S.Amdt. 2790

SA 2790. Mr. CASEY submitted an amendment intended to be proposed to
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr.
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal
Revenue Code of 1986 to modify the first-time homebuyers credit in the
case of members of the Armed Forces and certain other Federal
employees, and for other purposes; which was ordered to lie on the
table; as follows:

Beginning on page 436, strike line 18 and all that follows
through page 439, line 20, and insert the following:

SEC. 2101. PROTECTING LOW-INCOME CHILDREN FROM HARM AND
ENSURING THAT THEY BENEFIT FROM HEALTH REFORM.

(a) Integrating CHIP Eligibility With Methodologies Used
for Other Subsidies While Preserving CHIP for Children Who
Currently Qualify and Assuring CHIP Coverage for Low-Income
Children.--
(1) Definition of targeted low-income child.--Effective
January 1, 2014, section 2110(b)(1) of the Social Security
Act (42 U.S.C. 1397jj(b)(1)) is amended by striking
subparagraph (B) and inserting the following:
``(B) whose family's modified gross income, as determined
for purposes of allowing a premium credit assistance amount
for the purchase of a qualified health plan under section 36B
of the Internal Revenue Code of 1986, does not exceed 250
percent of the poverty line for a family of the size
involved; and''.
(2) State plan eligibility requirement.--Section
2102(b)(1)(B) of such Act (42 U.S.C. 1397bb(b)(1)(B)) is
amended--
(A) in clause (iii), by striking ``and'' at the end;
(B) in clause (iv), by striking the period at the end and
inserting ``; and'' and
(C) by adding at the end the following:
``(v) with respect to fiscal years beginning with fiscal
year 2014, may not deny eligibility or enrollment, because of
excess family income, to any child whose family income is at
or below the percentage of poverty level specified in section
2110(b)(1)(B), determined using the methodology described in
such section.''.
(b) Maintenance of Effort.--Section 2105(d) of the Social
Security Act (42 U.S.C. 1397ee(d)) is amended by adding at
the end the following:
``(3) Continuation of eligibility standards for children.--
``(A) Fiscal years before fiscal year 2014.--During the
period that begins on the date of enactment of the Patient
Protection and Affordable Care Act and ends on September 30,
2013, a State shall not have in effect eligibility standards,
methodologies, or procedures under its State child health
plan (including any waiver under such plan) for children
(including children provided medical assistance for which
payment is made under section 2105(a)(1)(A)) that are more
restrictive than the eligibility standards, methodologies, or
procedures, respectively, under such plan (or waiver) as in
effect on October 1, 2009.
``(B) Fiscal year 2014 and thereafter.--
``(i) In general.--Subject to clause (ii), with respect to
fiscal years beginning with fiscal year 2014 a State shall
not have in effect eligibility standards, methodologies, or
procedures under its State child health plan (including any
waiver under such plan) for children that are more
restrictive than the eligibility methodologies or procedures,
respectively, under such plan (or waiver) as in effect on
October 1, 2009.
``(ii) Exception.--A State that, prior to fiscal year 2014,
has an income eligibility standard, methodology, or procedure
under its State child health plan (including any waiver under
such plan) for children that results in children whose
family's modified gross income (as determined for purposes of
allowing a premium credit assistance amount for the purchase
of a qualified health plan under section 36B of the Internal
Revenue Code of 1986) exceeds 250 percent of the poverty line
may modify such standard, methodology, or procedure so that
it will not result in eligibility for children under the
State plan in whose family modified gross income exceeds that
percentage of the poverty line.
``(C) Rule of construction.--Subparagraphs (A) and (B)
shall not be construed as preventing a State from applying
eligibility standards, methodologies, or procedures for
children under the State child health plan or under any
waiver of the plan that are less restrictive than the
eligibility standards, methodologies, or procedures,
respectively, for children under the plan or waiver that were
in effect on October 1, 2009.''.
(c) Protecting CHIP Children Against Unaffordable Costs for
Essential Health Care.--
(1) Continuation of cost-sharing protections for
children.--Section 2103(e) of such Act (42 U.S.C. 1397cc(e))
is amended by adding at the end the following:
``(5) Continuation of cost-sharing protections for
children.--
``(A) In general.--Except as described in subparagraph (B),
during the period that begins on the date of enactment of the
Patient Protection and Affordable Care Act, a State shall not
have in effect cost-sharing policies under its State child
health plan (including any waiver under such plan) that
increase premiums or out-of-pocket costs above the amounts
for children of the same income

