I 
114TH CONGRESS 
1ST SESSION 
H. R. 919 
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 
FEBRUARY 12, 2015 
Mr. GENE GREEN of Texas (for himself, Mr. PALLONE, Mr. RUSH, Ms. 
ESHOO, Mr. ENGEL, Ms. DEGETTE, Mrs. CAPPS, Mr. MICHAEL F. 
DOYLE of Pennsylvania, Ms. SCHAKOWSKY, Mr. BUTTERFIELD, Ms. 
MATSUI, Ms. CASTOR of Florida, Mr. SARBANES, Mr. MCNERNEY, Mr. 
WELCH, Mr. BEN RAY LUJA´N of New Mexico, Mr. TONKO, Mr. YAR-
MUTH, Ms. CLARKE of New York, Mr. LOEBSACK, Mr. SCHRADER, Mr. 
KENNEDY, and Mr. CA´RDENAS) introduced the following bill; which was 
referred to the Committee on Energy and Commerce, and in addition to 
the Committee on Ways and Means, for a period to be subsequently de-
termined 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, 
VerDate Sep 11 2014 
00:22 Feb 20, 2015
Jkt 049200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H919.IH
H919
smartinez on DSK4TPTVN1PROD with BILLS
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 2015’’. 
(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. 
VerDate Sep 11 2014 
00:22 Feb 20, 2015
Jkt 049200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6211
E:\BILLS\H919.IH
H919
smartinez on DSK4TPTVN1PROD with BILLS
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. 
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, 2015, and shall apply to medical 
assistance and child health assistance furnished under ti-
VerDate Sep 11 2014 
00:22 Feb 20, 2015
Jkt 049200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H919.IH
H919
smartinez on DSK4TPTVN1PROD with BILLS
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 
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 
VerDate Sep 11 2014 
00:22 Feb 20, 2015
Jkt 049200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H919.IH
H919
smartinez on DSK4TPTVN1PROD with BILLS
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 
(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 
VerDate Sep 11 2014 
00:22 Feb 20, 2015
Jkt 049200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H919.IH
H919
smartinez on DSK4TPTVN1PROD with BILLS
State’s failure to comply with such regulations or 
guidance. 
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 
VerDate Sep 11 2014 
00:22 Feb 20, 2015
Jkt 049200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H919.IH
H919
smartinez on DSK4TPTVN1PROD with BILLS
‘‘(B) $2,850,000,000 for the period begin-
ning on April 1, 2019, and ending on Sep-
tember 30, 2019.’’. 
(b) ALLOTMENTS.— 
(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: 
VerDate Sep 11 2014 
00:22 Feb 20, 2015
Jkt 049200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H919.IH
H919
smartinez on DSK4TPTVN1PROD with BILLS
‘‘(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 
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.—Except 
as provided in clause (iii), for fiscal year 
2014 and each succeeding even-numbered 
fiscal year, the allotment of the State is 
equal to the sum of— 
VerDate Sep 11 2014 
00:22 Feb 20, 2015
Jkt 049200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H919.IH
H919
smartinez on DSK4TPTVN1PROD with BILLS
‘‘(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, 
multiplied by the allotment increase factor 
under paragraph (5) for such even-num-
bered fiscal year. 
