Directs the Secretary of Health and Human Services to establish a program to award demonstration grants to States to allow them to demonstrate the effectiveness of innovative ways to increase access to health insurance through market reforms and other innovative means.
Authorizes the Secretary to award demonstration grants to a limited number of States to conduct innovative programs designed to improve outreach to homeless individuals and families under specified programs for the homeless (including Medicaid and FamilyCare) with respect to enrollment of such individuals and families and the provision of services under such programs.
[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 1244 Introduced in Senate (IS)]
107th CONGRESS
1st Session
S. 1244
To amend titles XIX and XXI of the Social Security Act to provide for
FamilyCare coverage for parents of enrolled children, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 25, 2001
Mr. Kennedy (for himself, Ms. Snowe, Mr. Rockefeller, Mr. Chafee, Ms.
Collins, Mr. Daschle, Mr. Baucus, Mr. Breaux, Mr. Torricelli, Mrs.
Lincoln, Mr. Graham, Mr. Bingaman, Mr. Kerry, Mrs. Clinton, and Mr.
Corzine) introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend titles XIX and XXI of the Social Security Act to provide for
FamilyCare coverage for parents of enrolled children, 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 OF TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``FamilyCare Act of
2001''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title of title; table of contents.
Sec. 2. Renaming of title XXI program.
Sec. 3. FamilyCare coverage of parents under the medicaid program and
title XXI.
Sec. 4. Automatic enrollment of children born to title XXI parents.
Sec. 5. Optional coverage of legal immigrants under the medicaid
program and title XXI.
Sec. 6. Optional coverage of children through age 20 under the medicaid
program and title XXI.
Sec. 7. Application of simplified title XXI procedures under the
medicaid program.
Sec. 8. Improving welfare-to-work transition under the medicaid
program.
Sec. 9. Elimination of 100 hour rule and other AFDC-related eligibility
restrictions.
Sec. 10. State grant program for market innovation.
Sec. 11. Limitations on conflicts of interest.
Sec. 12. Increase in CHIP allotment for each of fiscal years 2002
through 2004.
Sec. 13. Demonstration programs to improve medicaid and CHIP outreach
to homeless individuals and families.
Sec. 14. Technical and conforming amendments to authority to pay
medicaid expansion costs from title XXI
appropriation.
Sec. 15. Additional CHIP revisions.
SEC. 2. RENAMING OF TITLE XXI PROGRAM.
(a) In General.--The heading of title XXI of the Social Security
Act (42 U.S.C. 1397aa et seq.) is amended to read as follows:
``TITLE XXI--FAMILYCARE PROGRAM''.
(b) Program References.--Any reference in any provision of Federal
law or regulation to ``SCHIP'' or ``State children's health insurance
program'' under title XXI of the Social Security Act shall be deemed a
reference to the FamilyCare program under such title.
SEC. 3. FAMILYCARE COVERAGE OF PARENTS UNDER THE MEDICAID PROGRAM AND
TITLE XXI.
(a) Incentives To Implement FamilyCare Coverage.--
(1) Under medicaid.--
(A) Establishment of new optional eligibility
category.--Section 1902(a)(10)(A)(ii) of the Social
Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is
amended--
(i) by striking ``or'' at the end of
subclause (XVII);
(ii) by adding ``or'' at the end of
subclause (XVIII); and
(iii) by adding at the end the following:
``(XIX) who are individuals
described in subsection (k)(1)
(relating to parents of categorically
eligible children);''.
(B) Parents described.--Section 1902 of the Social
Security Act is further amended by inserting after
subsection (j) the following:
``(k)(1)(A) Individuals described in this paragraph are
individuals--
``(i) who are the parents of an individual who is under 19
years of age (or such higher age as the State may have elected
under section 1902(l)(1)(D)) and who is eligible for medical
assistance under subsection (a)(10)(A);
``(ii) who are not otherwise eligible for medical
assistance under such subsection, under section 1931, or under
a waiver approved under section 1115 or otherwise (except under
subsection (a)(10)(A)(ii)(XIX)); and
``(iii) whose family income exceeds the income level
applicable under the State plan under part A of title IV as in
effect as of July 16, 1996, but does not exceed the highest
income level applicable to a child in the family under this
title.
``(B) In establishing an income eligibility level for individuals
described in this paragraph, a State may vary such level consistent
with the various income levels established under subsection (l)(2)
based on the ages of children described in subsection (l)(1) in order
to ensure, to the maximum extent possible, that such individuals shall
be enrolled in the same program as their children.
``(C) An individual may not be treated as being described in this
paragraph unless, at the time of the individual's enrollment under this
title, the child referred to in subparagraph (A)(i) of the individual
is also enrolled under this title.
``(D) In this subsection, the term `parent' includes an individual
treated as a caregiver for purposes of carrying out section 1931.
``(2) In the case of a parent described in paragraph (1) who is
also the parent of a child who is eligible for child health assistance
under title XXI, the State may elect (on a uniform basis) to cover all
such parents under section 2111 or under this title.''.
(C) Enhanced matching funds available if certain
conditions met.--Section 1905 of the Social Security
Act (42 U.S.C. 1396d) is amended--
(i) in the fourth sentence of subsection
(b), by striking ``or subsection (u)(3)'' and
inserting ``, (u)(3), or (u)(4)''; and
(ii) in subsection (u)--
(I) by redesignating paragraph (4)
as paragraph (6), and
(II) by inserting after paragraph
(3) the following:
``(4) For purposes of subsection (b) and section 2105(a)(1):
``(A) FamilyCare parents.--The expenditures described in
this subparagraph are the expenditures described in the
following clauses (i) and (ii):
``(i) Parents.--If the conditions described in
clause (iii) are met, expenditures for
medical assistance for parents described in section 1902(k)(1) and for
parents who would be described in such section but for the fact that
they are eligible for medical assistance under section 1931 or under a
waiver approved under section 1115.
``(ii) Certain pregnant women.--Expenditures for
medical assistance for pregnant women under section
1902(l)(1)(A) in a family the income of which exceeds
the income level applicable under section 1902(l)(2)(A)
to a family of the size involved as of January 1, 2000.
``(iii) Conditions.--The conditions described in
this clause are the following:
``(I) The State has a State child health
plan under title XXI which (whether implemented
under such title or under this title) has an
effective income level for children that is at
least 200 percent of the poverty line.
``(II) Such State child health plan does
not limit the acceptance of applications, does
not use a waiting list for children who meet
eligibility standards to qualify for
assistance, and provides benefits to all
children in the State who apply for and meet
eligibility standards.
``(III) The State plans under this title
and title XXI do not provide coverage for
parents with higher family income without
covering parents with a lower family income.
``(IV) The State does not apply an income
level for parents that is lower than the
effective income level (expressed as a percent
of the poverty line) that has been specified
under the State plan under title XIX (including
under a waiver authorized by the Secretary or
under section 1902(r)(2)), as of January 1,
2000, to be eligible for medical assistance as
a parent under this title.
