Subtitle E—Access 
Sec. 141. Children’s Access, Payment, and Equality Commission. 
Sec. 142. Model of Interstate coordinated enrollment and coverage process. 
Sec. 143. Medicaid citizenship documentation requirements. 
Sec. 144. Access to dental care for children. 
Sec. 145. Prohibiting initiation of new health opportunity account demonstration 
programs. 
Subtitle F—Quality and Program Integrity 
Sec. 151. Pediatric health quality measurement program. 
Sec. 152. Application of certain managed care quality safeguards to CHIP. 
Sec. 153. Updated Federal evaluation of CHIP. 
Sec. 154. Access to records for IG and GAO audits and evaluations. 
Sec. 155. References to title XXI. 
Sec. 156. Reliance on law; exception for State legislation. 
TITLE II—MEDICARE BENEFICIARY IMPROVEMENTS 
Subtitle A—Improvements in Benefits 
Sec. 201. Coverage and waiver of cost-sharing for preventive services. 
Sec. 202. Waiver of deductible for colorectal cancer screening tests regardless of 
coding, subsequent diagnosis, or ancillary tissue removal. 
Sec. 203. Parity for mental health coinsurance. 
Subtitle B—Improving, Clarifying, and Simplifying Financial Assistance for 
Low Income Medicare Beneficiaries 
Sec. 211. Improving assets tests for Medicare Savings Program and low-income 
subsidy program. 
Sec. 212. Making QI program permanent and expanding eligibility. 
Sec. 213. Eliminating barriers to enrollment. 
Sec. 214. Eliminating application of estate recovery. 
Sec. 215. Elimination of part D cost-sharing for certain non-institutionalized 
full-benefit dual eligible individuals. 
Sec. 216. Exemptions from income and resources for determination of eligibility 
for low-income subsidy. 
Sec. 217. Cost-sharing protections for low-income subsidy-eligible individuals. 
Sec. 218. Intelligent assignment in enrollment. 
Subtitle C—Part D Beneficiary Improvements 
Sec. 221. Including costs incurred by AIDS drug assistance programs and Indian 
Health Service in providing prescription drugs toward the an-
nual out of pocket threshold under Part D. 
Sec. 222. Permitting mid-year changes in enrollment for formulary changes ad-
versely impact an enrollee. 
Sec. 223. Removal of exclusion of benzodiazepines from required coverage under 
the Medicare prescription drug program. 
Sec. 224. Permitting updating drug compendia under part D using part B up-
date process. 
Sec. 225. Codification of special protections for six protected drug classifications. 
Sec. 226. Elimination of Medicare part D late enrollment penalties paid by low- 
income subsidy-eligible individuals. 
Sec. 227. Special enrollment period for subsidy eligible individuals. 
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Subtitle D—Reducing Health Disparities 
Sec. 231. Medicare data on race, ethnicity, and primary language. 
Sec. 232. Ensuring effective communication in Medicare. 
Sec. 233. Demonstration to promote access for Medicare beneficiaries with limited 
English proficiency by providing reimbursement for culturally 
and linguistically appropriate services. 
Sec. 234. Demonstration to improve care to previously uninsured. 
Sec. 235. Office of the Inspector General report on compliance with and enforce-
ment of national standards on culturally and linguistically ap-
propriate services (CLAS) in medicare. 
Sec. 236. IOM report on impact of language access services. 
Sec. 237. Definitions. 
TITLE III—PHYSICIANS’ SERVICE PAYMENT REFORM 
Sec. 301. Establishment of separate target growth rates for service categories. 
Sec. 302. Improving accuracy of relative values under the Medicare physician fee 
schedule. 
Sec. 303. Feedback mechanism on practice patterns. 
Sec. 304. Payments for efficient areas. 
Sec. 305. Recommendations on refining the physician fee schedule. 
Sec. 306. Improved and expanded medical home demonstration project. 
Sec. 307. Repeal of Physician Assistance and Quality Initiative Fund. 
Sec. 308. Adjustment to Medicare payment localities. 
Sec. 309. Payment for imaging services. 
Sec. 310. Reducing frequency of meetings of the Practicing Physicians Advisory 
Council. 
TITLE IV—MEDICARE ADVANTAGE REFORMS 
Subtitle A—Payment Reform 
Sec. 401. Equalizing payments between Medicare Advantage plans and fee-for- 
service Medicare. 
