TASK DEFINITION: In this task, you are given text for US Congressional and California state bills, your task is to generate a summary for this bill.
PROBLEM: SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Stop Westward Aquatic Threats Act''.

SEC. 2. AMENDMENT OF NONINDIGENOUS AQUATIC NUISANCE PREVENTION AND 
              CONTROL ACT OF 1990.

    Except as otherwise expressly provided, whenever in this Act an 
amendment or repeal is expressed in terms of an amendment to, or repeal 
of, a section or other provision, the reference shall be considered to 
be made to a section or other provision of Nonindigenous Aquatic 
Nuisance Prevention and Control Act of 1990 (16 U.S.C. 4701 et seq.).

SEC. 3. 100TH MERIDIAN AND WESTWARD PROGRAM.

    Subtitle C (16 U.S.C. 4721 et seq.) is amended by adding at the end 
the following:

``SEC. 1210. 100TH MERIDIAN AND WESTWARD PROGRAM.

    ``(a) Public Information and Education.--The Secretary shall 
coordinate with the States to provide the public with information and 
education on the threat of zebra mussels and other aquatic nuisance 
species and how to prevent their westward advance.
    ``(b) Source States Action Plan.--The Secretary, in consultation 
with the Task Force, shall work with States that contain aquatic 
nuisance species, including zebra mussels, that threaten western States 
to develop and implement a prevention action plan that includes 
inspections of vessels at boat launches and elsewhere.
    ``(c) Movement Across the 100th Meridian.--
            ``(1) Early detection and rapid response.--The Secretary, 
        in consultation with the Task Force, shall seek to prevent 
        westward movement of aquatic nuisance species by monitoring and 
        preventing westward movement of zebra mussels and other aquatic 
        nuisance species across and beyond the 100th meridian, 
        monitoring water bodies, educating boaters leaving waters 
        infected by aquatic nuisance species, and providing rapid 
        response capacity in North Dakota, South Dakota, Nebraska, 
        Kansas, Oklahoma, and Texas.
            ``(2) Check stations.--Under this subsection, the 
        Secretary, in collaboration with the Secretary of 
        Transportation and the States, shall--
                    ``(A) work with States to establish check stations 
                on highways and waterways that cross the 100th 
                meridian, and require that all commercial vessels 
                moving westward across the meridian stop and be checked 
                for zebra mussels and aquatic weeds at such check 
                stations;
                    ``(B) require that contaminated vessels identified 
                at such check stations be cleaned in accordance with 
                protocols developed by the Task Force before being 
                moved across the 100th meridian;
                    ``(C) assess and collect from persons who violate 
                such requirement more than one time a civil penalty of 
                $150 for each violation after the first violation;
                    ``(D) identify and record all vessels that stop at 
                such check stations and the water body most recently 
                visited by each such vessel;
                    ``(E) focus prevention resources on States having 
                the greatest number of contaminated vessels; and
                    ``(F) coordinate implementation of this subsection 
                with appropriate Canadian authorities.
    ``(d) Vector Action Plans.--The Secretary and the Task Force, in 
collaboration with the States and within 18 months after the date of 
the enactment of this subsection, shall--
            ``(1) assess the relative risk of vectors and pathways of 
        westward movement of zebra mussels and other aquatic nuisance 
        species across the 100th meridian and throughout the western 
        States and develop adequate action plans to control each 
        pathway, ranked by priority; and
            ``(2) provide to the Task Force, for distribution to the 
        States, data developed through such assessment.
    ``(e) Lewis and Clark Bicentennial Expedition.--
            ``(1) In general.--The Secretary of the Interior shall 
        ensure that the United States Fish and Wildlife Service and the 
        National Park Service coordinate efforts to implement an action 
        plan to prevent the spread of aquatic nuisance species by 
        vessels and other potential vectors involved in the Lewis and 
        Clark Bicentennial Expedition, including efforts to educate 
        participants in such Expedition by no later than January 1, 
        2003.
            ``(2) Authorization of appropriations.--There are 
        authorized to be appropriated to the Secretary of the Interior 
        to carry out this subsection $100,000 for each of fiscal years 
        2002 through 2005.
    ``(f) Application in Other States.--If the Secretary determines 
that any State (other than those listed in subsection (c)) that is 
located west of the 100th meridian needs to be involved in 
implementation of this section for this section to be effective, the 
Secretary may apply this section in such State.
    ``(g) Evaluation of Effectiveness.--The Secretary shall enter into 
an arrangement with an independent entity under which the entity shall, 
by January 1, 2005, evaluate the effectiveness of the 100th meridian 
and westward program under this section in stopping the westward 
movement of zebra mussels and other aquatic nuisance species across and 
beyond the 100th meridian.
    ``(h) Authorization of Appropriations.--There are authorized to be 
appropriated to the Secretary to carry out this section $5,000,000 for 
each of fiscal years 2003 through 2007.''.

