(1) STATE PLAN.—A State that seeks to oper-
ate a program under this section shall prepare and 
submit to the Commission, as part of the application 
under subsection (b), a State health care plan that 
shall have as its goal increased coverage, and in 
service of that goal such additional goals as improve-
ments in quality, efficiency, cost-effectiveness, and 
the appropriate use of information technology. To 
achieve such goal, the State plan shall comply with 
the following: 
(A) COVERAGE.— 
(i) IN
GENERAL.—With respect to 
coverage, the State plan shall— 
(I) provide and describe the man-
ner in which the State will ensure that 
an increased number of individuals re-
siding within the State will have ex-
panded access to health care coverage 
with a specific 5-year target for reduc-
tion in the number or proportion of 
uninsured individuals through either 
private or public program expansion, 
or both, in accordance with or in addi-
tion to the options established by the 
Commission; 
VerDate Aug 31 2005 
01:11 Jul 27, 2006
Jkt 049200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H5864.IH
H5864
jcorcoran on PROD1PC62 with BILLS
(II) describe the number and per-
centage of current uninsured individ-
uals who will achieve coverage under a 
State health program; 
(III) describe the coverage that 
will be provided to beneficiaries under 
a State health program; 
(IV) identify Federal, State, or 
local and private programs that cur-
rently provide health care services in 
the State and describe how such pro-
grams could be coordinated with a 
State health program, to the extent 
practicable; and 
(V) provide for improvements in 
the availability of appropriate health 
care coverage that will increase access 
to care in urban, suburban, rural, and 
frontier areas of the State with medi-
cally 
underserved 
populations 
or 
where there may be an inadequate 
supply of health care providers. 
(ii) COVERAGE
OPTIONS.—The cov-
erage under the State plan may be— 
VerDate Aug 31 2005 
01:11 Jul 27, 2006
Jkt 049200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H5864.IH
H5864
jcorcoran on PROD1PC62 with BILLS
(I) health insurance coverage 
that meets the aggregate actuarial 
value 
requirement 
of 
section 
2103(a)(2)(B) of the Social Security 
Act (42 U.S.C. 1397cc(a)(2)(B)); 
(II) a combination of health in-
surance coverage and a consumer-di-
rected health care spending account, if 
the actuarial value of such coverage 
plus the amount of annual deposits 
into such account from sources other 
than the beneficiary is not less than 
the actuarial value amount described 
in subclause (I); or 
(III) health care access not less 
on 
average 
than 
that 
provided 
through coverage described in sub-
clause (I). 
(iii) CONSTRUCTION.—Nothing in this 
clause shall be construed to limit in any 
way the authority of the Secretary of 
Health and Human Services to issue waiv-
ers under section 1115 of the Social Secu-
rity Act. 
VerDate Aug 31 2005 
01:11 Jul 27, 2006
Jkt 049200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H5864.IH
H5864
jcorcoran on PROD1PC62 with BILLS
(B) QUALITY.—With respect to quality, 
the State plan may describe efforts to improve 
health care quality in the State, including an 
explanation of how such efforts would change 
(if at all) under the State plan. 
(C) COSTS.—With respect to costs, the 
State plan shall— 
(i) describe such steps as the State 
may undertake to improve the efficiency of 
health care; 
(ii) describe the public and private 
sector financing to be provided for the 
State health program; 
(iii) estimate the amount of Federal, 
State, and local expenditures, as well as, 
the costs to business and individuals under 
the State health program; and 
(iv) describe how the State plan will 
ensure the financial solvency of the State 
health program. 
(D) 
HEALTH
INFORMATION
TECH-
NOLOGY.—With respect to health information 
technology, the State plan may describe efforts 
to improve the appropriate use of health infor-
mation technology, including an explanation of 
VerDate Aug 31 2005 
01:11 Jul 27, 2006
Jkt 049200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H5864.IH
H5864
jcorcoran on PROD1PC62 with BILLS
how such efforts would change (if at all) under 
the State plan. 
(E) EXCEPTIONS TO FEDERAL POLICIES.— 
The State plan shall describe the exceptions to 
otherwise applicable Federal statutes, regula-
tions, and policies that would apply within the 
geographic area and time period governed by 
the plan. 
(2) TECHNICAL
ASSISTANCE.—The Secretary 
shall, if requested, provide technical assistance to 
States to assist such States in developing applica-
tions and plans under this section, including tech-
nical assistance by private sector entities if deter-
mined appropriate by the Commission. 
(3) INITIAL REVIEW.—With respect to a State 
application under subsection (b), the Secretary and 
the Commission shall complete an initial review of 
such State application within 60 days of the receipt 
of such application, analyze the scope of the pro-
posal, and determine whether additional information 
is needed from the State. The Commission shall ad-
vise the State within such period of the need to sub-
mit additional information. 
(4) FINAL DETERMINATION.— 
VerDate Aug 31 2005 
01:11 Jul 27, 2006
Jkt 049200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H5864.IH
H5864
jcorcoran on PROD1PC62 with BILLS
(A) IN
GENERAL.—In a timely manner 
consistent with subparagraph (C), the Commis-
sion shall determine whether to submit a State 
proposal to Congress for approval. 
(B) VOTING.— 
(i) IN GENERAL.—The determination 
to submit a State proposal to Congress 
under subparagraph (A) shall be approved 
by 2⁄3 of the members of the Commission 
who are present and eligible to vote and a 
majority of the entire Commission. 
(ii) ELIGIBILITY.—A member of the 
Commission shall not participate in a de-
termination under subparagraph (A) if— 
(I) in the case of a member who 
is a Governor, such determination re-
lates to the State of which the mem-
ber is the Governor; or 
(II) in the case of member not 
described in subclause (I), such deter-
mination relates to the geographic 
area of a State of which such member 
serves as a State or local official or as 
a Member of Congress. 
VerDate Aug 31 2005 
01:11 Jul 27, 2006
Jkt 049200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H5864.IH
H5864
jcorcoran on PROD1PC62 with BILLS