(and assuming that section 1862(b)(2)(A)(i) did not 
apply). 
‘‘(2) ANNUAL PREMIUM.—Subject to subsection 
(d), the annual premium under this subsection for 
months in a year is equal to 25 percent of the aver-
age, annual per capita amount estimated under 
paragraph (1) for the year. 
‘‘(c) PAYMENT OF MONTHLY PREMIUM.— 
‘‘(1) PERIOD OF PAYMENT.—In the case of an 
individual who participates in the program estab-
lished by this title, subject to subsection (d), the 
monthly premium shall be payable for the period 
commencing with the first month of the individual’s 
coverage period and ending with the month in which 
the individual’s coverage under this title terminates. 
‘‘(2) COLLECTION
THROUGH
TAX
RETURN.— 
For provisions providing for the payment of monthly 
premiums under this subsection, see section 59B of 
the Internal Revenue Code of 1986. 
‘‘(3) 
PROTECTIONS
AGAINST
FRAUD
AND 
ABUSE.—The Secretary shall develop, in coordina-
tion with States and other health insurance issuers, 
administrative systems to ensure that claims which 
are submitted to more than one payor are coordi-
nated and duplicate payments are not made. 
VerDate Aug 31 2005 
23:19 May 18, 2007
Jkt 059200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H2357.IH
H2357
hsrobinson on PROD1PC76 with BILLS
‘‘(d) REDUCTION IN PREMIUM FOR CERTAIN LOW- 
INCOME FAMILIES.—For provisions reducing the premium 
under this section for certain low-income families, see sec-
tion 59B(d) of the Internal Revenue Code of 1986. 
‘‘SEC. 2204. MEDIKIDS TRUST FUND. 
‘‘(a) ESTABLISHMENT OF TRUST FUND.— 
‘‘(1) IN GENERAL.—There is hereby created on 
the books of the Treasury of the United States a 
trust fund to be known as the ‘MediKids Trust 
Fund’ (in this section referred to as the ‘Trust 
Fund’). The Trust Fund shall consist of such gifts 
and bequests as may be made as provided in section 
201(i)(1) and such amounts as may be deposited in, 
or appropriated to, such fund as provided in this 
title. 
‘‘(2) PREMIUMS.—Premiums collected under 
section 59B of the Internal Revenue Code of 1986 
shall be periodically transferred to the Trust Fund. 
‘‘(3) TRANSITIONAL FUNDING BEFORE RECEIPT 
OF PREMIUMS.—In order to provide for funds in the 
Trust Fund to cover expenditures from the fund in 
advance of receipt of premiums under section 2203, 
there are transferred to the Trust Fund from the 
general fund of the United States Treasury such 
amounts as may be necessary. 
VerDate Aug 31 2005 
23:19 May 18, 2007
Jkt 059200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6201
E:\BILLS\H2357.IH
H2357
hsrobinson on PROD1PC76 with BILLS
‘‘(b) INCORPORATION OF PROVISIONS.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
subsection (b) (other than the last sentence) and 
subsections (c) through (i) of section 1841 shall 
apply with respect to the Trust Fund and this title 
in the same manner as they apply with respect to 
the Federal Supplementary Medical Insurance Trust 
Fund and part B, respectively. 
‘‘(2) MISCELLANEOUS REFERENCES.—In apply-
ing provisions of section 1841 under paragraph 
(1)— 
‘‘(A) any reference in such section to ‘this 
part’ is construed to refer to title XXII; 
‘‘(B) any reference in section 1841(h) to 
section 1840(d) and in section 1841(i) to sec-
tions 1840(b)(1) and 1842(g) are deemed ref-
erences to comparable authority exercised under 
this title; 
‘‘(C) payments may be made under section 
1841(g) to the Trust Funds under sections 
1817 and 1841 as reimbursement to such funds 
for payments they made for benefits provided 
under this title; and 
‘‘(D) the Board of Trustees of the 
MediKids Trust Fund shall be the same as the 
VerDate Aug 31 2005 
23:19 May 18, 2007
Jkt 059200
PO 00000
Frm 00019
Fmt 6652
Sfmt 6201
E:\BILLS\H2357.IH
H2357
hsrobinson on PROD1PC76 with BILLS
Board of Trustees of the Federal Supple-
mentary Medical Insurance Trust Fund. 
