chip amendment

ERN15177 S.L.C.

AMENDMENT NO.llll Calendar No.lll

Purpose: To protect and retain our Children’s Health Insur-

ance Program for 4 years (PRO-CHIP).

IN THE SENATE OF THE UNITED STATES—114th Cong., 1st Sess.

H. R. 2

To amend title XVIII of the Social Security Act to repeal

the Medicare sustainable growth rate and strengthen

Medicare access by improving physician payments and

making other improvements, to reauthorize the Chil-

dren’s Health Insurance Program, and for other pur-

poses.

Referred to the Committee on llllllllll and

ordered to be printed

Ordered to lie on the table and to be printed

AMENDMENT intended to be proposed by lllllll

Viz:

Strike sections 301 through 304, and insert the fol-1

lowing: 2

SEC. 301. 4-YEAR EXTENSION OF THE CHILDREN’S HEALTH 3

INSURANCE PROGRAM. 4

(a) FUNDING.— 5

(1) IN GENERAL.—Section 2104(a) of the So-6

cial Security Act (42 U.S.C. 1397dd(a)) is amend-7

ed— 8

(A) in paragraph (17), by striking ‘‘and’’ 9

at the end; and 10

2

ERN15177 S.L.C.

(B) by striking paragraph (18) and insert-1

ing the following new paragraphs: 2

‘‘(18) for fiscal year 2015, $21,061,000,000; 3

‘‘(19) for fiscal year 2016, $19,300,000,000; 4

‘‘(20) for fiscal year 2017, $20,300,000,000; 5

‘‘(21) for fiscal year 2018, $21,300,000,000; 6

and 7

‘‘(22) for fiscal year 2019, for purposes of mak-8

ing 2 semi-annual allotments— 9

‘‘(A) $2,850,000,000 for the period begin-10

ning on October 1, 2018, and ending on March 11

31, 2019; and 12

‘‘(B) $2,850,000,000 for the period begin-13

ning on April 1, 2019, and ending on Sep-14

tember 30, 2019.’’. 15

(2) PREVENTION OF DUPLICATE APPROPRIA-16

TIONS FOR FISCAL YEAR 2015.—Notwithstanding 17

any other provision of law, insofar as funds have 18

been appropriated under subsection (a)(18) or (m) 19

of section 2104 of the Social Security Act (42 20

U.S.C. 1397dd), or under section 108 of the Chil-21

dren’s Health Insurance Program Reauthorization 22

Act of 2009 (Public Law 111–3), as such sub-23

sections and section are in effect on the day before 24

the date of the enactment of this Act, to provide al-25

3

ERN15177 S.L.C.

lotments to States under the State Children’s Health 1

Insurance Program established under title XXI of 2

the Social Security Act (42 U.S.C. 1397aa et seq.) 3

(whether implemented under title XIX, XXI, or 4

both, of the Social Security Act) for fiscal year 5

2015— 6

(A) any amounts that are so appropriated 7

that are not so allotted and obligated before the 8

date of the enactment of this Act, are re-9

scinded; and 10

(B) any amount provided for CHIP allot-11

ments to a State under this section (and the 12

amendments made by this section) for such fis-13

cal year shall be reduced by the amount of such 14

appropriations so allotted and obligated before 15

such date. 16

(b) ALLOTMENTS.— 17

(1) IN GENERAL.—Section 2104(m) of the So-18

cial Security Act (42 U.S.C. 1397dd(m)) is amend-19

ed— 20

(A) in the subsection heading, by striking 21

‘‘THROUGH 2015’’ and inserting ‘‘AND THERE-22

AFTER’’; 23

(B) in paragraph (2)— 24

4

ERN15177 S.L.C.

