[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6963 Introduced in House (IH)]
110th CONGRESS
2d Session
H. R. 6963
To amend title XXI of the Social Security Act to expand coverage
options under the State Children's Health Insurance Program (SCHIP)
through premium assistance.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 18, 2008
Mr. Fortenberry (for himself, Mr. Burgess, Mr. Sessions, and Mr. Terry)
introduced the following bill; which was referred to the Committee on
Energy and Commerce, and in addition to the Committees on Ways and
Means and Education and Labor, 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 amend title XXI of the Social Security Act to expand coverage
options under the State Children's Health Insurance Program (SCHIP)
through premium assistance.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``SCHIP Plus Act of 2008''.
SEC. 2. EXPANDING COVERAGE OPTIONS IN SCHIP THROUGH PREMIUM ASSISTANCE.
(a) Requiring Offering of Alternative Coverage Options.--Section
2102 of the Social Security Act (42 U.S.C. 1397b) is amended--
(1) in subsection (a)--
(A) in paragraph (6), by striking ``and'' at the
end;
(B) in paragraph (7), by striking the period at the
end and inserting ``; and''; and
(C) by adding at the end the following new
paragraph:
``(8) effective for plan years beginning on or after
October 1, 2009, how the plan will provide for child health
assistance with respect to applicable targeted low-income
children through alternative coverage options in accordance
with subsection (d).''; and
(2) by adding at the end the following new subsection:
``(d) Alternative Coverage Options.--
``(1) In general.--Effective October 1, 2009, a State child
health plan shall provide for the offering of any qualified
alternative coverage that a qualified entity seeks to offer to
applicable targeted low-income children through the plan in the
State.
``(2) Application of uniform financial limitation for all
alternative coverage options.--With respect to all qualified
alternative coverage offered in a State, the State child health
plan shall establish a uniform dollar limitation on the per
capita monthly amount that will be paid by the State to the
qualified entity with respect to such coverage provided to a
targeted low-income child. Such limitation may not be less than
90 percent of the per capita monthly payment made for coverage
offered under the State child health plan that is not in the
form of an alternative coverage option. Nothing in this
paragraph shall be construed--
``(A) as requiring a State to provide for the full
payment of premiums for qualified alternative coverage;
``(B) as preventing a State from charging
additional premiums to cover the difference between the
cost of qualified alternative coverage and the amount
of such payment limitation;
``(C) as preventing a State from using its own
funds to provide a dollar limitation that exceeds the
Federal financial participation as limited under
section 2105(c)(8).
``(3) Qualified alternative coverage defined.--In this
section, the term `qualified alternative coverage' means health
insurance coverage that--
``(A) meets the coverage requirements of section
2103 (other than cost-sharing requirements of such
section); and
``(B) is offered by a qualified insurer, and not
directly by the State.
``(4) Qualified insurer defined.--In this section, the term
`qualified insurer' means, with respect to a State, an entity
that is licensed to offer health insurance coverage in the
State.
``(5) Applicable targeted low-income children defined.--In
this title, the term `applicable targeted low-income children'
means targeted low-income children with family income that does
not exceed 200 percent of the poverty line applicable to family
of the size involved.''.
(b) Federal Financial Participation for Qualified Alternative
Coverage.--Section 2105 of such Act (42 U.S.C. 1397d) is amended--
(1) in subsection (a)(1)(C), by inserting before the
semicolon at the end the following: ``and, subject to paragraph
(8)(C), in the form of payment of the premiums for coverage for
qualified alternative coverage''; and
(2) by adding at the end of subsection (c) the following
new paragraph:
``(8) Purchase of qualified alternative coverage.--
``(A) In general.--Payment may be made to a State
under subsection (a)(1)(C), subject to the provisions
of this paragraph, for the purchase of qualified
alternative coverage for applicable targeted low-income
children.
``(B) Waiver of certain provisions.--With respect
to coverage described in subparagraph (A), no
limitation on beneficiary cost-sharing otherwise
applicable under this title or title XIX shall apply.
