1787 
total amount that would otherwise apply for 
any violation described in this section com-
mitted in furtherance of the conspiracy in-
volved, or in cases under paragraph (13), an as-
sessment of not more than 3 times the total 
amount of the obligation to which the false 
record or statement was material or that was 
avoided or decreased)’’. 
(2) in subsection (c)(1), by striking ‘‘six years’’ 
and inserting ‘‘10 years’’; and 
(3) in subsection (i)— 
(A) by amending paragraph (2) to read as 
follows: 
‘‘(2) The term ‘‘claim’’ means any application, 
request, or demand, whether under contract, or oth-
erwise, for money or property for items and services 
under a Federal health care program (as defined in 
section 1128B(f)), whether or not the United States 
or a State agency has title to the money or property, 
that— 
‘‘(A) is presented or caused to be pre-
sented to an officer, employee, or agent of the 
United States, or of any department or agency 
thereof, or of any State agency (as defined in 
subsection (i)(1)); or 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01787
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1788 
‘‘(B) is made to a contractor, grantee, or 
other recipient if the money or property is to be 
spent or used on the Federal health care pro-
gram’s behalf or to advance a Federal health 
care program interest, and if the Federal health 
care program— 
‘‘(i) provides or has provided any por-
tion of the money or property requested or 
demanded; or 
‘‘(ii) will reimburse such contractor, 
grantee, or other recipient for any portion 
of the money or property which is re-
quested or demanded.’’; 
(B) by amending paragraph (3) to read as 
follows: 
‘‘(3) The term ‘item or service’ means, without 
limitation, any medical, social, management, admin-
istrative, or other item or service used in connection 
with or directly or indirectly related to a Federal 
health care program.’’; 
(C) in paragraph (6)— 
(i) in subparagraph (C), by striking at 
the end ‘‘or’’; 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01788
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1789 
(ii) in the first subparagraph (D), by 
striking at the end the period and inserting 
‘‘; or’’; and 
(iii) by redesignating the second sub-
paragraph (D) as a subparagraph (E); 
(D) by amending paragraph (7) to read as 
follows: 
‘‘(7) The terms ‘knowing’, ‘knowingly’, and 
‘should know’ mean that a person, with respect to 
information— 
‘‘(A) has actual knowledge of the informa-
tion; 
‘‘(B) acts in deliberate ignorance of the 
truth or falsity of the information; or 
‘‘(C) acts in reckless disregard of the truth 
or falsity of the information; 
and require no proof of specific intent to defraud.’’; 
and 
(E) by adding at the end the following new 
paragraphs: 
‘‘(8) The term ‘obligation’ means an established 
duty, whether or not fixed, arising from an express 
or implied contractual, grantor-grantee, or licensor- 
licensee relationship, from a fee-based or similar re-
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01789
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1790 
lationship, from statute or regulation, or from the 
retention of any overpayment. 
‘‘(9) The term ‘material’ means having a nat-
ural tendency to influence, or be capable of influ-
encing, the payment or receipt of money or prop-
erty.’’. 
Subtitle D—Access to Information 
Needed 
To 
Prevent 
Fraud, 
Waste, and Abuse 
SEC. 1651. ACCESS TO INFORMATION NECESSARY TO IDEN-
TIFY FRAUD, WASTE, AND ABUSE. 
Section 1128G of the Social Security Act, as added 
by section 1631 and amended by sections 1632 and 1641, 
is further amended by adding at the end the following new 
subsection; 
‘‘(d) ACCESS
TO
INFORMATION
NECESSARY
TO 
IDENTIFY FRAUD, WASTE, AND ABUSE.—For purposes of 
law enforcement activity, and to the extent consistent with 
applicable disclosure, privacy, and security laws, including 
the Health Insurance Portability and Accountability Act 
of 1996 and the Privacy Act of 1974, and subject to any 
information systems security requirements enacted by law 
or otherwise required by the Secretary, the Attorney Gen-
eral shall have access, facilitation by the Inspector General 
of the Department of Health and Human Services, to 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01790
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1791 
claims and payment data relating to titles XVIII and XIX, 
in consultation with the Centers for Medicare & Medicaid 
Services or the owner of such data.’’. 
