CHIP Extension and Improvement Act of 2014 - Revises and extends through FY2019 at generally increased levels the program under title XXI (State Children's Health Insurance) (CHIP) of the Social Security Act (SSA), and adjusts CHIP allotment requirements accordingly, including the rebasing and growth factor update rules for computing state allotments. Makes appropriations for certain allotments.
Directs the Secretary of Health and Human Services (HHS) to make payments to shortfall states from the Child Enrollment Contingency Fund in each of FY2016-FY2019.
Amends the Internal Revenue Code, with respect to minimum essential coverage for a targeted pregnant low-income woman under CHIP, to exclude from such coverage, at a woman's option, pregnancy-related assistance.
Directs the Secretary to issue regulations to ensure continuity of care for children who: (1) are undergoing an active course of treatment; and (2) involuntarily change coverage under health insurance, the state plan under Medicaid (SSA title XIX), or the state child health plan under CHIP during such course of treatment for any reason.
Amends SSA title XIX to allow a state Medicaid plan to provide that an adult determined eligible for Medicaid benefits shall remain eligible for those benefits until the end of a period (not to exceed 12 months) following the determination.
Makes permanent the express lane option and the CHIP outreach and enrollment grant program. Gives states the option to extend express lane Medicaid eligibility to adults.
Makes permanent the program of grants to conduct outreach and enrollment efforts designed to increase the enrollment and participation of eligible children under CHIP.
Requires each contract with a managed care entity under Medicaid to require the provision of and payment for language services for enrolled individuals who are limited English proficient.
Prescribes additional cost-sharing requirements under CHIP.
Amends SSA titles XIX and XXI to cover preventive services for children or pregnant women without cost-sharing.
Amends SSA title XIX to cover newly approved vaccines within 30 days after the Advisory Committee on Immunization Practices approves them. Treats CHIP-eligible children as federally vaccine-eligible children.
Extends Medicaid coverage of primary care services through calendar 2019, and expands the types of physicians and health care practitioners eligible for reimbursement for providing such services.
Amends SSA title XI to extend the pediatric quality measures program through calendar 2019.
Revises the federal medical assistance percentage (FMAP, or federal matching rate) for activities related to pediatric quality measures.
Extends the technical assistance provided to states in adopting and utilizing certain core sets of child health measures to assistance in building their data collection infrastructures as well.
Revises requirements for initial core measures.
Directs the Secretary to report to Congress on the core set of child health quality measures.
Modifies and extends through FY2019: (1) the demonstration projects for improving the quality of children's health care and the use of health information technology, and (2) funding for childhood obesity demonstration projects.
Amends SSA title V (Maternal and Child Health Services) to extend funding through FY2019 for maternal, infant, and early childhood home visiting programs.
Amends the Patient Protection and Affordable Care Act to extend through calendar 2019 the Pediatric Accountable Care Organization Demonstration Project.
Amends SSA title XIX to cover therapeutic foster care services.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5364 Introduced in House (IH)]
113th CONGRESS
2d Session
H. R. 5364
To amend title XXI of the Social Security Act to extend and improve the
Children's Health Insurance Program, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 31, 2014
Mr. Pallone (for himself, Mr. Waxman, Ms. Schakowsky, Ms. Castor of
Florida, Mrs. Capps, Mrs. Christensen, Mr. Gene Green of Texas, Mr.
Dingell, Mr. Butterfield, Mr. Sarbanes, Mr. Engel, and Mr. Matheson)
introduced the following bill; which was referred to the Committee on
Energy and Commerce, and in addition to the Committee on Ways and
Means, 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 title XXI of the Social Security Act to extend and improve the
Children's Health Insurance 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; AMENDMENTS TO SOCIAL SECURITY ACT; REFERENCES;
TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``CHIP Extension and
Improvement Act of 2014''.
(b) References to CHIP; Medicaid; Secretary.--In this Act:
(1) CHIP.--The term ``CHIP'' means the State Children's
Health Insurance Program established under title XXI of the
Social Security Act (42 U.S.C. 1397aa et seq.) (whether
implemented under title XIX, XXI, or both, of the Social
Security Act).
(2) Medicaid.--The term ``Medicaid'' means the program for
medical assistance established under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).
(3) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(c) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; amendments to Social Security Act; references;
table of contents.
Sec. 2. General effective date; exception for State legislation;
reliance on law.
TITLE I--FINANCING
Sec. 101. 4-year extension of CHIP funding.
Sec. 102. Performance incentive program improvements.
Sec. 103. Child enrollment contingency fund adjustment.
TITLE II--COVERAGE STABILITY AND REDUCED BUREAUCRACY
Sec. 201. Improving coverage stability.
Sec. 202. Assuring care continuity during transitions among CHIP,
Medicaid, and qualified health plans.
Sec. 203. Continuous eligibility option for certain adults.
Sec. 204. State flexibility to use administrative simplification
policies for enrollment.
Sec. 205. Outreach to targeted populations.
TITLE III--BENEFITS AND AFFORDABILITY
Sec. 301. Strengthened cost-sharing protections under CHIP.
Sec. 302. Ensuring coverage of preventive health services under
Medicaid and CHIP.
Sec. 303. Timely immunization coverage.
Sec. 304. Payment parity for Medicaid primary care services.
TITLE IV--ACCESS AND QUALITY
Subtitle A--Pediatric Quality Measures
Sec. 401. Extending the pediatric quality measures program.
Sec. 402. Enhanced FMAP for activities related to pediatric quality
measures.
Sec. 403. Reporting of full set of pediatric quality measures.
Sec. 404. Technical assistance to States for adopting and utilizing
pediatric quality measures.
Sec. 405. Improving the effectiveness of the pediatric quality
measures.
Sec. 406. Reports regarding State-specific quality of care measures
applied under Medicaid or CHIP.
Sec. 407. Advisory panel regarding pediatric quality.
Sec. 408. Extending and expanding demonstration projects.
Subtitle B--Continuing Delivery System Reform
Sec. 411. Supporting evidence-based care coordination in communities.
Sec. 412. Ensuring care coordination for children.
Subtitle C--Miscellaneous
Sec. 421. Assuring coverage continuity for former foster care children.
Sec. 422. Definition of therapeutic foster care as medical assistance.
Sec. 423. Technical correction.
SEC. 2. GENERAL EFFECTIVE DATE; EXCEPTION FOR STATE LEGISLATION;
RELIANCE ON LAW.
(a) General Effective Date.--Unless otherwise provided in this Act,
subject to subsections (b) and (c), this Act (and the amendments made
by this Act) shall take effect on October 1, 2014, and shall apply to
medical assistance and child health assistance furnished under titles
XIX and XXI, respectively, of the Social Security Act on or after that
date.
(b) Exception for State Legislation.--In the case of a State plan
under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) or
a State child health plan under title XXI of such Act (42 U.S.C. 1397aa
et seq.), which the Secretary determines requires State legislation in
order for the respective plan to meet one or more additional
requirements imposed by amendments made by this Act, the respective
plan shall not be regarded as failing to comply with the requirements
of such title solely on the basis of its failure to meet such an
additional requirement before the first day of the first calendar
quarter beginning after the close of the first regular session of the
State legislature that begins after the date of enactment of this Act.
