[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 2461 Introduced in Senate (IS)]
113th CONGRESS
2d Session
S. 2461
To amend title XXI of the Social Security Act to extend and improve the
Children's Health Insurance Program, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 11, 2014
Mr. Rockefeller introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XXI of the Social Security Act to extend and improve the
Children's Health Insurance Program, 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; AMENDMENTS TO SOCIAL SECURITY ACT; REFERENCES;
TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``CHIP Extension Act
of 2014''.
(b) Amendments to Social Security Act.--Except as otherwise
specifically provided, whenever in this Act an amendment 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 that section or other
provision of the Social Security Act.
(c) References to CHIP; Medicaid; Secretary.--In this Act:
(1) CHIP.--The term ``CHIP'' means the program established
under title XXI of the Social Security Act (42 U.S.C. 1397aa et
seq.) (whether implemented under title XIX, XXI, or both, of
the Social Security Act).
(2) Medicaid.--The term ``Medicaid'' means the program for
medical assistance established under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).
(3) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(d) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; amendments to Social Security Act; references;
table of contents.
Sec. 2. Purposes.
Sec. 3. General effective date; exception for State legislation;
reliance on law.
TITLE I--FINANCING
Sec. 101. Extension of CHIP.
Sec. 102. Continuation and update of performance incentives.
Sec. 103. Funds to address any Federal funding shortfalls for States.
TITLE II--ELIGIBILITY AND ENROLLMENT
Subtitle A--Coverage Continuity
Sec. 201. State option to increase upper age limit for children with
special health care needs.
Sec. 202. Improving coverage transitions from Medicaid or CHIP to
coverage under a qualified health plan.
Sec. 203. Assuring coverage continuity for former foster care children.
Subtitle B--Enrollment Simplification and Improvements
Sec. 211. Automatic enrollment for newborns under CHIP.
Sec. 212. Express Lane Eligibility extension and application to
pregnant women, foster children, and
children with special health care needs.
Sec. 213. Outreach to targeted populations.
TITLE III--AFFORDABILITY
Sec. 301. Strengthened cost sharing protections under Medicaid and
CHIP.
TITLE IV--BENEFITS
Sec. 401. Preventive health services.
Sec. 402. Timely immunization coverage.
TITLE V--ACCESS AND QUALITY
Subtitle A--Pediatric Quality Measures
Sec. 501. Extending the pediatric quality measures program.
Sec. 502. Improving the effectiveness of the pediatric quality
measures.
Sec. 503. Annual State reports regarding State-specific quality of care
measures applied under Medicaid or CHIP.
Sec. 504. Advisory panel regarding pediatric quality.
Sec. 505. Extending and expanding demonstration projects.
Subtitle B--Maternal, Infant, and Early Childhood Home Visiting Program
Sec. 511. Supporting evidence-based care coordination in communities.
Subtitle C--Comparative Study of Medicaid, CHIP, and Qualified Health
Plans
Sec. 521. GAO study and report.
TITLE VI--BUDGETARY EFFECTS
Sec. 601. Budgetary effect of this Act.
SEC. 2. PURPOSES.
The purposes of this Act are to ensure the extension of CHIP,
safeguard child-specific health coverage for millions of children, and
make improvements to promote children's access to cost-effective, high-
quality health care.
SEC. 3. GENERAL EFFECTIVE DATE; EXCEPTION FOR STATE LEGISLATION;
RELIANCE ON LAW.
(a) General Effective Date.--Unless otherwise provided in this Act,
subject to subsections (b) and (c), this Act and the amendments made by
this Act shall take effect on October 1, 2015, and shall apply to child
health assistance and medical assistance provided on or after that
date.
(b) Exception for State Legislation.--In the case of a State plan
under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) or
a State child health plan under title XXI of such Act (42 U.S.C. 1397aa
et seq.), which the Secretary determines requires State legislation in
order for the respective plan to meet 1 or more additional requirements
imposed by amendments made by this Act, the respective plan shall not
be regarded as failing to comply with the requirements of such title
solely on the basis of its failure to meet such an additional
requirement before the first day of the first calendar quarter
beginning after the close of the first regular session of the State
legislature that begins after the date of enactment of this Act. For
purposes of the previous sentence, in the case of a State that has a 2-
year legislative session, each year of the session shall be considered
to be a separate regular session of the State legislature.
(c) Reliance on Law.--With respect to amendments made by this Act
that become effective as of a date--
(1) such amendments are effective as of such date whether
or not regulations implementing such amendments have been
issued; and
(2) Federal financial participation for medical assistance
or child health assistance furnished under title XIX or XXI,
respectively, of the Social Security Act on or after such date
by a State in good faith reliance on such amendments before the
date of promulgation of final regulations, if any, to carry out
such amendments (or before the date of guidance, if any,
regarding the implementation of such amendments) shall not be
denied on the basis of the State's failure to comply with such
regulations or guidance.
TITLE I--FINANCING
SEC. 101. EXTENSION OF CHIP.
(a) Funding.--
(1) In general.--Section 2104(a) (42 U.S.C. 1397dd(a)) is
amended--
(A) in paragraph (17), by striking ``and'' at the
end;
(B) by striking paragraph (18) and inserting the
following:
``(18) for fiscal year 2015, $21,061,000,000;''; and
(C) by adding at the end the following new
paragraphs:
``(19) for fiscal year 2016, $19,300,000,000;
``(20) for fiscal year 2017, $20,300,000,000;
``(21) for fiscal year 2018, $21,300,000,000; and
``(22) for fiscal year 2019, for purposes of making 2 semi-
annual allotments--
``(A) $2,850,000,000 for the period beginning on
October 1, 2018, and ending on March 31, 2019, and
``(B) $2,850,000,000 for the period beginning on
April 1, 2019, and ending on September 30, 2019.''.
(2) Prevention of duplicate appropriations for fiscal year
2015.--Expenditures made under section 2104(a)(18) of the
Social Security Act (42 U.S.C. 1387dd(a)(18)) pursuant to the
amendments made by section 10203 of the Patient Protection and
Affordable Care Act (Public Law 111-148) for fiscal year 2015
shall be charged to the appropriation provided by the amendment
made by paragraph (1) to such section for that fiscal year.
(b) Allotments.--
(1) In general.--Section 2104(m) (42 U.S.C. 1397dd(m)) is
amended--
(A) in paragraph (3)--
(i) by striking ``2015'' in the paragraph
heading and inserting ``2019'';
(ii) in subparagraph (A), by striking
``paragraph (18)'' and inserting ``paragraph
(22)'';
(iii) in subparagraph (B), by striking
``paragraph (18)'' and inserting ``paragraph
(22)'';
(iv) in subparagraph (C)--
(I) by striking ``2014'' each place
it appears and inserting ``2018''; and
(II) by striking ``2015'' and
inserting ``2019''; and
(v) in subparagraph (D)--
(I) in clause (i), by striking
``the sum of--'' and all that follows
through ``2009;'' and inserting ``the
amount made available under subsection
(a)(22)(A),''; and
(II) in subclause (II) of clause
(ii), by striking ``subsection
(a)(18)(B)'' and inserting ``subsection
(a)(22)(B)'';
(B) in paragraph (4), by striking ``2015'' and
inserting ``2019'';
(C) in paragraph (8)--
(i) by striking ``2015'' in the paragraph
heading and inserting ``2019''; and
(ii) by striking ``for a period in fiscal
year 2015'' and inserting ``for a period in
fiscal year 2019''; and
(D) by adding at the end the following new
paragraph:
``(9) Rebasing and growth factor update rules for fiscal
years after fiscal year 2014.--Subject to paragraphs (3), (4),
and (6), from the amount made available under subsection (a)
for each fiscal year after fiscal year 2014, the Secretary
shall compute a State allotment for each State (including the
District of Columbia and each commonwealth and territory) for
each such fiscal year as follows:
``(A) Rebasing in odd-numbered fiscal years.--If
the fiscal year is an odd-numbered fiscal year, the
allotment of the State is equal to the Federal payments
to the State that are attributable to (and countable
towards) the total amount of allotments available under
this section to the State in the preceding fiscal year
(including any payments made to the State under
subsections (n) and (o) for the preceding fiscal year
as well as amounts redistributed to the State in the
preceding fiscal year), multiplied by the allotment
increase factor under paragraph (5) for the fiscal
year.
``(B) Growth factor update for even-numbered fiscal
years.--If the fiscal year is an even-numbered fiscal
year, the allotment of the State is equal to the sum
of--
``(i) the amount of the State allotment for
the preceding fiscal year; and
``(ii) the amount of any payments made to
the State under subsections (n) and (o) for the
preceding fiscal year,
multiplied by the allotment increase factor under
paragraph (5) for the fiscal year.''.
