Amounts appro10 priated and paid under the authority of this section shall 

11 be in addition to amounts appropriated under section 

12 2104 and paid to States in accordance with section 2105, 

13 including with respect to expenditures for outreach activi14 ties in accordance with subsections (a)(1)(D)(iii) and 

15 (c)(2)(C) of that section. 

16 ‘‘(h) NATIONAL ENROLLMENT CAMPAIGN.—From 

17 the amounts made available under subsection (a)(2), the 

18 Secretary shall develop and implement a national enroll19 ment campaign to improve the enrollment of underserved 

20 child populations in the programs established under this 

21 title and title XIX. Such campaign may include— 

22 ‘‘(1) the establishment of partnerships with the 

23 Secretary of Education and the Secretary of Agri24 culture to develop national campaigns to link the eli25 gibility and enrollment systems for the assistance 


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1 programs each Secretary administers that often 

2 serve the same children; 

3 ‘‘(2) the integration of information about the 

4 programs established under this title and title XIX 

5 in public health awareness campaigns administered 

6 by the Secretary; 

7 ‘‘(3) increased financial and technical support 

8 for enrollment hotlines maintained by the Secretary 

9 to ensure that all States participate in such hotlines; 

10 ‘‘(4) the establishment of joint public awareness 

11 outreach initiatives with the Secretary of Education 

12 and the Secretary of Labor regarding the impor13 tance of health insurance to building strong commu14 nities and the economy; 

15 ‘‘(5) the development of special outreach mate16 rials for Native Americans or for individuals with 

17 limited English proficiency; and 

18 ‘‘(6) such other outreach initiatives as the Sec19 retary determines would increase public awareness of 

20 the programs under this title and title XIX.’’. 

21 (b) ENHANCED ADMINISTRATIVE FUNDING FOR

22 TRANSLATION OR INTERPRETATION SERVICES UNDER

23 CHIP.—Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)), as 

24 amended by section 603, is amended— 


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

2 by inserting ‘‘(or, in the case of expenditures de3 scribed in subparagraph (D)(iv), the higher of 75 

4 percent or the sum of the enhanced FMAP plus 5 

5 percentage points)’’ after ‘‘enhanced FMAP’’; and 

6 (2) in subparagraph (D)— 

7 (A) in clause (iii), by striking ‘‘and’’ at the 

8 end; 

9 (B) by redesignating clause (iv) as clause 

10 (v); and 

11 (C) by inserting after clause (iii) the fol12 lowing new clause: 

13 ‘‘(iv) for translation or interpretation 

14 services in connection with the enrollment 

15 and use of services under this title by indi16 viduals for whom English is not their pri17 mary language (as found necessary by the 

18 Secretary for the proper and efficient ad19 ministration of the State plan); and’’. 

20 (c) NONAPPLICATION OF ADMINISTRATIVE EXPENDI21 TURES CAP.—Section 2105(c)(2) (42 U.S.C. 

22 1397ee(c)(2)) is amended by adding at the end the fol23 lowing: 

24 ‘‘(C) NONAPPLICATION TO CERTAIN EX25 PENDITURES.—The limitation under subparaVerDate Aug 31 2005 03:57 Jul 27, 2007 Jkt 059200 PO 00000 Frm 00092 Fmt 6652 Sfmt 6201 E:\BILLS\S1893.PCS S1893

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1 graph (A) shall not apply with respect to the 

2 following expenditures: 

3 ‘‘(i) EXPENDITURES FUNDED UNDER

4 SECTION 2113.—Expenditures for outreach 

5 and enrollment activities funded under a 

6 grant awarded to the State under section 

7 2113.’’. 

8 SEC. 202. INCREASED OUTREACH AND ENROLLMENT OF IN9 DIANS. 

10 (a) IN GENERAL.—Section 1139 (42 U.S.C. 1320b– 

11 9) is amended to read as follows: 

12 ‘‘SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, 

13 HEALTH CARE FOR INDIANS UNDER TITLES 

14 XIX AND XXI. 

15 ‘‘(a) AGREEMENTS WITH STATES FOR MEDICAID

16 AND CHIP OUTREACH ON OR NEAR RESERVATIONS TO

17 INCREASE THE ENROLLMENT OF INDIANS IN THOSE

18 PROGRAMS.— 

19 ‘‘(1) IN GENERAL.—In order to improve the ac20 cess of Indians residing on or near a reservation to 

21 obtain benefits under the Medicaid and State chil22 dren’s health insurance programs established under 

23 titles XIX and XXI, the Secretary shall encourage 

24 the State to take steps to provide for enrollment on 

25 or near the reservation. Such steps may include outVerDate Aug 31 2005 03:57 Jul 27, 2007 Jkt 059200 PO 00000 Frm 00093 Fmt 6652 Sfmt 6201 E:\BILLS\S1893.PCS S1893

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1 reach efforts such as the outstationing of eligibility 

2 workers, entering into agreements with the Indian 

3 Health Service, Indian Tribes, Tribal Organizations, 

4 and Urban Indian Organizations to provide out5 reach, education regarding eligibility and benefits, 

6 enrollment, and translation services when such serv7 ices are appropriate. 

8 ‘‘(2) CONSTRUCTION.—Nothing in paragraph 

9 (1) shall be construed as affecting arrangements en10 tered into between States and the Indian Health 

11 Service, Indian Tribes, Tribal Organizations, or 

12 Urban Indian Organizations for such Service, 

13 Tribes, or Organizations to conduct administrative 

14 activities under such titles. 

15 ‘‘(b) REQUIREMENT TO FACILITATE COOPERA16 TION.—The Secretary, acting through the Centers for 

17 Medicare & Medicaid Services, shall take such steps as are 

18 necessary to facilitate cooperation with, and agreements 

19 between, States and the Indian Health Service, Indian 

20 Tribes, Tribal Organizations, or Urban Indian Organiza21 tions with respect to the provision of health care items 

22 and services to Indians under the programs established 

23 under title XIX or XXI. 

24 ‘‘(c) DEFINITION OF INDIAN; INDIAN TRIBE; INDIAN

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1 DIAN ORGANIZATION.—In this section, the terms ‘Indian’, 

2 ‘Indian Tribe’, ‘Indian Health Program’, ‘Tribal Organi3 zation’, and ‘Urban Indian Organization’ have the mean4 ings given those terms in section 4 of the Indian Health 

5 Care Improvement Act.’’. 

6 (b) NONAPPLICATION OF 10 PERCENT LIMIT ON

7 OUTREACH AND CERTAIN OTHER EXPENDITURES.—Sec8 tion 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)(C)), as added 

9 by section 201(c), is amended by adding at the end the 

10 following new clause: 

11 ‘‘(ii) EXPENDITURES TO INCREASE

12 OUTREACH TO, AND THE ENROLLMENT OF, 

13 INDIAN CHILDREN UNDER THIS TITLE AND

14 TITLE XIX.—Expenditures for outreach ac15 tivities to families of Indian children likely 

16 to be eligible for child health assistance 

17 under the plan or medical assistance under 

18 the State plan under title XIX (or under 

19 a waiver of such plan), to inform such 

20 families of the availability of, and to assist 

21 them in enrolling their children in, such 

22 plans, including such activities conducted 

23 under grants, contracts, or agreements en24 tered into under section 1139(a).’’. 


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1 SEC. 203. DEMONSTRATION PROGRAM TO PERMIT STATES 

2 TO RELY ON FINDINGS BY AN EXPRESS LANE 

3 AGENCY TO DETERMINE COMPONENTS OF A 

4 CHILD’S ELIGIBILITY FOR MEDICAID OR 

5 CHIP. 

6 (a) REQUIREMENT TO CONDUCT DEMONSTRATION

7 PROGRAM.— 

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

9 a 3–year demonstration program under which up to 

10 10 States shall be authorized to rely on a finding 

11 made within the preceding 12 months by an Express 

12 Lane agency to determine whether a child has met 

13 1 or more of the eligibility requirements, such as in14 come, assets or resources, citizenship status, or 

15 other criteria, necessary to determine the child’s ini16 tial eligibility, eligibility redetermination, or renewal 

17 of eligibility, for medical assistance under the State 

18 Medicaid plan or child health assistance under the 

19 State CHIP plan. A State selected to participate in 

20 the demonstration program— 

21 (A) shall not be required to direct a child 

22 (or a child’s family) to submit information or 

23 documentation previously submitted by the 

24 child or family to an Express Lane agency that 

25 the State relies on for its Medicaid or CHIP eli26 gibility determination; and 


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1 (B) may rely on information from an Ex2 press Lane agency when evaluating a child’s eli3 gibility for medical assistance under the State 

4 Medicaid plan or child health assistance under 

5 the State CHIP plan without a separate, inde6 pendent confirmation of the information at the 

7 time of enrollment, redetermination, or renewal. 

8 (2) PAYMENTS TO STATES.—From the amount 

9 appropriated under paragraph (1) of subsection (f), 

10 after the application of paragraph (2) of that sub11 section, the Secretary shall pay the States selected 

12 to participate in the demonstration program such 

13 sums as the Secretary shall determine for expendi14 tures made by the State for systems upgrades and 

15 implementation of the demonstration program. In no 

16 event shall a payment be made to a State from the 

17 amount appropriated under subsection (f) for any 

18 expenditures incurred for providing medical assist19 ance or child health assistance to a child enrolled in 

20 the State Medicaid plan or the State CHIP plan 

21 through reliance on a finding made by an Express 

22 Lane agency. 

23 (b) REQUIREMENTS; OPTIONS FOR APPLICATION.— 

24 (1) STATE REQUIREMENTS.—A State selected 

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1 lished under this section may rely on a finding of an 

2 Express Lane agency only if the following conditions 

3 are met: 

4 (A) REQUIREMENT TO DETERMINE ELIGI5 BILITY USING REGULAR PROCEDURES IF CHILD

6 IS FIRST FOUND INELIGIBLE.—If reliance on a 

7 finding from an Express Lane agency results in 

8 a child not being found eligible for the State 

9 Medicaid plan or the State CHIP plan, the 

10 State would be required to determine eligibility 

11 under such plan using its regular procedures. 

12 (B) NOTICE.—The State shall inform the 

13 families (especially those whose children are en14 rolled in the State CHIP plan) that they may 

15 qualify for lower premium payments or more 

16 comprehensive health coverage under the State 

17 Medicaid plan if the family’s income were di18 rectly evaluated for an eligibility determination 

19 by the State Medicaid agency, and that, at the 

20 family’s option, the family may seek an eligi21 bility determination by the State Medicaid 

22 agency. 

23 (C) COMPLIANCE WITH DEPARTMENT OF

24 HOMELAND SECURITY PROCEDURES.—The 

25 State may rely on an Express Lane agency 


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1 finding that a child is a qualified alien as long 

2 as the Express Lane agency complies with guid3 ance and regulatory procedures issued by the 

4 Secretary of Homeland Security for eligibility 

5 determinations of qualified aliens (as defined in 

6 subsections (b) and (c) of section 431 of the 

7 Personal Responsibility and Work Opportunity 

8 Reconciliation Act of 1996 (8 U.S.C. 1641)). 

9 (D) VERIFICATION OF CITIZENSHIP OR NA10 TIONALITY STATUS.—The State shall satisfy 

11 the requirements of section 1902(a)(46)(B) or 

12 2105(c)(9) of the Social Security Act, as appli13 cable (and as added by section 301 of this Act) 

14 for verifications of citizenship or nationality sta15 tus. 

16 (E) CODING; APPLICATION TO ENROLL17 MENT ERROR RATES.— 

18 (i) IN GENERAL.—The State agrees 

19 to— 

20 (I) assign such codes as the Sec21 retary shall require to the children 

22 who are enrolled in the State Med23 icaid plan or the State CHIP plan 

24 through reliance on a finding made by 

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1 tion of the State’s participation in the 

2 demonstration program; 

3 (II) annually provide the Sec4 retary with a statistically valid sample 

5 (that is approved by Secretary) of the 

6 children enrolled in such plans 

7 through reliance on such a finding by 

8 conducting a full Medicaid eligibility 

9 review of the children identified for 

10 such sample for purposes of deter11 mining an eligibility error rate with 

12 respect to the enrollment of such chil13 dren; 

14 (III) submit the error rate deter15 mined under subclause (II) to the 

16 Secretary; 

17 (IV) if such error rate exceeds 3 

18 percent for either of the first 2 fiscal 

19 years in which the State participates 

20 in the demonstration program, dem21 onstrate to the satisfaction of the Sec22 retary the specific corrective actions 

23 implemented by the State to improve 

24 upon such error rate; and 


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1 (V) if such error rate exceeds 3 

2 percent for any fiscal year in which 

3 the State participates in the dem4 onstration program, a reduction in the 

5 amount otherwise payable to the State 

6 under section 1903(a) of the Social 

7 Security Act (42 Secretary 1396b(a)) 

8 for quarters for that fiscal year, equal 

9 to the total amount of erroneous ex10 cess payments determined for the fis11 cal year only with respect to the chil12 dren included in the sample for the 

13 fiscal year that are in excess of a 3 

14 percent error rate with respect to such 

15 children. 

16 (ii) NO PUNITIVE ACTION BASED ON

17 ERROR RATE.—The Secretary shall not 

18 apply the error rate derived from the sam19 ple under clause (i) to the entire popu20 lation of children enrolled in the State 

21 Medicaid plan or the State CHIP plan 

22 through reliance on a finding made by an 

23 Express Lane agency, or to the population 

24 of children enrolled in such plans on the 

25 basis of the State’s regular procedures for 


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1 determining eligibility, or penalize the 

2 State on the basis of such error rate in any 

3 manner other than the reduction of pay4 ments provided for under clause (i)(V). 

5 (iii) RULE OF CONSTRUCTION.—Noth6 ing in this section shall be construed as re7 lieving a State that participates in the 

8 demonstration program established under 

9 this section from being subject to a penalty 

10 under section 1903(u) of the Social Secu11 rity Act (42 U.S.C. 1396b(u)) for pay12 ments made under the State Medicaid plan 

13 with respect to ineligible individuals and 

14 families that are determined to exceed the 

15 error rate permitted under that section (as 

16 determined without regard to the error 

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

18 (2) STATE OPTIONS FOR APPLICATION.—A 

19 State selected to participate in the demonstration 

20 program may elect to apply any of the following: 

21 (A) SATISFACTION OF CHIP SCREEN AND

22 ENROLL REQUIREMENTS.—If the State relies on 

23 a finding of an Express Lane agency for pur24 poses of determining eligibility under the State 

25 CHIP plan, the State may meet the screen and 


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1 enroll requirements imposed under subpara2 graphs (A) and (B) of section 2102(b)(3) of the 

3 Social Security Act (42 U.S.C. 1397bb(b)(3)) 

4 by using any of the following: 

5 (i) Establishing a threshold percent6 age of the poverty line that is 30 percent7 age points (or such other higher number of 

8 percentage points) as the State determines 

9 reflects the income methodologies of the 

10 program administered by the Express Lane 

11 Agency and the State Medicaid plan. 

12 (ii) Providing that a child satisfies all 

13 income requirements for eligibility under 

14 the State Medicaid plan. 

15 (iii) Providing that a child has a fam16 ily income that exceeds the Medicaid appli17 cable income level. 

18 (B) PRESUMPTIVE ELIGIBILITY.—The 

19 State may provide for presumptive eligibility 

20 under the State CHIP plan for a child who, 

21 based on an eligibility determination of an in22 come finding from an Express Lane agency, 

23 would qualify for child health assistance under 

24 the State CHIP plan. During the period of pre25 sumptive eligibility, the State may determine 


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1 the child’s eligibility for child health assistance 

2 under the State CHIP plan based on telephone 

3 contact with family members, access to data 

4 available in electronic or paper format, or other 

5 means that minimize to the maximum extent 

6 feasible the burden on the family. 

7 (C) AUTOMATIC ENROLLMENT.— 

8 (i) IN GENERAL.—The State may ini9 tiate and determine eligibility for medical 

10 assistance under the State Medicaid plan 

11 or for child health assistance under the 

12 State CHIP plan without a program appli13 cation from, or on behalf of, the child 

14 based on data obtained from sources other 

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

16 a child can only be automatically enrolled 

17 in the State Medicaid plan or the State 

18 CHIP plan if the child or the family af19 firmatively consents to being enrolled 

20 through affirmation and signature on an 

21 Express Lane agency application. 

22 (ii) INFORMATION REQUIREMENT.—A 

23 State that elects the option under clause 

24 (i) shall have procedures in place to inform 

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1 ices that will be covered under the State 

2 Medicaid plan or the State CHIP plan (as 

3 applicable), appropriate methods for using 

4 such services, premium or other cost shar5 ing charges (if any) that apply, medical 

6 support obligations created by the enroll7 ment (if applicable), and the actions the 

8 child or the child’s family must take to 

9 maintain enrollment and renew coverage. 

10 (iii) OPTION TO WAIVE SIGNA11 TURES.—The State may waive any signa12 ture requirements for enrollment for a 

13 child who consents to, or on whose behalf 

14 consent is provided for, enrollment in the 

15 State Medicaid plan or the State CHIP 

16 plan. 

17 (3) SIGNATURE REQUIREMENTS.—In the case 

18 of a State selected to participate in the demonstra19 tion program— 

20 (A) no signature under penalty of perjury 

21 shall be required on an application form for 

22 medical assistance under the State Medicaid 

23 plan or child health assistance under the State 

24 CHIP plan to attest to any element of the ap25 plication for which eligibility is based on inforVerDate Aug 31 2005 03:57 Jul 27, 2007 Jkt 059200 PO 00000 Frm 00105 Fmt 6652 Sfmt 6201 E:\BILLS\S1893.PCS S1893

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1 mation received from an Express Lane agency 

2 or a source other than an applicant; and 

3 (B) any signature requirement for deter4 mination of an application for medical assist5 ance under the State Medicaid plan or child 

6 health assistance under the State CHIP plan 

7 may be satisfied through an electronic signa8 ture. 

9 (4) RULES OF CONSTRUCTION.—Nothing in 

10 this subsection shall be construed to— 

11 (A) relieve a State of the obligation under 

12 section 1902(a)(5) of the Social Security Act 

13 (42 U.S.C. 1396a(a)(5)) to determine eligibility 

14 for medical assistance under the State Medicaid 

15 plan; or 

16 (B) prohibit any State options otherwise 

17 permitted under Federal law (without regard to 

18 this paragraph or the demonstration program 

19 established under this section) that are in20 tended to increase the enrollment of eligible 

21 children for medical assistance under the State 

22 Medicaid plan or child health assistance under 

23 the State CHIP plan, including options related 

24 to outreach, enrollment, applications, or the de25 termination or redetermination of eligibility. 


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1 (c) LIMITED WAIVER OF OTHER APPLICABLE RE2 QUIREMENTS.— 

3 (1) SOCIAL SECURITY ACT.—The Secretary 

4 shall waive only such requirements of the Social Se5 curity Act as the Secretary determines are necessary 

6 to carry out the demonstration program established 

7 under this section. 

8 (2) AUTHORIZATION FOR PARTICIPATING

9 STATES TO RECEIVE CERTAIN DATA DIRECTLY REL10 EVANT TO DETERMINING ELIGIBILITY AND CORRECT

11 AMOUNT OF ASSISTANCE.—For provisions relating to 

12 the authority of States participating in the dem13 onstration program to receive certain data directly, 

14 see section 204(c). 

15 (d) EVALUATION AND REPORT.— 

16 (1) EVALUATION.—The Secretary shall con17 duct, by grant, contract, or interagency agreement, 

18 a comprehensive, independent evaluation of the dem19 onstration program established under this section. 