For purposes of the previous sentence, in the case of a State that has
a 2-year legislative session, each year of the session shall be
considered to be a separate regular session of the State legislature.
(c) Coordination of CHIP Funding for Fiscal Year 2015.--
Notwithstanding any other provision of law, insofar as funds have been
appropriated under subsection (a)(18) or (m) of section 2104 of the
Social Security Act (42 U.S.C. 1397dd), as such subsections are in
effect on the day before the date of the enactment of this Act, to
provide allotments to States under CHIP for fiscal year 2015--
(1) any amounts that are so appropriated that are not so
allotted and obligated before April 1, 2015, are rescinded; and
(2) any amount provided for CHIP allotments to a State
under this Act (and the amendments made by this Act) for such
fiscal year shall be reduced by the amount of such
appropriations so allotted and obligated before such date.
(d) Reliance on Law.--With respect to amendments made by this Act
that become effective as of a date--
(1) such amendments are effective as of such date whether
or not regulations implementing such amendments have been
issued; and
(2) Federal financial participation for medical assistance
or child health assistance furnished under title XIX or XXI,
respectively, of the Social Security Act on or after such date
by a State in good faith reliance on such amendments before the
date of promulgation of final regulations, if any, to carry out
such amendments (or before the date of guidance, if any,
regarding the implementation of such amendments) shall not be
denied on the basis of the State's failure to comply with such
regulations or guidance.
TITLE I--FINANCING
SEC. 101. 4-YEAR EXTENSION OF CHIP FUNDING.
(a) Funding.--Section 2104(a) of the Social Security Act (42 U.S.C.
1397dd(a)) is amended--
(1) in paragraph (17), by striking ``and'' at the end;
(2) by striking paragraph (18) and inserting the following
new paragraph:
``(18) for fiscal year 2015, $21,061,000,000;''; and
(3) by adding at the end the following new paragraphs:
``(19) for fiscal year 2016, $19,300,000,000;
``(20) for fiscal year 2017, $20,300,000,000;
``(21) for fiscal year 2018, $21,300,000,000; and
``(22) for fiscal year 2019, for purposes of making 2 semi-
annual allotments--
``(A) $2,850,000,000 for the period beginning on
October 1, 2018, and ending on March 31, 2019; and
``(B) $2,850,000,000 for the period beginning on
April 1, 2019, and ending on September 30, 2019.''.
(b) Allotments.--
(1) In general.--Section 2104(m) of the Social Security Act
(42 U.S.C. 1397dd(m)) is amended--
(A) in the subsection heading, by striking ``2015''
and inserting ``2019'';
(B) in paragraph (2)--
(i) in the paragraph heading, by striking
``2014'' and inserting ``2018''; and
(ii) by striking subparagraph (B) and
inserting the following new subparagraph:
``(B) Fiscal year 2013 and each succeeding fiscal
year.--Subject to paragraphs (4) and (6), from the
amount made available under paragraphs (16) through
(21) of subsection (a) for fiscal year 2013 and each
succeeding fiscal year, respectively, the Secretary
shall compute a State allotment for each State
(including the District of Columbia and each
commonwealth and territory) for each such fiscal year
as follows:
``(i) Rebasing in fiscal year 2013 and each
succeeding odd-numbered fiscal year.--For
fiscal year 2013 and each succeeding odd-
numbered fiscal year, the allotment of the
State is equal to the Federal payments to the
State that are attributable to (and countable
toward) the total amount of allotments
available under this section to the State in
the preceding fiscal year (including payments
made to the State under subsection (n) for such
preceding fiscal year as well as amounts
redistributed to the State in such preceding
fiscal year), multiplied by the allotment
increase factor under paragraph (5) for such
odd-numbered fiscal year.
``(ii) Growth factor update for fiscal year
2014 and each succeeding even-numbered fiscal
year.--For fiscal year 2014 and each succeeding
even-numbered fiscal year, the allotment of the
State is equal to the sum of--
``(I) the amount of the State
allotment under clause (i) for the
preceding fiscal year; and
``(II) the amount of any payments
made to the State under subsection (n)
for such preceding fiscal year,
multiplied by the allotment increase factor
under paragraph (5) for such even-numbered
fiscal year.'';
(C) in paragraph (3)--
(i) in the heading, by striking ``2015''
and inserting ``2019'';
(ii) in subparagraph (A), by striking
``paragraph (18)'' and inserting ``paragraph
(22)'';
(iii) in subparagraph (B), by striking
``paragraph (18)'' and inserting ``paragraph
(22)'';
(iv) in subparagraph (C)--
(I) by striking ``2014'' each place
it appears and inserting ``2018''; and
(II) by striking ``2015'' and
inserting ``2019''; and
(v) in subparagraph (D)--
(I) in clause (i)--
(aa) in subclause (I), by
striking ``subsection
(a)(18)(A)'' and inserting
``subsection (a)(22)(A)''; and
(bb) in subclause (II), by
striking ``section 108 of the
Children's Health Insurance
Program Reauthorization Act of
2009'' and inserting ``section
101(b)(2) of the CHIP Extension
and Improvement Act of 2014'';
and
(II) in clause (ii)(II), by
striking ``subsection (a)(18)(B)'' and
inserting ``subsection (a)(22)(B)'';
(D) in paragraph (4), by striking ``2015'' and
inserting ``2019'';
(E) in paragraph (6)--
(i) in subparagraph (A), by striking
``2015'' and inserting ``2019''; and
(ii) in the second sentence, by striking
``or fiscal year 2014'' and inserting ``fiscal
year 2014, fiscal year 2016, or fiscal year
2018''; and
(F) in paragraph (8)--
(i) in the paragraph heading, by striking
``2015'' and inserting ``2019''; and
(ii) by striking ``for a period in fiscal
year 2015'' and inserting ``for a period in
fiscal year 2019''.
(2) Supplemental appropriation for fiscal year 2019.--There
is appropriated to the Secretary, out of any money in the
Treasury not otherwise appropriated, $16,700,000,000 to
accompany the allotment made for the period beginning on
October 1, 2018, and ending on March 31, 2019, under section
2104(a)(22)(A) of the Social Security Act (42 U.S.C.
1397dd(a)(22)(A)) (as added by subsection (a)), to remain
available until expended. Such amount shall be used to provide
allotments to States under paragraph (3) of section 2104(m) of
such Act (42 U.S.C. 1397dd(m)) (as amended by paragraph (1)(C))
for the first 6 months of fiscal year 2019 in the same manner
as allotments are provided under subsection (a)(22)(A) of such
section 2104 and subject to the same terms and conditions as
apply to the allotments provided from such subsection
(a)(22)(A).
(c) Extension of Qualifying States Option.--Section 2105(g)(4) of
the Social Security Act (42 U.S.C. 1397ee(g)(4)) is amended--
(1) in the paragraph heading, by striking ``2015'' and
inserting ``2019''; and
(2) in subparagraph (A), by striking ``2015'' and inserting
``2019''.
SEC. 102. PERFORMANCE INCENTIVE PROGRAM IMPROVEMENTS.
