HR 747 IHCommentsClose CommentsPermalink

To amend the Social Security Act to provide health insurance coverage for children and pregnant women throughout the United States by combining the children and pregnant woman health coverage under Medicaid and SCHIP into a new All Healthy Children Program, and for other purposes.CommentsClose CommentsPermalink

January 28, 2009CommentsClose CommentsPermalink

Mr. SCOTT of Virginia (for himself, Mr. WATT, Mr. THOMPSON of Mississippi, Mr. BISHOP of Georgia, Mr. JOHNSON of Georgia, Mr. SARBANES, Mr. ROTHMAN of New Jersey, Mr. GRIJALVA, and Ms. MCCOLLUM) introduced the following bill; which was referred to the Committee on Energy and CommerceCommentsClose CommentsPermalink

To amend the Social Security Act to provide health insurance coverage for children and pregnant women throughout the United States by combining the children and pregnant woman health coverage under Medicaid and SCHIP into a new All Healthy Children Program, and for other purposes.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; TABLE OF CONTENTS; FINDINGS; PURPOSE.

(a) Short Title- This Act may be cited as the ‘All Healthy Children Act of 2009’.CommentsClose CommentsPermalink





(b) Table of Contents- The table of contents of this Act is as follows:CommentsClose CommentsPermalink





Sec. 1. Short title; table of contents; findings; purpose.CommentsClose CommentsPermalink





Sec. 2. Creation of new title XXII of the Social Security Act.CommentsClose CommentsPermalink

‘TITLE XXII--ALL HEALTHY CHILDREN PROGRAM

‘Sec. 2201. All Healthy Children Program.CommentsClose CommentsPermalink

‘Sec. 2202. General contents of State All Healthy Children Plan; eligibility; enrollment.CommentsClose CommentsPermalink

‘Sec. 2203. Benefits; premiums; cost-sharing; provider payment rates.CommentsClose CommentsPermalink

‘Sec. 2204. Payments to States.CommentsClose CommentsPermalink

‘Sec. 2205. Application of SCHIP, medicaid and related SSA provisions; waivers; administration.CommentsClose CommentsPermalink

‘Sec. 2206. Definitions.CommentsClose CommentsPermalink

‘Sec. 2207. Effective dates; transition.CommentsClose CommentsPermalink

Sec. 3. Commission on Children’s Health Coverage.CommentsClose CommentsPermalink





(c) Findings- Congress finds the following:CommentsClose CommentsPermalink





(1) More than nine million children in the United States, one in nine, have no health insurance coverage.CommentsClose CommentsPermalink





(2) Every 39 seconds, another baby is born uninsured in the United States.CommentsClose CommentsPermalink





(3) Existing health care programs for low-income children vary widely, with different standards for eligibility, cost-sharing, and benefits in each of the 50 States and the District of Columbia.CommentsClose CommentsPermalink





(4) More than six million uninsured children are eligible for coverage under Medicaid or the State Children’s Health Insurance Program (SCHIP), but are not enrolled in existing programs because of different eligibility and enrollment barriers that make it difficult to obtain or keep coverage.CommentsClose CommentsPermalink





(5) Millions more children are underinsured or at risk of losing coverage if their parents change jobs or more employers drop family coverage.CommentsClose CommentsPermalink





(6) Uninsured children are almost 12 times as likely as insured children to have an untreated medical need and are four times as likely as insured children to have an unmet dental need.CommentsClose CommentsPermalink





(7) Uninsured children are more than five times as likely as insured children to have gone more than two years without a doctor visit.CommentsClose CommentsPermalink





(8) The majority of uninsured children live in two-parent households and almost 90 percent of such children live in families where at least one parent works.CommentsClose CommentsPermalink





(9) An estimated two-thirds of children and adolescents with mental health needs are not getting the care they need and only one in five children with serious emotional disturbances receives specialized treatment.CommentsClose CommentsPermalink





(10) It costs less to provide health insurance coverage to children than to any other group of people.CommentsClose CommentsPermalink





(11) Increases in private health insurance costs are dramatically outpacing increases in wages.CommentsClose CommentsPermalink





(12) The United States spending on health care per person is more than twice the average spent in industrialized countries, yet the United States ranks near the bottom among those countries in infant mortality rates.CommentsClose CommentsPermalink





(13) Children enrolled in a health coverage program experienced significant improvements in health after just one year and significant decreases of limitations in their daily activities.CommentsClose CommentsPermalink





(14) Enrollment in health insurance has been associated with improvements in school.CommentsClose CommentsPermalink





(15) When juvenile offenders arrested for minor offenses had access to intensive and coordinated mental health services, more than a third fewer were re-arrested the following year, compared to those who only had access to basic mental health services.CommentsClose CommentsPermalink





(d) Purpose- It is the purpose of this Act to simplify and consolidate children’s health coverage under Medicaid and SCHIP into a single program that guarantees children in all States, territories, and the District of Columbia all medically necessary services.CommentsClose CommentsPermalink

SEC. 2. CREATION OF NEW TITLE XXII OF THE SOCIAL SECURITY ACT.

The Social Security Act is amended by adding at the end the following new title:CommentsClose CommentsPermalink

‘TITLE XXII--ALL HEALTHY CHILDREN PROGRAMCommentsClose CommentsPermalink

‘SEC. 2201. ALL HEALTHY CHILDREN PROGRAM.