SEC. 1652. ELIMINATION OF DUPLICATION BETWEEN THE 
HEALTHCARE INTEGRITY AND PROTECTION 
DATA BANK AND THE NATIONAL PRACTI-
TIONER DATA BANK. 
(a) IN GENERAL.—To eliminate duplication between 
the Healthcare Integrity and Protection Data Bank 
(HIPDB) established under section 1128E of the Social 
Security Act and the National Practitioner Data Bank 
(NPBD) established under the Health Care Quality Im-
provement Act of 1986, section 1128E of the Social Secu-
rity Act (42 U.S.C. 1320a–7e) is amended— 
(1) in subsection (a), by striking ‘‘Not later 
than’’ and inserting ‘‘Subject to subsection (h), not 
later than’’; 
(2) in the first sentence of subsection (d)(2), by 
striking ‘‘(other than with respect to requests by 
Federal agencies)’’; and 
(3) by adding at the end the following new sub-
section: 
‘‘(h) SUNSET OF THE HEALTHCARE INTEGRITY AND 
PROTECTION DATA BANK; TRANSITION PROCESS.—Ef-
fective upon the enactment of this subsection, the Sec-
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01791
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1792 
retary shall implement a process to eliminate duplication 
between the Healthcare Integrity and Protection Data 
Bank (in this subsection referred to as the ‘HIPDB’ es-
tablished pursuant to subsection (a) and the National 
Practitioner Data Bank (in this subsection referred to as 
the ‘NPDB’) as implemented under the Health Care Qual-
ity Improvement Act of 1986 and section 1921 of this Act, 
including systems testing necessary to ensure that infor-
mation formerly collected in the HIPDB will be accessible 
through the NPDB, and other activities necessary to 
eliminate duplication between the two data banks. Upon 
the completion of such process, notwithstanding any other 
provision of law, the Secretary shall cease the operation 
of the HIPDB and shall collect information required to 
be reported under the preceding provisions of this section 
in the NPDB. Except as otherwise provided in this sub-
section, the provisions of subsections (a) through (g) shall 
continue to apply with respect to the reporting of (or fail-
ure to report), access to, and other treatment of the infor-
mation specified in this section.’’. 
(b) ELIMINATION OF THE RESPONSIBILITY OF THE 
HHS OFFICE OF THE INSPECTOR GENERAL.—Section 
1128C(a)(1) of the Social Security Act (42 U.S.C. 1320a– 
7c(a)(1)) is amended— 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01792
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1793 
(1) in subparagraph (C), by adding at the end 
‘‘and’’; 
(2) in subparagraph (D), by striking at the end 
‘‘, and’’ and inserting a period; and 
(3) by striking subparagraph (E). 
(c) SPECIAL PROVISION FOR ACCESS TO THE NA-
TIONAL PRACTITIONER DATA BANK BY THE DEPART-
MENT OF VETERANS AFFAIRS.— 
(1) IN GENERAL.—Notwithstanding any other 
provision of law, during the one year period that be-
gins on the effective date specified in subsection 
(e)(1), the information described in paragraph (2) 
shall be available from the National Practitioner 
Data Bank (described in section 1921 of the Social 
Security Act) to the Secretary of Veterans Affairs 
without charge. 
(2) INFORMATION DESCRIBED.—For purposes 
of paragraph (1), the information described in this 
paragraph is the information that would, but for the 
amendments made by this section, have been avail-
able to the Secretary of Veterans Affairs from the 
Healthcare Integrity and Protection Data Bank. 