(a) Extension Through Fiscal Year 2019.--Section 2105(a)(3) of the
Social Security Act (42 U.S.C. 1397ee(a)(3)) is amended--
(1) in subparagraph (A), by striking ``2013'' and inserting
``2019'';
(2) in subparagraph (E)--
(A) in clause (ii)--
(i) in the matter preceding subclause (I),
by inserting ``after the application of section
2104(n)(3)(D)(ii) with respect to such
amounts,'' after ``limitation,'';
(ii) by striking subclause (I) and
inserting the following new subclause:
``(I) Unobligated national
allotment for fiscal years 2009 through
2015.--As of December 31 of fiscal year
2009, and as of December 31 of each
succeeding fiscal year through fiscal
year 2015, the portion, if any, of the
amount appropriated under section
2104(a) for such fiscal year that is
unobligated for allotment to a State
under section 2104(m) for such fiscal
year or set aside under subsection
(a)(3) or (b)(2) of section 2111 for
such fiscal year.'';
(iii) in subclause (II), by striking
``2013'' and inserting ``2015''; and
(iv) in subclause (III), by striking
``2013'' and inserting ``2015'';
(B) by redesignating clause (iii) as clause (iv);
and
(C) by inserting after clause (ii), the following
new clause:
``(iii) Appropriation for fiscal years 2016
through 2019.--Out of any money in the Treasury
not otherwise appropriated, there are
appropriated $500,000,000 for each of fiscal
years 2016 through 2019 for making payments
under this paragraph. Amounts appropriated for
a fiscal year under this clause shall remain
available for making payments under this
paragraph until January 1 of the following
fiscal year. Any amounts of such appropriations
that remain unexpended or unobligated as of
such date shall be transferred and made
available for making payments under section
2104(n).''; and
(3) in subparagraph (F)(iii), by striking ``2013'' and
inserting ``2019''.
(b) Updated Performance Incentive Criteria for Fiscal Years 2015
Through 2019.--Section 2105(a) of the Social Security Act (42 U.S.C.
1397ee(a)) is amended--
(1) in paragraph (3)(A), by inserting ``or (5)'' after
``paragraph (4)'';
(2) in paragraph (4)--
(A) in the heading, by inserting ``fiscal years
2009 through 2014'' after ``for children''; and
(B) in the matter preceding subparagraph (A), by
striking ``for a fiscal year if'' and inserting ``for
fiscal years 2009 through 2014 if''; and
(3) by adding at the end the following new paragraph:
``(5) Enrollment and retention provisions for children for
fiscal year 2015 and succeeding fiscal years.--
``(A) In general.--For purposes of paragraph
(3)(A), a State meets the condition of this paragraph
for fiscal year 2015 and any succeeding fiscal year if
it is implementing at least 5 of the enrollment and
retention provisions specified in subparagraph (B)
(treating each clause as a separate enrollment and
retention provision) throughout the entire fiscal year.
``(B) Enrollment and retention provisions.--The
enrollment and retention provisions specified in this
subparagraph are the following:
``(i) Continuous eligibility.--The State
has elected the option of continuous
eligibility for a full 12 months for all
children (as defined in section
1902(e)(13)(G)), as well as applying such
policy under its State child health plan under
this title.
``(ii) Express lane eligibility.--The State
is implementing the option described in section
1902(e)(13) under title XIX as well as,
pursuant to section 2107(e)(1), under this
title.
``(iii) Presumptive eligibility.--The State
is implementing section 1920A under title XIX
as well as, pursuant to section 2107(e)(1),
under this title.
``(iv) Premium assistance for employer-
sponsored plans.--The State is implementing
section 1906A under title XIX or the option
described in section 2105(c)(10) under this
title.
``(v) Seamless coverage options.--In the
case of a State that provides medical
assistance under the State plan under title XIX
through managed care entities (as defined in
section 1932(a)(1)(B)) or health benefits
coverage under the State child health plan
through such entities, the State shall ensure
that at least one such entity offers a
qualified health plan through the Exchange
established under title I of the Patient
Protection and Affordable Care Act in the
State.
``(vi) Retroactive coverage reinstatement
upon premium payment.--The State child health
plan, in the case of an individual whose
coverage under the plan has been terminated for
failure to make premium payments, provides
assistance to such individual for purposes of
the immediate reenrollment of the individual
upon payment of outstanding premiums, with
coverage retroactive to the beginning of the
most recent month for which an outstanding
premium has been paid, and shall not impose any
waiting period or fee as a condition of such
reenrollment.
``(vii) Effective transition to the
community for vulnerable youth.--
``(I) In general.--Subject to the
subdivision (A) following paragraph
(29) of section 1905(a), the State,
before the date of the release of an
eligible juvenile from any public
institution, and notwithstanding that
the juvenile is an inmate of a public
institution--
``(aa) screens for
eligibility for and processes
any application for medical
assistance submitted by, or on
behalf of, such an eligible
juvenile; and
``(bb) refers such juvenile
to health care providers for
purposes of receiving the
services described in section
1905(a)(4)(B) (relating to
early and periodic screening,
diagnostic, and treatment
services defined in section
1905(r)).
``(II) Eligible juvenile.--For
purposes of subclause (I), the term
`eligible juvenile' means an individual
who--
``(aa) is under 19 years of
age (or such higher age as the
State has elected under section
475(8)(B)(iii)); and
``(bb) is an inmate of a
public institution.
``(III) Inmate of a public
institution.--For purposes of this
clause, the term `inmate of a public
institution' has the meaning given such
term for purposes of applying the
subdivision (A) following paragraph
(29) of section 1905(a), taking into
account the exception in such
subdivision for a patient of a medical
institution.''.
SEC. 103. CHILD ENROLLMENT CONTINGENCY FUND ADJUSTMENT.
(a) In General.--Section 2104(n) of the Social Security Act (42
U.S.C. 1397dd(n)) is amended--
(1) in paragraph (2)--
(A) by striking ``2014'' and inserting ``2018''
each place it appears in subparagraphs (A)(ii) and (B);
and
(B) by striking ``2015'' and inserting ``2019''
each place it appears in subparagraphs (A)(ii) and (B);
(2) in paragraph (3)--
(A) in subparagraph (A)--
(i) in the heading, by striking ``In
general'' and inserting ``Fiscal years 2009
through 2015'';
(ii) in the matter preceding clause (i)--
(I) by striking ``a semi-annual
allotment period for''; and
(II) by striking ``(determined
without regard to any redistribution it
receives under subsection (f) that is
available for expenditure during such
fiscal year or period, but including
any carryover from a previous fiscal
year)'';
(iii) by striking ``or period'' each place
it appears; and
(iv) in clause (ii), by striking ``(or in
which the period occurs)'';
(B) in subparagraph (B)(ii), by striking ``(or
semi-annual period occurring in a fiscal year)'';
(C) in subparagraph (C)(ii), by striking ``(or
semi-annual period occurring in a fiscal year)'';
(D) by redesignating subparagraphs (D), (E), (F),
and (G) as subparagraphs (E), (F), (G), and (H),
respectively;
(E) by inserting after subparagraph (C) the
following new subparagraph:
``(D) Fiscal years 2016 through 2019.--
``(i) In general.--For each of fiscal years
2016 through 2018 and each semi-annual
allotment period for fiscal year 2019, if the
Secretary determines that a State is a
shortfall State described in subparagraph (I)
for that fiscal year or period, the Secretary
shall pay the State from the Fund, in addition
to any other payments made to a State under
this title for the fiscal year or period an
amount equal to the amount of projected
expenditures for the State under this title for
the fiscal year or period that exceeds the sum
determined under subparagraph (I) for the State
and fiscal year or period.
