[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 567 Introduced in House (IH)]
113th CONGRESS
1st Session
H. R. 567
To amend the Social Security Act to replace the Medicaid program and
the Children's Health Insurance program with a block grant to the
States, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 6, 2013
Mr. Rokita (for himself, Mr. Lamborn, Mr. Garrett, Mr. Scalise, Mr.
Mulvaney, Mr. Huelskamp, Mr. Broun of Georgia, Mr. Westmoreland, Mr.
Radel, Mr. Ross, Mr. Poe of Texas, Mr. Holding, Mr. Hensarling, Mr.
Duncan of South Carolina, Mr. Cotton, Mr. Culberson, Mr. Huizenga of
Michigan, Mrs. Black, Mr. Bucshon, Mr. Bishop of Utah, Mr. Stewart, Mr.
Fleming, Mr. Pearce, Mr. Austin Scott of Georgia, Mr. LaMalfa, Mr.
Marchant, Mr. Roe of Tennessee, Mr. Palazzo, Mrs. Lummis, Mrs.
Blackburn, Mr. Flores, Mr. Gohmert, Mr. Amodei, Mr. McHenry, and Mr.
Schweikert) 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, the Judiciary, Natural
Resources, House Administration, 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 amend the Social Security Act to replace the Medicaid program and
the Children's Health Insurance program with a block grant to the
States, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``State Health
Flexibility Act of 2013''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Health grants to the States for health care services to
indigent individuals.
``TITLE XXII--BLOCK GRANTS TO STATES FOR HEALTH CARE SERVICES TO
INDIGENT INDIVIDUALS
``Sec. 2201. Purpose.
``Sec. 2202. Grants to States.
``Sec. 2203. Administrative and fiscal accountability.
``Sec. 2204. Nondiscrimination provisions.
``Sec. 2205. Emergency assistance.
``Sec. 2206. Definitions.
Sec. 3. Repeal of PPACA, HCERA, and the Federal requirements of
Medicaid and CHIP.
Sec. 4. Severability.
Sec. 5. Effective date.
SEC. 2. HEALTH GRANTS TO THE STATES FOR HEALTH CARE SERVICES TO
INDIGENT INDIVIDUALS.
(a) Health Care Block Grant to States.--The Social Security Act is
amended by adding at the end the following new title:
``TITLE XXII--BLOCK GRANTS TO STATES FOR HEALTH CARE SERVICES TO
INDIGENT INDIVIDUALS
``SEC. 2201. PURPOSE.
``The purpose of this title is to provide Federal financial
assistance to the States, in the form of a single grant, to allow the
States maximum flexibility in providing, and financing the provision
of, health-care-related items and services to indigent individuals.
``SEC. 2202. GRANTS TO STATES.
``(a) In General.--Subject to the requirements of this title, each
State is entitled to receive from the Secretary of the Treasury a grant
for each quarter of fiscal years 2014, 2015, 2016, 2017, 2018, 2019,
2020, 2021, 2022, and 2023, in an amount that is equal to 25 percent of
the total amount received by a State under title XIX and title XXI for
fiscal year 2012.
``(b) Appropriation.--Out of any money in the Treasury of the
United States not otherwise appropriated, there are appropriated for
fiscal years 2014, 2015, 2016, 2017, 2018, 2019, 2020, 2021, 2022, and
2023 such sums as are necessary for grants under this section.
``(c) Requirements Relating to Intergovernmental Financing.--The
Secretary of the Treasury shall make the transfer of funds under grants
under subsection (a) directly to each State in accordance with the
requirements of section 6503 of title 31, United States Code.
``(d) Expenditure of Funds.--
``(1) In general.--Except as provided in paragraph (2),
amounts received by a State under this title for any fiscal
year shall be expended by the State in such fiscal year or in
the succeeding fiscal year.
``(2) Use of rainy day fund permitted.--Of the amounts
received by a State under this title, the State may set aside,
in a separate account, such amounts as the State deems
necessary to provide, without fiscal limitation, health-care-
related items and services for indigent individuals during--
``(A) periods of unexpectedly high rates of
unemployment; or
``(B) periods related to circumstances that are not
described in subparagraph (A) and that cause unexpected
increases in the need for such items and services for
such individuals.
