To improve the provisions relating to dental health.

TEXT OF AMENDMENTS

SA 2529. Mr. KERRY (for himself and Ms. Snowe) submitted an amendment
intended to be proposed by him to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

At the appropriate place, insert the following:

SEC. __. OUTREACH REGARDING HEALTH INSURANCE OPTIONS
AVAILABLE TO CHILDREN.

(a) Definitions.--In this section--
(1) the terms ``Administration'' and ``Administrator''
means the Small Business Administration and the Administrator
thereof, respectively;
(2) the term ``certified development company'' means a
development company participating in the program under title
V of the Small Business Investment Act of 1958 (15 U.S.C. 695
et seq.);
(3) the term ``Medicaid program'' means the program
established under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.);
(4) the term ``Service Corps of Retired Executives'' means
the Service Corps of Retired Executives authorized by section
8(b)(1) of the Small Business Act (15 U.S.C. 637(b)(1));
(5) the term ``small business concern'' has the meaning
given that term in section 3 of the Small Business Act (15
U.S.C. 632);
(6) the term ``small business development center'' means a
small business development center described in section 21 of
the Small Business Act (15 U.S.C. 648);
(7) the term ``State'' has the meaning given that term for
purposes of title XXI of the Social Security Act (42 U.S.C.
1397aa et seq.);
(8) the term ``State Children's Health Insurance Program''
means the State Children's Health Insurance Program
established under title XXI of the Social Security Act (42
U.S.C. 1397aa et seq.);
(9) the term ``task force'' means the task force
established under subsection (b)(1); and
(10) the term ``women's business center'' means a women's
business center described in section 29 of the Small Business
Act (15 U.S.C. 656).
(b) Establishment of Task Force.--
(1) Establishment.--There is established a task force to
conduct a nationwide campaign of education and outreach for
small business concerns regarding the availability of
coverage for children through private insurance options, the
Medicaid program, and the State Children's Health Insurance
Program.
(2) Membership.--The task force shall consist of the
Administrator, the Secretary of Health and Human Services,
the Secretary of Labor, and the Secretary of the Treasury.
(3) Responsibilities.--The campaign conducted under this
subsection shall include--
(A) efforts to educate the owners of small business
concerns about the value of health coverage for children;
(B) information regarding options available to the owners
and employees of small business concerns to make insurance
more affordable, including Federal and State tax deductions
and credits for health care-related expenses and health
insurance expenses and Federal tax exclusion for health
insurance options available under employer-sponsored
cafeteria plans under section 125 of the Internal Revenue
Code of 1986;
(C) efforts to educate the owners of small business
concerns about assistance available through public programs;
and
(D) efforts to educate the owners and employees of small
business concerns regarding the availability of the hotline
operated as part of the Insure Kids Now program of the
Department of Health and Human Services.
(4) Implementation.--In carrying out this subsection, the
task force may--
(A) use any business partner of the Administration,
including--
(i) a small business development center;
(ii) a certified development company;
(iii) a women's business center; and
(iv) the Service Corps of Retired Executives;
(B) enter into--
(i) a memorandum of understanding with a chamber of
commerce; and
(ii) a partnership with any appropriate small business
concern or health advocacy group; and
(C) designate outreach programs at regional offices of the
Department of Health and Human Services to work with district
offices of the Administration.
(5) Website.--The Administrator shall ensure that links to
information on the eligibility and enrollment requirements
for the Medicaid program and State Children's Health
Insurance Program of each State are prominently displayed on
the website of the Administration.
(6) Report.--
(A) In general.--Not later than 2 years after the date of
enactment of this Act, and every 2 years thereafter, the
Administrator shall submit to the Committee on Small Business
and Entrepreneurship of the Senate and the Committee on Small
Business of the

[[Page S10434]]

House of Representatives a report on the status of the
nationwide campaign conducted under paragraph (1).
(B) Contents.--Each report submitted under subparagraph (A)
shall include a status update on all efforts made to educate
owners and employees of small business concerns on options
for providing health insurance for children through public
and private alternatives.
______

SA 2530. Mr. BAUCUS (for himself, Mr. Grassley, Mr. Rockefeller, and
Mr. Hatch) proposed an amendment to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; as follows:

SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT;
REFERENCES; TABLE OF CONTENTS.

(a) Short Title.--This Act may be cited as the ``Children's
Health Insurance Program Reauthorization Act of 2007''.
(b) Amendments to Social Security Act.--Except as otherwise
specifically provided, whenever in this Act an amendment is
expressed in terms of an amendment to or repeal of a section
or other provision, the reference shall be considered to be
made to that section or other provision of the Social
Security Act.
(c) References to Medicaid; CHIP; 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.).
(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.
(d) 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.

TITLE I--FINANCING OF CHIP

Sec. 101. Extension of CHIP.
Sec. 102. Allotments for the 50 States and the District of Columbia.
Sec. 103. One-time appropriation.
Sec. 104. Improving funding for the territories under CHIP and
Medicaid.
Sec. 105. Incentive bonuses for States.
Sec. 106. Phase-out of coverage for nonpregnant childless adults under
CHIP; conditions for coverage of parents.
Sec. 107. State option to cover low-income pregnant women under CHIP
through a State plan amendment.
Sec. 108. CHIP Contingency fund.
Sec. 109. Two-year availability of allotments; expenditures counted
against oldest allotments.
Sec. 110. Limitation on matching rate for States that propose to cover
children with effective family income that exceeds 300
percent of the poverty line.
Sec. 111. Option for qualifying States to receive the enhanced portion
of the CHIP matching rate for Medicaid coverage of
certain children.

TITLE II--OUTREACH AND ENROLLMENT

Sec. 201. Grants for outreach and enrollment.
Sec. 202. Increased outreach and enrollment of Indians.
Sec. 203. Demonstration project to permit States to rely on findings by
an Express Lane agency to determine components of a
child's eligibility for Medicaid or CHIP.
Sec. 204. Authorization of certain information disclosures to simplify
health coverage determinations.

TITLE III--REDUCING BARRIERS TO ENROLLMENT

Sec. 301. Verification of declaration of citizenship or nationality for
purposes of eligibility for Medicaid and CHIP.
Sec. 302. Reducing administrative barriers to enrollment.

TITLE IV--REDUCING BARRIERS TO PROVIDING PREMIUM ASSISTANCE

Subtitle A--Additional State Option for Providing Premium Assistance

Sec. 401. Additional State option for providing premium assistance.
Sec. 402. Outreach, education, and enrollment assistance.

Subtitle B--Coordinating Premium Assistance With Private Coverage

Sec. 411. Special enrollment period under group health plans in case of
termination of Medicaid or CHIP coverage or eligibility
for assistance in purchase of employment-based coverage;
coordination of coverage.

TITLE V--STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES OF CHILDREN

Sec. 501. Child health quality improvement activities for children
enrolled in Medicaid or CHIP.
Sec. 502. Improved information regarding access to coverage under CHIP.
Sec. 503. Application of certain managed care quality safeguards to
CHIP.

TITLE VI--MISCELLANEOUS

Sec. 601. Technical correction regarding current State authority under
Medicaid.
Sec. 602. Payment error rate measurement (``PERM'').
Sec. 603. Elimination of counting medicaid child presumptive
eligibility costs against title XXI allotment.
Sec. 604. Improving data collection.
Sec. 605. Deficit Reduction Act technical corrections.
Sec. 606. Elimination of confusing program references.
Sec. 607. Mental health parity in CHIP plans.
Sec. 608. Dental health grants.
Sec. 609. Application of prospective payment system for services
provided by Federally-qualified health centers and rural
health clinics.

TITLE VII--REVENUE PROVISIONS

Sec. 701. Increase in excise tax rate on tobacco products.
Sec. 702. Administrative improvements.
Sec. 703. Time for payment of corporate estimated taxes.

TITLE VIII--EFFECTIVE DATE

Sec. 801. Effective date.

TITLE I--FINANCING OF CHIP

SEC. 101. EXTENSION OF CHIP.

Section 2104(a) (42 U.S.C. 1397dd(a)) is amended--
(1) in paragraph (9), by striking ``and'' at the end;
(2) in paragraph (10), by striking the period at the end
and inserting a semicolon; and
(3) by adding at the end the following new paragraphs:
``(11) for fiscal year 2008, $9,125,000,000;
``(12) for fiscal year 2009, $10,675,000,000;
``(13) for fiscal year 2010, $11,850,000,000;
``(14) for fiscal year 2011, $13,750,000,000; and
``(15) for fiscal year 2012, for purposes of making 2 semi-
annual allotments--
``(A) $1,750,000,000 for the period beginning on October 1,
2011, and ending on March 31, 2012, and
``(B) $1,750,000,000 for the period beginning on April 1,
2012, and ending on September 30, 2012.''.

SEC. 102. ALLOTMENTS FOR THE 50 STATES AND THE DISTRICT OF
COLUMBIA.

(a) In General.--Section 2104 (42 U.S.C. 1397dd) is amended
by adding at the end the following new subsection:
``(i) Determination of Allotments for the 50 States and the
District of Columbia for Fiscal Years 2008 Through 2012.--
``(1) Computation of allotment.--
``(A) In general.--Subject to the succeeding paragraphs of
this subsection, the Secretary shall for each of fiscal years
2008 through 2012 allot to each subsection (b) State from the
available national allotment an amount equal to 110 percent
of--
``(i) in the case of fiscal year 2008, the highest of the
amounts determined under paragraph (2);
``(ii) in the case of each of fiscal years 2009 through
2011, the Federal share of the expenditures determined under
subparagraph (B) for the fiscal year; and
``(iii) beginning with fiscal year 2012, subject to
subparagraph (E), each semi-annual allotment determined under
subparagraph (D).
``(B) Projected state expenditures for the fiscal year.--
For purposes of subparagraphs (A)(ii) and (D), the
expenditures determined under this subparagraph for a fiscal
year are the projected expenditures under the State child
health plan for the fiscal year (as certified by the State
and submitted to the Secretary by not later than August 31 of
the preceding fiscal year).
``(C) Available national allotment.--For purposes of this
subsection, the term `available national allotment' means,
with respect to any fiscal year, the amount available for
allotment under subsection (a) for the fiscal year, reduced
by the amount of the allotments made for the fiscal year
under subsection (c). Subject to paragraph (3)(B), the
available national allotment with respect to the amount
available under subsection (a)(15)(A) for fiscal year 2012
shall be increased by the amount of the appropriation for the
period beginning on October 1 and ending on March 31 of such
fiscal year under section 103 of the Children's Health
Insurance Program Reauthorization Act of 2007.
``(D) Semi-annual allotments.--For purposes of subparagraph
(A)(iii), the semi-annual allotments determined under this
paragraph with respect to a fiscal year are as follows:
``(i) For the period beginning on October 1 and ending on
March 31 of the fiscal year, the Federal share of the portion
of the expenditures determined under subparagraph (B) for the
fiscal year which are allocable to such period.
``(ii) For the period beginning on April 1 and ending on
September 30 of the fiscal year, the Federal share of the
portion of the expenditures determined under subparagraph (B)
for the fiscal year which are allocable to such period.
``(E) Availability.--Each semi-annual allotment made under
subparagraph (A)(iii) shall remain available for expenditure
under this title for periods after the period specified in
subparagraph (D) for purposes of determining the allotment in
the same manner

[[Page S10435]]

as the allotment would have been available for expenditure if
made for an entire fiscal year.
``(2) Special rule for fiscal year 2008.--
``(A) In general.--For purposes of paragraph (1)(A)(i), the
amounts determined under this paragraph for fiscal year 2008
are as follows:
``(i) The total Federal payments to the State under this
title for fiscal year 2007, multiplied by the annual
adjustment determined under subparagraph (B) for fiscal year
2008.
``(ii) The Federal share of the amount allotted to the
State for fiscal year 2007 under subsection (b), multiplied
by the annual adjustment determined under subparagraph (B)
for fiscal year 2008.
``(iii) Only in the case of--

``(I) a State that received a payment, redistribution, or
allotment under any of paragraphs (1), (2), or (4) of
subsection (h), the amount of the projected total Federal
payments to the State under this title for fiscal year 2007,
as determined on the basis of the November 2006 estimates
certified by the State to the Secretary;
``(II) a State whose projected total Federal payments to
the State under this title for fiscal year 2007, as
determined on the basis of the May 2006 estimates certified
by the State to the Secretary, were at least $95,000,000 but
not more than $96,000,000 higher than the projected total
Federal payments to the State under this title for fiscal
year 2007 on the basis of the November 2006 estimates, the
amount of the projected total Federal payments to the State
under this title for fiscal year 2007 on the basis of the May
2006 estimates; or
``(III) a State whose projected total Federal payments
under this title for fiscal year 2007, as determined on the
basis of the November 2006 estimates certified by the State
to the Secretary, exceeded all amounts available to the State
for expenditure for fiscal year 2007 (including any amounts
paid, allotted, or redistributed to the State in prior fiscal
years), the amount of the projected total Federal payments to
the State under this title for fiscal year 2007, as
determined on the basis of the November 2006 estimates
certified by the State to the Secretary,

multiplied by the annual adjustment determined under
subparagraph (B) for fiscal year 2008.
``(iv) The projected total Federal payments to the State
under this title for fiscal year 2008, as determined on the
basis of the August 2007 projections certified by the State
to the Secretary by not later than September 30, 2007.
``(B) Annual adjustment for health care cost growth and
child population growth.--The annual adjustment determined
under this subparagraph for a fiscal year with respect to a
State is equal to the product of the amounts determined under
clauses (i) and (ii):
``(i) Per capita health care growth.--1 plus the percentage
increase (if any) in the projected nominal per capita amount
of National Health Expenditures for the calendar year that
begins during the fiscal year involved over the preceding
calendar year, as most recently published by the Secretary.
``(ii) Child population growth.--1.01 plus the percentage
change in the population of children under 19 years of age in
the State from July 1 of the fiscal year preceding the fiscal
year involved to July 1 of the fiscal year involved, as
determined by the Secretary based on the most timely and
accurate published estimates of the Bureau of the Census.
``(C) Definition.--For purposes of subparagraph (B), the
term `fiscal year involved' means the fiscal year for which
an allotment under this subsection is being determined.
``(D) Proration rule.--If, after the application of this
paragraph without regard to this subparagraph, the sum of the
State allotments determined under this paragraph for fiscal
year 2008 exceeds the available national allotment for fiscal
year 2008, the Secretary shall reduce each such allotment on
a proportional basis.
``(3) Alternative allotments for fiscal years 2009 through
2012.--
``(A) In general.--If the sum of the State allotments
determined under paragraph (1)(A)(ii) for any of fiscal years
2009 through 2011 exceeds the available national allotment
for the fiscal year, the Secretary shall allot to each
subsection (b) State from the available national allotment
for the fiscal year an amount equal to the product of--
``(i) the available national allotment for the fiscal year;
and
``(ii) the percentage equal to the sum of the State
allotment factors for the fiscal year determined under
paragraph (4) with respect to the State.
``(B) Special rules beginning in fiscal year 2012.--
Beginning in fiscal year 2012--
``(i) this paragraph shall be applied separately with
respect to each of the periods described in clauses (i) and
(ii) of paragraph (1)(D) and the available national allotment
for each such period shall be the amount appropriated for
such period (rather than the amount appropriated for the
entire fiscal year), reduced by the amount of the allotments
made for the fiscal year under subsection (c) for each such
period, and
``(ii) if--

``(I) the sum of the State allotments determined under
paragraph (1)(A)(iii) for either such period exceeds the
amount of such available national allotment for such period,
the Secretary shall make the allotment for each State for
such period in the same manner as under subparagraph (A), and
``(II) the amount of such available national allotment for
either such period exceeds the sum of the State allotments
determined under paragraph (1)(A)(iii) for such period, the
Secretary shall increase the allotment for each State for
such period by the amount that bears the same ratio to such
excess as the State's allotment determined under paragraph
(1)(A)(iii) for such period (without regard to this
subparagraph) bears to the sum of such allotments for all
States.

``(4) Weighted factors.--
``(A) Factors described.--For purposes of paragraph (3),
the factors described in this subparagraph are the following:
``(i) Projected state expenditures for the fiscal year.--
The ratio of the projected expenditures under the State child
health plan for the fiscal year (as certified by the State to
the Secretary by not later than August 31 of the preceding
fiscal year) to the sum of the projected expenditures under
all such plans for all subsection (b) States for the fiscal
year, multiplied by the applicable percentage weight assigned
under subparagraph (B).
``(ii) Number of low-income children in the state.--The
ratio of the number of low-income children in the State, as
determined on the basis of the most timely and accurate
published estimates of the Bureau of the Census, to the sum
of the number of low-income children so determined for all
subsection (b) States for such fiscal year, multiplied by the
applicable percentage weight assigned under subparagraph (B).
``(iii) Projected state expenditures for the preceding
fiscal year.--The ratio of the projected expenditures under
the State child health plan for the preceding fiscal year (as
determined on the basis of the projections certified by the
State to the Secretary for November of the fiscal year), to
the sum of the projected expenditures under all such plans
for all subsection (b) States for such preceding fiscal year
(as so determined), multiplied by the applicable percentage
weight assigned under subparagraph (B).
``(iv) Actual state expenditures for the second preceding
fiscal year.--The ratio of the actual expenditures under the
State child health plan for the second preceding fiscal year,
as determined by the Secretary on the basis of expenditure
data reported by States on CMS Form 64 or CMS Form 21, to
such sum of the actual expenditures under all such plans for
all subsection (b) States for such second preceding fiscal
year, multiplied by the applicable percentage weight assigned
under subparagraph (B).
``(B) Assignment of weights.--For each of fiscal years 2009
through 2012, the applicable weights assigned under this
subparagraph are the following:
``(i) With respect to the factor described in subparagraph
(A)(i), a weight of 75 percent for each such fiscal year.
``(ii) With respect to the factor described in subparagraph
(A)(ii), a weight of 12\1/2\ percent for each such fiscal
year.
``(iii) With respect to the factor described in
subparagraph (A)(iii), a weight of 7\1/2\ percent for each
such fiscal year.
``(iv) With respect to the factor described in subparagraph
(A)(iv), a weight of 5 percent for each such fiscal year.
``(5) Demonstration of need for increased allotment based
on projected state expenditures exceeding 10 percent of the
preceding fiscal year allotment.--
``(A) In general.--If the projected expenditures under the
State child health plan described in paragraph (1)(B) for any
of fiscal years 2009 through 2012 are at least 10 percent
more than the allotment determined for the State for the
preceding fiscal year (determined without regard to paragraph
(2)(D) or paragraph (3)), and, during the preceding fiscal
year, the State did not receive approval for a State plan
amendment or waiver to expand coverage under the State child
health plan or did not receive a CHIP contingency fund
payment under subsection (k)--
``(i) the State shall submit to the Secretary, by not later
than August 31 of the preceding fiscal year, information
relating to the factors that contributed to the need for the
increase in the State's allotment for the fiscal year, as
well as any other additional information that the Secretary
may require for the State to demonstrate the need for the
increase in the State's allotment for the fiscal year;
``(ii) the Secretary shall--

``(I) review the information submitted under clause (i);
``(II) notify the State in writing within 60 days after
receipt of the information that--

``(aa) the projected expenditures under the State child
health plan are approved or disapproved (and if disapproved,
the reasons for disapproval); or
``(bb) specified additional information is needed; and

``(III) if the Secretary disapproved the projected
expenditures or determined additional information is needed,
provide the State with a reasonable opportunity to submit
additional information to demonstrate the need for the
increase in the State's allotment for the fiscal year.

``(B) Provisional and final allotment.--In the case of a
State described in subparagraph (A) for which the Secretary
has not determined by September 30 of a fiscal year whether
the State has demonstrated the need for the increase in the
State's allotment for the succeeding fiscal year, the
Secretary shall provide the State with a provisional
allotment for the fiscal year equal to

[[Page S10436]]

110 percent of the allotment determined for the State under
this subsection for the preceding fiscal year (determined
without regard to paragraph (2)(D) or paragraph (3)), and
may, not later than November 30 of the fiscal year, adjust
the State's allotment (and the allotments of other subsection
(b) States), as necessary (and, if applicable, subject to
paragraph (3)), on the basis of information submitted by the
State in accordance with subparagraph (A).
``(6) Special rules.--
``(A) Deadline and data for determining fiscal year 2008
allotments.--In computing the amounts under paragraph (2)(A)
and subsection (c)(5)(A) that determine the allotments to
subsection (b) States and territories for fiscal year 2008,
the Secretary shall use the most recent data available to the
Secretary before the start of that fiscal year. The Secretary
may adjust such amounts and allotments, as necessary, on the
basis of the expenditure data for the prior year reported by
States on CMS Form 64 or CMS Form 21 not later than November
30, 2007, but in no case shall the Secretary adjust the
allotments provided under paragraph (2)(A) or subsection
(c)(5)(A) for fiscal year 2008 after December 31, 2007.
``(B) Inclusion of certain expenditures.--
``(i) Projected expenditures of qualifying states.--
Payments made or projected to be made to a qualifying State
described in paragraph (2) of section 2105(g) for
expenditures described in paragraph (1)(B)(ii) or (4)(B) of
that section shall be included for purposes of determining
the projected expenditures described in paragraph (1)(B) with
respect to the allotments determined for each of fiscal years
2009 through 2012 and for purposes of determining the amounts
described in clauses (i) and (iv) of paragraph (2)(A) with
respect to the allotments determined for fiscal year 2008.
``(ii) Projected expenditures under block grant set-asides
for nonpregnant childless adults and parents.--Payments
projected to be made to a State under subsection (a) or (b)
of section 2111 shall be included for purposes of determining
the projected expenditures described in paragraph (1)(B) with
respect to the allotments determined for each of fiscal years
2009 through 2012 (to the extent such payments are permitted
under such section), including for purposes of allocating
such expenditures for purposes of clauses (i) and (ii) of
paragraph (1)(D).
``(7) Subsection (b) state.--In this paragraph, the term
`subsection (b) State' means 1 of the 50 States or the
District of Columbia.''.
(b) Conforming Amendments.--Section 2104 (42 U.S.C. 1397dd)
is amended--
(1) in subsection (a), by striking ``subsection (d)'' and
inserting ``subsections (d), (h), and (i)'';
(2) in subsection (b)(1), by striking ``subsection (d)''
and inserting ``subsections (d), (h), and (i)''; and
(3) in subsection (c)(1), by striking ``subsection (d)''
and inserting ``subsections (d), (h), and (i)''.

SEC. 103. ONE-TIME APPROPRIATION.

There is appropriated to the Secretary, out of any money in
the Treasury not otherwise appropriated, $12,500,000,000 to
accompany the allotment made for the period beginning on
October 1, 2011, and ending on March 31, 2012, under section
2104(a)(15)(A) of the Social Security Act (42 U.S.C.
1397dd(a)(15)(A)) (as added by section 101), to remain
available until expended. Such amount shall be used to
provide allotments to States under subsections (c)(5) and (i)
of section 2104 of the Social Security Act (42 U.S.C. 1397dd)
for the first 6 months of fiscal year 2012 in the same manner
as allotments are provided under subsection (a)(15)(A) of
such section and subject to the same terms and conditions as
apply to the allotments provided from such subsection
(a)(15)(A).

SEC. 104. IMPROVING FUNDING FOR THE TERRITORIES UNDER CHIP
AND MEDICAID.

(a) Update of CHIP Allotments.--Section 2104(c) (42 U.S.C.
1397dd(c)) is amended--
(1) in paragraph (1), by inserting ``and paragraphs (5) and
(6)'' after ``and (i)''; and
(2) by adding at the end the following new paragraphs:
``(5) Annual allotments for territories beginning with
fiscal year 2008.--Of the total allotment amount appropriated
under subsection (a) for a fiscal year beginning with fiscal
year 2008, the Secretary shall allot to each of the
commonwealths and territories described in paragraph (3) the
following:
``(A) Fiscal year 2008.--For fiscal year 2008, the highest
amount of Federal payments to the commonwealth or territory
under this title for any fiscal year occurring during the
period of fiscal years 1998 through 2007, multiplied by the
annual adjustment determined under subsection (i)(2)(B) for
fiscal year 2008, except that clause (ii) thereof shall be
applied by substituting `the United States' for `the State'.
``(B) Fiscal years 2009 through 2012.--
``(i) In general.--For each of fiscal years 2009 through
2012, except as provided in clause (ii), the amount
determined under this paragraph for the preceding fiscal year
multiplied by the annual adjustment determined under
subsection (i)(2)(B) for the fiscal year, except that clause
(ii) thereof shall be applied by substituting `the United
States' for `the State'.
``(ii) Special rule for fiscal year 2012.--In the case of
fiscal year 2012--

``(I) 89 percent of the amount allocated to the
commonwealth or territory for such fiscal year (without
regard to this subclause) shall be allocated for the period
beginning on October 1, 2011, and ending on March 31, 2012,
and
``(II) 11 percent of such amount shall be allocated for the
period beginning on April 1, 2012, and ending on September
30, 2012.''.

(b) Removal of Federal Matching Payments for Data Reporting
Systems From the Overall Limit on Payments to Territories
Under Title XIX.--Section 1108(g) (42 U.S.C. 1308(g)) is
amended by adding at the end the following new paragraph:
``(4) Exclusion of certain expenditures from payment
limits.--With respect to fiscal years beginning with fiscal
year 2008, if Puerto Rico, the Virgin Islands, Guam, the
Northern Mariana Islands, or American Samoa qualify for a
payment under subparagraph (A)(i), (B), or (F) of section
1903(a)(3) for a calendar quarter of such fiscal year, the
payment shall not be taken into account in applying
subsection (f) (as increased in accordance with paragraphs
(1), (2), and (3) of this subsection) to such commonwealth or
territory for such fiscal year.''.
(c) GAO Study and Report.--Not later than September 30,
2009, the Comptroller General of the United States shall
submit a report to the appropriate committees of Congress
regarding Federal funding under Medicaid and CHIP for Puerto
Rico, the United States Virgin Islands, Guam, American Samoa,
and the Northern Mariana Islands. The report shall include
the following:
(1) An analysis of all relevant factors with respect to--
(A) eligible Medicaid and CHIP populations in such
commonwealths and territories;
(B) historical and projected spending needs of such
commonwealths and territories and the ability of capped
funding streams to respond to those spending needs;
(C) the extent to which Federal poverty guidelines are used
by such commonwealths and territories to determine Medicaid
and CHIP eligibility; and
(D) the extent to which such commonwealths and territories
participate in data collection and reporting related to
Medicaid and CHIP, including an analysis of territory
participation in the Current Population Survey versus the
American Community Survey.
(2) Recommendations for improving Federal funding under
Medicaid and CHIP for such commonwealths and territories.

SEC. 105. INCENTIVE BONUSES FOR STATES.

(a) In General.--Section 2104 (42 U.S.C. 1397dd), as
amended by section 102, is amended by adding at the end the
following new subsection:
``(j) Incentive Bonuses.--
``(1) Establishment of incentive pool from unobligated
national allotment and unexpended state allotments.--
``(A) In general.--There is hereby established in the
Treasury of the United States a fund which shall be known as
the `CHIP Incentive Bonuses Pool' (in this subsection
referred to as the `Incentive Pool'). Amounts in the
Incentive Pool are authorized to be appropriated for payments
under this subsection and shall remain available until
expended.
``(B) Deposits through initial appropriation and transfers
of funds.--
``(i) Initial appropriation.--There is appropriated to the
Incentive Pool, out of any money in the Treasury not
otherwise appropriated, $3,000,000,000 for fiscal year 2008.
``(ii) Transfers.--Notwithstanding any other provision of
law, the following amounts are hereby appropriated or
transferred to, deposited in, and made available for
expenditure from the Incentive Pool on the following dates:

``(I) Unexpended fiscal year 2006 and 2007 allotments.--On
December 31, 2007, the sum for all States of the excess (if
any) for each State of--

``(aa) the aggregate allotments provided for the State
under subsection (b) or (c) for fiscal years 2006 and 2007
that are not expended by September 30, 2007, over
``(bb) an amount equal to 50 percent of the allotment
provided for the State under subsection (c) or (i) for fiscal
year 2008 (as determined in accordance with subsection
(i)(6)).

``(II) Unobligated national allotment.--

``(aa) Fiscal years 2008 through 2011.--On December 31 of
fiscal year 2008, and on December 31 of each succeeding
fiscal year through fiscal year 2011, 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 (c) or (i) for such fiscal year or set aside under
subsection (a)(3) or (b)(2) of section 2111 for such fiscal
year.
``(bb) First half of fiscal year 2012.--On December 31 of
fiscal year 2012, the portion, if any, of the sum of the
amounts appropriated under subsection (a)(15)(A) and under
section 103 of the Children's Health Insurance Program
Reauthorization Act of 2007 for the period beginning on
October 1, 2011, and ending on March 31, 2012, that is
unobligated for allotment to a State under subsection (c) or
(i) for such fiscal year or set aside under subsection (b)(2)
of section 2111 for such fiscal year.
``(cc) Second half of fiscal year 2012.--On June 30 of
fiscal year 2012, the portion, if any, of the amount
appropriated under subsection (a)(15)(B) for the period
beginning on April 1, 2012, and ending on September 30, 2012,
that is unobligated for allotment to a

[[Page S10437]]

State under subsection (c) or (i) for such fiscal year or set
aside under subsection (b)(2) of section 2111 for such fiscal
year.

``(III) Percentage of state allotments that are unexpended
by the end of the first year of availability beginning with
the fiscal year 2009 allotments.--On October 1 of each of
fiscal years 2009 through 2012, the sum for all States for
such fiscal year (the `current fiscal year') of the excess
(if any) for each State of--

``(aa) the allotment made for the State under subsection
(b), (c), or (i) for the fiscal year preceding the current
fiscal year (reduced by any amounts set aside under section
2111(a)(3)) that is not expended by the end of such preceding
fiscal year, over
``(bb) an amount equal to the applicable percentage (for
the fiscal year) of the allotment made for the State under
subsection (b), (c), or (i) (as so reduced) for such
preceding fiscal year.

For purposes of item (bb), the applicable percentage is 20
percent for fiscal year 2009, and 10 percent for each of
fiscal years 2010, 2011, and 2012.
``(IV) Remainder of state allotments that are unexpended by
the end of the period of availability beginning with the
fiscal year 2006 allotments.--On October 1 of each of fiscal
years 2009 through 2012, the total amount of allotments made
to States under subsection (b), (c), or (i) for the second
preceding fiscal year (third preceding fiscal year in the
case of the fiscal year 2006 allotments) and remaining after
the application of subclause (III) that are not expended by
September 30 of the preceding fiscal year.
``(V) Unexpended transitional coverage block grant for
nonpregnant childless adults.--On October 1, 2009, any
amounts set aside under section 2111(a)(3) that are not
expended by September 30, 2009.
``(VI)  Excess chip contingency funds.--

``(aa) Amounts in excess of the aggregate cap.--On October
1 of each of fiscal years 2010 through 2012, any amount in
excess of the aggregate cap applicable to the CHIP
Contingency Fund for the fiscal year under subsection
(k)(2)(B).
``(bb) Unexpended chip contingency fund payments.--On
October 1 of each of fiscal years 2010 through 2012, any
portion of a CHIP Contingency Fund payment made to a State
that remains unexpended at the end of the period for which
the payment is available for expenditure under subsection
(e)(3).

``(VII) Extension of availability for portion of unexpended
state allotments.--The portion of the allotment made to a
State for a fiscal year that is not transferred to the
Incentive Pool under subclause (I) or (III) shall remain
available for expenditure by the State only during the fiscal
year in which such transfer occurs, in accordance with
subclause (IV) and subsection (e)(4).

``(C) Investment of fund.--The Secretary of the Treasury
shall invest, in interest bearing securities of the United
States, such currently available portions of the Incentive
Pool as are not immediately required for payments from the
Pool. The income derived from these investments constitutes a
part of the Incentive Pool.
``(2) Payments to states increasing enrollment.--
``(A) In general.--Subject to paragraph (3)(D), with
respect to each of fiscal years 2009 through 2012, the
Secretary shall make payments to States from the Incentive
Pool determined under subparagraph (B).
``(B) Determination of payments.--If, for any coverage
period ending in a fiscal year ending after September 30,
2008, the average monthly enrollment of children in the State
plan under title XIX exceeds the baseline monthly average for
such period, the payment made for the fiscal year shall be
equal to the applicable amount determined under subparagraph
(C).
``(C) Applicable amount.--For purposes of subparagraph (B),
the applicable amount is the product determined in accordance
with the following:
``(i) If such excess with respect to the number of
individuals who are enrolled in the State plan under title
XIX does not exceed 2 percent, the product of $75 and the
number of such individuals included in such excess.
``(ii) If such excess with respect to the number of
individuals who are enrolled in the State plan under title
XIX exceeds 2, but does not exceed 5 percent, the product of
$300 and the number of such individuals included in such
excess, less the amount of such excess calculated in clause
(i).
``(iii) If such excess with respect to the number of
individuals who are enrolled in the State plan under title
XIX exceeds 5 percent, the product of $625 and the number of
such individuals included in such excess, less the sum of the
amount of such excess calculated in clauses (i) and (ii).
``(D) Indexing of dollar amounts.--For each coverage period
ending in a fiscal year ending after September 30, 2009, the
dollar amounts specified in subparagraph (C) shall be
increased by the percentage increase (if any) in the
projected nominal per capita amount of National Health
Expenditures for the calendar year beginning on January 1 of
the coverage period over the preceding coverage period, as
most recently published by the Secretary before the beginning
of the coverage period involved.
``(3) Rules relating to enrollment increases.--For purposes
of paragraph (2)(B)--
``(A) Baseline monthly average.--Except as provided in
subparagraph (C), the baseline monthly average for any fiscal
year for a State is equal to--
``(i) the baseline monthly average for the preceding fiscal
year; multiplied by
``(ii) the sum of 1 plus the sum of--

``(I) 0.01; and
``(II) the percentage increase in the population of low-
income children in the State from the preceding fiscal year
to the fiscal year involved, as determined by the Secretary
based on the most timely and accurate published estimates of
the Bureau of the Census before the beginning of the fiscal
year involved.

``(B) Coverage period.--Except as provided in subparagraph
(C), the coverage period for any fiscal year consists of the
last 2 quarters of the preceding fiscal year and the first 2
quarters of the fiscal year.
``(C) Special rules for fiscal year 2009.--With respect to
fiscal year 2009--
``(i) the coverage period for that fiscal year shall be
based on the first 2 quarters of fiscal year 2009; and
``(ii) the baseline monthly average shall be--

``(I) the average monthly enrollment of low-income children
enrolled in the State's plan under title XIX for the first 2
quarters of fiscal year 2007 (as determined over a 6-month
period on the basis of the most recent information reported
through the Medicaid Statistical Information System (MSIS));
multiplied by
``(II) the sum of 1 plus the sum of--

``(aa) 0.02; and
``(bb) the percentage increase in the population of low-
income children in the State from fiscal year 2007 to fiscal
year 2009, as determined by the Secretary based on the most
timely and accurate published estimates of the Bureau of the
Census before the beginning of the fiscal year involved.
``(D) Additional requirement for eligibility for payment.--
For purposes of subparagraphs (B) and (C), the average
monthly enrollment shall be determined without regard to
children who do not meet the income eligibility criteria in
effect on July 19, 2007, for enrollment under the State plan
under title XIX or under a waiver of such plan.
``(4) Time of payment.--Payments under paragraph (2) for
any fiscal year shall be made during the last quarter of such
year.
``(5) Use of payments.--Payments made to a State from the
Incentive Pool shall be used for any purpose that the State
determines is likely to reduce the percentage of low-income
children in the State without health insurance.
``(6) Proration rule.--If the amount available for payment
from the Incentive Pool is less than the total amount of
payments to be made for such fiscal year, the Secretary shall
reduce the payments described in paragraph (2) on a
proportional basis.
``(7) References.--With respect to a State plan under title
XIX, any references to a child in this subsection shall
include a reference to any individual provided medical
assistance under the plan who has not attained age 19 (or, if
a State has so elected under such State plan, age 20 or
21).''.
(b) Redistribution of Unexpended Fiscal Year 2005
Allotments.--Notwithstanding section 2104(f) of the Social
Security Act (42 U.S.C. 1397dd(f)), with respect to fiscal
year 2008, the Secretary shall provide for a redistribution
under such section from the allotments for fiscal year 2005
under subsection (b) and (c) of such section that are not
expended by the end of fiscal year 2007, to each State
described in clause (iii) of section 2104(i)(2)(A) of the
Social Security Act, as added by section 102(a), of an amount
that bears the same ratio to such unexpended fiscal year 2005
allotments as the ratio of the fiscal year 2007 allotment
determined for each such State under subsection (b) of
section 2104 of such Act for fiscal year 2007 (without regard
to any amounts paid, allotted, or redistributed to the State
under section 2104 for any preceding fiscal year) bears to
the total amount of the fiscal year 2007 allotments for all
such States (as so determined).
(c) Conforming Amendment Eliminating Rules for
Redistribution of Unexpended Allotments for Fiscal Years
After 2005.--Effective January 1, 2008, section 2104(f) (42
U.S.C. 1397dd(f)) is amended to read as follows:
``(f) Unallocated Portion of National Allotment and Unused
Allotments.--For provisions relating to the distribution of
portions of the unallocated national allotment under
subsection (a) for fiscal years beginning with fiscal year
2008, and unexpended allotments for fiscal years beginning
with fiscal year 2006, see subsection (j).''.
(d) Additional Funding for the Secretary To Improve
Timeliness of Data Reporting and Analysis for Purposes of
Determining Enrollment Increases Under Medicaid and CHIP.--
(1) Appropriation.--There is appropriated, out of any money
in the Treasury not otherwise appropriated, $5,000,000 to the
Secretary for fiscal year 2008 for the purpose of improving
the timeliness of the data reported and analyzed from the
Medicaid Statistical Information System (MSIS) for purposes
of carrying out section 2104(j)(2)(B) of the Social Security
Act (as added by subsection (a)) and to provide guidance to
States with respect to any new reporting requirements related
to such improvements. Amounts appropriated under this
paragraph shall remain available until expended.
(2) Requirements.--The improvements made by the Secretary
under paragraph (1) shall be designed and implemented
(including with respect to any necessary guidance for States)
so that, beginning no later than October 1, 2008, data
regarding the enrollment of low-income children (as defined
in

[[Page S10438]]

section 2110(c)(4) of the Social Security Act (42 U.S.C.
1397jj(c)(4)) of a State enrolled in the State plan under
Medicaid or the State child health plan under CHIP with
respect to a fiscal year shall be collected and analyzed by
the Secretary within 6 months of submission.

SEC. 106. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS
ADULTS UNDER CHIP; CONDITIONS FOR COVERAGE OF
PARENTS.

(a) Phase-Out Rules.--
(1) In general.--Title XXI (42 U.S.C. 1397aa et seq.) is
amended by adding at the end the following new section:

``SEC. 2111. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS
ADULTS; CONDITIONS FOR COVERAGE OF PARENTS.

``(a) Termination of Coverage for Nonpregnant Childless
Adults.--
``(1) No new chip waivers; automatic extensions at state
option through fiscal year 2008.--Notwithstanding section
1115 or any other provision of this title, except as provided
in this subsection--
``(A) the Secretary shall not on or after the date of the
enactment of the Children's Health Insurance Program
Reauthorization Act of 2007, approve or renew a waiver,
experimental, pilot, or demonstration project that would
allow funds made available under this title to be used to
provide child health assistance or other health benefits
coverage to a nonpregnant childless adult; and
``(B) notwithstanding the terms and conditions of an
applicable existing waiver, the provisions of paragraphs (2)
and (3) shall apply for purposes of any fiscal year beginning
on or after October 1, 2008, in determining the period to
which the waiver applies, the individuals eligible to be
covered by the waiver, and the amount of the Federal payment
under this title.
``(2) Termination of chip coverage under applicable
existing waivers at the end of fiscal year 2008.--
``(A) In general.--No funds shall be available under this
title for child health assistance or other health benefits
coverage that is provided to a nonpregnant childless adult
under an applicable existing waiver after September 30, 2008.
``(B) Extension upon state request.--If an applicable
existing waiver described in subparagraph (A) would otherwise
expire before October 1, 2008, and the State requests an
extension of such waiver, the Secretary shall grant such an
extension, but only through September 30, 2008.
``(C) Application of enhanced fmap.--The enhanced FMAP
determined under section 2105(b) shall apply to expenditures
under an applicable existing waiver for the provision of
child health assistance or other health benefits coverage to
a nonpregnant childless adult during fiscal year 2008.
``(3) Optional 1-year transitional coverage block grant
funded from state allotment.--Subject to paragraph (4)(B),
each State for which coverage under an applicable existing
waiver is terminated under paragraph (2)(A) may elect to
provide nonpregnant childless adults who were provided child
health assistance or health benefits coverage under the
applicable existing waiver at any time during fiscal year
2008 with such assistance or coverage during fiscal year
2009, as if the authority to provide such assistance or
coverage under an applicable existing waiver was extended
through that fiscal year, but subject to the following terms
and conditions:
``(A) Block grant set aside from state allotment.--The
Secretary shall set aside for the State an amount equal to
the Federal share of the State's projected expenditures under
the applicable existing waiver for providing child health
assistance or health benefits coverage to all nonpregnant
childless adults under such waiver for fiscal year 2008 (as
certified by the State and submitted to the Secretary by not
later than August 31, 2008, and without regard to whether any
such individual lost coverage during fiscal year 2008 and was
later provided child health assistance or other health
benefits coverage under the waiver in that fiscal year),
increased by the annual adjustment for fiscal year 2009
determined under section 2104(i)(2)(B)(i). The Secretary may
adjust the amount set aside under the preceding sentence, as
necessary, on the basis of the expenditure data for fiscal
year 2008 reported by States on CMS Form 64 or CMS Form 21
not later than November 30, 2008, but in no case shall the
Secretary adjust such amount after December 31, 2008.
``(B) No coverage for nonpregnant childless adults who were
not covered during fiscal year 2008.--
``(i) FMAP applied to expenditures.--The Secretary shall
pay the State for each quarter of fiscal year 2009, from the
amount set aside under subparagraph (A), an amount equal to
the Federal medical assistance percentage (as determined
under section 1905(b) without regard to clause (4) of such
section) of expenditures in the quarter for providing child
health assistance or other health benefits coverage to a
nonpregnant childless adult but only if such adult was
enrolled in the State program under this title during fiscal
year 2008 (without regard to whether the individual lost
coverage during fiscal year 2008 and was reenrolled in that
fiscal year or in fiscal year 2009).
``(ii) Federal payments limited to amount of block grant
set-aside.--No payments shall be made to a State for
expenditures described in this subparagraph after the total
amount set aside under subparagraph (A) for fiscal year 2009
has been paid to the State.
``(4) State option to apply for medicaid waiver to continue
coverage for nonpregnant childless adults.--
``(A) In general.--Each State for which coverage under an
applicable existing waiver is terminated under paragraph
(2)(A) may submit, not later than June 30, 2009, an
application to the Secretary for a waiver under section 1115
of the State plan under title XIX to provide medical
assistance to a nonpregnant childless adult whose coverage is
so terminated (in this subsection referred to as a `Medicaid
nonpregnant childless adults waiver').
``(B) Deadline for approval.--The Secretary shall make a
decision to approve or deny an application for a Medicaid
nonpregnant childless adults waiver submitted under
subparagraph (A) within 90 days of the date of the submission
of the application. If no decision has been made by the
Secretary as of September 30, 2009, on the application of a
State for a Medicaid nonpregnant childless adults waiver that
was submitted to the Secretary by June 30, 2009, the
application shall be deemed approved.
``(C) Standard for budget neutrality.--The budget
neutrality requirement applicable with respect to
expenditures for medical assistance under a Medicaid
nonpregnant childless adults waiver shall--
``(i) in the case of fiscal year 2010, allow expenditures
for medical assistance under title XIX for all such adults to
not exceed the total amount of payments made to the State
under paragraph (3)(B) for fiscal year 2009, increased by the
percentage increase (if any) in the projected nominal per
capita amount of National Health Expenditures for calendar
year 2010 over calendar year 2009, as most recently published
by the Secretary; and
``(ii) in the case of any succeeding fiscal year, allow
such expenditures to not exceed the amount in effect under
this subparagraph for the preceding fiscal year, increased by
the percentage increase (if any) in the projected nominal per
capita amount of National Health Expenditures for the
calendar year that begins during the fiscal year involved
over the preceding calendar year, as most recently published
by the Secretary.
``(b) Rules and Conditions for Coverage of Parents of
Targeted Low-Income Children.--
``(1) Two-year transition period; automatic extension at
state option through fiscal year 2009.--
``(A) No new chip waivers.--Notwithstanding section 1115 or
any other provision of this title, except as provided in this
subsection--
``(i) the Secretary shall not on or after the date of the
enactment of the Children's Health Insurance Program
Reauthorization Act of 2007 approve or renew a waiver,
experimental, pilot, or demonstration project that would
allow funds made available under this title to be used to
provide child health assistance or other health benefits
coverage to a parent of a targeted low-income child; and
``(ii) notwithstanding the terms and conditions of an
applicable existing waiver, the provisions of paragraphs (2)
and (3) shall apply for purposes of any fiscal year beginning
on or after October 1, 2009, in determining the period to
which the waiver applies, the individuals eligible to be
covered by the waiver, and the amount of the Federal payment
under this title.
``(B) Extension upon state request.--If an applicable
existing waiver described in subparagraph (A) would otherwise
expire before October 1, 2009, and the State requests an
extension of such waiver, the Secretary shall grant such an
extension, but only, subject to paragraph (2)(A), through
September 30, 2009.
``(C) Application of enhanced fmap.--The enhanced FMAP
determined under section 2105(b) shall apply to expenditures
under an applicable existing waiver for the provision of
child health assistance or other health benefits coverage to
a parent of a targeted low-income child during fiscal years
2008 and 2009.
``(2) Rules for fiscal years 2010 through 2012.--
``(A) Payments for coverage limited to block grant funded
from state allotment.--Any State that provides child health
assistance or health benefits coverage under an applicable
existing waiver for a parent of a targeted low-income child
may elect to continue to provide such assistance or coverage
through fiscal year 2010, 2011, or 2012, subject to the same
terms and conditions that applied under the applicable
existing waiver, unless otherwise modified in subparagraph
(B).
``(B) Terms and conditions.--
``(i) Block grant set aside from state allotment.--If the
State makes an election under subparagraph (A), the Secretary
shall set aside for the State for each such fiscal year an
amount equal to the Federal share of 110 percent of the
State's projected expenditures under the applicable existing
waiver for providing child health assistance or health
benefits coverage to all parents of targeted low-income
children enrolled under such waiver for the fiscal year (as
certified by the State and submitted to the Secretary by not
later than August 31 of the preceding fiscal year). In the
case of fiscal year 2012, the set aside for any State shall
be computed separately for each period described in clauses
(i) and (ii) of subsection (i))(1)(D) and any increase or
reduction in the allotment for either such period under
subsection

[[Page S10439]]

(i)(3)(B)(ii) shall be allocated on a pro rata basis to such
set aside.
``(ii) Payments from block grant.--The Secretary shall pay
the State from the amount set aside under clause (i) for the
fiscal year, an amount for each quarter of such fiscal year
equal to the applicable percentage determined under clause
(iii) or (iv) for expenditures in the quarter for providing
child health assistance or other health benefits coverage to
a parent of a targeted low-income child.
``(iii) Enhanced fmap only in fiscal year 2010 for states
with significant child outreach or that achieve child
coverage benchmarks; fmap for any other states.--For purposes
of clause (ii), the applicable percentage for any quarter of
fiscal year 2010 is equal to--

``(I) the enhanced FMAP determined under section 2105(b) in
the case of a State that meets the outreach or coverage
benchmarks described in any of subparagraphs (A), (B), or (C)
of paragraph (3) for fiscal year 2009; or
``(II) the Federal medical assistance percentage (as
determined under section 1905(b) without regard to clause (4)
of such section) in the case of any other State.

``(iv) Amount of federal matching payment in 2011 or
2012.--For purposes of clause (ii), the applicable percentage
for any quarter of fiscal year 2011 or 2012 is equal to--

``(I) the REMAP percentage if the State met either of the
coverage benchmarks described in subparagraph (B) or (C) of
paragraph (3) for the preceding fiscal year; or
``(II) the Federal medical assistance percentage (as so
determined) in the case of any State to which subclause (I)
does not apply.

For purposes of subclause (I), the REMAP percentage is the
percentage which is the sum of such Federal medical
assistance percentage and a number of percentage points equal
to one-half of the difference between such Federal medical
assistance percentage and such enhanced FMAP.
``(v) No federal payments other than from block grant set
aside.--No payments shall be made to a State for expenditures
described in clause (ii) after the total amount set aside
under clause (i) for a fiscal year has been paid to the
State.
``(vi) No increase in income eligibility level for
parents.--No payments shall be made to a State from the
amount set aside under clause (i) for a fiscal year for
expenditures for providing child health assistance or health
benefits coverage to a parent of a targeted low-income child
whose family income exceeds the income eligibility level
applied under the applicable existing waiver to parents of
targeted low-income children on the date of enactment of the
Children's Health Insurance Program Reauthorization Act of
2007.
``(3) Outreach or coverage benchmarks.--For purposes of
paragraph (2), the outreach or coverage benchmarks described
in this paragraph are as follows:
``(A) Significant child outreach campaign.--The State--
``(i) was awarded a grant under section 2113 for fiscal
year 2009;
``(ii) implemented 1 or more of the process measures
described in section 2104(j)(3)(A)(i) for such fiscal year;
or
``(iii) has submitted a specific plan for outreach for such
fiscal year.
``(B) High-performing state.--The State, on the basis of
the most timely and accurate published estimates of the
Bureau of the Census, ranks in the lowest \1/3\ of States in
terms of the State's percentage of low-income children
without health insurance.
``(C) State increasing enrollment of low-income children.--
The State qualified for a payment from the Incentive Fund
under paragraph (2)(C) of section 2104(j) for the most recent
coverage period applicable under such section.
``(4) Rules of construction.--Nothing in this subsection
shall be construed as prohibiting a State from submitting an
application to the Secretary for a waiver under section 1115
of the State plan under title XIX to provide medical
assistance to a parent of a targeted low-income child that
was provided child health assistance or health benefits
coverage under an applicable existing waiver.
``(c) Applicable Existing Waiver.--For purposes of this
section--
``(1) In general.--The term `applicable existing waiver'
means a waiver, experimental, pilot, or demonstration project
under section 1115, grandfathered under section 6102(c)(3) of
the Deficit Reduction Act of 2005, or otherwise conducted
under authority that--
``(A) would allow funds made available under this title to
be used to provide child health assistance or other health
benefits coverage to--
``(i) a parent of a targeted low-income child;
``(ii) a nonpregnant childless adult; or
``(iii) individuals described in both clauses (i) and (ii);
and
``(B) was in effect during fiscal year 2007.
``(2) Definitions.--
``(A) Parent.--The term `parent' includes a caretaker
relative (as such term is used in carrying out section 1931)
and a legal guardian.
``(B) Nonpregnant childless adult.--The term `nonpregnant
childless adult' has the meaning given such term by section
2107(f).''.
(2) Conforming amendments.--
(A) Section 2107(f) (42 U.S.C. 1397gg(f)) is amended--
(i) by striking ``, the Secretary'' and inserting ``:
``(1) The Secretary'';
(ii) in the first sentence, by inserting ``or a parent (as
defined in section 2111(c)(2)(A)), who is not pregnant, of a
targeted low-income child'' before the period;
(iii) by striking the second sentence; and
(iv) by adding at the end the following new paragraph:
``(2) The Secretary may not approve, extend, renew, or
amend a waiver, experimental, pilot, or demonstration project
with respect to a State after the date of enactment of the
Children's Health Insurance Program Reauthorization Act of
2007 that would waive or modify the requirements of section
2111.''.
(B) Section 6102(c) of the Deficit Reduction Act of 2005
(Public Law 109-171; 120 Stat. 131) is amended by striking
``Nothing'' and inserting ``Subject to section 2111 of the
Social Security Act, as added by section 106(a)(1) of the
Children's Health Insurance Program Reauthorization Act of
2007, nothing''.
(b) GAO Study and Report.--
(1) In general.--The Comptroller General of the United
States shall conduct a study of whether--
(A) the coverage of a parent, a caretaker relative (as such
term is used in carrying out section 1931), or a legal
guardian of a targeted low-income child under a State health
plan under title XXI of the Social Security Act increases the
enrollment of, or the quality of care for, children, and
(B) such parents, relatives, and legal guardians who enroll
in such a plan are more likely to enroll their children in
such a plan or in a State plan under title XIX of such Act.
(2) Report.--Not later than 2 years after the date of the
enactment of this Act, the Comptroller General shall report
the results of the study to the appropriate committees of
Congress, including recommendations (if any) for changes in
legislation.

SEC. 107. STATE OPTION TO COVER LOW-INCOME PREGNANT WOMEN
UNDER CHIP THROUGH A STATE PLAN AMENDMENT.

(a) In General.--Title XXI (42 U.S.C. 1397aa et seq.), as
amended by section 106(a), is amended by adding at the end
the following new section:

``SEC. 2112. OPTIONAL COVERAGE OF TARGETED LOW-INCOME
PREGNANT WOMEN THROUGH A STATE PLAN AMENDMENT.

``(a) In General.--Subject to the succeeding provisions of
this section, a State may elect through an amendment to its
State child health plan under section 2102 to provide
pregnancy-related assistance under such plan for targeted
low-income pregnant women.
``(b) Conditions.--A State may only elect the option under
subsection (a) if the following conditions are satisfied:
``(1) Medicaid income eligibility level for pregnant women
of at least 185 percent of poverty.--The State has
established an income eligibility level for pregnant women
under subsection (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or
(l)(1)(A) of section 1902 that is at least 185 percent of the
income official poverty line.
``(2) No chip income eligibility level for pregnant women
lower than the state's medicaid level.--The State does not
apply an effective income level for pregnant women under the
State plan amendment that is lower than the effective income
level (expressed as a percent of the poverty line and
considering applicable income disregards) specified under
subsection (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or
(l)(1)(A) of section 1902, on the date of enactment of this
paragraph to be eligible for medical assistance as a pregnant
woman.
``(3) No coverage for higher income pregnant women without
covering lower income pregnant women.--The State does not
provide coverage for pregnant women with higher family income
without covering pregnant women with a lower family income.
``(4) Application of requirements for coverage of targeted
low-income children.--The State provides pregnancy-related
assistance for targeted low-income pregnant women in the same
manner, and subject to the same requirements, as the State
provides child health assistance for targeted low-income
children under the State child health plan, and in addition
to providing child health assistance for such women.
``(5) No preexisting condition exclusion or waiting
period.--The State does not apply any exclusion of benefits
for pregnancy-related assistance based on any preexisting
condition or any waiting period (including any waiting period
imposed to carry out section 2102(b)(3)(C)) for receipt of
such assistance.
``(6) Application of cost-sharing protection.--The State
provides pregnancy-related assistance to a targeted low-
income woman consistent with the cost-sharing protections
under section 2103(e) and applies the limitation on total
annual aggregate cost sharing imposed under paragraph (3)(B)
of such section to the family of such a woman.
``(c) Option To Provide Presumptive Eligibility.--A State
that elects the option under subsection (a) and satisfies the
conditions described in subsection (b) may elect to apply
section 1920 (relating to presumptive eligibility for
pregnant women) to the State child health plan in the same
manner as such section applies to the State plan under title
XIX.
``(d) Definitions.--For purposes of this section:

[[Page S10440]]

``(1) Pregnancy-related assistance.--The term `pregnancy-
related assistance' has the meaning given the term `child
health assistance' in section 2110(a) and includes any
medical assistance that the State would provide for a
pregnant woman under the State plan under title XIX during
pregnancy and the period described in paragraph (2)(A).
``(2) Targeted low-income pregnant woman.--The term
`targeted low-income pregnant woman' means a woman--
``(A) during pregnancy and through the end of the month in
which the 60-day period (beginning on the last day of her
pregnancy) ends;
``(B) whose family income does not exceed the income
eligibility level established under the State child health
plan under this title for a targeted low-income child; and
``(C) who satisfies the requirements of paragraphs (1)(A),
(1)(C), (2), and (3) of section 2110(b) in the same manner as
a child applying for child health assistance would have to
satisfy such requirements.
``(e) Automatic Enrollment for Children Born to Women
Receiving Pregnancy-Related Assistance.--If a child is born
to a targeted low-income pregnant woman who was receiving
pregnancy-related assistance under this section on the date
of the child's birth, the child shall be deemed to have
applied for child health assistance under the State child
health plan and to have been found eligible for such
assistance under such plan or to have applied for medical
assistance under title XIX and to have been found eligible
for such assistance under such title, as appropriate, on the
date of such birth and to remain eligible for such assistance
until the child attains 1 year of age. During the period in
which a child is deemed under the preceding sentence to be
eligible for child health or medical assistance, the child
health or medical assistance eligibility identification
number of the mother shall also serve as the identification
number of the child, and all claims shall be submitted and
paid under such number (unless the State issues a separate
identification number for the child before such period
expires).
``(f) States Providing Assistance Through Other Options.--
``(1) Continuation of other options for providing
assistance.--The option to provide assistance in accordance
with the preceding subsections of this section shall not
limit any other option for a State to provide--
``(A) child health assistance through the application of
sections 457.10, 457.350(b)(2), 457.622(c)(5), and
457.626(a)(3) of title 42, Code of Federal Regulations (as in
effect after the final rule adopted by the Secretary and set
forth at 67 Fed. Reg. 61956-61974 (October 2, 2002)), or
``(B) pregnancy-related services through the application of
any waiver authority (as in effect on June 1, 2007).
``(2) Clarification of authority to provide postpartum
services.--Any State that provides child health assistance
under any authority described in paragraph (1) may continue
to provide such assistance, as well as postpartum services,
through the end of the month in which the 60-day period
(beginning on the last day of the pregnancy) ends, in the
same manner as such assistance and postpartum services would
be provided if provided under the State plan under title XIX,
but only if the mother would otherwise satisfy the
eligibility requirements that apply under the State child
health plan (other than with respect to age) during such
period.
``(3) No inference.--Nothing in this subsection shall be
construed--
``(A) to infer congressional intent regarding the legality
or illegality of the content of the sections specified in
paragraph (1)(A); or
``(B) to modify the authority to provide pregnancy-related
services under a waiver specified in paragraph (1)(B).''.
(b) Additional Conforming Amendments.--
(1) No cost sharing for pregnancy-related benefits.--
Section 2103(e)(2) (42 U.S.C. 1397cc(e)(2)) is amended--
(A) in the heading, by inserting ``or pregnancy-related
assistance'' after ``preventive services''; and
(B) by inserting before the period at the end the
following: ``or for pregnancy-related assistance''.
(2) No waiting period.--Section 2102(b)(1)(B) (42 U.S.C.
1397bb(b)(1)(B)) is amended--
(A) in clause (i), by striking ``, and'' at the end and
inserting a semicolon;
(B) in clause (ii), by striking the period at the end and
inserting ``; and''; and
(C) by adding at the end the following new clause:
``(iii) may not apply a waiting period (including a waiting
period to carry out paragraph (3)(C)) in the case of a
targeted low-income pregnant woman provided pregnancy-related
assistance under section 2112.''.

SEC. 108. CHIP CONTINGENCY FUND.

Section 2104 (42 U.S.C. 1397dd), as amended by section 105,
is amended by adding at the end the following new subsection:
``(k) CHIP Contingency Fund.--
``(1) Establishment.--There is hereby established in the
Treasury of the United States a fund which shall be known as
the `CHIP Contingency Fund' (in this subsection referred to
as the `Fund'). Amounts in the Fund are authorized to be
appropriated for payments under this subsection.
``(2) Deposits into fund.--
``(A) Initial and subsequent appropriations.--Subject to
subparagraphs (B) and (E), out of any money in the Treasury
of the United States not otherwise appropriated, there are
appropriated to the Fund--
``(i) for fiscal year 2009, an amount equal to 12.5 percent
of the available national allotment under subsection
(i)(1)(C) for the fiscal year; and
``(ii) for each of fiscal years 2010 through 2012, such
sums as are necessary for making payments to eligible States
for such fiscal year, but not in excess of the aggregate cap
described in subparagraph (B).
``(B) Aggregate cap.--Subject to subparagraph (E), the
total amount available for payment from the Fund for each of
fiscal years 2009 through 2012 (taking into account deposits
made under subparagraph (C)), shall not exceed 12.5 percent
of the available national allotment under subsection
(i)(1)(C) for the fiscal year.
``(C) 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.
``(D) Transfer of excess funds to the incentive fund.--The
Secretary of the Treasury shall transfer to, and deposit in,
the CHIP Incentive Bonuses Pool established under subsection
(j) any amounts in excess of the aggregate cap described in
subparagraph (B) for a fiscal year.
``(E) Special rules for amounts set aside for parents and
childless adults.--For purposes of subparagraphs (A) and
(B)--
``(i) the available national allotment under subsection
(i)(1)(C) shall be reduced by any amount set aside under
section 2111(a)(3) for block grant payments for transitional
coverage for childless adults; and
``(ii) the Secretary shall establish a separate account in
the Fund for the portion of any amount appropriated to the
Fund for any fiscal year which is allocable to the portion of
the available national allotment under subsection (i)(1)(C)
which is set aside for the fiscal year under section
2111(b)(2)(B)(i) for coverage of parents of low-income
children.

The Secretary shall include in the account established under
clause (ii) any income derived under subparagraph (C) which
is allocable to amounts in such account.
``(3) CHIP contingency fund payments.--
``(A) Payments.--
``(i) In general.--Subject to clauses (ii) and (iii) and
the succeeding subparagraphs of this paragraph, the Secretary
shall pay from the Fund to a State that is an eligible State
for a month of a fiscal year a CHIP contingency fund payment
equal to the Federal share of the shortfall determined under
subparagraph (D). In the case of an eligible State under
subparagraph (D)(i), the Secretary shall not make the payment
under this subparagraph until the State makes, and submits to
the Secretary, a projection of the amount of the shortfall.
``(ii) Separate determinations of shortfalls.--The
Secretary shall separately compute the shortfall under
subparagraph (D) for expenditures for eligible individuals
other than nonpregnant childless adults and parents with
respect to whom amounts are set aside under section 2111, for
expenditures for such childless adults, and for expenditures
for such parents.
``(iii) Payments.--

``(I) Nonpregnant childless adults.--No payments shall be
made from the Fund for nonpregnant childless adults with
respect to whom amounts are set aside under section
2111(a)(3).
``(II) Parents.--Any payments with respect to any shortfall
for parents who are paid from amounts set aside under section
2111(b)(2)(B)(i) shall be made only from the account
established under paragraph (2)(E)(ii) and not from any other
amounts in the Fund. No other payments may be made from such
account.

``(iv) Special rules.--Subparagraphs (B) and (C) shall be
applied separately with respect to shortfalls described in
clause (ii).
``(B) Use of funds.--Amounts paid to an eligible State from
the Fund shall be used only to eliminate the Federal share of
a shortfall in the State's allotment under subsection (i) for
a fiscal year.
``(C) Proration rule.--If the amounts available for payment
from the Fund for a fiscal year are less than the total
amount of payments determined under subparagraph (A) for the
fiscal year, the amount to be paid under such subparagraph to
each eligible State shall be reduced proportionally.
``(D) Eligible state.--
``(i) In general.--A State is an eligible State for a month
if the State is a subsection (b) State (as defined in
subsection (i)(7)), the State requests access to the Fund for
the month, and it is described in clause (ii) or (iii).
``(ii) Shortfall of federal allotment funding of not more
than 5 percent.--The Secretary estimates, on the basis of the
most recent data available to the Secretary or requested from
the State by the Secretary, that the State's allotment for
the fiscal year is at least 95 percent, but less than 100
percent, of the projected expenditures under the State child
health plan for the State for the fiscal year determined
under subsection (i) (without regard to incentive bonuses or
payments for which the State is eligible for under subsection
(j)(2) for the fiscal year).
``(iii) Shortfall of federal allotment funding of more than
5 percent caused by

[[Page S10441]]

specific events.--The Secretary estimates, on the basis of
the most recent data available to the Secretary or requested
from the State by the Secretary, that the State's allotment
for the fiscal year is less than 95 percent of the projected
expenditures under the State child health plan for the State
for the fiscal year determined under subsection (i) (without
regard to incentive bonuses or payments for which the State
is eligible for under subsection (j)(2) for the fiscal year)
and that such shortfall is attributable to 1 or more of the
following events:

``(I) Stafford act or public health emergency.--The State
has--

``(aa) 1 or more parishes or counties for which a major
disaster has been declared in accordance with section 401 of
the Robert T. Stafford Disaster Relief and Emergency
Assistance Act (42 U.S.C. 5170) and which the President has
determined warrants individual and public assistance from the
Federal Government under such Act; or
``(bb) a public health emergency declared by the Secretary
under section 319 of the Public Health Service Act.

``(II) State economic downturn.--The State unemployment
rate is at least 5.5 percent during any 13-consecutive week
period during the fiscal year and such rate is at least 120
percent of the State unemployment rate for the same period as
averaged over the last 3 fiscal years.
``(III)  Event resulting in rise in percentage of low-
income children without health insurance.--The State
experienced a recent event that resulted in an increase in
the percentage of low-income children in the State without
health insurance (as determined on the basis of the most
timely and accurate published estimates of the Bureau of the
Census) that was outside the control of the State and
warrants granting the State access to the Fund (as determined
by the Secretary).

``(E) Payments made to all eligible states on a monthly
basis; authority for pro rata payments.--The Secretary shall
make monthly payments from the Fund to all States that are
determined to be eligible States with respect to a month. If
the sum of the payments to be made from the Fund for a month
exceed the amount in the Fund, the Secretary shall reduce
each such payment on a proportional basis.
``(F) Payments limited to fiscal year of eligibility
determination unless new eligibility basis determined.--No
State shall receive a CHIP contingency fund payment under
this section for a month beginning after September 30 of the
fiscal year in which the State is determined to be an
eligible State under this subsection, except that in the case
of an event described in subclause (I) or (III) of
subparagraph (D)(iii) that occurred after July 1 of the
fiscal year, any such payment with respect to such event
shall remain available until September 30 of the subsequent
fiscal year. Nothing in the preceding sentence shall be
construed as prohibiting a State from being determined to be
an eligible State under this subsection for any fiscal year
occurring after a fiscal year in which such a determination
is made.
``(G) Exemption from determination of percentage of
allotment retained after first year of availability.--In no
event shall payments made to a State under this subsection be
treated as part of the allotment determined for a State for a
fiscal year under subsection (i) for purposes of subsection
(j)(1)(B)(ii)(III).
``(H) Application of allotment reporting rules.--Rules
applicable to States for purposes of receiving payments from
an allotment determined under subsection (c) or (i) shall
apply in the same manner to an eligible State for purposes of
receiving a CHIP contingency fund payment under this
subsection.
``(4) Annual reports.--The Secretary shall annually report
to the Congress on the amounts in the Fund, the specific
events that caused States to apply for payments from the
Fund, and the payments made from the Fund.''.

SEC. 109. TWO-YEAR AVAILABILITY OF ALLOTMENTS; EXPENDITURES
COUNTED AGAINST OLDEST ALLOTMENTS.

Section 2104(e) (42 U.S.C. 1397dd(e)) is amended to read as
follows:
``(e) Availability of Amounts Allotted.--
``(1) In general.--Except as provided in subsection
(j)(1)(B)(ii)(III), amounts allotted to a State pursuant to
this section--
``(A) for each of fiscal years 1998 through 2006, shall
remain available for expenditure by the State through the end
of the second succeeding fiscal year; and
``(B) for each of fiscal years 2007 through 2012, shall
remain available for expenditure by the State only through
the end of the succeeding fiscal year for which such amounts
are allotted.
``(2) Incentive bonuses.--Incentive bonuses paid to a State
under subsection (j)(2) for a fiscal year shall remain
available for expenditure by the State without limitation.
``(3) CHIP contingency fund payments.--Except as provided
in paragraph (3)(F) of subsection (k), CHIP Contingency Fund
payments made to a State under such subsection for a month of
a fiscal year shall remain available for expenditure by the
State through the end of the fiscal year.
``(4) Rule for counting expenditures against chip
contingency fund payments, fiscal year allotments, and
incentive bonuses.--
``(A) In general.--Expenditures under the State child
health plan made on or after October 1, 2007, shall be
counted against--
``(i) first, any CHIP Contingency Fund payment made to the
State under subsection (k) for the earliest month of the
earliest fiscal year for which the payment remains available
for expenditure; and
``(ii) second, amounts allotted to the State for the
earliest fiscal year for which amounts remain available for
expenditure.
``(B) Incentive bonuses.--A State may elect, but is not
required, to count expenditures under the State child health
plan against any incentive bonuses paid to the State under
subsection (j)(2) for a fiscal year.
``(C) Block grant set-asides.--Expenditures for coverage
of--
``(i) nonpregnant childless adults for fiscal year 2009
shall be counted only against the amount set aside for such
coverage under section 2111(a)(3); and
``(ii) parents of targeted low-income children for each of
fiscal years 2010 through 2012, shall be counted only against
the amount set aside for such coverage under section
2111(b)(2)(B)(i).''.

SEC. 110. LIMITATION ON MATCHING RATE FOR STATES THAT PROPOSE
TO COVER CHILDREN WITH EFFECTIVE FAMILY INCOME
THAT EXCEEDS 300 PERCENT OF THE POVERTY LINE.

(a) FMAP Applied to Expenditures.--Section 2105(c) (42
U.S.C. 1397ee(c)) is amended by adding at the end the
following new paragraph:
``(8) Limitation on matching rate for expenditures for
child health assistance provided to children whose effective
family income exceeds 300 percent of the poverty line.--
``(A) FMAP applied to expenditures.--Except as provided in
subparagraph (B), for fiscal years beginning with fiscal year
2008, the Federal medical assistance percentage (as
determined under section 1905(b) without regard to clause (4)
of such section) shall be substituted for the enhanced FMAP
under subsection (a)(1) with respect to any expenditures for
providing child health assistance or health benefits coverage
for a targeted low-income child whose effective family income
would exceed 300 percent of the poverty line but for the
application of a general exclusion of a block of income that
is not determined by type of expense or type of income.
``(B) Exception.--Subparagraph (A) shall not apply to any
State that, on the date of enactment of the Children's Health
Insurance Program Reauthorization Act of 2007, has an
approved State plan amendment or waiver to provide, or has
enacted a State law to submit a State plan amendment to
provide, expenditures described in such subparagraph under
the State child health plan.''.
(b) Conforming Amendment.--Section 2105(a)(1) ( 42 U.S.C.
1397dd(a)(1)) is amended, in the matter preceding
subparagraph (A), by inserting ``or subsection (c)(8)'' after
``subparagraph (B)''.

SEC. 111. OPTION FOR QUALIFYING STATES TO RECEIVE THE
ENHANCED PORTION OF THE CHIP MATCHING RATE FOR
MEDICAID COVERAGE OF CERTAIN CHILDREN.

Section 2105(g) (42 U.S.C. 1397ee(g)) is amended--
(1) in paragraph (1)(A), by inserting ``subject to
paragraph (4),'' after ``Notwithstanding any other provision
of law,''; and
(2) by adding at the end the following new paragraph:
``(4) Option for allotments for fiscal years 2008 through
2012.--
``(A) Payment of enhanced portion of matching rate for
certain expenditures.--In the case of expenditures described
in subparagraph (B), a qualifying State (as defined in
paragraph (2)) may elect to be paid from the State's
allotment made under section 2104 for any of fiscal years
2008 through 2012 (insofar as the allotment is available to
the State under subsections (e) and (i) of such section) an
amount each quarter equal to the additional amount that would
have been paid to the State under title XIX with respect to
such expenditures if the enhanced FMAP (as determined under
subsection (b)) had been substituted for the Federal medical
assistance percentage (as defined in section 1905(b)).
``(B) Expenditures described.--For purposes of subparagraph
(A), the expenditures described in this subparagraph are
expenditures made after the date of the enactment of this
paragraph and during the period in which funds are available
to the qualifying State for use under subparagraph (A), for
the provision of medical assistance to individuals residing
in the State who are eligible for medical assistance under
the State plan under title XIX or under a waiver of such plan
and who have not attained age 19 (or, if a State has so
elected under the State plan under title XIX, age 20 or 21),
and whose family income equals or exceeds 133 percent of the
poverty line but does not exceed the Medicaid applicable
income level.''.

TITLE II--OUTREACH AND ENROLLMENT

SEC. 201. GRANTS FOR OUTREACH AND ENROLLMENT.

(a) Grants.--Title XXI (42 U.S.C. 1397aa et seq.), as
amended by section 107, is amended by adding at the end the
following:

``SEC. 2113. GRANTS TO IMPROVE OUTREACH AND ENROLLMENT.

``(a) Outreach and Enrollment Grants; National Campaign.--
``(1) In general.--From the amounts appropriated under
subsection (g), subject to paragraph (2), the Secretary shall
award grants to eligible entities during the period of fiscal
years 2008 through 2012 to conduct

[[Page S10442]]

outreach and enrollment efforts that are designed to increase
the enrollment and participation of eligible children under
this title and title XIX.
``(2) Ten percent set aside for national enrollment
campaign.--An amount equal to 10 percent of such amounts
shall be used by the Secretary for expenditures during such
period to carry out a national enrollment campaign in
accordance with subsection (h).
``(b) Priority for Award of Grants.--
``(1) In general.--In awarding grants under subsection (a),
the Secretary shall give priority to eligible entities that--
``(A) propose to target geographic areas with high rates
of--
``(i) eligible but unenrolled children, including such
children who reside in rural areas; or
``(ii) racial and ethnic minorities and health disparity
populations, including those proposals that address cultural
and linguistic barriers to enrollment; and
``(B) submit the most demonstrable evidence required under
paragraphs (1) and (2) of subsection (c).
``(2) Ten percent set aside for outreach to indian
children.--An amount equal to 10 percent of the funds
appropriated under subsection (g) shall be used by the
Secretary to award grants to Indian Health Service providers
and urban Indian organizations receiving funds under title V
of the Indian Health Care Improvement Act (25 U.S.C. 1651 et
seq.) for outreach to, and enrollment of, children who are
Indians.
``(c) Application.--An eligible entity that desires to
receive a grant under subsection (a) shall submit an
application to the Secretary in such form and manner, and
containing such information, as the Secretary may decide.
Such application shall include--
``(1) evidence demonstrating that the entity includes
members who have access to, and credibility with, ethnic or
low-income populations in the communities in which activities
funded under the grant are to be conducted;
``(2) evidence demonstrating that the entity has the
ability to address barriers to enrollment, such as lack of
awareness of eligibility, stigma concerns and punitive fears
associated with receipt of benefits, and other cultural
barriers to applying for and receiving child health
assistance or medical assistance;
``(3) specific quality or outcomes performance measures to
evaluate the effectiveness of activities funded by a grant
awarded under this section; and
``(4) an assurance that the eligible entity shall--
``(A) conduct an assessment of the effectiveness of such
activities against the performance measures;
``(B) cooperate with the collection and reporting of
enrollment data and other information in order for the
Secretary to conduct such assessments; and
``(C) in the case of an eligible entity that is not the
State, provide the State with enrollment data and other
information as necessary for the State to make necessary
projections of eligible children and pregnant women.
``(d) Dissemination of Enrollment Data and Information
Determined From Effectiveness Assessments; Annual Report.--
The Secretary shall--
``(1) make publicly available the enrollment data and
information collected and reported in accordance with
subsection (c)(4)(B); and
``(2) submit an annual report to Congress on the outreach
and enrollment activities conducted with funds appropriated
under this section.
``(e) Maintenance of Effort for States Awarded Grants; No
State Match Required.--In the case of a State that is awarded
a grant under this section--
``(1) the State share of funds expended for outreach and
enrollment activities under the State child health plan shall
not be less than the State share of such funds expended in
the fiscal year preceding the first fiscal year for which the
grant is awarded; and
``(2) no State matching funds shall be required for the
State to receive a grant under this section.
``(f) Definitions.--In this section:
``(1) Eligible entity.--The term `eligible entity' means
any of the following:
``(A) A State with an approved child health plan under this
title.
``(B) A local government.
``(C) An Indian tribe or tribal consortium, a tribal
organization, an urban Indian organization receiving funds
under title V of the Indian Health Care Improvement Act (25
U.S.C. 1651 et seq.), or an Indian Health Service provider.
``(D) A Federal health safety net organization.
``(E) A national, State, local, or community-based public
or nonprofit private organization, including organizations
that use community health workers or community-based doula
programs.
``(F) A faith-based organization or consortia, to the
extent that a grant awarded to such an entity is consistent
with the requirements of section 1955 of the Public Health
Service Act (42 U.S.C. 300x-65) relating to a grant award to
nongovernmental entities.
``(G) An elementary or secondary school.
``(2) Federal health safety net organization.--The term
`Federal health safety net organization' means--
``(A) a Federally-qualified health center (as defined in
section 1905(l)(2)(B));
``(B) a hospital defined as a disproportionate share
hospital for purposes of section 1923;
``(C) a covered entity described in section 340B(a)(4) of
the Public Health Service Act (42 U.S.C. 256b(a)(4)); and
``(D) any other entity or consortium that serves children
under a federally funded program, including the special
supplemental nutrition program for women, infants, and
children (WIC) established under section 17 of the Child
Nutrition Act of 1966 (42 U.S.C. 1786), the Head Start and
Early Head Start programs under the Head Start Act (42 U.S.C.
9801 et seq.), the school lunch program established under the
Richard B. Russell National School Lunch Act, and an
elementary or secondary school.
``(3) Indians; indian tribe; tribal organization; urban
indian organization.--The terms `Indian', `Indian tribe',
`tribal organization', and `urban Indian organization' have
the meanings given such terms in section 4 of the Indian
Health Care Improvement Act (25 U.S.C. 1603).
``(4) Community health worker.--The term `community health
worker' means an individual who promotes health or nutrition
within the community in which the individual resides--
``(A) by serving as a liaison between communities and
health care agencies;
``(B) by providing guidance and social assistance to
community residents;
``(C) by enhancing community residents' ability to
effectively communicate with health care providers;
``(D) by providing culturally and linguistically
appropriate health or nutrition education;
``(E) by advocating for individual and community health or
nutrition needs; and
``(F) by providing referral and followup services.
``(g) Appropriation.--There is appropriated, out of any
money in the Treasury not otherwise appropriated,
$100,000,000 for the period of fiscal years 2008 through
2012, to remain available until expended, for the purpose of
awarding grants under this section. Amounts appropriated and
paid under the authority of this section shall be in addition
to amounts appropriated under section 2104 and paid to States
in accordance with section 2105, including with respect to
expenditures for outreach activities in accordance with
subsections (a)(1)(D)(iii) and (c)(2)(C) of that section.
``(h) National Enrollment Campaign.--From the amounts made
available under subsection (a)(2), the Secretary shall
develop and implement a national enrollment campaign to
improve the enrollment of underserved child populations in
the programs established under this title and title XIX. Such
campaign may include--
``(1) the establishment of partnerships with the Secretary
of Education and the Secretary of Agriculture to develop
national campaigns to link the eligibility and enrollment
systems for the assistance programs each Secretary
administers that often serve the same children;
``(2) the integration of information about the programs
established under this title and title XIX in public health
awareness campaigns administered by the Secretary;
``(3) increased financial and technical support for
enrollment hotlines maintained by the Secretary to ensure
that all States participate in such hotlines;
``(4) the establishment of joint public awareness outreach
initiatives with the Secretary of Education and the Secretary
of Labor regarding the importance of health insurance to
building strong communities and the economy;
``(5) the development of special outreach materials for
Native Americans or for individuals with limited English
proficiency; and
``(6) such other outreach initiatives as the Secretary
determines would increase public awareness of the programs
under this title and title XIX.''.
(b) Enhanced Administrative Funding for Translation or
Interpretation Services Under CHIP.--Section 2105(a)(1) (42
U.S.C. 1397ee(a)(1)), as amended by section 603, is amended--
(1) in the matter preceding subparagraph (A), by inserting
``(or, in the case of expenditures described in subparagraph
(D)(iv), the higher of 75 percent or the sum of the enhanced
FMAP plus 5 percentage points)'' after ``enhanced FMAP''; and
(2) in subparagraph (D)--
(A) in clause (iii), by striking ``and'' at the end;
(B) by redesignating clause (iv) as clause (v); and
(C) by inserting after clause (iii) the following new
clause:
``(iv) for translation or interpretation services in
connection with the enrollment and use of services under this
title by individuals for whom English is not their primary
language (as found necessary by the Secretary for the proper
and efficient administration of the State plan); and''.
(c) Nonapplication of Administrative Expenditures Cap.--
Section 2105(c)(2) (42 U.S.C. 1397ee(c)(2)) is amended by
adding at the end the following:
``(C) Nonapplication to certain expenditures.--The
limitation under subparagraph (A) shall not apply with
respect to the following expenditures:
``(i) Expenditures funded under section 2113.--Expenditures
for outreach and enrollment activities funded under a grant
awarded to the State under section 2113.''.

[[Page S10443]]

SEC. 202. INCREASED OUTREACH AND ENROLLMENT OF INDIANS.

(a) In General.--Section 1139 (42 U.S.C. 1320b-9) is
amended to read as follows:

``SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, HEALTH CARE
FOR INDIANS UNDER TITLES XIX AND XXI.

``(a) Agreements With States for Medicaid and CHIP Outreach
On or Near Reservations To Increase the Enrollment of Indians
in Those Programs.--
``(1) In general.--In order to improve the access of
Indians residing on or near a reservation to obtain benefits
under the Medicaid and State children's health insurance
programs established under titles XIX and XXI, the Secretary
shall encourage the State to take steps to provide for
enrollment on or near the reservation. Such steps may include
outreach efforts such as the outstationing of eligibility
workers, entering into agreements with the Indian Health
Service, Indian Tribes, Tribal Organizations, and Urban
Indian Organizations to provide outreach, education regarding
eligibility and benefits, enrollment, and translation
services when such services are appropriate.
``(2) Construction.--Nothing in paragraph (1) shall be
construed as affecting arrangements entered into between
States and the Indian Health Service, Indian Tribes, Tribal
Organizations, or Urban Indian Organizations for such
Service, Tribes, or Organizations to conduct administrative
activities under such titles.
``(b) Requirement To Facilitate Cooperation.--The
Secretary, acting through the Centers for Medicare & Medicaid
Services, shall take such steps as are necessary to
facilitate cooperation with, and agreements between, States
and the Indian Health Service, Indian Tribes, Tribal
Organizations, or Urban Indian Organizations with respect to
the provision of health care items and services to Indians
under the programs established under title XIX or XXI.
``(c) Definition of Indian; Indian Tribe; Indian Health
Program; Tribal Organization; Urban Indian Organization.--In
this section, the terms `Indian', `Indian Tribe', `Indian
Health Program', `Tribal Organization', and `Urban Indian
Organization' have the meanings given those terms in section
4 of the Indian Health Care Improvement Act.''.
(b) Nonapplication of 10 Percent Limit on Outreach and
Certain Other Expenditures.--Section 2105(c)(2)(C) (42 U.S.C.
1397ee(c)(2)(C)), as added by section 201(c), is amended by
adding at the end the following new clause:
``(ii) Expenditures to increase outreach to, and the
enrollment of, indian children under this title and title
xix.--Expenditures for outreach activities to families of
Indian children likely to be eligible for child health
assistance under the plan or medical assistance under the
State plan under title XIX (or under a waiver of such plan),
to inform such families of the availability of, and to assist
them in enrolling their children in, such plans, including
such activities conducted under grants, contracts, or
agreements entered into under section 1139(a).''.

SEC. 203. DEMONSTRATION PROGRAM TO PERMIT STATES TO RELY ON
FINDINGS BY AN EXPRESS LANE AGENCY TO DETERMINE
COMPONENTS OF A CHILD'S ELIGIBILITY FOR
MEDICAID OR CHIP.

(a) Requirement To Conduct Demonstration Program.--
(1) In general.--The Secretary shall establish a 3-year
demonstration program under which up to 10 States shall be
authorized to rely on a finding made within the preceding 12
months by an Express Lane agency to determine whether a child
has met 1 or more of the eligibility requirements, such as
income, assets or resources, citizenship status, or other
criteria, necessary to determine the child's initial
eligibility, eligibility redetermination, or renewal of
eligibility, for medical assistance under the State Medicaid
plan or child health assistance under the State CHIP plan. A
State selected to participate in the demonstration program--
(A) shall not be required to direct a child (or a child's
family) to submit information or documentation previously
submitted by the child or family to an Express Lane agency
that the State relies on for its Medicaid or CHIP eligibility
determination; and
(B) may rely on information from an Express Lane agency
when evaluating a child's eligibility for medical assistance
under the State Medicaid plan or child health assistance
under the State CHIP plan without a separate, independent
confirmation of the information at the time of enrollment,
redetermination, or renewal.
(2) Payments to states.--From the amount appropriated under
paragraph (1) of subsection (f), after the application of
paragraph (2) of that subsection, the Secretary shall pay the
States selected to participate in the demonstration program
such sums as the Secretary shall determine for expenditures
made by the State for systems upgrades and implementation of
the demonstration program. In no event shall a payment be
made to a State from the amount appropriated under subsection
(f) for any expenditures incurred for providing medical
assistance or child health assistance to a child enrolled in
the State Medicaid plan or the State CHIP plan through
reliance on a finding made by an Express Lane agency.
(b) Requirements; Options for Application.--
(1) State requirements.--A State selected to participate in
the demonstration program established under this section may
rely on a finding of an Express Lane agency only if the
following conditions are met:
(A) Requirement to determine eligibility using regular
procedures if child is first found ineligible.--If reliance
on a finding from an Express Lane agency results in a child
not being found eligible for the State Medicaid plan or the
State CHIP plan, the State would be required to determine
eligibility under such plan using its regular procedures.
(B) Notice.--The State shall inform the families
(especially those whose children are enrolled in the State
CHIP plan) that they may qualify for lower premium payments
or more comprehensive health coverage under the State
Medicaid plan if the family's income were directly evaluated
for an eligibility determination by the State Medicaid
agency, and that, at the family's option, the family may seek
an eligibility determination by the State Medicaid agency.
(C) Compliance with department of homeland security
procedures.--The State may rely on an Express Lane agency
finding that a child is a qualified alien as long as the
Express Lane agency complies with guidance and regulatory
procedures issued by the Secretary of Homeland Security for
eligibility determinations of qualified aliens (as defined in
subsections (b) and (c) of section 431 of the Personal
Responsibility and Work Opportunity Reconciliation Act of
1996 (8 U.S.C. 1641)).
(D) Verification of citizenship or nationality status.--The
State shall satisfy the requirements of section
1902(a)(46)(B) or 2105(c)(9) of the Social Security Act, as
applicable (and as added by section 301 of this Act) for
verifications of citizenship or nationality status.
(E) Coding; application to enrollment error rates.--
(i) In general.--The State agrees to--

(I) assign such codes as the Secretary shall require to the
children who are enrolled in the State Medicaid plan or the
State CHIP plan through reliance on a finding made by an
Express Lane agency for the duration of the State's
participation in the demonstration program;
(II) annually provide the Secretary with a statistically
valid sample (that is approved by Secretary) of the children
enrolled in such plans through reliance on such a finding by
conducting a full Medicaid eligibility review of the children
identified for such sample for purposes of determining an
eligibility error rate with respect to the enrollment of such
children;
(III) submit the error rate determined under subclause (II)
to the Secretary;
(IV) if such error rate exceeds 3 percent for either of the
first 2 fiscal years in which the State participates in the
demonstration program, demonstrate to the satisfaction of the
Secretary the specific corrective actions implemented by the
State to improve upon such error rate; and
(V) if such error rate exceeds 3 percent for any fiscal
year in which the State participates in the demonstration
program, a reduction in the amount otherwise payable to the
State under section 1903(a) of the Social Security Act (42
Secretary 1396b(a)) for quarters for that fiscal year, equal
to the total amount of erroneous excess payments determined
for the fiscal year only with respect to the children
included in the sample for the fiscal year that are in excess
of a 3 percent error rate with respect to such children.

(ii) No punitive action based on error rate.--The Secretary
shall not apply the error rate derived from the sample under
clause (i) to the entire population of children enrolled in
the State Medicaid plan or the State CHIP plan through
reliance on a finding made by an Express Lane agency, or to
the population of children enrolled in such plans on the
basis of the State's regular procedures for determining
eligibility, or penalize the State on the basis of such error
rate in any manner other than the reduction of payments
provided for under clause (i)(V).
(iii) Rule of construction.--Nothing in this section shall
be construed as relieving a State that participates in the
demonstration program established under this section from
being subject to a penalty under section 1903(u) of the
Social Security Act (42 U.S.C. 1396b(u)) for payments made
under the State Medicaid plan with respect to ineligible
individuals and families that are determined to exceed the
error rate permitted under that section (as determined
without regard to the error rate determined under clause
(i)(II)).
(2) State options for application.--A State selected to
participate in the demonstration program may elect to apply
any of the following:
(A) Satisfaction of chip screen and enroll requirements.--
If the State relies on a finding of an Express Lane agency
for purposes of determining eligibility under the State CHIP
plan, the State may meet the screen and enroll requirements
imposed under subparagraphs (A) and (B) of section 2102(b)(3)
of the Social Security Act (42 U.S.C. 1397bb(b) (3)) by using
any of the following:
(i) Establishing a threshold percentage of the poverty line
that is 30 percentage points (or such other higher number of
percentage points) as the State determines reflects the
income methodologies of the program administered by the
Express Lane Agency and the State Medicaid plan.
(ii) Providing that a child satisfies all income
requirements for eligibility under the State Medicaid plan.

[[Page S10444]]

(iii) Providing that a child has a family income that
exceeds the Medicaid applicable income level.
(B) Presumptive eligibility.--The State may provide for
presumptive eligibility under the State CHIP plan for a child
who, based on an eligibility determination of an income
finding from an Express Lane agency, would qualify for child
health assistance under the State CHIP plan. During the
period of presumptive eligibility, the State may determine
the child's eligibility for child health assistance under the
State CHIP plan based on telephone contact with family
members, access to data available in electronic or paper
format, or other means that minimize to the maximum extent
feasible the burden on the family.
(C) Automatic enrollment.--
(i) In general.--The State may initiate and determine
eligibility for medical assistance under the State Medicaid
plan or for child health assistance under the State CHIP plan
without a program application from, or on behalf of, the
child based on data obtained from sources other than the
child (or the child's family), but a child can only be
automatically enrolled in the State Medicaid plan or the
State CHIP plan if the child or the family affirmatively
consents to being enrolled through affirmation and signature
on an Express Lane agency application.
(ii) Information requirement.--A State that elects the
option under clause (i) shall have procedures in place to
inform the child or the child's family of the services that
will be covered under the State Medicaid plan or the State
CHIP plan (as applicable), appropriate methods for using such
services, premium or other cost sharing charges (if any) that
apply, medical support obligations created by the enrollment
(if applicable), and the actions the child or the child's
family must take to maintain enrollment and renew coverage.
(iii) Option to waive signatures.--The State may waive any
signature requirements for enrollment for a child who
consents to, or on whose behalf consent is provided for,
enrollment in the State Medicaid plan or the State CHIP plan.
(3) Signature requirements.--In the case of a State
selected to participate in the demonstration program--
(A) no signature under penalty of perjury shall be required
on an application form for medical assistance under the State
Medicaid plan or child health assistance under the State CHIP
plan to attest to any element of the application for which
eligibility is based on information received from an Express
Lane agency or a source other than an applicant; and
(B) any signature requirement for determination of an
application for medical assistance under the State Medicaid
plan or child health assistance under the State CHIP plan may
be satisfied through an electronic signature.
(4) Rules of construction.--Nothing in this subsection
shall be construed to--
(A) relieve a State of the obligation under section
1902(a)(5) of the Social Security Act (42 U.S.C. 1396a(a)(5))
to determine eligibility for medical assistance under the
State Medicaid plan; or
(B) prohibit any State options otherwise permitted under
Federal law (without regard to this paragraph or the
demonstration program established under this section) that
are intended to increase the enrollment of eligible children
for medical assistance under the State Medicaid plan or child
health assistance under the State CHIP plan, including
options related to outreach, enrollment, applications, or the
determination or redetermination of eligibility.
(c) Limited Waiver of Other Applicable Requirements.--
(1) Social security act.--The Secretary shall waive only
such requirements of the Social Security Act as the Secretary
determines are necessary to carry out the demonstration
program established under this section.
(2) Authorization for participating states to receive
certain data directly relevant to determining eligibility and
correct amount of assistance.--For provisions relating to the
authority of States participating in the demonstration
program to receive certain data directly, see section 204(c).
(d) Evaluation and Report.--
(1) Evaluation.--The Secretary shall conduct, by grant,
contract, or interagency agreement, a comprehensive,
independent evaluation of the demonstration program
established under this section. Such evaluation shall include
an analysis of the effectiveness of the program, and shall
include--
(A) obtaining a statistically valid sample of the children
who were enrolled in the State Medicaid plan or the State
CHIP plan through reliance on a finding made by an Express
Lane agency and determining the percentage of children who
were erroneously enrolled in such plans;
(B) determining whether enrolling children in such plans
through reliance on a finding made by an Express Lane agency
improves the ability of a State to identify and enroll low-
income, uninsured children who are eligible but not enrolled
in such plans;
(C) evaluating the administrative costs or savings related
to identifying and enrolling children in such plans through
reliance on such findings, and the extent to which such costs
differ from the costs that the State otherwise would have
incurred to identify and enroll low-income, uninsured
children who are eligible but not enrolled in such plans; and
(D) any recommendations for legislative or administrative
changes that would improve the effectiveness of enrolling
children in such plans through reliance on such findings.
(2) Report to congress.--Not later than September 30, 2012,
the Secretary shall submit a report to Congress on the
results of the evaluation of the demonstration program
established under this section.
(e) Definitions.--In this section:
(1) Child; children.--With respect to a State selected to
participate in the demonstration program established under
this section, the terms ``child'' and ``children'' have the
meanings given such terms for purposes of the State plans
under titles XIX and XXI of the Social Security Act.
(2) Express lane agency.--
(A) In general.--The term ``Express Lane agency'' means a
public agency that--
(i) is determined by the State Medicaid agency or the State
CHIP agency (as applicable) to be capable of making the
determinations of 1 or more eligibility requirements
described in subsection (a)(1);
(ii) is identified in the State Medicaid plan or the State
CHIP plan; and
(iii) notifies the child's family--

(I) of the information which shall be disclosed in
accordance with this section;
(II) that the information disclosed will be used solely for
purposes of determining eligibility for medical assistance
under the State Medicaid plan or for child health assistance
under the State CHIP plan; and
(III) that the family may elect to not have the information
disclosed for such purposes; and

(iv) enters into, or is subject to, an interagency
agreement to limit the disclosure and use of the information
disclosed.
(B) Inclusion of specific public agencies.--Such term
includes the following:
(i) A public agency that determines eligibility for
assistance under any of the following:

(I) The temporary assistance for needy families program
funded under part A of title IV of the Social Security Act
(42 U.S.C. 601 et seq.).
(II) A State program funded under part D of title IV of
such Act (42 U.S.C. 651 et seq.).
(III) The State Medicaid plan.
(IV) The State CHIP plan.
(V) The Food Stamp Act of 1977 (7 U.S.C. 2011 et seq.).
(VI) The Head Start Act (42 U.S.C. 9801 et seq.).
(VII) The Richard B. Russell National School Lunch Act (42
U.S.C. 1751 et seq.).
(VIII) The Child Nutrition Act of 1966 (42 U.S.C. 1771 et
seq.).
(IX) The Child Care and Development Block Grant Act of 1990
(42 U.S.C. 9858 et seq.).
(X) The Stewart B. McKinney Homeless Assistance Act (42
U.S.C. 11301 et seq.).
(XI) The United States Housing Act of 1937 (42 U.S.C. 1437
et seq.).
(XII) The Native American Housing Assistance and Self-
Determination Act of 1996 (25 U.S.C. 4101 et seq.).