``(ii) Transfers.--Notwithstanding any
other provision of this title, the following
amounts shall also be available, without fiscal
year limitation, for making payments from the
Fund:
``(I) Unobligated national
allotment for fiscal years beginning
with fiscal year 2016.--As of December
31 of fiscal year 2016, and as of
December 31 of each succeeding fiscal
year, the portion, if any, of the
amount appropriated under subsection
(a) for such fiscal year that is
unobligated for allotment to a State
under subsection (m) for such fiscal
year.
``(II) Unexpended allotments not
used for redistribution.--As of
November 15 of fiscal year 2016 and
each succeeding fiscal year, the total
amount of allotments made to States
under subsection (a) for the second
preceding fiscal year that is not
expended or redistributed under
subsection (f) during the period in
which such allotments are available for
obligation.
``(III) Unexpended performance
incentive funds.--As of September 1,
2017, and as of September 1 of each
succeeding calendar year, the portion,
if any, of the amount appropriated
under subparagraph (E)(iii) of section
2105(a)(3) for the preceding fiscal
year that is not expended or obligated
under such section.
``(iii) Investment of fund.--The Secretary
of the Treasury shall invest, in interest
bearing securities of the United States, such
currently available portions of the Fund as are
not immediately required for payments from the
Fund. The income derived from these investments
constitutes a part of the Fund.'';
(F) in subparagraph (E) (as so redesignated), by
inserting ``or (D)'' after ``subparagraph (A)''; and
(G) in subparagraph (H) (as so redesignated), by
inserting ``and regarding the expenditures under the
State child health plan'' after ``subparagraphs (A) and
(B)''; and
(3) by adding at the end the following new subparagraph:
``(I) Shortfall states described.--For purposes of
subparagraph (D), with respect to a fiscal year or
semi-annual allotment period, a shortfall State is a
State for which the Secretary estimates, on the basis
of the most recent data available to the Secretary,
that the projected expenditures for the State for the
fiscal year or period under this title (including in
the form of coverage described in paragraph (1) or (2)
of section 2101, or both) will exceed the sum of--
``(i) the amount of the State's allotments
for any preceding fiscal year or period that
remains available for expenditure and that will
not be expended by the end of the immediately
preceding fiscal year;
``(ii) the amount (if any) that will be
redistributed to the State under subsection (f)
for the fiscal year or period;
``(iii) the portion, if any, of the amount
appropriated under subparagraph (E)(iii) of
section 2105(a)(3) for the preceding fiscal
year or period that is not expended or
obligated under such section; and
``(iv) the amount of the State's allotment
for the fiscal year or period.''.
(b) Conforming Amendments.--Section 2104(f)(2)(A) of the Social
Security Act (42 U.S.C. 13957dd(f)(2)(A)) is amended--
(1) in clause (i), by inserting ``and'' at the end;
(2) by striking clause (ii); and
(3) by redesignating clause (iii) as clause (ii).
TITLE II--COVERAGE STABILITY AND REDUCED BUREAUCRACY
SEC. 201. IMPROVING COVERAGE STABILITY.
(a) In General.--Section 2102(b)(1)(B) of the Social Security Act
(42 U.S.C. 1397bb(b)(1)(B)) is amended--
(1) in clause (iii), by striking ``in the case of a
targeted low-income pregnant woman provided pregnancy-related
assistance under section 2112''; and
(2) in clause (iv), by striking ``at State option,''.
(b) Conforming Amendments.--
(1) Section 2105(c)(10) of the Social Security Act (42
U.S.C. 1397(ee)(10)) is amended--
(A) by striking subparagraph (F); and
(B) by redesignating subparagraphs (G) through (M)
as subparagraphs (F) through (L), respectively.
(2) Section 2112(b)(5) of the Social Security Act (42
U.S.C. 1397ll(b)(5)) is amended--
(A) in the heading, by striking ``or waiting
period''; and
(B) by striking ``or any waiting period'' and all
that follows through ``receipt of such assistance''.
(c) Effective Date.--The amendments made by this section shall take
effect on the date of enactment of this Act.
SEC. 202. ASSURING CARE CONTINUITY DURING TRANSITIONS AMONG CHIP,
MEDICAID, AND QUALIFIED HEALTH PLANS.
(a) Minimum Essential Coverage.--
(1) In general.--Section 5000A(f) of the Internal Revenue
Code of 1986 is amended by adding at the end the following:
``(6) Pregnancy-related assistance under chip.--With
respect to a targeted low-income pregnant woman (as defined in
section 2112(d)(2) of the Social Security Act (42 U.S.C.
1397ll(d)(2))), notwithstanding paragraph (1)(A)(iii), the term
`minimum essential coverage', at the option of such a woman,
shall not include pregnancy-related assistance (as defined in
section 2112(d)(1) of the Social Security Act (42 U.S.C.
1397ll(d)(1))).''.
(2) Effective date.--The amendment made by this subsection
applies to taxable years beginning after December 31, 2014.
(b) Continuity of Care.--The Secretary of Health and Human Services
shall issue regulations for purposes of ensuring continuity of care for
children who--
(1) are undergoing an active course of treatment; and
(2) involuntarily change coverage under health insurance,
the State plan under the Medicaid program under title XIX of
the Social Security Act, or the State child health plan under
title XXI of such Act during such course of treatment for any
reason, including a reason related to a change in income,
health plan termination, or a material change or changes to the
plan's health benefits coverage.
(c) Ensuring Comparability of Coverage.--
(1) In general.--Not later than 18 months after the date of
the enactment of the CHIP Extension and Improvement Act of
2014, the Secretary of Health and Human Services shall review,
with respect to a State, the benefits (by each benefit class)
offered for children and the cost-sharing imposed with respect
to such benefits by qualified health plans offered through an
Exchange established under title I of the Patient Protection
and Affordable Care Act in the State. The Secretary shall make
the findings of such review available on the public Internet
site of the Department of Health and Human Services.
(2) Regulations required.--If, following such review, the
Secretary determines that benefits and cost-sharing protections
referred to in paragraph (1) are not comparable to the benefits
(by each benefit class) offered and cost-sharing protections
provided under the State child health plan under title XXI of
the Social Security Act (42 U.S.C. 1397aa et seq.) in the
State, the Secretary, not later than January 1, 2017, shall
issue a rule, to apply with respect to plan years beginning in
2019, establishing requirements designed to ensure that such
qualified health plans offer benefits and cost-sharing
protections that are comparable to the benefits and cost-
sharing protections provided under such State child health plan
for plan year 2019.
SEC. 203. STATE FLEXIBILITY TO PROVIDE FOR CONTINUOUS ELIGIBILITY.
Section 1902(e)(12) of the Social Security Act (42 U.S.C.
1396a(e)(12)) is amended to read as follows:
``(12) Continuous eligibility option.--
``(A) Children.--At the option of the State, the
plan may provide that a child (as defined in paragraph
(13)(G)) who is determined to be eligible for benefits
under a State plan approved under this title under
subsection (a)(10)(A) shall remain eligible for those
benefits until the earlier of--
``(i) the end of a period (not to exceed 12
months) following the determination; or
``(ii) the time that the child exceeds the
age specified in such paragraph (13)(G).