(2) One-time appropriation for fiscal year 2019.--Section
108 of the Children's Health Insurance Program Reauthorization
Act of 2009 (Public Law 111-3), as amended by section
10203(d)(2)(F) of the Patient Protection and Affordable Care
Act (Public Law 111-148), is amended by striking
``$15,361,000,000'' and all that follows through the second
sentence, and inserting ``$16,700,000,000 to accompany the
allotment made for the period beginning on October 1, 2018, and
ending on March 31, 2019, under section 2104(a)(22)(A) of the
Social Security Act (42 U.S.C. 1397dd(a)(22)(A)), to remain
available until expended. Such amount shall be used to provide
allotments to States under paragraph (3) of section 2104(m) of
such Act (42 U.S.C. 1397dd(m)) for the first 6 months of fiscal
year 2019 in the same manner as allotments are provided under
subsection (a)(22)(A) of such section 2104 and subject to the
same terms and conditions as apply to the allotments provided
from such subsection (a)(22)(A).''.
(3) Conforming amendments.--Section 2104(m) (42 U.S.C.
1397dd(m)) is amended--
(A) in the subsection heading, by striking ``2015''
and inserting ``2019''; and
(B) in paragraph (6)--
(i) in subparagraph (A), by striking
``2015'' and inserting ``2019''; and
(ii) in the second sentence, by striking
``or fiscal year 2014'' and inserting ``fiscal
year 2014, fiscal year 2016, or fiscal year
2018''.
(c) Extension of Qualifying States Option.--Section 2105(g)(4) (42
U.S.C. 1397ee(g)(4)) is amended--
(1) in the paragraph heading, by striking ``2015'' and
inserting ``2019''; and
(2) in subparagraph (A), by striking ``2015'' and inserting
``2019''.
SEC. 102. CONTINUATION AND UPDATE OF PERFORMANCE INCENTIVES.
(a) Extension Through Fiscal Year 2019.--Section 2105(a)(3) (42
U.S.C. 1397ee(a)(3)) is amended--
(1) in subparagraph (A), by striking ``2013'' and inserting
``2019'';
(2) in subparagraph (E)--
(A) in clause (ii)--
(i) by striking subclause (I) and inserting
the following:
``(I) Unobligated national
allotment.--As of December 31 of fiscal
year 2009, and as of December 31 of
each succeeding fiscal year through
fiscal year 2015, the portion, if any,
of the amount appropriated under
section 2104(a) for such fiscal year
that is unobligated for allotment to a
State under section 2104(m) for such
fiscal year or set aside under
subsection (a)(3) or (b)(2) of section
2111 for such fiscal year.'';
(ii) in subclause (II), by striking
``2013'' and inserting ``2015''; and
(iii) in subclause (III), by striking
``2013'' and inserting ``2015'';
(B) by redesignating clause (iii) as clause (iv);
and
(C) by inserting after clause (ii), the following
new clause:
``(iii) Appropriation for fiscal years 2016
through 2019.--Out of any money in the Treasury
not otherwise appropriated, there are
appropriated $750,000,000 for each of fiscal
years 2016 through 2019 for making payments
under this paragraph. Amounts appropriated for
a fiscal year under this clause shall remain
available for making payments under this
paragraph through December 31 of the following
fiscal year. Any amount of such appropriations
that remains unexpended or unobligated as of
such date shall be transferred and made
available on January 1 of such following fiscal
year for making payments under section
2104(o).''; and
(3) in subparagraph (F)(iii), by striking ``2013'' and
inserting ``2019''.
(b) Updated Performance Incentive Criteria for Fiscal Years 2015
Through 2019.--Section 2105(a) (42 U.S.C. 1397ee(a)) is amended--
(1) in paragraph (3)(A), by inserting ``or (5)'' after
``paragraph (4)'';
(2) in paragraph (4)--
(A) in the heading, by inserting ``for fiscal years
before fiscal year 2015'' after ``for children''; and
(B) in the matter preceding subparagraph (A), by
striking ``for a fiscal year if'' and inserting ``for a
fiscal year before fiscal year 2015 if''; and
(3) by adding at the end the following new paragraph:
``(5) Enrollment and retention provisions for children for
fiscal years after fiscal year 2014.--
``(A) In general.--For purposes of paragraph
(3)(A), a State meets the condition of this paragraph
for a fiscal year after fiscal year 2014 if it is
implementing at least 7 of the enrollment and retention
provisions specified in subparagraph (B) (treating each
clause of that subparagraph as a separate enrollment
and retention provision) throughout the entire fiscal
year and achieves a program rating of `effective' or
`highly effective' under metrics established by the
Secretary under subparagraph (C) for the fiscal year
(beginning with the first fiscal year for which such
metrics are established).
``(B) Enrollment and retention provisions.--The
enrollment and retention provisions specified in this
subparagraph are the following:
``(i) 12-month continuous eligibility.--The
State has elected the option of continuous
eligibility for a full 12 months under title
XIX for all children described in section
1902(e)(12) and applies such policy under its
State child health plan under this title.
``(ii) Express lane eligibility.--The State
is implementing the option described in section
1902(e)(13) under title XIX as well as,
pursuant to section 2107(e)(1), under this
title.
``(iii) Presumptive eligibility.--The State
is implementing section 1920A under title XIX
as well as, pursuant to section 2107(e)(1),
under this title.
``(iv) Elimination of chip premiums.--In
the case of any targeted low-income child or a
targeted low-income pregnant woman, the State
child health plan does not impose any
enrollment fee, premium, or similar charge.
``(v) Premium assistance for employer-
sponsored plans.--The State has opted to offer
a premium assistance subsidy for qualified
employer-sponsored coverage by implementing
section 1906A under title XIX or the option
described in section 2105(c)(10) under this
title.
``(vi) Comprehensive coverage for pregnant
women.--If the State has elected to offer
pregnancy-related assistance to targeted low-
income women (as defined in section 2112(d)(2))
under section 2112, the State also has elected
to include, as part of such pregnancy-related
assistance and as part of the medical
assistance provided to women under section
1902(e)(5) while pregnant and during the 60-day
period described in such section--
``(I) dental services necessary to
prevent disease and promote oral
health, restore oral structure to
health and function, and treat
emergency conditions;
``(II) vision services, including
vision screening and corrective lenses;
and
``(III) all services covered under
the State child health plan.
``(vii) Improved coverage for pregnant
women.--If the State has elected to offer
pregnancy-related assistance to targeted low-
income women (as defined in section 2112(d)(2))
under section 2112--
``(I) the State also has elected to
provide that a pregnant woman who is
determined to be eligible for
pregnancy-related assistance under the
amendment to the State child health
plan under section 2112 shall remain
eligible for those benefits until the
end of a period (not to exceed 12
months) following the determination;
and
``(II) the State is implementing
section 1906A under title XIX.
``(viii) Supplemental dental coverage.--The
State has elected to provide dental-only
supplemental coverage under section 2110(b)(5).
``(ix) Raising chip eligibility age to
align with medicaid eligibility age.--If the
State has elected to provide eligibility as a
child under the State plan under title XIX for
an individual who has attained age 19 or 20,
the State has elected to apply the same age
under the State plan under this title for
purposes of eligibility as a child.
``(x) Increase in income eligibility.--
``(I) Up to at least 300 percent of
the poverty line.--The State has
elected to extend eligibility for
medical assistance under the State plan
under title XIX or eligibility for
child health assistance under the State
child health plan to any otherwise
eligible child whose family income does
not exceed 300 percent of the poverty
line for a family of the size involved.
``(II) Rule of construction.--
Nothing in subclause (I) shall be
construed as prohibiting a State from
extending eligibility for medical
assistance under the State plan under
title XIX or eligibility for child
health assistance under the State child
health plan to any otherwise eligible
child whose family income exceeds 300
percent of the poverty line.
``(xi) Prohibiting lockout periods.--The
State child health plan permits an individual
whose coverage under the plan has been
terminated for failure to make premium payments
to be immediately reenrolled upon payment of
outstanding premiums, with coverage retroactive
to the beginning of the most recent month for
which an outstanding premium has been paid, and
shall not impose any waiting period or
enrollment fee as a condition of reenrollment.
``(xii) CHIP coverage for children of state
employees.--The State offers enrollment in the
State child health plan for a child who is a
member of a family that is eligible for health
benefits coverage under a State health benefits
plan on the basis of a family member's
employment with a public agency in accordance
with section 2110(b)(6) and provides resources
to help the family member so employed compare
the coverage options for the family member's
child under the State health benefits plan on
the basis of cost and provider networks.
