‘‘(3) EFFECTIVE
DATE.—Paragraph (1) shall 
take effect on the first day of the first month that 
begins more than 30 days after the date the Sec-
retary issues the regulations referred to in para-
graph (2). 
‘‘SEC. 2254. UNIFORM HOSPITAL COST REPORTING. 
‘‘Each hospital, as a requirement under a participa-
tion agreement under this title for each cost reporting pe-
riod beginning during or after fiscal year 2008, shall pro-
vide for the reporting of information to the Secretary with 
respect to any hospital care provided in a uniform manner 
consistent with standards established by the Secretary to 
carry out section 4007(c) of the Omnibus Budget Rec-
onciliation Act of 1987 and in an electronic form con-
sistent with standards established by the Secretary. 
‘‘SEC. 2255. HEALTH SERVICE PROVIDER DEFINED. 
‘‘In this part, the term ‘health service provider’ in-
cludes a provider of services (as defined in section 
1861(u)), physician, supplier, and other entity furnishing 
health care services. 
‘‘PART E—GENERAL PROVISIONS 
‘‘SEC. 2261. DEFINITIONS RELATING TO BENEFICIARIES 
AND INCOME. 
‘‘(a) TERMS RELATING TO BENEFICIARIES.—In this 
title: 
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‘‘(1) CHILD.—The term ‘child’ means an indi-
vidual who throughout a month has not attained 24 
years of age. 
‘‘(2) LOW-INCOME
INDIVIDUAL.—The term 
‘low-income individual’ means an individual whose 
applicable modified gross income (as defined in sub-
section (b)(1)) is less than 200 percent of the pov-
erty level (as defined in subsection (b)(2)). The de-
termination that an individual is a low-income indi-
vidual shall be effective for a period of one year and 
shall be redetermined on an annual basis. 
‘‘(3) PREGNANT WOMAN.—The term ‘pregnant 
woman’ means a woman (regardless of age) who has 
been certified by a physician (in a manner specified 
by the Secretary) as being pregnant, until the last 
day of the month in which the 60-day period (begin-
ning on the date of termination of the pregnancy) 
ends. 
‘‘(b) TERMS RELATING TO INCOME.—In this title: 
‘‘(1) APPLICABLE MODIFIED GROSS INCOME.— 
‘‘(A) IN GENERAL.—Except as provided in 
this paragraph, the term ‘applicable modified 
gross income’ means, for a calendar year for an 
individual, the modified gross income (as de-
fined in section 202(a)(3)(B) of the Americare 
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Health Care Act of 2007) of the taxpayer (or 
the taxpayer for whom the individual may be 
claimed as a dependent) for the taxable year 
ending in the second previous calendar year. 
‘‘(B) APPLICATION
OF
CURRENT
YEAR 
MODIFIED GROSS INCOME.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), the Secretary shall establish a proce-
dure under which an individual may file a 
declaration of estimated modified gross in-
come for a taxable year ending in a cal-
endar year, which modified gross income 
will apply under this subsection as the ap-
plicable modified gross income for the cal-
endar year. Subject to clause (ii), such pro-
cedure shall be applicable regardless of 
whether or not the individual filed a tax 
return for the taxable year ending in the 
second previous calendar year. 
‘‘(ii) LIMITATION ON APPLICATION.— 
The Secretary may limit the application of 
clause (i), in the case of individuals who 
have filed tax returns for the taxable year 
ending in the second previous calendar 
year, to individuals with respect to whom 
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the applicable modified gross income will 
be reduced by at least 20 percent as a re-
sult of the application of such clause. 
‘‘(iii) REQUIREMENT FOR RETURN.— 
Any individual who has filed a declaration 
under clause (i) for a calendar year is re-
quired to file an income tax return for the 
taxable year in the calendar year, regard-
less of whether any income tax is actually 
owed for the year. The failure of the indi-
vidual to file such a return makes the indi-
vidual liable for overpayments under this 
title under clause (iv) in the same manner 
as if this paragraph had not applied. 