``(iv) Definitions.--For purposes of this
subsection:
``(I) The term `parent' has the meaning
given such term for purposes of section
1902(k)(1).
``(II) The term `poverty line' has the
meaning given such term in section
2110(c)(5).''.
(D) Appropriation from title xxi allotment for
certain medicaid expansion costs.--Subparagraph (B) of
section 2105(a)(1) of the Social Security Act, as
amended by section 14(a), is amended to read as
follows:
``(B) FamilyCare parents.--Expenditures for medical
assistance that is attributable to expenditures
described in section 1905(u)(4)(A).''.
(E) Only counting enhanced portion for coverage of
additional pregnant women.--Section 1905 of the Social
Security Act (42 U.S.C. 1396d) is amended--
(i) in the fourth sentence of subsection
(b), by inserting ``(except in the case of
expenditures described in subsection (u)(5))''
after ``do not exceed'';
(ii) in subsection (u), by inserting after
paragraph (4) (as inserted by subparagraph
(C)), the following:
``(5) For purposes of the fourth sentence of subsection (b) and
section 2105(a), the following payments under this title do not count
against a State's allotment under section 2104:
``(A) Regular fmap for expenditures for pregnant women with
income above january 1, 2000 income level and below 185 percent
of poverty.--The portion of the payments made for expenditures
described in paragraph (4)(A)(ii) that represents the amount
that would have been paid if the enhanced FMAP had not been
substituted for the Federal medical assistance percentage.''.
(2) Under title xxi.--
(A) FamilyCare coverage.--Title XXI of the Social
Security Act (42 U.S.C. 1397aa et seq.) is amended by
adding at the end the following:
``SEC. 2111. OPTIONAL FAMILYCARE COVERAGE OF PARENTS OF TARGETED LOW-
INCOME CHILDREN.
``(a) Optional Coverage.--Notwithstanding any other provision of
this title, a State child health plan may provide for coverage, through
an amendment to its State child health plan under section 2102, of
FamilyCare assistance for individuals who are targeted low-income
parents in accordance with this section, but only if--
``(1) the State meets the conditions described in section
1905(u)(4)(A)(iii); and
``(2) the State elects to provide medical assistance under
section 1902(a)(10)(A)(ii)(XIX), under section 1931, or under a
waiver under section 1115 to individuals described in section
1902(k)(1)(A)(i) and elects an applicable income level for such
individuals that consistent with paragraphs (1)(B) and (2) of
section 1902(k), ensures to the maximum extent possible, that
those individuals shall be enrolled in the same program as
their children if their children are eligible for coverage
under title XIX (including under a waiver authorized by the
Secretary or under section 1902(r)(2)).''.
``(b) Definitions.--For purposes of this title:
``(1) FamilyCare assistance.--The term `FamilyCare
assistance' has the meaning given the term child health
assistance in section 2110(a) as if any reference to targeted
low-income children were a reference to targeted low-income
parents.
``(2) Targeted low-income parent.--The term `targeted low-
income parent' has the meaning given the term targeted low-
income child in section 2110(b) as if the reference to a child
were deemed a reference to a parent (as defined in paragraph
(3)) of the child; except that in applying such section--
``(A) there shall be substituted for the income
level described in paragraph (1)(B)(ii)(I) the
applicable income level in effect for a targeted low-
income child;
``(B) in paragraph (3), January 1, 2000, shall be
substituted for July 1, 1997; and
``(C) in paragraph (4), January 1, 2000, shall be
substituted for March 31, 1997.
``(3) Parent.--The term `parent' includes an individual
treated as a caregiver for purposes of carrying out section
1931.
``(4) Optional treatment of pregnant women as parents.--A
State child health plan may treat a pregnant woman who is not
otherwise a parent as a targeted low-income parent for purposes
of this section but only if the State has established an income
level under section 1902(l)(2)(A)(i) for pregnant women that is
at least 185 percent of the income official poverty line
described in such section.
``(c) References to Terms and Special Rules.--In the case of, and
with respect to, a State providing for coverage of FamilyCare
assistance to targeted low-income parents under subsection (a), the
following special rules apply:
``(1) Any reference in this title (other than subsection
(b)) to a targeted low-income child is deemed to include a
reference to a targeted low-income parent.
``(2) Any such reference to child health assistance with
respect to such parents is deemed a reference to FamilyCare
assistance.
``(3) In applying section 2103(e)(3)(B) in the case of a
family provided coverage under this section, the limitation on
total annual aggregate cost-sharing shall be applied to the
entire family.
``(4) In applying section 2110(b)(4), any reference to
`section 1902(l)(2) or 1905(n)(2) (as selected by a State)' is
deemed a reference to the income level applicable to parents
under section 1931 or under a waiver approved under section
1115, or, in the case of a pregnant woman described in
subsection (b)(4), the income level established under section
1902(l)(2)(A).
``(5) In applying section 2102(b)(3)(B), any reference to
children is deemed a reference to parents.''.
(B) Additional allotment for states providing
familycare.--
(i) In general.--Section 2104 of the Social
Security Act (42 U.S.C. 1397dd) is amended by
inserting after subsection (c) the following:
``(d) Additional Allotments for State Providing FamilyCare.--
``(1) Appropriation; total allotment.--For the purpose of
providing additional allotments to States to provide FamilyCare
coverage under section 2111, there is appropriated, out of any
money in the Treasury not otherwise appropriated--
``(A) for fiscal year 2002, $2,000,000,000;
``(B) for fiscal year 2003, $2,000,000,000;
``(C) for fiscal year 2004, $3,000,000,000;
``(D) for fiscal year 2005, $3,000,000,000;
``(E) for fiscal year 2006, $6,000,000,000;
``(F) for fiscal year 2007, $7,000,000,000;
``(G) for fiscal year 2008, $8,000,000,000;
``(H) for fiscal year 2009, $9,000,000,000;
``(I) for fiscal year 2010, $10,000,000,000; and
``(J) for fiscal year 2011 and each fiscal year
thereafter, the amount of the allotment provided under
this paragraph for the preceding fiscal year increased
by the percentage increase (if any) in the medical care
expenditure category of the Consumer Price Index for
All Urban Consumers (United States city average).
``(2) State and territorial allotments.--
``(A) In general.--In addition to the allotments
provided under subsections (b) and (c), subject to
paragraphs (3) and (4), of the amount available for the
additional allotments under paragraph (1) for a fiscal
year, the Secretary shall allot to each State with a
State child health plan approved under this title--
``(i) in the case of such a State other
than a commonwealth or territory described in
clause (ii), the same proportion as the
proportion of the State's allotment under
subsection (b) (determined without regard to
subsection (f)) to 98.95 percent of the total
amount of the allotments under such section for
such States eligible for an allotment under
this subparagraph for such fiscal year; and
``(ii) in the case of a commonwealth or
territory described in subsection (c)(3), the
same proportion as the proportion of the
commonwealth's or territory's allotment under
subsection (c) (determined without regard to
subsection (f)) to 1.05 percent of the total
amount of the allotments under such section for
commonwealths and territories eligible for an
allotment under this subparagraph for such
fiscal year.