SEC. 4. STATE MANAGEMENT PLANS.

    (a) Grants to States for Development of Management Plans.--Section 
1204(b) (16 U.S.C. 4724(b)) is amended--
            (1) in paragraph (1) by inserting ``make grants to States 
        to develop management plans under this section, including for 
        hiring personnel for such development, and'' after ``at the 
        recommendation of the Task Force,'';
            (2) in paragraph (3)(A) by striking ``each comprehensive 
        management plan implemented with Federal assistance'' and 
        inserting ``implementation of each comprehensive management 
        plan''; and
            (3) in paragraph (3)(B) by striking ``each public facility 
        management plan implemented with Federal assistance'' and 
        inserting ``implementation of each public facility management 
        plan''.
    (b) Authorization of Appropriations.--Section 1301 (16 U.S.C. 4724) 
is amended--
            (1) in subsection (c) by striking ``There are authorized'' 
        and all that follows through ``of which'' and inserting ``For 
        grants to States under section 1204(b) there are authorized to 
        be appropriated to the Director $10,000,000 for each of fiscal 
        years 2003 through 2007, of which up to 20 percent may be 
        available for plan development and of which''; and
            (2) by adding at the end the following:
    ``(f) Funding for Capacity Building by Western Regional Panel.--To 
build capacity and foster the development and implementation of 
comprehensive management plans under section 1204 for States located on 
or west of the 100th meridian there are authorized to be appropriated 
to the Western Regional panel established under section 1203(b) 
$600,000 for each of fiscal years 2003 through 2007.''.

SOLUTION: Stop Westward Aquatic Threats Act - Amends the Nonindigenous Aquatic Nuisance Prevention and Control Act of 1990 to direct the Secretary of the Interior to: (1) provide the public with information and education on the threat of zebra mussels and other aquatic nuisance species and how to prevent their westward advance; (2) work with States that contain aquatic nuisance species (including zebra mussels) that threaten western States to develop and implement a prevention action plan that includes inspections of vessels at boat launches and elsewhere (including vessels involved in the Lewis and Clark Bicentennial Expedition); and (3) prevent westward movement of aquatic nuisance species by monitoring and preventing westward movement of zebra mussels and other aquatic nuisance species beyond the 100th meridian, monitoring water bodies, educating boaters leaving waters infected by aquatic nuisance species, and providing rapid response capacity in North Dakota, South Dakota, Nebraska, Kansas, Oklahoma, and Texas.Authorizes the Director of the of the Aquatic Nuisance Species Task Force to make grants to States to develop management plans which identify those areas or activities within the State for which assistance is needed to eliminate or reduce the environmental, public health, and safety risks associated with aquatic nuisance species, particularly the zebra mussel.

PROBLEM: SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Route 66 Centennial Commission 
Act''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Route 66 was the Nation's first all-paved highway under 
        the U.S. Highway System connecting the Midwest to California 
        and has played a major role in the history of the United 
        States.
            (2) Route 66 was the symbol of opportunity to hundreds of 
        thousands of people seeking escape from the Dust Bowl in the 
        1930s, serving as a ``road to opportunity'' in the West and 
        providing employment during the Great Depression, as thousands 
        were put to work on road crews to pave the road.
            (3) Route 66 was invaluable in transporting troops, 
        equipment, and supplies across the country to the West, where 
        the government established multiple industries and armed force 
        bases during World War II. Upon the conclusion of the war in 
        1945, Route 66 was a key route taken by thousands of troops as 
        they returned home.
            (4) Route 66 symbolized the Nation's positive outlook 
        during the postwar economic recovery in the 1950s and 1960s, 
        serving as an icon of free-spirited independence and linking 
        people across the United States. During this period, the 
        tourist industry along Route 66 grew tremendously, giving rise 
        to countless tourist courts, motels, service stations, garages, 
        and diners.
            (5) Since June 27, 1985, when Route 66 was decommissioned 
        as a Federal highway, the popularity and mythical stature of 
        Route 66 has grown domestically and internationally, as the 
        road has experienced a rebirth of interest and support.
            (6) The year 2026 will be the centennial anniversary of 
        Route 66, and a commission should be established to study and 
        recommend to Congress activities that are fitting and proper to 
        celebrate that anniversary in a manner that appropriately 
        honors America's Mother Road.

