To provide for the development of best practice recommendations and to ensure coverage of low income children.

SA 77. Ms. MURKOWSKI (for herself, Mr. Specter, Mr. Johanns, and Ms.
Collins) submitted an amendment intended to be proposed by her to the
bill H.R. 2, to amend title XXI of the Social Security Act to extend
and improve the Children's Health Insurance Program, and for other
purposes; as follows:

At the appropriate place, insert the following:

SEC. __. DEVELOPMENT OF BEST PRACTICE RECOMMENDATIONS AND
COVERAGE OF LOW INCOME CHILDREN.

(a) Development of Best Practice Recommendations.--Section
2107 (42 U.S.C. 1397gg) is amended by adding at the end the
following:
``(g) Development of Best Practice Recommendations.--Not
later than 12 months after the date of enactment of this Act,
the Secretary, in consultation with States, including
Medicaid and CHIP directors in States, shall publish in the
Federal Register, and post on the public website for the
Department of Health and Human Services--
``(1) recommendations regarding best practices for States
to use to address CHIP crowd-out; and
``(2) uniform standards for data collection by States to
measure and report--
``(A) health benefits coverage for children with family
income below 200 percent of the poverty line; and
``(B) on CHIP crowd-out, including for children with family
income that exceeds 200 percent of the poverty line.

The Secretary, in consultation with States, including
Medicaid and CHIP directors in States, may from time to time
update the best practice recommendations and uniform
standards set published under paragraphs (1) and (2) and
shall provide for publication and posting of such updated
recommendations and standards.''.
(b) Limitation on Payments for States Covering Higher
Income Children.--
(1) In general.--Section 2105(c) (42 U.S.C. 1397ee(c)), as
amended by section 601(a), is further amended by adding at
the end the following new paragraph:
``(12) Limitation on payments for states covering higher
income children.--
``(A) Determinations.--
``(i) In general.--The Secretary shall determine, for each
State that is a higher income eligibility State as of October
1 of 2010 and each subsequent year, whether the State meets
the target rate of coverage of low-income children required
under subparagraph (C) and shall notify the State in that
month of such determination.
``(ii) Determination of failure.--If the Secretary
determines in such month that a higher income eligibility
State does not meet such target rate of coverage, no payment
shall be made as of April 30 of the following year, under
this section for child health assistance provided for higher-
income children (as defined in subparagraph (D)) under the
State child health plan unless and until the Secretary
establishes that the

[[Page S1000]]

State is in compliance with such requirement, but in no case
more than 12 months.
``(B) Higher income eligibility state.--A higher income
eligibility State described in this clause is a State that--
``(i) applies under its State child health plan an
eligibility income standard for targeted low-income children
that exceeds 300 percent of the poverty line; or
``(ii) because of the application of a general exclusion of
a block of income that is not determined by type of expense
or type of income, applies an effective income standard under
the State child health plan for such children that exceeds
300 percent of the poverty line.
``(C) Requirement for target rate of coverage of low-income
children.--The requirement of this subparagraph for a State
is that the rate of health benefits coverage (both private
and public) for low-income children in the State is not
statistically significantly (at a p=0.05 level) less than 80
percent of the low-income children who reside in the State
and are eligible for child health assistance under the State
child health plan.
``(D) Higher-income child.--For purposes of this paragraph,
the term `higher income child' means, with respect to a State
child health plan, a targeted low-income child whose family
income--
``(i) exceeds 300 percent of the poverty line; or
``(ii) would exceed 300 percent of the poverty line if
there were not taken into account any general exclusion
described in subparagraph (B)(ii).''.
(2) Construction.--Nothing in the amendment made by
paragraph (1) or this section this shall be construed as
authorizing the Secretary of Health and Human Services to
limit payments under title XXI of the Social Security Act in
the case of a State that is not a higher income eligibility
State (as defined in section 2105(c)(12)(B) of such Act, as
added by paragraph (1)).
______