``(B) Availability and redistribution of unused
allotments.--In applying subsections (e) and (f) with
respect to additional allotments made available under
this subsection, the procedures established under such
subsections shall ensure such additional allotments are
only made available to States which have elected to
provide coverage under section 2111.
``(3) Use of additional allotment.--Additional allotments
provided under this subsection are not available for amounts
expended before October 1, 2001. Such amounts are available for
amounts expended on or after such date for child health
assistance for targeted low-income children, as well as for
FamilyCare assistance.
``(4) Requiring election to provide familycare coverage.--
No payments may be made to a State under this title from an
allotment provided under this subsection unless the State has made an
election to provide FamilyCare assistance.''.
(ii) Conforming amendments.--Section 2104
of the Social Security Act (42 U.S.C. 1397dd)
is amended--
(I) in subsection (a), by inserting
``subject to subsection (d),'' after
``under this section,'';
(II) in subsection (b)(1), by
inserting ``and subsection (d)'' after
``Subject to paragraph (4)''; and
(III) in subsection (c)(1), by
inserting ``subject to subsection
(d),'' after ``for a fiscal year,''.
(C) No cost-sharing for pregnancy-related
benefits.--Section 2103(e)(2) of the Social Security
Act (42 U.S.C. 1397cc(e)(2)) is amended--
(i) in the heading, by inserting ``and
pregnancy-related services'' after ``preventive
services''; and
(ii) by inserting before the period at the
end the following: ``and for pregnancy-related
services''.
(3) Effective date.--The amendments made by this subsection
apply to items and services furnished on or after October 1,
2001, whether or not regulations implementing such amendments
have been issued.
(b) Rules for Implementation Beginning With Fiscal Year 2005.--
(1) Required coverage of familycare parents.--Section
1902(a)(10)(A)(i) of the Social Security Act (42 U.S.C.
1396a(a)(10)(A)(i)) is amended--
(A) by striking ``or'' at the end of subclause
(VI);
(B) by striking the semicolon at the end of
subclause (VII) and insert ``, or''; and
(C) by adding at the end the following:
``(VIII) who are described in
subsection (k)(1) (or would be
described if subparagraph (A)(ii) of
such subsection did not apply) and who
are in families with incomes that do
not exceed 100 percent of the poverty
line applicable to a family of the size
involved;''.
(2) Expansion of availability of enhanced match under
medicaid for pre-chip expansions.--Paragraph (4) of section
1905(u) of the Social Security Act (42 U.S.C. 1396d(u)), as
inserted by subsection (a)(1)(C), is amended--
(A) by amending clause (ii) of subparagraph (A) to
read as follows:
``(ii) Certain pregnant women.--Expenditures for
medical assistance for pregnant women under section
1902(l)(1)(A) in a family the income of which exceeds
the 133 percent of the income official poverty line.'';
and
(B) by adding at the end the following:
``(B) Children in families with income above medicaid
mandatory level not previously described.--The expenditures
described in this subparagraph are expenditures (other than
expenditures described in paragraph (2) or (3)) for medical
assistance made available to any child who is eligible for
assistance under section 1902(a)(10)(A) (other than under
clause (i)) and the income of whose family exceeds the minimum
income level required under subsection 1902(l)(2) (or, if
higher, the minimum level required under section 1931 for that
State) for a child of the age involved (treating any child who
is 19 or 20 years of age as being 18 years of age).''.
(3) Offset of additional expenditures for enhanced match
for pre-chip expansion; elimination of offset for required
coverage of familycare parents.--
(A) In general.--Section 1905(u)(5) of the Social
Security Act (42 U.S.C. 1396d(u)(5)), as added by
subsection (a)(1)(E), is amended--
(i) by amending subparagraph (A) to read as
follows:
``(A) Regular fmap for expenditures for pregnant women with
income above 133 percent of poverty.--The portion of the
payments made for expenditures described in paragraph
(4)(A)(ii) that represents the amount that would have been paid
if the enhanced FMAP had not been substituted for the Federal
medical assistance percentage.''; and
(ii) by adding at the end the following:
``(B) FamilyCare parents under 100 percent of poverty.--
Payments for expenditures described in paragraph (4)(A)(i) in
the case of parents whose income does not exceed 100 percent of
the income official poverty line applicable to a family of the
size involved.
``(C) Regular fmap for expenditures for certain children in
families with income above medicaid mandatory level.--The
portion of the payments made for expenditures described in
paragraph (4)(B) that represents the amount that would have
been paid if the enhanced FMAP had not been substituted for the
Federal medical assistance percentage.''.
(B) Conforming amendments.--Subparagraph (B) of
section 2105(a)(1) of the Social Security Act, as
amended by section 14(a) and subsection (a)(1)(D), is
amended to read as follows:
``(B) Certain familycare parents and others.--
Expenditures for medical assistance that is
attributable to expenditures described in section
1905(u)(4), except as provided in section
1905(u)(5).''.
(4) Effective date.--The amendments made by this subsection
apply as of October 1, 2004, to fiscal years beginning on or
after such date and to expenditures under the State plan on and
after such date, whether or not regulations implementing such
amendments have been issued.
(c) Making Title XXI Base Allotments Permanent.--Section 2104(a) of
the Social Security Act (42 U.S.C. 1397dd(a)) is amended--
(1) by striking ``and'' at the end of paragraph (9);
(2) by striking the period at the end of paragraph (10) and
inserting ``; and''; and
(3) by adding at the end the following:
``(11) for fiscal year 2008 and each fiscal year
thereafter, the amount of the allotment provided under this
subsection for the preceding fiscal year increased by the
percentage increase (if any) in the medical care expenditure
category of the Consumer Price Index for All Urban Consumers
(United States city average).''.
(d) Optional Application of Presumptive Eligibility Provisions to
Parents.--Section 1920A of the Social Security Act (42 U.S.C. 1396r-1a)
is amended by adding at the end the following:
``(e) A State may elect to apply the previous provisions of this
section to provide for a period of presumptive eligibility for medical
assistance for a parent (as defined for purposes of section 1902(k)(1))
of a child with respect to whom such a period is provided under this
section.''.
(e) Conforming Amendments.--
(1) Eligibility categories.--Section 1905(a) of the Social
Security Act (42 U.S.C. 1396d(a)) is amended, in the matter
before paragraph (1)--
(A) by striking ``or'' at the end of clause (xii);
(B) by inserting ``or'' at the end of clause
(xiii); and
(C) by inserting after clause (xiii) the following:
``(xiv) who are parents described (or treated as if
described) in section 1902(k)(1),''.
