II 

113TH CONGRESS 

2D SESSION S. 2461 

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

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

IN THE SENATE OF THE UNITED STATES 

JUNE 11, 2014 

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

referred to the Committee on Finance 

A BILL 

To amend title XXI of the Social Security Act to extend 

and improve the Children’s Health Insurance Program, 

and for other purposes. 

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

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

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

7 ‘‘CHIP Extension Act of 2014’’. 

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

10 Act an amendment is expressed in terms of an amendment 

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

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

3 provision of the Social Security Act. 

4 (c) REFERENCES TO CHIP; MEDICAID; SEC5 RETARY.—In this Act: 

6 (1) CHIP.—The term ‘‘CHIP’’ means the pro7 gram established under title XXI of the Social Secu8 rity Act (42 U.S.C. 1397aa et seq.) (whether imple9 mented under title XIX, XXI, or both, of the Social 

10 Security Act). 

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

12 the program for medical assistance established under 

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

14 et seq.). 

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

16 the Secretary of Health and Human Services. 

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

18 this Act is as follows: 

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

Sec. 2. Purposes. 

Sec. 3. General effective date; exception for State legislation; reliance on law. 

TITLE I—FINANCING 

Sec. 101. Extension of CHIP. 

Sec. 102. Continuation and update of performance incentives. 

Sec. 103. Funds to address any Federal funding shortfalls for States. 

TITLE II—ELIGIBILITY AND ENROLLMENT 

Subtitle A—Coverage Continuity 

Sec. 201. State option to increase upper age limit for children with special 

health care needs. 

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Sec. 202. Improving coverage transitions from Medicaid or CHIP to coverage 

under a qualified health plan. 

Sec. 203. Assuring coverage continuity for former foster care children. 

Subtitle B—Enrollment Simplification and Improvements 

Sec. 211. Automatic enrollment for newborns under CHIP. 

Sec. 212. Express Lane Eligibility extension and application to pregnant 

women, foster children, and children with special health care 

needs. 

Sec. 213. Outreach to targeted populations. 

TITLE III—AFFORDABILITY 

Sec. 301. Strengthened cost sharing protections under Medicaid and CHIP. 

TITLE IV—BENEFITS 

Sec. 401. Preventive health services. 

Sec. 402. Timely immunization coverage. 

TITLE V—ACCESS AND QUALITY 

Subtitle A—Pediatric Quality Measures 

Sec. 501. Extending the pediatric quality measures program. 

Sec. 502. Improving the effectiveness of the pediatric quality measures. 

Sec. 503. Annual State reports regarding State-specific quality of care measures applied under Medicaid or CHIP. 

Sec. 504. Advisory panel regarding pediatric quality. 

Sec. 505. Extending and expanding demonstration projects. 

Subtitle B—Maternal, Infant, and Early Childhood Home Visiting Program 

Sec. 511. Supporting evidence-based care coordination in communities. 

Subtitle C—Comparative Study of Medicaid, CHIP, and Qualified Health 

Plans 

Sec. 521. GAO study and report. 

TITLE VI—BUDGETARY EFFECTS 

Sec. 601. Budgetary effect of this Act. 

1 SEC. 2. PURPOSES. 

2 The purposes of this Act are to ensure the extension 

3 of CHIP, safeguard child-specific health coverage for mil4 lions of children, and make improvements to promote chil5 dren’s access to cost-effective, high-quality health care. 

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1 SEC. 3. GENERAL EFFECTIVE DATE; EXCEPTION FOR STATE 

2 LEGISLATION; RELIANCE ON LAW. 

3 (a) GENERAL EFFECTIVE DATE.—Unless otherwise 

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

5 this Act and the amendments made by this Act shall take 

6 effect on October 1, 2015, and shall apply to child health 

7 assistance and medical assistance provided on or after that 

8 date. 

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

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

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

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

13 which the Secretary determines requires State legislation 

14 in order for the respective plan to meet 1 or more addi15 tional requirements imposed by amendments made by this 

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

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

18 basis of its failure to meet such an additional requirement 

19 before the first day of the first calendar quarter beginning 

20 after the close of the first regular session of the State leg21 islature that begins after the date of enactment of this 

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

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

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

25 session of the State legislature. 

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1 (c) RELIANCE ON LAW.—With respect to amend2 ments made by this Act that become effective as of a 

3 date— 

4 (1) such amendments are effective as of such 

5 date whether or not regulations implementing such 

6 amendments have been issued; and 

7 (2) Federal financial participation for medical 

8 assistance or child health assistance furnished under 

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

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

11 reliance on such amendments before the date of pro12 mulgation of final regulations, if any, to carry out 

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

14 any, regarding the implementation of such amend15 ments) shall not be denied on the basis of the 

16 State’s failure to comply with such regulations or 

17 guidance. 

18 TITLE I—FINANCING 

19 SEC. 101. EXTENSION OF CHIP. 

20 (a) FUNDING.— 

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

22 1397dd(a)) is amended— 

23 (A) in paragraph (17), by striking ‘‘and’’ 

24 at the end; 

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1 (B) by striking paragraph (18) and insert2 ing the following: 

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

4 and 

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

6 paragraphs: 

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

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

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

10 and 

11 ‘‘(22) for fiscal year 2019, for purposes of mak12 ing 2 semi-annual allotments— 

13 ‘‘(A) $2,850,000,000 for the period begin14 ning on October 1, 2018, and ending on March 

15 31, 2019, and 

16 ‘‘(B) $2,850,000,000 for the period begin17 ning on April 1, 2019, and ending on Sep18 tember 30, 2019.’’. 

19 (2) PREVENTION OF DUPLICATE APPROPRIA20 TIONS FOR FISCAL YEAR 2015.—Expenditures made 

21 under section 2104(a)(18) of the Social Security Act 

22 (42 U.S.C. 1387dd(a)(18)) pursuant to the amend23 ments made by section 10203 of the Patient Protec24 tion and Affordable Care Act (Public Law 111–148) 

25 for fiscal year 2015 shall be charged to the appromstockstill on DSK4VPTVN1PROD with BILLS

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1 priation provided by the amendment made by para2 graph (1) to such section for that fiscal year. 

3 (b) ALLOTMENTS.— 

4 (1) IN GENERAL.—Section 2104(m) (42 U.S.C. 

5 1397dd(m)) is amended— 

6 (A) in paragraph (3)— 

7 (i) by striking ‘‘2015’’ in the para8 graph heading and inserting ‘‘2019’’; 

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

10 ‘‘paragraph (18)’’ and inserting ‘‘para11 graph (22)’’; 

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

13 ‘‘paragraph (18)’’ and inserting ‘‘para14 graph (22)’’; 

15 (iv) in subparagraph (C)— 

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

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

18 (II) by striking ‘‘2015’’ and in19 serting ‘‘2019’’; and 

20 (v) in subparagraph (D)— 

21 (I) in clause (i), by striking ‘‘the 

22 sum of—’’ and all that follows 

23 through ‘‘2009;’’ and inserting ‘‘the 

24 amount made available under sub25 section (a)(22)(A),’’; and 

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1 (II) in subclause (II) of clause 

2 (ii), by striking ‘‘subsection 

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

4 (a)(22)(B)’’; 

5 (B) in paragraph (4), by striking ‘‘2015’’ 

6 and inserting ‘‘2019’’; 

7 (C) in paragraph (8)— 

8 (i) by striking ‘‘2015’’ in the para9 graph heading and inserting ‘‘2019’’; and 

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

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

12 fiscal year 2019’’; and 

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

14 paragraph: 

15 ‘‘(9) REBASING AND GROWTH FACTOR UPDATE

16 RULES FOR FISCAL YEARS AFTER FISCAL YEAR

17 2014.—Subject to paragraphs (3), (4), and (6), from 

18 the amount made available under subsection (a) for 

19 each fiscal year after fiscal year 2014, the Secretary 

20 shall compute a State allotment for each State (in21 cluding the District of Columbia and each common22 wealth and territory) for each such fiscal year as fol23 lows: 

24 ‘‘(A) REBASING IN ODD-NUMBERED FISCAL

25 YEARS.—If the fiscal year is an odd-numbered 

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1 fiscal year, the allotment of the State is equal 

2 to the Federal payments to the State that are 

3 attributable to (and countable towards) the 

4 total amount of allotments available under this 

5 section to the State in the preceding fiscal year 

6 (including any payments made to the State 

7 under subsections (n) and (o) for the preceding 

8 fiscal year as well as amounts redistributed to 

9 the State in the preceding fiscal year), multi10 plied by the allotment increase factor under 

11 paragraph (5) for the fiscal year. 

12 ‘‘(B) GROWTH FACTOR UPDATE FOR EVEN13 NUMBERED FISCAL YEARS.—If the fiscal year is 

14 an even-numbered fiscal year, the allotment of 

15 the State is equal to the sum of— 

16 ‘‘(i) the amount of the State allotment 

17 for the preceding fiscal year; and 

18 ‘‘(ii) the amount of any payments 

19 made to the State under subsections (n) 

20 and (o) for the preceding fiscal year, 

21 multiplied by the allotment increase factor 

22 under paragraph (5) for the fiscal year.’’. 

23 (2) ONE-TIME APPROPRIATION FOR FISCAL

24 YEAR 2019.—Section 108 of the Children’s Health 

25 Insurance Program Reauthorization Act of 2009 

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1 (Public Law 111–3), as amended by section 

2 10203(d)(2)(F) of the Patient Protection and Af3 fordable Care Act (Public Law 111–148), is amend4 ed by striking ‘‘$15,361,000,000’’ and all that fol5 lows through the second sentence, and inserting 

6 ‘‘$16,700,000,000 to accompany the allotment made 

7 for the period beginning on October 1, 2018, and 

8 ending on March 31, 2019, under section 

9 2104(a)(22)(A) of the Social Security Act (42 

10 U.S.C. 1397dd(a)(22)(A)), to remain available until 

11 expended. Such amount shall be used to provide al12 lotments to States under paragraph (3) of section 

13 2104(m) of such Act (42 U.S.C. 1397dd(m)) for the 

14 first 6 months of fiscal year 2019 in the same man15 ner as allotments are provided under subsection 

16 (a)(22)(A) of such section 2104 and subject to the 

17 same terms and conditions as apply to the allot18 ments provided from such subsection (a)(22)(A).’’. 

19 (3) CONFORMING AMENDMENTS.—Section 

20 2104(m) (42 U.S.C. 1397dd(m)) is amended— 

21 (A) in the subsection heading, by striking 

22 ‘‘2015’’ and inserting ‘‘2019’’; and 

23 (B) in paragraph (6)— 

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

25 ‘‘2015’’ and inserting ‘‘2019’’; and 

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1 (ii) in the second sentence, by striking 

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

3 year 2014, fiscal year 2016, or fiscal year 

4 2018’’. 