(d) FUNDING.—Notwithstanding any provisions of 
this Act, sections 1128E(d)(2) and 1817(k)(3) of the So-
cial Security Act, or any other provision of law, there shall 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01793
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1794 
be available for carrying out the transition process under 
section 1128E(h) of the Social Security Act over the pe-
riod required to complete such process, and for operation 
of the National Practitioner Data Bank until such process 
is completed, without fiscal year limitation— 
(1) any fees collected pursuant to section 
1128E(d)(2) of such Act; and 
(2) such additional amounts as necessary, from 
appropriations available to the Secretary and to the 
Office of the Inspector General of the Department of 
Health and Human Services under clauses (i) and 
(ii), respectively, of section 1817(k)(3)(A) of such 
Act, for costs of such activities during the first 12 
months following the date of the enactment of this 
Act. 
(e) EFFECTIVE DATE.—The amendments made— 
(1) by subsection (a)(2) shall take effect on the 
first day after the Secretary of Health and Human 
Services certifies that the process implemented pur-
suant to section 1128E(h) of the Social Security Act 
(as added by subsection (a)(3)) is complete; and 
(2) by subsection (b) shall take effect on the 
earlier of the date specified in paragraph (1) or the 
first day of the second succeeding fiscal year after 
the fiscal year during which this Act is enacted. 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01794
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1795 
SEC. 1653. COMPLIANCE WITH HIPAA PRIVACY AND SECU-
RITY STANDARDS. 
The provisions of sections 262(a) and 264 of the 
Health Insurance Portability and Accountability Act of 
1996 (and standards promulgated pursuant to such sec-
tions) and the Privacy Act of 1974 shall apply with respect 
to the provisions of this subtitle and amendments made 
by this subtitle. 
TITLE O—MEDICAID AND CHIP 
Subtitle A—Medicaid and Health 
Reform 
SEC. 1701. ELIGIBILITY FOR INDIVIDUALS WITH INCOME 
BELOW 1331⁄3
PERCENT OF THE FEDERAL 
POVERTY LEVEL. 
(a) ELIGIBILITY
FOR NON-TRADITIONAL INDIVID-
UALS WITH INCOME BELOW 133 PERCENT OF THE FED-
ERAL POVERTY LEVEL.— 
(1) IN GENERAL.—Section 1902(a)(10)(A)(i) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396b(a)(10)(A)(i) is amended— 
(A) by striking ‘‘or’’ at the end of sub-
clause (VI); 
(B) by adding ‘‘or’’ at the end of subclause 
(VII); and 
(C) by adding at the end the following new 
subclause: 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01795
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1796 
‘‘(VIII) who are under 65 years 
of age, who are not described in a pre-
vious subclause of this clause, and 
who are in families whose income (de-
termined using methodologies and 
procedures specified by the Secretary 
in 
consultation 
with 
the 
Health 
Choices Commissioner) does not ex-
ceed 1331⁄3 percent of the income offi-
cial poverty line (as defined by the Of-
fice of Management and Budget, and 
revised annually in accordance with 
section 673(2) of the Omnibus Budget 
Reconciliation Act of 1981) applicable 
to a family of the size involved;’’. 
(2) 100% FMAP FOR NON-TRADITIONAL MED-
ICAID
ELIGIBLE
INDIVIDUALS.—Section 1905 of 
such Act (42 U.S.C. 1396d) is amended— 
(A) in the third sentence of subsection (b) 
by inserting before the period at the end the 
following: ‘‘and with respect to amounts de-
scribed in subsection (y)’’; and 
(B) by adding at the end the following new 
subsection: 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01796
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1797 
‘‘(y) ADDITIONAL
EXPENDITURES
SUBJECT
TO 
100% FMAP.—For purposes of section 1905(b), the 
amounts described in this subsection are the following: 
‘‘(1) Amounts expended for medical assistance 
for individuals described in subclause (VIII) of sec-
tion 1902(a)(10)(A)(i).’’. 
(3) CONSTRUCTION.—Nothing in this sub-
section shall be construed as not providing for cov-
erage 
under 
subclause 
(VIII) 
of 
section 
1902(a)(10)(A)(i) of the Social Security Act, as 
added by paragraph (1) of, and an increased FMAP 
under the amendment made by paragraph (2) for, 
an individual who has been provided medical assist-
ance under title XIX of the Act under a demonstra-
tion waiver approved under section 1115 of such Act 
or with State funds. 
