SEC. 102. PERFORMANCE INCENTIVE PROGRAM IMPROVE-
MENTS. 
(a) EXTENSION THROUGH FISCAL YEAR 2019.—Sec-
tion 2105(a)(3) of the Social Security Act (42 U.S.C. 
1397ee(a)(3)) is amended— 
(1) in subparagraph (A), by striking ‘‘2013’’ 
and inserting ‘‘2019’’; 
(2) in subparagraph (E)— 
(A) in clause (ii)— 
(i) in the matter preceding subclause 
(I), by inserting ‘‘after the application of 
section 2104(n)(3)(D)(ii) with respect to 
such amounts,’’ after ‘‘limitation,’’; 
(ii) by striking subclause (I) and in-
serting the following new subclause: 
‘‘(I) 
UNOBLIGATED
NATIONAL 
ALLOTMENT FOR FISCAL YEARS 2009 
THROUGH 2015.—As of December 31 
of fiscal year 2009, and as of Decem-
ber 31 of each succeeding fiscal year 
through fiscal year 2015, the portion, 
if any, of the amount appropriated 
under section 2104(a) for such fiscal 
year that is unobligated for allotment 
to a State under section 2104(m) for 
such fiscal year or set aside under 
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subsection (a)(3) or (b)(2) of section 
2111 for such fiscal year.’’; 
(iii) in subclause (II), by striking 
‘‘2013’’ and inserting ‘‘2015’’; and 
(iv) in subclause (III), by striking 
‘‘2013’’ and inserting ‘‘2015’’; 
(B) by redesignating clause (iii) as clause 
(iv); and 
(C) by inserting after clause (ii), the fol-
lowing new clause: 
‘‘(iii) APPROPRIATION
FOR
FISCAL 
YEARS 2016 THROUGH 2019.—Out of any 
money in the Treasury not otherwise ap-
propriated, 
there 
are 
appropriated 
$500,000,000 for each of fiscal years 2016 
through 2019 for making payments under 
this paragraph. Amounts appropriated for 
a fiscal year under this clause shall remain 
available for making payments under this 
paragraph until January 1 of the following 
fiscal year. Any amounts of such appro-
priations that remain unexpended or unob-
ligated as of such date shall be transferred 
and made available for making payments 
under section 2104(n).’’; and 
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(3) in subparagraph (F)(iii), by striking 
‘‘2013’’ and inserting ‘‘2019’’. 
(b) UPDATED PERFORMANCE INCENTIVE CRITERIA 
FOR FISCAL YEARS 2016 THROUGH 2019.—Section 
2105(a) of the Social Security Act (42 U.S.C. 1397ee(a)) 
is amended— 
(1) in paragraph (3)(A), by inserting ‘‘or (5)’’ 
after ‘‘paragraph (4)’’; 
(2) in paragraph (4)— 
(A) in the heading, by inserting ‘‘FISCAL 
YEARS 2009 THROUGH 2015’’ after ‘‘FOR CHIL-
DREN’’; and 
(B) in the matter preceding subparagraph 
(A), by striking ‘‘for a fiscal year if’’ and in-
serting ‘‘for fiscal years 2009 through 2015 if’’; 
and 
(3) by adding at the end the following new 
paragraph: 
‘‘(5) ENROLLMENT
AND
RETENTION
PROVI-
SIONS FOR CHILDREN FOR FISCAL YEAR 2016 AND 
SUCCEEDING FISCAL YEARS.— 
‘‘(A) IN GENERAL.—For purposes of para-
graph (3)(A), a State meets the condition of 
this paragraph for fiscal year 2016 and any 
succeeding fiscal year if it is implementing at 
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least 5 of the enrollment and retention provi-
sions specified in subparagraph (B) (treating 
each clause as a separate enrollment and reten-
tion provision) throughout the entire fiscal year. 
‘‘(B) ENROLLMENT AND RETENTION PRO-
VISIONS.—The enrollment and retention provi-
sions specified in this subparagraph are the fol-
lowing: 
‘‘(i) CONTINUOUS ELIGIBILITY.—The 
State has elected the option of continuous 
eligibility for a full 12 months for all chil-
dren 
(as 
defined 
in 
section 
1902(e)(13)(G)), as well as applying such 
policy under its State child health plan 
under this title. 
‘‘(ii) EXPRESS
LANE
ELIGIBILITY.— 
The State is implementing the option de-
scribed in section 1902(e)(13) under title 
XIX as well as, pursuant to section 
2107(e)(1), under this title. 
‘‘(iii) PRESUMPTIVE
ELIGIBILITY.— 
The State is implementing section 1920A 
under title XIX as well as, pursuant to 
section 2107(e)(1), under this title. 
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‘‘(iv) PREMIUM ASSISTANCE FOR EM-
PLOYER-SPONSORED PLANS.—The State is 
implementing section 1906A under title 
XIX or the option described in section 
2105(c)(10) under this title. 
‘‘(v) 
SEAMLESS
COVERAGE
OP-
TIONS.—In the case of a State that pro-
vides medical assistance under the State 
plan under title XIX through managed 
care 
entities 
(as 
defined 
in 
section 
1932(a)(1)(B)) or health benefits coverage 
under the State child health plan through 
such entities, the State shall ensure that at 
least one such entity offers a qualified 
health plan through the Exchange estab-
lished under title I of the Patient Protec-
tion and Affordable Care Act in the State. 
‘‘(vi) RETROACTIVE COVERAGE REIN-
STATEMENT UPON PREMIUM PAYMENT.— 
The State child health plan, in the case of 
an individual whose coverage under the 
plan has been terminated for failure to 
make premium payments, provides assist-
ance to such individual for purposes of the 
immediate reenrollment of the individual 
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upon payment of outstanding premiums, 
with coverage retroactive to the beginning 
of the most recent month for which an out-
standing premium has been paid, and shall 
not impose any waiting period or fee as a 
condition of such reenrollment. 
‘‘(vii) EFFECTIVE
TRANSITION
TO 
THE
COMMUNITY
FOR
VULNERABLE 
YOUTH.— 
‘‘(I) IN
GENERAL.—Subject to 
the subdivision (A) following para-
graph (29) of section 1905(a), the 
State, before the date of the release of 
an eligible juvenile from any public in-
stitution, and notwithstanding that 
the juvenile is an inmate of a public 
institution— 
‘‘(aa) screens for eligibility 
for and processes any application 
for medical assistance submitted 
by, or on behalf of, such an eligi-
ble juvenile; and 
‘‘(bb) refers such juvenile to 
health care providers for pur-
poses of receiving the services de-
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scribed in section 1905(a)(4)(B) 
(relating to early and periodic 
screening, diagnostic, and treat-
ment services defined in section 
1905(r)). 
