[Congressional Bills 112th Congress]
[From the U.S. Government Printing Office]
[H.R. 2013 Introduced in House (IH)]
112th CONGRESS
1st Session
H. R. 2013
To empower States with programmatic flexibility and financial
predictability to improve their Medicaid programs and State Children's
Health Insurance Programs by ensuring better health care for low-income
pregnant women, children, and families, and for elderly individuals and
disabled individuals in need of long-term care services and supports,
whose income and resources are insufficient to meet the costs of
necessary medical services.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 26, 2011
Mr. Nunes introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Ways and Means, Education and the Workforce, House Administration,
Natural Resources, the Judiciary, Rules, and Appropriations, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To empower States with programmatic flexibility and financial
predictability to improve their Medicaid programs and State Children's
Health Insurance Programs by ensuring better health care for low-income
pregnant women, children, and families, and for elderly individuals and
disabled individuals in need of long-term care services and supports,
whose income and resources are insufficient to meet the costs of
necessary medical services.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
(a) Short Title.--This Act may be cited as the ``Medicaid
Improvement and State Empowerment Act''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title.
Sec. 2. Sustainable Medicaid and CHIP programs that meet the needs of
each State.
``Part B--Taxpayer-Provided Pass-Through Funding of Health Care Grants
to States for Pregnant Women, Low-Income Children, and Low-Income
Families and for Long-Term Care Services and Supports for Low-Income
Elderly or Disabled Individuals
``Sec. 1950. Purposes; application.
``Sec. 1951. State plans.
``Sec. 1952. Grants to States.
``Sec. 1953. Use of grants.
``Sec. 1954. Administrative provisions.
``Sec. 1955. Penalties.
``Sec. 1956. Appeal of adverse decision.
``Sec. 1957. Annual Reports.
``Sec. 1958. Definitions.
Sec. 3. Medical malpractice reform State incentive fund.
Sec. 4. Repeals.
Sec. 5. Development of new formula for Federal financial participation
for State child support and welfare
programs to replace the FMAP.
SEC. 2. SUSTAINABLE MEDICAID AND CHIP PROGRAMS THAT MEET THE NEEDS OF
EACH STATE.
(a) In General.--Title XIX of the Social Security Act (42 U.S.C.
1396 et seq.) is amended--
(1) by inserting after section 1900, the following:
``Part A--FMAP-Based Acute Care State Health Programs for the Elderly
and Disabled'';
and
(2) by adding at the end the following:
``Part B--Taxpayer-Provided Pass-Through Funding of Health Care Grants
to States for Pregnant Women, Low-Income Children, and Low-Income
Families and for Long-Term Care Services and Supports for Low-Income
Elderly or Disabled Individuals
``purposes; application
``Sec. 1950. (a) In General.--The purposes of this part are to
empower States with programmatic flexibility and financial
predictability in designing and operating State programs to--
``(1) provide medical assistance for pregnant women, low-
income children, and low-income families with children whose
income and resources are insufficient to meet the costs of
necessary medical services and rehabilitation and other
services to help such women, children, and families attain or
retain capability for independence or self-care; and
``(2) provide long-term care services and supports for low-
income elderly or disabled individuals whose income and
resources are insufficient to meet the costs of such services
and supports and rehabilitation and other services to help such
individuals attain or retain capability for independence or
self-care.
``(b) Application.--
``(1) In general.--Except as provided in paragraph (2) and
section 1951(a)(1)(B)(iv), with respect to a State, on and
after January 1, 2013:
``(A) Medical assistance for pregnant women, low-
income children, or low-income families with children
shall be provided only in accordance with the
provisions of this part and the provisions of title XI
applicable to the provision of such assistance.
``(B) Long-term care services and supports for low-
income elderly or disabled individuals (including dual
eligible individuals) shall only be provided in
accordance with the provisions of this part and the
provisions of title XI applicable to the provision of
such services and supports.
``(C) The provisions of part A of this title shall
no longer apply to a State program established under
this title to provide medical assistance for pregnant
women, low-income children, or low-income families with
children or to provide long-term care services and
supports to low-income elderly or disabled individuals
and the provisions of any drug rebate agreement that is
in effect under section 1927 on that date that relate
to the provision of medical assistance for covered
outpatient drugs for such women, children, or families
or to the provision of long-term care services and
supports for low-income elderly or disabled individuals
are terminated as of such effective date.
