H. R. 2—82 
paragraph (1). The report shall include recommendations for 
such Federal and State legislative and administrative changes 
as the Comptroller General determines are necessary to address 
any barriers to access to oral health care, including preventive 
and restorative services, under Medicaid and CHIP that may 
exist. 
SEC. 502. MENTAL HEALTH PARITY IN CHIP PLANS. 
(a) ASSURANCE
OF
PARITY.—Section 2103(c) (42 U.S.C. 
1397cc(c)), as amended by section 501(a)(1)(B), is amended by 
inserting after paragraph (5), the following: 
‘‘(6) MENTAL HEALTH SERVICES PARITY.— 
‘‘(A) IN GENERAL.—In the case of a State child health 
plan that provides both medical and surgical benefits and 
mental health or substance use disorder benefits, such 
plan shall ensure that the financial requirements and treat-
ment limitations applicable to such mental health or sub-
stance use disorder benefits comply with the requirements 
of section 2705(a) of the Public Health Service Act in the 
same manner as such requirements apply to a group health 
plan. 
‘‘(B) DEEMED COMPLIANCE.—To the extent that a State 
child health plan includes coverage with respect to an 
individual described in section 1905(a)(4)(B) and covered 
under the State plan under section 1902(a)(10)(A) of the 
services described in section 1905(a)(4)(B) (relating to early 
and periodic screening, diagnostic, and treatment services 
defined in section 1905(r)) and provided in accordance with 
section 1902(a)(43), such plan shall be deemed to satisfy 
the requirements of subparagraph (A).’’. 
(b) CONFORMING
AMENDMENTS.—Section 2103 (42 U.S.C. 
1397cc) is amended— 
(1) in subsection (a), as amended by section 501(a)(1)(A)(i), 
in the matter preceding paragraph (1), by inserting ‘‘, (6),’’ 
after ‘‘(5)’’; and 
(2) in subsection (c)(2), by striking subparagraph (B) and 
redesignating subparagraphs (C) and (D) as subparagraphs (B) 
and (C), respectively. 
SEC. 503. APPLICATION OF PROSPECTIVE PAYMENT SYSTEM FOR 
SERVICES PROVIDED BY FEDERALLY-QUALIFIED HEALTH 
CENTERS AND RURAL HEALTH CLINICS. 
(a) APPLICATION OF PROSPECTIVE PAYMENT SYSTEM.— 
(1) 
IN
GENERAL.—Section 
2107(e)(1) 
(42 
U.S.C. 
1397gg(e)(1)), as amended by section 501(c)(2) is amended by 
inserting after subparagraph (C) the following new subpara-
graph (and redesignating the succeeding subparagraphs accord-
ingly): 
‘‘(D) Section 1902(bb) (relating to payment for services 
provided by Federally-qualified health centers and rural 
health clinics).’’. 
(2) EFFECTIVE DATE.—The amendment made by paragraph 
(1) shall apply to services provided on or after October 1, 
2009. 
(b) TRANSITION GRANTS.— 
(1) APPROPRIATION.—Out of any funds in the Treasury 
not otherwise appropriated, there is appropriated to the Sec-
retary for fiscal year 2009, $5,000,000, to remain available
H. R. 2—83 
until expended, for the purpose of awarding grants to States 
with State child health plans under CHIP that are operated 
separately from the State Medicaid plan under title XIX of 
the Social Security Act (including any waiver of such plan), 
or in combination with the State Medicaid plan, for expendi-
tures related to transitioning to compliance with the require-
ment of section 2107(e)(1)(D) of the Social Security Act (as 
added by subsection (a)) to apply the prospective payment 
system established under section 1902(bb) of the such Act (42 
U.S.C. 1396a(bb)) to services provided by Federally-qualified 
health centers and rural health clinics. 
(2) MONITORING AND REPORT.—The Secretary shall monitor 
the impact of the application of such prospective payment 
system on the States described in paragraph (1) and, not later 
than October 1, 2011, shall report to Congress on any effect 
on access to benefits, provider payment rates, or scope of bene-
fits offered by such States as a result of the application of 
such payment system. 