(4) 
CONFORMING
AMENDMENT.—Section 
1903(f)(4) of the Social Security Act (42 U.S.C. 
1396b(f)(4)) 
is 
amended 
by 
inserting 
‘‘1902(a)(10)(A)(i)(VIII),’’ 
after 
‘‘1902(a)(10)(A)(i)(VII),’’. 
(b) ELIGIBILITY FOR TRADITIONAL MEDICAID ELI-
GIBLE INDIVIDUALS WITH INCOME NOT EXCEEDING 
1331⁄3 PERCENT OF THE FEDERAL POVERTY LEVEL.— 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01797
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1798 
(1) IN GENERAL.—Section 1902(a)(10)(A)(i) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396b(a)(10)(A)(i)), as amended by subsection (a), 
is amended— 
(A) by striking ‘‘or’’ at the end of sub-
clause (VII); 
(B) by adding ‘‘or’’ at the end of subclause 
(VIII); and 
(C) by adding at the end the following new 
subclause: 
‘‘(IX) who are under 65 years of 
age, who would be eligible for medical 
assistance under the State plan under 
one of subclauses (I) through (VII) 
(based on the income standards, 
methodologies, and procedures in ef-
fect as of June 16, 2009) but for in-
come and who are in families whose 
income does not exceed 1331⁄3 percent 
of the income official poverty line (as 
defined by the Office of Management 
and Budget, and revised annually in 
accordance with section 673(2) of the 
Omnibus Budget Reconciliation Act of 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01798
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1799 
1981) applicable to a family of the 
size involved;’’. 
(2) 100% FMAP
FOR
CERTAIN
TRADITIONAL 
MEDICAID ELIGIBLE INDIVIDUALS.—Section 1905(y) 
of such Act (42 U.S.C. 1396d(b)), as added by sub-
section (a)(2)(B), is amended by inserting ‘‘or (IX)’’ 
after ‘‘(VIII)’’. 
(3) CONSTRUCTION.—Nothing in this sub-
section shall be construed as not providing for cov-
erage 
under 
subclause 
(IX) 
of 
section 
1902(a)(10)(A)(i) of the Social Security Act, as 
added by paragraph (1) of, and an increased FMAP 
under the amendment made by paragraph (2) for, 
an individual who has been provided medical assist-
ance under title XIX of the Act under a demonstra-
tion waiver approved under section 1115 of such Act 
or with State funds. 
(4) 
CONFORMING
AMENDMENT.—Section 
1903(f)(4) of the Social Security Act (42 U.S.C. 
1396b(f)(4)), as amended by subsection (a)(4), is 
amended by inserting ‘‘1902(a)(10)(A)(i)(IX),’’ after 
‘‘1902(a)(10)(A)(i)(VIII),’’. 
(c) 100% MATCHING RATE FOR TEMPORARY COV-
ERAGE
OF CERTAIN NEWBORNS.—Section 1905(y) of 
such Act, as added by subsection (a)(2)(B), is amended— 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01799
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1800 
(1) in paragraph (1), by inserting before the pe-
riod at the end the following: ‘‘, and who is not pro-
vided medical assistance under section 1943(b)(2) of 
this title or section 205(d)(1)(B) of the America’s 
Affordable Health Choices Act of 2009’’; and 
(2) by adding at the end the following: 
‘‘(2) Amounts expended for medical assistance 
for children described in section 203(d)(1)(A) of the 
America’s Affordable Health Choices Act of 2009 
during the time period specified in such section.’’. 
(d) NETWORK ADEQUACY.—Section 1932(a)(2) of 
the Social Security Act (42 U.S.C. 1396u–2(a)(2)) is 
amended by adding at the end the following new subpara-
graph: 
‘‘(D) ENROLLMENT OF NON-TRADITIONAL 
MEDICAID
ELIGIBLES.—A State may not re-
quire under paragraph (1) the enrollment in a 
managed care entity of an individual described 
in section 1902(a)(10)(A)(i)(VIII) unless the 
State demonstrates, to the satisfaction of the 
Secretary, that the entity, through its provider 
network and other arrangements, has the ca-
pacity to meet the health, mental health, and 
substance abuse needs of such individuals.’’. 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01800
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1801 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the first day of Y1, and 
shall apply with respect to items and services furnished 
on or after such date. 
