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paragraph unless the State satisfies the following 
conditions: 
‘‘(i) INCOME ELIGIBILITY.—The State 
child health plan under this title— 
‘‘(I) has the highest income eligi-
bility standard permitted under this 
title (or a waiver) as of January 1, 
2009; 
‘‘(II) does not limit the acceptance 
of applications for children or impose 
any numerical limitation, waiting list, 
or similar limitation on the eligibility 
of such children for child health assist-
ance under such State plan; and 
‘‘(III) provides benefits to all chil-
dren in the State who apply for and 
meet eligibility standards. 
‘‘(ii) NO
MORE
FAVORABLE
TREAT-
MENT.—The State child health plan may 
not provide more favorable dental coverage 
or cost-sharing protection for dental cov-
erage to children provided dental-only sup-
plemental coverage under this paragraph 
than the dental coverage and cost-sharing 
protection for dental coverage provided to
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† HR 2 EAS 
targeted low-income children who are eligi-
ble for the full range of child health assist-
ance provided under the State child health 
plan.’’. 
(2) STATE OPTION TO WAIVE WAITING PERIOD.— 
Section 2102(b)(1)(B) (42 U.S.C. 1397bb(b)(1)(B)), 
as amended by section 111(b)(2), is amended— 
(A) in clause (ii), by striking ‘‘and’’ at the 
end; 
(B) in clause (iii), by striking the period 
and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
clause: 
‘‘(iv) at State option, may not apply a 
waiting period in the case of a child pro-
vided dental-only supplemental coverage 
under section 2110(b)(5).’’. 
(c) 
DENTAL
EDUCATION
FOR
PARENTS
OF 
NEWBORNS.—The Secretary shall develop and implement, 
through entities that fund or provide perinatal care services 
to targeted low-income children under a State child health 
plan under title XXI of the Social Security Act, a program 
to deliver oral health educational materials that inform new 
parents about risks for, and prevention of, early childhood
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† HR 2 EAS 
caries and the need for a dental visit within their newborn’s 
first year of life. 
(d) PROVISION
OF
DENTAL
SERVICES
THROUGH 
FQHCS.— 
(1) MEDICAID.—Section 1902(a) (42 U.S.C. 
1396a(a)) is amended— 
(A) by striking ‘‘and’’ at the end of para-
graph (70); 
(B) by striking the period at the end of 
paragraph (71) and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (71) the 
following new paragraph: 
‘‘(72) provide that the State will not prevent a 
Federally-qualified health center from entering into 
contractual relationships with private practice dental 
providers in the provision of Federally-qualified 
health center services.’’. 
(2) CHIP.—Section 2107(e)(1) (42 U.S.C. 
1397g(e)(1)), as amended by subsections (a)(2) and 
(d)(2) of section 203, is amended by inserting after 
subparagraph (B) the following new subparagraph 
(and redesignating the succeeding subparagraphs ac-
cordingly):
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† HR 2 EAS 
‘‘(C) Section 1902(a)(72) (relating to lim-
iting FQHC contracting for provision of dental 
services).’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect on January 1, 
2009. 
(e) REPORTING INFORMATION ON DENTAL HEALTH.— 
(1) MEDICAID.—Section 1902(a)(43)(D)(iii) (42 
U.S.C. 1396a(a)(43)(D)(iii)) is amended by inserting 
‘‘and other information relating to the provision of 
dental services to such children described in section 
2108(e)’’ after ‘‘receiving dental services,’’. 
(2) CHIP.—Section 2108 (42 U.S.C. 1397hh) is 
amended by adding at the end the following new sub-
section: 
‘‘(e) INFORMATION
ON DENTAL CARE
FOR CHIL-
DREN.— 
‘‘(1) IN GENERAL.—Each annual report under 
subsection (a) shall include the following information 
with respect to care and services described in section 
1905(r)(3) provided to targeted low-income children 
enrolled in the State child health plan under this title 
at any time during the year involved:
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† HR 2 EAS 
‘‘(A) The number of enrolled children by age 
grouping used for reporting purposes under sec-
tion 1902(a)(43). 
