110th CONGRESS
1st Session
H. R. 1688
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.
IN THE HOUSE OF REPRESENTATIVES
March 26, 2007
Mr. SCOTT of Virginia introduced the following bill; which was referred
to the Committee on Energy and Commerce, and in addition to the Committee
on Rules, for a period to be subsequently determined by the Speaker, in
each case for consideration of such provisions as fall within the jurisdiction
of the committee concerned
A BILL
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.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS; FINDINGS; PURPOSE.
(a) Short Title- This Act may be cited as the `All Healthy Children Act
of 2007'.
(b) Table of Contents- The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents; findings; purpose.
Sec. 2. Creation of new title XXII of the Social Security Act.
`TITLE XXII--ALL HEALTHY CHILDREN PROGRAM
`Sec. 2201. All Healthy Children Program.
`Sec. 2202. General contents of State all healthy children plan; eligibility;
enrollment.
`Sec. 2203. Benefits; premiums; cost-sharing; provider payment rates.
`Sec. 2204. Payments to States.
`Sec. 2205. Application of SCHIP, medicaid and related SSA provisions;
waivers; administration.
`Sec. 2206. Definitions.
`Sec. 2207. Effective dates; transition.
Sec. 3. Commission on Children's Health Coverage.
(c) Findings- Congress finds the following:
(1) More than nine million children in the United States--one in nine--have
no health insurance coverage.
(2) Every 46 seconds, another baby is born uninsured in the United States.
(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.
(4) The majority of 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.
(5) Millions more children are underinsured or at risk of losing coverage
if their parents change jobs or more employers drop family coverage.
(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.
(7) Uninsured children are more than five times as likely as insured children
to have gone more than two years without a doctor visit.
(8) The majority of uninsured children live in two-parent households and
almost 90 percent live in families where at least one parent works.
(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.
(10) It costs less to provide health insurance coverage to children than
to any other group of people.
(11) Increases in private health insurance costs are dramatically outpacing
increases in wages.
(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.
(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.
(14) Enrollment in health insurance has been associated with improvements
in school.
(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.
(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 50 States and the District of Columbia all medically necessary
services.
SEC. 2. CREATION OF NEW TITLE XXII OF THE SOCIAL SECURITY ACT.
(a) In General- The Social Security Act is amended by adding at the end
the following new title:
`TITLE XXII--ALL HEALTHY CHILDREN PROGRAM
`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 and pregnant and post-partum women in place
of benefits previously provided for children and pregnant and post-partum
women under the Medicaid program under title XIX and the State Children's
Health Insurance Program under title XXI.
`(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--
`(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, and
`(2) has been approved under section 2202.
`(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.
`(d) Private Right of Action-
`(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.
`(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.
`(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.
`(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 or pregnant and post-partum
women receive adequate health care services.
`(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, 2008.
`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--
`(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;
`(2) eligibility standards consistent with subsection (b);
`(3) enrollment and outreach activities consistent with subsection (c);
and
`(4) methods (including monitoring) used--
`(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, and
`(B) to assure access to all medically necessary health care services,
including emergency services.
`(b) Eligibility Standards and Methodology-
`(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:
`(A) FULL SUBSIDY INDIVIDUALS-
`(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)).
`(ii) All pregnant and post-partum women whose family income does
not exceed 300 percent of the poverty line.
`(iii) All children under age 19 and pregnant and post-partum women
who would have qualified for medical assistance under title XIX (as
applied in the State as of October 1, 2005).
`(iv) All children who are meet the requirements of subparagraphs
(A) and (B) of section 1905(w)(1) (relating to independent foster
care adolescents).
`(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. Cost-sharing for transition
coverage may not exceed the amounts the State plan charged for such
individual before receiving transitional assistance.
`(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.
`(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).
`(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.
`(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).
`(5) NO ASSET TEST- The State plan may not impose any asset or resource
test for eligibility.
`(6) CONSTRUCTION- Nothing in this title shall be construed as preventing
a State from covering individuals (such as individuals who are 19 or 20
years of age) who are not all healthy children eligible individuals under
title XIX.
`(7) 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.
`(8) SPECIAL RULES FOR TERRITORIES- In the case of States that are 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, costs of living, and
availability of health care coverage in a manner that assures equitable
access to health coverage for children and pregnant and post-partum women
residing in such States.
`(1) STREAMLINED ENROLLMENT SYSTEM- Each State plan shall provide for
a system of streamlined enrollment that includes the following (as specified
by the Secretary):
`(A) A simple, short application form translated into multiple languages.
`(B) Applicant self-attestation of eligibility, subject to verification,
random audits, or both.