(i) in the paragraph heading, by strik-1

ing ‘‘2014’’ and inserting ‘‘2018’’; and 2

(ii) by striking subparagraph (B) and 3

inserting the following new subparagraph: 4

‘‘(B) FISCAL YEAR 2013 THROUGH 2018.— 5

Subject to paragraphs (4) and (6), from the 6

amount made available under paragraphs (16) 7

through (21) of subsection (a) for each of fiscal 8

years 2013 through 2018, respectively, the Sec-9

retary shall compute a State allotment for each 10

State (including the District of Columbia and 11

each commonwealth and territory) for each 12

such fiscal year as follows: 13

‘‘(i) REBASING IN FISCAL YEAR 2013 14

AND EACH SUCCEEDING ODD-NUMBERED 15

FISCAL YEAR.—For fiscal year 2013 and 16

each succeeding odd-numbered fiscal year, 17

the allotment of the State is equal to the 18

Federal payments to the State that are at-19

tributable to (and countable toward) the 20

total amount of allotments available under 21

this section to the State in the preceding 22

fiscal year (including payments made to 23

the State under subsection (n) for such 24

preceding fiscal year as well as amounts 25

5

ERN15177 S.L.C.

redistributed to the State in such pre-1

ceding fiscal year), multiplied by the allot-2

ment increase factor under paragraph (5) 3

for such odd-numbered fiscal year. 4

‘‘(ii) GROWTH FACTOR UPDATE FOR 5

FISCAL YEAR 2014 AND EACH SUCCEEDING 6

EVEN-NUMBERED FISCAL YEAR.—Except 7

as provided in clause (iii), for fiscal year 8

2014 and each succeeding even-numbered 9

fiscal year, the allotment of the State is 10

equal to the sum of— 11

‘‘(I) the amount of the State al-12

lotment under clause (i) for the pre-13

ceding fiscal year; and 14

‘‘(II) the amount of any pay-15

ments made to the State under sub-16

section (n) for such preceding fiscal 17

year, 18

multiplied by the allotment increase factor 19

under paragraph (5) for such even-num-20

bered fiscal year. 21

‘‘(iii) SPECIAL RULE FOR FISCAL 22

YEAR 2016.—For fiscal year 2016, the al-23

lotment of the State is equal to the Fed-24

eral payments to the State that are attrib-25

6

ERN15177 S.L.C.

utable to (and countable toward) the total 1

amount of allotments available under this 2

section to the State in the preceding fiscal 3

year (including payments made to the 4

State under subsection (n) for such pre-5

ceding fiscal year as well as amounts redis-6

tributed to the State in such preceding fis-7

cal year), but determined as if the last two 8

sentences of section 2105(b) were in effect 9

in such preceding fiscal year and then mul-10

tiplying the result by the allotment in-11

crease factor under paragraph (5) for fis-12

cal year 2016.’’; 13

(C) in paragraph (3)— 14

(i) in the heading, by striking 15

‘‘2015’’and inserting ‘‘2019’’; 16

(ii) in subparagraph (A)— 17

(I) by striking ‘‘paragraph (18)’’ 18

and inserting ‘‘paragraph (22)’’; and 19

(II) by striking ‘‘section 108 of 20

the Children’s Health Insurance Pro-21

gram Reauthorization Act of 2009’’ 22

and inserting ‘‘section 301(b)(2) of 23

the Medicare Access and CHIP Reau-24

thorization Act of 2015’’; 25

7

ERN15177 S.L.C.

(iii) in subparagraph (B), by striking 1

‘‘paragraph (18)’’ and inserting ‘‘para-2

graph (22)’’; 3

(iv) in subparagraph (C)— 4

(I) by striking ‘‘2014’’ each place 5

it appears and inserting ‘‘2018’’; and 6

(II) by striking ‘‘2015’’ and in-7

serting ‘‘2019’’; and 8

(v) in subparagraph (D)— 9

(I) in clause (i)— 10

(aa) in subclause (I), by 11

striking ‘‘subsection (a)(18)(A)’’ 12

and inserting ‘‘subsection 13

(a)(22)(A)’’; and 14

(bb) in subclause (II), by 15

striking ‘‘section 108 of the Chil-16

dren’s Health Insurance Program 17

Reauthorization Act of 2009’’ 18

and inserting ‘‘section 301(b)(2) 19

of the Medicare Access and 20

CHIP Reauthorization Act of 21

2015’’; and 22

(II) in clause (ii)(II), by striking 23

‘‘subsection (a)(18)(B)’’ and inserting 24

‘‘subsection (a)(22)(B)’’; 25

8

ERN15177 S.L.C.