‘(a) In General- There is established under this title a State-operated program receiving Federal financial assistance to provide comprehensive health coverage for children, pregnant women, and post-partum women in place of benefits previously provided for children, pregnant women, and post-partum women under the Medicaid program under title XIX and the State Children’s Health Insurance Program under title XXI.CommentsClose CommentsPermalink





‘(b) State All Healthy Children Plan Required- A State is not eligible for payment under section 2204 unless the State has submitted to the Secretary under section 2202 a plan that--CommentsClose CommentsPermalink





‘(1) sets forth how the State intends to use the funds provided under this title to provide all healthy children assistance to uninsured children and pregnant women consistent with the provisions of this title; andCommentsClose CommentsPermalink





‘(2) has been approved under section 2202.CommentsClose CommentsPermalink





‘(c) State and Individual Entitlement- This title constitutes budget authority in advance of appropriations Acts and represents the obligation of the Federal Government to provide for the payment to States of amounts provided under section 2204. Each individual who is an all healthy children eligible individual and who qualifies for benefits under this title has an entitlement to such benefits in accordance with this title.CommentsClose CommentsPermalink





‘(d) Private Right of Action-CommentsClose CommentsPermalink





‘(1) IN GENERAL- Any person aggrieved by a violation of this title or a failure of an individual or entity, including a State or Federal agency, to comply with the provisions of this title, including any regulation promulgated pursuant to this title, may bring a civil action in any Federal district court, regardless of amount in controversy, or State court of competent jurisdiction to enforce such person’s rights.CommentsClose CommentsPermalink





‘(2) NO EXCLUSION OF OTHER REMEDIES- The availability of a private right of action under this subsection shall not be construed to preclude the ability of any person aggrieved to obtain relief for a violation of this title or a failure of an individual or entity to comply with the provision of this title, or any regulations promulgated pursuant to this title, under any other applicable statute or other basis for relief.CommentsClose CommentsPermalink





‘(3) RELIEF- In an action under this subsection, the court may award all relief allowed by law, including but not limited to compensatory and exemplary damages and injunctive relief, and attorneys’ fees and court costs.CommentsClose CommentsPermalink





‘(4) PERSON AGGRIEVED DEFINED- In this subsection, the term ‘person aggrieved’ includes a child or individual entitled to benefits under this title, the parent or guardian of such child, a provider of services to children or other individuals entitled to such benefits, or an association or other entity whose mission is to ensure that children, pregnant women, or post-partum women receive adequate health care services.CommentsClose CommentsPermalink





‘(e) Effective Date- No State is eligible for payments under section 2204 for all healthy children assistance for coverage provided for periods beginning before October 1, 2010.CommentsClose CommentsPermalink

‘SEC. 2202. GENERAL CONTENTS OF STATE ALL HEALTHY CHILDREN PLAN; ELIGIBILITY; ENROLLMENT.

‘(a) General Contents- A State all healthy children plan shall include a description, consistent with the requirements of this title, of--CommentsClose CommentsPermalink





‘(1) the all healthy children assistance provided under the plan for all healthy children eligible individuals, including the proposed methods of delivery and utilization control systems;CommentsClose CommentsPermalink





‘(2) eligibility standards consistent with subsection (b);CommentsClose CommentsPermalink





‘(3) enrollment and outreach activities consistent with subsection (c); andCommentsClose CommentsPermalink





‘(4) methods (including monitoring) used--CommentsClose CommentsPermalink





‘(A) to assure the quality and appropriateness of care, particularly with respect to pre-natal care, well-baby care, well-child care, and immunizations provided under the plan, andCommentsClose CommentsPermalink





‘(B) to assure access to all medically necessary health care services, including emergency services.CommentsClose CommentsPermalink





‘(b) Eligibility Standards and Methodology-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The all healthy children plan for a State shall provide that all of the following are all healthy children eligible individuals if they are residents:CommentsClose CommentsPermalink





‘(A) FULL SUBSIDY INDIVIDUALS-CommentsClose CommentsPermalink





‘(i) All children under age 19 whose family income does not exceed 300 percent of the poverty line (as defined in section 2110(c)(5)).CommentsClose CommentsPermalink





‘(ii) All pregnant women and post-partum women whose family income does not exceed 300 percent of the poverty line.CommentsClose CommentsPermalink





‘(iii) All children under age 19, pregnant women, and post-partum women who would have qualified for medical assistance under title XIX (as applied in the State as of October 1, 2005).CommentsClose CommentsPermalink





‘(iv) All children under age 19 who meet the requirements of subparagraphs (A) and (B) of section 1905(w)(1) (relating to independent foster care adolescents).CommentsClose CommentsPermalink





‘(B) TRANSITIONAL ASSISTANCE- An individual who loses eligibility as an individual described in subparagraph (A) because of an increase in family income, but only during the 3-month period beginning with the first month in which such eligibility is lost.CommentsClose CommentsPermalink





‘(C) BUY-IN ELIGIBLE INDIVIDUALS- Individuals who, but for the amount of family income, would be an individual described in subparagraph (A) and who are not described in subparagraph (B) if they meet such terms and conditions as the Secretary determines appropriate.CommentsClose CommentsPermalink





‘(2) RESIDENCY REQUIREMENT- For purposes of this title, an individual is a resident of a State if the individual is present in the State with intent to remain, and includes any individual who would be treated as such a resident under title XIX (as in effect as of January 1, 2007).CommentsClose CommentsPermalink





‘(3) POST-PARTUM WOMAN DEFINED- In this title, the term ‘post-partum woman’ means a woman during the period beginning on the date of completion of pregnancy and ending on the last day of the first month that ends at least 60 days after such date.CommentsClose CommentsPermalink





‘(4) INCOME METHODOLOGY- The methodology for determining income under a State all healthy children plan shall not be more restrictive than the income methodology described in section 1931(b)(1)(B), to the extent such methodology is consistent with the requirements of section 1902(a)(17).CommentsClose CommentsPermalink





‘(5) COST-SHARING- Any cost-sharing required by the State to be paid by an individual under paragraph (1)(B) during the period described in that paragraph may not exceed the amount the State plan charged for such individual prior to such period.CommentsClose CommentsPermalink





‘(6) NO ASSET TEST- The State plan may not impose any asset or resource test for eligibility.CommentsClose CommentsPermalink





‘(7) CONSTRUCTION- Nothing in this title shall be construed as preventing a State from covering individuals under Title XIX (such as individuals who are 19 or 20 years of age) who are not all healthy children eligible individuals.CommentsClose CommentsPermalink