SEC. 3. ESTABLISHMENT.

    There is established a commission to be known as the Route 66 
Centennial Commission (referred to in this Act as the ``Commission'').

SEC. 4. DUTIES.

    The Commission shall have the following duties:
            (1) To study activities that may be carried out by the 
        Federal Government to determine whether the activities are 
        fitting and proper to honor Route 66 on the occasion of its 
        centennial anniversary, including any of the activities 
        described under section 8(b)(2)(B).
            (2) To recommend to Congress the activities the Commission 
        considers most fitting and proper to honor Route 66 on such 
        occasion, to be carried out by the Department of Transportation 
        and any other entity or entities within the Federal Government 
        that the Commission considers most appropriate to carry out 
        such activities.
            (3) To plan and host, in cooperation with such partners, a 
        conference on the U.S. Numbered Highway System, and assist in 
        the activities of such a conference.

SEC. 5. MEMBERSHIP.

    (a) Number and Appointment.--The Commission shall be composed of 19 
members appointed as follows:
            (1) Three members, each of whom shall be a qualified 
        citizen described in subsection (b), appointed by the 
        President.
            (2) Two members, each of whom shall be a qualified citizen 
        described in subsection (b), appointed by the President on the 
        recommendation of the Secretary of Transportation.
            (3) One member, who shall be a qualified citizen described 
        in subsection (b), appointed by the President on the 
        recommendation of the Governor of Illinois.
            (4) One member, who shall be a qualified citizen described 
        in subsection (b), appointed by the President on the 
        recommendation of the Governor of Missouri.
            (5) One member, who shall be a qualified citizen described 
        in subsection (b), appointed by the President on the 
        recommendation of the Governor of Kansas.
            (6) One member, who shall be a qualified citizen described 
        in subsection (b), appointed by the President on the 
        recommendation of the Governor of Oklahoma.
            (7) One member, who shall be a qualified citizen described 
        in subsection (b), appointed by the President on the 
        recommendation of the Governor of Texas.
            (8) One member, who shall be a qualified citizen described 
        in subsection (b), appointed by the President on the 
        recommendation of the Governor of New Mexico.
            (9) One member, who shall be a qualified citizen described 
        in subsection (b), appointed by the President on the 
        recommendation of the Governor of Arizona.
            (10) One member, who shall be a qualified citizen described 
        in subsection (b), appointed by the President on the 
        recommendation of the Governor of California.
            (11) Three members, each of whom shall be a qualified 
        citizen described in subsection (b), appointed by the President 
        on the recommendation of the Speaker of the House of 
        Representatives, in consultation with the minority leader of 
        the House of Representatives.
            (12) Three members, each of whom shall be a qualified 
        citizen described in subsection (b), appointed by the President 
        on the recommendation of the majority leader of the Senate, in 
        consultation with the minority leader of the Senate.
    (b) Qualified Citizen.--A qualified citizen described in this 
subsection is a private citizen of the United States with--
            (1) a demonstrated dedication to educating others about the 
        importance of historical figures and events; and
            (2) substantial knowledge and appreciation of Route 66.
    (c) Time of Appointment.--Each initial appointment of a member of 
the Commission shall be made before the expiration of the 120-day 
period beginning on the date of the enactment of this Act.
    (d) Continuation of Membership.--If a member of the Commission was 
appointed to the Commission as a Member of Congress, and ceases to be a 
Member of Congress, that member may continue to serve on the Commission 
for not longer than the 30-day period beginning on the date that member 
ceases to be a Member of Congress.
    (e) Terms.--Each member shall be appointed for the life of the 
Commission.
    (f) Vacancies.--A vacancy in the Commission shall not affect the 
powers of the Commission but shall be filled in the manner in which the 
original appointment was made.
    (g) Basic Pay.--Members shall serve on the Commission without pay.
    (h) Travel Expenses.--Each member shall receive travel expenses, 
including per diem in lieu of subsistence, in accordance with sections 
5702 and 5703 of title 5, United States Code.
    (i) Quorum.--Seven members of the Commission shall constitute a 
quorum but a lesser number may hold hearings.
    (j) Chair.--The President, in consultation with the Secretary of 
Transportation, shall designate one member of the Commission as Chair.
    (k) Meetings.--The Commission shall meet at the call of the Chair.