(D) in paragraph (4), by striking ‘‘2015’’ 1

and inserting ‘‘2019’’; 2

(E) in paragraph (6)— 3

(i) in subparagraph (A), by striking 4

‘‘2015’’ and inserting ‘‘2019’’; and 5

(ii) in the second sentence, by striking 6

‘‘or fiscal year 2014’’ and inserting ‘‘fiscal 7

year 2014, fiscal year 2016, or fiscal year 8

2018’’; and 9

(F) in paragraph (8)— 10

(i) in the paragraph heading, by strik-11

ing ‘‘2015’’ and inserting ‘‘2019’’; and 12

(ii) by striking ‘‘for a period in fiscal 13

year 2015’’ and inserting ‘‘for a period in 14

fiscal year 2019’’. 15

(2) ONE-TIME APPROPRIATION FOR FISCAL 16

YEAR 2019.—There is appropriated to the Secretary 17

of Health and Human Services, out of any money in 18

the Treasury not otherwise appropriated, 19

$16,700,000,000 to accompany the allotment made 20

for the period beginning on October 1, 2018, and 21

ending on March 31, 2019, under section 22

2104(a)(22)(A) of the Social Security Act (42 23

U.S.C. 1397dd(a)(22)(A)) (as added by subsection 24

(a)(1)), to remain available until expended. Such 25

9

ERN15177 S.L.C.

amount shall be used to provide allotments to States 1

under paragraph (3) of section 2104(m) of such Act 2

(42 U.S.C. 1397dd(m)) (as amended by paragraph 3

(1)(C)) for the first 6 months of fiscal year 2019 in 4

the same manner as allotments are provided under 5

subsection (a)(22)(A) of such section 2104 and sub-6

ject to the same terms and conditions as apply to 7

the allotments provided from such subsection 8

(a)(22)(A). 9

(c) CHILD ENROLLMENT CONTINGENCY FUND.— 10

(1) IN GENERAL.—Section 2104(n) of the So-11

cial Security Act (42 U.S.C. 1397dd(n)) is amend-12

ed— 13

(A) in paragraph (2)— 14

(i) in subparagraph (A)— 15

(I) in the matter preceding clause 16

(i), by striking ‘‘and (D)’’ and insert-17

ing ‘‘, (D), and (E)’’; and 18

(II) by striking clause (ii) and in-19

serting the following: 20

‘‘(ii) for each of— 21

‘‘(I) fiscal years 2010 through 22

2014, such sums as are necessary for 23

making payments to eligible States for 24

such fiscal year, but not in excess of 25

10

ERN15177 S.L.C.

the aggregate cap described in sub-1

paragraph (B); and 2

‘‘(II) fiscal years 2015 through 3

2018 (and for each of the semi-annual 4

allotment periods for fiscal year 5

2019), such sums as are necessary for 6

making payments to eligible States for 7

such fiscal year or period.’’; and 8

(ii) by striking subparagraph (B) and 9

inserting the following: 10

‘‘(B) AGGREGATE CAP.—The total amount 11

available for payment from the Fund for each 12

of fiscal years 2010 through 2014, taking into 13

account deposits made under subparagraph (C), 14

shall not exceed 20 percent of the amount made 15

available under subsection (a) for the fiscal 16

year. In the case of fiscal years 2015 through 17

2018 (and for each of the semi-annual allot-18

ment periods for fiscal year 2019), there shall 19

be no limit on the amount available for pay-20

ment from the Fund.’’; 21

(iii) in subparagraph (D)— 22

(I) by inserting ‘‘before fiscal 23

year 2015’’ after ‘‘fiscal year or pe-24

riod’’; and 25

11

ERN15177 S.L.C.