``(3) Funds remaining after fiscal year 2022.--If, after
fiscal year 2023, a State has funds in the account under
paragraph (2), the State may only expend such funds if such
funds are used in a manner that is permitted under subsection
(e), as such subsection is in effect on September 30, 2023.
``(e) Use of Funds.--A State may only use the amounts received
under subsection (a) as follows:
``(1) General purpose.--For the purpose under section 2201,
including the provision of health-care-related items and
services as required under section 2205. Nothing in this title
shall be construed as limiting the flexibility of a State to
determine which providers of such items and services qualify to
receive payment from a grant made to the State under this
title.
``(2) Funding for risk adjustment mechanisms.--To fund
qualified high risk pools, reinsurance pools, or other risk-
adjustment mechanisms used for the purpose of subsidizing the
purchase of private health insurance for the high-risk
population.
``(3) Authority to use portion of federal assistance for
other welfare-related programs.--
``(A) In general.--Subject to the limit under
subparagraph (B), to carry out a State program pursuant
to any or all of the following provisions of law:
``(i) Part A of title IV of this Act.
``(ii) Section 1616 of this Act.
``(iii) The Food and Nutrition Act of 2008.
``(B) Limitation.--A State may not use more than 30
percent of the amount received under subsection (a) for
a fiscal year to carry out a State program, or
programs, under subparagraph (A).
``(C) Requirements on funds.--Any amounts that are
used under subparagraph (A)--
``(i) shall not be subject to any of the
requirements of subsection (d), subsection (f),
section 2204, or section 2205; and
``(ii) shall be subject to--
``(I) the audit requirements under
section 2203; and
``(II) any requirements that apply
to Federal funds provided directly for
such State program.
``(f) Maintenance of Current Law Restrictions on Use of Federal
Funds.--
``(1) In general.--
``(A) No funding for abortions.--None of the funds
appropriated in this title shall be expended for any
abortion.
``(B) No funds for coverage of abortion.--None of
the funds appropriated in this title shall be expended
for health benefits coverage that includes coverage of
abortion.
``(C) Health benefits coverage defined.--For
purposes of this subsection, the term `health benefits
coverage' means the package of services covered by a
managed care provider or organization pursuant to a
contract or other arrangement.
``(2) Exceptions.--The limitations established in paragraph
(1) shall not apply to an abortion--
``(A) if the pregnancy is the result of an act of
rape or incest; or
``(B) in the case where a woman suffers from a
physical disorder, physical injury, or physical illness
that would, as certified by a physician, place the
woman in danger of death unless an abortion is
performed, including a life-endangering physical
condition caused by or arising from the pregnancy
itself.
``(3) State funds used in conjunction with federal funds.--
The limitations established in paragraph (1) shall apply to any
State funds used in conjunction with Federal funds appropriated
under this title to provide, or finance the provision of,
health-care-related items and services to indigent individuals
pursuant to section 2201 or subsections (d)(2), (e)(1), or
(e)(2) of this section.
``(4) Option to purchase separate coverage or plan.--
Nothing in this subsection shall be construed as prohibiting a
State from purchasing separate coverage for abortions for which
funding is prohibited under this subsection, or a health plan
that includes such abortions, so long as such coverage or plan
is paid for entirely using funds not provided by this title.
``(5) Option to offer coverage or plan.--Nothing in this
subsection shall restrict any health insurance issuer from
offering separate coverage for abortions for which funding is
prohibited under this subsection, or a health plan that
includes such abortions, so long as--
``(A) premiums for such separate coverage or plan
are paid entirely with funds not provided by this
title; and
``(B) administrative costs and all services offered
through such separate coverage or plan are paid for
using only premiums collected for such coverage or
plan.
``(6) Conscience protections.--
``(A) None of the funds appropriated in this Act
may be made available to a Federal agency or program,
or to a State or local government, if such agency,
program, or government subjects any institutional or
individual health care entity to discrimination on the
basis that the health care entity does not provide, pay
for, provide coverage of, or refer for abortions.
``(B) In this paragraph, the term `health care
entity' includes an individual physician or other
health care professional, a hospital, a provider-
sponsored organization, a health maintenance
organization, a health insurance plan, or any other
kind of health care facility, organization, or plan.