(ii) A State-specified governmental agency that has fiscal
liability or legal responsibility for the accuracy of the
eligibility determination findings relied on by the State.
(iii) A public agency that is subject to an interagency
agreement limiting the disclosure and use of the information
disclosed for purposes of determining eligibility under the
State Medicaid plan or the State CHIP plan.
(C) Exclusions.--Such term does not include an agency that
determines eligibility for a program established under the
Social Services Block Grant established under title XX of the
Social Security Act (42 U.S.C. 1397 et seq.) or a private,
for-profit organization.
(D) Rules of construction.--Nothing in this paragraph shall
be construed as--
(i) affecting the authority of a State Medicaid agency to
enter into contracts with nonprofit and for-profit agencies
to administer the Medicaid application process;
(ii) exempting a State Medicaid agency from complying with
the requirements of section 1902(a)(4) of the Social Security
Act (relating to merit-based personnel standards for
employees of the State Medicaid agency and safeguards against
conflicts of interest); or
(iii) authorizing a State Medicaid agency that participates
in the demonstration program established under this section
to use the Express Lane option to avoid complying with such
requirements for purposes of making eligibility
determinations under the State Medicaid plan.
(3) Medicaid applicable income level.--With respect to a
State, the term ``Medicaid applicable income level'' has the
meaning given that term for purposes of such State under
section 2110(b)(4) of the Social Security Act (42 U.S.C.
1397jj(4)).
(4) Poverty line.--The term ``poverty line'' has the
meaning given that term in section 2110(c)(5) of the Social
Security Act (42 U.S.C. 1397jj(c)(5)).
(5) State.--The term ``State'' means 1 of the 50 States or
the District of Columbia.
(6) State chip agency.--The term ``State CHIP agency''
means the State agency responsible for administering the
State CHIP plan.
(7) State chip plan.--The term ``State CHIP plan'' means
the State child health plan established under title XXI of
the Social Security Act (42 U.S.C. 1397aa et seq.), and
includes any waiver of such plan.

[[Page S10445]]

(8) State medicaid agency.--The term ``State Medicaid
agency'' means the State agency responsible for administering
the State Medicaid plan.
(9) State medicaid plan.--The term ``State Medicaid plan''
means the State plan established under title XIX of the
Social Security Act (42 U.S.C. 1396 et seq.), and includes
any waiver of such plan.
(f) Appropriation.--
(1) Operational funds.--Out of any funds in the Treasury
not otherwise appropriated, there is appropriated to the
Secretary to carry out the demonstration program established
under this section, $49,000,000 for the period of fiscal
years 2008 through 2012.
(2) Evaluation funds.--$5,000,000 of the funds appropriated
under paragraph (1) shall be used to conduct the evaluation
required under subsection (d).
(3) Budget authority.--Paragraph (1) constitutes budget
authority in advance of appropriations Act and represents the
obligation of the Federal Government to provide for the
payment to States selected to participate in the
demonstration program established under this section of the
amounts provided under such paragraph (after the application
of paragraph (2)).

SEC. 204. AUTHORIZATION OF CERTAIN INFORMATION DISCLOSURES TO
SIMPLIFY HEALTH COVERAGE DETERMINATIONS.

(a) Authorization of Information Disclosure.--Title XIX (42
U.S.C. 1396 et seq.) is amended--
(1) by redesignating section 1939 as section 1940; and
(2) by inserting after section 1938 the following new
section:

``AUTHORIZATION TO RECEIVE PERTINENT INFORMATION

``Sec. 1939.  (a) In General.--Notwithstanding any other
provision of law, a Federal or State agency or private entity
in possession of the sources of data directly relevant to
eligibility determinations under this title (including
eligibility files, information described in paragraph (2) or
(3) of section 1137(a), vital records information about
births in any State, and information described in sections
453(i) and 1902(a)(25)(I)) is authorized to convey such data
or information to the State agency administering the State
plan under this title, but only if such conveyance meets the
requirements of subsection (b).
``(b) Requirements for Conveyance.--Data or information may
be conveyed pursuant to this section only if the following
requirements are met:
``(1) The child whose circumstances are described in the
data or information (or such child's parent, guardian,
caretaker relative, or authorized representative) has either
provided advance consent to disclosure or has not objected to
disclosure after receiving advance notice of disclosure and a
reasonable opportunity to object.
``(2) Such data or information are used solely for the
purposes of--
``(A) identifying children who are eligible or potentially
eligible for medical assistance under this title and
enrolling (or attempting to enroll) such children in the
State plan; and
``(B) verifying the eligibility of children for medical
assistance under the State plan.
``(3) An interagency or other agreement, consistent with
standards developed by the Secretary--
``(A) prevents the unauthorized use, disclosure, or
modification of such data and otherwise meets applicable
Federal requirements for safeguarding privacy and data
security; and
``(B) requires the State agency administering the State
plan to use the data and information obtained under this
section to seek to enroll children in the plan.
``(c) Criminal Penalty.--A person described in subsection
(a) who publishes, divulges, discloses, or makes known in any
manner, or to any extent, not authorized by Federal law, any
information obtained under this section shall be fined not
more than $1,000 or imprisoned not more than 1 year, or both,
for each such unauthorized activity.
``(d) Rule of Construction.--The limitations and
requirements that apply to disclosure pursuant to this
section shall not be construed to prohibit the conveyance or
disclosure of data or information otherwise permitted under
Federal law (without regard to this section).''.
(b) Conforming Amendment to Title XXI.--Section 2107(e)(1)
(42 U.S.C. 1397gg(e)(1)) is amended by adding at the end the
following new subparagraph:
``(E) Section 1939 (relating to authorization to receive
data directly relevant to eligibility determinations).''.
(c) Authorization for States Participating in the Express
Lane Demonstration Program To Receive Certain Data Directly
Relevant To Determining Eligibility and Correct Amount of
Assistance.--Only in the case of a State selected to
participate in the Express Lane demonstration program
established under section 203, the Secretary shall enter into
such agreements as are necessary to permit such a State to
receive data directly relevant to eligibility determinations
and determining the correct amount of benefits under the
State CHIP plan or the State Medicaid plan (as such terms are
defined in paragraphs (7) and (9) section 203(e)) from the
following:
(1) The National Directory of New Hires established under
section 453(i) of the Social Security Act (42 U.S.C. 653(i)).
(2) The National Income Data collected by the Commissioner
of Social Security from information described in
subparagraphs (A) and (B) of section 6103(l)(7) of the
Internal Revenue Code of 1986, in accordance with the
requirements of that section.
(3) Data regarding enrollment in insurance that may help to
facilitate outreach and enrollment under the State Medicaid
plan, the State CHIP plan, and such other programs as the
Secretary may specify.

TITLE III--REDUCING BARRIERS TO ENROLLMENT

SEC. 301. VERIFICATION OF DECLARATION OF CITIZENSHIP OR
NATIONALITY FOR PURPOSES OF ELIGIBILITY FOR
MEDICAID AND CHIP.

(a) State Option To Verify Declaration of Citizenship or
Nationality for Purposes of Eligibility for Medicaid Through
Verification of Name and Social Security Number.--
(1) Alternative to documentation requirement.--
(A) In general.--Section 1902 (42 U.S.C. 1396a) is
amended--
(i) in subsection (a)(46)--

(I) by inserting ``(A)'' after ``(46)'';
(II) by adding ``and'' after the semicolon; and
(III) by adding at the end the following new subparagraph:

``(B) provide, with respect to an individual declaring to
be a citizen or national of the United States for purposes of
establishing eligibility under this title, that the State
shall satisfy the requirements of--
``(i) section 1903(x); or
``(ii) subsection (dd);''; and
(ii) by adding at the end the following new subsection:
``(dd)(1) For purposes of section 1902(a)(46)(B)(ii), the
requirements of this subsection with respect to an individual
declaring to be a citizen or national of the United States
for purposes of establishing eligibility under this title,
are, in lieu of requiring the individual to present
satisfactory documentary evidence of citizenship or
nationality under section 1903(x) (if the individual is not
described in paragraph (2) of that section), as follows:
``(A) The State submits the name and social security number
of the individual to the Commissioner of Social Security as
part of the plan established under paragraph (2).
``(B) If the State receives notice from the Commissioner of
Social Security that the name or social security number of
the individual is invalid, the State--
``(i) notifies the individual of such fact;
``(ii) provides the individual with an opportunity to cure
the invalid determination with the Commissioner of Social
Security, followed by a period of 90 days from the date on
which the notice required under clause (i) is received by the
individual to present satisfactory documentary evidence of
citizenship or nationality (as defined in section
1903(x)(3)); and
``(iii) disenrolls the individual from the State plan under
this title within 30 days after the end of such 90-day period
if no such documentary evidence is presented.
``(2)(A) Each State electing to satisfy the requirements of
this subsection for purposes of section 1902(a)(46)(B) shall
establish a program under which the State submits each month
to the Commissioner of Social Security for verification the
name and social security number of each individual enrolled
in the State plan under this title that month who has
attained the age of 1 before the date of the enrollment.
``(B) In establishing the State program under this
paragraph, the State may enter into an agreement with the
Commissioner of Social Security to provide for the electronic
submission and verification of the name and social security
number of an individual before the individual is enrolled in
the State plan.
``(3)(A) The State agency implementing the plan approved
under this title shall, at such times and in such form as the
Secretary may specify, provide information on the percentage
each month that the invalid names and numbers submitted bears
to the total submitted for verification.
``(B) If, for any fiscal year, the average monthly
percentage determined under subparagraph (A) is greater than
7 percent--
``(i) the State shall develop and adopt a corrective plan
to review its procedures for verifying the identities of
individuals seeking to enroll in the State plan under this
title and to identify and implement changes in such
procedures to improve their accuracy; and
``(ii) pay to the Secretary an amount equal to the amount
which bears the same ratio to the total payments under the
State plan for the fiscal year for providing medical
assistance to individuals who provided invalid information as
the number of individuals with invalid information in excess
of 7 percent of such total submitted bears to the total
number of individuals with invalid information.
``(C) The Secretary may waive, in certain limited cases,
all or part of the payment under subparagraph (B)(ii) if the
State is unable to reach the allowable error rate despite a
good faith effort by such State.
``(D) This paragraph shall not apply to a State for a
fiscal year if there is an agreement described in paragraph
(2)(B) in effect as of the close of the fiscal year.
``(4) Nothing in this subsection shall affect the rights of
any individual under this title to appeal any disenrollment
from a State plan.''.

[[Page S10446]]

(B) Costs of implementing and maintaining system.--Section
1903(a)(3) (42 U.S.C. 1396b(a)(3)) is amended--
(i) by striking ``plus'' at the end of subparagraph (E) and
inserting ``and'', and
(ii) by adding at the end the following new subparagraph:
``(F)(i) 90 percent of the sums expended during the quarter
as are attributable to the design, development, or
installation of such mechanized verification and information
retrieval systems as the Secretary determines are necessary
to implement section 1902(dd) (including a system described
in paragraph (2)(B) thereof), and
``(ii) 75 percent of the sums expended during the quarter
as are attributable to the operation of systems to which
clause (i) applies, plus''.
(2) Limitation on waiver authority.--Notwithstanding any
provision of section 1115 of the Social Security Act (42
U.S.C. 1315), or any other provision of law, the Secretary
may not waive the requirements of section 1902(a)(46)(B) of
such Act (42 U.S.C. 1396a(a)(46)(B)) with respect to a State.
(3) Conforming amendments.--Section 1903 (42 U.S.C. 1396b)
is amended--
(A) in subsection (i)(22), by striking ``subsection (x)''
and inserting ``section 1902(a)(46)(B)''; and
(B) in subsection (x)(1), by striking ``subsection
(i)(22)'' and inserting ``section 1902(a)(46)(B)(i)''.
(b) Clarification of Requirements Relating to Presentation
of Satisfactory Documentary Evidence of Citizenship or
Nationality.--
(1) Acceptance of documentary evidence issued by a
federally recognized indian tribe.--Section 1903(x)(3)(B) (42
U.S.C. 1396b(x)(3)(B)) is amended--
(A) by redesignating clause (v) as clause (vi); and
(B) by inserting after clause (iv), the following new
clause:
``(v)(I) Except as provided in subclause (II), a document
issued by a federally recognized Indian tribe evidencing
membership or enrollment in, or affiliation with, such tribe
(such as a tribal enrollment card or certificate of degree of
Indian blood).
``(II) With respect to those federally recognized Indian
tribes located within States having an international border
whose membership includes individuals who are not citizens of
the United States, the Secretary shall, after consulting with
such tribes, issue regulations authorizing the presentation
of such other forms of documentation (including tribal
documentation, if appropriate) that the Secretary determines
to be satisfactory documentary evidence of citizenship or
nationality for purposes of satisfying the requirement of
this subsection.''.
(2) Requirement to provide reasonable opportunity to
present satisfactory documentary evidence.--Section 1903(x)
(42 U.S.C. 1396b(x)) is amended by adding at the end the
following new paragraph:
``(4) In the case of an individual declaring to be a
citizen or national of the United States with respect to whom
a State requires the presentation of satisfactory documentary
evidence of citizenship or nationality under section
1902(a)(46)(B)(i), the individual shall be provided at least
the reasonable opportunity to present satisfactory
documentary evidence of citizenship or nationality under this
subsection as is provided under clauses (i) and (ii) of
section 1137(d)(4)(A) to an individual for the submittal to
the State of evidence indicating a satisfactory immigration
status.''.
(3) Children born in the united states to mothers eligible
for medicaid.--
(A) Clarification of rules.--Section 1903(x) (42 U.S.C.
1396b(x)), as amended by paragraph (2), is amended--
(i) in paragraph (2)--

(I) in subparagraph (C), by striking ``or'' at the end;
(II) by redesignating subparagraph (D) as subparagraph (E);
and
(III) by inserting after subparagraph (C) the following new
subparagraph:

``(D) pursuant to the application of section 1902(e)(4)
(and, in the case of an individual who is eligible for
medical assistance on such basis, the individual shall be
deemed to have provided satisfactory documentary evidence of
citizenship or nationality and shall not be required to
provide further documentary evidence on any date that occurs
during or after the period in which the individual is
eligible for medical assistance on such basis); or''; and
(ii) by adding at the end the following new paragraph:
``(5) Nothing in subparagraph (A) or (B) of section
1902(a)(46), the preceding paragraphs of this subsection, or
the Deficit Reduction Act of 2005, including section 6036 of
such Act, shall be construed as changing the requirement of
section 1902(e)(4) that a child born in the United States to
an alien mother for whom medical assistance for the delivery
of such child is available as treatment of an emergency
medical condition pursuant to subsection (v) shall be deemed
eligible for medical assistance during the first year of such
child's life.''.
(B) State requirement to issue separate identification
number.--Section 1902(e)(4) (42 U.S.C. 1396a(e)(4)) is
amended by adding at the end the following new sentence:
``Notwithstanding the preceding sentence, in the case of a
child who is born in the United States to an alien mother for
whom medical assistance for the delivery of the child is made
available pursuant to section 1903(v), the State immediately
shall issue a separate identification number for the child
upon notification by the facility at which such delivery
occurred of the child's birth.''.
(4) Technical amendments.--Section 1903(x)(2) (42 U.S.C.
1396b(x)) is amended--
(A) in subparagraph (B)--
(i) by realigning the left margin of the matter preceding
clause (i) 2 ems to the left; and
(ii) by realigning the left margins of clauses (i) and
(ii), respectively, 2 ems to the left; and
(B) in subparagraph (C)--
(i) by realigning the left margin of the matter preceding
clause (i) 2 ems to the left; and
(ii) by realigning the left margins of clauses (i) and
(ii), respectively, 2 ems to the left.
(c) Application of Documentation System to CHIP.--
(1) In general.--Section 2105(c) (42 U.S.C. 1397ee(c)), as
amended by section 110(a), is amended by adding at the end
the following new paragraph:
``(9) Citizenship documentation requirements.--
``(A) In general.--No payment may be made under this
section with respect to an individual who has, or is,
declared to be a citizen or national of the United States for
purposes of establishing eligibility under this title unless
the State meets the requirements of section 1902(a)(46)(B)
with respect to the individual.
``(B) Enhanced payments.--Notwithstanding subsection (b),
the enhanced FMAP with respect to payments under subsection
(a) for expenditures described in clause (i) or (ii) of
section 1903(a)(3)(F) necessary to comply with subparagraph
(A) shall in no event be less than 90 percent and 75 percent,
respectively.''.
(2) Nonapplication of administrative expenditures cap.--
Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)(C)), as amended
by section 202(b), is amended by adding at the end the
following:
``(iii) Expenditures to comply with citizenship or
nationality verification requirements.--Expenditures
necessary for the State to comply with paragraph (9)(A).''.
(d) Effective Date.--
(1) In general.--The amendments made by this section shall
take effect on October 1, 2008.
(2) Restoration of eligibility.--In the case of an
individual who, during the period that began on July 1, 2006,
and ends on October 1, 2008, was determined to be ineligible
for medical assistance under a State Medicaid plan, including
any waiver of such plan, solely as a result of the
application of subsections (i)(22) and (x) of section 1903 of
the Social Security Act (as in effect during such period),
but who would have been determined eligible for such
assistance if such subsections, as amended by subsection (b),
had applied to the individual, a State may deem the
individual to be eligible for such assistance as of the date
that the individual was determined to be ineligible for such
medical assistance on such basis.
(3) Special transition rule for indians.--During the period
that begins on July 1, 2006, and ends on the effective date
of final regulations issued under subclause (II) of section
1903(x)(3)(B)(v) of the Social Security Act (42 U.S.C.
1396b(x)(3)(B)(v)) (as added by subsection (b)(1)(B)), an
individual who is a member of a federally-recognized Indian
tribe described in subclause (II) of that section who
presents a document described in subclause (I) of such
section that is issued by such Indian tribe, shall be deemed
to have presented satisfactory evidence of citizenship or
nationality for purposes of satisfying the requirement of
subsection (x) of section 1903 of such Act.

SEC. 302. REDUCING ADMINISTRATIVE BARRIERS TO ENROLLMENT.

Section 2102(b) (42 U.S.C. 1397bb(b)) is amended--
(1) by redesignating paragraph (4) as paragraph (5); and
(2) by inserting after paragraph (3) the following new
paragraph:
``(4) Reduction of administrative barriers to enrollment.--
``(A) In general.--Subject to subparagraph (B), the plan
shall include a description of the procedures used to reduce
administrative barriers to the enrollment of children and
pregnant women who are eligible for medical assistance under
title XIX or for child health assistance or health benefits
coverage under this title. Such procedures shall be
established and revised as often as the State determines
appropriate to take into account the most recent information
available to the State identifying such barriers.
``(B) Deemed compliance if joint application and renewal
process that permits application other than in person.--A
State shall be deemed to comply with subparagraph (A) if the
State's application and renewal forms and supplemental forms
(if any) and information verification process is the same for
purposes of establishing and renewing eligibility for
children and pregnant women for medical assistance under
title XIX and child health assistance under this title, and
such process does not require an application to be made in
person or a face-to-face interview.''.

[[Page S10447]]

TITLE IV--REDUCING BARRIERS TO PROVIDING PREMIUM ASSISTANCE

Subtitle A--Additional State Option for Providing Premium Assistance

SEC. 401. ADDITIONAL STATE OPTION FOR PROVIDING PREMIUM
ASSISTANCE.

(a) In General.--Section 2105(c) (42 U.S.C. 1397ee(c)), as
amended by section 301(c), is amended by adding at the end
the following:
``(10) State option to offer premium assistance.--
``(A) In general.--Subject to the succeeding provisions of
this paragraph, a State may elect to offer a premium
assistance subsidy (as defined in subparagraph (C)) for
qualified employer-sponsored coverage (as defined in
subparagraph (B)) to all targeted low-income children who are
eligible for child health assistance under the plan and have
access to such coverage in accordance with the requirements
of this paragraph.
``(B) Qualified employer-sponsored coverage.--
``(i) In general.--Subject to clauses (ii) and (iii), in
this paragraph, the term `qualified employer-sponsored
coverage' means a group health plan or health insurance
coverage offered through an employer--

``(I) that qualifies as creditable coverage as a group
health plan under section 2701(c)(1) of the Public Health
Service Act;
``(II) for which the employer contribution toward any
premium for such coverage is at least 40 percent; and
``(III) to all individuals in a manner that would be
considered a nondiscriminatory eligibility classification for
purposes of paragraph (3)(A)(ii) of section 105(h) of the
Internal Revenue Code of 1986 (but determined without regard
to clause (i) of subparagraph (B) of such paragraph).

``(ii) Exception.--Such term does not include coverage
consisting of--

``(I) benefits provided under a health flexible spending
arrangement (as defined in section 106(c)(2) of the Internal
Revenue Code of 1986); or
``(II) a high deductible health plan (as defined in section
223(c)(2) of such Code) purchased in conjunction with a
health savings account (as defined under section 223(d) of
such Code).

``(iii) Cost-effectiveness alternative to required employer
contribution.--A group health plan or health insurance
coverage offered through an employer that would be considered
qualified employer-sponsored coverage but for the application
of clause (i)(II) may be deemed to satisfy the requirement of
such clause if either of the following applies:

``(I) Application of child-based or family-based test.--The
State establishes to the satisfaction of the Secretary that
the cost of such coverage is less than the expenditures that
the State would have made to enroll the child or the family
(as applicable) in the State child health plan.
``(II) Aggregate program operational costs do not exceed
the cost of providing coverage under the state child health
plan.--If subclause (I) does not apply, the State establishes
to the satisfaction of the Secretary that the aggregate
amount of expenditures by the State for the purchase of all
such coverage for targeted low-income children under the
State child health plan (including administrative
expenditures) does not exceed the aggregate amount of
expenditures that the State would have made for providing
coverage under the State child health plan for all such
children.

``(C) Premium assistance subsidy.--
``(i) In general.--In this paragraph, the term `premium
assistance subsidy' means, with respect to a targeted low-
income child, the amount equal to the difference between the
employee contribution required for enrollment only of the
employee under qualified employer-sponsored coverage and the
employee contribution required for enrollment of the employee
and the child in such coverage, less any applicable premium
cost-sharing applied under the State child health plan
(subject to the limitations imposed under section 2103(e),
including the requirement to count the total amount of the
employee contribution required for enrollment of the employee
and the child in such coverage toward the annual aggregate
cost-sharing limit applied under paragraph (3)(B) of such
section).
``(ii) State payment option.--A State may provide a premium
assistance subsidy either as reimbursement to an employee for
out-of-pocket expenditures or, subject to clause (iii),
directly to the employee's employer.
``(iii) Employer opt-out.--An employer may notify a State
that it elects to opt-out of being directly paid a premium
assistance subsidy on behalf of an employee. In the event of
such a notification, an employer shall withhold the total
amount of the employee contribution required for enrollment
of the employee and the child in the qualified employer-
sponsored coverage and the State shall pay the premium
assistance subsidy directly to the employee.
``(iv) Treatment as child health assistance.--Expenditures
for the provision of premium assistance subsidies shall be
considered child health assistance described in paragraph
(1)(C) of subsection (a) for purposes of making payments
under that subsection.
``(D) Application of secondary payor rules.--The State
shall be a secondary payor for any items or services provided
under the qualified employer-sponsored coverage for which the
State provides child health assistance under the State child
health plan.
``(E) Requirement to provide supplemental coverage for
benefits and cost-sharing protection provided under the state
child health plan.--
``(i) In general.--Notwithstanding section 2110(b)(1)(C),
the State shall provide for each targeted low-income child
enrolled in qualified employer-sponsored coverage,
supplemental coverage consisting of--

``(I) items or services that are not covered, or are only
partially covered, under the qualified employer-sponsored
coverage; and
``(II) cost-sharing protection consistent with section
2103(e).

``(ii) Record keeping requirements.--For purposes of
carrying out clause (i), a State may elect to directly pay
out-of-pocket expenditures for cost-sharing imposed under the
qualified employer-sponsored coverage and collect or not
collect all or any portion of such expenditures from the
parent of the child.
``(F) Application of waiting period imposed under the
state.--Any waiting period imposed under the State child
health plan prior to the provision of child health assistance
to a targeted low-income child under the State plan shall
apply to the same extent to the provision of a premium
assistance subsidy for the child under this paragraph.
``(G) Opt-out permitted for any month.--A State shall
establish a process for permitting the parent of a targeted
low-income child receiving a premium assistance subsidy to
disenroll the child from the qualified employer-sponsored
coverage and enroll the child in, and receive child health
assistance under, the State child health plan, effective on
the first day of any month for which the child is eligible
for such assistance and in a manner that ensures continuity
of coverage for the child.
``(H) Application to parents.--If a State provides child
health assistance or health benefits coverage to parents of a
targeted low-income child in accordance with section 2111(b),
the State may elect to offer a premium assistance subsidy to
a parent of a targeted low-income child who is eligible for
such a subsidy under this paragraph in the same manner as the
State offers such a subsidy for the enrollment of the child
in qualified employer-sponsored coverage, except that--
``(i) the amount of the premium assistance subsidy shall be
increased to take into account the cost of the enrollment of
the parent in the qualified employer-sponsored coverage or,
at the option of the State if the State determines it cost-
effective, the cost of the enrollment of the child's family
in such coverage; and
``(ii) any reference in this paragraph to a child is deemed
to include a reference to the parent or, if applicable under
clause (i), the family of the child.
``(I) Additional state option for providing premium
assistance.--
``(i) In general.--A State may establish an employer-family
premium assistance purchasing pool for employers with less
than 250 employees who have at least 1 employee who is a
pregnant woman eligible for assistance under the State child
health plan (including through the application of an option
described in section 2112(f)) or a member of a family with at
least 1 targeted low-income child and to provide a premium
assistance subsidy under this paragraph for enrollment in
coverage made available through such pool.
``(ii) Access to choice of coverage.--A State that elects
the option under clause (i) shall identify and offer access
to not less than 2 private health plans that are health
benefits coverage that is equivalent to the benefits coverage
in a benchmark benefit package described in section 2103(b)
or benchmark-equivalent coverage that meets the requirements
of section 2103(a)(2) for employees described in clause (i).
``(J) No effect on previously approved premium assistance
programs.--Nothing in this paragraph shall be construed as
limiting the authority of a State to offer premium assistance
under section 1906, a waiver described in paragraph (2)(B) or
(3), a waiver approved under section 1115, or other authority
in effect prior to the date of enactment of the Children's
Health Insurance Program Reauthorization Act of 2007.
``(K) Notice of availability.--If a State elects to provide
premium assistance subsidies in accordance with this
paragraph, the State shall--
``(i) include on any application or enrollment form for
child health assistance a notice of the availability of
premium assistance subsidies for the enrollment of targeted
low-income children in qualified employer-sponsored coverage;
``(ii) provide, as part of the application and enrollment
process under the State child health plan, information
describing the availability of such subsidies and how to
elect to obtain such a subsidy; and
``(iii) establish such other procedures as the State
determines necessary to ensure that parents are fully
informed of the choices for receiving child health assistance
under the State child health plan or through the receipt of
premium assistance subsidies.
``(L) Application to qualified employer-sponsored benchmark
coverage.--If a group health plan or health insurance
coverage offered through an employer is certified by an
actuary as health benefits coverage that is equivalent to the
benefits coverage in a benchmark benefit package described in
section 2103(b) or benchmark-equivalent coverage that meets
the requirements of section 2103(a)(2), the State may provide
premium

[[Page S10448]]

assistance subsidies for enrollment of targeted low-income
children in such group health plan or health insurance
coverage in the same manner as such subsidies are provided
under this paragraph for enrollment in qualified employer-
sponsored coverage, but without regard to the requirement to
provide supplemental coverage for benefits and cost-sharing
protection provided under the State child health plan under
subparagraph (E).''.
(b) Application to Medicaid.--Section 1906 (42 U.S.C.
1396e) is amended by inserting after subsection (c) the
following:
``(d) A State may elect to offer a premium assistance
subsidy (as defined in section 2105(c)(10)(C)) for qualified
employer-sponsored coverage (as defined in section
2105(c)(10)(B)) to a child who is eligible for medical
assistance under the State plan under this title, to the
parent of such a child, and to a pregnant woman, in the same
manner as such a subsidy for such coverage may be offered
under a State child health plan under title XXI in accordance
with section 2105(c)(10) (except that subparagraph (E)(i)(II)
of such section shall be applied by substituting `1916 or, if
applicable, 1916A' for `2103(e)').''.
(c) GAO Study and Report.--Not later than January 1, 2009,
the Comptroller General of the United States shall study cost
and coverage issues relating to any State premium assistance
programs for which Federal matching payments are made under
title XIX or XXI of the Social Security Act, including under
waiver authority, and shall submit a report to the
appropriate committees of Congress on the results of such
study.

SEC. 402. OUTREACH, EDUCATION, AND ENROLLMENT ASSISTANCE.

(a) Requirement To Include Description of Outreach,
Education, and Enrollment Efforts Related to Premium
Assistance Subsidies in State Child Health Plan.--Section
2102(c) (42 U.S.C. 1397bb(c)) is amended by adding at the end
the following new paragraph:
``(3) Premium assistance subsidies.--Outreach, education,
and enrollment assistance for families of children likely to
be eligible for premium assistance subsidies under the State
child health plan in accordance with paragraphs (2)(B), (3),
or (10) of section 2105(c), or a waiver approved under
section 1115, to inform such families of the availability of,
and to assist them in enrolling their children in, such
subsidies, and for employers likely to provide coverage that
is eligible for such subsidies, including the specific,
significant resources the State intends to apply to educate
employers about the availability of premium assistance
subsidies under the State child health plan.''.
(b) Nonapplication of 10 Percent Limit on Outreach and
Certain Other Expenditures.--Section 2105(c)(2)(C) (42 U.S.C.
1397ee(c)(2)(C)), as amended by section 301(c)(2), is amended
by adding at the end the following new clause:
``(iv) Expenditures for outreach to increase the enrollment
of children under this title and title xix through premium
assistance subsidies.--Expenditures for outreach activities
to families of children likely to be eligible for premium
assistance subsidies in accordance with paragraphs (2)(B),
(3), or (10), or a waiver approved under section 1115, to
inform such families of the availability of, and to assist
them in enrolling their children in, such subsidies, and to
employers likely to provide qualified employer-sponsored
coverage (as defined in subparagraph (B) of such
paragraph).''.

Subtitle B--Coordinating Premium Assistance With Private Coverage

SEC. 411. SPECIAL ENROLLMENT PERIOD UNDER GROUP HEALTH PLANS
IN CASE OF TERMINATION OF MEDICAID OR CHIP
COVERAGE OR ELIGIBILITY FOR ASSISTANCE IN
PURCHASE OF EMPLOYMENT-BASED COVERAGE;
COORDINATION OF COVERAGE.

(a) Amendments to Internal Revenue Code of 1986.--Section
9801(f) of the Internal Revenue Code of 1986 (relating to
special enrollment periods) is amended by adding at the end
the following new paragraph:
``(3) Special rules relating to medicaid and chip.--
``(A) In general.--A group health plan shall permit an
employee who is eligible, but not enrolled, for coverage
under the terms of the plan (or a dependent of such an
employee if the dependent is eligible, but not enrolled, for
coverage under such terms) to enroll for coverage under the
terms of the plan if either of the following conditions is
met:
``(i) Termination of medicaid or chip coverage.--The
employee or dependent is covered under a Medicaid plan under
title XIX of the Social Security Act or under a State child
health plan under title XXI of such Act and coverage of the
employee or dependent under such a plan is terminated as a
result of loss of eligibility for such coverage and the
employee requests coverage under the group health plan not
later than 60 days after the date of termination of such
coverage.
``(ii) Eligibility for employment assistance under medicaid
or chip.--The employee or dependent becomes eligible for
assistance, with respect to coverage under the group health
plan under such Medicaid plan or State child health plan
(including under any waiver or demonstration project
conducted under or in relation to such a plan), if the
employee requests coverage under the group health plan not
later than 60 days after the date the employee or dependent
is determined to be eligible for such assistance.
``(B) Employee outreach and disclosure.--
``(i) Outreach to employees regarding availability of
medicaid and chip coverage.--

``(I) In general.--Each employer that maintains a group
health plan in a State that provides medical assistance under
a State Medicaid plan under title XIX of the Social Security
Act, or child health assistance under a State child health
plan under title XXI of such Act, in the form of premium
assistance for the purchase of coverage under a group health
plan, shall provide to each employee a written notice
informing the employee of potential opportunities then
currently available in the State in which the employee
resides for premium assistance under such plans for health
coverage of the employee or the employee's dependents. For
purposes of compliance with this clause, the employer may use
any State-specific model notice issued by the Secretary of
Labor or the Secretary of Health and Human Services in
accordance with section 701(f)(3)(B) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C.
1181(f)(3)(B)).
``(II) Option to provide concurrent with provision of
summary plan description.--An employer may provide the model
notice applicable to the State in which an employee resides
concurrent with the furnishing of the summary plan
description as provided in section 104(b) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1024).

``(ii) Disclosure about group health plan benefits to
states for medicaid and chip eligible individuals.--In the
case of a participant or beneficiary of a group health plan
who is covered under a Medicaid plan of a State under title
XIX of the Social Security Act or under a State child health
plan under title XXI of such Act, the plan administrator of
the group health plan shall disclose to the State, upon
request, information about the benefits available under the
group health plan in sufficient specificity, as determined
under regulations of the Secretary of Health and Human
Services in consultation with the Secretary that require use
of the model coverage coordination disclosure form developed
under section 411(b)(2)(C) of the Children's Health Insurance
Program Reauthorization Act of 2007, so as to permit the
State to make a determination (under paragraph (2)(B), (3),
or (10) of section 2105(c) of the Social Security Act or
otherwise) concerning the cost-effectiveness of the State
providing medical or child health assistance through premium
assistance for the purchase of coverage under such group
health plan and in order for the State to provide
supplemental benefits required under paragraph (10)(E) of
such section or other authority.''.
(b) Conforming Amendments.--
(1) Amendments to employee retirement income security
act.--
(A) In general.--Section 701(f) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1181(f)) is amended by
adding at the end the following new paragraph:
``(3) Special rules for application in case of medicaid and
chip.--
``(A) In general.--A group health plan, and a health
insurance issuer offering group health insurance coverage in
connection with a group health plan, shall permit an employee
who is eligible, but not enrolled, for coverage under the
terms of the plan (or a dependent of such an employee if the
dependent is eligible, but not enrolled, for coverage under
such terms) to enroll for coverage under the terms of the
plan if either of the following conditions is met:
``(i) Termination of medicaid or chip coverage.--The
employee or dependent is covered under a Medicaid plan under
title XIX of the Social Security Act or under a State child
health plan under title XXI of such Act and coverage of the
employee or dependent under such a plan is terminated as a
result of loss of eligibility for such coverage and the
employee requests coverage under the group health plan (or
health insurance coverage) not later than 60 days after the
date of termination of such coverage.
``(ii) Eligibility for employment assistance under medicaid
or chip.--The employee or dependent becomes eligible for
assistance, with respect to coverage under the group health
plan or health insurance coverage, under such Medicaid plan
or State child health plan (including under any waiver or
demonstration project conducted under or in relation to such
a plan), if the employee requests coverage under the group
health plan or health insurance coverage not later than 60
days after the date the employee or dependent is determined
to be eligible for such assistance.''.
``(B) Coordination with medicaid and chip.--
``(i) Outreach to employees regarding availability of
medicaid and chip coverage.--

``(I) In general.--Each employer that maintains a group
health plan in a State that provides medical assistance under
a State Medicaid plan under title XIX of the Social Security
Act, or child health assistance under a State child health
plan under title XXI of such Act, in the form of premium
assistance for the purchase of coverage under a group health
plan, shall provide to each employee a written notice
informing the employee of potential opportunities then
currently available in the State in which the employee
resides for premium

[[Page S10449]]

assistance under such plans for health coverage of the
employee or the employee's dependents.
``(II) Model notice.--Not later than 1 year after the date
of enactment of the Children's Health Insurance Program
Reauthorization Act of 2007, the Secretary and the Secretary
of Health and Human Services, in consultation with Directors
of State Medicaid agencies under title XIX of the Social
Security Act and Directors of State CHIP agencies under title
XXI of such Act, shall jointly develop national and State-
specific model notices for purposes of subparagraph (A). The
Secretary shall provide employers with such model notices so
as to enable employers to timely comply with the requirements
of subparagraph (A). Such model notices shall include
information regarding how an employee may contact the State
in which the employee resides for additional information
regarding potential opportunities for such premium
assistance, including how to apply for such assistance.
``(III) Option to provide concurrent with provision of
summary plan description.--An employer may provide the model
notice applicable to the State in which an employee resides
concurrent with the furnishing of the summary plan
description as provided in section 104(b).

``(ii) Disclosure about group health plan benefits to
states for medicaid and chip eligible individuals.--In the
case of a participant or beneficiary of a group health plan
who is covered under a Medicaid plan of a State under title
XIX of the Social Security Act or under a State child health
plan under title XXI of such Act, the plan administrator of
the group health plan shall disclose to the State, upon
request, information about the benefits available under the
group health plan in sufficient specificity, as determined
under regulations of the Secretary of Health and Human
Services in consultation with the Secretary that require use
of the model coverage coordination disclosure form developed
under section 411(b)(2)(C) of the Children's Health Insurance
Program Reauthorization Act of 2007, so as to permit the
State to make a determination (under paragraph (2)(B), (3),
or (10) of section 2105(c) of the Social Security Act or
otherwise) concerning the cost-effectiveness of the State
providing medical or child health assistance through premium
assistance for the purchase of coverage under such group
health plan and in order for the State to provide
supplemental benefits required under paragraph (10)(E) of
such section or other authority.''.
(B) Conforming amendment.--Section 102(b) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1022(b)) is
amended--
(i) by striking ``and the remedies'' and inserting ``, the
remedies''; and
(ii) by inserting before the period the following: ``, and
if the employer so elects for purposes of complying with
section 701(f)(3)(B)(i), the model notice applicable to the
State in which the participants and beneficiaries reside''.
(C) Working group to develop model coverage coordination
disclosure form.--
(i) Medicaid, chip, and employer-sponsored coverage
coordination working group.--

(I) In general.--Not later than 60 days after the date of
enactment of this Act, the Secretary of Health and Human
Services and the Secretary of Labor shall jointly establish a
Medicaid, CHIP, and Employer-Sponsored Coverage Coordination
Working Group (in this subparagraph referred to as the
``Working Group''). The purpose of the Working Group shall be
to develop the model coverage coordination disclosure form
described in subclause (II) and to identify the impediments
to the effective coordination of coverage available to
families that include employees of employers that maintain
group health plans and members who are eligible for medical
assistance under title XIX of the Social Security Act or
child health assistance or other health benefits coverage
under title XXI of such Act.
(II) Model coverage coordination disclosure form
described.--The model form described in this subclause is a
form for plan administrators of group health plans to
complete for purposes of permitting a State to determine the
availability and cost-effectiveness of the coverage available
under such plans to employees who have family members who are
eligible for premium assistance offered under a State plan
under title XIX or XXI of such Act and to allow for
coordination of coverage for enrollees of such plans. Such
form shall provide the following information in addition to
such other information as the Working Group determines
appropriate:

(aa) A determination of whether the employee is eligible
for coverage under the group health plan.
(bb) The name and contract information of the plan
administrator of the group health plan.
(cc) The benefits offered under the plan.
(dd) The premiums and cost-sharing required under the plan.
(ee) Any other information relevant to coverage under the
plan.
(ii) Membership.--The Working Group shall consist of not
more than 30 members and shall be composed of representatives
of--

(I) the Department of Labor;
(II) the Department of Health and Human Services;
(III) State directors of the Medicaid program under title
XIX of the Social Security Act;
(IV) State directors of the State Children's Health
Insurance Program under title XXI of the Social Security Act;
(V) employers, including owners of small businesses and
their trade or industry representatives and certified human
resource and payroll professionals;
(VI) plan administrators and plan sponsors of group health
plans (as defined in section 607(1) of the Employee
Retirement Income Security Act of 1974); and
(VII) children and other beneficiaries of medical
assistance under title XIX of the Social Security Act or
child health assistance or other health benefits coverage
under title XXI of such Act.

(iii) Compensation.--The members of the Working Group shall
serve without compensation.
(iv) Administrative support.--The Department of Health and
Human Services and the Department of Labor shall jointly
provide appropriate administrative support to the Working
Group, including technical assistance. The Working Group may
use the services and facilities of either such Department,
with or without reimbursement, as jointly determined by such
Departments.
(v) Report.--

(I) Report by working group to the secretaries.--Not later
than 18 months after the date of the enactment of this Act,
the Working Group shall submit to the Secretary of Labor and
the Secretary of Health and Human Services the model form
described in clause (i)(II) along with a report containing
recommendations for appropriate measures to address the
impediments to the effective coordination of coverage between
group health plans and the State plans under titles XIX and
XXI of the Social Security Act.
(II) Report by secretaries to the congress.--Not later than
2 months after receipt of the report pursuant to subclause
(I), the Secretaries shall jointly submit a report to each
House of the Congress regarding the recommendations contained
in the report under such subclause.

(vi) Termination.--The Working Group shall terminate 30
days after the date of the issuance of its report under
clause (v).
(D) Effective dates.--The Secretary of Labor and the
Secretary of Health and Human Services shall develop the
initial model notices under section 701(f)(3)(B)(i)(II) of
the Employee Retirement Income Security Act of 1974, and the
Secretary of Labor shall provide such notices to employers,
not later than the date that is 1 year after the date of
enactment of this Act, and each employer shall provide the
initial annual notices to such employer's employees beginning
with the first plan year that begins after the date on which
such initial model notices are first issued. The model
coverage coordination disclosure form developed under
subparagraph (C) shall apply with respect to requests made by
States beginning with the first plan year that begins after
the date on which such model coverage coordination disclosure
form is first issued.
(E) Enforcement.--Section 502 of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1132) is amended--
(i) in subsection (a)(6), by striking ``or (8)'' and
inserting ``(8), or (9)''; and
(ii) in subsection (c), by redesignating paragraph (9) as
paragraph (10), and by inserting after paragraph (8) the
following:
``(9)(A) The Secretary may assess a civil penalty against
any employer of up to $100 a day from the date of the
employer's failure to meet the notice requirement of section
701(f)(3)(B)(i)(I). For purposes of this subparagraph, each
violation with respect to any single employee shall be
treated as a separate violation.
``(B) The Secretary may assess a civil penalty against any
plan administrator of up to $100 a day from the date of the
plan administrator's failure to timely provide to any State
the information required to be disclosed under section
701(f)(3)(B)(ii). For purposes of this subparagraph, each
violation with respect to any single participant or
beneficiary shall be treated as a separate violation.''.

TITLE V--STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES OF CHILDREN

SEC. 501. CHILD HEALTH QUALITY IMPROVEMENT ACTIVITIES FOR
CHILDREN ENROLLED IN MEDICAID OR CHIP.

(a) Development of Child Health Quality Measures for
Children Enrolled in Medicaid or Chip.--Title XI (42 U.S.C.
1301 et seq.) is amended by inserting after section 1139 the
following new section:

``SEC. 1139A. CHILD HEALTH QUALITY MEASURES.

``(a) Development of an Initial Core Set of Health Care
Quality Measures for Children Enrolled in Medicaid or Chip.--
``(1) In general.--Not later than January 1, 2009, the
Secretary shall identify and publish for general comment an
initial, recommended core set of child health quality
measures for use by State programs administered under titles
XIX and XXI, health insurance issuers and managed care
entities that enter into contracts with such programs, and
providers of items and services under such programs.
``(2) Identification of initial core measures.--In
consultation with the individuals and entities described in
subsection (b)(3), the Secretary shall identify existing
quality of care measures for children that are in use under
public and privately sponsored health care coverage
arrangements, or that are part of reporting systems that
measure both the

[[Page S10450]]

presence and duration of health insurance coverage over time.
``(3) Recommendations and dissemination.--Based on such
existing and identified measures, the Secretary shall publish
an initial core set of child health quality measures that
includes (but is not limited to) the following:
``(A) The duration of children's health insurance coverage
over a 12-month time period.
``(B) The availability of a full range of--
``(i) preventive services, treatments, and services for
acute conditions, including services to promote healthy birth
and prevent and treat premature birth; and
``(ii) treatments to correct or ameliorate the effects of
chronic physical and mental conditions in infants, young
children, school-age children, and adolescents.
``(C) The availability of care in a range of ambulatory and
inpatient health care settings in which such care is
furnished.
``(D) The types of measures that, taken together, can be
used to estimate the overall national quality of health care
for children and to perform comparative analyses of pediatric
health care quality and racial, ethnic, and socioeconomic
disparities in child health and health care for children.
``(4) Encourage voluntary and standardized reporting.--Not
later than 2 years after the date of enactment of the
Children's Health Insurance Program Reauthorization Act of
2007, the Secretary, in consultation with States, shall
develop a standardized format for reporting information and
procedures and approaches that encourage States to use the
initial core measurement set to voluntarily report
information regarding the quality of pediatric health care
under titles XIX and XXI.
``(5) Adoption of best practices in implementing quality
programs.--The Secretary shall disseminate information to
States regarding best practices among States with respect to
measuring and reporting on the quality of health care for
children, and shall facilitate the adoption of such best
practices. In developing best practices approaches, the
Secretary shall give particular attention to State
measurement techniques that ensure the timeliness and
accuracy of provider reporting, encourage provider reporting
compliance, encourage successful quality improvement
strategies, and improve efficiency in data collection using
health information technology.
``(6) Reports to congress.--Not later than January 1, 2010,
and every 3 years thereafter, the Secretary shall report to
Congress on--
``(A) the status of the Secretary's efforts to improve--
``(i) quality related to the duration and stability of
health insurance coverage for children under titles XIX and
XXI;
``(ii) the quality of children's health care under such
titles, including preventive health services, health care for
acute conditions, chronic health care, and health services to
ameliorate the effects of physical and mental conditions and
to aid in growth and development of infants, young children,
school-age children, and adolescents with special health care
needs; and
``(iii) the quality of children's health care under such
titles across the domains of quality, including clinical
quality, health care safety, family experience with health
care, health care in the most integrated setting, and
elimination of racial, ethnic, and socioeconomic disparities
in health and health care;
``(B) the status of voluntary reporting by States under
titles XIX and XXI, utilizing the initial core quality
measurement set; and
``(C) any recommendations for legislative changes needed to
improve the quality of care provided to children under titles
XIX and XXI, including recommendations for quality reporting
by States.
``(7) Technical assistance.--The Secretary shall provide
technical assistance to States to assist them in adopting and
utilizing core child health quality measures in administering
the State plans under titles XIX and XXI.
``(8) Definition of core set.--In this section, the term
`core set' means a group of valid, reliable, and evidence-
based quality measures that, taken together--
``(A) provide information regarding the quality of health
coverage and health care for children;
``(B) address the needs of children throughout the
developmental age span; and
``(C) allow purchasers, families, and health care providers
to understand the quality of care in relation to the
preventive needs of children, treatments aimed at managing
and resolving acute conditions, and diagnostic and treatment
services whose purpose is to correct or ameliorate physical,
mental, or developmental conditions that could, if untreated
or poorly treated, become chronic.
``(b) Advancing and Improving Pediatric Quality Measures.--
``(1) Establishment of pediatric quality measures
program.--Not later than January 1, 2010, the Secretary shall
establish a pediatric quality measures program to--
``(A) improve and strengthen the initial core child health
care quality measures established by the Secretary under
subsection (a);
``(B) expand on existing pediatric quality measures used by
public and private health care purchasers and advance the
development of such new and emerging quality measures; and
``(C) increase the portfolio of evidence-based, consensus
pediatric quality measures available to public and private
purchasers of children's health care services, providers, and
consumers.
``(2) Evidence-based measures.--The measures developed
under the pediatric quality measures program shall, at a
minimum, be--
``(A) evidence-based and, where appropriate, risk adjusted;
``(B) designed to identify and eliminate racial and ethnic
disparities in child health and the provision of health care;
``(C) designed to ensure that the data required for such
measures is collected and reported in a standard format that
permits comparison of quality and data at a State, plan, and
provider level;
``(D) periodically updated; and
``(E) responsive to the child health needs, services, and
domains of health care quality described in clauses (i),
(ii), and (iii) of subsection (a)(6)(A).
``(3) Process for pediatric quality measures program.--In
identifying gaps in existing pediatric quality measures and
establishing priorities for development and advancement of
such measures, the Secretary shall consult with--
``(A) States;
``(B) pediatricians, children's hospitals, and other
primary and specialized pediatric health care professionals
(including members of the allied health professions) who
specialize in the care and treatment of children,
particularly children with special physical, mental, and
developmental health care needs;
``(C) dental professionals, including pediatric dental
professionals;
``(D) health care providers that furnish primary health
care to children and families who live in urban and rural
medically underserved communities or who are members of
distinct population sub-groups at heightened risk for poor
health outcomes;
``(E) national organizations representing consumers and
purchasers of children's health care;
``(F) national organizations and individuals with expertise
in pediatric health quality measurement; and
``(G) voluntary consensus standards setting organizations
and other organizations involved in the advancement of
evidence-based measures of health care.
``(4) Developing, validating, and testing a portfolio of
pediatric quality measures.--As part of the program to
advance pediatric quality measures, the Secretary shall--
``(A) award grants and contracts for the development,
testing, and validation of new, emerging, and innovative
evidence-based measures for children's health care services
across the domains of quality described in clauses (i),(ii),
and (iii) of subsection (a)(6)(A); and
``(B) award grants and contracts for--
``(i) the development of consensus on evidence-based
measures for children's health care services;
``(ii) the dissemination of such measures to public and
private purchasers of health care for children; and
``(iii) the updating of such measures as necessary.
``(5) Revising, strengthening, and improving initial core
measures.--Beginning no later than January 1, 2012, and
annually thereafter, the Secretary shall publish recommended
changes to the core measures described in subsection (a) that
shall reflect the testing, validation, and consensus process
for the development of pediatric quality measures described
in subsection paragraphs (1) through (4).
``(6) Definition of pediatric quality measure.--In this
subsection, the term `pediatric quality measure' means a
measurement of clinical care that is capable of being
examined through the collection and analysis of relevant
information, that is developed in order to assess 1 or more
aspects of pediatric health care quality in various
institutional and ambulatory health care settings, including
the structure of the clinical care system, the process of
care, the outcome of care, or patient experiences in care.
``(c) Annual State Reports Regarding State-Specific Quality
of Care Measures Applied Under Medicaid or Chip.--
``(1) Annual state reports.--Each State with a State plan
approved under title XIX or a State child health plan
approved under title XXI shall annually report to the
Secretary on the--
``(A) State-specific child health quality measures applied
by the States under such plans, including measures described
in subparagraphs (A) and (B) of subsection (a)(6); and
``(B) State-specific information on the quality of health
care furnished to children under such plans, including
information collected through external quality reviews of
managed care organizations under section 1932 of the Social
Security Act (42 U.S.C. 1396u-4) and benchmark plans under
sections 1937 and 2103 of such Act (42 U.S.C. 1396u-7,
1397cc).
``(2) Publication.--Not later than September 30, 2009, and
annually thereafter, the Secretary shall collect, analyze,
and make publicly available the information reported by
States under paragraph (1).
``(d) Demonstration Projects for Improving the Quality of
Children's Health Care and the Use of Health Information
Technology.--

[[Page S10451]]

``(1) In general.--During the period of fiscal years 2008
through 2012, the Secretary shall award not more than 10
grants to States and child health providers to conduct
demonstration projects to evaluate promising ideas for
improving the quality of children's health care provided
under title XIX or XXI, including projects to--
``(A) experiment with, and evaluate the use of, new
measures of the quality of children's health care under such
titles (including testing the validity and suitability for
reporting of such measures);
``(B) promote the use of health information technology in
care delivery for children under such titles;
``(C) evaluate provider-based models which improve the
delivery of children's health care services under such
titles, including care management for children with chronic
conditions and the use of evidence-based approaches to
improve the effectiveness, safety, and efficiency of health
care services for children; or
``(D) demonstrate the impact of the model electronic health
record format for children developed and disseminated under
subsection (f) on improving pediatric health, including the
effects of chronic childhood health conditions, and pediatric
health care quality as well as reducing health care costs.
``(2) Requirements.--In awarding grants under this
subsection, the Secretary shall ensure that--
``(A) only 1 demonstration project funded under a grant
awarded under this subsection shall be conducted in a State;
and
``(B) demonstration projects funded under grants awarded
under this subsection shall be conducted evenly between
States with large urban areas and States with large rural
areas.
``(3) Authority for multistate projects.--A demonstration
project conducted with a grant awarded under this subsection
may be conducted on a multistate basis, as needed.
``(4) Funding.--$20,000,000 of the amount appropriated
under subsection (i) for a fiscal year shall be used to carry
out this subsection.
``(e) Childhood Obesity Demonstration Project.--
``(1) Authority to conduct demonstration.--The Secretary,
in consultation with the Administrator of the Centers for
Medicare & Medicaid Services, shall conduct a demonstration
project to develop a comprehensive and systematic model for
reducing childhood obesity by awarding grants to eligible
entities to carry out such project. Such model shall--
``(A) identify, through self-assessment, behavioral risk
factors for obesity among children;
``(B) identify, through self-assessment, needed clinical
preventive and screening benefits among those children
identified as target individuals on the basis of such risk
factors;
``(C) provide ongoing support to such target individuals
and their families to reduce risk factors and promote the
appropriate use of preventive and screening benefits; and
``(D) be designed to improve health outcomes, satisfaction,
quality of life, and appropriate use of items and services
for which medical assistance is available under title XIX or
child health assistance is available under title XXI among
such target individuals.
``(2) Eligibility entities.--For purposes of this
subsection, an eligible entity is any of the following:
``(A) A city, county, or Indian tribe.
``(B) A local or tribal educational agency.
``(C) An accredited university, college, or community
college.
``(D) A Federally-qualified health center.
``(E) A local health department.
``(F) A health care provider.
``(G) A community-based organization.
``(H) Any other entity determined appropriate by the
Secretary, including a consortia or partnership of entities
described in any of subparagraphs (A) through (G).
``(3) Use of funds.--An eligible entity awarded a grant
under this subsection shall use the funds made available
under the grant to--
``(A) carry out community-based activities related to
reducing childhood obesity, including by--
``(i) forming partnerships with entities, including schools
and other facilities providing recreational services, to
establish programs for after school and weekend community
activities that are designed to reduce childhood obesity;
``(ii) forming partnerships with daycare facilities to
establish programs that promote healthy eating behaviors and
physical activity; and
``(iii) developing and evaluating community educational
activities targeting good nutrition and promoting healthy
eating behaviors;
``(B) carry out age-appropriate school-based activities
that are designed to reduce childhood obesity, including by--
``(i) developing and testing educational curricula and
intervention programs designed to promote healthy eating
behaviors and habits in youth, which may include--

``(I) after hours physical activity programs; and
``(II) science-based interventions with multiple components
to prevent eating disorders including nutritional content,
understanding and responding to hunger and satiety, positive
body image development, positive self-esteem development, and
learning life skills (such as stress management,
communication skills, problemsolving and decisionmaking
skills), as well as consideration of cultural and
developmental issues, and the role of family, school, and
community;

``(ii) providing education and training to educational
professionals regarding how to promote a healthy lifestyle
and a healthy school environment for children;
``(iii) planning and implementing a healthy lifestyle
curriculum or program with an emphasis on healthy eating
behaviors and physical activity; and
``(iv) planning and implementing healthy lifestyle classes
or programs for parents or guardians, with an emphasis on
healthy eating behaviors and physical activity for children;
``(C) carry out educational, counseling, promotional, and
training activities through the local health care delivery
systems including by--
``(i) promoting healthy eating behaviors and physical
activity services to treat or prevent eating disorders, being
overweight, and obesity;
``(ii) providing patient education and counseling to
increase physical activity and promote healthy eating
behaviors;
``(iii) training health professionals on how to identify
and treat obese and overweight individuals which may include
nutrition and physical activity counseling; and
``(iv) providing community education by a health
professional on good nutrition and physical activity to
develop a better understanding of the relationship between
diet, physical activity, and eating disorders, obesity, or
being overweight; and
``(D) provide, through qualified health professionals,
training and supervision for community health workers to--
``(i) educate families regarding the relationship between
nutrition, eating habits, physical activity, and obesity;
``(ii) educate families about effective strategies to
improve nutrition, establish healthy eating patterns, and
establish appropriate levels of physical activity; and
``(iii) educate and guide parents regarding the ability to
model and communicate positive health behaviors.
``(4) Priority.--In awarding grants under paragraph (1),
the Secretary shall give priority to awarding grants to
eligible entities--
``(A) that demonstrate that they have previously applied
successfully for funds to carry out activities that seek to
promote individual and community health and to prevent the
incidence of chronic disease and that can cite published and
peer-reviewed research demonstrating that the activities that
the entities propose to carry out with funds made available
under the grant are effective;
``(B) that will carry out programs or activities that seek
to accomplish a goal or goals set by the State in the Healthy
People 2010 plan of the State;
``(C) that provide non-Federal contributions, either in
cash or in-kind, to the costs of funding activities under the
grants;
``(D) that develop comprehensive plans that include a
strategy for extending program activities developed under
grants in the years following the fiscal years for which they
receive grants under this subsection;
``(E) located in communities that are medically
underserved, as determined by the Secretary;
``(F) located in areas in which the average poverty rate is
at least 150 percent or higher of the average poverty rate in
the State involved, as determined by the Secretary; and
``(G) that submit plans that exhibit multisectoral,
cooperative conduct that includes the involvement of a broad
range of stakeholders, including--
``(i) community-based organizations;
``(ii) local governments;
``(iii) local educational agencies;
``(iv) the private sector;
``(v) State or local departments of health;
``(vi) accredited colleges, universities, and community
colleges;
``(vii) health care providers;
``(viii) State and local departments of transportation and
city planning; and
``(ix) other entities determined appropriate by the
Secretary.
``(5) Program design.--
``(A) Initial design.--Not later than 1 year after the date
of enactment of the Children's Health Insurance Program
Reauthorization Act of 2007, the Secretary shall design the
demonstration project. The demonstration should draw upon
promising, innovative models and incentives to reduce
behavioral risk factors. The Administrator of the Centers for
Medicare & Medicaid Services shall consult with the Director
of the Centers for Disease Control and Prevention, the
Director of the Office of Minority Health, the heads of other
agencies in the Department of Health and Human Services, and
such professional organizations, as the Secretary determines
to be appropriate, on the design, conduct, and evaluation of
the demonstration.
``(B) Number and project areas.--Not later than 2 years
after the date of enactment of the Children's Health
Insurance Program Reauthorization Act of 2007, the Secretary
shall award 1 grant that is specifically designed to
determine whether programs similar to programs to be
conducted by other grantees under this subsection should be
implemented with respect to the general population of
children who are eligible for child health assistance under
State

[[Page S10452]]

child health plans under title XXI in order to reduce the
incidence of childhood obesity among such population.
``(6) Report to congress.--Not later than 3 years after the
date the Secretary implements the demonstration project under
this subsection, the Secretary shall submit to Congress a
report that describes the project, evaluates the
effectiveness and cost effectiveness of the project,
evaluates the beneficiary satisfaction under the project, and
includes any such other information as the Secretary
determines to be appropriate.
``(7) Definitions.--In this subsection:
``(A) Federally-qualified health center.--The term
`Federally-qualified health center' has the meaning given
that term in section 1905(l)(2)(B).
``(B) Indian tribe.--The term `Indian tribe' has the
meaning given that term in section 4 of the Indian Health
Care Improvement Act (25 U.S.C. 1603).
``(C) Self-assessment.--The term `self-assessment' means a
form that--
``(i) includes questions regarding--

``(I) behavioral risk factors;
``(II) needed preventive and screening services; and
``(III) target individuals' preferences for receiving
follow-up information;

``(ii) is assessed using such computer generated assessment
programs; and
``(iii) allows for the provision of such ongoing support to
the individual as the Secretary determines appropriate.
``(D) Ongoing support.--The term `ongoing support' means--
``(i) to provide any target individual with information,
feedback, health coaching, and recommendations regarding--

``(I) the results of a self-assessment given to the
individual;
``(II) behavior modification based on the self-assessment;
and
``(III) any need for clinical preventive and screening
services or treatment including medical nutrition therapy;

``(ii) to provide any target individual with referrals to
community resources and programs available to assist the
target individual in reducing health risks; and
``(iii) to provide the information described in clause (i)
to a health care provider, if designated by the target
individual to receive such information.
``(8) Authorization of appropriations.--There is authorized
to be appropriated to carry out this subsection, $25,000,000
for the period of fiscal years 2008 through 2012.
``(f) Development of Model Electronic Health Record Format
for Children Enrolled in Medicaid or CHIP.--
``(1) In general.--Not later than January 1, 2009, the
Secretary shall establish a program to encourage the
development and dissemination of a model electronic health
record format for children enrolled in the State plan under
title XIX or the State child health plan under title XXI that
is--
``(A) subject to State laws, accessible to parents,
caregivers, and other consumers for the sole purpose of
demonstrating compliance with school or leisure activity
requirements, such as appropriate immunizations or physicals;
``(B) designed to allow interoperable exchanges that
conform with Federal and State privacy and security
requirements;
``(C) structured in a manner that permits parents and
caregivers to view and understand the extent to which the
care their children receive is clinically appropriate and of
high quality; and
``(D) capable of being incorporated into, and otherwise
compatible with, other standards developed for electronic
health records.
``(2) Funding.--$5,000,000 of the amount appropriated under
subsection (i) for a fiscal year shall be used to carry out
this subsection.
``(g) Study of Pediatric Health and Health Care Quality
Measures.--
``(1) In general.--Not later than July 1, 2009, the
Institute of Medicine shall study and report to Congress on
the extent and quality of efforts to measure child health
status and the quality of health care for children across the
age span and in relation to preventive care, treatments for
acute conditions, and treatments aimed at ameliorating or
correcting physical, mental, and developmental conditions in
children. In conducting such study and preparing such report,
the Institute of Medicine shall--
``(A) consider all of the major national population-based
reporting systems sponsored by the Federal Government that
are currently in place, including reporting requirements
under Federal grant programs and national population surveys
and estimates conducted directly by the Federal Government;
``(B) identify the information regarding child health and
health care quality that each system is designed to capture
and generate, the study and reporting periods covered by each
system, and the extent to which the information so generated
is made widely available through publication;
``(C) identify gaps in knowledge related to children's
health status, health disparities among subgroups of
children, the effects of social conditions on children's
health status and use and effectiveness of health care, and
the relationship between child health status and family
income, family stability and preservation, and children's
school readiness and educational achievement and attainment;
and
``(D) make recommendations regarding improving and
strengthening the timeliness, quality, and public
transparency and accessibility of information about child
health and health care quality.
``(2) Funding.--Up to $1,000,000 of the amount appropriated
under subsection (i) for a fiscal year shall be used to carry
out this subsection.
``(h) Rule of Construction.--Notwithstanding any other
provision in this section, no evidence based quality measure
developed, published, or used as a basis of measurement or
reporting under this section may be used to establish an
irrebuttable presumption regarding either the medical
necessity of care or the maximum permissible coverage for any
individual child who is eligible for and receiving medical
assistance under title XIX or child health assistance under
title XXI .
``(i) Appropriation.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated for each of
fiscal years 2008 through 2012, $45,000,000 for the purpose
of carrying out this section (other than subsection (e)).
Funds appropriated under this subsection shall remain
available until expended.''.
(b) Increased Matching Rate for Collecting and Reporting on
Child Health Measures.--Section 1903(a)(3)(A) (42 U.S.C.
1396b(a)(3)(A)), is amended--
(1) by striking ``and'' at the end of clause (i); and
(2) by adding at the end the following new clause:
``(iii) an amount equal to the Federal medical assistance
percentage (as defined in section 1905(b)) of so much of the
sums expended during such quarter (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 child health measures; and''.

SEC. 502. IMPROVED INFORMATION REGARDING ACCESS TO COVERAGE
UNDER CHIP.

(a) Inclusion of Process and Access Measures in Annual
State Reports.--Section 2108 (42 U.S.C. 1397hh) is amended--
(1) in subsection (a), in the matter preceding paragraph
(1), by striking ``The State'' and inserting ``Subject to
subsection (e), the State''; and
(2) by adding at the end the following new subsection:
``(e) Information Required for Inclusion in State Annual
Report.--The State shall include the following information in
the annual report required under subsection (a):
``(1) Eligibility criteria, enrollment, and retention data
(including data with respect to continuity of coverage or
duration of benefits).
``(2) Data regarding the extent to which the State uses
process measures with respect to determining the eligibility
of children under the State child health plan, including
measures such as 12-month continuous eligibility, self-
declaration of income for applications or renewals, or
presumptive eligibility.
``(3) Data regarding denials of eligibility and
redeterminations of eligibility.
``(4) Data regarding access to primary and specialty
services, access to networks of care, and care coordination
provided under the State child health plan, using quality
care and consumer satisfaction measures included in the
Consumer Assessment of Healthcare Providers and Systems
(CAHPS) survey.
``(5) If the State provides child health assistance in the
form of premium assistance for the purchase of coverage under
a group health plan, data regarding the provision of such
assistance, including the extent to which employer-sponsored
health insurance coverage is available for children eligible
for child health assistance under the State child health
plan, the range of the monthly amount of such assistance
provided on behalf of a child or family, the number of
children or families provided such assistance on a monthly
basis, the income of the children or families provided such
assistance, the benefits and cost-sharing protection provided
under the State child health plan to supplement the coverage
purchased with such premium assistance, the effective
strategies the State engages in to reduce any administrative
barriers to the provision of such assistance, and, the
effects, if any, of the provision of such assistance on
preventing the coverage provided under the State child health
plan from substituting for coverage provided under employer-
sponsored health insurance offered in the State.
``(6) To the extent applicable, a description of any State
activities that are designed to reduce the number of
uncovered children in the State, including through a State
health insurance connector program or support for innovative
private health coverage initiatives.''.
(b) GAO Study and Report on Access to Primary and
Speciality Services.--
(1) In general.--The Comptroller General of the United
States shall conduct a study of children's access to primary
and specialty services under Medicaid and CHIP, including--
(A) the extent to which providers are willing to treat
children eligible for such programs;
(B) information on such children's access to networks of
care;
(C) geographic availability of primary and specialty
services under such programs;
(D) the extent to which care coordination is provided for
children's care under Medicaid and CHIP; and

[[Page S10453]]

(E) as appropriate, information on the degree of
availability of services for children under such programs.
(2) Report.--Not later than 2 years after the date of
enactment of this Act, the Comptroller General shall submit a
report to the appropriate committees of Congress on the study
conducted under paragraph (1) that includes recommendations
for such Federal and State legislative and administrative
changes as the Comptroller General determines are necessary
to address any barriers to access to children's care under
Medicaid and CHIP that may exist.

SEC. 503. APPLICATION OF CERTAIN MANAGED CARE QUALITY
SAFEGUARDS TO CHIP.

Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)), as amended by
section 204(b), is amended by redesignating subparagraph (E)
(as added by such section) as subparagraph (F) and by
inserting after subparagraph (D) the following new
subparagraph:
``(E) Subsections (a)(4), (a)(5), (b), (c), (d), and (e) of
section 1932 (relating to requirements for managed care).''.

TITLE VI--MISCELLANEOUS

SEC. 601. TECHNICAL CORRECTION REGARDING CURRENT STATE
AUTHORITY UNDER MEDICAID.

(a) In General.--Only with respect to expenditures for
medical assistance under a State Medicaid plan, including any
waiver of such plan, for fiscal years 2007 and 2008, a State
may elect, notwithstanding the fourth sentence of subsection
(b) of section 1905 of the Social Security Act (42 U.S.C.
1396d) or subsection (u) of such section--
(1) to cover individuals described in section
1902(a)(10)(A)(ii)(IX) of the Social Security Act and, at its
option, to apply less restrictive methodologies to such
individuals under section 1902(r)(2) of such Act or
1931(b)(2)(C) of such Act and thereby receive Federal
financial participation for medical assistance for such
individuals under title XIX of the Social Security Act; or
(2) to receive Federal financial participation for
expenditures for medical assistance under title XIX of such
Act for children described in paragraph (2)(B) or (3) of
section 1905(u) of such Act based on the Federal medical
assistance percentage, as otherwise determined based on the
first and third sentences of subsection (b) of section 1905
of the Social Security Act, rather than on the basis of an
enhanced FMAP (as defined in section 2105(b) of such Act).
(b) Repeal.--Effective October 1, 2008, subsection (a) is
repealed.
(c) Hold Harmless.--No State that elects the option
described in subsection (a) shall be treated as not having
been authorized to make such election and to receive Federal
financial participation for expenditures for medical
assistance described in that subsection for fiscal years 2007
and 2008 as a result of the repeal of the subsection under
subsection (b).

SEC. 602. PAYMENT ERROR RATE MEASUREMENT (``PERM'').

(a) Expenditures Related to Compliance With Requirements.--
(1) Enhanced payments.--Section 2105(c) (42 U.S.C.
1397ee(c)), as amended by section 401(a), is amended by
adding at the end the following new paragraph:
``(11) Enhanced payments.--Notwithstanding subsection (b),
the enhanced FMAP with respect to payments under subsection
(a) for expenditures related to the administration of the
payment error rate measurement (PERM) requirements applicable
to the State child health plan in accordance with the
Improper Payments Information Act of 2002 and parts 431 and
457 of title 42, Code of Federal Regulations (or any related
or successor guidance or regulations) shall in no event be
less than 90 percent.''.
(2) Exclusion of from cap on administrative expenditures.--
Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)C)), as amended
by section 402(b), is amended by adding at the end the
following:
``(v) Payment error rate measurement (perm) expenditures.--
Expenditures related to the administration of the payment
error rate measurement (PERM) requirements applicable to the
State child health plan in accordance with the Improper
Payments Information Act of 2002 and parts 431 and 457 of
title 42, Code of Federal Regulations (or any related or
successor guidance or regulations).''.
(b) Final Rule Required To Be in Effect for All States.--
Notwithstanding parts 431 and 457 of title 42, Code of
Federal Regulations (as in effect on the date of enactment of
this Act), the Secretary shall not calculate or publish any
national or State-specific error rate based on the
application of the payment error rate measurement (in this
section referred to as ``PERM'') requirements to CHIP until
after the date that is 6 months after the date on which a
final rule implementing such requirements in accordance with
the requirements of subsection (c) is in effect for all
States. Any calculation of a national error rate or a State
specific error rate after such final rule in effect for all
States may only be inclusive of errors, as defined in such
final rule or in guidance issued within a reasonable time
frame after the effective date for such final rule that
includes detailed guidance for the specific methodology for
error determinations.
(c) Requirements for Final Rule.--For purposes of
subsection (b), the requirements of this subsection are that
the final rule implementing the PERM requirements shall
include--
(1) clearly defined criteria for errors for both States and
providers;
(2) a clearly defined process for appealing error
determinations by review contractors; and
(3) clearly defined responsibilities and deadlines for
States in implementing any corrective action plans.
(d) Option for Application of Data for Certain States Under
the Interim Final Rule.--
(1) Option for states in first application cycle.--After
the final rule implementing the PERM requirements in
accordance with the requirements of subsection (c) is in
effect for all States, a State for which the PERM
requirements were first in effect under an interim final rule
for fiscal year 2007 may elect to accept any payment error
rate determined in whole or in part for the State on the
basis of data for that fiscal year or may elect to not have
any payment error rate determined on the basis of such data
and, instead, shall be treated as if fiscal year 2010 were
the first fiscal year for which the PERM requirements apply
to the State.
(2) Option for states in second application cycle.--If such
final rule is not in effect for all States by July 1, 2008, a
State for which the PERM requirements were first in effect
under an interim final rule for fiscal year 2008 may elect to
accept any payment error rate determined in whole or in part
for the State on the basis of data for that fiscal year or
may elect to not have any payment error rate determined on
the basis of such data and, instead, shall be treated as if
fiscal year 2011 were the first fiscal year for which the
PERM requirements apply to the State.
(e) Harmonization of MEQC and PERM.--
(1) Reduction of redundancies.--The Secretary shall review
the Medicaid Eligibility Quality Control (in this subsection
referred to as the ``MEQC'') requirements with the PERM
requirements and coordinate consistent implementation of both
sets of requirements, while reducing redundancies.
(2) State option to apply perm data.--A State may elect,
for purposes of determining the erroneous excess payments for
medical assistance ratio applicable to the State for a fiscal
year under section 1903(u) of the Social Security Act (42
U.S.C. 1396b(u)) to substitute data resulting from the
application of the PERM requirements to the State after the
final rule implementing such requirements is in effect for
all States for data obtained from the application of the MEQC
requirements to the State with respect to a fiscal year.
(f) Identification of Improved State-Specific Sample
Sizes.--The Secretary shall establish State-specific sample
sizes for application of the PERM requirements with respect
to State child health plans for fiscal years beginning with
fiscal year 2009, on the basis of such information as the
Secretary determines appropriate. In establishing such sample
sizes, the Secretary shall, to the greatest extent
practicable--
(1) minimize the administrative cost burden on States under
Medicaid and CHIP; and
(2) maintain State flexibility to manage such programs.

SEC. 603. ELIMINATION OF COUNTING MEDICAID CHILD PRESUMPTIVE
ELIGIBILITY COSTS AGAINST TITLE XXI ALLOTMENT.

Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)) is amended--
(1) in the matter preceding subparagraph (A), by striking
``(or, in the case of expenditures described in subparagraph
(B), the Federal medical assistance percentage (as defined in
the first sentence of section 1905(b)))''; and
(2) by striking subparagraph (B) and inserting the
following new subparagraph:
``(B) [reserved]''.

SEC. 604. IMPROVING DATA COLLECTION.

(a) Increased Appropriation.--Section 2109(b)(2) (42 U.S.C.
1397ii(b)(2)) is amended by striking ``$10,000,000 for fiscal
year 2000'' and inserting ``$20,000,000 for fiscal year
2008''.
(b) Use of Additional Funds.--Section 2109(b) (42 U.S.C.
1397ii(b)), as amended by subsection (a), is amended--
(1) by redesignating paragraph (2) as paragraph (4); and
(2) by inserting after paragraph (1), the following new
paragraphs:
``(2) Additional requirements.--In addition to making the
adjustments required to produce the data described in
paragraph (1), with respect to data collection occurring for
fiscal years beginning with fiscal year 2008, in appropriate
consultation with the Secretary of Health and Human Services,
the Secretary of Commerce shall do the following:
``(A) Make appropriate adjustments to the Current
Population Survey to develop more accurate State-specific
estimates of the number of children enrolled in health
coverage under title XIX or this title.
``(B) Make appropriate adjustments to the Current
Population Survey to improve the survey estimates used to
compile the State-specific and national number of low-income
children without health insurance for purposes of determining
allotments under subsections (c) and (i) of section 2104 and
making payments to States from the CHIP Incentive Bonuses
Pool established under subsection (j) of such section, the
CHIP Contingency Fund established under subsection (k) of
such section, and, to the extent applicable to a State, from
the block grant set aside under section 2112(b)(2)(A)(i) for
each of fiscal years 2010 through 2012.

[[Page S10454]]

``(C) Include health insurance survey information in the
American Community Survey related to children.
``(D) Assess whether American Community Survey estimates,
once such survey data are first available, produce more
reliable estimates than the Current Population Survey with
respect to the purposes described in subparagraph (B).
``(E) On the basis of the assessment required under
subparagraph (D), recommend to the Secretary of Health and
Human Services whether American Community Survey estimates
should be used in lieu of, or in some combination with,
Current Population Survey estimates for the purposes
described in subparagraph (B).
``(F) Continue making the adjustments described in the last
sentence of paragraph (1) with respect to expansion of the
sample size used in State sampling units, the number of
sampling units in a State, and using an appropriate
verification element.
``(3) Authority for the secretary of health and human
services to transition to the use of all, or some combination
of, acs estimates upon recommendation of the secretary of
commerce.--If, on the basis of the assessment required under
paragraph (2)(D), the Secretary of Commerce recommends to the
Secretary of Health and Human Services that American
Community Survey estimates should be used in lieu of, or in
some combination with, Current Population Survey estimates
for the purposes described in paragraph (2)(B), the Secretary
of Health and Human Services may provide for a period during
which the Secretary may transition from carrying out such
purposes through the use of Current Population Survey
estimates to the use of American Community Survey estimates
(in lieu of, or in combination with the Current Population
Survey estimates, as recommended), provided that any such
transition is implemented in a manner that is designed to
avoid adverse impacts upon States with approved State child
health plans under this title.''.

SEC. 605. DEFICIT REDUCTION ACT TECHNICAL CORRECTIONS.

(a) State Flexibility in Benefit Packages.--
(1) Clarification of requirement to provide epsdt services
for all children in benchmark benefit packages.--Section
1937(a)(1) (42 U.S.C. 1396u-7(a)(1)), as inserted by section
6044(a) of the Deficit Reduction Act of 2005 (Public Law 109-
171, 120 Stat. 88), is amended--
(A) in subparagraph (A)--
(i) in the matter before clause (i), by striking
``enrollment in coverage that provides'' and inserting
``coverage that'';
(ii) in clause (i), by inserting ``provides'' after
``(i)''; and
(iii) by striking clause (ii) and inserting the following:
``(ii) for any individual described in section
1905(a)(4)(B) who is eligible under the State plan in
accordance with paragraphs (10) and (17) of section 1902(a),
consists of the items and services described in section
1905(a)(4)(B) (relating to early and periodic screening,
diagnostic, and treatment services defined in section
1905(r)) and provided in accordance with the requirements of
section 1902(a)(43).'';
(B) in subparagraph (C)--
(i) in the heading, by striking ``wrap-around'' and
inserting ``additional''; and
(ii) by striking ``wrap-around or''; and
(C) by adding at the end the following new subparagraph:
``(E) Rule of construction.--Nothing in this paragraph
shall be construed as--
``(i) requiring a State to offer all or any of the items
and services required by subparagraph (A)(ii) through an
issuer of benchmark coverage described in subsection (b)(1)
or benchmark equivalent coverage described in subsection
(b)(2); or
``(ii) preventing a State from offering all or any of the
items and services required by subparagraph (A)(ii) through
an issuer of benchmark coverage described in subsection
(b)(1) or benchmark equivalent coverage described in
subsection (b)(2).''.
(2) Correction of reference to children in foster care
receiving child welfare services.--Section
1937(a)(2)(B)(viii) (42 U.S.C. 1396u-7(a)(2)(B)(viii), as
inserted by section 6044(a) of the Deficit Reduction Act of
2005, is amended by striking ``aid or assistance is made
available under part B of title IV to children in foster care
and individuals'' and inserting ``child welfare services are
made available under part B of title IV on the basis of being
a child in foster care or''.
(3) Transparency.--Section 1937 (42 U.S.C. 1396u-7), as
inserted by section 6044(a) of the Deficit Reduction Act of
2005, is amended by adding at the end the following:
``(c) Publication of Provisions Affected.--Not later than
30 days after the date the Secretary approves a State plan
amendment to provide benchmark benefits in accordance with
subsections (a) and (b), the Secretary shall publish in the
Federal Register and on the Internet website of the Centers
for Medicare & Medicaid Services, a list of the provisions of
this title that the Secretary has determined do not apply in
order to enable the State to carry out such plan amendment
and the reason for each such determination.''.
(4) Effective date.--The amendments made by this subsection
shall take effect as if included in the amendment made by
section 6044(a) of the Deficit Reduction Act of 2005.

SEC. 606. ELIMINATION OF CONFUSING PROGRAM REFERENCES.

Section 704 of the Medicare, Medicaid, and SCHIP Balanced
Budget Refinement Act of 1999, as enacted into law by
division B of Public Law 106-113 (113 Stat. 1501A-402) is
repealed.

SEC. 607. MENTAL HEALTH PARITY IN CHIP PLANS.

(a) Assurance of Parity.--Section 2103(c) (42 U.S.C.
1397cc(c)) is amended--
(1) by redesignating paragraph (5) as paragraph (6); and
(2) by inserting after paragraph (4), the following:
``(5) Mental health services parity.--
``(A) In general.--In the case of a State child health plan
that provides both medical and surgical benefits and mental
health or substance abuse benefits, such plan shall ensure
that the financial requirements and treatment limitations
applicable to such mental health or substance abuse benefits
are no more restrictive than the financial requirements and
treatment limitations applied to substantially all medical
and surgical benefits covered by the plan.
``(B) Deemed compliance.--To the extent that a State child
health plan includes coverage with respect to an individual
described in section 1905(a)(4)(B) and covered under the
State plan under section 1902(a)(10)(A) of the services
described in section 1905(a)(4)(B) (relating to early and
periodic screening, diagnostic, and treatment services
defined in section 1905(r)) and provided in accordance with
section 1902(a)(43), such plan shall be deemed to satisfy the
requirements of subparagraph (A).''.
(b) Conforming Amendments.--Section 2103 (42 U.S.C. 1397cc)
is amended--
(1) in subsection (a), in the matter preceding paragraph
(1), by striking ``subsection (c)(5)'' and inserting
``paragraphs (5) and (6) of subsection (c)''; and
(2) in subsection (c)(2), by striking subparagraph (B) and
redesignating subparagraphs (C) and (D) as subparagraphs (B)
and (C), respectively.

SEC. 608. DENTAL HEALTH GRANTS.

Title XXI (42 U.S.C. 1397aa et seq.), as amended by section
201, is amended by adding at the end the following:

``SEC. 2114. DENTAL HEALTH GRANTS.

``(a) Authority To Award Grants.--
``(1) In general.--From the amount appropriated under
subsection (e), the Secretary shall award grants from amounts
to eligible States for the purpose of carrying out programs
and activities that are designed to improve the availability
of dental services and strengthen dental coverage for
targeted low-income children enrolled in State child health
plans.
``(2) Eligible state.--In this section, the term `eligible
State' means a State with an approved State child health plan
under this title that submits an application under subsection
(b) that is approved by Secretary.
``(b) Application.--An eligible State that desires to
receive a grant under this paragraph shall submit an
application to the Secretary in such form and manner, and
containing such information, as the Secretary may require.
Such application shall include--
``(1) a detailed description of the programs and activities
proposed to be conducted with funds awarded under the grant;
``(2) quality and outcomes performance measures to evaluate
the effectiveness of such activities; and
``(3) an assurance that the State shall--
``(A) conduct an assessment of the effectiveness of such
activities against such performance measures; and
``(B) cooperate with the collection and reporting of data
and other information determined as a result of conducting
such assessments to the Secretary, in such form and manner as
the Secretary shall require.
``(c) Maintenance of Effort for States Awarded Grants; No
State Match Required.--In the case of a State that is awarded
a grant under this section--
``(1) the State share of funds expended for dental services
under the State child health plan shall not be less than the
State share of such funds expended in the fiscal year
preceding the first fiscal year for which the grant is
awarded; and
``(2) no State matching funds shall be required for the
State to receive a grant under this section.
``(d) Annual Report.--The Secretary shall submit an annual
report to the appropriate committees of Congress regarding
the grants awarded under this section that includes--
``(1) State specific descriptions of the programs and
activities conducted with funds awarded under such grants;
and
``(2) information regarding the assessments required of
States under subsection (b)(3).
``(e) Appropriation.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated, $200,000,000
for the period of fiscal years 2008 through 2012, to remain
available until expended, for the purpose of awarding grants
to States under this section. Amounts appropriated and paid
under the authority of this section shall be in addition to
amounts appropriated under section 2104 and paid to States in
accordance with section 2105.''.

SEC. 609. APPLICATION OF PROSPECTIVE PAYMENT SYSTEM FOR
SERVICES PROVIDED BY FEDERALLY-QUALIFIED HEALTH
CENTERS AND RURAL HEALTH CLINICS.

(a) Application of Prospective Payment System.--
(1) In general.--Section 2107(e)(1) (42 U.S.C.
1397gg(e)(1)), as amended by sections

[[Page S10455]]

204(b) and 503, is amended by inserting after subparagraph
(A) the following new subparagraph (and redesignating the
succeeding subparagraphs accordingly):
``(B) Section 1902(bb) (relating to payment for services
provided by Federally-qualified health centers and rural
health clinics).''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to services provided on or after October 1, 2008.
(b) Transition Grants.--
(1) Appropriation.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated to the
Secretary for fiscal year 2008, $5,000,000, to remain
available until expended, for the purpose of awarding grants
to States with State child health plans under CHIP that are
operated separately from the State Medicaid plan under title
XIX of the Social Security Act (including any waiver of such
plan), or in combination with the State Medicaid plan, for
expenditures related to transitioning to compliance with the
requirement of section 2107(e)(1)(B) of the Social Security
Act (as added by subsection (a)) to apply the prospective
payment system established under section 1902(bb) of the such
Act (42 U.S.C. 1396a(bb)) to services provided by Federally-
qualified health centers and rural health clinics.
(2) Monitoring and report.--The Secretary shall monitor the
impact of the application of such prospective payment system
on the States described in paragraph (1) and, not later than
October 1, 2010, shall report to Congress on any effect on
access to benefits, provider payment rates, or scope of
benefits offered by such States as a result of the
application of such payment system.

TITLE VII--REVENUE PROVISIONS

SEC. 701. INCREASE IN EXCISE TAX RATE ON TOBACCO PRODUCTS.

(a) Cigars.--Section 5701(a) of the Internal Revenue Code
of 1986 is amended--
(1) by striking ``$1.828 cents per thousand ($1.594 cents
per thousand on cigars removed during 2000 or 2001)'' in
paragraph (1) and inserting ``$50.00 per thousand'',
(2) by striking ``20.719 percent (18.063 percent on cigars
removed during 2000 or 2001)'' in paragraph (2) and inserting
``53.13 percent'', and
(3) by striking ``$48.75 per thousand ($42.50 per thousand
on cigars removed during 2000 or 2001)'' in paragraph (2) and
inserting ``$10.00 per cigar''.
(b) Cigarettes.--Section 5701(b) of such Code is amended--
(1) by striking ``$19.50 per thousand ($17 per thousand on
cigarettes removed during 2000 or 2001)'' in paragraph (1)
and inserting ``$50.00 per thousand'', and
(2) by striking ``$40.95 per thousand ($35.70 per thousand
on cigarettes removed during 2000 or 2001)'' in paragraph (2)
and inserting ``$104.9999 cents per thousand''.
(c) Cigarette Papers.--Section 5701(c) of such Code is
amended by striking ``1.22 cents (1.06 cents on cigarette
papers removed during 2000 or 2001)'' and inserting ``3.13
cents''.
(d) Cigarette Tubes.--Section 5701(d) of such Code is
amended by striking ``2.44 cents (2.13 cents on cigarette
tubes removed during 2000 or 2001)'' and inserting ``6.26
cents''.
(e) Smokeless Tobacco.--Section 5701(e) of such Code is
amended--
(1) by striking ``58.5 cents (51 cents on snuff removed
during 2000 or 2001)'' in paragraph (1) and inserting
``$1.50'', and
(2) by striking ``19.5 cents (17 cents on chewing tobacco
removed during 2000 or 2001)'' in paragraph (2) and inserting
``50 cents''.
(f) Pipe Tobacco.--Section 5701(f) of such Code is amended
by striking ``$1.0969 cents (95.67 cents on pipe tobacco
removed during 2000 or 2001)'' and inserting ``$2.8126
cents''.
(g) Roll-Your-Own Tobacco.--Section 5701(g) of such Code is
amended by striking ``$1.0969 cents (95.67 cents on roll-
your-own tobacco removed during 2000 or 2001)'' and inserting
``$8.8889 cents''.
(h) Floor Stocks Taxes.--
(1) Imposition of tax.--On tobacco products and cigarette
papers and tubes manufactured in or imported into the United
States which are removed before January 1, 2008, and held on
such date for sale by any person, there is hereby imposed a
tax in an amount equal to the excess of--
(A) the tax which would be imposed under section 5701 of
the Internal Revenue Code of 1986 on the article if the
article had been removed on such date, over
(B) the prior tax (if any) imposed under section 5701 of
such Code on such article.
(2) Credit against tax.--Each person shall be allowed as a
credit against the taxes imposed by paragraph (1) an amount
equal to $500. Such credit shall not exceed the amount of
taxes imposed by paragraph (1) on January 1, 2008, for which
such person is liable.
(3) Liability for tax and method of payment.--
(A) Liability for tax.--A person holding tobacco products,
cigarette papers, or cigarette tubes on January 1, 2008, to
which any tax imposed by paragraph (1) applies shall be
liable for such tax.
(B) Method of payment.--The tax imposed by paragraph (1)
shall be paid in such manner as the Secretary shall prescribe
by regulations.
(C) Time for payment.--The tax imposed by paragraph (1)
shall be paid on or before April 1, 2008.
(4) Articles in foreign trade zones.--Notwithstanding the
Act of June 18, 1934 (commonly known as the Foreign Trade
Zone Act, 48 Stat. 998, 19 U.S.C. 81a et seq.) or any other
provision of law, any article which is located in a foreign
trade zone on January 1, 2008, shall be subject to the tax
imposed by paragraph (1) if--
(A) internal revenue taxes have been determined, or customs
duties liquidated, with respect to such article before such
date pursuant to a request made under the 1st proviso of
section 3(a) of such Act, or
(B) such article is held on such date under the supervision
of an officer of the United States Customs and Border
Protection of the Department of Homeland Security pursuant to
the 2d proviso of such section 3(a).
(5) Definitions.--For purposes of this subsection--
(A) In general.--Any term used in this subsection which is
also used in section 5702 of the Internal Revenue Code of
1986 shall have the same meaning as such term has in such
section.
(B) Secretary.--The term ``Secretary'' means the Secretary
of the Treasury or the Secretary's delegate.
(6) Controlled groups.--Rules similar to the rules of
section 5061(e)(3) of such Code shall apply for purposes of
this subsection.
(7) Other laws applicable.--All provisions of law,
including penalties, applicable with respect to the taxes
imposed by section 5701 of such Code shall, insofar as
applicable and not inconsistent with the provisions of this
subsection, apply to the floor stocks taxes imposed by
paragraph (1), to the same extent as if such taxes were
imposed by such section 5701. The Secretary may treat any
person who bore the ultimate burden of the tax imposed by
paragraph (1) as the person to whom a credit or refund under
such provisions may be allowed or made.
(i) Effective Date.--The amendments made by this section
shall apply to articles removed (as defined in section
5702(j) of the Internal Revenue Code of 1986) after December
31, 2007.

SEC. 702. ADMINISTRATIVE IMPROVEMENTS.