[[Page S12014]]

level (stated as a percentage of the Federal poverty level)
under such plan (or waiver) as in effect on October 1, 2009.
``(B) Exception.--With respect to fiscal years beginning
with fiscal year 2014, a State may increase cost-sharing
amounts above those described in subparagraph (A) by an
amount that does not exceed the median percentage increase in
national household income since fiscal year 2013, as
determined by the Secretary, for households with incomes at
or below the percentage of poverty level specified in section
2110(b)(1)(B).
``(C) Rule of construction.--This paragraph shall not be
construed to prevent a State from reducing premiums or out-
of-pocket costs below the amounts described in subparagraph
(A).''.
(2) Equitable coverage of essential benefits.--Section
2103(f) of such Act (42 U.S.C. 1397cc(f)) is amended by
adding at the end the following:
``(4) Equitable coverage of essential benefits.--With
respect to fiscal years beginning with fiscal year 2014, the
State plan for child health assistance (including any waiver
under such plan) may not deny (whether through a restriction
on amount, duration, or scope, through excluding a category
of health care services or items, or otherwise) a service or
item to a child whose family income is at or below the
percentage of poverty level specified in section
2110(b)(1)(B), determined using the methodology described in
such section, if the State would cover or be required to
cover such service or item had the child qualified for
medical assistance under sub-clause (IV), (VI) or (VII) of
section 1902(a)(10)(i).''.
(d) Basing Federal Payments on State Conditions, Rather
Than Inflexible Dollar Amounts.--Section 2104(a) of such Act
(42 U.S.C. 1397dd(a)) is amended by striking paragraph (16)
and inserting the following:
``(16) notwithstanding any other provision of this title,
for each of fiscal years 2013 through 2019, such amounts as
are necessary to carry out this title.''.
(e) Defraying State Expansion Costs With Additional Federal
Dollars.--Section 2105(b) of such Act (42 U.S.C. 1397dd(b))
is amended--
(1) by striking ``For purposes'' and inserting the
following:
``(1) In general.--For purposes''; and
(2) by adding at the end the following:
``(2) Option for increased federal financial participation
beginning in fiscal year 2014.--Notwithstanding paragraph
(1), beginning with fiscal year 2014, the enhanced FMAP
determined for a State for a fiscal year (or for any portion
of a fiscal year occurring during such period) shall be
increased by 23 percentage points, but in no case shall
exceed 94 percent. The increase in the enhanced FMAP under
the preceding sentence shall not apply with respect to
determining the payment to a State under subsection (a)(1)
for expenditures described in subparagraph (D) of that
subsection, paragraphs (8), (9), or (11) of subsection (c),
or clause (4) of the first sentence of section 1905(b). A
State may not qualify for an enhanced FMAP pursuant to this
paragraph unless it implements--
``(A) each enrollment and retention provision described in
subparagraphs (A), (B)(i), and (C) through (G), respectively,
of section 2105(a)(4); and
``(B) any other practice for eligibility determination,
enrollment or retention that the Secretary finds--
``(i) has a substantial impact increasing the number of
eligible children who receive health coverage through State
plans for child health assistance under this title or State
plans for medical assistance under title XIX;
``(ii) reduces erroneous eligibility determinations under
the state plans described in clause (i); and
``(iii) lowers operational administrative costs under the
state plans described in clause (i).''.
(f) Continuing Performance Bonuses for States That Enroll
Large Numbers of Eligible Children.--Section 2105(a)(3) of
such Act (42 U.S.C. 1397dd(a)(3)) is amended--
(1) in subparagraph (A), by striking ``and ending with
fiscal year 2013''; and
(2) in subparagraph (E), by adding at the end the
following:
``(iv) Later appropriations.--There is appropriated, out of
any money in the Treasury not otherwise appropriated, for
each of fiscal years 2013 through 2019, 25 percent of the
amount described in clause (i), adjusted to reflect the
proportionate change in Consumer Price Index for All Urban
Consumers since fiscal year 2009, as determined by the
Secretary.''.
(g) Giving Families the Option of Using Their Federal
Income Tax Returns to Establish Eligibility.--Section 6055 of
the Internal Revenue Code of 1986, as added by section
1502(a) of the Patient Protection and Affordable Care Act, is
amended by adding at the end the following:
``(f) Use of Individual Income Tax Returns to Help
Determine Eligibility for Subsidies.--
``(1) In general.--For taxable years beginning not later
than January 1, 2012, the Secretary shall develop forms that
require all individuals filing returns with respect to income
taxes under subtitle A--
``(A) to identify the members of the individual's household
who lack health insurance at the time the return is filed;
and
``(B) to indicate whether there are members of the
individual's household who are under 19 years of age and for
whom the individual requests disclosure of pertinent tax
return information, pursuant to section 6103(c), to agencies
determining eligibility for subsidies for purposes of helping
such agencies determine whether the applicable household
members qualify for subsidies.
In developing the applicable language on tax forms, the
Secretary shall consult with the Secretary of Health and
Human Services. The goals of such consultation shall include
maximizing the form's comprehensibility to low-income
taxpayers and the convenience of making such identification
and indication.
``(2) Transfer of information.--When an individual
identifies a household member pursuant to paragraph (1)(B),
the Secretary shall promptly transfer pertinent tax return
information to all agencies determining eligibility for
subsidies in such member's state of residence, except that
such transfer shall not take place to an agency unless it is
subject to an enforceable agreement or other legal obligation
that meets the Secretary's requirements for safeguarding
taxpayer privacy and data security. The transfer described in
this paragraph may take place through the data matching
program described in section 1413(c)(2) of the Patient
Protection and Affordable Care Act.
``(3) Eligibility determination.--
``(A) In general.--Notwithstanding any other provision of
law except subparagraph (B), when an agency determining
eligibility for subsidies receives the information described
in paragraph (2), it shall determine such eligibility on the
basis of such information and other information obtainable by
data-matching, to the maximum extent possible.
``(B) Exceptions.--An agency described in subparagraph (A)
shall base eligibility on information other than described in
paragraph (2) (including through seeking additional
information from the applicable individual or household
member, if such information cannot be obtained through other
means)--
``(i) to the extent that an eligibility requirement for
subsidies cannot be decided based on the information
described in subparagraph (A);
``(ii) if the agency has good reason to believe that the
information described in subparagraph (A) is inaccurate; or
``(iii) if the information described in subparagraph (A)
does not result in a finding of eligibility for medical
assistance under title XIX of the Social Security Act, in
which case--