20 Such evaluation shall include an analysis of the ef21 fectiveness of the program, and shall include— 

22 (A) obtaining a statistically valid sample of 

23 the children who were enrolled in the State 

24 Medicaid plan or the State CHIP plan through 

25 reliance on a finding made by an Express Lane 


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1 agency and determining the percentage of chil2 dren who were erroneously enrolled in such 

3 plans; 

4 (B) determining whether enrolling children 

5 in such plans through reliance on a finding 

6 made by an Express Lane agency improves the 

7 ability of a State to identify and enroll low-in8 come, uninsured children who are eligible but 

9 not enrolled in such plans; 

10 (C) evaluating the administrative costs or 

11 savings related to identifying and enrolling chil12 dren in such plans through reliance on such 

13 findings, and the extent to which such costs dif14 fer from the costs that the State otherwise 

15 would have incurred to identify and enroll low16 income, uninsured children who are eligible but 

17 not enrolled in such plans; and 

18 (D) any recommendations for legislative or 

19 administrative changes that would improve the 

20 effectiveness of enrolling children in such plans 

21 through reliance on such findings. 

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

23 September 30, 2012, the Secretary shall submit a 

24 report to Congress on the results of the evaluation 


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1 of the demonstration program established under this 

2 section. 

3 (e) DEFINITIONS.—In this section: 

4 (1) CHILD; CHILDREN.—With respect to a 

5 State selected to participate in the demonstration 

6 program established under this section, the terms 

7 ‘‘child’’ and ‘‘children’’ have the meanings given 

8 such terms for purposes of the State plans under ti9 tles XIX and XXI of the Social Security Act. 

10 (2) EXPRESS LANE AGENCY.— 

11 (A) IN GENERAL.—The term ‘‘Express 

12 Lane agency’’ means a public agency that— 

13 (i) is determined by the State Med14 icaid agency or the State CHIP agency (as 

15 applicable) to be capable of making the de16 terminations of 1 or more eligibility re17 quirements described in subsection (a)(1); 

18 (ii) is identified in the State Medicaid 

19 plan or the State CHIP plan; and 

20 (iii) notifies the child’s family— 

21 (I) of the information which shall 

22 be disclosed in accordance with this 

23 section; 

24 (II) that the information dis25 closed will be used solely for purposes 


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1 of determining eligibility for medical 

2 assistance under the State Medicaid 

3 plan or for child health assistance 

4 under the State CHIP plan; and 

5 (III) that the family may elect to 

6 not have the information disclosed for 

7 such purposes; and 

8 (iv) enters into, or is subject to, an 

9 interagency agreement to limit the disclo10 sure and use of the information disclosed. 

11 (B) INCLUSION OF SPECIFIC PUBLIC AGEN12 CIES.—Such term includes the following: 

13 (i) A public agency that determines 

14 eligibility for assistance under any of the 

15 following: 

16 (I) The temporary assistance for 

17 needy families program funded under 

18 part A of title IV of the Social Secu19 rity Act (42 U.S.C. 601 et seq.). 

20 (II) A State program funded 

21 under part D of title IV of such Act 

22 (42 U.S.C. 651 et seq.). 

23 (III) The State Medicaid plan. 

24 (IV) The State CHIP plan. 


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1 (V) The Food Stamp Act of 1977 

2 (7 U.S.C. 2011 et seq.). 

3 (VI) The Head Start Act (42 

4 U.S.C. 9801 et seq.). 

5 (VII) The Richard B. Russell 

6 National School Lunch Act (42 

7 U.S.C. 1751 et seq.). 

8 (VIII) The Child Nutrition Act of 

9 1966 (42 U.S.C. 1771 et seq.). 

10 (IX) The Child Care and Devel11 opment Block Grant Act of 1990 (42 

12 U.S.C. 9858 et seq.). 

13 (X) The Stewart B. McKinney 

14 Homeless Assistance Act (42 U.S.C. 

15 11301 et seq.). 

16 (XI) The United States Housing 

17 Act of 1937 (42 U.S.C. 1437 et seq.). 

18 (XII) The Native American 

19 Housing Assistance and Self-Deter20 mination Act of 1996 (25 U.S.C. 

21 4101 et seq.). 

22 (ii) A State-specified governmental 

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1 bility determination findings relied on by 

2 the State. 

3 (iii) A public agency that is subject to 

4 an interagency agreement limiting the dis5 closure and use of the information dis6 closed for purposes of determining eligi7 bility under the State Medicaid plan or the 

8 State CHIP plan. 

9 (C) EXCLUSIONS.—Such term does not in10 clude an agency that determines eligibility for a 

11 program established under the Social Services 

12 Block Grant established under title XX of the 

13 Social Security Act (42 U.S.C. 1397 et seq.) or 

14 a private, for-profit organization. 

15 (D) RULES OF CONSTRUCTION.—Nothing 

16 in this paragraph shall be construed as— 

17 (i) affecting the authority of a State 

18 Medicaid agency to enter into contracts 

19 with nonprofit and for-profit agencies to 

20 administer the Medicaid application proc21 ess; 

22 (ii) exempting a State Medicaid agen23 cy from complying with the requirements 

24 of section 1902(a)(4) of the Social Security 

25 Act (relating to merit-based personnel 


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1 standards for employees of the State Med2 icaid agency and safeguards against con3 flicts of interest); or 

4 (iii) authorizing a State Medicaid 

5 agency that participates in the demonstra6 tion program established under this section 

7 to use the Express Lane option to avoid 

8 complying with such requirements for pur9 poses of making eligibility determinations 

10 under the State Medicaid plan. 

11 (3) MEDICAID APPLICABLE INCOME LEVEL.— 

12 With respect to a State, the term ‘‘Medicaid applica13 ble income level’’ has the meaning given that term 

14 for purposes of such State under section 2110(b)(4) 

15 of the Social Security Act (42 U.S.C. 1397jj(4)). 

16 (4) POVERTY LINE.—The term ‘‘poverty line’’ 

17 has the meaning given that term in section 

18 2110(c)(5) of the Social Security Act (42 U.S.C. 

19 1397jj(c)(5)). 

20 (5) STATE.—The term ‘‘State’’ means 1 of the 

21 50 States or the District of Columbia. 

22 (6) STATE CHIP AGENCY.—The term ‘‘State 

23 CHIP agency’’ means the State agency responsible 

24 for administering the State CHIP plan. 


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1 (7) STATE CHIP PLAN.—The term ‘‘State 

2 CHIP plan’’ means the State child health plan es3 tablished under title XXI of the Social Security Act 

4 (42 U.S.C. 1397aa et seq.), and includes any waiver 

5 of such plan. 

6 (8) STATE MEDICAID AGENCY.—The term 

7 ‘‘State Medicaid agency’’ means the State agency re8 sponsible for administering the State Medicaid plan. 

9 (9) STATE MEDICAID PLAN.—The term ‘‘State 

10 Medicaid plan’’ means the State plan established 

11 under title XIX of the Social Security Act (42 

12 U.S.C. 1396 et seq.), and includes any waiver of 

13 such plan. 

14 (f) APPROPRIATION.— 

15 (1) OPERATIONAL FUNDS.—Out of any funds 

16 in the Treasury not otherwise appropriated, there is 

17 appropriated to the Secretary to carry out the dem18 onstration program established under this section, 

19 $49,000,000 for the period of fiscal years 2008 

20 through 2012. 

21 (2) EVALUATION FUNDS.—$5,000,000 of the 

22 funds appropriated under paragraph (1) shall be 

23 used to conduct the evaluation required under sub24 section (d). 


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1 (3) BUDGET AUTHORITY.—Paragraph (1) con2 stitutes budget authority in advance of appropria3 tions Act and represents the obligation of the Fed4 eral Government to provide for the payment to 

5 States selected to participate in the demonstration 

6 program established under this section of the 

7 amounts provided under such paragraph (after the 

8 application of paragraph (2)). 

9 SEC. 204. AUTHORIZATION OF CERTAIN INFORMATION DIS10 CLOSURES TO SIMPLIFY HEALTH COVERAGE 

11 DETERMINATIONS. 

12 (a) AUTHORIZATION OF INFORMATION DISCLO13 SURE.—Title XIX (42 U.S.C. 1396 et seq.) is amended— 

14 (1) by redesignating section 1939 as section 

15 1940; and 

16 (2) by inserting after section 1938 the following 

17 new section: 

18 ‘‘AUTHORIZATION TO RECEIVE PERTINENT INFORMATION

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

20 other provision of law, a Federal or State agency or pri21 vate entity in possession of the sources of data directly 

22 relevant to eligibility determinations under this title (in23 cluding eligibility files, information described in paragraph 

24 (2) or (3) of section 1137(a), vital records information 

25 about births in any State, and information described in 

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1 vey such data or information to the State agency admin2 istering the State plan under this title, but only if such 

3 conveyance meets the requirements of subsection (b). 

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

5 information may be conveyed pursuant to this section only 

6 if the following requirements are met: 

7 ‘‘(1) The child whose circumstances are de8 scribed in the data or information (or such child’s 

9 parent, guardian, caretaker relative, or authorized 

10 representative) has either provided advance consent 

11 to disclosure or has not objected to disclosure after 

12 receiving advance notice of disclosure and a reason13 able opportunity to object. 

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

15 for the purposes of— 

16 ‘‘(A) identifying children who are eligible 

17 or potentially eligible for medical assistance 

18 under this title and enrolling (or attempting to 

19 enroll) such children in the State plan; and 

20 ‘‘(B) verifying the eligibility of children for 

21 medical assistance under the State plan. 

22 ‘‘(3) An interagency or other agreement, con23 sistent with standards developed by the Secretary— 

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1 wise meets applicable Federal requirements for 

2 safeguarding privacy and data security; and 

3 ‘‘(B) requires the State agency admin4 istering the State plan to use the data and in5 formation obtained under this section to seek to 

6 enroll children in the plan. 

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

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

9 known in any manner, or to any extent, not authorized 

10 by Federal law, any information obtained under this sec11 tion shall be fined not more than $1,000 or imprisoned 

12 not more than 1 year, or both, for each such unauthorized 

13 activity. 

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

15 requirements that apply to disclosure pursuant to this sec16 tion shall not be construed to prohibit the conveyance or 

17 disclosure of data or information otherwise permitted 

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

19 (b) CONFORMING AMENDMENT TO TITLE XXI.— 

20 Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)) is amended 

21 by adding at the end the following new subparagraph: 

22 ‘‘(E) Section 1939 (relating to authoriza23 tion to receive data directly relevant to eligi24 bility determinations).’’. 


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1 (c) AUTHORIZATION FOR STATES PARTICIPATING IN

2 THE EXPRESS LANE DEMONSTRATION PROGRAM TO RE3 CEIVE CERTAIN DATA DIRECTLY RELEVANT TO DETER4 MINING ELIGIBILITY AND CORRECT AMOUNT OF ASSIST5 ANCE.—Only in the case of a State selected to participate 

6 in the Express Lane demonstration program established 

7 under section 203, the Secretary shall enter into such 

8 agreements as are necessary to permit such a State to re9 ceive data directly relevant to eligibility determinations 

10 and determining the correct amount of benefits under the 

11 State CHIP plan or the State Medicaid plan (as such 

12 terms are defined in paragraphs (7) and (9) section 

13 203(e)) from the following: 

14 (1) The National Directory of New Hires estab15 lished under section 453(i) of the Social Security 

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

17 (2) The National Income Data collected by the 

18 Commissioner of Social Security from information 

19 described in subparagraphs (A) and (B) of section 

20 6103(l)(7) of the Internal Revenue Code of 1986, in 

21 accordance with the requirements of that section. 

22 (3) Data regarding enrollment in insurance that 

23 may help to facilitate outreach and enrollment under 

24 the State Medicaid plan, the State CHIP plan, and 

25 such other programs as the Secretary may specify. 


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1 TITLE III—REDUCING BARRIERS 

2 TO ENROLLMENT 

3 SEC. 301. VERIFICATION OF DECLARATION OF CITIZENSHIP 

4 OR NATIONALITY FOR PURPOSES OF ELIGI5 BILITY FOR MEDICAID AND CHIP. 

6 (a) STATE OPTION TO VERIFY DECLARATION OF

7 CITIZENSHIP OR NATIONALITY FOR PURPOSES OF ELIGI8 BILITY FOR MEDICAID THROUGH VERIFICATION OF

9 NAME AND SOCIAL SECURITY NUMBER.— 

10 (1) ALTERNATIVE TO DOCUMENTATION RE11 QUIREMENT.— 

12 (A) IN GENERAL.—Section 1902 (42 

13 U.S.C. 1396a) is amended— 

14 (i) in subsection (a)(46)— 

15 (I) by inserting ‘‘(A)’’ after 

16 ‘‘(46)’’; 

17 (II) by adding ‘‘and’’ after the 

18 semicolon; and 

19 (III) by adding at the end the 

20 following new subparagraph: 

21 ‘‘(B) provide, with respect to an individual de22 claring to be a citizen or national of the United 

23 States for purposes of establishing eligibility under 

24 this title, that the State shall satisfy the require25 ments of— 


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1 ‘‘(i) section 1903(x); or 

2 ‘‘(ii) subsection (dd);’’; and 

3 (ii) by adding at the end the following 

4 new subsection: 

5 ‘‘(dd)(1) For purposes of section 1902(a)(46)(B)(ii), 

6 the requirements of this subsection with respect to an indi7 vidual declaring to be a citizen or national of the United 

8 States for purposes of establishing eligibility under this 

9 title, are, in lieu of requiring the individual to present sat10 isfactory documentary evidence of citizenship or nation11 ality under section 1903(x) (if the individual is not de12 scribed in paragraph (2) of that section), as follows: 

13 ‘‘(A) The State submits the name and social se14 curity number of the individual to the Commissioner 

15 of Social Security as part of the plan established 

16 under paragraph (2). 

17 ‘‘(B) If the State receives notice from the Com18 missioner of Social Security that the name or social 

19 security number of the individual is invalid, the 

20 State— 

21 ‘‘(i) notifies the individual of such fact; 

22 ‘‘(ii) provides the individual with an oppor23 tunity to cure the invalid determination with 

24 the Commissioner of Social Security, followed 

25 by a period of 90 days from the date on which 


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1 the notice required under clause (i) is received 

2 by the individual to present satisfactory docu3 mentary evidence of citizenship or nationality 

4 (as defined in section 1903(x)(3)); and 

5 ‘‘(iii) disenrolls the individual from the 

6 State plan under this title within 30 days after 

7 the end of such 90-day period if no such docu8 mentary evidence is presented. 

9 ‘‘(2)(A) Each State electing to satisfy the require10 ments of this subsection for purposes of section 

11 1902(a)(46)(B) shall establish a program under which the 

12 State submits each month to the Commissioner of Social 

13 Security for verification the name and social security num14 ber of each individual enrolled in the State plan under this 

15 title that month who has attained the age of 1 before the 

16 date of the enrollment. 

17 ‘‘(B) In establishing the State program under this 

18 paragraph, the State may enter into an agreement with 

19 the Commissioner of Social Security to provide for the 

20 electronic submission and verification of the name and so21 cial security number of an individual before the individual 

22 is enrolled in the State plan. 

23 ‘‘(3)(A) The State agency implementing the plan ap24 proved under this title shall, at such times and in such 

25 form as the Secretary may specify, provide information on 


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1 the percentage each month that the invalid names and 

2 numbers submitted bears to the total submitted for 

3 verification. 

4 ‘‘(B) If, for any fiscal year, the average monthly per5 centage determined under subparagraph (A) is greater 

6 than 7 percent— 

7 ‘‘(i) the State shall develop and adopt a correc8 tive plan to review its procedures for verifying the 

9 identities of individuals seeking to enroll in the State 

10 plan under this title and to identify and implement 

11 changes in such procedures to improve their accu12 racy; and 

13 ‘‘(ii) pay to the Secretary an amount equal to 

14 the amount which bears the same ratio to the total 

15 payments under the State plan for the fiscal year for 

16 providing medical assistance to individuals who pro17 vided invalid information as the number of individ18 uals with invalid information in excess of 7 percent 

19 of such total submitted bears to the total number of 

20 individuals with invalid information. 

21 ‘‘(C) The Secretary may waive, in certain limited 

22 cases, all or part of the payment under subparagraph 

23 (B)(ii) if the State is unable to reach the allowable error 

24 rate despite a good faith effort by such State. 


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1 ‘‘(D) This paragraph shall not apply to a State for 

2 a fiscal year if there is an agreement described in para3 graph (2)(B) in effect as of the close of the fiscal year. 

4 ‘‘(4) Nothing in this subsection shall affect the rights 

5 of any individual under this title to appeal any 

6 disenrollment from a State plan.’’. 

7 (B) COSTS OF IMPLEMENTING AND MAIN8 TAINING SYSTEM.—Section 1903(a)(3) (42 

9 U.S.C. 1396b(a)(3)) is amended— 

10 (i) by striking ‘‘plus’’ at the end of 

11 subparagraph (E) and inserting ‘‘and’’, 

12 and 

13 (ii) by adding at the end the following 

14 new subparagraph: 

15 ‘‘(F)(i) 90 percent of the sums expended 

16 during the quarter as are attributable to the de17 sign, development, or installation of such 

18 mechanized verification and information re19 trieval systems as the Secretary determines are 

20 necessary to implement section 1902(dd) (in21 cluding a system described in paragraph (2)(B) 

22 thereof), and 

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1 ation of systems to which clause (i) applies, 

2 plus’’. 

3 (2) LIMITATION ON WAIVER AUTHORITY.—Not4 withstanding any provision of section 1115 of the 

5 Social Security Act (42 U.S.C. 1315), or any other 

6 provision of law, the Secretary may not waive the re7 quirements of section 1902(a)(46)(B) of such Act 

8 (42 U.S.C. 1396a(a)(46)(B)) with respect to a 

9 State. 

10 (3) CONFORMING AMENDMENTS.—Section 1903 

11 (42 U.S.C. 1396b) is amended— 

12 (A) in subsection (i)(22), by striking ‘‘sub13 section (x)’’ and inserting ‘‘section 

14 1902(a)(46)(B)’’; and 

15 (B) in subsection (x)(1), by striking ‘‘sub16 section (i)(22)’’ and inserting ‘‘section 

17 1902(a)(46)(B)(i)’’. 

18 (b) CLARIFICATION OF REQUIREMENTS RELATING

19 TO PRESENTATION OF SATISFACTORY DOCUMENTARY

20 EVIDENCE OF CITIZENSHIP OR NATIONALITY.— 

21 (1) ACCEPTANCE OF DOCUMENTARY EVIDENCE

22 ISSUED BY A FEDERALLY RECOGNIZED INDIAN

23 TRIBE.—Section 1903(x)(3)(B) (42 U.S.C. 

24 1396b(x)(3)(B)) is amended— 


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1 (A) by redesignating clause (v) as clause 

2 (vi); and 

3 (B) by inserting after clause (iv), the fol4 lowing new clause: 

5 ‘‘(v)(I) Except as provided in subclause (II), a 

6 document issued by a federally recognized Indian 

7 tribe evidencing membership or enrollment in, or af8 filiation with, such tribe (such as a tribal enrollment 

9 card or certificate of degree of Indian blood). 

10 ‘‘(II) With respect to those federally recognized 

11 Indian tribes located within States having an inter12 national border whose membership includes individ13 uals who are not citizens of the United States, the 

14 Secretary shall, after consulting with such tribes, 

15 issue regulations authorizing the presentation of 

16 such other forms of documentation (including tribal 

17 documentation, if appropriate) that the Secretary 

18 determines to be satisfactory documentary evidence 

19 of citizenship or nationality for purposes of satis20 fying the requirement of this subsection.’’. 

