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SEC. 1759. BILLING AGENTS, CLEARINGHOUSES, OR OTHER 
ALTERNATE PAYEES REQUIRED TO REG-
ISTER UNDER MEDICAID. 
(a) IN GENERAL.—Section 1902(a) of the Social Se-
curity Act (42 U.S.C. 42 U.S.C. 1396a(a)), as amended 
by sections 1631(b), 1703(a), 1729, 1753, and 1757(a), 
is further amended— 
(1) in paragraph (77); by striking at the end 
‘‘and’’; 
(2) in paragraph (78), by striking the period at 
the end and inserting ‘‘and’’; and 
(3) by inserting after paragraph (78) the fol-
lowing new paragraph: 
‘‘(79) provide that any agent, clearinghouse, or 
other alternate payee that submits claims on behalf 
of a health care provider must register with the 
State and the Secretary in a form and manner speci-
fied by the Secretary under section 1866(j)(1)(D).’’. 
(b) DENIAL OF PAYMENT.—Section 1903(i) of such 
Act (42 U.S.C. 1396b(i)), as amended by section 1751, 
is amended— 
(1) by striking ‘‘or’’ at the end of paragraph 
(24); 
(2) by striking the period at the end of para-
graph (25) and inserting ‘‘; or’’; and 
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(3) by inserting after paragraph (25) the fol-
lowing new paragraph: 
‘‘(26) with respect to any amount paid to a bill-
ing agent, clearinghouse, or other alternate payee 
that is not registered with the State and the Sec-
retary as required under section 1902(a)(79).’’. 
(c) EFFECTIVE DATE.—Except as provided in section 
1790, the amendments made by this section shall apply 
to claims submitted on or after January 1, 2012, without 
regard to whether or not final regulations to carry out 
such amendments have been promulgated by such date. 
SEC. 1760. DENIAL OF PAYMENTS FOR LITIGATION-RE-
LATED MISCONDUCT. 
(a) IN GENERAL.—Section 1903(i) of the Social Se-
curity Act (42 U.S.C. 1396b(i)), as amended by sections 
1751(a) and 1759(b), is amended— 
(1) by striking ‘‘or’’ at the end of paragraph 
(25); 
(2) by striking the period at the end of para-
graph (26) and inserting ‘‘; or’’; and 
(3) by inserting after paragraph (26) the fol-
lowing new paragraph: 
‘‘(27) with respect to any amount expended— 
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‘‘(A) on litigation in which a court imposes 
sanctions on the State, its employees, or its 
counsel for litigation-related misconduct; or 
‘‘(B) to reimburse (or otherwise com-
pensate) a managed care entity for payment of 
legal expenses associated with any action in 
which a court imposes sanctions on the man-
aged care entity for litigation-related mis-
conduct.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to amounts expended on or after 
January 1, 2010. 
SEC. 1761. MANDATORY STATE USE OF NATIONAL CORRECT 
CODING INITIATIVE. 
Section 1903(r) of the Social Security Act (42 U.S.C. 
1396b(r)) is amended— 
(1) in paragraph (1)(B)— 
(A) in clause (ii), by striking ‘‘and’’ at the 
end; 
(B) in clause (iii), by adding ‘‘and’’ at the 
end; and 
(C) by adding at the end the following new 
clause: 
‘‘(iv) effective for claims filed on or 
after October 1, 2010, incorporate compat-
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ible methodologies of the National Correct 
Coding Initiative administered by the Sec-
retary (or any successor initiative to pro-
mote correct coding and to control im-
proper coding leading to inappropriate pay-
ment) and such other methodologies of 
that Initiative (or such other national cor-
rect coding methodologies) as the Sec-
retary identifies in accordance with para-
graph (4);’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(4) Not later than September 1, 2010, the Secretary 
shall do the following: 
‘‘(A) Identify those methodologies of the Na-
tional Correct Coding Initiative administered by the 
Secretary (or any successor initiative to promote cor-
rect coding and to control improper coding leading 
to inappropriate payment) which are compatible to 
claims filed under this title. 
‘‘(B) Identify those methodologies of such Ini-
tiative (or such other national correct coding meth-
odologies) that should be incorporated into claims 
filed under this title with respect to items or services 
for which States provide medical assistance under 
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this title and no national correct coding methodolo-
gies have been established under such Initiative with 
respect to title XVIII. 
‘‘(C) Notify States of— 
‘‘(i) the methodologies identified under 
subparagraphs (A) and (B) (and of any other 
national correct coding methodologies identified 
under subparagraph (B)); and 
‘‘(ii) how States are to incorporate such 
methodologies into claims filed under this title. 
‘‘(D) Submit a report to Congress that includes 
the notice to States under subparagraph (C) and an 
analysis supporting the identification of the meth-
odologies made under subparagraphs (A) and (B).’’. 
Subtitle G—Payments to the 
Territories 
SEC. 1771. PAYMENT TO TERRITORIES. 