``(D) A targeted low-income child or a parent of
such a child who would be eligible for child health
assistance or health benefits coverage under a State
child health plan under title XXI on June 30, 2012,
shall no longer receive such assistance or benefits
under title XXI and shall be eligible for medical
assistance under a State program funded under this part
only to the extent the child or parent satisfies the
eligibility criteria established by the State in its
State plan under section 1951. Federal funds
appropriated for making payments under title XXI or for
administering title XXI that are unobligated on January
1, 2013, are rescinded on that date.
``(E) No payment shall be made under section
1903(a) to a State with respect to any disproportionate
share payment adjustment made under section 1923 on or
after January 1, 2013.
``(F) In the case of a State conducting a waiver
under section 1115 or other authority to provide
medical assistance for pregnant women, low-income
children, or low-income families with children under a
State program established under this title or to
provide long-term care services and supports for low-
income elderly or disabled individuals that is in
effect on such date, the State may elect to terminate
the waiver as of January 1, 2013, or may submit a
request to continue to provide medical assistance or
long-term care services and supports for such
individuals in accordance with the terms of the waiver.
The Secretary shall approve a request of a State with
such a waiver to extend the waiver for additional
periods so long as the total amount of Federal funds
paid to the State to conduct the waiver does not exceed
the amount of Federal funds that would be paid to the
State under this part if the waiver were not conducted
and medical assistance or long-term care services and
supports are provided under the waiver consistent with
the requirements of this part.
``(2) Hold harmless provisions.--
``(A) Acute care for low-income elderly and
disabled.--
``(i) In general.--The provisions of part A
shall apply to State expenditures attributable
to the provision of medical assistance for
acute care for low-income elderly or disabled
individuals (including dual eligible
individuals) on and after January 1, 2013.
``(ii) Rule of construction.--Clause (i)
shall not be construed as affecting--
``(I) the termination under
paragraph (1)(E) of payments under
section 1903(a) for disproportionate
share hospital adjustment payments
under section 1923; or
``(II) State flexibility to provide
dual eligible individuals with medical
assistance for acute care through
enrollment in a managed care entity
under the amendment made by section
2(b) of the Medicaid Improvement and
State Empowerment Act.
``(B) Commonwealths and territories.--This part
shall not apply to the Commonwealth of Puerto Rico, the
United States Virgin Islands, Guam, the Commonwealth of
the Northen Mariana Islands, and American Samoa. Any
program to provide medical assistance established under
this title by any such commonwealth or territory shall
be operated in accordance with the provisions of part A
of this title and subsections (f) and (g) of section
1108.
``(C) Vaccines for children program.--The program
for the distribution of pediatric vaccines established
under section 1928 shall continue to be operated in
accordance with the provisions of that section.
``(c) Budget Authority.--This part constitutes budget authority in
advance of appropriations Acts and represents the obligation of the
Federal Government to provide for the payment to States of amounts
provided under section 1952.
``(d) Nonentitlement.--This part shall not be interpreted to
entitle any individual or family to medical assistance under any State
program funded under this part or to entitle any provider or entity to
payment for the provision of items or services under any State program
funded under this part.
``state plans
``Sec. 1951. (a) In General.--In order to receive a grant under
section 1952 for a year and for the purpose of ensuring transparency
with respect to the expenditure of Federal revenues, a State shall
submit to the Secretary a plan that includes the following:
``(1) Outline of medical assistance program.--
``(A) General provisions.--A written document that
outlines how the State intends to conduct a program,
designed to serve all political subdivisions in the
State (not necessarily in a uniform manner), that
provides--
``(i) medical assistance to pregnant women,
low-income children, and low-income families
with children whose income and resources are
insufficient to meet the costs of necessary
medical services, and rehabilitation and other
services to help such women, children, and
families attain or retain capability for
independence or self-care; and
``(ii) long-term care services and supports
for low-income elderly or disabled individuals
whose income and resources are insufficient to
meet the costs of such services and supports
and rehabilitation and other services to help
such individuals attain or retain capability
for independence or self-care.
``(B) Special provisions.--
``(i) The document shall set forth
objective criteria for--
``(I) the determination of
eligibility for medical assistance and
for long-term care services and
supports (which may be based on
standards relating to income, family
composition, patient population, health
status, or age); and
``(II) fair and equitable treatment
of recipients and providers, including
an explanation of how the State will
provide opportunities for recipients
and providers who have been adversely
affected to be heard in a State
administrative or appeal process.