21 (2) REQUIREMENT TO PROVIDE REASONABLE

22 OPPORTUNITY TO PRESENT SATISFACTORY DOCU23 MENTARY EVIDENCE.—Section 1903(x) (42 U.S.C. 

24 1396b(x)) is amended by adding at the end the fol25 lowing new paragraph: 


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1 ‘‘(4) In the case of an individual declaring to be a 

2 citizen or national of the United States with respect to 

3 whom a State requires the presentation of satisfactory 

4 documentary evidence of citizenship or nationality under 

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

6 at least the reasonable opportunity to present satisfactory 

7 documentary evidence of citizenship or nationality under 

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

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

10 to the State of evidence indicating a satisfactory immigra11 tion status.’’. 

12 (3) CHILDREN BORN IN THE UNITED STATES

13 TO MOTHERS ELIGIBLE FOR MEDICAID.— 

14 (A) CLARIFICATION OF RULES.—Section 

15 1903(x) (42 U.S.C. 1396b(x)), as amended by 

16 paragraph (2), is amended— 

17 (i) in paragraph (2)— 

18 (I) in subparagraph (C), by strik19 ing ‘‘or’’ at the end; 

20 (II) by redesignating subpara21 graph (D) as subparagraph (E); and 

22 (III) by inserting after subpara23 graph (C) the following new subpara24 graph: 


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

2 1902(e)(4) (and, in the case of an individual who is 

3 eligible for medical assistance on such basis, the in4 dividual shall be deemed to have provided satisfac5 tory documentary evidence of citizenship or nation6 ality and shall not be required to provide further 

7 documentary evidence on any date that occurs dur8 ing or after the period in which the individual is eli9 gible for medical assistance on such basis); or’’; and 

10 (ii) by adding at the end the following 

11 new paragraph: 

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

13 1902(a)(46), the preceding paragraphs of this subsection, 

14 or the Deficit Reduction Act of 2005, including section 

15 6036 of such Act, shall be construed as changing the re16 quirement of section 1902(e)(4) that a child born in the 

17 United States to an alien mother for whom medical assist18 ance for the delivery of such child is available as treatment 

19 of an emergency medical condition pursuant to subsection 

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

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

22 (B) STATE REQUIREMENT TO ISSUE SEPA23 RATE IDENTIFICATION NUMBER.—Section 

24 1902(e)(4) (42 U.S.C. 1396a(e)(4)) is amended 

25 by adding at the end the following new senVerDate Aug 31 2005 03:57 Jul 27, 2007 Jkt 059200 PO 00000 Frm 00127 Fmt 6652 Sfmt 6201 E:\BILLS\S1893.PCS S1893

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1 tence: ‘‘Notwithstanding the preceding sentence, 

2 in the case of a child who is born in the United 

3 States to an alien mother for whom medical as4 sistance for the delivery of the child is made 

5 available pursuant to section 1903(v), the State 

6 immediately shall issue a separate identification 

7 number for the child upon notification by the 

8 facility at which such delivery occurred of the 

9 child’s birth.’’. 

10 (4) TECHNICAL AMENDMENTS.—Section 

11 1903(x)(2) (42 U.S.C. 1396b(x)) is amended— 

12 (A) in subparagraph (B)— 

13 (i) by realigning the left margin of the 

14 matter preceding clause (i) 2 ems to the 

15 left; and 

16 (ii) by realigning the left margins of 

17 clauses (i) and (ii), respectively, 2 ems to 

18 the left; and 

19 (B) in subparagraph (C)— 

20 (i) by realigning the left margin of the 

21 matter preceding clause (i) 2 ems to the 

22 left; and 

23 (ii) by realigning the left margins of 

24 clauses (i) and (ii), respectively, 2 ems to 

25 the left. 


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1 (c) APPLICATION OF DOCUMENTATION SYSTEM TO

2 CHIP.— 

3 (1) IN GENERAL.—Section 2105(c) (42 U.S.C. 

4 1397ee(c)), as amended by section 110(a), is amend5 ed by adding at the end the following new para6 graph: 

7 ‘‘(9) CITIZENSHIP DOCUMENTATION REQUIRE8 MENTS.— 

9 ‘‘(A) IN GENERAL.—No payment may be 

10 made under this section with respect to an indi11 vidual who has, or is, declared to be a citizen 

12 or national of the United States for purposes of 

13 establishing eligibility under this title unless the 

14 State meets the requirements of section 

15 1902(a)(46)(B) with respect to the individual. 

16 ‘‘(B) ENHANCED PAYMENTS.—Notwith17 standing subsection (b), the enhanced FMAP 

18 with respect to payments under subsection (a) 

19 for expenditures described in clause (i) or (ii) of 

20 section 1903(a)(3)(F) necessary to comply with 

21 subparagraph (A) shall in no event be less than 

22 90 percent and 75 percent, respectively.’’. 

23 (2) NONAPPLICATION OF ADMINISTRATIVE EX24 PENDITURES CAP.—Section 2105(c)(2)(C) (42 

25 U.S.C. 1397ee(c)(2)(C)), as amended by section 


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1 202(b), is amended by adding at the end the fol2 lowing: 

3 ‘‘(iii) EXPENDITURES TO COMPLY

4 WITH CITIZENSHIP OR NATIONALITY

5 VERIFICATION REQUIREMENTS.—Expendi6 tures necessary for the State to comply 

7 with paragraph (9)(A).’’. 

8 (d) EFFECTIVE DATE.— 

9 (1) IN GENERAL.—The amendments made by 

10 this section shall take effect on October 1, 2008. 

11 (2) RESTORATION OF ELIGIBILITY.—In the 

12 case of an individual who, during the period that 

13 began on July 1, 2006, and ends on October 1, 

14 2008, was determined to be ineligible for medical as15 sistance under a State Medicaid plan, including any 

16 waiver of such plan, solely as a result of the applica17 tion of subsections (i)(22) and (x) of section 1903 

18 of the Social Security Act (as in effect during such 

19 period), but who would have been determined eligible 

20 for such assistance if such subsections, as amended 

21 by subsection (b), had applied to the individual, a 

22 State may deem the individual to be eligible for such 

23 assistance as of the date that the individual was de24 termined to be ineligible for such medical assistance 

25 on such basis. 


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1 (3) SPECIAL TRANSITION RULE FOR INDIANS.— 

2 During the period that begins on July 1, 2006, and 

3 ends on the effective date of final regulations issued 

4 under subclause (II) of section 1903(x)(3)(B)(v) of 

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

6 1396b(x)(3)(B)(v)) (as added by subsection 

7 (b)(1)(B)), an individual who is a member of a fed8 erally-recognized Indian tribe described in subclause 

9 (II) of that section who presents a document de10 scribed in subclause (I) of such section that is issued 

11 by such Indian tribe, shall be deemed to have pre12 sented satisfactory evidence of citizenship or nation13 ality for purposes of satisfying the requirement of 

14 subsection (x) of section 1903 of such Act. 

15 SEC. 302. REDUCING ADMINISTRATIVE BARRIERS TO EN16 ROLLMENT. 

17 Section 2102(b) (42 U.S.C. 1397bb(b)) is amended— 

18 (1) by redesignating paragraph (4) as para19 graph (5); and 

20 (2) by inserting after paragraph (3) the fol21 lowing new paragraph: 

22 ‘‘(4) REDUCTION OF ADMINISTRATIVE BAR23 RIERS TO ENROLLMENT.— 

24 ‘‘(A) IN GENERAL.—Subject to subpara25 graph (B), the plan shall include a description 


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1 of the procedures used to reduce administrative 

2 barriers to the enrollment of children and preg3 nant women who are eligible for medical assist4 ance under title XIX or for child health assist5 ance or health benefits coverage under this title. 

6 Such procedures shall be established and re7 vised as often as the State determines appro8 priate to take into account the most recent in9 formation available to the State identifying 

10 such barriers. 

11 ‘‘(B) DEEMED COMPLIANCE IF JOINT AP12 PLICATION AND RENEWAL PROCESS THAT PER13 MITS APPLICATION OTHER THAN IN PERSON.— 

14 A State shall be deemed to comply with sub15 paragraph (A) if the State’s application and re16 newal forms and supplemental forms (if any) 

17 and information verification process is the same 

18 for purposes of establishing and renewing eligi19 bility for children and pregnant women for 

20 medical assistance under title XIX and child 

21 health assistance under this title, and such 

22 process does not require an application to be 

23 made in person or a face-to-face interview.’’. 


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1 TITLE IV—REDUCING BARRIERS 

2 TO PROVIDING PREMIUM AS3 SISTANCE 

4 Subtitle A—Additional State Op5 tion for Providing Premium As6 sistance 

7 SEC. 401. ADDITIONAL STATE OPTION FOR PROVIDING 

8 PREMIUM ASSISTANCE. 

9 (a) IN GENERAL.—Section 2105(c) (42 U.S.C. 

10 1397ee(c)), as amended by section 301(c), is amended by 

11 adding at the end the following: 

12 ‘‘(10) STATE OPTION TO OFFER PREMIUM AS13 SISTANCE.— 

14 ‘‘(A) IN GENERAL.—Subject to the suc15 ceeding provisions of this paragraph, a State 

16 may elect to offer a premium assistance subsidy 

17 (as defined in subparagraph (C)) for qualified 

18 employer-sponsored coverage (as defined in sub19 paragraph (B)) to all targeted low-income chil20 dren who are eligible for child health assistance 

21 under the plan and have access to such cov22 erage in accordance with the requirements of 

23 this paragraph. 

24 ‘‘(B) QUALIFIED EMPLOYER-SPONSORED

25 COVERAGE.— 


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1 ‘‘(i) IN GENERAL.—Subject to clauses 

2 (ii) and (iii), in this paragraph, the term 

3 ‘qualified employer-sponsored coverage’ 

4 means a group health plan or health insur5 ance coverage offered through an em6 ployer— 

7 ‘‘(I) that qualifies as creditable 

8 coverage as a group health plan under 

9 section 2701(c)(1) of the Public 

10 Health Service Act; 

11 ‘‘(II) for which the employer con12 tribution toward any premium for 

13 such coverage is at least 40 percent; 

14 and 

15 ‘‘(III) to all individuals in a man16 ner that would be considered a non17 discriminatory eligibility classification 

18 for purposes of paragraph (3)(A)(ii) 

19 of section 105(h) of the Internal Rev20 enue Code of 1986 (but determined 

21 without regard to clause (i) of sub22 paragraph (B) of such paragraph). 

23 ‘‘(ii) EXCEPTION.—Such term does 

24 not include coverage consisting of— 


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1 ‘‘(I) benefits provided under a 

2 health flexible spending arrangement 

3 (as defined in section 106(c)(2) of the 

4 Internal Revenue Code of 1986); or 

5 ‘‘(II) a high deductible health 

6 plan (as defined in section 223(c)(2) 

7 of such Code) purchased in conjunc8 tion with a health savings account (as 

9 defined under section 223(d) of such 

10 Code). 

11 ‘‘(iii) COST-EFFECTIVENESS ALTER12 NATIVE TO REQUIRED EMPLOYER CON13 TRIBUTION.—A group health plan or 

14 health insurance coverage offered through 

15 an employer that would be considered 

16 qualified employer-sponsored coverage but 

17 for the application of clause (i)(II) may be 

18 deemed to satisfy the requirement of such 

19 clause if either of the following applies: 

20 ‘‘(I) APPLICATION OF CHILD21 BASED OR FAMILY-BASED TEST.—The 

22 State establishes to the satisfaction of 

23 the Secretary that the cost of such 

24 coverage is less than the expenditures 

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1 roll the child or the family (as appli2 cable) in the State child health plan. 

3 ‘‘(II) AGGREGATE PROGRAM

4 OPERATIONAL COSTS DO NOT EXCEED

5 THE COST OF PROVIDING COVERAGE

6 UNDER THE STATE CHILD HEALTH

7 PLAN.—If subclause (I) does not 

8 apply, the State establishes to the sat9 isfaction of the Secretary that the ag10 gregate amount of expenditures by the 

11 State for the purchase of all such cov12 erage for targeted low-income children 

13 under the State child health plan (in14 cluding administrative expenditures) 

15 does not exceed the aggregate amount 

16 of expenditures that the State would 

17 have made for providing coverage 

18 under the State child health plan for 

19 all such children. 

20 ‘‘(C) PREMIUM ASSISTANCE SUBSIDY.— 

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

22 the term ‘premium assistance subsidy’ 

23 means, with respect to a targeted low-in24 come child, the amount equal to the dif25 ference between the employee contribution 


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•S 1893 PCS

1 required for enrollment only of the em2 ployee under qualified employer-sponsored 

3 coverage and the employee contribution re4 quired for enrollment of the employee and 

5 the child in such coverage, less any appli6 cable premium cost-sharing applied under 

7 the State child health plan (subject to the 

8 limitations imposed under section 2103(e), 

9 including the requirement to count the 

10 total amount of the employee contribution 

11 required for enrollment of the employee 

12 and the child in such coverage toward the 

13 annual aggregate cost-sharing limit applied 

14 under paragraph (3)(B) of such section). 

15 ‘‘(ii) STATE PAYMENT OPTION.—A 

16 State may provide a premium assistance 

17 subsidy either as reimbursement to an em18 ployee for out-of-pocket expenditures or, 

19 subject to clause (iii), directly to the em20 ployee’s employer. 

21 ‘‘(iii) EMPLOYER OPT-OUT.—An em22 ployer may notify a State that it elects to 

23 opt-out of being directly paid a premium 

24 assistance subsidy on behalf of an em25 ployee. In the event of such a notification, 


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1 an employer shall withhold the total 

2 amount of the employee contribution re3 quired for enrollment of the employee and 

4 the child in the qualified employer-spon5 sored coverage and the State shall pay the 

6 premium assistance subsidy directly to the 

7 employee. 

8 ‘‘(iv) TREATMENT AS CHILD HEALTH

9 ASSISTANCE.—Expenditures for the provi10 sion of premium assistance subsidies shall 

11 be considered child health assistance de12 scribed in paragraph (1)(C) of subsection 

13 (a) for purposes of making payments 

14 under that subsection. 

15 ‘‘(D) APPLICATION OF SECONDARY PAYOR

16 RULES.—The State shall be a secondary payor 

17 for any items or services provided under the 

18 qualified employer-sponsored coverage for which 

19 the State provides child health assistance under 

20 the State child health plan. 

21 ‘‘(E) REQUIREMENT TO PROVIDE SUPPLE22 MENTAL COVERAGE FOR BENEFITS AND COST23 SHARING PROTECTION PROVIDED UNDER THE

24 STATE CHILD HEALTH PLAN.— 


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1 ‘‘(i) IN GENERAL.—Notwithstanding 

2 section 2110(b)(1)(C), the State shall pro3 vide for each targeted low-income child en4 rolled in qualified employer-sponsored cov5 erage, supplemental coverage consisting 

6 of— 

7 ‘‘(I) items or services that are 

8 not covered, or are only partially cov9 ered, under the qualified employer10 sponsored coverage; and 

11 ‘‘(II) cost-sharing protection con12 sistent with section 2103(e). 

13 ‘‘(ii) RECORD KEEPING REQUIRE14 MENTS.—For purposes of carrying out 

15 clause (i), a State may elect to directly pay 

16 out-of-pocket expenditures for cost-sharing 

17 imposed under the qualified employer-spon18 sored coverage and collect or not collect all 

19 or any portion of such expenditures from 

20 the parent of the child. 

21 ‘‘(F) APPLICATION OF WAITING PERIOD

22 IMPOSED UNDER THE STATE.—Any waiting pe23 riod imposed under the State child health plan 

24 prior to the provision of child health assistance 

25 to a targeted low-income child under the State 


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1 plan shall apply to the same extent to the provi2 sion of a premium assistance subsidy for the 

3 child under this paragraph. 

4 ‘‘(G) OPT-OUT PERMITTED FOR ANY

5 MONTH.—A State shall establish a process for 

6 permitting the parent of a targeted low-income 

7 child receiving a premium assistance subsidy to 

8 disenroll the child from the qualified employer9 sponsored coverage and enroll the child in, and 

10 receive child health assistance under, the State 

11 child health plan, effective on the first day of 

12 any month for which the child is eligible for 

13 such assistance and in a manner that ensures 

14 continuity of coverage for the child. 

15 ‘‘(H) APPLICATION TO PARENTS.—If a 

16 State provides child health assistance or health 

17 benefits coverage to parents of a targeted low18 income child in accordance with section 

19 2111(b), the State may elect to offer a pre20 mium assistance subsidy to a parent of a tar21 geted low-income child who is eligible for such 

22 a subsidy under this paragraph in the same 

23 manner as the State offers such a subsidy for 

24 the enrollment of the child in qualified em25 ployer-sponsored coverage, except that— 


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•S 1893 PCS

1 ‘‘(i) the amount of the premium as2 sistance subsidy shall be increased to take 

3 into account the cost of the enrollment of 

4 the parent in the qualified employer-spon5 sored coverage or, at the option of the 

6 State if the State determines it cost-effec7 tive, the cost of the enrollment of the 

8 child’s family in such coverage; and 

9 ‘‘(ii) any reference in this paragraph 

10 to a child is deemed to include a reference 

11 to the parent or, if applicable under clause 

12 (i), the family of the child. 

13 ‘‘(I) ADDITIONAL STATE OPTION FOR PRO14 VIDING PREMIUM ASSISTANCE.— 

15 ‘‘(i) IN GENERAL.—A State may es16 tablish an employer-family premium assist17 ance purchasing pool for employers with 

18 less than 250 employees who have at least 

19 1 employee who is a pregnant woman eligi20 ble for assistance under the State child 

21 health plan (including through the applica22 tion of an option described in section 

23 2112(f)) or a member of a family with at 

24 least 1 targeted low-income child and to 

25 provide a premium assistance subsidy 


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1 under this paragraph for enrollment in 

2 coverage made available through such pool. 

3 ‘‘(ii) ACCESS TO CHOICE OF COV4 ERAGE.—A State that elects the option 

5 under clause (i) shall identify and offer ac6 cess to not less than 2 private health plans 

7 that are health benefits coverage that is 

8 equivalent to the benefits coverage in a 

9 benchmark benefit package described in 

10 section 2103(b) or benchmark-equivalent 

11 coverage that meets the requirements of 

12 section 2103(a)(2) for employees described 

13 in clause (i). 

14 ‘‘(J) NO EFFECT ON PREVIOUSLY AP15 PROVED PREMIUM ASSISTANCE PROGRAMS.— 

16 Nothing in this paragraph shall be construed as 

17 limiting the authority of a State to offer pre18 mium assistance under section 1906, a waiver 

19 described in paragraph (2)(B) or (3), a waiver 

20 approved under section 1115, or other authority 

21 in effect prior to the date of enactment of the 

22 Children’s Health Insurance Program Reau23 thorization Act of 2007. 

24 ‘‘(K) NOTICE OF AVAILABILITY.—If a 

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•S 1893 PCS

1 sidies in accordance with this paragraph, the 

2 State shall— 

3 ‘‘(i) include on any application or en4 rollment form for child health assistance a 

5 notice of the availability of premium assist6 ance subsidies for the enrollment of tar7 geted low-income children in qualified em8 ployer-sponsored coverage; 

9 ‘‘(ii) provide, as part of the applica10 tion and enrollment process under the 

11 State child health plan, information de12 scribing the availability of such subsidies 

13 and how to elect to obtain such a subsidy; 

14 and 

15 ‘‘(iii) establish such other procedures 

16 as the State determines necessary to en17 sure that parents are fully informed of the 

18 choices for receiving child health assistance 

19 under the State child health plan or 

20 through the receipt of premium assistance 

21 subsidies. 