‘‘SEC. 2205. OVERSIGHT AND ACCOUNTABILITY. 
‘‘(a) PERIODIC GAO REPORTS.—The Comptroller 
General of the United States shall periodically submit to 
Congress reports on the operation of the program under 
this title, including on the financing of coverage provided 
under this title. 
‘‘(b) PERIODIC MEDPAC REPORTS.—The Medicare 
Payment Advisory Commission shall periodically report to 
Congress concerning the program under this title. 
‘‘SEC. 2206. INCLUSION OF CARE COORDINATION SERVICES. 
‘‘(a) IN GENERAL.— 
‘‘(1) PROGRAM
AUTHORITY.—The Secretary, 
beginning in 2009, may implement a care coordina-
tion services program in accordance with the provi-
sions of this section under which, in appropriate cir-
cumstances, eligible individuals under section 2201 
may elect to have health care services covered under 
this title managed and coordinated by a designated 
care coordinator. 
‘‘(2) ADMINISTRATION
BY
CONTRACT.—The 
Secretary may administer the program under this 
section through a contract with an appropriate pro-
gram administrator. 
VerDate Aug 31 2005 
23:19 May 18, 2007
Jkt 059200
PO 00000
Frm 00020
Fmt 6652
Sfmt 6201
E:\BILLS\H2357.IH
H2357
hsrobinson on PROD1PC76 with BILLS
‘‘(3) COVERAGE.—Care coordination services 
furnished in accordance with this section shall be 
treated under this title as if they were included in 
the definition of medical and other health services 
under section 1861(s) and benefits shall be available 
under this title with respect to such services without 
the application of any deductible or coinsurance. 
‘‘(b) ELIGIBILITY CRITERIA; IDENTIFICATION AND 
NOTIFICATION OF ELIGIBLE INDIVIDUALS.— 
‘‘(1) INDIVIDUAL ELIGIBILITY CRITERIA.—The 
Secretary shall specify criteria to be used in making 
a determination as to whether an individual may ap-
propriately be enrolled in the care coordination serv-
ices program under this section, which shall include 
at least a finding by the Secretary that for cohorts 
of individuals with characteristics identified by the 
Secretary, professional management and coordina-
tion of care can reasonably be expected to improve 
processes or outcomes of health care and to reduce 
aggregate costs to the programs under this title. 
‘‘(2) PROCEDURES
TO
FACILITATE
ENROLL-
MENT.—The Secretary shall develop and implement 
procedures designed to facilitate enrollment of eligi-
ble individuals in the program under this section. 
‘‘(c) ENROLLMENT OF INDIVIDUALS.— 
VerDate Aug 31 2005 
23:19 May 18, 2007
Jkt 059200
PO 00000
Frm 00021
Fmt 6652
Sfmt 6201
E:\BILLS\H2357.IH
H2357
hsrobinson on PROD1PC76 with BILLS
‘‘(1) SECRETARY’S DETERMINATION OF ELIGI-
BILITY.—The Secretary shall determine the eligi-
bility for services under this section of individuals 
who are enrolled in the program under this section 
and who make application for such services in such 
form and manner as the Secretary may prescribe. 
‘‘(2) ENROLLMENT PERIOD.— 
‘‘(A) EFFECTIVE DATE AND DURATION.— 
Enrollment of an individual in the program 
under this section shall be effective as of the 
first day of the month following the month in 
which the Secretary approves the individual’s 
application under paragraph (1), shall remain 
in effect for one month (or such longer period 
as the Secretary may specify), and shall be 
automatically renewed for additional periods, 
unless terminated in accordance with such pro-
cedures as the Secretary shall establish by regu-
lation. Such procedures shall permit an indi-
vidual to disenroll for cause at any time and 
without cause at re-enrollment intervals. 