(a) Permit, Report, and Record Requirements for
Manufacturers and Importers of Processed Tobacco.--
(1) Permits.--
(A) Application.--Section 5712 of the Internal Revenue Code
of 1986 is amended by inserting ``or processed tobacco''
after ``tobacco products''.
(B) Issuance.--Section 5713(a) of such Code is amended by
inserting ``or processed tobacco'' after ``tobacco
products''.
(2) Inventories and reports.--
(A) Inventories.--Section 5721 of such Code is amended by
inserting ``, processed tobacco,'' after ``tobacco
products''.
(B) Reports.--Section 5722 of such Code is amended by
inserting ``, processed tobacco,'' after ``tobacco
products''.
(3) Records.--Section 5741 of such Code is amended by
inserting ``, processed tobacco,'' after ``tobacco
products''.
(4) Manufacturer of processed tobacco.--Section 5702 of
such Code is amended by adding at the end the following new
subsection:
``(p) Manufacturer of Processed Tobacco.--
``(1) In general.--The term `manufacturer of processed
tobacco' means any person who processes any tobacco other
than tobacco products.
``(2) Processed tobacco.--The processing of tobacco shall
not include the farming or growing of tobacco or the handling
of tobacco solely for sale, shipment, or delivery to a
manufacturer of tobacco products or processed tobacco.''.
(5) Conforming amendment.--Section 5702(k) of such Code is
amended by inserting ``, or any processed tobacco,'' after
``nontaxpaid tobacco products or cigarette papers or tubes''.
(6) Effective date.--The amendments made by this subsection
shall take effect on January 1, 2008.
(b) Basis for Denial, Suspension, or Revocation of
Permits.--
(1) Denial.--Paragraph (3) of section 5712 of such Code is
amended to read as follows:
``(3) such person (including, in the case of a corporation,
any officer, director, or principal stockholder and, in the
case of a partnership, a partner)--
``(A) is, by reason of his business experience, financial
standing, or trade connections or by reason of previous or
current legal proceedings involving a felony violation of any
other provision of Federal criminal law relating to tobacco
products, cigarette paper, or cigarette tubes, not likely to
maintain operations in compliance with this chapter,
``(B) has been convicted of a felony violation of any
provision of Federal or State criminal law relating to
tobacco products, cigarette paper, or cigarette tubes, or
``(C) has failed to disclose any material information
required or made any material false statement in the
application therefor.''.
(2) Suspension or revocation.--Subsection (b) of section
5713 of such Code is amended to read as follows:
``(b) Suspension or Revocation.--
``(1) Show cause hearing.--If the Secretary has reason to
believe that any person holding a permit--
``(A) has not in good faith complied with this chapter, or
with any other provision of this title involving intent to
defraud,
``(B) has violated the conditions of such permit,
``(C) has failed to disclose any material information
required or made any material false statement in the
application for such permit,

[[Page S10456]]

``(D) has failed to maintain his premises in such manner as
to protect the revenue,
``(E) is, by reason of previous or current legal
proceedings involving a felony violation of any other
provision of Federal criminal law relating to tobacco
products, cigarette paper, or cigarette tubes, not likely to
maintain operations in compliance with this chapter, or
``(F) has been convicted of a felony violation of any
provision of Federal or State criminal law relating to
tobacco products, cigarette paper, or cigarette tubes,
the Secretary shall issue an order, stating the facts
charged, citing such person to show cause why his permit
should not be suspended or revoked.
``(2) Action following hearing.--If, after hearing, the
Secretary finds that such person has not shown cause why his
permit should not be suspended or revoked, such permit shall
be suspended for such period as the Secretary deems proper or
shall be revoked.''.
(c) Application of Internal Revenue Code Statute of
Limitations for Alcohol and Tobacco Excise Taxes.--Section
514(a) of the Tariff Act of 1930 (19 U.S.C. 1514(a)) is
amended by striking ``and section 520 (relating to refunds)''
and inserting ``section 520 (relating to refunds), and
section 6501 of the Internal Revenue Code of 1986 (but only
with respect to taxes imposed under chapters 51 and 52 of
such Code)''.
(d) Expansion of Definition of Roll-Your-Own Tobacco.--
(1) In general.--Section 5702(o) of the Internal Revenue
Code of 1986 is amended by inserting ``or cigars, or for use
as wrappers thereof'' before the period at the end.
(2) Effective date.--The amendment made by this subsection
shall apply to articles removed (as defined in section
5702(j) of the Internal Revenue Code of 1986) after December
31, 2007.
(e) Time of Tax for Unlawfully Manufactured Tobacco
Products.--Section 5703(b)(2) of such Code is amended by
adding at the end the following new subparagraph:
``(F) Special rule for unlawfully manufactured tobacco
products.--In the case of any tobacco products, cigarette
paper, or cigarette tubes produced in the United States at
any place other than the premises of a manufacturer of
tobacco products, cigarette paper, or cigarette tubes that
has filed the bond and obtained the permit required under
this chapter, tax shall be due and payable immediately upon
manufacture.''.

SEC. 703. TIME FOR PAYMENT OF CORPORATE ESTIMATED TAXES.

Subparagraph (B) of section 401(1) of the Tax Increase
Prevention and Reconciliation Act of 2005 is amended by
striking ``114.50 percent'' and inserting ``113.25 percent''.

TITLE VIII--EFFECTIVE DATE

SEC. 801. EFFECTIVE DATE.

(a) In General.--Unless otherwise provided in this Act,
subject to subsection (b), the amendments made by this Act
shall take effect on October 1, 2007, and shall apply to
child health assistance and medical assistance provided on or
after that date without regard to whether or not final
regulations to carry out such amendments have been
promulgated by such date.
(b) Exception for State Legislation.--In the case of a
State plan under title XIX or XXI of the Social Security Act,
which the Secretary determines requires State legislation in
order for the plan to meet the additional requirements
imposed by an amendment made by this Act, the State plan
shall not be regarded as failing to comply with the
requirements of such Act solely on the basis of its failure
to meet these additional requirements 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
preceding 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.
______

S 2531. Mr. MARTINEZ submitted an amendment intended to be proposed
to amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other puuposes; which was ordered to lie on the
table; as follows:

On page 217, after line 25, insert the following:

SEC. _. CREDITS FOR HURRICANE AND TORNADO MITIGATION
EXPENDITURES.

(a) Nonrefundable Personal Credit for Hurricane and Tornado
Mitigation Property.--
(1) In general.--Subpart A of part IV of subchapter A of
chapter 1 of the Internal Revenue Code of 1986 is amended by
inserting after section 25D the following new section:

``SEC. 25E. HURRICANE AND TORNADO MITIGATION PROPERTY.

``(a) Allowance of Credit.--In the case of an individual,
there shall be allowed as a credit against the tax imposed by
this chapter for the taxable year an amount equal to 25
percent of the qualified hurricane and tornado mitigation
property expenditures made by the taxpayer during such
taxable year.
``(b) Maximum Credit.--The credit allowed under subsection
(a) for any taxable year shall not exceed $5,000.
``(c) Qualified Hurricane and Tornado Mitigation
Expenditure.--For purposes of this section--
``(1) In general.--The term `qualified hurricane and
tornado mitigation property expenditure' means an expenditure
for property--
``(A) to improve the strength of a roof deck attachment,
``(B) to create a secondary water barrier to prevent water
intrusion,
``(C) to improve the durability of a roof covering,
``(D) to brace gable-end walls,
``(E) to reinforce the connection between a roof and
supporting wall,
``(F) to protect openings from penetration by windborne
debris, or
``(G) to protect exterior doors and garages,
in a qualified dwelling unit owned by the taxpayer.
``(2) Qualified dwelling unit.--The term `qualified
dwelling unit' means a dwelling unit that is assessed at a
value that is less than $1,000,000 by the locality in which
such dwelling unit is located and with respect to the taxable
year for which the credit described in subsection (a) is
allowed.
``(d) Limitation.--An expenditure shall be taken into
account in determining the qualified hurricane and tornado
mitigation property expenditures made by the taxpayer during
the taxable year only if the onsite preparation, assembly, or
original installation of the property with respect to which
such expenditure is made has been completed in a manner that
is deemed to be adequate by a State-certified inspector.
``(e) Labor Costs.--For purposes of this section,
expenditures for labor costs properly allocable to the onsite
preparation, assembly, or original installation of the
property described in subsection (c) shall be taken into
account in determining the qualified hurricane and tornado
mitigation property expenditures made by the taxpayer during
the taxable year.
``(f) Inspection Costs.--For purposes of this section,
expenditures for inspection costs properly allocable to the
inspection of the preparation, assembly, or installation of
the property described in subsection (c) shall be taken into
account in determining the qualified hurricane and tornado
mitigation property expenditures made by the taxpayer during
the taxable year.''.
(2) Conforming amendment.--The table of sections for
subpart A of part IV of subchapter A of chapter 1 of such
Code is amended by inserting after the item relating to
section 25D the following new item:

``Sec. 25E. Hurricane and tornado mitigation property.''.
(3) Effective date.--The amendments made by this subsection
shall apply to taxable years beginning after December 31,
2007.
(b) Business Related Credit for Hurricane and Tornado
Mitigation.--
(1) In general.--Subpart D of part IV of subchapter A of
chapter 1 of the Internal Revenue Code of 1986 is amended by
inserting after section 45N the following new section:

``SEC. 45O. HURRICANE AND TORNADO MITIGATION CREDIT.

``(a) General Rule.--For purposes of section 38, the
hurricane and tornado mitigation credit determined under this
section for any taxable year is an amount equal to 25 percent
of the qualified hurricane and tornado mitigation property
expenditures made by the taxpayer during the taxable year.
``(b) Maximum Credit.--The amount of the credit determined
under subsection (a) for any taxable year shall not exceed
$5,000.
``(c) Qualified Hurricane and Tornado Mitigation
Expenditure.--For purposes of this section--
``(1) In general.--The term `qualified hurricane and
tornado mitigation property expenditure' means an expenditure
for property--
``(A) to improve the strength of a roof deck attachment,
``(B) to create a secondary water barrier to prevent water
intrusion,
``(C) to improve the durability of a roof covering,
``(D) to brace gable-end walls,
``(E) to reinforce the connection between a roof and
supporting wall,
``(F) to protect openings from penetration by windborne
debris, or
``(G) to protect exterior doors and garages,
in a qualified place of business owned by the taxpayer.
``(2) Qualified place of business.--The term `qualified
place of business' means a place of business that is assessed
at a value that is less than $5,000,000 by the locality in
which such business is located and with respect to the
taxable year for which the credit described in subsection (a)
is allowed.
``(d) Limitation.--An expenditure shall be taken into
account in determining the qualified hurricane and tornado
mitigation property expenditures made by the taxpayer during
the taxable year only if the onsite preparation, assembly, or
original installation of the property with respect to which
such expenditure is made has been completed in a manner that
is deemed to be adequate by a State-certified inspector.
``(e) Labor Costs.--For purposes of this section,
expenditures for labor costs properly allocable to the onsite
preparation, assembly, or original installation of the
property described in subsection (c) shall be taken into
account in determining the qualified hurricane and tornado
mitigation property expenditures made by the taxpayer during
the taxable year.
``(f) Inspection Costs.--For purposes of this section,
expenditures for inspection

[[Page S10457]]

costs properly allocable to the inspection of the
preparation, assembly, or installation of the property
described in subsection (c) shall be taken into account in
determining the qualified hurricane and tornado mitigation
property expenditures made by the taxpayer during the taxable
year.''.
(2) Conforming amendments.--
(A) Section 38(b) of such Code is amended by striking
``plus'' at the end of paragraph (30), by striking the period
at the end of paragraph (31) and inserting ``, plus'', and by
adding at the end the following new paragraph:
``(32) the hurricane and tornado mitigation credit
determined under section 45O(a).''.
(B) The table of sections for subpart D of part IV of
subchapter A of chapter 1 of such Code is amended by
inserting after the item relating to section 45N the
following new item:

``Sec. 45O. Hurricane and tornado mitigation credit.''.

(3) Effective date.--The amendments made by this subsection
shall apply to taxable years beginning after December 31,
2007.
______

SA 2532. Mr. MARTINEZ (for himself and Mr. Vitter) submitted an
amendment intended to be proposed to amendment SA 2530 proposed by Mr.
Baucus (for himself, Mr. Grassley, Mr. Rockefeller, and Mr. Hatch) to
the bill H.R. 976, to amend the Internal Revenue Code of 1986 to
provide tax relief for small businesses, and for other purposes; which
was ordered to lie on the table; as follows:

On page 217, after line 25, insert the following:

SEC. 61_. CREDIT FOR QUALIFIED ELEMENTARY AND SECONDARY
EDUCATION TUITION.

(a) In General.--Subpart A of part IV of subchapter A of
chapter 1 of the Internal Revenue Code of 1986 (relating to
nonrefundable personal credits) is amended by inserting after
section 25D the following new section:

``SEC. 25E. QUALIFIED ELEMENTARY AND SECONDARY EDUCATION
TUITION.

``(a) Allowance of Credit.--There shall be allowed as a
credit against the tax imposed by this chapter for a taxable
year an amount equal to the qualified elementary and
secondary education tuition paid or incurred by the taxpayer
during the taxable year.
``(b) Dollar Limitation.--The amount allowed as a credit
under subsection (a) with respect to the taxpayer for any
taxable year shall not exceed--
``(1) $4,500 in the case of a joint return,
``(2) $4,500 in the case of an individual who is not
married, and
``(3) $2,250 in the case of a married individual filing a
separate return.
``(c) Qualified Elementary and Secondary Education
Tuition.--
``(1) In general.--The term `qualified elementary and
secondary education tuition' means expenses for tuition which
are incurred in connection with the enrollment or attendance
of any dependent of the taxpayer with respect to whom the
taxpayer is allowed a deduction under section 151 as an
elementary or secondary school student at a private or
religious school.
``(2) School.--The term `school' means any school which
provides elementary education or secondary education
(kindergarten through grade 12), as determined under State
law.''.
(b) Clerical Amendment.--The table of sections for subpart
A of part IV of subchapter A of chapter 1 of such Code is
amended by inserting after the item relating to section 25D
the following new item:

``Sec. 25E. Qualified elementary and secondary education tuition.''.

(c) Effective Date.--The amendments made by this section
shall apply to taxable years beginning after December 31,
2006.
______

SA 2533. Mr. MARTINEZ submitted an amendment intended to be proposed
to amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

On page 217, after line 25, insert the following:

SEC. 61_. SPACEPORTS TREATED LIKE AIRPORTS UNDER EXEMPT
FACILITY BOND RULES.

(a) In General.--Paragraph (1) of section 142(a) of the
Internal Revenue Code of 1986 (relating to exempt facility
bonds) is amended to read as follows:
``(1) airports and spaceports,''.
(b) Treatment of Ground Leases.--Paragraph (1) of section
142(b) of the Internal Revenue Code of 1986 (relating to
certain facilities must be governmentally owned) is amended
by adding at the end the following new subparagraph:
``(C) Special rule for spaceport ground leases.--For
purposes of subparagraph (A), spaceport property which is
located on land owned by the United States and which is used
by a governmental unit pursuant to a lease (as defined in
section 168(h)(7)) from the United States shall be treated as
owned by such unit if--
``(i) the lease term (within the meaning of section
168(i)(3)) is at least 15 years, and
``(ii) such unit would be treated as owning such property
if such lease term were equal to the useful life of such
property.''.
(c) Definition of Spaceport.--Section 142 of the Internal
Revenue Code of 1986 is amended by adding at the end the
following new subsection:
``(n) Spaceport.--
``(1) In general.--For purposes of subsection (a)(1), the
term `spaceport' means--
``(A) any facility directly related and essential to
servicing spacecraft, enabling spacecraft to launch or
reenter, or transferring passengers or space cargo to or from
spacecraft, but only if such facility is located at, or in
close proximity to, the launch site or reentry site, and
``(B) any other functionally related and subordinate
facility at or adjacent to the launch site or reentry site at
which launch services or reentry services are provided,
including a launch control center, repair shop, maintenance
or overhaul facility, and rocket assembly facility.
``(2) Additional terms.--For purposes of paragraph (1)--
``(A) Space cargo.--The term `space cargo' includes
satellites, scientific experiments, other property
transported into space, and any other type of payload,
whether or not such property returns from space.
``(B) Spacecraft.--The term `spacecraft' means a launch
vehicle or a reentry vehicle.
``(C) Other terms.--The terms `launch', `launch site',
`launch services', `launch vehicle', `payload', `reenter',
`reentry services', `reentry site', and `reentry vehicle'
shall have the respective meanings given to such terms by
section 70102 of title 49, United States Code (as in effect
on the date of enactment of this subsection).''.
(d) Exception From Federally Guaranteed Bond Prohibition.--
Paragraph (3) of section 149(b) of the Internal Revenue Code
of 1986 (relating to exceptions) is amended by adding at the
end the following new subparagraph:
``(E) Exception for spaceports.--Paragraph (1) shall not
apply to any exempt facility bond issued as part of an issue
described in paragraph (1) of section 142(a) to provide a
spaceport in situations where--
``(i) the guarantee of the United States (or an agency or
instrumentality thereof) is the result of payment of rent,
user fees, or other charges by the United States (or any
agency or instrumentality thereof), and
``(ii) the payment of the rent, user fees, or other charges
is for, and conditioned upon, the use of the spaceport by the
United States (or any agency or instrumentality thereof).''.
(e) Conforming Amendment.--The heading for section 142(c)
of the Internal Revenue Code of 1986 is amended by inserting
``Spaceports,'' after ``Airports,''.
(f) Effective Date.--The amendments made by this section
shall apply to obligations issued after the date of the
enactment of this Act.
______

SA 2534. Mr. DORGAN (for himself, Mr. Johnson, Ms. Murkowski, Mr.
Stevens, and Mr. Bingaman) submitted an amendment intended to be
proposed to amendment SA 2530 proposed by Mr. Baucus ( for himself, Mr.
Grassley, Mr. Rockefeller, and Mr. Hatch) to the bill H.R 976, to amend
the Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; as follows:

At the end, add the following:

TITLE __--INDIAN HEALTH CARE IMPROVEMENT

SEC. _01. SHORT TITLE.

This title may be cited as the ``Indian Health Care
Improvement Act Amendments of 2007''.

Subtitle A--Amendments to Indian Laws

SEC. _11. INDIAN HEALTH CARE IMPROVEMENT ACT AMENDED.

(a) In General.--The Indian Health Care Improvement Act (25
U.S.C. 1601 et seq.) is amended to read as follows:

``SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

``(a) Short Title.--This Act may be cited as the `Indian
Health Care Improvement Act'.
``(b) Table of Contents.--The table of contents for this
Act is as follows:

``Sec. 1. Short title; table of contents.
``Sec. 2. Findings.
``Sec. 3. Declaration of national Indian health policy.
``Sec. 4. Definitions.

``TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT

``Sec. 101. Purpose.
``Sec. 102. Health professions recruitment program for Indians.
``Sec. 103. Health professions preparatory scholarship program for
Indians.
``Sec. 104. Indian health professions scholarships.
``Sec. 105. American Indians Into Psychology Program.
``Sec. 106. Scholarship programs for Indian Tribes.
``Sec. 107. Indian Health Service extern programs.
``Sec. 108. Continuing education allowances.
``Sec. 109. Community Health Representative Program.
``Sec. 110. Indian Health Service Loan Repayment Program.
``Sec. 111. Scholarship and Loan Repayment Recovery Fund.

[[Page S10458]]

``Sec. 112. Recruitment activities.
``Sec. 113. Indian recruitment and retention program.
``Sec. 114. Advanced training and research.
``Sec. 115. Quentin N. Burdick American Indians Into Nursing Program.
``Sec. 116. Tribal cultural orientation.
``Sec. 117. INMED Program.
``Sec. 118. Health training programs of community colleges.
``Sec. 119. Retention bonus.
``Sec. 120. Nursing residency program.
``Sec. 121. Community Health Aide Program.
``Sec. 122. Tribal Health Program administration.
``Sec. 123. Health professional chronic shortage demonstration
programs.
``Sec. 124. National Health Service Corps.
``Sec. 125. Substance abuse counselor educational curricula
demonstration programs.
``Sec. 126. Behavioral health training and community education
programs.
``Sec. 127. Authorization of appropriations.

``TITLE II--HEALTH SERVICES

``Sec. 201. Indian Health Care Improvement Fund.
``Sec. 202. Catastrophic Health Emergency Fund.
``Sec. 203. Health promotion and disease prevention services.
``Sec. 204. Diabetes prevention, treatment, and control.
``Sec. 205. Shared services for long-term care.
``Sec. 206. Health services research.
``Sec. 207. Mammography and other cancer screening.
``Sec. 208. Patient travel costs.
``Sec. 209. Epidemiology centers.
``Sec. 210. Comprehensive school health education programs.
``Sec. 211. Indian youth program.
``Sec. 212. Prevention, control, and elimination of communicable and
infectious diseases.
``Sec. 213. Other authority for provision of services.
``Sec. 214. Indian women's health care.
``Sec. 215. Environmental and nuclear health hazards.
``Sec. 216. Arizona as a contract health service delivery area.
``Sec. 216A. North Dakota and South Dakota as contract health service
delivery area.
``Sec. 217. California contract health services program.
``Sec. 218. California as a contract health service delivery area.
``Sec. 219. Contract health services for the Trenton service area.
``Sec. 220. Programs operated by Indian Tribes and Tribal
Organizations.
``Sec. 221. Licensing.
``Sec. 222. Notification of provision of emergency contract health
services.
``Sec. 223. Prompt action on payment of claims.
``Sec. 224. Liability for payment.
``Sec. 225. Office of Indian Men's Health.
``Sec. 226. Authorization of appropriations.

``TITLE III--FACILITIES

``Sec. 301. Consultation; construction and renovation of facilities;
reports.
``Sec. 302. Sanitation facilities.
``Sec. 303. Preference to Indians and Indian firms.
``Sec. 304. Expenditure of non-Service funds for renovation.
``Sec. 305. Funding for the construction, expansion, and modernization
of small ambulatory care facilities.
``Sec. 306. Indian health care delivery demonstration projects.
``Sec. 307. Land transfer.
``Sec. 308. Leases, contracts, and other agreements.
``Sec. 309. Study on loans, loan guarantees, and loan repayment.
``Sec. 310. Tribal leasing.
``Sec. 311. Indian Health Service/tribal facilities joint venture
program.
``Sec. 312. Location of facilities.
``Sec. 313. Maintenance and improvement of health care facilities.
``Sec. 314. Tribal management of Federally-owned quarters.
``Sec. 315. Applicability of Buy American Act requirement.
``Sec. 316. Other funding for facilities.
``Sec. 317. Authorization of appropriations.

``TITLE IV--ACCESS TO HEALTH SERVICES

``Sec. 401. Treatment of payments under Social Security Act health
benefits programs.
``Sec. 402. Grants to and contracts with the Service, Indian Tribes,
Tribal Organizations, and Urban Indian Organizations to
facilitate outreach, enrollment, and coverage of Indians
under Social Security Act health benefit programs and
other health benefits programs.
``Sec. 403. Reimbursement from certain third parties of costs of health
services.
``Sec. 404. Crediting of reimbursements.
``Sec. 405. Purchasing health care coverage.
``Sec. 406. Sharing arrangements with Federal agencies.
``Sec. 407. Payor of last resort.
``Sec. 408. Nondiscrimination under Federal health care programs in
qualifications for reimbursement for services.
``Sec. 409. Consultation.
``Sec. 410. State Children's Health Insurance Program (SCHIP).
``Sec. 411. Exclusion waiver authority for affected Indian Health
Programs and safe harbor transactions under the Social
Security Act.
``Sec. 412. Premium and cost sharing protections and eligibility
determinations under Medicaid and SCHIP and protection of
certain Indian property from Medicaid estate recovery.
``Sec. 413. Treatment under Medicaid and SCHIP managed care.
``Sec. 414. Navajo Nation Medicaid Agency feasibility study.
``Sec. 415. General exceptions.
``Sec. 416. Authorization of appropriations.

``TITLE V--HEALTH SERVICES FOR URBAN INDIANS

``Sec. 501. Purpose.
``Sec. 502. Contracts with, and grants to, Urban Indian Organizations.
``Sec. 503. Contracts and grants for the provision of health care and
referral services.
``Sec. 504. Contracts and grants for the determination of unmet health
care needs.
``Sec. 505. Evaluations; renewals.
``Sec. 506. Other contract and grant requirements.
``Sec. 507. Reports and records.
``Sec. 508. Limitation on contract authority.
``Sec. 509. Facilities.
``Sec. 510. Division of Urban Indian Health.
``Sec. 511. Grants for alcohol and substance abuse-related services.
``Sec. 512. Treatment of certain demonstration projects.
``Sec. 513. Urban NIAAA transferred programs.
``Sec. 514. Conferring with Urban Indian Organizations.
``Sec. 515. Urban youth treatment center demonstration.
``Sec. 516. Grants for diabetes prevention, treatment, and control.
``Sec. 517. Community Health Representatives.
``Sec. 518. Effective date.
``Sec. 519. Eligibility for services.
``Sec. 520. Further authorizations.
``Sec. 521. Authorization of appropriations.

``TITLE VI--ORGANIZATIONAL IMPROVEMENTS

``Sec. 601. Establishment of the Indian Health Service as an agency of
the Public Health Service.
``Sec. 602. Automated management information system.
``Sec. 603. Authorization of appropriations.

``TITLE VII--BEHAVIORAL HEALTH PROGRAMS

``Sec. 701. Behavioral health prevention and treatment services.
``Sec. 702. Memoranda of agreement with the Department of the Interior.
``Sec. 703. Comprehensive behavioral health prevention and treatment
program.
``Sec. 704. Mental health technician program.
``Sec. 705. Licensing requirement for mental health care workers.
``Sec. 706. Indian women treatment programs.
``Sec. 707. Indian youth program.
``Sec. 708. Indian youth telemental health demonstration project.
``Sec. 709. Inpatient and community-based mental health facilities
design, construction, and staffing.
``Sec. 710. Training and community education.
``Sec. 711. Behavioral health program.
``Sec. 712. Fetal alcohol spectrum disorders programs.
``Sec. 713. Child sexual abuse and prevention treatment programs.
``Sec. 714. Domestic and sexual violence prevention and treatment.
``Sec. 715. Behavioral health research.
``Sec. 716. Definitions.
``Sec. 717. Authorization of appropriations.

``TITLE VIII--MISCELLANEOUS

``Sec. 801. Reports.
``Sec. 802. Regulations.
``Sec. 803. Plan of implementation.
``Sec. 804. Availability of funds.
``Sec. 805. Limitation on use of funds appropriated to Indian Health
Service.
``Sec. 806. Eligibility of California Indians.
``Sec. 807. Health services for ineligible persons.
``Sec. 808. Reallocation of base resources.
``Sec. 809. Results of demonstration projects.
``Sec. 810. Provision of services in Montana.
``Sec. 811. Moratorium.
``Sec. 812. Tribal employment.
``Sec. 813. Severability provisions.
``Sec. 814. Establishment of National Bipartisan Commission on Indian
Health Care.
``Sec. 815. Confidentiality of medical quality assurance records;
qualified immunity for participants.
``Sec. 816. Appropriations; availability.
``Sec. 817. Authorization of appropriations.

``SEC. 2. FINDINGS.

``Congress makes the following findings:
``(1) Federal health services to maintain and improve the
health of the Indians are consonant with and required by the
Federal Government's historical and unique legal relationship
with, and resulting responsibility to, the American Indian
people.
``(2) A major national goal of the United States is to
provide the resources, processes,

[[Page S10459]]

and structure that will enable Indian Tribes and tribal
members to obtain the quantity and quality of health care
services and opportunities that will eradicate the health
disparities between Indians and the general population of the
United States.
``(3) A major national goal of the United States is to
provide the quantity and quality of health services which
will permit the health status of Indians to be raised to the
highest possible level and to encourage the maximum
participation of Indians in the planning and management of
those services.
``(4) Federal health services to Indians have resulted in a
reduction in the prevalence and incidence of preventable
illnesses among, and unnecessary and premature deaths of,
Indians.
``(5) Despite such services, the unmet health needs of the
American Indian people are severe and the health status of
the Indians is far below that of the general population of
the United States.

``SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POLICY.

``Congress declares that it is the policy of this Nation,
in fulfillment of its special trust responsibilities and
legal obligations to Indians--
``(1) to assure the highest possible health status for
Indians and Urban Indians and to provide all resources
necessary to effect that policy;
``(2) to raise the health status of Indians and Urban
Indians to at least the levels set forth in the goals
contained within the Healthy People 2010 or successor
objectives;
``(3) to ensure maximum Indian participation in the
direction of health care services so as to render the persons
administering such services and the services themselves more
responsive to the needs and desires of Indian communities;
``(4) to increase the proportion of all degrees in the
health professions and allied and associated health
professions awarded to Indians so that the proportion of
Indian health professionals in each Service Area is raised to
at least the level of that of the general population;
``(5) to require that all actions under this Act shall be
carried out with active and meaningful consultation with
Indian Tribes and Tribal Organizations, and conference with
Urban Indian Organizations, to implement this Act and the
national policy of Indian self-determination;
``(6) to ensure that the United States and Indian Tribes
work in a government-to-government relationship to ensure
quality health care for all tribal members; and
``(7) to provide funding for programs and facilities
operated by Indian Tribes and Tribal Organizations in amounts
that are not less than the amounts provided to programs and
facilities operated directly by the Service.

``SEC. 4. DEFINITIONS.

``For purposes of this Act:
``(1) The term `accredited and accessible' means on or near
a reservation and accredited by a national or regional
organization with accrediting authority.
``(2) The term `Area Office' means an administrative
entity, including a program office, within the Service
through which services and funds are provided to the Service
Units within a defined geographic area.
``(3) The term `Assistant Secretary' means the Assistant
Secretary for Indian Health.
``(4)(A) The term `behavioral health' means the blending of
substance (alcohol, drugs, inhalants, and tobacco) abuse and
mental health prevention and treatment, for the purpose of
providing comprehensive services.
``(B) The term `behavioral health' includes the joint
development of substance abuse and mental health treatment
planning and coordinated case management using a
multidisciplinary approach.
``(5) The term `California Indians' means those Indians who
are eligible for health services of the Service pursuant to
section 806.
``(6) The term `community college' means--
``(A) a tribal college or university, or
``(B) a junior or community college.
``(7) The term `contract health service' means health
services provided at the expense of the Service or a Tribal
Health Program by public or private medical providers or
hospitals, other than the Service Unit or the Tribal Health
Program at whose expense the services are provided.
``(8) The term `Department' means, unless otherwise
designated, the Department of Health and Human Services.
``(9) The term `disease prevention' means the reduction,
limitation, and prevention of disease and its complications
and reduction in the consequences of disease, including--
``(A) controlling--
``(i) the development of diabetes;
``(ii) high blood pressure;
``(iii) infectious agents;
``(iv) injuries;
``(v) occupational hazards and disabilities;
``(vi) sexually transmittable diseases; and
``(vii) toxic agents; and
``(B) providing--
``(i) fluoridation of water; and
``(ii) immunizations.
``(10) The term `health profession' means allopathic
medicine, family medicine, internal medicine, pediatrics,
geriatric medicine, obstetrics and gynecology, podiatric
medicine, nursing, public health nursing, dentistry,
psychiatry, osteopathy, optometry, pharmacy, psychology,
public health, social work, marriage and family therapy,
chiropractic medicine, environmental health and engineering,
allied health professions, and any other health profession.
``(11) The term `health promotion' means--
``(A) fostering social, economic, environmental, and
personal factors conducive to health, including raising
public awareness about health matters and enabling the people
to cope with health problems by increasing their knowledge
and providing them with valid information;
``(B) encouraging adequate and appropriate diet, exercise,
and sleep;
``(C) promoting education and work in conformity with
physical and mental capacity;
``(D) making available safe water and sanitary facilities;
``(E) improving the physical, economic, cultural,
psychological, and social environment;
``(F) promoting culturally competent care; and
``(G) providing adequate and appropriate programs, which
may include--
``(i) abuse prevention (mental and physical);
``(ii) community health;
``(iii) community safety;
``(iv) consumer health education;
``(v) diet and nutrition;
``(vi) immunization and other prevention of communicable
diseases, including HIV/AIDS;
``(vii) environmental health;
``(viii) exercise and physical fitness;
``(ix) avoidance of fetal alcohol spectrum disorders;
``(x) first aid and CPR education;
``(xi) human growth and development;
``(xii) injury prevention and personal safety;
``(xiii) behavioral health;
``(xiv) monitoring of disease indicators between health
care provider visits, through appropriate means, including
Internet-based health care management systems;
``(xv) personal health and wellness practices;
``(xvi) personal capacity building;
``(xvii) prenatal, pregnancy, and infant care;
``(xviii) psychological well-being;
``(xix) reproductive health and family planning;
``(xx) safe and adequate water;
``(xxi) healthy work environments;
``(xxii) elimination, reduction, and prevention of
contaminants that create unhealthy household conditions
(including mold and other allergens);
``(xxiii) stress control;
``(xxiv) substance abuse;
``(xxv) sanitary facilities;
``(xxvi) sudden infant death syndrome prevention;
``(xxvii) tobacco use cessation and reduction;
``(xxviii) violence prevention; and
``(xxix) such other activities identified by the Service, a
Tribal Health Program, or an Urban Indian Organization, to
promote achievement of any of the objectives described in
section 3(2).
``(12) The term `Indian', unless otherwise designated,
means any person who is a member of an Indian Tribe or is
eligible for health services under section 806, except that,
for the purpose of sections 102 and 103, the term also means
any individual who--
``(A)(i) irrespective of whether the individual lives on or
near a reservation, is a member of a tribe, band, or other
organized group of Indians, including those tribes, bands, or
groups terminated since 1940 and those recognized now or in
the future by the State in which they reside; or
``(ii) is a descendant, in the first or second degree, of
any such member;
``(B) is an Eskimo or Aleut or other Alaska Native;
``(C) is considered by the Secretary of the Interior to be
an Indian for any purpose; or
``(D) is determined to be an Indian under regulations
promulgated by the Secretary.
``(13) The term `Indian Health Program' means--
``(A) any health program administered directly by the
Service;
``(B) any Tribal Health Program; or
``(C) any Indian Tribe or Tribal Organization to which the
Secretary provides funding pursuant to section 23 of the Act
of June 25, 1910 (25 U.S.C. 47) (commonly known as the `Buy
Indian Act').
``(14) The term `Indian Tribe' has the meaning given the
term in the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.).
``(15) The term `junior or community college' has the
meaning given the term by section 312(e) of the Higher
Education Act of 1965 (20 U.S.C. 1058(e)).
``(16) The term `reservation' means any federally
recognized Indian Tribe's reservation, Pueblo, or colony,
including former reservations in Oklahoma, Indian allotments,
and Alaska Native Regions established pursuant to the Alaska
Native Claims Settlement Act (43 U.S.C. 1601 et seq.).
``(17) The term `Secretary', unless otherwise designated,
means the Secretary of Health and Human Services.
``(18) The term `Service' means the Indian Health Service.
``(19) The term `Service Area' means the geographical area
served by each Area Office.
``(20) The term `Service Unit' means an administrative
entity of the Service, or a Tribal Health Program through
which services are provided, directly or by contract, to
eligible Indians within a defined geographic area.

[[Page S10460]]

``(21) The term `telehealth' has the meaning given the term
in section 330K(a) of the Public Health Service Act (42
U.S.C. 254c-16(a)).
``(22) The term `telemedicine' means a telecommunications
link to an end user through the use of eligible equipment
that electronically links health professionals or patients
and health professionals at separate sites in order to
exchange health care information in audio, video, graphic, or
other format for the purpose of providing improved health
care services.
``(23) The term `tribal college or university' has the
meaning given the term in section 316(b)(3) of the Higher
Education Act (20 U.S.C. 1059c(b)(3)).
``(24) The term `Tribal Health Program' means an Indian
Tribe or Tribal Organization that operates any health
program, service, function, activity, or facility funded, in
whole or part, by the Service through, or provided for in, a
contract or compact with the Service under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.).
``(25) The term `Tribal Organization' has the meaning given
the term in the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.).
``(26) The term `Urban Center' means any community which
has a sufficient Urban Indian population with unmet health
needs to warrant assistance under title V of this Act, as
determined by the Secretary.
``(27) The term `Urban Indian' means any individual who
resides in an Urban Center and who meets 1 or more of the
following criteria:
``(A) Irrespective of whether the individual lives on or
near a reservation, the individual is a member of a tribe,
band, or other organized group of Indians, including those
tribes, bands, or groups terminated since 1940 and those
tribes, bands, or groups that are recognized by the States in
which they reside, or who is a descendant in the first or
second degree of any such member.
``(B) The individual is an Eskimo, Aleut, or other Alaska
Native.
``(C) The individual is considered by the Secretary of the
Interior to be an Indian for any purpose.
``(D) The individual is determined to be an Indian under
regulations promulgated by the Secretary.
``(28) The term `Urban Indian Organization' means a
nonprofit corporate body that (A) is situated in an Urban
Center; (B) is governed by an Urban Indian-controlled board
of directors; (C) provides for the participation of all
interested Indian groups and individuals; and (D) is capable
of legally cooperating with other public and private entities
for the purpose of performing the activities described in
section 503(a).

``TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT

``SEC. 101. PURPOSE.

``The purpose of this title is to increase, to the maximum
extent feasible, the number of Indians entering the health
professions and providing health services, and to assure an
optimum supply of health professionals to the Indian Health
Programs and Urban Indian Organizations involved in the
provision of health services to Indians.

``SEC. 102. HEALTH PROFESSIONS RECRUITMENT PROGRAM FOR
INDIANS.

``(a) In General.--The Secretary, acting through the
Service, shall make grants to public or nonprofit private
health or educational entities, Tribal Health Programs, or
Urban Indian Organizations to assist such entities in meeting
the costs of--
``(1) identifying Indians with a potential for education or
training in the health professions and encouraging and
assisting them--
``(A) to enroll in courses of study in such health
professions; or
``(B) if they are not qualified to enroll in any such
courses of study, to undertake such postsecondary education
or training as may be required to qualify them for
enrollment;
``(2) publicizing existing sources of financial aid
available to Indians enrolled in any course of study referred
to in paragraph (1) or who are undertaking training necessary
to qualify them to enroll in any such course of study; or
``(3) establishing other programs which the Secretary
determines will enhance and facilitate the enrollment of
Indians in, and the subsequent pursuit and completion by them
of, courses of study referred to in paragraph (1).
``(b) Grants.--
``(1) Application.--The Secretary shall not make a grant
under this section unless an application has been submitted
to, and approved by, the Secretary. Such application shall be
in such form, submitted in such manner, and contain such
information, as the Secretary shall by regulation prescribe
pursuant to this Act. The Secretary shall give a preference
to applications submitted by Tribal Health Programs or Urban
Indian Organizations.
``(2) Amount of grants; payment.--The amount of a grant
under this section shall be determined by the Secretary.
Payments pursuant to this section may be made in advance or
by way of reimbursement, and at such intervals and on such
conditions as provided for in regulations issued pursuant to
this Act. To the extent not otherwise prohibited by law,
grants shall be for 3 years, as provided in regulations
issued pursuant to this Act.

``SEC. 103. HEALTH PROFESSIONS PREPARATORY SCHOLARSHIP
PROGRAM FOR INDIANS.

``(a) Scholarships Authorized.--The Secretary, acting
through the Service, shall provide scholarship grants to
Indians who--
``(1) have successfully completed their high school
education or high school equivalency; and
``(2) have demonstrated the potential to successfully
complete courses of study in the health professions.
``(b) Purposes.--Scholarship grants provided pursuant to
this section shall be for the following purposes:
``(1) Compensatory preprofessional education of any
recipient, such scholarship not to exceed 2 years on a full-
time basis (or the part-time equivalent thereof, as
determined by the Secretary pursuant to regulations issued
under this Act).
``(2) Pregraduate education of any recipient leading to a
baccalaureate degree in an approved course of study
preparatory to a field of study in a health profession, such
scholarship not to exceed 4 years. An extension of up to 2
years (or the part-time equivalent thereof, as determined by
the Secretary pursuant to regulations issued pursuant to this
Act) may be approved.
``(c) Other Conditions.--Scholarships under this section--
``(1) may cover costs of tuition, books, transportation,
board, and other necessary related expenses of a recipient
while attending school;
``(2) shall not be denied solely on the basis of the
applicant's scholastic achievement if such applicant has been
admitted to, or maintained good standing at, an accredited
institution; and
``(3) shall not be denied solely by reason of such
applicant's eligibility for assistance or benefits under any
other Federal program.

``SEC. 104. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.

``(a) In General.--
``(1) Authority.--The Secretary, acting through the
Service, shall make scholarship grants to Indians who are
enrolled full or part time in accredited schools pursuing
courses of study in the health professions. Such scholarships
shall be designated Indian Health Scholarships and shall be
made in accordance with section 338A of the Public Health
Services Act (42 U.S.C. 254l), except as provided in
subsection (b) of this section.
``(2) Determinations by secretary.--The Secretary, acting
through the Service, shall determine--
``(A) who shall receive scholarship grants under subsection
(a); and
``(B) the distribution of the scholarships among health
professions on the basis of the relative needs of Indians for
additional service in the health professions.
``(3) Certain delegation not allowed.--The administration
of this section shall be a responsibility of the Assistant
Secretary and shall not be delegated in a contract or compact
under the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450 et seq.).
``(b) Active Duty Service Obligation.--
``(1) Obligation met.--The active duty service obligation
under a written contract with the Secretary under this
section that an Indian has entered into shall, if that
individual is a recipient of an Indian Health Scholarship, be
met in full-time practice equal to 1 year for each school
year for which the participant receives a scholarship award
under this part, or 2 years, whichever is greater, by service
in 1 or more of the following:
``(A) In an Indian Health Program.
``(B) In a program assisted under title V of this Act.
``(C) In the private practice of the applicable profession
if, as determined by the Secretary, in accordance with
guidelines promulgated by the Secretary, such practice is
situated in a physician or other health professional shortage
area and addresses the health care needs of a substantial
number of Indians.
``(D) In a teaching capacity in a tribal college or
university nursing program (or a related health profession
program) if, as determined by the Secretary, the health
service provided to Indians would not decrease.
``(2) Obligation deferred.--At the request of any
individual who has entered into a contract referred to in
paragraph (1) and who receives a degree in medicine
(including osteopathic or allopathic medicine), dentistry,
optometry, podiatry, or pharmacy, the Secretary shall defer
the active duty service obligation of that individual under
that contract, in order that such individual may complete any
internship, residency, or other advanced clinical training
that is required for the practice of that health profession,
for an appropriate period (in years, as determined by the
Secretary), subject to the following conditions:
``(A) No period of internship, residency, or other advanced
clinical training shall be counted as satisfying any period
of obligated service under this subsection.
``(B) The active duty service obligation of that individual
shall commence not later than 90 days after the completion of
that advanced clinical training (or by a date specified by
the Secretary).
``(C) The active duty service obligation will be served in
the health profession of that individual in a manner
consistent with paragraph (1).
``(D) A recipient of a scholarship under this section may,
at the election of the recipient,

[[Page S10461]]

meet the active duty service obligation described in
paragraph (1) by service in a program specified under that
paragraph that--
``(i) is located on the reservation of the Indian Tribe in
which the recipient is enrolled; or
``(ii) serves the Indian Tribe in which the recipient is
enrolled.
``(3) Priority when making assignments.--Subject to
paragraph (2), the Secretary, in making assignments of Indian
Health Scholarship recipients required to meet the active
duty service obligation described in paragraph (1), shall
give priority to assigning individuals to service in those
programs specified in paragraph (1) that have a need for
health professionals to provide health care services as a
result of individuals having breached contracts entered into
under this section.
``(c) Part-Time Students.--In the case of an individual
receiving a scholarship under this section who is enrolled
part time in an approved course of study--
``(1) such scholarship shall be for a period of years not
to exceed the part-time equivalent of 4 years, as determined
by the Secretary;
``(2) the period of obligated service described in
subsection (b)(1) shall be equal to the greater of--
``(A) the part-time equivalent of 1 year for each year for
which the individual was provided a scholarship (as
determined by the Secretary); or
``(B) 2 years; and
``(3) the amount of the monthly stipend specified in
section 338A(g)(1)(B) of the Public Health Service Act (42
U.S.C. 254l(g)(1)(B)) shall be reduced pro rata (as
determined by the Secretary) based on the number of hours
such student is enrolled.
``(d) Breach of Contract.--
``(1) Specified breaches.--An individual shall be liable to
the United States for the amount which has been paid to the
individual, or on behalf of the individual, under a contract
entered into with the Secretary under this section on or
after the date of enactment of the Indian Health Care
Improvement Act Amendments of 2007 if that individual--
``(A) fails to maintain an acceptable level of academic
standing in the educational institution in which he or she is
enrolled (such level determined by the educational
institution under regulations of the Secretary);
``(B) is dismissed from such educational institution for
disciplinary reasons;
``(C) voluntarily terminates the training in such an
educational institution for which he or she is provided a
scholarship under such contract before the completion of such
training; or
``(D) fails to accept payment, or instructs the educational
institution in which he or she is enrolled not to accept
payment, in whole or in part, of a scholarship under such
contract, in lieu of any service obligation arising under
such contract.
``(2) Other breaches.--If for any reason not specified in
paragraph (1) an individual breaches a written contract by
failing either to begin such individual's service obligation
required under such contract or to complete such service
obligation, the United States shall be entitled to recover
from the individual an amount determined in accordance with
the formula specified in subsection (l) of section 110 in the
manner provided for in such subsection.
``(3) Cancellation upon death of recipient.--Upon the death
of an individual who receives an Indian Health Scholarship,
any outstanding obligation of that individual for service or
payment that relates to that scholarship shall be canceled.
``(4) Waivers and suspensions.--
``(A) In general.--The Secretary shall provide for the
partial or total waiver or suspension of any obligation of
service or payment of a recipient of an Indian Health
Scholarship if the Secretary determines that--
``(i) it is not possible for the recipient to meet that
obligation or make that payment;
``(ii) requiring that recipient to meet that obligation or
make that payment would result in extreme hardship to the
recipient; or
``(iii) the enforcement of the requirement to meet the
obligation or make the payment would be unconscionable.
``(B) Factors for consideration.--Before waiving or
suspending an obligation of service or payment under
subparagraph (A), the Secretary shall consult with the
affected Area Office, Indian Tribes, or Tribal Organizations,
or confer with the affected Urban Indian Organizations, and
may take into consideration whether the obligation may be
satisfied in a teaching capacity at a tribal college or
university nursing program under subsection (b)(1)(D).
``(5) Extreme hardship.--Notwithstanding any other
provision of law, in any case of extreme hardship or for
other good cause shown, the Secretary may waive, in whole or
in part, the right of the United States to recover funds made
available under this section.
``(6) Bankruptcy.--Notwithstanding any other provision of
law, with respect to a recipient of an Indian Health
Scholarship, no obligation for payment may be released by a
discharge in bankruptcy under title 11, United States Code,
unless that discharge is granted after the expiration of the
5-year period beginning on the initial date on which that
payment is due, and only if the bankruptcy court finds that
the nondischarge of the obligation would be unconscionable.

``SEC. 105. AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM.

``(a) Grants Authorized.--The Secretary, acting through the
Service, shall make grants of not more than $300,000 to each
of 9 colleges and universities for the purpose of developing
and maintaining Indian psychology career recruitment programs
as a means of encouraging Indians to enter the behavioral
health field. These programs shall be located at various
locations throughout the country to maximize their
availability to Indian students and new programs shall be
established in different locations from time to time.
``(b) Quentin N. Burdick Program Grant.--The Secretary
shall provide a grant authorized under subsection (a) to
develop and maintain a program at the University of North
Dakota to be known as the `Quentin N. Burdick American
Indians Into Psychology Program'. Such program shall, to the
maximum extent feasible, coordinate with the Quentin N.
Burdick Indian Health Programs authorized under section
117(b), the Quentin N. Burdick American Indians Into Nursing
Program authorized under section 115(e), and existing
university research and communications networks.
``(c) Regulations.--The Secretary shall issue regulations
pursuant to this Act for the competitive awarding of grants
provided under this section.
``(d) Conditions of Grant.--Applicants under this section
shall agree to provide a program which, at a minimum--
``(1) provides outreach and recruitment for health
professions to Indian communities including elementary,
secondary, and accredited and accessible community colleges
that will be served by the program;
``(2) incorporates a program advisory board comprised of
representatives from the tribes and communities that will be
served by the program;
``(3) provides summer enrichment programs to expose Indian
students to the various fields of psychology through
research, clinical, and experimental activities;
``(4) provides stipends to undergraduate and graduate
students to pursue a career in psychology;
``(5) develops affiliation agreements with tribal colleges
and universities, the Service, university affiliated
programs, and other appropriate accredited and accessible
entities to enhance the education of Indian students;
``(6) to the maximum extent feasible, uses existing
university tutoring, counseling, and student support
services; and
``(7) to the maximum extent feasible, employs qualified
Indians in the program.
``(e) Active Duty Service Requirement.--The active duty
service obligation prescribed under section 338C of the
Public Health Service Act (42 U.S.C. 254m) shall be met by
each graduate who receives a stipend described in subsection
(d)(4) that is funded under this section. Such obligation
shall be met by service--
``(1) in an Indian Health Program;
``(2) in a program assisted under title V of this Act; or
``(3) in the private practice of psychology if, as
determined by the Secretary, in accordance with guidelines
promulgated by the Secretary, such practice is situated in a
physician or other health professional shortage area and
addresses the health care needs of a substantial number of
Indians.
``(f) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section $2,700,000 for
each of fiscal years 2008 through 2017.

``SEC. 106. SCHOLARSHIP PROGRAMS FOR INDIAN TRIBES.

``(a) In General.--
``(1) Grants authorized.--The Secretary, acting through the
Service, shall make grants to Tribal Health Programs for the
purpose of providing scholarships for Indians to serve as
health professionals in Indian communities.
``(2) Amount.--Amounts available under paragraph (1) for
any fiscal year shall not exceed 5 percent of the amounts
available for each fiscal year for Indian Health Scholarships
under section 104.
``(3) Application.--An application for a grant under
paragraph (1) shall be in such form and contain such
agreements, assurances, and information as consistent with
this section.
``(b) Requirements.--
``(1) In general.--A Tribal Health Program receiving a
grant under subsection (a) shall provide scholarships to
Indians in accordance with the requirements of this section.
``(2) Costs.--With respect to costs of providing any
scholarship pursuant to subsection (a)--
``(A) 80 percent of the costs of the scholarship shall be
paid from the funds made available pursuant to subsection
(a)(1) provided to the Tribal Health Program; and
``(B) 20 percent of such costs may be paid from any other
source of funds.
``(c) Course of Study.--A Tribal Health Program shall
provide scholarships under this section only to Indians
enrolled or accepted for enrollment in a course of study
(approved by the Secretary) in 1 of the health professions
contemplated by this Act.
``(d) Contract.--
``(1) In general.--In providing scholarships under
subsection (b), the Secretary and the Tribal Health Program
shall enter into a written contract with each recipient of
such scholarship.
``(2) Requirements.--Such contract shall--
``(A) obligate such recipient to provide service in an
Indian Health Program or Urban Indian Organization, in the
same Service Area where the Tribal Health Program providing
the scholarship is located, for--

[[Page S10462]]

``(i) a number of years for which the scholarship is
provided (or the part-time equivalent thereof, as determined
by the Secretary), or for a period of 2 years, whichever
period is greater; or
``(ii) such greater period of time as the recipient and the
Tribal Health Program may agree;
``(B) provide that the amount of the scholarship--
``(i) may only be expended for--

``(I) tuition expenses, other reasonable educational
expenses, and reasonable living expenses incurred in
attendance at the educational institution; and
``(II) payment to the recipient of a monthly stipend of not
more than the amount authorized by section 338(g)(1)(B) of
the Public Health Service Act (42 U.S.C. 254m(g)(1)(B)), with
such amount to be reduced pro rata (as determined by the
Secretary) based on the number of hours such student is
enrolled, and not to exceed, for any year of attendance for
which the scholarship is provided, the total amount required
for the year for the purposes authorized in this clause; and

``(ii) may not exceed, for any year of attendance for which
the scholarship is provided, the total amount required for
the year for the purposes authorized in clause (i);
``(C) require the recipient of such scholarship to maintain
an acceptable level of academic standing as determined by the
educational institution in accordance with regulations issued
pursuant to this Act; and
``(D) require the recipient of such scholarship to meet the
educational and licensure requirements appropriate to each
health profession.
``(3) Service in other service areas.--The contract may
allow the recipient to serve in another Service Area,
provided the Tribal Health Program and Secretary approve and
services are not diminished to Indians in the Service Area
where the Tribal Health Program providing the scholarship is
located.
``(e) Breach of Contract.--
``(1) Specific breaches.--An individual who has entered
into a written contract with the Secretary and a Tribal
Health Program under subsection (d) shall be liable to the
United States for the Federal share of the amount which has
been paid to him or her, or on his or her behalf, under the
contract if that individual--
``(A) fails to maintain an acceptable level of academic
standing in the educational institution in which he or she is
enrolled (such level as determined by the educational
institution under regulations of the Secretary);
``(B) is dismissed from such educational institution for
disciplinary reasons;
``(C) voluntarily terminates the training in such an
educational institution for which he or she is provided a
scholarship under such contract before the completion of such
training; or
``(D) fails to accept payment, or instructs the educational
institution in which he or she is enrolled not to accept
payment, in whole or in part, of a scholarship under such
contract, in lieu of any service obligation arising under
such contract.
``(2) Other breaches.--If for any reason not specified in
paragraph (1), an individual breaches a written contract by
failing to either begin such individual's service obligation
required under such contract or to complete such service
obligation, the United States shall be entitled to recover
from the individual an amount determined in accordance with
the formula specified in subsection (l) of section 110 in the
manner provided for in such subsection.
``(3) Cancellation upon death of recipient.--Upon the death
of an individual who receives an Indian Health Scholarship,
any outstanding obligation of that individual for service or
payment that relates to that scholarship shall be canceled.
``(4) Information.--The Secretary may carry out this
subsection on the basis of information received from Tribal
Health Programs involved or on the basis of information
collected through such other means as the Secretary deems
appropriate.
``(f) Relation to Social Security Act.--The recipient of a
scholarship under this section shall agree, in providing
health care pursuant to the requirements herein--
``(1) not to discriminate against an individual seeking
care on the basis of the ability of the individual to pay for
such care or on the basis that payment for such care will be
made pursuant to a program established in title XVIII of the
Social Security Act or pursuant to the programs established
in title XIX or title XXI of such Act; and
``(2) to accept assignment under section 1842(b)(3)(B)(ii)
of the Social Security Act for all services for which payment
may be made under part B of title XVIII of such Act, and to
enter into an appropriate agreement with the State agency
that administers the State plan for medical assistance under
title XIX, or the State child health plan under title XXI, of
such Act to provide service to individuals entitled to
medical assistance or child health assistance, respectively,
under the plan.
``(g) Continuance of Funding.--The Secretary shall make
payments under this section to a Tribal Health Program for
any fiscal year subsequent to the first fiscal year of such
payments unless the Secretary determines that, for the
immediately preceding fiscal year, the Tribal Health Program
has not complied with the requirements of this section.

``SEC. 107. INDIAN HEALTH SERVICE EXTERN PROGRAMS.

``(a) Employment Preference.--Any individual who receives a
scholarship pursuant to section 104 or 106 shall be given
preference for employment in the Service, or may be employed
by a Tribal Health Program or an Urban Indian Organization,
or other agencies of the Department as available, during any
nonacademic period of the year.
``(b) Not Counted Toward Active Duty Service Obligation.--
Periods of employment pursuant to this subsection shall not
be counted in determining fulfillment of the service
obligation incurred as a condition of the scholarship.
``(c) Timing; Length of Employment.--Any individual
enrolled in a program, including a high school program,
authorized under section 102(a) may be employed by the
Service or by a Tribal Health Program or an Urban Indian
Organization during any nonacademic period of the year. Any
such employment shall not exceed 120 days during any calendar
year.
``(d) Nonapplicability of Competitive Personnel System.--
Any employment pursuant to this section shall be made without
regard to any competitive personnel system or agency
personnel limitation and to a position which will enable the
individual so employed to receive practical experience in the
health profession in which he or she is engaged in study. Any
individual so employed shall receive payment for his or her
services comparable to the salary he or she would receive if
he or she were employed in the competitive system. Any
individual so employed shall not be counted against any
employment ceiling affecting the Service or the Department.

``SEC. 108. CONTINUING EDUCATION ALLOWANCES.

``In order to encourage scholarship and stipend recipients
under sections 104, 105, 106, and 115 and health
professionals, including community health representatives and
emergency medical technicians, to join or continue in an
Indian Health Program and to provide their services in the
rural and remote areas where a significant portion of Indians
reside, the Secretary, acting through the Service, may--
``(1) provide programs or allowances to transition into an
Indian Health Program, including licensing, board or
certification examination assistance, and technical
assistance in fulfilling service obligations under sections
104, 105, 106, and 115; and
``(2) provide programs or allowances to health
professionals employed in an Indian Health Program to enable
them for a period of time each year prescribed by regulation
of the Secretary to take leave of their duty stations for
professional consultation, management, leadership, and
refresher training courses.

``SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PROGRAM.

``(a) In General.--Under the authority of the Act of
November 2, 1921 (25 U.S.C. 13) (commonly known as the
`Snyder Act'), the Secretary, acting through the Service,
shall maintain a Community Health Representative Program
under which Indian Health Programs--
``(1) provide for the training of Indians as community
health representatives; and
``(2) use such community health representatives in the
provision of health care, health promotion, and disease
prevention services to Indian communities.
``(b) Duties.--The Community Health Representative Program
of the Service, shall--
``(1) provide a high standard of training for community
health representatives to ensure that the community health
representatives provide quality health care, health
promotion, and disease prevention services to the Indian
communities served by the Program;
``(2) in order to provide such training, develop and
maintain a curriculum that--
``(A) combines education in the theory of health care with
supervised practical experience in the provision of health
care; and
``(B) provides instruction and practical experience in
health promotion and disease prevention activities, with
appropriate consideration given to lifestyle factors that
have an impact on Indian health status, such as alcoholism,
family dysfunction, and poverty;
``(3) maintain a system which identifies the needs of
community health representatives for continuing education in
health care, health promotion, and disease prevention and
develop programs that meet the needs for continuing
education;
``(4) maintain a system that provides close supervision of
Community Health Representatives;
``(5) maintain a system under which the work of Community
Health Representatives is reviewed and evaluated; and
``(6) promote traditional health care practices of the
Indian Tribes served consistent with the Service standards
for the provision of health care, health promotion, and
disease prevention.

``SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT PROGRAM.

``(a) Establishment.--The Secretary, acting through the
Service, shall establish and administer a program to be known
as the Service Loan Repayment Program (hereinafter referred
to as the `Loan Repayment Program') in order to ensure an
adequate supply of trained health professionals necessary to
maintain accreditation of, and provide health care services
to Indians through, Indian Health Programs and Urban Indian
Organizations.

[[Page S10463]]

``(b) Eligible Individuals.--To be eligible to participate
in the Loan Repayment Program, an individual must--
``(1)(A) be enrolled--
``(i) in a course of study or program in an accredited
educational institution (as determined by the Secretary under
section 338B(b)(1)(c)(i) of the Public Health Service Act (42
U.S.C. 254l-1(b)(1)(c)(i))) and be scheduled to complete such
course of study in the same year such individual applies to
participate in such program; or
``(ii) in an approved graduate training program in a health
profession; or
``(B) have--
``(i) a degree in a health profession; and
``(ii) a license to practice a health profession;
``(2)(A) be eligible for, or hold, an appointment as a
commissioned officer in the Regular or Reserve Corps of the
Public Health Service;
``(B) be eligible for selection for civilian service in the
Regular or Reserve Corps of the Public Health Service;
``(C) meet the professional standards for civil service
employment in the Service; or
``(D) be employed in an Indian Health Program or Urban
Indian Organization without a service obligation; and
``(3) submit to the Secretary an application for a contract
described in subsection (e).
``(c) Application.--
``(1) Information to be included with forms.--In
disseminating application forms and contract forms to
individuals desiring to participate in the Loan Repayment
Program, the Secretary shall include with such forms a fair
summary of the rights and liabilities of an individual whose
application is approved (and whose contract is accepted) by
the Secretary, including in the summary a clear explanation
of the damages to which the United States is entitled under
subsection (l) in the case of the individual's breach of
contract. The Secretary shall provide such individuals with
sufficient information regarding the advantages and
disadvantages of service as a commissioned officer in the
Regular or Reserve Corps of the Public Health Service or a
civilian employee of the Service to enable the individual to
make a decision on an informed basis.
``(2) Clear language.--The application form, contract form,
and all other information furnished by the Secretary under
this section shall be written in a manner calculated to be
understood by the average individual applying to participate
in the Loan Repayment Program.
``(3) Timely availability of forms.--The Secretary shall
make such application forms, contract forms, and other
information available to individuals desiring to participate
in the Loan Repayment Program on a date sufficiently early to
ensure that such individuals have adequate time to carefully
review and evaluate such forms and information.
``(d) Priorities.--
``(1) List.--Consistent with subsection (k), the Secretary
shall annually--
``(A) identify the positions in each Indian Health Program
or Urban Indian Organization for which there is a need or a
vacancy; and
``(B) rank those positions in order of priority.
``(2) Approvals.--Notwithstanding the priority determined
under paragraph (1), the Secretary, in determining which
applications under the Loan Repayment Program to approve (and
which contracts to accept), shall--
``(A) give first priority to applications made by
individual Indians; and
``(B) after making determinations on all applications
submitted by individual Indians as required under
subparagraph (A), give priority to--
``(i) individuals recruited through the efforts of an
Indian Health Program or Urban Indian Organization; and
``(ii) other individuals based on the priority rankings
under paragraph (1).
``(e) Recipient Contracts.--
``(1) Contract required.--An individual becomes a
participant in the Loan Repayment Program only upon the
Secretary and the individual entering into a written contract
described in paragraph (2).
``(2) Contents of contract.--The written contract referred
to in this section between the Secretary and an individual
shall contain--
``(A) an agreement under which--
``(i) subject to subparagraph (C), the Secretary agrees--

``(I) to pay loans on behalf of the individual in
accordance with the provisions of this section; and
``(II) to accept (subject to the availability of
appropriated funds for carrying out this section) the
individual into the Service or place the individual with a
Tribal Health Program or Urban Indian Organization as
provided in clause (ii)(III); and

``(ii) subject to subparagraph (C), the individual agrees--

``(I) to accept loan payments on behalf of the individual;
``(II) in the case of an individual described in subsection
(b)(1)--

``(aa) to maintain enrollment in a course of study or
training described in subsection (b)(1)(A) until the
individual completes the course of study or training; and
``(bb) while enrolled in such course of study or training,
to maintain an acceptable level of academic standing (as
determined under regulations of the Secretary by the
educational institution offering such course of study or
training); and

``(III) to serve for a time period (hereinafter in this
section referred to as the `period of obligated service')
equal to 2 years or such longer period as the individual may
agree to serve in the full-time clinical practice of such
individual's profession in an Indian Health Program or Urban
Indian Organization to which the individual may be assigned
by the Secretary;

``(B) a provision permitting the Secretary to extend for
such longer additional periods, as the individual may agree
to, the period of obligated service agreed to by the
individual under subparagraph (A)(ii)(III);
``(C) a provision that any financial obligation of the
United States arising out of a contract entered into under
this section and any obligation of the individual which is
conditioned thereon is contingent upon funds being
appropriated for loan repayments under this section;
``(D) a statement of the damages to which the United States
is entitled under subsection (l) for the individual's breach
of the contract; and
``(E) such other statements of the rights and liabilities
of the Secretary and of the individual, not inconsistent with
this section.
``(f) Deadline for Decision on Application.--The Secretary
shall provide written notice to an individual within 21 days
on--
``(1) the Secretary's approving, under subsection (e)(1),
of the individual's participation in the Loan Repayment
Program, including extensions resulting in an aggregate
period of obligated service in excess of 4 years; or
``(2) the Secretary's disapproving an individual's
participation in such Program.
``(g) Payments.--
``(1) In general.--A loan repayment provided for an
individual under a written contract under the Loan Repayment
Program shall consist of payment, in accordance with
paragraph (2), on behalf of the individual of the principal,
interest, and related expenses on government and commercial
loans received by the individual regarding the undergraduate
or graduate education of the individual (or both), which
loans were made for--
``(A) tuition expenses;
``(B) all other reasonable educational expenses, including
fees, books, and laboratory expenses, incurred by the
individual; and
``(C) reasonable living expenses as determined by the
Secretary.
``(2) Amount.--For each year of obligated service that an
individual contracts to serve under subsection (e), the
Secretary may pay up to $35,000 or an amount equal to the
amount specified in section 338B(g)(2)(A) of the Public
Health Service Act, whichever is more, on behalf of the
individual for loans described in paragraph (1). In making a
determination of the amount to pay for a year of such service
by an individual, the Secretary shall consider the extent to
which each such determination--
``(A) affects the ability of the Secretary to maximize the
number of contracts that can be provided under the Loan
Repayment Program from the amounts appropriated for such
contracts;
``(B) provides an incentive to serve in Indian Health
Programs and Urban Indian Organizations with the greatest
shortages of health professionals; and
``(C) provides an incentive with respect to the health
professional involved remaining in an Indian Health Program
or Urban Indian Organization with such a health professional
shortage, and continuing to provide primary health services,
after the completion of the period of obligated service under
the Loan Repayment Program.
``(3) Timing.--Any arrangement made by the Secretary for
the making of loan repayments in accordance with this
subsection shall provide that any repayments for a year of
obligated service shall be made no later than the end of the
fiscal year in which the individual completes such year of
service.
``(4) Reimbursements for tax liability.--For the purpose of
providing reimbursements for tax liability resulting from a
payment under paragraph (2) on behalf of an individual, the
Secretary--
``(A) in addition to such payments, may make payments to
the individual in an amount equal to not less than 20 percent
and not more than 39 percent of the total amount of loan
repayments made for the taxable year involved; and
``(B) may make such additional payments as the Secretary
determines to be appropriate with respect to such purpose.
``(5) Payment schedule.--The Secretary may enter into an
agreement with the holder of any loan for which payments are
made under the Loan Repayment Program to establish a schedule
for the making of such payments.
``(h) Employment Ceiling.--Notwithstanding any other
provision of law, individuals who have entered into written
contracts with the Secretary under this section shall not be
counted against any employment ceiling affecting the
Department while those individuals are undergoing academic
training.
``(i) Recruitment.--The Secretary shall conduct recruiting
programs for the Loan Repayment Program and other manpower
programs of the Service at educational institutions training
health professionals or specialists identified in subsection
(a).
``(j) Applicability of Law.--Section 214 of the Public
Health Service Act (42 U.S.C. 215) shall not apply to
individuals during their period of obligated service under
the Loan Repayment Program.

[[Page S10464]]

``(k) Assignment of Individuals.--The Secretary, in
assigning individuals to serve in Indian Health Programs or
Urban Indian Organizations pursuant to contracts entered into
under this section, shall--
``(1) ensure that the staffing needs of Tribal Health
Programs and Urban Indian Organizations receive consideration
on an equal basis with programs that are administered
directly by the Service; and
``(2) give priority to assigning individuals to Indian
Health Programs and Urban Indian Organizations that have a
need for health professionals to provide health care services
as a result of individuals having breached contracts entered
into under this section.
``(l) Breach of Contract.--
``(1) Specific breaches.--An individual who has entered
into a written contract with the Secretary under this section
and has not received a waiver under subsection (m) shall be
liable, in lieu of any service obligation arising under such
contract, to the United States for the amount which has been
paid on such individual's behalf under the contract if that
individual--
``(A) is enrolled in the final year of a course of study
and--
``(i) fails to maintain an acceptable level of academic
standing in the educational institution in which he or she is
enrolled (such level determined by the educational
institution under regulations of the Secretary);
``(ii) voluntarily terminates such enrollment; or
``(iii) is dismissed from such educational institution
before completion of such course of study; or
``(B) is enrolled in a graduate training program and fails
to complete such training program.
``(2) Other breaches; formula for amount owed.--If, for any
reason not specified in paragraph (1), an individual breaches
his or her written contract under this section by failing
either to begin, or complete, such individual's period of
obligated service in accordance with subsection (e)(2), the
United States shall be entitled to recover from such
individual an amount to be determined in accordance with the
following formula: A=3Z(t-s/t) in which--
``(A) `A' is the amount the United States is entitled to
recover;
``(B) `Z' is the sum of the amounts paid under this section
to, or on behalf of, the individual and the interest on such
amounts which would be payable if, at the time the amounts
were paid, they were loans bearing interest at the maximum
legal prevailing rate, as determined by the Secretary of the
Treasury;
``(C) `t' is the total number of months in the individual's
period of obligated service in accordance with subsection
(f); and
``(D) `s' is the number of months of such period served by
such individual in accordance with this section.
``(3) Deductions in medicare payments.--Amounts not paid
within such period shall be subject to collection through
deductions in Medicare payments pursuant to section 1892 of
the Social Security Act.
``(4) Time period for repayment.--Any amount of damages
which the United States is entitled to recover under this
subsection shall be paid to the United States within the 1-
year period beginning on the date of the breach or such
longer period beginning on such date as shall be specified by
the Secretary.
``(5) Recovery of delinquency.--
``(A) In general.--If damages described in paragraph (4)
are delinquent for 3 months, the Secretary shall, for the
purpose of recovering such damages--
``(i) use collection agencies contracted with by the
Administrator of General Services; or
``(ii) enter into contracts for the recovery of such
damages with collection agencies selected by the Secretary.
``(B) Report.--Each contract for recovering damages
pursuant to this subsection shall provide that the contractor
will, not less than once each 6 months, submit to the
Secretary a status report on the success of the contractor in
collecting such damages. Section 3718 of title 31, United
States Code, shall apply to any such contract to the extent
not inconsistent with this subsection.
``(m) Waiver or Suspension of Obligation.--
``(1) In general.--The Secretary shall by regulation
provide for the partial or total waiver or suspension of any
obligation of service or payment by an individual under the
Loan Repayment Program whenever compliance by the individual
is impossible or would involve extreme hardship to the
individual and if enforcement of such obligation with respect
to any individual would be unconscionable.
``(2) Canceled upon death.--Any obligation of an individual
under the Loan Repayment Program for service or payment of
damages shall be canceled upon the death of the individual.
``(3) Hardship waiver.--The Secretary may waive, in whole
or in part, the rights of the United States to recover
amounts under this section in any case of extreme hardship or
other good cause shown, as determined by the Secretary.
``(4) Bankruptcy.--Any obligation of an individual under
the Loan Repayment Program for payment of damages may be
released by a discharge in bankruptcy under title 11 of the
United States Code only if such discharge is granted after
the expiration of the 5-year period beginning on the first
date that payment of such damages is required, and only if
the bankruptcy court finds that nondischarge of the
obligation would be unconscionable.
``(n) Report.--The Secretary shall submit to the President,
for inclusion in the report required to be submitted to
Congress under section 801, a report concerning the previous
fiscal year which sets forth by Service Area the following:
``(1) A list of the health professional positions
maintained by Indian Health Programs and Urban Indian
Organizations for which recruitment or retention is
difficult.
``(2) The number of Loan Repayment Program applications
filed with respect to each type of health profession.
``(3) The number of contracts described in subsection (e)
that are entered into with respect to each health profession.
``(4) The amount of loan payments made under this section,
in total and by health profession.
``(5) The number of scholarships that are provided under
sections 104 and 106 with respect to each health profession.
``(6) The amount of scholarship grants provided under
section 104 and 106, in total and by health profession.
``(7) The number of providers of health care that will be
needed by Indian Health Programs and Urban Indian
Organizations, by location and profession, during the 3
fiscal years beginning after the date the report is filed.
``(8) The measures the Secretary plans to take to fill the
health professional positions maintained by Indian Health
Programs or Urban Indian Organizations for which recruitment
or retention is difficult.

``SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOVERY FUND.

``(a) Establishment.--There is established in the Treasury
of the United States a fund to be known as the Indian Health
Scholarship and Loan Repayment Recovery Fund (hereafter in
this section referred to as the `LRRF'). The LRRF shall
consist of such amounts as may be collected from individuals
under section 104(d), section 106(e), and section 110(l) for
breach of contract, such funds as may be appropriated to the
LRRF, and interest earned on amounts in the LRRF. All amounts
collected, appropriated, or earned relative to the LRRF shall
remain available until expended.
``(b) Use of Funds.--
``(1) By secretary.--Amounts in the LRRF may be expended by
the Secretary, acting through the Service, to make payments
to an Indian Health Program--
``(A) to which a scholarship recipient under section 104
and 106 or a loan repayment program participant under section
110 has been assigned to meet the obligated service
requirements pursuant to such sections; and
``(B) that has a need for a health professional to provide
health care services as a result of such recipient or
participant having breached the contract entered into under
section 104, 106, or section 110.
``(2) By tribal health programs.--A Tribal Health Program
receiving payments pursuant to paragraph (1) may expend the
payments to provide scholarships or recruit and employ,
directly or by contract, health professionals to provide
health care services.
``(c) Investment of Funds.--The Secretary of the Treasury
shall invest such amounts of the LRRF as the Secretary of
Health and Human Services determines are not required to meet
current withdrawals from the LRRF. Such investments may be
made only in interest bearing obligations of the United
States. For such purpose, such obligations may be acquired on
original issue at the issue price, or by purchase of
outstanding obligations at the market price.
``(d) Sale of Obligations.--Any obligation acquired by the
LRRF may be sold by the Secretary of the Treasury at the
market price.

``SEC. 112. RECRUITMENT ACTIVITIES.

``(a) Reimbursement for Travel.--The Secretary, acting
through the Service, may reimburse health professionals
seeking positions with Indian Health Programs or Urban Indian
Organizations, including individuals considering entering
into a contract under section 110 and their spouses, for
actual and reasonable expenses incurred in traveling to and
from their places of residence to an area in which they may
be assigned for the purpose of evaluating such area with
respect to such assignment.
``(b) Recruitment Personnel.--The Secretary, acting through
the Service, shall assign 1 individual in each Area Office to
be responsible on a full-time basis for recruitment
activities.

``SEC. 113. INDIAN RECRUITMENT AND RETENTION PROGRAM.

``(a) In General.--The Secretary, acting through the
Service, shall fund, on a competitive basis, innovative
demonstration projects for a period not to exceed 3 years to
enable Tribal Health Programs and Urban Indian Organizations
to recruit, place, and retain health professionals to meet
their staffing needs.
``(b) Eligible Entities; Application.--Any Tribal Health
Program or Urban Indian Organization may submit an
application for funding of a project pursuant to this
section.

``SEC. 114. ADVANCED TRAINING AND RESEARCH.

``(a) Demonstration Program.--The Secretary, acting through
the Service, shall establish a demonstration project to
enable

[[Page S10465]]

health professionals who have worked in an Indian Health
Program or Urban Indian Organization for a substantial period
of time to pursue advanced training or research areas of
study for which the Secretary determines a need exists.
``(b) Service Obligation.--An individual who participates
in a program under subsection (a), where the educational
costs are borne by the Service, shall incur an obligation to
serve in an Indian Health Program or Urban Indian
Organization for a period of obligated service equal to at
least the period of time during which the individual
participates in such program. In the event that the
individual fails to complete such obligated service, the
individual shall be liable to the United States for the
period of service remaining. In such event, with respect to
individuals entering the program after the date of enactment
of the Indian Health Care Improvement Act Amendments of 2007,
the United States shall be entitled to recover from such
individual an amount to be determined in accordance with the
formula specified in subsection (l) of section 110 in the
manner provided for in such subsection.
``(c) Equal Opportunity for Participation.--Health
professionals from Tribal Health Programs and Urban Indian
Organizations shall be given an equal opportunity to
participate in the program under subsection (a).

``SEC. 115. QUENTIN N. BURDICK AMERICAN INDIANS INTO NURSING
PROGRAM.

``(a) Grants Authorized.--For the purpose of increasing the
number of nurses, nurse midwives, and nurse practitioners who
deliver health care services to Indians, the Secretary,
acting through the Service, shall provide grants to the
following:
``(1) Public or private schools of nursing.
``(2) Tribal colleges or universities.
``(3) Nurse midwife programs and advanced practice nurse
programs that are provided by any tribal college or
university accredited nursing program, or in the absence of
such, any other public or private institutions.
``(b) Use of Grants.--Grants provided under subsection (a)
may be used for 1 or more of the following:
``(1) To recruit individuals for programs which train
individuals to be nurses, nurse midwives, or advanced
practice nurses.
``(2) To provide scholarships to Indians enrolled in such
programs that may pay the tuition charged for such program
and other expenses incurred in connection with such program,
including books, fees, room and board, and stipends for
living expenses.
``(3) To provide a program that encourages nurses, nurse
midwives, and advanced practice nurses to provide, or
continue to provide, health care services to Indians.
``(4) To provide a program that increases the skills of,
and provides continuing education to, nurses, nurse midwives,
and advanced practice nurses.
``(5) To provide any program that is designed to achieve
the purpose described in subsection (a).
``(c) Applications.--Each application for a grant under
subsection (a) shall include such information as the
Secretary may require to establish the connection between the
program of the applicant and a health care facility that
primarily serves Indians.
``(d) Preferences for Grant Recipients.--In providing
grants under subsection (a), the Secretary shall extend a
preference to the following:
``(1) Programs that provide a preference to Indians.
``(2) Programs that train nurse midwives or advanced
practice nurses.
``(3) Programs that are interdisciplinary.
``(4) Programs that are conducted in cooperation with a
program for gifted and talented Indian students.
``(5) Programs conducted by tribal colleges and
universities.
``(e) Quentin N. Burdick Program Grant.--The Secretary
shall provide 1 of the grants authorized under subsection (a)
to establish and maintain a program at the University of
North Dakota to be known as the `Quentin N. Burdick American
Indians Into Nursing Program'. Such program shall, to the
maximum extent feasible, coordinate with the Quentin N.
Burdick Indian Health Programs established under section
117(b) and the Quentin N. Burdick American Indians Into
Psychology Program established under section 105(b).
``(f) Active Duty Service Obligation.--The active duty
service obligation prescribed under section 338C of the
Public Health Service Act (42 U.S.C. 254m) shall be met by
each individual who receives training or assistance described
in paragraph (1) or (2) of subsection (b) that is funded by a
grant provided under subsection (a). Such obligation shall be
met by service--
``(1) in the Service;
``(2) in a program of an Indian Tribe or Tribal
Organization conducted under the Indian Self-Determination
and Education Assistance Act (25 U.S.C. 450 et seq.)
(including programs under agreements with the Bureau of
Indian Affairs);
``(3) in a program assisted under title V of this Act;
``(4) in the private practice of nursing if, as determined
by the Secretary, in accordance with guidelines promulgated
by the Secretary, such practice is situated in a physician or
other health shortage area and addresses the health care
needs of a substantial number of Indians; or
``(5) in a teaching capacity in a tribal college or
university nursing program (or a related health profession
program) if, as determined by the Secretary, health services
provided to Indians would not decrease.

``SEC. 116. TRIBAL CULTURAL ORIENTATION.

``(a) Cultural Education of Employees.--The Secretary,
acting through the Service, shall require that appropriate
employees of the Service who serve Indian Tribes in each
Service Area receive educational instruction in the history
and culture of such Indian Tribes and their relationship to
the Service.
``(b) Program.--In carrying out subsection (a), the
Secretary shall establish a program which shall, to the
extent feasible--
``(1) be developed in consultation with the affected Indian
Tribes, Tribal Organizations, and Urban Indian Organizations;
``(2) be carried out through tribal colleges or
universities;
``(3) include instruction in American Indian studies; and
``(4) describe the use and place of traditional health care
practices of the Indian Tribes in the Service Area.

``SEC. 117. INMED PROGRAM.

``(a) Grants Authorized.--The Secretary, acting through the
Service, is authorized to provide grants to colleges and
universities for the purpose of maintaining and expanding the
Indian health careers recruitment program known as the
`Indians Into Medicine Program' (hereinafter in this section
referred to as `INMED') as a means of encouraging Indians to
enter the health professions.
``(b) Quentin N. Burdick Grant.--The Secretary shall
provide 1 of the grants authorized under subsection (a) to
maintain the INMED program at the University of North Dakota,
to be known as the `Quentin N. Burdick Indian Health
Programs', unless the Secretary makes a determination, based
upon program reviews, that the program is not meeting the
purposes of this section. Such program shall, to the maximum
extent feasible, coordinate with the Quentin N. Burdick
American Indians Into Psychology Program established under
section 105(b) and the Quentin N. Burdick American Indians
Into Nursing Program established under section 115.
``(c) Regulations.--The Secretary, pursuant to this Act,
shall develop regulations to govern grants pursuant to this
section.
``(d) Requirements.--Applicants for grants provided under
this section shall agree to provide a program which--
``(1) provides outreach and recruitment for health
professions to Indian communities including elementary and
secondary schools and community colleges located on
reservations which will be served by the program;
``(2) incorporates a program advisory board comprised of
representatives from the Indian Tribes and Indian communities
which will be served by the program;
``(3) provides summer preparatory programs for Indian
students who need enrichment in the subjects of math and
science in order to pursue training in the health
professions;
``(4) provides tutoring, counseling, and support to
students who are enrolled in a health career program of study
at the respective college or university; and
``(5) to the maximum extent feasible, employs qualified
Indians in the program.

``SEC. 118. HEALTH TRAINING PROGRAMS OF COMMUNITY COLLEGES.

``(a) Grants to Establish Programs.--
``(1) In general.--The Secretary, acting through the
Service, shall award grants to accredited and accessible
community colleges for the purpose of assisting such
community colleges in the establishment of programs which
provide education in a health profession leading to a degree
or diploma in a health profession for individuals who desire
to practice such profession on or near a reservation or in an
Indian Health Program.
``(2) Amount of grants.--The amount of any grant awarded to
a community college under paragraph (1) for the first year in
which such a grant is provided to the community college shall
not exceed $250,000.
``(b) Grants for Maintenance and Recruiting.--
``(1) In general.--The Secretary, acting through the
Service, shall award grants to accredited and accessible
community colleges that have established a program described
in subsection (a)(1) for the purpose of maintaining the
program and recruiting students for the program.
``(2) Requirements.--Grants may only be made under this
section to a community college which--
``(A) is accredited;
``(B) has a relationship with a hospital facility, Service
facility, or hospital that could provide training of nurses
or health professionals;
``(C) has entered into an agreement with an accredited
college or university medical school, the terms of which--
``(i) provide a program that enhances the transition and
recruitment of students into advanced baccalaureate or
graduate programs that train health professionals; and
``(ii) stipulate certifications necessary to approve
internship and field placement opportunities at Indian Health
Programs;
``(D) has a qualified staff which has the appropriate
certifications;
``(E) is capable of obtaining State or regional
accreditation of the program described in subsection (a)(1);
and
``(F) agrees to provide for Indian preference for
applicants for programs under this section.
``(c) Technical Assistance.--The Secretary shall encourage
community colleges described in subsection (b)(2) to
establish

[[Page S10466]]

and maintain programs described in subsection (a)(1) by--
``(1) entering into agreements with such colleges for the
provision of qualified personnel of the Service to teach
courses of study in such programs; and
``(2) providing technical assistance and support to such
colleges.
``(d) Advanced Training.--
``(1) Required.--Any program receiving assistance under
this section that is conducted with respect to a health
profession shall also offer courses of study which provide
advanced training for any health professional who--
``(A) has already received a degree or diploma in such
health profession; and
``(B) provides clinical services on or near a reservation
or for an Indian Health Program.
``(2) May be offered at alternate site.--Such courses of
study may be offered in conjunction with the college or
university with which the community college has entered into
the agreement required under subsection (b)(2)(C).
``(e) Priority.--Where the requirements of subsection (b)
are met, grant award priority shall be provided to tribal
colleges and universities in Service Areas where they exist.

``SEC. 119. RETENTION BONUS.

``(a) Bonus Authorized.--The Secretary may pay a retention
bonus to any health professional employed by, or assigned to,
and serving in, an Indian Health Program or Urban Indian
Organization either as a civilian employee or as a
commissioned officer in the Regular or Reserve Corps of the
Public Health Service who--
``(1) is assigned to, and serving in, a position for which
recruitment or retention of personnel is difficult;
``(2) the Secretary determines is needed by Indian Health
Programs and Urban Indian Organizations;
``(3) has--
``(A) completed 2 years of employment with an Indian Health
Program or Urban Indian Organization; or
``(B) completed any service obligations incurred as a
requirement of--
``(i) any Federal scholarship program; or
``(ii) any Federal education loan repayment program; and
``(4) enters into an agreement with an Indian Health
Program or Urban Indian Organization for continued employment
for a period of not less than 1 year.
``(b) Rates.--The Secretary may establish rates for the
retention bonus which shall provide for a higher annual rate
for multiyear agreements than for single year agreements
referred to in subsection (a)(4), but in no event shall the
annual rate be more than $25,000 per annum.
``(c) Default of Retention Agreement.--Any health
professional failing to complete the agreed upon term of
service, except where such failure is through no fault of the
individual, shall be obligated to refund to the Government
the full amount of the retention bonus for the period covered
by the agreement, plus interest as determined by the
Secretary in accordance with section 110(l)(2)(B).
``(d) Other Retention Bonus.--The Secretary may pay a
retention bonus to any health professional employed by a
Tribal Health Program if such health professional is serving
in a position which the Secretary determines is--
``(1) a position for which recruitment or retention is
difficult; and
``(2) necessary for providing health care services to
Indians.

``SEC. 120. NURSING RESIDENCY PROGRAM.

``(a) Establishment of Program.--The Secretary, acting
through the Service, shall establish a program to enable
Indians who are licensed practical nurses, licensed
vocational nurses, and registered nurses who are working in
an Indian Health Program or Urban Indian Organization, and
have done so for a period of not less than 1 year, to pursue
advanced training. Such program shall include a combination
of education and work study in an Indian Health Program or
Urban Indian Organization leading to an associate or
bachelor's degree (in the case of a licensed practical nurse
or licensed vocational nurse), a bachelor's degree (in the
case of a registered nurse), or advanced degrees or
certifications in nursing and public health.
``(b) Service Obligation.--An individual who participates
in a program under subsection (a), where the educational
costs are paid by the Service, shall incur an obligation to
serve in an Indian Health Program or Urban Indian
Organization for a period of obligated service equal to 1
year for every year that nonprofessional employee (licensed
practical nurses, licensed vocational nurses, nursing
assistants, and various health care technicals), or 2 years
for every year that professional nurse (associate degree and
bachelor-prepared registered nurses), participates in such
program. In the event that the individual fails to complete
such obligated service, the United States shall be entitled
to recover from such individual an amount determined in
accordance with the formula specified in subsection (l) of
section 110 in the manner provided for in such subsection.

``SEC. 121. COMMUNITY HEALTH AIDE PROGRAM.

``(a) General Purposes of Program.--Under the authority of
the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as
the `Snyder Act'), the Secretary, acting through the Service,
shall develop and operate a Community Health Aide Program in
Alaska under which the Service--
``(1) provides for the training of Alaska Natives as health
aides or community health practitioners;
``(2) uses such aides or practitioners in the provision of
health care, health promotion, and disease prevention
services to Alaska Natives living in villages in rural
Alaska; and
``(3) provides for the establishment of teleconferencing
capacity in health clinics located in or near such villages
for use by community health aides or community health
practitioners.
``(b) Specific Program Requirements.--The Secretary, acting
through the Community Health Aide Program of the Service,
shall--
``(1) using trainers accredited by the Program, provide a
high standard of training to community health aides and
community health practitioners to ensure that such aides and
practitioners provide quality health care, health promotion,
and disease prevention services to the villages served by the
Program;
``(2) in order to provide such training, develop a
curriculum that--
``(A) combines education in the theory of health care with
supervised practical experience in the provision of health
care;
``(B) provides instruction and practical experience in the
provision of acute care, emergency care, health promotion,
disease prevention, and the efficient and effective
management of clinic pharmacies, supplies, equipment, and
facilities; and
``(C) promotes the achievement of the health status
objectives specified in section 3(2);
``(3) establish and maintain a Community Health Aide
Certification Board to certify as community health aides or
community health practitioners individuals who have
successfully completed the training described in paragraph
(1) or can demonstrate equivalent experience;
``(4) develop and maintain a system which identifies the
needs of community health aides and community health
practitioners for continuing education in the provision of
health care, including the areas described in paragraph
(2)(B), and develop programs that meet the needs for such
continuing education;
``(5) develop and maintain a system that provides close
supervision of community health aides and community health
practitioners;
``(6) develop a system under which the work of community
health aides and community health practitioners is reviewed
and evaluated to assure the provision of quality health care,
health promotion, and disease prevention services; and
``(7) ensure that pulpal therapy (not including pulpotomies
on deciduous teeth) or extraction of adult teeth can be
performed by a dental health aide therapist only after
consultation with a licensed dentist who determines that the
procedure is a medical emergency that cannot be resolved with
palliative treatment, and further that dental health aide
therapists are strictly prohibited from performing all other
oral or jaw surgeries, provided that uncomplicated
extractions shall not be considered oral surgery under this
section.
``(c) Program Review.--
``(1) Neutral panel.--
``(A) Establishment.--The Secretary, acting through the
Service, shall establish a neutral panel to carry out the
study under paragraph (2).
``(B) Membership.--Members of the neutral panel shall be
appointed by the Secretary from among clinicians, economists,
community practitioners, oral epidemiologists, and Alaska
Natives.
``(2) Study.--
``(A) In general.--The neutral panel established under
paragraph (1) shall conduct a study of the dental health aide
therapist services provided by the Community Health Aide
Program under this section to ensure that the quality of care
provided through those services is adequate and appropriate.
``(B) Parameters of study.--The Secretary, in consultation
with interested parties, including professional dental
organizations, shall develop the parameters of the study.
``(C) Inclusions.--The study shall include a determination
by the neutral panel with respect to--
``(i) the ability of the dental health aide therapist
services under this section to address the dental care needs
of Alaska Natives;
``(ii) the quality of care provided through those services,
including any training, improvement, or additional oversight
required to improve the quality of care; and
``(iii) whether safer and less costly alternatives to the
dental health aide therapist services exist.
``(D) Consultation.--In carrying out the study under this
paragraph, the neutral panel shall consult with Alaska Tribal
Organizations with respect to the adequacy and accuracy of
the study.
``(3) Report.--The neutral panel shall submit to the
Secretary, the Committee on Indian Affairs of the Senate, and
the Committee on Natural Resources of the House of
Representatives a report describing the results of the study
under paragraph (2), including a description of--
``(A) any determination of the neutral panel under
paragraph (2)(C); and
``(B) any comments received from an Alaska Tribal
Organization under paragraph (2)(D).

[[Page S10467]]

``(d) Nationalization of Program.--
``(1) In general.--Except as provided in paragraph (2), the
Secretary, acting through the Service, may establish a
national Community Health Aide Program in accordance with the
program under this section, as the Secretary determines to be
appropriate.
``(2) Exception.--The national Community Health Aide
Program under paragraph (1) shall not include dental health
aide therapist services.
``(3) Requirement.--In establishing a national program
under paragraph (1), the Secretary shall not reduce the
amount of funds provided for the Community Health Aide
Program described in subsections (a) and (b).

``SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.

``The Secretary, acting through the Service, shall, by
contract or otherwise, provide training for Indians in the
administration and planning of Tribal Health Programs.

``SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE
DEMONSTRATION PROGRAMS.

``(a) Demonstration Programs Authorized.--The Secretary,
acting through the Service, may fund demonstration programs
for Tribal Health Programs to address the chronic shortages
of health professionals.
``(b) Purposes of Programs.--The purposes of demonstration
programs funded under subsection (a) shall be--
``(1) to provide direct clinical and practical experience
at a Service Unit to health profession students and residents
from medical schools;
``(2) to improve the quality of health care for Indians by
assuring access to qualified health care professionals; and
``(3) to provide academic and scholarly opportunities for
health professionals serving Indians by identifying all
academic and scholarly resources of the region.
``(c) Advisory Board.--The demonstration programs
established pursuant to subsection (a) shall incorporate a
program advisory board composed of representatives from the
Indian Tribes and Indian communities in the area which will
be served by the program.

``SEC. 124. NATIONAL HEALTH SERVICE CORPS.

``(a) No Reduction in Services.--The Secretary shall not--
``(1) remove a member of the National Health Service Corps
from an Indian Health Program or Urban Indian Organization;
or
``(2) withdraw funding used to support such member, unless
the Secretary, acting through the Service, has ensured that
the Indians receiving services from such member will
experience no reduction in services.
``(b) Exemption From Limitations.--National Health Service
Corps scholars qualifying for the Commissioned Corps in the
Public Health Service shall be exempt from the full-time
equivalent limitations of the National Health Service Corps
and the Service when serving as a commissioned corps officer
in a Tribal Health Program or an Urban Indian Organization.

``SEC. 125. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL CURRICULA
DEMONSTRATION PROGRAMS.