‘‘(iv) COLLECTION
FOR
OVERPAY-
MENTS.—If a declaration of estimated 
modified gross income is made applicable 
to a calendar year under clause (i) and the 
actual modified gross income for that tax-
able year exceeds such estimated modified 
gross income, the individual shall be liable 
to the United States for 110 percent of the 
amount of additional payments made 
under this title as a result of the use of 
such estimated modified gross income in-
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stead of the actual modified gross income 
for that taxable year. 
‘‘(C) TRANSMITTAL OF INFORMATION.—By 
not later than October 1 of each year, the Sec-
retary of the Treasury shall transmit to the 
Secretary such information relating to the ap-
plicable modified gross income of individuals for 
the taxable year ending in the previous year as 
may be necessary to apply this title in the suc-
ceeding calendar year. 
‘‘(2) POVERTY
LEVEL.—The term ‘poverty 
level’ means, for an individual in a family, the offi-
cial poverty line (as defined by the Office of Man-
agement and Budget, and revised annually in ac-
cordance with section 673(2) of the Omnibus Budget 
Reconciliation Act of 1981) applicable to a family of 
the size involved. 
‘‘SEC. 2262. INCORPORATION OF CERTAIN MEDICARE PRO-
VISIONS AND OTHER PROVISIONS. 
‘‘(a) USE OF MEDICARE ADMINISTRATIVE CONTRAC-
TORS.—The Secretary shall provide for the administration 
of this title through the use of medicare administrative 
contractors in the same manner as title XVIII is carried 
out through the use of such contractors, except that no 
payment shall be made under this title except on the basis 
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of bills or charges that are submitted electronically in a 
manner specified by the Secretary. 
‘‘(b) DEFINITIONS.— 
‘‘(1) IN GENERAL.—Except as otherwise pro-
vided in this title, the definitions contained in sec-
tion 1861 shall apply for purposes of this title in the 
same manner as they apply for purposes of title 
XVIII. 
‘‘(2) STATE; UNITED STATES.—(A) The term 
‘State’ means the 50 States and includes the Dis-
trict of Columbia, Puerto Rico, the Virgin Islands, 
Guam, American Samoa, and the Northern Mariana 
Islands. 
‘‘(B) The term ‘United States’ means all the 
States. 
‘‘(c) CERTIFICATION, PROVIDER
QUALIFICATION, 
ETC.—The provisions of sections 1863 through 1875, sec-
tions 1877 through 1880, section 1883, section 1885, and 
sections 1887 through 1895 shall apply to this title in the 
same manner as they apply to title XVIII. 
‘‘(d) TITLE XI PROVISIONS.—The following provi-
sions shall apply to this title in the same manner as they 
apply to title XVIII: 
‘‘(1) Sections 1124, 1126, and 1128 through 
1128E (relating to fraud and abuse). 
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‘‘(2) Section 1134 (relating to nonprofit hos-
pital philanthropy). 
‘‘(3) Section 1138 (relating to hospital proto-
cols for organ procurement and standards for organ 
procurement agencies). 
‘‘(4) Section 1142 (relating to research on out-
comes of health care services and procedures), ex-
cept that any reference in such section to a Trust 
Fund is deemed a reference to the AmeriCare Trust 
Fund. 
‘‘(5) Part B of title XI (relating to peer review 
of the utilization and quality of health care services). 
‘‘(6) Part C of title XI (relating to administra-
tive simplification). 
‘‘(e) OTHER PROVISIONS.—The provisions of section 
201(i) shall apply to this title and the AmeriCare Trust 
Fund in the same manner as they apply to title XVIII 
and the Federal Hospital Insurance Trust Fund. 
‘‘SEC. 2263. STATE MAINTENANCE OF EFFORT PAYMENTS. 
‘‘(a) CONDITION
OF COVERAGE.—Notwithstanding 
any other provision of this title, no individual who is a 
resident of a State is eligible for benefits under this title 
for a month in a calendar year, unless the State provides 
(in a manner and at a time specified by the Secretary) 
for payment to the AmeriCare Trust Fund of 1⁄12th of the 
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amount specified in subsection (b) for the year. Such 
funds shall be used offset the costs of providing subsidies 
for low-income individuals under section 202. 
