how such efforts would change (if at all) under 
the State plan. 
(E) EXCEPTIONS TO FEDERAL POLICIES.— 
The State plan shall describe the exceptions to 
otherwise applicable Federal statutes, regula-
tions, and policies that would apply within the 
geographic area and time period governed by 
the plan. 
(2) TECHNICAL
ASSISTANCE.—The Secretary 
shall, if requested, provide technical assistance to 
States to assist such States in developing applica-
tions and plans under this section, including tech-
nical assistance by private sector entities if deter-
mined appropriate by the Commission. 
(3) INITIAL REVIEW.—With respect to a State 
application under subsection (b), the Secretary and 
the Commission shall complete an initial review of 
such State application within 60 days of the receipt 
of such application, analyze the scope of the pro-
posal, and determine whether additional information 
is needed from the State. The Commission shall ad-
vise the State within such period of the need to sub-
mit additional information. 
(4) FINAL DETERMINATION.— 
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(A) IN
GENERAL.—In a timely manner 
consistent with subparagraph (C), the Commis-
sion shall determine whether to submit a State 
proposal to Congress for approval. 
(B) VOTING.— 
(i) IN GENERAL.—The determination 
to submit a State proposal to Congress 
under subparagraph (A) shall be approved 
by 2⁄3 of the members of the Commission 
who are present and eligible to vote and a 
majority of the entire Commission. 
(ii) ELIGIBILITY.—A member of the 
Commission shall not participate in a de-
termination under subparagraph (A) if— 
(I) in the case of a member who 
is a Governor, such determination re-
lates to the State of which the mem-
ber is the Governor; or 
(II) in the case of member not 
described in subclause (I), such deter-
mination relates to the geographic 
area of a State of which such member 
serves as a State or local official or as 
a Member of Congress. 
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(C) SUBMISSION.—Not later than 90 days 
prior to October 1 of each fiscal year, the Com-
mission may submit to Congress a list, in the 
form of a legislative proposal, of the State ap-
plications that the Commission recommends for 
approval under this section. 
(5) PROGRAM OR PROJECT PERIOD.—A State 
program or project may be approved for a period of 
5 years and may be extended for a subsequent pe-
riod of time upon approval by the Commission, 
based upon achievement of targets. 
(e) EXPEDITED CONGRESSIONAL CONSIDERATION.— 
(1) INTRODUCTION AND EXPEDITED CONSIDER-
ATION IN THE HOUSE OF REPRESENTATIVES.— 
(A) INTRODUCTION
IN
HOUSE
OF
REP-
RESENTATIVES.—The legislative proposal sub-
mitted pursuant to subsection (d)(4)(C) shall be 
in the form of a joint resolution (in this sub-
section referred to as the ‘‘resolution’’). Such 
resolution shall be introduced in the House of 
Representatives by the Speaker immediately 
upon receipt of the language and shall be re-
ferred non-sequentially to the appropriate com-
mittee (or committees) of House of Representa-
tives. If the resolution is not introduced in ac-
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cordance with the preceding sentence, the reso-
lution may be introduced by any member of the 
House of Representatives. 
(B) COMMITTEE
CONSIDERATION.—Not 
later than 15 calendar days after the introduc-
tion of the resolution described in subparagraph 
(A), each committee of House of Representa-
tives to which the resolution was referred shall 
report the resolution. The report may include, 
at the committee’s discretion, a recommenda-
tion for action by the House. If a committee 
has not reported such resolution (or an iden-
tical resolution) at the end of 15 calendar days 
after its introduction or at the end of the first 
day after there has been reported to the House 
a resolution, whichever is earlier, such com-
mittee shall be deemed to be discharged from 
further consideration of such resolution and 
such resolution shall be placed on the appro-
priate calendar of the House of Representatives. 
(C) EXPEDITED PROCEDURE IN HOUSE.— 
Not later than 5 legislative days after the date 
on which all committees have been discharged 
from consideration of a resolution, the Speaker 
of the House of Representatives, or the Speak-
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er’s designee, shall move to proceed to the con-
sideration of the resolution. It shall also be in 
order for any member of the House of Rep-
resentatives to move to proceed to the consider-
ation of the resolution at any time after the 
conclusion of such 5-day period. All points of 
order against the resolution (and against con-
sideration of the resolution) are waived. A mo-
tion to proceed to the consideration of the reso-
lution is highly privileged in the House of Rep-
resentatives and is not debatable. The motion is 
not subject to amendment, to a motion to post-
pone consideration of the resolution, or to a mo-
tion to proceed to the consideration of other 
business. A motion to reconsider the vote by 
which the motion to proceed is agreed to or not 
agreed to shall not be in order. If the motion 
to proceed is agreed to, the House of Rep-
resentatives shall immediately proceed to con-
sideration of the resolution without intervening 
motion, order, or other business, and the reso-
lution shall remain the unfinished business of 
the House of Representatives until disposed of. 