``(a) Contracts and Grants.--The Secretary, acting through
the Service, may enter into contracts with, or make grants
to, accredited tribal colleges and universities and eligible
accredited and accessible community colleges to establish
demonstration programs to develop educational curricula for
substance abuse counseling.
``(b) Use of Funds.--Funds provided under this section
shall be used only for developing and providing educational
curriculum for substance abuse counseling (including paying
salaries for instructors). Such curricula may be provided
through satellite campus programs.
``(c) Time Period of Assistance; Renewal.--A contract
entered into or a grant provided under this section shall be
for a period of 3 years. Such contract or grant may be
renewed for an additional 2-year period upon the approval of
the Secretary.
``(d) Criteria for Review and Approval of Applications.--
Not later than 180 days after the date of enactment of the
Indian Health Care Improvement Act Amendments of 2007, the
Secretary, after consultation with Indian Tribes and
administrators of tribal colleges and universities and
eligible accredited and accessible community colleges, shall
develop and issue criteria for the review and approval of
applications for funding (including applications for renewals
of funding) under this section. Such criteria shall ensure
that demonstration programs established under this section
promote the development of the capacity of such entities to
educate substance abuse counselors.
``(e) Assistance.--The Secretary shall provide such
technical and other assistance as may be necessary to enable
grant recipients to comply with the provisions of this
section.
``(f) Report.--Each fiscal year, the Secretary shall submit
to the President, for inclusion in the report which is
required to be submitted under section 801 for that fiscal
year, a report on the findings and conclusions derived from
the demonstration programs conducted under this section
during that fiscal year.
``(g) Definition.--For the purposes of this section, the
term `educational curriculum' means 1 or more of the
following:
``(1) Classroom education.
``(2) Clinical work experience.
``(3) Continuing education workshops.

``SEC. 126. BEHAVIORAL HEALTH TRAINING AND COMMUNITY
EDUCATION PROGRAMS.

``(a) Study; List.--The Secretary, acting through the
Service, and the Secretary of the Interior, in consultation
with Indian Tribes and Tribal Organizations, shall conduct a
study and compile a list of the types of staff positions
specified in subsection (b) whose qualifications include, or
should include, training in the identification, prevention,
education, referral, or treatment of mental illness, or
dysfunctional and self destructive behavior.
``(b) Positions.--The positions referred to in subsection
(a) are--
``(1) staff positions within the Bureau of Indian Affairs,
including existing positions, in the fields of--
``(A) elementary and secondary education;
``(B) social services and family and child welfare;
``(C) law enforcement and judicial services; and
``(D) alcohol and substance abuse;
``(2) staff positions within the Service; and
``(3) staff positions similar to those identified in
paragraphs (1) and (2) established and maintained by Indian
Tribes and Tribal Organizations (without regard to the
funding source).
``(c) Training Criteria.--
``(1) In general.--The appropriate Secretary shall provide
training criteria appropriate to each type of position
identified in subsection (b)(1) and (b)(2) and ensure that
appropriate training has been, or shall be provided to any
individual in any such position. With respect to any such
individual in a position identified pursuant to subsection
(b)(3), the respective Secretaries shall provide appropriate
training to, or provide funds to, an Indian Tribe or Tribal
Organization for training of appropriate individuals. In the
case of positions funded under a contract or compact under
the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450 et seq.), the appropriate Secretary shall
ensure that such training costs are included in the contract
or compact, as the Secretary determines necessary.
``(2) Position specific training criteria.--Position
specific training criteria shall be culturally relevant to
Indians and Indian Tribes and shall ensure that appropriate
information regarding traditional health care practices is
provided.
``(d) Community Education on Mental Illness.--The Service
shall develop and implement, on request of an Indian Tribe,
Tribal Organization, or Urban Indian Organization, or assist
the Indian Tribe, Tribal Organization, or Urban Indian
Organization to develop and implement, a program of community
education on mental illness. In carrying out this subsection,
the Service shall, upon request of an Indian Tribe, Tribal
Organization, or Urban Indian Organization, provide technical
assistance to the Indian Tribe, Tribal Organization, or Urban
Indian Organization to obtain and develop community
educational materials on the identification, prevention,
referral, and treatment of mental illness and dysfunctional
and self-destructive behavior.
``(e) Plan.--Not later than 90 days after the date of
enactment of the Indian Health Care Improvement Act
Amendments of 2007, the Secretary shall develop a plan under
which the Service will increase the health care staff
providing behavioral health services by at least 500
positions within 5 years after the date of enactment of this
section, with at least 200 of such positions devoted to
child, adolescent, and family services. The plan developed
under this subsection shall be implemented under the Act of
November 2, 1921 (25 U.S.C. 13) (commonly known as the
`Snyder Act').

``SEC. 127. AUTHORIZATION OF APPROPRIATIONS.

``There are authorized to be appropriated such sums as may
be necessary for each fiscal year through fiscal year 2017 to
carry out this title.

``TITLE II--HEALTH SERVICES

``SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND.

``(a) Use of Funds.--The Secretary, acting through the
Service, is authorized to expend funds, directly or under the
authority of the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.), which are
appropriated under the authority of this section, for the
purposes of--
``(1) eliminating the deficiencies in health status and
health resources of all Indian Tribes;
``(2) eliminating backlogs in the provision of health care
services to Indians;
``(3) meeting the health needs of Indians in an efficient
and equitable manner, including the use of telehealth and
telemedicine when appropriate;
``(4) eliminating inequities in funding for both direct
care and contract health service programs; and
``(5) augmenting the ability of the Service to meet the
following health service responsibilities with respect to
those Indian Tribes with the highest levels of health status
deficiencies and resource deficiencies:
``(A) Clinical care, including inpatient care, outpatient
care (including audiology, clinical eye, and vision care),
primary care, secondary and tertiary care, and long-term
care.
``(B) Preventive health, including mammography and other
cancer screening in accordance with section 207.
``(C) Dental care.
``(D) Mental health, including community mental health
services, inpatient mental health services, dormitory mental
health

[[Page S10468]]

services, therapeutic and residential treatment centers, and
training of traditional health care practitioners.
``(E) Emergency medical services.
``(F) Treatment and control of, and rehabilitative care
related to, alcoholism and drug abuse (including fetal
alcohol spectrum disorders) among Indians.
``(G) Injury prevention programs, including data collection
and evaluation, demonstration projects, training, and
capacity building.
``(H) Home health care.
``(I) Community health representatives.
``(J) Maintenance and improvement.
``(b) No Offset or Limitation.--Any funds appropriated
under the authority of this section shall not be used to
offset or limit any other appropriations made to the Service
under this Act or the Act of November 2, 1921 (25 U.S.C. 13)
(commonly known as the `Snyder Act'), or any other provision
of law.
``(c) Allocation; Use.--
``(1) In general.--Funds appropriated under the authority
of this section shall be allocated to Service Units, Indian
Tribes, or Tribal Organizations. The funds allocated to each
Indian Tribe, Tribal Organization, or Service Unit under this
paragraph shall be used by the Indian Tribe, Tribal
Organization, or Service Unit under this paragraph to improve
the health status and reduce the resource deficiency of each
Indian Tribe served by such Service Unit, Indian Tribe, or
Tribal Organization.
``(2) Apportionment of allocated funds.--The apportionment
of funds allocated to a Service Unit, Indian Tribe, or Tribal
Organization under paragraph (1) among the health service
responsibilities described in subsection (a)(5) shall be
determined by the Service in consultation with, and with the
active participation of, the affected Indian Tribes and
Tribal Organizations.
``(d) Provisions Relating to Health Status and Resource
Deficiencies.--For the purposes of this section, the
following definitions apply:
``(1) Definition.--The term `health status and resource
deficiency' means the extent to which--
``(A) the health status objectives set forth in section
3(2) are not being achieved; and
``(B) the Indian Tribe or Tribal Organization does not have
available to it the health resources it needs, taking into
account the actual cost of providing health care services
given local geographic, climatic, rural, or other
circumstances.
``(2) Available resources.--The health resources available
to an Indian Tribe or Tribal Organization include health
resources provided by the Service as well as health resources
used by the Indian Tribe or Tribal Organization, including
services and financing systems provided by any Federal
programs, private insurance, and programs of State or local
governments.
``(3) Process for review of determinations.--The Secretary
shall establish procedures which allow any Indian Tribe or
Tribal Organization to petition the Secretary for a review of
any determination of the extent of the health status and
resource deficiency of such Indian Tribe or Tribal
Organization.
``(e) Eligibility for Funds.--Tribal Health Programs shall
be eligible for funds appropriated under the authority of
this section on an equal basis with programs that are
administered directly by the Service.
``(f) Report.--By no later than the date that is 3 years
after the date of enactment of the Indian Health Care
Improvement Act Amendments of 2007, the Secretary shall
submit to Congress the current health status and resource
deficiency report of the Service for each Service Unit,
including newly recognized or acknowledged Indian Tribes.
Such report shall set out--
``(1) the methodology then in use by the Service for
determining Tribal health status and resource deficiencies,
as well as the most recent application of that methodology;
``(2) the extent of the health status and resource
deficiency of each Indian Tribe served by the Service or a
Tribal Health Program;
``(3) the amount of funds necessary to eliminate the health
status and resource deficiencies of all Indian Tribes served
by the Service or a Tribal Health Program; and
``(4) an estimate of--
``(A) the amount of health service funds appropriated under
the authority of this Act, or any other Act, including the
amount of any funds transferred to the Service for the
preceding fiscal year which is allocated to each Service
Unit, Indian Tribe, or Tribal Organization;
``(B) the number of Indians eligible for health services in
each Service Unit or Indian Tribe or Tribal Organization; and
``(C) the number of Indians using the Service resources
made available to each Service Unit, Indian Tribe or Tribal
Organization, and, to the extent available, information on
the waiting lists and number of Indians turned away for
services due to lack of resources.
``(g) Inclusion in Base Budget.--Funds appropriated under
this section for any fiscal year shall be included in the
base budget of the Service for the purpose of determining
appropriations under this section in subsequent fiscal years.
``(h) Clarification.--Nothing in this section is intended
to diminish the primary responsibility of the Service to
eliminate existing backlogs in unmet health care needs, nor
are the provisions of this section intended to discourage the
Service from undertaking additional efforts to achieve equity
among Indian Tribes and Tribal Organizations.
``(i) Funding Designation.--Any funds appropriated under
the authority of this section shall be designated as the
`Indian Health Care Improvement Fund'.

``SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND.

``(a) Establishment.--There is established an Indian
Catastrophic Health Emergency Fund (hereafter in this section
referred to as the `CHEF') consisting of--
``(1) the amounts deposited under subsection (f); and
``(2) the amounts appropriated to CHEF under this section.
``(b) Administration.--CHEF shall be administered by the
Secretary, acting through the headquarters of the Service,
solely for the purpose of meeting the extraordinary medical
costs associated with the treatment of victims of disasters
or catastrophic illnesses who are within the responsibility
of the Service.
``(c) Conditions on Use of Fund.--No part of CHEF or its
administration shall be subject to contract or grant under
any law, including the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.), nor shall
CHEF funds be allocated, apportioned, or delegated on an Area
Office, Service Unit, or other similar basis.
``(d) Regulations.--The Secretary shall promulgate
regulations consistent with the provisions of this section
to--
``(1) establish a definition of disasters and catastrophic
illnesses for which the cost of the treatment provided under
contract would qualify for payment from CHEF;
``(2) provide that a Service Unit shall not be eligible for
reimbursement for the cost of treatment from CHEF until its
cost of treating any victim of such catastrophic illness or
disaster has reached a certain threshold cost which the
Secretary shall establish at--
``(A) the 2000 level of $19,000; and
``(B) for any subsequent year, not less than the threshold
cost of the previous year increased by the percentage
increase in the medical care expenditure category of the
consumer price index for all urban consumers (United States
city average) for the 12-month period ending with December of
the previous year;
``(3) establish a procedure for the reimbursement of the
portion of the costs that exceeds such threshold cost
incurred by--
``(A) Service Units; or
``(B) whenever otherwise authorized by the Service, non-
Service facilities or providers;
``(4) establish a procedure for payment from CHEF in cases
in which the exigencies of the medical circumstances warrant
treatment prior to the authorization of such treatment by the
Service; and
``(5) establish a procedure that will ensure that no
payment shall be made from CHEF to any provider of treatment
to the extent that such provider is eligible to receive
payment for the treatment from any other Federal, State,
local, or private source of reimbursement for which the
patient is eligible.
``(e) No Offset or Limitation.--Amounts appropriated to
CHEF under this section shall not be used to offset or limit
appropriations made to the Service under the authority of the
Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the
`Snyder Act'), or any other law.
``(f) Deposit of Reimbursement Funds.--There shall be
deposited into CHEF all reimbursements to which the Service
is entitled from any Federal, State, local, or private source
(including third party insurance) by reason of treatment
rendered to any victim of a disaster or catastrophic illness
the cost of which was paid from CHEF.

``SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION SERVICES.

``(a) Findings.--Congress finds that health promotion and
disease prevention activities--
``(1) improve the health and well-being of Indians; and
``(2) reduce the expenses for health care of Indians.
``(b) Provision of Services.--The Secretary, acting through
the Service and Tribal Health Programs, shall provide health
promotion and disease prevention services to Indians to
achieve the health status objectives set forth in section
3(2).
``(c) Evaluation.--The Secretary, after obtaining input
from the affected Tribal Health Programs, shall submit to the
President for inclusion in the report which is required to be
submitted to Congress under section 801 an evaluation of--
``(1) the health promotion and disease prevention needs of
Indians;
``(2) the health promotion and disease prevention
activities which would best meet such needs;
``(3) the internal capacity of the Service and Tribal
Health Programs to meet such needs; and
``(4) the resources which would be required to enable the
Service and Tribal Health Programs to undertake the health
promotion and disease prevention activities necessary to meet
such needs.

``SEC. 204. DIABETES PREVENTION, TREATMENT, AND CONTROL.

``(a) Determinations Regarding Diabetes.--The Secretary,
acting through the Service, and in consultation with Indian
Tribes and Tribal Organizations, shall determine--
``(1) by Indian Tribe and by Service Unit, the incidence
of, and the types of complications resulting from, diabetes
among Indians; and

[[Page S10469]]

``(2) based on the determinations made pursuant to
paragraph (1), the measures (including patient education and
effective ongoing monitoring of disease indicators) each
Service Unit should take to reduce the incidence of, and
prevent, treat, and control the complications resulting from,
diabetes among Indian Tribes within that Service Unit.
``(b) Diabetes Screening.--To the extent medically
indicated and with informed consent, the Secretary shall
screen each Indian who receives services from the Service for
diabetes and for conditions which indicate a high risk that
the individual will become diabetic and establish a cost-
effective approach to ensure ongoing monitoring of disease
indicators. Such screening and monitoring may be conducted by
a Tribal Health Program and may be conducted through
appropriate Internet-based health care management programs.
``(c) Diabetes Projects.--The Secretary shall continue to
maintain each model diabetes project in existence on the date
of enactment of the Indian Health Care Improvement Act
Amendments of 2007, any such other diabetes programs operated
by the Service or Tribal Health Programs, and any additional
diabetes projects, such as the Medical Vanguard program
provided for in title IV of Public Law 108-87, as implemented
to serve Indian Tribes. Tribal Health Programs shall receive
recurring funding for the diabetes projects that they operate
pursuant to this section, both at the date of enactment of
the Indian Health Care Improvement Act Amendments of 2007 and
for projects which are added and funded thereafter.
``(d) Dialysis Programs.--The Secretary is authorized to
provide, through the Service, Indian Tribes, and Tribal
Organizations, dialysis programs, including the purchase of
dialysis equipment and the provision of necessary staffing.
``(e) Other Duties of the Secretary.--
``(1) In general.--The Secretary shall, to the extent
funding is available--
``(A) in each Area Office, consult with Indian Tribes and
Tribal Organizations regarding programs for the prevention,
treatment, and control of diabetes;
``(B) establish in each Area Office a registry of patients
with diabetes to track the incidence of diabetes and the
complications from diabetes in that area; and
``(C) ensure that data collected in each Area Office
regarding diabetes and related complications among Indians
are disseminated to all other Area Offices, subject to
applicable patient privacy laws.
``(2) Diabetes control officers.--
``(A) In general.--The Secretary may establish and maintain
in each Area Office a position of diabetes control officer to
coordinate and manage any activity of that Area Office
relating to the prevention, treatment, or control of diabetes
to assist the Secretary in carrying out a program under this
section or section 330C of the Public Health Service Act (42
U.S.C. 254c-3).
``(B) Certain activities.--Any activity carried out by a
diabetes control officer under subparagraph (A) that is the
subject of a contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.), and any funds made available to carry out such an
activity, shall not be divisible for purposes of that Act.

``SEC. 205. SHARED SERVICES FOR LONG-TERM CARE.

``(a) Long-Term Care.--Notwithstanding any other provision
of law, the Secretary, acting through the Service, is
authorized to provide directly, or enter into contracts or
compacts under the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.) with Indian Tribes or
Tribal Organizations for, the delivery of long-term care
(including health care services associated with long-term
care) provided in a facility to Indians. Such agreements
shall provide for the sharing of staff or other services
between the Service or a Tribal Health Program and a long-
term care or related facility owned and operated (directly or
through a contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.)) by such Indian Tribe or Tribal Organization.
``(b) Contents of Agreements.--An agreement entered into
pursuant to subsection (a)--
``(1) may, at the request of the Indian Tribe or Tribal
Organization, delegate to such Indian Tribe or Tribal
Organization such powers of supervision and control over
Service employees as the Secretary deems necessary to carry
out the purposes of this section;
``(2) shall provide that expenses (including salaries)
relating to services that are shared between the Service and
the Tribal Health Program be allocated proportionately
between the Service and the Indian Tribe or Tribal
Organization; and
``(3) may authorize such Indian Tribe or Tribal
Organization to construct, renovate, or expand a long-term
care or other similar facility (including the construction of
a facility attached to a Service facility).
``(c) Minimum Requirement.--Any nursing facility provided
for under this section shall meet the requirements for
nursing facilities under section 1919 of the Social Security
Act.
``(d) Other Assistance.--The Secretary shall provide such
technical and other assistance as may be necessary to enable
applicants to comply with the provisions of this section.
``(e) Use of Existing or Underused Facilities.--The
Secretary shall encourage the use of existing facilities that
are underused or allow the use of swing beds for long-term or
similar care.

``SEC. 206. HEALTH SERVICES RESEARCH.

``(a) In General.--The Secretary, acting through the
Service, shall make funding available for research to further
the performance of the health service responsibilities of
Indian Health Programs.
``(b) Coordination of Resources and Activities.--The
Secretary shall also, to the maximum extent practicable,
coordinate departmental research resources and activities to
address relevant Indian Health Program research needs.
``(c) Availability.--Tribal Health Programs shall be given
an equal opportunity to compete for, and receive, research
funds under this section.
``(d) Use of Funds.--This funding may be used for both
clinical and nonclinical research.
``(e) Evaluation and Dissemination.--The Secretary shall
periodically--
``(1) evaluate the impact of research conducted under this
section; and
``(2) disseminate to Tribal Health Programs information
regarding that research as the Secretary determines to be
appropriate.

``SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREENING.

``The Secretary, acting through the Service or Tribal
Health Programs, shall provide for screening as follows:
``(1) Screening mammography (as defined in section 1861(jj)
of the Social Security Act) for Indian women at a frequency
appropriate to such women under accepted and appropriate
national standards, and under such terms and conditions as
are consistent with standards established by the Secretary to
ensure the safety and accuracy of screening mammography under
part B of title XVIII of such Act.
``(2) Other cancer screening that receives an A or B rating
as recommended by the United States Preventive Services Task
Force established under section 915(a)(1) of the Public
Health Service Act (42 U.S.C. 299b-4(a)(1)). The Secretary
shall ensure that screening provided for under this paragraph
complies with the recommendations of the Task Force with
respect to--
``(A) frequency;
``(B) the population to be served;
``(C) the procedure or technology to be used;
``(D) evidence of effectiveness; and
``(E) other matters that the Secretary determines
appropriate.

``SEC. 208. PATIENT TRAVEL COSTS.

``(a) Definition of Qualified Escort.--In this section, the
term `qualified escort' means--
``(1) an adult escort (including a parent, guardian, or
other family member) who is required because of the physical
or mental condition, or age, of the applicable patient;
``(2) a health professional for the purpose of providing
necessary medical care during travel by the applicable
patient; or
``(3) other escorts, as the Secretary or applicable Indian
Health Program determines to be appropriate.
``(b) Provision of Funds.--The Secretary, acting through
the Service and Tribal Health Programs, is authorized to
provide funds for the following patient travel costs,
including qualified escorts, associated with receiving health
care services provided (either through direct or contract
care or through a contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.)) under this Act--
``(1) emergency air transportation and non-emergency air
transportation where ground transportation is infeasible;
``(2) transportation by private vehicle (where no other
means of transportation is available), specially equipped
vehicle, and ambulance; and
``(3) transportation by such other means as may be
available and required when air or motor vehicle
transportation is not available.

``SEC. 209. EPIDEMIOLOGY CENTERS.

``(a) Establishment of Centers.--The Secretary shall
establish an epidemiology center in each Service Area to
carry out the functions described in subsection (b). Any new
center established after the date of enactment of the Indian
Health Care Improvement Act Amendments of 2007 may be
operated under a grant authorized by subsection (d), but
funding under such a grant shall not be divisible.
``(b) Functions of Centers.--In consultation with and upon
the request of Indian Tribes, Tribal Organizations, and Urban
Indian communities, each Service Area epidemiology center
established under this section shall, with respect to such
Service Area--
``(1) collect data relating to, and monitor progress made
toward meeting, each of the health status objectives of the
Service, the Indian Tribes, Tribal Organizations, and Urban
Indian communities in the Service Area;
``(2) evaluate existing delivery systems, data systems, and
other systems that impact the improvement of Indian health;
``(3) assist Indian Tribes, Tribal Organizations, and Urban
Indian Organizations in identifying their highest priority
health status objectives and the services needed to achieve
such objectives, based on epidemiological data;
``(4) make recommendations for the targeting of services
needed by the populations served;

[[Page S10470]]

``(5) make recommendations to improve health care delivery
systems for Indians and Urban Indians;
``(6) provide requested technical assistance to Indian
Tribes, Tribal Organizations, and Urban Indian Organizations
in the development of local health service priorities and
incidence and prevalence rates of disease and other illness
in the community; and
``(7) provide disease surveillance and assist Indian
Tribes, Tribal Organizations, and Urban Indian communities to
promote public health.
``(c) Technical Assistance.--The Director of the Centers
for Disease Control and Prevention shall provide technical
assistance to the centers in carrying out the requirements of
this section.
``(d) Grants for Studies.--
``(1) In general.--The Secretary may make grants to Indian
Tribes, Tribal Organizations, Indian organizations, and
eligible intertribal consortia to conduct epidemiological
studies of Indian communities.
``(2) Eligible intertribal consortia.--An intertribal
consortium or Indian organization is eligible to receive a
grant under this subsection if--
``(A) the intertribal consortium is incorporated for the
primary purpose of improving Indian health; and
``(B) the intertribal consortium is representative of the
Indian Tribes or urban Indian communities in which the
intertribal consortium is located.
``(3) Applications.--An application for a grant under this
subsection shall be submitted in such manner and at such time
as the Secretary shall prescribe.
``(4) Requirements.--An applicant for a grant under this
subsection shall--
``(A) demonstrate the technical, administrative, and
financial expertise necessary to carry out the functions
described in paragraph (5);
``(B) consult and cooperate with providers of related
health and social services in order to avoid duplication of
existing services; and
``(C) demonstrate cooperation from Indian Tribes or Urban
Indian Organizations in the area to be served.
``(5) Use of funds.--A grant awarded under paragraph (1)
may be used--
``(A) to carry out the functions described in subsection
(b);
``(B) to provide information to and consult with tribal
leaders, urban Indian community leaders, and related health
staff on health care and health service management issues;
and
``(C) in collaboration with Indian Tribes, Tribal
Organizations, and urban Indian communities, to provide the
Service with information regarding ways to improve the health
status of Indians.
``(e) Access to Information.--An epidemiology center
operated by a grantee pursuant to a grant awarded under
subsection (d) shall be treated as a public health authority
for purposes of the Health Insurance Portability and
Accountability Act of 1996 (Public Law 104-191; 110 Stat.
2033), as such entities are defined in part 164.501 of title
45, Code of Federal Regulations (or a successor regulation).
The Secretary shall grant such grantees access to and use of
data, data sets, monitoring systems, delivery systems, and
other protected health information in the possession of the
Secretary.

``SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION PROGRAMS.

``(a) Funding for Development of Programs.--In addition to
carrying out any other program for health promotion or
disease prevention, the Secretary, acting through the
Service, is authorized to award grants to Indian Tribes and
Tribal Organizations to develop comprehensive school health
education programs for children from pre-school through grade
12 in schools for the benefit of Indian and Urban Indian
children.
``(b) Use of Grant Funds.--A grant awarded under this
section may be used for purposes which may include, but are
not limited to, the following:
``(1) Developing health education materials both for
regular school programs and afterschool programs.
``(2) Training teachers in comprehensive school health
education materials.
``(3) Integrating school-based, community-based, and other
public and private health promotion efforts.
``(4) Encouraging healthy, tobacco-free school
environments.
``(5) Coordinating school-based health programs with
existing services and programs available in the community.
``(6) Developing school programs on nutrition education,
personal health, oral health, and fitness.
``(7) Developing behavioral health wellness programs.
``(8) Developing chronic disease prevention programs.
``(9) Developing substance abuse prevention programs.
``(10) Developing injury prevention and safety education
programs.
``(11) Developing activities for the prevention and control
of communicable diseases.
``(12) Developing community and environmental health
education programs that include traditional health care
practitioners.
``(13) Violence prevention.
``(14) Such other health issues as are appropriate.
``(c) Technical Assistance.--Upon request, the Secretary,
acting through the Service, shall provide technical
assistance to Indian Tribes and Tribal Organizations in the
development of comprehensive health education plans and the
dissemination of comprehensive health education materials and
information on existing health programs and resources.
``(d) Criteria for Review and Approval of Applications.--
The Secretary, acting through the Service, and in
consultation with Indian Tribes and Tribal Organizations,
shall establish criteria for the review and approval of
applications for grants awarded under this section.
``(e) Development of Program for BIA-Funded Schools.--
``(1) In general.--The Secretary of the Interior, acting
through the Bureau of Indian Affairs and in cooperation with
the Secretary, acting through the Service, and affected
Indian Tribes and Tribal Organizations, shall develop a
comprehensive school health education program for children
from preschool through grade 12 in schools for which support
is provided by the Bureau of Indian Affairs.
``(2) Requirements for programs.--Such programs shall
include--
``(A) school programs on nutrition education, personal
health, oral health, and fitness;
``(B) behavioral health wellness programs;
``(C) chronic disease prevention programs;
``(D) substance abuse prevention programs;
``(E) injury prevention and safety education programs; and
``(F) activities for the prevention and control of
communicable diseases.
``(3) Duties of the secretary.--The Secretary of the
Interior shall--
``(A) provide training to teachers in comprehensive school
health education materials;
``(B) ensure the integration and coordination of school-
based programs with existing services and health programs
available in the community; and
``(C) encourage healthy, tobacco-free school environments.

``SEC. 211. INDIAN YOUTH PROGRAM.

``(a) Program Authorized.--The Secretary, acting through
the Service, is authorized to establish and administer a
program to provide grants to Indian Tribes, Tribal
Organizations, and Urban Indian Organizations for innovative
mental and physical disease prevention and health promotion
and treatment programs for Indian preadolescent and
adolescent youths.
``(b) Use of Funds.--
``(1) Allowable uses.--Funds made available under this
section may be used to--
``(A) develop prevention and treatment programs for Indian
youth which promote mental and physical health and
incorporate cultural values, community and family
involvement, and traditional health care practitioners; and
``(B) develop and provide community training and education.
``(2) Prohibited use.--Funds made available under this
section may not be used to provide services described in
section 707(c).
``(c) Duties of the Secretary.--The Secretary shall--
``(1) disseminate to Indian Tribes and Tribal Organizations
information regarding models for the delivery of
comprehensive health care services to Indian and Urban Indian
adolescents;
``(2) encourage the implementation of such models; and
``(3) at the request of an Indian Tribe or Tribal
Organization, provide technical assistance in the
implementation of such models.
``(d) Criteria for Review and Approval of Applications.--
The Secretary, in consultation with Indian Tribes and Tribal
Organizations, and in conference with Urban Indian
Organizations, shall establish criteria for the review and
approval of applications or proposals under this section.

``SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF
COMMUNICABLE AND INFECTIOUS DISEASES.

``(a) Grants Authorized.--The Secretary, acting through the
Service, and after consultation with the Centers for Disease
Control and Prevention, may make grants available to Indian
Tribes and Tribal Organizations for the following:
``(1) Projects for the prevention, control, and elimination
of communicable and infectious diseases, including
tuberculosis, hepatitis, HIV, respiratory syncytial virus,
hanta virus, sexually transmitted diseases, and H. Pylori.
``(2) Public information and education programs for the
prevention, control, and elimination of communicable and
infectious diseases.
``(3) Education, training, and clinical skills improvement
activities in the prevention, control, and elimination of
communicable and infectious diseases for health
professionals, including allied health professionals.
``(4) Demonstration projects for the screening, treatment,
and prevention of hepatitis C virus (HCV).
``(b) Application Required.--The Secretary may provide
funding under subsection (a) only if an application or
proposal for funding is submitted to the Secretary.
``(c) Coordination With Health Agencies.--Indian Tribes and
Tribal Organizations receiving funding under this section are
encouraged to coordinate their activities with the Centers
for Disease Control and Prevention and State and local health
agencies.
``(d) Technical Assistance; Report.--In carrying out this
section, the Secretary--

[[Page S10471]]

``(1) may, at the request of an Indian Tribe or Tribal
Organization, provide technical assistance; and
``(2) shall prepare and submit a report to Congress
biennially on the use of funds under this section and on the
progress made toward the prevention, control, and elimination
of communicable and infectious diseases among Indians and
Urban Indians.

``SEC. 213. OTHER AUTHORITY FOR PROVISION OF SERVICES.

``(a) Funding Authorized.--The Secretary, acting through
the Service, Indian Tribes, and Tribal Organizations, may
provide funding under this Act to meet the objectives set
forth in section 3 of this Act through health care-related
services and programs not otherwise described in this Act,
including--
``(1) hospice care;
``(2) assisted living;
``(3) long-term care; and
``(4) home- and community-based services.
``(b) Terms and Conditions.--
``(1) In general.--Any service provided under this section
shall be in accordance with such terms and conditions as are
consistent with accepted and appropriate standards relating
to the service, including any licensing term or condition
under this Act.
``(2) Standards.--
``(A) State standards.--Any service authorized under this
section provided by the Service, an Indian Tribe, or a Tribal
Organization shall be in accordance with the standards for
such service established by the State in which such service
is or will be provided.
``(B) Secretarial standards.--In the absence of State
standards for provision of a service authorized under this
section as described in paragraph (1), the Secretary may, by
regulation, establish standards for the provision of such
service.
``(C) Tribal standards.--In the absence of State standards
as described in subparagraph (A) and Secretarial standards as
described in subparagraph (B) for provision of a service
authorized under this section, an Indian Tribe or Tribal
Organization, pursuant to the fourth sentence of section
102(a)(2) of the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450f(a)(2)), shall propose
standards under which the Indian Tribe or Tribal Organization
will provide such service, which shall be the standards
applicable to such service on approval of the agreement of
the Indian Tribe or Tribal Organization pursuant to that Act
(25 U.S.C. 450 et seq.).
``(D) Verification.--If a service authorized under this
section is provided by an Indian Tribe or Tribal Organization
pursuant to the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.), the verification by
the Secretary that the service meets the State standards
described in subparagraph (A) shall be considered to meet the
terms and conditions required under this subsection.
``(3) Eligibility.--The following individuals shall be
eligible to receive long-term care under this section:
``(A) Individuals who are unable to perform a certain
number of activities of daily living without assistance.
``(B) Individuals with a mental impairment, such as
dementia, Alzheimer's disease, or another disabling mental
illness, who may be able to perform activities of daily
living under supervision.
``(C) Such other individuals as an applicable Indian Health
Program determines to be appropriate.
``(c) Definitions.--For the purposes of this section, the
following definitions shall apply:
``(1) The term `home- and community-based services' means 1
or more of the services specified in paragraphs (1) through
(9) of section 1929(a) of the Social Security Act (42 U.S.C.
1396t(a)) (whether provided by the Service or by an Indian
Tribe or Tribal Organization pursuant to the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.)) that are or will be provided in accordance with the
standards described in subsection (b).
``(2) The term `hospice care' means the items and services
specified in subparagraphs (A) through (H) of section
1861(dd)(1) of the Social Security Act (42 U.S.C.
1395x(dd)(1)), and such other services which an Indian Tribe
or Tribal Organization determines are necessary and
appropriate to provide in furtherance of this care.
``(d) Authorization of Convenient Care Services.--The
Secretary, acting through the Service, Indian Tribes, and
Tribal Organizations, may also provide funding under this Act
to meet the objectives set forth in section 3 of this Act for
convenient care services programs pursuant to section
306(c)(2)(A).

``SEC. 214. INDIAN WOMEN'S HEALTH CARE.

``The Secretary, acting through the Service and Indian
Tribes, Tribal Organizations, and Urban Indian Organizations,
shall monitor and improve the quality of health care for
Indian women of all ages through the planning and delivery of
programs administered by the Service, in order to improve and
enhance the treatment models of care for Indian women.

``SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZARDS.

``(a) Studies and Monitoring.--The Secretary and the
Service shall conduct, in conjunction with other appropriate
Federal agencies and in consultation with concerned Indian
Tribes and Tribal Organizations, studies and ongoing
monitoring programs to determine trends in the health hazards
to Indian miners and to Indians on or near reservations and
Indian communities as a result of environmental hazards which
may result in chronic or life threatening health problems,
such as nuclear resource development, petroleum
contamination, and contamination of water sources and of the
food chain. Such studies shall include--
``(1) an evaluation of the nature and extent of health
problems caused by environmental hazards currently exhibited
among Indians and the causes of such health problems;
``(2) an analysis of the potential effect of ongoing and
future environmental resource development on or near
reservations and Indian communities, including the cumulative
effect over time on health;
``(3) an evaluation of the types and nature of activities,
practices, and conditions causing or affecting such health
problems, including uranium mining and milling, uranium mine
tailing deposits, nuclear power plant operation and
construction, and nuclear waste disposal; oil and gas
production or transportation on or near reservations or
Indian communities; and other development that could affect
the health of Indians and their water supply and food chain;
``(4) a summary of any findings and recommendations
provided in Federal and State studies, reports,
investigations, and inspections during the 5 years prior to
the date of enactment of the Indian Health Care Improvement
Act Amendments of 2007 that directly or indirectly relate to
the activities, practices, and conditions affecting the
health or safety of such Indians; and
``(5) the efforts that have been made by Federal and State
agencies and resource and economic development companies to
effectively carry out an education program for such Indians
regarding the health and safety hazards of such development.
``(b) Health Care Plans.--Upon completion of such studies,
the Secretary and the Service shall take into account the
results of such studies and develop health care plans to
address the health problems studied under subsection (a). The
plans shall include--
``(1) methods for diagnosing and treating Indians currently
exhibiting such health problems;
``(2) preventive care and testing for Indians who may be
exposed to such health hazards, including the monitoring of
the health of individuals who have or may have been exposed
to excessive amounts of radiation or affected by other
activities that have had or could have a serious impact upon
the health of such individuals; and
``(3) a program of education for Indians who, by reason of
their work or geographic proximity to such nuclear or other
development activities, may experience health problems.
``(c) Submission of Report and Plan to Congress.--The
Secretary and the Service shall submit to Congress the study
prepared under subsection (a) no later than 18 months after
the date of enactment of the Indian Health Care Improvement
Act Amendments of 2007. The health care plan prepared under
subsection (b) shall be submitted in a report no later than 1
year after the study prepared under subsection (a) is
submitted to Congress. Such report shall include recommended
activities for the implementation of the plan, as well as an
evaluation of any activities previously undertaken by the
Service to address such health problems.
``(d) Intergovernmental Task Force.--
``(1) Establishment; members.--There is established an
Intergovernmental Task Force to be composed of the following
individuals (or their designees):
``(A) The Secretary of Energy.
``(B) The Secretary of the Environmental Protection Agency.
``(C) The Director of the Bureau of Mines.
``(D) The Assistant Secretary for Occupational Safety and
Health.
``(E) The Secretary of the Interior.
``(F) The Secretary of Health and Human Services.
``(G) The Assistant Secretary.
``(2) Duties.--The Task Force shall--
``(A) identify existing and potential operations related to
nuclear resource development or other environmental hazards
that affect or may affect the health of Indians on or near a
reservation or in an Indian community; and
``(B) enter into activities to correct existing health
hazards and ensure that current and future health problems
resulting from nuclear resource or other development
activities are minimized or reduced.
``(3) Chairman; meetings.--The Secretary of Health and
Human Services shall be the Chairman of the Task Force. The
Task Force shall meet at least twice each year.
``(e) Health Services to Certain Employees.--In the case of
any Indian who--
``(1) as a result of employment in or near a uranium mine
or mill or near any other environmental hazard, suffers from
a work-related illness or condition;
``(2) is eligible to receive diagnosis and treatment
services from an Indian Health Program; and
``(3) by reason of such Indian's employment, is entitled to
medical care at the expense of such mine or mill operator or
entity responsible for the environmental hazard, the Indian
Health Program shall, at the request of such Indian, render
appropriate medical care to such Indian for such illness or
condition and may be reimbursed for any medical care so
rendered to which such Indian is entitled at the expense of
such operator or entity from such operator or entity. Nothing
in this subsection shall affect the rights of such Indian to
recover damages

[[Page S10472]]

other than such amounts paid to the Indian Health Program
from the employer for providing medical care for such illness
or condition.

``SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DELIVERY
AREA.

``(a) In General.--For fiscal years beginning with the
fiscal year ending September 30, 1983, and ending with the
fiscal year ending September 30, 2016, the State of Arizona
shall be designated as a contract health service delivery
area by the Service for the purpose of providing contract
health care services to members of federally recognized
Indian Tribes of Arizona.
``(b) Maintenance of Services.--The Service shall not
curtail any health care services provided to Indians residing
on reservations in the State of Arizona if such curtailment
is due to the provision of contract services in such State
pursuant to the designation of such State as a contract
health service delivery area pursuant to subsection (a).

``SEC. 216A. NORTH DAKOTA AND SOUTH DAKOTA AS A CONTRACT
HEALTH SERVICE DELIVERY AREA.

``(a) In General.--Beginning in fiscal year 2003, the
States of North Dakota and South Dakota shall be designated
as a contract health service delivery area by the Service for
the purpose of providing contract health care services to
members of federally recognized Indian Tribes of North Dakota
and South Dakota.
``(b) Limitation.--The Service shall not curtail any health
care services provided to Indians residing on any
reservation, or in any county that has a common boundary with
any reservation, in the State of North Dakota or South Dakota
if such curtailment is due to the provision of contract
services in such States pursuant to the designation of such
States as a contract health service delivery area pursuant to
subsection (a).

``SEC. 217. CALIFORNIA CONTRACT HEALTH SERVICES PROGRAM.

``(a) Funding Authorized.--The Secretary is authorized to
fund a program using the California Rural Indian Health Board
(hereafter in this section referred to as the `CRIHB') as a
contract care intermediary to improve the accessibility of
health services to California Indians.
``(b) Reimbursement Contract.--The Secretary shall enter
into an agreement with the CRIHB to reimburse the CRIHB for
costs (including reasonable administrative costs) incurred
pursuant to this section, in providing medical treatment
under contract to California Indians described in section
806(a) throughout the California contract health services
delivery area described in section 218 with respect to high
cost contract care cases.
``(c) Administrative Expenses.--Not more than 5 percent of
the amounts provided to the CRIHB under this section for any
fiscal year may be for reimbursement for administrative
expenses incurred by the CRIHB during such fiscal year.
``(d) Limitation on Payment.--No payment may be made for
treatment provided hereunder to the extent payment may be
made for such treatment under the Indian Catastrophic Health
Emergency Fund described in section 202 or from amounts
appropriated or otherwise made available to the California
contract health service delivery area for a fiscal year.
``(e) Advisory Board.--There is established an advisory
board which shall advise the CRIHB in carrying out this
section. The advisory board shall be composed of
representatives, selected by the CRIHB, from not less than 8
Tribal Health Programs serving California Indians covered
under this section at least \1/2\ of whom of whom are not
affiliated with the CRIHB.

``SEC. 218. CALIFORNIA AS A CONTRACT HEALTH SERVICE DELIVERY
AREA.

``The State of California, excluding the counties of
Alameda, Contra Costa, Los Angeles, Marin, Orange,
Sacramento, San Francisco, San Mateo, Santa Clara, Kern,
Merced, Monterey, Napa, San Benito, San Joaquin, San Luis
Obispo, Santa Cruz, Solano, Stanislaus, and Ventura, shall be
designated as a contract health service delivery area by the
Service for the purpose of providing contract health services
to California Indians. However, any of the counties listed
herein may only be included in the contract health services
delivery area if funding is specifically provided by the
Service for such services in those counties.

``SEC. 219. CONTRACT HEALTH SERVICES FOR THE TRENTON SERVICE
AREA.

``(a) Authorization for Services.--The Secretary, acting
through the Service, is directed to provide contract health
services to members of the Turtle Mountain Band of Chippewa
Indians that reside in the Trenton Service Area of Divide,
McKenzie, and Williams counties in the State of North Dakota
and the adjoining counties of Richland, Roosevelt, and
Sheridan in the State of Montana.
``(b) No Expansion of Eligibility.--Nothing in this section
may be construed as expanding the eligibility of members of
the Turtle Mountain Band of Chippewa Indians for health
services provided by the Service beyond the scope of
eligibility for such health services that applied on May 1,
1986.

``SEC. 220. PROGRAMS OPERATED BY INDIAN TRIBES AND TRIBAL
ORGANIZATIONS.

``The Service shall provide funds for health care programs
and facilities operated by Tribal Health Programs on the same
basis as such funds are provided to programs and facilities
operated directly by the Service.

``SEC. 221. LICENSING.

``Health care professionals employed by a Tribal Health
Program shall, if licensed in any State, be exempt from the
licensing requirements of the State in which the Tribal
Health Program performs the services described in its
contract or compact under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.).

``SEC. 222. NOTIFICATION OF PROVISION OF EMERGENCY CONTRACT
HEALTH SERVICES.

``With respect to an elderly Indian or an Indian with a
disability receiving emergency medical care or services from
a non-Service provider or in a non-Service facility under the
authority of this Act, the time limitation (as a condition of
payment) for notifying the Service of such treatment or
admission shall be 30 days.

``SEC. 223. PROMPT ACTION ON PAYMENT OF CLAIMS.

``(a) Deadline for Response.--The Service shall respond to
a notification of a claim by a provider of a contract care
service with either an individual purchase order or a denial
of the claim within 5 working days after the receipt of such
notification.
``(b) Effect of Untimely Response.--If the Service fails to
respond to a notification of a claim in accordance with
subsection (a), the Service shall accept as valid the claim
submitted by the provider of a contract care service.
``(c) Deadline for Payment of Valid Claim.--The Service
shall pay a valid contract care service claim within 30 days
after the completion of the claim.

``SEC. 224. LIABILITY FOR PAYMENT.

``(a) No Patient Liability.--A patient who receives
contract health care services that are authorized by the
Service shall not be liable for the payment of any charges or
costs associated with the provision of such services.
``(b) Notification.--The Secretary shall notify a contract
care provider and any patient who receives contract health
care services authorized by the Service that such patient is
not liable for the payment of any charges or costs associated
with the provision of such services not later than 5 business
days after receipt of a notification of a claim by a provider
of contract care services.
``(c) No Recourse.--Following receipt of the notice
provided under subsection (b), or, if a claim has been deemed
accepted under section 223(b), the provider shall have no
further recourse against the patient who received the
services.

``SEC. 225. OFFICE OF INDIAN MEN'S HEALTH.

``(a) Establishment.--The Secretary may establish within
the Service an office to be known as the `Office of Indian
Men's Health' (referred to in this section as the `Office').
``(b) Director.--
``(1) In general.--The Office shall be headed by a
director, to be appointed by the Secretary.
``(2) Duties.--The director shall coordinate and promote
the status of the health of Indian men in the United States.
``(c) Report.--Not later than 2 years after the date of
enactment of the Indian Health Care Improvement Act
Amendments of 2007, the Secretary, acting through the
director of the Office, shall submit to Congress a report
describing--
``(1) any activity carried out by the director as of the
date on which the report is prepared; and
``(2) any finding of the director with respect to the
health of Indian men.

``SEC. 226. AUTHORIZATION OF APPROPRIATIONS.

``There are authorized to be appropriated such sums as may
be necessary for each fiscal year through fiscal year 2017 to
carry out this title.

``TITLE III--FACILITIES

``SEC. 301. CONSULTATION; CONSTRUCTION AND RENOVATION OF
FACILITIES; REPORTS.

``(a) Prerequisites for Expenditure of Funds.--Prior to the
expenditure of, or the making of any binding commitment to
expend, any funds appropriated for the planning, design,
construction, or renovation of facilities pursuant to the Act
of November 2, 1921 (25 U.S.C. 13) (commonly known as the
`Snyder Act'), the Secretary, acting through the Service,
shall--
``(1) consult with any Indian Tribe that would be
significantly affected by such expenditure for the purpose of
determining and, whenever practicable, honoring tribal
preferences concerning size, location, type, and other
characteristics of any facility on which such expenditure is
to be made; and
``(2) ensure, whenever practicable and applicable, that
such facility meets the construction standards of any
accrediting body recognized by the Secretary for the purposes
of the Medicare, Medicaid, and SCHIP programs under titles
XVIII, XIX, and XXI of the Social Security Act by not later
than 1 year after the date on which the construction or
renovation of such facility is completed.
``(b) Closures.--
``(1) Evaluation required.--Notwithstanding any other
provision of law, no facility operated by the Service, or any
portion of such facility, may be closed if the Secretary has
not submitted to Congress not less than 1 year, and not more
than 2 years, before the date of the proposed closure an
evaluation, completed not more than 2 years before the
submission, of the impact of the proposed closure that
specifies, in addition to other considerations--

[[Page S10473]]

``(A) the accessibility of alternative health care
resources for the population served by such facility;
``(B) the cost-effectiveness of such closure;
``(C) the quality of health care to be provided to the
population served by such facility after such closure;
``(D) the availability of contract health care funds to
maintain existing levels of service;
``(E) the views of the Indian Tribes served by such
facility concerning such closure;
``(F) the level of use of such facility by all eligible
Indians; and
``(G) the distance between such facility and the nearest
operating Service hospital.
``(2) Exception for certain temporary closures.--Paragraph
(1) shall not apply to any temporary closure of a facility or
any portion of a facility if such closure is necessary for
medical, environmental, or construction safety reasons.
``(c) Health Care Facility Priority System.--
``(1) In general.--
``(A) Priority system.--The Secretary, acting through the
Service, shall maintain a health care facility priority
system, which--
``(i) shall be developed in consultation with Indian Tribes
and Tribal Organizations;
``(ii) shall give Indian Tribes' needs the highest
priority;
``(iii)(I) may include the lists required in paragraph
(2)(B)(ii); and
``(II) shall include the methodology required in paragraph
(2)(B)(v); and
``(III) may include such other facilities, and such
renovation or expansion needs of any health care facility, as
the Service, Indian Tribes, and Tribal Organizations may
identify; and
``(iv) shall provide an opportunity for the nomination of
planning, design, and construction projects by the Service,
Indian Tribes, and Tribal Organizations for consideration
under the priority system at least once every 3 years, or
more frequently as the Secretary determines to be
appropriate.
``(B) Needs of facilities under isdeaa agreements.--The
Secretary shall ensure that the planning, design,
construction, renovation, and expansion needs of Service and
non-Service facilities operated under contracts or compacts
in accordance with the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.) are fully
and equitably integrated into the health care facility
priority system.
``(C) Criteria for evaluating needs.--For purposes of this
subsection, the Secretary, in evaluating the needs of
facilities operated under a contract or compact under the
Indian Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq.), shall use the criteria used by the
Secretary in evaluating the needs of facilities operated
directly by the Service.
``(D) Priority of certain projects protected.--The priority
of any project established under the construction priority
system in effect on the date of enactment of the Indian
Health Care Improvement Act Amendments of 2007 shall not be
affected by any change in the construction priority system
taking place after that date if the project--
``(i) was identified in the fiscal year 2008 Service budget
justification as--

``(I) 1 of the 10 top-priority inpatient projects;
``(II) 1 of the 10 top-priority outpatient projects;
``(III) 1 of the 10 top-priority staff quarters
developments; or
``(IV) 1 of the 10 top-priority Youth Regional Treatment
Centers;

``(ii) had completed both Phase I and Phase II of the
construction priority system in effect on the date of
enactment of such Act; or
``(iii) is not included in clause (i) or (ii) and is
selected, as determined by the Secretary--

``(I) on the initiative of the Secretary; or
``(II) pursuant to a request of an Indian Tribe or Tribal
Organization.

``(2) Report; contents.--
``(A) Initial comprehensive report.--
``(i) Definitions.--In this subparagraph:

``(I) Facilities appropriation advisory board.--The term
`Facilities Appropriation Advisory Board' means the advisory
board, comprised of 12 members representing Indian tribes and
2 members representing the Service, established at the
discretion of the Assistant Secretary--

``(aa) to provide advice and recommendations for policies
and procedures of the programs funded pursuant to facilities
appropriations; and
``(bb) to address other facilities issues.

``(II) Facilities needs assessment workgroup.--The term
`Facilities Needs Assessment Workgroup' means the workgroup
established at the discretion of the Assistant Secretary--

``(aa) to review the health care facilities construction
priority system; and
``(bb) to make recommendations to the Facilities
Appropriation Advisory Board for revising the priority
system.
``(ii) Initial report.--

``(I) In general.--Not later than 1 year after the date of
enactment of the Indian Health Care Improvement Act
Amendments of 2007, the Secretary shall submit to the
Committee on Indian Affairs of the Senate and the Committee
on Natural Resources of the House of Representatives a report
that describes the comprehensive, national, ranked list of
all health care facilities needs for the Service, Indian
Tribes, and Tribal Organizations (including inpatient health
care facilities, outpatient health care facilities,
specialized health care facilities (such as for long-term
care and alcohol and drug abuse treatment), wellness centers,
staff quarters and hostels associated with health care
facilities, and the renovation and expansion needs, if any,
of such facilities) developed by the Service, Indian Tribes,
and Tribal Organizations for the Facilities Needs Assessment
Workgroup and the Facilities Appropriation Advisory Board.
``(II) Inclusions.--The initial report shall include--

``(aa) the methodology and criteria used by the Service in
determining the needs and establishing the ranking of the
facilities needs; and
``(bb) such other information as the Secretary determines
to be appropriate.
``(iii) Updates of report.--Beginning in calendar year
2011, the Secretary shall--

``(I) update the report under clause (ii) not less
frequently that once every 5 years; and
``(II) include the updated report in the appropriate annual
report under subparagraph (B) for submission to Congress
under section 801.

``(B) Annual reports.--The Secretary shall submit to the
President, for inclusion in the report required to be
transmitted to Congress under section 801, a report which
sets forth the following:
``(i) A description of the health care facility priority
system of the Service established under paragraph (1).
``(ii) Health care facilities lists, which may include--

``(I) the 10 top-priority inpatient health care facilities;
``(II) the 10 top-priority outpatient health care
facilities;
``(III) the 10 top-priority specialized health care
facilities (such as long-term care and alcohol and drug abuse
treatment);
``(IV) the 10 top-priority staff quarters developments
associated with health care facilities; and
``(V) the 10 top-priority hostels associated with health
care facilities.

``(iii) The justification for such order of priority.
``(iv) The projected cost of such projects.
``(v) The methodology adopted by the Service in
establishing priorities under its health care facility
priority system.
``(3) Requirements for preparation of reports.--In
preparing the report required under paragraph (2), the
Secretary shall--
``(A) consult with and obtain information on all health
care facilities needs from Indian Tribes and Tribal
Organizations; and
``(B) review the total unmet needs of all Indian Tribes and
Tribal Organizations for health care facilities (including
hostels and staff quarters), including needs for renovation
and expansion of existing facilities.
``(d) Review of Methodology Used for Health Facilities
Construction Priority System.--
``(1) In general.--Not later than 1 year after the
establishment of the priority system under subsection
(c)(1)(A), the Comptroller General of the United States shall
prepare and finalize a report reviewing the methodologies
applied, and the processes followed, by the Service in making
each assessment of needs for the list under subsection
(c)(2)(A)(ii) and developing the priority system under
subsection (c)(1), including a review of--
``(A) the recommendations of the Facilities Appropriation
Advisory Board and the Facilities Needs Assessment Workgroup
(as those terms are defined in subsection (c)(2)(A)(i)); and
``(B) the relevant criteria used in ranking or prioritizing
facilities other than hospitals or clinics.
``(2) Submission to congress.--The Comptroller General of
the United States shall submit the report under paragraph (1)
to--
``(A) the Committees on Indian Affairs and Appropriations
of the Senate;
``(B) the Committees on Natural Resources and
Appropriations of the House of Representatives; and
``(C) the Secretary.
``(e) Funding Condition.--All funds appropriated under the
Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the
`Snyder Act'), for the planning, design, construction, or
renovation of health facilities for the benefit of 1 or more
Indian Tribes shall be subject to the provisions of the
Indian Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq.).
``(f) Development of Innovative Approaches.--The Secretary
shall consult and cooperate with Indian Tribes and Tribal
Organizations, and confer with Urban Indian Organizations, in
developing innovative approaches to address all or part of
the total unmet need for construction of health facilities,
including those provided for in other sections of this title
and other approaches.

``SEC. 302. SANITATION FACILITIES.

``(a) Findings.--Congress finds the following:
``(1) The provision of sanitation facilities is primarily a
health consideration and function.
``(2) Indian people suffer an inordinately high incidence
of disease, injury, and illness directly attributable to the
absence or inadequacy of sanitation facilities.
``(3) The long-term cost to the United States of treating
and curing such disease, injury, and illness is substantially
greater

[[Page S10474]]

than the short-term cost of providing sanitation facilities
and other preventive health measures.
``(4) Many Indian homes and Indian communities still lack
sanitation facilities.
``(5) It is in the interest of the United States, and it is
the policy of the United States, that all Indian communities
and Indian homes, new and existing, be provided with
sanitation facilities.
``(b) Facilities and Services.--In furtherance of the
findings made in subsection (a), Congress reaffirms the
primary responsibility and authority of the Service to
provide the necessary sanitation facilities and services as
provided in section 7 of the Act of August 5, 1954 (42 U.S.C.
2004a). Under such authority, the Secretary, acting through
the Service, is authorized to provide the following:
``(1) Financial and technical assistance to Indian Tribes,
Tribal Organizations, and Indian communities in the
establishment, training, and equipping of utility
organizations to operate and maintain sanitation facilities,
including the provision of existing plans, standard details,
and specifications available in the Department, to be used at
the option of the Indian Tribe, Tribal Organization, or
Indian community.
``(2) Ongoing technical assistance and training to Indian
Tribes, Tribal Organizations, and Indian communities in the
management of utility organizations which operate and
maintain sanitation facilities.
``(3) Priority funding for operation and maintenance
assistance for, and emergency repairs to, sanitation
facilities operated by an Indian Tribe, Tribal Organization
or Indian community when necessary to avoid an imminent
health threat or to protect the investment in sanitation
facilities and the investment in the health benefits gained
through the provision of sanitation facilities.
``(c) Funding.--Notwithstanding any other provision of
law--
``(1) the Secretary of Housing and Urban Development is
authorized to transfer funds appropriated under the Native
American Housing Assistance and Self-Determination Act of
1996 (25 U.S.C. 4101 et seq.) to the Secretary of Health and
Human Services;
``(2) the Secretary of Health and Human Services is
authorized to accept and use such funds for the purpose of
providing sanitation facilities and services for Indians
under section 7 of the Act of August 5, 1954 (42 U.S.C.
2004a);
``(3) unless specifically authorized when funds are
appropriated, the Secretary shall not use funds appropriated
under section 7 of the Act of August 5, 1954 (42 U.S.C.
2004a), to provide sanitation facilities to new homes
constructed using funds provided by the Department of Housing
and Urban Development;
``(4) the Secretary of Health and Human Services is
authorized to accept from any source, including Federal and
State agencies, funds for the purpose of providing sanitation
facilities and services and place these funds into contracts
or compacts under the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.);
``(5) except as otherwise prohibited by this section, the
Secretary may use funds appropriated under the authority of
section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), to
fund up to 100 percent of the amount of an Indian Tribe's
loan obtained under any Federal program for new projects to
construct eligible sanitation facilities to serve Indian
homes;
``(6) except as otherwise prohibited by this section, the
Secretary may use funds appropriated under the authority of
section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a) to
meet matching or cost participation requirements under other
Federal and non-Federal programs for new projects to
construct eligible sanitation facilities;
``(7) all Federal agencies are authorized to transfer to
the Secretary funds identified, granted, loaned, or
appropriated whereby the Department's applicable policies,
rules, and regulations shall apply in the implementation of
such projects;
``(8) the Secretary of Health and Human Services shall
enter into interagency agreements with Federal and State
agencies for the purpose of providing financial assistance
for sanitation facilities and services under this Act;
``(9) the Secretary of Health and Human Services shall, by
regulation, establish standards applicable to the planning,
design, and construction of sanitation facilities funded
under this Act; and
``(10) the Secretary of Health and Human Services is
authorized to accept payments for goods and services
furnished by the Service from appropriate public authorities,
nonprofit organizations or agencies, or Indian Tribes, as
contributions by that authority, organization, agency, or
tribe to agreements made under section 7 of the Act of August
5, 1954 (42 U.S.C. 2004a), and such payments shall be
credited to the same or subsequent appropriation account as
funds appropriated under the authority of section 7 of the
Act of August 5, 1954 (42 U.S.C. 2004a).
``(d) Certain Capabilities Not Prerequisite.--The financial
and technical capability of an Indian Tribe, Tribal
Organization, or Indian community to safely operate, manage,
and maintain a sanitation facility shall not be a
prerequisite to the provision or construction of sanitation
facilities by the Secretary.
``(e) Financial Assistance.--The Secretary is authorized to
provide financial assistance to Indian Tribes, Tribal
Organizations, and Indian communities for operation,
management, and maintenance of their sanitation facilities.
``(f) Operation, Management, and Maintenance of
Facilities.--The Indian Tribe has the primary responsibility
to establish, collect, and use reasonable user fees, or
otherwise set aside funding, for the purpose of operating,
managing, and maintaining sanitation facilities. If a
sanitation facility serving a community that is operated by
an Indian Tribe or Tribal Organization is threatened with
imminent failure and such operator lacks capacity to maintain
the integrity or the health benefits of the sanitation
facility, then the Secretary is authorized to assist the
Indian Tribe, Tribal Organization, or Indian community in the
resolution of the problem on a short-term basis through
cooperation with the emergency coordinator or by providing
operation, management, and maintenance service.
``(g) ISDEAA Program Funded on Equal Basis.--Tribal Health
Programs shall be eligible (on an equal basis with programs
that are administered directly by the Service) for--
``(1) any funds appropriated pursuant to this section; and
``(2) any funds appropriated for the purpose of providing
sanitation facilities.
``(h) Report.--
``(1) Required contents.--The Secretary, in consultation
with the Secretary of Housing and Urban Development, Indian
Tribes, Tribal Organizations, and tribally designated housing
entities (as defined in section 4 of the Native American
Housing Assistance and Self-Determination Act of 1996 (25
U.S.C. 4103)) shall submit to the President, for inclusion in
the report required to be transmitted to Congress under
section 801, a report which sets forth--
``(A) the current Indian sanitation facility priority
system of the Service;
``(B) the methodology for determining sanitation
deficiencies and needs;
``(C) the criteria on which the deficiencies and needs will
be evaluated;
``(D) the level of initial and final sanitation deficiency
for each type of sanitation facility for each project of each
Indian Tribe or Indian community;
``(E) the amount and most effective use of funds, derived
from whatever source, necessary to accommodate the sanitation
facilities needs of new homes assisted with funds under the
Native American Housing Assistance and Self-Determination Act
(25 U.S.C. 4101 et seq.), and to reduce the identified
sanitation deficiency levels of all Indian Tribes and Indian
communities to level I sanitation deficiency as defined in
paragraph (3)(A); and
``(F) a 10-year plan to provide sanitation facilities to
serve existing Indian homes and Indian communities and new
and renovated Indian homes.
``(2) Uniform methodology.--The methodology used by the
Secretary in determining, preparing cost estimates for, and
reporting sanitation deficiencies for purposes of paragraph
(1) shall be applied uniformly to all Indian Tribes and
Indian communities.
``(3) Sanitation deficiency levels.--For purposes of this
subsection, the sanitation deficiency levels for an
individual, Indian Tribe, or Indian community sanitation
facility to serve Indian homes are determined as follows:
``(A) A level I deficiency exists if a sanitation facility
serving an individual, Indian Tribe, or Indian community--
``(i) complies with all applicable water supply, pollution
control, and solid waste disposal laws; and
``(ii) deficiencies relate to routine replacement, repair,
or maintenance needs.
``(B) A level II deficiency exists if a sanitation facility
serving an individual, Indian Tribe, or Indian community
substantially or recently complied with all applicable water
supply, pollution control, and solid waste laws and any
deficiencies relate to--
``(i) small or minor capital improvements needed to bring
the facility back into compliance;
``(ii) capital improvements that are necessary to enlarge
or improve the facilities in order to meet the current needs
for domestic sanitation facilities; or
``(iii) the lack of equipment or training by an Indian
Tribe, Tribal Organization, or an Indian community to
properly operate and maintain the sanitation facilities.
``(C) A level III deficiency exists if a sanitation
facility serving an individual, Indian Tribe or Indian
community meets 1 or more of the following conditions--
``(i) water or sewer service in the home is provided by a
haul system with holding tanks and interior plumbing;
``(ii) major significant interruptions to water supply or
sewage disposal occur frequently, requiring major capital
improvements to correct the deficiencies; or
``(iii) there is no access to or no approved or permitted
solid waste facility available.
``(D) A level IV deficiency exists--
``(i) if a sanitation facility for an individual home, an
Indian Tribe, or an Indian community exists but--

``(I) lacks--

``(aa) a safe water supply system; or
``(bb) a waste disposal system;

``(II) contains no piped water or sewer facilities; or
``(III) has become inoperable due to a major component
failure; or

``(ii) if only a washeteria or central facility exists in
the community.

[[Page S10475]]

``(E) A level V deficiency exists in the absence of a
sanitation facility, where individual homes do not have
access to safe drinking water or adequate wastewater
(including sewage) disposal.
``(i) Definitions.--For purposes of this section, the
following terms apply:
``(1) Indian community.--The term `Indian community' means
a geographic area, a significant proportion of whose
inhabitants are Indians and which is served by or capable of
being served by a facility described in this section.
``(2) Sanitation facilities.--The terms `sanitation
facility' and `sanitation facilities' mean safe and adequate
water supply systems, sanitary sewage disposal systems, and
sanitary solid waste systems (and all related equipment and
support infrastructure).

``SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS.

``(a) Buy Indian Act.--The Secretary, acting through the
Service, may use the negotiating authority of section 23 of
the Act of June 25, 1910 (25 U.S.C. 47, commonly known as the
`Buy Indian Act'), to give preference to any Indian or any
enterprise, partnership, corporation, or other type of
business organization owned and controlled by an Indian or
Indians including former or currently federally recognized
Indian Tribes in the State of New York (hereinafter referred
to as an `Indian firm') in the construction and renovation of
Service facilities pursuant to section 301 and in the
construction of sanitation facilities pursuant to section
302. Such preference may be accorded by the Secretary unless
the Secretary finds, pursuant to regulations, that the
project or function to be contracted for will not be
satisfactory or such project or function cannot be properly
completed or maintained under the proposed contract. The
Secretary, in arriving at such a finding, shall consider
whether the Indian or Indian firm will be deficient with
respect to--
``(1) ownership and control by Indians;
``(2) equipment;
``(3) bookkeeping and accounting procedures;
``(4) substantive knowledge of the project or function to
be contracted for;
``(5) adequately trained personnel; or
``(6) other necessary components of contract performance.
``(b) Labor Standards.--
``(1) In general.--For the purposes of implementing the
provisions of this title, contracts for the construction or
renovation of health care facilities, staff quarters, and
sanitation facilities, and related support infrastructure,
funded in whole or in part with funds made available pursuant
to this title, shall contain a provision requiring compliance
with subchapter IV of chapter 31 of title 40, United States
Code (commonly known as the `Davis-Bacon Act'), unless such
construction or renovation--
``(A) is performed by a contractor pursuant to a contract
with an Indian Tribe or Tribal Organization with funds
supplied through a contract or compact authorized by the
Indian Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq.), or other statutory authority; and
``(B) is subject to prevailing wage rates for similar
construction or renovation in the locality as determined by
the Indian Tribes or Tribal Organizations to be served by the
construction or renovation.
``(2) Exception.--This subsection shall not apply to
construction or renovation carried out by an Indian Tribe or
Tribal Organization with its own employees.

``SEC. 304. EXPENDITURE OF NON-SERVICE FUNDS FOR RENOVATION.

``(a) In General.--Notwithstanding any other provision of
law, if the requirements of subsection (c) are met, the
Secretary, acting through the Service, is authorized to
accept any major expansion, renovation, or modernization by
any Indian Tribe or Tribal Organization of any Service
facility or of any other Indian health facility operated
pursuant to a contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.), including--
``(1) any plans or designs for such expansion, renovation,
or modernization; and
``(2) any expansion, renovation, or modernization for which
funds appropriated under any Federal law were lawfully
expended.
``(b) Priority List.--
``(1) In general.--The Secretary shall maintain a separate
priority list to address the needs for increased operating
expenses, personnel, or equipment for such facilities. The
methodology for establishing priorities shall be developed
through regulations. The list of priority facilities will be
revised annually in consultation with Indian Tribes and
Tribal Organizations.
``(2) Report.--The Secretary shall submit to the President,
for inclusion in the report required to be transmitted to
Congress under section 801, the priority list maintained
pursuant to paragraph (1).
``(c) Requirements.--The requirements of this subsection
are met with respect to any expansion, renovation, or
modernization if--
``(1) the Indian Tribe or Tribal Organization--
``(A) provides notice to the Secretary of its intent to
expand, renovate, or modernize; and
``(B) applies to the Secretary to be placed on a separate
priority list to address the needs of such new facilities for
increased operating expenses, personnel, or equipment; and
``(2) the expansion, renovation, or modernization--
``(A) is approved by the appropriate area director of the
Service for Federal facilities; and
``(B) is administered by the Indian Tribe or Tribal
Organization in accordance with any applicable regulations
prescribed by the Secretary with respect to construction or
renovation of Service facilities.
``(d) Additional Requirement for Expansion.--In addition to
the requirements under subsection (c), for any expansion, the
Indian Tribe or Tribal Organization shall provide to the
Secretary additional information pursuant to regulations,
including additional staffing, equipment, and other costs
associated with the expansion.
``(e) Closure or Conversion of Facilities.--If any Service
facility which has been expanded, renovated, or modernized by
an Indian Tribe or Tribal Organization under this section
ceases to be used as a Service facility during the 20-year
period beginning on the date such expansion, renovation, or
modernization is completed, such Indian Tribe or Tribal
Organization shall be entitled to recover from the United
States an amount which bears the same ratio to the value of
such facility at the time of such cessation as the value of
such expansion, renovation, or modernization (less the total
amount of any funds provided specifically for such facility
under any Federal program that were expended for such
expansion, renovation, or modernization) bore to the value of
such facility at the time of the completion of such
expansion, renovation, or modernization.

``SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, AND
MODERNIZATION OF SMALL AMBULATORY CARE
FACILITIES.

``(a) Grants.--
``(1) In general.--The Secretary, acting through the
Service, shall make grants to Indian Tribes and Tribal
Organizations for the construction, expansion, or
modernization of facilities for the provision of ambulatory
care services to eligible Indians (and noneligible persons
pursuant to subsections (b)(2) and (c)(1)(C)). A grant made
under this section may cover up to 100 percent of the costs
of such construction, expansion, or modernization. For the
purposes of this section, the term `construction' includes
the replacement of an existing facility.
``(2) Grant agreement required.--A grant under paragraph
(1) may only be made available to a Tribal Health Program
operating an Indian health facility (other than a facility
owned or constructed by the Service, including a facility
originally owned or constructed by the Service and
transferred to an Indian Tribe or Tribal Organization).
``(b) Use of Grant Funds.--
``(1) Allowable uses.--A grant awarded under this section
may be used for the construction, expansion, or modernization
(including the planning and design of such construction,
expansion, or modernization) of an ambulatory care facility--
``(A) located apart from a hospital;
``(B) not funded under section 301 or section 306; and
``(C) which, upon completion of such construction or
modernization will--
``(i) have a total capacity appropriate to its projected
service population;
``(ii) provide annually no fewer than 150 patient visits by
eligible Indians and other users who are eligible for
services in such facility in accordance with section
807(c)(2); and
``(iii) provide ambulatory care in a Service Area
(specified in the contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.)) with a population of no fewer than 1,500 eligible
Indians and other users who are eligible for services in such
facility in accordance with section 807(c)(2).
``(2) Additional allowable use.--The Secretary may also
reserve a portion of the funding provided under this section
and use those reserved funds to reduce an outstanding debt
incurred by Indian Tribes or Tribal Organizations for the
construction, expansion, or modernization of an ambulatory
care facility that meets the requirements under paragraph
(1). The provisions of this section shall apply, except that
such applications for funding under this paragraph shall be
considered separately from applications for funding under
paragraph (1).
``(3) Use only for certain portion of costs.--A grant
provided under this section may be used only for the cost of
that portion of a construction, expansion, or modernization
project that benefits the Service population identified above
in subsection (b)(1)(C) (ii) and (iii). The requirements of
clauses (ii) and (iii) of paragraph (1)(C) shall not apply to
an Indian Tribe or Tribal Organization applying for a grant
under this section for a health care facility located or to
be constructed on an island or when such facility is not
located on a road system providing direct access to an
inpatient hospital where care is available to the Service
population.
``(c) Grants.--
``(1) Application.--No grant may be made under this section
unless an application or proposal for the grant has been
approved by the Secretary in accordance with applicable
regulations and has set forth reasonable assurance by the
applicant that, at all times after the construction,
expansion, or modernization of a facility carried out using a
grant received under this section--
``(A) adequate financial support will be available for the
provision of services at such facility;

[[Page S10476]]

``(B) such facility will be available to eligible Indians
without regard to ability to pay or source of payment; and
``(C) such facility will, as feasible without diminishing
the quality or quantity of services provided to eligible
Indians, serve noneligible persons on a cost basis.
``(2) Priority.--In awarding grants under this section, the
Secretary shall give priority to Indian Tribes and Tribal
Organizations that demonstrate--
``(A) a need for increased ambulatory care services; and
``(B) insufficient capacity to deliver such services.
``(3) Peer review panels.--The Secretary may provide for
the establishment of peer review panels, as necessary, to
review and evaluate applications and proposals and to advise
the Secretary regarding such applications using the criteria
developed pursuant to subsection (a)(1).
``(d) Reversion of Facilities.--If any facility (or portion
thereof) with respect to which funds have been paid under
this section, ceases, at any time after completion of the
construction, expansion, or modernization carried out with
such funds, to be used for the purposes of providing health
care services to eligible Indians, all of the right, title,
and interest in and to such facility (or portion thereof)
shall transfer to the United States unless otherwise
negotiated by the Service and the Indian Tribe or Tribal
Organization.
``(e) Funding Nonrecurring.--Funding provided under this
section shall be nonrecurring and shall not be available for
inclusion in any individual Indian Tribe's tribal share for
an award under the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.) or for reallocation or
redesign thereunder.

``SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRATION
PROJECTS.

``(a) In General.--The Secretary, acting through the
Service, is authorized to carry out, or to enter into
contracts under the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.) with Indian Tribes or
Tribal Organizations to carry out, a health care delivery
demonstration project to test alternative means of delivering
health care and services to Indians through facilities.
``(b) Use of Funds.--The Secretary, in approving projects
pursuant to this section, may authorize such contracts for
the construction and renovation of hospitals, health centers,
health stations, and other facilities to deliver health care
services and is authorized to--
``(1) waive any leasing prohibition;
``(2) permit carryover of funds appropriated for the
provision of health care services;
``(3) permit the use of other available funds;
``(4) permit the use of funds or property donated from any
source for project purposes;
``(5) provide for the reversion of donated real or personal
property to the donor; and
``(6) permit the use of Service funds to match other funds,
including Federal funds.
``(c) Health Care Demonstration Projects.--
``(1) General projects.--
``(A) Criteria.--The Secretary may approve under this
section demonstration projects that meet the following
criteria:
``(i) There is a need for a new facility or program, such
as a program for convenient care services, or the
reorientation of an existing facility or program.
``(ii) A significant number of Indians, including Indians
with low health status, will be served by the project.
``(iii) The project has the potential to deliver services
in an efficient and effective manner.
``(iv) The project is economically viable.
``(v) For projects carried out by an Indian Tribe or Tribal
Organization, the Indian Tribe or Tribal Organization has the
administrative and financial capability to administer the
project.
``(vi) The project is integrated with providers of related
health and social services and is coordinated with, and
avoids duplication of, existing services in order to expand
the availability of services.
``(B) Priority.--In approving demonstration projects under
this paragraph, the Secretary shall give priority to
demonstration projects, to the extent the projects meet the
criteria described in subparagraph (A), located in any of the
following Service Units:
``(i) Cass Lake, Minnesota.
``(ii) Mescalero, New Mexico.
``(iii) Owyhee, Nevada.
``(iv) Schurz, Nevada.
``(v) Ft. Yuma, California.
``(2) Convenient care service projects.--
``(A) Definition of convenient care service.--In this
paragraph, the term `convenient care service' means any
primary health care service, such as urgent care services,
nonemergent care services, prevention services and
screenings, and any service authorized by sections 203 or
213(d), that is--
``(i) provided outside the regular hours of operation of a
health care facility; or
``(ii) offered at an alternative setting.
``(B) Approval.--In addition to projects described in
paragraph (1), in any fiscal year, the Secretary is
authorized to approve not more than 10 applications for
health care delivery demonstration projects that--
``(i) include a convenient care services program as an
alternative means of delivering health care services to
Indians; and
``(ii) meet the criteria described in subparagraph (C).
``(C) Criteria.--The Secretary shall approve under
subparagraph (B) demonstration projects that meet all of the
following criteria:
``(i) The criteria set forth in paragraph (1)(A).
``(ii) There is a lack of access to health care services at
existing health care facilities, which may be due to limited
hours of operation at those facilities or other factors.
``(iii) The project--

``(I) expands the availability of services; or
``(II) reduces--

``(aa) the burden on Contract Health Services; or
``(bb) the need for emergency room visits.
``(d) Peer Review Panels.--The Secretary may provide for
the establishment of peer review panels, as necessary, to
review and evaluate applications using the criteria described
in paragraphs (1)(A) and (2)(C) of subsection (c).
``(e) Technical Assistance.--The Secretary shall provide
such technical and other assistance as may be necessary to
enable applicants to comply with this section.
``(f) Service to Ineligible Persons.--Subject to section
807, the authority to provide services to persons otherwise
ineligible for the health care benefits of the Service, and
the authority to extend hospital privileges in Service
facilities to non-Service health practitioners as provided in
section 807, may be included, subject to the terms of that
section, in any demonstration project approved pursuant to
this section.
``(g) Equitable Treatment.--For purposes of subsection (c),
the Secretary, in evaluating facilities operated under any
contract or compact under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.), shall use
the same criteria that the Secretary uses in evaluating
facilities operated directly by the Service.
``(h) Equitable Integration of Facilities.--The Secretary
shall ensure that the planning, design, construction,
renovation, and expansion needs of Service and non-Service
facilities that are the subject of a contract or compact
under the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450 et seq.) for health services are fully and
equitably integrated into the implementation of the health
care delivery demonstration projects under this section.

``SEC. 307. LAND TRANSFER.

``Notwithstanding any other provision of law, the Bureau of
Indian Affairs and all other agencies and departments of the
United States are authorized to transfer, at no cost, land
and improvements to the Service for the provision of health
care services. The Secretary is authorized to accept such
land and improvements for such purposes.

``SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS.

``The Secretary, acting through the Service, may enter into
leases, contracts, and other agreements with Indian Tribes
and Tribal Organizations which hold (1) title to, (2) a
leasehold interest in, or (3) a beneficial interest in (when
title is held by the United States in trust for the benefit
of an Indian Tribe) facilities used or to be used for the
administration and delivery of health services by an Indian
Health Program. Such leases, contracts, or agreements may
include provisions for construction or renovation and provide
for compensation to the Indian Tribe or Tribal Organization
of rental and other costs consistent with section 105(l) of
the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450j(l)) and regulations thereunder.

``SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND LOAN
REPAYMENT.

``(a) In General.--The Secretary, in consultation with the
Secretary of the Treasury, Indian Tribes, and Tribal
Organizations, shall carry out a study to determine the
feasibility of establishing a loan fund to provide to Indian
Tribes and Tribal Organizations direct loans or guarantees
for loans for the construction of health care facilities,
including--
``(1) inpatient facilities;
``(2) outpatient facilities;
``(3) staff quarters;
``(4) hostels; and
``(5) specialized care facilities, such as behavioral
health and elder care facilities.
``(b) Determinations.--In carrying out the study under
subsection (a), the Secretary shall determine--
``(1) the maximum principal amount of a loan or loan
guarantee that should be offered to a recipient from the loan
fund;
``(2) the percentage of eligible costs, not to exceed 100
percent, that may be covered by a loan or loan guarantee from
the loan fund (including costs relating to planning, design,
financing, site land development, construction,
rehabilitation, renovation, conversion, improvements, medical
equipment and furnishings, and other facility-related costs
and capital purchase (but excluding staffing));
``(3) the cumulative total of the principal of direct loans
and loan guarantees, respectively, that may be outstanding at
any 1 time;
``(4) the maximum term of a loan or loan guarantee that may
be made for a facility from the loan fund;
``(5) the maximum percentage of funds from the loan fund
that should be allocated for payment of costs associated with
planning and applying for a loan or loan guarantee;
``(6) whether acceptance by the Secretary of an assignment
of the revenue of an Indian Tribe or Tribal Organization as
security for any direct loan or loan guarantee from the loan
fund would be appropriate;

[[Page S10477]]

``(7) whether, in the planning and design of health
facilities under this section, users eligible under section
807(c) may be included in any projection of patient
population;
``(8) whether funds of the Service provided through loans
or loan guarantees from the loan fund should be eligible for
use in matching other Federal funds under other programs;
``(9) the appropriateness of, and best methods for,
coordinating the loan fund with the health care priority
system of the Service under section 301; and
``(10) any legislative or regulatory changes required to
implement recommendations of the Secretary based on results
of the study.
``(c) Report.--Not later than September 30, 2009, the
Secretary shall submit to the Committee on Indian Affairs of
the Senate and the Committee on Natural Resources and the
Committee on Energy and Commerce of the House of
Representatives a report that describes--
``(1) the manner of consultation made as required by
subsection (a); and
``(2) the results of the study, including any
recommendations of the Secretary based on results of the
study.

``SEC. 310. TRIBAL LEASING.

``A Tribal Health Program may lease permanent structures
for the purpose of providing health care services without
obtaining advance approval in appropriation Acts.

``SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES JOINT
VENTURE PROGRAM.

``(a) In General.--The Secretary, acting through the
Service, shall make arrangements with Indian Tribes and
Tribal Organizations to establish joint venture demonstration
projects under which an Indian Tribe or Tribal Organization
shall expend tribal, private, or other available funds, for
the acquisition or construction of a health facility for a
minimum of 10 years, under a no-cost lease, in exchange for
agreement by the Service to provide the equipment, supplies,
and staffing for the operation and maintenance of such a
health facility. An Indian Tribe or Tribal Organization may
use tribal funds, private sector, or other available
resources, including loan guarantees, to fulfill its
commitment under a joint venture entered into under this
subsection. An Indian Tribe or Tribal Organization shall be
eligible to establish a joint venture project if, when it
submits a letter of intent, it--
``(1) has begun but not completed the process of
acquisition or construction of a health facility to be used
in the joint venture project; or
``(2) has not begun the process of acquisition or
construction of a health facility for use in the joint
venture project.
``(b) Requirements.--The Secretary shall make such an
arrangement with an Indian Tribe or Tribal Organization only
if--
``(1) the Secretary first determines that the Indian Tribe
or Tribal Organization has the administrative and financial
capabilities necessary to complete the timely acquisition or
construction of the relevant health facility; and
``(2) the Indian Tribe or Tribal Organization meets the
need criteria determined using the criteria developed under
the health care facility priority system under section 301,
unless the Secretary determines, pursuant to regulations,
that other criteria will result in a more cost-effective and
efficient method of facilitating and completing construction
of health care facilities.
``(c) Continued Operation.--The Secretary shall negotiate
an agreement with the Indian Tribe or Tribal Organization
regarding the continued operation of the facility at the end
of the initial 10 year no-cost lease period.
``(d) Breach of Agreement.--An Indian Tribe or Tribal
Organization that has entered into a written agreement with
the Secretary under this section, and that breaches or
terminates without cause such agreement, shall be liable to
the United States for the amount that has been paid to the
Indian Tribe or Tribal Organization, or paid to a third party
on the Indian Tribe's or Tribal Organization's behalf, under
the agreement. The Secretary has the right to recover
tangible property (including supplies) and equipment, less
depreciation, and any funds expended for operations and
maintenance under this section. The preceding sentence does
not apply to any funds expended for the delivery of health
care services, personnel, or staffing.
``(e) Recovery for Nonuse.--An Indian Tribe or Tribal
Organization that has entered into a written agreement with
the Secretary under this subsection shall be entitled to
recover from the United States an amount that is proportional
to the value of such facility if, at any time within the 10-
year term of the agreement, the Service ceases to use the
facility or otherwise breaches the agreement.
``(f) Definition.--For the purposes of this section, the
term `health facility' or `health facilities' includes
quarters needed to provide housing for staff of the relevant
Tribal Health Program.

``SEC. 312. LOCATION OF FACILITIES.

``(a) In General.--In all matters involving the
reorganization or development of Service facilities or in the
establishment of related employment projects to address
unemployment conditions in economically depressed areas, the
Bureau of Indian Affairs and the Service shall give priority
to locating such facilities and projects on Indian lands, or
lands in Alaska owned by any Alaska Native village, or
village or regional corporation under the Alaska Native
Claims Settlement Act (43 U.S.C. 1601 et seq.), or any land
allotted to any Alaska Native, if requested by the Indian
owner and the Indian Tribe with jurisdiction over such lands
or other lands owned or leased by the Indian Tribe or Tribal
Organization. Top priority shall be given to Indian land
owned by 1 or more Indian Tribes.
``(b) Definition.--For purposes of this section, the term
`Indian lands' means--
``(1) all lands within the exterior boundaries of any
reservation; and
``(2) any lands title to which is held in trust by the
United States for the benefit of any Indian Tribe or
individual Indian or held by any Indian Tribe or individual
Indian subject to restriction by the United States against
alienation.

``SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH CARE
FACILITIES.

``(a) Report.--The Secretary shall submit to the President,
for inclusion in the report required to be transmitted to
Congress under section 801, a report which identifies the
backlog of maintenance and repair work required at both
Service and tribal health care facilities, including new
health care facilities expected to be in operation in the
next fiscal year. The report shall also identify the need for
renovation and expansion of existing facilities to support
the growth of health care programs.
``(b) Maintenance of Newly Constructed Space.--The
Secretary, acting through the Service, is authorized to
expend maintenance and improvement funds to support
maintenance of newly constructed space only if such space
falls within the approved supportable space allocation for
the Indian Tribe or Tribal Organization. Supportable space
allocation shall be defined through the health care facility
priority system under section 301(c).
``(c) Replacement Facilities.--In addition to using
maintenance and improvement funds for renovation,
modernization, and expansion of facilities, an Indian Tribe
or Tribal Organization may use maintenance and improvement
funds for construction of a replacement facility if the costs
of renovation of such facility would exceed a maximum
renovation cost threshold. The maximum renovation cost
threshold shall be determined through the negotiated
rulemaking process provided for under section 802.

``SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY-OWNED QUARTERS.

``(a) Rental Rates.--
``(1) Establishment.--Notwithstanding any other provision
of law, a Tribal Health Program which operates a hospital or
other health facility and the federally-owned quarters
associated therewith pursuant to a contract or compact under
the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450 et seq.) shall have the authority to establish
the rental rates charged to the occupants of such quarters by
providing notice to the Secretary of its election to exercise
such authority.
``(2) Objectives.--In establishing rental rates pursuant to
authority of this subsection, a Tribal Health Program shall
endeavor to achieve the following objectives:
``(A) To base such rental rates on the reasonable value of
the quarters to the occupants thereof.
``(B) To generate sufficient funds to prudently provide for
the operation and maintenance of the quarters, and subject to
the discretion of the Tribal Health Program, to supply
reserve funds for capital repairs and replacement of the
quarters.
``(3) Equitable funding.--Any quarters whose rental rates
are established by a Tribal Health Program pursuant to this
subsection shall remain eligible for quarters improvement and
repair funds to the same extent as all federally-owned
quarters used to house personnel in Services-supported
programs.
``(4) Notice of rate change.--A Tribal Health Program which
exercises the authority provided under this subsection shall
provide occupants with no less than 60 days notice of any
change in rental rates.
``(b) Direct Collection of Rent.--
``(1) In general.--Notwithstanding any other provision of
law, and subject to paragraph (2), a Tribal Health Program
shall have the authority to collect rents directly from
Federal employees who occupy such quarters in accordance with
the following:
``(A) The Tribal Health Program shall notify the Secretary
and the subject Federal employees of its election to exercise
its authority to collect rents directly from such Federal
employees.
``(B) Upon receipt of a notice described in subparagraph
(A), the Federal employees shall pay rents for occupancy of
such quarters directly to the Tribal Health Program and the
Secretary shall have no further authority to collect rents
from such employees through payroll deduction or otherwise.
``(C) Such rent payments shall be retained by the Tribal
Health Program and shall not be made payable to or otherwise
be deposited with the United States.
``(D) Such rent payments shall be deposited into a separate
account which shall be used by the Tribal Health Program for
the maintenance (including capital repairs and replacement)
and operation of the quarters and facilities as the Tribal
Health Program shall determine.
``(2) Retrocession of authority.--If a Tribal Health
Program which has made an election under paragraph (1)
requests retrocession of its authority to directly collect
rents from Federal employees occupying federally-owned
quarters, such retrocession shall become effective on the
earlier of--

[[Page S10478]]

``(A) the first day of the month that begins no less than
180 days after the Tribal Health Program notifies the
Secretary of its desire to retrocede; or
``(B) such other date as may be mutually agreed by the
Secretary and the Tribal Health Program.
``(c) Rates in Alaska.--To the extent that a Tribal Health
Program, pursuant to authority granted in subsection (a),
establishes rental rates for federally-owned quarters
provided to a Federal employee in Alaska, such rents may be
based on the cost of comparable private rental housing in the
nearest established community with a year-round population of
1,500 or more individuals.

``SEC. 315. APPLICABILITY OF BUY AMERICAN ACT REQUIREMENT.

``(a) Applicability.--The Secretary shall ensure that the
requirements of the Buy American Act apply to all
procurements made with funds provided pursuant to section
317. Indian Tribes and Tribal Organizations shall be exempt
from these requirements.
``(b) Effect of Violation.--If it has been finally
determined by a court or Federal agency that any person
intentionally affixed a label bearing a `Made in America'
inscription or any inscription with the same meaning, to any
product sold in or shipped to the United States that is not
made in the United States, such person shall be ineligible to
receive any contract or subcontract made with funds provided
pursuant to section 317, pursuant to the debarment,
suspension, and ineligibility procedures described in
sections 9.400 through 9.409 of title 48, Code of Federal
Regulations.
``(c) Definitions.--For purposes of this section, the term
`Buy American Act' means title III of the Act entitled `An
Act making appropriations for the Treasury and Post Office
Departments for the fiscal year ending June 30, 1934, and for
other purposes', approved March 3, 1933 (41 U.S.C. 10a et
seq.).

``SEC. 316. OTHER FUNDING FOR FACILITIES.

``(a) Authority to Accept Funds.--The Secretary is
authorized to accept from any source, including Federal and
State agencies, funds that are available for the construction
of health care facilities and use such funds to plan, design,
and construct health care facilities for Indians and to place
such funds into a contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.). Receipt of such funds shall have no effect on the
priorities established pursuant to section 301.
``(b) Interagency Agreements.--The Secretary is authorized
to enter into interagency agreements with other Federal
agencies or State agencies and other entities and to accept
funds from such Federal or State agencies or other sources to
provide for the planning, design, and construction of health
care facilities to be administered by Indian Health Programs
in order to carry out the purposes of this Act and the
purposes for which the funds were appropriated or for which
the funds were otherwise provided.
``(c) Establishment of Standards.--The Secretary, through
the Service, shall establish standards by regulation for the
planning, design, and construction of health care facilities
serving Indians under this Act.

``SEC. 317. AUTHORIZATION OF APPROPRIATIONS.

``There are authorized to be appropriated such sums as may
be necessary for each fiscal year through fiscal year 2017 to
carry out this title.

``TITLE IV--ACCESS TO HEALTH SERVICES

``SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SECURITY ACT
HEALTH BENEFITS PROGRAMS.

``(a) Disregard of Medicare, Medicaid, and SCHIP Payments
in Determining Appropriations.--Any payments received by an
Indian Health Program or by an Urban Indian Organization
under title XVIII, XIX, or XXI of the Social Security Act for
services provided to Indians eligible for benefits under such
respective titles shall not be considered in determining
appropriations for the provision of health care and services
to Indians.
``(b) Nonpreferential Treatment.--Nothing in this Act
authorizes the Secretary to provide services to an Indian
with coverage under title XVIII, XIX, or XXI of the Social
Security Act in preference to an Indian without such
coverage.
``(c) Use of Funds.--
``(1) Special fund.--
``(A) 100 percent pass-through of payments due to
facilities.--Notwithstanding any other provision of law, but
subject to paragraph (2), payments to which a facility of the
Service is entitled by reason of a provision of the Social
Security Act shall be placed in a special fund to be held by
the Secretary. In making payments from such fund, the
Secretary shall ensure that each Service Unit of the Service
receives 100 percent of the amount to which the facilities of
the Service, for which such Service Unit makes collections,
are entitled by reason of a provision of the Social Security
Act.
``(B) Use of funds.--Amounts received by a facility of the
Service under subparagraph (A) shall first be used (to such
extent or in such amounts as are provided in appropriation
Acts) for the purpose of making any improvements in the
programs of the Service operated by or through such facility
which may be necessary to achieve or maintain compliance with
the applicable conditions and requirements of titles XVIII
and XIX of the Social Security Act. Any amounts so received
that are in excess of the amount necessary to achieve or
maintain such conditions and requirements shall, subject to
consultation with the Indian Tribes being served by the
Service Unit, be used for reducing the health resource
deficiencies (as determined under section 201(d)) of such
Indian Tribes.
``(2) Direct payment option.--Paragraph (1) shall not apply
to a Tribal Health Program upon the election of such Program
under subsection (d) to receive payments directly. No payment
may be made out of the special fund described in such
paragraph with respect to reimbursement made for services
provided by such Program during the period of such election.
``(d) Direct Billing.--
``(1) In general.--Subject to complying with the
requirements of paragraph (2), a Tribal Health Program may
elect to directly bill for, and receive payment for, health
care items and services provided by such Program for which
payment is made under title XVIII or XIX of the Social
Security Act or from any other third party payor.
``(2) Direct reimbursement.--
``(A) Use of funds.--Each Tribal Health Program making the
election described in paragraph (1) with respect to a program
under a title of the Social Security Act shall be reimbursed
directly by that program for items and services furnished
without regard to subsection (c)(1), but all amounts so
reimbursed shall be used by the Tribal Health Program for the
purpose of making any improvements in facilities of the
Tribal Health Program that may be necessary to achieve or
maintain compliance with the conditions and requirements
applicable generally to such items and services under the
program under such title and to provide additional health
care services, improvements in health care facilities and
Tribal Health Programs, any health care related purpose, or
otherwise to achieve the objectives provided in section 3 of
this Act.
``(B) Audits.--The amounts paid to a Tribal Health Program
making the election described in paragraph (1) with respect
to a program under a title of the Social Security Act shall
be subject to all auditing requirements applicable to the
program under such title, as well as all auditing
requirements applicable to programs administered by an Indian
Health Program. Nothing in the preceding sentence shall be
construed as limiting the application of auditing
requirements applicable to amounts paid under title XVIII,
XIX, or XXI of the Social Security Act.
``(C) Identification of source of payments.--Any Tribal
Health Program that receives reimbursements or payments under
title XVIII, XIX, or XXI of the Social Security Act, shall
provide to the Service a list of each provider enrollment
number (or other identifier) under which such Program
receives such reimbursements or payments.
``(3) Examination and implementation of changes.--
``(A) In general.--The Secretary, acting through the
Service and with the assistance of the Administrator of the
Centers for Medicare & Medicaid Services, shall examine on an
ongoing basis and implement any administrative changes that
may be necessary to facilitate direct billing and
reimbursement under the program established under this
subsection, including any agreements with States that may be
necessary to provide for direct billing under a program under
a title of the Social Security Act.
``(B) Coordination of information.--The Service shall
provide the Administrator of the Centers for Medicare &
Medicaid Services with copies of the lists submitted to the
Service under paragraph (2)(C), enrollment data regarding
patients served by the Service (and by Tribal Health
Programs, to the extent such data is available to the
Service), and such other information as the Administrator may
require for purposes of administering title XVIII, XIX, or
XXI of the Social Security Act.
``(4) Withdrawal from program.--A Tribal Health Program
that bills directly under the program established under this
subsection may withdraw from participation in the same manner
and under the same conditions that an Indian Tribe or Tribal
Organization may retrocede a contracted program to the
Secretary under the authority of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.). All cost accounting and billing authority under the
program established under this subsection shall be returned
to the Secretary upon the Secretary's acceptance of the
withdrawal of participation in this program.
``(5) Termination for failure to comply with
requirements.--The Secretary may terminate the participation
of a Tribal Health Program or in the direct billing program
established under this subsection if the Secretary determines
that the Program has failed to comply with the requirements
of paragraph (2). The Secretary shall provide a Tribal Health
Program with notice of a determination that the Program has
failed to comply with any such requirement and a reasonable
opportunity to correct such noncompliance prior to
terminating the Program's participation in the direct billing
program established under this subsection.
``(e) Related Provisions Under the Social Security Act.--
For provisions related to subsections (c) and (d), see
sections 1880, 1911, and 2107(e)(1)(D) of the Social Security
Act.