``(B) Certain nonelderly adults.--
``(i) In general.--At the option of the
State, the plan may provide that in the case of
an eligible adult who is determined to be
eligible for benefits under a State plan
approved under this title (or a waiver of such
plan), the eligible adult shall remain eligible
for those benefits until the end of a period
(not to exceed 12 months) following the
determination.
``(ii) Eligible adult defined.--In this
subparagraph, the term `eligible adult' means--
``(I) an individual (other than a
child) whose income eligibility under
the State plan or under a waiver of the
plan for medical assistance is
determined under paragraph (14); and
``(II) an individual included in
any other group of individuals the
Secretary determines appropriate.''.
SEC. 204. STATE FLEXIBILITY TO USE ADMINISTRATIVE SIMPLIFICATION
POLICIES FOR ENROLLMENT.
(a) Permanent Extension of Medicaid and CHIP Express Lane Option.--
Section 1902(e)(13) of the Social Security Act (42 U.S.C. 1396a(e)(13))
is amended by striking subparagraph (I).
(b) Extending Express Lane Eligibility to Adults.--Section
1902(e)(13)(A) of the Social Security Act (42 U.S.C. 1396a(e)(13)(A))
is amended by adding at the end the following new clause:
``(iii) State option to extend express lane
eligibility to adults.--
``(I) In general.--At the option of the
State, the State may apply the provisions of
this paragraph with respect to determining
eligibility under this title for an eligible
individual (as defined in subclause (II)). In
applying this paragraph in the case of a State
making such an option, any reference in this
paragraph to a child with respect to this title
(other than a reference to child health
assistance) shall be deemed to be a reference
to an eligible individual.
``(II) Eligible individual defined.--In
this clause, the term `eligible individual'
means--
``(aa) any individual (other than a
child) whose income eligibility under
the State plan or under a waiver of the
plan for medical assistance is
determined under paragraph (14); and
``(bb) an individual included in
any other group of individuals the
Secretary determines appropriate.''.
SEC. 205. OUTREACH TO TARGETED POPULATIONS.
(a) Outreach and Enrollment Grants.--Section 2113 of the Social
Security Act (42 U.S.C. 1397mm) is amended--
(1) in subsection (a)--
(A) in paragraph (1), by striking ``during the
period of fiscal years 2009 through 2015''; and
(B) in paragraph (2)--
(i) in the heading, by striking ``Ten
percent set aside'' and inserting ``Set
aside''; and
(ii) by striking ``10 percent'' and
inserting ``15 percent''; and
(2) in subsection (g), by inserting ``and $40,000,000 for
each fiscal year thereafter, to remain available until
expended'' after ``2015,''.
(b) Requirement That Managed Care Organizations Provide Language
Services to Enrollees.--Section 1932(b) of the Social Security Act (42
U.S.C. 1396u-2(b)) is amended by adding at the end the following new
paragraph:
``(9) Language services.--Each contract with a managed care
entity under section 1903(m) or under section 1905(t)(3) shall
require the entity to provide and pay for language services,
including oral interpretation and written translation services,
for an individual and the parent or guardian of such individual
who is eligible for medical assistance under the State plan
under this title and is enrolled with the entity and is limited
English proficient when interacting with the entity or with any
provider receiving payment from the entity. Such language
services shall be provided in conjunction with all covered
items and services that are available to such individuals under
the contract.''.
(c) Medicaid Health Care Disparities.--Section 1946 of the Social
Security Act (42 U.S.C. 1396w-5) is amended by adding at the end the
following new subsection:
``(d) Appropriation.--Out of any funds in the Treasury not
otherwise appropriated, there are appropriated to carry out this
section $20,000,000, to remain available until expended.''.
(d) Effective Date.--The amendments made by this section take
effect on the date of enactment of this Act.
TITLE III--BENEFITS AND AFFORDABILITY
SEC. 301. STRENGTHENED COST-SHARING PROTECTIONS UNDER CHIP.
Section 2103(e) of the Social Security Act (42 U.S.C. 1397cc(e)) is
amended--
(1) in paragraph (3)(B)--
(A) by inserting ``, including with respect to
benefits for dental services,'' after ``State child
health plan'';
(B) by striking ``annual aggregate cost-sharing''
and inserting ``aggregate cost-sharing''; and
(C) by striking ``for the year involved'' and
inserting ``, as applied on a quarterly or monthly
basis (as specified by the State)''; and
(2) by adding at the end the following new paragraph:
``(5) Additional requirements.--
``(A) Tracking of expenses; notice.--Except as
provided in subparagraph (B), in the case of a State
child health plan that imposes premiums, deductibles,
cost sharing, or similar charges that could (as
determined by the Secretary) cause families that
include a targeted low-income child or a targeted low-
income pregnant woman to have out-of-pocket expenses
that exceed the limit imposed under paragraph (3)(B)
for a month or quarter (as applicable under the State
plan), the State child health plan shall--
``(i) establish an electronic process for
tracking such expenses that does not rely on
documentation provided by the targeted low-
income child, the targeted low-income pregnant
woman, or the family; and
``(ii) notify each such family--
``(I) of the aggregate monthly or
quarterly limits on out-of-pocket
expenses applicable to the family
imposed under paragraph (3)(B); and
``(II) that no premiums,
deductibles, cost sharing, or similar
charges shall be imposed on any
targeted low-income child or targeted
low-income pregnant woman in the family
for the remainder of any month or
quarter with respect to which the
family has reached the aggregate
monthly or quarterly family limit
imposed under such paragraph applicable
to the family.
``(B) Managed care entities or organizations.--In
the case of a State child health plan that provides
child health assistance through managed care entities
or organizations, the entities or organizations shall,
with respect to families described in subparagraph
(A)--
``(i) establish an electronic process
described in subparagraph (A)(i); and
``(ii) coordinate with the State agency
responsible for implementing the State child
health plan under this title to ensure that any
premiums, deductibles, cost sharing, or similar
charges imposed on such a family are included
in the aggregate limit applicable to the family
under paragraph (3)(B).''.
SEC. 302. ENSURING COVERAGE OF PREVENTIVE HEALTH SERVICES UNDER
MEDICAID AND CHIP.
(a) Medicaid.--
(1) Clarifying preventive coverage.--Section 1905(a)(13) of
the Social Security Act (42 U.S.C. 1396d(a)(13)) is amended--
(A) by striking subparagraphs (A) and (B);
(B) by redesignating subparagraph (C) as
subparagraph (B); and
(C) by inserting before subparagraph (B) (as so
redesignated) the following new subparagraph:
``(A) the items and services described in
paragraphs (1) through (5) of section 2713(a) of the
Public Health Service Act; and''.
(2) Conforming amendment.--Section 1902(a)(10)(A) of the
Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended in
the matter preceding clause (i), by inserting ``, (13)(A)''
before ``, (17)''.
(b) CHIP.--Section 2103(c)(1)(D) of the Social Security Act (42
U.S.C. 1397cc(c)(1)(D)) is amended by striking ``Well-baby'' and
inserting ``Items and services described in paragraphs (1) through (5)
of section 2713(a) of the Public Health Service Act, including well-
baby''.