‘‘(II) ELIGIBLE JUVENILE.—For 
purposes of subclause (I), the term 
‘eligible juvenile’ means an individual 
who— 
‘‘(aa) is under 19 years of 
age (or such higher age as the 
State has elected under section 
475(8)(B)(iii)); and 
‘‘(bb) is an inmate of a pub-
lic institution. 
‘‘(III) INMATE OF A PUBLIC IN-
STITUTION.—For purposes of this 
clause, the term ‘inmate of a public 
institution’ has the meaning given 
such term for purposes of applying 
the subdivision (A) following para-
graph (29) of section 1905(a), taking 
into account the exception in such 
subdivision for a patient of a medical 
institution.’’. 
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SEC. 103. CHILD ENROLLMENT CONTINGENCY FUND AD-
JUSTMENT. 
(a) IN GENERAL.—Section 2104(n) of the Social Se-
curity Act (42 U.S.C. 1397dd(n)) is amended— 
(1) in paragraph (2)— 
(A) by striking ‘‘2014’’ and inserting 
‘‘2018’’ each place it appears in subparagraphs 
(A)(ii) and (B); and 
(B) by striking ‘‘2015’’ and inserting 
‘‘2019’’ each place it appears in subparagraphs 
(A)(ii) and (B); 
(2) in paragraph (3)— 
(A) in subparagraph (A)— 
(i) in the heading, by striking ‘‘IN 
GENERAL’’ and inserting ‘‘FISCAL YEARS 
2009 THROUGH 2015’’; 
(ii) in the matter preceding clause 
(i)— 
(I) by striking ‘‘a semi-annual al-
lotment period for’’; and 
(II) by striking ‘‘(determined 
without regard to any redistribution it 
receives under subsection (f) that is 
available for expenditure during such 
fiscal year or period, but including 
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any carryover from a previous fiscal 
year)’’; 
(iii) by striking ‘‘or period’’ each place 
it appears; and 
(iv) in clause (ii), by striking ‘‘(or in 
which the period occurs)’’; 
(B) in subparagraph (B)(ii), by striking 
‘‘(or semi-annual period occurring in a fiscal 
year)’’; 
(C) in subparagraph (C)(ii), by striking 
‘‘(or semi-annual period occurring in a fiscal 
year)’’; 
(D) by redesignating subparagraphs (D), 
(E), (F), and (G) as subparagraphs (E), (F), 
(G), and (H), respectively; 
(E) by inserting after subparagraph (C) 
the following new subparagraph: 
‘‘(D) FISCAL YEARS 2016 THROUGH 2019.— 
‘‘(i) IN GENERAL.—For each of fiscal 
years 2016 through 2018 and each semi- 
annual allotment period for fiscal year 
2019, if the Secretary determines that a 
State is a shortfall State described in sub-
paragraph (I) for that fiscal year or pe-
riod, the Secretary shall pay the State 
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from the Fund, in addition to any other 
payments made to a State under this title 
for the fiscal year or period, an amount 
equal to the amount of projected expendi-
tures for the State under this title for the 
fiscal year or period that exceeds the sum 
determined under subparagraph (I) for the 
State and fiscal year or period. 
‘‘(ii) 
TRANSFERS.—Notwithstanding 
any other provision of this title, the fol-
lowing amounts shall also be available, 
without fiscal year limitation, for making 
payments from the Fund: 
‘‘(I) 
UNOBLIGATED
NATIONAL 
ALLOTMENT FOR FISCAL YEARS BE-
GINNING WITH FISCAL YEAR 2016.— 
As of December 31 of fiscal year 
2016, and as of December 31 of each 
succeeding fiscal year, the portion, if 
any, of the amount appropriated 
under subsection (a) for such fiscal 
year that is unobligated for allotment 
to a State under subsection (m) for 
such fiscal year. 
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‘‘(II) 
UNEXPENDED
ALLOT-
MENTS NOT USED FOR REDISTRIBU-
TION.—As of November 15 of fiscal 
year 2016 and each succeeding fiscal 
year, the total amount of allotments 
made to States under subsection (a) 
for the second preceding fiscal year 
that is not expended or redistributed 
under subsection (f) during the period 
in which such allotments are available 
for obligation. 
‘‘(III) UNEXPENDED
PERFORM-
ANCE INCENTIVE FUNDS.—As of Sep-
tember 1, 2017, and as of September 
1 of each succeeding calendar year, 
the portion, if any, of the amount ap-
propriated 
under 
subparagraph 
(E)(iii) of section 2105(a)(3) for the 
preceding fiscal year that is not ex-
pended or obligated under such sec-
tion. 
‘‘(iii) INVESTMENT
OF
FUND.—The 
Secretary of the Treasury shall invest, in 
interest bearing securities of the United 
States, such currently available portions of 
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the Fund as are not immediately required 
for payments from the Fund. The income 
derived from these investments constitutes 
a part of the Fund.’’; 
(F) in subparagraph (E) (as so redesig-
nated), by inserting ‘‘or (D)’’ after ‘‘subpara-
graph (A)’’; and 
(G) in subparagraph (H) (as so redesig-
nated), by inserting ‘‘and regarding the expend-
itures under the State child health plan’’ after 
‘‘subparagraphs (A) and (B)’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(I) SHORTFALL
STATES
DESCRIBED.— 
For purposes of subparagraph (D), with respect 
to a fiscal year or semi-annual allotment period, 
a shortfall State is a State for which the Sec-
retary estimates, on the basis of the most re-
cent data available to the Secretary, that the 
projected expenditures for the State for the fis-
cal year or period under this title (including in 
the form of coverage described in paragraph (1) 
or (2) of section 2101, or both) will exceed the 
sum of— 
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‘‘(i) the amount of the State’s allot-
ments for any preceding fiscal year or pe-
riod that remains available for expenditure 
and that will not be expended by the end 
of the immediately preceding fiscal year; 
‘‘(ii) the amount (if any) that will be 
redistributed to the State under subsection 
(f) for the fiscal year or period; 
‘‘(iii) the portion, if any, of the 
amount appropriated under subparagraph 
(E)(iii) of section 2105(a)(3) for the pre-
ceding fiscal year or period that is not ex-
pended or obligated under such section; 
and 
‘‘(iv) the amount of the State’s allot-
ment for the fiscal year or period.’’. 
(b) 
CONFORMING
AMENDMENTS.—Section 
2104(f)(2)(A) of the Social Security Act (42 U.S.C. 
