796 
fordable Health Choices Act of 2009), if the State 
applies any asset or resource test in determining 
(or redetermining) eligibility of any individual 
on or after such first day under any of the fol-
lowing: 
‘‘(i) Subclause (I), (III), (IV), or (VI) 
of section 1902(a)(10)(A)(i). 
‘‘(ii) Subclause (II), (IX), (XIV) or 
(XVII) of section 1902(a)(10)(A)(ii). 
‘‘(iii) Section 1931(b). 
‘‘(B) OVERRIDING
CONTRARY
PROVISIONS; 
REFERENCES.—The provisions of this title that 
prevent the waiver of an asset or resource test de-
scribed in subparagraph (A) are hereby waived. 
‘‘(C) REFERENCES.—Any reference to a 
provision described in a provision in subpara-
graph (A) shall be deemed to be a reference to 
such provision as modified through the applica-
tion of subparagraphs (A) and (B).’’. 
(2) CONFORMING
AMENDMENTS.—(A) Section 
1902(a)(10)(A) 
of 
such 
Act 
(42 
U.S.C. 
1396a(a)(10)(A)) is amended, in the matter before 
clause 
(i), 
by 
inserting 
‘‘subject 
to 
section 
1903(aa)(2),’’ after ‘‘(A)’’. 
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797 
(B) Section 1931(b)(1) of such Act (42 U.S.C. 
1396u–1(b)(1)) is amended by inserting ‘‘and section 
1903(aa)(2)’’ after ‘‘and (3)’’. 
(c) STANDARDS FOR BENCHMARK PACKAGES.—Sec-
tion 1937(b) of such Act (42 U.S.C. 1396u–7(b)) is amend-
ed— 
(1) in each of paragraphs (1) and (2), by insert-
ing ‘‘subject to paragraph (5),’’ after ‘‘subsection 
(a)(1),’’; and 
(2) by adding at the end the following new para-
graph: 
‘‘(5) MINIMUM STANDARDS.—Effective January 
1, 2013, any benchmark benefit package (or bench-
mark equivalent coverage under paragraph (2)) must 
meet the minimum benefits and cost-sharing stand-
ards of a basic plan offered through the Health Insur-
ance Exchange.’’. 
SEC. 1704. REDUCTION IN MEDICAID DSH. 
(a) REPORT.— 
(1) IN GENERAL.—Not later than January 1, 
2016, the Secretary of Health and Human Services 
(in this title referred to as the ‘‘Secretary’’) shall sub-
mit to Congress a report concerning the extent to 
which, based upon the impact of the health care re-
forms carried out under division A in reducing the 
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798 
number of uninsured individuals, there is a continued 
role for Medicaid DSH. In preparing the report, the 
Secretary shall consult with community-based health 
care networks serving low-income beneficiaries. 
(2) MATTERS
TO
BE
INCLUDED.—The report 
shall include the following: 
(A) 
RECOMMENDATIONS.—Recommenda-
tions regarding— 
(i) the appropriate targeting of Med-
icaid DSH within States; and 
(ii) the distribution of Medicaid DSH 
among the States, taking into account the 
ratio of the amount of DSH funds allocated 
to a State to the number of uninsured indi-
viduals in such State. 
(B) SPECIFICATION OF DSH HEALTH RE-
FORM METHODOLOGY.—The DSH Health Reform 
methodology described in paragraph (2) of sub-
section (b) for purposes of implementing the re-
quirements of such subsection. 
(3) COORDINATION
WITH
MEDICARE
DSH
RE-
PORT.—The Secretary shall coordinate the report 
under this subsection with the report on Medicare 
DSH under section 1112. 
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(4) MEDICAID DSH.—In this section, the term 
‘‘Medicaid DSH’’ means adjustments in payments 
under section 1923 of the Social Security Act for in-
patient hospital services furnished by dispropor-
tionate share hospitals. 
(b) MEDICAID DSH REDUCTIONS.— 
(1) IN
GENERAL.—The Secretary shall reduce 
Medicaid DSH so as to reduce total Federal pay-
ments 
to 
all 
States 
for 
such 
purpose 
by 
$1,500,000,000 in fiscal year 2017, $2,500,000,000 in 
fiscal year 2018, and $6,000,000,000 in fiscal year 
2019. 
(2) DSH HEALTH REFORM METHODOLOGY.—The 
Secretary shall carry out paragraph (1) through use 
of a DSH Health Reform methodology issued by the 
Secretary that imposes the largest percentage reduc-
tions on the States that— 
(A) have the lowest percentages of uninsured 
individuals (determined on the basis of audited 
hospital cost reports) during the most recent year 
for which such data are available; or 
(B) do not target their DSH payments 
on— 
(i) hospitals with high volumes of Med-
icaid inpatients (as defined in section 
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1923(b)(1)(A) of the Social Security Act (42 
U.S.C. 1396r–4(b)(1)(A)); and 
(ii) hospitals that have high levels of 
uncompensated care (excluding bad debt). 
