I 
113TH CONGRESS 
2D SESSION 
H. R. 5364 
To amend title XXI of the Social Security Act to extend and improve the 
Children’s Health Insurance Program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 31, 2014 
Mr. PALLONE (for himself, Mr. WAXMAN, Ms. SCHAKOWSKY, Ms. CASTOR of 
Florida, Mrs. CAPPS, Mrs. CHRISTENSEN, Mr. GENE GREEN of Texas, 
Mr. DINGELL, Mr. BUTTERFIELD, Mr. SARBANES, Mr. ENGEL, and Mr. 
MATHESON) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committee on 
Ways and Means, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
A BILL 
To amend title XXI of the Social Security Act to extend 
and improve the Children’s Health Insurance Program, 
and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECU-
RITY ACT; REFERENCES; TABLE OF CON-
TENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘CHIP Extension and Improvement Act of 2014’’. 
VerDate Mar 15 2010 
00:56 Aug 15, 2014
Jkt 039200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H5364.IH
H5364
smartinez on DSK4TPTVN1PROD with BILLS
(b) REFERENCES
TO
CHIP; MEDICAID; SEC-
RETARY.—In this Act: 
(1) CHIP.—The term ‘‘CHIP’’ means the 
State Children’s Health Insurance Program estab-
lished under title XXI of the Social Security Act (42 
U.S.C. 1397aa et seq.) (whether implemented under 
title XIX, XXI, or both, of the Social Security Act). 
(2) MEDICAID.—The term ‘‘Medicaid’’ means 
the program for medical assistance established under 
title XIX of the Social Security Act (42 U.S.C. 1396 
et seq.). 
(3) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(c) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; amendments to Social Security Act; references; table of con-
tents. 
Sec. 2. General effective date; exception for State legislation; reliance on law. 
TITLE I—FINANCING 
Sec. 101. 4-year extension of CHIP funding. 
Sec. 102. Performance incentive program improvements. 
Sec. 103. Child enrollment contingency fund adjustment. 
TITLE II—COVERAGE STABILITY AND REDUCED BUREAUCRACY 
Sec. 201. Improving coverage stability. 
Sec. 202. Assuring care continuity during transitions among CHIP, Medicaid, 
and qualified health plans. 
Sec. 203. Continuous eligibility option for certain adults. 
Sec. 204. State flexibility to use administrative simplification policies for enroll-
ment. 
Sec. 205. Outreach to targeted populations. 
TITLE III—BENEFITS AND AFFORDABILITY 
Sec. 301. Strengthened cost-sharing protections under CHIP. 
VerDate Mar 15 2010 
03:49 Aug 15, 2014
Jkt 039200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6211
E:\BILLS\H5364.IH
H5364
smartinez on DSK4TPTVN1PROD with BILLS
Sec. 302. Ensuring coverage of preventive health services under Medicaid and 
CHIP. 
Sec. 303. Timely immunization coverage. 
Sec. 304. Payment parity for Medicaid primary care services. 
TITLE IV—ACCESS AND QUALITY 
Subtitle A—Pediatric Quality Measures 
Sec. 401. Extending the pediatric quality measures program. 
Sec. 402. Enhanced FMAP for activities related to pediatric quality measures. 
Sec. 403. Reporting of full set of pediatric quality measures. 
Sec. 404. Technical assistance to States for adopting and utilizing pediatric 
quality measures. 
Sec. 405. Improving the effectiveness of the pediatric quality measures. 
Sec. 406. Reports regarding State-specific quality of care measures applied 
under Medicaid or CHIP. 
Sec. 407. Advisory panel regarding pediatric quality. 
Sec. 408. Extending and expanding demonstration projects. 
Subtitle B—Continuing Delivery System Reform 
Sec. 411. Supporting evidence-based care coordination in communities. 
Sec. 412. Ensuring care coordination for children. 
Subtitle C—Miscellaneous 
Sec. 421. Assuring coverage continuity for former foster care children. 
Sec. 422. Definition of therapeutic foster care as medical assistance. 
Sec. 423. Technical correction. 
SEC. 2. GENERAL EFFECTIVE DATE; EXCEPTION FOR STATE 
LEGISLATION; RELIANCE ON LAW. 