``(ii) The document shall include a
description of--
``(I) the benefits to be provided,
which, in the case of medical
assistance, shall at a minimum be of
the types listed in paragraph (1) of
section 8904(a) of title 5, United
States Code; and
``(II) the amount (if any) of
premiums, deductibles, coinsurance, or
other cost sharing imposed.
``(iii) The document shall include a
description of how medical assistance and long-
term care services and supports will be
provided under the State plan, such as through
contracts with health maintenance
organizations, managed care organizations, or
regional preferred provider organization care
networks, the establishment of cash-for-
counseling programs, family health care
scholarships, or health savings accounts, the
provision of consumer-driven health vouchers,
or any other health coverage benefit delivery
design determined by the State as appropriate
for achieving the purpose of this part.
``(iv) The document shall indicate how the
State shall satisfy the requirements of
sections 1902(a)(46) (relating to verification
of declarations of citizenship, nationality, or
satisfactory immigration status).
``(2) Certification of the administration of the program.--
A certification by the Governor of the State specifying which
State agency or agencies will administer and supervise the
State plan under this part, which shall include assurances that
local governments and private sector organizations--
``(A) have been consulted regarding the plan and
design of the provision of medical assistance and long-
term care services and supports in the State so that
such assistance and services and supports are provided
in a manner appropriate to local populations; and
``(B) have had at least 45 days to submit comments
on such plan and design.
``(3) Certification that the state will provide medical
assistance to children in foster care and adoption assistance
program.--A certification by the Governor of the State that the
State will take such actions as are necessary to ensure that
children receiving assistance under part E of title IV are
eligible for medical assistance under the State plan under this
part.
``(4) Certification that the state will provide indians
with equitable access to assistance.--A certification by the
Governor of the State that the State will provide each member
of an Indian tribe who is domiciled in the State with equitable
access to medical assistance and to long-term care services and
supports under the State plan under this part.
``(5) Certification of standards and procedures to ensure
against program fraud, waste, and abuse.--A certification by
the Governor of the State that the State has established and is
enforcing standards and procedures to ensure against program
fraud, waste, and abuse, including standards and procedures
concerning nepotism, conflicts of interest among individuals
responsible for the administration and supervision of the State
program, kickbacks, and the use of political patronage.
``(b) Plan Amendments.--Within 30 days after a State amends a plan
submitted pursuant to subsection (a), the State shall notify the
Secretary of the amendment.
``(c) Public Availability of State Plan Summary.--The State shall
make a summary of any plan or plan amendment submitted by the State
under this section publicly available on a website and through such
other means as the State determines appropriate.
``(d) Limitation on Secretarial Authority.--The Secretary may only
review a State plan or plan amendment submitted under this section for
the purpose of confirming that a State has submitted the required
documentation. The Secretary shall not have any authority to approve or
deny a State plan or plan amendment submitted under this section or to
otherwise inhibit or control the expenditure of grants paid to a State
under section 1952.
``grants to states
``Sec. 1952. (a) Establishment of Sustainable Medicaid Funding for
States.--
``(1) In general.--Beginning January 1, 2013, and annually
thereafter, each State that has submitted a plan under section
1951 shall be entitled to receive from the Secretary for each
12-month period, a grant in an amount equal to the State health
grant determined for the State for the period under subsection
(b).
``(2) Termination of old medicaid and chip funding.--No
payment shall be made by the Secretary to any State under part
A of this title or under title XXI for State expenditures
attributable to providing on or after January 1, 2013--
``(A) medical assistance (as defined in section
1905(a)), child health assistance (as defined in
section 2110(a)), or health benefits coverage for
pregnant women, low-income children, or low-income
families with children; or
``(B) long-term care services and supports for
elderly or disabled individuals.
``(b) Taxpayer-Provided Pass-Through Funding of Health Grants to
States.--
``(1) Appropriation.--For the purpose of making health
grants to States under this part, there is appropriated, out of
any money in the Treasury not otherwise appropriated--
``(A) for the 12-month period beginning January 1,
2013, an amount equal to the product of--
``(i) the base appropriation amount
determined under paragraph (3); and
``(ii) the appropriation increase factor
determined under paragraph (4) for the period;
and
``(B) for each 12-month period thereafter, an
amount equal to the amount appropriated under this
paragraph for the preceding 12-month period, increased
by the appropriation increase factor determined under
paragraph (4) for the period.