``(g) No Funding for Illegal Aliens.--Except as provided under this
section and section 2205, no funds appropriated in this title may be
used to provide health-care-related items and services to an alien who
is not lawfully admitted for permanent residence or otherwise
permanently residing in the United States under color of law.
``(h) Nonentitlement.--Nothing in this title shall be construed as
providing an individual with an entitlement to health-care-related
items and services under this title.
``SEC. 2203. ADMINISTRATIVE AND FISCAL ACCOUNTABILITY.
``(a) Audits.--
``(1) Contract with approved auditing entity.--Not later
than October 1, 2014, and annually thereafter, a State shall
contract with an approved auditing entity (as defined under
paragraph (3)(B)) for purposes of conducting an audit under
paragraph (2) (with respect to the fiscal year ending September
30 of such year).
``(2) Audit requirement.--Under a contract under paragraph
(1), an approved auditing entity shall conduct an audit of the
expenditures or transfers made by a State from amounts received
under a grant under this title, or from State funds described
in section 2202(f)(3), with respect to the fiscal year which
such audit covers, to determine the extent to which such
expenditures and transfers were expended in accordance with
this title.
``(3) Entity conducting audit.--
``(A) In general.--With respect to a State, the
audit under paragraph (2) shall be conducted by an
approved auditing entity in accordance with generally
accepted auditing principles.
``(B) Approved auditing entity.--For purposes of
this section, the term `approved auditing entity'
means, with respect to a State, an entity that is--
``(i) approved by the Secretary of the
Treasury;
``(ii) approved by the chief executive
officer of the State; and
``(iii) independent of any Federal, State,
or local agency.
``(4) Submission of audit.--Not later than December 31,
2014, and annually thereafter, a State shall submit the results
of the audit under paragraph (2) (with respect to the fiscal
year ending on September 30 of such year) to the State
legislature and to the Secretary of the Treasury.
``(5) Additional accounting requirements.--The provisions
of chapter 75 of title 31, United States Code, shall apply to
the audit requirements of this section.
``(b) Reimbursement and Penalty.--
``(1) In general.--If, through an audit conducted under
subsection (a), an approved auditing entity finds that any
amounts paid to a State under a grant under this title were not
expended in accordance with this title--
``(A) the State shall pay to the Treasury of the
United States any such amount, plus 10 percent of such
amount as a penalty; or
``(B) the Secretary of the Treasury shall offset
such amount plus the 10 percent penalty against any
other amount in any other fiscal year that the State
may be entitled to receive under a grant under this
title.
``(2) Misuse of state funds.--If, through an audit
conducted under subsection (a), an approved auditing entity
finds that a State violated the requirements of section
2202(f)(3), the State shall pay to the Treasury of the United
States 100 percent of the amount of State funds that were used
in violation of section 2202(f)(3) as a penalty. Insofar as a
State fails to pay any such penalty, the Secretary of the
Treasury shall offset the amount not so paid against the amount
of any grant otherwise payable to the State under this title.
``(c) Annual Reporting Requirements.--
``(1) In general.--Not later than January 31, 2015, and
annually thereafter, each State shall submit to the Secretary
of the Treasury and the State legislature a report on the
activities carried out by the State during the most recently
completed fiscal year with funds received by the State under a
grant under this title for such fiscal year.
``(2) Content.--A report under paragraph (1) shall, with
respect to a fiscal year--
``(A) contain the results of the audit conducted by
an approved auditing entity for a State for such fiscal
year, in accordance with the requirements of subsection
(a) of this section;
``(B) specify the amount of the grant made to the
State under this title that is used to carry out a
program under section 2202(e)(3); and
``(C) be in such form and contain such other
information as the State determines is necessary to
provide--
``(i) an accurate description of the
activities conducted by the State for the
purpose described under section 2201 and any
other use of funds permitted under subsections
(d) and (e) of section 2202; and
``(ii) a complete record of the purposes
for which amounts were expended in accordance
with this title.
``(3) Conformity with accounting principals.--Any financial
information in the report under paragraph (1) shall be prepared
and reported in accordance with generally accepted accounting
principles, including the provisions of chapter 75 of title 31,
United States Code.