22 ‘‘(L) APPLICATION TO QUALIFIED EM23 PLOYER-SPONSORED BENCHMARK COVERAGE.— 

24 If a group health plan or health insurance cov25 erage offered through an employer is certified 


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•S 1893 PCS

1 by an actuary as health benefits coverage that 

2 is equivalent to the benefits coverage in a 

3 benchmark benefit package described in section 

4 2103(b) or benchmark-equivalent coverage that 

5 meets the requirements of section 2103(a)(2), 

6 the State may provide premium assistance sub7 sidies for enrollment of targeted low-income 

8 children in such group health plan or health in9 surance coverage in the same manner as such 

10 subsidies are provided under this paragraph for 

11 enrollment in qualified employer-sponsored cov12 erage, but without regard to the requirement to 

13 provide supplemental coverage for benefits and 

14 cost-sharing protection provided under the 

15 State child health plan under subparagraph 

16 (E).’’. 

17 (b) APPLICATION TO MEDICAID.—Section 1906 (42 

18 U.S.C. 1396e) is amended by inserting after subsection 

19 (c) the following: 

20 ‘‘(d) A State may elect to offer a premium assistance 

21 subsidy (as defined in section 2105(c)(10)(C)) for quali22 fied employer-sponsored coverage (as defined in section 

23 2105(c)(10)(B)) to a child who is eligible for medical as24 sistance under the State plan under this title, to the par25 ent of such a child, and to a pregnant woman, in the same 


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1 manner as such a subsidy for such coverage may be of2 fered under a State child health plan under title XXI in 

3 accordance with section 2105(c)(10) (except that subpara4 graph (E)(i)(II) of such section shall be applied by sub5 stituting ‘1916 or, if applicable, 1916A’ for ‘2103(e)’).’’. 

6 (c) GAO STUDY AND REPORT.—Not later than Janu7 ary 1, 2009, the Comptroller General of the United States 

8 shall study cost and coverage issues relating to any State 

9 premium assistance programs for which Federal matching 

10 payments are made under title XIX or XXI of the Social 

11 Security Act, including under waiver authority, and shall 

12 submit a report to the appropriate committees of Congress 

13 on the results of such study. 

14 SEC. 402. OUTREACH, EDUCATION, AND ENROLLMENT AS15 SISTANCE. 

16 (a) REQUIREMENT TO INCLUDE DESCRIPTION OF

17 OUTREACH, EDUCATION, AND ENROLLMENT EFFORTS

18 RELATED TO PREMIUM ASSISTANCE SUBSIDIES IN STATE

19 CHILD HEALTH PLAN.—Section 2102(c) (42 U.S.C. 

20 1397bb(c)) is amended by adding at the end the following 

21 new paragraph: 

22 ‘‘(3) PREMIUM ASSISTANCE SUBSIDIES.—Out23 reach, education, and enrollment assistance for fami24 lies of children likely to be eligible for premium as25 sistance subsidies under the State child health plan 


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1 in accordance with paragraphs (2)(B), (3), or (10) 

2 of section 2105(c), or a waiver approved under sec3 tion 1115, to inform such families of the availability 

4 of, and to assist them in enrolling their children in, 

5 such subsidies, and for employers likely to provide 

6 coverage that is eligible for such subsidies, including 

7 the specific, significant resources the State intends 

8 to apply to educate employers about the availability 

9 of premium assistance subsidies under the State 

10 child health plan.’’. 

11 (b) NONAPPLICATION OF 10 PERCENT LIMIT ON

12 OUTREACH AND CERTAIN OTHER EXPENDITURES.—Sec13 tion 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)(C)), as 

14 amended by section 301(c)(2), is amended by adding at 

15 the end the following new clause: 

16 ‘‘(iv) EXPENDITURES FOR OUTREACH

17 TO INCREASE THE ENROLLMENT OF CHIL18 DREN UNDER THIS TITLE AND TITLE XIX

19 THROUGH PREMIUM ASSISTANCE SUB20 SIDIES.—Expenditures for outreach activi21 ties to families of children likely to be eligi22 ble for premium assistance subsidies in ac23 cordance with paragraphs (2)(B), (3), or 

24 (10), or a waiver approved under section 

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1 ability of, and to assist them in enrolling 

2 their children in, such subsidies, and to 

3 employers likely to provide qualified em4 ployer-sponsored coverage (as defined in 

5 subparagraph (B) of such paragraph).’’. 

6 Subtitle B—Coordinating Premium 

7 Assistance With Private Coverage 

8 SEC. 411. SPECIAL ENROLLMENT PERIOD UNDER GROUP 

9 HEALTH PLANS IN CASE OF TERMINATION OF 

10 MEDICAID OR CHIP COVERAGE OR ELIGI11 BILITY FOR ASSISTANCE IN PURCHASE OF 

12 EMPLOYMENT-BASED COVERAGE; COORDINA13 TION OF COVERAGE. 

14 (a) AMENDMENTS TO INTERNAL REVENUE CODE OF

15 1986.—Section 9801(f) of the Internal Revenue Code of 

16 1986 (relating to special enrollment periods) is amended 

17 by adding at the end the following new paragraph: 

18 ‘‘(3) SPECIAL RULES RELATING TO MEDICAID

19 AND CHIP.— 

20 ‘‘(A) IN GENERAL.—A group health plan 

21 shall permit an employee who is eligible, but 

22 not enrolled, for coverage under the terms of 

23 the plan (or a dependent of such an employee 

24 if the dependent is eligible, but not enrolled, for 

25 coverage under such terms) to enroll for covVerDate Aug 31 2005 03:57 Jul 27, 2007 Jkt 059200 PO 00000 Frm 00147 Fmt 6652 Sfmt 6201 E:\BILLS\S1893.PCS S1893

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1 erage under the terms of the plan if either of 

2 the following conditions is met: 

3 ‘‘(i) TERMINATION OF MEDICAID OR

4 CHIP COVERAGE.—The employee or de5 pendent is covered under a Medicaid plan 

6 under title XIX of the Social Security Act 

7 or under a State child health plan under 

8 title XXI of such Act and coverage of the 

9 employee or dependent under such a plan 

10 is terminated as a result of loss of eligi11 bility for such coverage and the employee 

12 requests coverage under the group health 

13 plan not later than 60 days after the date 

14 of termination of such coverage. 

15 ‘‘(ii) ELIGIBILITY FOR EMPLOYMENT

16 ASSISTANCE UNDER MEDICAID OR CHIP.— 

17 The employee or dependent becomes eligi18 ble for assistance, with respect to coverage 

19 under the group health plan under such 

20 Medicaid plan or State child health plan 

21 (including under any waiver or demonstra22 tion project conducted under or in relation 

23 to such a plan), if the employee requests 

24 coverage under the group health plan not 

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1 ployee or dependent is determined to be el2 igible for such assistance. 

3 ‘‘(B) EMPLOYEE OUTREACH AND DISCLO4 SURE.— 

5 ‘‘(i) OUTREACH TO EMPLOYEES RE6 GARDING AVAILABILITY OF MEDICAID AND

7 CHIP COVERAGE.— 

8 ‘‘(I) IN GENERAL.—Each em9 ployer that maintains a group health 

10 plan in a State that provides medical 

11 assistance under a State Medicaid 

12 plan under title XIX of the Social Se13 curity Act, or child health assistance 

14 under a State child health plan under 

15 title XXI of such Act, in the form of 

16 premium assistance for the purchase 

17 of coverage under a group health 

18 plan, shall provide to each employee a 

19 written notice informing the employee 

20 of potential opportunities then cur21 rently available in the State in which 

22 the employee resides for premium as23 sistance under such plans for health 

24 coverage of the employee or the em25 ployee’s dependents. For purposes of 


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1 compliance with this clause, the em2 ployer may use any State-specific 

3 model notice issued by the Secretary 

4 of Labor or the Secretary of Health 

5 and Human Services in accordance 

6 with section 701(f)(3)(B) of the Em7 ployee Retirement Income Security 

8 Act of 1974 (29 U.S.C. 

9 1181(f)(3)(B)). 

10 ‘‘(II) OPTION TO PROVIDE CON11 CURRENT WITH PROVISION OF SUM12 MARY PLAN DESCRIPTION.—An em13 ployer may provide the model notice 

14 applicable to the State in which an 

15 employee resides concurrent with the 

16 furnishing of the summary plan de17 scription as provided in section 104(b) 

18 of the Employee Retirement Income 

19 Security Act of 1974 (29 U.S.C. 

20 1024). 

21 ‘‘(ii) DISCLOSURE ABOUT GROUP

22 HEALTH PLAN BENEFITS TO STATES FOR

23 MEDICAID AND CHIP ELIGIBLE INDIVID24 UALS.—In the case of a participant or ben25 eficiary of a group health plan who is covVerDate Aug 31 2005 03:57 Jul 27, 2007 Jkt 059200 PO 00000 Frm 00150 Fmt 6652 Sfmt 6201 E:\BILLS\S1893.PCS S1893

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1 ered under a Medicaid plan of a State 

2 under title XIX of the Social Security Act 

3 or under a State child health plan under 

4 title XXI of such Act, the plan adminis5 trator of the group health plan shall dis6 close to the State, upon request, informa7 tion about the benefits available under the 

8 group health plan in sufficient specificity, 

9 as determined under regulations of the 

10 Secretary of Health and Human Services 

11 in consultation with the Secretary that re12 quire use of the model coverage coordina13 tion disclosure form developed under sec14 tion 411(b)(2)(C) of the Children’s Health 

15 Insurance Program Reauthorization Act of 

16 2007, so as to permit the State to make a 

17 determination (under paragraph (2)(B), 

18 (3), or (10) of section 2105(c) of the So19 cial Security Act or otherwise) concerning 

20 the cost-effectiveness of the State pro21 viding medical or child health assistance 

22 through premium assistance for the pur23 chase of coverage under such group health 

24 plan and in order for the State to provide 

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1 graph (10)(E) of such section or other au2 thority.’’. 

3 (b) CONFORMING AMENDMENTS.— 

4 (1) AMENDMENTS TO EMPLOYEE RETIREMENT

5 INCOME SECURITY ACT.— 

6 (A) IN GENERAL.—Section 701(f) of the 

7 Employee Retirement Income Security Act of 

8 1974 (29 U.S.C. 1181(f)) is amended by adding 

9 at the end the following new paragraph: 

10 ‘‘(3) SPECIAL RULES FOR APPLICATION IN CASE

11 OF MEDICAID AND CHIP.— 

12 ‘‘(A) IN GENERAL.—A group health plan, 

13 and a health insurance issuer offering group 

14 health insurance coverage in connection with a 

15 group health plan, shall permit an employee 

16 who is eligible, but not enrolled, for coverage 

17 under the terms of the plan (or a dependent of 

18 such an employee if the dependent is eligible, 

19 but not enrolled, for coverage under such 

20 terms) to enroll for coverage under the terms of 

21 the plan if either of the following conditions is 

22 met: 

23 ‘‘(i) TERMINATION OF MEDICAID OR

24 CHIP COVERAGE.—The employee or de25 pendent is covered under a Medicaid plan 


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1 under title XIX of the Social Security Act 

2 or under a State child health plan under 

3 title XXI of such Act and coverage of the 

4 employee or dependent under such a plan 

5 is terminated as a result of loss of eligi6 bility for such coverage and the employee 

7 requests coverage under the group health 

8 plan (or health insurance coverage) not 

9 later than 60 days after the date of termi10 nation of such coverage. 

11 ‘‘(ii) ELIGIBILITY FOR EMPLOYMENT

12 ASSISTANCE UNDER MEDICAID OR CHIP.— 

13 The employee or dependent becomes eligi14 ble for assistance, with respect to coverage 

15 under the group health plan or health in16 surance coverage, under such Medicaid 

17 plan or State child health plan (including 

18 under any waiver or demonstration project 

19 conducted under or in relation to such a 

20 plan), if the employee requests coverage 

21 under the group health plan or health in22 surance coverage not later than 60 days 

23 after the date the employee or dependent is 

24 determined to be eligible for such assist25 ance.’’. 


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1 ‘‘(B) COORDINATION WITH MEDICAID AND

2 CHIP.— 

3 ‘‘(i) OUTREACH TO EMPLOYEES RE4 GARDING AVAILABILITY OF MEDICAID AND

5 CHIP COVERAGE.— 

6 ‘‘(I) IN GENERAL.—Each em7 ployer that maintains a group health 

8 plan in a State that provides medical 

9 assistance under a State Medicaid 

10 plan under title XIX of the Social Se11 curity Act, or child health assistance 

12 under a State child health plan under 

13 title XXI of such Act, in the form of 

14 premium assistance for the purchase 

15 of coverage under a group health 

16 plan, shall provide to each employee a 

17 written notice informing the employee 

18 of potential opportunities then cur19 rently available in the State in which 

20 the employee resides for premium as21 sistance under such plans for health 

22 coverage of the employee or the em23 ployee’s dependents. 

24 ‘‘(II) MODEL NOTICE.—Not later 

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1 ment of the Children’s Health Insur2 ance Program Reauthorization Act of 

3 2007, the Secretary and the Secretary 

4 of Health and Human Services, in 

5 consultation with Directors of State 

6 Medicaid agencies under title XIX of 

7 the Social Security Act and Directors 

8 of State CHIP agencies under title 

9 XXI of such Act, shall jointly develop 

10 national and State-specific model no11 tices for purposes of subparagraph 

12 (A). The Secretary shall provide em13 ployers with such model notices so as 

14 to enable employers to timely comply 

15 with the requirements of subpara16 graph (A). Such model notices shall 

17 include information regarding how an 

18 employee may contact the State in 

19 which the employee resides for addi20 tional information regarding potential 

21 opportunities for such premium assist22 ance, including how to apply for such 

23 assistance. 

24 ‘‘(III) OPTION TO PROVIDE CON25 CURRENT WITH PROVISION OF SUMVerDate Aug 31 2005 03:57 Jul 27, 2007 Jkt 059200 PO 00000 Frm 00155 Fmt 6652 Sfmt 6201 E:\BILLS\S1893.PCS S1893

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1 MARY PLAN DESCRIPTION.—An em2 ployer may provide the model notice 

3 applicable to the State in which an 

4 employee resides concurrent with the 

5 furnishing of the summary plan de6 scription as provided in section 

7 104(b). 

8 ‘‘(ii) DISCLOSURE ABOUT GROUP

9 HEALTH PLAN BENEFITS TO STATES FOR

10 MEDICAID AND CHIP ELIGIBLE INDIVID11 UALS.—In the case of a participant or ben12 eficiary of a group health plan who is cov13 ered under a Medicaid plan of a State 

14 under title XIX of the Social Security Act 

15 or under a State child health plan under 

16 title XXI of such Act, the plan adminis17 trator of the group health plan shall dis18 close to the State, upon request, informa19 tion about the benefits available under the 

20 group health plan in sufficient specificity, 

21 as determined under regulations of the 

22 Secretary of Health and Human Services 

23 in consultation with the Secretary that re24 quire use of the model coverage coordina25 tion disclosure form developed under secVerDate Aug 31 2005 03:57 Jul 27, 2007 Jkt 059200 PO 00000 Frm 00156 Fmt 6652 Sfmt 6201 E:\BILLS\S1893.PCS S1893

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1 tion 411(b)(2)(C) of the Children’s Health 

2 Insurance Program Reauthorization Act of 

3 2007, so as to permit the State to make a 

4 determination (under paragraph (2)(B), 

5 (3), or (10) of section 2105(c) of the So6 cial Security Act or otherwise) concerning 

7 the cost-effectiveness of the State pro8 viding medical or child health assistance 

9 through premium assistance for the pur10 chase of coverage under such group health 

11 plan and in order for the State to provide 

12 supplemental benefits required under para13 graph (10)(E) of such section or other au14 thority.’’. 

15 (B) CONFORMING AMENDMENT.—Section 

16 102(b) of the Employee Retirement Income Se17 curity Act of 1974 (29 U.S.C. 1022(b)) is 

18 amended— 

19 (i) by striking ‘‘and the remedies’’ 

20 and inserting ‘‘, the remedies’’; and 

21 (ii) by inserting before the period the 

22 following: ‘‘, and if the employer so elects 

23 for purposes of complying with section 

24 701(f)(3)(B)(i), the model notice applicable 


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1 to the State in which the participants and 

2 beneficiaries reside’’. 

3 (C) WORKING GROUP TO DEVELOP MODEL

4 COVERAGE COORDINATION DISCLOSURE

5 FORM.— 

6 (i) MEDICAID, CHIP, AND EMPLOYER7 SPONSORED COVERAGE COORDINATION

8 WORKING GROUP.— 

9 (I) IN GENERAL.—Not later than 

10 60 days after the date of enactment of 

11 this Act, the Secretary of Health and 

12 Human Services and the Secretary of 

13 Labor shall jointly establish a Med14 icaid, CHIP, and Employer-Sponsored 

15 Coverage Coordination Working 

16 Group (in this subparagraph referred 

17 to as the ‘‘Working Group’’). The 

18 purpose of the Working Group shall 

19 be to develop the model coverage co20 ordination disclosure form described 

21 in subclause (II) and to identify the 

22 impediments to the effective coordina23 tion of coverage available to families 

24 that include employees of employers 

25 that maintain group health plans and 


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1 members who are eligible for medical 

2 assistance under title XIX of the So3 cial Security Act or child health as4 sistance or other health benefits cov5 erage under title XXI of such Act. 

6 (II) MODEL COVERAGE COORDI7 NATION DISCLOSURE FORM DE8 SCRIBED.—The model form described 

9 in this subclause is a form for plan 

10 administrators of group health plans 

11 to complete for purposes of permitting 

12 a State to determine the availability 

13 and cost-effectiveness of the coverage 

14 available under such plans to employ15 ees who have family members who are 

16 eligible for premium assistance offered 

17 under a State plan under title XIX or 

18 XXI of such Act and to allow for co19 ordination of coverage for enrollees of 

20 such plans. Such form shall provide 

21 the following information in addition 

22 to such other information as the 

23 Working Group determines appro24 priate: 


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1 (aa) A determination of 

2 whether the employee is eligible 

3 for coverage under the group 

4 health plan. 

5 (bb) The name and contract 

6 information of the plan adminis7 trator of the group health plan. 

8 (cc) The benefits offered 

9 under the plan. 

10 (dd) The premiums and 

11 cost-sharing required under the 

12 plan. 

13 (ee) Any other information 

14 relevant to coverage under the 

15 plan. 

16 (ii) MEMBERSHIP.—The Working 

17 Group shall consist of not more than 30 

18 members and shall be composed of rep19 resentatives of— 

20 (I) the Department of Labor; 

21 (II) the Department of Health 

22 and Human Services; 

23 (III) State directors of the Med24 icaid program under title XIX of the 

25 Social Security Act; 


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1 (IV) State directors of the State 

2 Children’s Health Insurance Program 

3 under title XXI of the Social Security 

4 Act; 

5 (V) employers, including owners 

6 of small businesses and their trade or 

7 industry representatives and certified 

8 human resource and payroll profes9 sionals; 

10 (VI) plan administrators and 

11 plan sponsors of group health plans 

12 (as defined in section 607(1) of the 

13 Employee Retirement Income Security 

14 Act of 1974); and 

15 (VII) children and other bene16 ficiaries of medical assistance under 

17 title XIX of the Social Security Act or 

18 child health assistance or other health 

19 benefits coverage under title XXI of 

20 such Act. 