(c) Cost-Sharing Prohibitions.--
(1) In general.--Section 1916 of the Social Security Act
(42 U.S.C. 1396(o)) is amended--
(A) in subsection (a)(2)--
(i) in subparagraph (D), by striking ``or''
at the end;
(ii) in subparagraph (E), by striking
``hospice care (as defined in section 1905(o));
and'' at the end and inserting ``hospice care
(as defined in section 1905(o)), or''; and
(iii) by adding at the end the following
new subparagraph:
``(F) items and services described in section
1905(a)(13)(A); and''; and
(B) in subsection (b)(2)--
(i) in subparagraph (D), by striking ``or''
at the end;
(ii) in subparagraph (E), by striking
``hospice care (as defined in section 1905(o));
and'' at the end and inserting ``hospice care
(as defined in section 1905(o)), or''; and
(iii) by adding at the end the following
new subparagraph:
``(F) items and services described in section
1905(a)(13)(A); and''.
(2) State option.--Section 1916A(b)(3)(B) of the Social
Security Act (42 U.S.C. 1396o-1(b)(3)(B)) is amended by adding
at the end the following new clause:
``(xi) Items and services described in
section 1905(a)(13)(A).''.
SEC. 303. TIMELY IMMUNIZATION COVERAGE.
(a) Coverage for Newly Approved Vaccines Within 30 Days.--
(1) In general.--Section 1928(e) of the Social Security Act
(42 U.S.C. 1396s(e)) is amended by adding at the end the
following new sentence: ``Each revision of the list established
by such Advisory Committee shall apply to the purchase,
delivery, and administration of pediatric vaccines under this
section not later than 30 days after the date such Advisory
Committee approves the revision.''.
(2) Conforming amendment.--Section 2103(c)(1)(D) of the
Social Security Act (42 U.S.C. 1397cc(c)(1)(D)) is amended by
inserting ``, administered in accordance with the schedule
referred to in section 1928(c)(2)(B)(i) for pediatric
vaccines'' after ``immunizations''.
(b) Treatment of CHIP-Eligible Children as Federally Vaccine-
Eligible Children.--Section 1928(b)(2) of the Social Security Act (42
U.S.C. 1396s(b)(2)) is amended--
(1) in subparagraph (A)(i), by inserting ``or CHIP-
eligible'' after ``medicaid-eligible''; and
(2) in subparagraph (B), by striking clause (i) and
inserting the following:
``(i) The term `medicaid-eligible or CHIP-
eligible child' means, with respect to a child,
a child who is entitled to medical assistance
under a State plan approved under this title or
a waiver of such plan, or who is eligible for
child health assistance under a State child
health plan approved under title XXI.''.
(c) Effective Date.--The amendments made by this section take
effect on the date of enactment of this Act.
SEC. 304. PAYMENT PARITY FOR MEDICAID PRIMARY CARE SERVICES.
(a) In General.--Section 1902(a)(13)(C) of the Social Security Act
(42 U.S.C. 1396a(a)(13)(C)) is amended--
(1) by striking ``2013 and 2014'' and inserting ``calendar
years 2014 through 2019'';
(2) by striking ``, general internal medicine'' and
inserting ``, general internal medicine, neurology, psychiatry,
obstetrics and gynecology'';
(3) by inserting ``or a health care practitioner who is a
nurse practitioner, physician assistant, or clinical nurse
specialist (as such terms are defined in section 1861(aa)(5))
or a certified nurse midwife (as defined in section
1861(gg)(2))'' after ``pediatric medicine''; and
(4) by striking ``such services and physician'' and
inserting ``such services and physician or health care
practitioner''.
(b) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after the first day of the
first calendar quarter that begins after the date of the enactment of
this Act.
TITLE IV--ACCESS AND QUALITY
Subtitle A--Pediatric Quality Measures
SEC. 401. EXTENDING THE PEDIATRIC QUALITY MEASURES PROGRAM.
Section 1139A(i) of the Social Security Act (42 U.S.C. 1320b-9a(i))
is amended by inserting ``, and for each of fiscal years 2015 through
2019, $50,000,000,'' after ``$45,000,000''.
SEC. 402. ENHANCED FMAP FOR ACTIVITIES RELATED TO PEDIATRIC QUALITY
MEASURES.
Section 1903(a)(3)(A)(iii) of the Social Security Act (42 U.S.C.
1396b(a)(3)(A)(iii)) is amended to read as follows:
``(iii) 95 percent of so much of the sums expended
during any such quarter in fiscal years 2015, 2016, and
2017, 90 percent of so much of the sums expended during
any such quarter in fiscal years 2018 and 2019, and the
higher of an amount equal to the Federal medical
assistance percentage (as defined in section 1905(b))
or 75 percent of so much of the sums expended during
any such quarter in any fiscal year thereafter (as
found necessary by the Secretary for the proper and
efficient administration of the State plan) as are
attributable to such developments or modifications of
systems of the type described in clause (i) as are
necessary for the efficient collection and reporting on
the core set of child health quality measures under
subsections (a), (b), (c), and (f) of section 1139A;
and''.
SEC. 403. REPORTING OF FULL SET OF PEDIATRIC QUALITY MEASURES.
Section 1139A(a)(4) of the Social Security Act (42 U.S.C. 1320b-
9a(a)(4)) is amended--
(1) in the heading, by striking ``Encourage voluntary and
standardized'' and inserting ``Standardized'';
(2) by striking ``Not later than'' and inserting the
following:
``(A) Encouraging voluntary reporting.--Not later
than''; and
(3) by adding at the end the following new subparagraph:
``(B) Other reporting.--Not later than five years
after the date of the enactment of the CHIP Extension
and Improvement Act of 2014, the Secretary shall
require that each State submit information on the core
set of child health quality measures (as in effect on
such date of enactment), as updated under subsection
(b)(5).''.
SEC. 404. TECHNICAL ASSISTANCE TO STATES FOR ADOPTING AND UTILIZING
PEDIATRIC QUALITY MEASURES.
Section 1139A(a)(7) of the Social Security Act (42 U.S.C. 1320b-
9a(a)(7)) is amended to read as follows:
``(7) Technical assistance.--
``(A) In general.--The Secretary shall provide
technical assistance to States to assist them in
adopting and utilizing the core set of child health
measures in administering the State plans under titles
XIX and XXI, including by assisting States in building
their data collection infrastructures.
``(B) Funding.--$5,000,000 of the amount
appropriated under subsection (i) for a fiscal year
shall be used to carry out this paragraph.''.
SEC. 405. IMPROVING THE EFFECTIVENESS OF THE PEDIATRIC QUALITY
MEASURES.