``(C) Limitation on ffp.--The amount of the payment
under paragraph (1)(C) for coverage described in
subparagraph (A) during a fiscal year in the aggregate
for all such coverage in the State may not exceed the
product of--
``(i) the national per capita expenditure
under this title (taking into account both
Federal and State expenditures) for the
previous fiscal year (as determined by the
Secretary using the best available data);
``(ii) the enhanced FMAP for the State and
fiscal year involved; and
``(iii) the number of targeted low-income
children for whom such coverage is provided.
``(D) Voluntary enrollment.--A State child health
plan--
``(i) may not require a targeted low-income
child to enroll in coverage described in
subparagraph (A) in order to obtain child
health assistance under this title;
``(ii) before providing such child health
assistance for such coverage of a child, shall
make available (which may be through an
Internet website or other means) to the parent
or guardian of the child information on the
coverage available under this title, including
benefits and cost-sharing; and
``(iii) shall--
``(I) provide at least one
opportunity per fiscal year for
beneficiaries to switch coverage under
this title from coverage described in
subparagraph (A) to the coverage that
is otherwise made available under this
title; and
``(II) permit beneficiaries to
switch such coverage under such other
circumstances, such as the change in
employment, birth of a child, or change
in households, as the Secretary
specifies.
``(E) Information on coverage options.--A State
child health plan shall--
``(i) describe how the State will notify
potential beneficiaries of coverage described
in subparagraph (A);
``(ii) provide such notification in writing
at least during the initial application for
enrollment under this title and during
redeterminations of eligibility if the
individual was enrolled before October 1, 2009;
and
``(iii) post a description of these
coverage options on any official website that
may be established by the State in connection
with the plan.
``(F) Rule of construction.--Nothing in this
section is to be construed to prohibit a State from--
``(i) establishing limits on beneficiary
cost-sharing under such alternative coverage;
``(ii) paying all or part of a
beneficiary's cost-sharing requirements under
such coverage;
``(iii) paying less than the full cost of a
child's share of the premium under such
coverage, insofar as the premium for such
coverage exceeds the limitation established by
the State under subparagraph (C);
``(iv) using State funds to pay for
benefits above the Federal upper limit
established under subparagraph (C); or
``(v) providing any guidance or information
it deems appropriate in order to help
beneficiaries make an informed decision
regarding the option to enroll in coverage
described in subparagraph (A).''.
SEC. 3. EASING ADMINISTRATIVE BARRIERS TO STATE COOPERATION WITH
EMPLOYER-SPONSORED INSURANCE COVERAGE.
(a) Requiring Some Coverage for Employer-Sponsored Insurance.--
(1) In general.--Section 2102(a) of the Social Security Act
(42 U.S.C. 1397b(a)), as amended by section 2(a), is amended--
(A) in paragraph (7), by striking ``and'' at the
end;
(B) in paragraph (8), by striking the period at the
end and inserting ``; and''; and
(C) by adding at the end the following new
paragraph:
``(9) effective for plan years beginning on or after
October 1, 2009, how the plan will provide for child health
assistance with respect to targeted low-income children covered
under a group health plan.''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply beginning with fiscal year 2010.
(b) Federal Financial Participation for Employer-Sponsored
Insurance.--Section 2105 of such Act (42 U.S.C. 1397d) is amended--
(1) in subsection (a)(1)(C), as amended by section 3(b), by
inserting before the semicolon at the end the following: ``and,
subject to paragraph (3)(C), in the form of payment of the
premiums for coverage under a group health plan that includes
coverage of targeted low-income children and benefits
supplemental to such coverage''; and
(2) paragraph (3) of subsection (c) is amended to read as
follows:
``(3) Purchase of employer-sponsored insurance.--
``(A) In general.--Payment may be made to a State
under subsection (a)(1)(C), subject to the provisions
of this paragraph, for the purchase of family coverage
under a group health plan that includes coverage of
targeted low-income children unless such coverage would
otherwise substitute for coverage that would be
provided to such children but for the purchase of
family coverage.
``(B) Waiver of certain provisions.--With respect
to coverage described in subparagraph (A)--
``(i) notwithstanding section 2102, no
minimum benefits requirement (other than those
otherwise applicable with respect to services
referred to in section 2102(a)(7)) under this
title shall apply; and
``(ii) no limitation on beneficiary cost-
sharing otherwise applicable under this title
or title XIX shall apply.
