[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5218 Introduced in House (IH)]
108th CONGRESS
2d Session
H. R. 5218
To increase health insurance coverage in America by requiring employers
to offer health insurance coverage with greater government assistance
and by expanding current safety net programs, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 5, 2004
Mr. Gephardt introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Ways and Means and Education and the Workforce, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To increase health insurance coverage in America by requiring employers
to offer health insurance coverage with greater government assistance
and by expanding current safety net programs, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Matt's Health
Insurance Plan Act of 2004''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--REQUIREMENT FOR EMPLOYERS TO PROVIDE HEALTH INSURANCE COVERAGE
Sec. 101. Requirement for employers to provide health insurance
coverage.
Sec. 102. Tax credits for employers to provide health insurance
coverage.
Sec. 103. Health care costs of nontaxpayer employers.
TITLE II--EXPANSION OF EXISTING PUBLIC PROGRAMS
Subtitle A--Access to Medicare Benefits for Individuals 55-to-65 Years
of Age
Sec. 201. Access to medicare benefits for individuals 55-to-65 years of
age.
Subtitle B--Refundable Tax Credit for Employee Costs of COBRA Coverage
Sec. 211. Refundable tax credit for employee costs of COBRA coverage.
Subtitle C--FamilyCare
Sec. 221. Renaming of title XXI program.
Sec. 222. Familycare coverage of parents and pregnant women under the
medicaid program and title XXI.
Sec. 223. Automatic enrollment of children born to title XXI parents.
Sec. 224. Allowing States to simplify rules for families.
Sec. 225. Revision and simplification of the transitional medical
assistance program (TMA).
Sec. 226. Limitations on conflicts of interest.
Sec. 227. Increase in chip allotment for each of fiscal years 2002
through 2004.
Sec. 228. Demonstration programs to improve medicaid and chip outreach
to homeless individuals and families.
Sec. 229. Additional chip revisions.
Sec. 230. Increased Federal reimbursement for language services under
the medicaid program and title XXI.
TITLE III--NATIONAL CENTER FOR EVIDENCE-BASED HEALTHCARE PRACTICES
Sec. 301. Establishment of center.
TITLE I--REQUIREMENT FOR EMPLOYERS TO PROVIDE HEALTH INSURANCE COVERAGE
SEC. 101. REQUIREMENT FOR EMPLOYERS TO PROVIDE HEALTH INSURANCE
COVERAGE.
(a) In General.--Each employers must offer health insurance
coverage constituting qualified health care to employees and former
employees of such employer and to their families.
(b) Incorporation of Terms.--For purposes of subsection (a), the
terms ``employer'', ``qualified health care'', ``employee'', ``former
employee'', and ``family'' have the meanings given such terms for
purposes of chapter 101 of the Internal Revenue Code of 1986, as added
by section 102(a).
SEC. 102. TAX CREDITS FOR EMPLOYERS TO PROVIDE HEALTH INSURANCE
COVERAGE.
(a) In General.--The Internal Revenue Code of 1986 is amended by
adding at the end the following new subtitle:
``Subtitle L--Employment-Based Health Insurance Tax Credits
``Chapter 101--EMPLOYMENT-BASED HEALTH INSURANCE TAX CREDITS
``CHAPTER 101--EMPLOYMENT-BASED HEALTH INSURANCE TAX CREDITS
``Sec. 9901. Health care costs of
employers.
``Sec. 9902. Health insurance costs of
the self-employed.
``Sec. 9903. Health insurance costs of
certain low wage workers.
``Sec. 9904. Special rules.
``SEC. 9901. HEALTH CARE COSTS OF EMPLOYERS.
``(a) Credit for Employers Providing Insurance Pre-Effective
Date.--
``(1) In general.--In the case of a specified employer,
there shall be allowed as a credit against the tax imposed by
subtitle A an amount equal to 60 percent of the amount paid or
incurred by the employer during the taxable year to provide
qualified health care (directly or otherwise) to the employees
and former employees of such employer and to their families.
``(2) Specified employer.--For purposes of this
subsection--
``(A) In general.--The term `specified employer'
means any employer who provided health care (directly
or otherwise) to any employee or former employee of
such employer under a group health plan (as defined in
section 5000(b)) during the 1-year period ending on
January 1, 2005.
``(B) Successor employers.--Except as provided in
regulations, any entity and any predecessor or
successor entities of such entity shall be treated as 1
entity.
(b) Credit for Other Employers.--
(1) In general.--In the case of any employer (other than an
employer to which subsection (a) applies), there shall be
allowed as a credit against the tax imposed by subtitle A an
amount equal to the lesser of--
``(A) 100 percent of the amount paid or incurred by
the employer during the taxable year to provide
qualified health care (directly or otherwise) to the
employees and former employees of such employer and to
their families, or
``(B) 60 percent of the total amounts paid or
incurred (including any amounts paid or incurred by
employees or former employees of the employer as
premiums or other cost-sharing) during the taxable year
to provide qualified health care (directly or
otherwise) to the employees and former employees of
such employer and to their families.
``(c) Qualified Health Care.--For purposes of this section, the
term `qualified health care' means health care for which the employer
bears 60 percent or more of the cost.
``(d) Certain Employment Not Taken Into Account.--For purposes this
section, except as provided in regulations by the Secretary, an
individual shall be treated as an employee only with respect to
employment described in section 3121(b) (determined without regard to
paragraph (7) thereof).
``SEC. 9902. HEALTH INSURANCE COSTS OF THE SELF-EMPLOYED.
``(a) In General.--In the case of an individual who is an employee
within the meaning of section 401(c)(1), there shall be allowed as a
credit against the tax imposed by subtitle A an amount equal to 60
percent of the amount paid by the taxpayer during the taxable year for
insurance which constitutes medical care for the taxpayer, his spouse,
and dependents.
``(b) Limitations.--
``(1) Dollar amount.--No credit shall be allowed under
subsection (a) to the extent that the amount of such credit
exceeds the taxpayer's earned income (within the meaning of
section 401(c)) derived by the taxpayer from the trade or
business with respect to which the plan providing the medical
care coverage is established.
``(2) Other coverage.--Subsection (a) shall not apply to
any taxpayer for any calendar month for which the taxpayer is
eligible to participate in any subsidized health plan
maintained by any employer of the taxpayer or of the spouse of
the taxpayer. The preceding sentence shall be applied
separately with respect to--
``(A) plans which include coverage for qualified
long-term care services (as defined in section
7702B(c)) or are qualified long-term care insurance
contracts (as defined in section 7702B(b)), and
``(B) plans which do not include such coverage and
are not such contracts.
``(3) Long-term care premiums.--In the case of a qualified
long-term care insurance contract (as defined in section
7702B(b)), only eligible long-term care premiums (as defined in
section 213(d)(10) shall be taken into account under paragraph
(1).
``SEC. 9903. HEALTH INSURANCE COSTS OF CERTAIN LOW WAGE WORKERS.
``(a) In General.--In the case of an individual, there shall be
allowed as a credit against the tax imposed by subtitle A an amount
equal to 25 percent of the amount paid by the taxpayer for coverage of
the taxpayer, his spouse, and dependents under any subsidized health
plan maintained by any employer of the taxpayer or of the spouse of the
taxpayer.
``(b) Limitation.--
``(1) In general.--The amount of the credit allowed under
subsection (a) shall be reduced (but not below zero) by an
amount which bears the same ratio to the amount so determined
as--
``(A) the amount (if any) by which the taxpayer's
adjusted gross income for the taxable year exceeds the
threshold amount, bears to
``(B) the threshold amount.
``(2) Threshold amount.--For purposes of this subsection,
the term `threshold amount' means the poverty line (as defined
in section 673(2) of the Community Services Block Grant Act,
including any revision required by such section) for a family
of the size involved, as in effect at the close of the taxable
year.
``(c) Special Rules.--
``(1) Coordination with savings accounts.--Amounts
distributed from an Archer MSA (as defined in section 220(d))
or a health savings account (as defined in section 223(d))
shall not be taken into account under subsection (a).
``(2) 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.
``(3) Married couples must file joint return.--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. Rules similar to the rules of paragraphs (3) and (4) of
section 21(e) shall apply for purposes of this paragraph.
``SEC. 9904. SPECIAL RULES.
``(a) Credits Treated as Refundable.--For purposes of this title,
the credits allowed under this chapter shall be treated as allowed
under subpart C of part IV of subchapter A of chapter 1.
``(b) Coordination With Deductions.--Any amount which is taken into
account under section 9901(a)(1), 9901(b)(1) (determined without regard
to section 9901(b)(1)(B)), 9902(a), or 9903(a) shall not be taken into
account in determining any deduction under subtitle A.