(3) DSH ALLOTMENT PUBLICATIONS.— 
(A) IN GENERAL.—Not later than the publi-
cation deadline specified in subparagraph (B), 
the Secretary shall publish in the Federal Reg-
ister a notice specifying the DSH allotment to 
each State under 1923(f) of the Social Security 
Act for the respective fiscal year specified in such 
subparagraph, consistent with the application of 
the DSH Health Reform methodology described 
in paragraph (2). 
(B) PUBLICATION DEADLINE.—The publica-
tion deadline specified in this subparagraph is— 
(i) January 1, 2016, with respect to 
DSH allotments described in subparagraph 
(A) for fiscal year 2017; 
(ii) January 1, 2017, with respect to 
DSH allotments described in subparagraph 
(A) for fiscal year 2018; and 
(iii) January 1, 2018, with respect to 
DSH allotments described in subparagraph 
(A) for fiscal year 2019. 
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801 
(c) CONFORMING AMENDMENTS.— 
(1) Section 1923(f) of the Social Security Act 
(42 U.S.C. 1396r–4(f)) is amended— 
(A) by redesignating paragraph (7) as 
paragraph (8); and 
(B) by inserting after paragraph (6) the fol-
lowing new paragraph: 
‘‘(7) SPECIAL
RULE
FOR
FISCAL
YEARS
2017, 
2018, AND 2019.— 
‘‘(A) FISCAL YEAR 2017.—Notwithstanding 
paragraph (2), the total DSH allotments for all 
States for— 
‘‘(i) fiscal year 2017, shall be the total 
DSH allotments that would otherwise be de-
termined under this subsection for such fis-
cal year decreased by $1,500,000,000; 
‘‘(ii) fiscal year 2018, shall be the total 
DSH allotments that would otherwise be de-
termined under this subsection for such fis-
cal year decreased by $2,500,000,000; and 
‘‘(iii) fiscal year 2019, shall be the 
total DSH allotments that would otherwise 
be determined under this subsection for such 
fiscal year decreased by $6,000,000,000.’’. 
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802 
(2) The second sentence of section 1923(b)(4) of 
such Act (42 U.S.C. 1396r–4(b)(4)) is amended by in-
serting before the period the following: ‘‘or to affect 
the authority of the Secretary to issue and implement 
the DSH Health Reform methodology under section 
1704(b)(2) of the America’s Health Choices Act of 
2009’’. 
(d) DISPROPORTIONATE SHARE HOSPITALS (DSH) 
AND ESSENTIAL ACCESS HOSPITAL (EAH) NON-DISCRIMI-
NATION.— 
(1) IN GENERAL.—Section 1923(d) of the Social 
Security Act (42 U.S.C. 1396r-4) is amended by add-
ing at the end the following new paragraph: 
‘‘(4) No hospital may be defined or deemed as a 
disproportionate share hospital, or as an essential ac-
cess hospital (for purposes of subsection (f)(6)(A)(iv)), 
under a State plan under this title or subsection (b) 
of this section (including any waiver under section 
1115) unless the hospital— 
‘‘(A) provides services to beneficiaries under 
this title without discrimination on the ground 
of race, color, national origin, creed, source of 
payment, status as a beneficiary under this title, 
or any other ground unrelated to such bene-
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803 
ficiary’s need for the services or the availability 
of the needed services in the hospital; and 
‘‘(B) makes arrangements for, and accepts, 
reimbursement under this title for services pro-
vided to eligible beneficiaries under this title.’’. 
(2) EFFECTIVE DATE.—The amendment made by 
paragraph (1) shall apply to expenditures made on or 
after July 1, 2010. 
SEC. 1705. EXPANDED OUTSTATIONING. 
(a) IN GENERAL.—Section 1902(a)(55) of the Social 
Security Act (42 U.S.C. 1396a(a)(55)) is amended by strik-
ing ‘‘under subsection (a)(10)(A)(i)(IV), (a)(10)(A)(i)(VI), 
(a)(10)(A)(i)(VII), or (a)(10)(A)(ii)(IX)’’ and inserting 
‘‘(including receipt and processing of applications of indi-
viduals for affordability credits under subtitle C of title II 
of division A of the America’s Affordable Health Choices 
Act of 2009 pursuant to a Medicaid memorandum of under-
standing under section 1943(a)(1))’’. 
(b) EFFECTIVE DATE.— 
(1) Except as provided in paragraph (2), the 
amendment made by subsection (a) shall apply to 
services furnished on or after July 1, 2010, without 
regard to whether or not final regulations to carry 
out such amendment have been promulgated by such 
date. 