13957dd(f)(2)(A)) is amended— 
(1) in clause (i), by inserting ‘‘and’’ at the end; 
(2) by striking clause (ii); and 
(3) by redesignating clause (iii) as clause (ii). 
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TITLE II—COVERAGE STABILITY 
AND REDUCED BUREAUCRACY 
SEC. 201. IMPROVING COVERAGE STABILITY. 
(a) IN GENERAL.—Section 2102(b)(1)(B) of the So-
cial Security Act (42 U.S.C. 1397bb(b)(1)(B)) is amend-
ed— 
(1) in clause (iii), by striking ‘‘in the case of a 
targeted low-income pregnant woman provided preg-
nancy-related assistance under section 2112’’; and 
(2) in clause (iv), by striking ‘‘at State op-
tion,’’. 
(b) CONFORMING AMENDMENTS.— 
(1) Section 2105(c)(10) of the Social Security 
Act (42 U.S.C. 1397(ee)(10)) is amended— 
(A) by striking subparagraph (F); and 
(B) by redesignating subparagraphs (G) 
through (M) as subparagraphs (F) through (L), 
respectively. 
(2) Section 2112(b)(5) of the Social Security 
Act (42 U.S.C. 1397ll(b)(5)) is amended— 
(A) in the heading, by striking ‘‘OR WAIT-
ING PERIOD’’; and 
(B) by striking ‘‘or any waiting period’’ 
and all that follows through ‘‘receipt of such as-
sistance’’. 
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(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date of enactment of 
this Act. 
SEC. 202. ASSURING CARE CONTINUITY DURING TRANSI-
TIONS AMONG CHIP, MEDICAID, AND QUALI-
FIED HEALTH PLANS. 
(a) MINIMUM ESSENTIAL COVERAGE.— 
(1) IN GENERAL.—Section 5000A(f) of the In-
ternal Revenue Code of 1986 is amended by adding 
at the end the following: 
‘‘(6) PREGNANCY-RELATED ASSISTANCE UNDER 
CHIP.—With respect to a targeted low-income preg-
nant woman (as defined in section 2112(d)(2) of the 
Social Security Act (42 U.S.C. 1397ll(d)(2))), not-
withstanding paragraph (1)(A)(iii), the term ‘min-
imum essential coverage’, at the option of such a 
woman, shall not include pregnancy-related assist-
ance (as defined in section 2112(d)(1) of the Social 
Security Act (42 U.S.C. 1397ll(d)(1))).’’. 
(2) EFFECTIVE DATE.—The amendment made 
by this subsection applies to taxable years beginning 
after December 31, 2015. 
(b) CONTINUITY OF CARE.—The Secretary of Health 
and Human Services shall issue regulations for purposes 
of ensuring continuity of care for children who— 
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(1) are undergoing an active course of treat-
ment; and 
(2) involuntarily change coverage under health 
insurance, the State plan under the Medicaid pro-
gram under title XIX of the Social Security Act, or 
the State child health plan under title XXI of such 
Act during such course of treatment for any reason, 
including a reason related to a change in income, 
health plan termination, or a material change or 
changes to the plan’s health benefits coverage. 
(c) ENSURING COMPARABILITY OF COVERAGE.— 
(1) IN GENERAL.—Not later than 18 months 
after the date of the enactment of the CHIP Exten-
sion and Improvement Act of 2015, the Secretary of 
Health and Human Services shall review, with re-
spect to a State, the benefits (by each benefit class) 
offered for children and the cost-sharing imposed 
with respect to such benefits by qualified health 
plans offered through an Exchange established 
under title I of the Patient Protection and Afford-
able Care Act in the State. The Secretary shall 
make the findings of such review available on the 
public Internet site of the Department of Health and 
Human Services. 
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(2) REGULATIONS
REQUIRED.—If, following 
such review, the Secretary determines that benefits 
and cost-sharing protections referred to in para-
graph (1) are not comparable to the benefits (by 
each benefit class) offered and cost-sharing protec-
tions provided under the State child health plan 
under title XXI of the Social Security Act (42 
U.S.C. 1397aa et seq.) in the State, the Secretary, 
not later than January 1, 2017, shall issue a rule, 
to apply with respect to plan years beginning in 
2019, establishing requirements designed to ensure 
that such qualified health plans offer benefits and 
cost-sharing protections that are comparable to the 
benefits and cost-sharing protections provided under 
such State child health plan for plan year 2019. 
SEC. 203. STATE FLEXIBILITY TO PROVIDE FOR CONTIN-
UOUS ELIGIBILITY. 
Section 1902(e)(12) of the Social Security Act (42 
U.S.C. 1396a(e)(12)) is amended to read as follows: 
‘‘(12) CONTINUOUS ELIGIBILITY OPTION.— 
‘‘(A) CHILDREN.—At the option of the State, 
the plan may provide that a child (as defined in 
paragraph (13)(G)) who is determined to be eligible 
for benefits under a State plan approved under this 
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title under subsection (a)(10)(A) shall remain eligi-
ble for those benefits until the earlier of— 
‘‘(i) the end of a period (not to exceed 12 
months) following the determination; or 
‘‘(ii) the time that the child exceeds the 
age specified in such paragraph (13)(G). 
‘‘(B) CERTAIN NONELDERLY ADULTS.— 
‘‘(i) IN GENERAL.—At the option of the 
State, the plan may provide that in the case of 
an eligible adult who is determined to be eligible 
for benefits under a State plan approved under 
this title (or a waiver of such plan), the eligible 
adult shall remain eligible for those benefits 
until the end of a period (not to exceed 12 
months) following the determination. 
‘‘(ii) ELIGIBLE ADULT DEFINED.—In this 
subparagraph, the term ‘eligible adult’ means— 
‘‘(I) an individual (other than a child) 
whose income eligibility under the State 
plan or under a waiver of the plan for 
medical assistance is determined under 
paragraph (14); and 
‘‘(II) an individual included in any 
other group of individuals the Secretary 
determines appropriate.’’. 
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SEC. 204. STATE FLEXIBILITY TO USE ADMINISTRATIVE 
SIMPLIFICATION 
POLICIES 
FOR 
ENROLL-
MENT. 
(a) PERMANENT EXTENSION
OF MEDICAID
AND 
CHIP EXPRESS LANE OPTION.—Section 1902(e)(13) of 
the Social Security Act (42 U.S.C. 1396a(e)(13)) is 
amended by striking subparagraph (I). 