[[Page S10479]]

``SEC. 402. GRANTS TO AND CONTRACTS WITH THE SERVICE, INDIAN
TRIBES, TRIBAL ORGANIZATIONS, AND URBAN INDIAN
ORGANIZATIONS TO FACILITATE OUTREACH,
ENROLLMENT, AND COVERAGE OF INDIANS UNDER
SOCIAL SECURITY ACT HEALTH BENEFIT PROGRAMS AND
OTHER HEALTH BENEFITS PROGRAMS.

``(a) Indian Tribes and Tribal Organizations.--From funds
appropriated to carry out this title in accordance with
section 416, the Secretary, acting through the Service, shall
make grants to or enter into contracts with Indian Tribes and
Tribal Organizations to assist such Tribes and Tribal
Organizations in establishing and administering programs on
or near reservations and trust lands to assist individual
Indians--
``(1) to enroll for benefits under a program established
under title XVIII, XIX, or XXI of the Social Security Act and
other health benefits programs; and
``(2) with respect to such programs for which the charging
of premiums and cost sharing is not prohibited under such
programs, to pay premiums or cost sharing for coverage for
such benefits, which may be based on financial need (as
determined by the Indian Tribe or Tribes or Tribal
Organizations being served based on a schedule of income
levels developed or implemented by such Tribe, Tribes, or
Tribal Organizations).
``(b) Conditions.--The Secretary, acting through the
Service, shall place conditions as deemed necessary to effect
the purpose of this section in any grant or contract which
the Secretary makes with any Indian Tribe or Tribal
Organization pursuant to this section. Such conditions shall
include requirements that the Indian Tribe or Tribal
Organization successfully undertake--
``(1) to determine the population of Indians eligible for
the benefits described in subsection (a);
``(2) to educate Indians with respect to the benefits
available under the respective programs;
``(3) to provide transportation for such individual Indians
to the appropriate offices for enrollment or applications for
such benefits; and
``(4) to develop and implement methods of improving the
participation of Indians in receiving benefits under such
programs.
``(c) Application to Urban Indian Organizations.--
``(1) In general.--The provisions of subsection (a) shall
apply with respect to grants and other funding to Urban
Indian Organizations with respect to populations served by
such organizations in the same manner they apply to grants
and contracts with Indian Tribes and Tribal Organizations
with respect to programs on or near reservations.
``(2) Requirements.--The Secretary shall include in the
grants or contracts made or provided under paragraph (1)
requirements that are--
``(A) consistent with the requirements imposed by the
Secretary under subsection (b);
``(B) appropriate to Urban Indian Organizations and Urban
Indians; and
``(C) necessary to effect the purposes of this section.
``(d) Facilitating Cooperation.--The Secretary, acting
through the Centers for Medicare & Medicaid Services, shall
take such steps as are necessary to facilitate cooperation
with, and agreements between, States and the Service, Indian
Tribes, Tribal Organizations, or Urban Indian Organizations
with respect to the provision of health care items and
services to Indians under the programs established under
title XVIII, XIX, or XXI of the Social Security Act.
``(e) Agreements Relating to Improving Enrollment of
Indians Under Social Security Act Health Benefits Programs.--
For provisions relating to agreements between the Secretary,
acting through the Service, and Indian Tribes, Tribal
Organizations, and Urban Indian Organizations for the
collection, preparation, and submission of applications by
Indians for assistance under the Medicaid and State
children's health insurance programs established under titles
XIX and XXI of the Social Security Act, and benefits under
the Medicare program established under title XVIII of such
Act, see subsections (a) and (b) of section 1139 of the
Social Security Act.
``(f) Definition of Premiums and Cost Sharing.--In this
section:
``(1) Premium.--The term `premium' includes any enrollment
fee or similar charge.
``(2) Cost sharing.--The term `cost sharing' includes any
deduction, deductible, copayment, coinsurance, or similar
charge.

``SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS
OF HEALTH SERVICES.

``(a) Right of Recovery.--Except as provided in subsection
(f), the United States, an Indian Tribe, or Tribal
Organization shall have the right to recover from an
insurance company, health maintenance organization, employee
benefit plan, third-party tortfeasor, or any other
responsible or liable third party (including a political
subdivision or local governmental entity of a State) the
reasonable charges billed by the Secretary, an Indian Tribe,
or Tribal Organization in providing health services through
the Service, an Indian Tribe, or Tribal Organization to any
individual to the same extent that such individual, or any
nongovernmental provider of such services, would be eligible
to receive damages, reimbursement, or indemnification for
such charges or expenses if--
``(1) such services had been provided by a nongovernmental
provider; and
``(2) such individual had been required to pay such charges
or expenses and did pay such charges or expenses.
``(b) Limitations on Recoveries From States.--Subsection
(a) shall provide a right of recovery against any State, only
if the injury, illness, or disability for which health
services were provided is covered under--
``(1) workers' compensation laws; or
``(2) a no-fault automobile accident insurance plan or
program.
``(c) Nonapplication of Other Laws.--No law of any State,
or of any political subdivision of a State and no provision
of any contract, insurance or health maintenance organization
policy, employee benefit plan, self-insurance plan, managed
care plan, or other health care plan or program entered into
or renewed after the date of the enactment of the Indian
Health Care Amendments of 1988, shall prevent or hinder the
right of recovery of the United States, an Indian Tribe, or
Tribal Organization under subsection (a).
``(d) No Effect on Private Rights of Action.--No action
taken by the United States, an Indian Tribe, or Tribal
Organization to enforce the right of recovery provided under
this section shall operate to deny to the injured person the
recovery for that portion of the person's damage not covered
hereunder.
``(e) Enforcement.--
``(1) In general.--The United States, an Indian Tribe, or
Tribal Organization may enforce the right of recovery
provided under subsection (a) by--
``(A) intervening or joining in any civil action or
proceeding brought--
``(i) by the individual for whom health services were
provided by the Secretary, an Indian Tribe, or Tribal
Organization; or
``(ii) by any representative or heirs of such individual,
or
``(B) instituting a civil action, including a civil action
for injunctive relief and other relief and including, with
respect to a political subdivision or local governmental
entity of a State, such an action against an official
thereof.
``(2) Notice.--All reasonable efforts shall be made to
provide notice of action instituted under paragraph (1)(B) to
the individual to whom health services were provided, either
before or during the pendency of such action.
``(3) Recovery from tortfeasors.--
``(A) In general.--In any case in which an Indian Tribe or
Tribal Organization that is authorized or required under a
compact or contract issued pursuant to the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.) to furnish or pay for health services to a person who
is injured or suffers a disease on or after the date of
enactment of the Indian Health Care Improvement Act
Amendments of 2007 under circumstances that establish grounds
for a claim of liability against the tortfeasor with respect
to the injury or disease, the Indian Tribe or Tribal
Organization shall have a right to recover from the
tortfeasor (or an insurer of the tortfeasor) the reasonable
value of the health services so furnished, paid for, or to be
paid for, in accordance with the Federal Medical Care
Recovery Act (42 U.S.C. 2651 et seq.), to the same extent and
under the same circumstances as the United States may recover
under that Act.
``(B) Treatment.--The right of an Indian Tribe or Tribal
Organization to recover under subparagraph (A) shall be
independent of the rights of the injured or diseased person
served by the Indian Tribe or Tribal Organization.
``(f) Limitation.--Absent specific written authorization by
the governing body of an Indian Tribe for the period of such
authorization (which may not be for a period of more than 1
year and which may be revoked at any time upon written notice
by the governing body to the Service), the United States
shall not have a right of recovery under this section if the
injury, illness, or disability for which health services were
provided is covered under a self-insurance plan funded by an
Indian Tribe, Tribal Organization, or Urban Indian
Organization. Where such authorization is provided, the
Service may receive and expend such amounts for the provision
of additional health services consistent with such
authorization.
``(g) Costs and Attorneys' Fees.--In any action brought to
enforce the provisions of this section, a prevailing
plaintiff shall be awarded its reasonable attorneys' fees and
costs of litigation.
``(h) Nonapplication of Claims Filing Requirements.--An
insurance company, health maintenance organization, self-
insurance plan, managed care plan, or other health care plan
or program (under the Social Security Act or otherwise) may
not deny a claim for benefits submitted by the Service or by
an Indian Tribe or Tribal Organization based on the format in
which the claim is submitted if such format complies with the
format required for submission of claims under title XVIII of
the Social Security Act or recognized under section 1175 of
such Act.
``(i) Application to Urban Indian Organizations.--The
previous provisions of this section shall apply to Urban
Indian Organizations with respect to populations served by
such Organizations in the same manner they apply to Indian
Tribes and Tribal Organizations with respect to populations
served by such Indian Tribes and Tribal Organizations.
``(j) Statute of Limitations.--The provisions of section
2415 of title 28, United States Code, shall apply to all
actions commenced under this section, and the references
therein to the United States are deemed to include Indian
Tribes, Tribal Organizations, and Urban Indian Organizations.

[[Page S10480]]

``(k) Savings.--Nothing in this section shall be construed
to limit any right of recovery available to the United
States, an Indian Tribe, or Tribal Organization under the
provisions of any applicable, Federal, State, or Tribal law,
including medical lien laws.

``SEC. 404. CREDITING OF REIMBURSEMENTS.

``(a) Use of Amounts.--
``(1) Retention by program.--Except as provided in section
202(f) (relating to the Catastrophic Health Emergency Fund)
and section 807 (relating to health services for ineligible
persons), all reimbursements received or recovered under any
of the programs described in paragraph (2), including under
section 807, by reason of the provision of health services by
the Service, by an Indian Tribe or Tribal Organization, or by
an Urban Indian Organization, shall be credited to the
Service, such Indian Tribe or Tribal Organization, or such
Urban Indian Organization, respectively, and may be used as
provided in section 401. In the case of such a service
provided by or through a Service Unit, such amounts shall be
credited to such unit and used for such purposes.
``(2) Programs covered.--The programs referred to in
paragraph (1) are the following:
``(A) Titles XVIII, XIX, and XXI of the Social Security
Act.
``(B) This Act, including section 807.
``(C) Public Law 87-693.
``(D) Any other provision of law.
``(b) No Offset of Amounts.--The Service may not offset or
limit any amount obligated to any Service Unit or entity
receiving funding from the Service because of the receipt of
reimbursements under subsection (a).

``SEC. 405. PURCHASING HEALTH CARE COVERAGE.

``(a) In General.--Insofar as amounts are made available
under law (including a provision of the Social Security Act,
the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450 et seq.), or other law, other than under
section 402) to Indian Tribes, Tribal Organizations, and
Urban Indian Organizations for health benefits for Service
beneficiaries, Indian Tribes, Tribal Organizations, and Urban
Indian Organizations may use such amounts to purchase health
benefits coverage for such beneficiaries in any manner,
including through--
``(1) a tribally owned and operated health care plan;
``(2) a State or locally authorized or licensed health care
plan;
``(3) a health insurance provider or managed care
organization; or
``(4) a self-insured plan.

The purchase of such coverage by an Indian Tribe, Tribal
Organization, or Urban Indian Organization may be based on
the financial needs of such beneficiaries (as determined by
the Indian Tribe or Tribes being served based on a schedule
of income levels developed or implemented by such Indian
Tribe or Tribes).
``(b) Expenses for Self-Insured Plan.--In the case of a
self-insured plan under subsection (a)(4), the amounts may be
used for expenses of operating the plan, including
administration and insurance to limit the financial risks to
the entity offering the plan.
``(c) Construction.--Nothing in this section shall be
construed as affecting the use of any amounts not referred to
in subsection (a).

``SEC. 406. SHARING ARRANGEMENTS WITH FEDERAL AGENCIES.

``(a) Authority.--
``(1) In general.--The Secretary may enter into (or expand)
arrangements for the sharing of medical facilities and
services between the Service, Indian Tribes, and Tribal
Organizations and the Department of Veterans Affairs and the
Department of Defense.
``(2) Consultation by secretary required.--The Secretary
may not finalize any arrangement between the Service and a
Department described in paragraph (1) without first
consulting with the Indian Tribes which will be significantly
affected by the arrangement.
``(b) Limitations.--The Secretary shall not take any action
under this section or under subchapter IV of chapter 81 of
title 38, United States Code, which would impair--
``(1) the priority access of any Indian to health care
services provided through the Service and the eligibility of
any Indian to receive health services through the Service;
``(2) the quality of health care services provided to any
Indian through the Service;
``(3) the priority access of any veteran to health care
services provided by the Department of Veterans Affairs;
``(4) the quality of health care services provided by the
Department of Veterans Affairs or the Department of Defense;
or
``(5) the eligibility of any Indian who is a veteran to
receive health services through the Department of Veterans
Affairs.
``(c) Reimbursement.--The Service, Indian Tribe, or Tribal
Organization shall be reimbursed by the Department of
Veterans Affairs or the Department of Defense (as the case
may be) where services are provided through the Service, an
Indian Tribe, or a Tribal Organization to beneficiaries
eligible for services from either such Department,
notwithstanding any other provision of law.
``(d) Construction.--Nothing in this section may be
construed as creating any right of a non-Indian veteran to
obtain health services from the Service.

``SEC. 407. PAYOR OF LAST RESORT.

``Indian Health Programs and health care programs operated
by Urban Indian Organizations shall be the payor of last
resort for services provided to persons eligible for services
from Indian Health Programs and Urban Indian Organizations,
notwithstanding any Federal, State, or local law to the
contrary.

``SEC. 408. NONDISCRIMINATION UNDER FEDERAL HEALTH CARE
PROGRAMS IN QUALIFICATIONS FOR REIMBURSEMENT
FOR SERVICES.

``(a) Requirement To Satisfy Generally Applicable
Participation Requirements.--
``(1) In general.--A Federal health care program must
accept an entity that is operated by the Service, an Indian
Tribe, Tribal Organization, or Urban Indian Organization as a
provider eligible to receive payment under the program for
health care services furnished to an Indian on the same basis
as any other provider qualified to participate as a provider
of health care services under the program if the entity meets
generally applicable State or other requirements for
participation as a provider of health care services under the
program.
``(2) Satisfaction of state or local licensure or
recognition requirements.--Any requirement for participation
as a provider of health care services under a Federal health
care program that an entity be licensed or recognized under
the State or local law where the entity is located to furnish
health care services shall be deemed to have been met in the
case of an entity operated by the Service, an Indian Tribe,
Tribal Organization, or Urban Indian Organization if the
entity meets all the applicable standards for such licensure
or recognition, regardless of whether the entity obtains a
license or other documentation under such State or local law.
In accordance with section 221, the absence of the licensure
of a health care professional employed by such an entity
under the State or local law where the entity is located
shall not be taken into account for purposes of determining
whether the entity meets such standards, if the professional
is licensed in another State.
``(b) Application of Exclusion From Participation in
Federal Health Care Programs.--
``(1) Excluded entities.--No entity operated by the
Service, an Indian Tribe, Tribal Organization, or Urban
Indian Organization that has been excluded from participation
in any Federal health care program or for which a license is
under suspension or has been revoked by the State where the
entity is located shall be eligible to receive payment or
reimbursement under any such program for health care services
furnished to an Indian.
``(2) Excluded individuals.--No individual who has been
excluded from participation in any Federal health care
program or whose State license is under suspension shall be
eligible to receive payment or reimbursement under any such
program for health care services furnished by that
individual, directly or through an entity that is otherwise
eligible to receive payment for health care services, to an
Indian.
``(3) Federal health care program defined.--In this
subsection, the term, `Federal health care program' has the
meaning given that term in section 1128B(f) of the Social
Security Act (42 U.S.C. 1320a-7b(f)), except that, for
purposes of this subsection, such term shall include the
health insurance program under chapter 89 of title 5, United
States Code.
``(c) Related Provisions.--For provisions related to
nondiscrimination against providers operated by the Service,
an Indian Tribe, Tribal Organization, or Urban Indian
Organization, see section 1139(c) of the Social Security Act
(42 U.S.C. 1320b-9(c)).

``SEC. 409. CONSULTATION.

``For provisions related to consultation with
representatives of Indian Health Programs and Urban Indian
Organizations with respect to the health care programs
established under titles XVIII, XIX, and XXI of the Social
Security Act, see section 1139(d) of the Social Security Act
(42 U.S.C. 1320b-9(d)).

``SEC. 410. STATE CHILDREN'S HEALTH INSURANCE PROGRAM
(SCHIP).

``For provisions relating to--
``(1) outreach to families of Indian children likely to be
eligible for child health assistance under the State
children's health insurance program established under title
XXI of the Social Security Act, see sections 2105(c)(2)(C)
and 1139(a) of such Act (42 U.S.C. 1397ee(c)(2), 1320b-9);
and
``(2) ensuring that child health assistance is provided
under such program to targeted low-income children who are
Indians and that payments are made under such program to
Indian Health Programs and Urban Indian Organizations
operating in the State that provide such assistance, see
sections 2102(b)(3)(D) and 2105(c)(6)(B) of such Act (42
U.S.C. 1397bb(b)(3)(D), 1397ee(c)(6)(B)).

``SEC. 411. EXCLUSION WAIVER AUTHORITY FOR AFFECTED INDIAN
HEALTH PROGRAMS AND SAFE HARBOR TRANSACTIONS
UNDER THE SOCIAL SECURITY ACT.

``For provisions relating to--
``(1) exclusion waiver authority for affected Indian Health
Programs under the Social Security Act, see section 1128(k)
of the Social Security Act (42 U.S.C. 1320a-7(k)); and
``(2) certain transactions involving Indian Health Programs
deemed to be in safe harbors under that Act, see section
1128B(b)(4) of the Social Security Act (42 U.S.C. 1320a-
7b(b)(4)).

``SEC. 412. PREMIUM AND COST SHARING PROTECTIONS AND
ELIGIBILITY DETERMINATIONS UNDER MEDICAID AND
SCHIP AND PROTECTION OF CERTAIN INDIAN PROPERTY
FROM MEDICAID ESTATE RECOVERY.

``For provisions relating to--

[[Page S10481]]

``(1) premiums or cost sharing protections for Indians
furnished items or services directly by Indian Health
Programs or through referral under the contract health
service under the Medicaid program established under title
XIX of the Social Security Act, see sections 1916(j) and
1916A(a)(1) of the Social Security Act (42 U.S.C. 1396o(j),
1396o-1(a)(1));
``(2) rules regarding the treatment of certain property for
purposes of determining eligibility under such programs, see
sections 1902(e)(13) and 2107(e)(1)(B) of such Act (42 U.S.C.
1396a(e)(13), 1397gg(e)(1)(B)); and
``(3) the protection of certain property from estate
recovery provisions under the Medicaid program, see section
1917(b)(3)(B) of such Act (42 U.S.C. 1396p(b)(3)(B)).

``SEC. 413. TREATMENT UNDER MEDICAID AND SCHIP MANAGED CARE.

``For provisions relating to the treatment of Indians
enrolled in a managed care entity under the Medicaid program
under title XIX of the Social Security Act and Indian Health
Programs and Urban Indian Organizations that are providers of
items or services to such Indian enrollees, see sections
1932(h) and 2107(e)(1)(H) of the Social Security Act (42
U.S.C. 1396u-2(h), 1397gg(e)(1)(H)).

``SEC. 414. NAVAJO NATION MEDICAID AGENCY FEASIBILITY STUDY.

``(a) Study.--The Secretary shall conduct a study to
determine the feasibility of treating the Navajo Nation as a
State for the purposes of title XIX of the Social Security
Act, to provide services to Indians living within the
boundaries of the Navajo Nation through an entity established
having the same authority and performing the same functions
as single-State medicaid agencies responsible for the
administration of the State plan under title XIX of the
Social Security Act.
``(b) Considerations.--In conducting the study, the
Secretary shall consider the feasibility of--
``(1) assigning and paying all expenditures for the
provision of services and related administration funds, under
title XIX of the Social Security Act, to Indians living
within the boundaries of the Navajo Nation that are currently
paid to or would otherwise be paid to the State of Arizona,
New Mexico, or Utah;
``(2) providing assistance to the Navajo Nation in the
development and implementation of such entity for the
administration, eligibility, payment, and delivery of medical
assistance under title XIX of the Social Security Act;
``(3) providing an appropriate level of matching funds for
Federal medical assistance with respect to amounts such
entity expends for medical assistance for services and
related administrative costs; and
``(4) authorizing the Secretary, at the option of the
Navajo Nation, to treat the Navajo Nation as a State for the
purposes of title XIX of the Social Security Act (relating to
the State children's health insurance program) under terms
equivalent to those described in paragraphs (2) through (4).
``(c) Report.--Not later then 3 years after the date of
enactment of the Indian Health Care Improvement Act
Amendments of 2007, the Secretary shall submit to the
Committee on Indian Affairs and Committee on Finance of the
Senate and the Committee on Natural Resources and Committee
on Energy and Commerce of the House of Representatives a
report that includes--
``(1) the results of the study under this section;
``(2) a summary of any consultation that occurred between
the Secretary and the Navajo Nation, other Indian Tribes, the
States of Arizona, New Mexico, and Utah, counties which
include Navajo Lands, and other interested parties, in
conducting this study;
``(3) projected costs or savings associated with
establishment of such entity, and any estimated impact on
services provided as described in this section in relation to
probable costs or savings; and
``(4) legislative actions that would be required to
authorize the establishment of such entity if such entity is
determined by the Secretary to be feasible.

``SEC. 415. GENERAL EXCEPTIONS.

``The requirements of this title shall not apply to any
excepted benefits described in paragraph (1)(A) or (3) of
section 2791(c) of the Public Health Service Act (42 U.S.C.
300gg-91).

``SEC. 416. AUTHORIZATION OF APPROPRIATIONS.

``There are authorized to be appropriated such sums as may
be necessary for each fiscal year through fiscal year 2017 to
carry out this title.

``TITLE V--HEALTH SERVICES FOR URBAN INDIANS

``SEC. 501. PURPOSE.

``The purpose of this title is to establish and maintain
programs in Urban Centers to make health services more
accessible and available to Urban Indians.

``SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN INDIAN
ORGANIZATIONS.

``Under authority of the Act of November 2, 1921 (25 U.S.C.
13) (commonly known as the `Snyder Act'), the Secretary,
acting through the Service, shall enter into contracts with,
or make grants to, Urban Indian Organizations to assist such
organizations in the establishment and administration, within
Urban Centers, of programs which meet the requirements set
forth in this title. Subject to section 506, the Secretary,
acting through the Service, shall include such conditions as
the Secretary considers necessary to effect the purpose of
this title in any contract into which the Secretary enters
with, or in any grant the Secretary makes to, any Urban
Indian Organization pursuant to this title.

``SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION OF HEALTH
CARE AND REFERRAL SERVICES.

``(a) Requirements for Grants and Contracts.--Under
authority of the Act of November 2, 1921 (25 U.S.C. 13)
(commonly known as the `Snyder Act'), the Secretary, acting
through the Service, shall enter into contracts with, and
make grants to, Urban Indian Organizations for the provision
of health care and referral services for Urban Indians. Any
such contract or grant shall include requirements that the
Urban Indian Organization successfully undertake to--
``(1) estimate the population of Urban Indians residing in
the Urban Center or centers that the organization proposes to
serve who are or could be recipients of health care or
referral services;
``(2) estimate the current health status of Urban Indians
residing in such Urban Center or centers;
``(3) estimate the current health care needs of Urban
Indians residing in such Urban Center or centers;
``(4) provide basic health education, including health
promotion and disease prevention education, to Urban Indians;
``(5) make recommendations to the Secretary and Federal,
State, local, and other resource agencies on methods of
improving health service programs to meet the needs of Urban
Indians; and
``(6) where necessary, provide, or enter into contracts for
the provision of, health care services for Urban Indians.
``(b) Criteria.--The Secretary, acting through the Service,
shall, by regulation, prescribe the criteria for selecting
Urban Indian Organizations to enter into contracts or receive
grants under this section. Such criteria shall, among other
factors, include--
``(1) the extent of unmet health care needs of Urban
Indians in the Urban Center or centers involved;
``(2) the size of the Urban Indian population in the Urban
Center or centers involved;
``(3) the extent, if any, to which the activities set forth
in subsection (a) would duplicate any project funded under
this title, or under any current public health service
project funded in a manner other than pursuant to this title;
``(4) the capability of an Urban Indian Organization to
perform the activities set forth in subsection (a) and to
enter into a contract with the Secretary or to meet the
requirements for receiving a grant under this section;
``(5) the satisfactory performance and successful
completion by an Urban Indian Organization of other contracts
with the Secretary under this title;
``(6) the appropriateness and likely effectiveness of
conducting the activities set forth in subsection (a) in an
Urban Center or centers; and
``(7) the extent of existing or likely future participation
in the activities set forth in subsection (a) by appropriate
health and health-related Federal, State, local, and other
agencies.
``(c) Access to Health Promotion and Disease Prevention
Programs.--The Secretary, acting through the Service, shall
facilitate access to or provide health promotion and disease
prevention services for Urban Indians through grants made to
Urban Indian Organizations administering contracts entered
into or receiving grants under subsection (a).
``(d) Immunization Services.--
``(1) Access or services provided.--The Secretary, acting
through the Service, shall facilitate access to, or provide,
immunization services for Urban Indians through grants made
to Urban Indian Organizations administering contracts entered
into or receiving grants under this section.
``(2) Definition.--For purposes of this subsection, the
term `immunization services' means services to provide
without charge immunizations against vaccine-preventable
diseases.
``(e) Behavioral Health Services.--
``(1) Access or services provided.--The Secretary, acting
through the Service, shall facilitate access to, or provide,
behavioral health services for Urban Indians through grants
made to Urban Indian Organizations administering contracts
entered into or receiving grants under subsection (a).
``(2) Assessment required.--Except as provided by paragraph
(3)(A), a grant may not be made under this subsection to an
Urban Indian Organization until that organization has
prepared, and the Service has approved, an assessment of the
following:
``(A) The behavioral health needs of the Urban Indian
population concerned.
``(B) The behavioral health services and other related
resources available to that population.
``(C) The barriers to obtaining those services and
resources.
``(D) The needs that are unmet by such services and
resources.
``(3) Purposes of grants.--Grants may be made under this
subsection for the following:
``(A) To prepare assessments required under paragraph (2).
``(B) To provide outreach, educational, and referral
services to Urban Indians regarding the availability of
direct behavioral health services, to educate Urban Indians
about behavioral health issues and services, and effect
coordination with existing behavioral health providers in
order to improve services to Urban Indians.

[[Page S10482]]

``(C) To provide outpatient behavioral health services to
Urban Indians, including the identification and assessment of
illness, therapeutic treatments, case management, support
groups, family treatment, and other treatment.
``(D) To develop innovative behavioral health service
delivery models which incorporate Indian cultural support
systems and resources.
``(f) Prevention of Child Abuse.--
``(1) Access or services provided.--The Secretary, acting
through the Service, shall facilitate access to or provide
services for Urban Indians through grants to Urban Indian
Organizations administering contracts entered into or
receiving grants under subsection (a) to prevent and treat
child abuse (including sexual abuse) among Urban Indians.
``(2) Evaluation required.--Except as provided by paragraph
(3)(A), a grant may not be made under this subsection to an
Urban Indian Organization until that organization has
prepared, and the Service has approved, an assessment that
documents the prevalence of child abuse in the Urban Indian
population concerned and specifies the services and programs
(which may not duplicate existing services and programs) for
which the grant is requested.
``(3) Purposes of grants.--Grants may be made under this
subsection for the following:
``(A) To prepare assessments required under paragraph (2).
``(B) For the development of prevention, training, and
education programs for Urban Indians, including child
education, parent education, provider training on
identification and intervention, education on reporting
requirements, prevention campaigns, and establishing service
networks of all those involved in Indian child protection.
``(C) To provide direct outpatient treatment services
(including individual treatment, family treatment, group
therapy, and support groups) to Urban Indians who are child
victims of abuse (including sexual abuse) or adult survivors
of child sexual abuse, to the families of such child victims,
and to Urban Indian perpetrators of child abuse (including
sexual abuse).
``(4) Considerations when making grants.--In making grants
to carry out this subsection, the Secretary shall take into
consideration--
``(A) the support for the Urban Indian Organization
demonstrated by the child protection authorities in the area,
including committees or other services funded under the
Indian Child Welfare Act of 1978 (25 U.S.C. 1901 et seq.), if
any;
``(B) the capability and expertise demonstrated by the
Urban Indian Organization to address the complex problem of
child sexual abuse in the community; and
``(C) the assessment required under paragraph (2).
``(g) Other Grants.--The Secretary, acting through the
Service, may enter into a contract with or make grants to an
Urban Indian Organization that provides or arranges for the
provision of health care services (through satellite
facilities, provider networks, or otherwise) to Urban Indians
in more than 1 Urban Center.

``SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINATION OF
UNMET HEALTH CARE NEEDS.

``(a) Grants and Contracts Authorized.--Under authority of
the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as
the `Snyder Act'), the Secretary, acting through the Service,
may enter into contracts with or make grants to Urban Indian
Organizations situated in Urban Centers for which contracts
have not been entered into or grants have not been made under
section 503.
``(b) Purpose.--The purpose of a contract or grant made
under this section shall be the determination of the matters
described in subsection (c)(1) in order to assist the
Secretary in assessing the health status and health care
needs of Urban Indians in the Urban Center involved and
determining whether the Secretary should enter into a
contract or make a grant under section 503 with respect to
the Urban Indian Organization which the Secretary has entered
into a contract with, or made a grant to, under this section.
``(c) Grant and Contract Requirements.--Any contract
entered into, or grant made, by the Secretary under this
section shall include requirements that--
``(1) the Urban Indian Organization successfully undertakes
to--
``(A) document the health care status and unmet health care
needs of Urban Indians in the Urban Center involved; and
``(B) with respect to Urban Indians in the Urban Center
involved, determine the matters described in paragraphs (2),
(3), (4), and (7) of section 503(b); and
``(2) the Urban Indian Organization complete performance of
the contract, or carry out the requirements of the grant,
within 1 year after the date on which the Secretary and such
organization enter into such contract, or within 1 year after
such organization receives such grant, whichever is
applicable.
``(d) No Renewals.--The Secretary may not renew any
contract entered into or grant made under this section.

``SEC. 505. EVALUATIONS; RENEWALS.

``(a) Procedures for Evaluations.--The Secretary, acting
through the Service, shall develop procedures to evaluate
compliance with grant requirements and compliance with and
performance of contracts entered into by Urban Indian
Organizations under this title. Such procedures shall include
provisions for carrying out the requirements of this section.
``(b) Evaluations.--The Secretary, acting through the
Service, shall evaluate the compliance of each Urban Indian
Organization which has entered into a contract or received a
grant under section 503 with the terms of such contract or
grant. For purposes of this evaluation, the Secretary shall--
``(1) acting through the Service, conduct an annual onsite
evaluation of the organization; or
``(2) accept in lieu of such onsite evaluation evidence of
the organization's provisional or full accreditation by a
private independent entity recognized by the Secretary for
purposes of conducting quality reviews of providers
participating in the Medicare program under title XVIII of
the Social Security Act.
``(c) Noncompliance; Unsatisfactory Performance.--If, as a
result of the evaluations conducted under this section, the
Secretary determines that an Urban Indian Organization has
not complied with the requirements of a grant or complied
with or satisfactorily performed a contract under section
503, the Secretary shall, prior to renewing such contract or
grant, attempt to resolve with the organization the areas of
noncompliance or unsatisfactory performance and modify the
contract or grant to prevent future occurrences of
noncompliance or unsatisfactory performance. If the Secretary
determines that the noncompliance or unsatisfactory
performance cannot be resolved and prevented in the future,
the Secretary shall not renew the contract or grant with the
organization and is authorized to enter into a contract or
make a grant under section 503 with another Urban Indian
Organization which is situated in the same Urban Center as
the Urban Indian Organization whose contract or grant is not
renewed under this section.
``(d) Considerations for Renewals.--In determining whether
to renew a contract or grant with an Urban Indian
Organization under section 503 which has completed
performance of a contract or grant under section 504, the
Secretary shall review the records of the Urban Indian
Organization, the reports submitted under section 507, and
shall consider the results of the onsite evaluations or
accreditations under subsection (b).

``SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS.

``(a) Procurement.--Contracts with Urban Indian
Organizations entered into pursuant to this title shall be in
accordance with all Federal contracting laws and regulations
relating to procurement except that in the discretion of the
Secretary, such contracts may be negotiated without
advertising and need not conform to the provisions of
sections 1304 and 3131 through 3133 of title 40, United
States Code.
``(b) Payments Under Contracts or Grants.--
``(1) In general.--Payments under any contracts or grants
pursuant to this title, notwithstanding any term or condition
of such contract or grant--
``(A) may be made in a single advance payment by the
Secretary to the Urban Indian Organization by no later than
the end of the first 30 days of the funding period with
respect to which the payments apply, unless the Secretary
determines through an evaluation under section 505 that the
organization is not capable of administering such a single
advance payment; and
``(B) if any portion thereof is unexpended by the Urban
Indian Organization during the funding period with respect to
which the payments initially apply, shall be carried forward
for expenditure with respect to allowable or reimbursable
costs incurred by the organization during 1 or more
subsequent funding periods without additional justification
or documentation by the organization as a condition of
carrying forward the availability for expenditure of such
funds.
``(2) Semiannual and quarterly payments and
reimbursements.--If the Secretary determines under paragraph
(1)(A) that an Urban Indian Organization is not capable of
administering an entire single advance payment, on request of
the Urban Indian Organization, the payments may be made--
``(A) in semiannual or quarterly payments by not later than
30 days after the date on which the funding period with
respect to which the payments apply begins; or
``(B) by way of reimbursement.
``(c) Revision or Amendment of Contracts.--Notwithstanding
any provision of law to the contrary, the Secretary may, at
the request and consent of an Urban Indian Organization,
revise or amend any contract entered into by the Secretary
with such organization under this title as necessary to carry
out the purposes of this title.
``(d) Fair and Uniform Services and Assistance.--Contracts
with or grants to Urban Indian Organizations and regulations
adopted pursuant to this title shall include provisions to
assure the fair and uniform provision to Urban Indians of
services and assistance under such contracts or grants by
such organizations.

``SEC. 507. REPORTS AND RECORDS.

``(a) Reports.--
``(1) In general.--For each fiscal year during which an
Urban Indian Organization receives or expends funds pursuant
to a contract entered into or a grant received pursuant to
this title, such Urban Indian Organization shall submit to
the Secretary not

[[Page S10483]]

more frequently than every 6 months, a report that includes
the following:
``(A) In the case of a contract or grant under section 503,
recommendations pursuant to section 503(a)(5).
``(B) Information on activities conducted by the
organization pursuant to the contract or grant.
``(C) An accounting of the amounts and purpose for which
Federal funds were expended.
``(D) A minimum set of data, using uniformly defined
elements, as specified by the Secretary after consultation
with Urban Indian Organizations.
``(2) Health status and services.--
``(A) In general.--Not later than 18 months after the date
of enactment of the Indian Health Care Improvement Act
Amendments of 2007, the Secretary, acting through the Service
and working with a national membership-based consortium of
Urban Indian Organizations, shall submit to Congress a report
evaluating--
``(i) the health status of Urban Indians;
``(ii) the services provided to Indians pursuant to this
title; and
``(iii) areas of unmet needs in the delivery of health
services to Urban Indians, including unmet health care
facilities needs.
``(B) Consultation and contracts.--In preparing the report
under paragraph (1), the Secretary--
``(i) shall confer with Urban Indian Organizations; and
``(ii) may enter into a contract with a national
organization representing Urban Indian Organizations to
conduct any aspect of the report.
``(b) Audit.--The reports and records of the Urban Indian
Organization with respect to a contract or grant under this
title shall be subject to audit by the Secretary and the
Comptroller General of the United States.
``(c) Costs of Audits.--The Secretary shall allow as a cost
of any contract or grant entered into or awarded under
section 502 or 503 the cost of an annual independent
financial audit conducted by--
``(1) a certified public accountant; or
``(2) a certified public accounting firm qualified to
conduct Federal compliance audits.

``SEC. 508. LIMITATION ON CONTRACT AUTHORITY.

``The authority of the Secretary to enter into contracts or
to award grants under this title shall be to the extent, and
in an amount, provided for in appropriation Acts.

``SEC. 509. FACILITIES.

``(a) Grants.--The Secretary, acting through the Service,
may make grants to contractors or grant recipients under this
title for the lease, purchase, renovation, construction, or
expansion of facilities, including leased facilities, in
order to assist such contractors or grant recipients in
complying with applicable licensure or certification
requirements.
``(b) Loan Fund Study.--The Secretary, acting through the
Service, may carry out a study to determine the feasibility
of establishing a loan fund to provide to Urban Indian
Organizations direct loans or guarantees for loans for the
construction of health care facilities in a manner consistent
with section 309, including by submitting a report in
accordance with subsection (c) of that section.

``SEC. 510. DIVISION OF URBAN INDIAN HEALTH.

``There is established within the Service a Division of
Urban Indian Health, which shall be responsible for--
``(1) carrying out the provisions of this title;
``(2) providing central oversight of the programs and
services authorized under this title; and
``(3) providing technical assistance to Urban Indian
Organizations working with a national membership-based
consortium of Urban Indian Organizations.

``SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE-RELATED
SERVICES.

``(a) Grants Authorized.--The Secretary, acting through the
Service, may make grants for the provision of health-related
services in prevention of, treatment of, rehabilitation of,
or school- and community-based education regarding, alcohol
and substance abuse, including fetal alcohol spectrum
disorders, in Urban Centers to those Urban Indian
Organizations with which the Secretary has entered into a
contract under this title or under section 201.
``(b) Goals.--Each grant made pursuant to subsection (a)
shall set forth the goals to be accomplished pursuant to the
grant. The goals shall be specific to each grant as agreed to
between the Secretary and the grantee.
``(c) Criteria.--The Secretary shall establish criteria for
the grants made under subsection (a), including criteria
relating to the following:
``(1) The size of the Urban Indian population.
``(2) Capability of the organization to adequately perform
the activities required under the grant.
``(3) Satisfactory performance standards for the
organization in meeting the goals set forth in such grant.
The standards shall be negotiated and agreed to between the
Secretary and the grantee on a grant-by-grant basis.
``(4) Identification of the need for services.
``(d) Allocation of Grants.--The Secretary shall develop a
methodology for allocating grants made pursuant to this
section based on the criteria established pursuant to
subsection (c).
``(e) Grants Subject to Criteria.--Any grant received by an
Urban Indian Organization under this Act for substance abuse
prevention, treatment, and rehabilitation shall be subject to
the criteria set forth in subsection (c).

``SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION PROJECTS.

``Notwithstanding any other provision of law, the Tulsa
Clinic and Oklahoma City Clinic demonstration projects
shall--
``(1) be permanent programs within the Service's direct
care program;
``(2) continue to be treated as Service Units and Operating
Units in the allocation of resources and coordination of
care; and
``(3) continue to meet the requirements and definitions of
an Urban Indian Organization in this Act, and shall not be
subject to the provisions of the Indian Self-Determination
and Education Assistance Act (25 U.S.C. 450 et seq.).

``SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS.

``(a) Grants and Contracts.--The Secretary, through the
Division of Urban Indian Health, shall make grants to, or
enter into contracts with, Urban Indian Organizations, to
take effect not later than September 30, 2010, for the
administration of Urban Indian alcohol programs that were
originally established under the National Institute on
Alcoholism and Alcohol Abuse (hereafter in this section
referred to as `NIAAA') and transferred to the Service.
``(b) Use of Funds.--Grants provided or contracts entered
into under this section shall be used to provide support for
the continuation of alcohol prevention and treatment services
for Urban Indian populations and such other objectives as are
agreed upon between the Service and a recipient of a grant or
contract under this section.
``(c) Eligibility.--Urban Indian Organizations that operate
Indian alcohol programs originally funded under the NIAAA and
subsequently transferred to the Service are eligible for
grants or contracts under this section.
``(d) Report.--The Secretary shall evaluate and report to
Congress on the activities of programs funded under this
section not less than every 5 years.

``SEC. 514. CONFERRING WITH URBAN INDIAN ORGANIZATIONS.

``(a) In General.--The Secretary shall ensure that the
Service confers or conferences, to the greatest extent
practicable, with Urban Indian Organizations.
``(b) Definition of Confer; Conference.--In this section,
the terms `confer' and `conference' mean an open and free
exchange of information and opinions that--
``(1) leads to mutual understanding and comprehension; and
``(2) emphasizes trust, respect, and shared responsibility.

``SEC. 515. URBAN YOUTH TREATMENT CENTER DEMONSTRATION.

``(a) Construction and Operation.--
``(1) In general.--The Secretary, acting through the
Service, through grant or contract, shall fund the
construction and operation of at least 1 residential
treatment center in each Service Area that meets the
eligibility requirements set forth in subsection (b) to
demonstrate the provision of alcohol and substance abuse
treatment services to Urban Indian youth in a culturally
competent residential setting.
``(2) Treatment.--Each residential treatment center
described in paragraph (1) shall be in addition to any
facilities constructed under section 707(b).
``(b) Eligibility Requirements.--To be eligible to obtain a
facility under subsection (a)(1), a Service Area shall meet
the following requirements:
``(1) There is an Urban Indian Organization in the Service
Area.
``(2) There reside in the Service Area Urban Indian youth
with need for alcohol and substance abuse treatment services
in a residential setting.
``(3) There is a significant shortage of culturally
competent residential treatment services for Urban Indian
youth in the Service Area.

``SEC. 516. GRANTS FOR DIABETES PREVENTION, TREATMENT, AND
CONTROL.

``(a) Grants Authorized.--The Secretary may make grants to
those Urban Indian Organizations that have entered into a
contract or have received a grant under this title for the
provision of services for the prevention and treatment of,
and control of the complications resulting from, diabetes
among Urban Indians.
``(b) Goals.--Each grant made pursuant to subsection (a)
shall set forth the goals to be accomplished under the grant.
The goals shall be specific to each grant as agreed to
between the Secretary and the grantee.
``(c) Establishment of Criteria.--The Secretary shall
establish criteria for the grants made under subsection (a)
relating to--
``(1) the size and location of the Urban Indian population
to be served;
``(2) the need for prevention of and treatment of, and
control of the complications resulting from, diabetes among
the Urban Indian population to be served;
``(3) performance standards for the organization in meeting
the goals set forth in such grant that are negotiated and
agreed to by the Secretary and the grantee;
``(4) the capability of the organization to adequately
perform the activities required under the grant; and

[[Page S10484]]

``(5) the willingness of the organization to collaborate
with the registry, if any, established by the Secretary under
section 204(e) in the Area Office of the Service in which the
organization is located.
``(d) Funds Subject to Criteria.--Any funds received by an
Urban Indian Organization under this Act for the prevention,
treatment, and control of diabetes among Urban Indians shall
be subject to the criteria developed by the Secretary under
subsection (c).

``SEC. 517. COMMUNITY HEALTH REPRESENTATIVES.

``The Secretary, acting through the Service, may enter into
contracts with, and make grants to, Urban Indian
Organizations for the employment of Indians trained as health
service providers through the Community Health
Representatives Program under section 109 in the provision of
health care, health promotion, and disease prevention
services to Urban Indians.

``SEC. 518. EFFECTIVE DATE.

``The amendments made by the Indian Health Care Improvement
Act Amendments of 2007 to this title shall take effect
beginning on the date of enactment of that Act, regardless of
whether the Secretary has promulgated regulations
implementing such amendments.

``SEC. 519. ELIGIBILITY FOR SERVICES.

``Urban Indians shall be eligible for, and the ultimate
beneficiaries of, health care or referral services provided
pursuant to this title.

``SEC. 520. FURTHER AUTHORIZATIONS.

``The Secretary, acting through the Service, is authorized
to establish programs, including programs for the awarding of
grants, for Urban Indian Organizations that are identical to
any programs established pursuant to sections 126, 210, 212,
701, and 707(g).

``SEC. 521. AUTHORIZATION OF APPROPRIATIONS.

``There are authorized to be appropriated such sums as may
be necessary for each fiscal year through fiscal year 2017 to
carry out this title.

``TITLE VI--ORGANIZATIONAL IMPROVEMENTS

``SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERVICE AS AN
AGENCY OF THE PUBLIC HEALTH SERVICE.

``(a) Establishment.--
``(1) In general.--In order to more effectively and
efficiently carry out the responsibilities, authorities, and
functions of the United States to provide health care
services to Indians and Indian Tribes, as are or may be
hereafter provided by Federal statute or treaties, there is
established within the Public Health Service of the
Department the Indian Health Service.
``(2) Assistant secretary for indian health.--The Service
shall be administered by an Assistant Secretary for Indian
Health, who shall be appointed by the President, by and with
the advice and consent of the Senate. The Assistant Secretary
shall report to the Secretary. Effective with respect to an
individual appointed by the President, by and with the advice
and consent of the Senate, after January 1, 2007, the term of
service of the Assistant Secretary shall be 4 years. An
Assistant Secretary may serve more than 1 term.
``(3) Incumbent.--The individual serving in the position of
Director of the Service on the day before the date of
enactment of the Indian Health Care Improvement Act
Amendments of 2007 shall serve as Assistant Secretary.
``(4) Advocacy and consultation.--The position of Assistant
Secretary is established to, in a manner consistent with the
government-to-government relationship between the United
States and Indian Tribes--
``(A) facilitate advocacy for the development of
appropriate Indian health policy; and
``(B) promote consultation on matters relating to Indian
health.
``(b) Agency.--The Service shall be an agency within the
Public Health Service of the Department, and shall not be an
office, component, or unit of any other agency of the
Department.
``(c) Duties.--The Assistant Secretary shall--
``(1) perform all functions that were, on the day before
the date of enactment of the Indian Health Care Improvement
Act Amendments of 2007, carried out by or under the direction
of the individual serving as Director of the Service on that
day;
``(2) perform all functions of the Secretary relating to
the maintenance and operation of hospital and health
facilities for Indians and the planning for, and provision
and utilization of, health services for Indians;
``(3) administer all health programs under which health
care is provided to Indians based upon their status as
Indians which are administered by the Secretary, including
programs under--
``(A) this Act;
``(B) the Act of November 2, 1921 (25 U.S.C. 13);
``(C) the Act of August 5, 1954 (42 U.S.C. 2001 et seq.);
``(D) the Act of August 16, 1957 (42 U.S.C. 2005 et seq.);
and
``(E) the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.);
``(4) administer all scholarship and loan functions carried
out under title I;
``(5) report directly to the Secretary concerning all
policy- and budget-related matters affecting Indian health;
``(6) collaborate with the Assistant Secretary for Health
concerning appropriate matters of Indian health that affect
the agencies of the Public Health Service;
``(7) advise each Assistant Secretary of the Department
concerning matters of Indian health with respect to which
that Assistant Secretary has authority and responsibility;
``(8) advise the heads of other agencies and programs of
the Department concerning matters of Indian health with
respect to which those heads have authority and
responsibility;
``(9) coordinate the activities of the Department
concerning matters of Indian health; and
``(10) perform such other functions as the Secretary may
designate.
``(d) Authority.--
``(1) In general.--The Secretary, acting through the
Assistant Secretary, shall have the authority--
``(A) except to the extent provided for in paragraph (2),
to appoint and compensate employees for the Service in
accordance with title 5, United States Code;
``(B) to enter into contracts for the procurement of goods
and services to carry out the functions of the Service; and
``(C) to manage, expend, and obligate all funds
appropriated for the Service.
``(2) Personnel actions.--Notwithstanding any other
provision of law, the provisions of section 12 of the Act of
June 18, 1934 (48 Stat. 986; 25 U.S.C. 472), shall apply to
all personnel actions taken with respect to new positions
created within the Service as a result of its establishment
under subsection (a).
``(e) References.--Any reference to the Director of the
Indian Health Service in any other Federal law, Executive
order, rule, regulation, or delegation of authority, or in
any document of or relating to the Director of the Indian
Health Service, shall be deemed to refer to the Assistant
Secretary.

``SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM.

``(a) Establishment.--
``(1) In general.--The Secretary shall establish an
automated management information system for the Service.
``(2) Requirements of system.--The information system
established under paragraph (1) shall include--
``(A) a financial management system;
``(B) a patient care information system for each area
served by the Service;
``(C) a privacy component that protects the privacy of
patient information held by, or on behalf of, the Service;
``(D) a services-based cost accounting component that
provides estimates of the costs associated with the provision
of specific medical treatments or services in each Area
office of the Service;
``(E) an interface mechanism for patient billing and
accounts receivable system; and
``(F) a training component.
``(b) Provision of Systems to Tribes and Organizations.--
The Secretary shall provide each Tribal Health Program
automated management information systems which--
``(1) meet the management information needs of such Tribal
Health Program with respect to the treatment by the Tribal
Health Program of patients of the Service; and
``(2) meet the management information needs of the Service.
``(c) Access to Records.--Notwithstanding any other
provision of law, each patient shall have reasonable access
to the medical or health records of such patient which are
held by, or on behalf of, the Service.
``(d) Authority To Enhance Information Technology.--The
Secretary, acting through the Assistant Secretary, shall have
the authority to enter into contracts, agreements, or joint
ventures with other Federal agencies, States, private and
nonprofit organizations, for the purpose of enhancing
information technology in Indian Health Programs and
facilities.

``SEC. 603. AUTHORIZATION OF APPROPRIATIONS.

``There is authorized to be appropriated such sums as may
be necessary for each fiscal year through fiscal year 2017 to
carry out this title.

``TITLE VII--BEHAVIORAL HEALTH PROGRAMS

``SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREATMENT
SERVICES.

``(a) Purposes.--The purposes of this section are as
follows:
``(1) To authorize and direct the Secretary, acting through
the Service, Indian Tribes and Tribal Organizations to
develop a comprehensive behavioral health prevention and
treatment program which emphasizes collaboration among
alcohol and substance abuse, social services, and mental
health programs.
``(2) To provide information, direction, and guidance
relating to mental illness and dysfunction and self-
destructive behavior, including child abuse and family
violence, to those Federal, tribal, State, and local agencies
responsible for programs in Indian communities in areas of
health care, education, social services, child and family
welfare, alcohol and substance abuse, law enforcement, and
judicial services.
``(3) To assist Indian Tribes to identify services and
resources available to address mental illness and
dysfunctional and self-destructive behavior.
``(4) To provide authority and opportunities for Indian
Tribes and Tribal Organizations to develop, implement, and
coordinate with community-based programs which include
identification, prevention, education, referral, and
treatment services, including through multidisciplinary
resource teams.

[[Page S10485]]

``(5) To ensure that Indians, as citizens of the United
States and of the States in which they reside, have the same
access to behavioral health services to which all citizens
have access.
``(6) To modify or supplement existing programs and
authorities in the areas identified in paragraph (2).
``(b) Plans.--
``(1) Development.--The Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, shall
encourage Indian Tribes and Tribal Organizations to develop
tribal plans and to participate in developing areawide plans
for Indian Behavioral Health Services. The plans shall
include, to the extent feasible, the following components:
``(A) An assessment of the scope of alcohol or other
substance abuse, mental illness, and dysfunctional and self-
destructive behavior, including suicide, child abuse, and
family violence, among Indians, including--
``(i) the number of Indians served who are directly or
indirectly affected by such illness or behavior; or
``(ii) an estimate of the financial and human cost
attributable to such illness or behavior.
``(B) An assessment of the existing and additional
resources necessary for the prevention and treatment of such
illness and behavior, including an assessment of the progress
toward achieving the availability of the full continuum of
care described in subsection (c).
``(C) An estimate of the additional funding needed by the
Service, Indian Tribes, and Tribal Organizations to meet
their responsibilities under the plans.
``(2) Coordination with national clearinghouses and
information centers.--The Secretary, acting through the
Service, shall coordinate with existing national
clearinghouses and information centers to include at the
clearinghouses and centers plans and reports on the outcomes
of such plans developed by Indian Tribes, Tribal
Organizations, and Service Areas relating to behavioral
health. The Secretary shall ensure access to these plans and
outcomes by any Indian Tribe, Tribal Organization, or the
Service.
``(3) Technical assistance.--The Secretary shall provide
technical assistance to Indian Tribes and Tribal
Organizations in preparation of plans under this section and
in developing standards of care that may be used and adopted
locally.
``(c) Programs.--The Secretary, acting through the Service,
Indian Tribes, and Tribal Organizations, shall provide, to
the extent feasible and if funding is available, programs
including the following:
``(1) Comprehensive care.--A comprehensive continuum of
behavioral health care which provides--
``(A) community-based prevention, intervention, outpatient,
and behavioral health aftercare;
``(B) detoxification (social and medical);
``(C) acute hospitalization;
``(D) intensive outpatient/day treatment;
``(E) residential treatment;
``(F) transitional living for those needing a temporary,
stable living environment that is supportive of treatment and
recovery goals;
``(G) emergency shelter;
``(H) intensive case management; and
``(I) diagnostic services.
``(2) Child care.--Behavioral health services for Indians
from birth through age 17, including--
``(A) preschool and school age fetal alcohol spectrum
disorder services, including assessment and behavioral
intervention;
``(B) mental health and substance abuse services
(emotional, organic, alcohol, drug, inhalant, and tobacco);
``(C) identification and treatment of co-occurring
disorders and comorbidity;
``(D) prevention of alcohol, drug, inhalant, and tobacco
use;
``(E) early intervention, treatment, and aftercare;
``(F) promotion of healthy approaches to risk and safety
issues; and
``(G) identification and treatment of neglect and physical,
mental, and sexual abuse.
``(3) Adult care.--Behavioral health services for Indians
from age 18 through 55, including--
``(A) early intervention, treatment, and aftercare;
``(B) mental health and substance abuse services
(emotional, alcohol, drug, inhalant, and tobacco), including
sex specific services;
``(C) identification and treatment of co-occurring
disorders (dual diagnosis) and comorbidity;
``(D) promotion of healthy approaches for risk-related
behavior;
``(E) treatment services for women at risk of a fetal
alcohol-exposed pregnancy; and
``(F) sex specific treatment for sexual assault and
domestic violence.
``(4) Family care.--Behavioral health services for
families, including--
``(A) early intervention, treatment, and aftercare for
affected families;
``(B) treatment for sexual assault and domestic violence;
and
``(C) promotion of healthy approaches relating to
parenting, domestic violence, and other abuse issues.
``(5) Elder care.--Behavioral health services for Indians
56 years of age and older, including--
``(A) early intervention, treatment, and aftercare;
``(B) mental health and substance abuse services
(emotional, alcohol, drug, inhalant, and tobacco), including
sex specific services;
``(C) identification and treatment of co-occurring
disorders (dual diagnosis) and comorbidity;
``(D) promotion of healthy approaches to managing
conditions related to aging;
``(E) sex specific treatment for sexual assault, domestic
violence, neglect, physical and mental abuse and
exploitation; and
``(F) identification and treatment of dementias regardless
of cause.
``(d) Community Behavioral Health Plan.--
``(1) Establishment.--The governing body of any Indian
Tribe or Tribal Organization may adopt a resolution for the
establishment of a community behavioral health plan providing
for the identification and coordination of available
resources and programs to identify, prevent, or treat
substance abuse, mental illness, or dysfunctional and self-
destructive behavior, including child abuse and family
violence, among its members or its service population. This
plan should include behavioral health services, social
services, intensive outpatient services, and continuing
aftercare.
``(2) Technical assistance.--At the request of an Indian
Tribe or Tribal Organization, the Bureau of Indian Affairs
and the Service shall cooperate with and provide technical
assistance to the Indian Tribe or Tribal Organization in the
development and implementation of such plan.
``(3) Funding.--The Secretary, acting through the Service,
may make funding available to Indian Tribes and Tribal
Organizations which adopt a resolution pursuant to paragraph
(1) to obtain technical assistance for the development of a
community behavioral health plan and to provide
administrative support in the implementation of such plan.
``(e) Coordination for Availability of Services.--The
Secretary, acting through the Service, Indian Tribes, and
Tribal Organizations, shall coordinate behavioral health
planning, to the extent feasible, with other Federal agencies
and with State agencies, to encourage comprehensive
behavioral health services for Indians regardless of their
place of residence.
``(f) Mental Health Care Need Assessment.--Not later than 1
year after the date of enactment of the Indian Health Care
Improvement Act Amendments of 2007, the Secretary, acting
through the Service, shall make an assessment of the need for
inpatient mental health care among Indians and the
availability and cost of inpatient mental health facilities
which can meet such need. In making such assessment, the
Secretary shall consider the possible conversion of existing,
underused Service hospital beds into psychiatric units to
meet such need.

``SEC. 702. MEMORANDA OF AGREEMENT WITH THE DEPARTMENT OF THE
INTERIOR.

``(a) Contents.--Not later than 12 months after the date of
enactment of the Indian Health Care Improvement Act
Amendments of 2007, the Secretary, acting through the
Service, and the Secretary of the Interior shall develop and
enter into a memoranda of agreement, or review and update any
existing memoranda of agreement, as required by section 4205
of the Indian Alcohol and Substance Abuse Prevention and
Treatment Act of 1986 (25 U.S.C. 2411) under which the
Secretaries address the following:
``(1) The scope and nature of mental illness and
dysfunctional and self-destructive behavior, including child
abuse and family violence, among Indians.
``(2) The existing Federal, tribal, State, local, and
private services, resources, and programs available to
provide behavioral health services for Indians.
``(3) The unmet need for additional services, resources,
and programs necessary to meet the needs identified pursuant
to paragraph (1).
``(4)(A) The right of Indians, as citizens of the United
States and of the States in which they reside, to have access
to behavioral health services to which all citizens have
access.
``(B) The right of Indians to participate in, and receive
the benefit of, such services.
``(C) The actions necessary to protect the exercise of such
right.
``(5) The responsibilities of the Bureau of Indian Affairs
and the Service, including mental illness identification,
prevention, education, referral, and treatment services
(including services through multidisciplinary resource
teams), at the central, area, and agency and Service Unit,
Service Area, and headquarters levels to address the problems
identified in paragraph (1).
``(6) A strategy for the comprehensive coordination of the
behavioral health services provided by the Bureau of Indian
Affairs and the Service to meet the problems identified
pursuant to paragraph (1), including--
``(A) the coordination of alcohol and substance abuse
programs of the Service, the Bureau of Indian Affairs, and
Indian Tribes and Tribal Organizations (developed under the
Indian Alcohol and Substance Abuse Prevention and Treatment
Act of 1986 (25 U.S.C. 2401 et seq.)) with behavioral health
initiatives pursuant to this Act, particularly with respect
to the referral and treatment of dually diagnosed individuals
requiring behavioral health and substance abuse treatment;
and
``(B) ensuring that the Bureau of Indian Affairs and
Service programs and services (including multidisciplinary
resource teams) addressing child abuse and family violence
are coordinated with such non-Federal programs and services.

[[Page S10486]]

``(7) Directing appropriate officials of the Bureau of
Indian Affairs and the Service, particularly at the agency
and Service Unit levels, to cooperate fully with tribal
requests made pursuant to community behavioral health plans
adopted under section 701(c) and section 4206 of the Indian
Alcohol and Substance Abuse Prevention and Treatment Act of
1986 (25 U.S.C. 2412).
``(8) Providing for an annual review of such agreement by
the Secretaries which shall be provided to Congress and
Indian Tribes and Tribal Organizations.
``(b) Specific Provisions Required.--The memoranda of
agreement updated or entered into pursuant to subsection (a)
shall include specific provisions pursuant to which the
Service shall assume responsibility for--
``(1) the determination of the scope of the problem of
alcohol and substance abuse among Indians, including the
number of Indians within the jurisdiction of the Service who
are directly or indirectly affected by alcohol and substance
abuse and the financial and human cost;
``(2) an assessment of the existing and needed resources
necessary for the prevention of alcohol and substance abuse
and the treatment of Indians affected by alcohol and
substance abuse; and
``(3) an estimate of the funding necessary to adequately
support a program of prevention of alcohol and substance
abuse and treatment of Indians affected by alcohol and
substance abuse.
``(c) Publication.--Each memorandum of agreement entered
into or renewed (and amendments or modifications thereto)
under subsection (a) shall be published in the Federal
Register. At the same time as publication in the Federal
Register, the Secretary shall provide a copy of such
memoranda, amendment, or modification to each Indian Tribe,
Tribal Organization, and Urban Indian Organization.

``SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PREVENTION AND
TREATMENT PROGRAM.

``(a) Establishment.--
``(1) In general.--The Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, shall
provide a program of comprehensive behavioral health,
prevention, treatment, and aftercare, which shall include--
``(A) prevention, through educational intervention, in
Indian communities;
``(B) acute detoxification, psychiatric hospitalization,
residential, and intensive outpatient treatment;
``(C) community-based rehabilitation and aftercare;
``(D) community education and involvement, including
extensive training of health care, educational, and
community-based personnel;
``(E) specialized residential treatment programs for high-
risk populations, including pregnant and postpartum women and
their children; and
``(F) diagnostic services.
``(2) Target populations.--The target population of such
programs shall be members of Indian Tribes. Efforts to train
and educate key members of the Indian community shall also
target employees of health, education, judicial, law
enforcement, legal, and social service programs.
``(b) Contract Health Services.--
``(1) In general.--The Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, may enter
into contracts with public or private providers of behavioral
health treatment services for the purpose of carrying out the
program required under subsection (a).
``(2) Provision of assistance.--In carrying out this
subsection, the Secretary shall provide assistance to Indian
Tribes and Tribal Organizations to develop criteria for the
certification of behavioral health service providers and
accreditation of service facilities which meet minimum
standards for such services and facilities.

``SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM.

``(a) In General.--Under the authority of the Act of
November 2, 1921 (25 U.S.C. 13) (commonly known as the
`Snyder Act'), the Secretary shall establish and maintain a
mental health technician program within the Service which--
``(1) provides for the training of Indians as mental health
technicians; and
``(2) employs such technicians in the provision of
community-based mental health care that includes
identification, prevention, education, referral, and
treatment services.
``(b) Paraprofessional Training.--In carrying out
subsection (a), the Secretary, acting through the Service,
Indian Tribes, and Tribal Organizations, shall provide high-
standard paraprofessional training in mental health care
necessary to provide quality care to the Indian communities
to be served. Such training shall be based upon a curriculum
developed or approved by the Secretary which combines
education in the theory of mental health care with supervised
practical experience in the provision of such care.
``(c) Supervision and Evaluation of Technicians.--The
Secretary, acting through the Service, Indian Tribes, and
Tribal Organizations, shall supervise and evaluate the mental
health technicians in the training program.
``(d) Traditional Health Care Practices.--The Secretary,
acting through the Service, shall ensure that the program
established pursuant to this subsection involves the use and
promotion of the traditional health care practices of the
Indian Tribes to be served.

``SEC. 705. LICENSING REQUIREMENT FOR MENTAL HEALTH CARE
WORKERS.

``(a) In General.--Subject to the provisions of section
221, and except as provided in subsection (b), any individual
employed as a psychologist, social worker, or marriage and
family therapist for the purpose of providing mental health
care services to Indians in a clinical setting under this Act
is required to be licensed as a psychologist, social worker,
or marriage and family therapist, respectively.
``(b) Trainees.--An individual may be employed as a trainee
in psychology, social work, or marriage and family therapy to
provide mental health care services described in subsection
(a) if such individual--
``(1) works under the direct supervision of a licensed
psychologist, social worker, or marriage and family
therapist, respectively;
``(2) is enrolled in or has completed at least 2 years of
course work at a post-secondary, accredited education program
for psychology, social work, marriage and family therapy, or
counseling; and
``(3) meets such other training, supervision, and quality
review requirements as the Secretary may establish.

``SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.

``(a) Grants.--The Secretary, consistent with section 701,
may make grants to Indian Tribes, Tribal Organizations, and
Urban Indian Organizations to develop and implement a
comprehensive behavioral health program of prevention,
intervention, treatment, and relapse prevention services that
specifically addresses the cultural, historical, social, and
child care needs of Indian women, regardless of age.
``(b) Use of Grant Funds.--A grant made pursuant to this
section may be used to--
``(1) develop and provide community training, education,
and prevention programs for Indian women relating to
behavioral health issues, including fetal alcohol spectrum
disorders;
``(2) identify and provide psychological services,
counseling, advocacy, support, and relapse prevention to
Indian women and their families; and
``(3) develop prevention and intervention models for Indian
women which incorporate traditional health care practices,
cultural values, and community and family involvement.
``(c) Criteria.--The Secretary, in consultation with Indian
Tribes and Tribal Organizations, shall establish criteria for
the review and approval of applications and proposals for
funding under this section.
``(d) Earmark of Certain Funds.--Twenty percent of the
funds appropriated pursuant to this section shall be used to
make grants to Urban Indian Organizations.

``SEC. 707. INDIAN YOUTH PROGRAM.

``(a) Detoxification and Rehabilitation.--The Secretary,
acting through the Service, consistent with section 701,
shall develop and implement a program for acute
detoxification and treatment for Indian youths, including
behavioral health services. The program shall include
regional treatment centers designed to include detoxification
and rehabilitation for both sexes on a referral basis and
programs developed and implemented by Indian Tribes or Tribal
Organizations at the local level under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.). Regional centers shall be integrated with the intake
and rehabilitation programs based in the referring Indian
community.
``(b) Alcohol and Substance Abuse Treatment Centers or
Facilities.--
``(1) Establishment.--
``(A) In general.--The Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, shall
construct, renovate, or, as necessary, purchase, and
appropriately staff and operate, at least 1 youth regional
treatment center or treatment network in each area under the
jurisdiction of an Area Office.
``(B) Area office in california.--For the purposes of this
subsection, the Area Office in California shall be considered
to be 2 Area Offices, 1 office whose jurisdiction shall be
considered to encompass the northern area of the State of
California, and 1 office whose jurisdiction shall be
considered to encompass the remainder of the State of
California for the purpose of implementing California
treatment networks.
``(2) Funding.--For the purpose of staffing and operating
such centers or facilities, funding shall be pursuant to the
Act of November 2, 1921 (25 U.S.C. 13).
``(3) Location.--A youth treatment center constructed or
purchased under this subsection shall be constructed or
purchased at a location within the area described in
paragraph (1) agreed upon (by appropriate tribal resolution)
by a majority of the Indian Tribes to be served by such
center.
``(4) Specific provision of funds.--
``(A) In general.--Notwithstanding any other provision of
this title, the Secretary may, from amounts authorized to be
appropriated for the purposes of carrying out this section,
make funds available to--
``(i) the Tanana Chiefs Conference, Incorporated, for the
purpose of leasing, constructing, renovating, operating, and
maintaining a residential youth treatment facility in
Fairbanks, Alaska; and
``(ii) the Southeast Alaska Regional Health Corporation to
staff and operate a residential youth treatment facility
without regard

[[Page S10487]]

to the proviso set forth in section 4(l) of the Indian Self-
Determination and Education Assistance Act (25 U.S.C.
450b(l)).
``(B) Provision of services to eligible youths.--Until
additional residential youth treatment facilities are
established in Alaska pursuant to this section, the
facilities specified in subparagraph (A) shall make every
effort to provide services to all eligible Indian youths
residing in Alaska.
``(c) Intermediate Adolescent Behavioral Health Services.--
``(1) In general.--The Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, may provide
intermediate behavioral health services to Indian children
and adolescents, including--
``(A) pretreatment assistance;
``(B) inpatient, outpatient, and aftercare services;
``(C) emergency care;
``(D) suicide prevention and crisis intervention; and
``(E) prevention and treatment of mental illness and
dysfunctional and self-destructive behavior, including child
abuse and family violence.
``(2) Use of funds.--Funds provided under this subsection
may be used--
``(A) to construct or renovate an existing health facility
to provide intermediate behavioral health services;
``(B) to hire behavioral health professionals;
``(C) to staff, operate, and maintain an intermediate
mental health facility, group home, sober housing,
transitional housing or similar facilities, or youth shelter
where intermediate behavioral health services are being
provided;
``(D) to make renovations and hire appropriate staff to
convert existing hospital beds into adolescent psychiatric
units; and
``(E) for intensive home- and community-based services.
``(3) Criteria.--The Secretary, acting through the Service,
shall, in consultation with Indian Tribes and Tribal
Organizations, establish criteria for the review and approval
of applications or proposals for funding made available
pursuant to this subsection.
``(d) Federally-Owned Structures.--
``(1) In general.--The Secretary, in consultation with
Indian Tribes and Tribal Organizations, shall--
``(A) identify and use, where appropriate, federally-owned
structures suitable for local residential or regional
behavioral health treatment for Indian youths; and
``(B) establish guidelines for determining the suitability
of any such federally-owned structure to be used for local
residential or regional behavioral health treatment for
Indian youths.
``(2) Terms and conditions for use of structure.--Any
structure described in paragraph (1) may be used under such
terms and conditions as may be agreed upon by the Secretary
and the agency having responsibility for the structure and
any Indian Tribe or Tribal Organization operating the
program.
``(e) Rehabilitation and Aftercare Services.--
``(1) In general.--The Secretary, Indian Tribes, or Tribal
Organizations, in cooperation with the Secretary of the
Interior, shall develop and implement within each Service
Unit, community-based rehabilitation and follow-up services
for Indian youths who are having significant behavioral
health problems, and require long-term treatment, community
reintegration, and monitoring to support the Indian youths
after their return to their home community.
``(2) Administration.--Services under paragraph (1) shall
be provided by trained staff within the community who can
assist the Indian youths in their continuing development of
self-image, positive problem-solving skills, and nonalcohol
or substance abusing behaviors. Such staff may include
alcohol and substance abuse counselors, mental health
professionals, and other health professionals and
paraprofessionals, including community health
representatives.
``(f) Inclusion of Family in Youth Treatment Program.--In
providing the treatment and other services to Indian youths
authorized by this section, the Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, shall
provide for the inclusion of family members of such youths in
the treatment programs or other services as may be
appropriate. Not less than 10 percent of the funds
appropriated for the purposes of carrying out subsection (e)
shall be used for outpatient care of adult family members
related to the treatment of an Indian youth under that
subsection.
``(g) Multidrug Abuse Program.--The Secretary, acting
through the Service, Indian Tribes, and Tribal Organizations,
shall provide, consistent with section 701, programs and
services to prevent and treat the abuse of multiple forms of
substances, including alcohol, drugs, inhalants, and tobacco,
among Indian youths residing in Indian communities, on or
near reservations, and in urban areas and provide appropriate
mental health services to address the incidence of mental
illness among such youths.
``(h) Indian Youth Mental Health.--The Secretary, acting
through the Service, shall collect data for the report under
section 801 with respect to--
``(1) the number of Indian youth who are being provided
mental health services through the Service and Tribal Health
Programs;
``(2) a description of, and costs associated with, the
mental health services provided for Indian youth through the
Service and Tribal Health Programs;
``(3) the number of youth referred to the Service or Tribal
Health Programs for mental health services;
``(4) the number of Indian youth provided residential
treatment for mental health and behavioral problems through
the Service and Tribal Health Programs, reported separately
for on- and off-reservation facilities; and
``(5) the costs of the services described in paragraph (4).

``SEC. 708. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRATION
PROJECT.

``(a) Purpose.--The purpose of this section is to authorize
the Secretary to carry out a demonstration project to test
the use of telemental health services in suicide prevention,
intervention and treatment of Indian youth, including
through--
``(1) the use of psychotherapy, psychiatric assessments,
diagnostic interviews, therapies for mental health conditions
predisposing to suicide, and alcohol and substance abuse
treatment;
``(2) the provision of clinical expertise to, consultation
services with, and medical advice and training for frontline
health care providers working with Indian youth;
``(3) training and related support for community leaders,
family members and health and education workers who work with
Indian youth;
``(4) the development of culturally-relevant educational
materials on suicide; and
``(5) data collection and reporting.
``(b) Definitions.--For the purpose of this section, the
following definitions shall apply:
``(1) Demonstration project.--The term `demonstration
project' means the Indian youth telemental health
demonstration project authorized under subsection (c).
``(2) Telemental health.--The term `telemental health'
means the use of electronic information and
telecommunications technologies to support long distance
mental health care, patient and professional-related
education, public health, and health administration.
``(c) Authorization.--
``(1) In general.--The Secretary is authorized to award
grants under the demonstration project for the provision of
telemental health services to Indian youth who--
``(A) have expressed suicidal ideas;
``(B) have attempted suicide; or
``(C) have mental health conditions that increase or could
increase the risk of suicide.
``(2) Eligibility for grants.--Such grants shall be awarded
to Indian Tribes and Tribal Organizations that operate 1 or
more facilities--
``(A) located in Alaska and part of the Alaska Federal
Health Care Access Network;
``(B) reporting active clinical telehealth capabilities; or
``(C) offering school-based telemental health services
relating to psychiatry to Indian youth.
``(3) Grant period.--The Secretary shall award grants under
this section for a period of up to 4 years.
``(4) Awarding of grants.--Not more than 5 grants shall be
provided under paragraph (1), with priority consideration
given to Indian Tribes and Tribal Organizations that--
``(A) serve a particular community or geographic area where
there is a demonstrated need to address Indian youth suicide;
``(B) enter in to collaborative partnerships with Indian
Health Service or Tribal Health Programs or facilities to
provide services under this demonstration project;
``(C) serve an isolated community or geographic area which
has limited or no access to behavioral health services; or
``(D) operate a detention facility at which Indian youth
are detained.
``(d) Use of Funds.--
``(1) In general.--An Indian Tribe or Tribal Organization
shall use a grant received under subsection (c) for the
following purposes:
``(A) To provide telemental health services to Indian
youth, including the provision of--
``(i) psychotherapy;
``(ii) psychiatric assessments and diagnostic interviews,
therapies for mental health conditions predisposing to
suicide, and treatment; and
``(iii) alcohol and substance abuse treatment.
``(B) To provide clinician-interactive medical advice,
guidance and training, assistance in diagnosis and
interpretation, crisis counseling and intervention, and
related assistance to Service, tribal, or urban clinicians
and health services providers working with youth being served
under this demonstration project.
``(C) To assist, educate and train community leaders,
health education professionals and paraprofessionals, tribal
outreach workers, and family members who work with the youth
receiving telemental health services under this demonstration
project, including with identification of suicidal
tendencies, crisis intervention and suicide prevention,
emergency skill development, and building and expanding
networks among these individuals and with State and local
health services providers.
``(D) To develop and distribute culturally appropriate
community educational materials on--
``(i) suicide prevention;
``(ii) suicide education;
``(iii) suicide screening;
``(iv) suicide intervention; and
``(v) ways to mobilize communities with respect to the
identification of risk factors for suicide.

[[Page S10488]]

``(E) For data collection and reporting related to Indian
youth suicide prevention efforts.
``(2) Traditional health care practices.--In carrying out
the purposes described in paragraph (1), an Indian Tribe or
Tribal Organization may use and promote the traditional
health care practices of the Indian Tribes of the youth to be
served.
``(e) Applications.--To be eligible to receive a grant
under subsection (c), an Indian Tribe or Tribal Organization
shall prepare and submit to the Secretary an application, at
such time, in such manner, and containing such information as
the Secretary may require, including--
``(1) a description of the project that the Indian Tribe or
Tribal Organization will carry out using the funds provided
under the grant;
``(2) a description of the manner in which the project
funded under the grant would--
``(A) meet the telemental health care needs of the Indian
youth population to be served by the project; or
``(B) improve the access of the Indian youth population to
be served to suicide prevention and treatment services;
``(3) evidence of support for the project from the local
community to be served by the project;
``(4) a description of how the families and leadership of
the communities or populations to be served by the project
would be involved in the development and ongoing operations
of the project;
``(5) a plan to involve the tribal community of the youth
who are provided services by the project in planning and
evaluating the mental health care and suicide prevention
efforts provided, in order to ensure the integration of
community, clinical, environmental, and cultural components
of the treatment; and
``(6) a plan for sustaining the project after Federal
assistance for the demonstration project has terminated.
``(f) Collaboration; Reporting to National Clearinghouse.--
``(1) Collaboration.--The Secretary, acting through the
Service, shall encourage Indian Tribes and Tribal
Organizations receiving grants under this section to
collaborate to enable comparisons about best practices across
projects.
``(2) Reporting to national clearinghouse.--The Secretary,
acting through the Service, shall also encourage Indian
Tribes and Tribal Organizations receiving grants under this
section to submit relevant, declassified project information
to the national clearinghouse authorized under section
701(b)(2) in order to better facilitate program performance
and improve suicide prevention, intervention, and treatment
services.
``(g) Annual Report.--Each grant recipient shall submit to
the Secretary an annual report that--
``(1) describes the number of telemental health services
provided; and
``(2) includes any other information that the Secretary may
require.
``(h) Report to Congress.--Not later than 270 days after
the termination of the demonstration project, the Secretary
shall submit to the Committee on Indian Affairs of the Senate
and the Committee on Natural Resources and Committee on
Energy and Commerce of the House of Representatives a final
report, based on the annual reports provided by grant
recipients under subsection (h), that--
``(1) describes the results of the projects funded by
grants awarded under this section, including any data
available which indicates the number of attempted suicides;
``(2) evaluates the impact of the telemental health
services funded by the grants in reducing the number of
completed suicides among Indian youth;
``(3) evaluates whether the demonstration project should
be--
``(A) expanded to provide more than 5 grants; and
``(B) designated a permanent program; and
``(4) evaluates the benefits of expanding the demonstration
project to include Urban Indian Organizations.
``(i) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section $1,500,000 for
each of fiscal years 2008 through 2011.

``SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL HEALTH
FACILITIES DESIGN, CONSTRUCTION, AND STAFFING.

``Not later than 1 year after the date of enactment of the
Indian Health Care Improvement Act Amendments of 2007, the
Secretary, acting through the Service, Indian Tribes, and
Tribal Organizations, may provide, in each area of the
Service, not less than 1 inpatient mental health care
facility, or the equivalent, for Indians with behavioral
health problems. For the purposes of this subsection,
California shall be considered to be 2 Area Offices, 1 office
whose location shall be considered to encompass the northern
area of the State of California and 1 office whose
jurisdiction shall be considered to encompass the remainder
of the State of California. The Secretary shall consider the
possible conversion of existing, underused Service hospital
beds into psychiatric units to meet such need.

``SEC. 710. TRAINING AND COMMUNITY EDUCATION.

``(a) Program.--The Secretary, in cooperation with the
Secretary of the Interior, shall develop and implement or
assist Indian Tribes and Tribal Organizations to develop and
implement, within each Service Unit or tribal program, a
program of community education and involvement which shall be
designed to provide concise and timely information to the
community leadership of each tribal community. Such program
shall include education about behavioral health issues to
political leaders, Tribal judges, law enforcement personnel,
members of tribal health and education boards, health care
providers including traditional practitioners, and other
critical members of each tribal community. Such program may
also include community-based training to develop local
capacity and tribal community provider training for
prevention, intervention, treatment, and aftercare.
``(b) Instruction.--The Secretary, acting through the
Service, shall, either directly or through Indian Tribes and
Tribal Organizations, provide instruction in the area of
behavioral health issues, including instruction in crisis
intervention and family relations in the context of alcohol
and substance abuse, child sexual abuse, youth alcohol and
substance abuse, and the causes and effects of fetal alcohol
spectrum disorders to appropriate employees of the Bureau of
Indian Affairs and the Service, and to personnel in schools
or programs operated under any contract with the Bureau of
Indian Affairs or the Service, including supervisors of
emergency shelters and halfway houses described in section
4213 of the Indian Alcohol and Substance Abuse Prevention and
Treatment Act of 1986 (25 U.S.C. 2433).
``(c) Training Models.--In carrying out the education and
training programs required by this section, the Secretary, in
consultation with Indian Tribes, Tribal Organizations, Indian
behavioral health experts, and Indian alcohol and substance
abuse prevention experts, shall develop and provide
community-based training models. Such models shall address--
``(1) the elevated risk of alcohol and behavioral health
problems faced by children of alcoholics;
``(2) the cultural, spiritual, and multigenerational
aspects of behavioral health problem prevention and recovery;
and
``(3) community-based and multidisciplinary strategies for
preventing and treating behavioral health problems.

``SEC. 711. BEHAVIORAL HEALTH PROGRAM.

``(a) Innovative Programs.--The Secretary, acting through
the Service, Indian Tribes, and Tribal Organizations,
consistent with section 701, may plan, develop, implement,
and carry out programs to deliver innovative community-based
behavioral health services to Indians.
``(b) Awards; Criteria.--The Secretary may award a grant
for a project under subsection (a) to an Indian Tribe or
Tribal Organization and may consider the following criteria:
``(1) The project will address significant unmet behavioral
health needs among Indians.
``(2) The project will serve a significant number of
Indians.
``(3) The project has the potential to deliver services in
an efficient and effective manner.
``(4) The Indian Tribe or Tribal Organization has the
administrative and financial capability to administer the
project.
``(5) The project may deliver services in a manner
consistent with traditional health care practices.
``(6) The project is coordinated with, and avoids
duplication of, existing services.
``(c) Equitable Treatment.--For purposes of this
subsection, the Secretary shall, in evaluating project
applications or proposals, use the same criteria that the
Secretary uses in evaluating any other application or
proposal for such funding.

``SEC. 712. FETAL ALCOHOL SPECTRUM DISORDERS PROGRAMS.

``(a) Programs.--
``(1) Establishment.--The Secretary, consistent with
section 701, acting through the Service, Indian Tribes, and
Tribal Organizations, is authorized to establish and operate
fetal alcohol spectrum disorders programs as provided in this
section for the purposes of meeting the health status
objectives specified in section 3.
``(2) Use of funds.--
``(A) In general.--Funding provided pursuant to this
section shall be used for the following:
``(i) To develop and provide for Indians community and in-
school training, education, and prevention programs relating
to fetal alcohol spectrum disorders.
``(ii) To identify and provide behavioral health treatment
to high-risk Indian women and high-risk women pregnant with
an Indian's child.
``(iii) To identify and provide appropriate psychological
services, educational and vocational support, counseling,
advocacy, and information to fetal alcohol spectrum
disorders-affected Indians and their families or caretakers.
``(iv) To develop and implement counseling and support
programs in schools for fetal alcohol spectrum disorders-
affected Indian children.
``(v) To develop prevention and intervention models which
incorporate practitioners of traditional health care
practices, cultural values, and community involvement.
``(vi) To develop, print, and disseminate education and
prevention materials on fetal alcohol spectrum disorders.

[[Page S10489]]

``(vii) To develop and implement, in consultation with
Indian Tribes and Tribal Organizations, and in conference
with Urban Indian Organizations, culturally sensitive
assessment and diagnostic tools including dysmorphology
clinics and multidisciplinary fetal alcohol spectrum
disorders clinics for use in Indian communities and Urban
Centers.
``(B) Additional uses.--In addition to any purpose under
subparagraph (A), funding provided pursuant to this section
may be used for 1 or more of the following:
``(i) Early childhood intervention projects from birth on
to mitigate the effects of fetal alcohol spectrum disorders
among Indians.
``(ii) Community-based support services for Indians and
women pregnant with Indian children.
``(iii) Community-based housing for adult Indians with
fetal alcohol spectrum disorders.
``(3) Criteria for applications.--The Secretary shall
establish criteria for the review and approval of
applications for funding under this section.
``(b) Services.--The Secretary, acting through the Service,
Indian Tribes, and Tribal Organizations, shall--
``(1) develop and provide services for the prevention,
intervention, treatment, and aftercare for those affected by
fetal alcohol spectrum disorders in Indian communities; and
``(2) provide supportive services, including services to
meet the special educational, vocational, school-to-work
transition, and independent living needs of adolescent and
adult Indians with fetal alcohol spectrum disorders.
``(c) Task Force.--The Secretary shall establish a task
force to be known as the Fetal Alcohol Spectrum Disorders
Task Force to advise the Secretary in carrying out subsection
(b). Such task force shall be composed of representatives
from the following:
``(1) The National Institute on Drug Abuse.
``(2) The National Institute on Alcohol and Alcoholism.
``(3) The Office of Substance Abuse Prevention.
``(4) The National Institute of Mental Health.
``(5) The Service.
``(6) The Office of Minority Health of the Department of
Health and Human Services.
``(7) The Administration for Native Americans.
``(8) The National Institute of Child Health and Human
Development (NICHD).
``(9) The Centers for Disease Control and Prevention.
``(10) The Bureau of Indian Affairs.
``(11) Indian Tribes.
``(12) Tribal Organizations.
``(13) Urban Indian communities.
``(14) Indian fetal alcohol spectrum disorders experts.
``(d) Applied Research Projects.--The Secretary, acting
through the Substance Abuse and Mental Health Services
Administration, shall make grants to Indian Tribes, Tribal
Organizations, and Urban Indian Organizations for applied
research projects which propose to elevate the understanding
of methods to prevent, intervene, treat, or provide
rehabilitation and behavioral health aftercare for Indians
and Urban Indians affected by fetal alcohol spectrum
disorders.
``(e) Funding for Urban Indian Organizations.--Ten percent
of the funds appropriated pursuant to this section shall be
used to make grants to Urban Indian Organizations funded
under title V.

``SEC. 713. CHILD SEXUAL ABUSE PREVENTION AND TREATMENT
PROGRAMS.

``(a) Establishment.--The Secretary, acting through the
Service, and the Secretary of the Interior, Indian Tribes,
and Tribal Organizations, shall establish, consistent with
section 701, in every Service Area, programs involving
treatment for--
``(1) victims of sexual abuse who are Indian children or
children in an Indian household; and
``(2) perpetrators of child sexual abuse who are Indian or
members of an Indian household.
``(b) Use of Funds.--Funding provided pursuant to this
section shall be used for the following:
``(1) To develop and provide community education and
prevention programs related to sexual abuse of Indian
children or children in an Indian household.
``(2) To identify and provide behavioral health treatment
to victims of sexual abuse who are Indian children or
children in an Indian household, and to their family members
who are affected by sexual abuse.
``(3) To develop prevention and intervention models which
incorporate traditional health care practices, cultural
values, and community involvement.
``(4) To develop and implement culturally sensitive
assessment and diagnostic tools for use in Indian communities
and Urban Centers.
``(5) To identify and provide behavioral health treatment
to Indian perpetrators and perpetrators who are members of an
Indian household--
``(A) making efforts to begin offender and behavioral
health treatment while the perpetrator is incarcerated or at
the earliest possible date if the perpetrator is not
incarcerated; and
``(B) providing treatment after the perpetrator is
released, until it is determined that the perpetrator is not
a threat to children.
``(c) Coordination.--The programs established under
subsection (a) shall be carried out in coordination with
programs and services authorized under the Indian Child
Protection and Family Violence Prevention Act (25 U.S.C. 3201
et seq.).

``SEC. 714. DOMESTIC AND SEXUAL VIOLENCE PREVENTION AND
TREATMENT.

``(a) In General.--The Secretary, in accordance with
section 701, is authorized to establish in each Service Area
programs involving the prevention and treatment of--
``(1) Indian victims of domestic violence or sexual abuse;
and
``(2) perpetrators of domestic violence or sexual abuse who
are Indian or members of an Indian household.
``(b) Use of Funds.--Funds made available to carry out this
section shall be used--
``(1) to develop and implement prevention programs and
community education programs relating to domestic violence
and sexual abuse;
``(2) to provide behavioral health services, including
victim support services, and medical treatment (including
examinations performed by sexual assault nurse examiners) to
Indian victims of domestic violence or sexual abuse;
``(3) to purchase rape kits,
``(4) to develop prevention and intervention models, which
may incorporate traditional health care practices; and
``(5) to identify and provide behavioral health treatment
to perpetrators who are Indian or members of an Indian
household.
``(c) Training and Certification.--
``(1) In general.--Not later than 1 year after the date of
enactment of the Indian Health Care Improvement Act
Amendments of 2007, the Secretary shall establish appropriate
protocols, policies, procedures, standards of practice, and,
if not available elsewhere, training curricula and training
and certification requirements for services for victims of
domestic violence and sexual abuse.
``(2) Report.--Not later than 18 months after the date of
enactment of the Indian Health Care Improvement Act
Amendments of 2007, the Secretary shall submit to the
Committee on Indian Affairs of the Senate and the Committee
on Natural Resources of the House of Representatives a report
that describes the means and extent to which the Secretary
has carried out paragraph (1).
``(d) Coordination.--
``(1) In general.--The Secretary, in coordination with the
Attorney General, Federal and tribal law enforcement
agencies, Indian Health Programs, and domestic violence or
sexual assault victim organizations, shall develop
appropriate victim services and victim advocate training
programs--
``(A) to improve domestic violence or sexual abuse
responses;
``(B) to improve forensic examinations and collection;
``(C) to identify problems or obstacles in the prosecution
of domestic violence or sexual abuse; and
``(D) to meet other needs or carry out other activities
required to prevent, treat, and improve prosecutions of
domestic violence and sexual abuse.
``(2) Report.--Not later than 2 years after the date of
enactment of the Indian Health Care Improvement Act
Amendments of 2007, the Secretary shall submit to the
Committee on Indian Affairs of the Senate and the Committee
on Natural Resources of the House of Representatives a report
that describes, with respect to the matters described in
paragraph (1), the improvements made and needed, problems or
obstacles identified, and costs necessary to address the
problems or obstacles, and any other recommendations that the
Secretary determines to be appropriate.

``SEC. 715. BEHAVIORAL HEALTH RESEARCH.

``The Secretary, in consultation with appropriate Federal
agencies, shall make grants to, or enter into contracts with,
Indian Tribes, Tribal Organizations, and Urban Indian
Organizations or enter into contracts with, or make grants to
appropriate institutions for, the conduct of research on the
incidence and prevalence of behavioral health problems among
Indians served by the Service, Indian Tribes, or Tribal
Organizations and among Indians in urban areas. Research
priorities under this section shall include--
``(1) the multifactorial causes of Indian youth suicide,
including--
``(A) protective and risk factors and scientific data that
identifies those factors; and
``(B) the effects of loss of cultural identity and the
development of scientific data on those effects;
``(2) the interrelationship and interdependence of
behavioral health problems with alcoholism and other
substance abuse, suicide, homicides, other injuries, and the
incidence of family violence; and
``(3) the development of models of prevention techniques.
The effect of the interrelationships and interdependencies
referred to in paragraph (2) on children, and the development
of prevention techniques under paragraph (3) applicable to
children, shall be emphasized.

``SEC. 716. DEFINITIONS.

``For the purpose of this title, the following definitions
shall apply:
``(1) Assessment.--The term `assessment' means the
systematic collection, analysis, and dissemination of
information on health status, health needs, and health
problems.
``(2) Alcohol-related neurodevelop-
mental disorders or arnd.--The term `alcohol-related
neurodevelopmental disorders' or `ARND' means any 1 of a
spectrum of effects that--

[[Page S10490]]

``(A) may occur when a woman drinks alcohol during
pregnancy; and
``(B) involves a central nervous system abnormality that
may be structural, neurological, or functional.
``(3) Behavioral health aftercare.--The term `behavioral
health aftercare' includes those activities and resources
used to support recovery following inpatient, residential,
intensive substance abuse, or mental health outpatient or
outpatient treatment. The purpose is to help prevent or deal
with relapse by ensuring that by the time a client or patient
is discharged from a level of care, such as outpatient
treatment, an aftercare plan has been developed with the
client. An aftercare plan may use such resources as a
community-based therapeutic group, transitional living
facilities, a 12-step sponsor, a local 12-step or other
related support group, and other community-based providers.
``(4) Dual diagnosis.--The term `dual diagnosis' means
coexisting substance abuse and mental illness conditions or
diagnosis. Such clients are sometimes referred to as mentally
ill chemical abusers (MICAs).
``(5) Fetal alcohol spectrum disorders.--
``(A) In general.--The term `fetal alcohol spectrum
disorders' includes a range of effects that can occur in an
individual whose mother drank alcohol during pregnancy,
including physical, mental, behavioral, and/or learning
disabilities with possible lifelong implications.
``(B) Inclusions.--The term `fetal alcohol spectrum
disorders' may include--
``(i) fetal alcohol syndrome (FAS);
``(ii) fetal alcohol effect (FAE);
``(iii) alcohol-related birth defects; and
``(iv) alcohol-related neurodevelopmental disorders (ARND).
``(6) Fetal alcohol syndrome or fas.--The term `fetal
alcohol syndrome' or `FAS' means any 1 of a spectrum of
effects that may occur when a woman drinks alcohol during
pregnancy, the diagnosis of which involves the confirmed
presence of the following 3 criteria:
``(A) Craniofacial abnormalities.
``(B) Growth deficits.
``(C) Central nervous system abnormalities.
``(7) Rehabilitation.--The term `rehabilitation' means to
restore the ability or capacity to engage in usual and
customary life activities through education and therapy.
``(8) Substance abuse.--The term `substance abuse' includes
inhalant abuse.