``(c) Regulations.--The Secretary may prescribe such regulations
and other guidance as may be necessary or appropriate to carry out this
chapter.''.
(b) Conforming Amendments.--
(1) Section 162 of the Internal Revenue Code of 1986 is
amended by striking subsection (l).
(2) Paragraph (2) of section 1324(b) of title 31, United
States Code, is amended by inserting ``or chapter 101'' after
``section 35''.
(3) The table of subtitles of the Internal Revenue Code of
1986 is amended by adding at the end the following new item:
``Subtitle L--Employment-based health insurance tax credits.''.
(c) Effective Date.--The amendments made by this subsection shall
apply to taxable years beginning after December 31, 2004.
SEC. 103. HEALTH CARE COSTS OF NONTAXPAYER EMPLOYERS.
(a) Payments by Secretary of the Treasury.--The Secretary of the
Treasury shall establish a program under which the Secretary shall make
payments to qualified nontaxpayer employers in amounts equal to the
credits that such employers would have been allowed under section 9901
of the Internal Revenue Code of 1986 if such employers were subject to,
and not exempt from, taxation under subtitle A of such Code.
(b) Qualified Nontaxpayer Employers.--For purposes of this section,
the term ``qualified nontaxpayer employer'' means any employer which
is--
(A) a State, political subdivision of a State, or
any agency or instrumentality of a State or political
subdivision of a State,
(B) any Indian tribal government (as defined in
section 7701(a)(40) of the Internal Revenue Code of
1986), subdivision of an Indian tribal government
(determined in accordance with section 7871(d) of such
Code), or an agency or instrumentality of an Indian
tribal government or subdivision thereof, or
(C) any other organization (other than a
governmental or tribal unit) exempt from tax under
subtitle A of the Internal Revenue Code of 1986.
TITLE II--EXPANSION OF EXISTING PUBLIC PROGRAMS
Subtitle A--Access to Medicare Benefits for Individuals 55-to-65 Years
of Age
SEC. 201. ACCESS TO MEDICARE BENEFITS FOR INDIVIDUALS 55-TO-65 YEARS OF
AGE.
(a) In General.--Title XVIII of the Social Security Act, as amended
by section 101(a) of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Public Law 108-173), is amended--
(1) by redesignating part E as part F; and
(2) by inserting after part D the following new part:
``PART E--PURCHASE OF MEDICARE BENEFITS BY CERTAIN INDIVIDUALS 55-TO-65
YEARS OF AGE
``SEC. 1860E-1. PROGRAM BENEFITS; ELIGIBILITY.
``(a) Entitlement to Medicare Benefits for Enrolled Individuals.--
``(1) In general.--An individual enrolled under this part
is entitled to the same benefits under this title as an
individual entitled to benefits or enrolled under any part of
this title.
``(2) Definitions.--For purposes of this part:
``(A) Federal or state COBRA continuation
provision.--The term `Federal or State COBRA
continuation provision' has the meaning given the term
`COBRA continuation provision' in section 2791(d)(4) of
the Public Health Service Act and includes a comparable
State program, as determined by the Secretary.
``(B) Federal health insurance program defined.--
The term `Federal health insurance program' means any
of the following:
``(i) Medicare.--Any part of this title
(other than by reason of this part).
``(ii) Medicaid.--A State plan under title
XIX.
``(iii) FEHBP.--The Federal employees
health benefit program under chapter 89 of
title 5, United States Code.
``(iv) TRICARE.--The TRICARE program (as
defined in section 1072(7) of title 10, United
States Code).
``(v) Active duty military.--Health
benefits under title 10, United States Code, to
an individual as a member of the uniformed
services of the United States.
``(C) Group health plan.--The term `group health
plan' has the meaning given such term in section
2791(a)(1) of the Public Health Service Act.
``(b) Eligibility of Individuals Age 55-to-65 Years of Age.--
``(1) In general.--Subject to paragraph (2), an individual
who meets the following requirements with respect to a month is
eligible to enroll under this part with respect to such month:
``(A) Age.--As of the last day of the month, the
individual has attained 55 years of age, but has not
attained 65 years of age.
``(B) Medicare eligibility (but for age).--The
individual would be eligible for benefits under part A
or part B for the month if the individual were 65 years
of age.
``(C) Not eligible for coverage under group health
plans or federal health insurance programs.--The
individual is not eligible for benefits or coverage
under a Federal health insurance program (as defined in
subsection (a)(2)(B)) or under a group health plan
(other than such eligibility merely through a Federal
or State COBRA continuation provision) as of the last
day of the month involved.
``(2) Limitation on eligibility if terminated enrollment.--
If an individual described in paragraph (1) enrolls under this
part and coverage of the individual is terminated under section
1860E-2(d) (other than because of age), the individual is not
again eligible to enroll under this subsection unless the
following requirements are met:
``(A) New coverage under group health plan or
federal health insurance program.--After the date of
termination of coverage under such section, the
individual obtains coverage under a group health plan
or under a Federal health insurance program.
``(B) Subsequent loss of new coverage.--The
individual subsequently loses eligibility for the
coverage described in subparagraph (A) without regard
to whether the individual has exhausted any eligibility
the individual may subsequently have for coverage under
a Federal or State COBRA continuation provision.
``(3) Change in health plan eligibility does not affect
coverage.--In the case of an individual who is eligible for and
enrolls under this part under this subsection, the individual's
continued entitlement to benefits under this part shall not be
affected by the individual's subsequent eligibility for
benefits or coverage described in paragraph (1)(C), or
entitlement to such benefits or coverage.
``SEC. 1860E-2. ENROLLMENT PROCESS; COVERAGE.
``(a) In General.--An individual may enroll in the program
established under this part only in such manner and form as may be
prescribed by regulations, and only during an enrollment period
prescribed by the Secretary consistent with the provisions of this
section. Such regulations shall provide a process under which
individuals eligible to enroll as of a month are permitted to pre-
enroll during a prior month within an enrollment period described in
subsection (b).
``(b) Enrollment Periods.--
``(1) Individuals 55-to-65 years of age.--In the case of
individuals eligible to enroll under this part under section
1860E-1(b)--
``(A) Initial enrollment period.--If the individual
is eligible to enroll under such section for January
2005, the enrollment period shall begin on November 1,
2004, and shall end on February 28, 2005. Any such
enrollment before January 1, 2005, is conditioned upon
compliance with the conditions of eligibility for
January 2005.
``(B) Subsequent periods.--If the individual is
eligible to enroll under such section for a month after
January 2005, the enrollment period shall begin on the
first day of the second month before the month in which
the individual first is eligible to so enroll and shall
end four months later. Any such enrollment before the
first day of the third month of such enrollment period
is conditioned upon compliance with the conditions of
eligibility for such third month.
``(2) Authority to correct for government errors.--The
provisions of section 1837(h) apply with respect to enrollment
under this part in the same manner as they apply to enrollment
under part B.
``(c) Date Coverage Begins.--
``(1) In general.--The period during which an individual is
entitled to benefits under this part shall begin as follows,
but in no case earlier than January 1, 2005:
``(A) In the case of an individual who enrolls
(including pre-enrolls) before the month in which the
individual satisfies eligibility for enrollment under
section 1860E-1, the first day of such month of
eligibility.
``(B) In the case of an individual who enrolls
during or after the month in which the individual first
satisfies eligibility for enrollment under such
section, the first day of the following month.
``(2) Authority to provide for partial months of
coverage.--Under regulations, the Secretary may, in the
Secretary's discretion, provide for coverage periods that
include portions of a month in order to avoid lapses of
coverage.
``(3) Limitation on payments.--No payments may be made
under this title with respect to the expenses of an individual
enrolled under this part unless such expenses were incurred by
such individual during a period which, with respect to the
individual, is a coverage period under this section.
``(d) Termination of Coverage.--
``(1) In general.--An individual's coverage period under
this part shall continue until the individual's enrollment has
been terminated at the earliest of the following:
``(A) General provisions.--
``(i) Notice.--The individual files notice
(in a form and manner prescribed by the
Secretary) that the individual no longer wishes
to participate in the insurance program under
this part.
``(ii) Nonpayment of premiums.--The
individual fails to make payment of premiums
required for enrollment under this part.
``(iii) Medicare eligibility.--The
individual becomes entitled to benefits or
enrolled under any other part of this title
(other than by reason of this part).
``(B) Termination based on age.--The individual
attains 65 years of age.
``(2) Effective date of termination.--
``(A) Notice.--The termination of a coverage period
under paragraph (1)(A)(i) shall take effect at the
close of the month following for which the notice is
filed.
