H. R. 2015—317
‘‘(ii) the quality of health coverage provided includ-
ing the types of benefits provided,
‘‘(iii) the amount and level (including payment of
part or all of any premium) of assistance provided
by the State,
‘‘(iv) the service area of the State plan,
‘‘(v) the time limits for coverage of a child under
the State plan,
‘‘(vi) the State’s choice of health benefits coverage
and other methods used for providing child health
assistance, and
‘‘(vii) the sources of non-Federal funding used in
the State plan.
‘‘(C) An assessment of the effectiveness of other public
and private programs in the State in increasing the avail-
ability of affordable quality individual and family health
insurance for children.
‘‘(D) A review and assessment of State activities to
coordinate the plan under this title with other public and
private programs providing health care and health care
financing, including medicaid and maternal and child
health services.
‘‘(E) An analysis of changes and trends in the State
that affect the provision of accessible, affordable, quality
health insurance and health care to children.
‘‘(F) A description of any plans the State has for
improving the availability of health insurance and health
care for children.
‘‘(G) Recommendations for improving the program
under this title.
‘‘(H) Any other matters the State and the Secretary
consider appropriate.
‘‘(2) REPORT OF THE SECRETARY.—The Secretary shall sub-
mit to Congress and make available to the public by December
31, 2001, a report based on the evaluations submitted by States
under paragraph (1), containing any conclusions and rec-
ommendations the Secretary considers appropriate.
‘‘SEC. 2109. MISCELLANEOUS PROVISIONS.
‘‘(a) RELATION TO OTHER LAWS.—
‘‘(1) HIPAA.—Health benefits coverage provided under sec-
tion 2101(a)(1) (and coverage provided under a waiver under
section 2105(c)(2)(B)) shall be treated as creditable coverage
for purposes of part 7 of subtitle B of title II of the Employee
Retirement Income Security Act of 1974, title XXVII of the
Public Health Service Act, and subtitle K of the Internal Reve-
nue Code of 1986.
‘‘(2) ERISA.—Nothing in this title shall be construed as
affecting or modifying section 514 of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1144) with respect
to a group health plan (as defined in section 2791(a)(1) of
the Public Health Service Act (42 U.S.C. 300gg–91(a)(1)).
‘‘SEC. 2110. DEFINITIONS.
‘‘(a) CHILD HEALTH ASSISTANCE.—For purposes of this title,
the term ‘child health assistance’ means payment for part or all
of the cost of health benefits coverage for targeted low-income
children that includes any of the following (and includes, in the
H. R. 2015—318
case described in section 2105(a)(2)(A), payment for part or all
of the cost of providing any of the following), as specified under
the State plan:
‘‘(1) Inpatient hospital services.
‘‘(2) Outpatient hospital services.
‘‘(3) Physician services.
‘‘(4) Surgical services.
‘‘(5) Clinic services (including health center services) and
other ambulatory health care services.
‘‘(6) Prescription drugs and biologicals and the administra-
tion of such drugs and biologicals, only if such drugs and
biologicals are not furnished for the purpose of causing, or
assisting in causing, the death, suicide, euthanasia, or mercy
killing of a person.
‘‘(7) Over-the-counter medications.
‘‘(8) Laboratory and radiological services.
‘‘(9) Prenatal care and prepregnancy family planning serv-
ices and supplies.
‘‘(10) Inpatient mental health services, other than services
described in paragraph (18) but including services furnished
in a State-operated mental hospital and including residential
or other 24-hour therapeutically planned structured services.
‘‘(11) Outpatient mental health services, other than services
described in paragraph (19) but including services furnished
in a State-operated mental hospital and including community-
based services.
‘‘(12) Durable medical equipment and other medically-
related or remedial devices (such as prosthetic devices,
implants, eyeglasses, hearing aids, dental devices, and adaptive
devices).
‘‘(13) Disposable medical supplies.
‘‘(14) Home and community-based health care services and
related supportive services (such as home health nursing serv-
ices, home health aide services, personal care, assistance with
activities of daily living, chore services, day care services, res-
pite care services, training for family members, and minor
modifications to the home).
‘‘(15) Nursing care services (such as nurse practitioner
services, nurse midwife services, advanced practice nurse serv-
ices, private duty nursing care, pediatric nurse services, and
respiratory care services) in a home, school, or other setting.
‘‘(16) Abortion only if necessary to save the life of the
mother or if the pregnancy is the result of an act of rape
or incest.
‘‘(17) Dental services.
‘‘(18) Inpatient substance abuse treatment services and
residential substance abuse treatment services.
‘‘(19) Outpatient substance abuse treatment services.
‘‘(20) Case management services.
‘‘(21) Care coordination services.
‘‘(22) Physical therapy, occupational therapy, and services
for individuals with speech, hearing, and language disorders.
‘‘(23) Hospice care.
‘‘(24) Any other medical, diagnostic, screening, preventive,
restorative, remedial, therapeutic, or rehabilitative services
(whether in a facility, home, school, or other setting) if recog-
nized by State law and only if the service is—
H. R. 2015—319
‘‘(A) prescribed by or furnished by a physician or other
licensed or registered practitioner within the scope of prac-
tice as defined by State law,
‘‘(B) performed under the general supervision or at
the direction of a physician, or
‘‘(C) furnished by a health care facility that is operated
by a State or local government or is licensed under State
law and operating within the scope of the license.
‘‘(25) Premiums for private health care insurance coverage.
‘‘(26) Medical transportation.