‘‘(B) LIMITATION
ON
REENROLLMENT.— 
The Secretary may establish limits on an indi-
vidual’s eligibility to reenroll in the program 
under this section if the individual has 
VerDate Aug 31 2005 
23:19 May 18, 2007
Jkt 059200
PO 00000
Frm 00022
Fmt 6652
Sfmt 6201
E:\BILLS\H2357.IH
H2357
hsrobinson on PROD1PC76 with BILLS
disenrolled from the program more than once 
during a specified time period. 
‘‘(d) PROGRAM.—The care coordination services pro-
gram under this section shall include the following ele-
ments: 
‘‘(1) BASIC CARE COORDINATION SERVICES.— 
‘‘(A) IN GENERAL.—Subject to the cost-ef-
fectiveness criteria specified in subsection 
(b)(1), except as otherwise provided in this sec-
tion, enrolled individuals shall receive services 
described in section 1905(t)(1) and may receive 
additional items and services as described in 
subparagraph (B). 
‘‘(B) ADDITIONAL
BENEFITS.—The Sec-
retary may specify additional benefits for which 
payment would not otherwise be made under 
this title that may be available to individuals 
enrolled in the program under this section (sub-
ject to an assessment by the care coordinator of 
an individual’s circumstance and need for such 
benefits) in order to encourage enrollment in, or 
to improve the effectiveness of, such program. 
‘‘(2) CARE
COORDINATION
REQUIREMENT.— 
Notwithstanding any other provision of this title, the 
Secretary may provide that an individual enrolled in 
VerDate Aug 31 2005 
23:19 May 18, 2007
Jkt 059200
PO 00000
Frm 00023
Fmt 6652
Sfmt 6201
E:\BILLS\H2357.IH
H2357
hsrobinson on PROD1PC76 with BILLS
the program under this section may be entitled to 
payment under this title for any specified health 
care items or services only if the items or services 
have been furnished by the care coordinator, or co-
ordinated through the care coordination services pro-
gram. Under such provision, the Secretary shall pre-
scribe exceptions for emergency medical services as 
described in section 1852(d)(3), and other excep-
tions determined by the Secretary for the delivery of 
timely and needed care. 
‘‘(e) CARE COORDINATORS.— 
‘‘(1) CONDITIONS OF PARTICIPATION.—In order 
to be qualified to furnish care coordination services 
under this section, an individual or entity shall— 
‘‘(A) be a health care professional or entity 
(which may include physicians, physician group 
practices, or other health care professionals or 
entities the Secretary may find appropriate) 
meeting such conditions as the Secretary may 
specify; 
‘‘(B) have entered into a care coordination 
agreement; and 
‘‘(C) meet such criteria as the Secretary 
may establish (which may include experience in 
VerDate Aug 31 2005 
23:19 May 18, 2007
Jkt 059200
PO 00000
Frm 00024
Fmt 6652
Sfmt 6201
E:\BILLS\H2357.IH
H2357
hsrobinson on PROD1PC76 with BILLS
the provision of care coordination or primary 
care physician’s services). 
‘‘(2) AGREEMENT TERM; PAYMENT.— 
‘‘(A) DURATION AND RENEWAL.—A care 
coordination agreement under this subsection 
shall be for one year and may be renewed if the 
Secretary is satisfied that the care coordinator 
continues to meet the conditions of participa-
tion specified in paragraph (1). 
‘‘(B) PAYMENT FOR SERVICES.—The Sec-
retary may negotiate or otherwise establish pay-
ment terms and rates for services described in 
subsection (d)(1). 
‘‘(C) LIABILITY.—Care coordinators shall 
be subject to liability for actual health damages 
which may be suffered by recipients as a result 
of the care coordinator’s decisions, failure or 
delay in making decisions, or other actions as 
a care coordinator. 
‘‘(D) TERMS.—In addition to such other 
terms as the Secretary may require, an agree-
ment under this section shall include the terms 
specified in subparagraphs (A) through (C) of 
section 1905(t)(3). 
VerDate Aug 31 2005 
23:19 May 18, 2007
Jkt 059200
PO 00000
Frm 00025
Fmt 6652
Sfmt 6201
E:\BILLS\H2357.IH
H2357
hsrobinson on PROD1PC76 with BILLS
‘‘SEC. 2207. ADMINISTRATION AND MISCELLANEOUS. 
