HR 3823 IHCommentsClose CommentsPermalink

To amend titles XIX and XXI of the Social Security Act to make certain changes to the State Children’s Health Insurance Program and the Medicaid Program.CommentsClose CommentsPermalink

October 15, 2009CommentsClose CommentsPermalink

Mr. DEAL of Georgia (for himself, Mr. PITTS, Mr. BLUNT, Mr. BARTON of Texas, and Mr. BUYER) introduced the following bill; which was referred to the Committee on Energy and CommerceCommentsClose CommentsPermalink

To amend titles XIX and XXI of the Social Security Act to make certain changes to the State Children’s Health Insurance Program and the Medicaid Program.CommentsClose CommentsPermalink

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,CommentsClose CommentsPermalink

SECTION 1. SHORT TITLE.

This Act may be cited as the ‘Medicaid and SCHIP Beneficiary Choice Improvement Act of 2009’.CommentsClose CommentsPermalink

SEC. 2. EASING ADMINISTRATIVE BARRIERS TO STATE COOPERATION WITH EMPLOYER-SPONSORED INSURANCE COVERAGE.

(a) Requiring Some Coverage for Employer-Sponsored Insurance-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 2102(a) of the Social Security Act (42 U.S.C. 1397b(a)) is amended--CommentsClose CommentsPermalink





(A) in paragraph (6), by striking ‘and’ at the end;CommentsClose CommentsPermalink





(B) in paragraph (7), by striking the period at the end and inserting ‘; and’; andCommentsClose CommentsPermalink





(C) by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(8) effective for plan years beginning on or after October 1, 2010, how the plan will provide for child health assistance with respect to targeted low-income children who have access to coverage under a group health plan.’.CommentsClose CommentsPermalink





(2) EFFECTIVE DATE- The amendments made by paragraph (1) shall apply beginning on October 1, 2010.CommentsClose CommentsPermalink





(b) Federal Financial Participation for Employer-Sponsored Insurance- Section 2105 of such Act (42 U.S.C. 1397d) is amended--CommentsClose CommentsPermalink





(1) in subsection (a)(1)(C), by inserting before the semicolon at the end the following: ‘and, subject to paragraph (3)(C) of subsection (c), in the form of payment of the premiums for coverage under a group health plan that includes coverage of targeted low-income children and benefits supplemental to such coverage’; andCommentsClose CommentsPermalink





(2) by amending paragraph (3) of subsection (c) to read as follows:CommentsClose CommentsPermalink





‘(3) PURCHASE OF EMPLOYER-SPONSORED INSURANCE-CommentsClose CommentsPermalink





‘(A) IN GENERAL- Payment may be made to a State under subsection (a)(1)(C), subject to the provisions of this paragraph, for the purchase of family coverage under a group health plan that includes coverage of targeted low-income children unless such coverage would otherwise substitute for coverage that would be provided to such children but for the purchase of family coverage.CommentsClose CommentsPermalink





‘(B) WAIVER OF CERTAIN PROVISIONS- With respect to coverage described in subparagraph (A)--CommentsClose CommentsPermalink





‘(i) notwithstanding section 2102, no minimum benefits requirement (other than those otherwise applicable with respect to services within the categories of basic services described in section 2103(c)(1) and emergency services) under this title shall apply; andCommentsClose CommentsPermalink





‘(ii) no limitation on beneficiary cost-sharing otherwise applicable under this title or title XIX shall apply.CommentsClose CommentsPermalink





‘(C) REQUIRED PROVISION OF SUPPLEMENTAL BENEFITS- If the coverage described in subparagraph (A) does not provide coverage for the services in each of the categories of basic services described in section 2103(c)(1) and for emergency services, the State child health plan shall provide coverage of such services as supplemental benefits.CommentsClose CommentsPermalink





‘(D) LIMITATION ON FFP- The amount of the payment under subsection (a)(1)(C) for coverage described in subparagraph (A) (and supplemental benefits under subparagraph (C) for individuals so covered) during a fiscal year may not exceed the product of--CommentsClose CommentsPermalink