21 (iii) COMPENSATION.—The members 

22 of the Working Group shall serve without 

23 compensation. 

24 (iv) ADMINISTRATIVE SUPPORT.—The 

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1 ices and the Department of Labor shall 

2 jointly provide appropriate administrative 

3 support to the Working Group, including 

4 technical assistance. The Working Group 

5 may use the services and facilities of either 

6 such Department, with or without reim7 bursement, as jointly determined by such 

8 Departments. 

9 (v) REPORT.— 

10 (I) REPORT BY WORKING GROUP

11 TO THE SECRETARIES.—Not later 

12 than 18 months after the date of the 

13 enactment of this Act, the Working 

14 Group shall submit to the Secretary of 

15 Labor and the Secretary of Health 

16 and Human Services the model form 

17 described in clause (i)(II) along with a 

18 report containing recommendations 

19 for appropriate measures to address 

20 the impediments to the effective co21 ordination of coverage between group 

22 health plans and the State plans 

23 under titles XIX and XXI of the So24 cial Security Act. 


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1 (II) REPORT BY SECRETARIES TO

2 THE CONGRESS.—Not later than 2 

3 months after receipt of the report 

4 pursuant to subclause (I), the Secre5 taries shall jointly submit a report to 

6 each House of the Congress regarding 

7 the recommendations contained in the 

8 report under such subclause. 

9 (vi) TERMINATION.—The Working 

10 Group shall terminate 30 days after the 

11 date of the issuance of its report under 

12 clause (v). 

13 (D) EFFECTIVE DATES.—The Secretary of 

14 Labor and the Secretary of Health and Human 

15 Services shall develop the initial model notices 

16 under section 701(f)(3)(B)(i)(II) of the Em17 ployee Retirement Income Security Act of 1974, 

18 and the Secretary of Labor shall provide such 

19 notices to employers, not later than the date 

20 that is 1 year after the date of enactment of 

21 this Act, and each employer shall provide the 

22 initial annual notices to such employer’s em23 ployees beginning with the first plan year that 

24 begins after the date on which such initial 

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1 erage coordination disclosure form developed 

2 under subparagraph (C) shall apply with re3 spect to requests made by States beginning 

4 with the first plan year that begins after the 

5 date on which such model coverage coordination 

6 disclosure form is first issued. 

7 (E) ENFORCEMENT.—Section 502 of the 

8 Employee Retirement Income Security Act of 

9 1974 (29 U.S.C. 1132) is amended— 

10 (i) in subsection (a)(6), by striking 

11 ‘‘or (8)’’ and inserting ‘‘(8), or (9)’’; and 

12 (ii) in subsection (c), by redesignating 

13 paragraph (9) as paragraph (10), and by 

14 inserting after paragraph (8) the following: 

15 ‘‘(9)(A) The Secretary may assess a civil penalty 

16 against any employer of up to $100 a day from the date 

17 of the employer’s failure to meet the notice requirement 

18 of section 701(f)(3)(B)(i)(I). For purposes of this sub19 paragraph, each violation with respect to any single em20 ployee shall be treated as a separate violation. 

21 ‘‘(B) The Secretary may assess a civil penalty against 

22 any plan administrator of up to $100 a day from the date 

23 of the plan administrator’s failure to timely provide to any 

24 State the information required to be disclosed under sec25 tion 701(f)(3)(B)(ii). For purposes of this subparagraph, 


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1 each violation with respect to any single participant or 

2 beneficiary shall be treated as a separate violation.’’. 

3 TITLE V—STRENGTHENING 

4 QUALITY OF CARE AND 

5 HEALTH OUTCOMES OF CHIL6 DREN 

7 SEC. 501. CHILD HEALTH QUALITY IMPROVEMENT ACTIVI8 TIES FOR CHILDREN ENROLLED IN MED9 ICAID OR CHIP. 

10 (a) DEVELOPMENT OF CHILD HEALTH QUALITY

11 MEASURES FOR CHILDREN ENROLLED IN MEDICAID OR

12 CHIP.—Title XI (42 U.S.C. 1301 et seq.) is amended by 

13 inserting after section 1139 the following new section: 

14 ‘‘SEC. 1139A. CHILD HEALTH QUALITY MEASURES. 

15 ‘‘(a) DEVELOPMENT OF AN INITIAL CORE SET OF

16 HEALTH CARE QUALITY MEASURES FOR CHILDREN EN17 ROLLED IN MEDICAID OR CHIP.— 

18 ‘‘(1) IN GENERAL.—Not later than January 1, 

19 2009, the Secretary shall identify and publish for 

20 general comment an initial, recommended core set of 

21 child health quality measures for use by State pro22 grams administered under titles XIX and XXI, 

23 health insurance issuers and managed care entities 

24 that enter into contracts with such programs, and 


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1 providers of items and services under such pro2 grams. 

3 ‘‘(2) IDENTIFICATION OF INITIAL CORE MEAS4 URES.—In consultation with the individuals and en5 tities described in subsection (b)(3), the Secretary 

6 shall identify existing quality of care measures for 

7 children that are in use under public and privately 

8 sponsored health care coverage arrangements, or 

9 that are part of reporting systems that measure both 

10 the presence and duration of health insurance cov11 erage over time. 

12 ‘‘(3) RECOMMENDATIONS AND DISSEMINA13 TION.—Based on such existing and identified meas14 ures, the Secretary shall publish an initial core set 

15 of child health quality measures that includes (but 

16 is not limited to) the following: 

17 ‘‘(A) The duration of children’s health in18 surance coverage over a 12-month time period. 

19 ‘‘(B) The availability of a full range of— 

20 ‘‘(i) preventive services, treatments, 

21 and services for acute conditions, including 

22 services to promote healthy birth and pre23 vent and treat premature birth; and 

24 ‘‘(ii) treatments to correct or amelio25 rate the effects of chronic physical and 


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1 mental conditions in infants, young chil2 dren, school-age children, and adolescents. 

3 ‘‘(C) The availability of care in a range of 

4 ambulatory and inpatient health care settings 

5 in which such care is furnished. 

6 ‘‘(D) The types of measures that, taken to7 gether, can be used to estimate the overall na8 tional quality of health care for children and to 

9 perform comparative analyses of pediatric 

10 health care quality and racial, ethnic, and socio11 economic disparities in child health and health 

12 care for children. 

13 ‘‘(4) ENCOURAGE VOLUNTARY AND STANDARD14 IZED REPORTING.—Not later than 2 years after the 

15 date of enactment of the Children’s Health Insur16 ance Program Reauthorization Act of 2007, the Sec17 retary, in consultation with States, shall develop a 

18 standardized format for reporting information and 

19 procedures and approaches that encourage States to 

20 use the initial core measurement set to voluntarily 

21 report information regarding the quality of pediatric 

22 health care under titles XIX and XXI. 

23 ‘‘(5) ADOPTION OF BEST PRACTICES IN IMPLE24 MENTING QUALITY PROGRAMS.—The Secretary shall 

25 disseminate information to States regarding best 


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1 practices among States with respect to measuring 

2 and reporting on the quality of health care for chil3 dren, and shall facilitate the adoption of such best 

4 practices. In developing best practices approaches, 

5 the Secretary shall give particular attention to State 

6 measurement techniques that ensure the timeliness 

7 and accuracy of provider reporting, encourage pro8 vider reporting compliance, encourage successful 

9 quality improvement strategies, and improve effi10 ciency in data collection using health information 

11 technology. 

12 ‘‘(6) REPORTS TO CONGRESS.—Not later than 

13 January 1, 2010, and every 3 years thereafter, the 

14 Secretary shall report to Congress on— 

15 ‘‘(A) the status of the Secretary’s efforts 

16 to improve— 

17 ‘‘(i) quality related to the duration 

18 and stability of health insurance coverage 

19 for children under titles XIX and XXI; 

20 ‘‘(ii) the quality of children’s health 

21 care under such titles, including preventive 

22 health services, health care for acute condi23 tions, chronic health care, and health serv24 ices to ameliorate the effects of physical 

25 and mental conditions and to aid in growth 


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1 and development of infants, young chil2 dren, school-age children, and adolescents 

3 with special health care needs; and 

4 ‘‘(iii) the quality of children’s health 

5 care under such titles across the domains 

6 of quality, including clinical quality, health 

7 care safety, family experience with health 

8 care, health care in the most integrated 

9 setting, and elimination of racial, ethnic, 

10 and socioeconomic disparities in health and 

11 health care; 

12 ‘‘(B) the status of voluntary reporting by 

13 States under titles XIX and XXI, utilizing the 

14 initial core quality measurement set; and 

15 ‘‘(C) any recommendations for legislative 

16 changes needed to improve the quality of care 

17 provided to children under titles XIX and XXI, 

18 including recommendations for quality reporting 

19 by States. 

20 ‘‘(7) TECHNICAL ASSISTANCE.—The Secretary 

21 shall provide technical assistance to States to assist 

22 them in adopting and utilizing core child health 

23 quality measures in administering the State plans 

24 under titles XIX and XXI. 


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1 ‘‘(8) DEFINITION OF CORE SET.—In this sec2 tion, the term ‘core set’ means a group of valid, reli3 able, and evidence-based quality measures that, 

4 taken together— 

5 ‘‘(A) provide information regarding the 

6 quality of health coverage and health care for 

7 children; 

8 ‘‘(B) address the needs of children 

9 throughout the developmental age span; and 

10 ‘‘(C) allow purchasers, families, and health 

11 care providers to understand the quality of care 

12 in relation to the preventive needs of children, 

13 treatments aimed at managing and resolving 

14 acute conditions, and diagnostic and treatment 

15 services whose purpose is to correct or amelio16 rate physical, mental, or developmental condi17 tions that could, if untreated or poorly treated, 

18 become chronic. 

19 ‘‘(b) ADVANCING AND IMPROVING PEDIATRIC QUAL20 ITY MEASURES.— 

21 ‘‘(1) ESTABLISHMENT OF PEDIATRIC QUALITY

22 MEASURES PROGRAM.—Not later than January 1, 

23 2010, the Secretary shall establish a pediatric qual24 ity measures program to— 


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1 ‘‘(A) improve and strengthen the initial 

2 core child health care quality measures estab3 lished by the Secretary under subsection (a); 

4 ‘‘(B) expand on existing pediatric quality 

5 measures used by public and private health care 

6 purchasers and advance the development of 

7 such new and emerging quality measures; and 

8 ‘‘(C) increase the portfolio of evidence9 based, consensus pediatric quality measures 

10 available to public and private purchasers of 

11 children’s health care services, providers, and 

12 consumers. 

13 ‘‘(2) EVIDENCE-BASED MEASURES.—The meas14 ures developed under the pediatric quality measures 

15 program shall, at a minimum, be— 

16 ‘‘(A) evidence-based and, where appro17 priate, risk adjusted; 

18 ‘‘(B) designed to identify and eliminate ra19 cial and ethnic disparities in child health and 

20 the provision of health care; 

21 ‘‘(C) designed to ensure that the data re22 quired for such measures is collected and re23 ported in a standard format that permits com24 parison of quality and data at a State, plan, 

25 and provider level; 


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1 ‘‘(D) periodically updated; and 

2 ‘‘(E) responsive to the child health needs, 

3 services, and domains of health care quality de4 scribed in clauses (i), (ii), and (iii) of subsection 

5 (a)(6)(A). 

6 ‘‘(3) PROCESS FOR PEDIATRIC QUALITY MEAS7 URES PROGRAM.—In identifying gaps in existing pe8 diatric quality measures and establishing priorities 

9 for development and advancement of such measures, 

10 the Secretary shall consult with— 

11 ‘‘(A) States; 

12 ‘‘(B) pediatricians, children’s hospitals, 

13 and other primary and specialized pediatric 

14 health care professionals (including members of 

15 the allied health professions) who specialize in 

16 the care and treatment of children, particularly 

17 children with special physical, mental, and de18 velopmental health care needs; 

19 ‘‘(C) dental professionals, including pedi20 atric dental professionals; 

21 ‘‘(D) health care providers that furnish 

22 primary health care to children and families 

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1 tinct population sub-groups at heightened risk 

2 for poor health outcomes; 

3 ‘‘(E) national organizations representing 

4 consumers and purchasers of children’s health 

5 care; 

6 ‘‘(F) national organizations and individuals 

7 with expertise in pediatric health quality meas8 urement; and 

9 ‘‘(G) voluntary consensus standards setting 

10 organizations and other organizations involved 

11 in the advancement of evidence-based measures 

12 of health care. 

13 ‘‘(4) DEVELOPING, VALIDATING, AND TESTING

14 A PORTFOLIO OF PEDIATRIC QUALITY MEASURES.— 

15 As part of the program to advance pediatric quality 

16 measures, the Secretary shall— 

17 ‘‘(A) award grants and contracts for the 

18 development, testing, and validation of new, 

19 emerging, and innovative evidence-based meas20 ures for children’s health care services across 

21 the domains of quality described in clauses 

22 (i),(ii), and (iii) of subsection (a)(6)(A); and 

23 ‘‘(B) award grants and contracts for— 


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1 ‘‘(i) the development of consensus on 

2 evidence-based measures for children’s 

3 health care services; 

4 ‘‘(ii) the dissemination of such meas5 ures to public and private purchasers of 

6 health care for children; and 

7 ‘‘(iii) the updating of such measures 

8 as necessary. 

9 ‘‘(5) REVISING, STRENGTHENING, AND IMPROV10 ING INITIAL CORE MEASURES.—Beginning no later 

11 than January 1, 2012, and annually thereafter, the 

12 Secretary shall publish recommended changes to the 

13 core measures described in subsection (a) that shall 

14 reflect the testing, validation, and consensus process 

15 for the development of pediatric quality measures 

16 described in subsection paragraphs (1) through (4). 

17 ‘‘(6) DEFINITION OF PEDIATRIC QUALITY

18 MEASURE.—In this subsection, the term ‘pediatric 

19 quality measure’ means a measurement of clinical 

20 care that is capable of being examined through the 

21 collection and analysis of relevant information, that 

22 is developed in order to assess 1 or more aspects of 

23 pediatric health care quality in various institutional 

24 and ambulatory health care settings, including the 

25 structure of the clinical care system, the process of 


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1 care, the outcome of care, or patient experiences in 

2 care. 

3 ‘‘(c) ANNUAL STATE REPORTS REGARDING STATE4 SPECIFIC QUALITY OF CARE MEASURES APPLIED UNDER

5 MEDICAID OR CHIP.— 

6 ‘‘(1) ANNUAL STATE REPORTS.—Each State 

7 with a State plan approved under title XIX or a 

8 State child health plan approved under title XXI 

9 shall annually report to the Secretary on the— 

10 ‘‘(A) State-specific child health quality 

11 measures applied by the States under such 

12 plans, including measures described in subpara13 graphs (A) and (B) of subsection (a)(6); and 

14 ‘‘(B) State-specific information on the 

15 quality of health care furnished to children 

16 under such plans, including information col17 lected through external quality reviews of man18 aged care organizations under section 1932 of 

19 the Social Security Act (42 U.S.C. 1396u–4) 

20 and benchmark plans under sections 1937 and 

21 2103 of such Act (42 U.S.C. 1396u–7, 1397cc). 

22 ‘‘(2) PUBLICATION.—Not later than September 

23 30, 2009, and annually thereafter, the Secretary 

24 shall collect, analyze, and make publicly available the 

25 information reported by States under paragraph (1). 


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1 ‘‘(d) DEMONSTRATION PROJECTS FOR IMPROVING

2 THE QUALITY OF CHILDREN’S HEALTH CARE AND THE

3 USE OF HEALTH INFORMATION TECHNOLOGY.— 

4 ‘‘(1) IN GENERAL.—During the period of fiscal 

5 years 2008 through 2012, the Secretary shall award 

6 not more than 10 grants to States and child health 

7 providers to conduct demonstration projects to 

8 evaluate promising ideas for improving the quality of 

9 children’s health care provided under title XIX or 

10 XXI, including projects to— 

11 ‘‘(A) experiment with, and evaluate the use 

12 of, new measures of the quality of children’s 

13 health care under such titles (including testing 

14 the validity and suitability for reporting of such 

15 measures); 

16 ‘‘(B) promote the use of health information 

17 technology in care delivery for children under 

18 such titles; 

19 ‘‘(C) evaluate provider-based models which 

20 improve the delivery of children’s health care 

21 services under such titles, including care man22 agement for children with chronic conditions 

23 and the use of evidence-based approaches to im24 prove the effectiveness, safety, and efficiency of 

25 health care services for children; or 


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1 ‘‘(D) demonstrate the impact of the model 

2 electronic health record format for children de3 veloped and disseminated under subsection (f) 

4 on improving pediatric health, including the ef5 fects of chronic childhood health conditions, and 

6 pediatric health care quality as well as reducing 

7 health care costs. 

8 ‘‘(2) REQUIREMENTS.—In awarding grants 

9 under this subsection, the Secretary shall ensure 

10 that— 

11 ‘‘(A) only 1 demonstration project funded 

12 under a grant awarded under this subsection 

13 shall be conducted in a State; and 

14 ‘‘(B) demonstration projects funded under 

15 grants awarded under this subsection shall be 

16 conducted evenly between States with large 

17 urban areas and States with large rural areas. 

18 ‘‘(3) AUTHORITY FOR MULTISTATE

19 PROJECTS.—A demonstration project conducted with 

20 a grant awarded under this subsection may be con21 ducted on a multistate basis, as needed. 

22 ‘‘(4) FUNDING.—$20,000,000 of the amount 

23 appropriated under subsection (i) for a fiscal year 

24 shall be used to carry out this subsection. 


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1 ‘‘(e) CHILDHOOD OBESITY DEMONSTRATION

2 PROJECT.— 

3 ‘‘(1) AUTHORITY TO CONDUCT DEMONSTRA4 TION.—The Secretary, in consultation with the Ad5 ministrator of the Centers for Medicare & Medicaid 

6 Services, shall conduct a demonstration project to 

7 develop a comprehensive and systematic model for 

8 reducing childhood obesity by awarding grants to eli9 gible entities to carry out such project. Such model 

10 shall— 

11 ‘‘(A) identify, through self-assessment, be12 havioral risk factors for obesity among children; 

13 ‘‘(B) identify, through self-assessment, 

14 needed clinical preventive and screening benefits 

15 among those children identified as target indi16 viduals on the basis of such risk factors; 

17 ‘‘(C) provide ongoing support to such tar18 get individuals and their families to reduce risk 

19 factors and promote the appropriate use of pre20 ventive and screening benefits; and 

21 ‘‘(D) be designed to improve health out22 comes, satisfaction, quality of life, and appro23 priate use of items and services for which med24 ical assistance is available under title XIX or 


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1 child health assistance is available under title 

2 XXI among such target individuals. 

3 ‘‘(2) ELIGIBILITY ENTITIES.—For purposes of 

4 this subsection, an eligible entity is any of the fol5 lowing: 

6 ‘‘(A) A city, county, or Indian tribe. 

7 ‘‘(B) A local or tribal educational agency. 

8 ‘‘(C) An accredited university, college, or 

9 community college. 

10 ‘‘(D) A Federally-qualified health center. 

11 ‘‘(E) A local health department. 

12 ‘‘(F) A health care provider. 

13 ‘‘(G) A community-based organization. 

14 ‘‘(H) Any other entity determined appro15 priate by the Secretary, including a consortia or 

16 partnership of entities described in any of sub17 paragraphs (A) through (G). 

