H. R. 2—86 
‘‘(8) VOTING AND REPORTING REQUIREMENTS.—With respect 
to each recommendation contained in a report submitted under 
paragraph (1), each member of MACPAC shall vote on the 
recommendation, and MACPAC shall include, by member, the 
results of that vote in the report containing the recommenda-
tion. 
‘‘(9) EXAMINATION
OF
BUDGET
CONSEQUENCES.—Before 
making any recommendations, MACPAC shall examine the 
budget consequences of such recommendations, directly or 
through consultation with appropriate expert entities. 
‘‘(c) MEMBERSHIP.— 
‘‘(1) NUMBER AND APPOINTMENT.—MACPAC shall be com-
posed of 17 members appointed by the Comptroller General 
of the United States. 
‘‘(2) QUALIFICATIONS.— 
‘‘(A) IN GENERAL.—The membership of MACPAC shall 
include individuals who have had direct experience as 
enrollees or parents of enrollees in Medicaid or CHIP and 
individuals with national recognition for their expertise 
in Federal safety net health programs, health finance and 
economics, actuarial science, health facility management, 
health plans and integrated delivery systems, reimburse-
ment of health facilities, health information technology, 
pediatric physicians, dentists, and other providers of health 
services, and other related fields, who provide a mix of 
different professionals, broad geographic representation, 
and a balance between urban and rural representatives. 
‘‘(B) INCLUSION.—The membership of MACPAC shall 
include (but not be limited to) physicians and other health 
professionals, employers, third-party payers, and individ-
uals with expertise in the delivery of health services. Such 
membership shall also include consumers representing chil-
dren, pregnant women, the elderly, and individuals with 
disabilities, current or former representatives of State agen-
cies responsible for administering Medicaid, and current 
or former representatives of State agencies responsible for 
administering CHIP. 
‘‘(C) MAJORITY
NONPROVIDERS.—Individuals who are 
directly involved in the provision, or management of the 
delivery, of items and services covered under Medicaid 
or CHIP shall not constitute a majority of the membership 
of MACPAC. 
‘‘(D) ETHICAL DISCLOSURE.—The Comptroller General 
of the United States shall establish a system for public 
disclosure by members of MACPAC of financial and other 
potential conflicts of interest relating to such members. 
Members of MACPAC shall be treated as employees of 
Congress for purposes of applying title I of the Ethics 
in Government Act of 1978 (Public Law 95–521). 
‘‘(3) TERMS.— 
‘‘(A) IN GENERAL.—The terms of members of MACPAC 
shall be for 3 years except that the Comptroller General 
of the United States shall designate staggered terms for 
the members first appointed. 
‘‘(B) VACANCIES.—Any member appointed to fill a 
vacancy occurring before the expiration of the term for 
which the member’s predecessor was appointed shall be
H. R. 2—87 
appointed only for the remainder of that term. A member 
may serve after the expiration of that member’s term until 
a successor has taken office. A vacancy in MACPAC shall 
be filled in the manner in which the original appointment 
was made. 
‘‘(4) COMPENSATION.—While serving on the business of 
MACPAC (including travel time), a member of MACPAC shall 
be entitled to compensation at the per diem equivalent of the 
rate provided for level IV of the Executive Schedule under 
section 5315 of title 5, United States Code; and while so serving 
away from home and the member’s regular place of business, 
a member may be allowed travel expenses, as authorized by 
the Chairman of MACPAC. Physicians serving as personnel 
of MACPAC may be provided a physician comparability allow-
ance by MACPAC in the same manner as Government physi-
cians may be provided such an allowance by an agency under 
section 5948 of title 5, United States Code, and for such purpose 
subsection (i) of such section shall apply to MACPAC in the 
same manner as it applies to the Tennessee Valley Authority. 
For purposes of pay (other than pay of members of MACPAC) 
and employment benefits, rights, and privileges, all personnel 
of MACPAC shall be treated as if they were employees of 
the United States Senate. 
‘‘(5) CHAIRMAN; VICE CHAIRMAN.—The Comptroller General 
of the United States shall designate a member of MACPAC, 
at the time of appointment of the member as Chairman and 
a member as Vice Chairman for that term of appointment, 
except that in the case of vacancy of the Chairmanship or 
Vice Chairmanship, the Comptroller General of the United 
States may designate another member for the remainder of 
that member’s term. 
‘‘(6) MEETINGS.—MACPAC shall meet at the call of the 
Chairman. 
‘‘(d) DIRECTOR AND STAFF; EXPERTS AND CONSULTANTS.—Sub-
ject to such review as the Comptroller General of the United States 
deems necessary to assure the efficient administration of MACPAC, 
MACPAC may— 
‘‘(1) employ and fix the compensation of an Executive 
Director (subject to the approval of the Comptroller General 
of the United States) and such other personnel as may be 
necessary to carry out its duties (without regard to the provi-
sions of title 5, United States Code, governing appointments 
in the competitive service); 
‘‘(2) seek such assistance and support as may be required 
in the performance of its duties from appropriate Federal 
departments and agencies; 
‘‘(3) enter into contracts or make other arrangements, as 
may be necessary for the conduct of the work of MACPAC 
(without regard to section 3709 of the Revised Statutes (41 
U.S.C. 5)); 
‘‘(4) make advance, progress, and other payments which 
relate to the work of MACPAC; 
‘‘(5) provide transportation and subsistence for persons 
serving without compensation; and 
‘‘(6) prescribe such rules and regulations as it deems nec-
essary with respect to the internal organization and operation 
of MACPAC.