``(B) Nonpayment of premium.--The termination of a
coverage period under paragraph (1)(A)(ii) shall take
effect on a date determined under regulations, which
may be determined so as to provide a grace period in
which overdue premiums may be paid and coverage
continued. The grace period determined under the
preceding sentence shall not exceed 60 days; except
that it may be extended for an additional 30 days in
any case where the Secretary determines that there was
good cause for failure to pay the overdue premiums
within such 60-day period.
``(C) Age or medicare eligibility.--The termination
of a coverage period under paragraph (1)(A)(iii) or
(1)(B) shall take effect as of the first day of the
month in which the individual attains 65 years of age
or becomes entitled to benefits or enrolled in any
other part of this title (other than by reason of this
part).
``SEC. 1860E-3. PREMIUMS.
``(a) Amount of Monthly Premiums.--The Secretary shall, during
September of each year (beginning with 2004), determine a monthly
premium for individuals 55 years of age or older, equal to \1/12\ of
the annual premium computed under subsection (b)(2), which shall apply
with respect to coverage provided under this title for any month in the
succeeding year.
``(b) Annual Premium.--
``(1) National, per capita average.--The Secretary shall
estimate the average, annual per capita amount that would be
payable under this title with respect to individuals residing
in the United States who meet the requirement of section 1860E-
1(b)(1)(A) as if all such individuals were eligible for (and
enrolled) under this title during the entire year (and assuming
that section 1862(b)(2)(A)(i) did not apply).
``(2) Annual premium.--The annual premium under this
subsection for months in a year is equal to the average, annual
per capita amount estimated under paragraph (1) for the year.
``SEC. 1860E-4. PAYMENT OF PREMIUMS.
``(a) Payment of Monthly Premium.--
``(1) In general.--The Secretary shall provide for payment
and collection of the monthly premium, determined under section
1860E-3(a) for the age of the individual involved, in the same
manner as for payment of monthly premiums under section 1840,
except that, for purposes of applying this section, any
reference in such section to the Federal Supplementary Medical
Insurance Trust Fund is deemed a reference to the Trust Fund
established under section 1860E-6.
``(2) Period of payment.--In the case of an individual who
participates in the program established by this title, the
monthly premium shall be payable for the period commencing with
the first month of the individual's coverage period and ending
with the month in which the individual's coverage under this
title terminates.
``(b) Application of Certain Provisions.--The provisions of section
1840 (other than subsection (h)) shall apply to premiums collected
under this section in the same manner as they apply to premiums
collected under part B, except that any reference in such section to
the Federal Supplementary Medical Insurance Trust Fund is deemed a
reference to the Trust Fund established under section 1860E-6.
``SEC. 1860E-5. PROVISIONS RELATING TO EMPLOYMENT-BASED RETIREE HEALTH
COVERAGE.
``(a) In General.--In the case of an individual who would be
eligible to enroll under this part but for the provision of employment-
based retiree health coverage by an employer to the individual,
notwithstanding the limitation under section 1860E-1(b)(1)(C), the
individual is eligible to enroll under this part.
``(b) Maintenance of Effort.--In the case of an employer that
offers employment-based retiree health coverage to an individual who
enrolls under this part, upon enrollment of the individual under this
part, the employer may modify such coverage to provide for the
following benefits:
``(1) Payment is made by the employer under such coverage
for items and services for which payment may not be made under
this title.
``(2) Payment is made by the employer sponsoring such
coverage of 25 percent of the monthly premium under section
1860E-3 applicable to the individual after enrollment under
this part.
``(c) Employment-Based Retiree Health Coverage.--The term
`employment-based retiree health coverage' has the meaning given that
term in section 1860D-22(c)(1), except that, fur purposes of this part,
any reference in such section to `part D' is deemed to be a reference
to `part E'.
``SEC. 1860E-6. MEDICARE EARLY ACCESS TRUST FUND.
``(a) Establishment of Trust Fund.--
``(1) In general.--There is hereby created on the books of
the Treasury of the United States a trust fund to be known as
the `Medicare Early Access Trust Fund' (in this section
referred to as the `Trust Fund'). The Trust Fund shall consist
of such gifts and bequests as may be made as provided in
section 201(i)(1) and such amounts as may be deposited in, or
appropriated to, such fund as provided in this title.
``(2) Premiums.--Premiums collected under section 1860E-3
and payable under section 1860E-5(a)(2) shall be transferred to
the Trust Fund.
``(b) Incorporation of Provisions.--
``(1) In general.--Subject to paragraph (2), subsections
(b) through (i) of section 1841 shall apply with respect to the
Trust Fund and this title in the same manner as they apply with
respect to the Federal Supplementary Medical Insurance Trust
Fund and part B, respectively.
``(2) Miscellaneous references.--In applying provisions of
section 1841 under paragraph (1)--
``(A) any reference in such section to `this part'
is construed to refer to this part E;
``(B) any reference in section 1841(h) to section
1840(d) and in section 1841(i) to sections 1840(b)(1)
and 1842(g) are deemed references to comparable
authority exercised under this part; and
``(C) payments may be made under section 1841(g) to
the Trust Funds under sections 1817 and 1841 as
reimbursement to such funds for payments they made for
benefits provided under this part.
``SEC. 1860E-7. OVERSIGHT AND ACCOUNTABILITY.
``(a) Through Annual Reports of Trustees.--The Board of Trustees of
the Medicare Early Access Trust Fund under section 1860E-6(b)(1) shall
report on an annual basis to Congress concerning the status of the
Trust Fund and the need for adjustments in the program under this part
to maintain financial solvency of the program under this part.
``(b) Periodic GAO Reports.--The Comptroller General of the United
States shall periodically submit to Congress reports on the adequacy of
the financing of coverage provided under this part. The Comptroller
General shall include in such report such recommendations for
adjustments in such financing and coverage as the Comptroller General
deems appropriate in order to maintain financial solvency of the
program under this part.
``SEC. 1860E-8. ADMINISTRATION AND MISCELLANEOUS.
``(a) Treatment for Purposes of Title.--Except as otherwise
provided in this part--
``(1) individuals enrolled under this part shall be treated
for purposes of this title as though the individual were
entitled to benefits and enrolled under any part of this title;
and
``(2) benefits described in section 1860E-1 shall be
payable under this title to such individuals in the same manner
as if such individuals were so entitled and enrolled.
``(b) Not Treated as Medicare Program for Purposes of Medicaid
Program.--For purposes of applying title XIX (including the provision
of medicare cost-sharing assistance under such title), an individual
who is enrolled under this part shall not be treated as being entitled
to benefits under this title.
``(c) Not Treated as Medicare Program for Purposes of COBRA
Continuation Provisions.--In applying a COBRA continuation provision
(as defined in section 2791(d)(4) of the Public Health Service Act),
any reference to an entitlement to benefits under this title shall not
be construed to include entitlement to benefits under this title
pursuant to the operation of this part.''.
(b) Conforming Amendments to Social Security Act.--(1) Section
201(i)(1) of the Social Security Act (42 U.S.C. 401(i)(1)) is amended
by striking ``or the Federal Supplementary Medical Insurance Trust
Fund'' and inserting ``the Federal Supplementary Medical Insurance
Trust Fund, and the Medicare Early Access Trust Fund''.
(2) Section 201(g)(1)(A) of such Act (42 U.S.C. 401(g)(1)(A)) is
amended by striking ``and the Federal Supplementary Medical Insurance
Trust Fund established by title XVIII'' and inserting ``, the Federal
Supplementary Medical Insurance Trust Fund, and the Medicare Early
Access Trust Fund established by title XVIII''.
(3) Section 1820(i) of such Act (42 U.S.C. 1395i-4(i)) is amended
by striking ``part D'' and inserting ``part F''.
(4) Section 1853 of such Act (42 U.S.C. 1395w-23), as
amended by section 222(d) of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (Public Law 108-
173), is amended by adding at the end the following new
subsection:
``(k) Adjustment for Early Access.--In applying this section with
respect to individuals entitled to benefits under part E, the Secretary
shall provide for an appropriate adjustment in, for 2005, the
Medicare+Choice capitation rate, and for years beginning with 2006, the
payment amount determined under this section or section 1858, as may be
appropriate to reflect differences between the population served under
such part and the population under parts A and B.''.
(5) Section 1860D-15(c)(1) of such Act, as added by section
101(a) of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Public Law 108-173), is amended by
adding at the end the following new subparagraph:
``(E) Adjustment for early access.--In applying
this section with respect to individuals entitled to
benefits under part E, the Secretary shall provide for
an appropriate adjustment in the payment amount
determined under this section as may be appropriate to
reflect differences between the population served under
such part and the population under parts A and B.''.
(c) Other Conforming.--(1) Section 602(2)(D)(ii) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1162(2)) is amended
by inserting ``(not including an individual who is so entitled pursuant
to enrollment under section 1860E-1)'' after ``Social Security Act''.