‘‘(B) For children within each such age 
grouping, information of the type contained in 
questions 12(a)–(c) of CMS Form 416 (that con-
sists of the number of enrolled targeted low in-
come children who receive any, preventive, or re-
storative dental care under the State plan). 
‘‘(C) For the age grouping that includes 
children 8 years of age, the number of such chil-
dren who have received a protective sealant on at 
least one permanent molar tooth. 
‘‘(2) INCLUSION OF INFORMATION ON ENROLLEES 
IN MANAGED CARE PLANS.—The information under 
paragraph (1) shall include information on children 
who are enrolled in managed care plans and other 
private health plans and contracts with such plans 
under this title shall provide for the reporting of such 
information by such plans to the State.’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall be effective for annual reports 
submitted for years beginning after date of enactment.
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† HR 2 EAS 
(f) IMPROVED ACCESSIBILITY OF DENTAL PROVIDER 
INFORMATION
TO ENROLLEES UNDER MEDICAID
AND 
CHIP.—The Secretary shall— 
(1) work with States, pediatric dentists, and 
other dental providers (including providers that are, 
or are affiliated with, a school of dentistry) to in-
clude, not later than 6 months after the date of the 
enactment of this Act, on the Insure Kids Now website 
(http://www.insurekidsnow.gov/) and hotline (1–877– 
KIDS–NOW) (or on any successor websites or hot-
lines) a current and accurate list of all such dentists 
and providers within each State that provide dental 
services to children enrolled in the State plan (or 
waiver) under Medicaid or the State child health plan 
(or waiver) under CHIP, and shall ensure that such 
list is updated at least quarterly; and 
(2) work with States to include, not later than 
6 months after the date of the enactment of this Act, 
a description of the dental services provided under 
each State plan (or waiver) under Medicaid and each 
State child health plan (or waiver) under CHIP on 
such Insure Kids Now website, and shall ensure that 
such list is updated at least annually. 
(g) INCLUSION OF STATUS OF EFFORTS TO IMPROVE 
DENTAL CARE IN REPORTS ON THE QUALITY OF CHIL-
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† HR 2 EAS 
DREN’S HEALTH CARE UNDER MEDICAID AND CHIP.— 
Section 1139A(a), as added by section 401(a), is amend-
ed— 
(1) in paragraph (3)(B)(ii), by inserting ‘‘and, 
with respect to dental care, conditions requiring the 
restoration of teeth, relief of pain and infection, and 
maintenance of dental health’’ after ‘‘chronic condi-
tions’’; and 
(2) in paragraph (6)(A)(ii), by inserting ‘‘dental 
care,’’ after ‘‘preventive health services,’’. 
(h) GAO STUDY AND REPORT.— 
(1) STUDY.—The Comptroller General of the 
United States shall provide for a study that exam-
ines— 
(A) access to dental services by children in 
underserved areas; 
(B) children’s access to oral health care, in-
cluding preventive and restorative services, under 
Medicaid and CHIP, including— 
(i) the extent to which dental providers 
are willing to treat children eligible for such 
programs; 
(ii) information on such children’s ac-
cess to networks of care, including such net-
works that serve special needs children; and
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† HR 2 EAS 
(iii) geographic availability of oral 
health care, including preventive and restor-
ative services, under such programs; and 
(C) the feasibility and appropriateness of 
using qualified mid-level dental health providers, 
in coordination with dentists, to improve access 
for children to oral health services and public 
health overall. 
(2) REPORT.—Not later than 18 months year 
after the date of the enactment of this Act, the Comp-
troller General shall submit to Congress a report on 
the study conducted under paragraph (1). The report 
shall include recommendations for such Federal and 
State legislative and administrative changes as the 
Comptroller General determines are necessary to ad-
dress any barriers to access to oral health care, in-
cluding preventive and restorative services, under 
Medicaid and CHIP that may exist. 
SEC. 502. MENTAL HEALTH PARITY IN CHIP PLANS. 