``(2) Amount of grants.--
``(A) Based on poverty population.--For each 12-
month period beginning on and after January 1, 2013,
the Secretary shall pay each State an amount equal to
the product of--
``(i) the amount appropriated under
paragraph (1) for the period; and
``(ii) the ratio of the number of
individuals residing in the State whose income
does not exceed 100 percent of the poverty line
applicable to a family of the size involved to
the number of such individuals in all States
that have submitted a plan under section 1951
for the period (based on data for the most
recent 12-month period for which data is
available).
``(B) Pro rata adjustments.--The Secretary shall
make pro rata increases or reductions in the amounts
determined for States under subparagraph (A) for a
period as necessary to ensure that the total amount
appropriated for the period is allotted among all
States and that the total amount of all health grants
for States determined for a period does not exceed the
amount appropriated for the period.
``(3) Base appropriation amount.--The base appropriation
amount determined under this paragraph is the product of--
``(A) $165,000,000,000;
``(B) the appropriation increase factor determined
under paragraph (4) with respect to the 12-month period
beginning on January 1, 2011; and
``(C) the appropriation increase factor determined
under paragraph (4) with respect to the 12-month period
beginning on January 1, 2012.
``(4) Appropriation increase factor.--The appropriation
increase factor determined under this paragraph for a 12-month
period is equal to the sum of 1 plus the sum of following:
``(A) CPI-U growth factor.--The percentage
increase, if any, in the consumer price index for all
urban consumers (all items; United States city average)
published by the Bureau of Labor Statistics, or the
successor index thereto, for the fiscal year ending on
September 30 of the preceding 12-month period.
``(B) Population growth factor.--The percentage
increase (if any) in the population of the United
States for the fiscal year ending on September 30 of
the preceding 12-month period, as determined by the
Secretary based on the most recent published estimates
of the Bureau of the Census.
``(c) Availability.--A health grant paid to a State under this
section for a period shall remain available until expended.
``(d) Reports to Congress.--Not later than January 1 of 2018, and
of every 5 years thereafter, the Comptroller General of the United
States shall submit a report to Congress that includes an analysis of
changes among the States in the population of individuals described in
each clause of subsection (b)(2)(A) and such recommendations for
legislative changes to the health grant distribution formula applied
under subsection (b)(2) as the Comptroller General determines
appropriate to achieve the purpose of this part and ensure a fair
distribution of the Federal funds appropriated to carry out this part
among the States.
``use of grants
``Sec. 1953. (a) General Rule.--A State to which a grant is made
under section 1952 may use the grant in any manner that is reasonably
demonstrated to accomplish the purpose of this part.
``(b) Limitation on Use of Grant for Administrative Purposes.--
``(1) Limitation.--A State to which a grant is made under
section 1952 shall not expend more than 5 percent of the grant
for administrative purposes.
``(2) Exception.--Paragraph (1) shall not apply to the use
of a grant for expenditures related to preventing or
eliminating waste, fraud, or abuse, and expenditures for
information technology and computerization needed for tracking
or monitoring required by or under this part.
``administrative provisions
``Sec. 1954. (a) Payments to States.--
``(1) Quarterly payments.--The Secretary shall pay each
health grant payable to a State under section 1952 in quarterly
installments, subject to this section.
``(2) Computation and certification of payments to
states.--
``(A) Computation.--The Secretary shall estimate
the amount to be paid to each State for each quarter
under this part, with such estimate to be based on a
report filed by the State containing an estimate by the
State of the total sum to be expended by the State in
the quarter under the State program funded under this
part and such other information as the Secretary may
find necessary.
``(B) Certification.--The Secretary of Health and
Human Services shall certify to the Secretary of the
Treasury the amount estimated under subparagraph (A)
with respect to a State, reduced or increased to the
extent of any overpayment or underpayment which the
Secretary of Health and Human Services determines was
made under this part to the State for any prior quarter
and with respect to which adjustment has not been made
under this paragraph.
``(3) Payment method.--Upon receipt of a certification
under paragraph (2)(B) with respect to a State, the Secretary
of the Treasury shall, through the Fiscal Service of the
Department of the Treasury and before audit or settlement by
the General Accounting Office, pay to the State, at the time or
times fixed by the Secretary of Health and Human Services, the
amount so certified.