SEC. 504. PREMIUM GRACE PERIOD. 
(a) IN GENERAL.—Section 2103(e)(3) (42 U.S.C. 1397cc(e)(3)) 
is amended by adding at the end the following new subparagraph: 
‘‘(C) PREMIUM GRACE PERIOD.—The State child health 
plan— 
‘‘(i) shall afford individuals enrolled under the plan 
a grace period of at least 30 days from the beginning 
of a new coverage period to make premium payments 
before the individual’s coverage under the plan may 
be terminated; and 
‘‘(ii) shall provide to such an individual, not later 
than 7 days after the first day of such grace period, 
notice— 
‘‘(I) that failure to make a premium payment 
within the grace period will result in termination 
of coverage under the State child health plan; and 
‘‘(II) of the individual’s right to challenge the 
proposed termination pursuant to the applicable 
Federal regulations. 
For purposes of clause (i), the term ‘new coverage period’ 
means the month immediately following the last month 
for which the premium has been paid.’’. 
(b) EFFECTIVE DATE.—The amendment made by subsection (a) 
shall apply to new coverage periods beginning on or after the 
date of the enactment of this Act. 
SEC. 505. CLARIFICATION OF COVERAGE OF SERVICES PROVIDED 
THROUGH SCHOOL-BASED HEALTH CENTERS. 
(a) IN GENERAL.—Section 2103(c) (42 U.S.C. 1397cc(c)), as 
amended by section 501(a)(1)(B), is amended by adding at the 
end the following new paragraph: 
‘‘(8) AVAILABILITY OF COVERAGE FOR ITEMS AND SERVICES 
FURNISHED
THROUGH
SCHOOL-BASED
HEALTH
CENTERS.— 
Nothing in this title shall be construed as limiting a State’s 
ability to provide child health assistance for covered items 
and services that are furnished through school-based health 
centers (as defined in section 2110(c)(9)).’’. 
(b) DEFINITION.—Section 2110(c) (42 U.S.C. 1397jj) is amended 
by adding at the end the following:
H. R. 2—84 
‘‘(9) SCHOOL-BASED HEALTH CENTER.— 
‘‘(A) IN
GENERAL.—The term ‘school-based health 
center’ means a health clinic that— 
‘‘(i) is located in or near a school facility of a 
school district or board or of an Indian tribe or tribal 
organization; 
‘‘(ii) is organized through school, community, and 
health provider relationships; 
‘‘(iii) is administered by a sponsoring facility; 
‘‘(iv) provides through health professionals primary 
health services to children in accordance with State 
and local law, including laws relating to licensure and 
certification; and 
‘‘(v) satisfies such other requirements as a State 
may establish for the operation of such a clinic. 
‘‘(B) SPONSORING FACILITY.—For purposes of subpara-
graph (A)(iii), the term ‘sponsoring facility’ includes any 
of the following: 
‘‘(i) A hospital. 
‘‘(ii) A public health department. 
‘‘(iii) A community health center. 
‘‘(iv) A nonprofit health care agency. 
‘‘(v) A school or school system. 
‘‘(vi) A program administered by the Indian Health 
Service or the Bureau of Indian Affairs or operated 
by an Indian tribe or a tribal organization.’’. 
SEC. 506. MEDICAID AND CHIP PAYMENT AND ACCESS COMMISSION. 
(a) IN GENERAL.—Title XIX (42 U.S.C. 1396 et seq.) is amended 
by inserting before section 1901 the following new section: 
‘‘MEDICAID AND CHIP PAYMENT AND ACCESS COMMISSION 
‘‘SEC. 1900. (a) ESTABLISHMENT.—There is hereby established 
the Medicaid and CHIP Payment and Access Commission (in this 
section referred to as ‘MACPAC’). 