A motion to recommit the resolution shall not 
be in order. Upon its passage in the House, the 
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clerk of the House shall provide for its imme-
diate transmittal to the Senate. 
(2) EXPEDITED CONSIDERATION IN THE SEN-
ATE.— 
(A) REFERRAL
TO
COMMITTEE.—If the 
resolution is agreed to by the House of Rep-
resentatives, upon its receipt in the Senate the 
majority leader of the Senate, or the leader’s 
designee, the resolution shall be referred to the 
appropriate committee of Senate. 
(B) COMMITTEE
CONSIDERATION.—Not 
later than 15 calendar days after the referral of 
the resolution under subparagraph (A), the 
committee of the Senate to which the resolution 
was referred shall report the resolution. The re-
port may include, at the committee’s discretion, 
a recommendation for action by the Senate. If 
a committee has not reported such resolution 
(or an identical resolution) at the end of 15 cal-
endar days after its referral or at the end of the 
first day after there has been reported to the 
Senate a resolution, whichever is earlier, such 
committee shall be deemed to be discharged 
from further consideration of such resolution 
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and such resolution shall be placed on the ap-
propriate calendar of the Senate. 
(C) EXPEDITED FLOOR CONSIDERATION.— 
Not later than 5 legislative days after the date 
on which all committees have been discharged 
from consideration of a resolution, the majority 
leader of the Senate, or the majority leader’s 
designee, shall move to proceed to the consider-
ation of the resolution. It shall also be in order 
for any member of the Senate to move to pro-
ceed to the consideration of the resolution at 
any time after the conclusion of such 5-day pe-
riod. All points of order against the resolution 
(and against consideration of the resolution) 
are waived. A motion to proceed to the consid-
eration of the resolution in the Senate is privi-
leged and is not debatable. The motion is not 
subject to amendment, to a motion to postpone 
consideration of the resolution, or to a motion 
to proceed to the consideration of other busi-
ness. A motion to reconsider the vote by which 
the motion to proceed is agreed to or not 
agreed to shall not be in order. If the motion 
to proceed is agreed to, the Senate shall imme-
diately proceed to consideration of the resolu-
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tion without intervening motion, order, or other 
business, and the resolution shall remain the 
unfinished business of the Senate until disposed 
of. 
(3) RULES OF THE SENATE AND HOUSE OF 
REPRESENTATIVES.—This subsection is enacted by 
Congress— 
(A) as an exercise of the rulemaking power 
of the Senate and House of Representatives, re-
spectively, and is deemed to be part of the rules 
of each House, respectively, but applicable only 
with respect to the procedure to be followed in 
that House in the case of a resolution under 
this subsection, and it supersedes other rules 
only to the extent that it is inconsistent with 
such rules; and 
(B) with full recognition of the constitu-
tional right of either House to change the rules 
(so far as they relate to the procedure of that 
House) at any time, in the same manner, and 
to the same extent as in the case of any other 
rule of that House. 
(4) FEDERAL
BUDGET
NEUTRALITY.—Except 
insofar as it allots appropriations made pursuant to 
subsection (k), the legislative proposal submitted 
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pursuant to subsection (d)(4)(C) may not increase 
the cumulative, net Federal budget deficit during the 
multi-year operation of all the State applications 
contained therein, taking into account such applica-
tions’ impact on Federal mandatory and discre-
tionary spending, Federal revenue, and Federal tax 
expenditures. 
(f) FUNDING.— 
(1) IN GENERAL.—The Secretary shall provide 
a grant to a State that has an application approved 
under subsection (e) to enable such State to carry 
out an innovative State health program in the State, 
to the extent that such a grant is included in the 
recommendation of the Commission. 
(2) AMOUNT
OF
GRANT.—The amount of a 
grant provided to a State under paragraph (1) shall 
be determined based upon the recommendations of 
the Commission, subject to the amount appropriated 
under subsection (k). 
(3) PERFORMANCE-BASED
FUNDING
ALLOCA-
TION.—In awarding grants under paragraph (1), the 
Commission shall direct the Secretary to— 
(A) fund a balanced diversity of ap-
proaches as provided for by the Commission in 
subsection (c)(1)(B); and 
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(B) link allocations to the State to the 
meeting of the goals and performance measures 
relating to health care coverage and health care 
costs established under this section through the 
State project application process. 
