(E) Three members shall be appointed by 
the minority leader of the House of Representa-
tives of whom— 
(i) one shall be a Member or former 
Member of Congress; 
(ii) one shall be an advocate for popu-
lations who are served by Medicaid; and 
(iii) one shall be a health care pro-
vider that provides a disproportionate 
share of care to recipients of benefits 
under Medicaid or a representative of an 
organization that represent such providers. 
(F) Two members shall be appointed by 
the National Governors Association and shall be 
chief executive officers of a State who are not 
of the same political party. 
(G) Two members shall be appointed by 
the National Conference of State Legislatures 
and shall be members of a State legislature who 
are not of the same political party. 
(H) Two members shall be appointed by 
the National Association of State Medicaid Di-
rectors and shall be chief officials responsible 
for administering Medicaid in a State who are 
not of the same political party.
(I) Two members shall be appointed by the 
National Association of Counties and shall be 
officials of a local government involved in Med-
icaid financing or that directly provides medical 
services to Medicaid beneficiaries and uninsured 
individuals who are not of the same political 
party. 
(J) Two members shall be appointed by 
the Comptroller General of the United States 
and shall be health policy experts with special 
expertise regarding Medicaid or the populations 
served by Medicaid who are not of the same po-
litical party. 
(2) QUALIFICATIONS.—The members of the 
Commission appointed under paragraph (1), shall 
reflect— 
(A) a broad geographic representation; and 
(B) a balance between urban and rural 
representation. 
(3) DEADLINE FOR APPOINTMENT.—Members 
of the Commission shall be appointed by not later 
than the 60th day after the date of enactment of 
this Act. 
(c) DUTIES OF COMMISSION.— 
(1) IN GENERAL.—The Commission shall—
(A) review and make recommendations 
with respect to each of Medicaid’s major func-
tional responsibilities, including being— 
(i) a source of coverage for low-income 
children, pregnant women, and some par-
ents; 
(ii) a payer for a complex range of 
acute and long-term care services for the 
frail elderly and individuals with disabil-
ities, including the medically needy; 
(iii) the source of wrap-around cov-
erage or assistance for low-income seniors 
and individuals with disabilities on Medi-
care, including coverage of additional bene-
fits and assistance with Medicare pre-
miums and copayments; and 
(iv) the primary source of funding to 
safety net providers that serve both Med-
icaid patients and the 45,000,000 unin-
sured; 
(B) review and make recommendations for 
a clearer delineation of— 
(i) the Federal and State roles and re-
sponsibilities under Medicaid; and
(ii) the interaction of Medicaid with 
Medicare and other Federal health pro-
grams; 
(C) review and identify issues that either 
threaten or could improve the long-term finan-
cial condition of Medicaid, including forth-
coming demographic changes, Federal and 
State revenue options, private sector health cov-
erage, and health care information; 
(D) review the Federal matching payments 
and requirements under Medicaid, and issues 
related to such payments and requirements, and 
make recommendations on how to make such 
payments more equitable with respect to the 
populations served and the States, and on how 
to improve the program’s responsiveness to 
changes in economic conditions; 
(E) review and make recommendations 
with respect to health care for individuals du-
ally eligible for both Medicare and Medicaid, in-
cluding issues related to Federal, State, pro-
vider, and beneficiary responsibilities, coordina-
tion, and outcomes; 
(F) review research and data with respect 
to health disparities for populations served by
Medicaid, particularly with respect to individ-
uals with disabilities or special health care 
needs, and make recommendations on how to 
improve health quality, coordination of services 
and providers, and access to health care for vul-
nerable populations, including the implementa-
tion of managed care protections for Medicaid 
enrollees with special health care needs; 
(G) review Federal and State policies for 
enrollment (including enrollment sites), income 
eligibility (including methodology and length of 
eligibility periods), outreach, and documentation 
with respect to Medicaid and Medicare and 
make recommendations on how to simplify such 
policies and improve enrollment and retention 
in such programs and coordination with other 
Federal and State programs to improve service 
delivery and coverage; 
(H) review the operation and effectiveness 
of Medicaid premium assistance programs, in-
cluding the payment of premiums under section 
1906(a)(3) of the Social Security Act (42 
U.S.C. 1396e(a)(3)) and payment waivers 
under section 1115 of such Act (42 U.S.C. 
