In the Senate of the United States, 
January 29, 2009. 
Resolved, That the bill from the House of Representa-
tives (H.R. 2) entitled ‘‘An Act to amend title XXI of the So-
cial Security Act to extend and improve the Children’s Health 
Insurance Program, and for other purposes.’’, do pass with 
the following 
AMENDMENT: 
Strike all after the enacting clause and insert the 
following: 
SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECU-
RITY ACT; REFERENCES; TABLE OF CON-
TENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Children’s Health Insurance Program Reauthorization 
Act of 2009’’. 
(b) AMENDMENTS TO SOCIAL SECURITY ACT.—Except 
as otherwise specifically provided, whenever in this Act an 
amendment is expressed in terms of an amendment to or
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repeal of a section or other provision, the reference shall 
be considered to be made to that section or other provision 
of the Social Security Act. 
(c) REFERENCES TO CHIP; MEDICAID; SECRETARY.— 
In this Act: 
(1) CHIP.—The term ‘‘CHIP’’ means the State 
Children’s Health Insurance Program established 
under title XXI of the Social Security Act (42 U.S.C. 
1397aa et seq.). 
(2) MEDICAID.—The term ‘‘Medicaid’’ means the 
program for medical assistance established under title 
XIX of the Social Security Act (42 U.S.C. 1396 et 
seq.). 
(3) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(d) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; amendments to Social Security Act; references; table of con-
tents. 
Sec. 2. Purpose. 
Sec. 3. General effective date; exception for State legislation; contingent effective 
date; reliance on law. 
TITLE I—FINANCING 
Subtitle A—Funding 
Sec. 101. Extension of CHIP. 
Sec. 102. Allotments for States and territories for fiscal years 2009 through 2013. 
Sec. 103. Child Enrollment Contingency Fund. 
Sec. 104. CHIP performance bonus payment to offset additional enrollment costs 
resulting from enrollment and retention efforts. 
Sec. 105. Two-year initial availability of CHIP allotments. 
Sec. 106. Redistribution of unused allotments. 
Sec. 107. Option for qualifying States to receive the enhanced portion of the 
CHIP matching rate for Medicaid coverage of certain children.
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Sec. 108. One-time appropriation. 
Sec. 109. Improving funding for the territories under CHIP and Medicaid. 
Subtitle B—Focus on Low-Income Children and Pregnant Women 
Sec. 111. State option to cover low-income pregnant women under CHIP through 
a State plan amendment. 
Sec. 112. Phase-out of coverage for nonpregnant childless adults under CHIP; 
conditions for coverage of parents. 
Sec. 113. Elimination of counting Medicaid child presumptive eligibility costs 
against title XXI allotment. 
Sec. 114. Limitation on matching rate for States that propose to cover children 
with effective family income that exceeds 300 percent of the pov-
erty line. 
Sec. 115. State authority under Medicaid. 
TITLE II—OUTREACH AND ENROLLMENT 
Subtitle A—Outreach and Enrollment Activities 
Sec. 201. Grants and enhanced administrative funding for outreach and enroll-
ment. 
Sec. 202. Increased outreach and enrollment of Indians. 
Sec. 203. State option to rely on findings from an Express Lane agency to con-
duct simplified eligibility determinations. 
Subtitle B—Reducing Barriers to Enrollment 
Sec. 211. Verification of declaration of citizenship or nationality for purposes of 
eligibility for Medicaid and CHIP. 
Sec. 212. Reducing administrative barriers to enrollment. 
Sec. 213. Model of Interstate coordinated enrollment and coverage process. 
Sec. 214. Permitting States to ensure coverage without a 5-year delay of certain 
children and pregnant women under the Medicaid program and 
CHIP. 
TITLE III—REDUCING BARRIERS TO PROVIDING PREMIUM 
ASSISTANCE 
Subtitle A—Additional State Option for Providing Premium Assistance 
Sec. 301. Additional State option for providing premium assistance. 
Sec. 302. Outreach, education, and enrollment assistance. 