(2) Section 2202(2)(D)(ii) of the Public Health Service Act (42
U.S.C. 300bb-2(2)(D)(ii)) is amended by inserting ``(not including an
individual who is so entitled pursuant to enrollment under section
1860E-1)'' after ``Social Security Act''.
(3) Section 4980B(f)(2)(B)(i)(V) of the Internal Revenue Code of
1986 is amended by inserting ``(not including an individual who is so
entitled pursuant to enrollment under section 1860E-1)'' after ``Social
Security Act''.
Subtitle B--Refundable Tax Credit for Employee Costs of COBRA Coverage
SEC. 211. REFUNDABLE TAX CREDIT FOR EMPLOYEE COSTS OF COBRA COVERAGE.
(a) In General.--Chapter 101 of the Internal Revenue Code of 1986,
as added by section 102, is amended by redesignating section 9905 as
section 9906 and by inserting after section 9904 the following new
section:
``SEC. 9905. EMPLOYEE COSTS OF COBRA COVERAGE.
``(a) In General.--In the case of an individual, there shall be
allowed against the tax imposed by subtitle A an amount equal to 65
percent of the amount paid by the taxpayer for coverage of the
taxpayer, his spouse, and dependents under a COBRA continuation
provision (as defined in section 9832(d)(1)).
``(b) Special Rules.--Rules similar to the rules of section 9904(c)
shall apply for purposes of this section.''.
(b) Conforming Amendments.--
(1) Subsection (b) of section 9906 of such Code (as added
by section 102 and redesignated by subsection (a)) is further
amended by striking ``or 9904(a)'' and inserting ``9904(a), or
9905(a)''.
(2) The table of sections for chapter 101 of such Code is
amended by striking the item relating to section 9905 and
inserting the following new items:
``Sec. 9905. Employee costs of COBRA
coverage.
``Sec. 9906. Special rules.''.
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2004.
Subtitle C--FamilyCare <plus-minus>
SEC. 221. RENAMING OF TITLE XXI PROGRAM.
(a) In General.--The heading of title XXI of the Social Security
Act (42 U.S.C. 1397aa et seq.) is amended to read as follows:
``TITLE XXI--FAMILYCARE PROGRAM''.
(b) Program References.--Any reference in any provision of Federal
law or regulation to ``SCHIP'' or ``State children's health insurance
program'' under title XXI of the Social Security Act shall be deemed a
reference to the FamilyCare program under such title.
SEC. 222. FAMILYCARE COVERAGE OF PARENTS AND PREGNANT WOMEN UNDER THE
MEDICAID PROGRAM AND TITLE XXI.
(a) Incentives To Implement FamilyCare Coverage.--
(1) Under medicaid.--
(A) Establishment of new optional eligibility
category.--Section 1902(a)(10)(A)(ii) of the Social
Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is
amended--
(i) by striking ``or'' at the end of
subclause (XVII);
(ii) by adding ``or'' at the end of
subclause (XVIII); and
(iii) by adding at the end the following:
``(XIX) who are individuals
described in subsection (k)(1)
(relating to parents of categorically
eligible children);''.
(B) Parents described.--Section 1902 of the Social
Security Act is further amended by inserting after
subsection (j) the following:
``(k)(1)(A) Individuals described in this paragraph are
individuals--
``(i) who are the parents of an individual who is under 19
years of age (or such higher age as the State may have elected
under section 1902(l)(1)(D)) and who is eligible for medical
assistance under subsection (a)(10)(A);
``(ii) who are not otherwise eligible for medical
assistance under such subsection or under a waiver approved
under section 1115 or otherwise (except under section 1931 or
under subsection (a)(10)(A)(ii)(XIX)); and
``(iii) whose family income or resources exceeds the
effective income level or resource level applicable under the
State plan under part A of title IV as in effect as of July 16,
1996, but does not exceed the highest effective income or
resource level (if any) applicable to a child in the family
under this title.
``(B) In establishing an income eligibility level for individuals
described in this paragraph, a State may vary such level consistent
with the various income levels established under subsection (l)(2) in
order to ensure, to the maximum extent possible, that such individuals
shall be enrolled in the same program as their children.
``(C) An individual may not be treated as being described in this
paragraph unless, at the time of the individual's enrollment under this
title, the child referred to in subparagraph (A)(i) of the individual
is also enrolled under this title or otherwise insured.
``(D) In this subsection, the term `parent' includes an individual
treated as a caretaker for purposes of carrying out section 1931.
``(E) In this subsection, the term `effective income level' means
the income level expressed as a percent of the poverty line and
considering applicable income disregards.
``(2) The State shall provide for coverage of a parent described in
paragraph (1) or section 2111 of a child who is covered under this
title or title XXI under the same title as the title as such child is
covered. In the case of a parent described in paragraph (1) who is also
the parent of a child who is eligible for child health assistance under
title XXI, the State may elect (on a uniform basis) to cover all such
parents under section 2111 or under this title.''.
(C) Enhanced matching funds available if certain
conditions met.--Section 1905 of the Social Security
Act (42 U.S.C. 1396d) is amended--
(i) in the fourth sentence of subsection
(b), by striking ``or subsection (u)(3)'' and
inserting ``, (u)(3), or (u)(4)(A)''; and
(ii) in subsection (u)--
(I) by redesignating paragraph (4)
as paragraph (6), and
(II) by inserting after paragraph
(3) the following:
``(4) For purposes of subsection (b) and section 2105(a)(1):
``(A) FamilyCare parents.--The expenditures described in
this subparagraph are the expenditures described in the
following clauses (i) and (ii):
``(i) Parents.--If the conditions described in
clauses (iii) and (iv) are met, expenditures for
medical assistance for parents described in section
1902(k)(1) and for parents who would be described in
such section but for the fact that they are eligible
for medical assistance under section 1931 or under a
waiver approved under section 1115.
``(ii) Certain pregnant women.--If the conditions
described in clause (v) are met, expenditures for
medical assistance for pregnant women described in
subsection (n) or under section 1902(l)(1)(A) in a
family the income of which exceeds the effective income
level applicable under subsection (a)(10)(A)(i)(III) or
(l)(2)(A) of section 1902 to a family of the size
involved as of January 1, 2005.
``(iii) Conditions relating to ensuring children's
coverage for enhanced match for parents.--The
conditions described in this clause are the following:
``(I) The State has a State child health
plan under title XXI which (whether implemented
under such title or under this title) has an
effective income level for children that is at
least 200 percent of the poverty line.
``(II) Such State child health plan does
not limit the acceptance of applications, does
not use a waiting list for children who meet
eligibility standards to qualify for
assistance, and provides benefits to all
children in the State who apply for and meet
eligibility standards.
``(III) Effective for determinations of
eligibility made on or after the date that is 1
year after the date of the enactment of this
clause, the application and renewal procedures
for individuals under 19 years of age (or such
higher age as the State has elected under
section 1902(l)(1)(D)) for medical assistance
under section 1902(a)(10)(A) are not be more
restrictive or burdensome than such procedures
used for children with higher income under the
State child health plan under title XXI.
``(iv) Conditions relating to minimum coverage for
parents for enhanced match for parents.--The conditions
described in this clause are the following:
``(I) The State does not apply an income
level for parents that is lower than the
effective income level (expressed as a percent
of the poverty line) that has been specified
under the State plan under title XIX (including
under a waiver authorized by the Secretary or
under section 1902(r)(2)), as of January 1,
2005, to be eligible for medical assistance as
a parent under this title.
``(II) The State plans under this title and
title XXI do not provide coverage for parents
with higher family income without covering
parents with a lower family income.
``(v) Conditions for enhanced match for certain
pregnant women.--The conditions described in this
clause are the following:
``(I) The State has established an
effective income eligibility level for pregnant
women under subsection (a)(10)(A)(i)(III) or
(l)(2)(A) of section 1902 that is at least 185
percent of the poverty line.
``(II) The State plans under this title and
title XXI do not provide coverage for pregnant
women described in subparagraph (A)(ii) with
higher family income without covering such
pregnant women with a lower family income.
``(III) The State does not apply an income
level for pregnant women that is lower than the
effective income level that has been specified
under the State plan under subsection
(a)(10)(A)(i)(III) or (l)(2)(A) of section
1902, as of January 1, 2005, to be eligible for
medical assistance as a pregnant woman.
``(IV) The State satisfies the conditions
described in subclauses (I) and (II) of clause
(iii).
``(vi) Definitions.--For purposes of this
subsection:
``(I) The term `parent' has the meaning
given such term for purposes of section
1902(k)(1).
``(II) The term `poverty line' has the
meaning given such term in section
2110(c)(5).''.