5 (c) EXTENSION OF QUALIFYING STATES OPTION.— 

6 Section 2105(g)(4) (42 U.S.C. 1397ee(g)(4)) is amend7 ed— 

8 (1) in the paragraph heading, by striking 

9 ‘‘2015’’ and inserting ‘‘2019’’; and 

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

11 and inserting ‘‘2019’’. 

12 SEC. 102. CONTINUATION AND UPDATE OF PERFORMANCE 

13 INCENTIVES. 

14 (a) EXTENSION THROUGH FISCAL YEAR 2019.—Sec15 tion 2105(a)(3) (42 U.S.C. 1397ee(a)(3)) is amended— 

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

17 and inserting ‘‘2019’’; 

18 (2) in subparagraph (E)— 

19 (A) in clause (ii)— 

20 (i) by striking subclause (I) and in21 serting the following: 

22 ‘‘(I) UNOBLIGATED NATIONAL

23 ALLOTMENT.—As of December 31 of 

24 fiscal year 2009, and as of December 

25 31 of each succeeding fiscal year 

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1 through fiscal year 2015, the portion, 

2 if any, of the amount appropriated 

3 under section 2104(a) for such fiscal 

4 year that is unobligated for allotment 

5 to a State under section 2104(m) for 

6 such fiscal year or set aside under 

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

8 2111 for such fiscal year.’’; 

9 (ii) in subclause (II), by striking 

10 ‘‘2013’’ and inserting ‘‘2015’’; and 

11 (iii) in subclause (III), by striking 

12 ‘‘2013’’ and inserting ‘‘2015’’; 

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

14 (iv); and 

15 (C) by inserting after clause (ii), the fol16 lowing new clause: 

17 ‘‘(iii) APPROPRIATION FOR FISCAL

18 YEARS 2016 THROUGH 2019.—Out of any 

19 money in the Treasury not otherwise ap20 propriated, there are appropriated 

21 $750,000,000 for each of fiscal years 2016 

22 through 2019 for making payments under 

23 this paragraph. Amounts appropriated for 

24 a fiscal year under this clause shall remain 

25 available for making payments under this 

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1 paragraph through December 31 of the fol2 lowing fiscal year. Any amount of such ap3 propriations that remains unexpended or 

4 unobligated as of such date shall be trans5 ferred and made available on January 1 of 

6 such following fiscal year for making pay7 ments under section 2104(o).’’; and 

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

9 ‘‘2013’’ and inserting ‘‘2019’’. 

10 (b) UPDATED PERFORMANCE INCENTIVE CRITERIA

11 FOR FISCAL YEARS 2015 THROUGH 2019.—Section 

12 2105(a) (42 U.S.C. 1397ee(a)) is amended— 

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

14 after ‘‘paragraph (4)’’; 

15 (2) in paragraph (4)— 

16 (A) in the heading, by inserting ‘‘FOR FIS17 CAL YEARS BEFORE FISCAL YEAR 2015’’ after 

18 ‘‘FOR CHILDREN’’; and 

19 (B) in the matter preceding subparagraph 

20 (A), by striking ‘‘for a fiscal year if’’ and in21 serting ‘‘for a fiscal year before fiscal year 2015 

22 if’’; and 

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

24 paragraph: 

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1 ‘‘(5) ENROLLMENT AND RETENTION PROVI2 SIONS FOR CHILDREN FOR FISCAL YEARS AFTER

3 FISCAL YEAR 2014.— 

4 ‘‘(A) IN GENERAL.—For purposes of para5 graph (3)(A), a State meets the condition of 

6 this paragraph for a fiscal year after fiscal year 

7 2014 if it is implementing at least 7 of the en8 rollment and retention provisions specified in 

9 subparagraph (B) (treating each clause of that 

10 subparagraph as a separate enrollment and re11 tention provision) throughout the entire fiscal 

12 year and achieves a program rating of ‘effec13 tive’ or ‘highly effective’ under metrics estab14 lished by the Secretary under subparagraph (C) 

15 for the fiscal year (beginning with the first fis16 cal year for which such metrics are established). 

17 ‘‘(B) ENROLLMENT AND RETENTION PRO18 VISIONS.—The enrollment and retention provi19 sions specified in this subparagraph are the fol20 lowing: 

21 ‘‘(i) 12-MONTH CONTINUOUS ELIGI22 BILITY.—The State has elected the option 

23 of continuous eligibility for a full 12 

24 months under title XIX for all children de25 scribed in section 1902(e)(12) and applies 

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1 such policy under its State child health 

2 plan under this title. 

3 ‘‘(ii) EXPRESS LANE ELIGIBILITY.— 

4 The State is implementing the option de5 scribed in section 1902(e)(13) under title 

6 XIX as well as, pursuant to section 

7 2107(e)(1), under this title. 

8 ‘‘(iii) PRESUMPTIVE ELIGIBILITY.— 

9 The State is implementing section 1920A 

10 under title XIX as well as, pursuant to 

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

12 ‘‘(iv) ELIMINATION OF CHIP PRE13 MIUMS.—In the case of any targeted low14 income child or a targeted low-income 

15 pregnant woman, the State child health 

16 plan does not impose any enrollment fee, 

17 premium, or similar charge. 

18 ‘‘(v) PREMIUM ASSISTANCE FOR EM19 PLOYER-SPONSORED PLANS.—The State 

20 has opted to offer a premium assistance 

21 subsidy for qualified employer-sponsored 

22 coverage by implementing section 1906A 

23 under title XIX or the option described in 

24 section 2105(c)(10) under this title. 

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1 ‘‘(vi) COMPREHENSIVE COVERAGE

2 FOR PREGNANT WOMEN.—If the State has 

3 elected to offer pregnancy-related assist4 ance to targeted low-income women (as de5 fined in section 2112(d)(2)) under section 

6 2112, the State also has elected to include, 

7 as part of such pregnancy-related assist8 ance and as part of the medical assistance 

9 provided to women under section 

10 1902(e)(5) while pregnant and during the 

11 60-day period described in such section— 

12 ‘‘(I) dental services necessary to 

13 prevent disease and promote oral 

14 health, restore oral structure to health 

15 and function, and treat emergency 

16 conditions; 

17 ‘‘(II) vision services, including vi18 sion screening and corrective lenses; 

19 and 

20 ‘‘(III) all services covered under 

21 the State child health plan. 

22 ‘‘(vii) IMPROVED COVERAGE FOR

23 PREGNANT WOMEN.—If the State has 

24 elected to offer pregnancy-related assist25 ance to targeted low-income women (as demstockstill on DSK4VPTVN1PROD with BILLS

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1 fined in section 2112(d)(2)) under section 

2 2112— 

3 ‘‘(I) the State also has elected to 

4 provide that a pregnant woman who is 

5 determined to be eligible for preg6 nancy-related assistance under the 

7 amendment to the State child health 

8 plan under section 2112 shall remain 

9 eligible for those benefits until the end 

10 of a period (not to exceed 12 months) 

11 following the determination; and 

12 ‘‘(II) the State is implementing 

13 section 1906A under title XIX. 

14 ‘‘(viii) SUPPLEMENTAL DENTAL COV15 ERAGE.—The State has elected to provide 

16 dental-only supplemental coverage under 

17 section 2110(b)(5). 

18 ‘‘(ix) RAISING CHIP ELIGIBILITY AGE

19 TO ALIGN WITH MEDICAID ELIGIBILITY

20 AGE.—If the State has elected to provide 

21 eligibility as a child under the State plan 

22 under title XIX for an individual who has 

23 attained age 19 or 20, the State has elect24 ed to apply the same age under the State 

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1 plan under this title for purposes of eligi2 bility as a child. 

3 ‘‘(x) INCREASE IN INCOME ELIGI4 BILITY.— 

5 ‘‘(I) UP TO AT LEAST 300 PER6 CENT OF THE POVERTY LINE.—The 

7 State has elected to extend eligibility 

8 for medical assistance under the State 

9 plan under title XIX or eligibility for 

10 child health assistance under the 

11 State child health plan to any other12 wise eligible child whose family income 

13 does not exceed 300 percent of the 

14 poverty line for a family of the size in15 volved. 

16 ‘‘(II) RULE OF CONSTRUC17 TION.—Nothing in subclause (I) shall 

18 be construed as prohibiting a State 

19 from extending eligibility for medical 

20 assistance under the State plan under 

21 title XIX or eligibility for child health 

22 assistance under the State child 

23 health plan to any otherwise eligible 

24 child whose family income exceeds 

25 300 percent of the poverty line. 

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1 ‘‘(xi) PROHIBITING LOCKOUT PERI2 ODS.—The State child health plan permits 

3 an individual whose coverage under the 

4 plan has been terminated for failure to 

5 make premium payments to be imme6 diately reenrolled upon payment of out7 standing premiums, with coverage retro8 active to the beginning of the most recent 

9 month for which an outstanding premium 

10 has been paid, and shall not impose any 

11 waiting period or enrollment fee as a con12 dition of reenrollment. 

13 ‘‘(xii) CHIP COVERAGE FOR CHIL14 DREN OF STATE EMPLOYEES.—The State 

15 offers enrollment in the State child health 

16 plan for a child who is a member of a fam17 ily that is eligible for health benefits cov18 erage under a State health benefits plan on 

19 the basis of a family member’s employment 

20 with a public agency in accordance with 

21 section 2110(b)(6) and provides resources 

22 to help the family member so employed 

23 compare the coverage options for the fam24 ily member’s child under the State health 

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1 benefits plan on the basis of cost and pro2 vider networks. 

3 ‘‘(xiii) INTERAGENCY COORDINATION

4 FOR JUVENILE JUSTICE YOUTH.—The 

5 State— 

6 ‘‘(I) does not terminate (but may 

7 suspend) enrollment under a State 

8 plan for medical assistance for any in9 dividual under age 21 on the basis 

10 that the individual is an inmate of a 

11 public institution (as defined in sec12 tion 435.1010 of title 42, Code of 

13 Federal Regulations); 

14 ‘‘(II) informs such individual im15 mediately upon release from such pub16 lic institution that the individual’s eli17 gibility for medical assistance is no 

18 longer suspended and the limitations 

19 on medical assistance under the sub20 division (A) following paragraph (29) 

21 of section 1905(a) will no longer apply 

22 (unless and until there is a determina23 tion that the individual no longer 

24 meets the State or Federal eligibility 

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1 requirements for such medical assist2 ance); 

3 ‘‘(III) processes any application 

4 for medical assistance submitted by, 

5 or on behalf of any individual under 

6 age 21 who is an inmate of a public 

7 institution (as defined in section 

8 435.1010 of title 42, Code of Federal 

9 Regulations) notwithstanding that the 

10 individual is such an inmate; and 

11 ‘‘(IV) screens any individual 

12 under age 21 who is such an inmate 

13 for eligibility for medical assistance 

14 under title XIX or child health assist15 ance under this title and assists those 

16 individuals who are identified as likely 

17 to be eligible for either such assist18 ance in applying for either such as19 sistance and enrolling in either such 

20 plan. 