``SEC. 717. AUTHORIZATION OF APPROPRIATIONS.

``There is authorized to be appropriated such sums as may
be necessary for each fiscal year through fiscal year 2017 to
carry out the provisions of this title.

``TITLE VIII--MISCELLANEOUS

``SEC. 801. REPORTS.

``For each fiscal year following the date of enactment of
the Indian Health Care Improvement Act Amendments of 2007,
the Secretary shall transmit to Congress a report containing
the following:
``(1) A report on the progress made in meeting the
objectives of this Act, including a review of programs
established or assisted pursuant to this Act and assessments
and recommendations of additional programs or additional
assistance necessary to, at a minimum, provide health
services to Indians and ensure a health status for Indians,
which are at a parity with the health services available to
and the health status of the general population.
``(2) A report on whether, and to what extent, new national
health care programs, benefits, initiatives, or financing
systems have had an impact on the purposes of this Act and
any steps that the Secretary may have taken to consult with
Indian Tribes, Tribal Organizations, and Urban Indian
Organizations to address such impact, including a report on
proposed changes in allocation of funding pursuant to section
808.
``(3) A report on the use of health services by Indians--
``(A) on a national and area or other relevant geographical
basis;
``(B) by gender and age;
``(C) by source of payment and type of service;
``(D) comparing such rates of use with rates of use among
comparable non-Indian populations; and
``(E) provided under contracts.
``(4) A report of contractors to the Secretary on Health
Care Educational Loan Repayments every 6 months required by
section 110.
``(5) A general audit report of the Secretary on the Health
Care Educational Loan Repayment Program as required by
section 110(n).
``(6) A report of the findings and conclusions of
demonstration programs on development of educational
curricula for substance abuse counseling as required in
section 125(f).
``(7) A separate statement which specifies the amount of
funds requested to carry out the provisions of section 201.
``(8) A report of the evaluations of health promotion and
disease prevention as required in section 203(c).
``(9) A biennial report to Congress on infectious diseases
as required by section 212.
``(10) A report on environmental and nuclear health hazards
as required by section 215.
``(11) An annual report on the status of all health care
facilities needs as required by section 301(c)(2)(B) and
301(d).
``(12) Reports on safe water and sanitary waste disposal
facilities as required by section 302(h).
``(13) An annual report on the expenditure of non-Service
funds for renovation as required by sections 304(b)(2).
``(14) A report identifying the backlog of maintenance and
repair required at Service and tribal facilities required by
section 313(a).
``(15) A report providing an accounting of reimbursement
funds made available to the Secretary under titles XVIII,
XIX, and XXI of the Social Security Act.
``(16) A report on any arrangements for the sharing of
medical facilities or services, as authorized by section 406.
``(17) A report on evaluation and renewal of Urban Indian
programs under section 505.
``(18) A report on the evaluation of programs as required
by section 513(d).
``(19) A report on alcohol and substance abuse as required
by section 701(f).
``(20) A report on Indian youth mental health services as
required by section 707(h).
``(21) A report on the reallocation of base resources if
required by section 808.

``SEC. 802. REGULATIONS.

``(a) Deadlines.--
``(1) Procedures.--Not later than 90 days after the date of
enactment of the Indian Health Care Improvement Act
Amendments of 2007, the Secretary shall initiate procedures
under subchapter III of chapter 5 of title 5, United States
Code, to negotiate and promulgate such regulations or
amendments thereto that are necessary to carry out titles II
(except section 202) and VII, the sections of title III for
which negotiated rulemaking is specifically required, and
section 807. Unless otherwise required, the Secretary may
promulgate regulations to carry out titles I, III, IV, and V,
and section 202, using the procedures required by chapter V
of title 5, United States Code (commonly known as the
`Administrative Procedure Act').
``(2) Proposed regulations.--Proposed regulations to
implement this Act shall be published in the Federal Register
by the Secretary no later than 2 years after the date of
enactment of the Indian Health Care Improvement Act
Amendments of 2007 and shall have no less than a 120-day
comment period.
``(3) Final regulations.--The Secretary shall publish in
the Federal Register final regulations to implement this Act
by not later than 3 years after the date of enactment of the
Indian Health Care Improvement Act Amendments of 2007.
``(b) Committee.--A negotiated rulemaking committee
established pursuant to section 565 of title 5, United States
Code, to carry out this section shall have as its members
only representatives of the Federal Government and
representatives of Indian Tribes, and Tribal Organizations, a
majority of whom shall be nominated by and be representatives
of Indian Tribes and Tribal Organizations from each Service
Area.
``(c) Adaptation of Procedures.--The Secretary shall adapt
the negotiated rulemaking procedures to the unique context of
self-governance and the government-to-government relationship
between the United States and Indian Tribes.
``(d) Lack of Regulations.--The lack of promulgated
regulations shall not limit the effect of this Act.
``(e) Inconsistent Regulations.--The provisions of this Act
shall supersede any conflicting provisions of law in effect
on the day before the date of enactment of the Indian Health
Care Improvement Act Amendments of 2007, and the Secretary is
authorized to repeal any regulation inconsistent with the
provisions of this Act.

``SEC. 803. PLAN OF IMPLEMENTATION.

``Not later than 9 months after the date of enactment of
the Indian Health Care Improvement Act Amendments of 2007,
the Secretary, in consultation with Indian Tribes and Tribal
Organizations, and in conference with Urban Indian
Organizations, shall submit to Congress a plan explaining the
manner and schedule, by title and section, by which the
Secretary will implement the provisions of this Act. This
consultation may be conducted jointly with the annual budget
consultation pursuant to the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq).

``SEC. 804. AVAILABILITY OF FUNDS.

``The funds appropriated pursuant to this Act shall remain
available until expended.

``SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED TO INDIAN
HEALTH SERVICE.

``Any limitation on the use of funds contained in an Act
providing appropriations for the Department for a period with
respect to the performance of abortions shall apply for that
period with respect to the performance of abortions using
funds contained in an Act providing appropriations for the
Service.

``SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS.

``(a) In General.--The following California Indians shall
be eligible for health services provided by the Service:
``(1) Any member of a federally recognized Indian Tribe.
``(2) Any descendant of an Indian who was residing in
California on June 1, 1852, if such descendant--
``(A) is a member of the Indian community served by a local
program of the Service; and
``(B) is regarded as an Indian by the community in which
such descendant lives.
``(3) Any Indian who holds trust interests in public
domain, national forest, or reservation allotments in
California.
``(4) Any Indian in California who is listed on the plans
for distribution of the assets of rancherias and reservations
located within

[[Page S10491]]

the State of California under the Act of August 18, 1958 (72
Stat. 619), and any descendant of such an Indian.
``(b) Clarification.--Nothing in this section may be
construed as expanding the eligibility of California Indians
for health services provided by the Service beyond the scope
of eligibility for such health services that applied on May
1, 1986.

``SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS.

``(a) Children.--Any individual who--
``(1) has not attained 19 years of age;
``(2) is the natural or adopted child, stepchild, foster
child, legal ward, or orphan of an eligible Indian; and
``(3) is not otherwise eligible for health services
provided by the Service,
shall be eligible for all health services provided by the
Service on the same basis and subject to the same rules that
apply to eligible Indians until such individual attains 19
years of age. The existing and potential health needs of all
such individuals shall be taken into consideration by the
Service in determining the need for, or the allocation of,
the health resources of the Service. If such an individual
has been determined to be legally incompetent prior to
attaining 19 years of age, such individual shall remain
eligible for such services until 1 year after the date of a
determination of competency.
``(b) Spouses.--Any spouse of an eligible Indian who is not
an Indian, or who is of Indian descent but is not otherwise
eligible for the health services provided by the Service,
shall be eligible for such health services if all such
spouses or spouses who are married to members of each Indian
Tribe being served are made eligible, as a class, by an
appropriate resolution of the governing body of the Indian
Tribe or Tribal Organization providing such services. The
health needs of persons made eligible under this paragraph
shall not be taken into consideration by the Service in
determining the need for, or allocation of, its health
resources.
``(c) Provision of Services to Other Individuals.--
``(1) In general.--The Secretary is authorized to provide
health services under this subsection through health programs
operated directly by the Service to individuals who reside
within the Service Unit and who are not otherwise eligible
for such health services if--
``(A) the Indian Tribes served by such Service Unit request
such provision of health services to such individuals; and
``(B) the Secretary and the served Indian Tribes have
jointly determined that--
``(i) the provision of such health services will not result
in a denial or diminution of health services to eligible
Indians; and
``(ii) there is no reasonable alternative health facilities
or services, within or without the Service Unit, available to
meet the health needs of such individuals.
``(2) ISDEAA programs.--In the case of health programs and
facilities operated under a contract or compact entered into
under the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450 et seq.), the governing body of the Indian
Tribe or Tribal Organization providing health services under
such contract or compact is authorized to determine whether
health services should be provided under such contract to
individuals who are not eligible for such health services
under any other subsection of this section or under any other
provision of law. In making such determinations, the
governing body of the Indian Tribe or Tribal Organization
shall take into account the considerations described in
paragraph (1)(B).
``(3) Payment for services.--
``(A) In general.--Persons receiving health services
provided by the Service under this subsection shall be liable
for payment of such health services under a schedule of
charges prescribed by the Secretary which, in the judgment of
the Secretary, results in reimbursement in an amount not less
than the actual cost of providing the health services.
Notwithstanding section 404 of this Act or any other
provision of law, amounts collected under this subsection,
including Medicare, Medicaid, or SCHIP reimbursements under
titles XVIII, XIX, and XXI of the Social Security Act, shall
be credited to the account of the program providing the
service and shall be used for the purposes listed in section
401(d)(2) and amounts collected under this subsection shall
be available for expenditure within such program.
``(B) Indigent people.--Health services may be provided by
the Secretary through the Service under this subsection to an
indigent individual who would not be otherwise eligible for
such health services but for the provisions of paragraph (1)
only if an agreement has been entered into with a State or
local government under which the State or local government
agrees to reimburse the Service for the expenses incurred by
the Service in providing such health services to such
indigent individual.
``(4) Revocation of consent for services.--
``(A) Single tribe service area.--In the case of a Service
Area which serves only 1 Indian Tribe, the authority of the
Secretary to provide health services under paragraph (1)
shall terminate at the end of the fiscal year succeeding the
fiscal year in which the governing body of the Indian Tribe
revokes its concurrence to the provision of such health
services.
``(B) Multitribal service area.--In the case of a
multitribal Service Area, the authority of the Secretary to
provide health services under paragraph (1) shall terminate
at the end of the fiscal year succeeding the fiscal year in
which at least 51 percent of the number of Indian Tribes in
the Service Area revoke their concurrence to the provisions
of such health services.
``(d) Other Services.--The Service may provide health
services under this subsection to individuals who are not
eligible for health services provided by the Service under
any other provision of law in order to--
``(1) achieve stability in a medical emergency;
``(2) prevent the spread of a communicable disease or
otherwise deal with a public health hazard;
``(3) provide care to non-Indian women pregnant with an
eligible Indian's child for the duration of the pregnancy
through postpartum; or
``(4) provide care to immediate family members of an
eligible individual if such care is directly related to the
treatment of the eligible individual.
``(e) Hospital Privileges for Practitioners.--Hospital
privileges in health facilities operated and maintained by
the Service or operated under a contract or compact pursuant
to the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450 et seq.) may be extended to non-Service health
care practitioners who provide services to individuals
described in subsection (a), (b), (c), or (d). Such non-
Service health care practitioners may, as part of the
privileging process, be designated as employees of the
Federal Government for purposes of section 1346(b) and
chapter 171 of title 28, United States Code (relating to
Federal tort claims) only with respect to acts or omissions
which occur in the course of providing services to eligible
individuals as a part of the conditions under which such
hospital privileges are extended.
``(f) Eligible Indian.--For purposes of this section, the
term `eligible Indian' means any Indian who is eligible for
health services provided by the Service without regard to the
provisions of this section.

``SEC. 808. REALLOCATION OF BASE RESOURCES.

``(a) Report Required.--Notwithstanding any other provision
of law, any allocation of Service funds for a fiscal year
that reduces by 5 percent or more from the previous fiscal
year the funding for any recurring program, project, or
activity of a Service Unit may be implemented only after the
Secretary has submitted to Congress, under section 801, a
report on the proposed change in allocation of funding,
including the reasons for the change and its likely effects.
``(b) Exception.--Subsection (a) shall not apply if the
total amount appropriated to the Service for a fiscal year is
at least 5 percent less than the amount appropriated to the
Service for the previous fiscal year.

``SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.

``The Secretary shall provide for the dissemination to
Indian Tribes, Tribal Organizations, and Urban Indian
Organizations of the findings and results of demonstration
projects conducted under this Act.

``SEC. 810. PROVISION OF SERVICES IN MONTANA.

``(a) Consistent With Court Decision.--The Secretary,
acting through the Service, shall provide services and
benefits for Indians in Montana in a manner consistent with
the decision of the United States Court of Appeals for the
Ninth Circuit in McNabb for McNabb v. Bowen, 829 F.2d 787
(9th Cir. 1987).
``(b) Clarification.--The provisions of subsection (a)
shall not be construed to be an expression of the sense of
Congress on the application of the decision described in
subsection (a) with respect to the provision of services or
benefits for Indians living in any State other than Montana.

``SEC. 811. MORATORIUM.

``During the period of the moratorium imposed on
implementation of the final rule published in the Federal
Register on September 16, 1987, by the Department of Health
and Human Services, relating to eligibility for the health
care services of the Indian Health Service, the Indian Health
Service shall provide services pursuant to the criteria for
eligibility for such services that were in effect on
September 15, 1987, subject to the provisions of sections 806
and 807, until the Service has submitted to the Committees on
Appropriations of the Senate and the House of Representatives
a budget request reflecting the increased costs associated
with the proposed final rule, and the request has been
included in an appropriations Act and enacted into law.

``SEC. 812. TRIBAL EMPLOYMENT.

``For purposes of section 2(2) of the Act of July 5, 1935
(49 Stat. 450, chapter 372), an Indian Tribe or Tribal
Organization carrying out a contract or compact pursuant to
the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450 et seq.) shall not be considered an
`employer'.

``SEC. 813. SEVERABILITY PROVISIONS.

``If any provision of this Act, any amendment made by the
Act, or the application of such provision or amendment to any
person or circumstances is held to be invalid, the remainder
of this Act, the remaining amendments made by this Act, and
the application of such provisions to persons or
circumstances other than those to which it is held invalid,
shall not be affected thereby.

``SEC. 814. ESTABLISHMENT OF NATIONAL BIPARTISAN COMMISSION
ON INDIAN HEALTH CARE.

``(a) Establishment.--There is established the National
Bipartisan Indian Health Care Commission (the `Commission').

[[Page S10492]]

``(b) Duties of Commission.--The duties of the Commission
are the following:
``(1) To establish a study committee composed of those
members of the Commission appointed by the Director of the
Service and at least 4 members of Congress from among the
members of the Commission, the duties of which shall be the
following:
``(A) To the extent necessary to carry out its duties,
collect and compile data necessary to understand the extent
of Indian needs with regard to the provision of health
services, regardless of the location of Indians, including
holding hearings and soliciting the views of Indians, Indian
Tribes, Tribal Organizations, and Urban Indian Organizations,
which may include authorizing and making funds available for
feasibility studies of various models for providing and
funding health services for all Indian beneficiaries,
including those who live outside of a reservation,
temporarily or permanently.
``(B) To make legislative recommendations to the Commission
regarding the delivery of Federal health care services to
Indians. Such recommendations shall include those related to
issues of eligibility, benefits, the range of service
providers, the cost of such services, financing such
services, and the optimal manner in which to provide such
services.
``(C) To determine the effect of the enactment of such
recommendations on (i) the existing system of delivery of
health services for Indians, and (ii) the sovereign status of
Indian Tribes.
``(D) Not later than 12 months after the appointment of all
members of the Commission, to submit a written report of its
findings and recommendations to the full Commission. The
report shall include a statement of the minority and majority
position of the Committee and shall be disseminated, at a
minimum, to every Indian Tribe, Tribal Organization, and
Urban Indian Organization for comment to the Commission.
``(E) To report regularly to the full Commission regarding
the findings and recommendations developed by the study
committee in the course of carrying out its duties under this
section.
``(2) To review and analyze the recommendations of the
report of the study committee.
``(3) To make legislative recommendations to Congress
regarding the delivery of Federal health care services to
Indians. Such recommendations shall include those related to
issues of eligibility, benefits, the range of service
providers, the cost of such services, financing such
services, and the optimal manner in which to provide such
services.
``(4) Not later than 18 months following the date of
appointment of all members of the Commission, submit a
written report to Congress regarding the delivery of Federal
health care services to Indians. Such recommendations shall
include those related to issues of eligibility, benefits, the
range of service providers, the cost of such services,
financing such services, and the optimal manner in which to
provide such services.
``(c) Members.--
``(1) Appointment.--The Commission shall be composed of 25
members, appointed as follows:
``(A) Ten members of Congress, including 3 from the House
of Representatives and 2 from the Senate, appointed by their
respective majority leaders, and 3 from the House of
Representatives and 2 from the Senate, appointed by their
respective minority leaders, and who shall be members of the
standing committees of Congress that consider legislation
affecting health care to Indians.
``(B) Twelve persons chosen by the congressional members of
the Commission, 1 from each Service Area as currently
designated by the Director of the Service to be chosen from
among 3 nominees from each Service Area put forward by the
Indian Tribes within the area, with due regard being given to
the experience and expertise of the nominees in the provision
of health care to Indians and to a reasonable representation
on the commission of members who are familiar with various
health care delivery modes and who represent Indian Tribes of
various size populations.
``(C) Three persons appointed by the Director who are
knowledgeable about the provision of health care to Indians,
at least 1 of whom shall be appointed from among 3 nominees
put forward by those programs whose funds are provided in
whole or in part by the Service primarily or exclusively for
the benefit of Urban Indians.
``(D) All those persons chosen by the congressional members
of the Commission and by the Director shall be members of
federally recognized Indian Tribes.
``(2) Chair; vice chair.--The Chair and Vice Chair of the
Commission shall be selected by the congressional members of
the Commission.
``(3) Terms.--The terms of members of the Commission shall
be for the life of the Commission.
``(4) Deadline for appointments.--Congressional members of
the Commission shall be appointed not later than 180 days
after the date of enactment of the Indian Health Care
Improvement Act Amendments of 2007, and the remaining members
of the Commission shall be appointed not later than 60 days
following the appointment of the congressional members.
``(5) Vacancy.--A vacancy in the Commission shall be filled
in the manner in which the original appointment was made.
``(d) Compensation.--
``(1) Congressional members.--Each congressional member of
the Commission shall receive no additional pay, allowances,
or benefits by reason of their service on the Commission and
shall receive travel expenses and per diem in lieu of
subsistence in accordance with sections 5702 and 5703 of
title 5, United States Code.
``(2) Other members.--Remaining members of the Commission,
while serving on the business of the Commission (including
travel time), shall be entitled to receive compensation at
the per diem equivalent of the rate provided for level IV of
the Executive Schedule under section 5315 of title 5, United
States Code, and while so serving away from home and the
member's regular place of business, a member may be allowed
travel expenses, as authorized by the Chairman of the
Commission. For purpose of pay (other than pay of members of
the Commission) and employment benefits, rights, and
privileges, all personnel of the Commission shall be treated
as if they were employees of the United States Senate.
``(e) Meetings.--The Commission shall meet at the call of
the Chair.
``(f) Quorum.--A quorum of the Commission shall consist of
not less than 15 members, provided that no less than 6 of the
members of Congress who are Commission members are present
and no less than 9 of the members who are Indians are
present.
``(g) Executive Director; Staff; Facilities.--
``(1) Appointment; pay.--The Commission shall appoint an
executive director of the Commission. The executive director
shall be paid the rate of basic pay for level V of the
Executive Schedule.
``(2) Staff appointment.--With the approval of the
Commission, the executive director may appoint such personnel
as the executive director deems appropriate.
``(3) Staff pay.--The staff of the Commission shall be
appointed without regard to the provisions of title 5, United
States Code, governing appointments in the competitive
service, and shall be paid without regard to the provisions
of chapter 51 and subchapter III of chapter 53 of such title
(relating to classification and General Schedule pay rates).
``(4) Temporary services.--With the approval of the
Commission, the executive director may procure temporary and
intermittent services under section 3109(b) of title 5,
United States Code.
``(5) Facilities.--The Administrator of General Services
shall locate suitable office space for the operation of the
Commission. The facilities shall serve as the headquarters of
the Commission and shall include all necessary equipment and
incidentals required for the proper functioning of the
Commission.
``(h) Hearings.--(1) For the purpose of carrying out its
duties, the Commission may hold such hearings and undertake
such other activities as the Commission determines to be
necessary to carry out its duties, provided that at least 6
regional hearings are held in different areas of the United
States in which large numbers of Indians are present. Such
hearings are to be held to solicit the views of Indians
regarding the delivery of health care services to them. To
constitute a hearing under this subsection, at least 5
members of the Commission, including at least 1 member of
Congress, must be present. Hearings held by the study
committee established in this section may count toward the
number of regional hearings required by this subsection.
``(2)(A) The Director of the Congressional Budget Office or
the Chief Actuary of the Centers for Medicare & Medicaid
Services, or both, shall provide to the Commission, upon the
request of the Commission, such cost estimates as the
Commission determines to be necessary to carry out its
duties.
``(B) The Commission shall reimburse the Director of the
Congressional Budget Office for expenses relating to the
employment in the office of that Director of such additional
staff as may be necessary for the Director to comply with
requests by the Commission under subparagraph (A).
``(3) Upon the request of the Commission, the head of any
Federal agency is authorized to detail, without
reimbursement, any of the personnel of such agency to the
Commission to assist the Commission in carrying out its
duties. Any such detail shall not interrupt or otherwise
affect the civil service status or privileges of the Federal
employee.
``(4) Upon the request of the Commission, the head of a
Federal agency shall provide such technical assistance to the
Commission as the Commission determines to be necessary to
carry out its duties.
``(5) The Commission may use the United States mails in the
same manner and under the same conditions as Federal agencies
and shall, for purposes of the frank, be considered a
commission of Congress as described in section 3215 of title
39, United States Code.
``(6) The Commission may secure directly from any Federal
agency information necessary to enable it to carry out its
duties, if the information may be disclosed under section 552
of title 4, United States Code. Upon request of the Chairman
of the Commission, the head of such agency shall furnish such
information to the Commission.
``(7) Upon the request of the Commission, the Administrator
of General Services shall provide to the Commission on a
reimbursable basis such administrative support services as
the Commission may request.
``(8) For purposes of costs relating to printing and
binding, including the cost of personnel detailed from the
Government Printing Office, the Commission shall be deemed to
be a committee of Congress.

[[Page S10493]]

``(i) Authorization of Appropriations.--There is authorized
to be appropriated $4,000,000 to carry out the provisions of
this section, which sum shall not be deducted from or affect
any other appropriation for health care for Indian persons.
``(j) Nonapplicability of FACA.--The Federal Advisory
Committee Act (5 U.S.C. App.) shall not apply to the
Commission.

``SEC. 815. CONFIDENTIALITY OF MEDICAL QUALITY ASSURANCE
RECORDS; QUALIFIED IMMUNITY FOR PARTICIPANTS.

``(a) Confidentiality of Records.--Medical quality
assurance records created by or for any Indian Health Program
or a health program of an Urban Indian Organization as part
of a medical quality assurance program are confidential and
privileged. Such records may not be disclosed to any person
or entity, except as provided in subsection (c).
``(b) Prohibition on Disclosure and Testimony.--
``(1) In general.--No part of any medical quality assurance
record described in subsection (a) may be subject to
discovery or admitted into evidence in any judicial or
administrative proceeding, except as provided in subsection
(c).
``(2) Testimony.--A person who reviews or creates medical
quality assurance records for any Indian Health Program or
Urban Indian Organization who participates in any proceeding
that reviews or creates such records may not be permitted or
required to testify in any judicial or administrative
proceeding with respect to such records or with respect to
any finding, recommendation, evaluation, opinion, or action
taken by such person or body in connection with such records
except as provided in this section.
``(c) Authorized Disclosure and Testimony.--
``(1) In general.--Subject to paragraph (2), a medical
quality assurance record described in subsection (a) may be
disclosed, and a person referred to in subsection (b) may
give testimony in connection with such a record, only as
follows:
``(A) To a Federal executive agency or private
organization, if such medical quality assurance record or
testimony is needed by such agency or organization to perform
licensing or accreditation functions related to any Indian
Health Program or to a health program of an Urban Indian
Organization to perform monitoring, required by law, of such
program or organization.
``(B) To an administrative or judicial proceeding commenced
by a present or former Indian Health Program or Urban Indian
Organization provider concerning the termination, suspension,
or limitation of clinical privileges of such health care
provider.
``(C) To a governmental board or agency or to a
professional health care society or organization, if such
medical quality assurance record or testimony is needed by
such board, agency, society, or organization to perform
licensing, credentialing, or the monitoring of professional
standards with respect to any health care provider who is or
was an employee of any Indian Health Program or Urban Indian
Organization.
``(D) To a hospital, medical center, or other institution
that provides health care services, if such medical quality
assurance record or testimony is needed by such institution
to assess the professional qualifications of any health care
provider who is or was an employee of any Indian Health
Program or Urban Indian Organization and who has applied for
or been granted authority or employment to provide health
care services in or on behalf of such program or
organization.
``(E) To an officer, employee, or contractor of the Indian
Health Program or Urban Indian Organization that created the
records or for which the records were created. If that
officer, employee, or contractor has a need for such record
or testimony to perform official duties.
``(F) To a criminal or civil law enforcement agency or
instrumentality charged under applicable law with the
protection of the public health or safety, if a qualified
representative of such agency or instrumentality makes a
written request that such record or testimony be provided for
a purpose authorized by law.
``(G) In an administrative or judicial proceeding commenced
by a criminal or civil law enforcement agency or
instrumentality referred to in subparagraph (F), but only
with respect to the subject of such proceeding.
``(2) Identity of participants.--With the exception of the
subject of a quality assurance action, the identity of any
person receiving health care services from any Indian Health
Program or Urban Indian Organization or the identity of any
other person associated with such program or organization for
purposes of a medical quality assurance program that is
disclosed in a medical quality assurance record described in
subsection (a) shall be deleted from that record or document
before any disclosure of such record is made outside such
program or organization. Such requirement does not apply to
the release of information pursuant to section 552a of title
5.
``(d) Disclosure for Certain Purposes.--
``(1) In general.--Nothing in this section shall be
construed as authorizing or requiring the withholding from
any person or entity aggregate statistical information
regarding the results of any Indian Health Program or Urban
Indian Organizations's medical quality assurance programs.
``(2) Withholding from congress.--Nothing in this section
shall be construed as authority to withhold any medical
quality assurance record from a committee of either House of
Congress, any joint committee of Congress, or the Government
Accountability Office if such record pertains to any matter
within their respective jurisdictions.
``(e) Prohibition on Disclosure of Record or Testimony.--A
person or entity having possession of or access to a record
or testimony described by this section may not disclose the
contents of such record or testimony in any manner or for any
purpose except as provided in this section.
``(f) Exemption From Freedom of Information Act.--Medical
quality assurance records described in subsection (a) may not
be made available to any person under section 552 of title 5.
``(g) Limitation on Civil Liability.--A person who
participates in or provides information to a person or body
that reviews or creates medical quality assurance records
described in subsection (a) shall not be civilly liable for
such participation or for providing such information if the
participation or provision of information was in good faith
based on prevailing professional standards at the time the
medical quality assurance program activity took place.
``(h) Application to Information in Certain Other
Records.--Nothing in this section shall be construed as
limiting access to the information in a record created and
maintained outside a medical quality assurance program,
including a patient's medical records, on the grounds that
the information was presented during meetings of a review
body that are part of a medical quality assurance program.
``(i) Regulations.--The Secretary, acting through the
Service, shall promulgate regulations pursuant to section
802.
``(j) Definitions.--In this section:
``(1) The term `health care provider' means any health care
professional, including community health aides and
practitioners certified under section 121, who are granted
clinical practice privileges or employed to provide health
care services in an Indian Health Program or health program
of an Urban Indian Organization, who is licensed or certified
to perform health care services by a governmental board or
agency or professional health care society or organization.
``(2) The term `medical quality assurance program' means
any activity carried out before, on, or after the date of
enactment of this Act by or for any Indian Health Program or
Urban Indian Organization to assess the quality of medical
care, including activities conducted by or on behalf of
individuals, Indian Health Program or Urban Indian
Organization medical or dental treatment review committees,
or other review bodies responsible for quality assurance,
credentials, infection control, patient safety, patient care
assessment (including treatment procedures, blood, drugs, and
therapeutics), medical records, health resources management
review and identification and prevention of medical or dental
incidents and risks.
``(3) The term `medical quality assurance record' means the
proceedings, records, minutes, and reports that emanate from
quality assurance program activities described in paragraph
(2) and are produced or compiled by or for an Indian Health
Program or Urban Indian Organization as part of a medical
quality assurance program.

``SEC. 816. APPROPRIATIONS; AVAILABILITY.

``Any new spending authority (described in subparagraph (A)
or (B) of section 401(c)(2) of the Congressional Budget Act
of 1974 (Public Law 93-344; 88 Stat. 317)) which is provided
under this Act shall be effective for any fiscal year only to
such extent or in such amounts as are provided in
appropriation Acts.

``SEC. 817. AUTHORIZATION OF APPROPRIATIONS.

``There are authorized to be appropriated such sums as may
be necessary for each fiscal year through fiscal year 2017 to
carry out this title.''.
(b) Rate of Pay.--
(1) Positions at level iv.--Section 5315 of title 5, United
States Code, is amended by striking ``Assistant Secretaries
of Health and Human Services (6).'' and inserting ``Assistant
Secretaries of Health and Human Services (7)''.
(2) Positions at level v.--Section 5316 of title 5, United
States Code, is amended by striking ``Director, Indian Health
Service, Department of Health and Human Services''.
(c) Amendments to Other Provisions of Law.--
(1) Section 3307(b)(1)(C) of the Children's Health Act of
2000 (25 U.S.C. 1671 note; Public Law 106-310) is amended by
striking ``Director of the Indian Health Service'' and
inserting ``Assistant Secretary for Indian Health''.
(2) The Indian Lands Open Dump Cleanup Act of 1994 is
amended--
(A) in section 3 (25 U.S.C. 3902)--
(i) by striking paragraph (2);
(ii) by redesignating paragraphs (1), (3), (4), (5), and
(6) as paragraphs (4), (5), (2), (6), and (1), respectively,
and moving those paragraphs so as to appear in numerical
order; and
(iii) by inserting before paragraph (4) (as redesignated by
subclause (II)) the following:
``(3) Assistant secretary.--The term `Assistant Secretary'
means the Assistant Secretary for Indian Health.'';
(B) in section 5 (25 U.S.C. 3904), by striking the section
designation and heading and inserting the following:

``SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR INDIAN
HEALTH.'';

(C) in section 6(a) (25 U.S.C. 3905(a)), in the subsection
heading, by striking ``Director'' and inserting ``Assistant
Secretary'';

[[Page S10494]]

(D) in section 9(a) (25 U.S.C. 3908(a)), in the subsection
heading, by striking ``Director'' and inserting ``Assistant
Secretary''; and
(E) by striking ``Director'' each place it appears and
inserting ``Assistant Secretary''.
(3) Section 5504(d)(2) of the Augustus F. Hawkins-Robert T.
Stafford Elementary and Secondary School Improvement
Amendments of 1988 (25 U.S.C. 2001 note; Public Law 100-297)
is amended by striking ``Director of the Indian Health
Service'' and inserting ``Assistant Secretary for Indian
Health''.
(4) Section 203(a)(1) of the Rehabilitation Act of 1973 (29
U.S.C. 763(a)(1)) is amended by striking ``Director of the
Indian Health Service'' and inserting ``Assistant Secretary
for Indian Health''.
(5) Subsections (b) and (e) of section 518 of the Federal
Water Pollution Control Act (33 U.S.C. 1377) are amended by
striking ``Director of the Indian Health Service'' each place
it appears and inserting ``Assistant Secretary for Indian
Health''.
(6) Section 317M(b) of the Public Health Service Act (42
U.S.C. 247b-14(b)) is amended--
(A) by striking ``Director of the Indian Health Service''
each place it appears and inserting ``Assistant Secretary for
Indian Health''; and
(B) in paragraph (2)(A), by striking ``the Directors
referred to in such paragraph'' and inserting ``the Director
of the Centers for Disease Control and Prevention and the
Assistant Secretary for Indian Health''.
(7) Section 417C(b) of the Public Health Service Act (42
U.S.C. 285-9(b)) is amended by striking ``Director of the
Indian Health Service'' and inserting ``Assistant Secretary
for Indian Health''.
(8) Section 1452(i) of the Safe Drinking Water Act (42
U.S.C. 300j-12(i)) is amended by striking ``Director of the
Indian Health Service'' each place it appears and inserting
``Assistant Secretary for Indian Health''.
(9) Section 803B(d)(1) of the Native American Programs Act
of 1974 (42 U.S.C. 2991b-2(d)(1)) is amended in the last
sentence by striking ``Director of the Indian Health
Service'' and inserting ``Assistant Secretary for Indian
Health''.
(10) Section 203(b) of the Michigan Indian Land Claims
Settlement Act (Public Law 105-143; 111 Stat. 2666) is
amended by striking ``Director of the Indian Health Service''
and inserting ``Assistant Secretary for Indian Health''.

SEC. _12. SOBOBA SANITATION FACILITIES.

The Act of December 17, 1970 (84 Stat. 1465), is amended by
adding at the end the following:
``Sec. 9.  Nothing in this Act shall preclude the Soboba
Band of Mission Indians and the Soboba Indian Reservation
from being provided with sanitation facilities and services
under the authority of section 7 of the Act of August 5, 1954
(68 Stat. 674), as amended by the Act of July 31, 1959 (73
Stat. 267).''.

SEC. _13. NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION.

(a) In General.--The Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.) is amended
by adding at the end the following:

``TITLE VIII--NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION

``SEC. 801. DEFINITIONS.

``In this title:
``(1) Board.--The term `Board' means the Board of Directors
of the Foundation.
``(2) Committee.--The term `Committee' means the Committee
for the Establishment of Native American Health and Wellness
Foundation established under section 802(f).
``(3) Foundation.--The term `Foundation' means the Native
American Health and Wellness Foundation established under
section 802.
``(4) Secretary.--The term `Secretary' means the Secretary
of Health and Human Services.
``(5) Service.--The term `Service' means the Indian Health
Service of the Department of Health and Human Services.

``SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION.

``(a) Establishment.--
``(1) In general.--As soon as practicable after the date of
enactment of this title, the Secretary shall establish, under
the laws of the District of Columbia and in accordance with
this title, the Native American Health and Wellness
Foundation.
``(2) Funding determinations.--No funds, gift, property, or
other item of value (including any interest accrued on such
an item) acquired by the Foundation shall--
``(A) be taken into consideration for purposes of
determining Federal appropriations relating to the provision
of health care and services to Indians; or
``(B) otherwise limit, diminish, or affect the Federal
responsibility for the provision of health care and services
to Indians.
``(b) Perpetual Existence.--The Foundation shall have
perpetual existence.
``(c) Nature of Corporation.--The Foundation--
``(1) shall be a charitable and nonprofit federally
chartered corporation; and
``(2) shall not be an agency or instrumentality of the
United States.
``(d) Place of Incorporation and Domicile.--The Foundation
shall be incorporated and domiciled in the District of
Columbia.
``(e) Duties.--The Foundation shall--
``(1) encourage, accept, and administer private gifts of
real and personal property, and any income from or interest
in such gifts, for the benefit of, or in support of, the
mission of the Service;
``(2) undertake and conduct such other activities as will
further the health and wellness activities and opportunities
of Native Americans; and
``(3) participate with and assist Federal, State, and
tribal governments, agencies, entities, and individuals in
undertaking and conducting activities that will further the
health and wellness activities and opportunities of Native
Americans.
``(f) Committee for the Establishment of Native American
Health and Wellness Foundation.--
``(1) In general.--The Secretary shall establish the
Committee for the Establishment of Native American Health and
Wellness Foundation to assist the Secretary in establishing
the Foundation.
``(2) Duties.--Not later than 180 days after the date of
enactment of this section, the Committee shall--
``(A) carry out such activities as are necessary to
incorporate the Foundation under the laws of the District of
Columbia, including acting as incorporators of the
Foundation;
``(B) ensure that the Foundation qualifies for and
maintains the status required to carry out this section,
until the Board is established;
``(C) establish the constitution and initial bylaws of the
Foundation;
``(D) provide for the initial operation of the Foundation,
including providing for temporary or interim quarters,
equipment, and staff; and
``(E) appoint the initial members of the Board in
accordance with the constitution and initial bylaws of the
Foundation.
``(g) Board of Directors.--
``(1) In general.--The Board of Directors shall be the
governing body of the Foundation.
``(2) Powers.--The Board may exercise, or provide for the
exercise of, the powers of the Foundation.
``(3) Selection.--
``(A) In general.--Subject to subparagraph (B), the number
of members of the Board, the manner of selection of the
members (including the filling of vacancies), and the terms
of office of the members shall be as provided in the
constitution and bylaws of the Foundation.
``(B) Requirements.--
``(i) Number of members.--The Board shall have at least 11
members, who shall have staggered terms.
``(ii) Initial voting members.--The initial voting members
of the Board--

``(I) shall be appointed by the Committee not later than
180 days after the date on which the Foundation is
established; and
``(II) shall have staggered terms.

``(iii) Qualification.--The members of the Board shall be
United States citizens who are knowledgeable or experienced
in Native American health care and related matters.
``(C) Compensation.--A member of the Board shall not
receive compensation for service as a member, but shall be
reimbursed for actual and necessary travel and subsistence
expenses incurred in the performance of the duties of the
Foundation.
``(h) Officers.--
``(1) In general.--The officers of the Foundation shall
be--
``(A) a secretary, elected from among the members of the
Board; and
``(B) any other officers provided for in the constitution
and bylaws of the Foundation.
``(2) Chief operating officer.--The secretary of the
Foundation may serve, at the direction of the Board, as the
chief operating officer of the Foundation, or the Board may
appoint a chief operating officer, who shall serve at the
direction of the Board.
``(3) Election.--The manner of election, term of office,
and duties of the officers of the Foundation shall be as
provided in the constitution and bylaws of the Foundation.
``(i) Powers.--The Foundation--
``(1) shall adopt a constitution and bylaws for the
management of the property of the Foundation and the
regulation of the affairs of the Foundation;
``(2) may adopt and alter a corporate seal;
``(3) may enter into contracts;
``(4) may acquire (through a gift or otherwise), own,
lease, encumber, and transfer real or personal property as
necessary or convenient to carry out the purposes of the
Foundation;
``(5) may sue and be sued; and
``(6) may perform any other act necessary and proper to
carry out the purposes of the Foundation.
``(j) Principal Office.--
``(1) In general.--The principal office of the Foundation
shall be in the District of Columbia.
``(2) Activities; offices.--The activities of the
Foundation may be conducted, and offices may be maintained,
throughout the United States in accordance with the
constitution and bylaws of the Foundation.
``(k) Service of Process.--The Foundation shall comply with
the law on service of process of each State in which the
Foundation is incorporated and of each State in which the
Foundation carries on activities.
``(l) Liability of Officers, Employees, and Agents.--
``(1) In general.--The Foundation shall be liable for the
acts of the officers, employees, and agents of the Foundation
acting within the scope of their authority.
``(2) Personal liability.--A member of the Board shall be
personally liable only for gross negligence in the
performance of the duties of the member.
``(m) Restrictions.--
``(1) Limitation on spending.--Beginning with the fiscal
year following the first full

[[Page S10495]]

fiscal year during which the Foundation is in operation, the
administrative costs of the Foundation shall not exceed the
percentage described in paragraph (2) of the sum of--
``(A) the amounts transferred to the Foundation under
subsection (o) during the preceding fiscal year; and
``(B) donations received from private sources during the
preceding fiscal year.
``(2) Percentages.--The percentages referred to in
paragraph (1) are--
``(A) for the first fiscal year described in that
paragraph, 20 percent;
``(B) for the following fiscal year, 15 percent; and
``(C) for each fiscal year thereafter, 10 percent.
``(3) Appointment and hiring.--The appointment of officers
and employees of the Foundation shall be subject to the
availability of funds.
``(4) Status.--A member of the Board or officer, employee,
or agent of the Foundation shall not by reason of association
with the Foundation be considered to be an officer, employee,
or agent of the United States.
``(n) Audits.--The Foundation shall comply with section
10101 of title 36, United States Code, as if the Foundation
were a corporation under part B of subtitle II of that title.
``(o) Funding.--
``(1) Authorization of appropriations.--There is authorized
to be appropriated to carry out subsection (e)(1) $500,000
for each fiscal year, as adjusted to reflect changes in the
Consumer Price Index for all-urban consumers published by the
Department of Labor.
``(2) Transfer of donated funds.--The Secretary shall
transfer to the Foundation funds held by the Department of
Health and Human Services under the Act of August 5, 1954 (42
U.S.C. 2001 et seq.), if the transfer or use of the funds is
not prohibited by any term under which the funds were
donated.

``SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT.

``(a) Provision of Support by Secretary.--Subject to
subsection (b), during the 5-year period beginning on the
date on which the Foundation is established, the Secretary--
``(1) may provide personnel, facilities, and other
administrative support services to the Foundation;
``(2) may provide funds for initial operating costs and to
reimburse the travel expenses of the members of the Board;
and
``(3) shall require and accept reimbursements from the
Foundation for--
``(A) services provided under paragraph (1); and
``(B) funds provided under paragraph (2).
``(b) Reimbursement.--Reimbursements accepted under
subsection (a)(3)--
``(1) shall be deposited in the Treasury of the United
States to the credit of the applicable appropriations
account; and
``(2) shall be chargeable for the cost of providing
services described in subsection (a)(1) and travel expenses
described in subsection (a)(2).
``(c) Continuation of Certain Services.--The Secretary may
continue to provide facilities and necessary support services
to the Foundation after the termination of the 5-year period
specified in subsection (a) if the facilities and services--
``(1) are available; and
``(2) are provided on reimbursable cost basis.''.
(b) Technical Amendments.--The Indian Self-Determination
and Education Assistance Act is amended--
(1) by redesignating title V (25 U.S.C. 458bbb et seq.) as
title VII;
(2) by redesignating sections 501, 502, and 503 (25 U.S.C.
458bbb, 458bbb-1, 458bbb-2) as sections 701, 702, and 703,
respectively; and
(3) in subsection (a)(2) of section 702 and paragraph (2)
of section 703 (as redesignated by paragraph (2)), by
striking ``section 501'' and inserting ``section 701''.

Subtitle B--Improvement of Indian Health Care Provided Under the Social
Security Act

SEC. _21. EXPANSION OF PAYMENTS UNDER MEDICARE, MEDICAID, AND
SCHIP FOR ALL COVERED SERVICES FURNISHED BY
INDIAN HEALTH PROGRAMS.

(a) Medicaid.--
(1) Expansion to all covered services.--Section 1911 of the
Social Security Act (42 U.S.C. 1396j) is amended--
(A) by amending the heading to read as follows:

``SEC. 1911. INDIAN HEALTH PROGRAMS.'';

and
(B) by amending subsection (a) to read as follows:
``(a) Eligibility for Payment for Medical Assistance.--The
Indian Health Service and an Indian Tribe, Tribal
Organization, or an Urban Indian Organization shall be
eligible for payment for medical assistance provided under a
State plan or under waiver authority with respect to items
and services furnished by the Indian Health Service, Indian
Tribe, Tribal Organization, or Urban Indian Organization if
the furnishing of such services meets all the conditions and
requirements which are applicable generally to the furnishing
of items and services under this title and under such plan or
waiver authority.''.
(2) Compliance with conditions and requirements.--
Subsection (b) of such section is amended to read as follows:
``(b) Compliance With Conditions and Requirements.--A
facility of the Indian Health Service or an Indian Tribe,
Tribal Organization, or an Urban Indian Organization which is
eligible for payment under subsection (a) with respect to the
furnishing of items and services, but which does not meet all
of the conditions and requirements of this title and under a
State plan or waiver authority which are applicable generally
to such facility, shall make such improvements as are
necessary to achieve or maintain compliance with such
conditions and requirements in accordance with a plan
submitted to and accepted by the Secretary for achieving or
maintaining compliance with such conditions and requirements,
and shall be deemed to meet such conditions and requirements
(and to be eligible for payment under this title), without
regard to the extent of its actual compliance with such
conditions and requirements, during the first 12 months after
the month in which such plan is submitted.''.
(3) Revision of authority to enter into agreements.--
Subsection (c) of such section is amended to read as follows:
``(c) Authority to Enter Into Agreements.--The Secretary
may enter into an agreement with a State for the purpose of
reimbursing the State for medical assistance provided by the
Indian Health Service, an Indian Tribe, Tribal Organization,
or an Urban Indian Organization (as so defined), directly,
through referral, or under contracts or other arrangements
between the Indian Health Service, an Indian Tribe, Tribal
Organization, or an Urban Indian Organization and another
health care provider to Indians who are eligible for medical
assistance under the State plan or under waiver authority.''.
(4) Cross-references to special fund for improvement of ihs
facilities; direct billing option; definitions.--Such section
is further amended by striking subsection (d) and adding at
the end the following new subsections:
``(d) Special Fund for Improvement of IHS Facilities.--For
provisions relating to the authority of the Secretary to
place payments to which a facility of the Indian Health
Service is eligible for payment under this title into a
special fund established under section 401(c)(1) of the
Indian Health Care Improvement Act, and the requirement to
use amounts paid from such fund for making improvements in
accordance with subsection (b), see subparagraphs (A) and (B)
of section 401(c)(1) of such Act.
``(e) Direct Billing.--For provisions relating to the
authority of a Tribal Health Program or an Urban Indian
Organization to elect to directly bill for, and receive
payment for, health care items and services provided by such
Program or Organization for which payment is made under this
title, see section 401(d) of the Indian Health Care
Improvement Act.
``(f) Definitions.--In this section, the terms `Indian
Health Program', `Indian Tribe',`Tribal Health Program',
`Tribal Organization', and `Urban Indian Organization' have
the meanings given those terms in section 4 of the Indian
Health Care Improvement Act.''.
(b) Medicare.--
(1) Expansion to all covered services.--Section 1880 of
such Act (42 U.S.C. 1395qq) is amended--
(A) by amending the heading to read as follows:

``SEC. 1880. INDIAN HEALTH PROGRAMS.'';

and
(B) by amending subsection (a) to read as follows:
``(a) Eligibility for Payments.--Subject to subsection (e),
the Indian Health Service and an Indian Tribe, Tribal
Organization, or an Urban Indian Organization shall be
eligible for payments under this title with respect to items
and services furnished by the Indian Health Service, Indian
Tribe, Tribal Organization, or Urban Indian Organization if
the furnishing of such services meets all the conditions and
requirements which are applicable generally to the furnishing
of items and services under this title.''.
(2) Compliance with conditions and requirements.--
Subsection (b) of such section is amended to read as follows:
``(b) Compliance With Conditions and Requirements.--Subject
to subsection (e), a facility of the Indian Health Service or
an Indian Tribe, Tribal Organization, or an Urban Indian
Organization which is eligible for payment under subsection
(a) with respect to the furnishing of items and services, but
which does not meet all of the conditions and requirements of
this title which are applicable generally to such facility,
shall make such improvements as are necessary to achieve or
maintain compliance with such conditions and requirements in
accordance with a plan submitted to and accepted by the
Secretary for achieving or maintaining compliance with such
conditions and requirements, and shall be deemed to meet such
conditions and requirements (and to be eligible for payment
under this title), without regard to the extent of its actual
compliance with such conditions and requirements, during the
first 12 months after the month in which such plan is
submitted.''.
(3) Cross-references to special fund for improvement of ihs
facilities; direct billing option; definitions.--
(A) In general.--Such section is further amended by
striking subsections (c) and (d) and inserting the following
new subsections:
``(c) Special Fund for Improvement of IHS Facilities.--For
provisions relating to the authority of the Secretary to
place payments to which a facility of the Indian Health
Service is eligible for payment under

[[Page S10496]]

this title into a special fund established under section
401(c)(1) of the Indian Health Care Improvement Act, and the
requirement to use amounts paid from such fund for making
improvements in accordance with subsection (b), see
subparagraphs (A) and (B) of section 401(c)(1) of such Act.
``(d) Direct Billing.--For provisions relating to the
authority of a Tribal Health Program or an Urban Indian
Organization to elect to directly bill for, and receive
payment for, health care items and services provided by such
Program or Organization for which payment is made under this
title, see section 401(d) of the Indian Health Care
Improvement Act.''.
(B) Conforming amendment.--Paragraph (3) of section 1880(e)
of such Act (42 U.S.C. 1395qq(e)) is amended by inserting
``and section 401(c)(1) of the Indian Health Care Improvement
Act'' after ``Subsection (c)''.
(4) Definitions.--Such section is further amended by
amending subsection (f) to read as follows:
``(f) Definitions.--In this section, the terms `Indian
Health Program', `Indian Tribe', `Service Unit', `Tribal
Health Program', `Tribal Organization', and `Urban Indian
Organization' have the meanings given those terms in section
4 of the Indian Health Care Improvement Act.''.
(c) Application to SCHIP.--Section 2107(e)(1) of the Social
Security Act (42 U.S.C. 1397gg(e)(1)) is amended--
(1) by redesignating subparagraph (D) as subparagraph (E);
and
(2) by inserting after subparagraph (C), the following new
subparagraph:
``(D) Section 1911 (relating to Indian Health Programs,
other than subsection (d) of such section).''.

SEC. _22. INCREASED OUTREACH TO INDIANS UNDER MEDICAID AND
SCHIP AND IMPROVED COOPERATION IN THE PROVISION
OF ITEMS AND SERVICES TO INDIANS UNDER SOCIAL
SECURITY ACT HEALTH BENEFIT PROGRAMS.

Section 1139 of the Social Security Act (42 U.S.C. 1320b-9)
is amended to read as follows:

``SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, HEALTH CARE
FOR INDIANS UNDER TITLES XVIII, XIX, AND XXI.

``(a) Agreements With States for Medicaid and SCHIP
Outreach on or Near Reservations to Increase the Enrollment
of Indians in Those Programs.--
``(1) In general.--In order to improve the access of
Indians residing on or near a reservation to obtain benefits
under the Medicaid and State children's health insurance
programs established under titles XIX and XXI, the Secretary
shall encourage the State to take steps to provide for
enrollment on or near the reservation. Such steps may include
outreach efforts such as the outstationing of eligibility
workers, entering into agreements with the Indian Health
Service, Indian Tribes, Tribal Organizations, and Urban
Indian Organizations to provide outreach, education regarding
eligibility and benefits, enrollment, and translation
services when such services are appropriate.
``(2) Construction.--Nothing in subparagraph (A) shall be
construed as affecting arrangements entered into between
States and the Indian Health Service, Indian Tribes, Tribal
Organizations, or Urban Indian Organizations for such
Service, Tribes, or Organizations to conduct administrative
activities under such titles.
``(b) Requirement to Facilitate Cooperation.--The
Secretary, acting through the Centers for Medicare & Medicaid
Services, shall take such steps as are necessary to
facilitate cooperation with, and agreements between, States
and the Indian Health Service, Indian Tribes, Tribal
Organizations, or Urban Indian Organizations with respect to
the provision of health care items and services to Indians
under the programs established under title XVIII, XIX, or
XXI.
``(c) Definition of Indian; Indian Tribe; Indian Health
Program; Tribal Organization; Urban Indian Organization.--In
this section, the terms `Indian', `Indian Tribe', `Indian
Health Program', `Tribal Organization', and `Urban Indian
Organization' have the meanings given those terms in section
4 of the Indian Health Care Improvement Act.''.

SEC. _23. ADDITIONAL PROVISIONS TO INCREASE OUTREACH TO, AND
ENROLLMENT OF, INDIANS IN SCHIP AND MEDICAID.

(a) Nonapplication of 10 Percent Limit on Outreach and
Certain Other Expenditures.--Section 2105(c)(2) of the Social
Security Act (42 U.S.C. 1397ee(c)(2)) is amended by adding at
the end the following new subparagraph:
``(C) Nonapplication to expenditures for outreach to
increase the enrollment of indian children under this title
and title xix.--The limitation under subparagraph (A) on
expenditures for items described in subsection (a)(1)(D)
shall not apply in the case of expenditures for outreach
activities to families of Indian children likely to be
eligible for child health assistance under the plan or
medical assistance under the State plan under title XIX (or
under a waiver of such plan), to inform such families of the
availability of, and to assist them in enrolling their
children in, such plans, including such activities conducted
under grants, contracts, or agreements entered into under
section 1139(a).''.
(b) Assurance of Payments to Indian Health Care Providers
for Child Health Assistance.--Section 2102(b)(3)(D) of such
Act (42 U.S.C. 1397bb(b)(3)(D)) is amended by striking ``(as
defined in section 4(c) of the Indian Health Care Improvement
Act, 25 U.S.C. 1603(c))'' and inserting ``, including how the
State will ensure that payments are made to Indian Health
Programs and Urban Indian Organizations operating in the
State for the provision of such assistance''.
(c) Inclusion of Other Indian Financed Health Care Programs
in Exemption From Prohibition on Certain Payments.--Section
2105(c)(6)(B) of such Act (42 U.S.C. 1397ee(c)(6)(B)) is
amended by striking ``insurance program, other than an
insurance program operated or financed by the Indian Health
Service'' and inserting ``program, other than a health care
program operated or financed by the Indian Health Service or
by an Indian Tribe, Tribal Organization, or Urban Indian
Organization''.
(d) Satisfaction of Medicaid Documentation Requirements.--
(1) In general.--Section 1903(x)(3)(B) of the Social
Security Act (42 U.S.C. 1396b(x)(3)(B)) is amended--
(A) by redesignating clause (v) as clause (vi); and
(B) by inserting after clause (iv), the following new
clause:
``(v)(I) Except as provided in subclause (II), a document
issued by a federally-recognized Indian tribe evidencing
membership or enrollment in, or affiliation with, such tribe.
``(II) With respect to those federally-recognized Indian
tribes located within States having an international border
whose membership includes individuals who are not citizens of
the United States, the Secretary shall, after consulting with
such tribes, issue regulations authorizing the presentation
of such other forms of documentation (including tribal
documentation, if appropriate) that the Secretary determines
to be satisfactory documentary evidence of citizenship or
nationality for purposes of satisfying the requirement of
this subsection.''.
(2) Transition rule.--During the period that begins on July
1, 2006, and ends on the effective date of final regulations
issued under subclause (II) of section 1903(x)(3)(B)(v) of
the Social Security Act (42 U.S.C. 1396b(x)(3)(B)(v)) (as
added by paragraph (1)), an individual who is a member of a
federally-recognized Indian tribe described in subclause (II)
of that section who presents a document described in
subclause (I) of such section that is issued by such Indian
tribe, shall be deemed to have presented satisfactory
evidence of citizenship or nationality for purposes of
satisfying the requirement of subsection (x) of section 1903
of such Act.
(e) Definitions.--Section 2110(c) of such Act (42 U.S.C.
1397jj(c)) is amended by adding at the end the following new
paragraph:
``(9) Indian; indian health program; indian tribe; etc.--
The terms `Indian', `Indian Health Program', `Indian Tribe',
`Tribal Organization', and `Urban Indian Organization' have
the meanings given those terms in section 4 of the Indian
Health Care Improvement Act.''.

SEC. _24. PREMIUMS AND COST SHARING PROTECTIONS UNDER
MEDICAID, ELIGIBILITY DETERMINATIONS UNDER
MEDICAID AND SCHIP, AND PROTECTION OF CERTAIN
INDIAN PROPERTY FROM MEDICAID ESTATE RECOVERY.

(a) Premiums and Cost Sharing Protection Under Medicaid.--
(1) In general.--Section 1916 of the Social Security Act
(42 U.S.C. 1396o) is amended--
(A) in subsection (a), in the matter preceding paragraph
(1), by striking ``and (i)'' and inserting ``, (i), and
(j)''; and
(B) by adding at the end the following new subsection:
``(j) No Premiums or Cost Sharing for Indians Furnished
Items or Services Directly by Indian Health Programs or
Through Referral Under the Contract Health Service.--
``(1) No cost sharing for items or services furnished to
indians through indian health programs.--
``(A) In general.--No enrollment fee, premium, or similar
charge, and no deduction, copayment, cost sharing, or similar
charge shall be imposed against an Indian who is furnished an
item or service directly by the Indian Health Service, an
Indian Tribe, Tribal Organization, or Urban Indian
Organization or through referral under the contract health
service for which payment may be made under this title.
``(B) No reduction in amount of payment to indian health
providers.--Payment due under this title to the Indian Health
Service, an Indian Tribe, Tribal Organization, or Urban
Indian Organization, or a health care provider through
referral under the contract health service for the furnishing
of an item or service to an Indian who is eligible for
assistance under such title, may not be reduced by the amount
of any enrollment fee, premium, or similar charge, or any
deduction, copayment, cost sharing, or similar charge that
would be due from the Indian but for the operation of
subparagraph (A).
``(2) Rule of construction.--Nothing in this subsection
shall be construed as restricting the application of any
other limitations on the imposition of premiums or cost
sharing that may apply to an individual receiving medical
assistance under this title who is an Indian.
``(3) Definitions.--In this subsection, the terms `contract
health service', `Indian', `Indian Tribe', `Tribal
Organization', and `Urban Indian Organization' have the
meanings given those terms in section 4 of the Indian Health
Care Improvement Act.''.
(2) Conforming amendment.--Section 1916A (a)(1) of such Act
(42 U.S.C. 1396o-

[[Page S10497]]

1(a)(1)) is amended by striking ``section 1916(g)'' and
inserting ``subsections (g), (i), or (j) of section 1916''.
(b) Treatment of Certain Property for Medicaid and SCHIP
Eligibility.--
(1) Medicaid.--Section 1902(e) of the Social Security Act
(42 U.S.C. 1396a) is amended by adding at the end the
following new paragraph:
``(13) Notwithstanding any other requirement of this title
or any other provision of Federal or State law, a State shall
disregard the following property for purposes of determining
the eligibility of an individual who is an Indian (as defined
in section 4 of the Indian Health Care Improvement Act) for
medical assistance under this title:
``(A) Property, including real property and improvements,
that is held in trust, subject to Federal restrictions, or
otherwise under the supervision of the Secretary of the
Interior, located on a reservation, including any federally
recognized Indian Tribe's reservation, pueblo, or colony,
including former reservations in Oklahoma, Alaska Native
regions established by the Alaska Native Claims Settlement
Act, and Indian allotments on or near a reservation as
designated and approved by the Bureau of Indian Affairs of
the Department of the Interior.
``(B) For any federally recognized Tribe not described in
subparagraph (A), property located within the most recent
boundaries of a prior Federal reservation.
``(C) Ownership interests in rents, leases, royalties, or
usage rights related to natural resources (including
extraction of natural resources or harvesting of timber,
other plants and plant products, animals, fish, and
shellfish) resulting from the exercise of federally protected
rights.
``(D) Ownership interests in or usage rights to items not
covered by subparagraphs (A) through (C) that have unique
religious, spiritual, traditional, or cultural significance
or rights that support subsistence or a traditional lifestyle
according to applicable tribal law or custom.''.
(2) Application to schip.--Section 2107(e)(1) of such Act
(42 U.S.C. 1397gg(e)(1)) is amended--
(A) by redesignating subparagraphs (B) through (E), as
subparagraphs (C) through (F), respectively; and
(B) by inserting after subparagraph (A), the following new
subparagraph:
``(B) Section 1902(e)(13) (relating to disregard of certain
property for purposes of making eligibility
determinations).''.
(c) Continuation of Current Law Protections of Certain
Indian Property From Medicaid Estate Recovery.--Section
1917(b)(3) of the Social Security Act (42 U.S.C. 1396p(b)(3))
is amended--
(1) by inserting ``(A)'' after ``(3)''; and
(2) by adding at the end the following new subparagraph:
``(B) The standards specified by the Secretary under
subparagraph (A) shall require that the procedures
established by the State agency under subparagraph (A) exempt
income, resources, and property that are exempt from the
application of this subsection as of April 1, 2003, under
manual instructions issued to carry out this subsection (as
in effect on such date) because of the Federal responsibility
for Indian Tribes and Alaska Native Villages. Nothing in this
subparagraph shall be construed as preventing the Secretary
from providing additional estate recovery exemptions under
this title for Indians.''.

SEC. _25. NONDISCRIMINATION IN QUALIFICATIONS FOR PAYMENT FOR
SERVICES UNDER FEDERAL HEALTH CARE PROGRAMS.

Section 1139 of the Social Security Act (42 U.S.C. 1320b-
9), as amended by section _22, is amended by redesignating
subsection (c) as subsection (d), and inserting after
subsection (b) the following new subsection:
``(c) Nondiscrimination in Qualifications for Payment for
Services Under Federal Health Care Programs.--
``(1) Requirement to satisfy generally applicable
participation requirements.--
``(A) In general.--A Federal health care program must
accept an entity that is operated by the Indian Health
Service, an Indian Tribe, Tribal Organization, or Urban
Indian Organization as a provider eligible to receive payment
under the program for health care services furnished to an
Indian on the same basis as any other provider qualified to
participate as a provider of health care services under the
program if the entity meets generally applicable State or
other requirements for participation as a provider of health
care services under the program.
``(B) Satisfaction of state or local licensure or
recognition requirements.--Any requirement for participation
as a provider of health care services under a Federal health
care program that an entity be licensed or recognized under
the State or local law where the entity is located to furnish
health care services shall be deemed to have been met in the
case of an entity operated by the Indian Health Service, an
Indian Tribe, Tribal Organization, or Urban Indian
Organization if the entity meets all the applicable standards
for such licensure or recognition, regardless of whether the
entity obtains a license or other documentation under such
State or local law. In accordance with section 221 of the
Indian Health Care Improvement Act, the absence of the
licensure of a health care professional employed by such an
entity under the State or local law where the entity is
located shall not be taken into account for purposes of
determining whether the entity meets such standards, if the
professional is licensed in another State.
``(2) Prohibition on federal payments to entities or
individuals excluded from participation in federal health
care programs or whose state licenses are under suspension or
have been revoked.--
``(A) Excluded entities.--No entity operated by the Indian
Health Service, an Indian Tribe, Tribal Organization, or
Urban Indian Organization that has been excluded from
participation in any Federal health care program or for which
a license is under suspension or has been revoked by the
State where the entity is located shall be eligible to
receive payment under any such program for health care
services furnished to an Indian.
``(B) Excluded individuals.--No individual who has been
excluded from participation in any Federal health care
program or whose State license is under suspension or has
been revoked shall be eligible to receive payment under any
such program for health care services furnished by that
individual, directly or through an entity that is otherwise
eligible to receive payment for health care services, to an
Indian.
``(C) Federal health care program defined.--In this
subsection, the term, `Federal health care program' has the
meaning given that term in section 1128B(f), except that, for
purposes of this subsection, such term shall include the
health insurance program under chapter 89 of title 5, United
States Code.''.

SEC. _26. CONSULTATION ON MEDICAID, SCHIP, AND OTHER HEALTH
CARE PROGRAMS FUNDED UNDER THE SOCIAL SECURITY
ACT INVOLVING INDIAN HEALTH PROGRAMS AND URBAN
INDIAN ORGANIZATIONS.

(a) In General.--Section 1139 of the Social Security Act
(42 U.S.C. 1320b-9), as amended by sections 202 and 205, is
amended by redesignating subsection (d) as subsection (e),
and inserting after subsection (c) the following new
subsection:
``(d) Consultation With Tribal Technical Advisory Group
(TTAG).--The Secretary shall maintain within the Centers for
Medicaid & Medicare Services (CMS) a Tribal Technical
Advisory Group, established in accordance with requirements
of the charter dated September 30, 2003, and in such group
shall include a representative of the Service.''.
(b) Solicitation of Advice Under Medicaid and SCHIP.--
(1) Medicaid state plan amendment.--Section 1902(a) of the
Social Security Act (42 U.S.C. 1396a(a)) is amended--
(A) in paragraph (69), by striking ``and'' at the end;
(B) in paragraph (70)(B)(iv), by striking the period at the
end and inserting ``; and''; and
(C) by inserting after paragraph (70)(B)(iv), the following
new paragraph:
``(71) in the case of any State in which the Indian Health
Service operates or funds health care programs, or in which 1
or more Indian Health Programs or Urban Indian Organizations
(as such terms are defined in section 4 of the Indian Health
Care Improvement Act) provide health care in the State for
which medical assistance is available under such title,
provide for a process under which the State seeks advice on a
regular, ongoing basis from designees of such Indian Health
Programs and Urban Indian Organizations on matters relating
to the application of this title that are likely to have a
direct effect on such Indian Health Programs and Urban Indian
Organizations and that--
``(A) shall include solicitation of advice prior to
submission of any plan amendments, waiver requests, and
proposals for demonstration projects likely to have a direct
effect on Indians, Indian Health Programs, or Urban Indian
Organizations; and
``(B) may include appointment of an advisory committee and
of a designee of such Indian Health Programs and Urban Indian
Organizations to the medical care advisory committee advising
the State on its State plan under this title.''.
(2) Application to schip.--Section 2107(e)(1) of such Act
(42 U.S.C. 1397gg(e)(1)), as amended by section _24(b)(2), is
amended--
(A) by redesignating subparagraphs (B) through (F) as
subparagraphs (C) through (G), respectively; and
(B) by inserting after subparagraph (A), the following new
subparagraph:
``(B) Section 1902(a)(71) (relating to the option of
certain States to seek advice from designees of Indian Health
Programs and Urban Indian Organizations).''.
(c) Rule of Construction.--Nothing in the amendments made
by this section shall be construed as superseding existing
advisory committees, working groups, guidance, or other
advisory procedures established by the Secretary of Health
and Human Services or by any State with respect to the
provision of health care to Indians.

SEC. _27. EXCLUSION WAIVER AUTHORITY FOR AFFECTED INDIAN
HEALTH PROGRAMS AND SAFE HARBOR TRANSACTIONS
UNDER THE SOCIAL SECURITY ACT.

(a) Exclusion Waiver Authority.--Section 1128 of the Social
Security Act (42 U.S.C. 1320a-7) is amended by adding at the
end the following new subsection:
``(k) Additional Exclusion Waiver Authority for Affected
Indian Health Programs.--In addition to the authority granted
the Secretary under subsections (c)(3)(B) and (d)(3)(B) to
waive an exclusion under subsection (a)(1), (a)(3), (a)(4),
or (b), the Secretary may, in the case of an Indian Health
Program, waive such an exclusion upon the

[[Page S10498]]

request of the administrator of an affected Indian Health
Program (as defined in section 4 of the Indian Health Care
Improvement Act) who determines that the exclusion would
impose a hardship on individuals entitled to benefits under
or enrolled in a Federal health care program.''.
(b) Certain Transactions Involving Indian Health Care
Programs Deemed to Be in Safe Harbors.--Section 1128B(b) of
the Social Security Act (42 U.S.C. 1320a-7b(b)) is amended by
adding at the end the following new paragraph:
``(4) Subject to such conditions as the Secretary may
promulgate from time to time as necessary to prevent fraud
and abuse, for purposes of paragraphs (1) and (2) and section
1128A(a), the following transfers shall not be treated as
remuneration:
``(A) Transfers between indian health programs, indian
tribes, tribal organizations, and urban indian
organizations.--Transfers of anything of value between or
among an Indian Health Program, Indian Tribe, Tribal
Organization, or Urban Indian Organization, that are made for
the purpose of providing necessary health care items and
services to any patient served by such Program, Tribe, or
Organization and that consist of--
``(i) services in connection with the collection,
transport, analysis, or interpretation of diagnostic
specimens or test data;
``(ii) inventory or supplies;
``(iii) staff; or
``(iv) a waiver of all or part of premiums or cost sharing.
``(B) Transfers between indian health programs, indian
tribes, tribal organizations, or urban indian organizations
and patients.--Transfers of anything of value between an
Indian Health Program, Indian Tribe, Tribal Organization, or
Urban Indian Organization and any patient served or eligible
for service from an Indian Health Program, Indian Tribe,
Tribal Organization, or Urban Indian Organization, including
any patient served or eligible for service pursuant to
section 807 of the Indian Health Care Improvement Act, but
only if such transfers--
``(i) consist of expenditures related to providing
transportation for the patient for the provision of necessary
health care items or services, provided that the provision of
such transportation is not advertised, nor an incentive of
which the value is disproportionately large in relationship
to the value of the health care item or service (with respect
to the value of the item or service itself or, for
preventative items or services, the future health care costs
reasonably expected to be avoided);
``(ii) consist of expenditures related to providing housing
to the patient (including a pregnant patient) and immediate
family members or an escort necessary to assuring the timely
provision of health care items and services to the patient,
provided that the provision of such housing is not advertised
nor an incentive of which the value is disproportionately
large in relationship to the value of the health care item or
service (with respect to the value of the item or service
itself or, for preventative items or services, the future
health care costs reasonably expected to be avoided); or
``(iii) are for the purpose of paying premiums or cost
sharing on behalf of such a patient, provided that the making
of such payment is not subject to conditions other than
conditions agreed to under a contract for the delivery of
contract health services.
``(C) Contract health services.--A transfer of anything of
value negotiated as part of a contract entered into between
an Indian Health Program, Indian Tribe, Tribal Organization,
Urban Indian Organization, or the Indian Health Service and a
contract care provider for the delivery of contract health
services authorized by the Indian Health Service, provided
that--
``(i) such a transfer is not tied to volume or value of
referrals or other business generated by the parties; and
``(ii) any such transfer is limited to the fair market
value of the health care items or services provided or, in
the case of a transfer of items or services related to
preventative care, the value of the future health care costs
reasonably expected to be avoided.
``(D) Other transfers.--Any other transfer of anything of
value involving an Indian Health Program, Indian Tribe,
Tribal Organization, or Urban Indian Organization, or a
patient served or eligible for service from an Indian Health
Program, Indian Tribe, Tribal Organization, or Urban Indian
Organization, that the Secretary, in consultation with the
Attorney General, determines is appropriate, taking into
account the special circumstances of such Indian Health
Programs, Indian Tribes, Tribal Organizations, and Urban
Indian Organizations, and of patients served by such
Programs, Tribes, and Organizations.''.

SEC. _28. RULES APPLICABLE UNDER MEDICAID AND SCHIP TO
MANAGED CARE ENTITIES WITH RESPECT TO INDIAN
ENROLLEES AND INDIAN HEALTH CARE PROVIDERS AND
INDIAN MANAGED CARE ENTITIES.

(a) In General.--Section 1932 of the Social Security Act
(42 U.S.C. 1396u-2) is amended by adding at the end the
following new subsection:
``(h) Special Rules With Respect to Indian Enrollees,
Indian Health Care Providers, and Indian Managed Care
Entities.--
``(1) Enrollee option to select an indian health care
provider as primary care provider.--In the case of a non-
Indian Medicaid managed care entity that--
``(A) has an Indian enrolled with the entity; and
``(B) has an Indian health care provider that is
participating as a primary care provider within the network
of the entity,

insofar as the Indian is otherwise eligible to receive
services from such Indian health care provider and the Indian
health care provider has the capacity to provide primary care
services to such Indian, the contract with the entity under
section 1903(m) or under section 1905(t)(3) shall require, as
a condition of receiving payment under such contract, that
the Indian shall be allowed to choose such Indian health care
provider as the Indian's primary care provider under the
entity.
``(2) Assurance of payment to indian health care providers
for provision of covered services.--Each contract with a
managed care entity under section 1903(m) or under section
1905(t)(3) shall require any such entity that has a
significant percentage of Indian enrollees (as determined by
the Secretary), as a condition of receiving payment under
such contract to satisfy the following requirements:
``(A) Demonstration of participating indian health care
providers or application of alternative payment
arrangements.--Subject to subparagraph (E), to--
``(i) demonstrate that the number of Indian health care
providers that are participating providers with respect to
such entity are sufficient to ensure timely access to covered
Medicaid managed care services for those enrollees who are
eligible to receive services from such providers; or
``(ii) agree to pay Indian health care providers who are
not participating providers with the entity for covered
Medicaid managed care services provided to those enrollees
who are eligible to receive services from such providers at a
rate equal to the rate negotiated between such entity and the
provider involved or, if such a rate has not been negotiated,
at a rate that is not less than the level and amount of
payment which the entity would make for the services if the
services were furnished by a participating provider which is
not an Indian health care provider.
``(B) Prompt payment.--To agree to make prompt payment (in
accordance with rules applicable to managed care entities) to
Indian health care providers that are participating providers
with respect to such entity or, in the case of an entity to
which subparagraph (A)(ii) or (E) applies, that the entity is
required to pay in accordance with that subparagraph.
``(C) Satisfaction of claim requirement.--To deem any
requirement for the submission of a claim or other
documentation for services covered under subparagraph (A) by
the enrollee to be satisfied through the submission of a
claim or other documentation by an Indian health care
provider that is consistent with section 403(h) of the Indian
Health Care Improvement Act.
``(D) Compliance with generally applicable requirements.--
``(i) In general.--Subject to clause (ii), as a condition
of payment under subparagraph (A), an Indian health care
provider shall comply with the generally applicable
requirements of this title, the State plan, and such entity
with respect to covered Medicaid managed care services
provided by the Indian health care provider to the same
extent that non-Indian providers participating with the
entity must comply with such requirements.
``(ii) Limitations on compliance with managed care entity
generally applicable requirements.--An Indian health care
provider--

``(I) shall not be required to comply with a generally
applicable requirement of a managed care entity described in
clause (i) as a condition of payment under subparagraph (A)
if such compliance would conflict with any other statutory or
regulatory requirements applicable to the Indian health care
provider; and
``(II) shall only need to comply with those generally
applicable requirements of a managed care entity described in
clause (i) as a condition of payment under subparagraph (A)
that are necessary for the entity's compliance with the State
plan, such as those related to care management, quality
assurance, and utilization management.

``(E) Application of special payment requirements for
federally-qualified health centers and encounter rate for
services provided by certain indian health care providers.--
``(i) Federally-qualified health centers.--

``(I) Managed care entity payment requirement.--To agree to
pay any Indian health care provider that is a Federally-
qualified health center but not a participating provider with
respect to the entity, for the provision of covered Medicaid
managed care services by such provider to an Indian enrollee
of the entity at a rate equal to the amount of payment that
the entity would pay a Federally-qualified health center that
is a participating provider with respect to the entity but is
not an Indian health care provider for such services.
``(II) Continued application of state requirement to make
supplemental payment.--Nothing in subclause (I) or
subparagraph (A) or (B) shall be construed as waiving the
application of section 1902(bb)(5) regarding the State plan
requirement to make any supplemental payment due under such
section to a Federally-qualified health center for services
furnished by such center

[[Page S10499]]

to an enrollee of a managed care entity (regardless of
whether the Federally-qualified health center is or is not a
participating provider with the entity).

``(ii) Continued application of encounter rate for services
provided by certain indian health care providers.--If the
amount paid by a managed care entity to an Indian health care
provider that is not a Federally-qualified health center and
that has elected to receive payment under this title as an
Indian Health Service provider under the July 11, 1996,
Memorandum of Agreement between the Health Care Financing
Administration (now the Centers for Medicare & Medicaid
Services) and the Indian Health Service for services provided
by such provider to an Indian enrollee with the managed care
entity is less than the encounter rate that applies to the
provision of such services under such memorandum, the State
plan shall provide for payment to the Indian health care
provider of the difference between the applicable encounter
rate under such memorandum and the amount paid by the managed
care entity to the provider for such services.
``(F) Construction.--Nothing in this paragraph shall be
construed as waiving the application of section
1902(a)(30)(A) (relating to application of standards to
assure that payments are consistent with efficiency, economy,
and quality of care).
``(3) Offering of managed care through indian medicaid
managed care entities.--If--
``(A) a State elects to provide services through Medicaid
managed care entities under its Medicaid managed care
program; and
``(B) an Indian health care provider that is funded in
whole or in part by the Indian Health Service, or a
consortium composed of 1 or more Tribes, Tribal
Organizations, or Urban Indian Organizations, and which also
may include the Indian Health Service, has established an
Indian Medicaid managed care entity in the State that meets
generally applicable standards required of such an entity
under such Medicaid managed care program,

the State shall offer to enter into an agreement with the
entity to serve as a Medicaid managed care entity with
respect to eligible Indians served by such entity under such
program.
``(4) Special rules for indian managed care entities.--The
following are special rules regarding the application of a
Medicaid managed care program to Indian Medicaid managed care
entities:
``(A) Enrollment.--
``(i) Limitation to indians.--An Indian Medicaid managed
care entity may restrict enrollment under such program to
Indians and to members of specific Tribes in the same manner
as Indian Health Programs may restrict the delivery of
services to such Indians and tribal members.
``(ii) No less choice of plans.--Under such program the
State may not limit the choice of an Indian among Medicaid
managed care entities only to Indian Medicaid managed care
entities or to be more restrictive than the choice of managed
care entities offered to individuals who are not Indians.
``(iii) Default enrollment.--

``(I) In general.--If such program of a State requires the
enrollment of Indians in a Medicaid managed care entity in
order to receive benefits, the State, taking into
consideration the criteria specified in subsection
(a)(4)(D)(ii)(I), shall provide for the enrollment of Indians
described in subclause (II) who are not otherwise enrolled
with such an entity in an Indian Medicaid managed care entity
described in such clause.
``(II) Indian described.--An Indian described in this
subclause, with respect to an Indian Medicaid managed care
entity, is an Indian who, based upon the service area and
capacity of the entity, is eligible to be enrolled with the
entity consistent with subparagraph (A).

``(iv) Exception to state lock-in.--A request by an Indian
who is enrolled under such program with a non-Indian Medicaid
managed care entity to change enrollment with that entity to
enrollment with an Indian Medicaid managed care entity shall
be considered cause for granting such request under
procedures specified by the Secretary.
``(B) Flexibility in application of solvency.--In applying
section 1903(m)(1) to an Indian Medicaid managed care
entity--
``(i) any reference to a `State' in subparagraph (A)(ii) of
that section shall be deemed to be a reference to the
`Secretary'; and
``(ii) the entity shall be deemed to be a public entity
described in subparagraph (C)(ii) of that section.
``(C) Exceptions to advance directives.--The Secretary may
modify or waive the requirements of section 1902(w) (relating
to provision of written materials on advance directives)
insofar as the Secretary finds that the requirements
otherwise imposed are not an appropriate or effective way of
communicating the information to Indians.
``(D) Flexibility in information and marketing.--
``(i) Materials.--The Secretary may modify requirements
under subsection (a)(5) to ensure that information described
in that subsection is provided to enrollees and potential
enrollees of Indian Medicaid managed care entities in a
culturally appropriate and understandable manner that clearly
communicates to such enrollees and potential enrollees their
rights, protections, and benefits.
``(ii) Distribution of marketing materials.--The provisions
of subsection (d)(2)(B) requiring the distribution of
marketing materials to an entire service area shall be deemed
satisfied in the case of an Indian Medicaid managed care
entity that distributes appropriate materials only to those
Indians who are potentially eligible to enroll with the
entity in the service area.
``(5) Malpractice insurance.--Insofar as, under a Medicaid
managed care program, a health care provider is required to
have medical malpractice insurance coverage as a condition of
contracting as a provider with a Medicaid managed care
entity, an Indian health care provider that is--
``(A) a Federally-qualified health center that is covered
under the Federal Tort Claims Act (28 U.S.C. 1346(b), 2671 et
seq.);
``(B) providing health care services pursuant to a contract
or compact under the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.) that are covered under
the Federal Tort Claims Act (28 U.S.C. 1346(b), 2671 et
seq.); or
``(C) the Indian Health Service providing health care
services that are covered under the Federal Tort Claims Act
(28 U.S.C. 1346(b), 2671 et seq.);

are deemed to satisfy such requirement.
``(6) Definitions.--For purposes of this subsection:
``(A) Indian health care provider.--The term `Indian health
care provider' means an Indian Health Program or an Urban
Indian Organization.
``(B) Indian; indian health program; service; tribe; tribal
organization; urban indian organization.--The terms `Indian',
`Indian Health Program', `Service', `Tribe', `tribal
organization', `Urban Indian Organization' have the meanings
given such terms in section 4 of the Indian Health Care
Improvement Act.
``(C) Indian medicaid managed care entity.--The term
`Indian Medicaid managed care entity' means a managed care
entity that is controlled (within the meaning of the last
sentence of section 1903(m)(1)(C)) by the Indian Health
Service, a Tribe, Tribal Organization, or Urban Indian
Organization, or a consortium, which may be composed of 1 or
more Tribes, Tribal Organizations, or Urban Indian
Organizations, and which also may include the Service.
``(D) Non-indian medicaid managed care entity.--The term
`non-Indian Medicaid managed care entity' means a managed
care entity that is not an Indian Medicaid managed care
entity.
``(E) Covered medicaid managed care services.--The term
`covered Medicaid managed care services' means, with respect
to an individual enrolled with a managed care entity, items
and services that are within the scope of items and services
for which benefits are available with respect to the
individual under the contract between the entity and the
State involved.
``(F) Medicaid managed care program.--The term `Medicaid
managed care program' means a program under sections 1903(m)
and 1932 and includes a managed care program operating under
a waiver under section 1915(b) or 1115 or otherwise.''.
(b) Application to SCHIP.--Section 2107(e)(1) of such Act
(42 U.S.C. 1397gg(1)), as amended by section _26(b)(2), is
amended by adding at the end the following new subparagraph:
``(H) Subsections (a)(2)(C) and (h) of section 1932.''.

SEC. _29. ANNUAL REPORT ON INDIANS SERVED BY SOCIAL SECURITY
ACT HEALTH BENEFIT PROGRAMS.

Section 1139 of the Social Security Act (42 U.S.C. 1320b-
9), as amended by the sections 202, 205, and 206, is amended
by redesignating subsection (e) as subsection (f), and
inserting after subsection (d) the following new subsection:
``(e) Annual Report on Indians Served by Health Benefit
Programs Funded Under This Act.--Beginning January 1, 2008,
and annually thereafter, the Secretary, acting through the
Administrator of the Centers for Medicare & Medicaid Services
and the Director of the Indian Health Service, shall submit a
report to Congress regarding the enrollment and health status
of Indians receiving items or services under health benefit
programs funded under this Act during the preceding year.
Each such report shall include the following:
``(1) The total number of Indians enrolled in, or receiving
items or services under, such programs, disaggregated with
respect to each such program.
``(2) The number of Indians described in paragraph (1) that
also received health benefits under programs funded by the
Indian Health Service.
``(3) General information regarding the health status of
the Indians described in paragraph (1), disaggregated with
respect to specific diseases or conditions and presented in a
manner that is consistent with protections for privacy of
individually identifiable health information under section
264(c) of the Health Insurance Portability and Accountability
Act of 1996.
``(4) A detailed statement of the status of facilities of
the Indian Health Service or an Indian Tribe, Tribal
Organization, or an Urban Indian Organization with respect to
such facilities' compliance with the applicable conditions
and requirements of titles XVIII, XIX, and XXI, and, in the
case of title XIX or XXI, under a State plan under such title
or under waiver authority, and of the progress being made by
such facilities (under plans submitted under section 1880(b),
1911(b) or otherwise) toward the achievement and maintenance
of such compliance.

[[Page S10500]]

``(5) Such other information as the Secretary determines is
appropriate.''.
______

SA 2535. Mr. ALLARD submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

At the appropriate place, insert the following:

SEC. __. TREATMENT OF UNBORN CHILDREN.

(a) Codification of Current Regulations.--Section
2110(c)(1) (42 U.S.C. 1397jj(c)(1)) is amended by striking
the period at the end and inserting the following: ``, and
includes, at the option of a State, an unborn child. For
purposes of the previous sentence, the term `unborn child'
means a member of the species Homo sapiens, at any stage of
development, who is carried in the womb.''.
(b) Clarifications Regarding Coverage of Mothers.--Section
2103 (42 U.S.C. 1397cc) is amended by adding at the end the
following new subsection:
``(g) Clarifications Regarding Authority to Provide
Postpartum Services and Maternal Health Care.--Any State that
provides child health assistance to an unborn child under the
option described in section 2110(c)(1) may--
``(1) continue to provide such assistance to the mother, as
well as postpartum services, through the end of the month in
which the 60-day period (beginning on the last day of
pregnancy) ends; and
``(2) in the interest of the child to be born, have
flexibility in defining and providing services to benefit
either the mother or unborn child consistent with the health
of both.''.
______

SA 2536. Mr. ALLARD submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; as follows:

At the end of title I, add the following:

SEC. __. STANDARDIZATION OF DETERMINATION OF FAMILY INCOME.

(a) Eligibility Based on Gross Income.--
(1) In general.--Section 2110 (42 U.S.C. 1397jj) is amended
by adding at the end the following new subsection:
``(d) Standardization of Determination of Family Income.--A
State shall determine family income for purposes of
determining income eligibility for child health assistance or
other health benefits coverage under the State child health
plan (or under a waiver of such plan under section 1115)
solely on the basis of the gross income (as defined by the
Secretary) of the family.''.
(2) Prohibition on waiver of requirements.--Section 2107(f)
(42 U.S.C. 1397gg(f)), as amended by section 106(a)(2)(A), is
amended by adding at the end the following new paragraph:
``(3) The Secretary may not approve a waiver, experimental,
pilot, or demonstration project with respect to a State after
the date of enactment of the Children's Health Insurance
Program Reauthorization Act of 2007 that would waive or
modify the requirements of section 2110(d) (relating to
determining income eligibility on the basis of gross income)
and regulations promulgated to carry out such
requirements.''.
(b) Regulations.--Not later than 90 days after the date of
enactment of this Act, the Secretary shall promulgate interim
final regulations defining gross income for purposes of
section 2110(d) of the Social Security Act, as added by
subsection (a)(1).
(c) Application to Current Enrollees.--The interim final
regulations promulgated under subsection (b) shall not be
used to determine the income eligibility of any individual
enrolled in a State child health plan under title XXI of the
Social Security Act on the date of enactment of this Act
before the date on which such eligibility of the individual
is required to be redetermined under the plan as in effect on
such date. In the case of any individual enrolled in such
plan on such date who, solely as a result of the application
of subsection (d) of section 2110 of the Social Security Act
(as added by subsection (a)(1))) and the regulations
promulgated under subsection (b), is determined to be
ineligible for child health assistance under the State child
health plan, a State may elect, subject to substitution of
the Federal medical assistance percentage for the enhanced
FMAP under section 2105(a)(1) of the Social Security Act, to
continue to provide the individual with such assistance for
so long as the individual otherwise would be eligible for
such assistance and the individual's family income, if
determined under the income and resource standards and
methodologies applicable under the State child health plan on
September 30, 2007, would not exceed the income eligibility
level applicable to the individual under the State child
health plan.
______

SA 2537. Mr. KYL submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

At the end, add the following:

SEC. __. DELAY IN EFFECTIVE DATE.

Notwithstanding any other provision of this Act, this Act
and the amendments made by this Act shall not take effect
until the day after the date on which the Director of the
Congressional Budget Office certifies that this Act and the
amendments made by the Act, will not result in a reduction of
private health insurance coverage greater than 20 percent.
______

SA 2538. Mr. ENSIGN submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; as follows:

At the appropriate place, insert the following:

SEC. _. DISEASE PREVENTION AND TREATMENT RESEARCH TRUST FUND.

(a) In General.--Subchapter A of chapter 98 of the Internal
Revenue Code of 1986 (relating to establishment of trust
funds) is amended by adding at the end the following new
section:

``SEC. 9511. DISEASE PREVENTION AND TREATMENT RESEARCH TRUST
FUND.

``(a) Creation of Trust Fund.--There is established in the
Treasury of the United States a trust fund to be known as the
`Disease Prevention and Treatment Research Trust Fund',
consisting of such amounts as may be appropriated or credited
to the Disease Prevention and Treatment Research Trust Fund.
``(b) Transfer to Disease Prevention and Treatment Research
Trust Fund of Amounts Equivalent to Certain Taxes.--There are
hereby appropriated to the Disease Prevention and Treatment
Research Trust Fund amounts equivalent to the taxes received
in the Treasury attributable to the amendments made by
section 701 of the Children's Health Insurance Program
Reauthorization Act of 2007.
``(c) Expenditures From Trust Fund.--
``(1) In general.--Amounts in the Disease Prevention and
Treatment Research Trust Fund shall be available, as provided
by appropriation Acts, for the purposes of funding the
disease prevention and treatment research activities of the
National Institutes of Health. Amounts appropriated from the
Disease Prevention and Treatment Research Trust Fund shall be
in addition to any other funds provided by appropriation Acts
for the National Institutes of Health.
``(2) Disease prevention and treatment research
activities.--Disease prevention and treatment research
activities shall include activities relating to:
``(A) Cancer.--Disease prevention and treatment research in
this category shall include activities relating to pediatric,
lung, breast, ovarian, uterine, prostate, colon, rectal,
oral, skin, bone, kidney, liver, stomach, bladder, thyroid,
pancreatic, brain and nervous system, and blood-related
cancers, including leukemia and lymphoma. Priority in this
category shall be given to disease prevention and treatment
research into pediatric cancers.
``(B) Respiratory diseases.--Disease prevention and
treatment research in this category shall include activities
relating to chronic obstructive pulmonary disease,
tuberculosis, bronchitis, asthma, and emphysema.
``(C) Cardiovascular diseases.--Disease prevention and
treatment research in this category shall include activities
relating to peripheral arterial disease, heart disease, valve
disease, stroke, and hypertension.
``(D) Other diseases, conditions, and disorders.--Disease
prevention and treatment research in this category shall
include activities relating to autism, diabetes (including
type I diabetes, also known as juvenile diabetes, and type II
diabetes), muscular dystrophy, Alzheimer's disease,
Parkinson's disease, multiple sclerosis, amyotrophic lateral
sclerosis, cerebral palsy, cystic fibrosis, spinal muscular
atrophy, osteoporosis, human immunodeficiency virus (HIV) and
acquired immunodeficiency syndrome (AIDS), depression and
other mental health disorders, infertility, arthritis,
anaphylaxis, lymphedema, psoriasis, eczema, lupus, cleft lip
and palate, fibromyalgia, chronic fatigue and immune
dysfunction syndrome, alopecia areata, and sepsis.''.
(b) Clerical Amendment.--The table of sections for
subchapter A of chapter 98 of the Internal Revenue Code of
1986 is amended by adding at the end the following new item:

``Sec. 9511. Disease Prevention and Treatment Research Trust Fund.''.
______

SA 2539. Mr. ENSIGN submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

[[Page S10501]]

Strike section 106 and insert the following:

SEC. 106. ELIMINATION OF COVERAGE FOR NONPREGNANT ADULTS.

(a) Elimination of Coverage.--Title XXI (42 U.S.C. 1397aa
et seq.) is amended by adding at the end the following new
section:

``SEC. 2111. ELIMINATION OF COVERAGE FOR NONPREGNANT ADULTS.

``(a) No Coverage for Nonpregnant Childless Adults and
Nonpregnant Parents.--
``(1) Termination of coverage under applicable existing
waivers.--No funds shall be available under this title for
child health assistance or other health benefits coverage
that is provided for any other adult other than a pregnant
woman after September 30, 2007.
``(2) No new waivers.--Notwithstanding section 1115 or any
other provision of this title the Secretary shall not on or
after the date of the enactment of the Children's Health
Insurance Program Reauthorization Act of 2007, approve or
renew a waiver, experimental, pilot, or demonstration project
that would allow funds made available under this title to be
used to provide child health assistance or other health
benefits coverage for any other adult other than a pregnant
woman.
``(b) Increased Outreach and Coverage of Low-Income
Children.--A State that, but for the application of
subsections (a) and (b), would have expended funds for child
health assistance or other health benefits coverage for an
adult other than a pregnant woman after fiscal year 2007
shall use the funds that would have been expended for such
assistance or coverage to conduct outreach to, and provide
child health assistance for, low-income children who are
eligible for such assistance under the State child health
plan.
``(c) Nonapplication.--Beginning with fiscal year 2008,
this title shall be applied without regard to any provision
of this title that would be contrary to the prohibition on
providing child health assistance or health benefits coverage
for an adult other than a pregnant woman established under
this section.''.
(b) Conforming Amendments.--
(1) Section 2107(f) (42 U.S.C. 1397gg(f)) is amended--
(A) by striking ``, the Secretary'' and inserting ``:
``(1) The Secretary'';
(B) in the first sentence, by inserting ``or a nonpregnant
parent (as defined in section 2111(d)(2)) of a targeted low-
income child'' before the period;
(C) by striking the second sentence; and
(D) by adding at the end the following new paragraph:
``(2) The Secretary may not approve, extend, renew, or
amend a waiver, experimental, pilot, or demonstration project
with respect to a State after the date of enactment of the
Children's Health Insurance Program Reauthorization Act of
2007 that would waive or modify the requirements of section
2111.''.
(2) Section 6102(c) of the Deficit Reduction Act of 2005
(Public Law 109-171; 120 Stat. 131) is amended by striking
``Nothing'' and inserting ``Subject to section 2111 of the
Social Security Act, as added by section 106(a)(1) of the
Children's Health Insurance Program Reauthorization Act of
2007, nothing''.
______

SA 2540. Mr. ENSIGN submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

On page 58, between lines 16 and 17, insert the following:
``(d) Cover Kids First Implementation Requirement.--
Notwithstanding the preceding subsections of this section, no
funds shall be available under this title for child health
assistance or other health benefits coverage that is provided
for any other adult other than a pregnant woman, and this
title shall be applied with respect to a State without regard
to such subsections, for each fiscal year quarter that begins
prior to the date on which the State demonstrates to the
Secretary that the State has enrolled in the State child
health plan at least 95 percent of the targeted low-income
children who reside in the State.''.
______

SA 2541. Mr. ENSIGN submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

At the end of title I, add the following:

SEC. 112. COVER LOW-INCOME KIDS FIRST.