``(xiii) Interagency coordination for
juvenile justice youth.--The State--
``(I) does not terminate (but may
suspend) enrollment under a State plan
for medical assistance for any
individual under age 21 on the basis
that the individual is an inmate of a
public institution (as defined in
section 435.1010 of title 42, Code of
Federal Regulations);
``(II) informs such individual
immediately upon release from such
public institution that the
individual's eligibility for medical
assistance is no longer suspended and
the limitations on medical assistance
under the subdivision (A) following
paragraph (29) of section 1905(a) will
no longer apply (unless and until there
is a determination that the individual
no longer meets the State or Federal
eligibility requirements for such
medical assistance);
``(III) processes any application
for medical assistance submitted by, or
on behalf of any individual under age
21 who is an inmate of a public
institution (as defined in section
435.1010 of title 42, Code of Federal
Regulations) notwithstanding that the
individual is such an inmate; and
``(IV) screens any individual under
age 21 who is such an inmate for
eligibility for medical assistance
under title XIX or child health
assistance under this title and assists
those individuals who are identified as
likely to be eligible for either such
assistance in applying for either such
assistance and enrolling in either such
plan.
``(xiv) Extended coverage for children with
special health care needs.--The State has
elected to extend eligibility for child health
assistance under the State child health plan
(whether implemented under this title, title
XIX, or both) to individuals under age 26 with
special health care needs by implementing the
option described in section 2110(c)(1)(B).
``(C) Metrics for evaluating program
effectiveness.--The Secretary shall establish metrics
for evaluating the effectiveness of the State program
established under this title (whether implemented under
this title, title XIX, or both). Such metrics shall
include a system for rating States as `effective',
`highly effective', or `in need of improvement'.''.
SEC. 103. FUNDS TO ADDRESS ANY FEDERAL FUNDING SHORTFALLS FOR STATES.
(a) In General.--Section 2104 (42 U.S.C. 1397dd) is amended by
adding at the end the following new subsection:
``(o) Fund To Alleviate CHIP Shortfalls.--
``(1) Establishment.--There is hereby established in the
Treasury of the United States a fund which shall be known as
the `CHIP Shortfall Fund' (in this subsection referred to as
the `Fund'). Amounts in the Fund shall be available without
further appropriations for payments under this subsection and
shall remain available until expended.
``(2) Deposits into fund.--
``(A) Initial appropriation.--Out of any money in
the Treasury of the United States not otherwise
appropriated, there are appropriated to the Fund
$3,860,000,000 for fiscal year 2016.
``(B) Transfers.--Notwithstanding any other
provision of this title, the following amounts shall
also be available, without fiscal year limitation, for
making payments from the Fund:
``(i) Unobligated national allotment for
fiscal years beginning with fiscal year 2016.--
As of January 1 of fiscal year 2017, and as of
January 1 of each succeeding fiscal year, the
portion, if any, of the amount appropriated
under subsection (a) for the preceding fiscal
year that is unobligated for allotment to a
State under subsection (m) for such preceding
fiscal year.
``(ii) Unexpended allotments not used for
redistribution.--As of November 15 of fiscal
year 2016 and each succeeding fiscal year, the
total amount of allotments made to States under
subsection (a) for the second preceding fiscal
year that is not expended or redistributed
under subsection (f) during the period in which
such allotments are available for obligation.
``(iii) Unexpended child enrollment
contingency funds.--As of October 1, 2015, any
unobligated amount in the Child Enrollment
Contingency Fund under subsection (n).
``(iv) Unexpended performance incentive
funds.--As of January 1, 2017, and as of
January 1 of each succeeding calendar year, the
portion, if any, of the amount appropriated
under subparagraph (E)(iii) of section
2105(a)(3) for the preceding fiscal year that
is not expended or obligated under such section
for such preceding fiscal year.
``(C) Investment of fund.--The Secretary of the
Treasury shall invest in interest bearing securities of
the United States such currently available portions of
the Fund as are not immediately required for payments
from the Fund. The income derived from these
investments shall constitute a part of the Fund.
``(3) Shortfall fund payments.--
``(A) Payments to shortfall states.--For each of
fiscal years 2016 through 2020, if the Secretary
determines that a State is a shortfall State described
in paragraph (4) for that fiscal year, the Secretary
shall pay the State from the Fund, in addition to any
other payments made to a State under this title for the
fiscal year, an amount equal to the amount described in
subparagraph (B) for the State and fiscal year.
``(B) Amount described.--With respect to a State
and a fiscal year, the amount described in this
subparagraph is the amount of projected expenditures
for the State under this title for the fiscal year that
exceeds the sum determined under paragraph (4) for the
State and fiscal year.
``(C) Proportional reduction.--If the sum of the
amounts otherwise payable under this paragraph for a
fiscal year exceeds the amount available in the Fund
for the fiscal year, the amount to be paid under this
paragraph to each State for the fiscal year shall be
reduced proportionally.
``(D) Application to commonwealths and
territories.--No payment shall be made under this
paragraph to a commonwealth or territory described in
subsection (c)(3) until such time as the Secretary
determines that there are in effect methods,
satisfactory to the Secretary, for the collection and
reporting of reliable data regarding the expenditures
under the State child health plan in order to
accurately determine the commonwealth's or territory's
eligibility for, and amount of payment, under this
paragraph.
``(4) Shortfall states described.--For purposes of
paragraph (3), with respect to a fiscal year, a shortfall State
is a State for which the Secretary estimates on the basis of
the most recent data available to the Secretary, that the
projected expenditures for the State for the fiscal year under
this title (whether the State plan is implemented under this
title, title XIX, or both) will exceed the sum of--
``(A) the amount of the State's allotments for any
preceding fiscal years that remains available for
expenditure and that will not be expended by the end of
the immediately preceding fiscal year;
``(B) the amount (if any) that will be
redistributed to the State under subsection (f) for the
fiscal year;
``(C) the amount (if any) of the child enrollment
contingency fund payment under subsection (n) for the
fiscal year; and
``(D) the amount of the State's allotment for the
fiscal year.
``(5) Retrospective adjustment.--The Secretary may adjust
the determinations made under this subsection with respect to a
State and fiscal year as necessary on the basis of the amounts
reported by States not later than November 30 of the succeeding
fiscal year, as approved by the Secretary.''.
(b) Technical Amendments.--Section 2104(f) (42 U.S.C. 1397dd(f)) is
amended--
(1) in paragraph (1)--
(A) by striking ``shortfall States'' and inserting
``redistribution States''; and
(B) by striking ``shortfall described'' and
inserting ``deficit described''; and
(2) in paragraph (2)--
(A) in the paragraph heading, by striking
``Shortfall'' and inserting ``Redistribution'';
(B) in subparagraph (A), by striking ``shortfall
State'' and inserting ``redistribution State''; and
(C) in subparagraph (B)--
(i) by striking ``shortfalls'' and
inserting ``deficits''; and
(ii) by striking ``shortfall State'' and
inserting ``redistribution State''.
TITLE II--ELIGIBILITY AND ENROLLMENT
Subtitle A--Coverage Continuity
SEC. 201. STATE OPTION TO INCREASE UPPER AGE LIMIT FOR CHILDREN WITH
SPECIAL HEALTH CARE NEEDS.
Section 2110(c)(1) (42 U.S.C. 2110(c)(1)) is amended--
(1) by striking ``The term'' and inserting the following:
``(A) In general.--Subject to subparagraph (B), the
term''; and
(2) by adding at the end the following:
``(B) Children with special health care needs.--At
State option, such term includes an individual under 26
years of age who has or is at an increased risk of a
chronic physical, developmental, behavioral, or
emotional condition and who also requires health and
related services of a type or amount beyond that
required by children typically.''.
SEC. 202. IMPROVING COVERAGE TRANSITIONS FROM MEDICAID OR CHIP TO
COVERAGE UNDER A QUALIFIED HEALTH PLAN.