(D) Appropriation from title xxi allotment for
certain medicaid expansion costs.--Section 2105(a) of
the Social Security Act (42 U.S.C. 1397ee(a)) is
amended--
(i) in paragraph (1), by redesignating
subparagraphs (B) through (D) as subparagraphs
(C) through (E), respectively, and by inserting
after subparagraph (A) the following new
subparagraph:
``(B) for medical assistance that is attributable
to expenditures described in section 1905(u)(4)(A);'';
and
(ii) in paragraph (2), by adding at the end
the following new subparagraph:
``(E) Fifth, for expenditures for items described
in paragraph (1)(E).''.
(E) Increasing enhanced fmap to 100 percent for
fiscal years 2005 and 2006 for coverage of parents.--
Section 2105(b) of such Act (42 U.S.C. 1397ee(b)) is
amended by adding at the end the following new
sentence: ``Notwithstanding the previous sentence, the
`enhanced FMAP' shall be 100 percent with respect to
medical assistance under title XIX for expenditures
described in section 1905(u)(4)(A)(i), but only for
such assistance furnished during fiscal year 2005 and
fiscal year 2006.''.
(2) Under title xxi.--
(A) FamilyCare coverage.--Title XXI of the Social
Security Act (42 U.S.C. 1397aa et seq.) is amended by
adding at the end the following:
``SEC. 2111. OPTIONAL FAMILYCARE COVERAGE OF PARENTS OF TARGETED LOW-
INCOME CHILDREN.
``(a) Optional Coverage.--Notwithstanding any other provision of
this title, a State may provide for coverage, through an amendment to
its State child health plan under section 2102, of parent health
assistance for targeted low-income parents, health care assistance for
targeted low-income pregnant women, or both, in accordance with this
section, but only if--
``(1) with respect to the provision of parent health
assistance, the State meets the conditions described in clause
(iii) of section 1905(u)(4)(A);
``(2) with respect to the provision of health care
assistance for pregnant women, the State meets the conditions
described in clause (iv) of section 1905(u)(4)(A); and
``(3) in the case of parent health assistance for targeted
low-income parents, the State elects to provide medical
assistance under section 1902(a)(10)(A)(ii)(XIX), under section
1931, or under a waiver under section 1115 to individuals
described in section 1902(k)(1)(A)(i) and elects an effective
income level that, consistent with paragraphs (1)(B) and (2) of
section 1902(k), ensures to the maximum extent possible, that
such individuals shall be enrolled in the same program as their
children if their children are eligible for coverage under
title XIX (including under a waiver authorized by the Secretary
or under section 1902(r)(2)).
``(b) Definitions.--For purposes of this title:
``(1) Parent health assistance.--The term `parent health
assistance' has the meaning given the term child health
assistance in section 2110(a) as if any reference to targeted
low-income children were a reference to targeted low-income
parents.
``(2) Parent.--The term `parent' has the meaning given the
term `caretaker relative' for purposes of carrying out section
1931.
``(3) Health care assistance for pregnant women.--The term
`health care assistance for pregnant women' has the meaning
given the term child health assistance in section 2110(a) as if
any reference to targeted low-income children were a reference
to targeted low-income pregnant women.
``(4) Targeted low-income parent.--The term `targeted low-
income parent' has the meaning given the term targeted low-
income child in section 2110(b) as if the reference to a child
were deemed a reference to a parent (as defined in paragraph
(3)) of the child; except that in applying such section--
``(A) there shall be substituted for the income
level described in paragraph (1)(B)(ii)(I) the
applicable income level in effect for a targeted low-
income child;
``(B) in paragraph (3), January 1, 2005, shall be
substituted for July 1, 1997; and
``(C) in paragraph (4), January 1, 2005, shall be
substituted for March 31, 1997.
``(5) Targeted low-income pregnant woman.--The term
`targeted low-income pregnant woman' has the meaning given the
term targeted low-income child in section 2110(b) as if any
reference to a child were a reference to a woman during
pregnancy and through the end of the month in which the 60-day
period beginning on the last day of her pregnancy ends; except
that in applying such section--
``(A) there shall be substituted for the income
level described in paragraph (1)(B)(ii)(I) the
applicable income level in effect for a targeted low-
income child;
``(B) in paragraph (3), January 1, 2005, shall be
substituted for July 1, 1997; and
``(C) in paragraph (4), January 1, 2005, shall be
substituted for March 31, 1997.
``(c) References to Terms and Special Rules.--In the case of, and
with respect to, a State providing for coverage of parent health
assistance to targeted low-income parents or health care assistance to
targeted low-income pregnant women under subsection (a), the following
special rules apply:
``(1) Any reference in this title (other than in subsection
(b)) to a targeted low-income child is deemed to include a
reference to a targeted low-income parent or a targeted low-
income pregnant woman (as applicable).
``(2) Any such reference to child health assistance--
``(A) with respect to such parents is deemed a
reference to parent health assistance; and
``(B) with respect to such pregnant women, is
deemed a reference to health care assistance for
pregnant women.
``(3) In applying section 2103(e)(3)(B) in the case of a
family (consisting of a parent and one or more children)
provided coverage under this section or a pregnant woman
provided coverage under this section without covering other
family members, the limitation on total annual aggregate cost-
sharing shall be applied to such entire family or such pregnant
woman, respectively.
``(4) In applying section 2110(b)(4), any reference to
`section 1902(l)(2) or 1905(n)(2) (as selected by a State)' is
deemed a reference to the effective income level applicable to
parents under section 1931 or under a waiver approved under
section 1115, or, in the case of a pregnant woman, the income
level established under section 1902(l)(2)(A).
``(5) In applying section 2102(b)(3)(B), any reference to
children found through screening to be eligible for medical
assistance under the State medicaid plan under title XIX is
deemed a reference to parents and pregnant women.''.
(B) Additional allotment for states providing
familycare.--
(i) In general.--Section 2104 of the Social
Security Act (42 U.S.C. 1397dd) is amended by
inserting after subsection (c) the following:
``(d) Additional Allotments for State Providing FamilyCare.--
``(1) Appropriation; total allotment.--For the purpose of
providing additional allotments to States to provide FamilyCare
coverage under section 2111, there is appropriated, out of any
money in the Treasury not otherwise appropriated--
``(A) for fiscal year 2005, $7,000,000,000;
``(B) for fiscal year 2006, $7,000,000,000;
``(C) for fiscal year 2007, $3,000,000,000;
``(D) for fiscal year 2008, $3,000,000,000;
``(E) for fiscal year 2009, $6,000,000,000;
``(F) for fiscal year 2010, $7,000,000,000;
``(G) for fiscal year 2011, $8,000,000,000;
``(H) for fiscal year 2012, $9,000,000,000; and
``(I) for fiscal year 2013 and each fiscal year
thereafter, the amount of the allotment provided under
this paragraph for the preceding fiscal year increased
by the percentage increase (if any) in the medical care
expenditure category of the Consumer Price Index for
All Urban Consumers (United States city average).
``(2) State and territorial allotments.--
``(A) In general.--In addition to the allotments
provided under subsections (b) and (c), subject to
paragraphs (3) and (4), of the amount available for the
additional allotments under paragraph (1) for a fiscal
year, the Secretary shall allot to each State with a
State child health plan approved under this title--
``(i) in the case of such a State other
than a commonwealth or territory described in
clause (ii), the same proportion as the
proportion of the State's allotment under
subsection (b) (determined without regard to
subsection (f)) to 98.95 percent of the total
amount of the allotments under such section for
such States eligible for an allotment under
this subparagraph for such fiscal year; and
``(ii) in the case of a commonwealth or
territory described in subsection (c)(3), the
same proportion as the proportion of the
commonwealth's or territory's allotment under
subsection (c) (determined without regard to
subsection (f)) to 1.05 percent of the total
amount of the allotments under such section for
commonwealths and territories eligible for an
allotment under this subparagraph for such
fiscal year.
``(B) Availability and redistribution of unused
allotments.--In applying subsections (e) and (f) with
respect to additional allotments made available under
this subsection, the procedures established under such
subsections shall ensure such additional allotments are
only made available to States which have elected to
provide coverage under section 2111.
``(3) Use of additional allotment.--Additional allotments
provided under this subsection are not available for amounts
expended before October 1, 2004. Such amounts are available for
amounts expended on or after such date for child health
assistance for targeted low-income children, as well as for
parent health assistance for targeted low-income parents, and
health care assistance for targeted low-income pregnant women.
``(4) Requiring election to provide coverage.--No payments
may be made to a State under this title from an allotment
provided under this subsection unless the State has made an
election to provide parent health assistance for targeted low-
income parents, or health care assistance for targeted low-
income pregnant women.''.