H. R. 2—88 
‘‘(e) POWERS.— 
‘‘(1) OBTAINING
OFFICIAL
DATA.—MACPAC may secure 
directly from any department or agency of the United States 
information necessary to enable it to carry out this section. 
Upon request of the Chairman, the head of that department 
or agency shall furnish that information to MACPAC on an 
agreed upon schedule. 
‘‘(2) DATA COLLECTION.—In order to carry out its functions, 
MACPAC shall— 
‘‘(A) utilize existing information, both published and 
unpublished, where possible, collected and assessed either 
by its own staff or under other arrangements made in 
accordance with this section; 
‘‘(B) carry out, or award grants or contracts for, original 
research and experimentation, where existing information 
is inadequate; and 
‘‘(C) adopt procedures allowing any interested party 
to submit information for MACPAC’s use in making reports 
and recommendations. 
‘‘(3) ACCESS OF GAO TO INFORMATION.—The Comptroller 
General of the United States shall have unrestricted access 
to all deliberations, records, and nonproprietary data of 
MACPAC, immediately upon request. 
‘‘(4) PERIODIC AUDIT.—MACPAC shall be subject to periodic 
audit by the Comptroller General of the United States. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.— 
‘‘(1) REQUEST FOR APPROPRIATIONS.—MACPAC shall submit 
requests for appropriations in the same manner as the Comp-
troller General of the United States submits requests for appro-
priations, but amounts appropriated for MACPAC shall be sepa-
rate from amounts appropriated for the Comptroller General 
of the United States. 
‘‘(2) AUTHORIZATION.—There are authorized to be appro-
priated such sums as may be necessary to carry out the provi-
sions of this section.’’. 
(b) DEADLINE
FOR INITIAL APPOINTMENTS.—Not later than 
January 1, 2010, the Comptroller General of the United States 
shall appoint the initial members of the Medicaid and CHIP Pay-
ment and Access Commission established under section 1900 of 
the Social Security Act (as added by subsection (a)). 
(c) ANNUAL REPORT ON MEDICAID.—Not later than January 
1, 2010, and annually thereafter, the Secretary, in consultation 
with the Secretary of the Treasury, the Secretary of Labor, and 
the States (as defined for purposes of Medicaid), shall submit an 
annual report to Congress on the financial status of, enrollment 
in, and spending trends for, Medicaid for the fiscal year ending 
on September 30 of the preceding year.
H. R. 2—89 
TITLE VI—PROGRAM INTEGRITY AND 
OTHER MISCELLANEOUS PROVISIONS 
Subtitle A—Program Integrity and Data 
Collection 
SEC. 601. PAYMENT ERROR RATE MEASUREMENT (‘‘PERM’’). 
(a) EXPENDITURES RELATED TO COMPLIANCE WITH REQUIRE-
MENTS.— 
(1) ENHANCED
PAYMENTS.—Section 2105(c) (42 U.S.C. 
1397ee(c)), as amended by section 301(a), is amended by adding 
at the end the following new paragraph: 
‘‘(11) ENHANCED
PAYMENTS.—Notwithstanding subsection 
(b), the enhanced FMAP with respect to payments under sub-
section (a) for expenditures related to the administration of 
the payment error rate measurement (PERM) requirements 
applicable to the State child health plan in accordance with 
the Improper Payments Information Act of 2002 and parts 
431 and 457 of title 42, Code of Federal Regulations (or any 
related or successor guidance or regulations) shall in no event 
be less than 90 percent.’’. 
(2) EXCLUSION OF FROM CAP ON ADMINISTRATIVE EXPENDI-
TURES.—Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)C)), as 
amended by section 302(b)), is amended by adding at the end 
the following: 
‘‘(iv) PAYMENT ERROR RATE MEASUREMENT (PERM) 
EXPENDITURES.—Expenditures related to the adminis-
tration of the payment error rate measurement 
(PERM) requirements applicable to the State child 
health plan in accordance with the Improper Payments 
Information Act of 2002 and parts 431 and 457 of 
title 42, Code of Federal Regulations (or any related 
or successor guidance or regulations).’’. 
(b) FINAL RULE REQUIRED TO BE IN EFFECT FOR ALL STATES.— 
Notwithstanding parts 431 and 457 of title 42, Code of Federal 
Regulations (as in effect on the date of enactment of this Act), 
the Secretary shall not calculate or publish any national or State- 
specific error rate based on the application of the payment error 
rate measurement (in this section referred to as ‘‘PERM’’) require-
ments to CHIP until after the date that is 6 months after the 
date on which a new final rule (in this section referred to as 
the ‘‘new final rule’’) promulgated after the date of the enactment 
of this Act and implementing such requirements in accordance 
with the requirements of subsection (c) is in effect for all States. 
Any calculation of a national error rate or a State specific error 
rate after such new final rule in effect for all States may only 
be inclusive of errors, as defined in such new final rule or in 
guidance issued within a reasonable time frame after the effective 
date for such new final rule that includes detailed guidance for 
the specific methodology for error determinations. 
(c) REQUIREMENTS
FOR NEW FINAL RULE.—For purposes of 
subsection (b), the requirements of this subsection are that the 
new final rule implementing the PERM requirements shall— 
(1) include—