A bill to amend titles XVIII, XIX, and XXI of the Social Security Act to extend and improve the children's health insurance program, to improve beneficiary protections under the Medicare, Medicaid, and the CHIP program, and for other purposes

2007·24.2 MB·English

by  United States. Congress. House

IB
110th congress
1st Session
[Report No. 110-284, Part I]
To amend titles X\T[I, XIX, and XXI of the Social Security Act to extend
and improve the eliildren's health insurance program, to improve bene-
ficiaiyprotectionsunderthe Medicare, Medicaid, andthe CHIPprogram,
andforotherpurposes.
IX THE HOUSE OF REPRESENTATIVES
July24, 2007
Mr. DiXGELL (for himself, Mr. Rangel, Mr. Stark, and Mr. Pallone) in-
troduced the follo'\^'ing bih; wliich was referred to the Committee on En-
ergy- and Commerce, and in adcUtion to the Conmiittee on Ways and
Means, for a period to be subsequently determined by the Speaker, in
each case for consideration of such pro\isions as fall \\ithin thejurisdic-
tionofthecommittee concerned
August 1 (legislative day, July 31), 2007
Additional sponsors: Ms. Bald\\t;n, Mr. Engel, Mr. CuELLAJR, Mr. Wynn,
Mr. Waxman, Ms. Hirono, Mr. Gene Green ofTexas, Ms. DeGette,
andMr. ALLEN
August 1 (legislativeday, July31), 2007
Reportedfromthe Committee onWays andMeanswith anamendment and
orderedtobeprinted
[Strikeoutallaftertheenactingclauseandinsertthepartprintedinitalic]
[FortextofintroducedbUl,seecopyofbUlasinti'oducedonJuly24,2007]
A
BILL
To amend titles X\^II, XIX, and XXI of the Social Security
Act to extend and improve the children's health insur-
ance prog7:'am, to improve beneficiary protections under
2
the Medicare, Medicaid, and the CHIP program, and
for other purposes.
1 Be it enacted by the Senate afid House ofRepresenta-
2 tives ofthe United States ofAmerica in Congress assembled,
3 SECTION1. SHORTTITLE; TABLEOFCONTENTS.
—
4 (a) Short Title. Tliis Act may be cited as the
5 ''Childrens Health and Medicare Protection Act of2007".
—
6 (b) Table of Contents. Tlie table ofcontents ofthis
1 Act is asfolloivs:
Sec. 1. Shod,title; tableofcontents.
TITLE I—CHILDREN'S HEALTHINSURANCE PROGRAM
Sec. 100. Pur-pose.
—
SubtitleA Funding
Sec. 101. EstablishmentofnewbaseCHIPallotments.
Sec. 102. 2-yearinitialavailabilityofCHIPallotments.
Sec. 103. Redistribution ofunusedallotmentsto address Statefundingshortfalls.
Sec. 104. ExtensionofoptionforqualifyingStates.
—
Subtitle B Improinng Enrollment and Retention ofEligible Children
Sec. 111. CHIPperformance bonuspayment to offsetadditional enrollment costs
resultingfromenrollmentandretentionefforts.
Sec. 112. Stateoptiontorelyonfindingsfroman expresslaneagericytoconduct
simplifiedeligibilitydeterminations.
Sec. 113. Application ofmedicaid outreach procedures to all children andpreg-
nantwomen.
Sec. 114. Encouragingculturallyappropriateenrollmentandretentionpractices.
—
Subtitle C Coverage
Sec. 121. Ensuringchild-centeredcoverage.
Sec. 122. Improvingbenchmarkcoverageoptions.
Sec. 123. Premiumgraceperiod.
—
Subtitle D Populations
Sec. 131. OptionalcoverageofolderchildrenunderMedicaidandCHIP.
Sec. 132. OptionalcoverageoflegalimmigrantsundertheMedicaidprogramand
CHIP.
Sec. 133. State option to expand or add coverage ofcertain pregnant women
underCHIP.
Sec. 134. Limitationonwaiverauthoritytocoveradults.
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. - Subtitle E Ac-cess
Sec. 141. Children'sAccess, Payment, andEqualityCommission.