(b) EXTENDING EXPRESS LANE ELIGIBILITY
TO 
ADULTS.—Section 1902(e)(13)(A) of the Social Security 
Act (42 U.S.C. 1396a(e)(13)(A)) is amended by adding 
at the end the following new clause: 
‘‘(iii) STATE OPTION TO EXTEND EXPRESS 
LANE ELIGIBILITY TO ADULTS.— 
‘‘(I) IN GENERAL.—At the option of 
the State, the State may apply the provi-
sions of this paragraph with respect to de-
termining eligibility under this title for an 
eligible individual (as defined in subclause 
(II)). In applying this paragraph in the 
case of a State making such an option, any 
reference in this paragraph to a child with 
respect to this title (other than a reference 
to child health assistance) shall be deemed 
to be a reference to an eligible individual. 
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‘‘(II) 
ELIGIBLE
INDIVIDUAL
DE-
FINED.—In this clause, the term ‘eligible 
individual’ means— 
‘‘(aa) any individual (other than 
a child) whose income eligibility under 
the State plan or under a waiver of 
the plan for medical assistance is de-
termined under paragraph (14); and 
‘‘(bb) an individual included in 
any other group of individuals the 
Secretary determines appropriate.’’. 
SEC. 205. OUTREACH TO TARGETED POPULATIONS. 
(a) OUTREACH AND ENROLLMENT GRANTS.—Sec-
tion 2113 of the Social Security Act (42 U.S.C. 1397mm) 
is amended— 
(1) in subsection (a)— 
(A) in paragraph (1), by striking ‘‘during 
the period of fiscal years 2009 through 2015’’; 
and 
(B) in paragraph (2)— 
(i) in the heading, by striking ‘‘TEN 
PERCENT SET ASIDE’’ and inserting ‘‘SET 
ASIDE’’; and 
(ii) by striking ‘‘10 percent’’ and in-
serting ‘‘15 percent’’; and 
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(2) in subsection (g), by inserting ‘‘and 
$40,000,000 for each fiscal year thereafter, to re-
main available until expended’’ after ‘‘2015,’’. 
(b) REQUIREMENT THAT MANAGED CARE ORGANI-
ZATIONS PROVIDE LANGUAGE SERVICES
TO ENROLL-
EES.—Section 1932(b) of the Social Security Act (42 
U.S.C. 1396u–2(b)) is amended by adding at the end the 
following new paragraph: 
‘‘(9) LANGUAGE
SERVICES.—Each contract 
with a managed care entity under section 1903(m) 
or under section 1905(t)(3) shall require the entity 
to provide and pay for language services, including 
oral interpretation and written translation services, 
for an individual and the parent or guardian of such 
individual who is eligible for medical assistance 
under the State plan under this title and is enrolled 
with the entity and is limited English proficient 
when interacting with the entity or with any pro-
vider receiving payment from the entity. Such lan-
guage services shall be provided in conjunction with 
all covered items and services that are available to 
such individuals under the contract.’’. 
(c) MEDICAID HEALTH CARE DISPARITIES.—Section 
1946 of the Social Security Act (42 U.S.C. 1396w–5) is 
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amended by adding at the end the following new sub-
section: 
‘‘(d) APPROPRIATION.—Out of any funds in the 
Treasury not otherwise appropriated, there are appro-
priated to carry out this section $20,000,000, to remain 
available until expended .’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section take effect on the date of enactment of this 
Act. 
TITLE III—BENEFITS AND 
AFFORDABILITY 
SEC. 301. STRENGTHENED COST-SHARING PROTECTIONS 
UNDER CHIP. 
Section 2103(e) of the Social Security Act (42 U.S.C. 
1397cc(e)) is amended— 
(1) in paragraph (3)(B)— 
(A) by inserting ‘‘, including with respect 
to benefits for dental services,’’ after ‘‘State 
child health plan’’; 
(B) by striking ‘‘annual aggregate cost- 
sharing’’ and inserting ‘‘aggregate cost-shar-
ing’’; and 
(C) by striking ‘‘for the year involved’’ and 
inserting ‘‘, as applied on a quarterly or month-
ly basis (as specified by the State)’’; and 
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(2) by adding at the end the following new 
paragraph: 
‘‘(5) ADDITIONAL REQUIREMENTS.— 
‘‘(A) TRACKING OF EXPENSES; NOTICE.— 
Except as provided in subparagraph (B), in the 
case of a State child health plan that imposes 
premiums, deductibles, cost sharing, or similar 
charges that could (as determined by the Sec-
retary) cause families that include a targeted 
low-income child or a targeted low-income preg-
nant woman to have out-of-pocket expenses that 
exceed the limit imposed under paragraph 
(3)(B) for a month or quarter (as applicable 
under the State plan), the State child health 
plan shall— 
‘‘(i) establish an electronic process for 
tracking such expenses that does not rely 
on documentation provided by the targeted 
low-income child, the targeted low-income 
pregnant woman, or the family; and 
‘‘(ii) notify each such family— 
‘‘(I) of the aggregate monthly or 
quarterly limits on out-of-pocket ex-
penses applicable to the family im-
posed under paragraph (3)(B); and 
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‘‘(II) 
that 
no 
premiums, 
deductibles, cost sharing, or similar 
charges shall be imposed on any tar-
geted low-income child or targeted 
low-income pregnant woman in the 
family for the remainder of any month 
or quarter with respect to which the 
family has reached the aggregate 
monthly or quarterly family limit im-
posed under such paragraph applica-
ble to the family. 
‘‘(B) MANAGED CARE ENTITIES OR ORGA-
NIZATIONS.—In the case of a State child health 
plan that provides child health assistance 
through managed care entities or organizations, 
the entities or organizations shall, with respect 
to families described in subparagraph (A)— 
‘‘(i) establish an electronic process de-
scribed in subparagraph (A)(i); and 
‘‘(ii) coordinate with the State agency 
responsible for implementing the State 
child health plan under this title to ensure 
that any premiums, deductibles, cost shar-
ing, or similar charges imposed on such a 
family are included in the aggregate limit 
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applicable to the family under paragraph 
(3)(B).’’. 
SEC. 302. ENSURING COVERAGE OF PREVENTIVE HEALTH 
SERVICES UNDER MEDICAID AND CHIP. 