Section 1139A(b) of the Social Security Act (42 U.S.C. 1320b-9a(b))
is amended--
(1) in paragraph (4)--
(A) by striking the paragraph heading and inserting
the following: ``Ensuring the development, maintenance,
and reporting of a portfolio of pediatric quality
measures'';
(B) in subparagraph (A), by striking ``and'' at the
end;
(C) in subparagraph (B)(iii)--
(i) by inserting ``establishment of a
sustainable mechanism for maintaining and''
before ``updating''; and
(ii) by striking ``as necessary.'' and
inserting ``in alignment with the most recent
version of the `Blueprint for the Measures
Management System' published by the Centers for
Medicare & Medicaid Services, as necessary;
and''; and
(D) by adding at the end the following new
subparagraph:
``(C) award grants or contracts to continue and
enhance the pediatric quality measures program, which
shall include awarding grants and contracts with a
particular emphasis on--
``(i) patient and family experience or
coordination of care;
``(ii) pediatric populations that are small
in size and may be most effectively addressed
by aggregating data across multiple States,
including pediatric populations with medical
complexity and pediatric populations with rare
conditions;
``(iii) the impacts of changes in life
events over various stages of child and
adolescent development, including changes in
morbidity and mortality, dependence status, and
developmental stages, and the impacts of such
changes on subsequent health and health care
quality; and
``(iv) establishing a sustainable mechanism
for identifying and assisting States in
developing a standardized data infrastructure
for the collection and national reporting of
pediatric quality measures, including
developing precise data element definitions and
utilizing consistent data collection
methods.'';
(2) by striking paragraph (5) and inserting the following
new paragraph:
``(5) Revising, strengthening, and improving initial core
measures.--
``(A) In general.--The Secretary shall annually
issue a rule (in accordance with section 553 of title
5, United States Code) to amend the core set of child
health quality measures described in subsection (a) so
that such core set--
``(i) is consistent with the purposes of
the pediatric quality measures program
established under paragraph (1);
``(ii) meets the conditions specified in
paragraph (2);
``(iii) includes measures that--
``(I) were developed by the
Secretary in consultation with the
entities specified in subparagraphs (A)
through (H) of paragraph (3);
``(II) were developed, validated,
tested, or maintained through a grant
or contract awarded under paragraph
(4); and
``(III) were submitted to the
Secretary for consideration that were
not developed under such a grant or
contract; and
``(iv) takes into account the reports and
demonstration projects described in
subparagraphs (c), (d), (e), and (f) of this
section.
``(B) Additional changes.--Beginning not later than
one year after the date of the enactment of the CHIP
Extension and Improvement Act of 2014, the amendments
made to the core set of measures under subparagraph (A)
shall include changes--
``(i) to measure the type of children's
health insurance coverage or other health
benefits coverage available over time, in
addition to the presence, stability, and
duration of such health insurance coverage or
such health benefits coverage over time, for
purposes of examining enrollment changes of a
child from one type of coverage to another;
``(ii) to ensure that the measures reflect
the care provided to the diverse pediatric
population, including adolescents and children
with special health care needs and the
management of acute and chronic conditions;
``(iii) to ensure that the measures reflect
care provided in all health care settings in
which an individual enrolled in the State plan
under title XIX receives care; and
``(iv) to encourage the adoption of
pediatric quality measures at the State, plan,
community, facility, and provider level
attribution, as well as across different health
care delivery and coverage systems, including
coverage provided through the Exchanges
established under title I of the Patient
Protection and Affordable Care Act.'';
(3) in paragraph (6)--
(A) by striking ``clinical care'' and inserting
``clinical effectiveness, patient safety, population
and public health, patient and family engagement, care
coordination, or efficiency''; and
(B) by striking ``in various institutional and
ambulatory health care settings''; and
(4) by adding at the end the following new paragraph:
``(8) Funding.--$20,000,000 of the amount appropriated
under subsection (i) for a fiscal year shall be used to carry
out this subsection.''.
SEC. 406. REPORTS REGARDING STATE-SPECIFIC QUALITY OF CARE MEASURES
APPLIED UNDER MEDICAID OR CHIP.
Section 1139A(c)(1) of the Social Security Act (42 U.S.C. 1320b-
9a(c)) is amended--
(1) in subparagraph (A), by striking ``and'' at the end;
(2) in subparagraph (B), by striking the period at the end
and inserting a semicolon; and
(3) by adding at the end the following new subparagraphs:
``(C) State-specific information on the annual
progress toward, and efforts to overcome barriers to,
reporting on all quality measures within the core set
of child health quality measures, as updated under
subsection (b)(5); and
``(D) beginning not later than 5 years after the
date of the enactment of this subparagraph, State-
specific information on all quality measures within the
core set of child health quality measures, as updated
under subsection (b)(5).''.
SEC. 407. ADVISORY PANEL REGARDING PEDIATRIC QUALITY.
(a) In General.--Section 1139A(g) of the Social Security Act (42
U.S.C. 1320b-9a(g)) is amended--
(1) in the heading, by striking ``Study of'' and inserting
``Stakeholder Input and Reports on'';
(2) by redesignating paragraph (2) as paragraph (3); and
(3) by inserting after paragraph (1) the following new
paragraph:
``(2) Pediatric quality measurement.--Not later than 18
months after the date of the enactment of this paragraph, the
Secretary, in consultation with representatives of State
agencies responsible for administering the Medicaid program
under title XIX and the Children's Health Insurance Program
under title XXI and representatives of relevant provider
organizations, shall submit (and periodically update) to the
Committee on Energy and Commerce of the House of
Representatives and the Committee on Finance of the Senate a
report that takes into account the priorities and goals to be
established pursuant to section 1890(b)(7)(E). Such report
shall include--
``(A) strategic and detailed operational plans to
address and overcome barriers to State collection of,
and reporting of, all quality measures within the core
set of child health quality measures, as updated under
subsection (b)(5);
``(B) an analysis of the types of incentives,
including Federal funding and any associated amounts
necessary for States to collect and report on all
quality measures within the core set of child health
quality measures, as updated under subsection (b)(5);
and
``(C) a standardized format and plan for States to
collect and report on all quality measures within the
core set of child health quality measures, as updated
under subsection (b)(5).''.
(b) Inclusion of Child and Adult Health Quality Measures for Multi-
Stakeholder Group Input.--Section 1890(b)(7) of the Social Security Act
(42 U.S.C. 1395aaa(b)(7)) is amended--
(1) in subparagraph (B)(i)(I), by inserting ``1139A(a),
1139B,'' after ``sections''; and
(2) by adding at the end the following new subparagraph:
``(E) Pediatric quality measurement.--With respect
to quality and efficiency measures for use pursuant to
section 1139A(a), the entity shall convene a panel,
composed of health experts (including experts employed
by the Federal Government and experts not so employed)
to establish priorities and goals for child health to--
``(i) advise and make recommendations to
the Secretary regarding changes that may be
made to the core set of child health quality
measures, as updated under section 1139A(b)(5);
``(ii) establish standards for the
timeliness and accuracy of data collected and
reported for purposes of such measures; and
``(iii) review and make recommendations, at
least annually, for strategies to enhance the
timeliness, accuracy, and utility of such
measures.''.
SEC. 408. EXTENDING AND EXPANDING DEMONSTRATION PROJECTS.
(a) Strengthening Demonstration Projects for Improving the Quality
of Children's Health Care and the Use of Health Information
Technology.--Section 1139A(d) of the Social Security Act (42 U.S.C.