SEC. 6. DIRECTOR AND STAFF.

    (a) Director.--The Commission may appoint and fix the pay of a 
Director and such additional personnel as the Commission considers to 
be appropriate.
    (b) Applicability of Certain Civil Service Laws.--
            (1) Director.--The Director of the Commission may be 
        appointed without regard to the provisions of title 5, United 
        States Code, governing appointments in the competitive service, 
        and may be paid without regard to the provisions of chapter 51 
        and subchapter III of chapter 53 of that title relating to 
        classification and General Schedule pay rates.
            (2) Staff.--The staff of the Commission shall be appointed 
        subject to the provisions of title 5, United States Code, 
        governing appointments in the competitive service, and shall be 
        paid in accordance with the provisions of chapter 51 and 
        subchapter III of chapter 53 of that title relating to 
        classification and General Schedule pay rates.

SEC. 7. POWERS.

    (a) Hearings and Sessions.--The Commission may, for the purpose of 
carrying out this Act, hold such hearings, sit and act at such times 
and places, take such testimony, and receive such evidence as the 
Commission considers to be appropriate.
    (b) Powers of Members and Agents.--Any member or agent of the 
Commission may, if authorized by the Commission, take any action that 
the Commission is authorized to take by this Act.
    (c) Obtaining Official Data.--The Commission may secure directly 
from any department or agency of the United States information 
necessary to enable the Commission to carry out this Act. Upon request 
of the Chair of the Commission, the head of that department or agency 
shall furnish that information to the Commission.
    (d) Mails.--The Commission may use the United States mails in the 
same manner and under the same conditions as other departments and 
agencies of the United States.
    (e) Administrative Support Services.--Upon the request of the 
Commission, the Administrator of General Services shall provide to the 
Commission, on a reimbursable basis, the administrative support 
services necessary for the Commission to carry out its responsibilities 
under this Act.

SEC. 8. REPORTS.

    (a) Interim Reports.--The Commission may submit to Congress such 
interim reports as the Commission considers to be appropriate.
    (b) Comprehensive Report.--
            (1) In general.--Not later than 5 years after the date of 
        enactment of this Act, the Commission shall submit to the 
        President and Congress a report incorporating specific 
        recommendations for the commemoration of the centennial of 
        Route 66 and related events.
            (2) Contents of report.--The report under paragraph (1)--
                    (A) shall include recommendations for the 
                allocation of financial and administrative 
                responsibility among the public and private authorities 
                and organizations recommended for participation by the 
                Commission; and
                    (B) may recommend activities such as--
                            (i) the production, publication, and 
                        distribution of books, pamphlets, films, 
                        electronic publications, and other educational 
                        materials focusing on the history and impact of 
                        Route 66 on the United States and the world;
                            (ii) bibliographical and documentary 
                        projects, publications, and electronic 
                        resources;
                            (iii) conferences, convocations, lectures, 
                        seminars, and other programs;
                            (iv) the development of programs by and for 
                        libraries, museums, parks, and historic sites, 
                        including national traveling exhibitions;
                            (v) ceremonies and celebrations 
                        commemorating specific events;
                            (vi) the production, distribution, and 
                        performance of artistic works, and of programs 
                        and activities, focusing on the national and 
                        international significance of Route 66; and
                            (vii) the issuance of commemorative coins, 
                        medals, certificates of recognition, and 
                        postage stamps.
    (c) Final Report.--The Commission shall submit to the President and 
Congress a final report not later than 90 days before the termination 
of the Commission provided in section 10.

SEC. 9. PLAN ON PRESERVATION NEEDS OF ROUTE 66.

    (a) In General.--The Secretary of Transportation, in consultation 
with the Governors referred to in section 5(a), shall prepare a plan on 
the preservation needs of Route 66.
    (b) Report to Congress.--Not later than 3 years after the date of 
enactment of this Act, the Secretary shall submit to the Committee on 
Transportation and Infrastructure of the House of Representatives, the 
Committee on Environment and Public Works of the Senate, and the 
President a report containing the plan prepared under subsection (a).

SEC. 10. TERMINATION.