(a) State Coordination Requirement.--Section 2105(d)(3)(B) (42
U.S.C. 1397ee(d)(3)(B)) is amended--
(1) in the subparagraph heading, by striking ``shortfalls''
and inserting ``shortfalls; coordination requirements for
transitioning to or from exchange coverage'';
(2) in the first sentence, by striking ``In the event'' and
inserting the following:
``(i) Exchange coverage as a result of
funding shortfalls.--In the event''; and
(3) by adding at the end the following:
``(ii) Coordination requirements for
transitioning to or from exchange coverage.--
The State shall establish procedures to
eliminate gaps in coverage and to assist a
child's and pregnant woman's transition from
coverage under the State plan under title XIX
or the State child health plan under this title
(whether implemented under this title, title
XIX, or both) to coverage under a qualified
health plan that has been certified by the
Secretary under subparagraph (C) and is offered
through an Exchange and from coverage under a
qualified health plan to coverage under the
State plan under title XIX or the State child
health plan under this title. Such procedures--
``(I) shall provide for coverage
for the child's or pregnant woman's
medical home, regardless of whether the
medical home providers are
participating providers under the State
plan under title XIX or the State child
health plan under this title, for a
transitional time to be determined
under regulations promulgated by the
Secretary;
``(II) in the case of a child or
pregnant woman with a chronic or
complex condition, shall provide that
the State plan under title XIX, or the
State child health plan under this
title (as applicable) shall permit the
child or pregnant woman to continue to
receive treatment from a non-network
provider for a transitional period as
determined under regulations
promulgated by the Secretary;
``(III) shall require that if the
benefits available and cost-sharing
imposed under a qualified health plan
available to the child or pregnant
woman (as applicable) are not
comparable to the benefits and coverage
available to the child or pregnant
woman under the State plan under title
XIX or the State child health plan
under this title (as applicable) the
child or pregnant woman shall remain
enrolled in the State plan under title
XIX or the State child health plan
under this title for so long as the
child or pregnant woman is otherwise
eligible for coverage under the title
XIX or XXI State plans; and
``(IV) shall establish a system
under which the State shall record all
transitions of children and pregnant
women from coverage under the State
plan under title XIX or the State child
health plan under this title to
coverage under a qualified health plan
and from coverage under a qualified
health plan to coverage under the State
plan under title XIX or the State child
health plan under this title and submit
a report to the Secretary each fiscal
quarter that includes data on the
number of children and pregnant women
who made such transitions in the
preceding fiscal quarter.''.
(b) Certification Requirement.--Section 2105(d)(3)(C) (42 U.S.C.
1397ee(d)(3)(C)) is amended--
(1) in the subparagraph heading, by striking ``Pediatric'';
(2) by striking ``With respect to'' and inserting the
following:
``(i) In general.--With respect to'';
(3) by inserting ``and pregnant women'' after ``children''
each place it appears;
(4) by striking ``are at least comparable to the benefits
offered and cost-sharing protections provided under the State
child health plan'' and inserting ``meet the comparability
standards described in clause (ii) and the continuous coverage
requirements described in clause (iii)''; and
(5) by adding at the end the following new clauses:
``(ii) Comparability standards.--The
Secretary shall develop, in consultation with
non-government stakeholder entities (including
not less than 1 national non-profit
organization focused on children's advocacy),
comparability standards for qualified health
plans seeking certification under clause (i).
Such standards must include standards for the
following areas:
``(I) Affordability.--The plan must
be comparable to the State child health
plan in terms of affordability,
including premiums, deductibles, co-
payments, co-insurance, medical home
maintenance costs, and the cost of
purchasing supplementary coverage for
health benefits and services that are
covered under the State child health
plan but are not covered under the
qualified health plan.
``(II) Benefits.--The plan must be
comparable to the State child health
plan in terms of pediatric and
pregnancy-related benefits.
``(III) Network adequacy.--The plan
must be comparable to the State child
health plan in terms of access to
appropriate providers of pediatric and
pregnancy-related services, and must
provide flexibility for children with
special health care needs to remain in
their medical home or seek appropriate
pediatric sub-specialists.
``(iii) Continuous coverage requirements.--
The Secretary shall require health plans
seeking certification as qualified health plans
for purposes of an American Health Benefits
Exchange to ensure that--
``(I) with respect to a child or
pregnant woman who is transitioning
from coverage under a State child
health plan or a State plan under title
XIX--
``(aa) coverage under the
qualified health plan shall be
effective as of the 60-day
period preceding the date on
which the first premium payment
is made for such coverage;
``(bb) coverage under the
State child health plan or
State plan under title XIX
shall remain in effect during
the 30-day period that precedes
the 60-day period described in
item (aa);
``(cc) the qualified health
plan shall provide coverage for
a child's or a pregnant woman's
medical home, regardless of
whether the medical home
provider is within the network
of the plan, to allow the child
or pregnant woman to finish a
course of treatment for an
acute illness or a treatment or
surgery scheduled prior to the
effective date for coverage
under the plan under item (aa)
or for a period of up to 90
days if, by the end of such
period, the child or pregnant
woman is enrolled with a
medical home provider that is
within the network of the plan;
and
``(dd) in the case of a
child or pregnant woman with a
chronic or complex condition,
the qualified health plan shall
permit the child or pregnant
woman to continue to receive
treatment from a non-network
provider for a transitional
time that is not less than 90
days, or until the child or
pregnant woman can be enrolled
with an in-network provider;
``(II) similar requirements apply
with respect to any child or pregnant
woman who transitions from coverage
under a qualified health plan to
coverage under the State child health
plan or the State plan under title XIX
in accordance with subparagraph
(B)(ii); and
``(III) a child or pregnant woman
transitioning to or from coverage under
the State child health plan or the
State plan under title XIX and a
qualified health plan is informed of
the differences between the benefits
available and cost-sharing imposed
under the coverage the child or
pregnant woman is transitioning from
and into, and that the pregnant woman
or the parent or guardian of the child
has the option of electing to remain
enrolled in whichever coverage is the
most affordable or provides the best
benefits for the child or pregnant
woman for such period as the Secretary
shall specify.''.
(c) Prohibition on Transitioning CHIP-Eligible Children.--No child
who is eligible for coverage under CHIP shall be transitioned from a
State child health plan to a qualified health plan unless that plan is
certified under section 2105(d)(3)(C) of the Social Security Act (42
U.S.C. 1397ee(d)(3)(C)) (as amended by subsection (b)).
(d) Minimum Essential Coverage.--
(1) In general.--Section 5000A(f) of the Internal Revenue
Code of 1986 is amended by adding at the end the following:
``(6) Pregnancy-related assistance under chip.--With
respect to a targeted low-income pregnant woman (as defined in
section 2112(d)(2) of the Social Security Act), notwithstanding
paragraph (1)(A)(iii), the term `minimum essential coverage',
at the option of such a woman, shall not include pregnancy-
related assistance (as defined in section 2112(d)(1) of the
Social Security Act).''.
(2) Effective date.--The amendment made by this subsection
applies to taxable years beginning after December 31, 2014.
SEC. 203. ASSURING COVERAGE CONTINUITY FOR FORMER FOSTER CARE CHILDREN.
(a) In General.--Section 1902(a)(10)(A)(i)(IX) (42 U.S.C.
1396a(a)(10)(A)(i)(IX)) is amended--
(1) in item (cc), by striking ``responsibility of the
State'' and inserting ``responsibility of a State''; and
(2) in item (dd), by striking ``the State plan under this
title or under a waiver of the'' and inserting ``a State plan
under this title or under a waiver of such a''.
(b) Effective Date.--The amendments made by this section shall take
effect on the date of enactment of this Act.
Subtitle B--Enrollment Simplification and Improvements
SEC. 211. AUTOMATIC ENROLLMENT FOR NEWBORNS UNDER CHIP.
(a) In General.--Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)) is
amended--
(1) by redesignating subparagraphs (E) through (O) as
subparagraphs (F) through (P), respectively; and
(2) by inserting after subparagraph (D) the following new
subparagraph:
``(E) Section 1902(e)(4) (relating to automatic
coverage for newborns through age 1).''.
(b) Effective Date.--The amendments made by this section shall take
effect on the date of enactment of this Act.
SEC. 212. EXPRESS LANE ELIGIBILITY EXTENSION AND APPLICATION TO
PREGNANT WOMEN, FOSTER CHILDREN, AND CHILDREN WITH
SPECIAL HEALTH CARE NEEDS.
(a) In General.--Section 1902(e)(13) (42 U.S.C. 1396a(e)(13)) is
amended--
(1) in subparagraph (A), by adding at the end the following
new clause:
``(iii) State option to extend express lane
eligibility to pregnant women.--At the option
of the State, the State may apply the
provisions of this paragraph with respect to
determining eligibility under this title for a
pregnant woman. In applying this paragraph in
the case of a State electing such an option,
any reference in this paragraph to a child with
respect to this title (other than a reference
to child health assistance) shall be deemed to
be a reference to a pregnant woman.'';
(2) in subparagraph (G), by adding at the end the following
new sentence: ``Notwithstanding the age limit specified in the
preceding sentence, such term includes an individual described
in subsection (a)(10)(A)(i)(IX) and, at the option of the
State, an individual described in section 2110(c)(1)(B).''; and
(3) by striking subparagraph (I).
(b) Effective Date.--The amendments made by this section shall take
effect on the date of enactment of this Act.