`(C) The option for applications to be submitted in-person, on-line,
by mail, or as part of applications for other programs.
`(D) Automatic enrollment, as provided under paragraph (2).
`(E) 12-month continuous eligibility for children.
`(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.
`(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.
`(2) AUTOMATIC ENROLLMENT PROCEDURES-
`(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:
`(i) Unless the individual otherwise establishes enrollment in health
benefits plan or coverage, at the point of a final determination--
`(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, or
`(II) that, based on the income determinations made as part of such
eligibility determination, the individual is eligible to participate
under this title.
`(ii) Birth of a child in the United States.
`(iii) Assignment of a social security account number for a child.
`(iv) A visit with any health care provider eligible to participate
in the program established under this title.
`(v) Enrollment in any public elementary or secondary school within
the State or any other elementary or secondary school subject to mandatory
immunization requirements.
`(vi) Enrollment in a publicly-subsidized child care program.
`(vii) Upon discharge of a child from a public institution or other
institution where the child has been confined.
`(viii) Such other points of enrollment as the State or Secretary
may establish.
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 Stamp Act of 1977, 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.
`(B) OPERATION OF AUTOMATIC ENROLLMENT-
`(i) IN GENERAL- In the case of automatic enrollment under subparagraph
(A)--
`(I) the enrolled individual (or parents or guardians of such individual)
shall be advised of the level of premiums and cost-sharing applicable
consistent with section 2203 and the fact that enrollment is conditioned
upon payment of any applicable premiums; and
`(II) the failure to pay any initial applicable premiums shall be
treated as an affirmative rejection of coverage.
`(ii) NOTICE- The State plan shall implement effective procedures,
consistent with the Secretary's guidelines, for ensuring that--
`(I) auto-enrolled individuals (or their parents or guardians) understand
their right to decline the coverage made available through auto-enrollment;
and
`(II) after enrollment, they receive confirmation of coverage and
information on benefits.
`(iii) 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.
`(iv) 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.
`(3) OUTREACH- Each State plan shall provide for a system for culturally
and linguistically competent outreach to families of potentially eligible
individuals, which shall--
`(A) be fully accessible to those whose ability to communicate is affected
by disability; and
`(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.
`(d) Avoiding Crowd-Out and Coordination With Other Health Coverage Programs-
`(1) IN GENERAL- The State plan shall include a description of procedures,
consistent with this subsection, to be used to ensure--
`(A) that benefits provided under the State all healthy children plan
do not substitute for coverage under group health plans;
`(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)); and
`(C) coordination with other public and private programs providing creditable
coverage for low-income children and pregnant women.
`(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:
`(A) The individual would have qualified for medical assistance under
title XIX under State law as in effect on October 1, 2005.
`(B) The individual has family income that does not exceed 150 percent
of the poverty line.
`(C) The individual's enrollment under a group health plan--
`(i) ended more than four months before applying for enrollment under
this title; or
`(ii) was involuntarily terminated because of the death of a parent,
job loss, or other circumstance.
`(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.
`(3) SUPPLEMENTAL COVERAGE-
`(A) IN GENERAL- In the case of an all healthy children eligible individual
who is enrolled in a group health plan, the State plan--
`(i) must provide full supplemental coverage (described in subparagraph
(B)) if--
`(I) the individual would have qualified for supplemental coverage
under title XIX under State law as in effect on October 1, 2005;
or
`(II) the individual is disabled (as defined for purposes of the
supplemental security income program under title XVI); and
`(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).
`(B) FULL SUPPLEMENTAL COVERAGE DESCRIBED- Full supplemental coverage
described in this subparagraph includes the following:
`(i) Benefits covered by the State plan that are outside the scope
of benefits offered under the group health plan.
`(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.
`(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.
`(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.
`(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.
`SEC. 2203. BENEFITS; PREMIUMS; COST-SHARING; PROVIDER PAYMENT RATES.
`(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).
`(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
exclusion.
`(b) Premiums- Subject to subsection (d)--
`(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.
`(2) REQUIRED PREMIUMS FOR BUY-IN ELIGIBLE INDIVIDUALS-
`(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 for coverage under this title shall be such premium (as
estimated under a methodology specified by the Secretary) as is equal
to the full average per capita cost of benefits for children (or pregnant
women, as the case may be) under the State all healthy children plan.
`(B) PROVISION OF PREMIUM SUBSIDY-
`(i) IN GENERAL- Subject to clause (ii), in no case shall the premium
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)--
`(I) 7.5 percent of the family income; or
`(II) in the case of multiple eligible individuals within the same
family, 15 percent of family income.