``(I) the agency shall provide the individual with notice
of--

``(aa) the circumstances under which such individual or
applicable household members may qualify for additional
assistance; and
``(bb) an opportunity to request a determination of whether
such circumstances apply to the individual or applicable
household members; and

``(II) if the individual requests such a determination, the
agency shall ensure that the individual and applicable
household members receive--

``(aa) an opportunity to provide any additional information
needed to determine whether the circumstances described in
sub-clause (I)(aa) apply;
``(bb) a determination of whether the circumstances
described in subclause (I)(aa) apply (but only if the
individual or applicable household members furnish requested
information that is necessary to such determination); and
``(cc) receive any subsidies for which the individual or
applicable household members qualify.
``(4) Definitions.--In this subsection:
``(A) Household.--The term `household' includes the
individual filing the return, the individual's spouse (if
any), and all dependents of the individual or the
individual's spouse (if any).
``(B) Subsidies.--The term `subsidies' includes premium
credits under section 36B, medical assistance under title XIX
of the Social Security Act, child health assistance under
title XXI of such Act, and cost-sharing subsidies under
section 1402 of the Patient Protection and Affordable Care
Act.
``(C) Pertinent tax information.--The term `pertinent tax
information' refers to all information on the tax return that
is potentially relevant to determining the applicable
household member's eligibility for subsidies or that may
facilitate data-matching with other records that are
potentially relevant to determining such eligibility.
``(5) Rule of construction.--Nothing in this subsection
shall be construed to forbid the Secretary, pursuant to
section 6013(c) and other applicable legal authority, or the
Secretary of Health and Human Services from implementing,
with respect to individuals who have attained age 19,
policies and procedures similar to those described in
paragraphs (1) through (3) with respect to individuals under
19 years of age.''.
(h) Continuing CHIP Outreach and Enrollment Grants.--
Section 2113(a) of the Social Security Act (42 U.S.C.
1397mm(a)) is amended--
(1) in paragraph (2), by striking ``such amounts'' and
inserting ``the amounts described in paragraph (1)''; and
(2) by adding at the end the following:
``(3) Additional grants for fiscal year 2012 and
thereafter.--There is appropriated, out of any money in the
Treasury not otherwise appropriated, $50,000,000 for each of
fiscal years 2012 through 2019, for purposes of awarding
grants to eligible entities to conduct outreach and
enrollment efforts that are designed to increase the
enrollment and participation of eligible children under this

[[Page S12015]]

