H. R. 2015—300
with respect to any additional information which is needed
in order to make a final determination with respect to the
application. After the date the Secretary receives such addi-
tional information, the application shall be deemed approved
unless the Secretary, within 90 days of such date, denies such
request.
(c) PRIORITY AND SPECIAL CONSIDERATION IN APPLICATION.—
During the 3-year period beginning on the date of the enactment
of this Act:
(1) PROVIDER STATUS.—The Secretary of Health and Human
Services shall give priority in processing applications of entities
to qualify as PACE programs under section 1894 or 1934 of
the Social Security Act—
(A) first, to entities that are operating a PACE dem-
onstration 
waiver 
program 
(as 
defined 
in 
sections
1894(a)(7) and 1934(a)(7) of such Act); and
(B) then to entities that have applied to operate such
a program as of May 1, 1997.
(2) NEW WAIVERS.—The Secretary shall give priority, in
the awarding of additional waivers under section 9412(b) of
the Omnibus Budget Reconciliation Act of 1986—
(A) to any entities that have applied for such waivers
under such section as of May 1, 1997; and
(B) to any entity that, as of May 1, 1997, has formally
contracted with a State to provide services for which pay-
ment is made on a capitated basis with an understanding
that the entity was seeking to become a PACE provider.
(3) SPECIAL CONSIDERATION.—The Secretary shall give spe-
cial consideration, in the processing of applications described
in paragraph (1) and the awarding of waivers described in
paragraph (2), to an entity which as of May 1, 1997, through
formal activities (such as entering into contracts for feasibility
studies) has indicated a specific intent to become a PACE
provider.
(d) REPEAL
OF
CURRENT
PACE DEMONSTRATION
PROJECT
WAIVER AUTHORITY.—
(1) IN GENERAL.—Subject to paragraph (2), the following
provisions of law are repealed:
(A) Section 603(c) of the Social Security Amendments
of 1983 (Public Law 98–21).
(B) Section 9220 of the Consolidated Omnibus Budget
Reconciliation Act of 1985 (Public Law 99–272).
(C) Section 9412(b) of the Omnibus Budget Reconcili-
ation Act of 1986 (Public Law 99–509).
(2) DELAY IN APPLICATION TO CURRENT WAIVERS.—
(A) IN GENERAL.—Subject to subparagraph (B), in the
case of waivers granted with respect to a PACE program
before the initial effective date of regulations described
in subsection (a), the repeals made by paragraph (1) shall
not apply until the end of a transition period (of up to
24 months) that begins on the initial effective date of
such regulations, and that allows sufficient time for an
orderly transition from demonstration project authority to
general authority provided under the amendments made
by this subtitle.
H. R. 2015—301
(B) STATE
OPTION
TO
SEEK
EXTENSION
OF
CURRENT
PERIOD.—A State may elect to maintain the PACE pro-
grams which (as of the date of the enactment of this Act)
were operating in the State under the authority described
in paragraph (1) until a date (specified by the State) that
is not later than 3 years after the initial effective date
of regulations described in subsection (a). If a State makes
such an election, the repeals made by paragraph (1) shall
not apply to the programs until the date so specified,
but only so long as such programs continue to operate
under the same terms and conditions as apply to such
programs as of the date of the enactment of this Act,
and subparagraph (A) shall not apply to such programs.
SEC. 4804. STUDY AND REPORTS.
(a) STUDY.—
(1) IN
GENERAL.—The Secretary of Health and Human
Services (in close consultation with State administering agen-
cies, as defined in sections 1894(a)(8) and 1934(a)(8) of the
Social Security Act) shall conduct a study of the quality and
cost of providing PACE program services under the medicare
and medicaid programs under the amendments made by this
subtitle.
(2) STUDY OF PRIVATE, FOR-PROFIT PROVIDERS.—Such study
shall specifically compare the costs, quality, and access to serv-
ices by entities that are private, for-profit entities operating
under demonstration projects waivers granted under sections
1894(h) and 1934(h) of the Social Security Act with the costs,
quality, and access to services of other PACE providers.
(b) REPORT.—
(1) IN GENERAL.—Not later than 4 years after the date
of the enactment of this Act, the Secretary shall provide for
a report to Congress on the impact of such amendments on
quality and cost of services. The Secretary shall include in
such report such recommendations for changes in the operation
of such amendments as the Secretary deems appropriate.
(2) TREATMENT OF PRIVATE, FOR-PROFIT PROVIDERS.—The
report shall include specific findings on whether any of the
following findings is true:
(A) The number of covered lives enrolled with entities
operating under demonstration project waivers under sec-
tions 1894(h) and 1934(h) of the Social Security Act is
fewer than 800 (or such lesser number as the Secretary
may find statistically sufficient to make determinations
respecting findings described in the succeeding subpara-
graphs).
(B) The population enrolled with such entities is less
frail than the population enrolled with other PACE provid-
ers.
(C) Access to or quality of care for individuals enrolled
with such entities is lower than such access or quality
for individuals enrolled with other PACE providers.
(D) The application of such section has resulted in
an increase in expenditures under the medicare or medicaid
programs above the expenditures that would have been
made if such section did not apply.