SEC. 1702. REQUIREMENTS AND SPECIAL RULES FOR CER-
TAIN MEDICAID ELIGIBLE INDIVIDUALS. 
(a) IN GENERAL.—Title XIX of the Social Security 
Act is amended by adding at the end the following new 
section: 
‘‘REQUIREMENTS AND SPECIAL RULES FOR CERTAIN 
MEDICAID ELIGIBLE INDIVIDUALS 
‘‘SEC. 1943. (a) COORDINATION WITH NHI EX-
CHANGE
THROUGH
MEMORANDUM
OF
UNDER-
STANDING.— 
‘‘(1) IN GENERAL.—The State shall enter into 
a Medicaid memorandum of understanding described 
in section 204(e)(4) of the America’s Affordable 
Health Choices Act of 2009 with the Health Choices 
Commissioner, acting in consultation with the Sec-
retary, with respect to coordinating the implementa-
tion of the provisions of subdivision A of such Act 
with the State plan under this title in order to en-
sure the enrollment of Medicaid eligible individuals 
in acceptable coverage. Nothing in this section shall 
be construed as permitting such memorandum to 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01801
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1802 
modify or vitiate any requirement of a State plan 
under this title. 
‘‘(2) ENROLLMENT
OF
EXCHANGE-REFERRED 
INDIVIDUALS.— 
‘‘(A) NON-TRADITIONAL
INDIVIDUALS.— 
Pursuant to such memorandum the State shall 
accept without further determination the enroll-
ment under this title of an individual deter-
mined by the Commissioner to be a non-tradi-
tional Medicaid eligible individual. The State 
shall not do any redeterminations of eligibility 
for such individuals unless the periodicity of 
such redeterminations is consistent with the pe-
riodicity for redeterminations by the Commis-
sioner of eligibility for affordability credits 
under subtitle C of title II of subdivision A of 
the America’s Affordable Health Choices Act of 
2009, as specified under such memorandum. 
‘‘(B) TRADITIONAL INDIVIDUALS.— 
‘‘(i) 
REGULAR
ENROLLMENT
OP-
TION.—Pursuant to such memorandum, 
insofar as the memorandum has selected 
the 
option 
described 
in 
section 
205(e)(3)(A) of the America’s Affordable 
Health Choices Act of 2009, the State 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01802
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1803 
shall accept without further determination 
the enrollment under this title of an indi-
vidual determined by the Commissioner to 
be a traditional Medicaid eligible indi-
vidual. The State may do redeterminations 
of eligibility of such individual consistent 
with such section and the memorandum. 
‘‘(ii) PRESUMPTIVE
ELIGIBILITY
OP-
TION.—Pursuant to such memorandum, 
insofar as the memorandum has selected 
the 
option 
described 
in 
section 
205(e)(3)(B) of the America’s Affordable 
Health Choices Act of 2009, the State 
shall provide for making medical assistance 
available during the presumptive eligibility 
period and shall, upon application of the 
individual for medical assistance under this 
title, promptly make a determination (and 
subsequent redeterminations) of eligibility 
in the same manner as if the individual 
had applied directly to the State for such 
assistance except that the State shall use 
the income-related information used by the 
Commissioner and provided to the State 
under the memorandum in making the pre-
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01803
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1804 
sumptive eligibility determination to the 
maximum extent feasible. 