Sec. 142. ModelofInterstatecoordinatedenrollmentandcoverageprocess.
Sec. 143. Medicaidcitizenshipdocumentationrequirements.
Sec. 144. Accesstodentalcareforchildren.
Sec. 145. Prohibitinginitiationofnewhealthopportunityaccountdemonstration
programs.
—
Subtitle F Quality and Program, Integrity
Sec. 151. Pediatrichealthqualitymeasurementprogram.
Sec. 152. Applicationofcertainmanagedcarequalitysafeguardsto CHIP.
See. 153. UpdatedFederalevaluationofCHIP.
See. 154. Accesstorecordsfor10andGAOauditsandevaluations.
Sec. 155. ReferencestotitleXXI.
Sec. 156. Relianceonlaw;exceptio7iforStatelegislation. . ' ,v
TITLE II—MEDICARE BENEFICIARYIMPROVEMENTS
—
SubtitleA Improvernents in Benefits - . ..
Sec. 201. Coverageandwaiverofcost-sharingforpreventiveservices.
Sec. 202. Waiver ofdeductiblefor colorectal cancer screening tests regardless of
coding, subsequentdiagnosis, orancillarytissueremoval.
Sec. 203. Parityformentalhealthcoinsurance.
—
Subtitle B Improving, Clarifying, and Simplifying FinancialAssistancefor
Low Income Medicare Beneficiaries
Sec. 211. Impro'ving assets testsfor Medicare Savings Program and law-income
subsidyprogram.
Sec. 212. MakingQIprogmmpermanentandexpandingeligibility.
See. 213. Eliminatingbarrierstoenrollment.
Sec. 214. Eliminatingapplicationofestaterecovery.
Sec. 215. Elimination ofpart D cost-sharing for certain non-institutionalized
full-benefitdualeligibleindividuals.
Sec. 216. Exemptionsfrom income and resourcesfor determination ofeligibility
forlow-incomesubsidy.
Sec. 217. Cost-sharingprotectionsforlow-incomesubsidy-eligibleindividuals.
Sec. 218. Intelligentassignmentinenrollment.
.
—
Subtitle C Part D Beneficiary Improvements
Sec. 221. IncludingcostsincurredbyAIDSdrugassistanceprogramsandIndian
Health Service in providing prescription drugs toward the an-
nualautofpocketthresholdunderPartD.
Sec. 222. Permitting mid-year changes in enrollmentforformulary changes ad-
verselyimpactanenrollee.
Sec. 223. Removal ofexclusion ofbenzodiazepinesfrom required coverage under
theMedicareprescriptiondrugprogram.
Sec. 224. Permitting updating drug compendia underpart D usifig part B up-
dateprocess.
Sec. 225. Codification ofspecialprotectionsforsixprotecteddrugclassifications.
Sec. 226. Elimination ofMedicarepartD lateenrollmentpenaltiespaidby low-
incomesubsidy-eligible individuals.
Sec. 227. Specialenrollmentperiodforsubsidyeligibleindividuals.
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Sec. 635. Adjustmentforerythropoietinstimulatingagents (ESAs).
Sec. 636. Siteneutralcompositerate.
Sec. 637. Development of ESRD bundling system and quality incentive pay-
ments.
Sec. 638. MedPACreportonESRDbundlingsystem.
Sec. 639. OIGstudyandreporton erythropoietin.
—
Subtitle D Miscellaneous '"''
Sec. 6.51. Limitation on exception to the prohibition on certain physician refer-
ralsforhospitals.
TITLE VII—PROVISIONS RELATING TO MEDICARE PARTSAAND B
Sec. 701. Homehealthpayment updatefor2008.
Sec. 702. 2-year extension of temporary Medicare payment increase for home
healthservicesfurnishedin aruralarea.
Sec. 703. Extension ofMedicare secondarypayerforbeneficiaries ivithend stage
renaldiseaseforlargegroupplans.
Sec. 704. PlanforMedicarepaymentadjustmentsforneverevents.
Sec. 705. Reinstatementofresidencyslots.
TITLE VIII—MEDICAID
—
SubtitleA Protecting Existing Coverage ,,,. .,.
Sec. 801. ModernizingtransitionalMedicaid.