    The Commission shall terminate not later than June 30, 2027.

SEC. 11. CLARIFICATION REGARDING FUNDING.

    No additional funds are authorized to carry out the requirements of 
this Act. Such requirements may be carried out using amounts otherwise 
authorized or made available for the Department of Transportation, 
except for amounts authorized from the Highway Trust Fund.

            Passed the House of Representatives July 16, 2018.

            Attest:

                                                 KAREN L. HAAS,

                                                                 Clerk.

SOLUTION: Route 66 Centennial Commission Act (Sec. 3) This bill establishes the Route 66 Centennial Commission to honor highway Route 66 on the occasion of its centennial anniversary. (Sec. 4) The bill sets forth the duties of the commission, its membership, powers, and reporting requirements.  (Sec. 9) The Department of Transportation shall prepare a plan on the preservation needs of Route 66. (Sec. 10) The commission shall terminate not later than June 30, 2027.

PROBLEM: SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicaid Health Allowance Act of 
1993''.

SEC. 2. ESTABLISHMENT OF PROGRAM.

    (a) In general.--Title XIX of the Social Security Act (42 U.S.C. 
1396 et seq.) is amended by adding at the end the following new 
section:

                   ``state health allowance programs

    ``Sec. 1931. (a) treatment of Expenditures Under Health Allowance 
Programs as Medical Assistance Under State Plan.--
            ``(1) In General.--Notwithstanding any other provision of 
        this title, for purposes of determining the amount to be paid 
        to a State under section 1903(a)(1) for quarters in any fiscal 
        year, amounts expended by an eligible State (as described in 
        subsection (b)) during the fiscal year under a State health 
        allowance program (as described in subsection (c)) shall be 
        included in the total amount expended during the fiscal year as 
        medical assistance under the State plan (except as provided 
        under paragraph (2) or under subsection (d)(1)(C)).
            ``(2) Federal payment restricted to acute care services.--
        No amounts expended under a State health allowance program that 
        are attributable to medical assistance described in paragraphs 
        (4), (14), (15), (23), or (24) of section 1905(a) shall be 
        included in the total amount expended as medical assistance 
        under the State plan.
    ``(b) Eligibility of State.--
            ``(1) In general.--A State is eligible for purposes of 
        subsection (a) if the State submits (at such time and in such 
        form as the Secretary may require) an application to the 
        Secretary containing the following information and assurances:
                    ``(A) Assurances that the State laws governing the 
                sale and marketing of health plans reflect standards 
                established by the National Association of Insurance 
                Commissioners (or by the Secretary in accordance with 
                paragraph (3)) relating to community rating of premiums 
                that meet the requirements of paragraph (2).
                    ``(B) Assurances that the State laws governing the 
                sale and marketing of health insurance plans reflect 
                standards established by the National Association of 
                Insurance Commissioners (or by the Secretary in 
                accordance with paragraph (3)) relating to pre-existing 
                conditions and guaranteed renewability.
                    ``(C) Assurances that the State has adopted and is 
                enforced standards regarding quality assurance for 
                health benefit plans participating in the State health 
                allowance program, including standards regarding--
                            ``(i) uniform reporting requirements for 
                        such plans relating to a minimum set of 
                        clinical data, patient satisfaction data, and 
                        other information that may be used by 
                        individuals to compare the quality of various 
                        plans; and
                            ``(ii) the establishment or designation of 
                        an entity of the State government to collect 
                        the data described in clause (i) and to 
                        regularly report such data to the Secretary.
                    ``(D) Such other information and assurances as the 
                Secretary may require.
            ``(2) Requirements for rating bands for premiums.--
                    ``(A) In general.--Under the standards relating to 
                community rating of premiums established by the 
                National Association of Insurance Commissioners or by 
                the Secretary, for a class of business of a carrier, 
                the premium rates charged during a rating period to 
                employers with similar demographic or other objective 
                characteristics (not relating to claims experience, 
                health status, or duration of coverage) for the same or 
                similar coverage, or the rates which could be charged 
                to such employers under the rating system for that 
                class of business, shall not vary from the index rate 
                by more than 15 percent of the index rate.
                    ``(B) Definitions.--In this paragraph:
                            ``(i) Base premium rate.--The term `base 
                        premium rate' means, for each class of business 
                        for each rating period, the lowest premium rate 
                        charged or which could have charged under a 
                        rating system for that class of business by the 
                        carrier to employers with similar demographic 
                        or other objective characteristics (not 
                        relating to claims experience, health status, 
                        or duration of coverage) for health benefit 
                        plans with the same or similar coverage.
                            ``(ii) Carrier.--The term `carrier' means 