``(C) Required provision of supplemental
benefits.--If the coverage described in subparagraph
(A) does not provide coverage for the services referred
to in section 2102(a)(7), the State child health plan
shall provide coverage of such services as supplemental
benefits.
``(D) Limitation on ffp.--The amount of the payment
under paragraph (1)(C) for coverage described in
subparagraph (A) (and supplemental benefits under
subparagraph (C) for individuals so covered) during a
fiscal year may not exceed the product of--
``(i) the national per capita expenditure
under this title (taking into account both
Federal and State expenditures) for the
previous fiscal year (as determined by the
Secretary using the best available data);
``(ii) the enhanced FMAP for the State and
fiscal year involved; and
``(iii) the number of targeted low-income
children for whom such coverage is provided.
``(E) Voluntary enrollment.--A State child health
plan--
``(i) may not require a targeted low-income
child to enroll in coverage described in
subparagraph (A) in order to obtain child
health assistance under this title;
``(ii) before providing such child health
assistance for such coverage of a child, shall
make available (which may be through an
Internet website or other means) to the parent
or guardian of the child information on the
coverage available under this title, including
benefits and cost-sharing; and
``(iii) shall--
``(I) provide at least one
opportunity per fiscal year for
beneficiaries to switch coverage under
this title from coverage described in
subparagraph (A) to the coverage that
is otherwise made available under this
title; and
``(II) permit beneficiaries to
switch such coverage under such other
circumstances, such as the change in
employment, birth of a child, or change
in households, as the Secretary
specifies.
``(F) Information on coverage options.--A State
child health plan shall--
``(i) describe how the State will notify
potential beneficiaries of coverage described
in subparagraph (A);
``(ii) provide such notification in writing
at least during the initial application for
enrollment under this title and during
redeterminations of eligibility if the
individual was enrolled before October 1, 2009;
and
``(iii) post a description of these
coverage options on any official website that
may be established by the State in connection
with the plan.
``(G) Semiannual verification of coverage.--If
coverage described in subparagraph (A) is provided
under a group health plan with respect to a targeted
low-income child, the State child health plan shall
provide for the collection, at least once every six
months, of proof from the plan that the child is
enrolled in such coverage.
``(H) Rule of construction.--Nothing in this
section is to be construed to prohibit a State from--
``(i) offering wrap around benefits in
order for a group health plan to meet any
State-established minimum benefit requirements;
``(ii) establishing a cost-effectiveness
test to qualify for coverage under such a plan;
``(iii) establishing limits on beneficiary
cost-sharing under such a plan;
``(iv) paying all or part of a
beneficiary's cost-sharing requirements under
such a plan;
``(v) paying less than the full cost of the
employee's share of the premium under such a
plan, including prorating the cost of the
premium to pay for only what the State
determines is the portion of the premium that
covers targeted low-income children;
``(vi) using State funds to pay for
benefits above the Federal upper limit
established under subparagraph (C);
``(vii) allowing beneficiaries enrolled in
group health plans from changing plans to
another coverage option available under this
title at any time; or
``(viii) providing any guidance or
information it deems appropriate in order to
help beneficiaries make an informed decision
regarding the option to enroll in coverage
described in subparagraph (A).
``(I) Group health plan defined.--In this
paragraph, the term `group health plan' has the meaning
given such term in section 2791(a)(1) of the Public
Health Service Act (42 U.S.C. 300gg-91(a)(1)).''.
SEC. 4. EMPLOYEE NOTIFICATION OF PREMIUM ASSISTANCE OPPORTUNITIES.
(a) Amendment to Internal Revenue Code of 1986.--Section 9801(f) of
the Internal Revenue Code of 1986 (relating to special enrollment
periods) is amended by adding at the end the following new paragraph:
``(3) Outreach to employees regarding availability of schip
coverage.--
``(A) In general.--Each employer that maintains a
group health plan in a State that provides child health
assistance under a State child health plan under title
XXI of the Social Security Act, in the form of premium
assistance for the purchase of coverage under a group
health plan, shall provide to each employee a written
notice informing the employee of potential
opportunities then currently available in the State in
which the employee resides for premium assistance under
such plans for health coverage of the employee's
dependents. For purposes of compliance with this
clause, the employer may use any State-specific model
notice developed in accordance with section
701(f)(3)(B) of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1181(f)(3)(B)).