‘‘(3) DETERMINATIONS
OF
ELIGIBILITY
FOR 
AFFORDABILITY CREDITS.—If the Commissioner de-
termines that a State Medicaid agency has the ca-
pacity to make determinations of eligibility for af-
fordability credits under subtitle C of title II of sub-
division A of the America’s Affordable Health 
Choices Act of 2009, under such memorandum— 
‘‘(A) the State Medicaid agency shall con-
duct such determinations for any Exchange-eli-
gible individual who requests such a determina-
tion; 
‘‘(B) in the case that a State Medicaid 
agency determines that an Exchange-eligible in-
dividual is not eligible for affordability credits, 
the agency shall forward the information on the 
basis of which such determination was made to 
the Commissioner; and 
‘‘(C) the Commissioner shall reimburse the 
State Medicaid agency for the costs of con-
ducting such determinations. 
‘‘(b) TREATMENT OF CERTAIN NEWBORNS.— 
‘‘(1) IN GENERAL.—In the case of a child who 
is deemed under section 205(d)(1) of the America’s 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01804
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1806 
traditional Medicaid eligible individual’ have the 
meanings given such terms in section 205(e)(5) of 
the America’s Affordable Health Choices Act of 
2009. 
‘‘(2) MEMORANDUM.—The term ‘memorandum’ 
means a Medicaid memorandum of understanding 
under section 205(e)(4) of the America’s Affordable 
Health Choices Act of 2009. 
‘‘(3) Y1.—The term ‘Y1’ has the meaning given 
such term in section 100(c) of the America’s Afford-
able Health Choices Act of 2009.’’. 
(b) CONFORMING AMENDMENTS TO ERROR RATE.— 
(1) Section 1903(u)(1)(D) of the Social Secu-
rity Act (42 U.S.C. 1396b(u)(1)(D)) is amended by 
adding at the end the following new clause: 
‘‘(vi) In determining the amount of erroneous excess 
payments, there shall not be included any erroneous pay-
ments made that are attributable to an error in an eligi-
bility determination under subtitle C of title II of subdivi-
sion A of the America’s Affordable Health Choices Act of 
2009.’’. 
(2) Section 2105(c)(11) of such Act (42 U.S.C. 
1397ee(c)(11)) is amended by adding at the end the 
following new sentence: ‘‘Clause (vi) of section 
1903(u)(1)(D) shall apply with respect to the appli-
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01806
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1807 
cation of such requirements under this title and title 
XIX.’’. 
SEC. 1703. CHIP AND MEDICAID MAINTENANCE OF EFFORT. 
(a) CHIP MAINTENANCE
OF
EFFORT.—Section 
1902 of the Social Security Act (42 U.S.C. 1396a) is 
amended— 
(1) in subsection (a), as amended by section 
1631(b)(1)(D)— 
(A) by striking ‘‘and’’ at the end of para-
graph (72); 
(B) by striking the period at the end of 
paragraph (73) and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (74) the 
following new paragraph: 
‘‘(75) provide for maintenance of effort under 
the State child health plan under title XXI in ac-
cordance with subsection (gg).’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(gg) CHIP MAINTENANCE OF EFFORT REQUIRE-
MENT.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
as a condition of its State plan under this title under 
subsection (a)(75) and receipt of any Federal finan-
cial assistance under section 1903(a) for calendar 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01807
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1808 
quarters beginning after the date of the enactment 
of this subsection and before CHIP MOE termi-
nation date specified in paragraph (3), a State shall 
not have in effect eligibility standards, methodolo-
gies, or procedures under its State child health plan 
under title XXI (including any waiver under such 
title or under section 1115 that is permitted to con-
tinue effect) that are more restrictive than the eligi-
bility standards, methodologies, or procedures, re-
spectively, under such plan (or waiver) as in effect 
on June 16, 2009. 
‘‘(2) LIMITATION.—Paragraph (1) shall not be 
construed as preventing a State from imposing a 
limitation described in section 2110(b)(5)(C)(i)(II) 
for a fiscal year in order to limit expenditures under 
its State child health plan under title XXI to those 
for which Federal financial participation is available 
under section 2105 for the fiscal year. 