(ii) Conforming amendments.--Section 2104
of the Social Security Act (42 U.S.C. 1397dd)
is amended--
(I) in subsection (a), by inserting
``subject to subsection (d),'' after
``under this section,'';
(II) in subsection (b)(1), by
inserting ``and subsection (d)'' after
``Subject to paragraph (4)''; and
(III) in subsection (c)(1), by
inserting ``subject to subsection
(d),'' after ``for a fiscal year,''.
(C) No cost-sharing for pregnancy-related
benefits.--Section 2103(e)(2) of the Social Security
Act (42 U.S.C. 1397cc(e)(2)) is amended--
(i) in the heading, by inserting ``and
pregnancy-related services'' after ``preventive
services''; and
(ii) by inserting before the period at the
end the following: ``and for pregnancy-related
services''.
(3) Effective date.--The amendments made by this subsection
apply to items and services furnished on or after October 1,
2004, whether or not regulations implementing such amendments
have been issued.
(b) Rules for Implementation Beginning With Fiscal Year 2006.--
(1) Expansion of availability of enhanced match under
medicaid for pre-chip expansions.--Paragraph (4) of section
1905(u) of the Social Security Act (42 U.S.C. 1396d(u)), as
inserted by subsection (a)(1)(C), is amended--
(A) by amending clause (ii) of subparagraph (A) to
read as follows:
``(ii) Certain pregnant women.--Expenditures for
medical assistance for pregnant women under section
1902(l)(1)(A) in a family the income of which exceeds
the 133 percent of the income official poverty line,
but only if the income level established under section
1902(l)(2) (or under a Statewide waiver under section
1115) for pregnant women is 185 percent of the income
official poverty line.''; and
(B) by adding at the end the following:
``(B) Children in families with income above medicaid
mandatory level not previously described.--The expenditures
described in this subparagraph are expenditures (other than
expenditures described in paragraph (2) or (3)) for medical
assistance made available to any child who is eligible for
assistance under section 1902(a)(10)(A) (other than under
clause (i)) and the income of whose family exceeds the minimum
income level required under subsection 1902(l)(2) (or, if
higher, the minimum level required under section 1931 for that
State) for a child of the age involved (treating any child who
is 19 or 20 years of age as being 18 years of age).''.
(2) Offset of additional expenditures for enhanced match
for pre-chip expansion.--Section 1905 of the Social Security
Act (42 U.S.C. 1396d) is amended--
(A) in the fourth sentence of subsection (b), by
inserting ``(except in the case of expenditures
described in subsection (u)(5))'' after ``do not
exceed'';
(B) in subsection (u), by inserting after paragraph
(4) (as inserted by subparagraph (C)), the following:
``(5) For purposes of the fourth sentence of subsection (b) and
section 2105(a), the following payments under this title do not count
against a State's allotment under section 2104:
``(A) Regular fmap for expenditures for pregnant women with
income above 133 percent of poverty.--The portion of the
payments made for expenditures described in paragraph
(4)(A)(ii) that represents the amount that would have been paid
if the enhanced FMAP had not been substituted for the Federal
medical assistance percentage.
``(B) FamilyCare parents.--Payments for expenditures
described in paragraph (4)(A)(i).
``(C) Regular fmap for expenditures for certain children in
families with income above medicaid mandatory level.--The
portion of the payments made for expenditures described in
paragraph (4)(B) that represents the amount that would have
been paid if the enhanced FMAP had not been substituted for the
Federal medical assistance percentage.''.
(B) Conforming amendments.--Subparagraph (B) of
section 2105(a)(1) of the Social Security Act, as
amended by subsection (a)(1)(D), is amended to read as
follows:
``(B) Certain familycare parents and others.--
Expenditures for medical assistance that is
attributable to expenditures described in section
1905(u)(4), except as provided in section
1905(u)(5).''.
(3) Effective date.--The amendments made by this subsection
apply as of October 1, 2005, to fiscal years beginning on or
after such date and to expenditures under the State plan on and
after such date, whether or not regulations implementing such
amendments have been issued.
(c) Making Title XXI Base Allotments Permanent.--Section 2104(a) of
the Social Security Act (42 U.S.C. 1397dd(a)) is amended--
(1) by striking ``and'' at the end of paragraph (9);
(2) by striking the period at the end of paragraph (10) and
inserting ``; and''; and
(3) by adding at the end the following:
``(11) for fiscal year 2008 and each fiscal year
thereafter, the amount of the allotment provided under this
subsection for the preceding fiscal year increased by the
percentage increase (if any) in the medical care expenditure
category of the Consumer Price Index for All Urban Consumers
(United States city average).''.
(d) GAO Study.--
(1) Study.--The Comptroller General of the United States
shall conduct a study regarding funding under title XXI of the
Social Security Act that examines--
(A) the adequacy of overall funding under such
title;
(B) the formula for determining allotments and for
redistribution of unspent funds under such title; and
(C) the effect of waiting lists and caps on
enrollment under such title.
(2) Report.--Not later than July 1, 2006, the Comptroller
General shall submit a report on the study conducted under
paragraph (1). Such report shall include recommendations
regarding a better mechanism for determining State allotments
and redistribution of unspent funds under such title in order
to ensure all eligible families in need can access coverage
through such title.
(e) Conforming Amendments.--
(1) Eligibility categories.--Section 1905(a) of the Social
Security Act (42 U.S.C. 1396d(a)) is amended, in the matter
before paragraph (1)--
(A) by striking ``or'' at the end of clause (xii);
(B) by inserting ``or'' at the end of clause
(xiii); and
(C) by inserting after clause (xiii) the following:
``(xiv) who are parents described (or treated as if
described) in section 1902(k)(1),''.
(2) Income limitations.--Section 1903(f)(4) of the Social
Security Act (42 U.S.C. 1396b(f)(4)) is amended--
(A) effective October 1, 2005, by inserting
``1902(a)(10)(A)(i)(VIII),'' after
``1902(a)(10)(A)(i)(VII),''; and
(B) by inserting ``1902(a)(10)(A)(ii)(XIX),'' after
``1902(a)(10)(A)(ii)(XVIII),''.
(3) Conforming amendment relating to no waiting period for
pregnant women.--Section 2102(b)(1)(B) of the Social Security
Act (42 U.S.C. 1397bb(b)(1)(B)) is amended--
(A) by striking ``, and'' at the end of clause (i)
and inserting a semicolon;
(B) by striking the period at the end of clause
(ii) and inserting ``; and''; and
(C) by adding at the end the following:
``(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 parent who is pregnant.''.
SEC. 223. AUTOMATIC ENROLLMENT OF CHILDREN BORN TO TITLE XXI PARENTS.
Section 2102(b)(1) of the Social Security Act (42 U.S.C.
1397bb(b)(1)) is amended by adding at the end the following:
``(C) Automatic eligibility of children born to a
parent being provided familycare.--Such eligibility
standards shall provide for automatic coverage of a
child born to an individual who is provided assistance
under this title in the same manner as medical
assistance would be provided under section 1902(e)(4)
to a child described in such section.''.
SEC. 224. ALLOWING STATES TO SIMPLIFY RULES FOR FAMILIES.
(a) Presumptive Eligibility.--
(1) Application to presumptive eligibility for pregnant
women under medicaid.--Section 1920(b) of the Social Security
Act (42 U.S.C. 1396r-1(b)) is amended by adding at the end
after and below paragraph (2) the following flush sentence:
``The term `qualified provider' includes a qualified entity as defined
in section 1920A(b)(3).''.
(2) Optional application of presumptive eligibility
provisions to parents.--Section 1920A of the Social Security
Act (42 U.S.C. 1396r-1a) is amended by adding at the end the
following:
``(e) A State may elect to apply the previous provisions of this
section to provide for a period of presumptive eligibility for medical
assistance for a parent of a child with respect to whom such a period
is provided under this section.''.
(3) Application under title xxi.--Section 2107(e)(1)(D) of
the Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended to
read as follows:
``(D) Sections 1920 and 1920A (relating to
presumptive eligibility).''.
(b) 12-Months Continuous Eligibility.--
(1) Medicaid.--Section 1902(e)(12) of the Social Security
Act (42 U.S.C. 1396a(e)(12)) is amended--
(A) by striking ``At the option of the State, the
plan may'' and inserting ``The plan shall'';
(B) by striking ``an age specified by the State
(not to exceed 19 years of age)'' and inserting ``19
years of age (or such higher age as the State has
elected under subsection (l)(1)(D)) or, at the option
of the State, who is eligible for medical assistance as
the parent of such a child''; and
(C) in subparagraph (A), by striking ``a period
(not to exceed 12 months) '' and inserting ``the 12-
month period beginning on the date''.
(2) Title XXI.--Section 2102(b)(2) of such Act (42 U.S.C.