``(4) Public availability.--A State shall make copies of
the reports required under this section available on a public
Web site and shall make copies available in other formats upon
request.
``(d) Failure To Comply With Requirements.--The Secretary of the
Treasury shall not make any payment to a State under a grant authorized
by section 2202(a)--
``(1) if an audit for a State is not submitted as required
under subsection (a), during the period between the date such
audit is due and the date on which such audit is submitted;
``(2) if a State fails to submit a report as required under
subsection (c), during the period between the date such report
is due and the date on which such report is submitted; or
``(3) if a State violates a requirement of section 2202(f),
during the period beginning on the date the Secretary becomes
aware of such violation and the date on which such violation is
corrected by the State.
``(e) Administrative Supervision and Oversight.--
``(1) Limited role for secretary of treasury and the
attorney general.--
``(A) Treasury.--The authority of the Secretary of
the Treasury under this title is limited to--
``(i) promulgating regulations, issuing
rules, or publishing guidance documents to the
extent necessary for purposes of implementing
subsection (a)(3)(B), subsection (b), and
subsection (d);
``(ii) making quarterly payments to the
States under grants under this title in
accordance with section 2202(a);
``(iii) approving entities under subsection
(a)(3)(B) for purposes of the audits required
under subsection (a);
``(iv) withholding payment to a State of a
grant under subsection (d) or offsetting a
payment of such a grant to a State under
subsection (b); and
``(v) exercising the authority relating to
nondiscrimination that is specified in section
2204(b).
``(B) Attorney general.--The authority of the
Attorney General to supervise the amounts received by a
State under this title is limited to the authority
under section 2204(c).
``(2) Federal supervision.--
``(A) In general.--Except as provided under
paragraph (1), an administrative officer, employee,
department, or agency of the United States (including
the Secretary of Health and Human Services) may not--
``(i) supervise--
``(I) the amounts received by the
States under this title; or
``(II) the use of such amounts by
the States; or
``(ii) promulgate regulations or issue
rules in accordance with this title.
``(B) Limitation on secretary of health and human
services.--The Secretary of Health and Human Services
shall have no authority over any provision of this
title.
``(f) Reservation of State Powers.--Nothing in this section shall
be construed to limit the power of a State, including the power of a
State to pursue civil and criminal penalties under State law against
any individual or entity that misuses, or engages in fraud or abuse
related to, the funds provided to a State under this title.
``SEC. 2204. NONDISCRIMINATION PROVISIONS.
``(a) No Discrimination Against Individuals.--No individual shall
be excluded from participation in, denied the benefits of, or subjected
to discrimination under, any program or activity funded in whole or in
part with amounts paid to a State under this title on the basis of such
individual's--
``(1) disability under section 504 of the Rehabilitation
Act of 1973 (29 U.S.C. 794);
``(2) sex under title IX of the Education Amendments of
1972 (20 U.S.C. 1681 et seq.); or
``(3) race, color, or national origin under title VI of the
Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.).
``(b) Compliance.--
``(1) If the Secretary of the Treasury determines that a
State or an entity that has received funds from amounts paid to
a State under a grant under this title has failed to comply
with a provision of law referred to in subsection (a), the
Secretary of the Treasury shall notify the chief executive
officer of the State of such failure to comply and shall
request that such chief executive officer secure such
compliance.
``(2) If, not later than 60 days after receiving
notification under paragraph (1), the chief executive officer
of a State fails or refuses to secure compliance with the
provision of law referred to in such notification, the
Secretary of the Treasury may--
``(A) refer the matter to the Attorney General with
a recommendation that an appropriate civil action be
instituted; or
``(B) exercise the powers and functions provided
under section 505 of the Rehabilitation Act of 1973 (29
U.S.C. 794a), title IX of the Education Amendments of
1972 (20 U.S.C. 1681 et seq.), or title VI of the Civil
Rights Act of 1964 (42 U.S.C. 2000d et seq.) (as
applicable).
``(c) Civil Actions.--If a matter is referred to the Attorney
General under subsection (b)(2)(A), or the Attorney General has reason
to believe that a State or entity has failed to comply with a provision
of law referred to in subsection (a), the Attorney General may bring a
civil action in an appropriate district court of the United States for
such relief as may be appropriate, including injunctive relief.