Subtitle B—Coordinating Premium Assistance With Private Coverage 
Sec. 311. Special enrollment period under group health plans in case of termi-
nation of Medicaid or CHIP coverage or eligibility for assistance 
in purchase of employment-based coverage; coordination of cov-
erage. 
TITLE IV—STRENGTHENING QUALITY OF CARE AND HEALTH 
OUTCOMES 
Sec. 401. Child health quality improvement activities for children enrolled in 
Medicaid or CHIP. 
Sec. 402. Improved availability of public information regarding enrollment of 
children in CHIP and Medicaid.
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Sec. 403. Application of certain managed care quality safeguards to CHIP. 
TITLE V—IMPROVING ACCESS TO BENEFITS 
Sec. 501. Dental benefits. 
Sec. 502. Mental health parity in CHIP plans. 
Sec. 503. Application of prospective payment system for services provided by Fed-
erally-qualified health centers and rural health clinics. 
Sec. 504. Premium grace period. 
Sec. 505. Clarification of coverage of services provided through school-based health 
centers. 
Sec. 506. Medicaid and CHIP Payment and Access Commission. 
TITLE VI—PROGRAM INTEGRITY AND OTHER MISCELLANEOUS 
PROVISIONS 
Subtitle A—Program Integrity and Data Collection 
Sec. 601. Payment error rate measurement (‘‘PERM’’). 
Sec. 602. Improving data collection. 
Sec. 603. Updated Federal evaluation of CHIP. 
Sec. 604. Access to records for IG and GAO audits and evaluations. 
Sec. 605. No Federal funding for illegal aliens; disallowance for unauthorized ex-
penditures. 
Subtitle B—Miscellaneous Health Provisions 
Sec. 611. Deficit Reduction Act technical corrections. 
Sec. 612. References to title XXI. 
Sec. 613. Prohibiting initiation of new health opportunity account demonstration 
programs. 
Sec. 614. Adjustment in computation of Medicaid FMAP to disregard an extraor-
dinary employer pension contribution. 
Sec. 615. Clarification treatment of regional medical center. 
Sec. 616. Extension of Medicaid DSH allotments for Tennessee and Hawaii. 
Sec. 617. GAO report on Medicaid managed care payment rates. 
Subtitle C—Other Provisions 
Sec. 621. Outreach regarding health insurance options available to children. 
Sec. 622. Sense of the Senate regarding access to affordable and meaningful 
health insurance coverage. 
TITLE VII—REVENUE PROVISIONS 
Sec. 701. Increase in excise tax rate on tobacco products. 
Sec. 702. Administrative improvements. 
Sec. 703. Treasury study concerning magnitude of tobacco smuggling in the 
United States. 
Sec. 704. Time for payment of corporate estimated taxes. 
SEC. 2. PURPOSE. 
It is the purpose of this Act to provide dependable and 
stable funding for children’s health insurance under titles
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XXI and XIX of the Social Security Act in order to enroll 
all six million uninsured children who are eligible, but not 
enrolled, for coverage today through such titles. 
SEC. 3. GENERAL EFFECTIVE DATE; EXCEPTION FOR STATE 
LEGISLATION; 
CONTINGENT 
EFFECTIVE 
DATE; RELIANCE ON LAW. 
(a) GENERAL EFFECTIVE DATE.—Unless otherwise 
provided in this Act, subject to subsections (b) through (d), 
this Act (and the amendments made by this Act) shall take 
effect on April 1, 2009, and shall apply to child health as-
sistance and medical assistance provided on or after that 
date. 
(b) EXCEPTION FOR STATE LEGISLATION.—In the case 
of a State plan under title XIX or State child health plan 
under XXI of the Social Security Act, which the Secretary 
of Health and Human Services determines requires State 
legislation in order for the respective plan to meet one or 
more additional requirements imposed by amendments 
made by this Act, the respective plan shall not be regarded 
as failing to comply with the requirements of such title sole-
ly on the basis of its failure to meet such an 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 enactment of 
this Act. For purposes of the previous sentence, in the case