21 ‘‘(xiv) EXTENDED COVERAGE FOR

22 CHILDREN WITH SPECIAL HEALTH CARE

23 NEEDS.—The State has elected to extend 

24 eligibility for child health assistance under 

25 the State child health plan (whether implemstockstill on DSK4VPTVN1PROD with BILLS

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1 mented under this title, title XIX, or both) 

2 to individuals under age 26 with special 

3 health care needs by implementing the op4 tion described in section 2110(c)(1)(B). 

5 ‘‘(C) METRICS FOR EVALUATING PROGRAM

6 EFFECTIVENESS.—The Secretary shall establish 

7 metrics for evaluating the effectiveness of the 

8 State program established under this title 

9 (whether implemented under this title, title 

10 XIX, or both). Such metrics shall include a sys11 tem for rating States as ‘effective’, ‘highly ef12 fective’, or ‘in need of improvement’.’’. 

13 SEC. 103. FUNDS TO ADDRESS ANY FEDERAL FUNDING 

14 SHORTFALLS FOR STATES. 

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

16 is amended by adding at the end the following new sub17 section: 

18 ‘‘(o) FUND TO ALLEVIATE CHIP SHORTFALLS.— 

19 ‘‘(1) ESTABLISHMENT.—There is hereby estab20 lished in the Treasury of the United States a fund 

21 which shall be known as the ‘CHIP Shortfall Fund’ 

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

23 Amounts in the Fund shall be available without fur24 ther appropriations for payments under this sub25 section and shall remain available until expended. 

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1 ‘‘(2) DEPOSITS INTO FUND.— 

2 ‘‘(A) INITIAL APPROPRIATION.—Out of 

3 any money in the Treasury of the United States 

4 not otherwise appropriated, there are appro5 priated to the Fund $3,860,000,000 for fiscal 

6 year 2016. 

7 ‘‘(B) TRANSFERS.—Notwithstanding any 

8 other provision of this title, the following 

9 amounts shall also be available, without fiscal 

10 year limitation, for making payments from the 

11 Fund: 

12 ‘‘(i) UNOBLIGATED NATIONAL ALLOT13 MENT FOR FISCAL YEARS BEGINNING WITH

14 FISCAL YEAR 2016.—As of January 1 of 

15 fiscal year 2017, and as of January 1 of 

16 each succeeding fiscal year, the portion, if 

17 any, of the amount appropriated under 

18 subsection (a) for the preceding fiscal year 

19 that is unobligated for allotment to a State 

20 under subsection (m) for such preceding 

21 fiscal year. 

22 ‘‘(ii) UNEXPENDED ALLOTMENTS NOT

23 USED FOR REDISTRIBUTION.—As of No24 vember 15 of fiscal year 2016 and each 

25 succeeding fiscal year, the total amount of 

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1 allotments made to States under sub2 section (a) for the second preceding fiscal 

3 year that is not expended or redistributed 

4 under subsection (f) during the period in 

5 which such allotments are available for ob6 ligation. 

7 ‘‘(iii) UNEXPENDED CHILD ENROLL8 MENT CONTINGENCY FUNDS.—As of Octo9 ber 1, 2015, any unobligated amount in 

10 the Child Enrollment Contingency Fund 

11 under subsection (n). 

12 ‘‘(iv) UNEXPENDED PERFORMANCE

13 INCENTIVE FUNDS.—As of January 1, 

14 2017, and as of January 1 of each suc15 ceeding calendar year, the portion, if any, 

16 of the amount appropriated under sub17 paragraph (E)(iii) of section 2105(a)(3) 

18 for the preceding fiscal year that is not ex19 pended or obligated under such section for 

20 such preceding fiscal year. 

21 ‘‘(C) INVESTMENT OF FUND.—The Sec22 retary of the Treasury shall invest in interest 

23 bearing securities of the United States such 

24 currently available portions of the Fund as are 

25 not immediately required for payments from the 

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1 Fund. The income derived from these invest2 ments shall constitute a part of the Fund. 

3 ‘‘(3) SHORTFALL FUND PAYMENTS.— 

4 ‘‘(A) PAYMENTS TO SHORTFALL STATES.— 

5 For each of fiscal years 2016 through 2020, if 

6 the Secretary determines that a State is a 

7 shortfall State described in paragraph (4) for 

8 that fiscal year, the Secretary shall pay the 

9 State from the Fund, in addition to any other 

10 payments made to a State under this title for 

11 the fiscal year, an amount equal to the amount 

12 described in subparagraph (B) for the State 

13 and fiscal year. 

14 ‘‘(B) AMOUNT DESCRIBED.—With respect 

15 to a State and a fiscal year, the amount de16 scribed in this subparagraph is the amount of 

17 projected expenditures for the State under this 

18 title for the fiscal year that exceeds the sum de19 termined under paragraph (4) for the State and 

20 fiscal year. 

21 ‘‘(C) PROPORTIONAL REDUCTION.—If the 

22 sum of the amounts otherwise payable under 

23 this paragraph for a fiscal year exceeds the 

24 amount available in the Fund for the fiscal 

25 year, the amount to be paid under this paramstockstill on DSK4VPTVN1PROD with BILLS

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1 graph to each State for the fiscal year shall be 

2 reduced proportionally. 

3 ‘‘(D) APPLICATION TO COMMONWEALTHS

4 AND TERRITORIES.—No payment shall be made 

5 under this paragraph to a commonwealth or 

6 territory described in subsection (c)(3) until 

7 such time as the Secretary determines that 

8 there are in effect methods, satisfactory to the 

9 Secretary, for the collection and reporting of re10 liable data regarding the expenditures under 

11 the State child health plan in order to accu12 rately determine the commonwealth’s or terri13 tory’s eligibility for, and amount of payment, 

14 under this paragraph. 

15 ‘‘(4) SHORTFALL STATES DESCRIBED.—For 

16 purposes of paragraph (3), with respect to a fiscal 

17 year, a shortfall State is a State for which the Sec18 retary estimates on the basis of the most recent data 

19 available to the Secretary, that the projected expend20 itures for the State for the fiscal year under this 

21 title (whether the State plan is implemented under 

22 this title, title XIX, or both) will exceed the sum 

23 of— 

24 ‘‘(A) the amount of the State’s allotments 

25 for any preceding fiscal years that remains 

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1 available for expenditure and that will not be 

2 expended by the end of the immediately pre3 ceding fiscal year; 

4 ‘‘(B) the amount (if any) that will be re5 distributed to the State under subsection (f) for 

6 the fiscal year; 

7 ‘‘(C) the amount (if any) of the child en8 rollment contingency fund payment under sub9 section (n) for the fiscal year; and 

10 ‘‘(D) the amount of the State’s allotment 

11 for the fiscal year. 

12 ‘‘(5) RETROSPECTIVE ADJUSTMENT.—The Sec13 retary may adjust the determinations made under 

14 this subsection with respect to a State and fiscal 

15 year as necessary on the basis of the amounts re16 ported by States not later than November 30 of the 

17 succeeding fiscal year, as approved by the Sec18 retary.’’. 

19 (b) TECHNICAL AMENDMENTS.—Section 2104(f) (42 

20 U.S.C. 1397dd(f)) is amended— 

21 (1) in paragraph (1)— 

22 (A) by striking ‘‘shortfall States’’ and in23 serting ‘‘redistribution States’’; and 

24 (B) by striking ‘‘shortfall described’’ and 

25 inserting ‘‘deficit described’’; and 

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1 (2) in paragraph (2)— 

2 (A) in the paragraph heading, by striking 

3 ‘‘SHORTFALL’’ and inserting ‘‘REDISTRIBU4 TION’’; 

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

6 ‘‘shortfall State’’ and inserting ‘‘redistribution 

7 State’’; and 

8 (C) in subparagraph (B)— 

9 (i) by striking ‘‘shortfalls’’ and insert10 ing ‘‘deficits’’; and 

11 (ii) by striking ‘‘shortfall State’’ and 

12 inserting ‘‘redistribution State’’. 

13 TITLE II—ELIGIBILITY AND 

14 ENROLLMENT 

15 Subtitle A—Coverage Continuity 

16 SEC. 201. STATE OPTION TO INCREASE UPPER AGE LIMIT 

17 FOR CHILDREN WITH SPECIAL HEALTH CARE 

18 NEEDS. 

19 Section 2110(c)(1) (42 U.S.C. 2110(c)(1)) is amend20 ed— 

21 (1) by striking ‘‘The term’’ and inserting the 

22 following: 

23 ‘‘(A) IN GENERAL.—Subject to subpara24 graph (B), the term’’; and 

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

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1 ‘‘(B) CHILDREN WITH SPECIAL HEALTH

2 CARE NEEDS.—At State option, such term in3 cludes an individual under 26 years of age who 

4 has or is at an increased risk of a chronic phys5 ical, developmental, behavioral, or emotional 

6 condition and who also requires health and re7 lated services of a type or amount beyond that 

8 required by children typically.’’. 

9 SEC. 202. IMPROVING COVERAGE TRANSITIONS FROM MED10 ICAID OR CHIP TO COVERAGE UNDER A 

11 QUALIFIED HEALTH PLAN. 

12 (a) STATE COORDINATION REQUIREMENT.—Section 

13 2105(d)(3)(B) (42 U.S.C. 1397ee(d)(3)(B)) is amended— 

14 (1) in the subparagraph heading, by striking 

15 ‘‘SHORTFALLS’’ and inserting ‘‘SHORTFALLS; CO16 ORDINATION REQUIREMENTS FOR TRANSITIONING

17 TO OR FROM EXCHANGE COVERAGE’’; 

18 (2) in the first sentence, by striking ‘‘In the 

19 event’’ and inserting the following: 

20 ‘‘(i) EXCHANGE COVERAGE AS A RE21 SULT OF FUNDING SHORTFALLS.—In the 

22 event’’; and 

23 (3) by adding at the end the following: 

24 ‘‘(ii) COORDINATION REQUIREMENTS

25 FOR TRANSITIONING TO OR FROM EXmstockstill on DSK4VPTVN1PROD with BILLS

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1 CHANGE COVERAGE.—The State shall es2 tablish procedures to eliminate gaps in cov3 erage and to assist a child’s and pregnant 

4 woman’s transition from coverage under 

5 the State plan under title XIX or the State 

6 child health plan under this title (whether 

7 implemented under this title, title XIX, or 

8 both) to coverage under a qualified health 

9 plan that has been certified by the Sec10 retary under subparagraph (C) and is of11 fered through an Exchange and from cov12 erage under a qualified health plan to cov13 erage under the State plan under title XIX 