title and title XIX and, with respect to fiscal years
beginning with fiscal year 2014, premium credits under
section 36B of the Internal Revenue Code of 1986 and cost-
sharing subsidies under section 1402 of the Patient
Protection and Affordable Care Act. Such grants and
appropriations shall supplement and not supplant grants and
appropriations that are made pursuant to other provisions of
this section.''.
(i) Secretarial Report Comparing CHIP to Subsidized
Coverage in the Exchange.--
(1) In general.--Not later than March 1, 2016, the
Secretary of Health and Human Services (in this subsection
referred to as the ``Secretary'') shall submit to Congress a
report that compares--
(A) the health plan coverage offered to eligible children
in fiscal year 2015 by an average or median State plan for
child health assistance under title XXI of the Social
Security Act; and
(B) the health plan coverage that such children would have
received in fiscal year 2015 if they were enrolled in a
qualified health benefits plan through an Exchange
established by the State under section 1311 of the Patient
Protection and Affordable Care Act, and received all premium
credits under section 36B of the Internal Revenue Code of
1986 and all cost-sharing subsidies under section 1402 of the
Patient Protection and Affordable Care Act for which such
children would have qualified if they were not eligible for
child health assistance under title XXI of the Social
Security Act.
(2) Policy analysis.--If, as to an aspect of health plan
coverage described in paragraph (3) (except as provided in
the next sentence of this paragraph), the Secretary finds
that the coverage described in paragraph (1)(A) is more
favorable to families and children than is the coverage
described in paragraph (1)(B), the report shall describe
policy changes that would be needed to improve the latter
coverage so that it reaches the level of favorability
achieved by the former coverage. The analysis described in
the previous sentence need not address the aspect of health
plan coverage described in paragraph (3)(C)).
(3) Health plan coverage.--In this subsection, the term
``health plan coverage'' includes the following:
(A) The adequacy of covered benefits in meeting the health
care needs of children, including those with special health
care needs.
(B) Families' out-of-pocket and premium costs.
(C) Public-sector costs.
(D) Adequacy of pediatric provider networks.
(E) Quality of care measures focused specifically on
children.
(F) Legal protections for children.
(G) Barriers to enrollment and service utilization.
(H) Interstate variation.
(I) Continuity of coverage and care.
(J) The impact of placing children and parents in different
health plans.
(4) Rule of construction.--Nothing in this subsection shall
be construed to prevent the report required under paragraph
(1) from--
(A) analyzing State programs of child health assistance
under title XXI of the Social Security Act that go beyond the
average or median such program; or
(B) including in its comparative analysis factors in
addition to those described in paragraph (3).
(j) Safeguarding Program Integrity and Improving Efficiency
by Providing Health Subsidy Programs With Access to the
National Directory of New Hires.--Section 453(j) of the
Social Security Act (42 U.S.C. 653(j)) is amended by adding
at the end the following:
``(12) Information comparisons and disclosure to assist in
administration of health subsidy programs.--
``(A) In general.--If, for purposes of administering a
State's medical assistance program under title XIX, a State's
children's health assistance program under title XXI, premium
assistance under section 36B of the Internal Revenue Code of
1986, or reduced cost-sharing subsidies under section 1402 of
the Patient Protection and Affordable Care Act, a State or
Federal agency responsible for the administration of the
program transmits to the Secretary the names and social
security account numbers of individuals, the Secretary shall