(II) by striking ‘‘for any suc-1

ceeding fiscal year’’; and 2

(iv) by adding at the end the following 3

subparagraph: 4

‘‘(E) TRANSFERS.—Notwithstanding any 5

other provision of this title, the following 6

amounts shall also be available, without fiscal 7

year limitation, for making payments from the 8

Fund: 9

‘‘(i) UNOBLIGATED NATIONAL ALLOT-10

MENT FOR FISCAL YEARS BEGINNING WITH 11

FISCAL YEAR 2014.— 12

‘‘(I) FISCAL YEAR 2014 ALLOT-13

MENT.—As of December 31 of fiscal 14

year 2015, the portion, if any, of the 15

amount appropriated under subsection 16

(a) for fiscal year 2014 that is unobli-17

gated for allotment to a State under 18

subsection (m) for such fiscal year. 19

‘‘(II) SUCCEEDING FISCAL YEAR 20

ALLOTMENTS.—As of December 31 of 21

fiscal year 2016, and each succeeding 22

fiscal year, the portion, if any, of the 23

amount appropriated under subsection 24

(a) for the preceding fiscal year that 25

12

ERN15177 S.L.C.

is unobligated for allotment to a State 1

under subsection (m) for such pre-2

ceding fiscal year. 3

‘‘(ii) UNEXPENDED ALLOTMENTS NOT 4

USED FOR REDISTRIBUTION.—As of De-5

cember 31 of fiscal year 2015, and as of 6

November 15 of each succeeding fiscal 7

year, the total amount of allotments made 8

to States under subsection (a) for the sec-9

ond preceding fiscal year that is not ex-10

pended or redistributed under subsection 11

(f) during the period in which such allot-12

ments are available for obligation. 13

‘‘(iii) UNEXPENDED PERFORMANCE 14

INCENTIVE FUNDS.—As of January 1, 15

2016, and as of January 1 of each suc-16

ceeding calendar year, the portion, if any, 17

of the amount appropriated under section 18

2105(a)(3)(E)(iii) for the preceding fiscal 19

year that is not expended or obligated 20

under such section.’’; and 21


(i) in subparagraph (A)— 23

(I) by redesignating clauses (i) 24

and (ii) as subclauses (I) and (II), re-25

13

ERN15177 S.L.C.

spectively, and realigning the left mar-1

gins accordingly; 2

(II) by striking ‘‘If a State’s’’ 3

and all that follows through ‘‘2015,’’ 4

and inserting the following: 5

‘‘(i) FOR FISCAL YEARS 2009 6

THROUGH 2014.—If a State’s expenditures 7

under this title in fiscal year 2009, fiscal 8

year 2010, fiscal year 2011, fiscal year 9

2012, fiscal year 2013, or fiscal year 10

2014’’; 11

(III) by striking ‘‘or period’’ each 12

place it appears; 13

(IV) in subclause (II) (as so re-14

designated), by striking ‘‘(or in which 15

the period occurs)’’; and 16

(V) by adding at the end the fol-17

lowing clause: 18

‘‘(ii) FOR FISCAL YEARS AFTER 19

2014.— 20

‘‘(I) IN GENERAL.—For each of 21

fiscal years 2015 through 2018 (and 22

for each of the semi-annual allotment 23

periods for fiscal year 2019), if the 24

Secretary determines that a State is a 25

14

ERN15177 S.L.C.

shortfall State described in subclause 1

(II) for that fiscal year or period, the 2

Secretary shall pay to the State from 3

the Fund, in addition to any other 4

payments made to the State under 5

this title for the fiscal year or period, 6

an amount equal to the amount de-7

scribed in subclause (III). 8

‘‘(II) SHORTFALL STATES DE-9

SCRIBED.—For purposes of this 10

clause, with respect to a fiscal year or 11

semi-annual allotment period, a short-12

fall State is a State for which the Sec-13

retary estimates, on the basis of the 14

most recent data available to the Sec-15

retary, that the projected expenditures 16

for the State and fiscal year or period 17

under this title (including in the form 18

of coverage described in paragraph (1) 19

or (2) of section 2101, or both) will 20

exceed the sum of— 21

‘‘(aa) the amount of the 22

State’s allotments for any pre-23

ceding fiscal year that remains 24

available for expenditure and 25

15

ERN15177 S.L.C.