(a) MEDICAID.— 
(1) CLARIFYING PREVENTIVE COVERAGE.—Sec-
tion 1905(a)(13) of the Social Security Act (42 
U.S.C. 1396d(a)(13)) is amended— 
(A) by striking subparagraphs (A) and 
(B); 
(B) by redesignating subparagraph (C) as 
subparagraph (B); and 
(C) by inserting before subparagraph (B) 
(as so redesignated) the following new subpara-
graph: 
‘‘(A) the items and services described in 
paragraphs (1) through (5) of section 2713(a) 
of the Public Health Service Act; and’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1902(a)(10)(A) of the Social Security Act (42 
U.S.C. 1396a(a)(10)(A)) is amended in the matter 
preceding clause (i), by inserting ‘‘, (13)(A)’’ before 
‘‘, (17)’’. 
(b) CHIP.—Section 2103(c)(1)(D) of the Social Se-
curity Act (42 U.S.C. 1397cc(c)(1)(D)) is amended by 
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striking ‘‘Well-baby’’ and inserting ‘‘Items and services 
described in paragraphs (1) through (5) of section 2713(a) 
of the Public Health Service Act, including well-baby’’. 
(c) COST-SHARING PROHIBITIONS.— 
(1) IN GENERAL.—Section 1916 of the Social 
Security Act (42 U.S.C. 1396(o)) is amended— 
(A) in subsection (a)(2)— 
(i) in subparagraph (D), by striking 
‘‘or’’ at the end; 
(ii) in subparagraph (E), by striking 
‘‘hospice care (as defined in section 
1905(o)); and’’ at the end and inserting 
‘‘hospice care (as defined in section 
1905(o)), or’’; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(F) items and services described in sec-
tion 1905(a)(13)(A); and’’; and 
(B) in subsection (b)(2)— 
(i) in subparagraph (D), by striking 
‘‘or’’ at the end; 
(ii) in subparagraph (E), by striking 
‘‘hospice care (as defined in section 
1905(o)); and’’ at the end and inserting 
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‘‘hospice care (as defined in section 
1905(o)), or’’; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(F) items and services described in sec-
tion 1905(a)(13)(A); and’’. 
(2) STATE OPTION.—Section 1916A(b)(3)(B) of 
the Social Security Act (42 U.S.C. 1396o– 
1(b)(3)(B)) is amended by adding at the end the fol-
lowing new clause: 
‘‘(xi) Items and services described in 
section 1905(a)(13)(A).’’. 
SEC. 303. TIMELY IMMUNIZATION COVERAGE. 
(a) COVERAGE FOR NEWLY APPROVED VACCINES 
WITHIN 30 DAYS.— 
(1) IN GENERAL.—Section 1928(e) of the So-
cial Security Act (42 U.S.C. 1396s(e)) is amended 
by adding at the end the following new sentence: 
‘‘Each revision of the list established by such Advi-
sory Committee shall apply to the purchase, delivery, 
and administration of pediatric vaccines under this 
section not later than 30 days after the date such 
Advisory Committee approves the revision.’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
2103(c)(1)(D) of the Social Security Act (42 U.S.C. 
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1397cc(c)(1)(D)), as amended by section 302(b), is 
further amended by inserting ‘‘, administered in ac-
cordance with the schedule referred to in section 
1928(c)(2)(B)(i) for pediatric vaccines’’ after ‘‘im-
munizations’’. 
(b) TREATMENT OF CHIP-ELIGIBLE CHILDREN AS 
FEDERALLY
VACCINE-ELIGIBLE
CHILDREN.—Section 
1928(b)(2) of the Social Security Act (42 U.S.C. 
1396s(b)(2)) is amended— 
(1) in subparagraph (A)(i), by inserting ‘‘or 
CHIP-eligible’’ after ‘‘medicaid-eligible’’; and 
(2) in subparagraph (B), by striking clause (i) 
and inserting the following: 
‘‘(i) The term ‘medicaid-eligible or 
CHIP-eligible child’ means, with respect to 
a child, a child who is entitled to medical 
assistance under a State plan approved 
under this title or a waiver of such plan, 
or who is eligible for child health assist-
ance under a State child health plan ap-
proved under title XXI.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section take effect on the date of enactment of this 
Act. 
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SEC. 304. PAYMENT PARITY FOR MEDICAID PRIMARY CARE 
SERVICES. 
(a) IN GENERAL.—Section 1902(a)(13)(C) of the So-
cial Security Act (42 U.S.C. 1396a(a)(13)(C)) is amend-
ed— 
(1) by striking ‘‘2013 and 2014’’ and inserting 
‘‘calendar years 2014 through 2019’’; 
(2) by striking ‘‘, general internal medicine’’ 
and inserting ‘‘, general internal medicine, neu-
rology, psychiatry, obstetrics and gynecology’’; 
(3) by inserting ‘‘or a health care practitioner 
who is a nurse practitioner, physician assistant, or 
clinical nurse specialist (as such terms are defined in 
section 1861(aa)(5)) or a certified nurse midwife (as 
defined in section 1861(gg)(2))’’ after ‘‘pediatric 
medicine’’; and 
(4) by striking ‘‘such services and physician’’ 
and inserting ‘‘such services and physician or health 
care practitioner’’. 
(b) EXTENSION OF INCREASED FMAP.— Section 
1905(dd) of the Social Security Act (42 U.S.C. 
1396d(dd)) is amended by striking ‘‘2015’’ and inserting 
‘‘2020’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished on 
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or after the first day of the first calendar quarter that 
begins after the date of the enactment of this Act. 
TITLE IV—ACCESS AND QUALITY 
Subtitle A—Pediatric Quality 
Measures 
SEC. 401. EXTENDING THE PEDIATRIC QUALITY MEASURES 
PROGRAM. 
Section 1139A(i) of the Social Security Act (42 
U.S.C. 1320b–9a(i)) is amended by inserting ‘‘, and for 
each of fiscal years 2016 through 2019, $50,000,000,’’ 
after ‘‘$45,000,000’’. 
SEC. 402. ENHANCED FMAP FOR ACTIVITIES RELATED TO 
PEDIATRIC QUALITY MEASURES. 
Section 1903(a)(3)(A)(iii) of the Social Security Act 
(42 U.S.C. 1396b(a)(3)(A)(iii)) is amended to read as fol-
lows: 
‘‘(iii) 95 percent of so much of the sums 
expended during any such quarter in fiscal 
years 2016, 2017, and 2018, 90 percent of so 
much of the sums expended during any such 
quarter in fiscal years 2019 and 2020, and the 
higher of an amount equal to the Federal med-
ical assistance percentage (as defined in section 
1905(b)) or 75 percent of so much of the sums 
expended during any such quarter in any fiscal 
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year thereafter (as found necessary by the Sec-
retary for the proper and efficient administra-
tion of the State plan) as are attributable to 
such developments or modifications of systems 
of the type described in clause (i) as are nec-
essary for the efficient collection and reporting 
on the core set of child health quality measures 
under subsections (a), (b), (c), and (f) of sec-
tion 1139A; and’’. 