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804 
(2) In the case of a State plan for medical assist-
ance under title XIX of the Social Security Act which 
the Secretary of Health and Human Services deter-
mines requires State legislation (other than legisla-
tion appropriating funds) in order for the plan to 
meet the additional requirement imposed by the 
amendment made by this section, the State plan shall 
not be regarded as failing to comply with the require-
ments of such title solely on the basis of its failure to 
meet this additional requirement before the first day 
of the first calendar quarter beginning after the close 
of the first regular session of the State legislature that 
begins after the date of the 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 such session shall be deemed to be a separate reg-
ular session of the State legislature. 
Subtitle B—Prevention 
SEC. 1711. REQUIRED COVERAGE OF PREVENTIVE SERV-
ICES. 
(a) COVERAGE.—Section 1905 of the Social Security 
Act 
(42 
U.S.C. 
1396d), 
as 
amended 
by 
section 
1701(a)(2)(B), is amended— 
(1) in subsection (a)(4)— 
(A) by striking ‘‘and’’ before ‘‘(C)’’; and 
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805 
(B) by inserting before the semicolon at the 
end the following: ‘‘; and (D) preventive services 
described in subsection (z)’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(z) PREVENTIVE SERVICES.—The preventive services 
described in this subsection are services not otherwise de-
scribed in subsection (a) or (r) that the Secretary deter-
mines are— 
‘‘(1)(A) recommended with a grade of A or B by 
the Task Force for Clinical Preventive Services; or 
‘‘(B) vaccines recommended for use as appro-
priate by the Director of the Centers for Disease Con-
trol and Prevention; and 
‘‘(2) appropriate for individuals entitled to med-
ical assistance under this title.’’. 
(b) ELIMINATION OF COST-SHARING.— 
(1) Subsections (a)(2)(D) and (b)(2)(D) of sec-
tion 1916 of such Act (42 U.S.C. 1396o) are each 
amended by inserting ‘‘preventive services described 
in section 1905(z),’’ after ‘‘emergency services (as de-
fined by the Secretary),’’. 
(2) Section 1916A(a)(1) of such Act (42 U.S.C. 
1396o–1 (a)(1)) is amended by inserting ‘‘, preventive 
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806 
services described in section 1905(z),’’ after ‘‘sub-
section (c)’’. 
(c) CONFORMING AMENDMENT.—Section 1928 of such 
Act (42 U.S.C. 1396s) is amended— 
(1) in subsection (c)(2)(B)(i), by striking ‘‘the 
advisory committee referred to in subsection (e)’’ and 
inserting ‘‘the Director of the Centers for Disease Con-
trol and Prevention’’; 
(2) in subsection (e), by striking ‘‘Advisory Com-
mittee’’ and all that follows and inserting ‘‘Director 
of the Centers for Disease Control and Prevention.’’; 
and 
(3) by striking subsection (g). 
(d) EFFECTIVE DATE.— 
(1) Except as provided in paragraph (2), the 
amendments made by this section shall apply to serv-
ices furnished on or after July 1, 2010, without re-
gard to whether or not final regulations to carry out 
such amendments have been promulgated by such 
date. 
(2) In the case of a State plan for medical assist-
ance under title XIX of the Social Security Act which 
the Secretary of Health and Human Services deter-
mines requires State legislation (other than legisla-
tion appropriating funds) in order for the plan to 
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807 
meet the additional requirements imposed by the 
amendments made by this section, the State plan 
shall not be regarded as failing to comply with the re-
quirements of such title solely on the basis of its fail-
ure to meet these additional requirements before the 
first day of the first calendar quarter beginning after 
the close of the first regular session of the State legis-
lature that begins after the date of the 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 such session shall be deemed to be a sepa-
rate regular session of the State legislature. 
SEC. 1712. TOBACCO CESSATION. 
(a) DROPPING TOBACCO CESSATION EXCLUSION FROM 
COVERED OUTPATIENT DRUGS.—Section 1927(d)(2) of the 
Social Security Act (42 U.S.C. 1396r–8(d)(2)) is amend-
ed— 
(1) by striking subparagraph (E); 
(2) in subparagraph (G), by inserting before the 
period at the end the following: ‘‘, except agents ap-
proved by the Food and Drug Administration for 
purposes of promoting, and when used to promote, to-
bacco cessation’’; and 
(3) by redesignating subparagraphs (F) through 
(K) as subparagraphs (E) through (J), respectively. 
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808 
(b) EFFECTIVE DATE.—The amendments made by this 
section shall apply to drugs and services furnished on or 
after January 1, 2010. 
SEC. 1713. OPTIONAL COVERAGE OF NURSE HOME VISITA-
TION SERVICES. 