‘(8) EXCLUSION OF PUBLIC BENEFIT DEFINITION- The benefits provided under this title shall not be deemed to constitute a Federal or State public benefit within the meaning of title IV of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Public Law 104-193) nor shall any documentation of citizenship be required for the purpose of securing benefits under this title.CommentsClose CommentsPermalink





‘(9) SPECIAL RULES FOR TERRITORIES- In the case of any State that is not one of the 50 States or the District of Columbia, the Secretary may, by regulation, adjust the income eligibility levels set forth in this title, taking into account factors such as average income, cost of living, and availability of health care coverage in a manner that assures the level of access to health coverage for children, pregnant women, and post-partum women residing in such a State is comparable to the level of access for children, pregnant women, and post-partum women residing in the 50 States or the District of Columbia.CommentsClose CommentsPermalink





‘(c) Enrollment-CommentsClose CommentsPermalink





‘(1) STREAMLINED ENROLLMENT SYSTEM- Each State plan shall provide for a system of streamlined enrollment that includes the following (as specified by the Secretary):CommentsClose CommentsPermalink





‘(A) A simple, short application form translated into multiple languages.CommentsClose CommentsPermalink





‘(B) Applicant self-attestation of eligibility, subject to verification, random audits, or both.CommentsClose CommentsPermalink





‘(C) The option for applications to be submitted in-person, on-line, by mail, or as part of applications for other programs.CommentsClose CommentsPermalink





‘(D) Automatic enrollment, as provided under paragraph (2).CommentsClose CommentsPermalink





‘(E) 12-month continuous eligibility for children.CommentsClose CommentsPermalink





‘(F) Presumptive eligibility during an interim period of coverage for individuals who appear to qualify for assistance under this title, on the basis of preliminary information.CommentsClose CommentsPermalink





‘(G) A determination of continued eligibility at the end of an individual’s eligibility period, based on all data available to the State. If such determination cannot be made, the individual or family shall be contacted for additional information, but only to the extent such information is not available to State officials from other sources. The family shall be notified of all determinations and findings and given an opportunity to contest and appeal them. An individual’s eligibility shall continue until the redetermination process is complete.CommentsClose CommentsPermalink





‘(2) AUTOMATIC ENROLLMENT PROCEDURES-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The automatic enrollment procedures under this paragraph shall include enrollment of any all healthy children eligible individual at the following points, unless the individual (or parent or guardian on the individual’s behalf) affirmatively declines such enrollment:CommentsClose CommentsPermalink





‘(i) Unless the individual otherwise establishes enrollment in a health benefits plan or coverage, at the point of a final determination--CommentsClose CommentsPermalink





‘(I) of individual’s eligibility to participate in any federally-funded, means-tested program, regardless of any differences between the program’s eligibility or income methodology and those otherwise used under this title, orCommentsClose CommentsPermalink





‘(II) that, based on the income determinations made as part of such eligibility determination, the individual is eligible to participate under this title.CommentsClose CommentsPermalink





‘(ii) Birth of a child in the United States.CommentsClose CommentsPermalink





‘(iii) Assignment of a social security account number for a child.CommentsClose CommentsPermalink





‘(iv) A visit with any health care provider eligible to participate in the program established under this title.CommentsClose CommentsPermalink





‘(v) Enrollment in any public elementary or secondary school within the State or any other elementary or secondary school subject to mandatory immunization requirements.CommentsClose CommentsPermalink





‘(vi) Enrollment in a publicly subsidized child care program.CommentsClose CommentsPermalink





‘(vii) Upon discharge of a child from a public institution or other institution where the child has been confined.CommentsClose CommentsPermalink





‘(viii) Such other points of enrollment as the State or Secretary may establish.CommentsClose CommentsPermalink





For purposes of this subparagraph, the term ‘federally-funded, means-tested program’ includes the National School Lunch Program under the Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et seq.), the Food Stamp Program under the Food and Nutrition Act of 2008 (7 U.S.C. 2011), the special supplemental nutrition program for women, infants, and children (WIC) under section 17 of the Child Nutrition Act of 1966 (42 U.S.C. 1786), subsidized child care under the Child Care Development Block Grant Act of 1990 (42 U.S.C. 9858 et seq.), programs carried out under the Head Start Act (42 U.S.C. 9831 et seq.), and other means-tested programs designated by the Secretary.CommentsClose CommentsPermalink





‘(B) OPERATION OF AUTOMATIC ENROLLMENT-CommentsClose CommentsPermalink





‘(i) IN GENERAL- In the case of an individual who is automatically enrolled under subparagraph (A) who does not pay any applicable initial premiums, such individual shall be deemed to have affirmatively declined such enrollment and such individual shall be disenrolled from coverage under the all healthy children program under section 2201.CommentsClose CommentsPermalink





‘(ii) NOTICE AT TIME OF ENROLLMENT- The State plan shall implement effective procedures, consistent with the Secretary’s guidelines, for ensuring that, at the time of enrollment, each auto-enrolled individual (or parent or guardian of such individual) is advised of--CommentsClose CommentsPermalink





‘(I) the level of premiums and cost-sharing applicable, consistent with section 2203;CommentsClose CommentsPermalink





‘(II) the fact that enrollment is conditioned upon payment of any applicable premiums; andCommentsClose CommentsPermalink





‘(III) such individual’s right to decline the coverage made available through auto-enrollment.CommentsClose CommentsPermalink





‘(iii) NOTICE AFTER ENROLLMENT- The State plan shall implement effective procedures, consistent with the Secretary’s guidelines, for ensuring that, after enrollment, each auto-enrolled individual (or parent or guardian of such individual) receives confirmation of coverage and information on benefits under the title.CommentsClose CommentsPermalink





‘(iv) EQUAL TREATMENT- A State plan shall implement effective procedures to ensure that individuals covered through auto-enrollment do not receive fewer services, on average, than do similar individuals enrolled through other means.CommentsClose CommentsPermalink