SEC. 213. OUTREACH TO TARGETED POPULATIONS.
(a) Outreach and Enrollment Grants.--Section 2113 (42 U.S.C.
1397mm) is amended--
(1) in subsection (a)(1), by striking ``during the period
of fiscal years 2009 through 2015''; and
(2) in subsection (g), by inserting ``and $40,000,000 for
each fiscal year thereafter,'' after ``2015,''.
(b) Outreach to Non-English Speakers and Other Populations.--
(1) National enrollment campaign requirements.--Such
section 2113 is amended--
(A) in subsection (h), by striking ``Such
campaign'' and inserting ``In addition to the
requirements described in subsection (i), such
campaign''; and
(B) by adding at the end the following subsection:
``(i) Required Elements of National Enrollment Campaign.--Beginning
with fiscal year 2015, each of the following initiatives shall be part
of the national enrollment campaign:
``(1) Initiative to increase enrollment among individuals
with limited english proficiency.--An initiative to increase
enrollment in the State child health plan under this title or
the State plan under title XIX of children from families that
speak a primary language other than English that shall
include--
``(A) language services, including oral
interpreting and written translation services, for
individuals with limited proficiency in English; and
``(B) other culturally appropriate efforts to
increase enrollment of such children.
``(2) Initiative to increase enrollment of children in
families with complex or multiple coverage sources.--An
initiative to identify and increase enrollment in the State
child health plan under this title or the State plan under
title XIX of children from families who have multiple coverage
sources or other coverage complexities, including children in
foster care and children subject to a medical child support
order.''.
(2) Increased reimbursement for state spending on language
services.--
(A) Medicaid.--Section 1903(a)(2)(E) (42 U.S.C.
1396b(a)(2)(E)) is amended by striking ``75 percent''
and inserting ``the higher of 90 percent or the sum of
the enhanced FMAP (as defined in section 2105(b)) plus
5 percentage points (not to exceed 100 percent)''.
(B) CHIP.--Section 2105(a)(1) (42 U.S.C.
1397ee(a)(1)) is amended in the matter preceding
paragraph (1), by striking ``the higher of 75 percent
or the sum of the enhanced FMAP plus 5 percentage
points'' and inserting ``the higher of 90 percent or
the sum of the enhanced FMAP plus 5 percentage points
(not to exceed 100 percent)''.
(3) Requirement that managed care organizations provide
language services to enrollees.--Section 1932(b) (42 U.S.C.
1396u-2(b)) is amended by adding at the end the following new
paragraph:
``(9) Language services.--Each contract with a medicaid
managed care organization under section 1903(m) shall require
the organization to provide (at no cost to the individual)
language services, including oral interpreting and written
translation services, to any individual who is eligible for
medical assistance under the State plan under this title and is
enrolled with the organization and to a parent or guardian of
such individual if such individual, parent, or guardian is in
need of such services when interacting with the organization or
with any provider receiving payment from the organization.''.
(4) Translation of applications and other vital
documents.--
(A) Medicaid.--Section 1902(a) (42 U.S.C. 1396a(a))
is amended--
(i) by striking ``and'' at the end of
paragraph (80);
(ii) by striking the period at the end of
paragraph (81) and inserting ``; and''; and
(iii) by inserting after paragraph (81) the
following new paragraph:
``(82) provide for the translation of all documents and
materials necessary to make application for medical assistance
under the plan, and such other documents and materials as the
Secretary may specify, including any such documents and
materials that are available via a website, into the primary
language spoken by any limited English proficiency group in the
State with a population of at least 1000 individuals or that
constitutes 5 percent of the State population.''.
(B) CHIP.--Section 2107(e)(1), as amended by
section 221, is amended--
(i) by redesignating subparagraphs (E)
through (P) as subparagraphs (F) through (Q),
respectively; and
(ii) by inserting after subparagraph (D)
the following subparagraph:
``(E) Section 1902(a)(82) (relating to the
translation of documents and materials).''.
(c) Primary Language Data Collection.--
(1) Data from eligible entities.--Section 2113(c)(4)(B) (42
U.S.C. 1397mm(c)(4)(B)) is amended by inserting ``under this
title and title XIX, individual data on the primary language of
enrollees under this title and title XIX (and for such
enrollees who are minors or incapacitated, data on the primary
language of their parents or guardians)'' after ``enrollment
data''.
(2) Annual report.--
(A) CHIP.--Section 2108 (42 U.S.C. 1397hh) is
amended--
(i) by redesignating the subsection (e)
added by section 501(e)(2) of Public Law 111-3
as subsection (f); and
(ii) in paragraph (1) of the subsection (e)
added by section 402 of Public Law 111-3, by
inserting ``and primary language'' after
``duration of benefits''.
(B) Medicaid.--Section 1946(c) (42 U.S.C. 1396w-
5(c)) is amended by inserting ``demographic'' before
``data on health care disparities''.
(d) Effective Date.--The amendments made by this section shall take
effect on the date of enactment of this Act.
TITLE III--AFFORDABILITY
SEC. 301. STRENGTHENED COST SHARING PROTECTIONS UNDER MEDICAID AND
CHIP.
(a) Medicaid.--
(1) In general.--Section 1916 (42 U.S.C. 1396o) is
amended--
(A) in subsection (a)--
(i) in subparagraph (E) of paragraph (2),
by striking ``and'' at the end;
(ii) in paragraph (3)--
(I) by inserting ``subject to
paragraph (4),'' before ``any
deduction''; and
(II) by striking the period at the
end and inserting ``; and''; and
(iii) by adding at the end the following
new paragraph:
``(4) the total annual aggregate amount of any premium,
enrollment fee, deduction, cost sharing, or similar charge
imposed under the plan with respect to such individuals and
their families shall not exceed 5 percent of the family income
of the individual involved, as applied on a quarterly or
monthly basis (as specified by the State).'';
(B) in subsection (b)--
(i) in subparagraph (E) of paragraph (2),
by striking ``and'' at the end;
(ii) in paragraph (3)--
(I) by inserting ``subject to
paragraph (4)'' before ``any
deduction''; and
(II) by striking the period at the
end and inserting ``; and''; and
(iii) by adding at the end the following
new paragraph:
``(4) the total annual aggregate amount of any premium,
enrollment fee, deduction, cost sharing, or similar charge
imposed under the plan with respect to such individuals and
their families shall not exceed 5 percent of the family income
of the individual involved, as applied on a quarterly or
monthly basis (as specified by the State).'';
(C) in subsection (d), by inserting ``, and
provided that the total annual aggregate amount of any
such premium, and any enrollment fee, deduction, cost
sharing, or similar charge imposed under the plan with
respect to such individuals and their families shall
not exceed 5 percent of the family income of the
individual involved, as applied on a quarterly or
monthly basis (as specified by the State)'' before the
period; and
(D) by adding at the end the following new
subsection:
``(k) Cost Sharing Tracking; Suspension of Charges; Notification
Requirements.--
``(1) Tracking.--If the State plan imposes premiums,
enrollment fees, deductions, cost sharing, or similar charges
under this section that, together with any such charges imposed
under section 1916A, could cause families to have out-of-pocket
expenses that exceed a total aggregate cost sharing limit
imposed under subsection (a)(4) or (b)(4) for the month or
quarter (as specified by the State), the State shall establish
a process for tracking and aggregating such expenses (including
expenses incurred for separately administered benefits) that--
``(A) does not rely on documentation provided by
the individual or the family;
``(B) is communicated in a manner designed to
ensure the privacy of patient-related information; and
``(C) allows for coordination with managed care
entities (as defined in section 1932(a)(1)(B)) that are
under contract with the State.
``(2) Suspension of charges.--When a family reaches any
limit for a period imposed on premiums, deductions, cost
sharing, or similar charges under this section, no further
premiums, deductions, cost sharing, or similar charges (or any
portions thereof) shall be imposed on any individual in the
family who is eligible for and receiving medical assistance
under the plan for the remainder of the period.
``(3) Notification requirements.--With respect to a limit
imposed on premiums, deductions, cost sharing, or similar
charges under this section the State plan shall provide for the
notification of providers and each family to which such a limit
applies--
``(A) of any such limit applicable to the family;
``(B) when the family has incurred out-of-pocket
expenses up to any such limit; and
``(C) when a family reaches any such limit for a
period, that the limit has been reached and that no
further premiums, deductions, cost sharing, or similar
charges (or portions thereof) shall be imposed on any
individual in the family who is eligible for and
receiving medical assistance under the plan for the
remainder of such month or quarter.
``(4) Reassessment process.--The State shall establish a
process for families that include an individual who is eligible
for and receiving medical assistance under the plan to request
a reassessment of the family's aggregate limit on premiums,
deductions, cost sharing, or similar charges if the family has
a change in circumstances, in accordance with criteria
specified by the Secretary.
