II
110th CONGRESS
1st Session
S. 158
IN THE SENATE OF THE UNITED STATES
January 4, 2007
Ms. Collins (for herself and Ms. Landrieu) introduced the following bill; which was read twice and referred to the Committee on Finance
A BILL
To expand access to affordable health care and to strengthen the health care safety net and make health care services more available in rural and underserved areas.
Short title; table of contents
Short Title
This Act may be cited as the Access to Affordable
Health Care Act
.
Table of Contents
The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—EXPANSION OF ACCESS TO AFFORDABLE HEALTH CARE FOR SMALL BUSINESSES
Subtitle A—Small Business Tax Credit
Sec. 101. Credit for employee health insurance expenses.
Subtitle B—Grants to States for Small Business Purchasing Groups
Sec. 121. Grants for small employer purchasing groups.
Sec. 122. Qualified small employer purchasing groups.
Subtitle C—Health Benefits Information for Small Employers
Sec. 131. Grant program to facilitate health benefits information for small employers.
Subtitle D—Grant Program to Encourage State Innovation
Sec. 141. Grant program to encourage State innovation.
TITLE II—EXPANSION OF ACCESS TO AFFORDABLE HEALTH CARE FOR INDIVIDUALS AND FAMILIES
Subtitle A—Internal Revenue Code Provisions
Sec. 201. Refundable health insurance costs credit.
Sec. 202. Advance Payment of credit to issuers of qualified health insurance.
Subtitle B—Elimination of SCHIP Funding Shortfalls
Sec. 206. Elimination of SCHIP funding shortfalls for fiscal year 2007.
Subtitle C—FamilyCare
Sec. 211. Renaming of title
XXI program.Sec. 212. FamilyCare coverage of parents under the medicaid program and title
XXI.Sec. 213. Optional coverage of children through age 20 under the medicaid program and title
XXI.Sec. 214. Sense of the Senate Regarding Authority To Use SCHIP Funds To Purchase Family Coverage.
Subtitle D—Simplified Enrollment
Sec. 221. Automatic enrollment of children born to title
XXI parents.Sec. 222. Application of simplified title
XXI procedures under the medicaid program.Subtitle E—State Option to Extend Medicaid Coverage to Certain Low-Income Individuals
Sec. 231. State option to extend medicaid coverage to certain low-income individuals.
Subtitle F—Grants to Promote Innovative Outreach and Enrollment Under Medicaid and SCHIP
Sec. 251. Grants to promote innovative outreach and enrollment under medicaid and SCHIP.
Sec. 252. State option to provide for simplified determinations of a child’s financial eligibility for medical assistance under medicaid or child health assistance under SCHIP.
Subtitle G—Demonstration Programs to Improve Medicaid and SCHIP Outreach to Homeless Individuals and Families
Sec. 261. Demonstration programs to improve medicaid and SCHIP outreach to homeless individuals and families.
TITLE III—STRENGTHENING THE HEALTH CARE SAFETY NET
Sec. 301. Increase in funding for the consolidated health Centers program.
TITLE IV—EXPANSION OF ACCESS TO HEALTH CARE IN RURAL AND UNDERSERVED AREAS
Sec. 401. Expansion of funding.
Sec. 402. Loan repayment and scholarship programs.
TITLE V—EXPANDED ACCESS TO AFFORDABLE LONG-TERM CARE
Sec. 501. Treatment of premiums on qualified Long-Term care insurance contracts.
Sec. 502. Credit for taxpayers with Long-Term care needs.
Sec. 503. Additional consumer protections for Long-Term care insurance.
TITLE VI—PROMOTING HEALTHIER LIFESTYLES
Sec. 601. Community partnerships to promote healthy lifestyles.
Sec. 602. Worksite wellness grant program.
Sec. 603. Comprehensive school health education.
TITLE VII—MEDICARE FAIRNESS
Subtitle A—Medicare Value and Quality Demonstration
Sec. 701. Findings.
Sec. 702. Demonstration project to encourage the provision of high-quality, cost-effective inpatient hospital services.
Sec. 703. Demonstration project to encourage the provision of high-quality, cost-effective physicians’ services.
Subtitle B—Graduate Medical Education Demonstration
Sec. 711. Clinical rotation demonstration project.
EXPANSION OF ACCESS TO AFFORDABLE HEALTH CARE FOR SMALL BUSINESSES
Small Business Tax Credit
Credit for employee health insurance expenses
In General
Subpart D of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986 (relating to business-related credits) is amended by inserting after section 45M the following:
Employee health insurance expenses
General Rule
For purposes of section 38, in the case of an employer, the employee health insurance expenses credit determined under this section is an amount equal to the applicable percentage of the amount paid by the taxpayer during the taxable year for qualified employee health insurance expenses.
Applicable Percentage
For purposes of subsection (a), the applicable percentage is equal to—
50 percent in the case of an employer with less than 10 employees,
30 percent in the case of an employer with more than 9 but less than 26 employees, and
zero percent for any other employer.