``(B) Option to provide concurrent with provision
of plan materials to employee.--An employer may provide
the model notice applicable to the State in which an
employee resides concurrent with the furnishing of
materials notifying the employee of health plan
eligibility, concurrent with materials provided to the
employee in connection with an open season or election
process conducted under the plan, or concurrent with
the furnishing of the summary plan description as
provided in section 104(b) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1024).''.
(b) Conforming Amendments.--
(1) Amendments to employee retirement income security
act.--
(A) In general.--Section 701(f) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C.
1181(f)) is amended by adding at the end the following
new paragraph:
``(3) Outreach to employees regarding availability of schip
coverage.--
``(A) In general.--Each employer that maintains a
group health plan in a State that provides child health
assistance under a State child health plan under title
XXI of such Act, in the form of premium assistance for
the purchase of coverage under a group health plan,
shall provide to each employee a written notice
informing the employee of potential opportunities then
currently available in the State in which the employee
resides for premium assistance under such plans for
health coverage of the employee or the employee's
dependents.
``(B) Model notice.--Not later than 1 year after
the date of enactment of this paragraph, the Secretary
and the Secretary of Health and Human Services, in
consultation with Directors of State SCHIP agencies
under title XXI of such Act, shall jointly develop
national and State-specific model notices for purposes
of subparagraph (A). The Secretary shall provide
employers with such model notices so as to enable
employers to timely comply with the requirements of
subparagraph (A). Such model notices shall include
information regarding how an employee may contact the
State in which the employee resides for additional
information regarding potential opportunities for such
premium assistance, including how to apply for such
assistance.
``(C) Option to provide concurrent with provision
of plan materials to employee.--An employer may provide
the model notice applicable to the State in which an
employee resides concurrent with the furnishing of
materials notifying the employee of health plan
eligibility, concurrent with materials provided to the
employee in connection with an open season or election
process conducted under the plan, or concurrent with
the furnishing of the summary plan description as
provided in section 104(b).''.
(B) Conforming amendment.--Section 102(b) of the
Employee Retirement Income Security Act of 1974 (29
U.S.C. 1022(b)) is amended--
(i) by striking ``and the remedies'' and
inserting ``, the remedies''; and
(ii) by inserting before the period the
following: ``, and if the employer so elects
for purposes of complying with section
701(f)(3)(B)(i), the model notice applicable to
the State in which the participants and
beneficiaries reside''.
(C) Effective dates.--The Secretary of Labor and
the Secretary of Health and Human Services shall
develop the initial model notices under section
701(f)(3)(B) of the Employee Retirement Income Security
Act of 1974, and the Secretary of Labor shall provide
such notices to employers, not later than the date that
is 1 year after the date of enactment of this Act, and
each employer shall provide the initial annual notices
to such employer's employees beginning with the first
plan year that begins after the date on which such
initial model notices are first issued.
(2) Amendments to public health service act.--Section
2701(f) of the Public Health Service Act (42 U.S.C. 300gg(f))
is amended by adding at the end the following new paragraph:
``(3) Outreach to employees regarding availability of schip
coverage.--
``(A) In general.--Each employer that maintains a
group health plan in a State that provides child health
assistance under a State child health plan under title
XXI of such Act, in the form of premium assistance for
the purchase of coverage under a group health plan,
shall provide to each employee a written notice
informing the employee of potential opportunities then
currently available in the State in which the employee
resides for premium assistance under such plans for
health coverage of the employee or the employee's
dependents. For purposes of compliance with this
subclause, the employer may use any State-specific
model notice developed in accordance with section
701(f)(3)(B) of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1181(f)(3)(B)).
``(B) Option to provide concurrent with provision
of plan materials to employee.--An employer may provide
the model notice applicable to the State in which an
employee resides concurrent with the furnishing of
materials notifying the employee of health plan
eligibility, concurrent with materials provided to the
employee in connection with an open season or election
process conducted under the plan, or concurrent with
the furnishing of the summary plan description as
provided in section 104(b) of the Employee Retirement
Income Security Act of 1974.''.
<all>