SEC. 403. REPORTING OF FULL SET OF PEDIATRIC QUALITY 
MEASURES. 
Section 1139A(a)(4) of the Social Security Act (42 
U.S.C. 1320b–9a(a)(4)) is amended— 
(1) in the heading, by striking ‘‘ENCOURAGE 
VOLUNTARY
AND
STANDARDIZED’’ and inserting 
‘‘STANDARDIZED’’; 
(2) by striking ‘‘Not later than’’ and inserting 
the following: 
‘‘(A) ENCOURAGING VOLUNTARY REPORT-
ING.—Not later than’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(B) OTHER REPORTING.—Not later than 
five years after the date of the enactment of the 
CHIP Extension and Improvement Act of 2015, 
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the Secretary shall require that each State sub-
mit information on the core set of child health 
quality measures (as in effect on such date of 
enactment), 
as 
updated 
under 
subsection 
(b)(5).’’. 
SEC. 404. TECHNICAL ASSISTANCE TO STATES FOR ADOPT-
ING AND UTILIZING PEDIATRIC QUALITY 
MEASURES. 
Section 1139A(a)(7) of the Social Security Act (42 
U.S.C. 1320b–9a(a)(7)) is amended to read as follows: 
‘‘(7) TECHNICAL ASSISTANCE.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
provide technical assistance to States to assist 
them in adopting and utilizing the core set of 
child health measures in administering the 
State plans under titles XIX and XXI, includ-
ing by assisting States in building their data 
collection infrastructures. 
‘‘(B) 
FUNDING.—$5,000,000 
of 
the 
amount appropriated under subsection (i) for a 
fiscal year shall be used to carry out this para-
graph.’’. 
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SEC. 405. IMPROVING THE EFFECTIVENESS OF THE PEDI-
ATRIC QUALITY MEASURES. 
Section 1139A(b) of the Social Security Act (42 
U.S.C. 1320b–9a(b)) is amended— 
(1) in paragraph (4)— 
(A) by striking the paragraph heading and 
inserting the following: ‘‘ENSURING
THE
DE-
VELOPMENT, MAINTENANCE, AND
REPORTING 
OF A PORTFOLIO OF PEDIATRIC QUALITY MEAS-
URES’’; 
(B) in subparagraph (A), by striking 
‘‘and’’ at the end; 
(C) in subparagraph (B)(iii)— 
(i) by inserting ‘‘establishment of a 
sustainable mechanism for maintaining 
and’’ before ‘‘updating’’; and 
(ii) by striking ‘‘as necessary.’’ and 
inserting ‘‘in alignment with the most re-
cent version of the ‘Blueprint for the 
Measures Management System’ published 
by the Centers for Medicare & Medicaid 
Services, as necessary; and’’; and 
(D) by adding at the end the following new 
subparagraph: 
‘‘(C) award grants or contracts to continue 
and enhance the pediatric quality measures pro-
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gram, which shall include awarding grants and 
contracts with a particular emphasis on— 
‘‘(i) patient and family experience or 
coordination of care; 
‘‘(ii) pediatric populations that are 
small in size and may be most effectively 
addressed by aggregating data across mul-
tiple States, including pediatric populations 
with medical complexity and pediatric pop-
ulations with rare conditions; 
‘‘(iii) the impacts of changes in life 
events over various stages of child and ad-
olescent development, including changes in 
morbidity and mortality, dependence sta-
tus, and developmental stages, and the im-
pacts of such changes on subsequent 
health and health care quality; and 
‘‘(iv) establishing a sustainable mech-
anism for identifying and assisting States 
in developing a standardized data infra-
structure for the collection and national re-
porting of pediatric quality measures, in-
cluding developing precise data element 
definitions and utilizing consistent data 
collection methods.’’; 
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(2) by striking paragraph (5) and inserting the 
following new paragraph: 
‘‘(5) REVISING, STRENGTHENING, AND IMPROV-
ING INITIAL CORE MEASURES.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
annually issue a rule (in accordance with sec-
tion 553 of title 5, United States Code) to 
amend the core set of child health quality meas-
ures described in subsection (a) so that such 
core set— 
‘‘(i) is consistent with the purposes of 
the pediatric quality measures program es-
tablished under paragraph (1); 
‘‘(ii) meets the conditions specified in 
paragraph (2); 
‘‘(iii) includes measures that— 
‘‘(I) were developed by the Sec-
retary in consultation with the entities 
specified 
in 
subparagraphs 
(A) 
through (H) of paragraph (3); 
‘‘(II) were developed, validated, 
tested, or maintained through a grant 
or contract awarded under paragraph 
(4); and 
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‘‘(III) were submitted to the Sec-
retary for consideration that were not 
developed under such a grant or con-
tract; and 
‘‘(iv) takes into account the reports 
and demonstration projects described in 
subparagraphs (c), (d), (e), and (f) of this 
section. 
‘‘(B) ADDITIONAL
CHANGES.—Beginning 
not later than one year after the date of the en-
actment of the CHIP Extension and Improve-
ment Act of 2015, the amendments made to the 
core set of measures under subparagraph (A) 
shall include changes— 
‘‘(i) to measure the type of children’s 
health insurance coverage or other health 
benefits coverage available over time, in 
addition to the presence, stability, and du-
ration of such health insurance coverage or 
such health benefits coverage over time, for 
purposes of examining enrollment changes 
of a child from one type of coverage to an-
other; 
‘‘(ii) to ensure that the measures re-
flect the care provided to the diverse pedi-
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atric population, including adolescents and 
children with special health care needs and 
the management of acute and chronic con-
ditions; 
‘‘(iii) to ensure that the measures re-
flect care provided in all health care set-
tings in which an individual enrolled in the 
State plan under title XIX receives care; 
and 
‘‘(iv) to encourage the adoption of pe-
diatric quality measures at the State, plan, 
community, facility, and provider level at-
tribution, as well as across different health 
care delivery and coverage systems, includ-
ing coverage provided through the Ex-
changes established under title I of the Pa-
tient Protection and Affordable Care Act.’’; 
(3) in paragraph (6)— 
(A) by striking ‘‘clinical care’’ and insert-
ing ‘‘clinical effectiveness, patient safety, popu-
lation and public health, patient and family en-
gagement, care coordination, or efficiency’’; and 
(B) by striking ‘‘in various institutional 
and ambulatory health care settings’’; and 
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(4) by adding at the end the following new 
paragraph: 
‘‘(8) FUNDING.—$20,000,000 of the amount 
appropriated under subsection (i) for a fiscal year 
shall be used to carry out this subsection.’’. 