`(ii) LIMITATION- Clause (i) shall not apply for a healthy child eligible
individual in a family if--
`(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;
and
`(II) the individual is not so covered because of a rejection of
such coverage option.
`(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--
`(i) individuals with family income within specific income ranges;
`(ii) individuals with special health care needs; and
`(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).
`(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--
`(i) discounts to encourage the payment of quarterly or annual premiums
in advance;
`(ii) options to make premium payments automatically by credit card,
debit account payments, electronic fund transfers, payroll withholding,
or otherwise; and
`(iii) payment opportunities at multiple, convenient community locations.
`(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, 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.
`(1) LIMITATIONS- Subject to subsection (d), for all healthy children
eligible individuals with a family income that--
`(A) does not exceed 200 percent of the poverty line, there shall be
no out-of-pocket cost-sharing imposed;
`(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;
or
`(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.
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.
`(2) WAIVER- A state may elect to waive or reduce out-of-pocket cost-sharing
otherwise authorized under this subsection.
`(d) Limitations on Out-of-Pocket Costs-
`(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.
`(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.
`(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.
`(f) Reimbursement Rates- The State shall establish under the State plan,
in consultation with appropriate child health providers and experts--
`(1) payment rates for providers that are--
`(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; and
`(B) sufficient in amount to ensure that enrolled all healthy children
eligible individuals have adequate access to all services covered under
this title; and
`(2) payments rates to capitated plans that are actuarially sound, based
on comprehensive encounter data.
`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).
`(b) Computation of Federal All Healthy Children Matching Rate-
`(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--
`(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),
to
`(B) the total expenditures referred to in subparagraph (A).
`(2) STATE SHARE FOR BASIC EXPENDITURES-
`(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:
`(i) BASE AMOUNT- The base FY 2006 amount (specified in subparagraph
(B) for the State).
`(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 2006 to the fiscal year involved.
`(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
2006 to the fiscal year involved.
`(B) BASE FY 2006 AMOUNT- For purposes of this paragraph, the `base
FY 2006 amount' for a State is equal to the sum of--
`(i) the total amount of expenditures made by the State during calendar
quarters in fiscal year 2006 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; and
`(ii) the total amount of expenditures made by the State during calendar
quarters in fiscal year 2006 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.
`(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.
`(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.
`(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.
`(e) Treatment of Territories- In the case of States that are not one of
the 50 States or the District of Columbia, the Secretary shall by regulation
establish an equitable formula for allocating funds to provide services
to all all healthy children eligible individuals residing in such States.
`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.
`(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.
`(c) Limitation on Waivers- No waiver shall be granted under section 1115
with respect to this title if it is likely to result in--
`(1) an increase in health care or health premium costs for all healthy
children eligible individuals under this title; or
`(2) a reduction in benefits, eligibility, guaranteed eligibility, health
care access, or health care quality for such individuals under this title.
`(d) Annual Reports- The Secretary shall present annual reports to Congress
describing implementation of this title. Such reports shall include a description
of--
`(1) optional coverage chosen by States; and
`(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.
`SEC. 2206. DEFINITIONS.
`(a) In General- For purposes of this title:
`(1) ALL HEALTHY CHILDREN ELIGIBLE INDIVIDUAL- The term `all healthy children
eligible individual' means individuals described in section 2202(b)(1).
`(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.
`(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).
`(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.
`(5) STATE- The term `State' has the meaning given such term for purposes
of titles XIX and XXI.
`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,
2008 (in this section referred to as the `All Healthy Children Program effective
date').
`(b) Transition Provisions-
`(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.
`(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).
`(3) GUIDANCE- The Secretary shall provide guidance and assistance to
the States in carrying out this section.
`(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.'.
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').
(1) IN GENERAL- The Commission shall be composed of the following:
(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.
(B) One member appointed by the Secretary of Health and Human Services.
(C) Two members one each appointed by the American Academy of Pediatrics
and by the Institute of Medicine of the National Academies of Science.
(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.
(E) One member appointed by the Secretary of Health and Human Services
who is a representative of a children's advocacy group.
(F) Two non-voting advisory members appointed by the National Governors
Association.
Appointment of members of the Commission shall first be made not later
than 60 days after the date of the enactment of this Act.
(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.
(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.
(4) CHAIR- The Secretary shall designate a member to serve as Chair of
the Commission.
(5) MEETINGS- The Commission shall meet at the call of the Chair.
(6) USE OF COMMITTEES- The Commission may establish committees if necessary
to carry out its duties.
(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).
(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.
(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.
(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.