(4) REPORT.—One year prior to the end of the 
5-year period beginning on the date on which the 
first State begins to implement a plan approved 
under subsection (e), the Commission shall prepare 
and submit to the appropriate committees of Con-
gress, a report on the progress made by States in 
meeting the goals of expanded coverage and cost 
containment through performance measures estab-
lished during the 5-year period of the State plan. 
Such report may contain the recommendation of the 
Commission concerning any future action that Con-
gress should take concerning health care reform, in-
cluding whether or not to extend the program estab-
lished under this subsection. 
(g) MONITORING AND EVALUATION.— 
(1) ANNUAL REPORTS AND PARTICIPATION BY 
STATES.—Each State that has received a program 
approval shall— 
(A) submit to the Commission an annual 
report based on the period representing the re-
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spective State’s fiscal year, detailing compliance 
with the requirements established by the Com-
mission and the Secretary in the approval and 
in this section; and 
(B) participate in the annual meeting 
under subsection (c)(4)(C). 
(2) EVALUATIONS BY COMMISSION.—The Com-
mission shall prepare and submit to the Congress 
annual reports that shall contain— 
(A) a description of the effects of the re-
forms undertaken in States receiving approvals 
under this section; 
(B) a description of the recommendations 
of the Commission and actions taken based on 
these recommendations; 
(C) an independent evaluation of the effec-
tiveness of such reforms in— 
(i) expanding health care coverage for 
State residents; and 
(ii) reducing or containing health care 
costs in the States, 
as well as other relevant or significant findings; 
(D) recommendations regarding the advis-
ability of increasing Federal financial assistance 
for State ongoing or future health program ini-
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tiatives, including the amount and source of 
such assistance; and 
(E) as required by the Commission or the 
Secretary under this section, a periodic, inde-
pendent evaluation of the program. 
(h) NONCOMPLIANCE.— 
(1) CORRECTIVE ACTION PLANS.—If a State is 
not in compliance with a requirement of this section, 
the Commission, on recommendation of the Sec-
retary, shall develop a corrective action plan for such 
State. 
(2) TERMINATION.—The Commission, on rec-
ommendation of the Secretary, may revoke any pro-
gram granted under this section. Such decisions 
shall be subject to a petition for reconsideration and 
appeal pursuant to regulations established by the 
Secretary. 
(i) RELATIONSHIP TO FEDERAL PROGRAMS.— 
(1) IN GENERAL.—Nothing in this section, or 
in section 1115 of the Social Security Act (42 
U.S.C. 1315) shall be construed as authorizing the 
Secretary, the Commission, a State, or any other 
person or entity to alter or affect in any way the 
provisions of title XIX of such Act (42 U.S.C. 1396 
et seq.) or the regulations implementing such title. 
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(2) MAINTENANCE OF EFFORT.—No payment 
may be made under subsection (f)(1) if the State 
adopts criteria for benefits or criteria for standards 
and methodologies for purposes of determining an 
individual’s eligibility for medical assistance under 
the State plan under title XIX that are more restric-
tive than those required under Federal law and ap-
plied as of the date of enactment of this Act. 
(j) MISCELLANEOUS PROVISIONS.— 
(1) 
APPLICATION
OF
CERTAIN
REQUIRE-
MENTS.— 
(A) RESTRICTION
ON
APPLICATION
OF 
PREEXISTING CONDITION EXCLUSIONS.— 
(i) IN GENERAL.—Subject to subpara-
graph (B), a State shall not permit the im-
position of any preexisting condition exclu-
sion for covered benefits under a program 
or project under this section. 
(ii) GROUP
HEALTH
PLANS
AND 
GROUP HEALTH INSURANCE COVERAGE.— 
If the State program or project provides 
for benefits through payment for, or a con-
tract with, a group health plan or group 
health insurance coverage, the program or 
project may permit the imposition of a pre-
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existing condition exclusion but only inso-
far and to the extent that such exclusion is 
permitted under the applicable provisions 
of part 7 of subtitle B of title I of the Em-
ployee Retirement Income Security Act of 
1974 and title XXVII of the Public Health 
Service Act. 
(B) COMPLIANCE WITH OTHER REQUIRE-
MENTS.—Coverage offered under the program 
or project shall comply with the requirements of 
subpart 2 of part A of title XXVII of the Public 
Health Service Act insofar as such require-
ments apply with respect to a health insurance 
issuer that offers group health insurance cov-
erage. 