(a) ASSURANCE
OF PARITY.—Section 2103(c) (42 
U.S.C. 1397cc(c)), as amended by section 501(a)(1)(B), is 
amended by inserting after paragraph (5), the following: 
‘‘(6) MENTAL HEALTH SERVICES PARITY.— 
‘‘(A) IN GENERAL.—In the case of a State 
child health plan that provides both medical and
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† HR 2 EAS 
surgical benefits and mental health or substance 
use disorder benefits, such plan shall ensure that 
the financial requirements and treatment limita-
tions applicable to such mental health or sub-
stance use disorder benefits comply with the re-
quirements of section 2705(a) of the Public 
Health Service Act in the same manner as such 
requirements apply to a group health plan. 
‘‘(B) DEEMED COMPLIANCE.—To the extent 
that a State child health plan includes coverage 
with respect to an individual described in section 
1905(a)(4)(B) and covered under the State plan 
under section 1902(a)(10)(A) of the services de-
scribed in section 1905(a)(4)(B) (relating to 
early and periodic screening, diagnostic, and 
treatment services defined in section 1905(r)) 
and 
provided 
in 
accordance 
with 
section 
1902(a)(43), such plan shall be deemed to satisfy 
the requirements of subparagraph (A).’’. 
(b) CONFORMING AMENDMENTS.—Section 2103 (42 
U.S.C. 1397cc) is amended— 
(1) in subsection (a), as amended by section 
501(a)(1)(A)(i), in the matter preceding paragraph 
(1), by inserting ‘‘, (6),’’ after ‘‘(5)’’; and
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† HR 2 EAS 
(2) in subsection (c)(2), by striking subpara-
graph (B) and redesignating subparagraphs (C) and 
(D) as subparagraphs (B) and (C), respectively. 
SEC. 503. APPLICATION OF PROSPECTIVE PAYMENT SYSTEM 
FOR SERVICES PROVIDED BY FEDERALLY- 
QUALIFIED HEALTH CENTERS AND RURAL 
HEALTH CLINICS. 
(a) APPLICATION
OF PROSPECTIVE PAYMENT SYS-
TEM.— 
(1) IN GENERAL.—Section 2107(e)(1) (42 U.S.C. 
1397gg(e)(1)), as amended by section 501(c)(2) is 
amended by inserting after subparagraph (C) the fol-
lowing new subparagraph (and redesignating the suc-
ceeding subparagraphs accordingly): 
‘‘(D) Section 1902(bb) (relating to payment 
for services provided by Federally-qualified 
health centers and rural health clinics).’’. 
(2) EFFECTIVE DATE.—The amendment made by 
paragraph (1) shall apply to services provided on or 
after October 1, 2009. 
(b) TRANSITION GRANTS.— 
(1) APPROPRIATION.—Out of any funds in the 
Treasury not otherwise appropriated, there is appro-
priated to the Secretary for fiscal year 2009, 
$5,000,000, to remain available until expended, for
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† HR 2 EAS 
the purpose of awarding grants to States with State 
child health plans under CHIP that are operated sep-
arately from the State Medicaid plan under title XIX 
of the Social Security Act (including any waiver of 
such plan), or in combination with the State Med-
icaid plan, for expenditures related to transitioning 
to compliance with the requirement of section 
2107(e)(1)(D) of the Social Security Act (as added by 
subsection (a)) to apply the prospective payment sys-
tem established under section 1902(bb) of the such Act 
(42 U.S.C. 1396a(bb)) to services provided by Feder-
ally-qualified health centers and rural health clinics. 
(2) MONITORING AND REPORT.—The Secretary 
shall monitor the impact of the application of such 
prospective payment system on the States described in 
paragraph (1) and, not later than October 1, 2011, 
shall report to Congress on any effect on access to ben-
efits, provider payment rates, or scope of benefits of-
fered by such States as a result of the application of 
such payment system. 
SEC. 504. PREMIUM GRACE PERIOD. 