(a) INCREASE IN CAP.—Section 1108 of the Social 
Security Act (42 U.S.C. 1308) is amended— 
(1) in subsection (f), by striking ‘‘subsection 
(g)’’ and inserting ‘‘subsections (g) and (h)’’; 
(2) in subsection (g)(1), by striking ‘‘With re-
spect to’’ and inserting ‘‘Subject to subsection (h), 
with respect to’’; and 
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(3) by adding at the end the following new sub-
section: 
‘‘(h) ADDITIONAL INCREASE
FOR FISCAL YEARS 
2011 THROUGH 2019.—Subject to section 347(b)(1) of 
the Affordable Health Care for America Act, with respect 
to fiscal years 2011 through 2019, the amounts otherwise 
determined under subsections (f) and (g) for Puerto Rico, 
the Virgin Islands, Guam, the Northern Mariana Islands 
and American Samoa shall be increased by the following 
amounts: 
‘‘(1) For Puerto Rico, for fiscal year 2011, 
$727,600,000; for fiscal year 2012, $775,000,000; 
for fiscal year 2013, $850,000,000; for fiscal year 
2014, 
$925,000,000; 
for 
fiscal 
year 
2015, 
$1,000,000,000; 
for 
fiscal 
year 
2016, 
$1,075,000,000; 
for 
fiscal 
year 
2017, 
$1,150,000,000; 
for 
fiscal 
year 
2018, 
$1,225,000,000; 
and 
for 
fiscal 
year 
2019, 
$1,396,400,000. 
‘‘(2) For the Virgin Islands, for fiscal year 
2011, 
$34,000,000; 
for 
fiscal 
year 
2012, 
$37,000,000; for fiscal year 2013, $40,000,000; for 
fiscal year 2014, $43,000,000; for fiscal year 2015, 
$46,000,000; for fiscal year 2016, $49,000,000; for 
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fiscal year 2017, $52,000,000; for fiscal year 2018, 
$55,000,000; and for fiscal year 2019, $58,000,000. 
‘‘(3) 
For 
Guam, 
for 
fiscal 
year 
2011, 
$34,000,000; for fiscal year 2012, $37,000,000; for 
fiscal year 2013, $40,000,000; for fiscal year 2014, 
$43,000,000; for fiscal year 2015, $46,000,000; for 
fiscal year 2016, $49,000,000; for fiscal year 2017, 
$52,000,000; for fiscal year 2018, $55,000,000; and 
for fiscal year 2019, $58,000,000. 
‘‘(4) For the Northern Mariana Islands, for fis-
cal year 2011, $13,500,000; fiscal year 2012, 
$14,500,000; for fiscal year 2013, $15,500,000; for 
fiscal year 2014, $16,500,000; for fiscal year 2015, 
$17,500,000; for fiscal year 2016, $18,500,000; for 
fiscal year 2017, $19,500,000; for fiscal year 2018, 
$21,000,000; and for fiscal year 2019, $22,000,000. 
‘‘(5) For American Samoa, fiscal year 2011, 
$22,000,000; fiscal year 2012, $23,687,500; for fis-
cal year 2013, $24,687,500; for fiscal year 2014, 
$25,687,500; for fiscal year 2015, $26,687,500; for 
fiscal year 2016, $27,687,500; for fiscal year 2017, 
$28,687,500; for fiscal year 2018, $29,687,500; and 
for fiscal year 2019, $30,687,500.’’. 
(b) REPORT ON ACHIEVING MEDICAID PARITY PAY-
MENTS BEGINNING WITH FISCAL YEAR 2020.— 
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(1) IN GENERAL.—Not later than October 1, 
2013, the Secretary of Health and Human Services 
shall submit to Congress a report that details a plan 
for the transition of each territory to full parity in 
Medicaid with the 50 States and the District of Co-
lumbia in fiscal year 2020 by modifying their exist-
ing Medicaid programs and outlining actions the 
Secretary and the governments of each territory 
must take by fiscal year 2020 to ensure parity in fi-
nancing. Such report shall include what the Federal 
medical assistance percentages would be for each 
territory if the formula applicable to the 50 States 
were applied. Such report shall also include any rec-
ommendations that the Secretary may have as to 
whether the mandatory ceiling amounts for each ter-
ritory provided for in section 1108 of the Social Se-
curity Act (42 U.S.C. 1308) should be increased any 
time before fiscal year 2020 due to any factors that 
the Secretary deems relevant. 
(2) PER CAPITA DATA.—As part of such report 
the Secretary shall include information about per 
capita income data that could be used to calculate 
Federal medical assistance percentages under section 
1905(b) of the Social Security Act, under section 
1108(a)(8)(B) of such Act, for each territory on how 
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such data differ from the per capita income data 
used to promulgate Federal medical assistance per-
centages for the 50 States. The report under this 
subsection shall include recommendations on how 
the Federal medical assistance percentages can be 
calculated for the territories beginning in fiscal year 
2020 to ensure parity with the 50 States. 