(a) IN GENERAL.—Section 1905 of the Social Security 
Act (42 U.S.C. 1396d), as amended by sections 1701(a)(2) 
and 1711(a), is amended— 
(1) in subsection (a)— 
(A) in paragraph (27), by striking ‘‘and’’ 
at the end; 
(B) by redesignating paragraph (28) as 
paragraph (29); and 
(C) by inserting after paragraph (27) the 
following new paragraph: 
‘‘(28) nurse home visitation services (as defined 
in subsection (aa)); and’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(aa) The term ‘nurse home visitation services’ means 
home visits by trained nurses to families with a first-time 
pregnant woman, or a child (under 2 years of age), who 
is eligible for medical assistance under this title, but only, 
to the extent determined by the Secretary based upon evi-
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809 
dence, that such services are effective in one or more of the 
following: 
‘‘(1) Improving maternal or child health and 
pregnancy outcomes or increasing birth intervals be-
tween pregnancies. 
‘‘(2) Reducing the incidence of child abuse, ne-
glect, and injury, improving family stability (includ-
ing reduction in the incidence of intimate partner vi-
olence), or reducing maternal and child involvement 
in the criminal justice system. 
‘‘(3) Increasing economic self-sufficiency, em-
ployment advancement, school-readiness, and edu-
cational achievement, or reducing dependence on pub-
lic assistance.’’. 
(b) EFFECTIVE DATE.—The amendments made by this 
section shall apply to services furnished on or after January 
1, 2010. 
(c) CONSTRUCTION.—Nothing in the amendments 
made by this section shall be construed as affecting the abil-
ity of a State under title XIX or XXI of the Social Security 
Act to provide nurse home visitation services as part of an-
other class of items and services falling within the definition 
of medical assistance or child health assistance under the 
respective title, or as an administrative expenditure for 
which payment is made under section 1903(a) or 2105(a) 
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810 
of such Act, respectively, on or after the date of the enact-
ment of this Act. 
SEC. 1714. STATE ELIGIBILITY OPTION FOR FAMILY PLAN-
NING SERVICES. 
(a) COVERAGE AS OPTIONAL CATEGORICALLY NEEDY 
GROUP.— 
(1) IN GENERAL.—Section 1902(a)(10)(A)(ii) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396a(a)(10)(A)(ii)) is amended— 
(A) in subclause (XVIII), by striking ‘‘or’’ 
at the end; 
(B) in subclause (XIX), by adding ‘‘or’’ at 
the end; and 
(C) by adding at the end the following new 
subclause: 
‘‘(XX) who are described in sub-
section (hh) (relating to individuals 
who meet certain income standards);’’. 
(2) GROUP DESCRIBED.—Section 1902 of such 
Act (42 U.S.C. 1396a), as amended by section 1703, 
is amended by adding at the end the following new 
subsection: 
‘‘(hh)(1) Individuals described in this subsection are 
individuals— 
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‘‘(A) whose income does not exceed an in-
come eligibility level established by the State that 
does not exceed the highest income eligibility 
level established under the State plan under this 
title (or under its State child health plan under 
title XXI) for pregnant women; and 
‘‘(B) who are not pregnant. 
‘‘(2) At the option of a State, individuals described 
in this subsection may include individuals who, had indi-
viduals applied on or before January 1, 2007, would have 
been made eligible pursuant to the standards and processes 
imposed by that State for benefits described in clause (XV) 
of the matter following subparagraph (G) of section sub-
section (a)(10) pursuant to a waiver granted under section 
1115. 
‘‘(3) At the option of a State, for purposes of subsection 
(a)(17)(B), in determining eligibility for services under this 
subsection, the State may consider only the income of the 
applicant or recipient.’’. 
(3) 
LIMITATION
ON
BENEFITS.—Section 
1902(a)(10) of such Act (42 U.S.C. 1396a(a)(10)) is 
amended in the matter following subparagraph (G)— 
(A) by striking ‘‘and (XIV)’’ and inserting 
‘‘(XIV)’’; and 
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812 
(B) by inserting ‘‘, and (XV) the medical 
assistance made available to an individual de-
scribed in subsection (hh) shall be limited to 
family planning services and supplies described 
in section 1905(a)(4)(C) including medical diag-
nosis and treatment services that are provided 
pursuant to a family planning service in a fam-
ily planning setting’’ after ‘‘cervical cancer’’. 
(4) 
CONFORMING
AMENDMENTS.—Section 
1905(a) of such Act (42 U.S.C. 1396d(a)), as amend-
ed by section 1731(c), is amended in the matter pre-
ceding paragraph (1)— 
(A) in clause (xiii), by striking ‘‘or’’ at the 
end; 
(B) in clause (xiv), by adding ‘‘or’’ at the 
end; and 
(C) by inserting after clause (xiv) the fol-
lowing: 
‘‘(xv) 
individuals 
described 
in 
section 
1902(hh),’’. 