that will not be expended by the 1

end of the immediately preceding 2

fiscal year; 3

‘‘(bb) the amount (if any) 4

that will be redistributed to the 5

State under subsection (f) for the 6

fiscal year or period; 7

‘‘(cc) the amount (if any) to 8

be paid to the State in the first 9

quarter of the fiscal year under 10

section 2105(a)(3); and 11

‘‘(dd) the amount of the 12

State’s allotment for the fiscal 13

year or period. 14

‘‘(III) AMOUNT DESCRIBED.— 15

With respect to a State and fiscal 16

year or period, the amount described 17

in this subclause is equal to the 18

amount by which the projected ex-19

penditures for the State under this 20

title for the fiscal year or period (esti-21

mated by the Secretary on the basis 22

of the most recent data available to 23

the Secretary) exceed the sum deter-24

16

ERN15177 S.L.C.

mined under subclause (II) for the 1

State and fiscal year or period. 2

‘‘(IV) RETROSPECTIVE ADJUST-3

MENT.—The Secretary may adjust the 4

determinations made under this clause 5

with respect to a State and fiscal year 6

or period as necessary on the basis of 7

the amounts reported by States not 8

later than November 30 of the suc-9

ceeding fiscal year, as approved by the 10

Secretary.’’; 11

(ii) in subparagraph (B)(ii), by strik-12

ing ‘‘(or semi-annual period occurring in a 13

fiscal year)’’; 14

(iii) in subparagraph (C)— 15

(I) in the matter preceding clause 16

(i), by striking ‘‘subparagraph (A)(ii)’’ 17

and inserting ‘‘subparagraph 18

(A)(i)(II)’’; and 19

(II) in clause (ii), by striking 20

‘‘(or semi-annual period occurring in a 21

fiscal year)’’; and 22

(iv) in subparagraph (G), by inserting 23

‘‘the expenditures under the State child 24

health plan and’’ after ‘‘regarding’’. 25

17

ERN15177 S.L.C.

(2) CONFORMING AMENDMENT.—Section 1

2104(f)(2)(A)(ii) of the Social Security Act (42 2

U.S.C. 13957dd(f)(2)(A)(ii)) is amended by insert-3

ing ‘‘only in the case of a fiscal year before fiscal 4

year 2015,’’ before ‘‘the amount’’. 5

(d) EXTENSION AND UPDATE OF PERFORMANCE IN-6

CENTIVE PAYMENTS.— 7

(1) EXTENSION THROUGH FISCAL YEAR 8

2019.—Section 2105(a)(3) of the Social Security 9

Act (42 U.S.C. 1397ee(a)(3)) is amended— 10

(A) in subparagraph (A)— 11

(i) by striking ‘‘2013’’ and inserting 12

‘‘2019’’; and 13

(ii) in the second sentence, by insert-14

ing ‘‘, except that payment under this 15

paragraph may be made to a State for fis-16

cal year 2014 as a single payment not 17

later than December 31, 2015’’ before the 18

period; 19

(B) in subparagraph (E)— 20

(i) in clause (ii)— 21

(I) by striking subclause (I) and 22

inserting the following: 23

‘‘(I) UNOBLIGATED NATIONAL 24

ALLOTMENT FOR FISCAL YEARS 2009 25

18

ERN15177 S.L.C.

THROUGH 2013.—As of December 31 1

of fiscal year 2009, and as of Decem-2

ber 31 of each succeeding fiscal year 3

through fiscal year 2013, the portion, 4

if any, of the amount appropriated 5

under section 2104(a) for such fiscal 6

year that is unobligated for allotment 7

to a State under section 2104(m) for 8

such fiscal year or set aside under 9

subsection (a)(3) or (b)(2) of section 10

2111 for such fiscal year.’’; 11

(II) in subclause (III), by strik-12

ing ‘‘2013’’ and inserting ‘‘2014’’; 13

(ii) by redesignating clause (iii) as 14

clause (iv); and 15

(iii) by inserting after clause (ii) the 16

following new clause: 17

‘‘(iii) APPROPRIATION FOR FISCAL 18

YEARS 2015 THROUGH 2019.—Out of any 19

money in the Treasury not otherwise ap-20

propriated, there are appropriated 21

$500,000,000 for each of fiscal years 2015 22

through 2019 for making payments under 23

this paragraph. Amounts appropriated for 24

a fiscal year under this clause shall remain 25

19

ERN15177 S.L.C.