(3) SUBSEQUENT
REPORTS.—The Secretary 
shall submit subsequent reports to Congress in 
2015, 2017, and 2019 detailing the progress that 
the Secretary and the governments of each territory 
have made in fulfilling the actions outlined in the 
plan submitted under paragraph (1). 
(c) APPLICATION
OF
FMAP 
FOR
ADDITIONAL 
FUNDS.—Section 1905(b) of such Act (42 U.S.C. 
1396d(b)) is amended by adding at the end the following 
sentence: ‘‘Notwithstanding the first sentence of this sub-
section and any other provision of law, for fiscal years 
2011 through 2019, the Federal medical assistance per-
centage for Puerto Rico, the Virgin Islands, Guam, the 
Northern Mariana Islands, and American Samoa shall be 
the highest Federal medical assistance percentage applica-
ble to any of the 50 States or the District of Columbia 
for the fiscal year involved, taking into account the appli-
cation of subsections (a) and (b)(1) of section 5001 of di-
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vision B of the American Recovery and Reinvestment Act 
of 2009 (Public Law 111–5) to such States and the Dis-
trict for calendar quarters during such fiscal years for 
which such subsections apply.’’. 
(d) WAIVERS.— 
(1) IN GENERAL.—Section 1902(j) of the Social 
Security Act (42 U.S.C. 1396a(j)) is amended— 
(A) by striking ‘‘American Samoa and the 
Northern Mariana Islands’’ and inserting 
‘‘Puerto Rico, the Virgin Islands, Guam, the 
Northern Mariana Islands, and American 
Samoa’’; and 
(B) by striking ‘‘American Samoa or the 
Northern Mariana Islands’’ and inserting 
‘‘Puerto Rico, the Virgin Islands, Guam, the 
Northern 
Mariana 
Islands, 
or 
American 
Samoa’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply beginning with fiscal 
year 2011. 
(e) TECHNICAL ASSISTANCE.—The Secretary shall 
provide nonmonetary technical assistance to the govern-
ments of Puerto Rico, the Virgin Islands, Guam, the 
Northern Mariana Islands, and American Samoa in up-
grading their existing computer systems in order to antici-
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pate meeting reporting requirements necessary to imple-
ment the plan contained in the report under subsection 
(b)(1). 
Subtitle H—Miscellaneous 
SEC. 1781. TECHNICAL CORRECTIONS. 
(a) TECHNICAL CORRECTION TO SECTION 1144 OF 
THE SOCIAL SECURITY ACT.—The first sentence of sec-
tion 1144(c)(3) of the Social Security Act (42 U.S.C. 
1320b—14(c)(3)) is amended— 
(1) by striking ‘‘transmittal’’; and 
(2) by inserting before the period the following: 
‘‘as specified in section 1935(a)(4)’’. 
(b) CLARIFYING AMENDMENT TO SECTION 1935 OF 
THE SOCIAL SECURITY ACT.—Section 1935(a)(4) of the 
Social Security Act (42 U.S.C. 1396u—5(a)(4)), as 
amended by section 113(b) of Public Law 110–275, is 
amended— 
(1) by striking the second sentence; 
(2) by redesignating the first sentence as a sub-
paragraph (A) with appropriate indentation and 
with the following heading: ‘‘IN GENERAL.—’’; 
(3) by adding at the end the following subpara-
graphs: 
‘‘(B) FURNISHING
MEDICAL
ASSISTANCE 
WITH
REASONABLE
PROMPTNESS.—For the 
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purpose of a State’s obligation under section 
1902(a)(8) to furnish medical assistance with 
reasonable promptness, the date of the elec-
tronic transmission of low-income subsidy pro-
gram data, as described in section 1144(c), 
from the Commissioner of Social Security to the 
State Medicaid Agency, shall constitute the date 
of filing of such application for benefits under 
the Medicare Savings Program. 
‘‘(C) 
DETERMINING
AVAILABILITY
OF 
MEDICAL ASSISTANCE.—For the purpose of de-
termining when medical assistance will be made 
available, the State shall consider the date of 
the individual’s application for the low income 
subsidy program to constitute the date of filing 
for benefits under the Medicare Savings Pro-
gram.’’. 
(c) EFFECTIVE
DATE
RELATING
TO
MEDICAID 
AGENCY CONSIDERATION OF LOW-INCOME SUBSIDY AP-
PLICATION AND DATA TRANSMITTAL.—The amendments 
made by subsections (a) and (b) shall be effective as if 
included in the enactment of section 113(b) of Public Law 
110–275. 
(d) TECHNICAL CORRECTION TO SECTION 605 OF 
CHIPRA.—Section 605 of the Children’s Health Insur-
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ance Program Reauthorization Act of 2009 (Public Law 
111–3) is amended by striking ‘‘legal residents’’ and in-
serting ‘‘lawfully residing in the United States’’. 