(2) Income limitations.--Section 1903(f)(4) of the Social
Security Act (42 U.S.C. 1396b(f)(4)) is amended--
(A) effective October 1, 2004, by inserting
``1902(a)(10)(A)(i)(VIII),'' after
``1902(a)(10)(A)(i)(VII),''; and
(B) by inserting ``1902(a)(10)(A)(ii)(XIX),'' after
``1902(a)(10)(A)(ii)(XVIII),''.
(3) Conforming amendment relating to no waiting period for
pregnant women.--Section 2102(b)(1)(B) of the Social Security
Act (42 U.S.C. 1397bb(b)(1)(B)) is amended--
(A) by striking ``, and'' at the end of clause (i)
and inserting a semicolon;
(B) by striking the period at the end of clause
(ii) and inserting ``; and''; and
(C) by adding at the end the following:
``(iii) may not apply a waiting period
(including a waiting period to carry out
paragraph (3)(C)) in the case of a targeted
low-income parent who is pregnant.''.
SEC. 4. AUTOMATIC ENROLLMENT OF CHILDREN BORN TO TITLE XXI PARENTS.
Section 2102(b)(1) of the Social Security Act (42 U.S.C.
1397bb(b)(1)) is amended by adding at the end the following:
``(C) Automatic eligibility of children born to a
parent being provided familycare.--Such eligibility
standards shall provide for automatic coverage of a
child born to an individual who is provided assistance
under this title in the same manner as medical
assistance would be provided under section 1902(e)(4)
to a child described in such section.''.
SEC. 5. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS UNDER THE MEDICAID
PROGRAM AND TITLE XXI.
(a) Medicaid Program.--Section 1903(v) of the Social Security Act
(42 U.S.C. 1396b(v)) is amended--
(1) in paragraph (1), by striking ``paragraph (2)'' and
inserting ``paragraphs (2) and (4)''; and
(2) by adding at the end the following:
``(4)(A) A State may elect (in a plan amendment under this title)
to provide medical assistance under this title, notwithstanding
sections 401(a), 402(b), 403, and 421 of the Personal Responsibility
and Work Opportunity Reconciliation Act of 1996, for aliens who are
lawfully residing in the United States (including battered aliens
described in section 431(c) of such Act) and who are otherwise eligible
for such assistance, within any of the following eligibility
categories:
``(i) Pregnant women.--Women during pregnancy (and during
the 60-day period beginning on the last day of the pregnancy).
``(ii) Children.--Children (as defined under such plan),
including optional targeted low-income children described in
section 1905(u)(2)(B).
``(iii) Parents.--If the State has elected the eligibility
category described in clause (ii), caretaker relatives who are
parents (including individuals treated as a caregiver for
purposes of carrying out section 1931) of children (described
in such clause or otherwise) who are eligible for medical
assistance under the plan.
``(B) In the case of a State that has elected to provide medical
assistance to a category of aliens under subparagraph (A), no debt
shall accrue under an affidavit of support against any sponsor of such
an alien on the basis of provision of assistance to such category and
the cost of such assistance shall not be considered as an unreimbursed
cost.''.
(b) Title XXI.--Section 2107(e)(1) of the Social Security Act (42
U.S.C. 1397gg(e)(1)) is amended by adding at the end the following:
``(E) Section 1903(v)(4) (relating to optional
coverage of categories of lawful resident alien
children and parents), but only with respect to an
eligibility category under this title, if the same
eligibility category has been elected under such section for purposes
of title XIX.''.
(c) Effective Date.--The amendments made by this section take
effect on October 1, 2001, and apply to medical assistance and child
health assistance furnished on or after such date, whether or not
regulations implementing such amendments have been issued.
SEC. 6. OPTIONAL COVERAGE OF CHILDREN THROUGH AGE 20 UNDER THE MEDICAID
PROGRAM AND TITLE XXI.
(a) Medicaid.--
(1) In general.--Section 1902(l)(1)(D) of the Social
Security Act (42 U.S.C. 1396a(l)(1)(D)) is amended by inserting
``(or, at the election of a State, 20 or 21 years of age)''
after ``19 years of age''.
(2) Conforming amendments.--
(A) Section 1902(e)(3)(A) of the Social Security
Act (42 U.S.C. 1396a(e)(3)(A)) is amended by inserting
``(or 1 year less than the age the State has elected
under subsection (l)(1)(D))'' after ``18 years of
age''.
(B) Section 1902(e)(12) of the Social Security Act
(42 U.S.C. 1396a(e)(12)) is amended by inserting ``or
such higher age as the State has elected under
subsection (l)(1)(D)'' after ``19 years of age''.
(C) Section 1920A(b)(1) of the Social Security Act
(42 U.S.C. 1396r-1a(b)(1)) is amended by inserting ``or
such higher age as the State has elected under section
1902(l)(1)(D)'' after ``19 years of age''.
(D) Section 1928(h)(1) of the Social Security Act
(42 U.S.C. 1396s(h)(1)) is amended by inserting ``or 1
year less than the age the State has elected under
section 1902(l)(1)(D)'' before the period at the end.
(E) Section 1932(a)(2)(A) of the Social Security
Act (42 U.S.C. 1396u-2(a)(2)(A)) is amended by
inserting ``(or such higher age as the State has
elected under section 1902(l)(1)(D))'' after ``19 years
of age''.
(b) Title XXI.--Section 2110(c)(1) of the Social Security Act (42
U.S.C. 1397jj(c)(1)) is amended by inserting ``(or such higher age as
the State has elected under section 1902(l)(1)(D))''.
(c) Effective Date.--The amendments made by this section take
effect on October 1, 2001, and apply to medical assistance and child
health assistance provided on or after such date, whether or not
regulations implementing such amendments have been issued.
SEC. 7. APPLICATION OF SIMPLIFIED TITLE XXI PROCEDURES UNDER THE
MEDICAID PROGRAM.
(a) Application Under Medicaid.--
(1) In general.--Section 1902(l) of the Social Security Act
(42 U.S.C. 1396a(l)) is amended--
(A) in paragraph (3), by inserting ``subject to
paragraph (5)'', after ``Notwithstanding subsection
(a)(17),''; and
(B) by adding at the end the following:
``(5) With respect to determining the eligibility of individuals
under 19 years of age (or such higher age as the State has elected
under paragraph (1)(D)) for medical assistance under subsection
(a)(10)(A) and, separately, with respect to determining the eligibility
of individuals for medical assistance under subsection
(a)(10)(A)(i)(VIII) or (a)(10)(A)(ii)(XIX), notwithstanding any other
provision of this title, if the State has established a State child
health plan under title XXI--
``(A) the State may not apply a resource standard;
``(B) the State shall use the same simplified eligibility
form (including, if applicable, permitting application other
than in person) as the State uses under such State child health
plan with respect to such individuals;
``(C) the State shall provide for initial eligibility
determinations and redeterminations of eligibility using
verification policies, forms, and frequency that are no less
restrictive than the policies, forms, and frequency the State
uses for such purposes under such State child health plan with
respect to such individuals; and
``(D) the State shall not require a face-to-face interview
for purposes of initial eligibility determinations and
redeterminations unless the State requires such an interview
for such purposes under such child health plan with respect to
such individuals.''.