available for making payments under this 1

paragraph until January 1 of the following 2

fiscal year. Any amounts of such appro-3

priations that remain unexpended or unob-4

ligated as of such date shall be transferred 5

and made available for making payments 6

under section 2104(n).’’; and 7

(C) in subparagraph (F)(iii), by striking 8

‘‘2013’’ and inserting ‘‘2019’’. 9

(2) UPDATED PERFORMANCE INCENTIVE CRI-10

TERIA FOR FISCAL YEARS 2015 THROUGH 2019.—Sec-11

tion 2105(a) of the Social Security Act (42 U.S.C. 12

1397ee(a)) is amended— 13

(A) in paragraph (3)(A), by inserting ‘‘or 14

(5)’’ after ‘‘paragraph (4)’’; 15


(i) in the heading, by inserting ‘‘FIS-17

CAL YEARS 2009 THROUGH 2014’’ after 18

‘‘FOR CHILDREN’’; and 19

(ii) in the matter preceding subpara-20

graph (A), by striking ‘‘for a fiscal year if’’ 21

and inserting ‘‘for fiscal years 2009 22

through 2014 if’’; and 23

(C) by adding at the end the following new 24

paragraph: 25

20

ERN15177 S.L.C.

‘‘(5) ENROLLMENT AND RETENTION PROVI-1

SIONS FOR CHILDREN FOR FISCAL YEAR 2015 AND 2

SUCCEEDING FISCAL YEARS.— 3

‘‘(A) IN GENERAL.—For purposes of para-4

graph (3)(A), a State meets the condition of 5

this paragraph for fiscal year 2015 and any 6

succeeding fiscal year if it is implementing at 7

least 4 of the enrollment and retention provi-8

sions specified in subparagraph (B) (treating 9

each clause as a separate enrollment and reten-10

tion provision) throughout the entire fiscal year. 11

‘‘(B) ENROLLMENT AND RETENTION PRO-12

VISIONS.—The enrollment and retention provi-13

sions specified in this subparagraph are the fol-14

lowing: 15

‘‘(i) CONTINUOUS ELIGIBILITY.—The 16

State has elected the option of continuous 17

eligibility for a full 12 months for all chil-18

dren described in section 1902(e)(12) 19

under title XIX under 19 years of age, as 20

well as applying such policy under its State 21

child health plan under this title. 22

‘‘(ii) EXPRESS LANE ELIGIBILITY.— 23

The State is implementing the option de-24

scribed in section 1902(e)(13) under title 25

21

ERN15177 S.L.C.

XIX as well as, pursuant to section 1

2107(e)(1), under this title. 2

‘‘(iii) PRESUMPTIVE ELIGIBILITY.— 3

The State provides medical assistance to 4

children during a presumptive eligibility 5

period by implementing section 1920A 6

under title XIX as well as, pursuant to 7

section 2107(e)(1), under this title, and 8

ensures that such period begins with the 9

determination by any qualified entity that 10

the family income of the child does not ex-11

ceed the applicable level of income eligi-12

bility under the State plan. A State shall 13

not satisfy this provision if the only type of 14

entity recognized by the State as a quali-15

fied entity is a hospital that has elected to 16

be a qualified entity under section 17

1902(a)(47)(B). 18

‘‘(iv) PREMIUM ASSISTANCE FOR EM-19

PLOYER-SPONSORED PLANS.—The State 20

has opted to offer a premium assistance 21

subsidy for qualified employer-sponsored 22

coverage by implementing section 1906A 23

under title XIX or the option described in 24

section 2105(c)(10) under this title. 25

22

ERN15177 S.L.C.