Sec. 802. Familyplanningservices.
Sec. 803. Authority to continue providing adult day health services approved
underaStateMedicaidplmi.
Sec. 804. State option to protect community spouses ofindividuals with disabil-
ities.
Sec. 805. Countymedicaidhealth insuringorganizations.
—
Subtitle B Payments '
Sec. 811. PaymentsforPuertoRicoandterritories.
Sec. 812. Medicaiddrugrebate.
Sec. 813. AdjustmentincomputationofMedicaidFMAPtodisregardanextraor-
dinaryemployerpensioncontribution.
Sec. 814. Moratoriumoncertainpaymentrestrictions.
Sec. 815. TennesseeDSH.
Sec. 816. Clarificationtreatmentofregionalmedicalcenter.
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Subtitle C Miscellaneous
Sec. 821. Demonstrationprojectforemployerbuy-in.
Sec. 822. Diabetesgrants.
Sec. 823. Technicalcorrection.
TITLE IX—MISCELLANEOUS
Sec. 901. MedicarePaymentAdvisoryCommissionstatus.
Sec. 902. Repealoftriggerprovision.
Sec. 903. Repealofcomparativecostadjustment (CCA)prograrn.
Sec. 904. Comparativeeffectivenessresearch.
Sec. 905. ImplementationofHealth information technology (IT) underMedicare.
Sec. 906. Development, reporting, anduseofhealthcuremeasures.
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Sec. 907. ImprovementstotheMedigapprogram. •
Sec. 908. Implementationfunding.
TITLEX—REVENUES
Sec. 1001. Increase in rate ofexcise taxes on tobacco products and cigarette pa-
persandtubes.
Sec. 1002. Exemptionforemergencymedicalservicestransportation.
TITLE I—CHILDREN'S HEALTH
1
INSURANCE PROGRAM
2
3 SEC. 100.PURPOSE.
4 It is the purpose ofthis title to provide dependable and
5 stable fundingfor children's health insurance under titles
6 XXI and XIXofthe Social Security Act in order to enroll
1 all six million uninsured children who are eligible, but not
8 enrolled,forcoverage today throughsuch titles.
— ]_
9 Subtitle A Funding
10 SEC. 101. ESTABLISHMENT OF NEW BASE CHIP ALLOT-
11 MENTS.
12 Section 2104 of the Social Security Act (42 U.S.C.
—
13 1397dd) is amended ,. ,\ ,;
—
14 (1) in subsection (a)
15 (A) in paragraph (9), by striking "and'' at
16 the end;
17 (B) in paragraph (10), by striking the pe-
18 riod at the end and inserting and''; and
19 (C) by adding at the end thefollowing new
20 paragraph:
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1 ''(11) for fiscal year 2008 and each succeeding
2 fiscal year, the sum of the State allotments provided
3 under subsection (i)for suchfiscal year.";
4 (2) in subsections (b)(1) and (c)(1), by striking
5 "subsection (d)" and inserting "subsections (d) and
6 (i)"; and
1 (3) by adding at the end thefollowing new sub-
8 section:
9 "(i) Allotments for Statesand TerritoriesBe-
—
10 GINNINGWithFiscal Year2008.
—
11 "(1) General allotment COMPUTATION. Sub-
12 ject to the succeeding provisions ofthis subsection, the
13 Secretary shall compute a State allotment for each
14 Statefor eachfiscal year asfollows:
—
15 "(A) For fiscal year 2008. For fiscal
16 year 2008, the allotment of a State is equal to
—
17 the greater of-
18 "(i) the State projection (in its submis-
19 sion onforms CMS—21B and CMS—37for
20 May 2007) ofFederal payments to the State
21 under this title for such fiscal year, except
22 that, in the case ofa State that has enacted
23 legislation to modify its State child health
24 pkm during 2007, the State may substitute
25 its projection in its submission on forms
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1 CMS—21B and CMS—37forAugust 2007,
2 instead ofsuchformsfor May 2007; or
3 "(ii) the allotment of the State under
4 this section forfiscal year 2007 multiplied
5 hy the allotment increasefactor underpara-
6 graph (2)forfiscal year2008.