Section 2105(c) (42 U.S.C. 1397ee(c)), as amended by
section 602, is amended by adding at the end the following
new paragraph:
``(12) No payments for expenditures for child health
assistance or health benefits coverage for individuals whose
gross family income exceeds 200 percent of the poverty line
unless at least 95 percent of eligible low-income children
enrolled.--Notwithstanding any other provision of this title,
for fiscal years beginning with fiscal year 2008, no payments
shall be made to a State under subsection (a)(1), or any
other provision of this title, for any fiscal year quarter
that begins prior to the date on which the State demonstrates
to the Secretary that the State has enrolled in the State
child health plan at least 95 percent of the low-income
children who reside in the State and are eligible for child
health assistance under this State child health plan with
respect to any expenditures for providing child health
assistance or health benefits coverage for any individual
whose gross family income exceeds 200 percent of the poverty
line.''.
______

SA 2542. Mr. ENSIGN submitted an amendment intended to be proposed to
the amendment SA 2530 proposed by Mr. Baucus (for himself, Mr.
Grassley, Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to
amend the Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

At the end of title I, add the following:

SEC. 112. REMOVING THE INCENTIVE TO COVER CHILDREN AT HIGHER
INCOME LEVELS RATHER THAN LOWER INCOME LEVELS.

(a) Elimination of Enhanced FMAP.--Section 2105 (42 U.S.C.
1397ee) is amended--
(1) in subsection (a)(1), in the matter preceding
subparagraph (A), by striking ``enhanced FMAP (or, in the
case of expenditures described in subparagraph (B), the
Federal medical assistance percentage (as defined in the
first sentence of section 1905(b)))'' and inserting ``Federal
medical assistance percentage'';
(2) in subparagraph (A), by striking ``on the basis of an
enhanced FMAP'';
(3) by striking subsection (b) and inserting the following:
``(b) Federal Medical Assistance Percentage.--The term
`Federal medical assistance percentage' has the meaning given
such term in the first sentence of section 1905(b).'';
(4) in subsection (d)(B)(ii), by striking ``an enhanced
FMAP'' and inserting ``payments''; and
(5) in subsection (g)(1)(B)(i), by striking ``the
additional amount'' and all that follows through the period
and inserting ``the Federal medical assistance percentage
with respect to expenditures described in clause (ii).''.
(b) Conforming Amendments to Title XIX.--Section 1905 (42
U.S.C. 1396d)) is amended--
(1) in subsection (b)--
(A) in the first sentence by striking ``and (4)'' and all
that follows up to the period;
(B) in the last sentence--
(i) by inserting ``the Federal medical assistance
percentage shall apply only'' after ``Notwithstanding the
first sentence of this subsection,''; and
(ii) by striking ``section 2104'' and all that follows
through the period and inserting ``section 2104.''; and
(2) in subsection (u)(4), by striking ``an enhanced FMAP
described in section 2105(b)'' and inserting ``this
subsection''.
(c) Conforming Amendments to Title XXI and the Amendments
Made by Other Provisions of This Act.--
(1) Subsections (a)(2) and (b)(1) of section 2111, as added
by section 106(a), are each amended by striking subparagraph
(C).
(2) Section 2111(b)(2)(B), as so added, is amended--
(A) in clause (ii), by striking ``applicable percentage
determined under clause (iii) or (iv) for'' and inserting
``Federal medical assistance percentage of'';
(B) by striking clauses (iii) and (iv); and
(C) by redesignating clauses (v) and (vi) as clauses (iii)
and (iv), respectively.
(3) This Act shall be applied without regard to the
amendment to section 2105(c) made by section 110.
(4) Section 2105(g)(4)(A), as added by section 111, is
amended by striking ``the additional amount'' and all that
follows through the period and inserting ``the Federal
medical assistance percentage with respect to expenditures
described in subparagraph (B).''.
(5) The amendment made by paragraph (1) of section 201(b)
of this Act is amended to read as follows:
``(1) in the matter preceding subparagraph (A) (as amended
by section 112(a)(1)(A)), by inserting `(or, in the case of
expenditures described in subparagraph (D)(iv), 75 percent )'
after `Federal medical assistance percentage'; and''.
(6) Section 2105(c)(9), as added by section 301(c)(1), is
amended by striking ``enhanced FMAP'' and inserting ``Federal
medical assistance percentage''.
(7) Section 601(a)(2) of this Act is amended by striking
``, rather than on the basis of an enhanced FMAP (as defined
in section 2105(b) of such Act)''.
(8) Section 2105(c)(11), as added by section 602(a)(1), is
amended by striking ``enhanced FMAP'' and inserting ``Federal
medical assistance percentage''.
______

SA 2543. Mr. ENSIGN submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other

[[Page S10502]]

purposes; which was ordered to lie on the table; as follows:

At the end of title VI, add the following:

SEC. 610. PERSONAL EMPOWERMENT THROUGH INDIVIDUAL
RESPONSIBILITY.

Section 2103(e) (42 U.S.C. 1397cc(e)) is amended by adding
at the end the following new paragraph:
``(5) Personal empowerment through individual
responsibility.--Notwithstanding the preceding provisions of
this subsection or any other provision of this title, for
fiscal years beginning with fiscal year 2008, a State shall
not be considered to have an approved State child health plan
unless the State has submitted a State plan amendment to the
Secretary specifying how the State will impose premiums,
deductibles, coinsurance, and other cost-sharing under the
State child health plan (regardless of whether such plan is
implemented under this title, title XIX, or both) for
populations of individuals whose family income exceeds the
effective income eligibility level applicable under the State
child health plan for that population on the date of the
enactment of the Children's Health Insurance Program
Reauthorization Act of 2007, in a manner that is consistent
with the authority and limitations for imposed cost-sharing
under section 1916A.''.
______

SA 2544. Mr. ENSIGN submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

Beginning on page 134, strike line 23 and all that follows
through page 135, line 10, and insert the following:
(ii) Inclusion of high deductible health plans; exclusion
of flexible spending arrangements.--Such term--

(I) includes coverage consisting of a high deductible
health plan (as defined in section 223(c)(2) of such Code)
purchased in conjunction with a health savings account (as
defined under section 223(d) of such Code); but
(II) does not include coverage consisting of benefits
provided under a health flexible spending arrangement (as
defined in section 106(c)(2) of the Internal Revenue Code of
1986).

______

SA 2545. Mr. ENSIGN (for himself and Mr. DeMint) submitted an
amendment intended to be proposed to amendment SA 2530 proposed by Mr.
Baucus (for himself, Mr. Grassley, Mr. Rockefeller, and Mr. Hatch) to
the bill H.R. 976, to amend the Internal Revenue Code of 1986 to
provide tax relief for small businesses, and for other purposes; which
was ordered to lie on the table; as follows:

On page 217, after line 25, insert the following:

SEC. _. USE OF HEALTH SAVINGS ACCOUNTS FOR NON-GROUP HIGH
DEDUCTIBLE HEALTH PLAN PREMIUMS.

(a) In General.--Section 223(d)(2)(C) of the Internal
Revenue Code of 1986 (relating to exceptions) is amended by
striking ``or'' at the end of clause (iii), by striking the
period at the end of clause (iv) and inserting ``, or'', and
by adding at the end the following new clause:
``(v) a high deductible health plan, other than a group
health plan (as defined in section 5000(b)(1)).''.
(b) Effective Date.--The amendment made by this section
shall apply to taxable years beginning after December 31,
2007.
______

SA 2546. Mr. ENSIGN submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

On page 217, after line 25, add the following:

SEC. ___. REPEAL OF EXCISE TAX ON TELEPHONE AND OTHER
COMMUNICATIONS SERVICES.

(a) In General.--Chapter 33 of the Internal Revenue Code of
1986 (relating to facilities and services) is amended by
striking subchapter B.
(b) Conforming Amendments.--
(1) Section 4293 of such Code is amended by striking
``chapter 32 (other than the taxes imposed by sections 4064
and 4121) and subchapter B of chapter 33,'' and inserting
``and chapter 32 (other than the taxes imposed by sections
4064 and 4121),''.
(2)(A) Paragraph (1) of section 6302(e) of such Code is
amended by striking ``section 4251 or''.
(B) Paragraph (2) of section 6302(e) of such Code is
amended--
(i) by striking ``imposed by--'' and all that follows
through ``with respect to'' and inserting ``imposed by
section 4261 or 4271 with respect to'', and
(ii) by striking ``bills rendered or''.
(C) The subsection heading for section 6302(e) of such Code
is amended by striking ``Communications Services and''.
(3) Section 6415 of such Code is amended by striking
``4251, 4261, or 4271'' each place it appears and inserting
``4261 or 4271''.
(4) Paragraph (2) of section 7871(a) of such Code is
amended by inserting ``or'' at the end of subparagraph (B),
by striking subparagraph (C), and by redesignating
subparagraph (D) as subparagraph (C).
(5) The table of subchapters for chapter 33 of such Code is
amended by striking the item relating to subchapter B.
(c) Effective Date.--The amendments made by this section
shall apply to amounts paid pursuant to bills first rendered
more than 90 days after the date of the enactment of this
Act.
______

SA 2547. Mr. BUNNING submitted an amendment intended to be proposed
to amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; as follows:

Beginning on page 79, strike line 21 and all that follows
through page 81, line 6, and insert the following:
(a) FMAP Applied to Expenditures.--Section 2105(c) (42
U.S.C. 1397ee(c)) is amended by adding at the end the
following new paragraph:
``(8) Limitation on matching rate for expenditures for
child health assistance provided to children whose effective
family income exceeds 300 percent of the poverty line.--For
fiscal years beginning with fiscal year 2008, the Federal
medical assistance percentage (as determined under section
1905(b) without regard to clause (4) of such section) shall
be substituted for the enhanced FMAP under subsection (a)(1)
with respect to any expenditures for providing child health
assistance or health benefits coverage for a targeted low-
income child whose effective family income would exceed 300
percent of the poverty line but for the application of a
general exclusion of a block of income that is not determined
by type of expense or type of income.''.
(b) Conforming Amendment.--Section 2105(a)(1) ( 42 U.S.C.
1397dd(a)(1)) is amended, in the matter preceding
subparagraph (A), by inserting ``or subsection (c)(8)'' after
``subparagraph (B)''.
(c) Application of Savings to Grants for Outreach and
Enrollment.--
(1) In general.--Notwithstanding the dollar amount
specified in section 2113(g) of the Social Security Act, as
added by section 201(a), the dollar amount specified in such
section shall be increased by the amount appropriated under
paragraph (2).
(2) Appropriation.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated such amount as
the Secretary determines is equal to the amount of additional
Federal expenditures for the period of fiscal years 2008
through 2012 that would have been made if the enhanced FMAP
(as defined in section 2105(b) of the Social Security Act)
applied to expenditures for providing child health assistance
to targeted low-income children residing in a State that, on
the date of enactment of the Children's Health Insurance
Program Reauthorization Act of 2007, has an approved State
plan amendment or waiver to provide, or has enacted a State
law to submit a State plan amendment to provide, expenditures
described in section 2105(c)(8) of such Act (as added by
subsection (a)). The preceding sentence constitutes budget
authority in advance of appropriations Act and represents the
obligation of the Federal Government to provide for the
payment of such amount to States awarded grants under section
2113 of the Social Security Act.
______

SA 2548. Mr. BURR (for himself, Mr. Corker, Mr. Coburn, Mr. Martinez,
and Mrs. Dole) submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other puuposes; which was ordered to lie on the
table; as follows:

At the end, add the following:

TITLE __--EVERY AMERICAN HEALTH INSURED

Subtitle A--Refundable and Advanceable Credit for Certain Health
Insurance Coverage

SEC. __00. REFERENCE.

Except as otherwise expressly provided, whenever in this
subtitle an amendment or repeal is expressed in terms of an
amendment to, or repeal of, a section or other provision, the
reference shall be considered to be made to a section or
other provision of the Internal Revenue Code of 1986.

SEC. __01. REFUNDABLE AND ADVANCEABLE CREDIT FOR CERTAIN
HEALTH INSURANCE COVERAGE.

(a) Advanceable Credit.--Subpart A of part IV of subchapter
A of chapter 1 (relating to nonrefundable personal credits)
is amended by adding at the end the following new section:

``SEC. 25E. QUALIFIED HEALTH INSURANCE CREDIT.

``(a) Allowance of Credit.--In the case of an individual,
there shall be allowed as a

[[Page S10503]]

credit against the tax imposed by this chapter for the
taxable year the sum of the monthly limitations determined
under subsection (b) for the taxpayer and the taxpayer's
spouse and dependents.
``(b) Monthly Limitation.--
``(1) In general.--The monthly limitation for each month
during the taxable year for an eligible individual is \1/
12\th of--
``(A) the applicable adult amount, in the case that the
eligible individual is the taxpayer or the taxpayer's spouse,
``(B) the applicable adult amount, in the case that the
eligible individual is an adult dependent, and
``(C) the applicable child amount, in the case that the
eligible individual is a child dependent.
``(2) Limitation on aggregate amount.--Notwithstanding
paragraph (1), the aggregate monthly limitations for the
taxpayer and the taxpayer's spouse and dependents for any
month shall not exceed \1/12\th of the applicable aggregate
amount.
``(3) Applicable amount.--For purposes of this section--

Applicable adult  Applicable child     Applicable
``Calendar year         amount            amount       aggregate amount

2009             $2,160             $1,620            $5,400
2010             $2,220             $1,670            $5,550
2011             $2,290             $1,710            $5,710
2012             $2,350             $1,760            $5,880
2013             $2,420             $1,810            $6,050
2014             $2,490             $1,870            $6,220
2015             $2,560             $1,920            $6,400
2016             $2,640             $1,980            $6,590
2017             $2,710             $2,030            $6,780

``(4) No credit for ineligible months.--With respect to any
individual, the monthly limitation shall be zero for any
month for which such individual is not an eligible
individual.
``(c) Limitation Based on Amount of Tax.--In the case of a
taxable year to which section 26(a)(2) does not apply, the
credit allowed under subsection (a) for the taxable year
shall not exceed the excess of--
``(1) the sum of the regular tax liability (as defined in
section 26(b)) plus the tax imposed by section 55, over
``(2) the sum of the credits allowable under this subpart
(other than this section) and section 27 for the taxable
year.
``(d) Excess Credit Refundable to Certain Tax-Favored
Accounts.--If--
``(1) the credit which would be allowable under subsection
(a) if only qualified refund eligible health insurance were
taken into account under this section, exceeds
``(2) the limitation imposed by section 26 or subsection
(c) for the taxable year,
such excess shall be paid by the Secretary into the
designated account of the taxpayer.
``(e) Eligible Individual.--For purposes of this section--
``(1) In general.--The term `eligible individual' means,
with respect to any month, an individual who--
``(A) is the taxpayer, the taxpayer's spouse, or the
taxpayer's dependent, and
``(B) is covered under qualified health insurance as of the
1st day of such month.
``(2) Coverage under medicare, medicaid, schip, military
coverage.--The term `eligible individual' shall not include
any individual who for any month is--
``(A) entitled to benefits under part A of title XVIII of
the Social Security Act or enrolled under part B of such
title, and the individual is not a participant or beneficiary
in a group health plan or large group health plan that is a
primary plan (as defined in section 1862(b)(2)(A) of such
Act),
``(B) enrolled in the program under title XIX or XXI of
such Act (other than under section 1928 of such Act), or
``(C) entitled to benefits under chapter 55 of title 10,
United States Code, including under the TRICARE program (as
defined in section 1072(7) of such title).
``(3) Identification requirements.--The term `eligible
individual' shall not include any individual for any month
unless the policy number associated with the qualified health
insurance and the TIN of each eligible individual covered
under such health insurance for such month are included on
the return of tax for the taxable year in which such month
occurs.
``(4) Prisoners.--The term `eligible individual' shall not
include any individual for a month if, as of the first day of
such month, such individual is imprisoned under Federal,
State, or local authority.
``(5) Aliens.--The term `eligible individual' shall not
include any alien individual who is not a lawful permanent
resident of the United States.
``(f) Health Insurance.--For purposes of this section--
``(1) Qualified health insurance.--The term `qualified
health insurance' means any insurance constituting medical
care which (as determined under regulations prescribed by the
Secretary)--
``(A) has a reasonable annual and lifetime benefit maximum,
and
``(B) provides coverage for inpatient and outpatient care,
emergency benefits, and physician care.
Such term does not include any insurance substantially all of
the coverage of which is coverage described in section
223(c)(1)(B).
``(2) Qualified refund eligible health insurance.--The term
`qualified refund eligible health insurance' means any
qualified health insurance which is--
``(A) coverage under a group health plan (as defined in
section 5000(b)(1)), or
``(B) coverage offered in a State which has been deemed by
the Secretary of Health and Human Services to meet the
refundability requirements of section 2201 of the Social
Security Act.
``(g) Designated Accounts.--
``(1) Designated account.--For purposes of this section,
the term `designated account' means any specified account
established and maintained by the provider of the taxpayer's
qualified refund eligible health insurance--
``(A) which is designated by the taxpayer (in such form and
manner as the Secretary may provide) on the return of tax for
the taxable year, and
``(B) which, under the terms of the account, accepts the
payment described in subparagraph (A) on behalf of the
taxpayer.
``(2) Specified account.--For purposes of this paragraph,
the term `specified account' means--
``(A) any health savings account under section 223 or
Archer MSA under section 220, or
``(B) any health insurance reserve account.
``(3) Health insurance reserve account.--For purposes of
this subsection, the term `health insurance reserve account'
means a trust created or organized in the United States as a
health insurance reserve account exclusively for the purpose
of paying the qualified medical expenses (within the meaning
of section 223(d)(2)) of the account beneficiary (as defined
in section 223(d)(3)), but only if the written governing
instrument creating the trust meets the requirements
described in subparagraphs (B), (C), (D), and (E) of section
223(d)(1). Rules similar to the rules under subsections (g)
and (h) of section 408 shall apply for purposes of this
subparagraph.
``(4) Treatment of payment.--Any payment under subsection
(d) to a designated account shall--
``(A) not be taken into account with respect to any dollar
limitation which applies with respect to contributions to
such account (or to tax benefits with respect to such
contributions),
``(B) be includible in the gross income of the taxpayer for
the taxable year in which the payment is made (except as
provided in subparagraph (C)), and
``(C) be taken into account in determining any deduction or
exclusion from gross income in the same manner as if such
contribution were made by the taxpayer.
``(h) Other Definitions.--For purposes of this section--
``(1) Dependent.--The term `dependent' has the meaning
given such term by section 152 (determined without regard to
subsections (b)(1), (b)(2), and (d)(1)(B) thereof). An
individual who is a child to whom section 152(e) applies
shall be treated as a dependent of the custodial parent for a
coverage month unless the custodial and noncustodial parent
provide otherwise.
``(2) Adult.--The term `adult' means an individual who is
not a child.
``(3) Child.--The term `child' means a qualifying child (as
defined in section 152(c).
``(i) Special Rules.--
``(1) Coordination with medical deduction, etc.--Any amount
paid by a taxpayer for insurance to which subsection (a)
applies shall not be taken into account in computing the
amount allowable to the taxpayer as a credit under section 35
or as a deduction under section 213(a).
``(2) Medical and health savings accounts.--The credit
allowed under subsection (a) for any taxable year shall be
reduced by the aggregate amount distributed from Archer MSAs
(as defined in section 220(d)) and health savings accounts
(as defined in section 223(d)) which are excludable from
gross income for such taxable years by reason of being used
to pay premiums for coverage of an eligible individual under
qualified health insurance for any month.
``(3) Denial of credit to dependents.--No credit shall be
allowed under this section to any individual with respect to
whom a deduction under section 151 is allowable to another
taxpayer for a taxable year beginning in the calendar year in
which such individual's taxable year begins.
``(4) Married couples must file joint return.--
``(A) In general.--If the taxpayer is married at the close
of the taxable year, the credit shall be allowed under
subsection (a) only if the taxpayer and his spouse file a
joint return for the taxable year.
``(B) Marital status; certain married individuals living
apart.--Rules similar to the rules of paragraphs (3) and (4)
of section 21(e) shall apply for purposes of this paragraph.
``(5) Verification of coverage, etc.--No credit shall be
allowed under this section with respect to any individual
unless such individual's coverage (and such related
information as the Secretary may require) is verified in such
manner as the Secretary may prescribe.
``(6) Insurance which covers other individuals; treatment
of payments.--Rules similar to the rules of paragraphs (7)
and (8) of section 35(g) shall apply for purposes of this
section.
``(j) Coordination With Advance Payments.--
``(1) Reduction in credit for advance payments.--With
respect to any taxable year, the amount which would (but for
this subsection) be allowed as a credit to the taxpayer under
subsection (a) shall be reduced (but not below zero) by the
aggregate amount paid on behalf of such taxpayer under
section 7527A for months beginning in such taxable year.

[[Page S10504]]

``(2) Recapture of excess advance payments.--If the
aggregate amount paid on behalf of the taxpayer under section
7527A for months beginning in the taxable year exceeds the
sum of the monthly limitations determined under subsection
(b) for the taxpayer and the taxpayer's spouse and dependents
for such months, then the tax imposed by this chapter for
such taxable year shall be increased by the sum of--
``(A) such excess, plus
``(B) interest on such excess determined at the
underpayment rate established under section 6621 for the
period from the date of the payment under section 7527A to
the date such excess is paid.
For purposes of subparagraph (B), an equal part of the
aggregate amount of the excess shall be deemed to be
attributable to payments made under section 7527A on the
first day of each month beginning in such taxable year,
unless the taxpayer establishes the date on which each such
payment giving rise to such excess occurred, in which case
subparagraph (B) shall be applied with respect to each date
so established.
``(k) Cost-of-Living Adjustments.--
``(1) In general.--In the case of any taxable year
beginning in a calendar year after 2017, each of the dollar
amounts contained in the last row of the table under
subsection (b)(3) shall be increased by an amount equal to
such dollar amount multiplied by the blended cost-of-living
adjustment.
``(2) Blended cost-of-living adjustment.--For purposes of
paragraph (1), the blended cost-of-living adjustment means
one-half of the sum of--
``(A) the cost-of-living adjustment determined under
section 1(f)(3) for the calendar year in which the taxable
year begins by substituting `calendar year 2016' for
`calendar year 1992' in subparagraph (B) thereof, plus
``(B) the cost-of-living adjustment determined under
section 213(d)(10)(B)(ii) for the calendar year in which the
taxable year begins by substituting `2016' for `1996' in
subclause (II) thereof.
``(3) Rounding.--Any increase determined under paragraph
(2) shall be rounded to the nearest multiple of $10.''.
(b) Advance Payment of Credit.--Chapter 77 (relating to
miscellaneous provisions) is amended by inserting after
section 7527 the following new section:

``SEC. 7527A. ADVANCE PAYMENT OF CREDIT FOR QUALIFIED REFUND
ELIGIBLE HEALTH INSURANCE.

``(a) In General.--The Secretary shall establish a program
for making payments on behalf of individuals to providers of
qualified refund eligible health insurance (as defined in
section 25E(f)(2)) for such individuals.
``(b) Limitation.--The Secretary may make payments under
subsection (a) only to the extent that the Secretary
determines that the amount of such payments made on behalf of
any taxpayer for any month does not exceed the sum of the
monthly limitations determined under section 25E(b) for the
taxpayer and taxpayer's spouse and dependents for such
month.''.
(c) Information Reporting.--
(1) In general.--Subpart B of part III of subchapter A of
chapter 61 (relating to information concerning transactions
with other persons) is amended by inserting after section
6050V the following new section:

``SEC. 6050W. RETURNS RELATING TO CREDIT FOR QUALIFIED REFUND
ELIGIBLE HEALTH INSURANCE.

``(a) Requirement of Reporting.--Every person who is
entitled to receive payments for any month of any calendar
year under section 7527A (relating to advance payment of
credit for qualified refund eligible health insurance) with
respect to any individual shall, at such time as the
Secretary may prescribe, make the return described in
subsection (b) with respect to each such individual.
``(b) Form and Manner of Returns.--A return is described in
this subsection if such return--
``(1) is in such form as the Secretary may prescribe, and
``(2) contains, with respect to each individual referred to
in subsection (a)--
``(A) the name, address, and TIN of each such individual,
``(B) the months for which amounts payments under section
7527A were received,
``(C) the amount of each such payment,
``(D) the type of insurance coverage provide by such person
with respect to such individual and the policy number
associated with such coverage,
``(E) the name, address, and TIN of the spouse and each
dependent covered under such coverage, and
``(F) such other information as the Secretary may
prescribe.
``(c) Statements to Be Furnished to Individuals With
Respect to Whom Information Is Required.--Every person
required to make a return under subsection (a) shall furnish
to each individual whose name is required to be set forth in
such return a written statement showing--
``(1) the name and address of the person required to make
such return and the phone number of the information contact
for such person, and
``(2) the information required to be shown on the return
with respect to such individual.
The written statement required under the preceding sentence
shall be furnished on or before January 31 of the year
following the calendar year for which the return under
subsection (a) is required to be made.
``(d) Returns Which Would Be Required to Be Made by 2 or
More Persons.--Except to the extent provided in regulations
prescribed by the Secretary, in the case of any amount
received by any person on behalf of another person, only the
person first receiving such amount shall be required to make
the return under subsection (a).''.
(2) Assessable penalties.--
(A) Subparagraph (B) of section 6724(d)(1) (relating to
definitions) is amended by redesignating clauses (xv) through
(xxi) as clauses (xvi) through (xxii), respectively, and by
inserting after clause (xiv) the following new clause:
``(xv) section 6050W (relating to returns relating to
credit for qualified refund eligible health insurance),''.
(B) Paragraph (2) of section 6724(d) is amended by striking
the period at the end of subparagraph (CC) and inserting ``,
or'' and by inserting after subparagraph (CC) the following
new subparagraph:
``(DD) section 6050W (relating to returns relating to
credit for qualified refund eligible health insurance).''.
(d) Conforming Amendments.--
(1) Paragraph (2) of section 1324(b) of title 31, United
States Code, is amended by inserting ``or 25E'' after
``section 35''.
(2)(A) Section 23(b)(4)(B) is amended by inserting ``and
section 25D'' after ``this section''.
(B) Section 24(b)(3)(B) is amended by striking ``and 25B''
and inserting ``, 25B, and 25D''.
(C) Section 25B(g)(2) is amended by striking ``section 23''
and inserting ``sections 23 and 25D''.
(D) Section 26(a)(1) is amended by striking ``and 25B'' and
inserting ``25B, and 25D''.
(3) The table of sections for subpart A of part IV of
subchapter A of chapter 1 is amended by inserting after the
item relating to section 25D the following new item:

``Sec. 25E. Qualified health insurance credit.''.
(4) The table of sections for chapter 77 is amended by
inserting after the item relating to section 7527 the
following new item:

``Sec. 7527A. Advance payment of credit for qualified refund eligible
health insurance.''.
(5) The table of sections for subpart B of part III of
subchapter A of chapter 61 is amended by adding at the end
the following new item:

``Sec. 6050W. Returns relating to credit for qualified refund eligible
health insurance.''.
(e) Effective Date.--The amendments made by this section
shall apply to taxable years beginning after December 31,
2008.

SEC. __02. CHANGES TO EXISTING TAX PREFERENCES FOR MEDICAL
COVERAGE, ETC., FOR INDIVIDUALS ELIGIBLE FOR
QUALIFIED HEALTH INSURANCE CREDIT OR STANDARD
DEDUCTION.

(a) Exclusion for Contributions by Employer to Accident and
Health Plans.--
(1) In general.--Section 106 (relating to contributions by
employer to accident and health plans) is amended by adding
at the end the following new subsection:
``(f) No Exclusion for Individuals Eligible for Qualified
Health Insurance Credit.--Subsection (a) shall not apply with
respect to any employer-provided coverage under an accident
or health plan for any individual for any month unless such
individual is described in paragraph (2) or (5) of section
25E(e) for such month. The amount includible in gross income
by reason of this subsection shall be determined under rules
similar to the rules of section 4980B(f)(4).''.
(2) Conforming amendments.--
(A) Section 106(b)(1) is amended--
(i) by inserting ``gross income does not include'' before
``amounts contributed'', and
(ii) by striking ``shall be treated as employer-provided
coverage for medical expenses under an accident or health
plan''.
(B) Section 106(d)(1) is amended--
(i) by inserting ``gross income does not include'' before
``amounts contributed'', and
(ii) by striking ``shall be treated as employer-provided
coverage for medical expenses under an accident or health
plan''.
(b) Amounts Received Under Accident and Health Plans.--
Section 105 (relating to amounts received under accident and
health plans) is amended by adding at the end the following
new subsection:
``(f) No Exclusion for Individuals Eligible for Qualified
Health Insurance Credit.--Subsection (b) shall not apply with
respect to any employer-provided coverage under an accident
or health plan for any individual for any month unless such
individual is described in paragraph (2) or (5) of section
25E(e) for such month.''.
(c) Special Rules for Health Insurance Costs of Self-
Employed Individuals.--Subsection (l) of section 162
(relating to special rules for health insurance costs of
self-employed individuals) is amended by adding at the end
the following new paragraph:
``(6) No deduction to individuals eligible for qualified
health insurance.--Paragraph (1) shall not apply for any
individual for any month unless such individual is described
in paragraph (2) or (5) of section 25E(e) for such month.''.
(d) Earned Income Credit Unaffected by Repealed
Exclusions.--Subparagraph (B) of section 32(c)(2) is amended
by redesignating clauses (v) and (vi) as clauses (vi) and
(vii), respectively, and by inserting after clause (iv) the
following new clause:
``(v) the earned income of an individual shall be computed
without regard to sections 105(f) and 106(f),''.

[[Page S10505]]

(e) Modification of Deduction for Medical Expenses.--
Subsection (d) of section 213 is amended by adding at the end
the following new paragraph:
``(12) Premiums for qualified health insurance.--The term
`medical care' does not include any amount paid as a premium
for coverage of an eligible individual (as defined in section
25E(e)) under qualified health insurance (as defined in
section 25E(f)) for any month.''.
(f)  Definition of Wages for Employment Tax Purposes.--
(1) Federal insurance contributions act.--Subsection (a) of
section 3121 is amended--
(A) by striking ``sickness or'' each place it appears in
paragraph (2), and
(B) by inserting after paragraph (2) the following new
paragraph:
``(3) any payment made to or for the benefit of an employee
if at the time of such payment it is reasonable to believe
that the employee will be able to exclude such payment from
income under section 104, 105, or 106;''.
(2) Railroad retirement tax.--Subsection (e) of section
3231 is amended--
(A) by striking ``sickness or'' each place it appears in
paragraph (1), and
(B) by adding at the end the following new paragraph:
``(13) The term `compensation' shall not include any
payment made to or for the benefit of an employee if at the
time of such payment it is reasonable to believe that the
employee will be able to exclude such payment from income
under section 104, 105, or 106.''.
(3) Unemployment tax.--Subsection (b) of section 3306 is
amended--
(A) by striking ``sickness or'' each place it appears in
paragraph (2), and
(B) by inserting after paragraph (2) the following new
paragraph:
``(3) any payment made to or for the benefit of an employee
if at the time of such payment it is reasonable to believe
that the employee will be able to exclude such payment from
income under section 104, 105, or 106;''.
(g) Reporting Requirement.--Subsection (a) of section 6051
is amended by striking ``and'' at the end of paragraph (12),
by striking the period at the end of paragraph (13) and
inserting ``and'', and by inserting after paragraph (13) the
following new paragraph:
``(14) the total amount of employer-provided coverage under
an accident or health plan which is includible in gross
income by reason of sections 105(f) and 106(f).''.
(h) Retired Public Safety Officers.--Section 402(l)(4)(D)
is amended by adding at the end the following: ``Such term
shall not include any premium for coverage by an accident or
health insurance plan for any month unless such individual is
described in paragraph (2) or (5) of section 25E(e) for such
month.''.
(i) Effective Date.--The amendments made by this section
shall apply to taxable years beginning after December 31,
2008.

Subtitle B--Improving Private Health Insurance Access and Affordability

SEC. __11. IMPROVING PRIVATE HEALTH INSURANCE ACCESS AND
AFFORDABILITY.

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

``TITLE XXII--REFUNDABILITY DEEMING; STATE HEALTH INSURANCE EXCHANGES

``Subtitle A--Refundability Deeming

``SEC. 2201. REFUNDABILITY DEEMING.

``(a) In General.--For purposes of section 25E of the
Internal Revenue Code of 1986, the Secretary shall deem
whether a State (as defined for purposes of title XIX) has
taken efforts to provide its citizens with greater access to
affordable private health insurance. Those efforts may
include, but are not limited to, the following initiatives:
``(1) The establishment of a State health insurance
exchange.
``(2) The establishment of a high risk solution, such as a
high risk pool, reinsurance mechanism, or other State-
designed high risk solution.
``(3) The availability of affordable coverage (as defined
in section 2212(b)(2), determined without regard to whether
such coverage is qualified exchange-based health insurance
coverage (as defined in section 2214).
``(b) More Individuals Covered.--A State shall demonstrate
to the Secretary that an initiative under subsection (a) is
reasonably designed to operate in a manner so as to result,
in combination with the qualified health insurance tax
credit, in a reduction in the number of eligible individuals
(as defined in section 2213) in the State who do not have
health insurance coverage, as measured by the Secretary based
upon information obtained in the Current Population Survey.
``(c) Reference to Refundability Requirement for
Application of Refundability of Qualified Health Insurance
Tax Credit.--For rules relating to limitations on the
refundability of the qualified health insurance credit under
section 25E of the Internal Revenue Code of 1986 in relation
to initiatives described in subsection (a), see section
25E(d). In this title, the term `qualified health insurance
tax credit' means the tax credit provided under such section.

``Subtitle B--State Health Insurance Exchanges

``SEC. 2211. STATE HEALTH INSURANCE EXCHANGES.

``(a) In General.--The Secretary shall provide a process
for the review and certification of applications of each
State of a State-based program as a certified health
insurance exchange for the State (each in this subtitle
referred to as a `certified State health insurance exchange'
or an `exchange'). A program shall not be treated as a
certified State health insurance exchange unless the
Secretary, in consultation with the Secretary of the
Treasury, determines that the program meets the requirements
for an exchange under this subtitle.
``(b) Continued Certification.--Upon certification of a
program under subsection (a), the program shall remain so
certified unless the Secretary determines that the program
has failed to meet any of the requirements for an exchange
under this subtitle.

``SEC. 2212. REQUIREMENTS FOR EXCHANGE CERTIFICATION.

``(a) General Requirements.--
``(1) In general.--The exchange shall be a means to pool
individual consumers purchasing private health insurance, to
provide them with greater negotiating leverage, and to
provide a market where private health insurance plans can
compete to offer coverage for these individuals.
``(2) Administration.--Nothing in this subtitle shall
prohibit a State from either directly contracting with the
health insurance plans participating in the exchange or a
third party administrator to operate the exchange.
``(3) Plan participation.--No State may restrict or
otherwise limit the ability of health insurance plans to
participate in and offer health insurance products through an
exchange, so long as the providers of these plans are duly
licensed under State insurance laws applicable to all health
insurance providers in the State and comply with the
requirements under this subtitle.
``(4) Benefits.--A State shall not impose requirements that
health insurance plans participating in the exchange provide
any benefits, beyond those requirements that the State
imposes upon all licensed health insurance providers
operating in the State.
``(5) Pricing.--A State shall not set prices for any
products offered through the exchange.
``(6) Premiums collection method.--A State shall ensure the
existence of an effective and efficient method for the
collection of premiums owed for qualified exchange-based
health insurance coverage.
``(7) Multi-state pooling arrangements.--Nothing in this
subtitle shall prohibit State health insurance exchanges from
organizing into a multi-state pooling arrangement.
``(b) Offering of Affordable Qualified Exchange-Based
Health Insurance Coverage to Eligible Individuals.--
``(1) Affordable and benchmark coverage.--The exchange must
have one or more health insurance plans participating in the
offering to each eligible individual (as defined in section
2213(a)) of qualified exchange-based health insurance
coverage (as defined in section 2214)--
``(A) at least one of which is affordable as determined
under paragraph (2); and
``(B) at least one of which provides benchmark benefits
coverage described in section 2113(b).
Private health insurance providers, duly licensed in the
State, may enter into agreements with the exchange to provide
qualified exchange-based health insurance coverage and
increase the choices available to eligible individuals.
``(2) Affordable coverage.--
``(A) In general.--Subject to subparagraph (B), a State
through an exchange shall meet the requirement under
paragraph (1)(A) in a year by using its funds to supplement
the premiums of the lowest cost plan participating in the
exchange (as determined by a methodology to be specified by
the Secretary), so that the average premium for individuals
enrolling in the plan will not exceed 6 percent of the
State's median income.
``(B) Exception.--A State is not required under
subparagraph (A) to provide any supplemental payments if
there is at least one plan available in all areas of the
State with average premiums that are below 6 percent of the
State's median income.
``(C) No use of price fixing.--The implementation of this
paragraph shall comply with subsection (a)(5).
``(D) Application.--
``(i) Disregarding late enrollment penalties and related
premium disincentives.--The amount of premium under
subparagraph (A) shall not take into account any increase in
premium resulting from the State's application of methods
permitted under subsection (a)(6).
``(ii) Application to sub-state areas.--A State may apply
subparagraph (A) separately for different areas within the
State.
``(c) Enrollment of Eligible Individuals.--
``(1) Enrollment mechanisms.--Health insurance plans
participating in the exchange in State shall have uniform
mechanisms designed to encourage and facilitate the
enrollment of all eligible individuals in qualified exchange-
based health insurance coverage.
``(2) Enrollment opportunities.--
``(A) In general.--Health insurance plans participating in
the exchange in a State shall permit the enrollment and
changes of enrollment of individuals at the time they become
eligible individuals in the State, such as through loss of
group-based qualifying health insurance coverage, changes in
residency or family composition, and other circumstances
specified by the Secretary.
``(B) Annual open enrollment periods.--Health insurance
plans participating in the

[[Page S10506]]

exchange in a State shall permit eligible individuals to
change enrollment among such plans in an annual manner,
subject to subparagraph (A).
``(3) Limitation on preexisting condition exclusions.--
Qualified exchange-based health insurance coverage shall meet
the requirements of section 9801 of the Internal Revenue Code
of 1986 in the same manner as if it were a group health plan.
``(d) Pathway for Enrollment by Medicaid and SCHIP
Beneficiaries.--A State through an exchange shall include a
pathway for eligible individuals who are enrolled (or
eligible to enroll) under title XIX or XXI in such State to
enroll in qualified exchange-based health insurance coverage.
A State may use the program under section 1938 in developing
such a pathway.
``(e) Methods to Reduce Adverse Selection.--Health
insurance plans participating in the exchange in a State
shall have a mechanism to reduce adverse selection in the
enrollment of eligible individuals. This mechanism shall be
uniform for all such plans and may include waiting periods
and premium surcharges for late enrollees (or individuals who
otherwise do not have periods of creditable coverage before
enrolling through the exchange) and other devices reasonably
designed to reduce adverse selection in the enrollment of
eligible individuals consistent with the requirements of
subpart 1 of part B of title XXVII of the Public Health
Service Act (relating to portability, access, and
renewability requirements for health insurance coverage in
the individual market).
``(f) Reinsurance or Other Risk Redistribution Mechanism.--
Health insurance plans participating in the exchange in a
State may have a uniform mechanism that protects entities
offering qualified exchange-based health insurance coverage
to manage risk. Such a mechanism may include reinsurance, a
high risk pool, or other mechanism approved by the Secretary.
``(g) Dissemination of Coverage Information.--Health
insurance plans participating in the exchange in a State
shall ensure that there is wide dissemination of information
about health insurance coverage options, including the plans
offered and premiums and benefits for such plans, to eligible
individuals and to employers that provide financial
assistance in purchasing such coverage.
``(h) Information Coordination.--Health insurance plans
participating in the exchange in a State shall report to the
Secretary of the Treasury such information as is required
under the Internal Revenue Code of 1986 to carry out the
qualified health insurance tax credit.

``SEC. 2213. ELIGIBLE INDIVIDUAL.

``(a) Eligible Individual.--In this subtitle--
``(1) In general.--The term `eligible individual' means,
with respect to a State and a month, an individual who, as of
the first day of the month--
``(A) is a resident of the State (as determined in
accordance with guidelines specified by the Secretary);
``(B) is citizen or national of the United States, an alien
lawfully admitted to the United States for permanent
residence or otherwise residing in the United States under
color of law, or an alien otherwise lawfully residing in the
United States under color of law for such period as the
Secretary shall specify; and
``(C) is not covered under group-based qualifying health
insurance coverage.
``(2) Group-based qualifying health insurance coverage.--
The term `group-based qualifying health insurance coverage'
means any of the following::
``(A) Group health plan coverage.--
``(i) In general.--Subject to clause (ii), coverage under a
group health plan (as defined in section 9832(a) of the
Internal Revenue Code of 1986).
``(ii) Exception.--Clause (i) shall not include--

``(I) a health plan if substantially all of its coverage is
coverage described in section 223(c)(1)(B) of the Internal
Revenue Code of 1986; or
``(II) coverage under a group health plan insofar as the
plan benefits consist (other than coverage described in
subclause (I)) of contribution towards a qualified exchange-
based health insurance coverage.

``(B) Medicare.--
``(i) In general.--Subject to clause (ii), coverage under
any part of the Medicare program under title XVIII.
``(ii) Exception.--Clause (i) shall not apply if all the
coverage under Medicare is, through the direct or indirect
application of section 1862(b), secondary to coverage under a
group health plan.
``(C) Military health care.--Coverage under the military
health program under chapter 55 of title 10, United States
Code, including under the TRICARE program (as defined in
section 1072(7) of such title).
``(D) FEHBP.--Coverage under the Federal employees health
benefit program under chapter 89 of title 5, United States
Code.
``(E) Full veterans coverage.--Coverage through the
Department of Veterans Affairs if such coverage is based on
enrollment of an individual who is described in paragraph (1)
of section 1705(a) of title 38, United States Code (relating
to veterans with service-connected disabilities rated 50
percent or greater).
``(b) Relation to Medicaid/SCHIP.--Except as a State may
otherwise provide, an individual is not disqualified from
being an eligible individual merely because the individual is
enrolled under title XIX or XXI.

``SEC. 2214. QUALIFIED EXCHANGE-BASED HEALTH INSURANCE
COVERAGE.

``In this subtitle, the term `qualified exchange-based
health insurance coverage' means qualified health insurance
(as defined in section 25E(f)(1) of the Internal Revenue Code
of 1986) offered by a private entity through an exchange.

``SEC. 2215. FLEXIBILITY IN APPLICATION TO LOWER-INCOME
INDIVIDUALS.

``(a) State Supplementation.--Nothing in this subtitle
shall be construed as preventing a State from providing,
under a certified State health insurance exchange and at the
State's own expense, additional assistance to eligible
individuals with respect to subsidizing premium and cost-
sharing costs for qualified exchange-based health insurance
coverage.
``(b) Treatment of Certain Medicaid and SCHIP
Beneficiaries.--Nothing in this subtitle shall be construed
as preventing a State Medicaid or children's health insurance
program under title XIX or XXI from permitting individuals
eligible for medical assistance or child health assistance
under the respective titles from obtaining such assistance
through enrollment in qualified exchange-based health
insurance coverage.''.

SEC. __12. EXPANSION OF MEDICAID HEALTH OPPORTUNITY ACCOUNTS
TO ALL STATES.

Section 1938 of the Social Security Act (42 U.S.C. 1396u-8)
is amended--
(1) in subsection (a)--
(A) by striking paragraph (1) and inserting the following:
``(1) In general.--Notwithstanding any other provision of
this title, the Secretary shall establish a program under
which States may provide under their State plans under this
title (including such a plan operating under a statewide
waiver under section 1115) in accordance with this section
for the provision of alternative benefits consistent with
subsection (c) for eligible population groups in one or more
geographic areas of the State specified by the State. An
amendment under the previous sentence is referred to in this
section as a `State health opportunity accounts program'.'';
and
(B) in paragraph (2)--
(i) by striking the paragraph heading and inserting
``Implementation.--'';
(ii) by striking subparagraph (A) and inserting the
following:
``(A) In general.--The program established under this
section shall begin on January 1, 2008.''; and
(iii) in subparagraph (B)--

(I) by striking clause (i) and inserting the following:

``(i) In general.--Not later than March 31, 2013, the
Comptroller General of the United States shall submit a
report to Congress evaluating the programs conducted under
this section .''; and

(II) in clause (ii), by striking ``2010'' and inserting
``2013''; and

(C) in paragraph (3)(E), by inserting ``that include plan
comparison information in language that is easily
understood'' before the period;
(2) in subsection (b)--
(A) in paragraph (1) , by striking ``consistent with
paragraphs (2) and (3)'';
(B) by striking paragraphs (2) through (4) and inserting
the following:
``(2) Limitation on enrollees in medicaid managed care
organizations.--Insofar as the State provides for eligibility
of individuals who are enrolled in Medicaid managed care
organizations, such individuals may participate in the State
health opportunity account program only if the State provides
assurances satisfactory to the Secretary that the following
conditions are met with respect to any such organization:
``(A) In no case may the number of such individuals
enrolled in the organization who participate in the program
exceed 5 percent of the total number of individuals enrolled
in such organization.
``(B) The proportion of enrollees in the organization who
so participate is not significantly disproportionate to the
proportion of such enrollees in other such organizations who
participate.
``(C) The State has provided for an appropriate adjustment
in the per capita payments to the organization to account for
such participation, taking into account differences in the
likely use of health services between enrollees who so
participate and enrollees who do not so participate.''; and
(C) by redesignating paragraphs (5) and (6) as paragraphs
(3) and (4), respectively;
(3) in subsection (d)--
(A) in paragraph (2)(C)(i)--
(i) in subclause (II), by striking ``and'' at the end;
(ii) in subclause (III), by striking the period at the end
and inserting ``; and''; and
(iii) by adding at the end the following:

``(IV) shall provide contributions into such an account on
a sliding-scale based on income.''; and

(B) in paragraph (3)(B)(ii)--
(i) in subclause (I), by striking ``and'' at the end;
(ii) by redesignating subclause (II) as subclause (III);
and
(iii) by inserting after subclause (I), the following:

``(II) may be transferred into a health savings account
established under section 223 of the Internal Revenue Code of
1986 and such transfer shall be treated as a rollover
contribution described in section 223(f) of the Internal
Revenue Code of 1986; and''; and

[[Page S10507]]

(4) by striking ``State demonstration program'' each place
it appears and inserting ``State health opportunity accounts
program''.
______

SA 2549. Mr. LOTT submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

On page 217, after line 25, insert the following:

SEC. 61_. ESTIMATED TAX SAFE HARBOR FOR ALTERNATIVE MINIMUM
TAX LIABILITY.

(a) In General.--Section 6654 of the Internal Revenue Code
of 1986 (relating to failure by individual to pay estimated
income tax) is amended by redesignating subsection (m) as
subsection (n) and by inserting after subsection (l) the
following new subsection:
``(m) Safe Harbor for Certain Alternative Minimum Tax
Payers.--In the case of any individual with respect to whom
there was no liability for the tax imposed under section 55
for the preceding taxable year--
``(1) any required payment calculated under subsection
(d)(1)(B)(i) shall be determined without regard to any tax
imposed under section 55,
``(2) any annualized income installment calculated under
subsection (d)(2)(B) shall determined without regard to
alternative minimum taxable income, and
``(3) the determination of the amount of the tax for the
taxable year for purposes of subsection (e)(1) shall not
include the amount of any tax imposed under section 55.''.
(b) Effective Date.--The amendment made by this section
shall apply to taxable years ending after the date of the
enactment of this Act.
______

SA 2550. Mr. LOTT submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

On page 217, after line 25, add the following:

SEC. ___. PERMANENT REPEAL OF ALTERNATIVE MINIMUM TAX.

(a) In General.--Section 55(a) of the Internal Revenue Code
of 1986 (relating to alternative minimum tax imposed) is
amended by adding at the end the following new flush
sentence:
``For purposes of this title, the tentative minimum tax on
any taxpayer for any taxable year beginning after December
31, 2006, shall be zero.''.
(b) Modification of Limitation on Use of Credit for Prior
Year Minimum Tax Liability.--Subsection (c) of section 53 of
the Internal Revenue Code of 1986 (relating to credit for
prior year minimum tax liability) is amended to read as
follows:
``(c) Limitation.--
``(1) In general.--Except as provided in paragraph (2), the
credit allowable under subsection (a) for any taxable year
shall not exceed the excess (if any) of--
``(A) the regular tax liability of the taxpayer for such
taxable year reduced by the sum of the credits allowable
under subparts A, B, D, E, and F of this part, over
``(B) the tentative minimum tax for the taxable year.
``(2) Taxable years beginning after 2006.--In the case of
any taxable year beginning after December 31, 2006, the
credit allowable under subsection (a) to a taxpayer other
than a corporation for any taxable year shall not exceed 90
percent of the regular tax liability of the taxpayer for such
taxable year reduced by the sum of the credits allowable
under subparts A, B, D, E, and F of this part.''.
(c) Effective Date.--The amendments made by this section
shall apply to taxable years beginning after December 31,
2006.
______

SA 2551. Mr. BROWN (for himself and Mr. Voinovich) submitted an
amendment intended to be proposed to amendment SA 2530 proposed by Mr.
Baucus (for himself, Mr. Grassley, Mr. Rockefeller, and Mr. Hatch) to
the bill H.R. 976, to amend the Internal Revenue Code of 1986 to
provide tax relief for small businesses, and for other purposes; which
was ordered to lie on the table; as follows:

At the appropriate place, insert the following:

SEC. __. LIMITING TO CLASS II NARCOTICS THE REQUIRED USE OF
TAMPER-RESISTANT PRESCRIPTION PADS UNDER
MEDICAID.

(a) In General.--Effective as if included in the enactment
of section 1903(i)(23) (42 U.S.C. 1396b(i)(23)), as added by
section 7002(b) of the U.S. Troop Readiness, Veterans' Care,
Katrina Recovery, and Iraq Accountability Appropriations Act,
2007 (Public Law 110-28), such section is amended by
inserting ``which are narcotic drugs included in schedule II
of section 202 of the Controlled Substances Act (21 U.S.C.
812) and'' after ``1927(k)(2))''.
(b) Delay in Effective Date for Requirement.--Effective as
if included in the enactment of section 7002(b) of the U.S.
Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq
Accountability Appropriations Act, 2007 (Public Law 110-28),
paragraph (2) of such section is amended by striking
``September 30, 2007'' and inserting ``March 31, 2009''.
______

SA 2552. Mr. SMITH (for himself and Mr. Kohl) submitted an amendment
intended to be proposed to amendment SA 2530 proposed by Mr. Baucus
(for himself, Mr. Grassley, Mr. Rockefeller, and Mr. Hatch) to the bill
H.R. 976, to amend the Internal Revenue Code of 1986 to provide tax
relief for small businesses, and for other purposes; which was ordered
to lie on the table; as follows:

At the end, insert the following:
(_) SSI Extensions for Humanitarian Immigrants; Collection
of Unemployment Compensation Debts Resulting From Fraud.--
(1) SSI extensions for humanitarian immigrants.--Section
402(a)(2) of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 (8 U.S.C. 1612(a)(2)) is amended
by adding at the end the following:
``(M) SSI extensions through fiscal year 2010.--
``(i) Two-year extension.--

``(I) In general.--Except as provided in clause (ii), with
respect to eligibility for benefits for the specified Federal
program described in paragraph (3)(A), the 7-year period
described in subparagraph (A) shall be deemed to be a 9-year
period during fiscal years 2008 through 2010.
``(II) Aliens whose benefits ceased in prior fiscal
years.--

``(aa) In general.--Beginning on the date of the enactment
of the SSI Extension for Elderly and Disabled Refugees Act,
any qualified alien rendered ineligible for the specified
Federal program described in paragraph (3)(A) during fiscal
years prior to fiscal year 2008 solely by reason of the
termination of the 7-year period described in subparagraph
(A) shall be eligible for such program for an additional 2-
year period in accordance with this clause, if such alien
meets all other eligibility factors under title XVI of the
Social Security Act.
``(bb) Payment of benefits.--Benefits paid under item (aa)
shall be paid prospectively over the duration of the
qualified alien's renewed eligibility.
``(ii) Pending naturalization application.--With respect to
eligibility for benefits for the specified program described
in paragraph (3)(A), subsection (a)(1) shall not apply during
fiscal years 2008 through 2010 to an alien described in one
of clauses (i) through (v) of subparagraph (A), if the alien
has submitted an application for naturalization that is
pending before the Secretary of Homeland Security, and such
submission is verified by the Commissioner of Social Security
either by receiving a receipt number from the alien for such
submitted application or by receiving confirmation from the
Secretary of Homeland Security.''.
(2) Collection of unemployment compensation debts resulting
from fraud.--
(A) In general.--Section 6402 of the Internal Revenue Code
(relating to authority to make credits or refunds) is amended
by redesignating subsections (f) through (k) as subsections
(g) through (l), respectively, and by inserting after
subsection (e) the following new subsection:
``(f) Collection of Unemployment Compensation Debts
Resulting From Fraud.--
``(1) In general.--Upon receiving notice from any State
that a named person owes a covered unemployment compensation
debt to such State, the Secretary shall, under such
conditions as may be prescribed by the Secretary--
``(A) reduce the amount of any overpayment payable to such
person by the amount of such covered unemployment
compensation debt;
``(B) pay the amount by which such overpayment is reduced
under subparagraph (A) to such State and notify such State of
such person's name, taxpayer identification number, address,
and the amount collected; and
``(C) notify the person making such overpayment that the
overpayment has been reduced by an amount necessary to
satisfy a covered unemployment compensation debt.
If an offset is made pursuant to a joint return, the notice
under subparagraph (B) shall include the names, taxpayer
identification numbers, and addresses of each person filing
such return and the notice under subparagraph (C) shall
include information related to the rights of a spouse of a
person subject to such an offset.
``(2) Priorities for offset.--Any overpayment by a person
shall be reduced pursuant to this subsection--
``(A) after such overpayment is reduced pursuant to--
``(i) subsection (a) with respect to any liability for any
internal revenue tax on the part of the person who made the
overpayment;
``(ii) subsection (c) with respect to past-due support; and
``(iii) subsection (d) with respect to any past-due,
legally enforceable debt owed to a Federal agency; and

[[Page S10508]]

``(B) before such overpayment is credited to the future
liability for any Federal internal revenue tax of such person
pursuant to subsection (b).
If the Secretary receives notice from a State or States of
more than one debt subject to paragraph (1) or subsection (e)
that is owed by a person to such State or States, any
overpayment by such person shall be applied against such
debts in the order in which such debts accrued.
``(3) Notice; consideration of evidence.--No State may take
action under this subsection until such State--
``(A) notifies the person owing the covered unemployment
compensation debt that the State proposes to take action
pursuant to this section;
``(B) provides such person at least 60 days to present
evidence that all or part of such liability is not legally
enforceable or due to fraud;
``(C) considers any evidence presented by such person and
determines that an amount of such debt is legally enforceable
and due to fraud; and
``(D) satisfies such other conditions as the Secretary may
prescribe to ensure that the determination made under
subparagraph (C) is valid and that the State has made
reasonable efforts to obtain payment of such covered
unemployment compensation debt.
``(4) Covered unemployment compensation debt.--For purposes
of this subsection, the term `covered unemployment
compensation debt' means--
``(A) a past-due debt for erroneous payment of unemployment
compensation due to fraud which has become final under the
law of a State certified by the Secretary of Labor pursuant
to section 3304 and which remains uncollected;
``(B) contributions due to the unemployment fund of a State
for which the State has determined the person to be liable
due to fraud; and
``(C) any penalties and interest assessed on such debt.
``(5) Regulations.--
``(A) In general.--The Secretary may issue regulations
prescribing the time and manner in which States must submit
notices of covered unemployment compensation debt and the
necessary information that must be contained in or accompany
such notices. The regulations may specify the minimum amount
of debt to which the reduction procedure established by
paragraph (1) may be applied.
``(B) Fee payable to secretary.--The regulations may
require States to pay a fee to the Secretary, which may be
deducted from amounts collected, to reimburse the Secretary
for the cost of applying such procedure. Any fee paid to the
Secretary pursuant to the preceding sentence shall be used to
reimburse appropriations which bore all or part of the cost
of applying such procedure.
``(C) Submission of notices through secretary of labor.--
The regulations may include a requirement that States submit
notices of covered unemployment compensation debt to the
Secretary via the Secretary of Labor in accordance with
procedures established by the Secretary of Labor. Such
procedures may require States to pay a fee to the Secretary
of Labor to reimburse the Secretary of Labor for the costs of
applying this subsection. Any such fee shall be established
in consultation with the Secretary of the Treasury. Any fee
paid to the Secretary of Labor may be deducted from amounts
collected and shall be used to reimburse the appropriation
account which bore all or part of the cost of applying this
subsection.
``(6) Erroneous payment to state.--Any State receiving
notice from the Secretary that an erroneous payment has been
made to such State under paragraph (1) shall pay promptly to
the Secretary, in accordance with such regulations as the
Secretary may prescribe, an amount equal to the amount of
such erroneous payment (without regard to whether any other
amounts payable to such State under such paragraph have been
paid to such State).''.
(B) Disclosure of certain information to states requesting
refund offsets for legally enforceable state unemployment
compensation debt resulting from fraud.--
(i) General rule.--Paragraph (3) of section 6103(a) of such
Code is amended by inserting ``(10),'' after ``(6),''.
(ii) Disclosure to department of labor and its agent.--
Paragraph (10) of section 6103(l) of such Code is amended--

(I) by striking ``(c), (d), or (e)'' each place it appears
in the heading and text and inserting ``(c), (d), (e), or
(f)'',
(II) in subparagraph (A) by inserting ``, to officers and
employees of the Department of Labor and its agent for
purposes of facilitating the exchange of data in connection
with a request made under subsection (f)(5) of section
6402,'' after ``section 6402'', and
(III) in subparagraph (B) by inserting ``, and any agents
of the Department of Labor,'' after ``agency'' the first
place it appears.

(iii) Safeguards.--Paragraph (4) of section 6103(p) of such
Code is amended--

(I) in the matter preceding subparagraph (A), by striking
``(l)(16),'' and inserting ``(l)(10), (16),'';
(II) in subparagraph (F)(i), by striking ``(l)(16),'' and
inserting ``(l)(10), (16),''; and
(III) in the matter following subparagraph (F)(iii)--

(aa) in each of the first two places it appears, by
striking ``(l)(16),'' and inserting ``(l)(10), (16),'';
(bb) by inserting ``(10),'' after ``paragraph (6)(A),'';
and
(cc) in each of the last two places it appears, by striking
``(l)(16)'' and inserting ``(l)(10) or (16)''.
(C) Expenditures from state fund.--Section 3304(a)(4) of
such Code is amended--
(i) in subparagraph (E), by striking ``and'' after the
semicolon;
(ii) in subparagraph (F), by inserting ``and'' after the
semicolon; and
(iii) by adding at the end the following new subparagraph:
``(G) with respect to amounts of covered unemployment
compensation debt (as defined in section 6402(f)(4))
collected under section 6402(f)--
``(i) amounts may be deducted to pay any fees authorized
under such section; and
``(ii) the penalties and interest described in section
6402(f)(4)(B) may be transferred to the appropriate State
fund into which the State would have deposited such amounts
had the person owing the debt paid such amounts directly to
the State;''.
(D) Conforming amendments.--
(i) Subsection (a) of section 6402 of such Code is amended
by striking ``(c), (d), and (e),'' and inserting ``(c), (d),
(e), and (f)''.
(ii) Paragraph (2) of section 6402(d) of such Code is
amended by striking ``and before such overpayment is reduced
pursuant to subsection (e)'' and inserting ``and before such
overpayment is reduced pursuant to subsections (e) and (f)''.
(iii) Paragraph (3) of section 6402(e) of such Code is
amended in the last sentence by inserting ``or subsection
(f)'' after ``paragraph (1)''.
(iv) Subsection (g) of section 6402 of such Code, as
redesignated by subsection (a), is amended by striking ``(c),
(d), or (e)'' and inserting ``(c), (d), (e), or (f)''.
(v) Subsection (i) of section 6402 of such Code, as
redesignated by subsection (a), is amended by striking
``subsection (c) or (e)'' and inserting ``subsection (c),
(e), or (f)''.
(E) Effective date.--The amendments made by this paragraph
shall apply to refunds payable under section 6402 of the
Internal Revenue Code of 1986 on or after the date of
enactment of this Act.
______

SA 2553. Mr. SMITH submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

On page 217, after line 25, insert the following:

SEC. _. MODIFICATIONS TO SOCIAL SECURITY ACT TO ENCOURAGE THE
INCLUSION OF INDIVIDUALS WITH DISABILITIES IN
WORK PROGRAMS.

(a) Authorization of Modified Employability Plan for
Individuals With Disabilities.--
(1) In general.--Section 407(c)(2) of the Social Security
Act (42 U.S.C. 607(c)(2)) is amended by adding at the end the
following new subparagraph:
``(E) Individuals with disabilities complying with a
modified employability plan deemed to be meeting work
participation requirements.--
``(i) Modified employability plan.--A State may develop a
modified employability plan for an adult or minor child head
of household recipient of assistance who has been determined
by a qualified medical, mental health, addiction, or social
services professional (as determined by the State) to have a
disability, or who is caring for a family member with a
disability (as so determined). The modified employability
plan shall--

``(I) include a determination that, because of the
disability of the recipient or the individual for whom the
recipient is caring, reasonable modification of work
activities, hourly participation requirements, or both, is
needed in order for the recipient to participate in work
activities;
``(II) set forth the modified work activities in which the
recipient is required to participate;
``(III) set forth the number of hours per week for which
the recipient is required to participate in such modified
work activities based on the State's evaluation of the
family's circumstances;
``(IV) set forth the services, supports, and modifications
that the State will provide to the recipient or the
recipient's family;
``(V) be developed in cooperation with the recipient; and
``(VI) be reviewed not less than every 6 months.

``(ii) Inclusion in monthly participation rates.--For the
purpose of determining monthly participation rates under
subsection (b)(1)(B)(i), and notwithstanding paragraphs (1),
(2)(A), (2)(B), (2)(C), and (2)(D) of this subsection and
subsection (d) of this section, a recipient is deemed to be
engaged in work for a month in a fiscal year if--

``(I) the State has determined that the recipient is in
substantial compliance with activities and hourly
participation requirements set forth in a modified
employability plan that meets the requirements set forth in
clause (i); and
``(II) the State complies with the reporting requirement
set forth in clause (iii) for the fiscal year in which the
month occurs.

``(iii) Reports.--

[[Page S10509]]

``(I) Report by state.--With respect to any fiscal year for
which a State counts a recipient as engaged in work pursuant
to a modified employability plan, the State shall submit a
report entitled `Annual State Report on TANF Recipients
Participating in Work Activities Pursuant to Modified
Employability Plans Due to Disability' to the Secretary not
later than March 31 of the succeeding fiscal year. The report
shall provide the following information:

``(aa) The aggregate number of recipients with modified
employability plans due to a disability.
``(bb) The percentage of all recipients with modified
employability plans who substantially complied with
activities set forth in the plans each month of the fiscal
year.
``(cc) Information regarding the most prevalent types of
physical and mental impairments that provided the basis for
the disability determinations.
``(dd) The percentage of cases with a modified
employability plan in which the recipient had a disability,
was caring for a child with a disability, or was caring for
another family member with a disability.
``(ee) A description of the most prevalent types of
modification in work activities or hours of participation
that were included in the modified employability plans.
``(ff) A description of the qualifications of the staff who
determined whether individuals had a disability, of the staff
who determined that individuals needed modifications to their
work requirements, and of the staff who developed the
modified employability plans.

``(II) Report by secretary.--The Secretary shall submit an
annual report to Congress entitled `Efforts in State TANF
Programs to Promote and Support Employment for Individuals
with Disabilities' not later than July 31 of each fiscal year
that includes information on State efforts to engage
individuals with disabilities in work activities for the
preceding fiscal year. The report shall include the
following:

``(aa) The number of individuals for whom each State has
developed a modified employability plan.
``(bb) The types of physical and mental impairments that
provided the basis for the disability determination, and
whether the individual with the disability was an adult
recipient or minor child head of household, a child, or a
non-recipient family member.
``(cc) The types of modifications that States have included
in modified employability plans.
``(dd) The extent to which individuals with a modified
employability plan are participating in work activities.
``(ee) An analysis of the extent to which the option to
establish such modified employability plans was a factor in
States' achieving or not achieving the minimum participation
rates under subsection (a) for the fiscal year.
``(iv) Definitions.--

``(I) Disability.--For purposes of this subparagraph, the
term `disability' means a mental or physical impairment,
including substance abuse or addiction, that--

``(aa) constitutes or results in a substantial impediment
to employment; or
``(bb) substantially limits 1 or more major life
activities.

``(II) Modified work activities.--For purposes of this
subparagraph, the term `modified work activities' means
activities the State has determined will help the recipient
become employable and which are not subject to and do not
count against the limitations and requirements under the
preceding provisions of this subsection and of subsection
(d).''.

(2) Effective date.--The amendments made by this subsection
shall take effect on October 1, 2007.
(b) State Option to Exclude SSI Applicants in Work
Participation Rate.--
(1) In general.--Section 407(b)(5) of the Social Security
Act (42 U.S.C. 607(b)(5)) is amended by striking ``at its
option, not require an individual'' and all that follows and
inserting ``at its option--
``(A) not require an individual who is a single custodial
parent caring for a child who has not attained 12 months of
age to engage in work, and may disregard such an individual
in determining the participation rates under subsection (a)
of this section for not more than 12 months;
``(B) disregard for purposes of determining such rates for
any month, on a case-by-case basis, an individual who is an
applicant for or a recipient of supplemental security income
benefits under title XVI or of social security disability
insurance benefits under title II, if--
``(i) the State has determined that an application for such
benefits has been filed by or on behalf of the individual;
``(ii) the State has determined that there is a reasonable
basis to conclude that the individual meets the disability or
blindness criteria applied under title II or XVI;
``(iii) there has been no final decision (including a
decision for which no appeal is pending at the administrative
or judicial level or for which the time period for filing
such an appeal has expired) denying benefits; and
``(iv) not less than every 6 months, the State reviews the
status of such application and determines that there is a
reasonable basis to conclude that the individual continues to
meet the disability or blindness criteria under title II or
XVI; and
``(C) disregard for purposes of determining such rates for
any month, on a case-by-case basis, an individual who the
State has determined would meet the disability criteria for
supplemental security income benefits under title XVI or
social security disability insurance benefits under title II
but for the requirement that the disability has lasted or is
expected to last for a continuous period of not less than 12
months.''.
(2) Effective date.--The amendments made by this subsection
shall take effect on October 1, 2007.
______

SA 2554. Mrs. DOLE submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

On page 217, after line 25, add the following:

SEC. __. BUDGET POINT OF ORDER AGAINST LEGISLATION THAT
RAISES EXCISE TAX RATES.

Title III of the Congressional Budget Act of 1974 is
amended by adding at the end the following:

``POINT OF ORDER AGAINST RAISES IN EXCISE TAX RATES

``Sec. 316.  (a) In General.--It shall not be in order in
the Senate to consider any bill, resolution, amendment,
amendment between Houses, motion, or conference report that
includes a Federal excise tax rate increase which
disproportionately affects taxpayers with earned income of
less than 200 percent of the Federal poverty level, as
determined by the Joint Committee on Taxation. In this
subsection, the term `Federal excise tax rate increase' means
any amendment to any section in subtitle D or E of the
Internal Revenue Code of 1986, that imposes a new percentage
or amount as a rate of tax and thereby increases the amount
of tax imposed by any such section.
``(b) Supermajority Waiver and Appeal.--
``(1) Waiver.--This section may be waived or suspended in
the Senate only by an affirmative vote of three-fifths of the
Members, duly chosen and sworn.
``(2) Appeal.--An affirmative vote of three-fifths of the
Members of the Senate, duly chosen and sworn, shall be
required in the Senate to sustain an appeal of the ruling of
the Chair on a point of order raised under this section.''.
______

SA 2555. Mrs. DOLE submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

On page 217, after line 25, insert the following:

SEC. 61_. CREDIT FOR TRANSPORTATION OF FOOD FOR CHARITABLE
PURPOSES.

(a) In General.--Subpart B of part IV of subchapter A of
chapter 1 of the Internal Revenue Code of 1986 is amended by
adding at the end the following new section:

``SEC. 30D. CREDIT FOR TRANSPORTATION OF FOOD FOR CHARITABLE
PURPOSES.

``(a) Allowance of Credit.--There shall be allowed as a
credit against the tax imposed by this chapter for the
taxable year an amount equal to 25 cents for each mile for
which the taxpayer uses a qualified truck for a qualified
charitable purpose during the taxable year.
``(b) Qualified Charitable Purpose.--For purposes of this
section, the term `qualified charitable purpose' means the
transportation of food in connection with the hunger relief
efforts of an organization which is described in section
501(c)(3) and is exempt from taxation under section 501(a)
(other than a private foundation, as defined in section
509(a), which is not an operating foundation, as defined in
section 4942(j)(3)).
``(c) Qualified Truck.--For purposes of this section, the
term `qualified truck' means a truck which--
``(1) has a capacity of not less than 1,760 cubic square
feet,
``(2) is owned, leased, or operated by the taxpayer, and
``(3) is ordinarily used for hauling property in the course
of a business.
``(d) Other Rules.--
``(1) Denial of double benefit.--No credit shall be allowed
under this section with respect to any amount for which a
deduction is allowed under any other provision of this
chapter.
``(2) No credit where taxpayer is compensated.--No credit
shall be allowed under this section if the taxpayer receives
compensation in connection with the use of the qualified
truck for the qualified charitable purpose.
``(3) Capacity requirement.--No credit shall be allowed
under this section unless at least 50 percent of the hauling
capacity of the qualified truck (measured in cubic square
feet) is used for the qualified charitable purpose.''.
(b) Conforming Amendment.--The table of sections for
subpart B of part IV of subchapter A of chapter 1 of the
Internal Revenue Code of 1986 is amended by adding at the end
the following new item:

[[Page S10510]]

``Sec. 30D. Credit for transportation of food for charitable
purposes.''.

(c) Effective Date.--The amendments made by this section
shall apply to taxable years ending after December 31, 2007.
______

SA 2556. Mrs. CLINTON (for herself, Mrs. Dole, Ms. Mikulski, Mr.
Graham, Mr. Brown, and Mrs. Boxer) submitted an amendment intended to
be proposed to amendment SA 2530 proposed by Mr. Baucus (for himself,
Mr. Grassley, Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to
amend the Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

At the end of title VI, insert the following:

SEC. __. MILITARY FAMILY AND MEDICAL LEAVE ACT.

(a) Short Title.--This section may be cited as the
``Military Family and Medical Leave Act''.
(b) Definitions.--Section 101 of the Family and Medical
Leave Act of 1993 (29 U.S.C. 2611) is amended by adding at
the end the following:
``(14) Active duty.--The term `active duty' means duty
under a call or order to active duty under a provision of law
referred to in section 101(a)(13)(B) of title 10, United
States Code.
``(15) Covered servicemember.--The term `covered
servicemember' means a member of the Armed Forces, including
a member of the National Guard or a Reserve, who is
undergoing medical treatment, recuperation, or therapy, or is
otherwise in medical hold or medical holdover status, for a
serious injury or illness.
``(16) Medical hold or medical holdover status.--The term
`medical hold or medical holdover status' means--
``(A) the status of a member of the Armed Forces, including
a member of the National Guard or a Reserve, assigned or
attached to a military hospital for medical care; and
``(B) the status of a member of a reserve component of the
Armed Forces who is separated, whether pre-deployment or
post-deployment, from the member's unit while in need of
health care based on a medical condition identified while the
member is on active duty in the Armed Forces.
``(17) Serious injury or illness.--The term `serious injury
or illness', in the case of a member of the Armed Forces,
means an injury or illness incurred by the member in line of
duty on active duty in the Armed Forces that may render the
member medically unfit to perform the duties of the member's
office, grade, rank, or rating.''.
(c) Military Family and Medical Leave.--
(1) Entitlement to leave.--Section 102(a) of such Act (29
U.S.C. 2612(a)) is amended by adding at the end the
following:
``(3) Military family and medical leave.--Subject to
section 103, an eligible employee shall be entitled to a
total of 26 workweeks of leave during a 12-month period to
care for a covered servicemember who is the spouse, son,
daughter, or parent of the employee. The leave described in
this paragraph shall only be available during a single 12-
month period.
``(4) Combined leave total.--During the single 12-month
period described in paragraph (3), an eligible employee shall
be entitled to a combined total of 26 workweeks of leave
under paragraphs (1) and (3). Nothing in this paragraph shall
be construed to limit the availability of leave under
paragraph (1) during any other 12-month period.''.
(2) Schedule.--Section 102(b) of such Act (29 U.S.C.
2612(b)) is amended--
(A) in paragraph (1), in the second sentence--
(i) by striking ``section 103(b)(5)'' and inserting
``subsection (b)(5) or (f) (as appropriate) of section 103'';
and
(ii) by inserting ``or under subsection (a)(3)'' after
``subsection (a)(1)''; and
(B) in paragraph (2), by inserting ``or under subsection
(a)(3)'' after ``subsection (a)(1)''.
(3) Substitution of paid leave.--Section 102(d) of such Act
(29 U.S.C. 2612(d)) is amended--
(A) in paragraph (1)--
(i) by inserting ``(or 26 workweeks in the case of leave
provided under subsection (a)(3))'' after ``12 workweeks''
the first place it appears; and
(ii) by inserting ``(or 26 workweeks, as appropriate)''
after ``12 workweeks'' the second place it appears; and
(B) in paragraph (2)--
(i) in subparagraph (A), by adding at the end the
following: ``An eligible employee may elect, or an employer
may require the employee, to substitute any of the accrued
paid vacation leave, personal leave, or family leave of the
employee for leave provided under subsection (a)(3) for any
part of the 26-week period of such leave under such
subsection.''; and
(ii) in subparagraph (B), by adding at the end the
following: ``An eligible employee may elect, or an employer
may require the employee, to substitute any of the accrued
paid vacation leave, personal leave, or medical or sick leave
of the employee for leave provided under subsection (a)(3)
for any part of the 26-week period of such leave under such
subsection.''.
(4) Notice.--Section 102(e)(2) of such Act (29 U.S.C.
2612(e)(2)) is amended by inserting ``or under subsection
(a)(3)'' after ``subsection (a)(1)''.
(5) Spouses employed by same employer.--Section 102(f) of
such Act (29 U.S.C. 2612(f)) is amended--
(A) by redesignating paragraphs (1) and (2) as
subparagraphs (A) and (B), and aligning the margins of the
subparagraphs with the margins of section 102(e)(2)(A);
(B) by striking ``In any'' and inserting the following:
``(1) In general.--In any''; and
(C) by adding at the end the following:
``(2) Military family and medical leave.--
``(A) In general.--The aggregate number of workweeks of
leave to which both that husband and wife may be entitled
under subsection (a) may be limited to 26 workweeks during
the single 12-month period described in subsection (a)(3) if
the leave is--
``(i) leave under subsection (a)(3); or
``(ii) a combination of leave under subsection (a)(3) and
leave described in paragraph (1).
``(B) Both limitations applicable.--If the leave taken by
the husband and wife includes leave described in paragraph
(1), the limitation in paragraph (1) shall apply to the leave
described in paragraph (1).''.
(d) Certification.--Section 103 of such Act (29 U.S.C.
2613) is amended by adding at the end the following:
``(f) Certification for Military Family and Medical
Leave.--An employer may require that a request for leave
under section 102(a)(3) be supported by a certification
issued at such time and in such manner as the Secretary may
by regulation prescribe.''.
(e) Failure to Return.--Section 104(c) of such Act (29
U.S.C. 2614(c)) is amended--
(1) in paragraph (2)(B)(i), by inserting ``or under section
102(a)(3)'' before the semicolon; and
(2) in paragraph (3)(A)--
(A) in clause (i), by striking ``or'' at the end;
(B) in clause (ii), by striking the period and inserting
``; or''; and
(C) by adding at the end the following:
``(iii) a certification issued by the health care provider
of the son, daughter, spouse, or parent of the employee, as
appropriate, in the case of an employee unable to return to
work because of a condition specified in section
102(a)(3).''.
(f) Enforcement.--Section 107 of such Act (29 U.S.C. 2617)
is amended, in subsection (a)(1)(A)(i)(II), by inserting
``(or 26 weeks, in a case involving leave under section
102(a)(3))'' after ``12 weeks''.
(g) Instructional Employees.--Section 108 of such Act (29
U.S.C. 2618) is amended, in subsections (c)(1), (d)(2), and
(d)(3), by inserting ``or under section 102(a)(3)'' after
``section 102(a)(1)''.
______

SA 2557. Mr. SPECTER submitted an amendment intended to be proposed
to amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

On page 217, after line 25, insert the following:

SEC. 61_. REDUCTION IN RATE OF TENTATIVE MINIMUM TAX FOR
NONCORPORATE TAXPAYERS.

(a) In General.--Clause (i) of section 55(b)(1)(A) of the
Internal Revenue Code of 1986 (relating to noncorporate
taxpayers) is amended to read as follows:
``(i) In general.--In the case of a taxpayer other than a
corporation, the tentative minimum tax for the taxable year
is--

``(I) 24 percent of the taxable excess, reduced by
``(II) the alternative minimum tax foreign tax credit for
the taxable year.''.

(b) Conforming Amendment.--Subparagraph (A) of section
55(b)(1) of such Code is amended by striking clause (iii).
(c) Effective Date.--The amendments made by this section
shall apply to taxable years beginning after December 31,
2006.
______

SA 2558. Mr. GRAHAM submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

Beginning on page 218, strike line 5 and all that follows
through page 220, line 2, and insert the following:
(a) Cigars.--Section 5701(a) of the Internal Revenue Code
of 1986 is amended--
(1) by striking ``($1.594 cents per thousand on cigars
removed during 2000 or 2001)'' in paragraph (1) and inserting
``($50.00 per thousand on cigars removed after December 31,
2007, and before October 1, 2012)'',
(2) by striking ``(18.063 percent on cigars removed during
2000 or 2001)'' in paragraph (2) and inserting ``(53.13
percent on cigars removed after December 31, 2007, and before
October 1, 2012)'', and
(3) by striking ``($42.50 per thousand on cigars removed
during 2000 or 2001)'' in paragraph (2) and inserting
``($10.00 per thousand on cigars removed after December 31,
2007, and before October 1, 2012)''.
(b) Cigarettes.--Section 5701(b) of such Code is amended--

[[Page S10511]]

(1) by striking ``($17 per thousand on cigarettes removed
during 2000 or 2001)'' in paragraph (1) and inserting
``($50.00 per thousand on cigarettes removed after December
31, 2007, and before October 1, 2012)'', and
(2) by striking ``($35.70 per thousand on cigarettes
removed during 2000 or 2001)'' in paragraph (2) and inserting
``($104.9999 per thousand on cigarettes removed after
December 31, 2007, and before October 1, 2012)''.
(c) Cigarette Papers.--Section 5701(c) of such Code is
amended by striking ``(1.06 cents on cigarette papers removed
during 2000 or 2001)'' and inserting ``(3.13 cents on
cigarette papers removed after December 31, 2007, and before
October 1, 2012)''.
(d) Cigarette Tubes.--Section 5701(d) of such Code is
amended by striking ``(2.13 cents on cigarette tubes removed
during 2000 or 2001)'' and inserting ``(6.26 cents on
cigarette tubes removed after December 31, 2007, and before
October 1, 2012)''.
(e) Smokeless Tobacco.--Section 5701(e) of such Code is
amended--
(1) by striking ``(51 cents on snuff removed during 2000 or
2001)'' in paragraph (1) and inserting ``($1.50 on snuff
removed after December 31, 2007, and before October 1,
2012)'', and
(2) by striking ``(17 cents on chewing tobacco removed
during 2000 or 2001)'' in paragraph (2) and inserting ``(50
cents on chewing tobacco removed after December 31, 2007, and
before October 1, 2012)''.
(f) Pipe Tobacco.--Section 5701(f) of such Code is amended
by striking ``(95.67 cents on pipe tobacco removed during
2000 or 2001)'' and inserting ``($2.8126 on pipe tobacco
removed after December 31, 2007, and before October 1,
2012)''.
(g) Roll-Your-Own Tobacco.--Section 5701(g) of such Code is
amended by striking ``(95.67 cents on roll-your-own tobacco
removed during 2000 or 2001)'' and inserting ``($8.8889 on
roll-your-own tobacco removed after December 31, 2007, and
before October 1, 2012)''.
______

SA 2559. Mr. GRAHAM submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

On page 217, after line 25, insert the following:

SEC. __. EXTENSION OF ELECTION TO INCLUDE COMBAT PAY AS
INCOME FOR PURPOSES OF THE EARNED INCOME TAX
CREDIT.

Paragraph (2)(B)(vi) of section 32(c) of the Internal
Revenue Code of 1986 (relating to earned income) is amended
by striking ``ending--'' and all that follows through the
period and inserting ``ending after the date of the enactment
of this clause, a taxpayer may elect to treat amounts
excluded from gross income by reason of section 112 as earned
income.''.
______

SA 2560. Mr. DODD submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

At the end of title VI, add the following:

SEC. 610. FAMILY LEAVE FOR CAREGIVERS OF MEMBERS OF THE ARMED
FORCES WITH COMBAT-RELATED INJURIES.

(a) Servicemember Family Leave.--
(1) Definitions.--Section 101 of the Family and Medical
Leave Act of 1993 (29 U.S.C. 2611) is amended by adding at
the end the following:
``(14) Combat-related injury.--The term `combat-related
injury' means an injury or illness that was incurred (as
determined under criteria prescribed by the Secretary of
Defense)--
``(A) as a direct result of armed conflict;
``(B) while an individual was engaged in hazardous service;
``(C) in the performance of duty under conditions
simulating war; or
``(D) through an instrumentality of war.
``(15) Servicemember.--The term `servicemember' means a
member of the Armed Forces.''.
(2) Entitlement to leave.--Section 102(a) of such Act (29
U.S.C. 2612(a)) is amended by adding at the end the
following:
``(3) Servicemember family leave.--Subject to section 103,
an eligible employee who is the primary caregiver for a
servicemember with a combat-related injury shall be entitled
to a total of 26 workweeks of leave during any 12-month
period to care for the servicemember.
``(4) Combined leave total.--An eligible employee shall be
entitled to a combined total of 26 workweeks of leave under
paragraphs (1) and (3).''.
(3) Requirements relating to leave.--
(A) Schedule.--Section 102(b) of such Act (29 U.S.C.
2612(b)) is amended--
(i) in paragraph (1), by inserting after the second
sentence the following: ``Subject to paragraph (2), leave
under subsection (a)(3) may be taken intermittently or on a
reduced leave schedule''; and
(ii) in paragraph (2), by inserting ``or subsection
(a)(3)'' after ``subsection (a)(1)''.
(B) Substitution of paid leave.--Section 102(d) of such Act
(29 U.S.C. 2612(d)) is amended--
(i) in paragraph (1)--

(I) by inserting ``(or 26 workweeks in the case of leave
provided under subsection (a)(3))'' after ``12 workweeks''
the first place it appears; and
(II) by inserting ``(or 26 workweeks, as appropriate)''
after ``12 workweeks'' the second place it appears; and

(ii) in paragraph (2)(B), by adding at the end the
following: ``An eligible employee may elect, or an employer
may require the employee, to substitute any of the accrued
paid vacation leave, personal leave, family leave, or medical
or sick leave of the employee for leave provided under
subsection (a)(3) for any part of the 26-week period of such
leave under such subsection.''.
(C) Notice.--Section 102(e) of such Act (29 U.S.C. 2612(e))
is amended by adding at the end the following:
``(3) Notice for servicemember family leave.--In any case
in which an employee seeks leave under subsection (a)(3), the
employee shall provide such notice as is practicable.''.
(D) Certification.--Section 103 of such Act (29 U.S.C.
2613) is amended by adding at the end the following:
``(f) Certification for Servicemember Family Leave.--An
employer may require that a request for leave under section
102(a)(3) be supported by a certification issued at such time
and in such manner as the Secretary may by regulation
prescribe.''.
(E) Failure to return.--Section 104(c) of such Act (29
U.S.C. 2614(c)) is amended--
(i) in paragraph (2)(B)(i), by inserting ``or section
102(a)(3)'' before the semicolon; and
(ii) in paragraph (3)(A)--

(I) in clause (i), by striking ``or'' at the end;
(II) in clause (ii), by striking the period and inserting
``; or''; and
(III) by adding at the end the following:

``(iii) a certification issued by the health care provider
of the person for whom the employee is the primary caregiver,
in the case of an employee unable to return to work because
of a condition specified in section 102(a)(3).''.
(F) Enforcement.--Section 107 of such Act (29 U.S.C. 2617)
is amended, in subsection (a)(1)(A)(i)(II), by inserting
``(or 26 weeks, in a case involving leave under section
102(a)(3))'' after ``12 weeks''.
(G) Instructional employees.--Section 108 of such Act (29
U.S.C. 2618) is amended, in subsections (c)(1), (d)(2), and
(d)(3), by inserting ``or section 102(a)(3)'' after ``section
102(a)(1)''.
(b) Servicemember Family Leave for Civil Service
Employees.--
(1) Definitions.--Section 6381 of title 5, United States
Code, is amended--
(A) in paragraph (5), by striking ``and'' at the end;
(B) in paragraph (6), by striking the period and inserting
``; and''; and
(C) by adding at the end the following:
``(7) the term `combat-related injury' means an injury or
illness that was incurred (as determined under criteria
prescribed by the Secretary of Defense)--
``(A) as a direct result of armed conflict;
``(B) while an individual was engaged in hazardous service;
``(C) in the performance of duty under conditions
simulating war; or
``(D) through an instrumentality of war; and
``(8) the term `servicemember' means a member of the Armed
Forces.''.
(2) Entitlement to leave.--Section 6382(a) of such title is
amended by adding at the end the following:
``(3) Subject to section 6383, an employee who is the
primary caregiver for a servicemember with a combat-related
injury shall be entitled to a total of 26 administrative
workweeks of leave during any 12-month period to care for the
servicemember.
``(4) An employee shall be entitled to a combined total of
26 administrative workweeks of leave under paragraphs (1) and
(3).''.
(3) Requirements relating to leave.--
(A) Schedule.--Section 6382(b) of such title is amended--
(i) in paragraph (1), by inserting after the second
sentence the following: ``Subject to paragraph (2), leave
under subsection (a)(3) may be taken intermittently or on a
reduced leave schedule.''; and
(ii) in paragraph (2), by inserting ``or subsection
(a)(3)'' after ``subsection (a)(1)''.
(B) Substitution of paid leave.--Section 6382(d) of such
title is amended by adding at the end the following: ``An
employee may elect to substitute for leave under subsection
(a)(3) any of the employee's accrued or accumulated annual or
sick leave under subchapter I for any part of the 26-week
period of leave under such subsection.''.
(C) Notice.--Section 6382(e) of such title is amended by
adding at the end the following:
``(3) In any case in which an employee seeks leave under
subsection (a)(3), the employee shall provide such notice as
is practicable.''.
(D) Certification.--Section 6383 of such title is amended
by adding at the end the following:
``(f) An employing agency may require that a request for
leave under section 6382(a)(3) be supported by a
certification issued at such time and in such manner as the
Office of Personnel Management may by regulation
prescribe.''.

[[Page S10512]]

______

SA 2561. Mr. SMITH (for himself and Mrs. Clinton) submitted an
amendment intended to be proposed to amendment SA 2530 proposed by Mr.
Baucus (for himself, Mr. Grassley, Mr. Rockefeller, and Mr. Hatch) to
the bill H.R. 976, to amend the Internal Revenue Code of 1986 to
provide tax relief for small businesses, and for other purposes; which
was ordered to lie on the table; as follows:

At the appropriate place, insert the following:

SEC. __. DEMONSTRATION PROJECT REGARDING MEDICAID COVERAGE OF
LOW-INCOME HIV-INFECTED INDIVIDUALS.

(a) Requirement To Conduct Demonstration Project.--
(1) In general.--The Secretary shall establish a
demonstration project under which a State may apply under
section 1115 of the Social Security Act (42 U.S.C. 1315) to
provide medical assistance under a State medicaid program to
HIV-infected individuals described in subsection (b) in
accordance with the provisions of this section.
(2) Limitation on number of approved applications.--The
Secretary shall only approve as many State applications to
provide medical assistance in accordance with this section as
will not exceed the limitation on aggregate payments under
subsection (d)(2)(A).
(3) Authority to waive restrictions on payments to
territories.--The Secretary shall waive the limitations on
payment under subsections (f) and (g) of section 1108 of the
Social Security Act (42 U.S.C. 1308) in the case of a State
that is subject to such limitations and submits an approved
application to provide medical assistance in accordance with
this section.
(b) HIV-Infected Individuals Described.--For purposes of
subsection (a), HIV-infected individuals described in this
subsection are individuals who are not described in section
1902(a)(10)(A)(i) of the Social Security Act (42 U.S.C.
1396a(a)(10)(A)(i))--
(1) who have HIV infection;
(2) whose income (as determined under the State Medicaid
plan with respect to disabled individuals) does not exceed
200 percent of the poverty line (as defined in section
2110(c)(5) of the Social Security Act (42 U.S.C.
1397jj(c)(5)); and
(3) whose resources (as determined under the State Medicaid
plan with respect to disabled individuals) do not exceed the
maximum amount of resources a disabled individual described
in section 1902(a)(10)(A)(i) of such Act may have and obtain
medical assistance under such plan.
(c) Length of Period for Provision of Medical Assistance.--
A State shall not be approved to provide medical assistance
to an HIV-infected individual in accordance with the
demonstration project established under this section for a
period of more than 5 consecutive years.
(d) Limitations on Federal Funding.--
(1) Appropriation.--
(A) In general.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated to carry out
this section, $500,000,000 for the period of fiscal years
2008 through 2012.
(B) Budget authority.--Subparagraph (A) constitutes budget
authority in advance of appropriations Act and represents the
obligation of the Federal Government to provide for the
payment of the amounts appropriated under that subparagraph.
(2) Limitation on payments.--In no case may--
(A) the aggregate amount of payments made by the Secretary
to eligible States under this section exceed $500,000,000; or
(B) payments be provided by the Secretary under this
section after September 30, 2012.
(3) Funds allocated to states.--The Secretary shall
allocate funds to States with approved applications under
this section based on their applications and the availability
of funds.
(4) Payments to states.--The Secretary shall pay to each
State, from its allocation under paragraph (3), an amount
each quarter equal to the enhanced FMAP described in section
2105(b) of the Social Security Act (42 U.S.C. 1397ee(b)) of
expenditures in the quarter for medical assistance provided
to HIV-infected individuals who are eligible for such
assistance under a State Medicaid program in accordance with
the demonstration project established under this section.
(e) Evaluation and Report.--
(1) Evaluation.--The Secretary shall conduct an evaluation
of the demonstration project established under this section.
Such evaluation shall include an analysis of the cost-
effectiveness of the project and the impact of the project on
the Medicare, Medicaid, and Supplemental Security Income
programs established under titles XVIII, XIX, and XVI,
respectively, of the Social Security Act (42 U.S.C. 1395 et
seq., 1396 et seq., 1381 et seq.).
(2) Report to congress.--Not later than December 31, 2012,
the Secretary shall submit a report to Congress on the
results of the evaluation of the demonstration project
established under this section.
______

SA 2562. Mr. KYL submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

On page 217, after line 25, insert the following:

SEC. 61_. EXTENSION AND MODIFICATION OF 15-YEAR STRAIGHT-LINE
COST RECOVERY FOR QUALIFIED LEASEHOLD
IMPROVEMENTS AND QUALIFIED RESTAURANT
IMPROVEMENTS; 15-YEAR STRAIGHT-LINE COST
RECOVERY FOR CERTAIN IMPROVEMENTS TO RETAIL
SPACE.