``(b) No Waiver Authority.--Except as provided in section
1950(b)(1)(F), the Secretary may not waive any provision of this part
under section 1115 or any other authority.
``(c) Limitation on Federal Authority.--No officer or employee of
the Federal Government may regulate the conduct of States under this
part or enforce any provision of this part, except to the extent
expressly provided in this part.
``penalties
``Sec. 1955. (a) In General.--Subject to this section:
``(1) Use of grant in violation of this part.--
``(A) General penalty.--If an audit conducted under
chapter 75 of title 31, United States Code, finds that
an amount paid to a State under section 1952 for a
period has been used in violation of this part, the
Secretary shall reduce the grant payable to the State
under that section for the immediately succeeding
period by the amount so used.
``(B) Enhanced penalty for intentional
violations.--If the State does not prove to the
satisfaction of the Secretary that the State did not
intend to use the amount in violation of this part, the
Secretary shall further reduce the grant payable to the
State under section 1952 for the immediately succeeding
period by an amount equal to 5 percent of the State
health grant determined for that period.
``(2) Failure to submit required report.--If the Secretary
determines that a State has not, within 45 days after the end
of a period for which a grant is made under section 1952,
submitted the report required by section 1957 for the period,
the Secretary shall reduce the grant payable to the State under
section 1952 for the immediately succeeding period by an amount
equal to 5 percent of the State health grant determined for
that period.
``(b) Reasonable Cause Exception.--The Secretary may not impose a
penalty on a State under subsection (a) with respect to a requirement
if the Secretary determines that the State has reasonable cause for
failing to comply with the requirement.
``(c) Corrective Compliance Plan.--
``(1) In general.--
``(A) Notification of violation.--Before imposing a
penalty against a State under subsection (a) with
respect to a violation of this part, the Secretary
shall notify the State of the violation and allow the
State the opportunity to enter into a corrective
compliance plan in accordance with this subsection
which outlines how the State will correct or
discontinue, as appropriate, the violation and how the
State will insure continuing compliance with this part.
``(B) 60-day period to propose a corrective
compliance plan.--During the 60-day period that begins
on the date the State receives a notice provided under
subparagraph (A) with respect to a violation, the State
may submit to the Federal Government a corrective
compliance plan to correct or discontinue, as
appropriate, the violation.
``(C) Consultation about modifications.--During the
60-day period that begins with the date the Secretary
receives a corrective compliance plan submitted by a
State in accordance with subparagraph (B), the
Secretary may consult with the State on modifications
to the plan.
``(D) Acceptance of plan.--A corrective compliance
plan submitted by a State in accordance with
subparagraph (B) is deemed to be accepted by the
Secretary if the Secretary does not accept or reject
the plan during 60-day period that begins on the date
the plan is submitted.
``(2) Effect of correcting or discontinuing violation.--The
Secretary may not impose any penalty under subsection (a) with
respect to any violation covered by a State corrective
compliance plan accepted by the Secretary if the State corrects
or discontinues, as appropriate, the violation pursuant to the
plan.
``(3) Effect of failing to correct or discontinue
violation.--The Secretary shall assess some or all of a penalty
imposed on a State under subsection (a) with respect to a
violation if the State does not, in a timely manner, correct or
discontinue, as appropriate, the violation pursuant to a State
corrective compliance plan accepted by the Secretary.
``(d) Limitation on Amount of Penalties.--
``(1) In general.--In imposing the penalties described in
subsection (a), the Secretary shall not reduce any health grant
payable to a State for a period by more than 10 percent.
``(2) Carryforward of unrecovered penalties.--To the extent
that paragraph (1) of this subsection prevents the Secretary
from recovering during a period the full amount of penalties
imposed on a State under subsection (a) of this section for a
prior period, the Secretary shall apply any remaining amount of
such penalties to the health grant payable to the State under
section 1952 for the immediately succeeding period.
``appeal of adverse decision
``Sec. 1956. (a) In General.--Within 5 days after the date the
Secretary takes any adverse action under this part with respect to a
State, the Secretary shall notify the Governor of the State of the
adverse action, including any action with respect to the State plan
submitted under section 1951 or the imposition of a penalty under
section 1955.
``(b) Administrative Review.--
``(1) In general.--Within 60 days after the date a State
receives notice under subsection (a) of an adverse action, the
State may appeal the action, in whole or in part, to the
Departmental Appeals Board established in the Department of
Health and Human Services (in this section referred to as the
`Board') by filing an appeal with the Board.