‘‘(a) IN GENERAL.—Except as otherwise provided in 
this title— 
‘‘(1) the Secretary shall enter into appropriate 
contracts with providers of services, other health 
care providers, carriers, and fiscal intermediaries, 
taking into account the types of contracts used 
under title XVIII with respect to such entities, to 
administer the program under this title; 
‘‘(2) beneficiary protections for individuals en-
rolled under this title shall not be less than the ben-
eficiary protections (including limits on balance bill-
ing) provided medicare beneficiaries under title 
XVIII; 
‘‘(3) benefits described in section 2202 that are 
payable under this title to such individuals shall be 
paid in a manner specified by the Secretary (taking 
into account, and based to the greatest extent prac-
ticable upon, the manner in which they are provided 
under title XVIII); and 
‘‘(4) provider participation agreements under 
title XVIII shall apply to enrollees and benefits 
under this title in the same manner as they apply 
to enrollees and benefits under title XVIII. 
‘‘(b) 
COORDINATION
WITH
MEDICAID
AND 
SCHIP.—Notwithstanding any other provision of law, in-
VerDate Aug 31 2005 
23:19 May 18, 2007
Jkt 059200
PO 00000
Frm 00026
Fmt 6652
Sfmt 6201
E:\BILLS\H2357.IH
H2357
hsrobinson on PROD1PC76 with BILLS
dividuals entitled to benefits for items and services under 
this title who also qualify for benefits under title XIX or 
XXI or any other Federally funded health care program 
that provides basic health insurance coverage described in 
section 2203(a)(2) may continue to qualify and obtain 
benefits under such other title or program, and in such 
case such an individual shall elect either— 
‘‘(1) such other title or program to be primary 
payor to benefits under this title, in which case no 
benefits shall be payable under this title and the 
monthly premium under section 2203 shall be zero; 
or 
‘‘(2) benefits under this title shall be primary 
payor to benefits provided under such title or pro-
gram, in which case the Secretary shall enter into 
agreements with States as may be appropriate to 
provide that, in the case of such individuals, the ben-
efits under titles XIX and XXI or such other pro-
gram (including reduction of cost-sharing) are pro-
vided on a ‘wrap-around’ basis to the benefits under 
this title.’’. 
(b) CONFORMING AMENDMENTS TO SOCIAL SECU-
RITY ACT PROVISIONS.— 
(1) Section 201(i)(1) of the Social Security Act 
(42 U.S.C. 401(i)(1)) is amended by striking ‘‘or the 
VerDate Aug 31 2005 
23:19 May 18, 2007
Jkt 059200
PO 00000
Frm 00027
Fmt 6652
Sfmt 6201
E:\BILLS\H2357.IH
H2357
hsrobinson on PROD1PC76 with BILLS
Federal Supplementary Medical Insurance Trust 
Fund’’ and inserting ‘‘the Federal Supplementary 
Medical Insurance Trust Fund, and the MediKids 
Trust Fund’’. 
(2) Section 201(g)(1)(A) of such Act (42 
U.S.C. 401(g)(1)(A)) is amended by striking ‘‘and 
the Federal Supplementary Medical Insurance Trust 
Fund established by title XVIII’’ and inserting ‘‘, 
the Federal Supplementary Medical Insurance Trust 
Fund, and the MediKids Trust Fund established by 
title XVIII’’. 
(c) MAINTENANCE OF MEDICAID ELIGIBILITY AND 
BENEFITS FOR CHILDREN.— 
(1) IN GENERAL.—In order for a State to con-
tinue to be eligible for payments under section 
1903(a) of the Social Security Act (42 U.S.C. 
1396b(a))— 
(A) the State may not reduce standards of 
eligibility, or benefits, provided under its State 
medicaid plan under title XIX of the Social Se-
curity Act or under its State child health plan 
under title XXI of such Act for individuals 
under 23 years of age below such standards of 
eligibility, and benefits, in effect on the date of 
the enactment of this Act; and 
VerDate Aug 31 2005 
23:19 May 18, 2007
Jkt 059200
PO 00000
Frm 00028
Fmt 6652
Sfmt 6201
E:\BILLS\H2357.IH
H2357
hsrobinson on PROD1PC76 with BILLS