‘(i) the national per capita expenditure under this title (taking into account both Federal and State expenditures) for the previous fiscal year (as determined by the Secretary using the best available data);CommentsClose CommentsPermalink





‘(ii) the enhanced FMAP for the State and fiscal year involved; andCommentsClose CommentsPermalink





‘(iii) the number of targeted low-income children for whom such coverage is provided.CommentsClose CommentsPermalink





‘(E) VOLUNTARY ENROLLMENT- A State child health plan--CommentsClose CommentsPermalink





‘(i) may not require a targeted low-income child to enroll in family coverage described in subparagraph (A) in order to obtain child health assistance under this title;CommentsClose CommentsPermalink





‘(ii) before providing such child health assistance for such coverage of a child, shall make available (which may be through an Internet website or other means) to the parent or guardian of the child information on the coverage available under this title, including benefits and cost-sharing; andCommentsClose CommentsPermalink





‘(iii) shall provide at least one opportunity per fiscal year for beneficiaries to switch coverage under this title from coverage described in subparagraph (A) to the coverage that is otherwise made available under this title.CommentsClose CommentsPermalink





‘(F) INFORMATION ON COVERAGE OPTIONS- A State child health plan shall--CommentsClose CommentsPermalink





‘(i) describe how the State will notify potential beneficiaries of coverage described in subparagraph (A);CommentsClose CommentsPermalink





‘(ii) provide such notification in writing at least during the initial application for enrollment under this title and during redeterminations of eligibility if the individual was enrolled before October 1, 2010; andCommentsClose CommentsPermalink





‘(iii) post a description of these coverage options on any official Internet website that may be established by the State in connection with the plan.CommentsClose CommentsPermalink





‘(G) SEMIANNUAL VERIFICATION OF COVERAGE- If coverage described in subparagraph (A) is provided under a group health plan with respect to a targeted low-income child, the State child health plan shall provide for the collection, at least once every six months, of proof from the plan that the child is enrolled in such coverage.CommentsClose CommentsPermalink





‘(H) RULE OF CONSTRUCTION- Nothing in this section is to be construed to prohibit a State from--CommentsClose CommentsPermalink





‘(i) offering wrap around benefits in order for a group health plan to meet any State-established minimum benefit requirements;CommentsClose CommentsPermalink





‘(ii) establishing a cost-effectiveness test to qualify for coverage under such a plan;CommentsClose CommentsPermalink





‘(iii) establishing limits on beneficiary cost-sharing under such a plan;CommentsClose CommentsPermalink





‘(iv) paying all or part of a beneficiary’s cost-sharing requirements under such a plan;CommentsClose CommentsPermalink





‘(v) paying less than the full cost of the employee’s share of the premium under such a plan, including prorating the cost of the premium to pay for only what the State determines is the portion of the premium that covers targeted low-income children;CommentsClose CommentsPermalink





‘(vi) using State funds to pay for benefits above the Federal upper limit established under subparagraph (D);CommentsClose CommentsPermalink





‘(vii) allowing beneficiaries enrolled in group health plans from changing plans to another coverage option available under this title at any time; orCommentsClose CommentsPermalink





‘(viii) providing any guidance or information it deems appropriate in order to help beneficiaries make an informed decision regarding the option to enroll in coverage described in subparagraph (A).CommentsClose CommentsPermalink





‘(I) GROUP HEALTH PLAN DEFINED- In this paragraph, the term ‘group health plan’ has the meaning given such term in section 2791(a)(1) of the Public Health Service Act (42 U.S.C. 300gg-91(a)(1)).’.CommentsClose CommentsPermalink

SEC. 3. IMPROVING BENEFICIARY CHOICE IN SCHIP.