14 or the State child health plan under this 

15 title. Such procedures— 

16 ‘‘(I) shall provide for coverage for 

17 the child’s or pregnant woman’s med18 ical home, regardless of whether the 

19 medical home providers are partici20 pating providers under the State plan 

21 under title XIX or the State child 

22 health plan under this title, for a 

23 transitional time to be determined 

24 under regulations promulgated by the 

25 Secretary; 

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1 ‘‘(II) in the case of a child or 

2 pregnant woman with a chronic or 

3 complex condition, shall provide that 

4 the State plan under title XIX, or the 

5 State child health plan under this title 

6 (as applicable) shall permit the child 

7 or pregnant woman to continue to re8 ceive treatment from a non-network 

9 provider for a transitional period as 

10 determined under regulations promul11 gated by the Secretary; 

12 ‘‘(III) shall require that if the 

13 benefits available and cost-sharing im14 posed under a qualified health plan 

15 available to the child or pregnant 

16 woman (as applicable) are not com17 parable to the benefits and coverage 

18 available to the child or pregnant 

19 woman under the State plan under 

20 title XIX or the State child health 

21 plan under this title (as applicable) 

22 the child or pregnant woman shall re23 main enrolled in the State plan under 

24 title XIX or the State child health 

25 plan under this title for so long as the 

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1 child or pregnant woman is otherwise 

2 eligible for coverage under the title 

3 XIX or XXI State plans; and 

4 ‘‘(IV) shall establish a system 

5 under which the State shall record all 

6 transitions of children and pregnant 

7 women from coverage under the State 

8 plan under title XIX or the State 

9 child health plan under this title to 

10 coverage under a qualified health plan 

11 and from coverage under a qualified 

12 health plan to coverage under the 

13 State plan under title XIX or the 

14 State child health plan under this title 

15 and submit a report to the Secretary 

16 each fiscal quarter that includes data 

17 on the number of children and preg18 nant women who made such transi19 tions in the preceding fiscal quarter.’’. 

20 (b) CERTIFICATION REQUIREMENT.—Section 

21 2105(d)(3)(C) (42 U.S.C. 1397ee(d)(3)(C)) is amended— 

22 (1) in the subparagraph heading, by striking 

23 ‘‘PEDIATRIC’’; 

24 (2) by striking ‘‘With respect to’’ and inserting 

25 the following: 

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1 ‘‘(i) IN GENERAL.—With respect to’’; 

2 (3) by inserting ‘‘and pregnant women’’ after 

3 ‘‘children’’ each place it appears; 

4 (4) by striking ‘‘are at least comparable to the 

5 benefits offered and cost-sharing protections pro6 vided under the State child health plan’’ and insert7 ing ‘‘meet the comparability standards described in 

8 clause (ii) and the continuous coverage requirements 

9 described in clause (iii)’’; and 

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

11 clauses: 

12 ‘‘(ii) COMPARABILITY STANDARDS.— 

13 The Secretary shall develop, in consulta14 tion with non-government stakeholder enti15 ties (including not less than 1 national 

16 non-profit organization focused on chil17 dren’s advocacy), comparability standards 

18 for qualified health plans seeking certifi19 cation under clause (i). Such standards 

20 must include standards for the following 

21 areas: 

22 ‘‘(I) AFFORDABILITY.—The plan 

23 must be comparable to the State child 

24 health plan in terms of affordability, 

25 including premiums, deductibles, comstockstill on DSK4VPTVN1PROD with BILLS

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1 payments, co-insurance, medical home 

2 maintenance costs, and the cost of 

3 purchasing supplementary coverage 

4 for health benefits and services that 

5 are covered under the State child 

6 health plan but are not covered under 

7 the qualified health plan. 

8 ‘‘(II) BENEFITS.—The plan must 

9 be comparable to the State child 

10 health plan in terms of pediatric and 

11 pregnancy-related benefits. 

12 ‘‘(III) NETWORK ADEQUACY.— 

13 The plan must be comparable to the 

14 State child health plan in terms of ac15 cess to appropriate providers of pedi16 atric and pregnancy-related services, 

17 and must provide flexibility for chil18 dren with special health care needs to 

19 remain in their medical home or seek 

20 appropriate pediatric sub-specialists. 

21 ‘‘(iii) CONTINUOUS COVERAGE RE22 QUIREMENTS.—The Secretary shall require 

23 health plans seeking certification as quali24 fied health plans for purposes of an Amermstockstill on DSK4VPTVN1PROD with BILLS

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1 ican Health Benefits Exchange to ensure 

2 that— 

3 ‘‘(I) with respect to a child or 

4 pregnant woman who is transitioning 

5 from coverage under a State child 

6 health plan or a State plan under title 

7 XIX— 

8 ‘‘(aa) coverage under the 

9 qualified health plan shall be ef10 fective as of the 60-day period 

11 preceding the date on which the 

12 first premium payment is made 

13 for such coverage; 

14 ‘‘(bb) coverage under the 

15 State child health plan or State 

16 plan under title XIX shall remain 

17 in effect during the 30-day period 

18 that precedes the 60-day period 

19 described in item (aa); 

20 ‘‘(cc) the qualified health 

21 plan shall provide coverage for a 

22 child’s or a pregnant woman’s 

23 medical home, regardless of 

24 whether the medical home pro25 vider is within the network of the 

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1 plan, to allow the child or preg2 nant woman to finish a course of 

3 treatment for an acute illness or 

4 a treatment or surgery scheduled 

5 prior to the effective date for cov6 erage under the plan under item 

7 (aa) or for a period of up to 90 

8 days if, by the end of such pe9 riod, the child or pregnant 

10 woman is enrolled with a medical 

11 home provider that is within the 

12 network of the plan; and 

13 ‘‘(dd) in the case of a child 

14 or pregnant woman with a chron15 ic or complex condition, the 

16 qualified health plan shall permit 

17 the child or pregnant woman to 

18 continue to receive treatment 

19 from a non-network provider for 

20 a transitional time that is not 

21 less than 90 days, or until the 

22 child or pregnant woman can be 

23 enrolled with an in-network pro24 vider; 

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1 ‘‘(II) similar requirements apply 

2 with respect to any child or pregnant 

3 woman who transitions from coverage 

4 under a qualified health plan to cov5 erage under the State child health 

6 plan or the State plan under title XIX 

7 in accordance with subparagraph 

8 (B)(ii); and 

9 ‘‘(III) a child or pregnant woman 

10 transitioning to or from coverage 

11 under the State child health plan or 

12 the State plan under title XIX and a 

13 qualified health plan is informed of 

14 the differences between the benefits 

15 available and cost-sharing imposed 

16 under the coverage the child or preg17 nant woman is transitioning from and 

18 into, and that the pregnant woman or 

19 the parent or guardian of the child 

20 has the option of electing to remain 

21 enrolled in whichever coverage is the 

22 most affordable or provides the best 

23 benefits for the child or pregnant 

24 woman for such period as the Sec25 retary shall specify.’’. 

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1 (c) PROHIBITION ON TRANSITIONING CHIP-ELIGI2 BLE CHILDREN.—No child who is eligible for coverage 

3 under CHIP shall be transitioned from a State child 

4 health plan to a qualified health plan unless that plan is 

5 certified under section 2105(d)(3)(C) of the Social Secu6 rity Act (42 U.S.C. 1397ee(d)(3)(C)) (as amended by sub7 section (b)). 

8 (d) MINIMUM ESSENTIAL COVERAGE.— 

9 (1) IN GENERAL.—Section 5000A(f) of the In10 ternal Revenue Code of 1986 is amended by adding 

11 at the end the following: 

12 ‘‘(6) PREGNANCY-RELATED ASSISTANCE UNDER

13 CHIP.—With respect to a targeted low-income preg14 nant woman (as defined in section 2112(d)(2) of the 

15 Social Security Act), notwithstanding paragraph 

16 (1)(A)(iii), the term ‘minimum essential coverage’, 

17 at the option of such a woman, shall not include 

18 pregnancy-related assistance (as defined in section 

19 2112(d)(1) of the Social Security Act).’’. 

20 (2) EFFECTIVE DATE.—The amendment made 

21 by this subsection applies to taxable years beginning 

22 after December 31, 2014. 

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1 SEC. 203. ASSURING COVERAGE CONTINUITY FOR FORMER 

2 FOSTER CARE CHILDREN. 

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

4 (42 U.S.C. 1396a(a)(10)(A)(i)(IX)) is amended— 

5 (1) in item (cc), by striking ‘‘responsibility of 

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

7 and 

8 (2) in item (dd), by striking ‘‘the State plan 

9 under this title or under a waiver of the’’ and insert10 ing ‘‘a State plan under this title or under a waiver 

11 of such a’’. 

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

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

14 this Act. 

15 Subtitle B—Enrollment 

16 Simplification and Improvements 

17 SEC. 211. AUTOMATIC ENROLLMENT FOR NEWBORNS 

18 UNDER CHIP. 

19 (a) IN GENERAL.—Section 2107(e)(1) (42 U.S.C. 

20 1397gg(e)(1)) is amended— 

21 (1) by redesignating subparagraphs (E) 

22 through (O) as subparagraphs (F) through (P), re23 spectively; and 

24 (2) by inserting after subparagraph (D) the fol25 lowing new subparagraph: 

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1 ‘‘(E) Section 1902(e)(4) (relating to auto2 matic coverage for newborns through age 1).’’. 

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

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

5 this Act. 

6 SEC. 212. EXPRESS LANE ELIGIBILITY EXTENSION AND AP7 PLICATION TO PREGNANT WOMEN, FOSTER 

8 CHILDREN, AND CHILDREN WITH SPECIAL 

9 HEALTH CARE NEEDS. 

10 (a) IN GENERAL.—Section 1902(e)(13) (42 U.S.C. 

11 1396a(e)(13)) is amended— 

12 (1) in subparagraph (A), by adding at the end 

13 the following new clause: 

14 ‘‘(iii) STATE OPTION TO EXTEND EX15 PRESS LANE ELIGIBILITY TO PREGNANT

16 WOMEN.—At the option of the State, the 

17 State may apply the provisions of this 

18 paragraph with respect to determining eli19 gibility under this title for a pregnant 

20 woman. In applying this paragraph in the 

21 case of a State electing such an option, 

22 any reference in this paragraph to a child 

23 with respect to this title (other than a ref24 erence to child health assistance) shall be 

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1 deemed to be a reference to a pregnant 

2 woman.’’; 

3 (2) in subparagraph (G), by adding at the end 

4 the following new sentence: ‘‘Notwithstanding the 

5 age limit specified in the preceding sentence, such 

6 term includes an individual described in subsection 

7 (a)(10)(A)(i)(IX) and, at the option of the State, an 

8 individual described in section 2110(c)(1)(B).’’; and 

9 (3) by striking subparagraph (I). 

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

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

12 this Act. 