Subtitle B—Beneficiary Protections 
Sec. 411. NAIC development of marketing, advertising, and related protections. 
Sec. 412. Limitation on out-of-pocket costs for individual health services. 
Sec. 413. MA plan enrollment modifications. 
Sec. 414. Information for beneficiaries on MA plan administrative costs. 
Subtitle C—Quality and Other Provisions 
Sec. 421. Requiring all MA plans to meet equal standards. 
Sec. 422. Development of new quality reporting measures on racial disparities. 
Sec. 423. Strengthening audit authority. 
Sec. 424. Improving risk adjustment for MA payments. 
Sec. 425. Eliminating special treatment of private fee-for-service plans. 
Sec. 426. Renaming of Medicare Advantage program. 
Subtitle D—Extension of Authorities 
Sec. 431. Extension and revision of authority for special needs plans (SNPs). 
Sec. 432. Extension and revision of authority for Medicare reasonable cost con-
tracts. 
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TITLE V—PROVISIONS RELATING TO MEDICARE PART A 
Sec. 501. Inpatient hospital payment updates. 
Sec. 502. Payment for inpatient rehabilitation facility (IRF) services. 
Sec. 503. Long-term care hospitals. 
Sec. 504. Increasing the DSH adjustment cap. 
Sec. 505. PPS-exempt cancer hospitals. 
Sec. 506. Skilled nursing facility payment update. 
Sec. 507. Revocation of unique deeming authority of the Joint Commission for the 
Accreditation of Healthcare Organizations. 
Sec. 508. Treatment of Medicare hospital reclassifications. 
Sec. 509. Medicare critical access hospital designations. 
TITLE VI—OTHER PROVISIONS RELATING TO MEDICARE PART B 
Subtitle A—Payment and Coverage Improvements 
Sec. 601. Payment for therapy services. 
Sec. 602. Medicare separate definition of outpatient speech-language pathology 
services. 
Sec. 603. Increased reimbursement rate for certified nurse-midwives. 
Sec. 604. Adjustment in outpatient hospital fee schedule increase factor. 
Sec. 605. Exception to 60-day limit on Medicare substitute billing arrangements 
in case of physicians ordered to active duty in the Armed Forces. 
Sec. 606. Excluding clinical social worker services from coverage under the medi-
care skilled nursing facility prospective payment system and 
consolidated payment. 
Sec. 607. Coverage of marriage and family therapist services and mental health 
counselor services. 
Sec. 608. Rental and purchase of power-driven wheelchairs. 
Sec. 609. Rental and purchase of oxygen equipment. 
Sec. 610. Adjustment for Medicare mental health services. 
Sec. 611. Extension of brachytherapy special rule. 
Sec. 612. Payment for part B drugs. 
Subtitle B—Extension of Medicare Rural Access Protections 
Sec. 621. 2-year extension of floor on medicare work geographic adjustment. 
Sec. 622. 2-year extension of special treatment of certain physician pathology 
services under Medicare. 
Sec. 623. 2-year extension of medicare reasonable costs payments for certain clin-
ical diagnostic laboratory tests furnished to hospital patients in 
certain rural areas. 
Sec. 624. 2-year extension of Medicare incentive payment program for physician 
scarcity areas . 
Sec. 625. 2-year extension of medicare increase payments for ground ambulance 
services in rural areas. 
Sec. 626. Extending hold harmless for small rural hospitals under the HOPD 
prospective payment system. 
Subtitle C—End Stage Renal Disease Program 
Sec. 631. Chronic kidney disease demonstration projects. 
Sec. 632. Medicare coverage of kidney disease patient education services. 
Sec. 633. Required training for patient care dialysis technicians. 
Sec. 634. MedPAC report on treatment modalities for patients with kidney fail-
ure. 
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Sec. 635. Adjustment for erythropoietin stimulating agents (ESAs). 
Sec. 636. Site neutral composite rate. 
Sec. 637. Development of ESRD bundling system and quality incentive pay-
ments. 
Sec. 638. MedPAC report on ESRD bundling system. 
Sec. 639. OIG study and report on erythropoietin. 
Subtitle D—Miscellaneous 
Sec. 651. Limitation on exception to the prohibition on certain physician refer-
rals for hospitals. 
TITLE VII—PROVISIONS RELATING TO MEDICARE PARTS A AND B 
Sec. 701. Home health payment update for 2008. 