(2) Effective date.--The amendments made by paragraph (1)
apply to determinations of eligibility made on or after the
date that is 1 year after the date of the enactment of this
Act, whether or not regulations implementing such amendments
have been issued.
(b) Presumptive Eligibility.--
(1) In general.--Section 1920A(b)(3)(A)(i) of the Social
Security Act (42 U.S.C. 1396r-1a(b)(3)(A)(i)) is amended by
inserting ``a child care resource and referral agency,'' after
``a State or tribal child support enforcement agency,''.
(2) Application to presumptive eligibility for pregnant
women under medicaid.--Section 1920(b) of the Social Security
Act (42 U.S.C. 1396r-1(b)) is amended by adding at the end
after and below paragraph (2) the following flush sentence:
``The term `qualified provider' includes a qualified entity as defined
in section 1920A(b)(3).''.
(3) Application under title xxi.--
(A) In general.--Section 2107(e)(1)(D) of the
Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended
to read as follows:
``(D) Sections 1920 and 1920A (relating to
presumptive eligibility).''.
(B) Conforming elimination of resource test.--
Section 2102(b)(1)(A) of such Act (42 U.S.C.
1397bb(b)(1)(A)) is amended--
(i) by striking `` and resources (including
any standards relating to spenddowns and
disposition of resources)''; and
(ii) by adding at the end the following:
``Effective 1 year after the date of the
enactment of the FamilyCare Act of 2001, such standards may not include
the application of a resource standard or test.''.
(c) Automatic Reassessment of Eligibility for Title XXI and
Medicaid Benefits for Children Losing Medicaid or Title XXI
Eligibility.--
(1) Loss of medicaid eligibility.--Section 1902(a) of the
Social Security Act (42 U.S.C. 1396a(a)) is amended--
(A) by striking the period at the end of paragraph
(65) and inserting ``; and'', and
(B) by inserting after paragraph (65) the
following:
``(66) provide, in the case of a State with a State child
health plan under title XXI, that before medical assistance to
a child (or a parent of a child) is discontinued under this
title, a determination of whether the child (or parent) is
eligible for benefits under title XXI shall be made and, if
determined to be so eligible, the child (or parent) shall be
automatically enrolled in the program under such title without
the need for a new application.''.
(2) Loss of title xxi eligibility and coordination with
medicaid.--Section 2102(b) (42 U.S.C. 1397bb(b)) is amended--
(A) in paragraph (3), by redesignating
subparagraphs (D) and (E) as subparagraphs (E) and (F),
respectively, and by inserting after subparagraph (C)
the following:
``(D) that before health assistance to a child (or
a parent of a child) is discontinued under this title,
a determination of whether the child (or parent) is
eligible for benefits under title XIX is made and, if
determined to be so eligible, the child (or parent) is
automatically enrolled in the program under such title
without the need for a new application;'';
(B) by redesignating paragraph (4) as paragraph
(5); and
(C) by inserting after paragraph (3) the following
new paragraph:
``(4) Coordination with medicaid.--The State shall
coordinate the screening and enrollment of individuals under
this title and under title XIX consistent with the following:
``(A) Information that is collected under this
title or under title XIX which is needed to make an
eligibility determination under the other title shall
be transmitted to the appropriate administering entity
under such other title in a timely manner so that
coverage is not delayed and families do not have to
submit the same information twice. Families shall be
provided the information they need to complete the
application process for coverage under both titles and
be given appropriate notice of any determinations made
on their applications for such coverage.
``(B) If a State does not use a joint application
under this title and such title, the State shall--
``(i) promptly inform a child's parent or
caretaker in writing and, if appropriate,
orally, that a child has been found likely to
be eligible under title XIX;
``(ii) provide the family with an
application for medical assistance under such
title and offer information about what (if any)
further information, documentation, or other
steps are needed to complete such application
process;
``(iii) offer assistance in completing such
application process; and
``(iv) promptly transmit the separate
application under this title or the information
obtained through such application, and all
other relevant information and documentation,
including the results of the screening process,
to the State agency under title XIX for a final
determination on eligibility under such title.
``(C) Applicants are notified in writing of--
``(i) benefits (including restrictions on
cost-sharing) under title XIX; and
``(ii) eligibility rules that prohibit
children who have been screened eligible for
medical assistance under such title from being
enrolled under this title, other than
provisional temporary enrollment while a final
eligibility determination is being made under
such title.
``(D) If the agency administering this title is
different from the agency administering a State plan
under title XIX, such agencies shall coordinate the
screening and enrollment of applicants for such
coverage under both titles.
``(E) The coordination procedures established
between the program under this title and under title
XIX shall apply not only to the initial eligibility
determination of a family but also to any renewals or
redeterminations of such eligibility.''.
(3) Effective date.--The amendments made by paragraphs (1)
and (2) apply to individuals who lose eligibility under the
medicaid program under title XIX, or under a State child health
insurance plan under title XXI, respectively, of the Social
Security Act on or after October 1, 2001 (or, if later, 60 days
after the date of the enactment of this Act), whether or not
regulations implementing such amendments have been issued.
(d) Provision of Medicaid and CHIP Applications and Information
Under the School Lunch Program.--Section 9(b)(2)(B) of the Richard B.
Russell National School Lunch Act (42 U.S.C. 1758(b)(2)(B)) is
amended--
(1) by striking ``(B) Applications'' and inserting ``(B)(i)
Applications''; and
(2) by adding at the end the following:
``(ii)(I) Applications for free and reduced price lunches that are
distributed pursuant to clause (i) to parents or guardians of children
in attendance at schools participating in the school lunch program
under this Act shall also contain information on the availability of
medical assistance under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) and of child health and FamilyCare assistance
under title XXI of such Act, including information on how to obtain an
application for assistance under such programs.
``(II) Information on the programs referred to in subclause (I)
shall be provided on a form separate from the application form for free
and reduced price lunches under clause (i).''.
(e) 12-Months Continuous Eligibility.--
(1) Medicaid.--Section 1902(e)(12) of the Social Security
Act (42 U.S.C. 1396a(e)(12)) is amended--
(A) by striking ``At the option of the State, the
plan may'' and inserting ``The plan shall'';
(B) by striking ``an age specified by the State
(not to exceed 19 years of age)'' and inserting ``19
years of age (or such higher age as the State has
elected under subsection (l)(1)(D)) or, at the option
of the State, who is eligible for medical assistance as
the parent of such a child''; and
(C) in subparagraph (A), by striking ``a period
(not to exceed 12 months) '' and inserting ``the 12-
month period beginning on the date''.
(2) Title xxi.--Section 2102(b)(2) of such Act (42 U.S.C.