(2) 
PREVENTION
OF
DUPLICATIVE
PAY-
MENTS.— 
(A) OTHER HEALTH PLANS.—No payment 
shall be made to a State under subsection (f)(1) 
for expenditures for health assistance provided 
for an individual to the extent that a private in-
surer (as defined by the Secretary by regulation 
and including a group health plan (as defined 
in section 607(1) of the Employee Retirement 
Income Security Act of 1974), a service benefit 
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plan, and a health maintenance organization) 
would have been obligated to provide such as-
sistance but for a provision of its insurance con-
tract which has the effect of limiting or exclud-
ing such obligation because the individual is eli-
gible for or is provided health assistance under 
the plan. 
(B) OTHER
FEDERAL
GOVERNMENTAL 
PROGRAMS.—Except as provided in any other 
provision of law, no payment shall be made to 
a State under subsection (f)(1) for expenditures 
for health assistance provided for an individual 
to the extent that payment has been made or 
can reasonably be expected to be made prompt-
ly (as determined in accordance with regula-
tions) under any other federally operated or fi-
nanced health care insurance program. For 
purposes of this paragraph, rules similar to the 
rules 
for 
overpayments 
under 
section 
1903(d)(2) of the Social Security Act shall 
apply. 
(3) APPLICATION OF CERTAIN GENERAL PROVI-
SIONS.—The following provisions of the Social Secu-
rity Act shall apply to States under subsection (f)(1) 
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in the same manner as they apply to a State under 
such title XIX: 
(A) TITLE XIX PROVISIONS.— 
(i) Section 1902(a)(4)(C) (relating to 
conflict of interest standards). 
(ii) Paragraphs (2), (16), and (17) of 
section 1903(i) (relating to limitations on 
payment). 
(iii) Section 1903(w) (relating to limi-
tations on provider taxes and donations). 
(iv) Section 1920A (relating to pre-
sumptive eligibility for children). 
(B) TITLE XI PROVISIONS.— 
(i) Section 1116 (relating to adminis-
trative and judicial review), but only inso-
far as consistent with this title. 
(ii) Section 1124 (relating to disclo-
sure of ownership and related informa-
tion). 
(iii) Section 1126 (relating to disclo-
sure of information about certain convicted 
individuals). 
(iv) Section 1128A (relating to civil 
monetary penalties). 
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(v) Section 1128B(d) (relating to 
criminal penalties for certain additional 
charges). 
(vi) Section 1132 (relating to periods 
within which claims must be filed). 
(4) RELATION TO HIPAA.—Health benefits cov-
erage provided under a State program or project 
under this section shall be treated as creditable cov-
erage for purposes of part 7 of subtitle B of title I 
of the Employee Retirement Income Security Act of 
1974, title XXVII of the Public Health Service Act, 
and subtitle K of the Internal Revenue Code of 
1986. 
(k) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section, 
such sums as may be necessary in each fiscal year. 
Amounts appropriated for a fiscal year under this sub-
section and not expended may be used in subsequent fiscal 
years to carry out this section. 
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TITLE IV—SENSE OF THE HOUSE 
OF REPRESENTATIVES 
SEC. 401. MEDICARE AND MEDICAID REFORM AND SAV-
INGS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall implement administrative reforms 
with respect to— 
(1) the Medicare program under title XVIII of 
the Social Security Act in— 
(A) the reduction of fraud and abuse in 
the program, 
(B) health information technology, 
(C) comparative effectiveness, and 
(D) chronic disease management; and 
(2) the Medicaid program under title XIX of 
the Social Security Act, including changes in the 
Medicaid matching rate and changes in the pay-
ments for Medicaid administrative costs to prevent 
duplication of such payments under the temporary 
assistance for needy families program under title IV 
of the Social Security Act; 
that are sufficient to result in projected reductions in the 
Medicare and Medicaid Federal budget baselines for fiscal 
years 2010 through 2015 that exceed the projected rev-
enue loss for the same period attributable to the refund-
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able portion of the tax credit under section 37 of the Inter-
nal Revenue Code of 1986 (as added by title II of this 
Act) and the increase in the Federal budget baseline for 
the State children’s health insurance program under title 
XXI of the Social Security Act from the provisions of and 
amendments made by title I of this Act. 
(b) CONSULTATION AND CONSIDERATION.—In devel-
oping the necessary program changes under subsection 
(a), the Secretary of Health and Human Services shall 
consult with the Government Accountability Office and the 
Medicare Payment Advisory Commission and shall also 
consider any significant proposals for program changes in 
the specified areas that have been issued by private orga-
nizations within the last 3 years. 
Æ 
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