Sec. 702. 2-year extension of temporary Medicare payment increase for home 
health services furnished in a rural area. 
Sec. 703. Extension of Medicare secondary payer for beneficiaries with end stage 
renal disease for large group plans. 
Sec. 704. Plan for Medicare payment adjustments for never events. 
Sec. 705. Reinstatement of residency slots. 
TITLE VIII—MEDICAID 
Subtitle A—Protecting Existing Coverage 
Sec. 801. Modernizing transitional Medicaid. 
Sec. 802. Family planning services. 
Sec. 803. Authority to continue providing adult day health services approved 
under a State Medicaid plan. 
Sec. 804. State option to protect community spouses of individuals with disabil-
ities. 
Sec. 805. County medicaid health insuring organizations . 
Subtitle B—Payments 
Sec. 811. Payments for Puerto Rico and territories. 
Sec. 812. Medicaid drug rebate. 
Sec. 813. Adjustment in computation of Medicaid FMAP to disregard an extraor-
dinary employer pension contribution. 
Sec. 814. Moratorium on certain payment restrictions. 
Sec. 815. Tennessee DSH. 
Sec. 816. Clarification treatment of regional medical center. 
Subtitle C—Miscellaneous 
Sec. 821. Demonstration project for employer buy-in. 
Sec. 822. Diabetes grants. 
Sec. 823. Technical correction. 
TITLE IX—MISCELLANEOUS 
Sec. 901. Medicare Payment Advisory Commission status. 
Sec. 902. Repeal of trigger provision. 
Sec. 903. Repeal of comparative cost adjustment (CCA) program. 
Sec. 904. Comparative effectiveness research. 
Sec. 905. Implementation of Health information technology (IT) under Medicare. 
Sec. 906. Development, reporting, and use of health care measures. 
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Sec. 907. Improvements to the Medigap program. 
Sec. 908. Implementation funding. 
TITLE X—REVENUES 
Sec. 1001. Increase in rate of excise taxes on tobacco products and cigarette pa-
pers and tubes. 
Sec. 1002. Exemption for emergency medical services transportation. 
TITLE I—CHILDREN’S HEALTH 
INSURANCE PROGRAM 
SEC. 100. PURPOSE. 
It is the purpose of this title to provide dependable and 
stable funding for children’s health insurance under titles 
XXI and XIX of the Social Security Act in order to enroll 
all six million uninsured children who are eligible, but not 
enrolled, for coverage today through such titles. 
Subtitle A—Funding 
SEC. 101. ESTABLISHMENT OF NEW BASE CHIP ALLOT-
MENTS. 
Section 2104 of the Social Security Act (42 U.S.C. 
1397dd) is amended— 
(1) in subsection (a)— 
(A) in paragraph (9), by striking ‘‘and’’ at 
the end; 
(B) in paragraph (10), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
paragraph: 
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‘‘(11) for fiscal year 2008 and each succeeding 
fiscal year, the sum of the State allotments provided 
under subsection (i) for such fiscal year.’’; 
(2) in subsections (b)(1) and (c)(1), by striking 
‘‘subsection (d)’’ and inserting ‘‘subsections (d) and 
(i)’’; and 
(3) by adding at the end the following new sub-
section: 
‘‘(i) ALLOTMENTS FOR STATES AND TERRITORIES BE-
GINNING WITH FISCAL YEAR 2008.— 
‘‘(1) GENERAL ALLOTMENT COMPUTATION.—Sub-
ject to the succeeding provisions of this subsection, the 
Secretary shall compute a State allotment for each 
State for each fiscal year as follows: 
‘‘(A) FOR
FISCAL
YEAR
2008.—For fiscal 
year 2008, the allotment of a State is equal to 
the greater of— 
‘‘(i) the State projection (in its submis-
sion on forms CMS—21B and CMS—37 for 
May 2007) of Federal payments to the State 
under this title for such fiscal year, except 
that, in the case of a State that has enacted 
legislation to modify its State child health 
plan during 2007, the State may substitute 
its projection in its submission on forms 
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CMS—21B and CMS—37 for August 2007, 
instead of such forms for May 2007; or 
‘‘(ii) the allotment of the State under 
this section for fiscal year 2007 multiplied 
by the allotment increase factor under para-
graph (2) for fiscal year 2008. 