‘‘(b) MAINTENANCE OF EFFORT AMOUNT.— 
‘‘(1) IN GENERAL.—Subject to paragraph (3), 
the amount of payment specified in this subsection 
for a State for a year is equal to the amount of pay-
ment (net of Federal payments) made by a State 
under its State plans under titles XIX and XXI for 
2007 for medical assistance for benefits described in 
paragraph (2). 
‘‘(2) BENEFITS DESCRIBED.—The benefits de-
scribed in this paragraph with respect to State plans 
of a State under titles XIX and XXI are benefits 
which— 
‘‘(A) would be available under this title for 
low-income individuals if this title had been in 
effect in 2007; and 
‘‘(B) are for low-income individuals who— 
‘‘(i) with respect to the State plan 
under title XIX, were required to be fur-
nished medical assistance under such title 
XIX; or 
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‘‘(ii) with respect to a State child 
health plan under title XXI, were low-in-
come children. 
‘‘SEC. 2264. MODIFICATION OF MEDICAID AND OTHER PRO-
GRAMS TO AVOID DUPLICATION OF BENE-
FITS. 
‘‘(a) IN GENERAL.—Notwithstanding any other pro-
vision of law— 
‘‘(1) a State plan under title XIX and a State 
child health plan under title XXI shall not provide 
any medical assistance for benefits with respect to 
which any payments may be made under this title; 
and 
‘‘(2) a health benefits plan under chapter 89 of 
title 5, United States Code, shall not provide bene-
fits for which any payment may be made under this 
title. 
‘‘(b) REVIEW
OF APPLICATION
TO OTHER PRO-
GRAMS.—The Secretary shall conduct a review of the fea-
sibility of applying the policy described in subsection (a) 
to additional Federal programs, such as the TRICARE 
program under title 10, United States Code. Not later 
than January 1, 2010, the Secretary submit to Congress 
on such review and shall include in such report such rec-
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ommendations for extending such policy to other Federal 
programs as the Secretary deems appropriate. 
‘‘SEC. 2265. CONSTRUCTION REGARDING CONTINUATION 
OF OBLIGATIONS UNDER CURRENT GROUP 
HEALTH PLAN CONTRACTS AND PROVISION 
OF ADDITIONAL BENEFITS. 
‘‘Nothing in this title shall be construed as— 
‘‘(1) affecting obligations for health care bene-
fits under group health plans as in effect on the date 
of the enactment of this title, including such plans 
established or maintained under or pursuant to one 
or more collective bargaining agreements; 
‘‘(2) limiting the additional benefits that may 
be provided under a group health plan to employees 
or their dependents, or to former employees or their 
dependents; or 
‘‘(3) limiting the benefits that may be made 
available under a State program to residents of the 
State at the expense of the State. 
‘‘SEC. 
2266. 
STANDARDS 
AND 
REQUIREMENTS 
FOR 
AMERICARE SUPPLEMENTAL POLICIES. 
‘‘(a) CERTIFICATION REQUIRED.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish rules and procedures consistent with this section 
under which AmeriCare supplemental policies may 
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only be issued if they are certified by the Secretary 
or under a State regulatory program approved by 
the Secretary as meeting standards established 
under subsection (b). 
‘‘(2) ENFORCEMENT.—Any person who issues 
an AmeriCare supplemental policy in violation of 
paragraph (1) is subject to a civil money penalty of 
not to exceed $25,000 for each such violation. The 
provisions of section 1128A (other than the first 
sentence of subsection (a) and other than subsection 
(b)) shall apply to a civil money penalty under the 
previous sentence in the same manner as such provi-
sions apply to a penalty or proceeding under section 
1128A(a). 
‘‘(3) AMERICARE
SUPPLEMENTAL
POLICY.— 
For purposes of this section, the term ‘AmeriCare 
supplemental policy’ is a health insurance policy or 
other health benefit plan offered by a private entity 
to individuals who are entitled to have payment 
made under this title, which provides reimbursement 
for expenses incurred for services and items for 
which payment may be made under this title but 
which are not reimbursable by reason of the applica-
tion of deductibles, coinsurance amounts, or other 
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limitations imposed pursuant to this title; but does 
not include— 
‘‘(A) any such policy or plan of the trust-
ees of a fund established by one or more em-
ployers or labor organizations (or combination 
thereof) if the policy or plan offers benefits as 
a direct service organization under section 
1833, or 
‘‘(B) a policy or plan of a health mainte-
nance organization which offers benefits under 
this title under section 2221(k). 