1397bb(b)(2)) is amended by adding at the end the following:
``Such methods shall provide continuous eligibility for
children under this title in a manner that is no less generous
than the 12-months continuous eligibility provided under
section 1902(e)(12) for children described in such section
under title XIX. If a State has elected to apply section
1902(e)(12) to parents, such methods may provide continuous
eligibility for parents under this title in a manner that is no
less generous than the 12-months continuous eligibility
provided under such section for parents described in such
section under title XIX.''.
(3) Effective date.--The amendments made by this subsection
shall take effect on July 1, 2005, whether or not regulations
implementing such amendments have been issued.
(c) Provision of Medicaid and CHIP Applications and Information
Under the School Lunch Program.--Section 9(b)(2)(B) of the Richard B.
Russell National School Lunch Act (42 U.S.C. 1758(b)(2)(B)) is
amended--
(1) by striking ``(B) Applications'' and inserting ``(B)(i)
Applications''; and
(2) by adding at the end the following:
``(ii)(I) Applications for free and reduced price lunches that are
distributed pursuant to clause (i) to parents or guardians of children
in attendance at schools participating in the school lunch program
under this Act shall also contain information on the availability of
medical assistance under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) and of child health and FamilyCare assistance
under title XXI of such Act, including information on how to obtain an
application for assistance under such programs.
``(II) Information on the programs referred to in subclause (I)
shall be provided on a form separate from the application form for free
and reduced price lunches under clause (i).''.
SEC. 225. REVISION AND SIMPLIFICATION OF THE TRANSITIONAL MEDICAL
ASSISTANCE PROGRAM (TMA).
(a) Making Reporting Requirements Optional; Option of Extended
Eligibility.--
(1) Option for making reporting requirements optional.--
Section 1925(b) of the Social Security Act (42 U.S.C. 1396r-
6(b)) is amended--
(A) in paragraph (1), by inserting ``, at the
option of a State,'' after ``and which'';
(B) in paragraph (2)(A), by inserting ``Subject to
subparagraph (C)--'' after ``(A) Notices.--'';
(C) in paragraph (2)(B), by inserting ``Subject to
subparagraph (C)--'' after ``(B) Reporting
requirements.--'';
(D) by adding at the end the following new
subparagraph:
``(C) State option to waive notice and reporting
requirements.--A State may waive some or all of the
reporting requirements under clauses (i) and (ii) of
subparagraph (B). Insofar as it waives such a reporting
requirement, the State need not provide for a notice
under subparagraph (A) relating to such requirement.'';
and
(E) in paragraph (3)(A)(iii), by inserting ``the
State has not waived under paragraph (2)(C) the
reporting requirement with respect to such month under
paragraph (2)(B) and if'' after ``6-month period if''.
(2) State option to extend eligibility for low-income
individuals for up to 12 additional months.--Section 1925 of
such Act (42 U.S.C. 1396r-6) is further amended--
(A) by redesignating subsections (c) through (f) as
subsections (d) through (g); and
(B) by inserting after subsection (b) the following
new subsection:
``(c) State Option of Up to 12 Months of Additional Eligibility.--
``(1) In general.--Notwithstanding any other provision of
this title, each State plan approved under this title may
provide, at the option of the State, that the State shall offer
to each family which received assistance during the entire 6-
month period under subsection (b) and which meets the
applicable requirement of paragraph (2), in the last month of
the period the option of extending coverage under this
subsection for the succeeding period not to exceed 12 months.
``(2) Income restriction.--The option under paragraph (1)
shall not be made available to a family for a succeeding period
unless the State determines that the family's average gross
monthly earnings (less such costs for such child care as is
necessary for the employment of the caretaker relative) as of
the end of the 6-month period under subsection (b) does not
exceed 185 percent of the official poverty line (as defined by
the Office of Management and Budget, and revised annually in
accordance with section 673(2) of the Omnibus Budget
Reconciliation Act of 1981) applicable to a family of the size
involved.
``(3) Application of extension rules.--The provisions of
paragraphs (2), (3), (4), and (5) of subsection (b) shall apply
to the extension provided under this subsection in the same
manner as they apply to the extension provided under subsection
(b)(1), except that for purposes of this subsection--
``(A) any reference to a 6-month period under
subsection (b)(1) is deemed a reference to the
extension period provided under paragraph (1) and any
deadlines for any notices or reporting and the premium
payment periods shall be modified to correspond to the
appropriate calendar quarters of coverage provided
under this subsection; and
``(B) any reference to a provision of subsection
(a) or (b) is deemed a reference to the corresponding
provision of subsection (b) or of this subsection,
respectively.''.
(b) State Option To Waive Receipt of Medicaid for 3 of Previous 6
Months To Qualify for TMA.--Section 1925(a)(1) of such Act (42 U.S.C.
1396r-6(a)(1)) is amended by adding at the end the following: ``A State
may, at its option, also apply the previous sentence in the case of a
family that was receiving such aid for fewer than 3 months, or that had
applied for and was eligible for such aid for fewer than 3 months,
during the 6 immediately preceding months described in such
sentence.''.
(c) Elimination of Sunset for TMA.--
(1) Subsection (g) of section 1925 of such Act (42 U.S.C.
1396r-6), as redesignated under subsection (a)(2), is repealed.
(2) Section 1902(e)(1) of such Act (42 U.S.C. 1396a(e)(1))
is amended by striking ``(A) Nothwithstanding'' and all that
follows through ``During such period, for'' in subparagraph (B)
and inserting ``For''.
(d) CMS Report on Enrollment and Participation Rates Under TMA.--
Section 1925 of such Act, as amended by subsections (a)(2) and (c)(1),
is amended by adding at the end the following new subsection:
``(g) Additional Provisions.--
``(1) Collection and reporting of participation
information.--Each State shall--
``(A) collect and submit to the Secretary, in a
format specified by the Secretary, information on
average monthly enrollment and average monthly
participation rates for adults and children under this
section; and
``(B) make such information publicly available.
Such information shall be submitted under subparagraph (A) at
the same time and frequency in which other enrollment
information under this title is submitted to the Secretary.
Using such information, the Secretary shall submit to Congress
annual reports concerning such rates.''.
(e) Coordination of Work.--Section 1925(g) of such Act, as added by
subsection (d), is amended by adding at the end the following new
paragraph:
``(2) Coordination with administration for children and
families.--The Administrator of the Centers for Medicare &
Medicaid Services, in carrying out this section, shall work
with the Assistant Secretary for the Administration for
Children and Families to develop guidance or other technical
assistance for States regarding best practices in guaranteeing
access to transitional medical assistance under this
section.''.
(f) Elimination of TMA Requirement for States that Extend Coverage
to Children and Parents Through 185 Percent of Poverty.--
(1) In general.--Section 1925 of such Act is further
amended by adding at the end the following new subsection:
``(h) Provisions Optional for States That Extend Coverage to
Children and Parents Through 185 Percent of Poverty.--A State may (but
is not required to) meet the requirements of subsections (a) and (b) if
it provides for medical assistance under section 1931 to families
(including both children and caretaker relatives) the average gross
monthly earning of which (less such costs for such child care as is
necessary for the employment of a caretaker relative) is at or below a
level that is at least 185 percent of the official poverty line (as
defined by the Office of Management and Budget, and revised annually in
accordance with section 673(2) of the Omnibus Budget Reconciliation Act
of 1981) applicable to a family of the size involved.''.
(2) Conforming amendments.--Such section is further
amended, in subsections (a)(1) and (b)(1), by inserting ``, but
subject to subsection (h),'' after ``Notwithstanding any other
provision of this title,'' each place it appears.
(g) Extending Use of Outstationed Workers to Accept Applications
for Transitional Medical Assistance.--Section 1902(a)(55) of such Act
(42 U.S.C. 1396a(a)(55)) is amended by inserting ``and under section
1931'' after ``(a)(10)(A)(ii)(IX)''.
(h) Effective Dates.--(1) Except as provided in this subsection,
the amendments made by this section shall apply to calendar quarters
beginning on or after the date of the enactment of this Act, without
regard to whether or not final regulations to carry out such amendments
have been promulgated by such date.
(2) In the case of a State plan for medical assistance under title
XIX of the Social Security Act which the Secretary of Health and Human
Services determines requires State legislation (other than legislation
appropriating funds) in order for the plan to meet the additional
requirements imposed by the amendments made by this section, the State
plan shall not be regarded as failing to comply with the requirements
of such title 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 the enactment of this
Act. For purposes of the previous sentence, in the case of a State that
has a 2-year legislative session, each year of such session shall be
deemed to be a separate regular session of the State legislature.
SEC. 226. LIMITATIONS ON CONFLICTS OF INTEREST.
