State, or a consortium of such units of local govern-
ments, may submit an application directly to the 
Commission for programs or projects under this sub-
section. Such an application shall be subject to the 
requirements of this section. 
(c) STATE HEALTH COVERAGE INNOVATION COM-
MISSION.— 
(1) IN
GENERAL.—Within 90 days after the 
date of the enactment of this Act, the Secretary of 
Health and Human Services (in this section referred 
to as the ‘‘Secretary’’) shall establish a State Health 
Coverage Innovation Commission that— 
(A) shall be comprised of— 
(i) the Secretary; 
(ii) four State governors to be ap-
pointed by the National Governors Associa-
tion on a bipartisan basis; 
(iii) two members of a State legisla-
ture to be appointed, on a joint and bipar-
tisan basis, by the National Conference of 
State Legislators and the American Legis-
lative Exchange Council; 
(iv) two county officials to be ap-
pointed by the National Association of 
Counties on a bipartisan basis; 
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(v) two mayors to be appointed, on a 
joint and bipartisan basis, by the National 
League of Cities and by the United States 
Conference of Mayors; 
(vi) two individuals to be appointed by 
the Speaker of the House of Representa-
tives; 
(vii) two individuals to be appointed 
by the minority leader of the House of 
Representatives; 
(viii) two individuals to be appointed 
by the majority leader of the Senate; and 
(ix) two individuals to be appointed by 
the minority leader of the Senate; 
(B) shall request States to submit pro-
posals, which may include a variety of reform 
options such as tax credit approaches, expan-
sions of public programs such as Medicaid and 
the State Children’s Health Insurance Pro-
gram, the creation of purchasing pooling ar-
rangements similar to the Federal Employees 
Health Benefits Program, individual market 
purchasing options, single risk pool or single 
payer systems, health savings accounts, a com-
bination of the options described in this sub-
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paragraph, or other alternatives determined ap-
propriate by the Commission, including options 
suggested by States or the public, and nothing 
in this subparagraph shall be construed to pre-
vent the Commission from approving a reform 
proposal not included in this subparagraph; 
(C) shall conduct a thorough review of the 
grant application from a State and carry on a 
dialogue with all State applicants concerning 
possible modifications and adjustments; 
(D) shall submit the recommendations and 
legislative proposal described in subsection 
(d)(4)(C); 
(E) shall be responsible for receiving infor-
mation to determine the status and progress 
achieved under program or projects granted 
under this section; 
(F) shall report to the public concerning 
progress made by States with respect to the 
performance measures and goals established 
under this section, the periodic progress of the 
State relative to its State performance meas-
ures and goals, and the State program applica-
tion procedures, by region and State jurisdic-
tion; 
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(G) shall promote information exchange 
between States and the Federal Government; 
(H) shall be responsible for making rec-
ommendations to the Secretary and the Con-
gress, using equivalency or minimum standards, 
for minimizing the negative effect of State pro-
gram on national employer groups, provider or-
ganizations, and insurers because of differing 
State requirements under the programs; and 
(I) may require States to submit additional 
information or reports concerning the status 
and progress achieved under health care expan-
sion and improvement programs granted under 
this section, as needed. 
(2) PERIOD
OF
APPOINTMENT; REPRESENTA-
TION
REQUIREMENTS; VACANCIES.—Members shall 
be appointed for a term of 5 years. In appointing 
such members under paragraph (1)(A), the des-
ignated appointing individuals shall ensure the rep-
resentation of urban and rural areas and an appro-
priate geographic distribution of such members. Any 
vacancy in the Commission shall not affect its pow-
ers, but shall be filled in the same manner as the 
original appointment. 
(3) CHAIRPERSON, MEETINGS.— 
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(A) CHAIRPERSON.—The Commission shall 
select a Chairperson from among its members. 
(B) QUORUM.—Two-thirds of the members 
of the Commission shall constitute a quorum, 
but a lesser number of members may hold hear-
ings. 
(C) MEETINGS.—Not later than 30 days 
after the date on which all members of the 
Commission have been appointed, the Commis-
sion shall hold its first meeting. The Commis-
sion shall meet at the call of the Chairperson. 
(4) POWERS OF THE COMMISSION.— 
(A) NEGOTIATIONS
WITH
STATES.—The 
Commission may conduct detailed discussions 
and negotiations with States submitting appli-
cations under this section, either individually or 
in groups, to facilitate a final set of rec-
ommendations 
for 
purposes 
of 
subsection 
(d)(4)(C). 
(B) HEARINGS.—The Commission may 
hold such hearings, sit and act at such times 
and places, take such testimony, and receive 
such evidence as the Commission considers ad-
visable to carry out the purposes of this sub-
section. 
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(C) MEETINGS.—In addition to other 
meetings the Commission may hold, the Com-
mission shall hold an annual meeting with the 
participating States under this section for the 
purpose of having States report progress to-
ward the purposes in subsection (a) and for an 
exchange of information. 
(D) INFORMATION.—The Commission may 
secure directly from any Federal department or 
agency such information as the Commission 
considers necessary to carry out the provisions 
of this subsection. Upon request of the Chair-
person of the Commission, the head of such de-
partment or agency shall furnish such informa-
tion to the Commission if the head of the de-
partment or agency involved determines it ap-
propriate. 
(E) POSTAL SERVICES.—The Commission 
may use the United States mails in the same 
manner and under the same conditions as other 
departments and agencies of the Federal Gov-
ernment. 
(5) PERSONNEL MATTERS.— 
(A) COMPENSATION.—Each member of the 
Commission who is not an officer or employee 
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of the Federal Government or of a State or 
local government shall be compensated at a rate 
equal to the daily equivalent of the annual rate 
of basic pay prescribed for level IV of the Exec-
utive Schedule under section 5315 of title 5, 
United States Code, for each day (including 
travel time) during which such member is en-
gaged in the performance of the duties of the 
Commission. All members of the Commission 
who are officers or employees of the United 
States shall serve without compensation in addi-
tion to that received for their services as offi-
cers or employees of the United States. 
(B) TRAVEL EXPENSES.—The members of 
the Commission shall be allowed travel ex-
penses, including per diem in lieu of subsist-
ence, at rates authorized for employees of agen-
cies under subchapter I of chapter 57 of title 5, 
United States Code, while away from their 
homes or regular places of business in the per-
formance of services for the Commission. 
(C) STAFF.—The Chairperson of the Com-
mission may, without regard to the civil service 
laws and regulations, appoint and terminate an 
executive director and such other additional 
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personnel as may be necessary to enable the 
Commission to perform its duties. The employ-
ment of an executive director shall be subject to 
confirmation by the Commission. 
(D) DETAIL
OF
GOVERNMENT
EMPLOY-
EES.—Any Federal Government employee may 
be detailed to the Commission without reim-
bursement, and such detail shall be without 
interruption or loss of civil service status or 
privilege. 
(E) 
TEMPORARY
AND
INTERMITTENT 
SERVICES.—The Chairperson of the Commis-
sion may procure temporary and intermittent 
services under section 3109(b) of title 5, United 
States Code, at rates for individuals which do 
not exceed the daily equivalent of the annual 
rate of basic pay prescribed for level V of the 
Executive Schedule under section 5316 of such 
title. 
(6) FUNDING.—For the purpose of carrying out 
this subsection, there are authorized to be appro-
priated $3,000,000 for fiscal year 2008 and each fis-
cal year thereafter. 
(d) REQUIREMENTS FOR PROGRAMS.— 
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(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; 
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(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— 
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(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. 
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(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 
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