18 ‘‘(3) USE OF FUNDS.—An eligible entity award19 ed a grant under this subsection shall use the funds 

20 made available under the grant to— 

21 ‘‘(A) carry out community-based activities 

22 related to reducing childhood obesity, including 

23 by— 

24 ‘‘(i) forming partnerships with enti25 ties, including schools and other facilities 


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1 providing recreational services, to establish 

2 programs for after school and weekend 

3 community activities that are designed to 

4 reduce childhood obesity; 

5 ‘‘(ii) forming partnerships with 

6 daycare facilities to establish programs 

7 that promote healthy eating behaviors and 

8 physical activity; and 

9 ‘‘(iii) developing and evaluating com10 munity educational activities targeting 

11 good nutrition and promoting healthy eat12 ing behaviors; 

13 ‘‘(B) carry out age-appropriate school14 based activities that are designed to reduce 

15 childhood obesity, including by— 

16 ‘‘(i) developing and testing edu17 cational curricula and intervention pro18 grams designed to promote healthy eating 

19 behaviors and habits in youth, which may 

20 include— 

21 ‘‘(I) after hours physical activity 

22 programs; and 

23 ‘‘(II) science-based interventions 

24 with multiple components to prevent 

25 eating disorders including nutritional 


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1 content, understanding and respond2 ing to hunger and satiety, positive 

3 body image development, positive self4 esteem development, and learning life 

5 skills (such as stress management, 

6 communication skills, problemsolving 

7 and decisionmaking skills), as well as 

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

10 school, and community; 

11 ‘‘(ii) providing education and training 

12 to educational professionals regarding how 

13 to promote a healthy lifestyle and a 

14 healthy school environment for children; 

15 ‘‘(iii) planning and implementing a 

16 healthy lifestyle curriculum or program 

17 with an emphasis on healthy eating behav18 iors and physical activity; and 

19 ‘‘(iv) planning and implementing 

20 healthy lifestyle classes or programs for 

21 parents or guardians, with an emphasis on 

22 healthy eating behaviors and physical ac23 tivity for children; 

24 ‘‘(C) carry out educational, counseling, 

25 promotional, and training activities through the 


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1 local health care delivery systems including 

2 by— 

3 ‘‘(i) promoting healthy eating behav4 iors and physical activity services to treat 

5 or prevent eating disorders, being over6 weight, and obesity; 

7 ‘‘(ii) providing patient education and 

8 counseling to increase physical activity and 

9 promote healthy eating behaviors; 

10 ‘‘(iii) training health professionals on 

11 how to identify and treat obese and over12 weight individuals which may include nu13 trition and physical activity counseling; 

14 and 

15 ‘‘(iv) providing community education 

16 by a health professional on good nutrition 

17 and physical activity to develop a better 

18 understanding of the relationship between 

19 diet, physical activity, and eating disorders, 

20 obesity, or being overweight; and 

21 ‘‘(D) provide, through qualified health pro22 fessionals, training and supervision for commu23 nity health workers to— 


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1 ‘‘(i) educate families regarding the re2 lationship between nutrition, eating habits, 

3 physical activity, and obesity; 

4 ‘‘(ii) educate families about effective 

5 strategies to improve nutrition, establish 

6 healthy eating patterns, and establish ap7 propriate levels of physical activity; and 

8 ‘‘(iii) educate and guide parents re9 garding the ability to model and commu10 nicate positive health behaviors. 

11 ‘‘(4) PRIORITY.—In awarding grants under 

12 paragraph (1), the Secretary shall give priority to 

13 awarding grants to eligible entities— 

14 ‘‘(A) that demonstrate that they have pre15 viously applied successfully for funds to carry 

16 out activities that seek to promote individual 

17 and community health and to prevent the inci18 dence of chronic disease and that can cite pub19 lished and peer-reviewed research dem20 onstrating that the activities that the entities 

21 propose to carry out with funds made available 

22 under the grant are effective; 

23 ‘‘(B) that will carry out programs or ac24 tivities that seek to accomplish a goal or goals 


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1 set by the State in the Healthy People 2010 

2 plan of the State; 

3 ‘‘(C) that provide non-Federal contribu4 tions, either in cash or in-kind, to the costs of 

5 funding activities under the grants; 

6 ‘‘(D) that develop comprehensive plans 

7 that include a strategy for extending program 

8 activities developed under grants in the years 

9 following the fiscal years for which they receive 

10 grants under this subsection; 

11 ‘‘(E) located in communities that are medi12 cally underserved, as determined by the Sec13 retary; 

14 ‘‘(F) located in areas in which the average 

15 poverty rate is at least 150 percent or higher of 

16 the average poverty rate in the State involved, 

17 as determined by the Secretary; and 

18 ‘‘(G) that submit plans that exhibit multi19 sectoral, cooperative conduct that includes the 

20 involvement of a broad range of stakeholders, 

21 including— 

22 ‘‘(i) community-based organizations; 

23 ‘‘(ii) local governments; 

24 ‘‘(iii) local educational agencies; 

25 ‘‘(iv) the private sector; 


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1 ‘‘(v) State or local departments of 

2 health; 

3 ‘‘(vi) accredited colleges, universities, 

4 and community colleges; 

5 ‘‘(vii) health care providers; 

6 ‘‘(viii) State and local departments of 

7 transportation and city planning; and 

8 ‘‘(ix) other entities determined appro9 priate by the Secretary. 

10 ‘‘(5) PROGRAM DESIGN.— 

11 ‘‘(A) INITIAL DESIGN.—Not later than 1 

12 year after the date of enactment of the Chil13 dren’s Health Insurance Program Reauthoriza14 tion Act of 2007, the Secretary shall design the 

15 demonstration project. The demonstration 

16 should draw upon promising, innovative models 

17 and incentives to reduce behavioral risk factors. 

18 The Administrator of the Centers for Medicare 

19 & Medicaid Services shall consult with the Di20 rector of the Centers for Disease Control and 

21 Prevention, the Director of the Office of Minor22 ity Health, the heads of other agencies in the 

23 Department of Health and Human Services, 

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1 sign, conduct, and evaluation of the demonstra2 tion. 

3 ‘‘(B) NUMBER AND PROJECT AREAS.—Not 

4 later than 2 years after the date of enactment 

5 of the Children’s Health Insurance Program 

6 Reauthorization Act of 2007, the Secretary 

7 shall award 1 grant that is specifically designed 

8 to determine whether programs similar to pro9 grams to be conducted by other grantees under 

10 this subsection should be implemented with re11 spect to the general population of children who 

12 are eligible for child health assistance under 

13 State child health plans under title XXI in 

14 order to reduce the incidence of childhood obe15 sity among such population. 

16 ‘‘(6) REPORT TO CONGRESS.—Not later than 3 

17 years after the date the Secretary implements the 

18 demonstration project under this subsection, the 

19 Secretary shall submit to Congress a report that de20 scribes the project, evaluates the effectiveness and 

21 cost effectiveness of the project, evaluates the bene22 ficiary satisfaction under the project, and includes 

23 any such other information as the Secretary deter24 mines to be appropriate. 

25 ‘‘(7) DEFINITIONS.—In this subsection: 


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1 ‘‘(A) FEDERALLY-QUALIFIED HEALTH

2 CENTER.—The term ‘Federally-qualified health 

3 center’ has the meaning given that term in sec4 tion 1905(l)(2)(B). 

5 ‘‘(B) INDIAN TRIBE.—The term ‘Indian 

6 tribe’ has the meaning given that term in sec7 tion 4 of the Indian Health Care Improvement 

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

9 ‘‘(C) SELF-ASSESSMENT.—The term ‘self10 assessment’ means a form that— 

11 ‘‘(i) includes questions regarding— 

12 ‘‘(I) behavioral risk factors; 

13 ‘‘(II) needed preventive and 

14 screening services; and 

15 ‘‘(III) target individuals’ pref16 erences for receiving follow-up infor17 mation; 

18 ‘‘(ii) is assessed using such computer 

19 generated assessment programs; and 

20 ‘‘(iii) allows for the provision of such 

21 ongoing support to the individual as the 

22 Secretary determines appropriate. 

23 ‘‘(D) ONGOING SUPPORT.—The term ‘on24 going support’ means— 


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1 ‘‘(i) to provide any target individual 

2 with information, feedback, health coach3 ing, and recommendations regarding— 

4 ‘‘(I) the results of a self-assess5 ment given to the individual; 

6 ‘‘(II) behavior modification based 

7 on the self-assessment; and 

8 ‘‘(III) any need for clinical pre9 ventive and screening services or 

10 treatment including medical nutrition 

11 therapy; 

12 ‘‘(ii) to provide any target individual 

13 with referrals to community resources and 

14 programs available to assist the target in15 dividual in reducing health risks; and 

16 ‘‘(iii) to provide the information de17 scribed in clause (i) to a health care pro18 vider, if designated by the target individual 

19 to receive such information. 

20 ‘‘(8) AUTHORIZATION OF APPROPRIATIONS.— 

21 There is authorized to be appropriated to carry out 

22 this subsection, $25,000,000 for the period of fiscal 

23 years 2008 through 2012. 


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1 ‘‘(f) DEVELOPMENT OF MODEL ELECTRONIC

2 HEALTH RECORD FORMAT FOR CHILDREN ENROLLED IN

3 MEDICAID OR CHIP.— 

4 ‘‘(1) IN GENERAL.—Not later than January 1, 

5 2009, the Secretary shall establish a program to en6 courage the development and dissemination of a 

7 model electronic health record format for children 

8 enrolled in the State plan under title XIX or the 

9 State child health plan under title XXI that is— 

10 ‘‘(A) subject to State laws, accessible to 

11 parents, caregivers, and other consumers for 

12 the sole purpose of demonstrating compliance 

13 with school or leisure activity requirements, 

14 such as appropriate immunizations or physicals; 

15 ‘‘(B) designed to allow interoperable ex16 changes that conform with Federal and State 

17 privacy and security requirements; 

18 ‘‘(C) structured in a manner that permits 

19 parents and caregivers to view and understand 

20 the extent to which the care their children re21 ceive is clinically appropriate and of high qual22 ity; and 

23 ‘‘(D) capable of being incorporated into, 

24 and otherwise compatible with, other standards 

25 developed for electronic health records. 


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1 ‘‘(2) FUNDING.—$5,000,000 of the amount ap2 propriated under subsection (i) for a fiscal year shall 

3 be used to carry out this subsection. 

4 ‘‘(g) STUDY OF PEDIATRIC HEALTH AND HEALTH

5 CARE QUALITY MEASURES.— 

6 ‘‘(1) IN GENERAL.—Not later than July 1, 

7 2009, the Institute of Medicine shall study and re8 port to Congress on the extent and quality of efforts 

9 to measure child health status and the quality of 

10 health care for children across the age span and in 

11 relation to preventive care, treatments for acute con12 ditions, and treatments aimed at ameliorating or 

13 correcting physical, mental, and developmental con14 ditions in children. In conducting such study and 

15 preparing such report, the Institute of Medicine 

16 shall— 

17 ‘‘(A) consider all of the major national 

18 population-based reporting systems sponsored 

19 by the Federal Government that are currently 

20 in place, including reporting requirements 

21 under Federal grant programs and national 

22 population surveys and estimates conducted di23 rectly by the Federal Government; 

24 ‘‘(B) identify the information regarding 

25 child health and health care quality that each 


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1 system is designed to capture and generate, the 

2 study and reporting periods covered by each 

3 system, and the extent to which the information 

4 so generated is made widely available through 

5 publication; 

6 ‘‘(C) identify gaps in knowledge related to 

7 children’s health status, health disparities 

8 among subgroups of children, the effects of so9 cial conditions on children’s health status and 

10 use and effectiveness of health care, and the re11 lationship between child health status and fam12 ily income, family stability and preservation, 

13 and children’s school readiness and educational 

14 achievement and attainment; and 

15 ‘‘(D) make recommendations regarding im16 proving and strengthening the timeliness, qual17 ity, and public transparency and accessibility of 

18 information about child health and health care 

19 quality. 

20 ‘‘(2) FUNDING.—Up to $1,000,000 of the 

21 amount appropriated under subsection (i) for a fis22 cal year shall be used to carry out this subsection. 

23 ‘‘(h) RULE OF CONSTRUCTION.—Notwithstanding 

24 any other provision in this section, no evidence based qual25 ity measure developed, published, or used as a basis of 


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1 measurement or reporting under this section may be used 

2 to establish an irrebuttable presumption regarding either 

3 the medical necessity of care or the maximum permissible 

4 coverage for any individual child who is eligible for and 

5 receiving medical assistance under title XIX or child 

6 health assistance under title XXI . 

7 ‘‘(i) APPROPRIATION.—Out of any funds in the 

8 Treasury not otherwise appropriated, there is appro9 priated for each of fiscal years 2008 through 2012, 

10 $45,000,000 for the purpose of carrying out this section 

11 (other than subsection (e)). Funds appropriated under 

12 this subsection shall remain available until expended.’’. 

13 (b) INCREASED MATCHING RATE FOR COLLECTING

14 AND REPORTING ON CHILD HEALTH MEASURES.—Sec15 tion 1903(a)(3)(A) (42 U.S.C. 1396b(a)(3)(A)), is amend16 ed— 

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

18 and 

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

20 clause: 

21 ‘‘(iii) an amount equal to the Federal med22 ical assistance percentage (as defined in section 

23 1905(b)) of so much of the sums expended dur24 ing such quarter (as found necessary by the 

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1 tration of the State plan) as are attributable to 

2 such developments or modifications of systems 

3 of the type described in clause (i) as are nec4 essary for the efficient collection and reporting 

5 on child health measures; and’’. 

6 SEC. 502. IMPROVED INFORMATION REGARDING ACCESS 

7 TO COVERAGE UNDER CHIP. 

8 (a) INCLUSION OF PROCESS AND ACCESS MEASURES

9 IN ANNUAL STATE REPORTS.—Section 2108 (42 U.S.C. 

10 1397hh) is amended— 

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

12 paragraph (1), by striking ‘‘The State’’ and insert13 ing ‘‘Subject to subsection (e), the State’’; and 

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

16 ‘‘(e) INFORMATION REQUIRED FOR INCLUSION IN

17 STATE ANNUAL REPORT.—The State shall include the fol18 lowing information in the annual report required under 

19 subsection (a): 

20 ‘‘(1) Eligibility criteria, enrollment, and reten21 tion data (including data with respect to continuity 

22 of coverage or duration of benefits). 

23 ‘‘(2) Data regarding the extent to which the 

24 State uses process measures with respect to deter25 mining the eligibility of children under the State 


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1 child health plan, including measures such as 12- 

2 month continuous eligibility, self-declaration of in3 come for applications or renewals, or presumptive 

4 eligibility. 

5 ‘‘(3) Data regarding denials of eligibility and 

6 redeterminations of eligibility. 

7 ‘‘(4) Data regarding access to primary and spe8 cialty services, access to networks of care, and care 

9 coordination provided under the State child health 

10 plan, using quality care and consumer satisfaction 

11 measures included in the Consumer Assessment of 

12 Healthcare Providers and Systems (CAHPS) survey. 

13 ‘‘(5) If the State provides child health assist14 ance in the form of premium assistance for the pur15 chase of coverage under a group health plan, data 

16 regarding the provision of such assistance, including 

17 the extent to which employer-sponsored health insur18 ance coverage is available for children eligible for 

19 child health assistance under the State child health 

20 plan, the range of the monthly amount of such as21 sistance provided on behalf of a child or family, the 

22 number of children or families provided such assist23 ance on a monthly basis, the income of the children 

24 or families provided such assistance, the benefits 

25 and cost-sharing protection provided under the State 


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1 child health plan to supplement the coverage pur2 chased with such premium assistance, the effective 

3 strategies the State engages in to reduce any admin4 istrative barriers to the provision of such assistance, 

5 and, the effects, if any, of the provision of such as6 sistance on preventing the coverage provided under 

7 the State child health plan from substituting for cov8 erage provided under employer-sponsored health in9 surance offered in the State. 

10 ‘‘(6) To the extent applicable, a description of 

11 any State activities that are designed to reduce the 

12 number of uncovered children in the State, including 

13 through a State health insurance connector program 

14 or support for innovative private health coverage ini15 tiatives.’’. 

16 (b) GAO STUDY AND REPORT ON ACCESS TO PRI17 MARY AND SPECIALITY SERVICES.— 

18 (1) IN GENERAL.—The Comptroller General of 

19 the United States shall conduct a study of children’s 

20 access to primary and specialty services under Med21 icaid and CHIP, including— 

22 (A) the extent to which providers are will23 ing to treat children eligible for such programs; 

24 (B) information on such children’s access 

25 to networks of care; 


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1 (C) geographic availability of primary and 

2 specialty services under such programs; 

3 (D) the extent to which care coordination 

4 is provided for children’s care under Medicaid 

5 and CHIP; and 

6 (E) as appropriate, information on the de7 gree of availability of services for children under 

8 such programs. 

9 (2) REPORT.—Not later than 2 years after the 

10 date of enactment of this Act, the Comptroller Gen11 eral shall submit a report to the appropriate com12 mittees of Congress on the study conducted under 

13 paragraph (1) that includes recommendations for 

14 such Federal and State legislative and administra15 tive changes as the Comptroller General determines 

16 are necessary to address any barriers to access to 

17 children’s care under Medicaid and CHIP that may 

18 exist. 

19 SEC. 503. APPLICATION OF CERTAIN MANAGED CARE 

20 QUALITY SAFEGUARDS TO CHIP. 

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

22 amended by section 204(b), is amended by redesignating 

23 subparagraph (E) (as added by such section) as subpara24 graph (F) and by inserting after subparagraph (D) the 

25 following new subparagraph: 


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1 ‘‘(E) Subsections (a)(4), (a)(5), (b), (c), 

2 (d), and (e) of section 1932 (relating to require3 ments for managed care).’’. 

4 TITLE VI—MISCELLANEOUS 

5 SEC. 601. TECHNICAL CORRECTION REGARDING CURRENT 

6 STATE AUTHORITY UNDER MEDICAID. 

7 (a) IN GENERAL.—Only with respect to expenditures 

8 for medical assistance under a State Medicaid plan, in9 cluding any waiver of such plan, for fiscal years 2007 and 

10 2008, a State may elect, notwithstanding the fourth sen11 tence of subsection (b) of section 1905 of the Social Secu12 rity Act (42 U.S.C. 1396d) or subsection (u) of such sec13 tion— 

14 (1) to cover individuals described in section 

15 1902(a)(10)(A)(ii)(IX) of the Social Security Act 

16 and, at its option, to apply less restrictive meth17 odologies to such individuals under section 

18 1902(r)(2) of such Act or 1931(b)(2)(C) of such Act 

19 and thereby receive Federal financial participation 

20 for medical assistance for such individuals under 

21 title XIX of the Social Security Act; or 

22 (2) to receive Federal financial participation for 

23 expenditures for medical assistance under title XIX 

24 of such Act for children described in paragraph 

25 (2)(B) or (3) of section 1905(u) of such Act based 


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1 on the Federal medical assistance percentage, as 

2 otherwise determined based on the first and third 

3 sentences of subsection (b) of section 1905 of the 

4 Social Security Act, rather than on the basis of an 

5 enhanced FMAP (as defined in section 2105(b) of 

6 such Act). 

7 (b) REPEAL.—Effective October 1, 2008, subsection 

8 (a) is repealed. 

9 (c) HOLD HARMLESS.—No State that elects the op10 tion described in subsection (a) shall be treated as not hav11 ing been authorized to make such election and to receive 

12 Federal financial participation for expenditures for med13 ical assistance described in that subsection for fiscal years 

14 2007 and 2008 as a result of the repeal of the subsection 

15 under subsection (b). 