``(5) Application of requirements.--The requirements of
this subsection shall apply in the same manner to limits
imposed under subsections (c), (d), (g), and (i).''.
(2) State option for alternative premiums and cost
sharing.--Section 1916A(b) (42 U.S.C. 1396o-1(b)) is amended--
(A) in paragraphs (1)(B)(ii) and (2)(A), by
inserting ``or section 1916'' after ``subsection (c) or
(e)'' in each place it appears; and
(B) by adding at the end the following new
paragraph:
``(7) Cost sharing tracking; suspension of charges;
notification requirements.--
``(A) Tracking.--If the State plan imposes premiums
or cost sharing under this section that, together with
cost sharing imposed under section 1916, could cause
families to have out-of-pocket expenses that exceed the
total aggregate limit imposed under paragraph (1) or
(2) of this subsection for a month or quarter (as
specified by the State), the State shall establish a
process for tracking and aggregating such expenses
(including expenses for separately administered
benefits) that--
``(i) does not rely on documentation
provided by the individual or the family;
``(ii) is communicated in a manner designed
to ensure the privacy of patient-related
information; and
``(iii) allows for coordination with
managed care entities (as defined in section
1932(a)(1)(B)) that are under contract with the
State.
``(B) Suspension of charges.--When a family reaches
any limit for a period imposed on premiums or cost
sharing under this section, no further premiums or cost
sharing (or any portions thereof) shall be imposed on
any individual in the family who is eligible for and
receiving medical assistance under the plan for the
remainder of the period.
``(C) Notification requirements.--With respect to a
limit imposed on premiums or cost sharing under
paragraph (1) or (2) of this subsection the State plan
shall provide for the notification of providers and
each family to which such a limit applies--
``(i) of any such limit applicable to the
family;
``(ii) when the family has incurred out-of-
pocket expenses up to any such limit; and
``(iii) when a family reaches such a limit
for a period, that the limit has been reached
and that no further premiums or cost sharing
(or portions thereof) shall be imposed on any
individual in the family who is eligible for
and receiving medical assistance under the plan
for the remainder of such month or quarter.
``(D) Reassessment process.--The State shall
establish a process for families that include an
individual who is eligible for and receiving medical
assistance under the plan to request a reassessment of
the family's aggregate limit on premiums, deductions,
cost sharing, or similar charges if the family has a
change in circumstances, in accordance with criteria
specified by the Secretary.''.
(3) Managed care organizations.--Section 1932(a)(5) (42
U.S.C. 1396u-2(a)(5)) is amended by adding at the end the
following new subparagraph:
``(E) Coordination with providers on cost
sharing.--The State shall require that a managed care
entity with a contract with the State, as a condition
of such contract, comply with the requirements of
sections 1916 and 1916A (as applicable), for such
individuals who are enrolled with the organization or
entity and coordinate with the State with respect to
tracking and aggregating an enrollee's family's out-of-
pocket expenses for premiums, deductions, cost sharing,
or similar charges.''.
(4) Conforming amendments.--Section 1916A(a)(2)(B) (42
U.S.C. 1396o-1(a)(2)(B)) is amended--
(A) by inserting ``and the tracking, suspension,
and notification requirements under subsection (b)(7)''
before ``shall apply''; and
(B) by inserting ``and requirements'' after
``limitations''.
(b) CHIP.--
(1) In general.--Section 2103(e) (42 U.S.C. 1397cc(e)) is
amended--
(A) by striking paragraphs (2) and (4);
(B) by redesignating paragraph (3) as paragraph
(2);
(C) in paragraph (2) (as so redesignated)--
(i) by striking subparagraph (B);
(ii) by redesignating subparagraph (C) as
subparagraph (D); and
(iii) by inserting after subparagraph (A)
the following new subparagraphs:
``(B) No cost sharing for pregnancy-related
assistance.--The State child health plan may not impose
deductions, cost sharing, or similar charges with
respect to pregnancy-related assistance.
``(C) Application of medicaid cost sharing
limits.--Subject to subparagraphs (A) and (B) and
paragraph (3), the State child health plan may only
impose deductions, cost sharing, or similar charges to
the extent that such charges do not exceed the nominal
limits set under section 1916(a)(3).''; and
(D) by adding at the end the following new
paragraph:
``(3) Additional requirements .--
``(A) In general.--Subject to paragraph (2)(A), any
premiums, deductions, cost sharing, or similar charges
imposed under the State child health plan for medical
or dental benefits may be imposed on a sliding scale
related to income, except that the total annual
aggregate cost sharing imposed for such benefits with
respect to all individuals in a family that includes a
targeted low-income child or a targeted low-income
pregnant woman under this title shall not exceed 5
percent of such family's income for the year involved.
``(B) Dental-only supplemental coverage.--With
respect to dental-only supplemental coverage offered
under section 2110(b)(5), the total annual aggregate
cost sharing imposed for such coverage shall not exceed
5 percent of a family's income for the year involved,
minus the amount the family is required to pay during
such year in premiums, deductions, cost sharing, or
similar charges for health care services for children
in the family enrolled in a group health plan or health
insurance coverage offered through an employer.
``(C) Tracking of expenses; suspension of charges;
notice; reassessments.--If the State child health plan
imposes premiums, deductions, cost sharing, or similar
charges that could cause families that include a
targeted low-income child or a targeted low-income
pregnant woman to have out-of-pocket expenses that
exceed the aggregate cost sharing limit imposed under
subparagraph (A) for the year, the State shall--
``(i) establish a process for tracking and
aggregating such expenses (including expenses
incurred for separately administered benefits)
that--
``(I) does not rely on
documentation provided by the targeted
low-income child, the targeted low-
income pregnant woman, or the family;
``(II) is communicated in a manner
designed to ensure the privacy of
patient-related information; and
``(III) allows for coordination
with managed care entities and managed
care organizations that are under
contract with the State;
``(ii) when a family reaches the aggregate
cost-sharing limit for a year imposed under
subparagraph (A), not impose any further
premiums or cost sharing (or any portions
thereof) on any targeted low-income child or
targeted low-income pregnant woman in the
family for the remainder of the year;
``(iii) notify providers and each family
that includes a targeted low-income child or a
targeted low-income pregnant woman--
``(I) of the annual aggregate
limits on out-of-pocket expenses
applicable to the family;
``(II) when the family has incurred
out-of-pocket expenses up to the annual
aggregate family limit imposed under
subparagraph (A); and
``(III) when a family reaches the
aggregate out-of-pocket expenses limit
for a year, that the limit has been
reached and that no further premiums,
deductions, cost sharing, or similar
charges (or portions thereof) shall be
imposed on any targeted low-income
child or targeted low-income pregnant
woman in the family for the remainder
of such year; and
``(iv) establish a process for families
that include a targeted low-income child or a
targeted low-income pregnant woman to request a
reassessment of the family's annual aggregate
limit on premiums, deductions, cost sharing, or
similar charges if the family has a change in
circumstances, in accordance with criteria
specified by the Secretary.''.
(2) Managed care organizations.--Section 2103(f) (42 U.S.C.
1397cc(f)) is amended by adding at the end following new
paragraph:
``(4) Coordination with providers on cost sharing.--The
State shall require that a managed care entity or a managed
care organization with a contract with the State, as a
condition of such contract, comply with the requirements of
2103(e) and coordinate with the State with respect to in
tracking and aggregating an enrollee's family's out-of-pocket
expenses for cost sharing as required under subsection
(e)(3)(C).''.
(c) Conforming Amendments.--
(1) Section 2105(c)(10)(C)(i) (42 U.S.C.
1397ee(c)(10)(C)(i)) is amended by striking ``paragraph (3)(B)
of''.
(2) Section 2112(b)(6) (42 U.S.C. 1397ll(b)(6)) is amended
by striking ``paragraph (3)(B) of''.
TITLE IV--BENEFITS
SEC. 401. PREVENTIVE HEALTH SERVICES.