H. R. 2015—302
(c) INFORMATION INCLUDED IN ANNUAL RECOMMENDATIONS.—
The Medicare Payment Advisory Commission shall include in its
annual report under section 1805(b)(1)(B) of the Social Security
Act recommendations on the methodology and level of payments
made to PACE providers under sections 1894(d) and 1934(d) of
such Act and on the treatment of private, for-profit entities as
PACE providers.
Subtitle J—State Children’s Health
Insurance Program
CHAPTER 1—STATE CHILDREN’S HEALTH INSURANCE
PROGRAM
SEC. 4901. ESTABLISHMENT OF PROGRAM.
(a) ESTABLISHMENT.—The Social Security Act is amended by
adding at the end the following new title:
‘‘TITLE XXI—STATE CHILDREN’S HEALTH INSURANCE
PROGRAM
‘‘SEC. 2101. PURPOSE; STATE CHILD HEALTH PLANS.
‘‘(a) PURPOSE.—The purpose of this title is to provide funds
to States to enable them to initiate and expand the provision
of child health assistance to uninsured, low-income children in
an effective and efficient manner that is coordinated with other
sources of health benefits coverage for children. Such assistance
shall be provided primarily for obtaining health benefits coverage
through—
‘‘(1) obtaining coverage that meets the requirements of
section 2103, or
‘‘(2) providing benefits under the State’s medicaid plan
under title XIX,
or a combination of both.
‘‘(b) STATE CHILD HEALTH PLAN REQUIRED.—A State is not
eligible for payment under section 2105 unless the State has submit-
ted to the Secretary under section 2106 a plan that—
‘‘(1) sets forth how the State intends to use the funds
provided under this title to provide child health assistance
to needy children consistent with the provisions of this title,
and
‘‘(2) has been approved under section 2106.
‘‘(c) STATE ENTITLEMENT.—This title constitutes budget author-
ity in advance of appropriations Acts and represents the obligation
of the Federal Government to provide for the payment to States
of amounts provided under section 2104.
‘‘(d) EFFECTIVE DATE.—No State is eligible for payments under
section 2105 for child health assistance for coverage provided for
periods beginning before October 1, 1997.
‘‘SEC. 2102. GENERAL CONTENTS OF STATE CHILD HEALTH PLAN;
ELIGIBILITY; OUTREACH.
‘‘(a) GENERAL BACKGROUND AND DESCRIPTION.—A State child
health plan shall include a description, consistent with the require-
ments of this title, of—
H. R. 2015—303
‘‘(1) the extent to which, and manner in which, children
in the State, including targeted low-income children and other
classes of children classified by income and other relevant fac-
tors, currently have creditable health coverage (as defined in
section 2110(c)(2));
‘‘(2) current State efforts to provide or obtain creditable
health coverage for uncovered children, including the steps
the State is taking to identify and enroll all uncovered children
who are eligible to participate in public health insurance pro-
grams and health insurance programs that involve public-pri-
vate partnerships;
‘‘(3) how the plan is designed to be coordinated with such
efforts to increase coverage of children under creditable health
coverage;
‘‘(4) the child health assistance provided under the plan
for targeted low-income children, including the proposed meth-
ods of delivery, and utilization control systems;
‘‘(5) eligibility standards consistent with subsection (b);
‘‘(6) outreach activities consistent with subsection (c); and
‘‘(7) methods (including monitoring) used—
‘‘(A) to assure the quality and appropriateness of care,
particularly with respect to well-baby care, well-child care,
and immunizations provided under the plan, and
‘‘(B) to assure access to covered services, including
emergency services.
‘‘(b) GENERAL DESCRIPTION
OF ELIGIBILITY STANDARDS
AND
METHODOLOGY.—
‘‘(1) ELIGIBILITY STANDARDS.—
‘‘(A) IN GENERAL.—The plan shall include a description
of the standards used to determine the eligibility of tar-
geted low-income children for child health assistance under
the plan. Such standards may include (to the extent consist-
ent with this title) those relating to the geographic areas
to be served by the plan, age, income and resources (includ-
ing any standards relating to spenddowns and disposition
of resources), residency, disability status (so long as any
standard relating to such status does not restrict eligi-
bility), access to or coverage under other health coverage,
and duration of eligibility. Such standards may not
discriminate on the basis of diagnosis.
‘‘(B) LIMITATIONS
ON
ELIGIBILITY
STANDARDS.—Such
eligibility standards—
‘‘(i) shall, within any defined group of covered tar-
geted low-income children, not cover such children with
higher family income without covering children with
a lower family income, and
‘‘(ii) may not deny eligibility based on a child hav-
ing a preexisting medical condition.
‘‘(2) METHODOLOGY.—The plan shall include a description
of methods of establishing and continuing eligibility and enroll-
ment.
‘‘(3) ELIGIBILITY
SCREENING; COORDINATION
WITH
OTHER
HEALTH
COVERAGE
PROGRAMS.—The plan shall include a
description of procedures to be used to ensure—
‘‘(A) through both intake and followup screening, that
only targeted low-income children are furnished child
health assistance under the State child health plan;