(a) IN GENERAL.—Section 2103(e)(3) (42 U.S.C. 
1397cc(e)(3)) is amended by adding at the end the following 
new subparagraph:
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† HR 2 EAS 
‘‘(C) PREMIUM GRACE PERIOD.—The State 
child health plan— 
‘‘(i) shall afford individuals enrolled 
under the plan a grace period of at least 30 
days from the beginning of a new coverage 
period to make premium payments before 
the individual’s coverage under the plan 
may be terminated; and 
‘‘(ii) shall provide to such an indi-
vidual, not later than 7 days after the first 
day of such grace period, notice— 
‘‘(I) that failure to make a pre-
mium payment within the grace period 
will result in termination of coverage 
under the State child health plan; and 
‘‘(II) of the individual’s right to 
challenge the proposed termination 
pursuant to the applicable Federal reg-
ulations. 
For purposes of clause (i), the term ‘new cov-
erage period’ means the month immediately fol-
lowing the last month for which the premium 
has been paid.’’.
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† HR 2 EAS 
(b) EFFECTIVE DATE.—The amendment made by sub-
section (a) shall apply to new coverage periods beginning 
on or after the date of the enactment of this Act. 
SEC. 505. CLARIFICATION OF COVERAGE OF SERVICES PRO-
VIDED THROUGH SCHOOL-BASED HEALTH 
CENTERS. 
(a) IN
GENERAL.—Section 2103(c) (42 U.S.C. 
1397cc(c)), as amended by section 501(a)(1)(B), is amended 
by adding at the end the following new paragraph: 
‘‘(8) AVAILABILITY
OF
COVERAGE
FOR
ITEMS 
AND SERVICES FURNISHED THROUGH SCHOOL-BASED 
HEALTH CENTERS.—Nothing in this title shall be con-
strued as limiting a State’s ability to provide child 
health assistance for covered items and services that 
are furnished through school-based health centers (as 
defined in section 2110(c)(9)).’’. 
(b) DEFINITION.—Section 2110(c) (42 U.S.C. 1397jj) 
is amended by adding at the end the following: 
‘‘(9) SCHOOL-BASED HEALTH CENTER.— 
‘‘(A) IN GENERAL.—The term ‘school-based 
health center’ means a health clinic that— 
‘‘(i) is located in or near a school facil-
ity of a school district or board or of an In-
dian tribe or tribal organization;
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† HR 2 EAS 
‘‘(ii) is organized through school, com-
munity, and health provider relationships; 
‘‘(iii) is administered by a sponsoring 
facility; 
‘‘(iv) provides through health profes-
sionals primary health services to children 
in accordance with State and local law, in-
cluding laws relating to licensure and cer-
tification; and 
‘‘(v) satisfies such other requirements 
as a State may establish for the operation 
of such a clinic. 
‘‘(B) SPONSORING FACILITY.—For purposes 
of subparagraph (A)(iii), the term ‘sponsoring 
facility’ includes any of the following: 
‘‘(i) A hospital. 
‘‘(ii) A public health department. 
‘‘(iii) A community health center. 
‘‘(iv) A nonprofit health care agency. 
‘‘(v) A school or school system. 
‘‘(vi) A program administered by the 
Indian Health Service or the Bureau of In-
dian Affairs or operated by an Indian tribe 
or a tribal organization.’’.
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† HR 2 EAS 
SEC. 506. MEDICAID AND CHIP PAYMENT AND ACCESS COM-
MISSION. 
(a) IN GENERAL.—Title XIX (42 U.S.C. 1396 et seq.) 
is amended by inserting before section 1901 the following 
new section: 
‘‘MEDICAID AND CHIP PAYMENT AND ACCESS COMMISSION 
‘‘SEC. 1900. (a) ESTABLISHMENT.—There is hereby es-
tablished the Medicaid and CHIP Payment and Access 
Commission (in this section referred to as ‘MACPAC’). 