‘(v) INFORMATION SHARING- Each State shall develop the information technology infrastructure needed for automated transmission and analysis of data involving means-tested programs referred to in subparagraph (A) and other sources of data pertinent to eligibility under this title, including State and Federal income tax records and information contained in the National Directory of New Hires. Consistent with standards developed by the Secretary, the State shall implement effective safeguards that protect the confidentiality of such data and limit its use to the effective administration of this title, including an identification of potentially eligible individuals not enrolled in the State plan as well as eligibility verification.CommentsClose CommentsPermalink





‘(3) OUTREACH- Each State plan shall provide for a system for culturally and linguistically competent outreach to families of potentially eligible individuals, which shall--CommentsClose CommentsPermalink





‘(A) be fully accessible to those whose ability to communicate is affected by disability; andCommentsClose CommentsPermalink





‘(B) incorporate proactive communication (via telephone or in-person visits) to such families, consumer education, a preliminary or final eligibility determination, and enrollment completed within a single encounter, whenever possible, and proactive follow-up, when necessary.CommentsClose CommentsPermalink





‘(d) Avoiding Crowd-Out and Coordination With Other Health Coverage Programs-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The State plan shall include a description of procedures, consistent with this subsection, to be used to ensure--CommentsClose CommentsPermalink





‘(A) that benefits provided under the State all healthy children plan do not substitute for coverage under group health plans;CommentsClose CommentsPermalink





‘(B) the provision of all healthy children assistance to all healthy children eligible individuals in the State who are Indians (as defined in section 4(c) of the Indian Health Care Improvement Act, 25 U.S.C. 1603(c)); andCommentsClose CommentsPermalink





‘(C) coordination with other public and private programs providing creditable coverage for low-income children and pregnant women.CommentsClose CommentsPermalink





‘(2) GROUP HEALTH PLAN COVERAGE PERMITTED- Notwithstanding paragraph (1)(A), a State plan may not deny enrollment under this title in the case of any of the following individuals or circumstances:CommentsClose CommentsPermalink





‘(A) The individual would have qualified for medical assistance under title XIX under State law as in effect on October 1, 2005.CommentsClose CommentsPermalink





‘(B) The individual has family income that does not exceed 150 percent of the poverty line.CommentsClose CommentsPermalink





‘(C) The individual’s enrollment under a group health plan--CommentsClose CommentsPermalink





‘(i) ended more than four months before applying for enrollment under this title; orCommentsClose CommentsPermalink





‘(ii) was involuntarily terminated because of the death of a parent, job loss, or other circumstance.CommentsClose CommentsPermalink





‘(D) Other than for the subsidies described in section 2203(b)(2)(B) (in the case of all healthy children eligible individuals with family income that exceeds 300 percent of the poverty line), the failure of a parent or other individual (other than the enrollee) to enroll the all healthy children eligible individual in an available group health plan.CommentsClose CommentsPermalink





‘(3) SUPPLEMENTAL COVERAGE-CommentsClose CommentsPermalink





‘(A) IN GENERAL- In the case of an all healthy children eligible individual who is enrolled in a group health plan, the State plan--CommentsClose CommentsPermalink





‘(i) must provide full supplemental coverage (described in subparagraph (B)) if--CommentsClose CommentsPermalink





‘(I) the individual would have qualified for supplemental coverage under title XIX under State law as in effect on October 1, 2005; orCommentsClose CommentsPermalink





‘(II) the individual is disabled (as defined for purposes of the supplemental security income program under title XVI); andCommentsClose CommentsPermalink





‘(ii) may provide some or all of such coverage to other healthy children eligible individuals (or to reasonable classifications of such individuals, as specified under the State plan).CommentsClose CommentsPermalink





‘(B) FULL SUPPLEMENTAL COVERAGE DESCRIBED- Full supplemental coverage described in this subparagraph includes the following:CommentsClose CommentsPermalink





‘(i) Benefits covered by the State plan that are outside the scope of benefits offered under the group health plan.CommentsClose CommentsPermalink





‘(ii) Reimbursement of families’ premium payments under the group health plan for all healthy children eligible individuals so that costs do not exceed levels otherwise permitted by the State plan.CommentsClose CommentsPermalink





‘(iii) Coverage of out-of-pocket costs incurred under the group health plan where such coverage prevents those costs from exceeding the levels otherwise permitted under the State plan.CommentsClose CommentsPermalink





‘(e) Assistance for Children Who Age Out of Assistance- The State plan shall provide assistance in obtaining health benefits to individuals who lose eligibility under this title because of age.CommentsClose CommentsPermalink





‘(f) Emergency Coverage- When an all healthy children eligible individual enrolled in a State plan in one State moves to another State because of natural disaster or other reasons, the individual shall receive immediate and automatic presumptive eligibility under this title in the State to which the individual moves.CommentsClose CommentsPermalink

‘SEC. 2203. BENEFITS; PREMIUMS; COST-SHARING; PROVIDER PAYMENT RATES.