1397bb(b)(2)) is amended by adding at the end the following:
``Such methods shall provide 12-months continuous eligibility
for children under this title in the same manner that section
1902(e)(12) provides 12-months continuous eligibility for
children described in such section under title XIX. If a State
has elected to apply section 1902(e)(12) to parents, such
methods may provide 12-months continuous eligibility for
parents under this title in the same manner that such section
provides 12-months continuous eligibility for parents described
in such section under title XIX.''.
(3) Effective date.--
(A) In general.--The amendments made by this
subsection shall take effect on October 1, 2001 (or, if
later, 60 days after the date of the enactment of this
Act), whether or not regulations implementing such
amendments have been issued.
SEC. 8. IMPROVING WELFARE-TO-WORK TRANSITION UNDER THE MEDICAID
PROGRAM.
(a) Making Provision Permanent.--
(1) In general.--Subsection (f) of section 1925 of the
Social Security Act (42 U.S.C. 1396r-6) is repealed.
(2) Conforming amendment.--Section 1902(e)(1) of the Social
Security Act (42 U.S.C. 1396a(e)(1)) is repealed.
(b) State Option of Initial 12-Month Eligibility.--Section 1925 of
the Social Security Act (42 U.S.C. 1396r-6) is amended--
(1) in subsection (a), by adding at the end the following:
``(5) Option of 12-month initial eligibility period.--A
State may elect to treat any reference in this subsection to a
6-month period (or 6 months) as a reference to a 12-month
period (or 12 months). In the case of such an election,
subsection (b) shall not apply.''; and
(2) in subsection (b)(1), by inserting ``and subsection
(a)(5)'' after ``paragraph (3)''.
(c) Simplification.--
(1) Removal of administrative reporting requirements for
additional 6-month extension.--Section 1925(b)(2) of the Social
Security Act (42 U.S.C. 1396r-6(b)(2)) is amended--
(A) by striking subparagraph (B);
(B) in subparagraph (A)(i)--
(i) in the heading, by striking ``and
requirements'';
(ii) by striking ``(I)'' and all that
follows through ``(II)'' and inserting ``(i)'';
(iii) by striking ``, and (III)'' and
inserting ``and (ii)'';
(iv) by redesignating such subparagraph as
subparagraph (A) (with appropriate
indentation); and
(C) in subparagraph (A)(ii)--
(i) in the heading, by striking ``reporting
requirements and'';
(ii) by striking ``notify the family of the
reporting requirement under subparagraph
(B)(ii) and'' and inserting ``provide the
family with notification of''; and
(iii) by redesignating such subparagraph as
subparagraph (B) (with appropriate
indentation).
(2) Removal of requirement for previous receipt of medical
assistance.--Section 1925(a)(1) of the Social Security Act (42
U.S.C. 1396r-6(a)(1)) is amended--
(A) by inserting ``but subject to subparagraph
(B)'' after ``any other provision of this title'';
(B) by redesignating the matter after
``Requirement.--'' as a subparagraph (A) with the
heading ``In general.--'' and with the same indentation
as subparagraph (B) (as added by subparagraph (C)); and
(C) by adding at the end the following:
``(B) State option to waive requirement for 3
months previous receipt of medical assistance.--A State
may, at its option, elect also to apply subparagraph
(A) in the case of a family that had applied for and
was eligible for such aid for fewer than 3 months
during the 6 immediately preceding months described in
such subparagraph.''.
(3) Permitting increase or waiver of 185 percent of poverty
earning limit.--Section 1925(b)(3)(A)(iii)(III) of the Social
Security Act (42 U.S.C. 1396r-6(b)(3)(A)(iii)(III)) is
amended--
(A) by inserting ``(at its option)'' after ``the
State''; and
(B) by inserting ``(or such higher percent as the
State may specify)'' after ``185 percent''.
(4) Exemption for states covering needy families up to 185
percent of poverty.--Section 1925 of the Social Security Act
(42 U.S.C. 1396r-6), as amended by subsection (a), is amended--
(A) in each of subsections (a)(1) and (b)(1), by
inserting ``but subject to subsection (f),'' after
``Notwithstanding any other provision of this title,'';
and
(B) by adding at the end the following:
``(f) Exemption for State Covering Needy Families up to 185 Percent
of Poverty.--
``(1) In general.--At State option, the provisions of this
section shall not apply to a State that uses the authority
under section 1902(a)(10)(A)(ii)(XIX), section 1931(b)(2)(C),
or otherwise to make medical assistance available under the
State plan under this title to eligible individuals described
in section 1902(k)(1), or all individuals described in section
1931(b)(1), and who are in families with gross incomes
(determined without regard to work-related child care expenses
of such individuals) at or below 185 percent of the income
official poverty line (as defined by the Office of Management
and Budget, and revised annually in accordance with section
673(2) of the Omnibus Budget Reconciliation Act of 1981)
applicable to a family of the size involved.
``(2) Application to other provisions of this title.--The
State plan of a State described in paragraph (1) shall be
deemed to meet the requirements of section
1902(a)(10)(A)(i)(I).''.
(d) Effective Date.--The amendments made by this section take
effect on October 1, 2001, whether or not regulations implementing such
amendments have been issued.
SEC. 9. ELIMINATION OF 100 HOUR RULE AND OTHER AFDC-RELATED ELIGIBILITY
RESTRICTIONS.
(a) In General.--Section 1931(b)(1)(A)(ii) of the Social Security
Act (42 U.S.C. 1396u-1(b)(1)(A)(ii)) is amended by inserting ``other
than the requirement that the child be deprived of parental support or
care by reason of the death, continued absence from the home,
incapacity, or unemployment of a parent,'' after ``section 407(a),''.
(b) Conforming Amendment.--Section 1905(a) of the Social Security
Act (42 U.S.C. 1396d(a)) is amended, in the matter before paragraph
(1), in clause (ii), by striking ``if such child is (or would, if
needy, be) a dependent child under part A of title IV''.
(c) Effective Date.--The amendments made by this section apply to
eligibility determinations made on or after October 1, 2001, whether or
not regulations implementing such amendments have been issued.
SEC. 10. STATE GRANT PROGRAM FOR MARKET INNOVATION.
(a) In General.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall establish a
program (in this section referred to as the ``program'') to award
demonstration grants under this section to States to allow States to
demonstrate the effectiveness of innovative ways to increase access to
health insurance through market reforms and other innovative means.
Such innovative means may include any of the following:
(1) Alternative group purchasing or pooling arrangements,
such as purchasing cooperatives for small businesses,
reinsurance pools, or high risk pools.
(2) Individual or small group market reforms.
(3) Consumer education and outreach.
(4) Subsidies to individuals, employers, or both, in
obtaining health insurance.
(b) Scope; Duration.--The program shall be limited to not more than
10 States and to a total period of 5 years, beginning on the date the
first demonstration grant is made.