(e) TECHNICAL CORRECTION TO SECTION 1905 OF 
THE SOCIAL SECURITY ACT.—Section 1905(a) of the So-
cial Security Act (42 U.S.C. 1396d(a)) is amended by in-
serting ‘‘or the care and services themselves, or both’’ be-
fore ‘‘(if provided in or after’’. 
(f) CLARIFYING AMENDMENT TO SECTION 1115 OF 
THE SOCIAL SECURITY ACT.—Section 1115(a) of the So-
cial Security Act (42 U.S.C. 1315(a)) is amended by add-
ing at the end the following: ‘‘If an experimental, pilot, 
or demonstration project that relates to title XIX is ap-
proved pursuant to any part of this subsection, such 
project shall be treated as part of the State plan, all med-
ical assistance provided on behalf of any individuals af-
fected by such project shall be medical assistance provided 
under the State plan, and all provisions of this Act not 
explicitly waived in approving such project shall remain 
fully applicable to all individuals receiving benefits under 
the State plan.’’. 
SEC. 1782. EXTENSION OF QI PROGRAM. 
(a) IN GENERAL.—Section 1902(a)(10)(E)(iv) of the 
Social Security Act (42 U.S.C. 1396b(a)(10)(E)(iv)) is 
amended— 
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(1) by striking ‘‘sections 1933 and’’ and by in-
serting ‘‘section’’; and 
(2) by striking ‘‘December 2010’’ and inserting 
‘‘December 2012’’. 
(b) ELIMINATION OF FUNDING LIMITATION.— 
(1) IN GENERAL.—Section 1933 of such Act 
(42 U.S.C. 1396u–3) is amended— 
(A) in subsection (a), by striking ‘‘who are 
selected to receive such assistance under sub-
section (b)’’; 
(B) by striking subsections (b), (c), (e), 
and (g); 
(C) in subsection (d), by striking ‘‘fur-
nished in a State’’ and all that follows and in-
serting ‘‘the Federal medical assistance percent-
age shall be equal to 100 percent.’’; and 
(D) by redesignating subsections (d) and 
(f) as subsections (b) and (c), respectively. 
(2) 
CONFORMING
AMENDMENT.—Section 
1905(b) of such Act (42 U.S.C. 1396d(b)) is amend-
ed by striking ‘‘1933(d)’’ and inserting ‘‘1933(b)’’. 
(3) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall take effect on January 1, 
2011. 
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SEC. 1783. ASSURING TRANSPARENCY OF INFORMATION. 
(a) IN GENERAL.—Section 1902(a) of the Social Se-
curity Act (42 U.S.C. 1396a(a)), as amended by sections 
1631(b), 1703(a), 1729, 1753, 1757(a), 1759(a), and 
1907(b), is amended— 
(1) by striking ‘‘and’’ at the end of paragraph 
(79); 
(2) by striking the period at the end of para-
graph (80) and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (80) the fol-
lowing new paragraph: 
‘‘(81) provide that the State will establish and 
maintain laws, in accordance with the requirements 
of section 1921A, to require disclosure of informa-
tion on hospital charges and quality and to make 
such information available to the public and the Sec-
retary.’’; and 
(4) by inserting after section 1921 the following 
new section: 
‘‘HOSPITAL PRICE TRANSPARENCY 
‘‘SEC. 1921A. (a) IN GENERAL.—The requirements 
referred to in section 1902(a)(81) are that the laws of a 
State must— 
‘‘(1) require reporting to the State (or its 
agent) by each hospital located therein, of informa-
tion on— 
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‘‘(A) the charges for the most common in-
patient and outpatient hospital services; 
‘‘(B) the Medicare and Medicaid reim-
bursement amount for such services; and 
‘‘(C) if the hospitals allows for or provides 
reduced charges for individuals based on finan-
cial need, the factors considered in making de-
terminations for reductions in charges, includ-
ing any formula for such determination and the 
contact information for the specific department 
of a hospital that responds to such inquiries; 
‘‘(2) provide for notice to individuals seeking or 
requiring such services of the availability of informa-
tion on charges described in paragraph (1); 
‘‘(3) provide for timely access to such informa-
tion, including at least through an Internet website, 
by individuals seeking or requiring such services; 
and 
‘‘(4) provide for timely access to information re-
garding the quality of care at each hospital made 
publicly available in accordance with section 501 of 
the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (Public Law 108–173), 
section 1139A, or section 1139B. 
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The Secretary shall consult with stakeholders (including 
those entities in section 1808(d)(6) and the National Gov-
ernors Association) through a formal process to obtain 
guidance prior to issuing implementing policies under this 
section. 
‘‘(b) HOSPITAL DEFINED.—For purposes of this sec-
tion, the term ‘hospital’ means an institution that meets 
the requirements of paragraphs (1) and (7) of section 
1861(e) and includes those to which section 1820(c) ap-
plies.’’. 
(b) EFFECTIVE DATE; ADMINISTRATION.— 
(1) IN GENERAL.—Except as provided in para-
graphs (2)(B) and section 1790, the amendments 
made by subsection (a) shall take effect on October 
1, 2010. 