                        any entity which provides health insurance or 
                        health benefits in a State, and includes a 
                        licensed insurance company, a prepaid hospital 
                        or medical service plan, a health maintenance 
                        organization, the plan sponsor of a multiple 
                        employer welfare arrangement or an employee 
                        benefit plan (as defined under the Employee 
                        Retirement Income Security Act of 1974), or any 
                        other entity providing a plan of health 
                        insurance subject to State insurance 
                        regulation.
                            ``(iii) Class of business.--The term `class 
                        of business' means, with respect to a carrier, 
                        all (or a distinct group of) small employers as 
                        shown on the records of the carrier. For 
                        purposes of the preceding sentence--
                                    ``(I) a carrier may establish, 
                                subject to subclause (II), a distinct 
                                group of employers on the basis that 
                                the applicable health benefit plans 
                                either--
                                            ``(aa) are marketed and 
                                        sold through individuals and 
                                        organizations which are not 
                                        participating in the marketing 
                                        or sale of other distinct 
                                        groups of employers for the 
                                        carrier,
                                            ``(bb) have been acquired 
                                        from another carrier as a 
                                        distinct group, or
                                            ``(cc) are provided through 
                                        an association that has a 
                                        membership of not less than 100 
                                        employers and that has been 
                                        formed for purposes other than 
                                        obtaining health coverage;
                                    ``(II) a carrier may not establish 
                                more than 2 groupings under each class 
                                of business based on the carrier's use 
                                of managed-care techniques if the 
                                techniques are expected to produce 
                                substantial variation in health care 
                                costs; and
                                    ``(III) notwithstanding subclauses 
                                (I) and (II), a State commissioner of 
                                Insurance of a State, upon application 
                                and if authorized under State law, may 
                                approve additional distinct groups upon 
                                a finding that such approval would 
                                enhance the efficiency and fairness of 
                                the employer marketplace.
                            ``(iv) Demographic characteristics.--The 
                        term `demographic characteristics' means age, 
                        gender, industry, geographic area, family 
                        composition, and group size.
                            ``(v) Index rate.--The term ``index rate'' 
                        means, with respect to a class of business, the 
                        arithmetic average of the applicable base 
                        premium rate and the corresponding highest 
                        premium rate for the class.
            ``(3) Establishment of standards by secretary.--If, after 
        the expiration of the 9-month period that begins on the date of 
        the enactment of this Act, the National Association of 
        Insurance Commissioners has not established the standards 
        described in paragraph (1), the Secretary shall establish such 
        standards not later than 1 year after the date of the enactment 
        of this Act.
    ``(c) State Health Allowance Program Described.--
            ``(1) Enrollment of participating individuals in approved 
        health benefit plans.--In this section, a State health 
        allowance program is a program in effect in all the political 
        subdivisions of the State (except as provided in (c)) under 
        which the State makes payments to the individual's insurer as 
        an allowance towards the costs of providing the individual with 
        benefits under an approved health benefit plan.
            ``(2) Approved plans described.--For purposes of paragraph 
        (1), a State shall approve health benefit plans in accordance 
        with such standards as the State may establish, except that--
                    ``(A) the State may not approve a plan for a year 
                unless the actuarial value of the benefits provided by 
                and the cost-sharing associated with the plan for the 
                year--
                            ``(i) with respect to the first year for 
                        which the plan is approved for purposes of this 
                        subsection, is not less than the actuarial 
                        value of the medical assistance provided under 
                        the State plan under this title for the year 
                        (as determined by the Secretary without regard 
                        to medical assistance described in paragraphs 
                        (4), (14), (15), (23), or (24) of section 
                        1905(a)); and
                            ``(ii) with respect to any subsequent year, 
                        is not greater than the amount determined under 
                        this subparagraph for the preceding year, 
                        increased by the amount (expressed as a 
                        percentage) by which the actuarial value of the 