(a) Requiring Offering of Alternative Coverage Options- Section 2102 of the Social Security Act (42 U.S.C. 1397b), as amended by section 1, is amended--CommentsClose CommentsPermalink





(1) in subsection (a)--CommentsClose CommentsPermalink





(A) in paragraph (7), by striking ‘and’ at the end;CommentsClose CommentsPermalink





(B) in paragraph (8), by striking the period at the end and inserting ‘; and’; andCommentsClose CommentsPermalink





(C) by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(9) effective for plan years beginning on or after October 1, 2010, how the plan will provide for child health assistance with respect to targeted low-income children through alternative coverage options in accordance with subsection (d).’; andCommentsClose CommentsPermalink





(2) by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(d) Alternative Coverage Options-CommentsClose CommentsPermalink





‘(1) IN GENERAL- Effective October 1, 2010, a State child health plan shall provide for the offering of any qualified alternative coverage that a qualified entity seeks to offer to targeted low-income children through the plan in the State.CommentsClose CommentsPermalink





‘(2) APPLICATION OF UNIFORM FINANCIAL LIMITATION FOR ALL ALTERNATIVE COVERAGE OPTIONS- With respect to all qualified alternative coverage offered in a State, the State child health plan shall establish a uniform dollar limitation on the per capita monthly amount that will be paid by the State to the qualified entity with respect to such coverage provided to a targeted low-income child. Such limitation may not be less than 90 percent of the per capita monthly payment made for coverage offered under the State child health plan that is not in the form of an alternative coverage option. Nothing in this paragraph shall be construed--CommentsClose CommentsPermalink





‘(A) as requiring a State to provide for the full payment of premiums for qualified alternative coverage;CommentsClose CommentsPermalink





‘(B) as preventing a State from charging additional premiums to cover the difference between the cost of qualified alternative coverage and the amount of such payment limitation;CommentsClose CommentsPermalink





‘(C) as preventing a State from using its own funds to provide a dollar limitation that exceeds the Federal financial participation as limited under section 2105(c)(8).CommentsClose CommentsPermalink





‘(3) QUALIFIED ALTERNATIVE COVERAGE DEFINED- In this section, the term ‘qualified alternative coverage’ means health insurance coverage that--CommentsClose CommentsPermalink





‘(A) meets the coverage requirements of section 2103; andCommentsClose CommentsPermalink





‘(B) is offered by a qualified insurer, and not directly by the State.CommentsClose CommentsPermalink





‘(4) QUALIFIED INSURER DEFINED- In this section, the term ‘qualified insurer’ means, with respect to a State, an entity that is licensed to offer health insurance coverage in the State.’.CommentsClose CommentsPermalink





(b) Federal Financial Participation for Qualified Alternative Coverage- Section 2105 of such Act (42 U.S.C. 1397d), as amended by sections 301(a) and 601(a) of the Children’s Health Insurance Program Reauthorization Act of 2009 (Public Law 111-5), is amended--CommentsClose CommentsPermalink





(1) in subsection (a)(1)(C), by inserting before the semicolon at the end the following: ‘and, subject to subsection (c)(12)(C), in the form of payment of the premiums for coverage for qualified alternative coverage’; andCommentsClose CommentsPermalink





(2) by adding at the end of subsection (c) the following new paragraph:CommentsClose CommentsPermalink





‘(12) PURCHASE OF QUALIFIED ALTERNATIVE COVERAGE-CommentsClose CommentsPermalink





‘(A) IN GENERAL- Payment may be made to a State under subsection (a)(1)(C), subject to the provisions of this paragraph, for the purchase of qualified alternative coverage.CommentsClose CommentsPermalink





‘(B) WAIVER OF CERTAIN PROVISIONS- With respect to coverage described in subparagraph (A), no limitation on beneficiary cost-sharing otherwise applicable under this title or title XIX shall apply.CommentsClose CommentsPermalink





‘(C) LIMITATION ON FFP- The amount of the payment under paragraph (1)(C) for coverage described in subparagraph (A) during a fiscal year in the aggregate for all such coverage in the State may not exceed the product of--CommentsClose CommentsPermalink