(D) GIFTS- The Commission may accept, use, and dispose of gifts or donations
of services or property.
(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.
(A) IN GENERAL- The Chair of the Commission may, without regard to the
civil service laws and regulations, appoint and terminate an executive
director and such other additional personnel as may be necessary to
enable the Commission to perform its duties. The employment of an executive
director shall be subject to confirmation by the Commission.
(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.
(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.
(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.
(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.
(f) Annual Reports- Beginning one year after the All Healthy Children Program
effective date, 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 Social
Security Act and recommendations for policy improvements at the State and
national levels and in the private sector to improve such coverage.
(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:
(1) Coverage shall include all medically necessary care for all children.
(2) Enrollment shall be simple and seamless.
(3) Unnecessary costs shall be avoided.
(4) Quality, access and continuity of care shall be promoted.
(h) Expedited Congressional Consideration of Legislative Proposal-
(A) IN GENERAL- Any legislative proposal described in subsection (f)
may be introduced as a bill by request in the following manner:
(i) HOUSE OF REPRESENTATIVES- In the House of Representatives, by
the majority leader and the minority leader not later than 10 days
after receipt of the legislative proposal.
(ii) SENATE- In the Senate, by the majority leader and the minority
leader not later than 10 days after receipt of the legislative proposal.
(B) ALTERNATIVE BY ADMINISTRATION- The President may submit a legislative
proposal based on the recommendations of the Commission and such legislative
proposal may be introduced in the manner described in subparagraph (A).
(2) COMMITTEE CONSIDERATION-
(A) IN GENERAL- Any legislative proposal submitted pursuant to subparagraph
(A) or (B) of paragraph (1) (in this subsection referred to as `implementing
legislation') shall be referred to the appropriate committees of the
House of Representatives and the Senate.
(B) COMMITTEE REPORTING- If, not later than 150 days after the date
on which the implementing legislation is referred to a committee under
subparagraph (A), the committee has reported the implementing legislation
or has reported an original bill whose subject is related to universal
health benefits coverage of children, or to providing access to affordable
health care coverage for all children, the regular rules of the applicable
House of Congress shall apply to such legislation.
(C) DISCHARGE FROM COMMITTEES-
(I) IN GENERAL- If the implementing legislation or an original bill
described in paragraph (1) has not been reported by a committee
of the Senate within 180 days after the date on which such legislation
was referred to committee under subparagraph (A), it shall be in
order for any Senator to move to discharge the committee from further
consideration of such implementing legislation.
(II) SEQUENTIAL REFERRALS- Should a sequential referral of the implementing
legislation be made, the additional committee has 30 days for consideration
of implementing legislation before the discharge motion described
in subclause (I) would be in order.
(III) PROCEDURE- The motion described in subclause (I) shall not
be in order after the implementing legislation has been placed on
the calendar. While the motion described in subclause (I) is pending,
no other motions related to the motion described in subclause (I)
shall be in order. Debate on a motion to discharge shall be limited
to not more than 10 hours, equally divided and controlled by the
majority leader and the minority leader, or their designees. An
amendment to the motion shall not be in order, nor shall it be in
order to move to reconsider the vote by which the motion is agreed
or disagreed to.
(IV) EXCEPTION- If implementing language is submitted on a date
later than May 1 of the second session of a Congress, the committee
shall have 90 days to consider the implementing legislation before
a motion to discharge under this clause would be in order.
(ii) HOUSE OF REPRESENTATIVES- If the implementing legislation or
an original bill described in paragraph (1) has not been reported
out of a committee of the House of Representatives within 180 days
after the date on which such legislation was referred to committee
under subparagraph (A), then on any day on which the call of the calendar
for motions to discharge committees is in order, any member of the
House of Representatives may move that the committee be discharged
from consideration of the implementing legislation, and this motion
shall be considered under the same terms and conditions, and if adopted
the House of Representatives shall follow the procedure described
in sparagraph (4)(A).
(A) MOTION TO PROCEED- If a motion to discharge made pursuant to paragraph
(3)(B)(ii)(I) or (3)(B)(ii)(II) is adopted, then, not earlier than 5
legislative days after the date on which the motion to discharge is
adopted, a motion may be made to proceed to the bill.
(B) FAILURE OF MOTION- If the motion to discharge made pursuant to either
such paragraph fails, such motion may be made not more than 2 additional
times, but in no case more frequently than within 30 days of the previous
motion. Debate on each of such motions shall be limited to 5 hours,
equally divided.
(C) APPLICABLE RULES- Once the Senate is debating the implementing legislation
the regular rules of the Senate shall apply.
END