(b) PRESUMPTIVE ELIGIBILITY.— 
(1) IN GENERAL.—Title XIX of the Social Secu-
rity Act (42 U.S.C. 1396 et seq.) is amended by in-
serting after section 1920B the following: 
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‘‘PRESUMPTIVE ELIGIBILITY FOR FAMILY PLANNING 
SERVICES 
‘‘SEC. 1920C. (a) STATE OPTION.—State plan ap-
proved under section 1902 may provide for making medical 
assistance available to an individual described in section 
1902(hh) (relating to individuals who meet certain income 
eligibility standard) during a presumptive eligibility pe-
riod. In the case of an individual described in section 
1902(hh), such medical assistance shall be limited to family 
planning services and supplies described in 1905(a)(4)(C) 
and, at the State’s option, medical diagnosis and treatment 
services that are provided in conjunction with a family 
planning service in a family planning setting. 
‘‘(b) DEFINITIONS.—For purposes of this section: 
‘‘(1) PRESUMPTIVE
ELIGIBILITY
PERIOD.—The 
term ‘presumptive eligibility period’ means, with re-
spect to an individual described in subsection (a), the 
period that— 
‘‘(A) begins with the date on which a quali-
fied entity determines, on the basis of prelimi-
nary information, that the individual is de-
scribed in section 1902(hh); and 
‘‘(B) ends with (and includes) the earlier 
of— 
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‘‘(i) the day on which a determination 
is made with respect to the eligibility of 
such individual for services under the State 
plan; or 
‘‘(ii) in the case of such an individual 
who does not file an application by the last 
day of the month following the month dur-
ing which the entity makes the determina-
tion referred to in subparagraph (A), such 
last day. 
‘‘(2) QUALIFIED ENTITY.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the term ‘qualified entity’ means any 
entity that— 
‘‘(i) is eligible for payments under a 
State plan approved under this title; and 
‘‘(ii) is determined by the State agency 
to be capable of making determinations of 
the type described in paragraph (1)(A). 
‘‘(B) RULE OF CONSTRUCTION.—Nothing in 
this paragraph shall be construed as preventing 
a State from limiting the classes of entities that 
may become qualified entities in order to prevent 
fraud and abuse. 
‘‘(c) ADMINISTRATION.— 
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‘‘(1) IN GENERAL.—The State agency shall pro-
vide qualified entities with— 
‘‘(A) such forms as are necessary for an ap-
plication to be made by an individual described 
in subsection (a) for medical assistance under 
the State plan; and 
‘‘(B) information on how to assist such in-
dividuals in completing and filing such forms. 
‘‘(2) NOTIFICATION
REQUIREMENTS.—A quali-
fied entity that determines under subsection (b)(1)(A) 
that an individual described in subsection (a) is pre-
sumptively eligible for medical assistance under a 
State plan shall— 
‘‘(A) notify the State agency of the deter-
mination within 5 working days after the date 
on which determination is made; and 
‘‘(B) inform such individual at the time the 
determination is made that an application for 
medical assistance is required to be made by not 
later than the last day of the month following the 
month during which the determination is made. 
‘‘(3) APPLICATION FOR MEDICAL ASSISTANCE.— 
In the case of an individual described in subsection 
(a) who is determined by a qualified entity to be pre-
sumptively eligible for medical assistance under a 
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State plan, the individual shall apply for medical as-
sistance by not later than the last day of the month 
following the month during which the determination 
is made. 
‘‘(d) PAYMENT.—Notwithstanding any other provision 
of law, medical assistance that— 
‘‘(1) is furnished to an individual described in 
subsection (a)— 
‘‘(A) during a presumptive eligibility pe-
riod; 
‘‘(B) by a entity that is eligible for pay-
ments under the State plan; and 
‘‘(2) is included in the care and services covered 
by the State plan, 
shall be treated as medical assistance provided by such plan 
for purposes of clause (4) of the first sentence of section 
1905(b).’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 1902(a)(47) of the Social Secu-
rity Act (42 U.S.C. 1396a(a)(47)) is amended by 
inserting before the semicolon at the end the fol-
lowing: ‘‘and provide for making medical assist-
ance available to individuals described in sub-
section (a) of section 1920C during a presump-
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tive eligibility period in accordance with such 
section’’. 
(B) Section 1903(u)(1)(D)(v) of such Act 
(42 U.S.C. 1396b(u)(1)(D)(v)) is amended— 
(i) by striking ‘‘or for’’ and inserting 
‘‘for’’; and 
(ii) by inserting before the period the 
following: ‘‘, or for medical assistance pro-
vided to an individual described in sub-
section (a) of section 1920C during a pre-
sumptive eligibility period under such sec-
tion’’. 