13 SEC. 213. OUTREACH TO TARGETED POPULATIONS. 

14 (a) OUTREACH AND ENROLLMENT GRANTS.—Sec15 tion 2113 (42 U.S.C. 1397mm) is amended— 

16 (1) in subsection (a)(1), by striking ‘‘during the 

17 period of fiscal years 2009 through 2015’’; and 

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

19 $40,000,000 for each fiscal year thereafter,’’ after 

20 ‘‘2015,’’. 

21 (b) OUTREACH TO NON-ENGLISH SPEAKERS AND

22 OTHER POPULATIONS.— 

23 (1) NATIONAL ENROLLMENT CAMPAIGN RE24 QUIREMENTS.—Such section 2113 is amended— 

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1 (A) in subsection (h), by striking ‘‘Such 

2 campaign’’ and inserting ‘‘In addition to the re3 quirements described in subsection (i), such 

4 campaign’’; and 

5 (B) by adding at the end the following sub6 section: 

7 ‘‘(i) REQUIRED ELEMENTS OF NATIONAL ENROLL8 MENT CAMPAIGN.—Beginning with fiscal year 2015, each 

9 of the following initiatives shall be part of the national 

10 enrollment campaign: 

11 ‘‘(1) INITIATIVE TO INCREASE ENROLLMENT

12 AMONG INDIVIDUALS WITH LIMITED ENGLISH PRO13 FICIENCY.—An initiative to increase enrollment in 

14 the State child health plan under this title or the 

15 State plan under title XIX of children from families 

16 that speak a primary language other than English 

17 that shall include— 

18 ‘‘(A) language services, including oral in19 terpreting and written translation services, for 

20 individuals with limited proficiency in English; 

21 and 

22 ‘‘(B) other culturally appropriate efforts to 

23 increase enrollment of such children. 

24 ‘‘(2) INITIATIVE TO INCREASE ENROLLMENT OF

25 CHILDREN IN FAMILIES WITH COMPLEX OR MULmstockstill on DSK4VPTVN1PROD with BILLS

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1 TIPLE COVERAGE SOURCES.—An initiative to iden2 tify and increase enrollment in the State child health 

3 plan under this title or the State plan under title 

4 XIX of children from families who have multiple 

5 coverage sources or other coverage complexities, in6 cluding children in foster care and children subject 

7 to a medical child support order.’’. 

8 (2) INCREASED REIMBURSEMENT FOR STATE

9 SPENDING ON LANGUAGE SERVICES.— 

10 (A) MEDICAID.—Section 1903(a)(2)(E) 

11 (42 U.S.C. 1396b(a)(2)(E)) is amended by 

12 striking ‘‘75 percent’’ and inserting ‘‘the higher 

13 of 90 percent or the sum of the enhanced 

14 FMAP (as defined in section 2105(b)) plus 5 

15 percentage points (not to exceed 100 percent)’’. 

16 (B) CHIP.—Section 2105(a)(1) (42 

17 U.S.C. 1397ee(a)(1)) is amended in the matter 

18 preceding paragraph (1), by striking ‘‘the high19 er of 75 percent or the sum of the enhanced 

20 FMAP plus 5 percentage points’’ and inserting 

21 ‘‘the higher of 90 percent or the sum of the en22 hanced FMAP plus 5 percentage points (not to 

23 exceed 100 percent)’’. 

24 (3) REQUIREMENT THAT MANAGED CARE ORGA25 NIZATIONS PROVIDE LANGUAGE SERVICES TO ENmstockstill on DSK4VPTVN1PROD with BILLS

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1 ROLLEES.—Section 1932(b) (42 U.S.C. 1396u–2(b)) 

2 is amended by adding at the end the following new 

3 paragraph: 

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

5 with a medicaid managed care organization under 

6 section 1903(m) shall require the organization to 

7 provide (at no cost to the individual) language serv8 ices, including oral interpreting and written trans9 lation services, to any individual who is eligible for 

10 medical assistance under the State plan under this 

11 title and is enrolled with the organization and to a 

12 parent or guardian of such individual if such indi13 vidual, parent, or guardian is in need of such serv14 ices when interacting with the organization or with 

15 any provider receiving payment from the organiza16 tion.’’. 

17 (4) TRANSLATION OF APPLICATIONS AND

18 OTHER VITAL DOCUMENTS.— 

19 (A) MEDICAID.—Section 1902(a) (42 

20 U.S.C. 1396a(a)) is amended— 

21 (i) by striking ‘‘and’’ at the end of 

22 paragraph (80); 

23 (ii) by striking the period at the end 

24 of paragraph (81) and inserting ‘‘; and’’; 

25 and 

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1 (iii) by inserting after paragraph (81) 

2 the following new paragraph: 

3 ‘‘(82) provide for the translation of all docu4 ments and materials necessary to make application 

5 for medical assistance under the plan, and such 

6 other documents and materials as the Secretary may 

7 specify, including any such documents and materials 

8 that are available via a website, into the primary 

9 language spoken by any limited English proficiency 

10 group in the State with a population of at least 

11 1000 individuals or that constitutes 5 percent of the 

12 State population.’’. 

13 (B) CHIP.—Section 2107(e)(1), as 

14 amended by section 221, is amended— 

15 (i) by redesignating subparagraphs 

16 (E) through (P) as subparagraphs (F) 

17 through (Q), respectively; and 

18 (ii) by inserting after subparagraph 

19 (D) the following subparagraph: 

20 ‘‘(E) Section 1902(a)(82) (relating to the 

21 translation of documents and materials).’’. 

22 (c) PRIMARY LANGUAGE DATA COLLECTION.— 

23 (1) DATA FROM ELIGIBLE ENTITIES.—Section 

24 2113(c)(4)(B) (42 U.S.C. 1397mm(c)(4)(B)) is 

25 amended by inserting ‘‘under this title and title 

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1 XIX, individual data on the primary language of en2 rollees under this title and title XIX (and for such 

3 enrollees who are minors or incapacitated, data on 

4 the primary language of their parents or guard5 ians)’’ after ‘‘enrollment data’’. 

6 (2) ANNUAL REPORT.— 

7 (A) CHIP.—Section 2108 (42 U.S.C. 

8 1397hh) is amended— 

9 (i) by redesignating the subsection (e) 

10 added by section 501(e)(2) of Public Law 

11 111–3 as subsection (f); and 

12 (ii) in paragraph (1) of the subsection 

13 (e) added by section 402 of Public Law 

14 111–3, by inserting ‘‘and primary lan15 guage’’ after ‘‘duration of benefits’’. 

16 (B) MEDICAID.—Section 1946(c) (42 

17 U.S.C. 1396w–5(c)) is amended by inserting 

18 ‘‘demographic’’ before ‘‘data on health care dis19 parities’’. 

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

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

22 this Act. 

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1 TITLE III—AFFORDABILITY 

2 SEC. 301. STRENGTHENED COST SHARING PROTECTIONS 

3 UNDER MEDICAID AND CHIP. 

4 (a) MEDICAID.— 

5 (1) IN GENERAL.—Section 1916 (42 U.S.C. 

6 1396o) is amended— 

7 (A) in subsection (a)— 

8 (i) in subparagraph (E) of paragraph 

9 (2), by striking ‘‘and’’ at the end; 

10 (ii) in paragraph (3)— 

11 (I) by inserting ‘‘subject to para12 graph (4),’’ before ‘‘any deduction’’; 

13 and 

14 (II) by striking the period at the 

15 end and inserting ‘‘; and’’; and 

16 (iii) by adding at the end the fol17 lowing new paragraph: 

18 ‘‘(4) the total annual aggregate amount of any 

19 premium, enrollment fee, deduction, cost sharing, or 

20 similar charge imposed under the plan with respect 

21 to such individuals and their families shall not ex22 ceed 5 percent of the family income of the individual 

23 involved, as applied on a quarterly or monthly basis 

24 (as specified by the State).’’; 

25 (B) in subsection (b)— 

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1 (i) in subparagraph (E) of paragraph 

2 (2), by striking ‘‘and’’ at the end; 

3 (ii) in paragraph (3)— 

4 (I) by inserting ‘‘subject to para5 graph (4)’’ before ‘‘any deduction’’; 

6 and 

7 (II) by striking the period at the 

8 end and inserting ‘‘; and’’; and 

9 (iii) by adding at the end the fol10 lowing new paragraph: 

11 ‘‘(4) the total annual aggregate amount of any 

12 premium, enrollment fee, deduction, cost sharing, or 

13 similar charge imposed under the plan with respect 

14 to such individuals and their families shall not ex15 ceed 5 percent of the family income of the individual 

16 involved, as applied on a quarterly or monthly basis 

17 (as specified by the State).’’; 

18 (C) in subsection (d), by inserting ‘‘, and 

19 provided that the total annual aggregate 

20 amount of any such premium, and any enroll21 ment fee, deduction, cost sharing, or similar 

22 charge imposed under the plan with respect to 

23 such individuals and their families shall not ex24 ceed 5 percent of the family income of the indi25 vidual involved, as applied on a quarterly or 

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1 monthly basis (as specified by the State)’’ be2 fore the period; and 

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

4 subsection: 

5 ‘‘(k) COST SHARING TRACKING; SUSPENSION OF

6 CHARGES; NOTIFICATION REQUIREMENTS.— 

7 ‘‘(1) TRACKING.—If the State plan imposes 

8 premiums, enrollment fees, deductions, cost sharing, 

9 or similar charges under this section that, together 

10 with any such charges imposed under section 1916A, 

11 could cause families to have out-of-pocket expenses 

12 that exceed a total aggregate cost sharing limit im13 posed under subsection (a)(4) or (b)(4) for the 

14 month or quarter (as specified by the State), the 

15 State shall establish a process for tracking and ag16 gregating such expenses (including expenses in17 curred for separately administered benefits) that— 

18 ‘‘(A) does not rely on documentation pro19 vided by the individual or the family; 

20 ‘‘(B) is communicated in a manner de21 signed to ensure the privacy of patient-related 

22 information; and 

23 ‘‘(C) allows for coordination with managed 

24 care entities (as defined in section 

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1 1932(a)(1)(B)) that are under contract with 

2 the State. 

3 ‘‘(2) SUSPENSION OF CHARGES.—When a fam4 ily reaches any limit for a period imposed on pre5 miums, deductions, cost sharing, or similar charges 

6 under this section, no further premiums, deductions, 

7 cost sharing, or similar charges (or any portions 

8 thereof) shall be imposed on any individual in the 

9 family who is eligible for and receiving medical as10 sistance under the plan for the remainder of the pe11 riod. 

12 ‘‘(3) NOTIFICATION REQUIREMENTS.—With re13 spect to a limit imposed on premiums, deductions, 

14 cost sharing, or similar charges under this section 

15 the State plan shall provide for the notification of 

16 providers and each family to which such a limit ap17 plies— 

18 ‘‘(A) of any such limit applicable to the 

19 family; 

20 ‘‘(B) when the family has incurred out-of21 pocket expenses up to any such limit; and 

22 ‘‘(C) when a family reaches any such limit 

23 for a period, that the limit has been reached 

24 and that no further premiums, deductions, cost 

25 sharing, or similar charges (or portions thereof) 

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1 shall be imposed on any individual in the family 

2 who is eligible for and receiving medical assist3 ance under the plan for the remainder of such 

4 month or quarter. 