SEC. 406. REPORTS REGARDING STATE-SPECIFIC QUALITY 
OF CARE MEASURES APPLIED UNDER MED-
ICAID OR CHIP. 
Section 1139A(c)(1) of the Social Security Act (42 
U.S.C. 1320b–9a(c)) is amended— 
(1) in subparagraph (A), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (B), by striking the period 
at the end and inserting a semicolon; and 
(3) by adding at the end the following new sub-
paragraphs: 
‘‘(C) State-specific information on the an-
nual progress toward, and efforts to overcome 
barriers to, reporting on all quality measures 
within the core set of child health quality meas-
ures, as updated under subsection (b)(5); and 
‘‘(D) beginning not later than 5 years after 
the date of the enactment of this subparagraph, 
State-specific information on all quality meas-
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ures within the core set of child health quality 
measures, as updated under subsection (b)(5).’’. 
SEC. 407. ADVISORY PANEL REGARDING PEDIATRIC QUAL-
ITY. 
(a) IN GENERAL.—Section 1139A(g) of the Social 
Security Act (42 U.S.C. 1320b–9a(g)) is amended— 
(1) in the heading, by striking ‘‘STUDY OF’’ and 
inserting ‘‘STAKEHOLDER
INPUT
AND
REPORTS 
ON’’; 
(2) by redesignating paragraph (2) as para-
graph (3); and 
(3) by inserting after paragraph (1) the fol-
lowing new paragraph: 
‘‘(2) PEDIATRIC QUALITY MEASUREMENT.—Not 
later than 18 months after the date of the enact-
ment of this paragraph, the Secretary, in consulta-
tion with representatives of State agencies respon-
sible for administering the Medicaid program under 
title XIX and the Children’s Health Insurance Pro-
gram under title XXI and representatives of relevant 
provider organizations, shall submit (and periodically 
update) to the Committee on Energy and Commerce 
of the House of Representatives and the Committee 
on Finance of the Senate a report that takes into 
account the priorities and goals to be established 
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pursuant to section 1890(b)(7)(E). Such report shall 
include— 
‘‘(A) strategic and detailed operational 
plans to address and overcome barriers to State 
collection of, and reporting of, all quality meas-
ures within the core set of child health quality 
measures, as updated under subsection (b)(5); 
‘‘(B) an analysis of the types of incentives, 
including Federal funding and any associated 
amounts necessary for States to collect and re-
port on all quality measures within the core set 
of child health quality measures, as updated 
under subsection (b)(5); and 
‘‘(C) a standardized format and plan for 
States to collect and report on all quality meas-
ures within the core set of child health quality 
measures, as updated under subsection (b)(5).’’. 
(b) INCLUSION
OF CHILD
AND ADULT HEALTH 
QUALITY MEASURES FOR MULTI-STAKEHOLDER GROUP 
INPUT.—Section 1890(b)(7) of the Social Security Act 
(42 U.S.C. 1395aaa(b)(7)) is amended— 
(1) in subparagraph (B)(i)(I), by inserting 
‘‘1139A(a), 1139B,’’ after ‘‘sections’’; and 
(2) by adding at the end the following new sub-
paragraph: 
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‘‘(E) 
PEDIATRIC
QUALITY
MEASURE-
MENT.—With respect to quality and efficiency 
measures for use pursuant to section 1139A(a), 
the entity shall convene a panel, composed of 
health experts (including experts employed by 
the Federal Government and experts not so em-
ployed) to establish priorities and goals for 
child health to— 
‘‘(i) advise and make recommenda-
tions to the Secretary regarding changes 
that may be made to the core set of child 
health quality measures, as updated under 
section 1139A(b)(5); 
‘‘(ii) establish standards for the time-
liness and accuracy of data collected and 
reported for purposes of such measures; 
and 
‘‘(iii) review and make recommenda-
tions, at least annually, for strategies to 
enhance the timeliness, accuracy, and util-
ity of such measures.’’. 
SEC. 408. EXTENDING AND EXPANDING DEMONSTRATION 
PROJECTS. 
(a) STRENGTHENING DEMONSTRATION PROJECTS 
FOR IMPROVING THE QUALITY OF CHILDREN’S HEALTH 
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CARE AND THE USE OF HEALTH INFORMATION TECH-
NOLOGY.—Section 1139A(d) of the Social Security Act 
(42 U.S.C. 1320b–9a(d)) is amended— 
(1) in paragraph (1)— 
(A) in the matter preceding subparagraph 
(A)— 
(i) by striking ‘‘2009 through 2013, 
the Secretary shall award not more than 
10 grants’’ and inserting ‘‘2015 through 
2019, the Secretary shall award not fewer 
than 10 grants,’’; and 
(ii) by inserting ‘‘(including oral 
care)’’ after ‘‘health care’’; 
(B) in subparagraph (C), by striking ‘‘or’’ 
at the end; 
(C) in subparagraph (D), by striking the 
period at the end and inserting a semicolon; 
and 
(D) by adding at the end the following new 
subparagraphs: 
‘‘(E) examine and address barriers to ef-
fective delivery of perinatal care and its impact 
on birth outcomes and subsequent pregnancies 
and children’s health; 
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‘‘(F) implement and expand pediatric and 
perinatal learning and quality improvement 
collaboratives on the quality of children’s and 
pregnant women’s health care, including im-
proving patient outcomes, reducing health costs, 
and addressing health disparities; 
‘‘(G) encourage and evaluate the use at the 
State level of payment reform and related policy 
proposals for purposes of promoting higher 
quality of care for children, including the 
shared savings program established under sec-
tion 1899 and other methods of encouraging in-
tegrated care models; or 
‘‘(H) with respect to the model electronic 
health record format for children developed and 
disseminated under subsection (f)— 
‘‘(i) assess the extent to which the 
format has been incorporated into widely 
used electronic health record formats; 
‘‘(ii) implement standards and activi-
ties that result in increased use of such 
format; and 
‘‘(iii) evaluate the impact of the in-
creased use of such format.’’; 
(2) in paragraph (2)— 
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(A) in subparagraph (A), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (B), by striking the 
period at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(C) with respect to grants awarded for 
projects described in paragraph (1)(F)— 
‘‘(i) give priority to collaboratives that 
would demonstrate substantial impacts on 
the pediatric population by— 
‘‘(I) affecting a large percentage 
of such population or by substantially 
improving outcomes in a smaller pop-
ulation; 
‘‘(II) reducing the cost of, and 
other barriers to access to, health care 
for children, including children with 
medically complex illnesses or chronic 
conditions; 
‘‘(III) having a high likelihood to 
reduce disparities in health status; or 
‘‘(IV) potentially having long- 
term health impacts by addressing 
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childhood precursors to adult condi-
tions; and 
‘‘(ii) 
encourage 
coordination 
with 
other sources of funding in the expansion 
of pediatric learning collaboratives, includ-
ing by coordinating care and utilizing com-
munity health workers (as defined in sec-
tion 399V(k) of the Public Health Service 
Act (42 U.S.C. 280g–11(k))).’’; and 
(3) in paragraph (4)— 
(A) by inserting ‘‘For each of fiscal years 
2009 through 2013,’’ before ‘‘$20,000,000’’; 
and 
(B) by adding at the end the following new 
sentence: ‘‘For each of fiscal years 2016 
through 2019, $25,000,000 of the amount ap-
propriated under subsection (i) for a fiscal year 
shall be used to carry out this subsection.’’. 