‘(a) Benefits-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The all healthy children assistance under this title shall include benefits for all medically necessary health care, including early and periodic screening, diagnostic, and treatment services (as defined in section 1905(r)) consistent with the requirements of section 1902(a)(43).CommentsClose CommentsPermalink





‘(2) BENEFIT PROTECTIONS- The State plan shall provide for all benefit protections for all healthy children eligible individuals that would otherwise have applied under title XIX if such individuals were entitled to medical assistance under such title, including the application of no preexisting condition exclusion as defined in section 2701(b)(1)(A) of the Public Health Service Act and section 701(b)(1)(A) of the Employee Retirement Income Security Act of 1974.CommentsClose CommentsPermalink





‘(b) Premiums- Subject to subsection (d)--CommentsClose CommentsPermalink





‘(1) NO PREMIUM FOR LOWER-INCOME INDIVIDUALS- For all healthy children eligible individuals described in subparagraph (A) or (B) of section 2202(b)(1), there shall be no premium imposed for coverage under this title.CommentsClose CommentsPermalink





‘(2) REQUIRED PREMIUMS FOR BUY-IN ELIGIBLE INDIVIDUALS-CommentsClose CommentsPermalink





‘(A) IN GENERAL- Except as provided in this paragraph, in the case of all healthy children eligible individuals described in section 2202(b)(1)(C), the premium charged to an individual for coverage under this title shall be the applicable percentage specified in subparagraph (D) of the total premium. The total premium (as estimated under a methodology specified by the Secretary) shall be equal to the full average per capita cost of benefits for all healthy children eligible individuals under the State all healthy children plan.CommentsClose CommentsPermalink





‘(B) PROVISION OF PREMIUM SUBSIDY-CommentsClose CommentsPermalink





‘(i) IN GENERAL- Subject to clause (ii), in no case shall the premium charged to an individual for coverage under this title exceed (taking into account any private coverage in which the individual is enrolled as well as supplemental coverage purchased under this title)--CommentsClose CommentsPermalink





‘(I) 7.5 percent of the family income; orCommentsClose CommentsPermalink





‘(II) in the case of multiple eligible individuals within the same family, 15 percent of family income.CommentsClose CommentsPermalink





‘(ii) LIMITATION- Clause (i) shall not apply for a healthy child eligible individual in a family if--CommentsClose CommentsPermalink





‘(I) the individual could be covered under a group health plan for which the employer (or other plan sponsor) provides for payment of at least 50 percent of the premium for coverage of such individual; andCommentsClose CommentsPermalink





‘(II) the individual is not so covered because of a rejection of such coverage option by the individual.CommentsClose CommentsPermalink





‘(C) OPTIONAL SUBSIDIES- A State plan may reduce premiums otherwise imposed for reasonable classifications of all healthy children eligible individuals described in section 2202(b)(1)(C). Such classifications may include--CommentsClose CommentsPermalink





‘(i) individuals with family income within specific income ranges;CommentsClose CommentsPermalink





‘(ii) individuals with special health care needs; andCommentsClose CommentsPermalink





‘(iii) individuals who could have qualified for medical assistance under an optional eligibility category under title XIX (as in effect as of January 1, 2007).CommentsClose CommentsPermalink





‘(D) APPLICABLE PERCENTAGE SPECIFIED- For purposes of subparagraph (A), with respect to all healthy children eligible individuals described in section 2202(b)(1)(C), the applicable percentage specified in this subparagraph is as follows:CommentsClose CommentsPermalink





‘(i) In the case of such all healthy children eligible individuals whose income exceeds 300, but does not exceed 320 percent of the poverty line, 25 percent.CommentsClose CommentsPermalink





‘(ii) In the case of such all healthy children eligible individuals whose income exceeds 320, but does not exceed 340 per cent of the poverty line, 35 percent.CommentsClose CommentsPermalink





‘(iii) In the case of such all healthy children eligible individuals whose income exceeds 340, but does not exceed 360 percent of the poverty line, 45 percent.CommentsClose CommentsPermalink





‘(iv) In the case of such all healthy children eligible individuals whose income exceeds 360, but does not exceed 380 percent of the poverty line, 55 percent.CommentsClose CommentsPermalink





‘(v) In the case of such all healthy children eligible individuals whose income exceeds 380, but does not exceed 400 percent of the poverty line, 65 percent.CommentsClose CommentsPermalink





‘(vi) In the case of such all healthy children eligible individuals whose income exceeds 400, but does not exceed 425 percent of the poverty line, 80 percent.CommentsClose CommentsPermalink





‘(vii) In the case of such all healthy children eligible individuals whose income exceeds 425, but does not exceed 450 percent of the poverty line, 90 percent.CommentsClose CommentsPermalink





‘(viii) In the case of such all healthy children eligible individuals whose income exceeds 450 percent of the poverty line, 100 percent.CommentsClose CommentsPermalink





‘(3) PREMIUM PAYMENTS-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The State all healthy children plan shall provide effective measures, consistent with standards established by the Secretary, to make premium payment simple and convenient to parents (or other payers) and to preserve continuity of coverage. Such measures shall include--CommentsClose CommentsPermalink





‘(i) discounts to encourage the payment of quarterly or annual premiums in advance;CommentsClose CommentsPermalink





‘(ii) options to make premium payments automatically by credit card, debit account payments, electronic fund transfers, payroll withholding, or otherwise; andCommentsClose CommentsPermalink





‘(iii) payment opportunities at multiple, convenient community locations.CommentsClose CommentsPermalink





‘(B) PROMOTING CONTINUITY OF COVERAGE- In the case of all healthy children eligible individuals for whom premium payments are required under the State plan, the plan shall have effective procedures to prevent premium non-payment from interrupting continuity of coverage. If there is a default on premium payments, not including the initial premium payment, the State plan shall provide reasonable opportunities to cure such default, including at least a 60-day period, following notice of default, during which overdue premium payments may be made without interrupting coverage or incurring interest charges, late fees, or other costs.CommentsClose CommentsPermalink





‘(c) Cost-Sharing-CommentsClose CommentsPermalink





‘(1) LIMITATIONS- Subject to subsection (d), for all healthy children eligible individuals with a family income that--CommentsClose CommentsPermalink





‘(A) does not exceed 200 percent of the poverty line, there shall be no out-of-pocket cost-sharing imposed;CommentsClose CommentsPermalink





‘(B) does exceed 200 percent, but does not exceed 300 percent, of the poverty line, only nominal out-of-pocket cost-sharing may be imposed; orCommentsClose CommentsPermalink





‘(C) exceeds 300 percent of the poverty line, out-of-pocket cost-sharing charged may not exceed levels the Secretary finds to be consistent with charges under employer-based health insurance for the majority of employees enrolled in such coverage nationally.CommentsClose CommentsPermalink