‘‘(3) CHIP MOE TERMINATION DATE.—In para-
graph (1), the ‘CHIP MOE termination date’ for a 
State is the date that is the first day of Y1 (as de-
fined in section 100(c) of the America’s Affordable 
Health Choices Act of 2009) or, if later, the first 
day after such date that both of the following deter-
minations have been made: 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01808
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1809 
‘‘(A) The Health Choices Commissioner 
has determined that the Health Insurance Ex-
change has the capacity to support the partici-
pation of CHIP enrollees who are Exchange-eli-
gible individuals (as defined in section 202(b) of 
the America’s Affordable Health Choices Act of 
2009), 
‘‘(B) The Secretary has determined that 
such Exchange, the State, and employers have 
procedures in effect to ensure the timely transi-
tion without interruption of coverage of CHIP 
enrollees from assistance under title XXI to ac-
ceptable coverage (as defined for purposes of 
such Act). 
In this paragraph, the term ‘CHIP enrollee’ means 
a targeted low-income child or (if the State has 
elected the option under section 2112, a targeted 
low-income pregnant woman) who is or otherwise 
would be (but for acceptable coverage) eligible for 
child health assistance or pregnancy-related assist-
ance, respectively, under the State child health plan 
referred to in paragraph (1).’’. 
(b) MEDICAID MAINTENANCE OF EFFORT; SIMPLI-
FYING
AND COORDINATING ELIGIBILITY RULES BE-
TWEEN EXCHANGE AND MEDICAID.— 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01809
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1810 
(1) IN GENERAL.—Section 1903 of such Act 
(42 U.S.C. 1396b) is amended by adding at the end 
the following new subsection: 
‘‘(aa) MAINTENANCE OF MEDICAID EFFORT; SIMPLI-
FYING
AND COORDINATING ELIGIBILITY RULES BE-
TWEEN
HEALTH
INSURANCE
EXCHANGE
AND
MED-
ICAID.— 
‘‘(1) MAINTENANCE OF EFFORT.—A State is 
not eligible for payment under subsection (a) for a 
calendar quarter beginning after the date of the en-
actment of this subsection if eligibility standards, 
methodologies, or procedures under its plan under 
this title (including any waiver under this title or 
under section 1115 that is permitted to continue ef-
fect) that are more restrictive than the eligibility 
standards, methodologies, or procedures, respec-
tively, under such plan (or waiver) as in effect on 
June 16, 2009. The Secretary shall extend such a 
waiver (including the availability of Federal financial 
participation under such waiver) for such period as 
may be required for a State to meet the requirement 
of the previous sentence. 
‘‘(2) REMOVAL OF ASSET TEST FOR CERTAIN 
ELIGIBILITY CATEGORIES.— 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01810
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1811 
‘‘(A) IN GENERAL.—A State is not eligible 
for payment under subsection (a) for a calendar 
quarter beginning on or after the first day of 
Y1 (as defined in section 100(c) of the Amer-
ica’s Affordable 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 following: 
‘‘(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 
described 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).’’. 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01811
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1812 
(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)’’. 
(B) Section 1931(b)(2) of such Act (42 U.S.C. 
1396u–1(b)(1)) is amended by inserting ‘‘subject to 
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 
amended— 
(1) in paragraph (1), by inserting ‘‘subject to 
paragraph (5)’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(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 
standards of a basic plan offered through the Health 
Insurance 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 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01812
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1813 
(in this title referred to as the ‘‘Secretary’’) shall 
submit to Congress a report concerning the extent to 
which, based upon the impact of the health care re-
forms carried out under subdivision A in reducing 
the number of uninsured individuals, there is a con-
tinued role for Medicaid DSH. In preparing the re-
port, the Secretary shall consult with community- 
based health care networks serving low-income bene-
ficiaries. 
(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. 
(B) SPECIFICATION OF DSH HEALTH RE-
FORM METHODOLOGY.—The DSH Health Re-
form methodology described in paragraph (2) of 
subsection (b) for purposes of implementing the 
requirements of such subsection. 
(3) COORDINATION WITH MEDICARE DSH RE-
PORT.—The Secretary shall coordinate the report 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01813
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1814 
under this subsection with the report on Medicare 
DSH under section 1112. 