1315), and the adequacy of covered benefits, af-
fordability of cost-sharing and premiums, and 
access to care under such programs; 
(I) review and make recommendations re-
garding payment policies under Medicaid, in-
cluding the adequacy of such policies with re-
spect to— 
(i) managed care plans (including 
payment policies for single benefit man-
aged care arrangements, such as managed 
behavioral health and dental care); 
(ii) providers in managed care, fee- 
for-service, long-term care, and primary 
care case management settings; and 
(iii) measures to assure and reward 
quality and access to care for Medicaid en-
rollees; 
(J) review how Medicare payment policies 
impact Medicaid and make recommendations on 
ways to address specific payment problems that 
such policies may create in service delivery to 
populations typically not covered by Medicare, 
such as children and pregnant women; 
(K) review payments to safety net pro-
viders, including a review of—
(i) the adjustments to payments under 
Medicaid— 
(I) under section 1923 of the So-
cial Security Act (42 U.S.C. 1396r–4) 
for inpatient hospital services fur-
nished by disproportionate share hos-
pitals; and 
(II) under section 1902(bb) of 
such Act (42 U.S.C. 1396a(bb)) for 
payments to Federally-qualified health 
centers and rural health clinics; and 
(ii) other payments that impact the 
capacity of the health care safety net to 
care for uninsured individuals, recipients of 
benefits under Medicaid, and other vulner-
able populations; 
(L) review interstate payment, enrollment, 
access, and quality concerns with respect to re-
cipients of benefits under Medicaid that are 
served by interstate providers, and make rec-
ommendations on ways to improve interstate 
health care delivery; 
(M) review and make recommendations 
with respect to financing and other issues im-
pacting Commonwealth and territorial programs 
as compared to other States; and 
(N) review and make recommendations on 
such other matters related to Medicaid as the 
Commission deems appropriate. 
(2) ANALYSIS
OF
EFFECT
OF
EACH
REC-
OMMENDATION.—Each 
recommendation 
required 
under paragraph (1) shall include an analysis of the 
effect of the recommendation under Medicaid and, if 
applicable, Medicare and other Federal health pro-
grams, on— 
(A) Federal and State expenditures; 
(B) provider payment rates; 
(C) beneficiary out-of-pocket expenditures; 
(D) beneficiary access to covered items and 
services; and 
(E) coverage of items and services. 
(3) EXPERT ADVICE.—The Comptroller General 
of the United States and the Director of the Con-
gressional Research Service shall advise the Commis-
sion on the methodology to be used in identifying 
problems and analyzing potential solutions in ac-
cordance with the duties of the Commission de-
scribed in paragraph (1). 
(d) GENERAL ADMINISTRATIVE PROVISIONS.—
(1) TERMS OF APPOINTMENT.—The members 
of the Commission shall be appointed for the life of 
the Commission. 
(2) VACANCIES.—A vacancy on the Commission 
shall be filled, not later than 30 days after the date 
on which the Commission is given notice of the va-
cancy, in the same manner in which the original ap-
pointment was made. 
(3) CHAIRPERSON AND VICE CHAIRPERSON.— 
The Commission shall designate 2 of its members to 
serve as the chairperson and vice chairperson of the 
Commission. 
(4) MEETINGS.—The Commission shall meet at 
the call of the chairperson of the Commission. 
(5) QUORUM.—Twelve members of the Commis-
sion shall constitute a quorum for purposes of vot-
ing, but a lesser number of members may meet and 
hold hearings. 
(6) COMPENSATION AND EXPENSES.— 
(A) COMPENSATION.—Except as provided 
in subparagraph (B), members of the Commis-
sion shall receive no additional pay, allowances, 
or benefits by reason of their service on the 
Commission.
(B) EXPENSES.—While away from their 
homes or regular places of business in the per-
formance of services for the Commission, mem-
bers of the Commission shall be allowed travel 
expenses, 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. 
(7) ETHICAL
DISCLOSURE.—The Comptroller 
General of the United States shall establish and im-
plement a system for public disclosure of financial 
and other potential conflicts of interest by members 
of the Commission. 
(e) STAFF AND SUPPORT SERVICES.— 
(1) EXECUTIVE
DIRECTOR.—The chairperson 
and vice-chair shall appoint an executive director of 
the Commission. 
(2) STAFF.—With the approval of the Commis-
sion, the executive director may appoint such per-
sonnel as the executive director determines to be ap-
propriate. 
(3) APPLICABILITY
OF
CIVIL
SERVICE
LAW; 
ETC.—The executive director and staff of the Com-
mission shall be appointed without regard to the 
provisions of title 5, United States Code, governing
appointment in the competitive service, and shall be 
paid without regard to chapter 51 and subchapter 
III of chapter 53 of title 5, United States Code, re-
lating to classification of positions and General 
Schedule pay rates, except that the rate of pay for 
the executive director and other personnel may not 
exceed the rate payable for level V of the Executive 
Schedule under section 5316 of such title. 