‘‘(27) Enabling services (such as transportation, translation,
and outreach services) only if designed to increase the acces-
sibility of primary and preventive health care services for
eligible low-income individuals.
‘‘(28) Any other health care services or items specified
by the Secretary and not excluded under this section.
‘‘(b) TARGETED LOW-INCOME CHILD DEFINED.—For purposes of
this title—
‘‘(1) IN GENERAL.—Subject to paragraph (2), the term ‘tar-
geted low-income child’ means a child—
‘‘(A) who has been determined eligible by the State
for child health assistance under the State plan;
‘‘(B)(i) who is a low-income child, or
‘‘(ii) is a child whose family income (as determined
under the State child health plan) exceeds the medicaid
applicable income level (as defined in paragraph (4)), but
does not exceed 50 percentage points above the medicaid
applicable income level; and
‘‘(C) who is not found to be eligible for medical assist-
ance under title XIX or covered under a group health
plan or under health insurance coverage (as such terms
are defined in section 2791 of the Public Health Service
Act).
‘‘(2) CHILDREN EXCLUDED.—Such term does not include—
‘‘(A) a child who is an inmate of a public institution
or a patient in an institution for mental diseases; or
‘‘(B) a child who is a member of a family that is
eligible for health benefits coverage under a State health
benefits plan on the basis of a family member’s employment
with a public agency in the State.
‘‘(3) SPECIAL
RULE.—A child shall not be considered to
be described in paragraph (1)(C) notwithstanding that the child
is covered under a health insurance coverage program that
has been in operation since before July 1, 1997, and that
is offered by a State which receives no Federal funds for the
program’s operation.
‘‘(4) MEDICAID
APPLICABLE
INCOME
LEVEL.—The term
‘medicaid applicable income level’ means, with respect to a
child, the effective income level (expressed as a percent of
the poverty line) that has been specified under the State plan
under title XIX (including under a waiver authorized by the
Secretary or under section 1902(r)(2)), as of June 1, 1997,
for the child to be eligible for medical assistance under section
1902(l)(2) for the age of such child.
‘‘(c) ADDITIONAL DEFINITIONS.—For purposes of this title:
‘‘(1) CHILD.—The term ‘child’ means an individual under
19 years of age.
H. R. 2015—320
‘‘(2) CREDITABLE HEALTH COVERAGE.—The term ‘creditable
health coverage’ has the meaning given the term ‘creditable
coverage’ under section 2701(c) of the Public Health Service
Act (42 U.S.C. 300gg(c)) and includes coverage that meets the
requirements of section 2103 provided to a targeted low-income
child under this title or under a waiver approved under section
2105(c)(2)(B) (relating to a direct service waiver).
‘‘(3) GROUP HEALTH PLAN; HEALTH INSURANCE COVERAGE;
ETC.—The terms ‘group health plan’, ‘group health insurance
coverage’, and ‘health insurance coverage’ have the meanings
given such terms in section 2191 of the Public Health Service
Act.
‘‘(4) LOW-INCOME.—The term ‘low-income child’ means a
child whose family income is at or below 200 percent of the
poverty line for a family of the size involved.
‘‘(5) POVERTY LINE DEFINED.—The term ‘poverty line’ has
the meaning given such term in section 673(2) of the Commu-
nity Services Block Grant Act (42 U.S.C. 9902(2)), including
any revision required by such section.
‘‘(6) 
PREEXISTING
CONDITION
EXCLUSION.—The 
term
‘preexisting condition exclusion’ has the meaning given such
term in section 2701(b)(1)(A) of the Public Health Service Act
(42 U.S.C. 300gg(b)(1)(A)).
‘‘(7) STATE CHILD HEALTH PLAN; PLAN.—Unless the context
otherwise requires, the terms ‘State child health plan’ and
‘plan’ mean a State child health plan approved under section
2106.
‘‘(8) UNCOVERED CHILD.—The term ‘uncovered child’ means
a child that does not have creditable health coverage.’’.
(b) CONFORMING AMENDMENTS.—
(1) DEFINITION OF STATE.—Section 1101(a)(1) is amended—
(A) by striking ‘‘and XIX’’ and inserting ‘‘XIX, and
XXI’’, and
(B) by striking ‘‘title XIX’’ and inserting ‘‘titles XIX
and XXI’’.
(2) TREATMENT AS STATE HEALTH CARE PROGRAM.—Section
1128(h) (42 U.S.C. 1320a–7(h)) is amended by—
(A) in paragraph (2), by striking ‘‘or’’ at the end;
(B) in paragraph (3), by striking the period and insert-
ing ‘‘, or’’; and
(C) by adding at the end the following:
‘‘(4) a State child health plan approved under title XXI.’’.
CHAPTER 2—EXPANDED COVERAGE OF CHILDREN
UNDER MEDICAID
SEC. 4911. OPTIONAL USE OF STATE CHILD HEALTH ASSISTANCE
FUNDS 
FOR 
ENHANCED 
MEDICAID 
MATCH 
FOR
EXPANDED MEDICAID ELIGIBILITY.
(a) INCREASED FMAP FOR MEDICAL ASSISTANCE FOR EXPANDED
COVERAGE OF TARGETED LOW-INCOME CHILDREN.—Section 1905 of
the Social Security Act (42 U.S.C. 1396d), as amended by section
4702(a)(2), is amended—
(1) in subsection (b), by adding at the end the following
new sentence: ‘‘Notwithstanding the first sentence of this sub-
section, in the case of a State plan that meets the condition
described in subsection (u)(1), with respect to expenditures