16 SEC. 602. PAYMENT ERROR RATE MEASUREMENT (‘‘PERM’’). 

17 (a) EXPENDITURES RELATED TO COMPLIANCE WITH

18 REQUIREMENTS.— 

19 (1) ENHANCED PAYMENTS.—Section 2105(c) 

20 (42 U.S.C. 1397ee(c)), as amended by section 

21 401(a), is amended by adding at the end the fol22 lowing new paragraph: 

23 ‘‘(11) ENHANCED PAYMENTS.—Notwith24 standing subsection (b), the enhanced FMAP with 

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1 penditures related to the administration of the pay2 ment error rate measurement (PERM) requirements 

3 applicable to the State child health plan in accord4 ance with the Improper Payments Information Act 

5 of 2002 and parts 431 and 457 of title 42, Code of 

6 Federal Regulations (or any related or successor 

7 guidance or regulations) shall in no event be less 

8 than 90 percent.’’. 

9 (2) EXCLUSION OF FROM CAP ON ADMINISTRA10 TIVE EXPENDITURES.—Section 2105(c)(2)(C) (42 

11 U.S.C. 1397ee(c)(2)C)), as amended by section 

12 402(b), is amended by adding at the end the fol13 lowing: 

14 ‘‘(v) PAYMENT ERROR RATE MEAS15 UREMENT (PERM) EXPENDITURES.—Ex16 penditures related to the administration of 

17 the payment error rate measurement 

18 (PERM) requirements applicable to the 

19 State child health plan in accordance with 

20 the Improper Payments Information Act of 

21 2002 and parts 431 and 457 of title 42, 

22 Code of Federal Regulations (or any re23 lated or successor guidance or regula24 tions).’’. 


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1 (b) FINAL RULE REQUIRED TO BE IN EFFECT FOR

2 ALL STATES.—Notwithstanding parts 431 and 457 of 

3 title 42, Code of Federal Regulations (as in effect on the 

4 date of enactment of this Act), the Secretary shall not cal5 culate or publish any national or State-specific error rate 

6 based on the application of the payment error rate meas7 urement (in this section referred to as ‘‘PERM’’) require8 ments to CHIP until after the date that is 6 months after 

9 the date on which a final rule implementing such require10 ments in accordance with the requirements of subsection 

11 (c) is in effect for all States. Any calculation of a national 

12 error rate or a State specific error rate after such final 

13 rule in effect for all States may only be inclusive of errors, 

14 as defined in such final rule or in guidance issued within 

15 a reasonable time frame after the effective date for such 

16 final rule that includes detailed guidance for the specific 

17 methodology for error determinations. 

18 (c) REQUIREMENTS FOR FINAL RULE.—For pur19 poses of subsection (b), the requirements of this sub20 section are that the final rule implementing the PERM 

21 requirements shall include— 

22 (1) clearly defined criteria for errors for both 

23 States and providers; 

24 (2) a clearly defined process for appealing error 

25 determinations by review contractors; and 


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1 (3) clearly defined responsibilities and deadlines 

2 for States in implementing any corrective action 

3 plans. 

4 (d) OPTION FOR APPLICATION OF DATA FOR CER5 TAIN STATES UNDER THE INTERIM FINAL RULE.— 

6 (1) OPTION FOR STATES IN FIRST APPLICATION

7 CYCLE.—After the final rule implementing the 

8 PERM requirements in accordance with the require9 ments of subsection (c) is in effect for all States, a 

10 State for which the PERM requirements were first 

11 in effect under an interim final rule for fiscal year 

12 2007 may elect to accept any payment error rate de13 termined in whole or in part for the State on the 

14 basis of data for that fiscal year or may elect to not 

15 have any payment error rate determined on the basis 

16 of such data and, instead, shall be treated as if fiscal 

17 year 2010 were the first fiscal year for which the 

18 PERM requirements apply to the State. 

19 (2) OPTION FOR STATES IN SECOND APPLICA20 TION CYCLE.—If such final rule is not in effect for 

21 all States by July 1, 2008, a State for which the 

22 PERM requirements were first in effect under an in23 terim final rule for fiscal year 2008 may elect to ac24 cept any payment error rate determined in whole or 

25 in part for the State on the basis of data for that 


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1 fiscal year or may elect to not have any payment 

2 error rate determined on the basis of such data and, 

3 instead, shall be treated as if fiscal year 2011 were 

4 the first fiscal year for which the PERM require5 ments apply to the State. 

6 (e) HARMONIZATION OF MEQC AND PERM.— 

7 (1) REDUCTION OF REDUNDANCIES.—The Sec8 retary shall review the Medicaid Eligibility Quality 

9 Control (in this subsection referred to as the 

10 ‘‘MEQC’’) requirements with the PERM require11 ments and coordinate consistent implementation of 

12 both sets of requirements, while reducing 

13 redundancies. 

14 (2) STATE OPTION TO APPLY PERM DATA.—A 

15 State may elect, for purposes of determining the er16 roneous excess payments for medical assistance ratio 

17 applicable to the State for a fiscal year under section 

18 1903(u) of the Social Security Act (42 U.S.C. 

19 1396b(u)) to substitute data resulting from the ap20 plication of the PERM requirements to the State 

21 after the final rule implementing such requirements 

22 is in effect for all States for data obtained from the 

23 application of the MEQC requirements to the State 

24 with respect to a fiscal year. 


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1 (f) IDENTIFICATION OF IMPROVED STATE-SPECIFIC

2 SAMPLE SIZES.—The Secretary shall establish State-spe3 cific sample sizes for application of the PERM require4 ments with respect to State child health plans for fiscal 

5 years beginning with fiscal year 2009, on the basis of such 

6 information as the Secretary determines appropriate. In 

7 establishing such sample sizes, the Secretary shall, to the 

8 greatest extent practicable— 

9 (1) minimize the administrative cost burden on 

10 States under Medicaid and CHIP; and 

11 (2) maintain State flexibility to manage such 

12 programs. 

13 SEC. 603. ELIMINATION OF COUNTING MEDICAID CHILD 

14 PRESUMPTIVE ELIGIBILITY COSTS AGAINST 

15 TITLE XXI ALLOTMENT. 

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

17 amended— 

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

19 by striking ‘‘(or, in the case of expenditures de20 scribed in subparagraph (B), the Federal medical 

21 assistance percentage (as defined in the first sen22 tence of section 1905(b)))’’; and 

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

24 the following new subparagraph: 

25 ‘‘(B) [reserved]’’. 


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1 SEC. 604. IMPROVING DATA COLLECTION. 

2 (a) INCREASED APPROPRIATION.—Section 

3 2109(b)(2) (42 U.S.C. 1397ii(b)(2)) is amended by strik4 ing ‘‘$10,000,000 for fiscal year 2000’’ and inserting 

5 ‘‘$20,000,000 for fiscal year 2008’’. 

6 (b) USE OF ADDITIONAL FUNDS.—Section 2109(b) 

7 (42 U.S.C. 1397ii(b)), as amended by subsection (a), is 

8 amended— 

9 (1) by redesignating paragraph (2) as para10 graph (4); and 

11 (2) by inserting after paragraph (1), the fol12 lowing new paragraphs: 

13 ‘‘(2) ADDITIONAL REQUIREMENTS.—In addition 

14 to making the adjustments required to produce the 

15 data described in paragraph (1), with respect to 

16 data collection occurring for fiscal years beginning 

17 with fiscal year 2008, in appropriate consultation 

18 with the Secretary of Health and Human Services, 

19 the Secretary of Commerce shall do the following: 

20 ‘‘(A) Make appropriate adjustments to the 

21 Current Population Survey to develop more ac22 curate State-specific estimates of the number of 

23 children enrolled in health coverage under title 

24 XIX or this title. 

25 ‘‘(B) Make appropriate adjustments to the 

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1 vey estimates used to compile the State-specific 

2 and national number of low-income children 

3 without health insurance for purposes of deter4 mining allotments under subsections (c) and (i) 

5 of section 2104 and making payments to States 

6 from the CHIP Incentive Bonuses Pool estab7 lished under subsection (j) of such section, the 

8 CHIP Contingency Fund established under sub9 section (k) of such section, and, to the extent 

10 applicable to a State, from the block grant set 

11 aside under section 2112(b)(2)(A)(i) for each of 

12 fiscal years 2010 through 2012. 

13 ‘‘(C) Include health insurance survey infor14 mation in the American Community Survey re15 lated to children. 

16 ‘‘(D) Assess whether American Community 

17 Survey estimates, once such survey data are 

18 first available, produce more reliable estimates 

19 than the Current Population Survey with re20 spect to the purposes described in subparagraph 

21 (B). 

22 ‘‘(E) On the basis of the assessment re23 quired under subparagraph (D), recommend to 

24 the Secretary of Health and Human Services 

25 whether American Community Survey estimates 


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1 should be used in lieu of, or in some combina2 tion with, Current Population Survey estimates 

3 for the purposes described in subparagraph (B). 

4 ‘‘(F) Continue making the adjustments de5 scribed in the last sentence of paragraph (1) 

6 with respect to expansion of the sample size 

7 used in State sampling units, the number of 

8 sampling units in a State, and using an appro9 priate verification element. 

10 ‘‘(3) AUTHORITY FOR THE SECRETARY OF

11 HEALTH AND HUMAN SERVICES TO TRANSITION TO

12 THE USE OF ALL, OR SOME COMBINATION OF, ACS

13 ESTIMATES UPON RECOMMENDATION OF THE SEC14 RETARY OF COMMERCE.—If, on the basis of the as15 sessment required under paragraph (2)(D), the Sec16 retary of Commerce recommends to the Secretary of 

17 Health and Human Services that American Commu18 nity Survey estimates should be used in lieu of, or 

19 in some combination with, Current Population Sur20 vey estimates for the purposes described in para21 graph (2)(B), the Secretary of Health and Human 

22 Services may provide for a period during which the 

23 Secretary may transition from carrying out such 

24 purposes through the use of Current Population 

25 Survey estimates to the use of American Community 


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1 Survey estimates (in lieu of, or in combination with 

2 the Current Population Survey estimates, as rec3 ommended), provided that any such transition is im4 plemented in a manner that is designed to avoid ad5 verse impacts upon States with approved State child 

6 health plans under this title.’’. 

7 SEC. 605. DEFICIT REDUCTION ACT TECHNICAL CORREC8 TIONS. 

9 (a) DETERMINATION OF MEDICAID PATIENT DAYS

10 FOR DSH COMPUTATION.— 

11 (1) IN GENERAL.—Section 5002 of the Deficit 

12 Reduction Act of 2005 (Public Law 109–171, 120 

13 Stat. 31) is amended by adding at the end the fol14 lowing new subsection: 

15 ‘‘(c) DETERMINATION OF MEDICAID PATIENT DAYS

16 FOR DISCHARGES OCCURRING ON OR AFTER THE DATE

17 OF ENACTMENT OF THIS SUBSECTION.—For discharges 

18 occurring on or after the date of enactment of this sub19 section, in determining under section 

20 1886(d)(5)(F)(vi)(II) of the Social Security Act (42 

21 U.S.C. 1395ww(d)(5)(F)(vi)(II)) the number of the hos22 pital’s patient days for the applicable cost reporting period 

23 which consist of patients who (for such days) were eligible 

24 for medical assistance under a State plan approved under 

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1 tients who are eligible to receive inpatient hospital benefits 

2 under a demonstration project approved under title XI 

3 and shall not include patient days under such a project 

4 if the patient is not eligible to receive inpatient hospital 

5 benefits under the project.’’. 

6 (2) CONFORMING AMENDMENT.—The last sen7 tence of section 1886(d)(5)(F)(vi) of the Social Se8 curity Act (42 U.S.C. 1395ww(d)(5)(F)(vi)), as 

9 added by section 5002(a) of the Deficit Reduction 

10 Act of 2005 (Public Law 109–171), is amended by 

11 striking ‘‘In determining under subclause (II)’’ and 

12 inserting ‘‘Subject to section 5002(c) of the Deficit 

13 Reduction Act of 2005, in determining under sub14 clause (II)’’. 

15 (3) EFFECTIVE DATE.—The amendments made 

16 by this subsection shall take effect on the date of en17 actment of this Act. 

18 (b) STATE FLEXIBILITY IN BENEFIT PACKAGES.— 

19 (1) CLARIFICATION OF REQUIREMENT TO PRO20 VIDE EPSDT SERVICES FOR ALL CHILDREN IN

21 BENCHMARK BENEFIT PACKAGES.—Section 

22 1937(a)(1) (42 U.S.C. 1396u–7(a)(1)), as inserted 

23 by section 6044(a) of the Deficit Reduction Act of 

24 2005 (Public Law 109–171, 120 Stat. 88), is 

25 amended— 


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1 (A) in subparagraph (A)— 

2 (i) in the matter before clause (i), by 

3 striking ‘‘enrollment in coverage that pro4 vides’’ and inserting ‘‘coverage that’’; 

5 (ii) in clause (i), by inserting ‘‘pro6 vides’’ after ‘‘(i)’’; and 

7 (iii) by striking clause (ii) and insert8 ing the following: 

9 ‘‘(ii) for any individual described in 

10 section 1905(a)(4)(B) who is eligible under 

11 the State plan in accordance with para12 graphs (10) and (17) of section 1902(a), 

13 consists of the items and services described 

14 in section 1905(a)(4)(B) (relating to early 

15 and periodic screening, diagnostic, and 

16 treatment services defined in section 

17 1905(r)) and provided in accordance with 

18 the requirements of section 1902(a)(43).’’; 

19 (B) in subparagraph (C)— 

20 (i) in the heading, by striking ‘‘WRAP21 AROUND’’ and inserting ‘‘ADDITIONAL’’; 

22 and 

23 (ii) by striking ‘‘wrap-around or’’; and 

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

25 subparagraph: 


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1 ‘‘(E) RULE OF CONSTRUCTION.—Nothing 

2 in this paragraph shall be construed as— 

3 ‘‘(i) requiring a State to offer all or 

4 any of the items and services required by 

5 subparagraph (A)(ii) through an issuer of 

6 benchmark coverage described in sub7 section (b)(1) or benchmark equivalent 

8 coverage described in subsection (b)(2); or 

9 ‘‘(ii) preventing a State from offering 

10 all or any of the items and services re11 quired by subparagraph (A)(ii) through an 

12 issuer of benchmark coverage described in 

13 subsection (b)(1) or benchmark equivalent 

14 coverage described in subsection (b)(2).’’. 

15 (2) CORRECTION OF REFERENCE TO CHILDREN

16 IN FOSTER CARE RECEIVING CHILD WELFARE SERV17 ICES.—Section 1937(a)(2)(B)(viii) (42 U.S.C. 

18 1396u–7(a)(2)(B)(viii), as inserted by section 

19 6044(a) of the Deficit Reduction Act of 2005, is 

20 amended by striking ‘‘aid or assistance is made 

21 available under part B of title IV to children in fos22 ter care and individuals’’ and inserting ‘‘child wel23 fare services are made available under part B of title 

24 IV on the basis of being a child in foster care or’’. 


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1 (3) TRANSPARENCY.—Section 1937 (42 U.S.C. 

2 1396u–7), as inserted by section 6044(a) of the Def3 icit Reduction Act of 2005, is amended by adding at 

4 the end the following: 

5 ‘‘(c) PUBLICATION OF PROVISIONS AFFECTED.—Not 

6 later than 30 days after the date the Secretary approves 

7 a State plan amendment to provide benchmark benefits 

8 in accordance with subsections (a) and (b), the Secretary 

9 shall publish in the Federal Register and on the Internet 

10 website of the Centers for Medicare & Medicaid Services, 

11 a list of the provisions of this title that the Secretary has 

12 determined do not apply in order to enable the State to 

13 carry out such plan amendment and the reason for each 

14 such determination.’’. 

15 (4) EFFECTIVE DATE.—The amendments made 

16 by this subsection shall take effect as if included in 

17 the amendment made by section 6044(a) of the Def18 icit Reduction Act of 2005. 

19 SEC. 606. ELIMINATION OF CONFUSING PROGRAM REF20 ERENCES. 

21 Section 704 of the Medicare, Medicaid, and SCHIP 

22 Balanced Budget Refinement Act of 1999, as enacted into 

23 law by division B of Public Law 106–113 (113 Stat. 

24 1501A–402) is repealed. 


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1 SEC. 607. MENTAL HEALTH PARITY IN CHIP PLANS. 

2 (a) ASSURANCE OF PARITY.—Section 2103(c) (42 

3 U.S.C. 1397cc(c)) is amended— 

4 (1) by redesignating paragraph (5) as para5 graph (6); and 

6 (2) by inserting after paragraph (4), the fol7 lowing: 

8 ‘‘(5) MENTAL HEALTH SERVICES PARITY.— 

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

10 child health plan that provides both medical 

11 and surgical benefits and mental health or sub12 stance abuse benefits, such plan shall ensure 

13 that the financial requirements and treatment 

14 limitations applicable to such mental health or 

15 substance abuse benefits are no more restrictive 

16 than the financial requirements and treatment 

17 limitations applied to substantially all medical 

18 and surgical benefits covered by the plan. 

19 ‘‘(B) DEEMED COMPLIANCE.—To the ex20 tent that a State child health plan includes cov21 erage with respect to an individual described in 

22 section 1905(a)(4)(B) and covered under the 

23 State plan under section 1902(a)(10)(A) of the 

24 services described in section 1905(a)(4)(B) (re25 lating to early and periodic screening, diag26 nostic, and treatment services defined in section 


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1 1905(r)) and provided in accordance with sec2 tion 1902(a)(43), such plan shall be deemed to 

3 satisfy the requirements of subparagraph (A).’’. 

4 (b) CONFORMING AMENDMENTS.—Section 2103 (42 

5 U.S.C. 1397cc) is amended— 

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

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

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

9 and 

10 (2) in subsection (c)(2), by striking subpara11 graph (B) and redesignating subparagraphs (C) and 

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

13 SEC. 608. DENTAL HEALTH GRANTS. 

14 Title XXI (42 U.S.C. 1397aa et seq.), as amended 

15 by section 201, is amended by adding at the end the fol16 lowing: 

17 ‘‘SEC. 2114. DENTAL HEALTH GRANTS. 

18 ‘‘(a) AUTHORITY TO AWARD GRANTS.— 

19 ‘‘(1) IN GENERAL.—From the amount appro20 priated under subsection (e), the Secretary shall 

21 award grants from amounts to eligible States for the 

22 purpose of carrying out programs and activities that 

23 are designed to improve the availability of dental 

24 services and strengthen dental coverage for targeted 


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1 low-income children enrolled in State child health 

2 plans. 

3 ‘‘(2) ELIGIBLE STATE.—In this section, the 

4 term ‘eligible State’ means a State with an approved 

5 State child health plan under this title that submits 

6 an application under subsection (b) that is approved 

7 by Secretary. 

8 ‘‘(b) APPLICATION.—An eligible State that desires to 

9 receive a grant under this paragraph shall submit an ap10 plication to the Secretary in such form and manner, and 

11 containing such information, as the Secretary may re12 quire. Such application shall include— 

13 ‘‘(1) a detailed description of the programs and 

14 activities proposed to be conducted with funds 

15 awarded under the grant; 

16 ‘‘(2) quality and outcomes performance meas17 ures to evaluate the effectiveness of such activities; 

18 and 

19 ‘‘(3) an assurance that the State shall— 

20 ‘‘(A) conduct an assessment of the effec21 tiveness of such activities against such perform22 ance measures; and 

23 ‘‘(B) cooperate with the collection and re24 porting of data and other information deter25 mined as a result of conducting such assessVerDate Aug 31 2005 03:57 Jul 27, 2007 Jkt 059200 PO 00000 Frm 00214 Fmt 6652 Sfmt 6201 E:\BILLS\S1893.PCS S1893

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1 ments to the Secretary, in such form and man2 ner as the Secretary shall require. 