(2) EXISTING PROGRAMS.— 
(A) 
IN
GENERAL.—The 
Secretary 
of 
Health and Human Services shall establish a 
process by which a State with an existing pro-
gram may certify to the Secretary that its pro-
gram satisfies the requirements of section 
1921A of the Social Security Act, as inserted 
by subsection (a). 
(B) 2-YEAR PERIOD TO BECOME IN COM-
PLIANCE.—States that, as of the date of the en-
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actment of this Act, administer hospital price 
transparency policies that do not meet such re-
quirements shall have 2 years from such date to 
make necessary modifications to come into com-
pliance and shall not be regarded as failing to 
comply with such requirements during such 2- 
year period. 
SEC. 1784. MEDICAID AND CHIP PAYMENT AND ACCESS 
COMMISSION. 
(a) REPORT ON NURSING FACILITY PAYMENT POLI-
CIES.—Section 1900(b) of the Social Security Act (42 
U.S.C. 1396(b)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(10) REPORTS ON SPECIAL TOPICS ON PAY-
MENT POLICIES.— 
‘‘(A) NURSING FACILITY PAYMENT POLI-
CIES.—Not later than January 1, 2012, the 
Commission shall submit to Congress a report 
on nursing facility payment policies under Med-
icaid that includes— 
‘‘(i) information on the difference be-
tween the amount paid by each State to 
nursing facilities in such State under the 
Medicaid program under this title and the 
cost to such facilities of providing efficient 
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quality care to Medicaid eligible individ-
uals; 
‘‘(ii) an evaluation of patient out-
comes and quality as a result of the sup-
plemental payments under section 1745(b) 
of the Affordable Health Care for America 
Act; and 
‘‘(iii) whether adjustments should be 
made under the Medicaid program to the 
rates that States pay skilled nursing facili-
ties to ensure that such rates are sufficient 
to provide efficient quality care to Med-
icaid eligible individuals.’’. 
(b) PEDIATRIC
SUBSPECIALIST
PAYMENT
POLI-
CIES.—Section 1900(b)(10) of the Social Security Act, as 
added by subsection (a) is amended by adding at the end 
the following new subparagraph: 
‘‘(B) PEDIATRIC SUBSPECIALIST PAYMENT 
POLICIES.—Not later than January 1, 2011, 
the Commission shall submit to Congress a re-
port on payment policies for pediatric sub-
specialist services under Medicaid that in-
cludes— 
‘‘(i) a comprehensive review of each 
State’s Medicaid payment rates for inpa-
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tient and outpatient pediatric speciality 
services; 
‘‘(ii) a comparison, on a State-by- 
State basis, of the rates under clause (i) to 
Medicare payments for similar services; 
‘‘(iii) information on any limitations 
in patient access to pediatric speciality 
care, such as delays in receiving care or 
wait times for receiving care; 
‘‘(iv) an analysis of the extent to 
which low Medicaid payment rates in any 
State contributes to limits in access to pe-
diatric subspecialty services in such State; 
and 
‘‘(v) recommendations to ameliorate 
any problems found with such payment 
rates or with access to such services.’’. 
(c) ADDITIONAL AMENDMENTS.— 
(1) COMMISSION STATUS.—Section 1900(a) of 
the Social Security Act is amended by inserting ‘‘as 
an agency of Congress’’ after ‘‘established’’. 
(2) 
EXPANSION
OF
SCOPE.—Section 
1900(b)(1)(A) of the Social Security Act is amended 
by striking ‘‘children’s access’’ and inserting ‘‘access 
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by low-income children and other eligible individ-
uals’’. 
(3) CHANGE IN REPORT DEADLINES.—Subpara-
graphs (C) and (D) of section 1900(b)(1) of such 
Act are amended by striking ‘‘2010’’ and inserting 
‘‘2011’’ each place it appears. 
(4) REPORT
IN
HEALTH
REFORM.—Section 
1900(b)(2) of such Act is amended— 
(A) in subparagraph (A)(i), by striking 
‘‘skilled’’; 
(B) by striking subparagraph (B); 
(C) by redesignating subparagraph (C) as 
subparagraph (B); and 
(D) by adding at the end the following new 
subparagraph: 
‘‘(C) IMPLEMENTATION
OF
HEALTH
RE-
FORM.—The implementation of the provisions 
of the Affordable Health Care for America Act 
that relate to Medicaid or CHIP by the Sec-
retary, the Health Choices Commissioner, and 
the States, including the effect of such imple-
mentation on the access to needed health care 
items and services by low-income individuals 
and families.’’. 
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(5) CLARIFICATION OF MEMBERSHIP.—Section 
1900(c)(2)(B) of such Act is amended by striking 
‘‘consumers’’ and inserting ‘‘individuals’’. 