(a) Extension of Leasehold and Restaurant Improvements.--
(1) In general.--Clauses (iv) and (v) of section
168(e)(3)(E) of the Internal Revenue Code of 1986 (relating
to 15-year property) are each amended by striking ``January
1, 2008'' and inserting ``January 1, 2009''.
(2) Effective date.--The amendment made by this subsection
shall apply to property placed in service after December 31,
2007.
(b) Modification of Treatment of Qualified Restaurant
Property as 15-Year Property for Purposes of Depreciation
Deduction.--
(1) Treatment to include new construction.--Paragraph (7)
of section 168(e) of the Internal Revenue Code of 1986
(relating to classification of property) is amended to read
as follows:
``(7) Qualified restaurant property.--The term `qualified
restaurant property' means any section 1250 property which is
a building (or its structural components) or an improvement
to such building if more than 50 percent of such building's
square footage is devoted to preparation of, and seating for
on-premises consumption of, prepared meals.''.
(2) Effective date.--The amendment made by this subsection
shall apply to any property placed in service after the date
of the enactment of this Act, the original use of which
begins with the taxpayer after such date.
(c) Recovery Period for Depreciation of Certain
Improvements to Retail Space.--
(1) 15-year recovery period.--Section 168(e)(3)(E) of the
Internal Revenue Code of 1986 (relating to 15-year property)
is amended by striking ``and'' at the end of clause (vii), by
striking the period at the end of clause (viii) and inserting
``, and'', and by adding at the end the following new clause:
``(ix) any qualified retail improvement property placed in
service before January 1, 2009.''.
(2) Qualified retail improvement property.--Section 168(e)
of such Code is amended by adding at the end the following
new paragraph:
``(8) Qualified retail improvement property.--
``(A) In general.--The term `qualified retail improvement
property' means any improvement to an interior portion of a
building which is nonresidential real property if--
``(i) such portion is open to the general public and is
used in the retail trade or business of selling tangible
personal property to the general public, and
``(ii) such improvement is placed in service more than 3
years after the date the building was first placed in
service.
``(B) Improvements made by owner.--In the case of an
improvement made by the owner of such improvement, such
improvement shall be qualified retail improvement property
(if at all) only so long as such improvement is held by such
owner. Rules similar to the rules under paragraph (6)(B)
shall apply for purposes of the preceding sentence.
``(C) Certain improvements not included.--Such term shall
not include any improvement for which the expenditure is
attributable to--
``(i) the enlargement of the building,
``(ii) any elevator or escalator,
``(iii) any structural component benefitting a common area,
or
``(iv) the internal structural framework of the
building.''.
(3) Requirement to use straight line method.--Section
168(b)(3) of such Code is amended by adding at the end the
following new subparagraph:
``(I) Qualified retail improvement property described in
subsection (e)(8).''.
(4) Alternative system.--The table contained in section
168(g)(3)(B) of such Code is amended by inserting after the
item relating to subparagraph (E)(viii) the following new
item:

(E)(ix)...........................................................39''.

(5) Effective date.--The amendments made by this subsection
shall apply to property placed in service after the date of
the enactment of this Act.
______

SA 2563. Mr. KYL submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

On page 217, after line 25, add the following:

SEC. ___. PERMANENT EXTENSION OF EXPENSING FOR SMALL
BUSINESSES.

(a) Dollar Limitation.--Paragraph (1) of section 179(b) of
the Internal Revenue Code

[[Page S10513]]

of 1986 is amended by striking ``$25,000 ($125,000 in the
case of taxable years beginning after 2006 and before 2011)''
and inserting ``$125,000''.
(b) Reduction in Limitation.--Paragraph (2) of section
179(b) of the Internal Revenue Code of 1986 is amended by
striking ``$200,000 ($500,000 in the case of taxable years
beginning after 2006 and before 2011)'' and inserting
``$500,000''.
(c) Inflation Adjustments.--Subparagraph (A) of section
179(b)(5) of the Internal Revenue Code of 1986 is amended by
striking ``and before 2011''.
(d) Election.--Paragraph (2) of section 179(c) of the
Internal Revenue Code of 1986 is amended by striking ``and
before 2011''.
(e) Computer Software.--Clause (ii) of section 179(d)(1)(A)
of the Internal Revenue Code of 1986 is amended by striking
``and before 2011''.
______

SA 2564. Mr. CARDIN submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

On page 196, between lines 18 and 19, insert the following:
(c) GAO Study and Report on Access to Oral Health Care,
Including Preventive and Restorative Services.--
(1) In general.--The Comptroller General of the United
States shall conduct a study of children's access to oral
health care, including preventive and restorative services,
under Medicaid and CHIP, including--
(A) the extent to which providers are willing to treat
children eligible for such programs;
(B) information on such children's access to networks of
care;
(C) geographic availability of oral health care, including
preventive and restorative services, under such programs; and
(D) as appropriate, information on the degree of
availability of oral health care, including preventive and
restorative services, for children under such programs.
(2) Report.--Not later than 2 years after the date of
enactment of this Act, the Comptroller General shall submit a
report to the appropriate committees of Congress on the study
conducted under paragraph (1) that includes recommendations
for such Federal and State legislative and administrative
changes as the Comptroller General determines are necessary
to address any barriers to access to oral health care,
including preventive and restorative services, under Medicaid
and CHIP that may exist.
______

SA 2565. Mr. CARDIN submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

On page 85, between lines 2 and 3, insert the following:
``(3) Five percent set aside for outreach to and enrollment
of children in undeserved communities.--An amount equal to 5
percent of the funds appropriated under subsection (g) shall
be used by the Secretary to award grants to school-based
health centers for outreach to and enrollment of children in
undeserved communities.
______

SA 2566. Mr. CARDIN submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

On page 168, line 22, insert ``dental care,'' after
``health services,''.
______

SA 2567. Mr. CARDIN submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

At the end of title II, add the following:

SEC. ____. ESTABLISHMENT OF STATE TELEPHONE HOTLINES FOR
ACCESS TO DENTAL PROVIDERS.

The Secretary shall work with States to establish telephone
hotlines for individuals enrolled in a State plan under title
XIX of the Social Security Act or a State child health plan
under title XXI of such Act, or any waiver of such plans, who
have dental coverage under such a plan or waiver in order to
identify participating dental providers who are willing to
accept such individuals as patients under such a plan or
waiver.
______

SA 2568. Mr. AKAKA (for himself, Mr. Alexander, Mr. Inouye, and Mr.
Corker) submitted an amendment intended to be proposed to amendment SA
2530 proposed by Mr. Baucus (for himself, Mr. Grassley, Mr.
Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the Internal
Revenue Code of 1986 to provide tax relief for small businesses, and
for other purposes; which was ordered to lie on the table; as follows:

At the appropriate place, insert the following:

SEC. __. MEDICAID DSH ALLOTMENTS FOR TENNESSEE AND HAWAII.

(a) Tennessee.--The DSH allotments for Tennessee for each
fiscal year beginning with fiscal year 2008 under subsection
(f)(3) of section 1923 of the Social Security Act (42 U.S.C.
13961396r-4) are deemed to be $30,000,000. The Secretary of
Health and Human Services may impose a limitation on the
total amount of payments made to hospitals under the TennCare
Section 1115 waiver only to the extent that such limitation
is necessary to ensure that a hospital does not receive
payment in excess of the amounts described in subsection (f)
of such section or as necessary to ensure that the waiver
remains budget neutral.
(b) Hawaii.--Section 1923(f)(6) (42 U.S.C. 1396r-4(f)(6))
is amended--
(1) in the paragraph heading, by striking ``for fiscal year
2007''; and
(2) in subparagraph (B)--
(A) in clause (i), by striking ``Only with respect to
fiscal year 2007'' and inserting ``With respect to each of
fiscal years 2007 and 2008'';
(B) by redesignating clause (ii) as clause (iv); and
(C) by inserting after clause (i), the following new
clauses:
``(ii) Treatment as a low-dsh state.--With respect to
fiscal year 2009 and each fiscal year thereafter,
notwithstanding the table set forth in paragraph (2), the DSH
allotment for Hawaii shall be increased in the same manner as
allotments for low DSH States are increased for such fiscal
year under clauses (ii) and (iii) of paragraph (5)(B).
``(iii) Certain hospital payments.--The Secretary may not
impose a limitation on the total amount of payments made to
hospitals under the QUEST section 1115 Demonstration Project
except to the extent that such limitation is necessary to
ensure that a hospital does not receive payments in excess of
the amounts described in subsection (g), or as necessary to
ensure that such payments under the waiver and such payments
pursuant to the allotment provided in this section do not, in
the aggregate in any year, exceed the amount that the
Secretary determines is equal to the Federal medical
assistance percentage component attributable to
disproportionate share hospital payment adjustments for such
year that is reflected in the budget neutrality provision of
the QUEST Demonstration Project.''.
______

SA 2569. Mr. MENENDEZ submitted an amendment intended to be proposed
to amendment SA 2547 submitted by Mr. Bunning to the amendment SA 2530
proposed by Mr. Baucus (for himself, Mr. Grassley, Mr. Rockefeller, and
Mr. Hatch) to the bill H.R. 976, to amend the Internal Revenue Code of
1986 to provide tax relief for small businesses, and for other
purposes; which was ordered to lie on the table; as follows:

At the end of the matter proposed to be inserted, add the
following:
(d) Exclusion of Federally Elected Officials With Incomes
Over 300 Percent of the Federal Poverty Line From Benefits
Under FEHBP.--Notwithstanding any other provision of law, on
and after October 1, 2007, any federally elected official,
including a Member of Congress and the President, whose
income exceeds 300 percent of the Federal poverty line shall
not be eligible for benefits under the Federal Employees
Health Benefits Program (FEHBP) under chapter 89 of title 5,
United States Code.
______

SA 2570. Mr. WYDEN submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

On page 39, line 8, after the period, insert the following:
``In addition, States may use up to 1 percent of any payments
received from the Incentive Pool to fund voluntary incentive
programs to promote children's receipt of relevant screenings
and improvements in healthy eating and physical activity with
the aim of reducing the incidence of type 2 diabetes. Such
programs may involve reductions in cost-sharing or premiums
when children receive regular screening and reach certain
benchmarks in healthy eating and physical activity. Under
such programs, a State may also provide financial bonuses for
partnerships with entities, such as schools, which increase
their education and efforts with respect to reducing the
incidence of type 2 diabetes and childhood obesity and may
also devise incentives for providers

[[Page S10514]]

serving children covered under this title and title XIX to
perform relevant screening and counseling regarding healthy
eating and physical activity.''.

On page 195, between lines 15 and 16, insert the following
new paragraph:
``(7) To the extent applicable, a description of any
efforts to address type 2 diabetes and childhood obesity that
are funded under the program under this title (and the
program under title XIX, as appropriate).''.
______

SA 2571. Mr. SANDERS submitted an amendment intended to be proposed
to amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

At the end of title I, insert the following:

SEC. __. INCENTIVE PROGRAM FOR STATE HEALTH ACCESS
INNOVATIONS.

Section 2104, as amended by section 108, is amended by
adding at the end the following new subsection:
``(l) Incentive Program for State Health Access
Innovations.--
``(1) Establishment of state health access innovations
incentive pool.--
``(A) In general.--There is hereby established in the
Treasury of the United States a fund which shall be known as
the `CHIP State Health Access Innovations Pool' (in this
subsection referred to as the `SHAI Pool''). Amounts in the
SHAI Pool are authorized to be appropriated for payments
under this subsection and shall remain available until
expended.
``(B) Transfer of funds.--Notwithstanding subsection
(j)(1)(B)(i), from the amount appropriated for fiscal year
2008 under such subsection, $250,000,000 of such amount is
hereby transferred to the SHAI Pool and made available for
expenditure from such pool for the period of fiscal years
2008 through 2012.
``(2) Award of grants.--
``(A) In general.--The Secretary shall award grants to
eligible States from amounts in the SHAI Pool in accordance
with this subsection.
``(B) Eligible state.--For purposes of this subsection, an
eligible State is a State--
``(i) for which the percentage of low-income children
without health insurance (as determined by the Secretary on
the basis of the most recent data available) is less than 10
percent; and
``(ii) that submits an application for a grant from the
SHAI Pool for the purpose of carrying out programs and
activities that are designed to expand access to health
providers and health services for low-income children who are
eligible for medical assistance under the State plan under
title XIX (or a waiver of such plan) or child health
assistance under the State child health plan under this
title.
``(3) Requirements.--
``(A) Priority in awarding of grants.--In awarding grants
under this subsection, the Secretary shall give preference to
grant applications that--
``(i) propose innovative approaches to increasing the
availability of health care providers and services;
``(ii) create longer-term improvements in health care
infrastructure;
``(iii) have potential application in other States;
``(iv) seek to remedy shortages of health care providers;
or
``(v) result in the direct provision of health services.
``(B) Prohibitions.--The Secretary shall not--
``(i) award a grant to carry out programs or activities
which the Secretary determines would substitute for services
or funds provided by a State or the Federal Government; or
``(ii) disapprove any grant application on the basis that
programs or activities to be conducted with funds provided
under the grant would be provided through or by an entity
that otherwise receives Federal or State funding, such as a
Federally-qualified health center.
``(C) Term, amount, and number of grants per eligible
states.--
``(i) Term.--A grant awarded under this subsection may be
renewed each year for a period of up to 5 years, but in no
case later than fiscal year 2012.
``(ii) Amount.--No grant awarded under this subsection may
exceed $2,000,000 for any fiscal year.
``(iii) No limit on number of grants per state.--Nothing in
this subsection shall be construed as limiting the number of
grants that an eligible State may be awarded under this
subsection.
``(D) Annual aggregate limit.--The aggregate amount of all
grants awarded from the SHAI pool shall not exceed--
``(i) $50,000,000 in fiscal year 2008;
``(ii) $100,000,000 in fiscal year 2009;
``(iii) $150,000,000 in fiscal year 2010;
``(iv) $200,000,000 in fiscal year 2011; and
``(v) $250,000,000 in fiscal year 2012.''.
______

SA 2572. Mr. SANDERS submitted an amendment intended to be proposed
to the bill H.R. 976, to amend the Internal Revenue Code of 1986 to
provide tax relief for small businesses, and for other purposes; which
was ordered to lie on the table; as follows:

At the end appropriate place, add the following:

SEC. ___. IMPROVMENTS TO MEDICARE COVERAGE OF AND PAYMENT FOR
FQHC SERVICES.

(a) Coverage for FQHC Ambulatory Services.--Section
1861(aa)(3) of the Social Security Act (42 U.S.C.
1395x(aa)(3)) is amended to read as follows:
``(3) The term `Federally qualified health center services'
means--
``(A) services of the type described in subparagraphs (A)
through (C) of paragraph (1), and such other services
furnished by a Federally qualified health center for which
payment may otherwise be made under this title if such
services were furnished by a health care provider or health
care professional other than a Federally qualified health
center; and
``(B) preventive primary health services that a center is
required to provide under section 330 of the Public Health
Service Act;

when furnished to an individual as a patient of a Federally
qualified health center.''.
(b) Per Visit Payment Requirements for FQHCs.--Section
1833(a)(3)(A) of the Social Security Act (42 U.S.C.
1395l(a)(3)(A)), is amended by adding ``(which regulations
may not limit the per visit payment amount, or a component of
such amount, for services described in section
1832(a)(2)(D)(ii))'' after ``the Secretary may prescribe in
regulations''.
(c) Effective Date.--The amendments made by this section
shall apply to services provided on or after January 1, 2008.
______

SA 2573. Mr. SANDERS submitted an amendment intended to be proposed
to amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

At the end of title VI, add the following:

SEC. ___. SENSE OF THE SENATE REGARDING MEDICARE PAYMENT FOR
FEDERALLY QUALIFIED HEALTH CENTER SERVICES.

It is the sense of the Senate that title XVIII of the
Social Security Act, regarding per visit Medicare payment
requirements for Federally qualified health centers (FQHCs),
should be amended by adding that regulations may not limit
the per visit payment amount or a component of such amount.
______

SA 2574. Mr. SANDERS submitted an amendment intended to be proposed
to amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

At the appropriate place, insert the following:

SEC. __. PREVENTING THE CARRYING OUT OF A PROPOSED RULE.

The Secretary shall not take any action to finalize (or
otherwise implement) provisions contained in the proposed
rule published on May 3, 2007, on pages 24680 through 25135
of volume 72, Federal Register, insofar as such provisions
propose--
(1) to alter payments for services under the hospital
inpatient prospective payment system under section 1886(d) of
the Social Security Act (42 U.S.C. 1395ww(d)) based on use of
a Medicare severity diagnosis related group (MS-DRG) system;
or
(2) to implement a prospective behavioral offset in
response to the implementation of such a Medicare Severity
Diagnosis Related Group (MS-DRG) system for purposes of such
hospital inpatient prospective payment system.
______

SA 2575. Mr. SANDERS submitted an amendment intended to be proposed
to amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

At the appropriate place, insert the following:

SEC. __. SENSE OF THE SENATE.

It is the sense of the Senate that the Secretary should not
take any action to finalize (or otherwise implement)
provisions contained in the proposed rule published on May 3,
2007, on pages 24680 through 25135 of volume 72, Federal
Register, insofar as such provisions propose--
(1) to alter payments for services under the hospital
inpatient prospective payment system under section 1886(d) of
the Social Security Act (42 U.S.C. 1395ww(d)) based on use of
a Medicare severity diagnosis related group (MS-DRG) system;
or
(2) to implement a prospective behavioral offset in
response to the implementation of such a Medicare Severity
Diagnosis Related Group (MS-DRG) system for purposes of such
hospital inpatient prospective payment system.

[[Page S10515]]

______

SA 2576. Mr. DeMINT submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

On page 217, after line 25, insert the following:

SEC. _. REPEAL OF MEDICINE AND DRUGS LIMITATION ON DEDUCTION
FOR MEDICAL CARE.

(a) In General.--Section 213 of the Internal Revenue Code
of 1986 (relating to medical, dental, etc., expenses) is
amended by striking subsection (b).
(b) Conforming Amendment.--Section 213(d) of such Code is
amended by striking paragraph (3).
(c) Effective Date.--The amendments made by this section
shall apply to taxable years beginning after the date of the
enactment of this Act.
______

SA 2577. Mr. DeMINT submitted an amendment intended to be proposed by
him to the bill H.R. 976, to amend the Internal Revenue Code of 1986 to
provide tax relief for small businesses, and for other purposes; which
was ordered to lie on the table; as follows:

At the appropriate place, insert the following:

TITLE __--HEALTH CARE CHOICE

SEC. _01. SHORT TITLE.

This title may be cited as ``Health Care Choice Act of
2007''.

SEC. _02. SPECIFICATION OF CONSTITUTIONAL AUTHORITY FOR
ENACTMENT OF LAW.

This title is enacted pursuant to the power granted
Congress under article I, section 8, clause 3, of the United
States Constitution.

SEC. _03. FINDINGS.

Congress finds the following:
(1) The application of numerous and significant variations
in State law impacts the ability of insurers to offer, and
individuals to obtain, affordable individual health insurance
coverage, thereby impeding commerce in individual health
insurance coverage.
(2) Individual health insurance coverage is increasingly
offered through the Internet, other electronic means, and by
mail, all of which are inherently part of interstate
commerce.
(3) In response to these issues, it is appropriate to
encourage increased efficiency in the offering of individual
health insurance coverage through a collaborative approach by
the States in regulating this coverage.
(4) The establishment of risk-retention groups has provided
a successful model for the sale of insurance across State
lines, as the acts establishing those groups allow insurance
to be sold in multiple States but regulated by a single
State.

SEC. _04. COOPERATIVE GOVERNING OF INDIVIDUAL HEALTH
INSURANCE COVERAGE.

(a) In General.--Title XXVII of the Public Health Service
Act (42 U.S.C. 300gg et seq.) is amended by adding at the end
the following new part:

``PART D--COOPERATIVE GOVERNING OF INDIVIDUAL HEALTH INSURANCE COVERAGE

``SEC. 2795. DEFINITIONS.

``In this part:
``(1) Primary state.--The term `primary State' means, with
respect to individual health insurance coverage offered by a
health insurance issuer, the State designated by the issuer
as the State whose covered laws shall govern the health
insurance issuer in the sale of such coverage under this
part. An issuer, with respect to a particular policy, may
only designate one such State as its primary State with
respect to all such coverage it offers. Such an issuer may
not change the designated primary State with respect to
individual health insurance coverage once the policy is
issued, except that such a change may be made upon renewal of
the policy. With respect to such designated State, the issuer
is deemed to be doing business in that State.
``(2) Secondary state.--The term `secondary State' means,
with respect to individual health insurance coverage offered
by a health insurance issuer, any State that is not the
primary State. In the case of a health insurance issuer that
is selling a policy in, or to a resident of, a secondary
State, the issuer is deemed to be doing business in that
secondary State.
``(3) Health insurance issuer.--The term `health insurance
issuer' has the meaning given such term in section
2791(b)(2), except that such an issuer must be licensed in
the primary State and be qualified to sell individual health
insurance coverage in that State.
``(4) Individual health insurance coverage.--The term
`individual health insurance coverage' means health insurance
coverage offered in the individual market, as defined in
section 2791(e)(1).
``(5) Applicable state authority.--The term `applicable
State authority' means, with respect to a health insurance
issuer in a State, the State insurance commissioner or
official or officials designated by the State to enforce the
requirements of this title for the State with respect to the
issuer.
``(6) Hazardous financial condition.--The term `hazardous
financial condition' means that, based on its present or
reasonably anticipated financial condition, a health
insurance issuer is unlikely to be able--
``(A) to meet obligations to policyholders with respect to
known claims and reasonably anticipated claims; or
``(B) to pay other obligations in the normal course of
business.
``(7) Covered laws.--The term `covered laws' means the
laws, rules, regulations, agreements, and orders governing
the insurance business pertaining to--
``(A) individual health insurance coverage issued by a
health insurance issuer;
``(B) the offer, sale, and issuance of individual health
insurance coverage to an individual; and
``(C) the provision to an individual in relation to
individual health insurance coverage of--
``(i) health care and insurance related services;
``(ii) management, operations, and investment activities of
a health insurance issuer; and
``(iii) loss control and claims administration for a health
insurance issuer with respect to liability for which the
issuer provides insurance.
``(8) State.--The term `State' means only the 50 States and
the District of Columbia.
``(9) Unfair claims settlement practices.--The term `unfair
claims settlement practices' means only the following
practices:
``(A) Knowingly misrepresenting to claimants and insured
individuals relevant facts or policy provisions relating to
coverage at issue.
``(B) Failing to acknowledge with reasonable promptness
pertinent communications with respect to claims arising under
policies.
``(C) Failing to adopt and implement reasonable standards
for the prompt investigation and settlement of claims arising
under policies.
``(D) Failing to effectuate prompt, fair, and equitable
settlement of claims submitted in which liability has become
reasonably clear.
``(E) Refusing to pay claims without conducting a
reasonable investigation.
``(F) Failing to affirm or deny coverage of claims within a
reasonable period of time after having completed an
investigation related to those claims.
``(10) Fraud and abuse.--The term `fraud and abuse' means
an act or omission committed by a person who, knowingly and
with intent to defraud, commits, or conceals any material
information concerning, one or more of the following:
``(A) Presenting, causing to be presented or preparing with
knowledge or belief that it will be presented to or by an
insurer, a reinsurer, broker or its agent, false information
as part of, in support of or concerning a fact material to
one or more of the following:
``(i) An application for the issuance or renewal of an
insurance policy or reinsurance contract.
``(ii) The rating of an insurance policy or reinsurance
contract.
``(iii) A claim for payment or benefit pursuant to an
insurance policy or reinsurance contract.
``(iv) Premiums paid on an insurance policy or reinsurance
contract.
``(v) Payments made in accordance with the terms of an
insurance policy or reinsurance contract.
``(vi) A document filed with the commissioner or the chief
insurance regulatory official of another jurisdiction.
``(vii) The financial condition of an insurer or reinsurer.
``(viii) The formation, acquisition, merger,
reconsolidation, dissolution or withdrawal from one or more
lines of insurance or reinsurance in all or part of a State
by an insurer or reinsurer.
``(ix) The issuance of written evidence of insurance.
``(x) The reinstatement of an insurance policy.
``(B) Solicitation or acceptance of new or renewal
insurance risks on behalf of an insurer reinsurer or other
person engaged in the business of insurance by a person who
knows or should know that the insurer or other person
responsible for the risk is insolvent at the time of the
transaction.
``(C) Transaction of the business of insurance in violation
of laws requiring a license, certificate of authority or
other legal authority for the transaction of the business of
insurance.
``(D) Attempt to commit, aiding or abetting in the
commission of, or conspiracy to commit the acts or omissions
specified in this paragraph.

``SEC. 2796. APPLICATION OF LAW.

``(a) In General.--The covered laws of the primary State
shall apply to individual health insurance coverage offered
by a health insurance issuer in the primary State and in any
secondary State, but only if the coverage and issuer comply
with the conditions of this section with respect to the
offering of coverage in any secondary State.
``(b) Exemptions From Covered Laws in a Secondary State.--
Except as provided in this section, a health insurance issuer
with respect to its offer, sale, renewal, and issuance of
individual health insurance coverage in any secondary State
is exempt from any covered laws of the secondary State (and
any rules, regulations, agreements, or orders sought or
issued by such State under or related to such covered laws)
to the extent that such laws would--

[[Page S10516]]

``(1) make unlawful, or regulate, directly or indirectly,
the operation of the health insurance issuer operating in the
secondary State, except that any secondary State may require
such an issuer--
``(A) to pay, on a nondiscriminatory basis, applicable
premium and other taxes (including high risk pool
assessments) which are levied on insurers and surplus lines
insurers, brokers, or policyholders under the laws of the
State;
``(B) to register with and designate the State insurance
commissioner as its agent solely for the purpose of receiving
service of legal documents or process;
``(C) to submit to an examination of its financial
condition by the State insurance commissioner in any State in
which the issuer is doing business to determine the issuer's
financial condition, if--
``(i) the State insurance commissioner of the primary State
has not done an examination within the period recommended by
the National Association of Insurance Commissioners; and
``(ii) any such examination is conducted in accordance with
the examiners' handbook of the National Association of
Insurance Commissioners and is coordinated to avoid
unjustified duplication and unjustified repetition;
``(D) to comply with a lawful order issued--
``(i) in a delinquency proceeding commenced by the State
insurance commissioner if there has been a finding of
financial impairment under subparagraph (C); or
``(ii) in a voluntary dissolution proceeding;
``(E) to comply with an injunction issued by a court of
competent jurisdiction, upon a petition by the State
insurance commissioner alleging that the issuer is in
hazardous financial condition;
``(F) to participate, on a nondiscriminatory basis, in any
insurance insolvency guaranty association or similar
association to which a health insurance issuer in the State
is required to belong;
``(G) to comply with any State law regarding fraud and
abuse (as defined in section 2795(10)), except that if the
State seeks an injunction regarding the conduct described in
this subparagraph, such injunction must be obtained from a
court of competent jurisdiction; or
``(H) to comply with any State law regarding unfair claims
settlement practices (as defined in section 2795(9));
``(2) require any individual health insurance coverage
issued by the issuer to be countersigned by an insurance
agent or broker residing in that Secondary State; or
``(3) otherwise discriminate against the issuer issuing
insurance in both the primary State and in any secondary
State.
``(c) Clear and Conspicuous Disclosure.--A health insurance
issuer shall provide the following notice, in 12-point bold
type, in any insurance coverage offered in a secondary State
under this part by such a health insurance issuer and at
renewal of the policy, with the 5 blank spaces therein being
appropriately filled with the name of the health insurance
issuer, the name of primary State, the name of the secondary
State, the name of the secondary State, and the name of the
secondary State, respectively, for the coverage concerned:
`This policy is issued by _____ and is governed by the laws
and regulations of the State of _____, and it has met all the
laws of that State as determined by that State's Department
of Insurance. This policy may be less expensive than others
because it is not subject to all of the insurance laws and
regulations of the State of _____, including coverage of some
services or benefits mandated by the law of the State of
_____. Additionally, this policy is not subject to all of the
consumer protection laws or restrictions on rate changes of
the State of _____. As with all insurance products, before
purchasing this policy, you should carefully review the
policy and determine what health care services the policy
covers and what benefits it provides, including any
exclusions, limitations, or conditions for such services or
benefits.'.
``(d) Prohibition on Certain Reclassifications and Premium
Increases.--
``(1) In general.--For purposes of this section, a health
insurance issuer that provides individual health insurance
coverage to an individual under this part in a primary or
secondary State may not upon renewal--
``(A) move or reclassify the individual insured under the
health insurance coverage from the class such individual is
in at the time of issue of the contract based on the health-
status related factors of the individual; or
``(B) increase the premiums assessed the individual for
such coverage based on a health status-related factor or
change of a health status-related factor or the past or
prospective claim experience of the insured individual.
``(2) Construction.--Nothing in paragraph (1) shall be
construed to prohibit a health insurance issuer--
``(A) from terminating or discontinuing coverage or a class
of coverage in accordance with subsections (b) and (c) of
section 2742;
``(B) from raising premium rates for all policy holders
within a class based on claims experience;
``(C) from changing premiums or offering discounted
premiums to individuals who engage in wellness activities at
intervals prescribed by the issuer, if such premium changes
or incentives--
``(i) are disclosed to the consumer in the insurance
contract;
``(ii) are based on specific wellness activities that are
not applicable to all individuals; and
``(iii) are not obtainable by all individuals to whom
coverage is offered;
``(D) from reinstating lapsed coverage; or
``(E) from retroactively adjusting the rates charged an
individual insured individual if the initial rates were set
based on material misrepresentation by the individual at the
time of issue.
``(e) Prior Offering of Policy in Primary State.--A health
insurance issuer may not offer for sale individual health
insurance coverage in a secondary State unless that coverage
is currently offered for sale in the primary State.
``(f) Licensing of Agents or Brokers for Health Insurance
Issuers.--Any State may require that a person acting, or
offering to act, as an agent or broker for a health insurance
issuer with respect to the offering of individual health
insurance coverage obtain a license from that State, except
that a State many not impose any qualification or requirement
which discriminates against a nonresident agent or broker.
``(g) Documents for Submission to State Insurance
Commissioner.--Each health insurance issuer issuing
individual health insurance coverage in both primary and
secondary States shall submit--
``(1) to the insurance commissioner of each State in which
it intends to offer such coverage, before it may offer
individual health insurance coverage in such State--
``(A) a copy of the plan of operation or feasibility study
or any similar statement of the policy being offered and its
coverage (which shall include the name of its primary State
and its principal place of business);
``(B) written notice of any change in its designation of
its primary State; and
``(C) written notice from the issuer of the issuer's
compliance with all the laws of the primary State; and
``(2) to the insurance commissioner of each secondary State
in which it offers individual health insurance coverage, a
copy of the issuer's quarterly financial statement submitted
to the primary State, which statement shall be certified by
an independent public accountant and contain a statement of
opinion on loss and loss adjustment expense reserves made
by--
``(A) a member of the American Academy of Actuaries; or
``(B) a qualified loss reserve specialist.
``(h) Power of Courts To Enjoin Conduct.--Nothing in this
section shall be construed to affect the authority of any
Federal or State court to enjoin--
``(1) the solicitation or sale of individual health
insurance coverage by a health insurance issuer to any person
or group who is not eligible for such insurance; or
``(2) the solicitation or sale of individual health
insurance coverage by, or operation of, a health insurance
issuer that is in hazardous financial condition.
``(i) State Powers To Enforce State Laws.--
``(1) In general.--Subject to the provisions of subsection
(b)(1)(G) (relating to injunctions) and paragraph (2),
nothing in this section shall be construed to affect the
authority of any State to make use of any of its powers to
enforce the laws of such State with respect to which a health
insurance issuer is not exempt under subsection (b).
``(2) Courts of competent jurisdiction.--If a State seeks
an injunction regarding the conduct described in paragraphs
(1) and (2) of subsection (h), such injunction must be
obtained from a Federal or State court of competent
jurisdiction.
``(j) States' Authority To Sue.--Nothing in this section
shall affect the authority of any State to bring action in
any Federal or State court.
``(k) Generally Applicable Laws.--Nothing in this section
shall be construed to affect the applicability of State laws
generally applicable to persons or corporations.

``SEC. 2797. PRIMARY STATE MUST MEET FEDERAL FLOOR BEFORE
ISSUER MAY SELL INTO SECONDARY STATES.

``A health insurance issuer may not offer, sell, or issue
individual health insurance coverage in a secondary State if
the primary State does not meet the following requirements:
``(1) The State insurance commissioner must use a risk-
based capital formula for the determination of capital and
surplus requirements for all health insurance issuers.
``(2) The State must have legislation or regulations in
place establishing an independent review process for
individuals who are covered by individual health insurance
coverage unless the issuer provides an independent review
mechanism functionally equivalent (as determined by the
primary State insurance commissioner or official) to that
prescribed in the `Health Carrier External Review Model Act'
of the National Association of Insurance Commissioners for
all individuals who purchase insurance coverage under the
terms of this part.

``SEC. 2798. ENFORCEMENT.

``(a) In General.--Subject to subsection (b), with respect
to specific individual health insurance coverage the primary
State for such coverage has sole jurisdiction to enforce the
primary State's covered laws in the primary State and any
secondary State.
``(b) Secondary State's Authority.--Nothing in subsection
(a) shall be construed to affect the authority of a secondary
State to enforce its laws as set forth in the exception
specified in section 2796(b)(1).

[[Page S10517]]

``(c) Court Interpretation.--In reviewing action initiated
by the applicable secondary State authority, the court of
competent jurisdiction shall apply the covered laws of the
primary State.
``(d) Notice of Compliance Failure.--In the case of
individual health insurance coverage offered in a secondary
State that fails to comply with the covered laws of the
primary State, the applicable State authority of the
secondary State may notify the applicable State authority of
the primary State.''.
(b) Effective Date.--The amendment made by subsection (a)
shall apply to individual health insurance coverage offered,
issued, or sold after the date of the enactment of this Act.

SEC. _05. SEVERABILITY.

If any provision of the title or the application of such
provision to any person or circumstance is held to be
unconstitutional, the remainder of this title and the
application of the provisions of such to any other person or
circumstance shall not be affected.
______

SA 2578. Mr. VITTER submitted an amendment intended to be proposed to
amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

At the end of title VI, insert the following:

SEC. ___. TREATMENT OF CERTAIN HOSPITALS IN DETERMINING THE
APPROVED FTE RESIDENT AMOUNT FOR PAYMENTS FOR
DIRECT GRADUATE MEDICAL EDUCATION COSTS UNDER
THE MEDICARE PROGRAM.

(a) Treatment.--
(1) In general.--For purposes of subparagraph (F) of
section 1886(h)(2) of the Social Security Act (42 U.S.C.
1395ww(h)(2)), and any regulations implementing such section,
in the case of an eligible hospital, the approved FTE
resident amount for the hospital's first cost reporting
period for which it has an approved medical residency
training program and is participating under title XVIII of
such Act, subject to paragraph (2), shall be based on the
hospital's actual costs incurred in connection with the
Graduate Medical Education program for the hospital's first
cost reporting period in which residents were on duty during
the first month of the cost reporting period.
(2) Limit.--The approved FTE resident amount for such first
cost reporting period may not exceed 140 percent of the
locality adjusted national average per resident amount
computed under subparagraph (E) of such section 1886(h)(2)
for the area in which the hospital is located and for the
period.
(b) Eligible Hospital Defined.--In this section, the term
``eligible hospital'' means a hospital that--
(1) did not have an approved medical residency training
program (as defined in section 1886(h)(5)(A) of the Social
Security Act (42 U.S.C. 1395ww(h)(5)(A)) in 1984;
(2) began such a program in a cost reporting period
beginning on or after July 1, 2005 and ending before
September 30, 2011; and
(3) is located within 150 miles of the Medical Center of
Louisiana at New Orleans.
______

SA 2579. Mr. THUNE (for himself, Mr. Lott, Mr. Cornyn, and Mr.
DeMint) submitted an amendment intended to be proposed to amendment SA
2530 proposed by Mr. Baucus (for himself, Mr. Grassley, Mr.
Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the Internal
Revenue Code of 1986 to provide tax relief for small businesses, and
for other purposes; which was ordered to lie on the table; as follows:

At the end of title VI, add the following:

SEC. ___. EXCLUSION OF INDIVIDUALS WITH ALTERNATIVE MINIMUM
TAX LIABILITY FROM ELIGIBILITY FOR SCHIP
COVERAGE.

(a) In General.--Section 2102(b), as amended by this Act,
is amended by adding at the end the following new paragraph:
``(6) Exclusion of individuals with alternative minimum tax
liability.--Notwithstanding any other provision of this
title, no individual whose income is subject to tax liability
imposed under section 55 of the Internal Revenue Code of 1986
for the taxable year shall be eligible for assistance under a
State plan under this title for the fiscal year following
such taxable year.''.
(b) Effective Date.--The amendment made by this section
shall apply to taxable years beginning after the date of the
enactment of this Act.
______

SA 2580. Mr. BINGAMAN (for himself, Mr. Levin, Ms. Stabenow, and Mr.
Feingold) submitted an amendment intended to be proposed to amendment
SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley, Mr.
Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the Internal
Revenue Code of 1986 to provide tax relief for small businesses, and
for other purposes; which was ordered to lie on the table; as follows:

At the end of title I, add the following:

SEC. __. ONE-YEAR DELAY IN PROVISIONS RELATING TO PHASE-OUT
FOR COVERAGE OF NONPREGNANT CHILDLESS ADULTS.

(a) One-Year Delay.--Notwithstanding section 2111(a) of the
Social Security Act (as added by section 106), or any other
provision of title XXI of such Act, as amended by this Act,
each date specified in such section and title relating to the
phase-out for coverage of nonpregnant childless adults under
an applicable existing waiver (as defined in section 2111(c)
of such Act) shall be applied as if such date were 1 year
later.
(b) Increase in Basic Rebate for Single Source Drugs and
Innovator Multiple Source Drugs.--
(1) In general.--Section 1927(c) (42 U.S.C. 1396r-8(c)) is
amended--
(A) in paragraph (1)(B)(i)--
(i) in subclause (IV), by striking ``and'' after the
semicolon;
(ii) in subclause (V)--

(I) by inserting ``and before January 1, 2008,'' after
``1995,''; and
(II) by striking the period and inserting ``; and''; and

(iii) by adding at the end the following:

``(VI) after December 31, 2007, is 20.1 percent.''; and

(B) in paragraph (3)(B)--
(i) in clause (i), by striking ``and'' at the end;
(ii) in clause (ii)--

(I) by inserting ``and before January 1, 2008,'' after
``1993,''; and
(II) by striking the period and inserting ``; and''; and
(III) by adding at the end the following new clause:

``(iii) after December 31, 2007, is 16 percent.''.
(2) Effective date.--The amendments made by this subsection
take effect on the date of enactment of this Act and apply to
rebate agreements entered into or renewed under section 1927
of the Social Security Act (42 U.S.C. 1396r-8) on or after
such date.
(c) Extension of Prescription Drug Discounts to Enrollees
of Medicaid Managed Care Organizations.--
(1) In general.--Section 1903(m)(2)(A) (42 U.S.C.
1396b(m)(2)(A)) is amended--
(A) in clause (xi), by striking ``and'' at the end;
(B) in clause (xii), by striking the period at the end and
inserting ``; and''; and
(C) by adding at the end the following:
``(xiii) such contract provides that (I) payment for
covered outpatient drugs dispensed to individuals eligible
for medical assistance who are enrolled with the entity shall
be subject to the same rebate required by the agreement
entered into under section 1927 as the State is subject to
and that the State shall allow the entity to collect such
rebates from manufacturers, and (II) capitation rates paid to
the entity shall be based on actual cost experience related
to rebates and subject to the Federal regulations requiring
actuarially sound rates.''.
(2) Conforming amendments.--Section 1927 (42 U.S.C. 1396r-
8) is amended--
(A) in subsection (d)--
(i) in paragraph (1), by adding at the end the following:
``(C) Notwithstanding subparagraphs (A) and (B)--
``(i) a medicaid managed care organization with a contract
under section 1903(m) may exclude or otherwise restrict
coverage of a covered outpatient drug on the basis of
policies or practices of the organization, such as those
affecting utilization management, formulary adherence, and
cost sharing or dispute resolution, in lieu of any State
policies or practices relating to the exclusion or
restriction of coverage of such drugs; and
``(ii) nothing in this section or paragraph (2)(A)(xiii) of
section 1903(m) shall be construed as requiring a medicaid
managed care organization with a contract under such section
to maintain the same such polices and practices as those
established by the State for purposes of individuals who
receive medical assistance for covered outpatient drugs on a
fee-for service basis.''; and
(ii) in paragraph (4), by inserting after subparagraph (E)
the following:
``(F) Notwithstanding the preceding subparagraphs of this
paragraph, any formulary established by medicaid managed care
organization with a contract under section 1903(m) may be
based on positive inclusion of drugs selected by a formulary
committee consisting of physicians, pharmacists, and other
individuals with appropriate clinical experience as long as
drugs excluded from the formulary are available through prior
authorization, as described in paragraph (5).''; and
(B) in subsection (j), by striking paragraph (1) and
inserting the following:
``(1) Covered outpatients drugs are not subject to the
requirements of this section if such drugs are--
``(A) dispensed by a health maintenance organization other
than a medicaid managed care organization with a contract
under section 1903(m); and
``(B) subject to discounts under section 340B of the Public
Health Service Act.''.
(3) Effective date.--The amendments made by this subsection
take effect on the date of enactment of this Act and apply to
rebate agreements entered into or renewed under section 1927
of the Social Security Act (42 U.S.C. 1396r-8) on or after
such date.
______

SA 2581. Mr. BINGAMAN (for himself, Mr. Kerry, and Mr. Johnson)
submitted an amendment intended to be

[[Page S10518]]

proposed by him to the bill H.R. 976, to amend the Internal Revenue
Code of 1986 to provide tax relief for small businesses, and for other
purposes; which was ordered to lie on the table; as follows:

At the appropriate place, insert the following:

SEC. __. INCLUDING COSTS INCURRED BY THE INDIAN HEALTH
SERVICE, A FEDERALLY QUALIFIED HEALTH CENTER,
AN AIDS DRUG ASSISTANCE PROGRAM, CERTAIN
HOSPITALS, OR A PHARMACEUTICAL MANUFACTURER
PATIENT ASSISTANCE PROGRAM IN PROVIDING
PRESCRIPTION DRUGS TOWARD THE ANNUAL OUT OF
POCKET THRESHOLD UNDER PART D.

(a) Including Costs Incurred.--
(1) In general.--Section 1860D-2(b)(4)(C) (42 U.S.C. 1395w-
102(b)(4)(C)) is amended--
(A) in clause (i), by striking ``and'' at the end;
(B) in clause (ii)--
(i) by striking ``such costs shall be treated as incurred
only if'' and inserting ``subject to clause (iii), such costs
shall be treated as incurred if'';
(ii) by striking ``, under section 1860D-14, or under a
State Pharmaceutical Assistance Program'';
(iii) by striking ``(other than under such section or such
a Program)''; and
(iv) by striking the period at the end and inserting ``;
and''; and
(C) by inserting after clause (ii) the following new
clause:
``(iii) such costs shall be treated as incurred and shall
not be considered to be reimbursed under clause (ii) if such
costs are borne or paid--

``(I) under section 1860D-14;
``(II) under a State Pharmaceutical Assistance Program;
``(III) by the Indian Health Service, an Indian tribe or
tribal organization, or an urban Indian organization (as
defined in section 4 of the Indian Health Care Improvement
Act);
``(IV) by a Federally qualified health center (as defined
in section 1861(aa)(4));
``(V) under an AIDS Drug Assistance Program under part B of
title XXVI of the Public Health Service Act;
``(VI) by a subsection (d) hospital (as defined in section
1886(d)(1)(B)) that meets the requirements of clauses (i) and
(ii) of section 340B(a)(4)(L) of the Public Health Service
Act; or
``(VII) by a pharmaceutical manufacturer patient assistance
program, either directly or through the distribution or
donation of covered part D drugs, which shall be valued at
the negotiated price of such covered part D drug under the
enrollee's prescription drug plan or MA-PD plan as of the
date that the drug was distributed or donated.''.

(2) Effective date.--The amendments made by paragraph (1)
shall apply to costs incurred on or after January 1, 2008.
(b) Increase in Basic Rebate for Single Source Drugs and
Innovator Multiple Source Drugs.--
(1) In general.--Section 1927(c) (42 U.S.C. 1396r-8(c)) is
amended--
(A) in paragraph (1)(B)(i)--
(i) in subclause (IV), by striking ``and'' after the
semicolon;
(ii) in subclause (V)--

(I) by inserting ``and before January 1, 2008,'' after
``1995,''; and
(II) by striking the period and inserting ``; and''; and

(iii) by adding at the end the following:

``(VI) after December 31, 2007, is 20.1 percent.''; and

(B) in paragraph (3)(B)--
(i) in clause (i), by striking ``and'' at the end;
(ii) in clause (ii)--

(I) by inserting ``and before January 1, 2008,'' after
``1993,''; and
(II) by striking the period and inserting ``; and''; and
(III) by adding at the end the following new clause:

``(iii) after December 31, 2007, is 16 percent.''.
(2) Effective date.--The amendments made by this subsection
take effect on the date of enactment of this Act and apply to
rebate agreements entered into or renewed under section 1927
of the Social Security Act (42 U.S.C. 1396r-8) on or after
such date.
______

SA 2582. Mr. BINGAMAN (for himself, Mr. Kerry, and Mrs. Lincoln)
submitted an amendment intended to be proposed by him to the bill H.R.
976, to amend the Internal Revenue Code of 1986 to provide tax relief
for small businesses, and for other purposes; which was ordered to lie
on the table; as follows:

At the appropriate place, insert the following:

SEC. __. EXTENSION OF MORATORIUM ON SECRETARIAL AUTHORITY.

(a) Extension.--Effective as if included in the enactment
of section 7002 of the U.S. Troop Readiness, Veterans' Care,
Katrina Recovery, and Iraq Accountability Appropriations Act,
2007 (Public Law 110-28), subsection (a)(1) of such section
is amended, in the matter preceding subparagraph (A), by
striking ``1 year'' and inserting ``2 years''.
(b) Increase in Basic Rebate for Single Source Drugs and
Innovator Multiple Source Drugs.--
(1) In general.--Section 1927(c) (42 U.S.C. 1396r-8(c)) is
amended--
(A) in paragraph (1)(B)(i)--
(i) in subclause (IV), by striking ``and'' after the
semicolon;
(ii) in subclause (V)--

(I) by inserting ``and before January 1, 2008,'' after
``1995,''; and
(II) by striking the period and inserting ``; and''; and

(iii) by adding at the end the following:

``(VI) after December 31, 2007, is 20.1 percent.''; and

(B) in paragraph (3) (B)--
(i) in clause (i), by striking ``and'' at the end;
(ii) in clause (ii)--

(I) by inserting ``and before January 1, 2008,'' after
``1993,''; and
(II) by striking the period and inserting ``; and''; and
(III) by adding at the end the following new clause:

``(iii) after December 31, 2007, is 16 percent.''.
(2) Effective date.--The amendments made by this subsection
take effect on the date of enactment of this Act and apply to
rebate agreements entered into or renewed under section 1927
of the Social Security Act (42 U.S.C. 1396r-8) on or after
such date.
______

SA 2583. Mr. BINGAMAN (for himself and Mr. Kerry) submitted an
amendment intended to be proposed to amendment SA 2530 proposed by Mr.
Baucus (for himself and Mr. Grassley, Mr. Rockefeller, and Mr. Hatch)
to the bill H.R. 976, to amend the Internal Revenue Code of 1986 to
provide tax relief for small businesses, and for other purposes; which
was ordered to lie on the table; as follows:

At the end of title VI, add the following:

SEC. ___. IMPROVEMENTS TO THE MEDICARE SAVINGS PROGRAM.

(a) Increasing SLMB Eligibility Income Level to 135 Percent
of Poverty.--Section 1902(a)(10)(E)(iii) (42 U.S.C.
1396a(a)(10)(E)(iii)) is amended by striking ``and 120
percent in 1995 and years thereafter'' and inserting ``, 120
percent in 1995 through 2007, and 135 percent in 2008 and
years thereafter''.
(b) Improving the Assets Test for the Medicare Savings
Program.--Section 1905(p)(1)(C) (42 U.S.C. 1396d(p)(1)(C)) is
amended to read as follows:
``(C) whose resources (as determined under section 1613 for
purposes of the supplemental security income program) do not
exceed--
``(i) for years before 2008, twice the maximum amount of
resources that an individual may have and obtain benefits
under that program; and
``(ii) for 2008 and subsequent years, the resource
limitation established under this clause (or clause (i)) for
the previous year increased by the annual percentage increase
in the consumer price index (all items; U.S. city average) as
of September of such previous year.''.
(c) Effective Date.--The amendments made by subsections (a)
and (b) shall apply to eligibility determinations for
medicare cost-sharing furnished for periods beginning on or
after January 1, 2008.
(d) Increase in Basic Rebate for Single Source Drugs and
Innovator Multiple Source Drugs.--
(1) In general.--Section 1927(c) (42 U.S.C. 1396r-8(c)) is
amended--
(A) in paragraph (1)(B)(i)--
(i) in subclause (IV), by striking ``and'' after the
semicolon;
(ii) in subclause (V)--

(I) by inserting ``and before January 1, 2008,'' after
``1995,''; and
(II) by striking the period and inserting ``; and''; and

(iii) by adding at the end the following:

``(VI) after December 31, 2007, is 20.1 percent.''; and

(B) in paragraph (3) (B)--
(i) in clause (i), by striking ``and'' at the end;
(ii) in clause (ii)--

(I) by inserting ``and before January 1, 2008,'' after
``1993,''; and
(II) by striking the period and inserting ``; and''; and
(III) by adding at the end the following new clause:

``(iii) after December 31, 2007, is 16 percent.''.
(2) Effective date.--The amendments made by this subsection
take effect on the date of enactment of this Act and apply to
rebate agreements entered into or renewed under section 1927
of the Social Security Act (42 U.S.C. 1396r-8) on or after
such date.
(e) Extension of Prescription Drug Discounts to Enrollees
of Medicaid Managed Care Organizations.--
(1) In general.--Section 1903(m)(2)(A) (42 U.S.C.
1396b(m)(2)(A)) is amended--
(A) in clause (xi), by striking ``and'' at the end;
(B) in clause (xii), by striking the period at the end and
inserting ``; and''; and
(C) by adding at the end the following:
``(xiii) such contract provides that (I) payment for
covered outpatient drugs dispensed to individuals eligible
for medical assistance who are enrolled with the entity shall
be subject to the same rebate required by the agreement
entered into under section 1927 as the State is subject to
and that the State shall allow the entity to collect such
rebates from manufacturers, and (II) capitation rates paid to
the entity shall be based on actual

[[Page S10519]]

cost experience related to rebates and subject to the Federal
regulations requiring actuarially sound rates.''.
(2) Conforming amendments.--Section 1927 (42 U.S.C. 1396r-
8) is amended--
(A) in subsection (d)--
(i) in paragraph (1), by adding at the end the following:
``(C) Notwithstanding subparagraphs (A) and (B)--
``(i) a medicaid managed care organization with a contract
under section 1903(m) may exclude or otherwise restrict
coverage of a covered outpatient drug on the basis of
policies or practices of the organization, such as those
affecting utilization management, formulary adherence, and
cost sharing or dispute resolution, in lieu of any State
policies or practices relating to the exclusion or
restriction of coverage of such drugs; and
``(ii) nothing in this section or paragraph (2)(A)(xiii) of
section 1903(m) shall be construed as requiring a medicaid
managed care organization with a contract under such section
to maintain the same such polices and practices as those
established by the State for purposes of individuals who
receive medical assistance for covered outpatient drugs on a
fee-for service basis.''; and
(ii) in paragraph (4), by inserting after subparagraph (E)
the following:
``(F) Notwithstanding the preceding subparagraphs of this
paragraph, any formulary established by medicaid managed care
organization with a contract under section 1903(m) may be
based on positive inclusion of drugs selected by a formulary
committee consisting of physicians, pharmacists, and other
individuals with appropriate clinical experience as long as
drugs excluded from the formulary are available through prior
authorization, as described in paragraph (5).''; and
(B) in subsection (j), by striking paragraph (1) and
inserting the following:
``(1) Covered outpatients drugs are not subject to the
requirements of this section if such drugs are--
``(A) dispensed by a health maintenance organization other
than a medicaid managed care organization with a contract
under section 1903(m); and
``(B) subject to discounts under section 340B of the Public
Health Service Act.''.
(3) Effective date.--The amendments made by this subsection
take effect on the date of enactment of this Act and apply to
rebate agreements entered into or renewed under section 1927
of the Social Security Act (42 U.S.C. 1396r-8) on or after
such date.
______

SA 2584. Mr. BINGAMAN (for himself, Mr. Kerry and Mr. Feingold)
submitted an amendment intended to be proposed to amendment SA 2530
proposed by Mr. Baucus (for himself and Mr. Grassley, Mr. Rockefeller,
and Mr. Hatch) to the bill H.R. 976, to amend the Internal Revenue Code
of 1986 to provide tax relief for small businesses, and for other
purposes; which was ordered to lie on the table; as follows:

Strike section 301 and insert the following:

SEC. 301. STATE OPTION TO REQUIRE CERTAIN INDIVIDUALS TO
PRESENT SATISFACTORY DOCUMENTARY EVIDENCE OF
PROOF OF CITIZENSHIP OR NATIONALITY FOR
PURPOSES OF ELIGIBILITY FOR MEDICAID.

(a) State Plan Amendment.--
(1) In general.--Section 1902(a)(46) (42 U.S.C.
1396a(a)(46)) is amended--
(A) by inserting ``(A)'' after ``(46)'';
(B) by adding ``and'' after the semicolon; and
(C) by adding at the end the following new subparagraph:
``(B) at the option of the State and subject to section
1903(x), require that, with respect to an individual (other
than an individual described in section 1903(x)(1)) who
declares to be a citizen or national of the United States for
purposes of establishing initial eligibility for medical
assistance under this title (or, at State option, for
purposes of renewing or redetermining such eligibility to the
extent that such satisfactory documentary evidence of
citizenship or nationality has not yet been presented), there
is presented satisfactory documentary evidence of citizenship
or nationality of the individual (using criteria determined
by the State, which shall be no more restrictive than the
criteria used by the Social Security Administration to
determine citizenship, and which shall accept as such
evidence a document issued by a federally-recognized Indian
tribe evidencing membership or enrollment in, or affiliation
with, such tribe (such as a tribal enrollment card or
certificate of degree of Indian blood, and, with respect to
those federally-recognized Indian tribes located within
States having an international border whose membership
includes individuals who are not citizens of the United
States, such other forms of documentation (including tribal
documentation, if appropriate) that the Secretary, after
consulting with such tribes, determines to be satisfactory
documentary evidence of citizenship or nationality for
purposes of satisfying the requirement of this
subparagraph));''.
(2) Limitation on waiver authority.--Notwithstanding any
provision of section 1115 of the Social Security Act (42
U.S.C. 1315), or any other provision of law, the Secretary of
Health and Human Services may not waive the requirements of
section 1902(a)(46)(B) of such Act (42 U.S.C.
1396a(a)(46)(B)) with respect to a State.
(3) Conforming amendments.--Section 1903 (42 U.S.C. 1396b)
is amended--
(A) in subsection (i)--
(i) in paragraph (20), by adding ``or'' after the
semicolon;
(ii) in paragraph (21), by striking ``; or'' and inserting
a period; and
(iii) by striking paragraph (22); and
(B) in subsection (x) (as amended by section 405(c)(1)(A)
of division B of the Tax Relief and Health Care Act of 2006
(Public Law 109-432))--
(i) by striking paragraphs (1) and (3);
(ii) by redesignating paragraph (2) as paragraph (1);
(iii) in paragraph (1), as so redesignated, by striking
``paragraph (1)'' and inserting ``section 1902(a)(46)(B)'';
and
(iv) by adding at the end the following new paragraph:
``(2) In the case of an individual declaring to be a
citizen or national of the United States with respect to whom
a State requires the presentation of satisfactory documentary
evidence of citizenship or nationality under section
1902(a)(46)(B), the individual shall be provided at least the
reasonable opportunity to present satisfactory documentary
evidence of citizenship or nationality under this subsection
as is provided under clauses (i) and (ii) of section
1137(d)(4)(A) to an individual for the submittal to the State
of evidence indicating a satisfactory immigration status.''.
(b) Clarification of Rules for Children Born in the United
States to Mothers Eligible for Medicaid.--Section 1903(x) (42
U.S.C. 1396b(x)), as amended by subsection a(3)(B), is
amended--
(1) in paragraph (1)--
(A) in subparagraph (C), by striking ``or'' at the end;
(B) by redesignating subparagraph (D) as subparagraph (E);
and
(C) by inserting after subparagraph (C) the following new
subparagraph:
``(D) pursuant to the application of section 1902(e)(4)
(and, in the case of an individual who is eligible for
medical assistance on such basis, the individual shall be
deemed to have provided satisfactory documentary evidence of
citizenship or nationality and shall not be required to
provide further documentary evidence on any date that occurs
during or after the period in which the individual is
eligible for medical assistance on such basis); or''; and
(2) by adding at the end the following new paragraph:
``(3) Nothing in subparagraph (A) or (B) of section
1902(a)(46), the preceding paragraphs of this subsection, or
the Deficit Reduction Act of 2005, including section 6036 of
such Act, shall be construed as changing the requirement of
section 1902(e)(4) that a child born in the United States to
an alien mother for whom medical assistance for the delivery
of such child is available as treatment of an emergency
medical condition pursuant to subsection (v) shall be deemed
eligible for medical assistance during the first year of such
child's life.''.
(c) Effective Date.--
(1) Retroactive application.--The amendments made by this
section shall take effect as if included in the enactment of
the Deficit Reduction Act of 2005 (Public Law 109-171; 120
Stat. 4).
(2) Restoration of eligibility.--In the case of an
individual who, during the period that began on July 1, 2006,
and ends on the date of enactment of this Act, was determined
to be ineligible for medical assistance under a State
Medicaid program solely as a result of the application of
subsections (i)(22) and (x) of section 1903 of the Social
Security Act (as in effect during such period), but who would
have been determined eligible for such assistance if such
subsections, as amended by subsections (a) and (b), had
applied to the individual, a State may deem the individual to
be eligible for such assistance as of the date that the
individual was determined to be ineligible for such medical
assistance on such basis.
(d) Increase in Basic Rebate for Single Source Drugs and
Innovator Multiple Source Drugs.--
(1) In general.--Section 1927(c) (42 U.S.C. 1396r-8(c)) is
amended--
(A) in paragraph (1)(B)(i)--
(i) in subclause (IV), by striking ``and'' after the
semicolon;
(ii) in subclause (V)--

(I) by inserting ``and before January 1, 2008,'' after
``1995,''; and
(II) by striking the period and inserting ``; and''; and

(iii) by adding at the end the following:

``(VI) after December 31, 2007, is 20.1 percent.''; and

(B) in paragraph (3)(B)--
(i) in clause (i), by striking ``and'' at the end;
(ii) in clause (ii)--

(I) by inserting ``and before January 1, 2008,'' after
``1993,''; and
(II) by striking the period and inserting ``; and''; and
(III) by adding at the end the following new clause:

``(iii) after December 31, 2007, is 16 percent.''.
(2) Effective date.--The amendments made by this subsection
take effect on the date of enactment of this Act and apply to
rebate agreements entered into or renewed under section 1927
of the Social Security Act (42 U.S.C. 1396r-8) on or after
such date.

[[Page S10520]]

(e) Extension of Prescription Drug Discounts to Enrollees
of Medicaid Managed Care Organizations.--
(1) In general.--Section 1903(m)(2)(A) (42 U.S.C.
1396b(m)(2)(A)) is amended--
(A) in clause (xi), by striking ``and'' at the end;
(B) in clause (xii), by striking the period at the end and
inserting ``; and''; and
(C) by adding at the end the following:
``(xiii) such contract provides that (I) payment for
covered outpatient drugs dispensed to individuals eligible
for medical assistance who are enrolled with the entity shall
be subject to the same rebate required by the agreement
entered into under section 1927 as the State is subject to
and that the State shall allow the entity to collect such
rebates from manufacturers, and (II) capitation rates paid to
the entity shall be based on actual cost experience related
to rebates and subject to the Federal regulations requiring
actuarially sound rates.''.
(2) Conforming amendments.--Section 1927 (42 U.S.C. 1396r-
8) is amended--
(A) in subsection (d)--
(i) in paragraph (1), by adding at the end the following:
``(C) Notwithstanding subparagraphs (A) and (B)--
``(i) a medicaid managed care organization with a contract
under section 1903(m) may exclude or otherwise restrict
coverage of a covered outpatient drug on the basis of
policies or practices of the organization, such as those
affecting utilization management, formulary adherence, and
cost sharing or dispute resolution, in lieu of any State
policies or practices relating to the exclusion or
restriction of coverage of such drugs; and
``(ii) nothing in this section or paragraph (2)(A)(xiii) of
section 1903(m) shall be construed as requiring a medicaid
managed care organization with a contract under such section
to maintain the same such polices and practices as those
established by the State for purposes of individuals who
receive medical assistance for covered outpatient drugs on a
fee-for service basis.''; and
(ii) in paragraph (4), by inserting after subparagraph (E)
the following:
``(F) Notwithstanding the preceding subparagraphs of this
paragraph, any formulary established by medicaid managed care
organization with a contract under section 1903(m) may be
based on positive inclusion of drugs selected by a formulary
committee consisting of physicians, pharmacists, and other
individuals with appropriate clinical experience as long as
drugs excluded from the formulary are available through prior
authorization, as described in paragraph (5).''; and
(B) in subsection (j), by striking paragraph (1) and
inserting the following:
``(1) Covered outpatients drugs are not subject to the
requirements of this section if such drugs are--
``(A) dispensed by a health maintenance organization other
than a medicaid managed care organization with a contract
under section 1903(m); and
``(B) subject to discounts under section 340B of the Public
Health Service Act.''.
(3) Effective date.--The amendments made by this subsection
take effect on the date of enactment of this Act and apply to
rebate agreements entered into or renewed under section 1927
of the Social Security Act (42 U.S.C. 1396r-8) on or after
such date.
______

SA 2585. Mr. BINGAMAN (for himself and Mr. Levin, Mr. Kerry, Mr.
Feingold, Mr. Durbin, and Mrs. Lincoln) submitted an amendment intended
to be proposed by him to the bill H.R. 976, to to amend the Internal
Revenue Code of 1986 to provide tax relief for small businesses, and
for other purposes; which was ordered to lie on the table; as follows:

At the appropriate place, insert the following:

SEC. __. INSTITUTE OF MEDICINE STUDY AND REPORT RELATING TO
CHIP COVERAGE OF ADULT POPULATIONS.

Not later than July 1, 2009, the Institute of Medicine
shall conduct a study and submit a report to Congress
regarding coverage of adult populations in CHIP. Such study
and report shall include the following:
(1) Quantification of the total Federal and State
expenditures made for providing coverage of adult populations
under--
(A) section 1115 waivers approved before the date of
enactment of this Act with respect to the provision of such
coverage under State child health plans; and
(B) the amendments made by this Act.
(2) An analysis of the impact of providing coverage for
parents under CHIP on the access of children to health
insurance and the access of children to health services.
(3) An analysis of the overall cost of providing coverage
to pregnant women enrolled in State child health plans under
CHIP. Such analysis shall include the long-term cost-savings
to Federal and State governments associated with the
provision of prenatal care, including the increase in Federal
and State health care expenditures that would be associated
with the mother and newborn child (over the mother's lifetime
and the child's lifetime) if such prenatal care had not been
provided.
______

SA 2586. Mr. BINGAMAN (for himself and Mr. Kerry) submitted an
amendment intended to be proposed by him to the bill H.R. 976, to amend
the Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

At the appropriate place, insert the following:

SEC. __. EXPEDITING LOW-INCOME SUBSIDIES AND REVISING THE
RESOURCE STANDARDS UNDER THE MEDICARE
PRESCRIPTION DRUG PROGRAM.

(a) Expediting Low-Income Subsidies.--
(1) In general.--Section 1860D-14 (42 U.S.C. 1395w-114) is
amended by adding at the end the following new subsection:
``(e) Expedited Application and Eligibility Process.--
``(1) Expedited process.--
``(A) In general.--The Commissioner of Social Security
shall provide for an expedited process under this subsection
for the qualification for low-income assistance under this
section through a request to the Secretary of the Treasury as
provided in subparagraphs (B) and (C) for information
described in section 6103(l)(21) of the Internal Revenue Code
of 1986. Such process shall be conducted in cooperation with
the Secretary.
``(B) Opt in for newly eligible individuals.--Not later
than 60 days after the date of the enactment of this
subsection, the Secretary shall ensure that, as part of the
Medicare enrollment process, enrolling individuals--
``(i) receive information describing the low-income subsidy
provided under this section; and
``(ii) are provided the opportunity to opt-in to the
expedited process described in this subsection by requesting
that the Commissioner of Social Security screen the
individual involved for eligibility for such subsidy through
a request to the Secretary of the Treasury under section
6103(l)(21) of the Internal Revenue Code of 1986.
``(C) Currently eligible individuals.--The Commissioner of
Social Security shall, as soon as practicable after
implementation of subparagraph (A), screen any part D
eligible individual to which subparagraph (B) did not apply
at the time of such individual's enrollment for eligibility
for the low-income subsidy provided under this section
through a request to the Secretary of the Treasury under
section 6103(l)(21) of the Internal Revenue Code of 1986.
``(2) Notification of potentially eligible individuals.--
Under such process, in the case of each individual identified
under paragraph (1) who has not otherwise applied for, or
been determined eligible for, benefits under this section (or
who has applied for and been determined ineligible for such
benefits based only on excess resources), the Commissioner of
Social Security shall send a notification that the individual
is likely eligible for low-income subsidies under this
section. Such notification shall include the following:
``(A) Application information.--Information on how to apply
for such low-income subsidies.
``(B) Description of the lis benefit.--A description of the
low-income subsidies available under this section.
``(C) Information on state health insurance programs.--
Information on--
``(i) the State Health Insurance Assistance Program for the
State in which the individual is located; and
``(ii) how the individual may contact such Program in order
to obtain assistance regarding enrollment and benefits under
this part.
``(D) Attestation.--An application form that provides for a
signed attestation, under penalty of law, as to the amount of
income and assets of the individual and constitutes an
application for the low-income subsidies under this section.
Such form--
``(i) shall not require the submittal of additional
documentation regarding income or assets;
``(ii) shall permit the appointment of a personal
representative described in paragraph (4); and
``(iii) shall allow for the specification of a language
(other than English) that is preferred by the individual for
subsequent communications with respect to the individual
under this part.

If a State is doing its own outreach to low-income seniors
regarding enrollment and low-income subsidies under this
part, such process shall be coordinated with the State's
outreach effort.
``(3) Hold-harmless.--Under such process, if an individual
in good faith and in the absence of fraud executes an
attestation described in paragraph (2)(D) and is provided
low-income subsidies under this section on the basis of such
attestation, if the individual is subsequently found not
eligible for such subsidies, there shall be no recovery made
against the individual because of such subsidies improperly
paid.
``(4) Use of authorized representative.--Under such
process, with proper authorization (which may be part of the
attestation form described in paragraph (2)(D)), an
individual may authorize another individual to act as the
individual's personal representative with respect to
communications under this part and the enrollment of the
individual under a prescription drug plan (or MA-PD plan) and
for low-income subsidies under this section.
``(5) Use of preferred language in subsequent
communications.--In the case where an attestation described
in paragraph (2)(D) is completed and in which a language
other than English is specified under clause (iii) of

[[Page S10521]]

such paragraph, the Commissioner of Social Security shall
provide that subsequent communications to the individual
under this part shall be in such language.
``(6) Construction.--Nothing in this subsection shall be
construed as precluding the Commissioner of Social Security
or the Secretary from taking additional outreach efforts to
enroll eligible individuals under this part and to provide
low-income subsidies to eligible individuals.''.
(2) Prescription drug plans required to provide expedited
low-income subsidy opt-in as part of applications.--
(A) In general.--Section 1860D-1(b)(1)(B)(vi) (42 U.S.C.
1395w-101(b)(1)(B)(vi)) is amended by inserting before the
period at the end the following: ``, except that any
application form distributed by a sponsor of a prescription
drug plan, or an organization offering an MA-PD plan, shall
contain an option for a part D eligible individual to opt-in
to the expedited process under section 1860D-14(e) for low-
income assistance subsidies under such section by requesting
that the individual be screened for eligibility for such
subsidy through a request to the Secretary of the Treasury
under section 6103(l)(21) of the Internal Revenue Code of
1986''.
(B) Effective date.--The amendment made by subparagraph (A)
shall apply to application forms for plan years beginning
with 2008.
(3) Disclosure of return information for purposes of
determining individuals eligible for subsidies under medicare
part d.--
(A) In general.--Subsection (l) of section 6103 of the
Internal Revenue Code of 1986 is amended by adding at the end
the following new paragraph:
``(21) Disclosure of return information to carry out
medicare part d subsidies.--
``(A) In general.--The Secretary shall, upon written
request from the Commissioner of Social Security under
section 1860D-14(e)(1) of the Social Security Act, disclose
to officers and employees of the Social Security
Administration return information of a taxpayer who
(according to the records of the Secretary) may be eligible
for a subsidy under section 1860D-14 of the Social Security
Act. Such return information shall be limited to--
``(i) taxpayer identity information with respect to such
taxpayer,
``(ii) the filing status of such taxpayer,
``(iii) the gross income of such taxpayer,
``(iv) such other information relating to the liability of
the taxpayer as is prescribed by the Secretary by regulation
as might indicate the eligibility of such taxpayer for a
subsidy under section 1860D-14 of the Social Security Act,
and
``(v) the taxable year with respect to which the preceding
information relates.
``(B) Restriction on use of disclosed information.--Return
information disclosed under this paragraph may be used by
officers and employees of the Social Security Administration
only for the purposes of identifying eligible individuals
for, and, if applicable, administering--
``(i) low-income subsidies under section 1860D-14 of the
Social Security Act, and
``(ii) the Medicare Savings Program implemented under
clauses (i), (iii), and (iv) of section 1902(a)(10)(E) of
such Act.
``(C) Termination.--Return information may not be disclosed
under this paragraph after the date that is one year after
the date of the enactment of this paragraph.''.
(B) Conforming amendments.--Paragraph (4) of section
6103(p) of the Internal Revenue Code of 1986 is amended--
(i) by striking ``(14) or (17)'' in the matter preceding
subparagraph (A) and inserting ``(14), (17), or (21)''; and
(ii) by striking ``(15) or (17)'' in subparagraph (F)(ii)
and inserting ``(15), (17), or (21)''.
(b) Modification of Resource Standards for Determination of
Eligibility for Low-Income Subsidy.--
(1) Increasing the resource standard applied to full low-
income subsidy.--Subparagraph (D) of section 1860D-14(a)(3)
(42 U.S.C. 1395w-114(a)(3)) is amended--
(A) in the heading, by striking ``three times'';
(B) in clause (i), by striking ``and'' at the end;
(C) in clause (ii)--
(i) by striking ``a subsequent year'' and inserting
``2007'';
(ii) by striking ``this clause for the previous year'' and
inserting ``clause (i) for 2006''; and
(iii) by inserting ``(or clause (i))'' after ``this
clause''; and
(iv) by striking the period at the end and inserting a
semicolon;
(D) by adding at the end the following new clauses:
``(iii) for 2008, six times the maximum amount of resources
that an individual may have and obtain benefits under such
supplemental security income program; and
``(iv) for a subsequent year the resource limitation
established under this clause (or clause (iii)) for the
previous year increased by the annual percentage increase in
the consumer price index (all items; U.S. city average) as of
September of such previous year.''; and
(E) in the last sentence, by inserting ``or (iv)'' after
``clause (ii)''.
(2) Increasing the alternate resource standard.--
Subparagraph (E)(i) of such section is amended--
(A) by striking ``and'' at the end of subclause (I);
(B) in subclause (II)--
(i) by striking ``a subsequent year'' and inserting
``2007'';
(ii) by striking ``in this subclause (or subclause (I)) for
the previous year'' and inserting ``in subclause (I) for
2006''; and
(iii) by striking the period at the end and inserting a
semicolon;
(C) by inserting after subclause (II) the following new
subclauses:

``(III) for 2008, $27,500 (or $55,000 in the case of the
combined value of the individual's assets or resources and
the assets or resources of the individual's spouse); and
``(IV) for a subsequent year the dollar amounts specified
in this subclause (or subclause (III)) for the previous year
increased by the annual percentage increase in the consumer
price index (all items; U.S. city average) as of September of
such previous year.''; and

(D) in the last sentence, by inserting ``or (IV)'' after
``subclause (II)''.
(3) Exemptions from resources.--Section 1860D-14(a)(3) (42
U.S.C. 1395w-114(a)(3)) is amended--
(A) in subparagraph (D), in the matter preceding clause
(i), by inserting ``, subject to the additional exclusions
provided under subparagraph (G)'' before ``)'';
(B) in subparagraph (E)(i), in the matter preceding
subclause (I), by inserting ``,subject to the additional
exclusions provided under subparagraph (G)'' before ``)'';
and
(C) by adding at the end the following new subparagraph:
``(G) Additional exclusions.--In determining the resources
of an individual (and their eligible spouse, if any) under
section 1613 for purposes of subparagraphs (D) and (E) the
following additional exclusions shall apply:
``(i) Life insurance policy.--No part of the value of any
life insurance policy shall be taken into account.
``(ii) In-kind contributions.--No in-kind contribution
shall be taken into account.
``(iii) Pension or retirement plan.--No balance in any
pension or retirement plan shall be taken into account.''.
(4) Effective date.--The amendments made by this subsection
shall take effect on the date of enactment of this Act.
(c) Indexing Deductible and Cost-Sharing Above Annual Out-
of-Pocket Threshold for Individuals With Income Below 150
Percent of Poverty Line.--
(1) Indexing deductible.--Section 1860D-14(a)(4)(B) (42
U.S.C. 1395w-114(a)(4)(B)) is amended--
(A) in clause (i), by striking ``or'';
(B) in clause (ii)--
(i) by striking ``a subsequent year'' and inserting
``2008'';
(ii) by striking ``this clause (or clause (i)) for the
previous year'' and inserting ``clause (i) for 2007''; and
(iii) by striking ``involved.'' and inserting ``involved;
and'';
(C) by adding after clause (ii) the following new clause:
``(iii) for 2008 and each succeeding year, the amount
determined under this subparagraph for the previous year
increased by the annual percentage increase in the consumer
price index (all items; U.S. city average) as of September of
such previous year.''; and
(D) in the flush sentence at the end, by striking ``clause
(i) or (ii)'' and inserting ``clause (i), (ii), or (iii)''.
(2) Indexing cost-sharing.--Section 1860D-14(a) (42 U.S.C.
1395w-114(a)) is amended-
(A) in paragraph (1)(D)(iii), by striking ``exceed the
copayment amount'' and all that follows through the period at
the end and inserting ``exceed--

``(I) for 2006 and 2007, the copayment amount specified
under section 1860D-2(b)(4)(A)(i)(I) for the drug and year
involved; and
``(II) for 2008 and each succeeding year, the amount
determined under this subparagraph for the previous year
increased by the annual percentage increase in the consumer
price index (all items; U.S. city average) as of September of
such previous year.''; and

(B) in paragraph (2)(E), by striking ``exceed the copayment
or coinsurance amount'' and all that follows through the
period at the end and inserting ``exceed--
``(i) for 2006 and 2007, the copayment or coinsurance
amount specified under section 1860D-2(b)(4)(A)(i)(I) for the
drug and year involved; and
``(ii) for 2008 and each succeeding year, the amount
determined under this clause for the previous year increased
by the annual percentage increase in the consumer price index
(all items; U.S. city average) as of September of such
previous year.''.
(d) No Impact on Eligibility for Benefits Under Other
Programs.--
(1) In general.--Section 1860D-14(a)(3) (42 U.S.C. 1395w-
114(a)(3)), as amended by subsection b(3), is amended--
(A) in subparagraph (A), in the matter preceding clause
(i), by striking ``subparagraph (F)'' and inserting
``subparagraphs (F) and (H)''; and
(B) by adding at the end the following new subparagraph:
``(H) No impact on eligibility for benefits under other
programs.--The availability of premium and cost-sharing
subsidies under this section shall not be treated as benefits
or otherwise taken into account in determining an
individual's eligibility for, or the amount of benefits
under, any other Federal program.''.

[[Page S10522]]

(2) Effective date.--The amendments made by this subsection
shall take effect on the date of enactment of this Act.
(e) Extension of Prescription Drug Discounts to Enrollees
of Medicaid Managed Care Organizations.--
(1) In general.--Section 1903(m)(2)(A) (42 U.S.C.
1396b(m)(2)(A)) is amended--
(A) in clause (xi), by striking ``and'' at the end;
(B) in clause (xii), by striking the period at the end and
inserting ``; and''; and
(C) by adding at the end the following:
``(xiii) such contract provides that (I) payment for
covered outpatient drugs dispensed to individuals eligible
for medical assistance who are enrolled with the entity shall
be subject to the same rebate required by the agreement
entered into under section 1927 as the State is subject to
and that the State shall allow the entity to collect such
rebates from manufacturers, and (II) capitation rates paid to
the entity shall be based on actual cost experience related
to rebates and subject to the Federal regulations requiring
actuarially sound rates.''.
(2) Conforming amendments.--Section 1927 (42 U.S.C. 1396r-
8) is amended--
(A) in subsection (d)--
(i) in paragraph (1), by adding at the end the following:
``(C) Notwithstanding subparagraphs (A) and (B)--
``(i) a medicaid managed care organization with a contract
under section 1903(m) may exclude or otherwise restrict
coverage of a covered outpatient drug on the basis of
policies or practices of the organization, such as those
affecting utilization management, formulary adherence, and
cost sharing or dispute resolution, in lieu of any State
policies or practices relating to the exclusion or
restriction of coverage of such drugs; and
``(ii) nothing in this section or paragraph (2)(A)(xiii) of
section 1903(m) shall be construed as requiring a medicaid
managed care organization with a contract under such section
to maintain the same such polices and practices as those
established by the State for purposes of individuals who
receive medical assistance for covered outpatient drugs on a
fee-for service basis.''; and
(ii) in paragraph (4), by inserting after subparagraph (E)
the following:
``(F) Notwithstanding the preceding subparagraphs of this
paragraph, any formulary established by medicaid managed care
organization with a contract under section 1903(m) may be
based on positive inclusion of drugs selected by a formulary
committee consisting of physicians, pharmacists, and other
individuals with appropriate clinical experience as long as
drugs excluded from the formulary are available through prior
authorization, as described in paragraph (5).''; and
(B) in subsection (j), by striking paragraph (1) and
inserting the following:
``(1) Covered outpatients drugs are not subject to the
requirements of this section if such drugs are--
``(A) dispensed by a health maintenance organization other
than a medicaid managed care organization with a contract
under section 1903(m); and
``(B) subject to discounts under section 340B of the Public
Health Service Act.''.
(3) Effective date.--The amendments made by this subsection
take effect on the date of enactment of this Act and apply to
rebate agreements entered into or renewed under section 1927
of the Social Security Act (42 U.S.C. 1396r-8) on or after
such date.
(f) Increase in Basic Rebate for Single Source Drugs and
Innovator Multiple Source Drugs.--
(1) In general.--Section 1927(c) (42 U.S.C. 1396r-8(c)) is
amended--
(A) in paragraph (1)(B)(i)--
(i) in subclause (IV), by striking ``and'' after the
semicolon;
(ii) in subclause (V)--

(I) by inserting ``and before January 1, 2008,'' after
``1995,''; and
(II) by striking the period and inserting ``; and''; and

(iii) by adding at the end the following:

``(VI) after December 31, 2007, is 20.1 percent.''; and

(B) in paragraph (3) (B)--
(i) in clause (i), by striking ``and'' at the end;
(ii) in clause (ii)--

(I) by inserting ``and before January 1, 2008,'' after
``1993,''; and
(II) by striking the period and inserting ``; and''; and
(III) by adding at the end the following new clause:

``(iii) after December 31, 2007, is 16 percent.''.
(2) Effective date.--The amendments made by this subsection
take effect on the date of enactment of this Act and apply to
rebate agreements entered into or renewed under section 1927
of the Social Security Act (42 U.S.C. 1396r-8) on or after
such date.
______

SA 2587. Mr. GREGG proposed an amendment to amendment SA 2530
proposed by Mr. Baucus (for himself, Mr. Grassley, Mr. Rockefeller, and
Mr. Hatch) to the bill H.R. 976, to amend the Internal Revenue Code of
1986 to provide tax relief for small businesses, and for other
purposes; as follows:

Beginning on page 42, strike line 4 and all that follows
through page 66, line 25, and insert the following:

SEC. 106. LIMITATIONS ON MATCHING RATES FOR POPULATIONS OTHER
THAN LOW-INCOME CHILDREN OR PREGNANT WOMEN
COVERED THROUGH A SECTION 1115 WAIVER.

(a) Limitation on Payments.--Section 2105(c) of the Social
Security Act (42 U.S.C. 1397ee(c)) is amended by adding at
the end the following new paragraph:
``(8) Limitations on matching rate for populations other
than targeted low-income children or pregnant women covered
through a section 1115 waiver.--For child health assistance
or health benefits coverage furnished in any fiscal year
beginning with fiscal year 2008:
``(A) FMAP applied to payments only for nonpregnant
childless adults and parents and caretaker relatives enrolled
under a section 1115 waiver on the date of enactment of the
state children's health insurance program reauthorization of
2007.--The Federal medical assistance percentage (as
determined under section 1905(b) without regard to clause (4)
of such section) shall be substituted for the enhanced FMAP
under subsection (a)(1) with respect to payments for child
health assistance or health benefits coverage provided under
the State child health plan for any of the following:
``(i) Parents or caretaker relatives enrolled under a
waiver on the date of enactment of the state children's
health insurance program reauthorization of 2007.--A
nonpregnant parent or a nonpregnant caretaker relative of a
targeted low-income child who is enrolled in the State child
health plan under a waiver, experimental, pilot, or
demonstration project on the date of enactment of the
Children's Health Insurance Program Reauthorization Act of
2007 and whose family income does not exceed the income
eligibility applied under such waiver with respect to that
population on such date.
``(ii) Nonpregnant childless adults enrolled under a waiver
on such date.--A nonpregnant childless adult enrolled in the
State child health plan under a waiver, experimental, pilot,
or demonstration project described in section 6102(c)(3) of
the Deficit Reduction Act of 2005 (42 U.S.C. 1397gg note) on
the date of enactment of the Children's Health Insurance
Program Reauthorization Act of 2007 and whose family income
does not exceed the income eligibility applied under such
waiver with respect to that population on such date.
``(iii) No replacement enrollees.--Nothing in clauses (i)
or (ii) shall be construed as authorizing a State to provide
child health assistance or health benefits coverage under a
waiver described in either such clause to a nonpregnant
parent or a nonpregnant caretaker relative of a targeted low-
income child, or a nonpregnant childless adult, who is not
enrolled under the waiver on the date of enactment of the
Children's Health Insurance Program Reauthorization Act of
2007.
``(B) No federal payment for any new nonpregnant adult
enrollees or for such enrollees who no longer satisfy income
eligibility requirements.--Payment shall not be made under
this section for child health assistance or other health
benefits coverage provided under the State child health plan
or under a waiver under section 1115 for any of the
following:
``(i) Parents or caretaker relatives under a section 1115
waiver approved after the date of enactment of the state
children's health insurance program reauthorization of
2007.--A nonpregnant parent or a nonpregnant caretaker
relative of a targeted low-income child under a waiver,
experimental, pilot, or demonstration project that is
approved on or after the date of enactment of the Children's
Health Insurance Program Reauthorization Act of 2007.
``(ii) Parents, caretaker relatives, and nonpregnant
childless adults whose family income exceeds the income
eligibility level specified under a section 1115 waiver
approved prior to the state children's health insurance
program reauthorization of 2007.--Any nonpregnant parent or a
nonpregnant caretaker relative of a targeted low-income child
whose family income exceeds the income eligibility level
referred to in subparagraph (B)(i), and any nonpregnant
childless adult whose family income exceeds the income
eligibility level referred to in subparagraph (B)(ii).
``(iii) Nonpregnant childless adults, parents, or caretaker
relatives not enrolled under a section 1115 waiver on the
date of enactment of the state children's health insurance
program reauthorization of 2007.--Any nonpregnant parent or a
nonpregnant caretaker relative of a targeted low-income child
who is not enrolled in the State child health plan under a
section 1115 waiver, experimental, pilot, or demonstration
project referred to in subparagraph (B)(i) on the date of
enactment of the Children's Health Insurance Program
Reauthorization Act of 2007, and any nonpregnant childless
adult who is not enrolled in the State child health plan
under a section 1115 waiver, experimental, pilot, or
demonstration project referred to in subparagraph (B)(ii)(I)
on such date.
``(C) Definition of caretaker relative.--In this
subparagraph, the term `caretaker relative' has the meaning
given that term for purposes of carrying out section 1931.
``(D) Rule of construction.--Nothing in this paragraph
shall be construed as implying that payments for coverage of
populations for which the Federal medical assistance
percentage (as so determined) is to be substituted for the
enhanced FMAP under subsection (a)(1) in accordance with this
paragraph are to be made from funds other

[[Page S10523]]

than the allotments determined for a State under section
2104.''.
(b) Conforming Amendment.--Section 2105(a)(1) ( 42 U.S.C.
1397dd(a)(1)) is amended, in the matter preceding
subparagraph (A), by inserting ``or subsection (c)(8)'' after
``subparagraph (B)''.
(c) Nonapplication of Certain References.--Subsections (e),
(i), (j), and (k) of section 2104 (42 U.S.C. 1397dd), as
added by this Act, shall be applied without regard to any
reference to section 2111.

SEC. 107. PROHIBITION ON NEW SECTION 1115 WAIVERS FOR
COVERAGE OF ADULTS OTHER THAN PREGNANT WOMEN.

(a) In General.--Section 2107(f) (42 U.S.C. 1397gg(f)) is
amended--
(1) by striking ``, the Secretary'' and inserting ``:
``(1) The Secretary''; and
(2) by adding at the end the following new paragraphs:
``(2) The Secretary may not approve, extend, renew, or
amend a waiver, experimental, pilot, or demonstration project
with respect to a State after the date of enactment of the
Children's Health Insurance Program Reauthorization Act of
2007 that would allow funds made available under this title
to be used to provide child health assistance or other health
benefits coverage for any other adult other than a pregnant
woman whose family income does not exceed the income
eligibility level specified for a targeted low-income child
in that State under a waiver or project approved as of such
date.
``(3) The Secretary may not approve, extend, renew, or
amend a waiver, experimental, pilot, or demonstration project
with respect to a State after the date of enactment of the
Children's Health Insurance Program Reauthorization Act of
2007 that would waive or modify the requirements of section
2105(c)(8).''.
(b) Clarification of Authority for Coverage of Pregnant
Women.--Section 2106 (42 U.S.C. 1397ff) is amended by adding
at the end the following new subsection:
``(f) No Authority to Cover Pregnant Women Through State
Plan.--For purposes of this title, a State may provide
assistance to a pregnant woman under the State child health
plan only--
``(1) by virtue of a waiver under section 1115; or
``(2) through the application of sections 457.10,
457.350(b)(2), 457.622(c)(5), and 457.626(a)(3) of title 42,
Code of Federal Regulations (as in effect on the date of
enactment of the Children's Health Insurance Program
Reauthorization Act of 2007.''.
(c) Assurance of Notice to Affected Enrollees.--The
Secretary of Health and Human Services shall establish
procedures to ensure that States provide adequate public
notice for parents, caretaker relatives, and nonpregnant
childless adults whose eligibility for child health
assistance or health benefits coverage under a waiver under
section 1115 of the Social Security Act will be terminated as
a result of the amendments made by subsection (a), and that
States otherwise adhere to regulations of the Secretary
relating to procedures for terminating waivers under section
1115 of the Social Security Act.
______

SA 2588. Mr. OBAMA (for himself, Mrs. McCaskill, Mr. Harkin, Mr.
Kerry, and Ms. Landrieu) submitted an amendment intended to be proposed
to amendment SA 2530 proposed by Mr. Baucus (for himself, Mr. Grassley,
Mr. Rockefeller, and Mr. Hatch) to the bill H.R. 976, to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes; which was ordered to lie on the
table; as follows:

At the end of title VI, insert the following:

SEC. ___. MILITARY FAMILY JOB PROTECTION.

(a) Short Title.--This section may be cited as the
``Military Family Job Protection Act''.
(b) Prohibition on Discrimination in Employment Against
Certain Family Members Caring for Recovering Members of the
Armed Forces.--A family member of a recovering servicemember
described in subsection (c) shall not be denied retention in
employment, promotion, or any benefit of employment by an
employer on the basis of the family member's absence from
employment as described in that subsection, for a period of
not more than 52 workweeks.
(c) Covered Family Members.--A family member described in
this subsection is a family member of a recovering
servicemember who is--
(1) on invitational orders while caring for the recovering
servicemember;
(2) a non-medical attendee caring for the recovering
servicemember; or
(3) receiving per diem payments from the Department of
Defense while caring for the recovering servicemember.
(d) Treatment of Actions.--An employer shall be considered
to have engaged in an action prohibited by subsection (b)
with respect to a person described in that subsection if the
absence from employment of the person as described in that
subsection is a motivating factor in the employer's action,
unless the employer can prove that the action would have been
taken in the absence of the absence of employment of the
person.
(e) Definitions.--In this section:
(1) Benefit of employment.--The term ``benefit of
employment'' has the meaning given such term in section 4303
of title 38, United States Code.
(2) Caring for.--The term ``caring for'', used with respect
to a recovering servicemember, means providing personal,
medical, or convalescent care to the recovering
servicemember, under circumstances that substantially
interfere with an employee's ability to work.
(3) Employer.--The term ``employer'' has the meaning given
such term in section 4303 of title 38, United States Code,
except that the term does not include any person who is not
considered to be an employer under title I of the Family and
Medical Leave Act of 1993 (29 U.S.C. 2611 et seq.) because
the person does not meet the requirements of section
101(4)(A)(i) of such Act (29 U.S.C. 2611(4)(A)(i)).
(4) Family member.--The term ``family member'', with
respect to a recovering servicemember, has the meaning given
that term in section 411h(b) of title 37, United States Code.
(5) Recovering servicemember.--The term ``recovering
servicemember'' means a member of the Armed Forces, including
a member of the National Guard or a Reserve, who is
undergoing medical treatment, recuperation, or therapy, or is
otherwise in medical hold or medical holdover status, for an
injury, illness, or disease incurred or aggravated while on
active duty in the Armed Forces.
______

SA 2589. Mr. REID proposed an amendment to the bill S. 1, to provide
greater transparency in the legislative process; as follows:

At the end of the amendment add the following:
This section shall take effect 3 days after date of
enactment.
______

SA 2590. Mr. REID proposed an amendment to amendment SA 2589 proposed
by Mr. REID to the bill S. 1, to provide greater transparency in the
legislative process; as follows:

In the amendment strike 3 and insert 1.
______

SA 2591. Mr. TESTER (for Mr. Biden) proposed an amendment to the
resolution S. Res. 276, calling for the urgent deployment of a robust
and effective multinational peacekeeping mission with sufficient size,
resources, leadership, and mandate to protect civilians in Darfur,
Sudan, and for efforts to strengthen the renewal of a just and
inclusive peace process; as follows:

On page 8, line 9, strike ``and'',
On page 8, between lines 9 and 10, insert the following:
(5) urges all participants in the conflict in Darfur,
including the leaders of rebel movements that were not
signatories to the Darfur Peace Agreement, to participate
fully in all meetings, conferences, and discussions within a
political process led by the United Nations and African Union
in order to return peace and security to the people of
Darfur;
(6) regards failure to participate in such meetings,
conferences, and discussions, as requested by the African
Union and United Nations, as an obstruction of the political
process and its goals that may be worthy of international
sanctions; and
On page 8, line 10, strike ``(5)'' and insert ``(7)''.
______

SA 2592. Mr. TESTER (for Mr. Biden) proposed an amendment to the
resolution S. Res. 276, calling for the urgent deployment of a robust
and effective multinational peacekeeping mission with sufficient size,
resources, leadership, and mandate to protect civilians in Darfur,
Sudan, and for efforts to strengthen the renewal of a just and
inclusive peace process; as follows:

In the twelfth whereas clause, insert ``and members of his
administration'' after ``al-Bashir''.
Strike the seventeenth whereas clause and insert the
following:
Whereas the United Nations and African Union have invited
leaders of the rebel movements in Darfur to participate in a
political process led by the United Nations and African Union
to return peace and stability to the people of Darfur;
Whereas deliberately targeting civilians and people
providing humanitarian assistance during an armed conflict is
a flagrant violation of international humanitarian law, and
those who commit such violations must be held accountable;
and

____________________