‘‘(B) INFLATION UPDATE FOR FISCAL YEAR 
2009
AND
EACH
SECOND
SUCCEEDING
FISCAL 
YEAR.—For fiscal year 2009 and each second 
succeeding fiscal year, the allotment of a State is 
equal to the amount of the State allotment under 
this paragraph for the previous fiscal year mul-
tiplied by the allotment increase factor under 
paragraph (2) for the fiscal year involved. 
‘‘(C) REBASING IN FISCAL YEAR 2010 AND 
EACH SECOND SUCCEEDING FISCAL YEAR.—For 
fiscal year 2010 and each second succeeding fis-
cal year, the allotment of a State is equal to the 
Federal payments to the State that are attrib-
utable to (and countable towards) the total 
amount of allotments available under this section 
to the State (including allotments made avail-
able under paragraph (3) as well as amounts re-
distributed to the State) in the previous fiscal 
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year multiplied by the allotment increase factor 
under paragraph (2) for the fiscal year involved. 
‘‘(D) SPECIAL RULES FOR TERRITORIES.— 
Notwithstanding the previous subparagraphs, the 
allotment for a State that is not one of the 50 
States or the District of Columbia for fiscal year 
2008 and for a succeeding fiscal year is equal to 
the Federal payments provided to the State 
under this title for the previous fiscal year mul-
tiplied by the allotment increase factor under 
paragraph (2) for the fiscal year involved (but 
determined by applying under paragraph (2)(B) 
as if the reference to ‘in the State’ were a ref-
erence to ‘in the United States’). 
‘‘(2) ALLOTMENT INCREASE FACTOR.—The allot-
ment increase factor under this paragraph for a fiscal 
year is equal to the product of the following: 
‘‘(A) PER CAPITA HEALTH CARE GROWTH 
FACTOR.—1 plus the percentage increase in the 
projected per capita amount of National Health 
Expenditures from the calendar year in which 
the previous fiscal year ends to the calendar year 
in which the fiscal year involved ends, as most 
recently published by the Secretary before the be-
ginning of the fiscal year. 
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‘‘(B) CHILD
POPULATION
GROWTH
FAC-
TOR.—1 plus the percentage increase (if any) in 
the population of children under 19 years of age 
in the State from July 1 in the previous fiscal 
year to July 1 in the fiscal year involved, as de-
termined by the Secretary based on the most re-
cent published estimates of the Bureau of the 
Census before the beginning of the fiscal year in-
volved, plus 1 percentage point 
‘‘(3) PERFORMANCE-BASED SHORTFALL ADJUST-
MENT.— 
‘‘(A) IN GENERAL.—If a State’s expendi-
tures under this title in a fiscal year (beginning 
with fiscal year 2008) exceed the total amount of 
allotments available under this section to the 
State in the fiscal year (determined without re-
gard to any redistribution it receives under sub-
section (f) that is available for expenditure dur-
ing such fiscal year, but including any carryover 
from a previous fiscal year) and if the average 
monthly unduplicated number of children en-
rolled under the State plan under this title (in-
cluding children receiving health care coverage 
through funds under this title pursuant to a 
waiver under section 1115) during such fiscal 
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year exceeds its target average number of such 
enrollees (as determined under subparagraph 
(B)) for that fiscal year, the allotment under this 
section for the State for the subsequent fiscal 
year (or, pursuant to subparagraph (F), for the 
fiscal year involved) shall be increased by the 
product of— 
‘‘(i) the amount by which such average 
monthly caseload exceeds such target num-
ber of enrollees; and 
‘‘(ii) the projected per capita expendi-
tures under the State child health plan (as 
determined under subparagraph (C) for the 
original fiscal year involved), multiplied by 
the enhanced FMAP (as defined in section 
2105(b)) for the State and fiscal year in-
volved 
‘‘(B) TARGET AVERAGE NUMBER OF CHILD 
ENROLLEES.—In this subsection, the target aver-
age number of child enrollees for a State— 
‘‘(i) for fiscal year 2008 is equal to the 
monthly average unduplicated number of 
children enrolled in the State child health 
plan under this title (including such chil-
dren receiving health care coverage through 
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funds under this title pursuant to a waiver 
under section 1115) during fiscal year 2007 
increased by the population growth for chil-
dren in that State for the year ending on 
June 30, 2006 (as estimated by the Bureau 
of the Census) plus 1 percentage point; or 
‘‘(ii) for a subsequent fiscal year is 
equal to the target average number of child 
enrollees for the State for the previous fiscal 
year increased by the population growth for 
children in that State for the year ending 
on June 30 before the beginning of the fiscal 
year (as estimated by the Bureau of the 
Census) plus 1 percentage point. 