(6) AUTHORIZATION OF APPROPRIATIONS.— 
(A) CURRENT
AUTHORIZATION.—Section 
1900(f)(2) of such Act is amended— 
(i) in the heading, by inserting ‘‘OF 
APPROPRIATIONS
PRIOR
TO
2010’’ after 
‘‘AUTHORIZATION’’; and 
(ii) by striking ‘‘There are’’ and in-
serting ‘‘Prior to January 1, 2010, there 
are’’ 
(B) FUTURE
AUTHORIZATION.—Section 
1900(f) of such Act is further amended by add-
ing at the end the following new paragraph: 
after the period the following: 
‘‘(3) AUTHORIZATION OF APPROPRIATIONS FOR 
2010.—Beginning on January 1, 2010, there is au-
thorized to be appropriated $11,800,000 to carry 
out the provisions of this section. Such funds shall 
remain available until expended.’’. 
SEC. 1785. OUTREACH AND ENROLLMENT OF MEDICAID 
AND CHIP ELIGIBLE INDIVIDUALS. 
(a) IN GENERAL.—Not later than 12 months after 
date of enactment of this Act, the Secretary of Health and 
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Human Services shall issue guidance regarding standards 
and best practices for conducting outreach to inform eligi-
ble individuals about healthcare coverage under Medicaid 
under title XIX of the Social Security Act or for child 
health assistance under CHIP under title XXI of such 
Act, providing assistance to such individuals for enroll-
ment in applicable programs, and establishing methods or 
procedures for eliminating application and enrollment bar-
riers. Such guidance shall include provisions to ensure 
that outreach, enrollment assistance, and administrative 
simplification efforts are targeted specifically to vulnerable 
populations such as children, unaccompanied homeless 
youth, victims of abuse or trauma, individuals with mental 
health or substance related disorders, and individuals with 
HIV/AIDS. Guidance issued pursuant to this section re-
lating to methods to increase outreach and enrollment pro-
vided for under titles XIX and XXI of the Social Security 
Act shall specifically target such vulnerable and under-
served populations and shall include, but not be limited 
to, guidance on outstationing of eligibility workers, express 
lane eligibility, residence requirements, documentation of 
income and assets, presumptive eligibility, continuous eli-
gibility, and automatic renewal. 
(b) IMPLEMENTATION.—In implementing the re-
quirements under subsection (a), the Secretary may use 
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such authorities as are available under law and may work 
with such entities as the Secretary deems appropriate to 
facilitate effective implementation of such programs. Not 
later than 2 years after the enactment of this Act and 
annually thereafter, the Secretary shall review and report 
to Congress on progress in implementing targeted out-
reach, application and enrollment assistance, and adminis-
trative simplification methods for such vulnerable and un-
derserved populations as are specified in subsection (a). 
SEC. 1786. PROHIBITIONS ON FEDERAL MEDICAID AND 
CHIP 
PAYMENT 
FOR 
UNDOCUMENTED 
ALIENS. 
Nothing in this title shall change current prohibitions 
against Federal Medicaid and CHIP payments under titles 
XIX and XXI of the Social Security Act on behalf of indi-
viduals who are not lawfully present in the United States. 
SEC. 1787. DEMONSTRATION PROJECT FOR STABILIZATION 
OF EMERGENCY MEDICAL CONDITIONS BY 
INSTITUTIONS FOR MENTAL DISEASES. 
(a) AUTHORITY
TO
CONDUCT
DEMONSTRATION 
PROJECT.—The Secretary of Health and Human Services 
(in this section referred to as the ‘‘Secretary’’) shall estab-
lish a demonstration project under which an eligible State 
(as described in subsection (c)) shall provide reimburse-
ment under the State Medicaid plan under title XIX of 
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the Social Security Act to an institution for mental dis-
eases that is subject to the requirements of section 1867 
of the Social Security Act (42 U.S.C. 1395dd) for the pro-
vision of medical assistance available under such plan to 
an individual who— 
(1) has attained age 21, but has not attained 
age 65; 
(2) is eligible for medical assistance under such 
plan; and 
(3) requires such medical assistance to stabilize 
an emergency medical condition. 
(b) IN-STAY REVIEW.—The Secretary shall establish 
a mechanism for in-stay review to determine whether or 
not the patient has been stabilized (as defined in sub-
section (h)(5)). This mechanism shall commence before 
the third day of the inpatient stay. States participating 
in the demonstration project may manage the provision 
of these benefits under the project through utilization re-
view, authorization, or management practices, or the ap-
plication of medical necessity and appropriateness criteria 
applicable to behavioral health. 
(c) ELIGIBLE STATE DEFINED.— 
(1) APPLICATION.—Upon approval of an appli-
cation submitted by a State described in paragraph 
(2), the State shall be an eligible State for purposes 
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of conducting a demonstration project under this 
section. 
(2) STATE
DESCRIBED.—States shall be se-
lected by the Secretary in a manner so as to provide 
geographic diversity on the basis of the application 
to conduct a demonstration project under this sec-
tion submitted by such States. 