(c) CLARIFICATION OF COVERAGE OF FAMILY PLAN-
NING SERVICES AND SUPPLIES.—Section 1937(b) of the So-
cial Security Act (42 U.S.C. 1396u–7(b)), as amended by 
section 1703(c)(2), is amended by adding at the end the 
following: 
‘‘(6) COVERAGE OF FAMILY PLANNING SERVICES 
AND SUPPLIES.—Notwithstanding the previous provi-
sions of this section, a State may not provide for 
medical assistance through enrollment of an indi-
vidual with benchmark coverage or benchmark-equiva-
lent coverage under this section unless such coverage 
includes for any individual described in section 
1905(a)(4)(C), medical assistance for family planning 
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services and supplies in accordance with such sec-
tion.’’. 
(d) EFFECTIVE DATE.—The amendments made by this 
section take effect on the date of the enactment of this Act 
and shall apply to items and services furnished on or after 
such date. 
Subtitle C—Access 
SEC. 1721. PAYMENTS TO PRIMARY CARE PRACTITIONERS. 
(a) IN GENERAL.— 
(1) 
FEE-FOR-SERVICE
PAYMENTS.—Section 
1902(a)(13) of the Social Security Act (42 U.S.C. 
1396b(a)(13)) is amended— 
(A) by striking ‘‘and’’ at the end of sub-
paragraph (A); 
(B) by adding ‘‘and’’ at the end of subpara-
graph (B); and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(C) payment for primary care services (as 
defined in section 1848(j)(5)(A), but applied 
without regard to clause (ii) thereof) furnished 
by physicians (or for services furnished by other 
health care professionals that would be primary 
care services under such section if furnished by 
a physician) at a rate not less than 80 percent 
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of the payment rate applicable to such services 
and physicians or professionals (as the case may 
be) under part B of title XVIII for services fur-
nished in 2010, 90 percent of such rate for serv-
ices and physicians (or professionals) furnished 
in 2011, and 100 percent of such payment rate 
for services and physicians (or professionals) fur-
nished in 2012 or a subsequent year;’’. 
(2) UNDER MEDICAID MANAGED CARE PLANS.— 
Section 1932(f) of such Act (42 U.S.C. 1396u–2(f)) is 
amended— 
(A) in the heading, by adding at the end the 
following: ‘‘; ADEQUACY OF PAYMENT FOR PRI-
MARY CARE SERVICES’’; and 
(B) by inserting before the period at the end 
the following: ‘‘and, in the case of primary care 
services described in section 1902(a)(13)(C), con-
sistent with the minimum payment rates speci-
fied in such section (regardless of the manner in 
which such payments are made, including in the 
form of capitation or partial capitation)’’. 
(b) INCREASE
IN
PAYMENT
USING
INCREASED 
FMAP.—Section 1905(y) of the Social Security Act, as 
added by section 1701(a)(2)(B) and as amended by section 
1701(c)(2), is amended by adding at the end the following: 
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‘‘(3)(A) The portion of the amounts expended for 
medical assistance for services described in section 
1902(a)(13)(C) furnished on or after January 1, 
2010, that is attributable to the amount by which the 
minimum payment rate required under such section 
(or, by application, section 1932(f)) exceeds the pay-
ment rate applicable to such services under the State 
plan as of June 16, 2009. 
‘‘(B) Subparagraphs (A) shall not be construed 
as preventing the payment of Federal financial par-
ticipation based on the Federal medical assistance 
percentage for amounts in excess of those specified 
under such subparagraphs.’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall apply to services furnished on or after January 
1, 2010. 
SEC. 1722. MEDICAL HOME PILOT PROGRAM. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall establish under this section a medical 
home pilot program under which a State may apply to the 
Secretary for approval of a medical home pilot project de-
scribed in subsection (b) (in this section referred to as a 
‘‘pilot project’’) for the application of the medical home con-
cept under title XIX of the Social Security Act. The pilot 
program shall operate for a period of up to 5 years. 
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(b) PILOT PROJECT DESCRIBED.— 
(1) IN GENERAL.—A pilot project is a project 
that applies one or more of the medical home models 
described in section 1866E(a)(3) of the Social Secu-
rity Act (as inserted by section 1302(a)) or such other 
model as the Secretary may approve, to high need 
beneficiaries (including medically fragile children 
and high-risk pregnant women) who are eligible for 
medical assistance under title XIX of the Social Secu-
rity Act. The Secretary shall provide for appropriate 
coordination of the pilot program under this section 
with the medical home pilot program under section 
1866E of such Act. 
(2) LIMITATION.—A pilot project shall be for a 
duration of not more than 5 years. 
(c) ADDITIONAL INCENTIVES.—In the case of a pilot 
project, the Secretary may— 
(1) waive the requirements of section 1902(a)(1) 
of the Social Security Act (relating to statewideness) 
and section 1902(a)(10)(B) of such Act (relating to 
comparability); and 
(2) increase to up to 90 percent (for the first 2 
years of the pilot program) or 75 percent (for the next 
3 years) the matching percentage for administrative 
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expenditures (such as those for community care work-
ers). 