disclose to such agency information on the individuals and
their employers maintained in the National Directory of New
Hires, subject to this paragraph.
``(B) Condition on disclosure by the secretary.--The
Secretary shall make a disclosure under subparagraph (A) only
to the extent that the Secretary determines that the
disclosure would not interfere with the effective operation
of the program under this part.
``(C) Use and disclosure of information by state or federal
agencies.--
``(i) In general.--A State or Federal agency may not use or
disclose information provided under this paragraph except for
purposes of administering a program referred to in
subparagraph (A).
``(ii) Information security.--A State or Federal agency
shall have in effect data security and control policies that
the Secretary finds adequate to ensure the security of
information obtained under this paragraph and to ensure that
access to such information is restricted to authorized
persons for purposes of authorized uses and disclosures.
``(iii) Penalty for misuse of information.--An officer or
employee of a State agency described in this paragraph who
fails to comply with this subparagraph shall be subject to
the sanctions under subsection (l)(2) to the same extent as
if the officer or employee were an officer or employee of the
United States.
``(D) Procedural requirements.--State or Federal agencies
requesting information under this paragraph shall adhere to
uniform procedures established by the Secretary governing
information requests and data matching under this paragraph.
``(E) Reimbursement of costs.--The State or Federal agency
shall reimburse the Secretary, in accordance with subsection
(k)(3), for the costs incurred by the Secretary in furnishing
the information requested under this paragraph.''.
(k) Deficit Reduction Contingency.--
(1) In general.--If a deficit reduction contingency applies
to this section and the amendments made by this section, then
there is appropriated, for each of fiscal years 2010 through
2019, to the Fund for Vulnerable Children and Families
described in paragraph (2), out of any money in the Treasury
not otherwise appropriated, an amount equal to 50 percent of
the annualized deficit reduction contingency amount.
(2) The fund for vulnerable children and families.--
(A) Authority to establish.--If a deficit reduction
contingency applies as described in paragraph (1), the
Secretary of Health and Human Services shall establish a Fund
for Vulnerable Children and Families. Any dollars
appropriated or donated to such Fund shall be used for any of
the following purposes:
(i) Combating infant mortality.
(ii) Providing additional supports or services for low-
income children with autism spectrum disorders or other
disabilities.
(iii) Assisting in the provision of services to improve
health care services (including mental health care services)
for children in foster care under the responsibility of a
State and homeless children.
(B) Annual reports.--The Secretary shall provide annual
reports to the Congress that provide a full accounting of the
revenue and expenditures of the Fund for Vulnerable Children
and Families.
(3) Definitions.--In this subsection:
(A) Deficit reduction contingency.--A ``deficit reduction
contingency'' applies to this section and the amendments made
by this section if the Director of the Congressional Budget
Office has found that such provisions, taken together (but
without regard to this subsection), will cause a net
reduction in the projected Federal budget deficit over the
period of fiscal years 2010 through 2019.
(B) Annualized deficit reduction contingency amount.--The
term ``annualized deficit reduction contingency amount''
means the amount of the net deficit reduction described in
subparagraph (A) divided by 10.
(l) Conforming Amendment to Title XXI Medicaid Maintenance
of Effort.--Section 2105(d)(1) of the Social Security Act (42
U.S.C. 1397ee(d)(1)) is amended by adding before the period
``, except as required under section 1902(e)(14)''.
______