‘‘(b) DUTIES.— 
‘‘(1) REVIEW OF ACCESS POLICIES AND ANNUAL REPORTS.— 
MACPAC shall— 
‘‘(A) review policies of the Medicaid program estab-
lished under this title (in this section referred to as ‘Med-
icaid’) and the State Children’s Health Insurance Program 
established under title XXI (in this section referred to 
as ‘CHIP’) affecting children’s access to covered items and 
services, including topics described in paragraph (2); 
‘‘(B) make recommendations to Congress concerning 
such access policies; 
‘‘(C) by not later than March 1 of each year (beginning 
with 2010), submit a report to Congress containing the 
results of such reviews and MACPAC’s recommendations 
concerning such policies; and 
‘‘(D) by not later than June 1 of each year (beginning 
with 2010), submit a report to Congress containing an 
examination of issues affecting Medicaid and CHIP, 
including the implications of changes in health care 
delivery in the United States and in the market for health 
care services on such programs.
H. R. 2—85 
‘‘(2) SPECIFIC
TOPICS
TO
BE
REVIEWED.—Specifically, 
MACPAC shall review and assess the following: 
‘‘(A) MEDICAID AND CHIP PAYMENT POLICIES.—Payment 
policies under Medicaid and CHIP, including— 
‘‘(i) the factors affecting expenditures for items 
and services in different sectors, including the process 
for updating hospital, skilled nursing facility, physi-
cian, Federally-qualified health center, rural health 
center, and other fees; 
‘‘(ii) payment methodologies; and 
‘‘(iii) the relationship of such factors and meth-
odologies to access and quality of care for Medicaid 
and CHIP beneficiaries. 
‘‘(B) INTERACTION OF MEDICAID AND CHIP PAYMENT POLI-
CIES WITH HEALTH CARE DELIVERY GENERALLY.—The effect 
of Medicaid and CHIP payment policies on access to items 
and services for children and other Medicaid and CHIP 
populations other than under this title or title XXI and 
the implications of changes in health care delivery in the 
United States and in the general market for health care 
items and services on Medicaid and CHIP. 
‘‘(C) OTHER ACCESS POLICIES.—The effect of other Med-
icaid and CHIP policies on access to covered items and 
services, including policies relating to transportation and 
language barriers. 
‘‘(3) CREATION OF EARLY-WARNING SYSTEM.—MACPAC shall 
create an early-warning system to identify provider shortage 
areas or any other problems that threaten access to care or 
the health care status of Medicaid and CHIP beneficiaries. 
‘‘(4) COMMENTS ON CERTAIN SECRETARIAL REPORTS.—If the 
Secretary submits to Congress (or a committee of Congress) 
a report that is required by law and that relates to access 
policies, including with respect to payment policies, under Med-
icaid or CHIP, the Secretary shall transmit a copy of the 
report to MACPAC. MACPAC shall review the report and, 
not later than 6 months after the date of submittal of the 
Secretary’s report to Congress, shall submit to the appropriate 
committees of Congress written comments on such report. Such 
comments may include such recommendations as MACPAC 
deems appropriate. 
‘‘(5) AGENDA
AND
ADDITIONAL
REVIEWS.—MACPAC shall 
consult periodically with the chairmen and ranking minority 
members of the appropriate committees of Congress regarding 
MACPAC’s agenda and progress towards achieving the agenda. 
MACPAC may conduct additional reviews, and submit addi-
tional reports to the appropriate committees of Congress, from 
time to time on such topics relating to the program under 
this title or title XXI as may be requested by such chairmen 
and members and as MACPAC deems appropriate. 
‘‘(6) AVAILABILITY OF REPORTS.—MACPAC shall transmit 
to the Secretary a copy of each report submitted under this 
subsection and shall make such reports available to the public. 
‘‘(7) APPROPRIATE COMMITTEE OF CONGRESS.—For purposes 
of this section, the term ‘appropriate committees of Congress’ 
means the Committee on Energy and Commerce of the House 
of Representatives and the Committee on Finance of the Senate.