(c) Conditions for Demonstration Grants.--
(1) In general.--The Secretary may not provide for a
demonstration grant to a State under the program unless the
Secretary finds that under the proposed demonstration grant--
(A) the State will provide for demonstrated
increase of access for some portion of the existing
uninsured population through a market innovation (other
than merely through a financial expansion of a program
initiated before the date of the enactment of this
Act);
(B) the State will comply with applicable Federal
laws;
(C) the State will not discriminate among
participants on the basis of any health status-related
factor (as defined in section 2791(d)(9) of the Public
Health Service Act (42 U.S.C. 300gg-91(d)(9)), except
to the extent a State wishes to focus on populations
that otherwise would not obtain health insurance
because of such factors; and
(D) the State will provide for such evaluation, in
coordination with the evaluation required under
subsection (d), as the Secretary may specify.
(2) Application.--The Secretary shall not provide a
demonstration grant under the program to a State unless--
(A) the State submits to the Secretary such an
application, in such a form and manner, as the
Secretary specifies;
(B) the application includes information regarding
how the demonstration grant will address issues such as
governance, targeted population, expected cost, and the
continuation after the completion of the demonstration
grant period; and
(C) the Secretary determines that the demonstration
grant will be used consistent with this section.
(3) Focus.--A demonstration grant proposal under this
section need not cover all uninsured individuals in a State or
all health care benefits with respect to such individuals.
(d) Evaluation.--The Secretary shall enter into a contract with an
appropriate entity outside the Department of Health and Human Services
to conduct an overall evaluation of the program at the end of the
program period. Such evaluation shall include an analysis of
improvements in access, costs, quality of care, or choice of coverage,
under different demonstration grants.
(e) Option To Provide for Initial Planning Grants.--Notwithstanding
the previous provisions of this section, under the program the
Secretary may provide for a portion of the amounts appropriated under
subsection (f) (not to exceed $5,000,000) to be made available to any
State for initial planning grants to permit States to develop
demonstration grant proposals under the previous provisions of this
section.
(f) Authorization of Appropriations.--There are authorized to be
appropriated $100,000,000 for each fiscal year to carry out this
section. Amounts appropriated under this subsection shall remain
available until expended.
(g) State Defined.--In this section, the term ``State'' has the
meaning given such term for purposes of title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).
SEC. 11. LIMITATIONS ON CONFLICTS OF INTEREST.
(a) Limitation on Conflicts of Interest in Marketing Activities.--
(1) Title xxi.--Section 2105(c) of the Social Security Act
(42 U.S.C. 300aa-5(c)) is amended by adding at the end the
following:
``(8) Limitation on expenditures for marketing
activities.--Amounts expended by a State for the use of an
administrative vendor in marketing health benefits coverage to
low-income children under this title shall not be considered,
for purposes of subsection (a)(2)(D), to be reasonable costs to
administer the plan unless the following conditions are met
with respect to the vendor:
``(A) The vendor is independent of any entity
offering the coverage in the same area of the State in
which the vendor is conducting marketing activities.
``(B) No person who is an owner, employee,
consultant, or has a contract with the vendor either
has any direct or indirect financial interest with such
an entity or has been excluded from participation in
the program under this title or title XVIII or XIX or
debarred by any Federal agency, or subject to a civil
money penalty under this Act.''.
(b) Prohibition of Affiliation With Debarred Individuals.--
(1) Medicaid.--Section 1903(i) of the Social Security Act
(42 U.S.C. 1396b(i))is amended--
(A) by striking the period at the end of paragraph
(20) and inserting ``; or''; and
(B) by inserting after paragraph (20) the
following:
``(21) with respect to any amounts expended for an entity
that receives payments under the plan unless--
``(A) no person with an ownership or control
interest (as defined in section 1124(a)(3)) in the
entity is a person that is debarred, suspended, or
otherwise excluded from participating in procurement or
non-procurement activities under the Federal
Acquisition Regulation; and
``(B) such entity has not entered into an
employment, consulting, or other agreement for the
provision of items or services that are material to
such entity's obligations under the plan with a person
described in subparagraph (A).''.
(2) Title xxi.--Section 2107(e)(1) of the Social Security
Act (42 U.S.C. 1397gg(e)(1)), as amended by sections 5(b) and
7(b)(3), is further amended--
(A) in subparagraph (B), by striking ``and (17)''
and inserting ``(17), and (21)''; and
(B) by adding at the end the following:
``(F) Section 1902(a)(67) (relating to prohibition
of affiliation with debarred individuals).''.
(c) Effective Date.--The amendments made by this section shall
apply to expenditures made on or after October 1, 2001, whether or not
regulations implementing such amendments have been issued.
SEC. 12. INCREASE IN CHIP ALLOTMENT FOR EACH OF FISCAL YEARS 2002
THROUGH 2004.
Paragraphs (5), (6), and (7) of section 2104(a) of the Social
Security Act (42 U.S.C. 1397dd(a)) are amended by striking
``$3,150,000,000'' each place it appears and inserting
``$4,150,000,000''.
SEC. 13. DEMONSTRATION PROGRAMS TO IMPROVE MEDICAID AND CHIP OUTREACH
TO HOMELESS INDIVIDUALS AND FAMILIES.
(a) Authority.--The Secretary of Health and Human Services may
award demonstration grants to not more than 7 States (or other
qualified entities) to conduct innovative programs that are designed to
improve outreach to homeless individuals and families under the
programs described in subsection (b) with respect to enrollment of such
individuals and families under such programs and the provision of
services (and coordinating the provision of such services) under such
programs.
(b) Programs for Homeless Described.--The programs described in
this subsection are as follows:
(1) Medicaid.--The program under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).
(2) CHIP.--The program under title XXI of the Social
Security Act (42 U.S.C. 1397aa et seq.).
(3) TANF.--The program under part of A of title IV of the
Social Security Act (42 U.S.C. 601 et seq.).
(4) SAMHSA block grants.--The program of grants under part
B of title XIX of the Public Health Service Act (42 U.S.C.
300x-1 et seq.).
(5) Food stamp program.--The program under the Food Stamp
Act of 1977 (7 U.S.C. 2011 et seq.).
(6) Workforce investment act.--The program under the
Workforce Investment Act of 1999 (29 U.S.C. 2801 et seq.).
(7) Welfare-to-work.--The welfare-to-work program under
section 403(a)(5) of the Social Security Act (42 U.S.C.
603(a)(5)).
(8) Other programs.--Other public and private benefit
programs that serve low-income individuals.
(c) Appropriations.--For the purposes of carrying out this section,
there is appropriated for fiscal year 2002, out of any funds in the
Treasury not otherwise appropriated, $10,000,000, to remain available
until expended.
SEC. 14. TECHNICAL AND CONFORMING AMENDMENTS TO AUTHORITY TO PAY
MEDICAID EXPANSION COSTS FROM TITLE XXI APPROPRIATION.
(a) Authority To Pay Medicaid Expansion Costs From Title XXI
Appropriation.--Section 2105(a) of the Social Security Act (42 U.S.C.