For purposes of this section, the term ‘policy’ in-
cludes a certificate issued under such policy. 
‘‘(b) CERTIFICATION STANDARDS.— 
‘‘(1) ISSUANCE.—The Secretary shall develop 
and publish specific standards consistent with this 
section for AmeriCare supplemental policies and 
shall consult with the Secretary of Labor regarding 
the application of such standards to employee wel-
fare benefit plans under title I of the Employee Re-
tirement Income Security Act of 1974. 
‘‘(2) MORE STRINGENT STATE STANDARDS PER-
MITTED.—In the case of insured AmeriCare supple-
mental policies (as defined in subsection (d)(3)), a 
State may implement standards that are more strin-
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gent than the standards established under para-
graph (1), including— 
‘‘(A) additional limitations on pre-existing 
exclusion limitations described in subsection 
(c)(1)(B); 
‘‘(B) additional restrictions on the groups 
of benefits described in subsection (c)(2) that 
may be offered in AmeriCare supplemental poli-
cies in the State, so long as a core-only benefit 
package described in subparagraph (A)(i) of 
such subsection may be offered in the State; 
and 
‘‘(C) requiring a higher loss-ratios than 
those specified in subsection (c)(3); 
‘‘(c) STANDARDS.—The Secretary shall establish 
standards for AmeriCare supplemental policies consistent 
with the following: 
‘‘(1) NO DISCRIMINATION BASED ON HEALTH 
STATUS.— 
‘‘(A) IN
GENERAL.—Except as provided 
under subparagraph (B), an AmeriCare supple-
mental policy may not deny, limit, or condition 
the coverage under (or benefits of) the policy, 
or vary premiums charged, based on the health 
status, claims experience, receipt of health care, 
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medical history, or lack of evidence of insur-
ability, of an individual. 
‘‘(B) LIMITATION ON USE OF PRE-EXIST-
ING
CONDITION
EXCLUSIONS.—An AmeriCare 
supplemental policy may exclude coverage with 
respect to services related to treatment of a 
pre-existing condition, except that— 
‘‘(i) the period of such exclusion may 
not exceed 6 months; 
‘‘(ii) such exclusion shall not apply to 
services furnished to newborns; and 
‘‘(iii) the period of exclusion under 
clause (i) shall be reduced by 1 month for 
each month in a period of continuous 
health benefits coverage (as defined by the 
Secretary) for the services involved. 
For purposes of this subparagraph, a condition 
is not pre-existing unless it was diagnosed or 
treated during the 3-month period ending on 
the day before the first date of such coverage. 
‘‘(2) SIMPLIFICATION OF BENEFITS.— 
‘‘(A) IN GENERAL.—Each AmeriCare sup-
plemental policy shall only offer benefits con-
sistent with the standards, promulgated by the 
Secretary, that provide— 
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‘‘(i) limitations on the groups or pack-
ages of benefits, including a core group of 
basic benefits and not to exceed 9 other 
different benefit packages, that may be of-
fered under an AmeriCare supplemental 
policy; 
‘‘(ii) that a person may not issue an 
AmeriCare supplemental policy without of-
fering such a policy with only the core- 
group of basic benefits and without pro-
viding an outline of coverage in a standard 
form approved by the Secretary; 
‘‘(iii) uniform language and defini-
tions to be used with respect to such bene-
fits, and 
‘‘(iv) uniform format to be used in the 
policy with respect to such benefits. 
‘‘(B) INNOVATION.—The Secretary may 
approve the offering of new or innovative and 
cost-effective benefit packages in addition to 
those provided under subparagraph (A). 
‘‘(3) MINIMUM
LOSS
RATIO
REQUIRED.—An 
AmeriCare supplemental policy, a specific disease 
policy (as defined by the Secretary), or a hospital 
confinement indemnity policy (as defined by the Sec-
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