(4) EXPERTS
AND
CONSULTANTS.—With the 
approval of the Commission, the executive director 
may procure temporary and intermittent services 
under section 3109(b) of title 5, United States Code. 
(5) FEDERAL AGENCIES.— 
(A) STAFF
OF
OTHER
FEDERAL
AGEN-
CIES.—Upon the request of the Commission, 
the head of any Federal agency may detail, 
without reimbursement, any of the personnel of 
such agency to the Commission to assist in car-
rying out the duties of the Commission. Any 
such detail shall not interrupt or otherwise af-
fect the civil service status or privileges of the 
Federal employee. 
(B) TECHNICAL
ASSISTANCE.—Upon the 
request of the Commission, the head of a Fed-
eral agency shall provide such technical assist-
ance to the Commission as the Commission de-
termines to be necessary to carry out its duties. 
(6) 
OTHER
RESOURCES.—The 
Commission 
shall have reasonable access to materials, resources, 
statistical data, and other information from the Li-
brary of Congress and agencies and elected rep-
resentatives of the executive and legislative branches 
of the Federal Government. The chairperson or vice- 
chair of the Commission shall make requests for 
such access in writing when necessary. 
(7) GSA SERVICES.— 
(A) PHYSICAL FACILITIES.—The Adminis-
trator of General Services shall locate suitable 
office space for the operation of the Commis-
sion. The facilities shall serve as the head-
quarters of the Commission and shall include 
all necessary equipment and incidentals re-
quired for the proper functioning of the Com-
mission. 
(B) 
ADMINISTRATIVE
SUPPORT
SERV-
ICES.—Upon the request of the Commission, 
the Administrator of General Services shall pro-
vide to the Commission, on a reimbursable 
basis, such administrative support services as 
the Commission may request.
(f) POWERS OF THE COMMISSION.— 
(1) HEARINGS.—The Commission shall conduct 
public hearings or forums at the discretion of the 
Commission, at any time and place the Commission 
is able to secure facilities and witnesses, for the pur-
pose of carrying out the duties of the Commission. 
(2) STUDIES OR INVESTIGATIONS.—Upon the 
request of the Commission, the Comptroller General 
of the United States, the Medicare Payment Advi-
sory Commission, or the Director of the Congres-
sional Research Service shall conduct such studies or 
investigations as the Commission determines to be 
necessary to carry out its duties. 
(3) COST
ESTIMATES.—The Director of the 
Congressional Budget Office, the Chief Actuary of 
the Centers for Medicare & Medicaid Services, the 
Medicare Payment Advisory Commission, or all 
three, shall provide to the Commission, upon the re-
quest of the Commission and without reimburse-
ment, such cost estimates as the Commission deter-
mines to be necessary to carry out its duties. 
(4) GIFTS.—The Commission may accept, use, 
and dispose of gifts or donations of services or prop-
erty.
(5) MAILS.—The Commission may use the 
United States mails in the same manner and under 
the same conditions as Federal agencies. 
(g) REPORT.— 
(1) IN GENERAL.—Not later than 14 months 
after the date of enactment of this Act, the Commis-
sion shall prepare and submit a report that contains 
a detailed statement of the recommendations, find-
ings, and conclusions of the Commission (as deter-
mined in accordance with paragraph (3)) to each of 
the following: 
(A) The President. 
(B) The Committee on Finance of the Sen-
ate. 
(C) The Committee on Energy and Com-
merce of the House of Representatives. 
(D) The chief executive officer of each 
State. 
(2) AVAILABILITY.—The report shall be made 
available to the public. 
(3) RECOMMENDATIONS, FINDINGS, AND CON-
CLUSIONS.—The recommendations, findings, and 
conclusions of the Commission shall be included in 
the report under paragraph (1) only if—
(A) each member of the Commission has 
had an opportunity to vote on such rec-
ommendation, finding, or conclusion; 
(B) the results of the vote are printed in 
the report, including a record of how each mem-
ber voted; and 
(C) at least 14 of the 23 members of the 
Commission voted in favor of such rec-
ommendation, finding, or conclusion. 
(h) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to the Commission such 
sums as may be necessary to carry out this section. 
(i) DEFINITION OF STATE.—In this Act, the term 
‘‘State’’ has the meaning given such term for purposes of 
title XIX of the Social Security Act (42 U.S.C. 1396 et 
seq.). 
(j) TERMINATION.—The Commission shall terminate 
on the date that is 30 days after the date on which the 
Commission submits the report under subsection (g) to the 
President, Congress, and the chief executive officer of each 
State. 
Æ