In no case shall a child described in subparagraph (A) or (B) of section 2202(b)(1) be denied services under this title because of failure to pay out-of-pocket cost-sharing.CommentsClose CommentsPermalink





‘(2) WAIVER- A state may elect to waive or reduce out-of-pocket cost-sharing otherwise authorized under this subsection.CommentsClose CommentsPermalink





‘(d) Limitations on Out-of-Pocket Costs-CommentsClose CommentsPermalink





‘(1) CURRENT MEDICAID- For each all healthy children eligible individual, premiums and out-of-pocket cost-sharing may not exceed the levels that would have been charged for that individual under State Medicaid and SCHIP law as of October 1, 2005, updated in a manner specified by the Secretary based on changes, after that date, to average earnings among families with incomes that do not exceed 200 percent of the poverty line.CommentsClose CommentsPermalink





‘(2) AFFORDABILITY- The State plan shall provide effective measures, consistent with standards established by the Secretary, to further limit out-of-pocket cost-sharing (taking into account both premiums and cost-sharing) of all healthy children eligible individuals to affordable levels, for both individual health care services and total family costs. Such measures may include coding of each individual’s enrollment card. Such measures may not include a requirement that households track incurred costs.CommentsClose CommentsPermalink





‘(e) Choice of Plans- To the extent feasible, a State plan must provide, insofar as the plan provides for benefits through enrollment in a health benefits plan, for each enrollee to have a choice of at least two health plan options, consistent with the requirements of section 1932.CommentsClose CommentsPermalink





‘(f) Reimbursement Rates- The State shall establish under the State plan, in consultation with appropriate child health providers and experts--CommentsClose CommentsPermalink





‘(1) payment rates for providers that are--CommentsClose CommentsPermalink





‘(A) not less than 80 percent of the average of payment rates for similar services for providers under private health insurance plans within that State; andCommentsClose CommentsPermalink





‘(B) sufficient in amount to ensure that enrolled all healthy children eligible individuals have adequate access to all services covered under this title; andCommentsClose CommentsPermalink





‘(2) payments rates to capitated plans that are actuarially sound, based on comprehensive encounter data.CommentsClose CommentsPermalink

‘SEC. 2204. PAYMENTS TO STATES.

‘(a) Payment- Subject to the succeeding provisions of this section, the Secretary shall pay to each State with a plan approved under this title, an amount for each quarter equal to the Federal all healthy children matching rate for the State (as determined under subsection (b)) of the total expenditures under the plan for the quarter, except that the matching rate for the development and operation of information technology shall be the same as the Federal matching percentage in effect for such technology under subparagraphs (A) and (B) of section 1903(a)(3).CommentsClose CommentsPermalink





‘(b) Computation of Federal All Healthy Children Matching Rate-CommentsClose CommentsPermalink





‘(1) IN GENERAL- Subject to paragraph (3), the Federal all healthy children matching rate under this subsection for a State for a calendar quarter in a fiscal year is equal to the ratio of--CommentsClose CommentsPermalink





‘(A) the total expenditures under the State plan under this title for the quarter that are attributable to required populations and services, less the State share of basic expenditures described in paragraph (2), toCommentsClose CommentsPermalink





‘(B) the total expenditures referred to in subparagraph (A).CommentsClose CommentsPermalink





‘(2) STATE SHARE FOR BASIC EXPENDITURES-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The State share of expenditures attributable to required populations and services under this title for a quarter in a fiscal year is equal to 1/4 of the product of the following:CommentsClose CommentsPermalink





‘(i) BASE AMOUNT- The base FY 2010 amount (specified in subparagraph (B) for the State).CommentsClose CommentsPermalink





‘(ii) CHILD INCREASE FACTOR- One plus the percentage increase in the number of children residing in the State, as estimated by the Secretary, from fiscal year 2010 to the fiscal year involved.CommentsClose CommentsPermalink





‘(iii) COST INCREASE FACTOR- One plus the percentage increase in the medical care component of the consumer price index for all urban consumers (U.S. city average), as estimated by the Secretary, from fiscal year 2010 to the fiscal year involved.CommentsClose CommentsPermalink





‘(B) BASE FY 2010 AMOUNT- For purposes of this paragraph, the ‘base FY 2010 amount’ for a State is equal to the sum of--CommentsClose CommentsPermalink





‘(i) the total amount of expenditures made by the State during calendar quarters in fiscal year 2010 under title XIX (including under any waiver under section 1115) that are attributable to coverage of individuals who meet the requirement to be all healthy children eligible individuals, including an appropriate portion of administrative expenses, reduced by the amount of Federal financial participation provided with respect to such expenditures; andCommentsClose CommentsPermalink





‘(ii) the total amount of expenditures made by the State during calendar quarters in fiscal year 2010 under title XXI (including under any waiver under section 1115), reduced by the amount of payment received by the State under such title for such quarters.CommentsClose CommentsPermalink





‘(3) COUNTER-CYCLICAL REDUCTION- The Secretary shall establish a formula for providing, in addition to the base Federal matching amounts, automatic supplemental assistance to States that experience a sustained economic downturn, based upon State’s quarterly unemployment rate exceeding the State’s average of such rates during a period of previous calendar quarters (in such number as the Secretary shall specify) and by a percentage to be determined by the Secretary and in an amount calculated on the basis of the relationship between changes in unemployment and anticipated increases in providing services under this title. The supplemental assistance shall be distributed quarterly through a supplement to the State’s Federal payment and shall be for such duration as the Secretary determines appropriate.CommentsClose CommentsPermalink





‘(c) Bonus for Meeting Enrollment Targets- The Secretary is authorized to establish a system for providing additional bonus payments for States that meet or exceed enrollment targets established for each State by the Secretary, taking into account the circumstances in each State.CommentsClose CommentsPermalink





‘(d) Advance Payment; Retrospective Adjustment- The Secretary may make payments under this section for each quarter on the basis of advance estimates of expenditures submitted by the State and such other investigation as the Secretary may find necessary, and may reduce or increase the payments as necessary to adjust for any overpayment or underpayment for prior quarters.CommentsClose CommentsPermalink





‘(e) Treatment of Territories- In the case of any State that is not one of the 50 States or the District of Columbia, the Secretary shall, by regulation, establish a formula for allocating funds to provide all healthy children assistance in such a State. Such formula shall produce a funding level for such a State that comparable to the level of funding for the provision of all healthy children assistance in the 50 States or the District of Columbia.CommentsClose CommentsPermalink

‘SEC. 2205. APPLICATION OF SCHIP, MEDICAID AND RELATED SSA PROVISIONS; WAIVERS; ADMINISTRATION.