(a) Limitation on Conflicts of Interest in Marketing Activities.--
(1) Title xxi.--Section 2105(c) of the Social Security Act
(42 U.S.C. 300aa-5(c)) is amended by adding at the end the
following:
``(8) Limitation on expenditures for marketing
activities.--Amounts expended by a State for the use of an
administrative vendor in marketing health benefits coverage to
low-income children under this title shall not be considered,
for purposes of subsection (a)(2)(D), to be reasonable costs to
administer the plan unless the following conditions are met
with respect to the vendor:
``(A) The vendor is independent of any entity
offering the coverage in the same area of the State in
which the vendor is conducting marketing activities.
``(B) No person who is an owner, employee,
consultant, or has a contract with the vendor either
has any direct or indirect financial interest with such
an entity or has been excluded from participation in
the program under this title or title XVIII or XIX or
debarred by any Federal agency, or subject to a civil
money penalty under this Act.''.
(b) Prohibition of Affiliation With Debarred Individuals.--
(1) Medicaid.--Section 1903(i) of the Social Security Act
(42 U.S.C. 1396b(i))is amended--
(A) by striking the period at the end of paragraph
(20) and inserting ``; or''; and
(B) by inserting after paragraph (20) the
following:
``(21) with respect to any amounts expended for an entity
that receives payments under the plan unless--
``(A) no person with an ownership or control
interest (as defined in section 1124(a)(3)) in the
entity is a person that is debarred, suspended, or
otherwise excluded from participating in procurement or
non-procurement activities under the Federal
Acquisition Regulation; and
``(B) such entity has not entered into an
employment, consulting, or other agreement for the
provision of items or services that are material to
such entity's obligations under the plan with a person
described in subparagraph (A).''.
(2) Title xxi.--Section 2107(e)(1) of the Social Security
Act (42 U.S.C. 1397gg(e)(1)) is amended
(A) in subparagraph (B), by striking ``and (17)''
and inserting ``(17), and (21)''; and
(B) by adding at the end the following:
``(E) Section 1902(a)(67) (relating to prohibition
of affiliation with debarred individuals).''.
(c) Effective Date.--The amendments made by this section shall
apply to expenditures made on or after July 1, 2005, whether or not
regulations implementing such amendments have been issued.
SEC. 227. INCREASE IN CHIP ALLOTMENT FOR EACH OF FISCAL YEARS 2002
THROUGH 2004.
Effective as if included in the enactment of the Balanced Budget
Act of 1997, paragraphs (5), (6), and (7) of section 2104(a) of the
Social Security Act (42 U.S.C. 1397dd(a)) are amended by striking
``$3,150,000,000'' each place it appears and inserting
``$4,150,000,000''.
SEC. 228. DEMONSTRATION PROGRAMS TO IMPROVE MEDICAID AND CHIP OUTREACH
TO HOMELESS INDIVIDUALS AND FAMILIES.
(a) Authority.--The Secretary of Health and Human Services may
award demonstration grants to not more than 7 States (or other
qualified entities) to conduct innovative programs that are designed to
improve outreach to homeless individuals and families under the
programs described in subsection (b) with respect to enrollment of such
individuals and families under such programs and the provision of
services (and coordinating the provision of such services) under such
programs.
(b) Programs for Homeless Described.--The programs described in
this subsection are as follows:
(1) Medicaid.--The program under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).
(2) CHIP.--The program under title XXI of the Social
Security Act (42 U.S.C. 1397aa et seq.).
(3) TANF.--The program under part of A of title IV of the
Social Security Act (42 U.S.C. 601 et seq.).
(4) SAMHSA block grants.--The program of grants under part
B of title XIX of the Public Health Service Act (42 U.S.C.
300x-1 et seq.).
(5) Food stamp program.--The program under the Food Stamp
Act of 1977 (7 U.S.C. 2011 et seq.).
(6) Workforce investment act.--The program under the
Workforce Investment Act of 1999 (29 U.S.C. 2801 et seq.).
(7) Welfare-to-work.--The welfare-to-work program under
section 403(a)(5) of the Social Security Act (42 U.S.C.
603(a)(5)).
(8) Other programs.--Other public and private benefit
programs that serve low-income individuals.
(c) Appropriations.--For the purposes of carrying out this section,
there is appropriated for fiscal year 2005, out of any funds in the
Treasury not otherwise appropriated, $10,000,000, to remain available
until expended.
SEC. 229. ADDITIONAL CHIP REVISIONS.
(a) Limiting Cost-Sharing to 2.5 Percent for Families With Income
Below 150 Percent of Poverty.--Section 2103(e)(3)(A) of the Social
Security Act (42 U.S.C. 1397cc(e)(3)(A)) is amended--
(1) by striking ``and'' at the end of clause (i);
(2) by striking the period at the end of clause (ii) and
inserting ``; and''; and
(3) by adding at the end the following new clause:
``(iii) total annual aggregate cost-sharing
described in clauses (i) and (ii) with respect
to all such targeted low-income children in a
family under this title that exceeds 2.5
percent of such family's income for the year
involved.''.
(b) Employer Coverage Waiver Changes.--Section 2105(c)(3) of such
Act (42 U.S.C. 1397ee(c)(3)) is amended--
(1) by redesignating subparagraphs (A) and (B) as clauses
(i) and (ii) and indenting appropriately;
(2) by designating the matter beginning with ``Payment may
be made'' as a subparagraph (A) with the heading ``In general''
and indenting appropriately; and
(3) by adding at the end the following new subparagraph:
``(B) Application of requirements.--In carrying out
subparagraph (A)--
``(i) in determining cost-effectiveness,
the Secretary shall measure against family
coverage costs to the extent that a State has
expanded coverage to parents pursuant to
section 2111;
``(ii) subject to clause (iii), the State
shall provide satisfactory assurances that the
minimum benefits and cost-sharing protections
established under this title are provided,
either through the coverage under subparagraph
(A) or as a supplement to such coverage; and
``(iii) coverage under such subparagraph
shall not be considered to violate clause (ii)
because it does not comply with requirements
relating to reviews of health service decisions
if the enrollee involved is provided the option
of being provided benefits directly under this
title.''.
(c) Effective Date.--The amendments made by this section apply as
of January 1, 2005, whether or not regulations implementing such
amendments have been issued.
SEC. 230. INCREASED FEDERAL REIMBURSEMENT FOR LANGUAGE SERVICES UNDER
THE MEDICAID PROGRAM AND TITLE XXI.
(a) Medicaid.--Section 1903(a)(3) of the Social Security Act (42
U.S.C. 1396b(a)(3)) is amended--
(1) in subparagraph (D), by striking ``plus'' at the end
and inserting ``and''; and
(2) by adding at the end the following:
``(E) 90 percent of the sums expended with respect
to costs incurred during such quarter as are
attributable to the provision of language services,
including oral interpretation, translations of written
materials, and other language services, for individuals
with limited English proficiency who apply for, or
receive, medical assistance under the State plan;
plus''.
(b) SCHIP.--Section 2105(a)(1) of the Social Security Act (42
U.S.C.1397ee(a)) is amended--
(1) in the matter preceding subparagraph (A), by inserting
``or, in the case of expenditures described in subparagraph
(D)(iv), 90 percent'' after ``enhanced FMAP''; and
(2) in subparagraph (D)--
(A) in clause (iii), by striking ``and'' at the
end;
(B) be redesignating clause (iv) as clause (v); and
(C) by inserting after clause (iii) the following:
``(iv) for expenditures attributable to the
provision of language services, including oral
interpretation, translations of written
materials, and other language services, for
individuals with limited English proficiency
who apply for, or receive, child health
assistance under the plan; and''.
(c) Effective Date.--The amendments made by this section take
effect on January 1, 2005.
TITLE III--NATIONAL CENTER FOR EVIDENCE-BASED HEALTHCARE PRACTICES
SEC. 301. ESTABLISHMENT OF CENTER.
Part E of title IV of the Public Health Service Act (42 U.S.C. 287
et seq.) is amended by adding at the end the following subpart:
``Subpart 7--National Center for Evidence-Based Healthcare Practices
``SEC. 485J. PURPOSE OF CENTER.
``(a) In General.--The general purpose of the National Center for
Evidence-Based Healthcare Practices (in this subpart referred to as the
`Center') is the establishment of national standards for healthcare
practices that are based on scientific evidence developed through the
conduct of research and the collection of data (in this subpart
referred to as `evidence-based practices').
``(b) Certain Duties.-- With respect to evidence-based practices
established under subsection (a), the Director of the Center--
``(1) shall disseminate the practices and provide general
information on the practices to the public and health
professionals;
``(2) may conduct and support programs for training health
professionals with respect to the practices; and
``(3) may provide to healthcare entities technical
assistance regarding the practices.
``(c) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated such sums as
may be necessary for each of the fiscal years 2005 through 2009.''
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