(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 re-
ductions on the States that— 
(A) have the lowest percentages of unin-
sured individuals (determined on the basis of 
audited hospital cost reports) during the most 
recent year for which such data are available; 
or 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01814
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1815 
(B) do not target their DSH payments 
on— 
(i) hospitals with high volumes of 
Medicaid inpatients (as defined in section 
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 pub-
lication 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 applica-
tion of the DSH Health Reform methodology 
described in paragraph (2). 
(B) PUBLICATION DEADLINE.—The publi-
cation deadline specified in this subparagraph 
is— 
(i) January 1, 2016, with respect to 
DSH allotments described in subparagraph 
(A) for fiscal year 2017; 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01815
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1816 
(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. 
(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 
following 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 
determined under this subsection for such 
fiscal year decreased by $1,500,000,000; 
‘‘(ii) fiscal year 2018, shall be the 
total DSH allotments that would otherwise 
be determined under this subsection for 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01816
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1817 
such 
fiscal 
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.’’. 
(2) Section 1923(b)(4) of such Act (42 U.S.C. 
1396r–4(b)(4)) is amended by adding before the pe-
riod 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-DIS-
CRIMINATION.— 
(1) IN GENERAL.—Section 1923(d) of the So-
cial Security Act (42 U.S.C. 1396r-4) is amended by 
adding at the end the following new paragraph: 
‘‘(4) No hospital may be defined or deemed as 
a disproportionate share hospital, or as an essential 
access 
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— 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01817
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1818 
‘‘(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 beneficiary’s need for the services or the 
availability of the needed services in the hos-
pital; 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 subsection (a) shall be 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 
striking 
‘‘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 individuals for affordability 
credits under subtitle C of title II of subdivision A of the 
America’s Affordable Health Choices Act of 2009 pursu-
ant to a Medicaid memorandum of understanding under 
section 1943(a)(1))’’. 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01818
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1819 
(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. 
(2) 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 leg-
islation 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 
requirements 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 en-
actment 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 regular session of the State 
legislature. 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01819
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1820 
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 
(B) by inserting before the semicolon at 
the end the following: ‘‘and (D) preventive serv-
ices described in subsection (z)’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(z) PREVENTIVE SERVICES.—The preventive serv-
ices described in this subsection are services not otherwise 
described 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 
Control and Prevention; and 
‘‘(2) appropriate for individuals entitled to med-
ical assistance under this title.’’. 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01820
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1821 
(b) 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 Dis-
ease Control and Prevention’’; 
(2) in subsection (e), by striking ‘‘Advisory 
Committee’’ and all that follows and inserting ‘‘Di-
rector of the Centers for Disease Control and Pre-
vention.’’; and 
(3) by striking subsection (g). 
(c) EFFECTIVE DATE.— 
(1) Except as provided in paragraph (2), the 
amendments made by this section shall apply to 
services furnished on or after July 1, 2010, without 
regard 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 as-
sistance under title XIX of the Social Security Act 
which the Secretary of Health and Human Services 
determines requires State legislation (other than leg-
islation appropriating funds) in order for the plan to 
meet the additional requirements imposed by the 
amendments made by this section, the State plan 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01821
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS
1827 
(A) by striking ‘‘and (XIV)’’ and inserting 
‘‘(XIV)’’; and 
(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 di-
agnosis and treatment services that are pro-
vided pursuant to a family planning service in 
a family planning setting’’ after ‘‘cervical can-
cer’’. 
(4) 
CONFORMING
AMENDMENTS.—Section 
1905(a) of such Act (42 U.S.C. 1396d(a)), as 
amended by section 1731(c), is amended in the mat-
ter preceding 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.— 
VerDate Nov 24 2008 
23:53 Mar 17, 2010
Jkt 089200
PO 00000
Frm 01827
Fmt 6652
Sfmt 6201
E:\BILLS\H4872.RH
H4872
dcolon on DSK2BSOYB1PROD with BILLS