‘(a) SCHIP Provisions Relating to Plan Submission, Strategic Objectives and Performance Goals, and Audits- Except to the extent inconsistent with the provisions of this title, sections 2106, 2107, and 2108(d) shall apply with respect to State plans under this title in the same manner as they applied with respect to State plans under title XXI.CommentsClose CommentsPermalink





‘(b) Medicaid Provisions- Except to the extent inconsistent with the provisions of this title, the provisions of title XIX (and the provisions of title XI, including section 1115, insofar as they are applicable to title XIX) shall apply to activities under this title.CommentsClose CommentsPermalink





‘(c) Limitation on Waivers- No waiver shall be granted under section 1115 with respect to this title if it is likely to result in--CommentsClose CommentsPermalink





‘(1) an increase in health care or health premium costs for all healthy children eligible individuals under this title; orCommentsClose CommentsPermalink





‘(2) a reduction in benefits, eligibility, guaranteed eligibility, health care access, or health care quality for such individuals under this title.CommentsClose CommentsPermalink





‘(d) Annual Reports- The Secretary shall present annual reports to Congress describing implementation of this title. Such reports shall include a description of--CommentsClose CommentsPermalink





‘(1) optional coverage chosen by States; andCommentsClose CommentsPermalink





‘(2) for each category of coverage and method of enrollment, nationwide and State-specific data showing the number and characteristics of all healthy children eligible individuals receiving coverage, services provided, categories and amounts of expenditures.CommentsClose CommentsPermalink

‘SEC. 2206. DEFINITIONS.

‘(a) In General- For purposes of this title:CommentsClose CommentsPermalink





‘(1) ALL HEALTHY CHILDREN ELIGIBLE INDIVIDUAL- The term ‘all healthy children eligible individual’ means individuals described in section 2202(b)(1).CommentsClose CommentsPermalink





‘(2) ALL HEALTHY CHILDREN ASSISTANCE- The term ‘all healthy children assistance’ means payment under this title for part or all of the cost of health benefits coverage for all healthy children eligible individual.CommentsClose CommentsPermalink





‘(3) CHILD, GROUP HEALTH PLAN, AND POVERTY LINE- The terms ‘child’, ‘group health plan’, and ‘poverty line’ have the meanings given such terms in section 2110(c).CommentsClose CommentsPermalink





‘(4) STATE ALL HEALTHY CHILDREN PLAN; STATE PLAN- The terms ‘State all healthy children plan’ and ‘State plan’ mean such a plan as approved under this title.CommentsClose CommentsPermalink





‘(5) STATE- The term ‘State’ has the meaning given such term for purposes of titles XIX and XXI.CommentsClose CommentsPermalink

‘SEC. 2207. EFFECTIVE DATES; TRANSITION.

‘(a) Effective Date- Benefits and payments to States shall first be available under this title for items and services furnished on or after October 1, 2010 (in this section referred to as the ‘All Healthy Children Program effective date’).CommentsClose CommentsPermalink





‘(b) Transition Provisions-CommentsClose CommentsPermalink





‘(1) IN GENERAL- Any child under 19 years of age, any pregnant woman, or any independent foster care adolescent (as defined in section 1905(w)(1)) who, as of the day before the All Healthy Children Program effective date, is enrolled under title XIX or XXI shall, as of such effective date, automatically qualify for and be enrolled in the State plan under this title, with the benefits based on the family income of the individual as most recently determined for purposes of the title under which the individual was enrolled.CommentsClose CommentsPermalink





‘(2) TREATMENT OF SCHIP ADULTS- In the case of an individual not described in paragraph (1) who, as of the day before the All Healthy Children Program effective date, was enrolled under title XXI through a program waiver, during the remainder of such program waiver period, so long as the individual continues to meet the conditions for eligibility under such program waiver, shall be eligible for medical assistance under the State plan under title XIX and, with respect to medical assistance to such individuals, the enhanced FMAP under title XXI shall be substituted for the Federal medical assistance percentage (FMAP) for purposes of section 1903(a)(1).CommentsClose CommentsPermalink





‘(3) GUIDANCE- The Secretary shall provide guidance and assistance to the States in carrying out this section.CommentsClose CommentsPermalink





‘(c) Medicaid; SCHIP Transition- Notwithstanding any other provision of law, as of the All Healthy Children Program effective date, any all healthy children eligible individual shall not be eligible for medical assistance under title XIX or child health assistance under title XXI and no Federal financial participation shall be available under either such title with respect to such individuals.’.CommentsClose CommentsPermalink

SEC. 3. COMMISSION ON CHILDREN’S HEALTH COVERAGE.