(a) GENERAL EFFECTIVE DATE.—Unless otherwise 
provided in this Act, subject to subsections (b) and (c), 
this Act (and the amendments made by this Act) shall 
take effect on October 1, 2014, and shall apply to medical 
assistance and child health assistance furnished under ti-
tles XIX and XXI, respectively, of the Social Security Act 
on or after that date. 
(b) EXCEPTION FOR STATE LEGISLATION.—In the 
case of a State plan under title XIX of the Social Security 
Act (42 U.S.C. 1396 et seq.) or a State child health plan 
VerDate Mar 15 2010 
03:49 Aug 15, 2014
Jkt 039200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H5364.IH
H5364
smartinez on DSK4TPTVN1PROD with BILLS
under title XXI of such Act (42 U.S.C. 1397aa et seq.), 
which the Secretary determines requires State legislation 
in order for the respective plan to meet one or more addi-
tional requirements imposed by amendments made by this 
Act, the respective plan shall not be regarded as failing 
to comply with the requirements of such title solely on the 
basis of its failure to meet such an additional requirement 
before the first day of the first calendar quarter beginning 
after the close of the first regular session of the State leg-
islature that begins after the date of enactment of this 
Act. For purposes of the previous sentence, in the case 
of a State that has a 2-year legislative session, each year 
of the session shall be considered to be a separate regular 
session of the State legislature. 
(c) COORDINATION OF CHIP FUNDING FOR FISCAL 
YEAR 2015.—Notwithstanding any other provision of law, 
insofar as funds have been appropriated under subsection 
(a)(18) or (m) of section 2104 of the Social Security Act 
(42 U.S.C. 1397dd), as such subsections are in effect on 
the day before the date of the enactment of this Act, to 
provide allotments to States under CHIP for fiscal year 
2015— 
(1) any amounts that are so appropriated that 
are not so allotted and obligated before April 1, 
2015, are rescinded; and 
VerDate Mar 15 2010 
03:49 Aug 15, 2014
Jkt 039200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H5364.IH
H5364
smartinez on DSK4TPTVN1PROD with BILLS
(2) any amount provided for CHIP allotments 
to a State under this Act (and the amendments 
made by this Act) for such fiscal year shall be re-
duced by the amount of such appropriations so allot-
ted and obligated before such date. 
(d) RELIANCE ON LAW.—With respect to amend-
ments made by this Act that become effective as of a 
date— 
(1) such amendments are effective as of such 
date whether or not regulations implementing such 
amendments have been issued; and 
(2) Federal financial participation for medical 
assistance or child health assistance furnished under 
title XIX or XXI, respectively, of the Social Security 
Act on or after such date by a State in good faith 
reliance on such amendments before the date of pro-
mulgation of final regulations, if any, to carry out 
such amendments (or before the date of guidance, if 
any, regarding the implementation of such amend-
ments) shall not be denied on the basis of the 
State’s failure to comply with such regulations or 
guidance. 
VerDate Mar 15 2010 
00:56 Aug 15, 2014
Jkt 039200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H5364.IH
H5364
smartinez on DSK4TPTVN1PROD with BILLS
TITLE I—FINANCING 
SEC. 101. 4-YEAR EXTENSION OF CHIP FUNDING. 
(a) FUNDING.—Section 2104(a) of the Social Secu-
rity Act (42 U.S.C. 1397dd(a)) is amended— 
(1) in paragraph (17), by striking ‘‘and’’ at the 
end; 
(2) by striking paragraph (18) and inserting 
the following new paragraph: 
‘‘(18) for fiscal year 2015, $21,061,000,000;’’; 
and 
(3) by adding at the end the following new 
paragraphs: 
‘‘(19) for fiscal year 2016, $19,300,000,000; 
‘‘(20) for fiscal year 2017, $20,300,000,000; 
‘‘(21) for fiscal year 2018, $21,300,000,000; 
and 
‘‘(22) for fiscal year 2019, for purposes of mak-
ing 2 semi-annual allotments— 
‘‘(A) $2,850,000,000 for the period begin-
ning on October 1, 2018, and ending on March 
31, 2019; and 
‘‘(B) $2,850,000,000 for the period begin-
ning on April 1, 2019, and ending on Sep-
tember 30, 2019.’’. 