``(2) Procedural rules.--The Board shall consider an appeal
filed by a State under paragraph (1) on the basis of such
documentation as the State may submit and as the Board may
require to support the final decision of the Board. In deciding
whether to uphold an adverse action or any portion of such an
action, the Board shall conduct a thorough review of the issues
and take into account all relevant evidence. The Board shall
make a final determination with respect to an appeal filed
under paragraph (1) not less than 60 days after the date the
appeal is filed.
``(c) Judicial Review of Adverse Decision.--
``(1) In general.--Within 90 days after the date of a final
decision by the Board under this section with respect to an
adverse action taken against a State, the State may obtain
judicial review of the final decision (and the findings
incorporated into the final decision) by filing an action in--
``(A) the district court of the United States for
the judicial district in which the principal or
headquarters office of the State agency is located; or
``(B) the United States District Court for the
District of Columbia.
``(2) Procedural rules.--The district court in which an
action is filed under paragraph (1) shall review the final
decision of the Board on the record established in the
administrative proceeding, in accordance with the standards of
review prescribed by subparagraphs (A) through (E) of section
706(2) of title 5, United States Code. The review shall be on
the basis of the documents and supporting data submitted to the
Board.
``annual reports
``Sec. 1957. Each State shall submit an annual report to the
Secretary that describes the State's expenditures of the amount paid to
the State under section 1952 for the most recently ended period, and
includes the number of individuals provided medical assistance and the
number of individuals provided long-term care services and supports
under the State plan under this part and such other information as the
Secretary may require. The Secretary shall submit to Congress copies of
all State reports submitted under this section with respect to a
period.
``definitions
``Sec. 1958. In this part:
``(1) Disabled individual.--The term `disabled individual'
means an individual who would be considered disabled under
section 1614(a)(3) or under criteria applied under the State
plan under part A (as in effect on March 22, 2010).
``(2) Dual eligible.--The term `dual eligible individual'
means an individual who is entitled to, or enrolled for,
benefits under part A of title XVIII of the Social Security
Act, or enrolled for benefits under part B of title XVIII of
such Act, and is eligible for medical assistance under a State
plan under this title or under a waiver of such plan (as in
effect on March 22, 2010).
``(3) Elderly individual.--The term `elderly individual'
means an individual who has attained age 65 or the age
specified in section 226(a)(1), whichever is greater.
``(4) Long-term care services and supports.--
``(A) In general.--The term `long-term care
services and supports' means any of the services or
supports described in subparagraph (B) that may be
provided in a nursing facility, an institution, a home,
or other setting.
``(B) Services and supports described.--For
purposes of subparagraph (A), the services and supports
described in this subparagraph include assistive
technology, adaptive equipment, remote monitoring
equipment, case management for the aged, case
management for individuals with disabilities, nursing
home services, long-term rehabilitative services
necessary to restore functional abilities, services
provided in intermediate care facilities for people
with disabilities, habilitation services (including
adult day care programs), community treatment teams for
individuals with mental illness, home health services,
services provided in an institution for mental disease,
a Program of All-Inclusive Care for the Elderly (PACE),
personal care (including personal assistance services),
recovery support including peer counseling, supportive
employment, training skills necessary to assist the
individual in achieving or maintaining independence,
training of family members including foster parents in
supportive and behavioral modification skills, ongoing
and periodic training to maintain life skills,
transitional care including room and board not to
exceed 60 days within a 12-month period.
``(5) Low-income.--The term `low-income' means income (as
determined under standards established by the State) that does
not exceed such percentage of the poverty line for a family of
the size involved as the State shall establish.
``(6) Medical assistance.--The term `medical assistance'
means health care coverage, as determined by a State and
described in the State plan in accordance with section
1951(a)(1)(B)(ii).
``(7) Poverty line defined.--The term `poverty line' has
the meaning given such term in section 673(2) of the Community
Services Block Grant Act (42 U.S.C. 9902(2)), including any
revision required by such section.
``(8) Pregnant woman.--The term `pregnant woman' includes a
woman during the 60-day period beginning on the last day of the
pregnancy.
``(9) State.--The term `State' means each of the 50 States
and the District of Columbia.''.