‘‘(b) DUTIES.— 
‘‘(1) REVIEW OF ACCESS POLICIES AND ANNUAL 
REPORTS.—MACPAC shall— 
‘‘(A) review policies of the Medicaid pro-
gram established under this title (in this section 
referred to as ‘Medicaid’) and the State Chil-
dren’s Health Insurance Program established 
under title XXI (in this section referred to as 
‘CHIP’) affecting children’s access to covered 
items and services, including topics described in 
paragraph (2); 
‘‘(B) make recommendations to Congress 
concerning such access policies; 
‘‘(C) by not later than March 1 of each year 
(beginning with 2010), submit a report to Con-
gress containing the results of such reviews and
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† HR 2 EAS 
MACPAC’s recommendations concerning such 
policies; and 
‘‘(D) by not later than June 1 of each year 
(beginning with 2010), submit a report to Con-
gress containing an examination of issues affect-
ing Medicaid and CHIP, including the implica-
tions of changes in health care delivery in the 
United States and in the market for health care 
services on such programs. 
‘‘(2) SPECIFIC TOPICS TO BE REVIEWED.—Spe-
cifically, MACPAC shall review and assess the fol-
lowing: 
‘‘(A) MEDICAID AND CHIP PAYMENT POLI-
CIES.—Payment policies under Medicaid and 
CHIP, including— 
‘‘(i) the factors affecting expenditures 
for items and services in different sectors, 
including the process for updating hospital, 
skilled nursing facility, physician, Feder-
ally-qualified health center, rural health 
center, and other fees; 
‘‘(ii) payment methodologies; and 
‘‘(iii) the relationship of such factors 
and methodologies to access and quality of 
care for Medicaid and CHIP beneficiaries.
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† HR 2 EAS 
‘‘(B) INTERACTION OF MEDICAID AND CHIP 
PAYMENT POLICIES WITH HEALTH CARE DELIV-
ERY
GENERALLY.—The effect of Medicaid and 
CHIP payment policies on access to items and 
services for children and other Medicaid and 
CHIP populations other than under this title or 
title XXI and the implications of changes in 
health care delivery in the United States and in 
the general market for health care items and 
services on Medicaid and CHIP. 
‘‘(C) OTHER ACCESS POLICIES.—The effect 
of other Medicaid and CHIP policies on access 
to covered items and services, including policies 
relating to transportation and language barriers. 
‘‘(3) CREATION OF EARLY-WARNING SYSTEM.— 
MACPAC shall create an early-warning system to 
identify provider shortage areas or any other prob-
lems that threaten access to care or the health care 
status of Medicaid and CHIP beneficiaries. 
‘‘(4) COMMENTS ON CERTAIN SECRETARIAL RE-
PORTS.—If the Secretary submits to Congress (or a 
committee of Congress) a report that is required by 
law and that relates to access policies, including with 
respect to payment policies, under Medicaid or CHIP, 
the Secretary shall transmit a copy of the report to
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† HR 2 EAS 
MACPAC. MACPAC shall review the report and, not 
later than 6 months after the date of submittal of the 
Secretary’s report to Congress, shall submit to the ap-
propriate committees of Congress written comments 
on such report. Such comments may include such rec-
ommendations as MACPAC deems appropriate. 
‘‘(5) AGENDA
AND
ADDITIONAL
REVIEWS.— 
MACPAC shall consult periodically with the chair-
men and ranking minority members of the appro-
priate committees of Congress regarding MACPAC’s 
agenda and progress towards achieving the agenda. 
MACPAC may conduct additional reviews, and sub-
mit additional reports to the appropriate committees 
of Congress, from time to time on such topics relating 
to the program under this title or title XXI as may 
be requested by such chairmen and members and as 
MACPAC deems appropriate. 
‘‘(6) AVAILABILITY
OF
REPORTS.—MACPAC 
shall transmit to the Secretary a copy of each report 
submitted under this subsection and shall make such 
reports available to the public. 
‘‘(7) APPROPRIATE COMMITTEE OF CONGRESS.— 
For purposes of this section, the term ‘appropriate 
committees of Congress’ means the Committee on En-