(d) MEDICALLY FRAGILE CHILDREN.—In the case of 
a model involving medically fragile children, the model 
shall ensure that the patient-centered medical home services 
received by each child, in addition to fulfilling the require-
ments under 1866E(b)(1) of the Social Security Act, pro-
vide for continuous involvement and education of the parent 
or caregiver and for assistance to the child in obtaining 
necessary transitional care if a child’s enrollment ceases for 
any reason. 
(e) EVALUATION; REPORT.— 
(1) EVALUATION.—The Secretary, using the cri-
teria described in section 1866E(g)(1) of the Social 
Security Act (as inserted by section 1123), shall con-
duct an evaluation of the pilot program under this 
section. 
(2) REPORT.—Not later than 60 days after the 
date of completion of the evaluation under paragraph 
(1), the Secretary shall submit to Congress and make 
available to the public a report on the findings of the 
evaluation under such paragraph. 
(f) FUNDING.—The additional Federal financial par-
ticipation resulting from the implementation of the pilot 
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program under this section may not exceed in the aggregate 
$1,235,000,000 over the 5-year period of the program. 
SEC. 1723. TRANSLATION OR INTERPRETATION SERVICES. 
(a) IN GENERAL.—Section 1903(a)(2)(E) of the Social 
Security Act (42 U.S.C. 1396b(a)(2)), as added by section 
201(b)(2)(A) of the Children’s Health Insurance Program 
Reauthorization Act of 2009 (Public Law 111–3), is amend-
ed by inserting ‘‘and other individuals’’ after ‘‘children of 
families’’. 
(b) EFFECTIVE DATE.—The amendment made by sub-
section (a) shall apply to payment for translation or inter-
pretation services furnished on or after January 1, 2010. 
SEC. 1724. OPTIONAL COVERAGE FOR FREESTANDING 
BIRTH CENTER SERVICES. 
(a) IN GENERAL.—Section 1905 of the Social Security 
Act (42 U.S.C. 1396d), as amended by section 1713(a), is 
amended— 
(1) in subsection (a)— 
(A) by redesignating paragraph (29) as 
paragraph (30); 
(B) in paragraph (28), by striking at the 
end ‘‘and’’; and 
(C) by inserting after paragraph (28) the 
following new paragraph: 
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‘‘(29) freestanding birth center services (as de-
fined in subsection (l)(3)(A)) and other ambulatory 
services that are offered by a freestanding birth center 
(as defined in subsection (l)(3)(B)) and that are oth-
erwise included in the plan; and’’; and 
(2) in subsection (l), by adding at the end the 
following new paragraph: 
‘‘(3)(A) The term ‘freestanding birth center services’ 
means services furnished to an individual at a freestanding 
birth center (as defined in subparagraph (B)), including 
by a licensed birth attendant (as defined in subparagraph 
(C)) at such center. 
‘‘(B) The term ‘freestanding birth center’ means a 
health facility— 
‘‘(i) that is not a hospital; and 
‘‘(ii) where childbirth is planned to occur away 
from the pregnant woman’s residence. 
‘‘(C) The term ‘licensed birth attendant’ means an in-
dividual who is licensed or registered by the State involved 
to provide health care at childbirth and who provides such 
care within the scope of practice under which the individual 
is legally authorized to perform such care under State law 
(or the State regulatory mechanism provided by State law), 
regardless of whether the individual is under the super-
vision of, or associated with, a physician or other health 
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care provider. Nothing in this subparagraph shall be con-
strued as changing State law requirements applicable to a 
licensed birth attendant.’’. 
(b) EFFECTIVE DATE.—The amendments made by this 
section shall apply to items and services furnished on or 
after the date of the enactment of this Act. 
SEC. 1725. INCLUSION OF PUBLIC HEALTH CLINICS UNDER 
THE VACCINES FOR CHILDREN PROGRAM. 
Section 1928(b)(2)(A)(iii)(I) of the Social Security Act 
(42 U.S.C. 1396s(b)(2)(A)(iii)(I)) is amended— 
(1) by striking ‘‘or a rural health clinic’’ and in-
serting ‘‘, a rural health clinic’’; and 
(2) by inserting ‘‘or a public health clinic,’’ after 
‘‘‘1905(l)(1)),’’. 
SEC. 1726. REQUIRING COVERAGE OF SERVICES OF PODIA-
TRISTS. 
(a) IN GENERAL.—Section 1905(a)(5)(A) of the Social 
Security Act (42 U.S.C. 1396d(a)(5)(A)) is amended by 
striking ‘‘section 1861(r)(1)’’ and inserting ‘‘paragraphs 
(1) and (3) of section 1861(r)’’. 