(b) ALLOTMENTS.— 
VerDate Mar 15 2010 
03:49 Aug 15, 2014
Jkt 039200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H5364.IH
H5364
smartinez on DSK4TPTVN1PROD with BILLS
(1) IN GENERAL.—Section 2104(m) of the So-
cial Security Act (42 U.S.C. 1397dd(m)) is amend-
ed— 
(A) in the subsection heading, by striking 
‘‘2015’’ and inserting ‘‘2019’’; 
(B) in paragraph (2)— 
(i) in the paragraph heading, by strik-
ing ‘‘2014’’ and inserting ‘‘2018’’; and 
(ii) by striking subparagraph (B) and 
inserting the following new subparagraph: 
‘‘(B) FISCAL YEAR 2013 AND EACH SUC-
CEEDING FISCAL YEAR.—Subject to paragraphs 
(4) and (6), from the amount made available 
under paragraphs (16) through (21) of sub-
section (a) for fiscal year 2013 and each suc-
ceeding fiscal year, respectively, the Secretary 
shall compute a State allotment for each State 
(including the District of Columbia and each 
commonwealth and territory) for each such fis-
cal year as follows: 
‘‘(i) REBASING IN FISCAL YEAR 2013 
AND
EACH
SUCCEEDING
ODD-NUMBERED 
FISCAL YEAR.—For fiscal year 2013 and 
each succeeding odd-numbered fiscal year, 
the allotment of the State is equal to the 
VerDate Mar 15 2010 
00:56 Aug 15, 2014
Jkt 039200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H5364.IH
H5364
smartinez on DSK4TPTVN1PROD with BILLS
Federal payments to the State that are at-
tributable to (and countable toward) the 
total amount of allotments available under 
this section to the State in the preceding 
fiscal year (including payments made to 
the State under subsection (n) for such 
preceding fiscal year as well as amounts 
redistributed to the State in such pre-
ceding fiscal year), multiplied by the allot-
ment increase factor under paragraph (5) 
for such odd-numbered fiscal year. 
‘‘(ii) GROWTH FACTOR UPDATE FOR 
FISCAL YEAR 2014 AND EACH SUCCEEDING 
EVEN-NUMBERED FISCAL YEAR.—For fis-
cal year 2014 and each succeeding even- 
numbered fiscal year, the allotment of the 
State is equal to the sum of— 
‘‘(I) the amount of the State al-
lotment under clause (i) for the pre-
ceding fiscal year; and 
‘‘(II) the amount of any pay-
ments made to the State under sub-
section (n) for such preceding fiscal 
year, 
VerDate Mar 15 2010 
00:56 Aug 15, 2014
Jkt 039200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H5364.IH
H5364
smartinez on DSK4TPTVN1PROD with BILLS
least 5 of the enrollment and retention provi-
sions specified in subparagraph (B) (treating 
each clause as a separate enrollment and reten-
tion provision) throughout the entire fiscal year. 
‘‘(B) ENROLLMENT AND RETENTION PRO-
VISIONS.—The enrollment and retention provi-
sions specified in this subparagraph are the fol-
lowing: 
‘‘(i) CONTINUOUS ELIGIBILITY.—The 
State has elected the option of continuous 
eligibility for a full 12 months for all chil-
dren 
(as 
defined 
in 
section 
1902(e)(13)(G)), as well as applying such 
policy under its State child health plan 
under this title. 
‘‘(ii) EXPRESS
LANE
ELIGIBILITY.— 
The State is implementing the option de-
scribed in section 1902(e)(13) under title 
XIX as well as, pursuant to section 
2107(e)(1), under this title. 
‘‘(iii) PRESUMPTIVE
ELIGIBILITY.— 
The State is implementing section 1920A 
under title XIX as well as, pursuant to 
section 2107(e)(1), under this title. 
VerDate Mar 15 2010 
00:56 Aug 15, 2014
Jkt 039200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H5364.IH
H5364
smartinez on DSK4TPTVN1PROD with BILLS