‘‘(v) ELIMINATION OF WAITING PERI-1

ODS.—The State does not impose a wait-2

ing period for coverage of any individual 3

under the State child health plan and en-4

sures that no waiting period applies in the 5

case of coverage provided to any individual 6

eligible for coverage under the State child 7

health plan through coverage purchased by 8

the State under section 2105(c)(3) or em-9

ployer-sponsored coverage subsidized by 10

the State under section 1906A of title XIX 11

or section 2105(c)(10) of this title. 12

‘‘(vi) AUTOMATED TRACKING OF COST 13

SHARING OR LOWER CAP ON COST SHAR-14

ING.—In the case of a State child health 15

plan that imposes premiums, deductibles, 16

cost sharing, or similar charges that could 17

(as determined by the Secretary) cause 18

families that include an individual receiv-19

ing assistance under the plan to have out- 20

of-pocket expenses that exceed the limit 21

imposed under section 2103(e)(3)(B), the 22

State has either— 23

‘‘(I) established, or, in the case 24

of a State child health plan that pro-25

23

ERN15177 S.L.C.

vides child health assistance through 1

managed care entities or organiza-2

tions, required such entities or organi-3

zations to coordinate with the State 4

agency responsible for implementing 5

the State child health plan under this 6

title in establishing— 7

‘‘(aa) an electronic process 8

for tracking such expenses that 9

does not rely on documentation 10

provided by the individual or the 11

family; and 12

‘‘(bb) a system for notifying 13

each such family of the aggregate 14

monthly or quarterly limits on 15

out-of-pocket expenses applicable 16

to the family under section 17

2103(e)(3)(B) and explaining to 18

each such family that no such ex-19

penses shall be imposed on any 20

individual in the family for the 21

remainder of any month or quar-22

ter with respect to which the 23

family has reached the applicable 24

aggregate monthly or quarterly 25

24

ERN15177 S.L.C.

family limit imposed under such 1

section; or 2

‘‘(II) elected to eliminate 3

deductibles, copayments, coinsurance, 4

or other forms of cost-sharing (other 5

than premiums) imposed under this 6

title with respect to any individual re-7

ceiving coverage under the State child 8

health plan. 9

‘‘(vii) REAL-TIME ELIGIBILITY DETER-10

MINATIONS THROUGH THE USE OF EN-11

HANCED DATA SOURCES.—With respect to 12

applications and renewals for medical as-13

sistance under title XIX or child health as-14

sistance under this title for a fiscal year, 15

the State meets the following criteria for 16

all income determinations made using 17

modified adjusted gross income under sec-18

tion 1902(e)(14)(A): 19

‘‘(I) The State relies on enhanced 20

data sources (which may include, but 21

shall not be limited to, the data 22

sources available under section 1137 23

or the federal Data Services Hub) to 24

make the determinations. 25

25

ERN15177 S.L.C.

‘‘(II) In the case of initial appli-1

cations, the State makes at least 50 2

percent of the determinations within 3

24 hours of receiving the application. 4

If a State successfully makes the re-5

quired minimum percentage of timely 6

determinations for a fiscal year, such 7

State shall not receive credit for meet-8

ing this provision in any subsequent 9

fiscal year unless the State makes a 10

percentage of timely income deter-11

minations that is at least 5 percentage 12

points higher (or, if at least 75 per-13

cent of the State’s determinations in a 14

previous fiscal year were timely, 1 15

percentage point higher) than the per-16

centage that the State achieved in the 17

last fiscal year in which the State re-18

ceived credit for meeting this provi-19

sion. 20

‘‘(III) In the case of renewals, 21

the State makes at least 50 percent of 22

the determinations within 24 hours of 23

receiving the renewal. If a State suc-24

cessfully makes the required minimum 25

26

ERN15177 S.L.C.

percentage of timely determinations 1

for a fiscal year, such State shall not 2

receive credit for meeting this provi-3

sion in any subsequent fiscal year un-4

less the State makes a percentage of 5

timely income determinations that is 6

at least 5 percentage points higher 7

(or, if at least 75 percent of the 8

State’s determinations in a previous 9

fiscal year were timely, 1 percentage 10

point higher) than the percentage that 11

the State achieved in the last fiscal 12

year in which the State received credit 13

for meeting this provision. 14

‘‘(viii) ELIMINATION OF PREMIUMS OR 15

RETROACTIVE REINSTATEMENT UPON PRE-16

MIUM PAYMENT.—The State has elected to 17

either— 18

‘‘(I) impose no premiums for cov-19

erage under the State child health 20

plan; or 21

‘‘(II) in the case of an individual 22

whose coverage under the State child 23

health plan has been terminated for 24

failure to make premium payments, 25

27

ERN15177 S.L.C.