(b) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendment made by subsection (a) 
shall apply to services furnished on or after January 
1, 2010. 
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(2) EXTENSION OF EFFECTIVE DATE FOR STATE 
LAW AMENDMENT.—In the case of a State plan under 
title XIX of the Social Security Act (42 U.S.C. 1396 
et seq.) which the Secretary of Health and Human 
Services determines requires State legislation in order 
for the plan to meet the additional requirement im-
posed by the amendment made by subsection (a), the 
State plan shall not be regarded as failing to comply 
with the requirements of such title solely on the basis 
of its failure to meet these additional requirements be-
fore the first day of the first calendar quarter begin-
ning after the close of the first regular session of the 
State legislature that begins after the date of enact-
ment of this Act. For purposes of the previous sen-
tence, in the case of a State that has a 2-year legisla-
tive session, each year of the session is considered to 
be a separate regular session of the State legislature. 
SEC. 1726A. REQUIRING COVERAGE OF SERVICES OF OP-
TOMETRISTS. 
(a) IN GENERAL.—Section 1905(a)(5) of the Social Se-
curity Act (42 U.S.C. 1396d(a)(5)) is amended— 
(1) by striking ‘‘and’’ before ‘‘(B)’’; and 
(2) by inserting before the semicolon at the end 
the following: ‘‘, and (C) medical and other health 
services (as defined in section 1861(s)) as authorized 
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by State law, furnished by an optometrist (described 
in section 1861(r)(4)) to the extent such services may 
be performed under State law’’. 
(b) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by subsection (a) 
shall take effect 90 days after the date of the enact-
ment of this Act and shall apply to services furnished 
or other actions required on or after such date. 
(2) EXCEPTION
IF
STATE
LEGISLATION
RE-
QUIRED.—In the case of a State plan for medical as-
sistance under title XIX of the Social Security Act 
which the Secretary of Health and Human Services 
determines requires State legislation (other than legis-
lation appropriating funds) in order for the plan to 
meet the additional requirements made by the amend-
ments made by subsection (a), the State plan shall 
not be regarded as failing to comply with the require-
ments of such title solely on the basis of its failure to 
meet these additional requirements before the first day 
of the first calendar quarter beginning after the close 
of the first regular session of the State legislature 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 
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of such session shall be deemed to be a separate reg-
ular session of the State legislature. 
SEC. 1727. THERAPEUTIC FOSTER CARE. 
(a) RULE OF CONSTRUCTION.—Nothing in this title 
shall prevent or limit a State from covering therapeutic fos-
ter care for eligible children in out-of-home placements 
under section 1905(a) of the Social Security Act (42 U.S.C. 
1396d(a)). 
(b) THERAPEUTIC FOSTER CARE DEFINED.—For pur-
poses of this section, the term ‘‘therapeutic foster care’’ 
means a foster care program that provides— 
(1) to the child— 
(A) structured daily activities that develop, 
improve, monitor, and reinforce age-appropriate 
social, communications, and behavioral skills; 
(B) crisis intervention and crisis support 
services; 
(C) medication monitoring; 
(D) counseling; and 
(E) case management services; and 
(2) specialized training for the foster parent and 
consultation with the foster parent on the manage-
ment of children with mental illnesses and related 
health and developmental conditions. 
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fair share per capita amount 
under subparagraph (A) for a fis-
cal year, the fair share per capita 
amount under this paragraph for 
the fiscal year shall be the default 
amount determined under clause 
(ii) for the fiscal year. 
‘‘(ii) 
DEFAULT
AMOUNT.—The 
default amount under this clause 
for— 
‘‘(I) fiscal year 2013 is 
equal to $2; or 
‘‘(II) a subsequent year is 
equal to the default amount 
under this clause for the pre-
ceding fiscal year increased 
by the annual percentage in-
crease in the medical care 
component of the consumer 
price 
index 
(United 
States 
city average) for the 12-month 
period ending with April of 
the preceding fiscal year. 
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‘applicable self-insured health plan’ means 
any plan for providing accident or health cov-
erage if— 
‘‘(1) any portion of such coverage is 
provided other than through an insur-
ance policy, and 
‘‘(2) such plan is established or main-
tained— 
‘‘(A) by one or more employers for 
the benefit of their employees or 
former employees, 
‘‘(B) by one or more employee or-
ganizations for the benefit of their 
members or former members, 
‘‘(C) jointly by 1 or more employ-
ers and 1 or more employee organiza-
tions for the benefit of employees or 
former employees, 
‘‘(D) by a voluntary employees’ 
beneficiary association described in 
section 501(c)(9), 
‘‘(E) 
by 
any 
organization 
de-
scribed in section 501(c)(6), or 
‘‘(F) in the case of a plan not de-
scribed in the preceding subpara-
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