1397ee(a)) is amended to read as follows:
``(a) Allowable Expenditures.--
``(1) In general.--Subject to the succeeding provisions of
this section, the Secretary shall pay to each State with a plan
approved under this title, from its allotment under section
2104, an amount for each quarter equal to the enhanced FMAP of
the following expenditures in the quarter:
``(A) Child health assistance under medicaid.--
Expenditures for child health assistance under the plan
for targeted low-income children in the form of
providing medical assistance for expenditures described
in the fourth sentence of section 1905(b).
``(B) Reserved.--[reserved].
``(C) Child health assistance under this title.--
Expenditures for child health assistance under the plan
for targeted low-income children in the form of
providing health benefits coverage that meets the
requirements of section 2103.
``(D) Assistance and administrative expenditures
subject to limit.--Expenditures only to the extent
permitted consistent with subsection (c)--
``(i) for other child health assistance for
targeted low-income children;
``(ii) for expenditures for health services
initiatives under the plan for improving the
health of children (including targeted low-
income children and other low-income children);
``(iii) for expenditures for outreach
activities as provided in section 2102(c)(1)
under the plan; and
``(iv) for other reasonable costs incurred
by the State to administer the plan.
``(2) Order of payments.--Payments under a subparagraph of
paragraph (1) from a State's allotment for expenditures
described in each such subparagraph shall be made on a
quarterly basis in the order of such subparagraph in such
paragraph.
``(3) No duplicative payment.--In the case of expenditures
for which payment is made under paragraph (1), no payment shall
be made under title XIX.''.
(b) Conforming Amendments.--
(1) Section 1905(u).--Section 1905(u)(1)(B) of the Social
Security Act (42 U.S.C. 1396d(u)(1)(B)) is amended by inserting
``and section 2105(a)(1)'' after ``subsection (b)''.
(2) Section 2105(c).--Section 2105(c)(2)(A) of the Social
Security Act (42 U.S.C. 1397ee(c)(2)(A)) is amended by striking
``subparagraphs (A), (C), and (D) of''.
(c) Effective Date.--The amendments made by this section shall be
effective as if included in the enactment of the Balanced Budget Act of
1997 (Public Law 105-33; 111 Stat. 251), whether or not regulations
implementing such amendments have been issued.
SEC. 15. ADDITIONAL CHIP REVISIONS.
(a) Limiting Cost-Sharing to 2.5 Percent for Families With Income
Below 150 Percent of Poverty.--Section 2103(e)(3)(A) of the Social
Security Act (42 U.S.C. 1397cc(e)(3)(A)) is amended--
(1) by striking ``and'' at the end of clause (i);
(2) by striking the period at the end of clause (ii) and
inserting ``; and''; and
(3) by adding at the end the following new clause:
``(iii) total annual aggregate cost-sharing
described in clauses (i) and (ii) with respect
to all such targeted low-income children in a
family under this title that exceeds 2.5
percent of such family's income for the year
involved.''.
(b) Reporting of Enrollment Data.--
(1) Quarterly reports.--Section 2107(b)(1) of such Act (42
U.S.C. 1397gg(b)(1)) is amended by adding at the end the
following: ``In quarterly reports on enrollment required under
this paragraph, a State shall include information on the age,
gender, race, ethnicity, service delivery system, and family
income of individuals enrolled.''.
(2) Annual reports.--Section 2108(b)(1)(B)(i) of such Act
(42 U.S.C. 1397hh(b)(1)(B)(i)) is amended by inserting
``primary language of enrollees,'' after ``family income,''.
(c) Employer Coverage Waiver Changes.--Section 2105(c)(3) of such
Act (42 U.S.C. 1397ee(c)(3)) is amended--
(1) by redesignating subparagraphs (A) and (B) as clauses
(i) and (ii) and indenting appropriately;
(2) by designating the matter beginning with ``Payment may
be made'' as a subparagraph (A) with the heading ``In general''
and indenting appropriately; and
(3) by adding at the end the following new subparagraphs:
``(B) Application of requirements.--In carrying out
subparagraph (A)--
``(i) the Secretary shall not require a
minimum employer contribution level that is
separate from the requirement of cost-
effectiveness under subparagraph (A)(i), but a
State shall identify a reasonable minimum
employer contribution level that is based on
data demonstrating that such a level is
representative to the employer-sponsored
insurance market in the State and shall monitor
employer contribution levels over time to
determine whether substitution is occurring and
report the findings in annual reports under
section 2108(a);
``(ii) the State shall establish a waiting
period of at least 6 months without group
health coverage, but may establish reasonable
exceptions to such period and shall not apply
such a waiting period to a child who is
provided coverage under a group health plan
under section 1906;
``(iii) subject to clause (iv), the State
shall provide satisfactory assurances that the
minimum benefits and cost-sharing protections
established under this title are provided,
either through the coverage under subparagraph
(A) or as a supplement to such coverage; and
``(iv) coverage under such subparagraph
shall not be considered to violate clause (iii)
because it does not comply with requirements
relating to reviews of health service decisions
if the enrollee involved is provided the option
of being provided benefits directly under this
title.
``(C) Access to external review process.--In
carrying out subparagraph (A), if a State provides
coverage under a group health plan that does not meet
the following external review requirements, the State
must give applicants and enrollees (at initial
enrollment and at each redetermination of eligibility)
the option to obtain health benefits coverage other
than through that group health plan:
``(i) The enrollee has an opportunity for
external review of a--
``(I) delay, denial, reduction,
suspension, or termination of health
services, in whole or in part,
including a determination about the
type or level of services; and
``(II) failure to approve, furnish,
or provide payment for health services
in a timely manner.
``(ii) The external review is conducted by
the State or a impartial contractor other than
the contractor responsible for the matter
subject to external review.
``(iii) The external review decision is
made on a timely basis in accordance with the
medical needs of the patient. If the medical
needs of the patient do not dictate a shorter
time frame, the review must be completed--
``(I) within 90 calendar days of
the date of the request for internal or
external review; or
``(II) within 72 hours if the
enrollee's physician or plan determines
that the deadline under subclause (I)
could seriously jeopardize the
enrollee's life or health or ability to
attain, maintain, or regain maximum
function (except that a State may
extend the 72-hour deadline by up to 14
days if the enrollee requests an
extension).
``(iv) The external review decision shall
be in writing.
``(v) Applicants and enrollees have an
opportunity--
``(I) to represent themselves or
have representatives of their choosing
in the review process;
``(II) timely review their files
and other applicable information
relevant to the review of the decision;
and
``(III) fully participate in the
review process, whether the review is
conducted in person or in writing,
including by presenting supplemental
information during the review
process.''.
(d) Effective Date.--The amendments made by this section apply as
of October 1, 2001, whether or not regulations implementing such
amendments have been issued.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S8224, S8230-8232)
Read twice and referred to the Committee on Finance. (text of measure as introduced: CR S8224-8230)
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