(a) Establishment- There is hereby established a Commission on Children’s Health Coverage (in this section referred to as the ‘Commission’).CommentsClose CommentsPermalink





(b) Composition-CommentsClose CommentsPermalink





(1) IN GENERAL- The Commission shall be composed of the following:CommentsClose CommentsPermalink





(A) Four members, one each appointed by the majority and minority leaders of the House of Representatives and the majority and minority leaders of the Senate.CommentsClose CommentsPermalink





(B) One member appointed by the Secretary of Health and Human Services.CommentsClose CommentsPermalink





(C) Two members, one each appointed by the American Academy of Pediatrics and by the Institute of Medicine of the National Academies of Science.CommentsClose CommentsPermalink





(D) One member appointed by the Secretary of Health and Human Services who is a representative of parents of children with special health care needs.CommentsClose CommentsPermalink





(E) One member appointed by the Secretary of Health and Human Services who is a representative of a children’s advocacy group.CommentsClose CommentsPermalink





(F) Two non-voting advisory members appointed by the National Governors Association.CommentsClose CommentsPermalink





Appointment of members of the Commission shall first be made not later than 60 days after the date of the enactment of this Act.CommentsClose CommentsPermalink





(2) TERMS- The term of each member of the Commission shall be for 2 years. A vacancy shall be filled in the same manner as the original appointment but the member so appointed shall serve for the remainder of the term of the vacating member.CommentsClose CommentsPermalink





(3) COMPENSATION- Members of the Commission who are not Federal officers or employees shall be entitled to compensation, including travel time, at a per diem rate equivalent of rate for level IV of Executive Schedule under section 5315 of title 5, United States Code, and for travel expense reimbursement, at rates authorized for employees of agencies under such title.CommentsClose CommentsPermalink





(4) CHAIR- The Secretary shall designate a member to serve as Chair of the Commission.CommentsClose CommentsPermalink





(5) MEETINGS- The Commission shall meet at the call of the Chair.CommentsClose CommentsPermalink





(6) USE OF COMMITTEES- The Commission may establish committees if necessary to carry out its duties.CommentsClose CommentsPermalink





(c) Supermajority Requirement for Actions- Commission actions must be approved by at least six of the members described in subparagraphs (A) through (E) of subsection (b)(1).CommentsClose CommentsPermalink





(d) Administration-CommentsClose CommentsPermalink





(1) POWERS-CommentsClose CommentsPermalink





(A) HEARINGS- The Commission may hold such hearings, sit and act at such times and places, take such testimony, and receive such evidence as the Commission considers advisable to carry out this section.CommentsClose CommentsPermalink





(B) INFORMATION FROM FEDERAL AGENCIES- The Commission may secure directly from any Federal department or agency such information as the Commission considers necessary to carry out this section. Upon request of the Chairperson of the Commission, the head of such department or agency shall furnish such information to the Commission.CommentsClose CommentsPermalink





(C) POSTAL SERVICES- The Commission may use the United States mails in the same manner and under the same conditions as other departments and agencies of the Federal Government.CommentsClose CommentsPermalink





(D) GIFTS- The Commission may accept, use, and dispose of gifts or donations of services or property.CommentsClose CommentsPermalink





(2) COMPENSATION- While serving on the business of the Commission (including travel time), a member of the Commission who is not a Federal officer or employee shall be entitled to compensation at the per diem equivalent of the rate provided for level IV of the Executive Schedule under section 5315 of title 5, United States Code, and while so serving away from home and the member’s regular place of business, any member may be allowed travel expenses, as authorized by the chairperson of the Commission. All members of the Commission who are officers or employees of the United States shall serve without compensation in addition to that received for their services as officers or employees of the United States.CommentsClose CommentsPermalink





(3) STAFF-CommentsClose CommentsPermalink





(A) IN GENERAL- The Chair of the Commission may, without regard to the civil service laws and regulations, appoint and terminate--CommentsClose CommentsPermalink





(i) subject to the approval of a majority of the Commission, an executive director; andCommentsClose CommentsPermalink





(ii) such other additional personnel as may be necessary to enable the Commission to perform its duties.CommentsClose CommentsPermalink





(B) STAFF COMPENSATION- The Chair of the Commission may fix the compensation of the executive director and other personnel without regard to chapter 51 and subchapter III of chapter 53 of title 5, United States Code, relating to classification of positions and General Schedule pay rates, except that the rate of pay for the executive director and other personnel may not exceed the rate payable for level V of the Executive Schedule under section 5316 of such title.CommentsClose CommentsPermalink





(C) DETAIL OF GOVERNMENT EMPLOYEES- Any Federal Government employee may be detailed to the Commission without reimbursement, and such detail shall be without interruption or loss of civil service status or privilege.CommentsClose CommentsPermalink





(D) PROCUREMENT OF TEMPORARY AND INTERMITTENT SERVICES- The Chair of the Commission may procure temporary and intermittent services under section 3109(b) of title 5, United States Code, at rates for individuals which do not exceed the daily equivalent of the annual rate of basic pay prescribed for level V of the Executive Schedule under section 5316 of such title.CommentsClose CommentsPermalink





(e) Reimbursement of Costs- The Secretary shall provide, from general operating funds of the Department of Health and Human Services, the Commission with such funds and support as may be necessary to support its activities.CommentsClose CommentsPermalink





(f) Annual Reports- Beginning one year after the All Healthy Children Program effective date under section 2207(a) of the Social Security Act, the Commission shall transmit to Congress an annual report that evaluates the status of children’s health coverage in the United States, including an evaluation of the implementation of title XXII of the such Act and recommendations for policy improvements at the State and national levels and in the private sector to improve such coverage.CommentsClose CommentsPermalink





(g) Submission of Legislative Proposal for Universal Coverage of Children- Not later than three years after the date of the enactment of this Act, the Commission shall submit to Congress a report that contains a legislative proposal that would assure health benefits coverage for all children in the United States. Such proposal may include a requirement that parents obtain coverage for their children or that employers fund coverage for children of their workers. The proposal shall provide for the following:CommentsClose CommentsPermalink





(1) Coverage shall include all medically necessary care for all children.CommentsClose CommentsPermalink





(2) Enrollment shall be simple and seamless.CommentsClose CommentsPermalink





(3) Unnecessary costs shall be avoided.CommentsClose CommentsPermalink





(4) Quality, access, and continuity of care shall be promoted.CommentsClose CommentsPermalink