(d) LENGTH OF DEMONSTRATION PROJECT.—The 
demonstration project established under this section shall 
be conducted for a period of 3 consecutive years. 
(e) LIMITATIONS ON FEDERAL FUNDING.— 
(1) APPROPRIATION.— 
(A) IN GENERAL.—Out of any funds in the 
Treasury not otherwise appropriated, there is 
appropriated 
to 
carry 
out 
this 
section, 
$75,000,000 for fiscal year 2010. 
(B) BUDGET AUTHORITY.—Subparagraph 
(A) constitutes budget authority in advance of 
appropriations Act and represents the obliga-
tion of the Federal Government to provide for 
the payment of the amounts appropriated under 
that subparagraph. 
(2) 
3-YEAR
AVAILABILITY.—Funds 
appro-
priated under paragraph (1) shall remain available 
for obligation through December 31, 2012. 
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(3) LIMITATION
ON
PAYMENTS.—In no case 
may— 
(A) the aggregate amount of payments 
made by the Secretary to eligible States under 
this section exceed $75,000,000; or 
(B) payments be provided by the Secretary 
under this section after December 31, 2012. 
(4) FUNDS ALLOCATED TO STATES.—The Sec-
retary shall allocate funds to eligible States based on 
their applications and the availability of funds. 
(5) PAYMENTS
TO
STATES.—The Secretary 
shall pay to each eligible State, from its allocation 
under paragraph (4), an amount each quarter equal 
to the Federal medical assistance percentage of ex-
penditures in the quarter for medical assistance de-
scribed in subsection (a). 
(f) REPORTS.— 
(1) ANNUAL
PROGRESS
REPORTS.—The Sec-
retary shall submit annual reports to Congress on 
the progress of the demonstration project conducted 
under this section. 
(2) FINAL REPORT AND RECOMMENDATION.— 
An evaluation shall be conducted of the demonstra-
tion project’s impact on the functioning of the health 
and mental health service system and on individuals 
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enrolled in the Medicaid program. This evaluation 
shall include collection of baseline data for one-year 
prior to the initiation of the demonstration project 
as well as collection of data from matched compari-
son states not participating in the demonstration. 
The evaluation measures shall include the following: 
(A) A determination, by State, as to 
whether the demonstration project resulted in 
increased access to inpatient mental health 
services under the Medicaid program and 
whether average length of stays were longer (or 
shorter) for individuals admitted under the 
demonstration project compared with individ-
uals otherwise admitted in comparison sites. 
(B) An analysis, by State, regarding 
whether the demonstration project produced a 
significant reduction in emergency room visits 
for individuals eligible for assistance under the 
Medicaid program or in the duration of emer-
gency room lengths of stay. 
(C) An assessment of discharge planning 
by participating hospitals that ensures access to 
further (non-emergency) inpatient or residential 
care as well as continuity of care for those dis-
charged to outpatient care. 
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(D) An assessment of the impact of the 
demonstration project on the costs of the full 
range of mental health services (including inpa-
tient, emergency and ambulatory care) under 
the plan as contrasted with the comparison 
areas. 
(E) Data on the percentage of consumers 
with Medicaid coverage who are admitted to in-
patient facilities as a result of the demonstra-
tion project as compared to those admitted to 
these same facilities through other means. 
(F) A recommendation regarding whether 
the demonstration project should be continued 
after December 31, 2012, and expanded on a 
national basis. 
(g) WAIVER AUTHORITY.— 
(1) IN GENERAL.—The Secretary shall waive 
the limitation of subdivision (B) following paragraph 
(28) of section 1905(a) of the Social Security Act 
(42 U.S.C. 1396d(a)) (relating to limitations on pay-
ments for care or services for individuals under 65 
years of age who are patients in an institution for 
mental diseases) for purposes of carrying out the 
demonstration project under this section. 
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(2) LIMITED OTHER WAIVER AUTHORITY.—The 
Secretary may waive other requirements of title XIX 
of the Social Security Act (including the require-
ments 
of 
sections 
1902(a)(1) 
(relating 
to 
statewideness) and 1902(1)(10)(B) (relating to com-
parability)) only to extent necessary to carry out the 
demonstration project under this section. 
(h) DEFINITIONS.—In this section: 
(1) EMERGENCY
MEDICAL
CONDITION.—The 
term ‘‘emergency medical condition’’ means, with re-
spect to an individual, an individual who expresses 
suicidal or homicidal thoughts or gestures, if deter-
mined dangerous to self or others. 
(2) FEDERAL MEDICAL ASSISTANCE PERCENT-
AGE.—The term ‘‘Federal medical assistance per-
centage’’ has the meaning given that term with re-
spect to a State under section 1905(b) of the Social 
Security Act (42 U.S.C. 1396d(b)). 
(3) INSTITUTION FOR MENTAL DISEASES.—The 
term ‘‘institution for mental diseases’’ has the mean-
ing given to that term in section 1905(i) of the So-
cial Security Act (42 U.S.C. 1396d(i)). 