provide assistance to such individual 1

for purposes of immediate reenroll-2

ment of the individual upon payment 3

of outstanding premiums, with cov-4

erage retroactive to the beginning of 5

the most recent month for which an 6

outstanding premium has been paid, 7

and shall not impose any waiting pe-8

riod or fee as a condition of such re-9

enrollment.’’. 10

(e) EXTENSION OF QUALIFYING STATES OPTION.— 11

Section 2105(g)(4) of the Social Security Act (42 U.S.C. 12

1397ee(g)(4)) is amended— 13

(1) in the paragraph heading, by striking 14


(2) in subparagraph (A), by striking ‘‘2015’’ 16

and inserting ‘‘2019’’. 17

(f) EXTENSION OF CERTAIN PROGRAMS AND DEM-18

ONSTRATION PROJECTS.— 19

(1) QUALITY CARE FOR CHILDREN DEM-20

ONSTRATION PROJECT.—Section 1139A(d)(1) of the 21

Social Security Act (42 U.S.C. 1320b–9a(d)(1)) is 22

amended in the matter before subparagraph (A) by 23

inserting ‘‘, and during the period of fiscal years 24

28

ERN15177 S.L.C.

2016 through 2019, the Secretary shall award not 1

more than 10 grants,’’ before ‘‘to States’’. 2

(2) CHILDHOOD OBESITY DEMONSTRATION 3

PROJECT.—Section 1139A(e)(8) of the Social Secu-4

rity Act (42 U.S.C. 1320b–9a(e)(8)) is amended by 5

inserting ‘‘, and $25,000,000 for the period of fiscal 6

years 2015 though 2019’’ after ‘‘2014’’. 7

(3) PEDIATRIC QUALITY MEASURES PRO-8

GRAM.—Section 1139A(i) of the Social Security Act 9

(42 U.S.C. 1320b–9a(i)) is amended in the first sen-10

tence by inserting before the period at the end the 11

following: ‘‘, and there is appropriated for each of 12

fiscal years 2016 through 2019, $45,000,000 for the 13

purpose of carrying out this section (other than sub-14

sections (e), (f), and (g)).’’. 15

(4) OUTREACH AND ENROLLMENT GRANTS; NA-16

TIONAL CAMPAIGN.—Section 2113 of the Social Se-17

curity Act (42 U.S.C. 1397mm) is amended— 18

(A) in subsection (a)(1), by striking 19


(B) in subsection (g), by inserting ‘‘, and 21

$80,000,000 for the period of fiscal years 2016 22

through 2019, to remain available until ex-23

pended,’’ after ‘‘2015’’. 24

29

ERN15177 S.L.C.

(g) EXPRESS LANE ELIGIBILITY.—Section 1

1902(e)(13)(I) of the Social Security Act (42 U.S.C. 2

1396a(e)(13)(I)) is amended by striking ‘‘September 30, 3

2015’’ and inserting ‘‘September 30, 2019’’. 4

(h) AUTHORITY TO USE INCOME DETERMINATION 5

MADE UNDER CERTAIN PROGRAMS.—Section 6

1902(e)(14) of the Social Security Act (42 U.S.C. 7

1396a(e)(14)) is amended— 8

(1) in subparagraph (A), in the first sentence, 9

by striking ‘‘subparagraph (D)’’ and inserting ‘‘sub-10

paragraphs (D) and (J)’’; and 11

(2) by adding at the end the following new sub-12

paragraph: 13

‘‘(J) USE OF INCOME DETERMINATION 14

MADE UNDER CERTAIN OTHER PROGRAMS.— 15

‘‘(i) IN GENERAL.—For purposes of 16

determining income eligibility for medical 17

assistance under the State plan or under 18

any waiver of such plan, a State may use 19

a determination of income made by— 20

‘‘(I) the State program funded 21

under part A of title IV; or 22

‘‘(II) the supplemental nutrition 23

assistance program established under 24

the Food and Nutrition Act of 2008. 25

30

ERN15177 S.L.C.

‘‘(ii) SUNSET.—Clause (i) shall not 1

apply after September 30, 2019.’’. 2

chip amendment

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