                        medical assistance described in clause (i) for 
                        the year exceeds or is less than the actuarial 
                        value of such medical assistance for the 
                        preceding year;
                    ``(B) at least one of the plans approved by the 
                State shall be a health maintenance organization or 
                other plan under which payments are otherwise made on a 
                capitated basis for providing medical assistance to 
                individuals enrolled in the State plan under this 
                title; and
                    ``(C) in the case of an individual who is entitled 
                to benefits under the State plan under this title as of 
                the first month during which the State health allowance 
                program is in effect, an approved plan may not require 
                the individual to contribute a greater amount of cost-
                sharing than the individual would have been required to 
                contribute under the State plan (except as may be 
                imposed on an individual described in subparagraph (B) 
                or subparagraph (C) of subsection (d)(1)).
            ``(3) Waiver of statewideness requirement.--At the request 
        of a State, the Secretary may waive for a period not to exceed 
        3 years (subject to one 3-year extension) the requirement under 
        paragraph (1) that the State health allowance program be in 
        effect in all political subdivisions of the State.
    ``(d) Eligibility of Individuals to Participate in Allowance 
Program.--
            ``(1) In general.--An individual is eligible to participate 
        in a State health allowance program described in subsection (c) 
        if the individual meets such criteria as the State may impose, 
        except that--
                    ``(A) the State shall enroll the individual in the 
                program if the individual's income is equal to or less 
                than 100 percent of the 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 1991) 
                applicable to a family of the size involved;
                    ``(B) the State may enroll the individual in the 
                program if the individual's income is greater than 100 
                percent of such official poverty line, except that the 
                State may require such an individual to contribute 
                additional cost-sharing towards the health benefit plan 
                if such cost-sharing is determined in accordance with a 
                sliding scale based on the individual's income;
                    ``(C) the State may enroll an individual who is 
                described in subparagraph (B) and whose income is equal 
                to or greater than 200 percent of such official poverty 
                line in the program, except that no amounts expended by 
                the State during a fiscal year on behalf of such an 
                individual may be included in the total amount expended 
                during the fiscal year as medical assistance under the 
                State plan; and
                    ``(D) no individual shall be eligible to 
                participate in the program if the individual is 
                entitled to benefits under title XVIII of the Social 
                Security Act pursuant to section 226 of such Act.
            ``(2) Automatic eligibility of medicaid categorically 
        eligible individuals.--Under the criteria imposed by a State 
        under paragraph (1), any individual to whom the State makes 
        medical assistance available under the State plan under this 
        title pursuant to clause (i) of section 1902(a)(10)(A) shall be 
        eligible to participate in the State health allowance program.
            ``(3) Use of resource standard.--Under the criteria imposed 
        by a State under paragraph (1), a State may not require an 
        individual to meet any resource standard unless the Secretary 
        approves the State's use of such a standard.
    ``(e) Evaluations and Reports.--
            ``(1) Evaluations.--Not later than 3 years after the date 
        of the enactment of this section (and at such subsequent 
        intervals as the Secretary considers appropriate), the 
        Secretary shall evaluate the effectiveness of the State health 
        allowance programs for which Federal financial participation is 
        provided under this section, and the impact of such programs on 
        increasing the number of individuals with health insurance 
        coverage in participating States and in controlling the costs 
        of health care in such States.
            ``(2) Reports.--Not later than 3 years after the date of 
        the enactment of this section (and at such subsequent intervals 
        as the Secretary considers appropriate), the Secretary shall 
        submit a report on the program to Congress.''.
    (b) Ensuring Budget Neutrality Through Reduction in 
Disproportionate Share Hospital Payments for Participating States.--
Section 1923 of the Social Security Act (42 U.S.C. 1396r-4) is amended 
by adding at the end the following new subsection:
    ``(g) Reduction in Payment Adjustments for States With Health 
Allowance Programs.--In the case of a State operating a State health 
allowance program under section 1931 in a fiscal year, the Secretary 
shall reduce the total payment adjustments made under this section for 
hospitals in the State for quarters in the year by such amount as the 
Secretary determines to be necessary to ensure that the total amount 
paid to the State under section 1903(a)(1) for the year does not exceed 
the amount that would have been paid to the State under such section 
for the year if the State did not operate such a program.

SEC. 3. EFFECTIVE DATE.

    The amendments made by section 2 shall apply to calendar quarters 
beginning on or after January 1, 1994.

SOLUTION:
Medicaid Health Allowance Act of 1993 - Amends title XIX (Medicaid) of the Social Security Act to create State health allowance programs under which the State makes payments to an insurer of an eligible individual as an allowance towards the cost of providing the individual with benefits under an approved health benefit plan.