1 "(B) Inflation update for fiscal year
8 2009 AND EACH SECOND SUCCEEDING FISCAL
—
9 YEAR. For fiscal year 2009 and each second
10 succeedingfiscal year, the allotment ofa State is
11 equal to the amount ofthe State allotment under
12 this paragraphfor the previousfiscal year mul-
13 tiplied hy the allotment increase factor under
14 paragraph (2)for thefiscal year involved.
15 "(C) REBASING in fiscal year 2010 AND
—
16 EACH second succeeding FISCAL YEAR. For
17 fiscal year 2010 and each second succeedingfis-
18 cal year, the allotment ofa State is equal to the
19 Federal payments to the State that are attrih-
20 utahle to (and countable towards) the total
21 amount ofallotments available under this section
22 to the State (including allotments made avail-
23 able under paragraph (3) as well as amounts re-
24 distributed to the State) in the previous fiscal
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1 year multiplied hy the allotment increase factor
2 under paragraph (2)for thefiscal year involved.
—
3 "(D) Special rules for territories.
4 Notwithstanding the previous subparagraphs, the
5 allotment for a State thai is not one of the 50
6 States or the District ofColumbiaforfiscal year
1 2008 andfor a succeedingfiscal year is equal to
:
8 the Federal payments provided to the State
9 under this titlefor the previousfiscal year mul-
10 tiplied by the allotment increase factor under
11 . paragraph (2) for the fiscal year involved (but
12 determined by applying under paragraph (2)(B)
13 as if the reference to 'in the State' were a ref-
14 erence to 'in the United States').
—
15 "(2) Allotment increase factor. The allot-
16 ment increasefactor under this paragraphfor afiscal
17 year is equal to the product ofthefollowing:
18 "(A) Per capita health care growth
—
19 FACTOR. 1 plus the percentage increase in the
20 projected per capita amount ofNational Health
,
21 Expenditures from the calendar year in which
22 the previousfiscal year ends to the calendar year
23 in which the fiscal year involved ends, as most
24 recently published by the Secretary before the be-
25 ginning ofthefiscal year.
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1 "(B) Child population growth fac-
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2 TOE. 1 plus the percentage increase (ifany) in
3 the population ofchildren under 19 years ofage
4 in the State fro7n July 1 in the previous fiscal
5 year to July 1 in thefiscal year involved, as de-
6 termined hy the Secretary based on the fnost re-
7 cent published estimates of the Bureau of the
8 Census before the beginning ofthefiscal year in-
9 volved, plus 1 percentage point
10 "(3) Performance-based shortfall adjust-
—
11 MENT.
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12 "(A) In GENERAL. If a State's expendi-
13 tures under this title in afiscal year (beginning
14 withfiscal year 2008) exceed the total amount of
15 allotments available under this section to the
16 State in the fiscal year (determined without re-
17 gard to any redistribution it receives under sub-
18 section (f) that is availablefor expenditure dur-
19 ing suchfiscal year, but including any carryover
20 from a previous fiscal year) and if the average
21 monthly unduplicated number of children en-
22 rolled under the State plan under this title (in-
23 eluding children receiving health care coverage
24 through funds under this title pursuant to a
25 waiver under section 1115) during such fiscal
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1 year exceeds its target average numher of such
2 enrollees (as determined ufider subparagraph
3 (B))for thatfiscal year, the allotment under this
4 section for the State for the subsequent fiscal
5 year (or, pursuant to subparagraph (F), for the
6 fiscal year involved) shall be increased by the
—
1 product of
8 "(i) the amount by which such average
9 monthly caseload exceeds such target num-
10 ber ofenrollees; and
11 "(ii) the projected per capita expendi-
12 tures under the State child health plan (as
13 determined under subparagraph (C) for the
14 originalfiscal year involved), multiplied by
15 the enhanced FMAP (as defined in section
16 2105(b)) for the State and fiscal year in-
17 volved
18 "(B) Target average number of child
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19 ENROLLEES. hi this subsection, the target aver-
—
20 age number ofchild eyirolleesfor a State
21 "(i)forfiscal year 2008 is equal to the
22 monthly average unduplicated number of
23 children enyvlled in the State child health
24 plan U7ider this title (including such chil-
25 dreri receiving health care coverage through
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