‘‘(iii) SPECIAL RULE FOR 2016.—For 
fiscal year 2016, the allotment of the State 
is equal to the Federal payments to the 
State that are attributable to (and count-
able toward) the total amount of allot-
ments available under this section to the 
State in the preceding fiscal year (includ-
ing payments made to the State under 
subsection (n) for such preceding fiscal 
year as well as amounts redistributed to 
the State in such preceding fiscal year), 
but determined as if the last two sentences 
of section 2105(b) were in effect in such 
preceding fiscal year and then multiplying 
VerDate Sep 11 2014 
00:22 Feb 20, 2015
Jkt 049200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H919.IH
H919
smartinez on DSK4TPTVN1PROD with BILLS
the result by the allotment increase factor 
under paragraph (5) for fiscal year 2016.’’; 
(C) in paragraph (3)— 
(i) in the heading, by striking ‘‘2015’’ 
and inserting ‘‘2019’’; 
(ii) in subparagraph (A), by striking 
‘‘paragraph (18)’’ and inserting ‘‘para-
graph (22)’’; 
(iii) in subparagraph (B), by striking 
‘‘paragraph (18)’’ and inserting ‘‘para-
graph (22)’’; 
(iv) in subparagraph (C)— 
(I) by striking ‘‘2014’’ each place 
it appears and inserting ‘‘2018’’; and 
(II) by striking ‘‘2015’’ and in-
serting ‘‘2019’’; and 
(v) in subparagraph (D)— 
(I) in clause (i)— 
(aa) in subclause (I), by 
striking ‘‘subsection (a)(18)(A)’’ 
and 
inserting 
‘‘subsection 
(a)(22)(A)’’; and 
(bb) in subclause (II), by 
striking ‘‘section 108 of the Chil-
dren’s Health Insurance Program 
VerDate Sep 11 2014 
00:22 Feb 20, 2015
Jkt 049200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H919.IH
H919
smartinez on DSK4TPTVN1PROD with BILLS
Reauthorization Act of 2009’’ 
and inserting ‘‘section 101(b)(2) 
of the CHIP Extension and Im-
provement Act of 2015’’; and 
(II) in clause (ii)(II), by striking 
‘‘subsection (a)(18)(B)’’ and inserting 
‘‘subsection (a)(22)(B)’’; 
(D) in paragraph (4), by striking ‘‘2015’’ 
and inserting ‘‘2019’’; 
(E) in paragraph (6)— 
(i) in subparagraph (A), by striking 
‘‘2015’’ and inserting ‘‘2019’’; and 
(ii) in the second sentence, by striking 
‘‘or fiscal year 2014’’ and inserting ‘‘fiscal 
year 2014, fiscal year 2016, or fiscal year 
2018’’; and 
(F) in paragraph (8)— 
(i) in the paragraph heading, by strik-
ing ‘‘2015’’ and inserting ‘‘2019’’; and 
(ii) by striking ‘‘for a period in fiscal 
year 2015’’ and inserting ‘‘for a period in 
fiscal year 2019’’. 
(2) SUPPLEMENTAL APPROPRIATION FOR FIS-
CAL YEAR 2019.—There is appropriated to the Sec-
retary, out of any money in the Treasury not other-
VerDate Sep 11 2014 
00:22 Feb 20, 2015
Jkt 049200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H919.IH
H919
smartinez on DSK4TPTVN1PROD with BILLS
wise appropriated, $16,700,000,000 to accompany 
the allotment made for the period beginning on Oc-
tober 1, 2018, and ending on March 31, 2019, 
under section 2104(a)(22)(A) of the Social Security 
Act (42 U.S.C. 1397dd(a)(22)(A)) (as added by sub-
section (a)), to remain available until expended. 
Such amount shall be used to provide allotments to 
States under paragraph (3) of section 2104(m) of 
such Act (42 U.S.C. 1397dd(m)) (as amended by 
paragraph (1)(C)) for the first 6 months of fiscal 
year 2019 in the same manner as allotments are 
provided under subsection (a)(22)(A) of such section 
2104 and subject to the same terms and conditions 
as apply to the allotments provided from such sub-
section (a)(22)(A). 
(c) EXTENSION OF QUALIFYING STATES OPTION.— 
Section 2105(g)(4) of the Social Security Act (42 U.S.C. 
1397ee(g)(4)) is amended— 
(1) in the paragraph heading, by striking 
‘‘2015’’ and inserting ‘‘2019’’; and 
(2) in subparagraph (A), by striking ‘‘2015’’ 
and inserting ‘‘2019’’. 
VerDate Sep 11 2014 
00:22 Feb 20, 2015
Jkt 049200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H919.IH
H919
smartinez on DSK4TPTVN1PROD with BILLS