(a) Preventive Health Services.--
(1) Medicaid.--Section 1905 (42 U.S.C. 1396d) is amended--
(A) in subsection (a)(4)--
(i) by striking ``and'' before ``(D)''; and
(ii) by inserting before the semicolon at
the end the following new subparagraph: ``; and
(E) preventive services described in subsection
(ee)''; and
(B) by adding at the end the following new
subsection:
``(ee) Preventive Services.--
``(1) In general.--For purposes of subsection (a)(4)(E),
the preventive services described in this subsection are
diagnostic, screening, and preventive services not otherwise
described in subsection (a) or required by subsection (r) that
the Secretary determines are appropriate for children or
pregnant women entitled to medical assistance under this title,
including--
``(A) evidence-based items or services that have in
effect a rating of `A' or `B' in the current
recommendations of the United States Preventive
Services Task Force;
``(B) with respect to pregnant women, immunizations
that have in effect a recommendation from the Advisory
Committee on Immunization Practices of the Centers for
Disease Control and Prevention with respect to the
individual involved;
``(C) with respect to infants, children, and
adolescents, evidence-informed preventive care and
screenings provided for in the comprehensive guidelines
supported by the Health Resources and Services
Administration; and
``(D) with respect to women, such additional
preventive care and screenings not described in this
paragraph as provided for in comprehensive guidelines
supported by the Health Resources and Services
Administration for purposes of this paragraph.
``(2) Additional services.--Nothing in this subsection
shall be construed to limit the application of any requirement
of subsection (r) or to prohibit a State plan under this title
from providing coverage for services in addition to those
recommended by United States Preventive Services Task Force or
to prohibit coverage of services.''.
(2) Elimination of cost-sharing.--
(A) Subsections (a)(2)(D) and (b)(2)(D) of section
1916 (42 U.S.C. 1396o) are each amended by inserting
``preventive services described in section 1905(ee),''
after ``emergency services (as defined by the
Secretary),''.
(B) Section 1916A(a)(1) (42 U.S.C. 1396o-1(a)(1))
is amended by inserting ``, preventive services
described in section 1905(ee),'' after ``subsection
(c)''.
(3) Interval period for inclusion of new recommendations in
state plans.--With respect to a recommendation issued on or
after the date of enactment of this Act that adds new
preventive services to the requirements described in subsection
(ee) of section 1905 of the Social Security Act, the Secretary
shall establish a maximum interval period, which shall not be
longer than 6 months, between the date on which the
recommendation is issued and the plan year for which a State
plan for medical assistance under title XIX of the Social
Security Act shall be required to include such preventive
service.
(b) CHIP.--Section 2103 (42 U.S.C. 1397cc) is amended--
(1) in subsection (a), in the matter preceding paragraph
(1), by striking ``and (7)'' and inserting ``(7), and (8)'';
and
(2) in subsection (c)--
(A) by redesignating paragraph (8) as paragraph
(9); and
(B) by inserting after paragraph (7), the following
new paragraph:
``(8) Preventive services.--The child health assistance
provided to a targeted low-income child and pregnancy-related
assistance provided to a targeted low-income pregnant woman
shall include coverage of preventive services for children or
pregnant women required under a State plan under title XIX
under subsections (a)(4)(E) and (ee) of section 1905 and no
deductible, cost sharing or similar charge shall be imposed
under the State child health plan with respect to such
services.''.
SEC. 402. TIMELY IMMUNIZATION COVERAGE.
(a) Coverage for Newly Approved Vaccines Within 30 Days.--
(1) In general.--Section 1928(e) (42 U.S.C. 1396s(e)) is
amended by adding at the end the following new sentence: ``Each
revision of the list established by such Advisory Committee
shall apply to the purchase, delivery, and administration of
pediatric vaccines under this section not later than 30 days
after the date such Advisory Committee approves the
revision.''.
(2) Conforming amendment.--Section 2103(c)(1)(D) (42 U.S.C.
1397cc(c)(1)(D)) is amended by inserting ``in accordance with
the schedule referred to in section 1928(c)(2)(B)(i) for
pediatric vaccines'' after ``immunizations''.
(b) Treatment of CHIP-Eligible Children as Federally Vaccine-
Eligible Children.--Section 1928(b)(2) (42 U.S.C. 1396s(b)(2)) is
amended--
(1) in subparagraph (A)(i), by inserting ``or CHIP-
eligible'' after ``medicaid-eligible''; and
(2) in subparagraph (B), by striking clause (i) and
inserting the following:
``(i) The term `medicaid-eligible or CHIP-
eligible child' means, with respect to a child,
a child who is entitled to medical assistance
under a State plan approved under this title or
a waiver of such plan, or who is eligible for
child health assistance under a State child
health plan approved under title XXI.''.
(c) Coding for Vaccine Administration.--Section 1928 (42 U.S.C.
1396s) is amended--
(1) by striking subsection (g) and inserting:
``(g) [Reserved].''; and
(2) in subsection (h)(6), by striking ``a vaccine'' and
inserting ``each vaccine component''.
(d) Effective Date.--The amendments made by this section shall take
effect on the date of enactment of this Act.
TITLE V--ACCESS AND QUALITY
Subtitle A--Pediatric Quality Measures
SEC. 501. EXTENDING THE PEDIATRIC QUALITY MEASURES PROGRAM.
(a) In General.--Section 1139A(i) (42 U.S.C. 1320b-9a(i)) is
amended by inserting ``, and for each of fiscal years 2014 through
2019, $50,000,000,'' after ``$45,000,000''.
(b) Effective Date.--The amendment made by this section shall take
effect on the date of enactment of this Act.
SEC. 502. IMPROVING THE EFFECTIVENESS OF THE PEDIATRIC QUALITY
MEASURES.
(a) In General.--Section 1139A(b) (42 U.S.C. 1320b-9a(b)) is
amended--
(1) in paragraph (4)--
(A) in subparagraph (A), by striking ``and'' at the
end;
(B) in subparagraph (B), by striking the period at
the end and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(C) establish a program to continue and enhance
pediatric quality measures program centers of
excellence, which may include developing centers of
excellence with a particular emphasis on patient and
family experience and pediatric populations that are
small in size and may be most effectively addressed by
aggregating data across multiple States, including
pediatric populations with medical complexity and
pediatric populations with rare conditions.''; and
(2) by amending paragraph (5) to read as follows:
``(5) Revising, strengthening, and improving initial core
measures.--
``(A) In general.--The Secretary shall annually
publish recommended changes to the core measures
described in subsection (a) that--
``(i) are consistent with the purposes of
the pediatric quality measures program
established under paragraph (1);
``(ii) meet the conditions specified in
paragraph (2);
``(iii) were developed by the Secretary in
consultation with the entities specified in
subparagraphs (A) through (H) of paragraph (3);
and
``(iv) were developed, validated, or tested
through a grant awarded under paragraph (4).
``(B) Additional recommended changes.--Beginning
not later than 1 year after the date of enactment of
the CHIP Extension Act of 2014, the recommended changes
published under subparagraph (A) shall include
changes--
``(i) to measure the type of children's
health insurance coverage or other health
benefits coverage available over time, in
addition to the presence, stability, and
duration of such health insurance coverage or
such health benefits coverage over time, for
purposes of examining enrollment changes of a
child from one type of coverage to another;
``(ii) to ensure that the measures reflect
the care provided to the diverse pediatric
population, including adolescents and children
with special health care needs, and the
management of acute and chronic conditions;
``(iii) to ensure that the measures reflect
care provided in diverse health care settings,
including both inpatient and ambulatory
settings;
``(iv) to encourage the development,
implementation, and stewardship of core
measures that can be used at the State,
hospital, practice, and plan levels, including
a sustainable mechanism to maintain and
disseminate such measures and collect and
report data on such measures; and
``(v) to facilitate the adoption,
dissemination, stewardship, and reporting of
such measures as well as measures developed
through the pediatric quality measures program
at the State, hospital, practice, and plan
levels and across different health care
delivery and coverage systems, including
coverage provided through the Exchanges
established under title I of the Patient
Protection and Affordable Care Act.''.
(b) Effective Date.--The amendments made by this section shall take
effect on the date of enactment of this Act.
SEC. 503. ANNUAL STATE REPORTS REGARDING STATE-SPECIFIC QUALITY OF CARE
MEASURES APPLIED UNDER MEDICAID OR CHIP.
(a) In General.--Section 1139A(c) (42 U.S.C. 1320b-9a(c)) is
amended by adding at the end the following new paragraph:
``(3) Data collection and reporting on full set of core
measures.--Beginning not later than 5 years after the date of
enactment of this paragraph, the information reported under
paragraph (1) shall include State-specific information on the
full set of pediatric core measures.''.
(b) Effective Date.--The amendment made by this section shall take
effect on the date of enactment of this Act.
SEC. 504. ADVISORY PANEL REGARDING PEDIATRIC QUALITY.