1320b-9a(d)) is amended--
(1) in paragraph (1)--
(A) in the matter preceding subparagraph (A)--
(i) by striking ``2009 through 2013, the
Secretary shall award not more than 10 grants''
and inserting ``2015 through 2019, the
Secretary shall award not fewer than 10
grants,''; and
(ii) by inserting ``(including oral care)''
after ``health care'';
(B) in subparagraph (C), by striking ``or'' at the
end;
(C) in subparagraph (D), by striking the period at
the end and inserting a semicolon; and
(D) by adding at the end the following new
subparagraphs:
``(E) examine and address barriers to effective
delivery of perinatal care and its impact on birth
outcomes and subsequent pregnancies and children's
health;
``(F) implement and expand pediatric and perinatal
learning and quality improvement collaboratives on the
quality of children's and pregnant women's health care,
including improving patient outcomes, reducing health
costs, and addressing health disparities;
``(G) encourage and evaluate the use at the State
level of payment reform and related policy proposals
for purposes of promoting higher quality of care for
children, including the shared savings program
established under section 1899 and other methods of
encouraging integrated care models; or
``(H) with respect to the model electronic health
record format for children developed and disseminated
under subsection (f)--
``(i) assess the extent to which the format
has been incorporated into widely used
electronic health record formats;
``(ii) implement standards and activities
that result in increased use of such format;
and
``(iii) evaluate the impact of the
increased use of such format.'';
(2) in paragraph (2)--
(A) in subparagraph (A), by striking ``and'' at the
end;
(B) in subparagraph (B), by striking the period at
the end and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(C) with respect to grants awarded for projects
described in paragraph (1)(F)--
``(i) give priority to collaboratives that
would demonstrate substantial impacts on the
pediatric population by--
``(I) affecting a large percentage
of such population or by substantially
improving outcomes in a smaller
population;
``(II) reducing the cost of, and
other barriers to access to, health
care for children, including children
with medically complex illnesses or
chronic conditions;
``(III) having a high likelihood to
reduce disparities in health status; or
``(IV) potentially having long-term
health impacts by addressing childhood
precursors to adult conditions; and
``(ii) encourage coordination with other
sources of funding in the expansion of
pediatric learning collaboratives, including by
coordinating care and utilizing community
health workers (as defined in section 399V(k)
of the Public Health Service Act (42 U.S.C.
280g-11(k))).''; and
(3) in paragraph (4)--
(A) by inserting ``For each of fiscal years 2009
through 2013,'' before ``$20,000,000''; and
(B) by adding at the end the following new
sentence: ``For each of fiscal years 2015 through 2019,
$25,000,000 of the amount appropriated under subsection
(i) for a fiscal year shall be used to carry out this
subsection.''.
(b) Extending Funding for Childhood Obesity Demonstration
Projects.--Section 1139A(e)(8) of the Social Security Act (42 U.S.C.
1320b-9a(e)(8)) is amended by inserting ``, and for the period of
fiscal years 2015 through 2019, $25,000,000'' after ``2014''.
Subtitle B--Continuing Delivery System Reform
SEC. 411. SUPPORTING EVIDENCE-BASED CARE COORDINATION IN COMMUNITIES.
(a) In General.--Section 511(j)(1) of the Social Security Act (42
U.S.C. 711(j)(1)) is amended--
(1) in subparagraph (D), by inserting ``and'' at the end;
(2) in subparagraph (E), by striking ``fiscal year 2014;
and'' and inserting ``each of fiscal years 2014 through
2019.''; and
(3) by striking subparagraph (F).
(b) Effective Date.--The amendments made by this section shall take
effect on the date of enactment of this Act.
SEC. 412. ENSURING CARE COORDINATION FOR CHILDREN.
Section 2706 of the Patient Protection and Affordable Care Act (42
U.S.C. 1396a note) is amended--
(1) in subsection (a)(2), by striking ``2016'' and
inserting ``2019''; and
(2) in subsection (e), by striking ``appropriated'' and all
that follows through the period at the end and inserting the
following: ``appropriated to carry out this section--
``(1) for fiscal year 2014, such sums as are necessary;
``(2) for each of fiscal years 2015 through 2019,
$100,000,000; and
``(3) for the period beginning on October 1, 2019, and
ending on December 31, 2019, $25,000,000.''.
Subtitle C--Miscellaneous
SEC. 421. ASSURING COVERAGE CONTINUITY FOR FORMER FOSTER CARE CHILDREN.
(a) In General.--Section 1902(a)(10)(A)(i)(IX) of the Social
Security Act (42 U.S.C. 1396a(a)(10)(A)(i)(IX)) is amended--
(1) in item (bb), by striking ``are not described in or
enrolled under'' and inserting ``are not described in and are
not enrolled under'';
(2) in item (cc), by striking ``responsibility of the
State'' and inserting ``responsibility of a State''; and
(3) in item (dd), by striking ``the State plan under this
title or under a waiver of the'' and inserting ``a State plan
under this title or under a waiver of such a''.
(b) Effective Date.--The amendments made by this section shall take
effect on July 1, 2015.
SEC. 422. DEFINITION OF THERAPEUTIC FOSTER CARE AS MEDICAL ASSISTANCE.
(a) In General.--Section 1905 of the Social Security Act (42 U.S.C.
1396d) is amended--
(1) in subsection (a)--
(A) in paragraph (28), by striking ``and'' at the
end;
(B) by redesignating paragraph (29) as paragraph
(30); and
(C) by inserting after paragraph (28) the following
new paragraph:
``(29) therapeutic foster care services described in
subsection (ee); and''; and
(2) by adding at the end the following new subsection:
``(ee)(1) For purposes of subsection (a)(29), subject to
subparagraph (C), therapeutic foster care services described in this
subsection are services provided for children who have not attained age
21, and who, as a result of mental illness, other emotional or
behavioral disorders, medically fragile conditions, or developmental
disabilities, need the level of care provided in an institution
(including a psychiatric residential treatment facility) or nursing
facility the cost of which could be reimbursed under the State plan but
who can be cared for or maintained in a community placement, through a
qualified therapeutic foster care program described in paragraph (2).
``(2) A qualified therapeutic foster care program described in this
paragraph is a program that--
``(A) is licensed by the State and accredited by the Joint
Commission on Accreditation of Healthcare Organizations, the
Commission on Accreditation of Rehabilitation Facilities, the
Council on Accreditation, or by another equivalent
accreditation agency (or agencies) as the Secretary may
recognize;
``(B) provides structured daily activities, including the
development, improvement, monitoring, and reinforcing of age-
appropriate social, communication and behavioral skills,
trauma-informed and gender-responsive services, crisis
intervention and crisis support services, medication
monitoring, counseling, and case management, and may furnish
other intensive community services; and
``(C) provides foster care parents with specialized
training and consultation in the management of children with
mental illness, trauma, other emotional or behavioral
disorders, medically fragile conditions, or developmental
disabilities, and specific additional training on the needs of
each child provided such services.
``(3) In making coverage determinations under paragraph (1), a
State may employ medical necessity criteria that are similar to the
medical necessity criteria applied to coverage determinations for other
services and supports under this title.
``(4) The services described in this subsection do not include the
training referred to in paragraph (2)(C).''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to calendar quarters beginning on or after the date of enactment
of this Act.
SEC. 423. TECHNICAL CORRECTION.
(a) In General.--Section 1917(d)(4)(A) of the Social Security Act
(42 U.S.C. 1396p(d)(4)(A)) is amended by inserting ``the individual,''
after ``for the benefit of such individual by''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to trusts established on or after the date of the enactment of
this Act.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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.
Referred to the Subcommittee on Health.
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