(b) Removal of Barrier to Providing Dual Eligible Individuals With
Acute Care Through a Managed Care Entity.--
(1) In general.--Section 1932(a)(2) of the Social Security
Act (42 U.S.C. 1396u-2(a)(2)) is amended by striking
subparagraph (B).
(2) Effective date.--The amendment made by paragraph (1)
takes effect on January 1, 2013.
SEC. 3. MEDICAL MALPRACTICE REFORM STATE INCENTIVE FUND.
(a) Grants.--The Secretary of Health and Human Services (referred
to in this section as the ``Secretary'') shall award grants to eligible
States to assist such States in implementing State-based medical
malpractice reforms.
(b) Eligibility.--
(1) In general.--To be eligible to receive a grant under
subsection (a), a State shall--
(A) submit to the Secretary an application, at such
time, in such manner, and containing such information
as the Secretary may require; and
(B) shall certify, as part of the application under
subparagraph (A), that the State has carried out
activities, including enacting State laws, that have
been demonstrated to lower medical malpractice claim or
premiums costs for physicians or to lower health care
costs for patients.
(2) Study.--As part of a certification provided under
paragraph (1)(B), the State shall include the results of at
least one longitudinal, empirically based study that
demonstrates cost reductions of the type described in such
paragraph. Such results shall be provided in a manner that
enables the Comptroller General of the United States to make a
determination as to whether such results are the reasonable and
demonstrable conclusion of the State activities involved.
(3) Types of laws.--Laws described in paragraph (1)(B) may
include caps on non-economic damages, the establishment of
health courts, the establishment of a comprehensive patient
compensation program, providing for administrative
determinations of compensation, providing for early offers,
establishing safe harbors for the practice of evidence-based
medicine, or other demonstrated methods to reduce costs.
(c) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section--
(1) $500,000,000 for the period of fiscal years 2012
through 2016; and
(2) $500,000,000 for the period of fiscal years 2017
through 2021.
(d) Sunset.--The authority established under this section shall not
apply after September 30, 2021.
SEC. 4. REPEALS.
(a) PPACA and the Health Care-Related Provisions in the Health Care
and Education Reconciliation Act of 2010.--
(1) In general.--Except as provided in paragraph (2):
(A) Effective as of the enactment of Public Law
111-148, such Act is repealed, and the provisions of
law amended or repealed by such Act are restored or
revived as if such Act had not been enacted.
(B) Effective as of the enactment of the Health
Care and Education Reconciliation Act of 2010 (Public
Law 111-152), title I and subtitle B of title II of
such Act are repealed, and the provisions of law
amended or repealed by such title or subtitle,
respectively, are restored or revived as if such title
and subtitle had not been enacted.
(2) Nonapplication to program integrity provisions.--The
repeals under paragraph (1) do not apply to the provisions of,
and amendments made by the following:
(A) Section 2801 of Public Law 111-148 (relating to
MACPAC).
(B) Title IV of Public Law 111-148 (relating to
transparency and program integrity).
(C) Subtitle D of title I of Public Law 111-152
(relating to reducing fraud, waste, and abuse).
(b) Repeal of ARRA Maintenance of Effort.--Subsection (f) of
section 5001 of the American Recovery and Reinvestment Act of 2009
(Public Law 111-5) is amended by striking paragraph (1).
(c) CHIP.--Effective January 1, 2013, title XXI of the Social
Security Act (42 U.S.C. 1397aa et seq.) is repealed.
SEC. 5. DEVELOPMENT OF NEW FORMULA FOR FEDERAL FINANCIAL PARTICIPATION
FOR STATE CHILD SUPPORT AND WELFARE PROGRAMS TO REPLACE
THE FMAP.
Not later than January 1, 2012, the Secretary of Health and Human
Services, in consultation with the States, shall establish a new
formula for payments made to or received from States under parts D and
E of title IV of the Social Security Act that are based on the Federal
medical assistance percentage applicable to the State under title XIX
of the Social Security Act. On and after January 1, 2013, the Federal
medical assistance percentage shall only be used for purposes of making
payments to States under part A of title XIX of that Act for
expenditures attributable to providing medical assistance for elderly
individuals, disabled individual, and dual eligible individuals in
accordance with section 1958 of such Act (as added by section 3).
Payments made to or received from a State under parts D or E of title
IV of such Act shall be made on and after January 1, 2013, by applying
the formula developed by the Secretary of Health and Human Services
under this section in lieu of the Federal medical assistance
percentage.
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