``SEC. 2205. EMERGENCY ASSISTANCE.
``(a) In General.--A State that receives a grant under this title
for a fiscal year shall provide payment for health-care-related items
and services provided to a citizen, legal resident, or an alien who is
not lawfully admitted for permanent residence or otherwise permanently
residing in the United States under color of law, consistent with the
requirements of section 1867, if--
``(1) such health-care-related items and services are--
``(A) necessary for the treatment of an emergency
medical condition; and
``(B) health-care-related items and services that
such State would provide payment for under this title,
if provided to an indigent individual;
``(2) the individual meets all necessary eligibility
requirements for health-care-related items and services under
the State program funded under this title, except for any
requirement related to immigration status; and
``(3) such items and services are not related to an organ
transplant procedure.
``(b) Emergency Medical Condition.--For purposes of this section,
the term `emergency medical condition' means a medical condition
(including emergency labor and delivery) manifesting itself by acute
symptoms of sufficient severity (including severe pain) such that the
absence of immediate medical attention could reasonably be expected to
result in--
``(1) placing the patient's health in serious jeopardy;
``(2) serious impairment to bodily functions; or
``(3) serious dysfunction of any bodily organ or part.
``SEC. 2206. DEFINITIONS.
``For purposes of this title:
``(1) Health-care-related items and services.--The term
`health-care-related items and services' shall be defined by a
State with respect to use of such term for purposes of the
application of this title to the State.
``(2) High-risk population.--The term `high-risk
population' means individuals who are described in one of the
following subparagraphs:
``(A) Individuals who, by reason of the existence
or history of a medical condition, are able to acquire
health coverage only at rates which are at least 150
percent of the standard risk rates for such coverage.
``(B) Individuals who are provided health coverage
by a qualified high risk pool.
``(3) Indigent individual.--The term `indigent individual'
shall be defined by a State with respect to use of such term
for purposes of the application of this title to the State.
``(4) Qualified high risk pool.--The term `qualified high
risk pool' has the meaning given such term in section
2745(g)(1)(A) of the Public Health Service Act.
``(5) Risk-adjustment mechanism defined.--For purposes of
this section, the term `risk-adjustment mechanism' means any
risk-spreading mechanism to subsidize the purchase of private
health insurance for the high-risk population, including a
qualified high risk pool.''.
(b) Report on Reduction of Federal Administrative Expenditures.--
Beginning not later than October 31, 2014, and annually thereafter
until October 31, 2023, the Secretary of Health and Human Services, in
consultation with the Secretary of the Treasury, shall submit a report
to the Committee on Energy and Commerce in the House of Representatives
and the Finance Committee in the Senate containing a description of the
total reduction in Federal expenditures required to administer and
provide oversight for the programs to provide health-care-related items
and services to indigent individuals under this Act, compared to the
expenditures required to administer and provide oversight for the
programs under titles XIX and XXI of the Social Security Act, as in
effect on September 30, 2012.
(c) State Defined.--Section 1101(a)(1) of the Social Security Act
(42 U.S.C. 1301(a)(1)) is amended--
(1) in the first sentence, by striking ``and XXI'' and
inserting ``XXI, and XXII''; and
(2) in the fourth sentence, by striking ``and XXI'' and
inserting ``, XXI, and XXII''.
SEC. 3. REPEAL OF PPACA, HCERA, AND THE FEDERAL REQUIREMENTS OF
MEDICAID AND CHIP.
(a) PPACA.--The Patient Protection and Affordable Care Act (Public
Law 111-148) 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) HCERA.--Title I and subtitle B of title II of the Health Care
and Education Reconciliation Act of 2010 (Public Law 111-152) 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.
(c) Medicaid and CHIP.--Titles XIX and XXI of the Social Security
Act are repealed.
SEC. 4. SEVERABILITY.
If any provision of this Act, or the application of such provision
to any person or circumstance, is found to be unconstitutional, the
remainder of this Act, or the application of that provision to other
persons or circumstances, shall not be affected.
SEC. 5. EFFECTIVE DATE.
This Act and the amendments made by this Act shall take effect with
respect to items and services furnished on or after October 1, 2013.
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