5 ‘‘(4) REASSESSMENT PROCESS.—The State 

6 shall establish a process for families that include an 

7 individual who is eligible for and receiving medical 

8 assistance under the plan to request a reassessment 

9 of the family’s aggregate limit on premiums, deduc10 tions, cost sharing, or similar charges if the family 

11 has a change in circumstances, in accordance with 

12 criteria specified by the Secretary. 

13 ‘‘(5) APPLICATION OF REQUIREMENTS.—The 

14 requirements of this subsection shall apply in the 

15 same manner to limits imposed under subsections 

16 (c), (d), (g), and (i).’’. 

17 (2) STATE OPTION FOR ALTERNATIVE PRE18 MIUMS AND COST SHARING.—Section 1916A(b) (42 

19 U.S.C. 1396o–1(b)) is amended— 

20 (A) in paragraphs (1)(B)(ii) and (2)(A), by 

21 inserting ‘‘or section 1916’’ after ‘‘subsection 

22 (c) or (e)’’ in each place it appears; and 

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

24 paragraph: 

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1 ‘‘(7) COST SHARING TRACKING; SUSPENSION OF

2 CHARGES; NOTIFICATION REQUIREMENTS.— 

3 ‘‘(A) TRACKING.—If the State plan im4 poses premiums or cost sharing under this sec5 tion that, together with cost sharing imposed 

6 under section 1916, could cause families to 

7 have out-of-pocket expenses that exceed the 

8 total aggregate limit imposed under paragraph 

9 (1) or (2) of this subsection for a month or 

10 quarter (as specified by the State), the State 

11 shall establish a process for tracking and aggre12 gating such expenses (including expenses for 

13 separately administered benefits) that— 

14 ‘‘(i) does not rely on documentation 

15 provided by the individual or the family; 

16 ‘‘(ii) is communicated in a manner de17 signed to ensure the privacy of patient-re18 lated information; and 

19 ‘‘(iii) allows for coordination with 

20 managed care entities (as defined in sec21 tion 1932(a)(1)(B)) that are under con22 tract with the State. 

23 ‘‘(B) SUSPENSION OF CHARGES.—When a 

24 family reaches any limit for a period imposed 

25 on premiums or cost sharing under this section, 

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1 no further premiums or cost sharing (or any 

2 portions thereof) shall be imposed on any indi3 vidual in the family who is eligible for and re4 ceiving medical assistance under the plan for 

5 the remainder of the period. 

6 ‘‘(C) NOTIFICATION REQUIREMENTS.— 

7 With respect to a limit imposed on premiums or 

8 cost sharing under paragraph (1) or (2) of this 

9 subsection the State plan shall provide for the 

10 notification of providers and each family to 

11 which such a limit applies— 

12 ‘‘(i) of any such limit applicable to the 

13 family; 

14 ‘‘(ii) when the family has incurred 

15 out-of-pocket expenses up to any such 

16 limit; and 

17 ‘‘(iii) when a family reaches such a 

18 limit for a period, that the limit has been 

19 reached and that no further premiums or 

20 cost sharing (or portions thereof) shall be 

21 imposed on any individual in the family 

22 who is eligible for and receiving medical 

23 assistance under the plan for the remain24 der of such month or quarter. 

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1 ‘‘(D) REASSESSMENT PROCESS.—The 

2 State shall establish a process for families that 

3 include an individual who is eligible for and re4 ceiving medical assistance under the plan to re5 quest a reassessment of the family’s aggregate 

6 limit on premiums, deductions, cost sharing, or 

7 similar charges if the family has a change in 

8 circumstances, in accordance with criteria speci9 fied by the Secretary.’’. 

10 (3) MANAGED CARE ORGANIZATIONS.—Section 

11 1932(a)(5) (42 U.S.C. 1396u–2(a)(5)) is amended 

12 by adding at the end the following new subpara13 graph: 

14 ‘‘(E) COORDINATION WITH PROVIDERS ON

15 COST SHARING.—The State shall require that a 

16 managed care entity with a contract with the 

17 State, as a condition of such contract, comply 

18 with the requirements of sections 1916 and 

19 1916A (as applicable), for such individuals who 

20 are enrolled with the organization or entity and 

21 coordinate with the State with respect to track22 ing and aggregating an enrollee’s family’s out23 of-pocket expenses for premiums, deductions, 

24 cost sharing, or similar charges.’’. 

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1 (4) CONFORMING AMENDMENTS.—Section 

2 1916A(a)(2)(B) (42 U.S.C. 1396o–1(a)(2)(B)) is 

3 amended— 

4 (A) by inserting ‘‘and the tracking, suspen5 sion, and notification requirements under sub6 section (b)(7)’’ before ‘‘shall apply’’; and 

7 (B) by inserting ‘‘and requirements’’ after 

8 ‘‘limitations’’. 

9 (b) CHIP.— 

10 (1) IN GENERAL.—Section 2103(e) (42 U.S.C. 

11 1397cc(e)) is amended— 

12 (A) by striking paragraphs (2) and (4); 

13 (B) by redesignating paragraph (3) as 

14 paragraph (2); 

15 (C) in paragraph (2) (as so redesig16 nated)— 

17 (i) by striking subparagraph (B); 

18 (ii) by redesignating subparagraph 

19 (C) as subparagraph (D); and 

20 (iii) by inserting after subparagraph 

21 (A) the following new subparagraphs: 

22 ‘‘(B) NO COST SHARING FOR PREGNANCY23 RELATED ASSISTANCE.—The State child health 

24 plan may not impose deductions, cost sharing, 

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1 or similar charges with respect to pregnancy-re2 lated assistance. 

3 ‘‘(C) APPLICATION OF MEDICAID COST

4 SHARING LIMITS.—Subject to subparagraphs 

5 (A) and (B) and paragraph (3), the State child 

6 health plan may only impose deductions, cost 

7 sharing, or similar charges to the extent that 

8 such charges do not exceed the nominal limits 

9 set under section 1916(a)(3).’’; and 

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

11 paragraph: 

12 ‘‘(3) ADDITIONAL REQUIREMENTS .— 

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

14 (2)(A), any premiums, deductions, cost sharing, 

15 or similar charges imposed under the State 

16 child health plan for medical or dental benefits 

17 may be imposed on a sliding scale related to in18 come, except that the total annual aggregate 

19 cost sharing imposed for such benefits with re20 spect to all individuals in a family that includes 

21 a targeted low-income child or a targeted low22 income pregnant woman under this title shall 

23 not exceed 5 percent of such family’s income for 

24 the year involved. 

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1 ‘‘(B) DENTAL-ONLY SUPPLEMENTAL COV2 ERAGE.—With respect to dental-only supple3 mental coverage offered under section 

4 2110(b)(5), the total annual aggregate cost 

5 sharing imposed for such coverage shall not ex6 ceed 5 percent of a family’s income for the year 

7 involved, minus the amount the family is re8 quired to pay during such year in premiums, 

9 deductions, cost sharing, or similar charges for 

10 health care services for children in the family 

11 enrolled in a group health plan or health insur12 ance coverage offered through an employer. 

13 ‘‘(C) TRACKING OF EXPENSES; SUSPEN14 SION OF CHARGES; NOTICE; REASSESSMENTS.— 

15 If the State child health plan imposes pre16 miums, deductions, cost sharing, or similar 

17 charges that could cause families that include a 

18 targeted low-income child or a targeted low-in19 come pregnant woman to have out-of-pocket ex20 penses that exceed the aggregate cost sharing 

21 limit imposed under subparagraph (A) for the 

22 year, the State shall— 

23 ‘‘(i) establish a process for tracking 

24 and aggregating such expenses (including 

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1 expenses incurred for separately adminis2 tered benefits) that— 

3 ‘‘(I) does not rely on documenta4 tion provided by the targeted low-in5 come child, the targeted low-income 

6 pregnant woman, or the family; 

7 ‘‘(II) is communicated in a man8 ner designed to ensure the privacy of 

9 patient-related information; and 

10 ‘‘(III) allows for coordination 

11 with managed care entities and man12 aged care organizations that are 

13 under contract with the State; 

14 ‘‘(ii) when a family reaches the aggre15 gate cost-sharing limit for a year imposed 

16 under subparagraph (A), not impose any 

17 further premiums or cost sharing (or any 

18 portions thereof) on any targeted low-in19 come child or targeted low-income preg20 nant woman in the family for the remain21 der of the year; 

22 ‘‘(iii) notify providers and each family 

23 that includes a targeted low-income child 

24 or a targeted low-income pregnant 

25 woman— 

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1 ‘‘(I) of the annual aggregate lim2 its on out-of-pocket expenses applica3 ble to the family; 

4 ‘‘(II) when the family has in5 curred out-of-pocket expenses up to 

6 the annual aggregate family limit im7 posed under subparagraph (A); and 

8 ‘‘(III) when a family reaches the 

9 aggregate out-of-pocket expenses limit 

10 for a year, that the limit has been 

11 reached and that no further pre12 miums, deductions, cost sharing, or 

13 similar charges (or portions thereof) 

14 shall be imposed on any targeted low15 income child or targeted low-income 

16 pregnant woman in the family for the 

17 remainder of such year; and 

18 ‘‘(iv) establish a process for families 

19 that include a targeted low-income child or 

20 a targeted low-income pregnant woman to 

21 request a reassessment of the family’s an22 nual aggregate limit on premiums, deduc23 tions, cost sharing, or similar charges if 

24 the family has a change in circumstances, 

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1 in accordance with criteria specified by the 

2 Secretary.’’. 

3 (2) MANAGED CARE ORGANIZATIONS.—Section 

4 2103(f) (42 U.S.C. 1397cc(f)) is amended by adding 

5 at the end following new paragraph: 

6 ‘‘(4) COORDINATION WITH PROVIDERS ON COST

7 SHARING.—The State shall require that a managed 

8 care entity or a managed care organization with a 

9 contract with the State, as a condition of such con10 tract, comply with the requirements of 2103(e) and 

11 coordinate with the State with respect to in tracking 

12 and aggregating an enrollee’s family’s out-of-pocket 

13 expenses for cost sharing as required under sub14 section (e)(3)(C).’’. 

15 (c) CONFORMING AMENDMENTS.— 

16 (1) Section 2105(c)(10)(C)(i) (42 U.S.C. 

17 1397ee(c)(10)(C)(i)) is amended by striking ‘‘para18 graph (3)(B) of’’. 

19 (2) Section 2112(b)(6) (42 U.S.C. 1397ll(b)(6)) 

20 is amended by striking ‘‘paragraph (3)(B) of’’. 