‘(i) the national per capita expenditure under this title (taking into account both Federal and State expenditures) for the previous fiscal year (as determined by the Secretary using the best available data);CommentsClose CommentsPermalink





‘(ii) the enhanced FMAP for the State and fiscal year involved; andCommentsClose CommentsPermalink





‘(iii) the number of targeted low-income children for whom such coverage is provided.CommentsClose CommentsPermalink





‘(D) VOLUNTARY ENROLLMENT- A State child health plan--CommentsClose CommentsPermalink





‘(i) may not require a targeted low-income child to enroll in coverage described in subparagraph (A) in order to obtain child health assistance under this title;CommentsClose CommentsPermalink





‘(ii) before providing such child health assistance for such coverage of a child, shall make available (which may be through an Internet website or other means) to the parent or guardian of the child information on the coverage available under this title, including benefits and cost-sharing; andCommentsClose CommentsPermalink





‘(iii) shall provide at least one opportunity per fiscal year for beneficiaries to switch coverage under this title from coverage described in subparagraph (A) to the coverage that is otherwise made available under this title.CommentsClose CommentsPermalink





‘(E) INFORMATION ON COVERAGE OPTIONS- A State child health plan shall--CommentsClose CommentsPermalink





‘(i) describe how the State will notify potential beneficiaries of coverage described in subparagraph (A);CommentsClose CommentsPermalink





‘(ii) provide such notification in writing at least during the initial application for enrollment under this title and during redeterminations of eligibility if the individual was enrolled before October 1, 2010; andCommentsClose CommentsPermalink





‘(iii) post a description of these coverage options on any official website that may be established by the State in connection with the plan.CommentsClose CommentsPermalink





‘(F) RULE OF CONSTRUCTION- Nothing in this section is to be construed to prohibit a State from--CommentsClose CommentsPermalink





‘(i) establishing limits on beneficiary cost-sharing under such alternative coverage;CommentsClose CommentsPermalink





‘(ii) paying all or part of a beneficiary’s cost-sharing requirements under such coverage;CommentsClose CommentsPermalink





‘(iii) paying less than the full cost of a child’s share of the premium under such coverage, insofar as the premium for such coverage exceeds the limitation established by the State under subparagraph (C);CommentsClose CommentsPermalink





‘(iv) using State funds to pay for benefits above the Federal upper limit established under subparagraph (C); orCommentsClose CommentsPermalink





‘(v) providing any guidance or information it deems appropriate in order to help beneficiaries make an informed decision regarding the option to enroll in coverage described in subparagraph (A).’.CommentsClose CommentsPermalink

SEC. 4. APPLICATION TO MEDICAID.

In accordance with rules established by the Secretary of Health and Human Services, the requirements imposed under a State child health plan under title XXI of the Social Security Act under the amendments made by the preceding sections of this subtitle shall apply in the same manner to a State plan under title XIX of such Act, except that--CommentsClose CommentsPermalink





(1) such requirements shall not apply to individuals whose eligibility for medical assistance under such title is based on being aged, blind, or disabled or to individuals with a category of individuals described in section 1937(a)(2)(B) of such Act;CommentsClose CommentsPermalink





(2) the national per capita expenditures shall be determined based on a benchmark coverage described in section 1937(b)(1) of such Act but without regard to expenditures for individuals described in paragraph (1) or for nursing facility services and other long-term care services (as determined by the Secretary).CommentsClose CommentsPermalink

SEC. 5. EXPANSION OF HEALTH OPPORTUNITY ACCOUNT PROGRAM.

(a) In General- Section 613 of the Children’s Health Insurance Program Reauthorization Act of 2009 (Public Law 111-3) is repealed.CommentsClose CommentsPermalink





(b) Expansion- Section 1938(a)(2) of the Social Security Act (42 U.S.C. 1396u-8(a)(2)) is amended--CommentsClose CommentsPermalink





(1) in subparagraph (A) by striking everything following the first sentence; andCommentsClose CommentsPermalink





(2) by striking subparagraph (B).CommentsClose CommentsPermalink