(b) EXTENDING FUNDING FOR CHILDHOOD OBESITY 
DEMONSTRATION PROJECTS.—Section 1139A(e)(8) of the 
Social Security Act (42 U.S.C. 1320b–9a(e)(8)) is amend-
ed by inserting ‘‘, and for the period of fiscal years 2016 
through 2019, $25,000,000’’ after ‘‘2014’’. 
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Subtitle B—Continuing Delivery 
System Reform 
SEC. 411. SUPPORTING EVIDENCE-BASED CARE COORDINA-
TION IN COMMUNITIES. 
(a) IN GENERAL.—Section 511(j)(1) of the Social Se-
curity Act (42 U.S.C. 711(j)(1)) is amended— 
(1) in subparagraph (D), by inserting ‘‘and’’ at 
the end; 
(2) in subparagraph (E), by striking ‘‘fiscal 
year 2014; and’’ and inserting ‘‘each of fiscal years 
2014 through 2019.’’; and 
(3) by striking subparagraph (F). 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date of enactment of 
this Act. 
SEC. 412. ENSURING CARE COORDINATION FOR CHILDREN. 
Section 2706 of the Patient Protection and Afford-
able Care Act (42 U.S.C. 1396a note) is amended— 
(1) in subsection (a)(2), by striking ‘‘2016’’ and 
inserting ‘‘2019’’; and 
(2) in subsection (e), by striking ‘‘appro-
priated’’ and all that follows through the period at 
the end and inserting the following: ‘‘appropriated to 
carry out this section— 
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‘‘(1) for fiscal years 2014 and 2015, such sums 
as are necessary; 
‘‘(2) for each of fiscal years 2016 through 
2019, $100,000,000; and 
‘‘(3) for the period beginning on October 1, 
2019, 
and 
ending 
on 
December 
31, 
2019, 
$25,000,000.’’. 
Subtitle C—Miscellaneous 
SEC. 421. ASSURING COVERAGE CONTINUITY FOR FORMER 
FOSTER CARE CHILDREN. 
(a) IN GENERAL.—Section 1902(a)(10)(A)(i)(IX) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396a(a)(10)(A)(i)(IX)) is amended— 
(1) in item (bb), by striking ‘‘are not described 
in or enrolled under’’ and inserting ‘‘are not de-
scribed in and are not enrolled under’’; 
(2) in item (cc), by striking ‘‘responsibility of 
the State’’ and inserting ‘‘responsibility of a State’’; 
and 
(3) in item (dd), by striking ‘‘the State plan 
under this title or under a waiver of the’’ and insert-
ing ‘‘a State plan under this title or under a waiver 
of such a’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on July 1, 2015. 
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SEC. 422. DEFINITION OF THERAPEUTIC FOSTER CARE AS 
MEDICAL ASSISTANCE. 
(a) IN GENERAL.—Section 1905 of the Social Secu-
rity Act (42 U.S.C. 1396d) is amended— 
(1) in subsection (a)— 
(A) in paragraph (28), by striking ‘‘and’’ 
at the end; 
(B) by redesignating paragraph (29) as 
paragraph (30); and 
(C) by inserting after paragraph (28) the 
following new paragraph: 
‘‘(29) therapeutic foster care services described 
in subsection (ee); and’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(ee)(1) For purposes of subsection (a)(29), subject 
to subparagraph (C), therapeutic foster care services de-
scribed in this subsection are services provided for children 
who have not attained age 21, and who, as a result of 
mental illness, other emotional or behavioral disorders, 
medically fragile conditions, or developmental disabilities, 
need the level of care provided in an institution (including 
a psychiatric residential treatment facility) or nursing fa-
cility the cost of which could be reimbursed under the 
State plan but who can be cared for or maintained in a 
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community placement, through a qualified therapeutic fos-
ter care program described in paragraph (2). 
‘‘(2) A qualified therapeutic foster care program de-
scribed in this paragraph is a program that— 
‘‘(A) is licensed by the State and accredited by 
the 
Joint 
Commission 
on 
Accreditation 
of 
Healthcare Organizations, the Commission on Ac-
creditation of Rehabilitation Facilities, the Council 
on Accreditation, or by another equivalent accredita-
tion agency (or agencies) as the Secretary may rec-
ognize; 
‘‘(B) provides structured daily activities, includ-
ing the development, improvement, monitoring, and 
reinforcing of age-appropriate social, communication 
and behavioral skills, trauma-informed and gender- 
responsive services, crisis intervention and crisis sup-
port services, medication monitoring, counseling, and 
case management, and may furnish other intensive 
community services; and 
‘‘(C) provides foster care parents with special-
ized training and consultation in the management of 
children with mental illness, trauma, other emotional 
or behavioral disorders, medically fragile conditions, 
or developmental disabilities, and specific additional 
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training on the needs of each child provided such 
services. 
‘‘(3) In making coverage determinations under para-
graph (1), a State may employ medical necessity criteria 
that are similar to the medical necessity criteria applied 
to coverage determinations for other services and supports 
under this title. 
‘‘(4) The services described in this subsection do not 
include the training referred to in paragraph (2)(C).’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to calendar quarters beginning 
on or after the date of enactment of this Act. 
SEC. 423. TECHNICAL CORRECTION. 
(a) IN GENERAL.—Section 1917(d)(4)(A) of the So-
cial Security Act (42 U.S.C. 1396p(d)(4)(A)) is amended 
by inserting ‘‘the individual,’’ after ‘‘for the benefit of such 
individual by’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to trusts established on or after 
the date of the enactment of this Act. 
Æ 
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