21 TITLE IV—BENEFITS 

22 SEC. 401. PREVENTIVE HEALTH SERVICES. 

23 (a) PREVENTIVE HEALTH SERVICES.— 

24 (1) MEDICAID.—Section 1905 (42 U.S.C. 

25 1396d) is amended— 

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1 (A) in subsection (a)(4)— 

2 (i) by striking ‘‘and’’ before ‘‘(D)’’; 

3 and 

4 (ii) by inserting before the semicolon 

5 at the end the following new subparagraph: 

6 ‘‘; and (E) preventive services described in 

7 subsection (ee)’’; and 

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

9 subsection: 

10 ‘‘(ee) PREVENTIVE SERVICES.— 

11 ‘‘(1) IN GENERAL.—For purposes of subsection 

12 (a)(4)(E), the preventive services described in this 

13 subsection are diagnostic, screening, and preventive 

14 services not otherwise described in subsection (a) or 

15 required by subsection (r) that the Secretary deter16 mines are appropriate for children or pregnant 

17 women entitled to medical assistance under this title, 

18 including— 

19 ‘‘(A) evidence-based items or services that 

20 have in effect a rating of ‘A’ or ‘B’ in the cur21 rent recommendations of the United States Pre22 ventive Services Task Force; 

23 ‘‘(B) with respect to pregnant women, im24 munizations that have in effect a recommenda25 tion from the Advisory Committee on Immunimstockstill on DSK4VPTVN1PROD with BILLS

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1 zation Practices of the Centers for Disease Con2 trol and Prevention with respect to the indi3 vidual involved; 

4 ‘‘(C) with respect to infants, children, and 

5 adolescents, evidence-informed preventive care 

6 and screenings provided for in the comprehen7 sive guidelines supported by the Health Re8 sources and Services Administration; and 

9 ‘‘(D) with respect to women, such addi10 tional preventive care and screenings not de11 scribed in this paragraph as provided for in 

12 comprehensive guidelines supported by the 

13 Health Resources and Services Administration 

14 for purposes of this paragraph. 

15 ‘‘(2) ADDITIONAL SERVICES.—Nothing in this 

16 subsection shall be construed to limit the application 

17 of any requirement of subsection (r) or to prohibit 

18 a State plan under this title from providing coverage 

19 for services in addition to those recommended by 

20 United States Preventive Services Task Force or to 

21 prohibit coverage of services.’’. 

22 (2) ELIMINATION OF COST-SHARING.— 

23 (A) Subsections (a)(2)(D) and (b)(2)(D) of 

24 section 1916 (42 U.S.C. 1396o) are each 

25 amended by inserting ‘‘preventive services demstockstill on DSK4VPTVN1PROD with BILLS

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1 scribed in section 1905(ee),’’ after ‘‘emergency 

2 services (as defined by the Secretary),’’. 

3 (B) Section 1916A(a)(1) (42 U.S.C. 

4 1396o–1(a)(1)) is amended by inserting ‘‘, pre5 ventive services described in section 1905(ee),’’ 

6 after ‘‘subsection (c)’’. 

7 (3) INTERVAL PERIOD FOR INCLUSION OF NEW

8 RECOMMENDATIONS IN STATE PLANS.—With respect 

9 to a recommendation issued on or after the date of 

10 enactment of this Act that adds new preventive serv11 ices to the requirements described in subsection (ee) 

12 of section 1905 of the Social Security Act, the Sec13 retary shall establish a maximum interval period, 

14 which shall not be longer than 6 months, between 

15 the date on which the recommendation is issued and 

16 the plan year for which a State plan for medical as17 sistance under title XIX of the Social Security Act 

18 shall be required to include such preventive service. 

19 (b) CHIP.—Section 2103 (42 U.S.C. 1397cc) is 

20 amended— 

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

22 paragraph (1), by striking ‘‘and (7)’’ and inserting 

23 ‘‘(7), and (8)’’; and 

24 (2) in subsection (c)— 

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1 (A) by redesignating paragraph (8) as 

2 paragraph (9); and 

3 (B) by inserting after paragraph (7), the 

4 following new paragraph: 

5 ‘‘(8) PREVENTIVE SERVICES.—The child health 

6 assistance provided to a targeted low-income child 

7 and pregnancy-related assistance provided to a tar8 geted low-income pregnant woman shall include cov9 erage of preventive services for children or pregnant 

10 women required under a State plan under title XIX 

11 under subsections (a)(4)(E) and (ee) of section 1905 

12 and no deductible, cost sharing or similar charge 

13 shall be imposed under the State child health plan 

14 with respect to such services.’’. 

15 SEC. 402. TIMELY IMMUNIZATION COVERAGE. 

16 (a) COVERAGE FOR NEWLY APPROVED VACCINES

17 WITHIN 30 DAYS.— 

18 (1) IN GENERAL.—Section 1928(e) (42 U.S.C. 

19 1396s(e)) is amended by adding at the end the fol20 lowing new sentence: ‘‘Each revision of the list es21 tablished by such Advisory Committee shall apply to 

22 the purchase, delivery, and administration of pedi23 atric vaccines under this section not later than 30 

24 days after the date such Advisory Committee ap25 proves the revision.’’. 

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1 (2) CONFORMING AMENDMENT.—Section 

2 2103(c)(1)(D) (42 U.S.C. 1397cc(c)(1)(D)) is 

3 amended by inserting ‘‘in accordance with the sched4 ule referred to in section 1928(c)(2)(B)(i) for pedi5 atric vaccines’’ after ‘‘immunizations’’. 

6 (b) TREATMENT OF CHIP-ELIGIBLE CHILDREN AS

7 FEDERALLY VACCINE-ELIGIBLE CHILDREN.—Section 

8 1928(b)(2) (42 U.S.C. 1396s(b)(2)) is amended— 

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

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

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

12 and inserting the following: 

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

14 CHIP-eligible child’ means, with respect to 

15 a child, a child who is entitled to medical 

16 assistance under a State plan approved 

17 under this title or a waiver of such plan, 

18 or who is eligible for child health assist19 ance under a State child health plan ap20 proved under title XXI.’’. 

21 (c) CODING FOR VACCINE ADMINISTRATION.—Sec22 tion 1928 (42 U.S.C. 1396s) is amended— 

23 (1) by striking subsection (g) and inserting: 

24 ‘‘(g) øReserved¿.’’; and 

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1 (2) in subsection (h)(6), by striking ‘‘a vaccine’’ 

2 and inserting ‘‘each vaccine component’’. 

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

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

5 this Act. 

6 TITLE V—ACCESS AND QUALITY 

7 Subtitle A—Pediatric Quality 

8 Measures 

9 SEC. 501. EXTENDING THE PEDIATRIC QUALITY MEASURES 

10 PROGRAM. 

11 (a) IN GENERAL.—Section 1139A(i) (42 U.S.C. 

12 1320b–9a(i)) is amended by inserting ‘‘, and for each of 

13 fiscal years 2014 through 2019, $50,000,000,’’ after 

14 ‘‘$45,000,000’’. 

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

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

17 this Act. 

18 SEC. 502. IMPROVING THE EFFECTIVENESS OF THE PEDI19 ATRIC QUALITY MEASURES. 

20 (a) IN GENERAL.—Section 1139A(b) (42 U.S.C. 

21 1320b–9a(b)) is amended— 

22 (1) in paragraph (4)— 

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

24 ‘‘and’’ at the end; 

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

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

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

4 subparagraph: 

5 ‘‘(C) establish a program to continue and 

6 enhance pediatric quality measures program 

7 centers of excellence, which may include devel8 oping centers of excellence with a particular 

9 emphasis on patient and family experience and 

10 pediatric populations that are small in size and 

11 may be most effectively addressed by aggre12 gating data across multiple States, including 

13 pediatric populations with medical complexity 

14 and pediatric populations with rare condi15 tions.’’; and 

16 (2) by amending paragraph (5) to read as fol17 lows: 

18 ‘‘(5) REVISING, STRENGTHENING, AND IMPROV19 ING INITIAL CORE MEASURES.— 

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

21 annually publish recommended changes to the 

22 core measures described in subsection (a) 

23 that— 

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1 ‘‘(i) are consistent with the purposes 

2 of the pediatric quality measures program 

3 established under paragraph (1); 

4 ‘‘(ii) meet the conditions specified in 

5 paragraph (2); 

6 ‘‘(iii) were developed by the Secretary 

7 in consultation with the entities specified 

8 in subparagraphs (A) through (H) of para9 graph (3); and 

10 ‘‘(iv) were developed, validated, or 

11 tested through a grant awarded under 

12 paragraph (4). 

13 ‘‘(B) ADDITIONAL RECOMMENDED

14 CHANGES.—Beginning not later than 1 year 

15 after the date of enactment of the CHIP Exten16 sion Act of 2014, the recommended changes 

17 published under subparagraph (A) shall include 

18 changes— 

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

20 health insurance coverage or other health 

21 benefits coverage available over time, in 

22 addition to the presence, stability, and du23 ration of such health insurance coverage or 

24 such health benefits coverage over time, for 

25 purposes of examining enrollment changes 

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1 of a child from one type of coverage to an2 other; 

3 ‘‘(ii) to ensure that the measures re4 flect the care provided to the diverse pedi5 atric population, including adolescents and 

6 children with special health care needs, 

7 and the management of acute and chronic 

8 conditions; 

9 ‘‘(iii) to ensure that the measures re10 flect care provided in diverse health care 

11 settings, including both inpatient and am12 bulatory settings; 

13 ‘‘(iv) to encourage the development, 

14 implementation, and stewardship of core 

15 measures that can be used at the State, 

16 hospital, practice, and plan levels, includ17 ing a sustainable mechanism to maintain 

18 and disseminate such measures and collect 

19 and report data on such measures; and 

20 ‘‘(v) to facilitate the adoption, dis21 semination, stewardship, and reporting of 

22 such measures as well as measures devel23 oped through the pediatric quality meas24 ures program at the State, hospital, prac25 tice, and plan levels and across different 

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1 health care delivery and coverage systems, 

2 including coverage provided through the 

3 Exchanges established under title I of the 

4 Patient Protection and Affordable Care 

5 Act.’’. 

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

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

8 this Act. 

9 SEC. 503. ANNUAL STATE REPORTS REGARDING STATE-SPE10 CIFIC QUALITY OF CARE MEASURES APPLIED 

11 UNDER MEDICAID OR CHIP. 

12 (a) IN GENERAL.—Section 1139A(c) (42 U.S.C. 

13 1320b–9a(c)) is amended by adding at the end the fol14 lowing new paragraph: 

15 ‘‘(3) DATA COLLECTION AND REPORTING ON

16 FULL SET OF CORE MEASURES.—Beginning not 

17 later than 5 years after the date of enactment of 

18 this paragraph, the information reported under 

19 paragraph (1) shall include State-specific informa20 tion on the full set of pediatric core measures.’’. 