(a) In General.--Section 1139A(g) (42 U.S.C. 1320b-9a(g)) is
amended--
(1) in the subsection heading, by striking ``Study of'' and
inserting ``Studies and Reports on'';
(2) by redesignating paragraph (2) as paragraph (4); and
(3) by inserting after paragraph (1) the following new
paragraphs:
``(2) Expert panel.--The Secretary shall convene a panel,
composed of health experts (including experts employed by the
Federal Government and experts not so employed) to establish
priorities and goals for child health as recommended in the
report submitted under paragraph (1) by the Institute of
Medicine. Such panel shall--
``(A) advise and make recommendations to the
Secretary regarding changes that may be made to the
core measures described in subsection (a);
``(B) establish standards for the timeliness and
accuracy of data so collected and reported; and
``(C) review and make recommendations, on an annual
basis, for strategies to enhance the timeliness,
accuracy, and utility of the core measures.
``(3) Collecting and reporting full set of core measures.--
Not later than 1 year after the date of enactment of this
paragraph, the Secretary, in consultation with representatives
of State agencies responsible for administering Medicaid and
the State Children's Health Insurance Program and
representatives of relevant provider organizations, shall
submit to the Committee on Energy and Commerce of the House of
Representatives and the Committee on Finance of the Senate a
report identifying--
``(A) strategies to address and overcome barriers
to State collection of and reporting of the full set of
pediatric core measures;
``(B) an analysis of the amount of Federal funding
needed to incentivize States to collect and report on
the full set of pediatric core measures; and
``(C) a standardized format and plan for States to
collect and report on the full set of pediatric core
measures.''.
(b) Effective Date.--The amendments made by this section shall take
effect on the date of enactment of this Act.
SEC. 505. EXTENDING AND EXPANDING DEMONSTRATION PROJECTS.
(a) Strengthening Demonstration Projects for Improving the Quality
of Children's Health Care and the Use of Health Information
Technology.--Section 1139A(d) (42 U.S.C. 1320b-9a(d)) is amended--
(1) in paragraph (1)--
(A) in the matter preceding subparagraph (A)--
(i) by inserting ``, and during the period
of fiscal years 2014 through 2019, the
Secretary shall award not less than 10
grants,'' after ``10 grants''; and
(ii) by inserting ``(including oral care)''
after ``health care'';
(B) in subparagraph (C), by striking ``or'' at the
end;
(C) in subparagraph (D), by striking the period at
the end and inserting a semicolon; and
(D) by adding at the end the following new
subparagraphs:
``(E) examine and address barriers to effective
delivery of perinatal care and its impact on birth
outcomes and subsequent pregnancies and children's
health;
``(F) implement and expand pediatric and perinatal
learning and quality improvement collaboratives on the
quality of children's and pregnant women's health care,
including improving patient outcomes, reducing health
costs, and addressing health disparities;
``(G) encourage and evaluate the use at the State
level of payment reform and related policy proposals
for purposes of promoting higher quality of care for
children, including the shared savings program
established under section 1899 and other methods of
encouraging integrated care models; or
``(H) with respect to the model electronic health
record format for children developed and disseminated
under subsection (f)--
``(i) assess the extent to which the format
has been incorporated into widely used
electronic health record formats;
``(ii) implement standards and activities
that result in increased use of such format;
and
``(iii) evaluate the impact of the
increased use of such format.'';
(2) in paragraph (2)--
(A) in subparagraph (A), by striking ``and'' at the
end;
(B) in subparagraph (B), by striking the period at
the end and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(C) with respect to grants awarded for projects
described in paragraph (1)(F), such grants shall be
awarded for projects that--
``(i) give priority to collaboratives that
would have substantial impacts on the pediatric
population by--
``(I) affecting a large percentage
of such population or by substantially
improving outcomes in a smaller
population;
``(II) reducing the cost of health
care for children, including children
with medically complex illnesses or
chronic conditions;
``(III) having a high likelihood to
reduce disparities in health status; or
``(IV) potentially having long-term
health impacts by addressing childhood
precursors to adult conditions; and
``(ii) encourage coordination with other
sources of funding in the expansion of
pediatric learning collaboratives, including by
coordinating care and utilizing community
health workers (as defined in section 399V(k)
of the Public Health Service Act (42 U.S.C.
280g-11(k))).''; and
(3) in paragraph (4)--
(A) by inserting ``For each of fiscal years 2009
through 2013,'' before ``$20,000,000''; and
(B) by adding at the end the following new
sentence: ``For each of fiscal years 2014 through 2019,
$36,000,000 of the amount appropriated under subsection
(i) for a fiscal year shall be used to carry out this
subsection.''.
(b) Extending Funding for Childhood Obesity Demonstration
Projects.--Section 1139A(e)(8) (42 U.S.C. 1320b-9a(e)(8)) is amended by
inserting ``, and for the period of fiscal years 2015 through 2019,
$25,000,000'' after ``2014''.
(c) Effective Date.--The amendments made by this section shall take
effect on the date of enactment of this Act.
Subtitle B--Maternal, Infant, and Early Childhood Home Visiting Program
SEC. 511. SUPPORTING EVIDENCE-BASED CARE COORDINATION IN COMMUNITIES.
(a) In General.--Section 511(j)(1) (42 U.S.C. 711(j)(1)) is amended
by striking subparagraph (F) and inserting the following:
``(F) $400,000,000 for each of fiscal years 2015
through 2019.''.
(b) Prevention of Duplicate Appropriations for Fiscal Year 2015.--
Expenditures made pursuant to the amendments made by section 209 of the
Protecting Access to Medicare Act of 2014 (Public Law 113-93) for
fiscal year 2015 shall be charged to the appropriation provided by the
amendment made by subsection (a) for such fiscal year.
(c) Effective Date.--The amendment made by this section shall take
effect on the date of enactment of this Act.
Subtitle C--Comparative Study of Medicaid, CHIP, and Qualified Health
Plans
SEC. 521. GAO STUDY AND REPORT.
(a) Study.--The Comptroller General of the United States shall
conduct a study of each State in which individuals eligible for medical
assistance under a State plan under title XIX of the Social Security
Act (42 U.S.C. 1396 et seq.) or for child health assistance under a
State child health plan under title XXI of the Social Security Act (42
U.S.C. 1397aa et seq.) are provided such assistance through enrollment
in a qualified health plan or employer-sponsored insurance. Such study
shall determine, for each such State--
(1) the number of such individuals enrolled in an employer-
sponsored health plan to whom wraparound services are offered;
(2) the number of such individuals enrolled in an employer-
sponsored health plan who use wraparound services for any
purpose during the plan year;
(3) the average cost of wraparound services per individual
enrolled in an employer-sponsored health plan who uses such
services;
(4) the number of such individuals with ``developmental
disabilities'' (as defined in section 102(8) of the
Developmental Disabilities Assistance and Bill of Rights Act of
2000 (42 U.S.C. 15002(8))), enrolled in an employer-sponsored
health plan who used wrap-around benefits;
(5) the number of disabled individuals enrolled in an
employer-sponsored health plan who use wraparound benefits for
habilitative services, rehabilitative services, or home health
services;
(6) the number of such individuals enrolled in qualified
health plans;
(7) average premiums and cost-sharing per such individual
enrolled in a qualified health plan; and
(8) comparative data with respect to the benefits offered
to such individuals under qualified health plans as compared to
the benefits offered to such individuals under State plans
under title XIX or XXI of the Social Security Act.
(b) Reports.--Not later than 2 years after the date of the
enactment of this Act, the Comptroller General of the United States
shall submit to the Committee on Energy and Commerce of the House of
Representatives and the Committee on Finance of the Senate a report on
the findings of the study conducted under subsection (a) that includes
any recommendations or proposed legislation. Not later than 4 years
after the date of enactment of this Act, the Comptroller General of the
United States shall submit to the Committee on Energy and Commerce of
the House of Representatives and the Committee on Finance of the Senate
an updated report on the findings of the study conducted under
subsection (a) that includes any recommendations or proposed
legislation.
(c) Definitions.--For purposes of this section:
(1) Qualified health plan.--The term ``qualified health
plan'' means a health plan that is offered through an American
Health Benefits Exchange established under the Patient
Protection and Affordable Care Act (Public Law 111-148).
(2) Wraparound services.--The term ``wraparound services''
means services provided by a State plan under title XIX or XXI
of the Social Security Act that are provided as a supplement to
items or services for which coverage is not offered or is
limited under a qualified health plan or an employer-sponsored
health plan.
TITLE VI--BUDGETARY EFFECTS
SEC. 601. BUDGETARY EFFECT OF THIS ACT.
The budgetary effects of this Act, for the purpose of complying
with the Statutory Pay-As-You-Go Act of 2010, shall be determined by
reference to the latest statement titled ``Budgetary Effects of PAYGO
Legislation'' for this Act, submitted for printing in the Congressional
Record by the Chairman of the Committee on the Budget of the House of
Representatives, as long as such statement has been submitted prior to
the vote on passage of this Act.
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