(4) MEDICAL ASSISTANCE.—The term ‘‘medical 
assistance’’ has the meaning given to that term in 
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section 1905(a) of the Social Security Act (42 
U.S.C. 1396d(a)). 
(5) 
STABILIZED.—The 
term 
‘‘stabilized’’ 
means, with respect to an individual, that the emer-
gency medical condition no longer exists with respect 
to the individual and the individual is no longer dan-
gerous to self or others. 
(6) STATE.—The term ‘‘State’’ has the mean-
ing given that term for purposes of title XIX of the 
Social Security Act (42 U.S.C. 1396 et seq.). 
SEC. 1788. APPLICATION OF MEDICAID IMPROVEMENT 
FUND. 
Section 1941(b)(1) of the Social Security Act (42 
U.S.C. 1396w–1(b)(1)) is amended by striking ‘‘from the 
Fund’’ and all that follows and inserting ‘‘from the Fund, 
only such amounts as may be appropriated or otherwise 
made available by law.’’. 
SEC. 1789. TREATMENT OF CERTAIN MEDICAID BROKERS. 
Section 1903(b)(4) of the Social Security Act (42 
U.S.C. 1396b(b)(4)) is amended— 
(1) in the matter before subparagraph (A), by 
inserting after ‘‘respect to the broker’’ the following: 
‘‘(or, in the case of subparagraph (A) and subpara-
graph (B)(i), if the Inspector General of Department 
of Health and Human Services finds that the broker 
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has established and maintains procedures to ensure 
the independence of its enrollment activities from 
the interests of any managed care entity or pro-
vider)’’; and 
(2) in subparagraph (B)— 
(A) by inserting ‘‘(i)’’ after ‘‘either’’; and 
(B) by inserting ‘‘(ii)’’ after ‘‘health care 
provider or’’. 
SEC. 1790. RULE FOR CHANGES REQUIRING STATE LEGIS-
LATION. 
In the case of a State plan for medical assistance 
under title XIX of the Social Security Act which the Sec-
retary of Health and Human Services determines requires 
State legislation (other than legislation appropriating 
funds) in order for the plan to meet an additional require-
ment imposed by an amendment made by this title, the 
State plan shall not be regarded as failing to comply with 
the requirements of such title XIX solely on the basis of 
its failure to meet this additional requirement before the 
first day of the first calendar quarter beginning after the 
close of the first regular session of the State legislature 
that begins after the date of the enactment of this Act. 
For purposes of the previous sentence, in the case of a 
State that has a 2-year legislative session, each year of 
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such session shall be deemed to be a separate regular ses-
sion of the State legislature. 
TITLE VIII—REVENUE-RELATED 
PROVISIONS 
SEC. 1801. DISCLOSURES TO FACILITATE IDENTIFICATION 
OF INDIVIDUALS LIKELY TO BE INELIGIBLE 
FOR THE LOW-INCOME ASSISTANCE UNDER 
THE MEDICARE PRESCRIPTION DRUG PRO-
GRAM TO ASSIST SOCIAL SECURITY ADMINIS-
TRATION’S OUTREACH TO ELIGIBLE INDIVID-
UALS. 
(a) IN GENERAL.—Paragraph (19) of section 6103(l) 
of the Internal Revenue Code of 1986 is amended to read 
as follows: 
‘‘(19) DISCLOSURES
TO
FACILITATE
IDENTI-
FICATION
OF
INDIVIDUALS
LIKELY
TO
BE
INELI-
GIBLE FOR LOW-INCOME SUBSIDIES UNDER MEDI-
CARE PRESCRIPTION DRUG PROGRAM TO ASSIST SO-
CIAL
SECURITY
ADMINISTRATION’S
OUTREACH
TO 
ELIGIBLE INDIVIDUALS.— 
‘‘(A) IN GENERAL.—Upon written request 
from the Commissioner of Social Security, the 
following return information (including such in-
formation disclosed to the Social Security Ad-
ministration under paragraph (1) or (5)) shall 
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‘‘(4) the characteristics of the recipients of serv-
ices provided through the program, including the 
number of the recipients, the demographic charac-
teristics of the recipients, and family retention; 
‘‘(5) the annual cost of implementing the pro-
gram, including the cost per family served under the 
program; 
‘‘(6) the outcomes experienced by recipients of 
services through the program; 
‘‘(7) the training and technical assistance pro-
vided to aid implementation of the program, and 
how the training and technical assistance contrib-
uted to the outcomes achieved through the program; 
‘‘(8) the indicators and methods used to mon-
itor whether the program is being implemented as 
designed; and 
‘‘(9) other information as determined necessary 
by the Secretary. 
‘‘(j) EVALUATION.— 
‘‘(1) IN
GENERAL.—The Secretary shall, by 
grant or contract, provide for the conduct of an 
independent evaluation of the effectiveness of home 
visitation programs receiving funds provided under 
this section, which shall examine the following: 
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