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

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

23 this Act. 

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1 SEC. 504. ADVISORY PANEL REGARDING PEDIATRIC QUAL2 ITY. 

3 (a) IN GENERAL.—Section 1139A(g) (42 U.S.C. 

4 1320b–9a(g)) is amended— 

5 (1) in the subsection heading, by striking 

6 ‘‘STUDY OF’’ and inserting ‘‘STUDIES AND REPORTS

7 ON’’; 

8 (2) by redesignating paragraph (2) as para9 graph (4); and 

10 (3) by inserting after paragraph (1) the fol11 lowing new paragraphs: 

12 ‘‘(2) EXPERT PANEL.—The Secretary shall con13 vene a panel, composed of health experts (including 

14 experts employed by the Federal Government and 

15 experts not so employed) to establish priorities and 

16 goals for child health as recommended in the report 

17 submitted under paragraph (1) by the Institute of 

18 Medicine. Such panel shall— 

19 ‘‘(A) advise and make recommendations to 

20 the Secretary regarding changes that may be 

21 made to the core measures described in sub22 section (a); 

23 ‘‘(B) establish standards for the timeliness 

24 and accuracy of data so collected and reported; 

25 and 

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1 ‘‘(C) review and make recommendations, 

2 on an annual basis, for strategies to enhance 

3 the timeliness, accuracy, and utility of the core 

4 measures. 

5 ‘‘(3) COLLECTING AND REPORTING FULL SET

6 OF CORE MEASURES.—Not later than 1 year after 

7 the date of enactment of this paragraph, the Sec8 retary, in consultation with representatives of State 

9 agencies responsible for administering Medicaid and 

10 the State Children’s Health Insurance Program and 

11 representatives of relevant provider organizations, 

12 shall submit to the Committee on Energy and Com13 merce of the House of Representatives and the Com14 mittee on Finance of the Senate a report identi15 fying— 

16 ‘‘(A) strategies to address and overcome 

17 barriers to State collection of and reporting of 

18 the full set of pediatric core measures; 

19 ‘‘(B) an analysis of the amount of Federal 

20 funding needed to incentivize States to collect 

21 and report on the full set of pediatric core 

22 measures; and 

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

24 States to collect and report on the full set of 

25 pediatric core measures.’’. 

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

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

3 this Act. 

4 SEC. 505. EXTENDING AND EXPANDING DEMONSTRATION 

5 PROJECTS. 

6 (a) STRENGTHENING DEMONSTRATION PROJECTS

7 FOR IMPROVING THE QUALITY OF CHILDREN’S HEALTH

8 CARE AND THE USE OF HEALTH INFORMATION TECH9 NOLOGY.—Section 1139A(d) (42 U.S.C. 1320b–9a(d)) is 

10 amended— 

11 (1) in paragraph (1)— 

12 (A) in the matter preceding subparagraph 

13 (A)— 

14 (i) by inserting ‘‘, and during the pe15 riod of fiscal years 2014 through 2019, the 

16 Secretary shall award not less than 10 

17 grants,’’ after ‘‘10 grants’’; and 

18 (ii) by inserting ‘‘(including oral 

19 care)’’ after ‘‘health care’’; 

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

21 at the end; 

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

23 period at the end and inserting a semicolon; 

24 and 

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

2 subparagraphs: 

3 ‘‘(E) examine and address barriers to ef4 fective delivery of perinatal care and its impact 

5 on birth outcomes and subsequent pregnancies 

6 and children’s health; 

7 ‘‘(F) implement and expand pediatric and 

8 perinatal learning and quality improvement 

9 collaboratives on the quality of children’s and 

10 pregnant women’s health care, including im11 proving patient outcomes, reducing health costs, 

12 and addressing health disparities; 

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

14 State level of payment reform and related policy 

15 proposals for purposes of promoting higher 

16 quality of care for children, including the 

17 shared savings program established under sec18 tion 1899 and other methods of encouraging in19 tegrated care models; or 

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

21 health record format for children developed and 

22 disseminated under subsection (f)— 

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

24 format has been incorporated into widely 

25 used electronic health record formats; 

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1 ‘‘(ii) implement standards and activi2 ties that result in increased use of such 

3 format; and 

4 ‘‘(iii) evaluate the impact of the in5 creased use of such format.’’; 

6 (2) in paragraph (2)— 

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

8 ‘‘and’’ at the end; 

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

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

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

12 subparagraph: 

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

14 projects described in paragraph (1)(F), such 

15 grants shall be awarded for projects that— 

16 ‘‘(i) give priority to collaboratives that 

17 would have substantial impacts on the pe18 diatric population by— 

19 ‘‘(I) affecting a large percentage 

20 of such population or by substantially 

21 improving outcomes in a smaller pop22 ulation; 

23 ‘‘(II) reducing the cost of health 

24 care for children, including children 

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1 with medically complex illnesses or 

2 chronic conditions; 

3 ‘‘(III) having a high likelihood to 

4 reduce disparities in health status; or 

5 ‘‘(IV) potentially having long6 term health impacts by addressing 

7 childhood precursors to adult condi8 tions; and 

9 ‘‘(ii) encourage coordination with 

10 other sources of funding in the expansion 

11 of pediatric learning collaboratives, includ12 ing by coordinating care and utilizing com13 munity health workers (as defined in sec14 tion 399V(k) of the Public Health Service 

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

16 (3) in paragraph (4)— 

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

18 2009 through 2013,’’ before ‘‘$20,000,000’’; 

19 and 

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

21 sentence: ‘‘For each of fiscal years 2014 

22 through 2019, $36,000,000 of the amount ap23 propriated under subsection (i) for a fiscal year 

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

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1 (b) EXTENDING FUNDING FOR CHILDHOOD OBESITY

2 DEMONSTRATION PROJECTS.—Section 1139A(e)(8) (42 

3 U.S.C. 1320b–9a(e)(8)) is amended by inserting ‘‘, and 

4 for the period of fiscal years 2015 through 2019, 

5 $25,000,000’’ after ‘‘2014’’. 

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

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

8 this Act. 

9 Subtitle B—Maternal, Infant, and 

10 Early Childhood Home Visiting 

11 Program 

12 SEC. 511. SUPPORTING EVIDENCE-BASED CARE COORDINA13 TION IN COMMUNITIES. 

14 (a) IN GENERAL.—Section 511(j)(1) (42 U.S.C. 

15 711(j)(1)) is amended by striking subparagraph (F) and 

16 inserting the following: 

17 ‘‘(F) $400,000,000 for each of fiscal years 

18 2015 through 2019.’’. 

19 (b) PREVENTION OF DUPLICATE APPROPRIATIONS

20 FOR FISCAL YEAR 2015.—Expenditures made pursuant 

21 to the amendments made by section 209 of the Protecting 

22 Access to Medicare Act of 2014 (Public Law 113–93) for 

23 fiscal year 2015 shall be charged to the appropriation pro24 vided by the amendment made by subsection (a) for such 

25 fiscal year. 

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

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

3 this Act. 

4 Subtitle C—Comparative Study of 

5 Medicaid, CHIP, and Qualified 

6 Health Plans 

7 SEC. 521. GAO STUDY AND REPORT. 

8 (a) STUDY.—The Comptroller General of the United 

9 States shall conduct a study of each State in which indi10 viduals eligible for medical assistance under a State plan 

11 under title XIX of the Social Security Act (42 U.S.C. 

12 1396 et seq.) or for child health assistance under a State 

13 child health plan under title XXI of the Social Security 

14 Act (42 U.S.C. 1397aa et seq.) are provided such assist15 ance through enrollment in a qualified health plan or em16 ployer-sponsored insurance. Such study shall determine, 

17 for each such State— 

18 (1) the number of such individuals enrolled in 

19 an employer-sponsored health plan to whom wrap20 around services are offered; 

21 (2) the number of such individuals enrolled in 

22 an employer-sponsored health plan who use wrap23 around services for any purpose during the plan 

24 year; 

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1 (3) the average cost of wraparound services per 

2 individual enrolled in an employer-sponsored health 

3 plan who uses such services; 

4 (4) the number of such individuals with ‘‘devel5 opmental disabilities’’ (as defined in section 102(8) 

6 of the Developmental Disabilities Assistance and Bill 

7 of Rights Act of 2000 (42 U.S.C. 15002(8))), en8 rolled in an employer-sponsored health plan who 

9 used wrap-around benefits; 

10 (5) the number of disabled individuals enrolled 

11 in an employer-sponsored health plan who use wrap12 around benefits for habilitative services, rehabilita13 tive services, or home health services; 

14 (6) the number of such individuals enrolled in 

15 qualified health plans; 

16 (7) average premiums and cost-sharing per 

17 such individual enrolled in a qualified health plan; 

18 and 

19 (8) comparative data with respect to the bene20 fits offered to such individuals under qualified health 

21 plans as compared to the benefits offered to such in22 dividuals under State plans under title XIX or XXI 

23 of the Social Security Act. 

24 (b) REPORTS.—Not later than 2 years after the date 

25 of the enactment of this Act, the Comptroller General of 

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1 the United States shall submit to the Committee on En2 ergy and Commerce of the House of Representatives and 

3 the Committee on Finance of the Senate a report on the 

4 findings of the study conducted under subsection (a) that 

5 includes any recommendations or proposed legislation. Not 

6 later than 4 years after the date of enactment of this Act, 

7 the Comptroller General of the United States shall submit 

8 to the Committee on Energy and Commerce of the House 

9 of Representatives and the Committee on Finance of the 

10 Senate an updated report on the findings of the study con11 ducted under subsection (a) that includes any rec12 ommendations or proposed legislation. 

13 (c) DEFINITIONS.—For purposes of this section: 

14 (1) QUALIFIED HEALTH PLAN.—The term 

15 ‘‘qualified health plan’’ means a health plan that is 

16 offered through an American Health Benefits Ex17 change established under the Patient Protection and 

18 Affordable Care Act (Public Law 111–148). 

19 (2) WRAPAROUND SERVICES.—The term 

20 ‘‘wraparound services’’ means services provided by a 

21 State plan under title XIX or XXI of the Social Se22 curity Act that are provided as a supplement to 

23 items or services for which coverage is not offered or 

24 is limited under a qualified health plan or an em25 ployer-sponsored health plan. 

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1 TITLE VI—BUDGETARY EFFECTS 

2 SEC. 601. BUDGETARY EFFECT OF THIS ACT. 

3 The budgetary effects of this Act, for the purpose of 

4 complying with the Statutory Pay-As-You-Go Act of 2010, 

5 shall be determined by reference to the latest statement 

6 titled ‘‘Budgetary Effects of PAYGO Legislation’’ for this 

7 Act, submitted for printing in the Congressional Record 

8 by the Chairman of the Committee on the Budget of the 

9 House of Representatives, as long as such statement has 

10 been submitted prior to the vote on passage of this Act. 

Æ 

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