‘‘(C) PROJECTED
PER
CAPITA
EXPENDI-
TURES.—For purposes of subparagraph (A)(ii), 
the projected per capita expenditures under a 
State child health plan— 
‘‘(i) for fiscal year 2008 is equal to the 
average per capita expenditures (including 
both State and Federal financial participa-
tion) under such plan for the targeted low- 
income children counted in the average 
monthly caseload for purposes of this para-
graph during fiscal year 2007, increased by 
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the annual percentage increase in the per 
capita amount of National Health Expendi-
tures (as estimated by the Secretary) for 
2008; or 
‘‘(ii) for a subsequent fiscal year is 
equal to the projected per capita expendi-
tures under such plan for the previous fiscal 
year (as determined under clause (i) or this 
clause) increased by the annual percentage 
increase in the per capita amount of Na-
tional Health Expenditures (as estimated 
by the Secretary) for the year in which such 
subsequent fiscal year ends. 
‘‘(D) AVAILABILITY.—Notwithstanding sub-
section (e), an increase in allotment under this 
paragraph shall only be available for expendi-
ture during the fiscal year in which it is pro-
vided. 
‘‘(E) NO
REDISTRIBUTION
OF
PERFORM-
ANCE-BASED
SHORTFALL
ADJUSTMENT.—In no 
case shall any increase in allotment under this 
paragraph for a State be subject to redistribution 
to other States. 
‘‘(F) INTERIM ALLOTMENT ADJUSTMENT.— 
The Secretary shall develop a process to admin-
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ister the performance-based shortfall adjustment 
in a manner so it is applied to (and before the 
end of) the fiscal year (rather than the subse-
quent fiscal year) involved for a State that the 
Secretary estimates will be in shortfall and will 
exceed its enrollment target for that fiscal year. 
‘‘(G) PERIODIC
AUDITING.—The Comp-
troller General of the United States shall periodi-
cally audit the accuracy of data used in the com-
putation of allotment adjustments under this 
paragraph. Based on such audits, the Comp-
troller General shall make such recommendations 
to the Congress and the Secretary as the Comp-
troller General deems appropriate. 
‘‘(4) CONTINUED REPORTING.—For purposes of 
paragraph (3) and subsection (f), the State shall sub-
mit to the Secretary the State’s projected Federal ex-
penditures, even if the amount of such expenditures 
exceeds the total amount of allotments available to the 
State in such fiscal year.’’. 
SEC. 102. 2-YEAR INITIAL AVAILABILITY OF CHIP ALLOT-
MENTS. 
Section 2104(e) of the Social Security Act (42 U.S.C. 
1397dd(e)) is amended to read as follows: 
‘‘(e) AVAILABILITY OF AMOUNTS ALLOTTED.— 
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‘‘(1) IN GENERAL.—Except as provided in para-
graph (2) and subsection (i)(3)(D), amounts allotted 
to a State pursuant to this section— 
‘‘(A) for each of fiscal years 1998 through 
2007, shall remain available for expenditure by 
the State through the end of the second suc-
ceeding fiscal year; and 
‘‘(B) for fiscal year 2008 and each fiscal 
year thereafter, shall remain available for ex-
penditure by the State through the end of the 
succeeding fiscal year. 
‘‘(2) AVAILABILITY
OF
AMOUNTS
REDISTRIB-
UTED.—Amounts redistributed to a State under sub-
section (f) shall be available for expenditure by the 
State through the end of the fiscal year in which they 
are redistributed, except that funds so redistributed to 
a State that are not expended by the end of such fis-
cal year shall remain available after the end of such 
fiscal year and shall be available in the following fis-
cal year for subsequent redistribution under such sub-
section.’’. 
SEC. 103. REDISTRIBUTION OF UNUSED ALLOTMENTS TO 
ADDRESS STATE FUNDING SHORTFALLS. 
Section 2104(f) of the Social Security Act (42 U.S.C. 