3 ‘‘(c) MAINTENANCE OF EFFORT FOR STATES

4 AWARDED GRANTS; NO STATE MATCH REQUIRED.—In 

5 the case of a State that is awarded a grant under this 

6 section— 

7 ‘‘(1) the State share of funds expended for den8 tal services under the State child health plan shall 

9 not be less than the State share of such funds ex10 pended in the fiscal year preceding the first fiscal 

11 year for which the grant is awarded; and 

12 ‘‘(2) no State matching funds shall be required 

13 for the State to receive a grant under this section. 

14 ‘‘(d) ANNUAL REPORT.—The Secretary shall submit 

15 an annual report to the appropriate committees of Con16 gress regarding the grants awarded under this section that 

17 includes— 

18 ‘‘(1) State specific descriptions of the programs 

19 and activities conducted with funds awarded under 

20 such grants; and 

21 ‘‘(2) information regarding the assessments re22 quired of States under subsection (b)(3). 

23 ‘‘(e) APPROPRIATION.—Out of any funds in the 

24 Treasury not otherwise appropriated, there is appro25 priated, $200,000,000 for the period of fiscal years 2008 


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1 through 2012, to remain available until expended, for the 

2 purpose of awarding grants to States under this section. 

3 Amounts appropriated and paid under the authority of 

4 this section shall be in addition to amounts appropriated 

5 under section 2104 and paid to States in accordance with 

6 section 2105.’’. 

7 SEC. 609. APPLICATION OF PROSPECTIVE PAYMENT SYS8 TEM FOR SERVICES PROVIDED BY FEDER9 ALLY-QUALIFIED HEALTH CENTERS AND 

10 RURAL HEALTH CLINICS. 

11 (a) APPLICATION OF PROSPECTIVE PAYMENT SYS12 TEM.— 

13 (1) IN GENERAL.—Section 2107(e)(1) (42 

14 U.S.C. 1397gg(e)(1)), as amended by sections 

15 204(b) and 503, is amended by inserting after sub16 paragraph (A) the following new subparagraph (and 

17 redesignating the succeeding subparagraphs accord18 ingly): 

19 ‘‘(B) Section 1902(bb) (relating to pay20 ment for services provided by Federally-quali21 fied health centers and rural health clinics).’’. 

22 (2) EFFECTIVE DATE.—The amendment made 

23 by paragraph (1) shall apply to services provided on 

24 or after October 1, 2008. 

25 (b) TRANSITION GRANTS.— 


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1 (1) APPROPRIATION.—Out of any funds in the 

2 Treasury not otherwise appropriated, there is appro3 priated to the Secretary for fiscal year 2008, 

4 $5,000,000, to remain available until expended, for 

5 the purpose of awarding grants to States with State 

6 child health plans under CHIP that are operated 

7 separately from the State Medicaid plan under title 

8 XIX of the Social Security Act (including any waiver 

9 of such plan), or in combination with the State Med10 icaid plan, for expenditures related to transitioning 

11 to compliance with the requirement of section 

12 2107(e)(1)(B) of the Social Security Act (as added 

13 by subsection (a)) to apply the prospective payment 

14 system established under section 1902(bb) of the 

15 such Act (42 U.S.C. 1396a(bb)) to services provided 

16 by Federally-qualified health centers and rural 

17 health clinics. 

18 (2) MONITORING AND REPORT.—The Secretary 

19 shall monitor the impact of the application of such 

20 prospective payment system on the States described 

21 in paragraph (1) and, not later than October 1, 

22 2010, shall report to Congress on any effect on ac23 cess to benefits, provider payment rates, or scope of 

24 benefits offered by such States as a result of the ap25 plication of such payment system. 


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1 TITLE VII—REVENUE 

2 PROVISIONS 

3 SEC. 701. INCREASE IN EXCISE TAX RATE ON TOBACCO 

4 PRODUCTS. 

5 (a) CIGARS.—Section 5701(a) of the Internal Rev6 enue Code of 1986 is amended— 

7 (1) by striking ‘‘$1.828 cents per thousand 

8 ($1.594 cents per thousand on cigars removed dur9 ing 2000 or 2001)’’ in paragraph (1) and inserting 

10 ‘‘$50.00 per thousand’’, 

11 (2) by striking ‘‘20.719 percent (18.063 percent 

12 on cigars removed during 2000 or 2001)’’ in para13 graph (2) and inserting ‘‘53.13 percent’’, and 

14 (3) by striking ‘‘$48.75 per thousand ($42.50 

15 per thousand on cigars removed during 2000 or 

16 2001)’’ in paragraph (2) and inserting ‘‘$10.00 per 

17 cigar’’. 

18 (b) CIGARETTES.—Section 5701(b) of such Code is 

19 amended— 

20 (1) by striking ‘‘$19.50 per thousand ($17 per 

21 thousand on cigarettes removed during 2000 or 

22 2001)’’ in paragraph (1) and inserting ‘‘$50.00 per 

23 thousand’’, and 

24 (2) by striking ‘‘$40.95 per thousand ($35.70 

25 per thousand on cigarettes removed during 2000 or 


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1 2001)’’ in paragraph (2) and inserting ‘‘$104.9999 

2 cents per thousand’’. 

3 (c) CIGARETTE PAPERS.—Section 5701(c) of such 

4 Code is amended by striking ‘‘1.22 cents (1.06 cents on 

5 cigarette papers removed during 2000 or 2001)’’ and in6 serting ‘‘3.13 cents’’. 

7 (d) CIGARETTE TUBES.—Section 5701(d) of such 

8 Code is amended by striking ‘‘2.44 cents (2.13 cents on 

9 cigarette tubes removed during 2000 or 2001)’’ and in10 serting ‘‘6.26 cents’’. 

11 (e) SMOKELESS TOBACCO.—Section 5701(e) of such 

12 Code is amended— 

13 (1) by striking ‘‘58.5 cents (51 cents on snuff 

14 removed during 2000 or 2001)’’ in paragraph (1) 

15 and inserting ‘‘$1.50’’, and 

16 (2) by striking ‘‘19.5 cents (17 cents on chew17 ing tobacco removed during 2000 or 2001)’’ in para18 graph (2) and inserting ‘‘50 cents’’. 

19 (f) PIPE TOBACCO.—Section 5701(f) of such Code is 

20 amended by striking ‘‘$1.0969 cents (95.67 cents on pipe 

21 tobacco removed during 2000 or 2001)’’ and inserting 

22 ‘‘$2.8126 cents’’. 

23 (g) ROLL-YOUR-OWN TOBACCO.—Section 5701(g) of 

24 such Code is amended by striking ‘‘$1.0969 cents (95.67 


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1 cents on roll-your-own tobacco removed during 2000 or 

2 2001)’’ and inserting ‘‘$8.8889 cents’’. 

3 (h) FLOOR STOCKS TAXES.— 

4 (1) IMPOSITION OF TAX.—On tobacco products 

5 and cigarette papers and tubes manufactured in or 

6 imported into the United States which are removed 

7 before January 1, 2008, and held on such date for 

8 sale by any person, there is hereby imposed a tax in 

9 an amount equal to the excess of— 

10 (A) the tax which would be imposed under 

11 section 5701 of the Internal Revenue Code of 

12 1986 on the article if the article had been re13 moved on such date, over 

14 (B) the prior tax (if any) imposed under 

15 section 5701 of such Code on such article. 

16 (2) CREDIT AGAINST TAX.—Each person shall 

17 be allowed as a credit against the taxes imposed by 

18 paragraph (1) an amount equal to $500. Such credit 

19 shall not exceed the amount of taxes imposed by 

20 paragraph (1) on January 1, 2008, for which such 

21 person is liable. 

22 (3) LIABILITY FOR TAX AND METHOD OF PAY23 MENT.— 

24 (A) LIABILITY FOR TAX.—A person hold25 ing tobacco products, cigarette papers, or cigaVerDate Aug 31 2005 03:57 Jul 27, 2007 Jkt 059200 PO 00000 Frm 00220 Fmt 6652 Sfmt 6201 E:\BILLS\S1893.PCS S1893

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1 rette tubes on January 1, 2008, to which any 

2 tax imposed by paragraph (1) applies shall be 

3 liable for such tax. 

4 (B) METHOD OF PAYMENT.—The tax im5 posed by paragraph (1) shall be paid in such 

6 manner as the Secretary shall prescribe by reg7 ulations. 

8 (C) TIME FOR PAYMENT.—The tax im9 posed by paragraph (1) shall be paid on or be10 fore April 1, 2008. 

11 (4) ARTICLES IN FOREIGN TRADE ZONES.— 

12 Notwithstanding the Act of June 18, 1934 (com13 monly known as the Foreign Trade Zone Act, 48 

14 Stat. 998, 19 U.S.C. 81a et seq.) or any other provi15 sion of law, any article which is located in a foreign 

16 trade zone on January 1, 2008, shall be subject to 

17 the tax imposed by paragraph (1) if— 

18 (A) internal revenue taxes have been deter19 mined, or customs duties liquidated, with re20 spect to such article before such date pursuant 

21 to a request made under the 1st proviso of sec22 tion 3(a) of such Act, or 

23 (B) such article is held on such date under 

24 the supervision of an officer of the United 

25 States Customs and Border Protection of the 


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1 Department of Homeland Security pursuant to 

2 the 2d proviso of such section 3(a). 

3 (5) DEFINITIONS.—For purposes of this sub4 section— 

5 (A) IN GENERAL.—Any term used in this 

6 subsection which is also used in section 5702 of 

7 the Internal Revenue Code of 1986 shall have 

8 the same meaning as such term has in such 

9 section. 

10 (B) SECRETARY.—The term ‘‘Secretary’’ 

11 means the Secretary of the Treasury or the 

12 Secretary’s delegate. 

13 (6) CONTROLLED GROUPS.—Rules similar to 

14 the rules of section 5061(e)(3) of such Code shall 

15 apply for purposes of this subsection. 

16 (7) OTHER LAWS APPLICABLE.—All provisions 

17 of law, including penalties, applicable with respect to 

18 the taxes imposed by section 5701 of such Code 

19 shall, insofar as applicable and not inconsistent with 

20 the provisions of this subsection, apply to the floor 

21 stocks taxes imposed by paragraph (1), to the same 

22 extent as if such taxes were imposed by such section 

23 5701. The Secretary may treat any person who bore 

24 the ultimate burden of the tax imposed by paraVerDate Aug 31 2005 03:57 Jul 27, 2007 Jkt 059200 PO 00000 Frm 00222 Fmt 6652 Sfmt 6201 E:\BILLS\S1893.PCS S1893

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1 graph (1) as the person to whom a credit or refund 

2 under such provisions may be allowed or made. 

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

4 this section shall apply to articles removed (as defined in 

5 section 5702(j) of the Internal Revenue Code of 1986) 

6 after December 31, 2007. 

7 SEC. 702. ADMINISTRATIVE IMPROVEMENTS. 

8 (a) PERMIT, REPORT, AND RECORD REQUIREMENTS

9 FOR MANUFACTURERS AND IMPORTERS OF PROCESSED

10 TOBACCO.— 

11 (1) PERMITS.— 

12 (A) APPLICATION.—Section 5712 of the 

13 Internal Revenue Code of 1986 is amended by 

14 inserting ‘‘or processed tobacco’’ after ‘‘tobacco 

15 products’’. 

16 (B) ISSUANCE.—Section 5713(a) of such 

17 Code is amended by inserting ‘‘or processed to18 bacco’’ after ‘‘tobacco products’’. 

19 (2) INVENTORIES AND REPORTS.— 

20 (A) INVENTORIES.—Section 5721 of such 

21 Code is amended by inserting ‘‘, processed to22 bacco,’’ after ‘‘tobacco products’’. 

23 (B) REPORTS.—Section 5722 of such Code 

24 is amended by inserting ‘‘, processed tobacco,’’ 

25 after ‘‘tobacco products’’. 


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1 (3) RECORDS.—Section 5741 of such Code is 

2 amended by inserting ‘‘, processed tobacco,’’ after 

3 ‘‘tobacco products’’. 

4 (4) MANUFACTURER OF PROCESSED TO5 BACCO.—Section 5702 of such Code is amended by 

6 adding at the end the following new subsection: 

7 ‘‘(p) MANUFACTURER OF PROCESSED TOBACCO.— 

8 ‘‘(1) IN GENERAL.—The term ‘manufacturer of 

9 processed tobacco’ means any person who processes 

10 any tobacco other than tobacco products. 

11 ‘‘(2) PROCESSED TOBACCO.—The processing of 

12 tobacco shall not include the farming or growing of 

13 tobacco or the handling of tobacco solely for sale, 

14 shipment, or delivery to a manufacturer of tobacco 

15 products or processed tobacco.’’. 

16 (5) CONFORMING AMENDMENT.—Section 

17 5702(k) of such Code is amended by inserting ‘‘, or 

18 any processed tobacco,’’ after ‘‘nontaxpaid tobacco 

19 products or cigarette papers or tubes’’. 

20 (6) EFFECTIVE DATE.—The amendments made 

21 by this subsection shall take effect on January 1, 

22 2008. 

23 (b) BASIS FOR DENIAL, SUSPENSION, OR REVOCA24 TION OF PERMITS.— 


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1 (1) DENIAL.—Paragraph (3) of section 5712 of 

2 such Code is amended to read as follows: 

3 ‘‘(3) such person (including, in the case of a 

4 corporation, any officer, director, or principal stock5 holder and, in the case of a partnership, a part6 ner)— 

7 ‘‘(A) is, by reason of his business experi8 ence, financial standing, or trade connections or 

9 by reason of previous or current legal pro10 ceedings involving a felony violation of any 

11 other provision of Federal criminal law relating 

12 to tobacco products, cigarette paper, or ciga13 rette tubes, not likely to maintain operations in 

14 compliance with this chapter, 

15 ‘‘(B) has been convicted of a felony viola16 tion of any provision of Federal or State crimi17 nal law relating to tobacco products, cigarette 

18 paper, or cigarette tubes, or 

19 ‘‘(C) has failed to disclose any material in20 formation required or made any material false 

21 statement in the application therefor.’’. 

22 (2) SUSPENSION OR REVOCATION.—Subsection 

23 (b) of section 5713 of such Code is amended to read 

24 as follows: 

25 ‘‘(b) SUSPENSION OR REVOCATION.— 


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1 ‘‘(1) SHOW CAUSE HEARING.—If the Secretary 

2 has reason to believe that any person holding a per3 mit— 

4 ‘‘(A) has not in good faith complied with 

5 this chapter, or with any other provision of this 

6 title involving intent to defraud, 

7 ‘‘(B) has violated the conditions of such 

8 permit, 

9 ‘‘(C) has failed to disclose any material in10 formation required or made any material false 

11 statement in the application for such permit, 

12 ‘‘(D) has failed to maintain his premises in 

13 such manner as to protect the revenue, 

14 ‘‘(E) is, by reason of previous or current 

15 legal proceedings involving a felony violation of 

16 any other provision of Federal criminal law re17 lating to tobacco products, cigarette paper, or 

18 cigarette tubes, not likely to maintain oper19 ations in compliance with this chapter, or 

20 ‘‘(F) has been convicted of a felony viola21 tion of any provision of Federal or State crimi22 nal law relating to tobacco products, cigarette 

23 paper, or cigarette tubes, 


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1 the Secretary shall issue an order, stating the facts 

2 charged, citing such person to show cause why his 

3 permit should not be suspended or revoked. 

4 ‘‘(2) ACTION FOLLOWING HEARING.—If, after 

5 hearing, the Secretary finds that such person has 

6 not shown cause why his permit should not be sus7 pended or revoked, such permit shall be suspended 

8 for such period as the Secretary deems proper or 

9 shall be revoked.’’. 

10 (c) APPLICATION OF INTERNAL REVENUE CODE

11 STATUTE OF LIMITATIONS FOR ALCOHOL AND TOBACCO

12 EXCISE TAXES.—Section 514(a) of the Tariff Act of 1930 

13 (19 U.S.C. 1514(a)) is amended by striking ‘‘and section 

14 520 (relating to refunds)’’ and inserting ‘‘section 520 (re15 lating to refunds), and section 6501 of the Internal Rev16 enue Code of 1986 (but only with respect to taxes imposed 

17 under chapters 51 and 52 of such Code)’’. 

18 (d) EXPANSION OF DEFINITION OF ROLL-YOUR-OWN

19 TOBACCO.— 

20 (1) IN GENERAL.—Section 5702(o) of the In21 ternal Revenue Code of 1986 is amended by insert22 ing ‘‘or cigars, or for use as wrappers thereof’’ be23 fore the period at the end. 

24 (2) EFFECTIVE DATE.—The amendment made 

25 by this subsection shall apply to articles removed (as 


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1 defined in section 5702(j) of the Internal Revenue 

2 Code of 1986) after December 31, 2007. 

3 (e) TIME OF TAX FOR UNLAWFULLY MANUFAC4 TURED TOBACCO PRODUCTS.—Section 5703(b)(2) of such 

5 Code is amended by adding at the end the following new 

6 subparagraph: 

7 ‘‘(F) SPECIAL RULE FOR UNLAWFULLY

8 MANUFACTURED TOBACCO PRODUCTS.—In the 

9 case of any tobacco products, cigarette paper, 

10 or cigarette tubes produced in the United 

11 States at any place other than the premises of 

12 a manufacturer of tobacco products, cigarette 

13 paper, or cigarette tubes that has filed the bond 

14 and obtained the permit required under this 

15 chapter, tax shall be due and payable imme16 diately upon manufacture.’’. 

17 SEC. 703. TIME FOR PAYMENT OF CORPORATE ESTIMATED 

18 TAXES. 

19 Subparagraph (B) of section 401(1) of the Tax In20 crease Prevention and Reconciliation Act of 2005 is 

21 amended by striking ‘‘114.50 percent’’ and inserting 

22 ‘‘113.25 percent’’. 


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1 TITLE VIII—EFFECTIVE DATE 

2 SEC. 801. EFFECTIVE DATE. 

3 (a) IN GENERAL.—Unless otherwise provided in this 

4 Act, subject to subsection (b), the amendments made by 

5 this Act shall take effect on October 1, 2007, and shall 

6 apply to child health assistance and medical assistance 

7 provided on or after that date without regard to whether 

8 or not final regulations to carry out such amendments 

9 have been promulgated by such date. 

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

11 case of a State plan under title XIX or XXI of the Social 

12 Security Act, which the Secretary determines requires 

13 State legislation in order for the plan to meet the addi14 tional requirements imposed by an amendment made by 

15 this Act, the State plan shall not be regarded as failing 

16 to comply with the requirements of such Act solely on the 

17 basis of its failure to meet these additional requirements 

18 before the first day of the first calendar quarter beginning 

19 after the close of the first regular session of the State leg20 islature that begins after the date of enactment of this 

21 Act. For purposes of the preceding sentence, in the case 

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

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

24 session of the State legislature. 


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Calendar No. 288 

110TH CONGRESS 

1ST SESSION S. 1893 

A BILL 

To amend title XXI of the Social Security Act to 

ance Program, and for other purposes. reauthorize the State Children’s Health InsurJULY 27 (legislative day, JULY 26), 2007 

Read twice and placed on the calendar 


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