1397dd(f)) is amended— 
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(1) by striking ‘‘The Secretary’’ and inserting 
the following: 
‘‘(1) IN GENERAL.—The Secretary’’; 
(2) by striking ‘‘States that have fully expended 
the amount of their allotments under this section.’’ 
and inserting ‘‘States that the Secretary determines 
with respect to the fiscal year for which unused allot-
ments are available for redistribution under this sub-
section, are shortfall States described in paragraph 
(2) for such fiscal year, but not to exceed the amount 
of the shortfall described in paragraph (2)(A) for each 
such State (as may be adjusted under paragraph 
(2)(C)). The amount of allotments not expended or re-
distributed under the previous sentence shall remain 
available for redistribution in the succeeding fiscal 
year.’’; and 
(3) by adding at the end the following new para-
graph: 
‘‘(2) SHORTFALL STATES DESCRIBED.— 
‘‘(A) IN GENERAL.—For purposes of para-
graph (1), with respect to a fiscal year, a short-
fall State described in this subparagraph is a 
State with a State child health plan approved 
under this title for which the Secretary estimates 
on the basis of the most recent data available to 
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the Secretary, that the projected expenditures 
under such plan for the State for the fiscal year 
will exceed the sum of— 
‘‘(i) the amount of the State’s allot-
ments for any preceding fiscal years that 
remains available for expenditure and that 
will not be expended by the end of the im-
mediately preceding fiscal year; 
‘‘(ii) the amount (if any) of the per-
formance based adjustment under subsection 
(i)(3)(A); and 
‘‘(iii) the amount of the State’s allot-
ment for the fiscal year. 
‘‘(B) PRORATION
RULE.—If the amounts 
available for redistribution under paragraph (1) 
for a fiscal year are less than the total amounts 
of the estimated shortfalls determined for the 
year under subparagraph (A), the amount to be 
redistributed under such paragraph for each 
shortfall State shall be reduced proportionally. 
‘‘(C) RETROSPECTIVE
ADJUSTMENT.—The 
Secretary may adjust the estimates and deter-
minations made under paragraph (1) and this 
paragraph with respect to a fiscal year as nec-
essary on the basis of the amounts reported by 
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States not later than November 30 of the suc-
ceeding fiscal year, as approved by the Sec-
retary.’’. 
SEC. 104. EXTENSION OF OPTION FOR QUALIFYING STATES. 
Section 2105(g)(1)(A) of the Social Security Act (42 
U.S.C. 1397ee(g)(1)(A)) is amended by inserting after ‘‘or 
2007’’ the following: ‘‘or 30 percent of any allotment under 
section 2104 for any subsequent fiscal year’’. 
Subtitle B—Improving Enrollment 
and Retention of Eligible Children 
SEC. 111. CHIP PERFORMANCE BONUS PAYMENT TO OFFSET 
ADDITIONAL ENROLLMENT COSTS RESULT-
ING FROM ENROLLMENT AND RETENTION EF-
FORTS. 
Section 2105(a) of the Social Security Act (42 U.S.C. 
1397ee(a)) is amended by adding at the end the following 
new paragraphs: 
‘‘(3) PERFORMANCE BONUS PAYMENT TO OFFSET 
ADDITIONAL MEDICAID AND CHIP CHILD ENROLLMENT 
COSTS RESULTING FROM ENROLLMENT AND RETEN-
TION EFFORTS.— 
‘‘(A) IN GENERAL.—In addition to the pay-
ments made under paragraph (1), for each fiscal 
year (beginning with fiscal year 2008) the Sec-
retary shall pay to each State that meets the con-
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dition under paragraph (4) for the fiscal year, 
an amount equal to the amount described in sub-
paragraph (B) for the State and fiscal year. The 
payment under this paragraph shall be made, to 
a State for a fiscal year, as a single payment not 
later than the last day of the first calendar quar-
ter of the following fiscal year. 
‘‘(B) AMOUNT.—The amount described in 
this subparagraph for a State for a fiscal year 
is equal to the sum of the following amounts: 
‘‘(i) FOR ABOVE BASELINE MEDICAID 
CHILD ENROLLMENT COSTS.— 
‘‘(I) FIRST TIER ABOVE BASELINE 
MEDICAID
ENROLLEES.—An amount 
equal to the number of first tier above 
baseline child enrollees (as determined 
under subparagraph (C)(i)) under title 
XIX for the State and fiscal year mul-
tiplied by 35 percent of the projected 
per capita State Medicaid expenditures 
(as determined under subparagraph 
(D)(i)) for the State and fiscal year 
under title XIX. 
‘‘(II) SECOND TIER ABOVE BASE-
LINE
MEDICAID
ENROLLEES.—An 
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