Per Employee Dollar Limitation
The amount of qualified employee health insurance expenses taken into account under subsection (a) with respect to any qualified employee for any taxable year shall not exceed—
$2,000 in the case of self-only coverage, and
$4,000 in the case of family coverage (as defined in section 223(c)(4)).
Special Rules and Definitions
For purposes of this section—
Eligibility for credit
No credit shall be allowed under subsection (a) with respect to any employer for any period if more than 20 percent of the number of employees employed by the employer during the period are highly compensated employees (within the meaning of section 414(q)).
Determination of employment
In general
An employer shall be considered an employer described in paragraph (1) or (2) of subsection (b) if such employer employed an average of the number of employees described in such paragraph on business days during either of the 2 preceding calendar years. For purposes of the preceding sentence, a preceding calendar year may be taken into account only if the employer was in existence throughout such year.
Employers not in existence in preceding year
In the case of an employer which was not in existence throughout the 1st preceding calendar year, the determination under subparagraph (A) shall be based on the average number of employees that it is reasonably expected such employer will employ on business days in the current calendar year.
Qualified employee health insurance expenses
In general
The term qualified employee health insurance expenses means any amount paid by an employer for health insurance coverage to the extent such amount—
is attributable to coverage provided to any employee while such employee is a qualified employee; and
is at least 50 percent of the premium for such coverage.
Exception for amounts paid under salary reduction arrangements
No amount paid or incurred for health insurance coverage pursuant to a salary reduction arrangement shall be taken into account under subparagraph (A).
Health insurance coverage
The term health insurance coverage has the meaning given such term by section 9832(b)(1).
Qualified employee
In general
The term qualified employee means, with respect to any period, an employee of an employer if the total amount of wages paid or incurred by such employer to such employee at an annual rate during the taxable year is not less than $5,000.
Treatment of certain employees
For purposes of subparagraph (A), the term employee—
shall not include an employee within the meaning of section 401(c)(1), but
shall include a leased employee within the meaning of section 414(n).
Wages
The term wages has the meaning given such term by section 3121(a) (determined without regard to any dollar limitation contained in such section).
Certain Rules Made Applicable
For purposes of this section, rules similar to the rules of section 52 shall apply.
Denial of Double Benefit
No deduction or credit under any other provision of this chapter shall be allowed with respect to qualified employee health insurance expenses taken into account under subsection (a).
.
Credit To Be Part of General Business Credit
Section 38(b) of the Internal
Revenue Code of 1986 (relating to current year business credit) is amended by
striking plus
at the end of paragraph (29), by striking the
period at the end of paragraph (30) and inserting , plus
, and by
inserting after paragraph (30) the following:
the employee health insurance expenses credit determined under section 45N.
.
Clerical Amendment
The table of sections for subpart D of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986 is amended by adding at the end the following:
Sec. 45N. Employee health insurance expenses.
.
Effective Date
The amendments made by this section shall apply to amounts paid or incurred in taxable years beginning after December 31, 2007.
Grants to States for Small Business Purchasing Groups
Grants for small employer purchasing groups
In General
The Secretary of Labor (referred to in this section as
the Secretary
) shall award grants to States to assist such
States in planning, developing, and operating qualified small employer
purchasing groups.
Application Requirements
To be eligible to receive a grant under this section, a State shall prepare and submit to the Secretary an application in such form, at such time, and containing such information, certifications, and assurances as the Secretary shall reasonably require.
Use of Funds
Amounts awarded under this section may be used to finance the costs associated with planning, developing, and operating a qualified small employer purchasing group that meets the requirements of section 122. Such costs may include the costs associated with—
engaging in education and outreach efforts to inform small employers, insurers, and the public about the small employer purchasing group;
soliciting bids and negotiating with insurers to make available group health plans;
preparing the documentation required to receive certification by the Secretary as a qualified small employer purchasing group; and
such other activities determined appropriate by the Secretary.
Authorization of Appropriations
There are authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2008 through 2012.
Qualified small employer purchasing groups
Qualified Small Employer Purchasing Groups Described
In general
A qualified small employer purchasing group is an entity that—
is a nonprofit entity certified under State law;
has a membership consisting solely of small employers;
is administered solely under the authority and control of its member employers;
with respect to each State in which its members are located, consists of not fewer than the number of small employers established by the State as appropriate for such a group;
offers a program under which group health plans are offered to eligible employees and eligible individuals (including the dependents of such employees and individuals) through its member employers; and
an insurer, agent, broker, or any other individual or entity engaged in the sale of insurance—
does not form or underwrite; and
does not hold or control any right to vote with respect to.
Special rule
Notwithstanding paragraph (1)(B), an employer member of a small employer purchasing group that has been certified by the State as meeting the requirements of paragraph (1) may retain its membership in the group if the number of employees of the employer increases such that the employer is no longer a small employer.
Board of Directors
Each qualified small employer purchasing group established under this section shall be governed by a board of directors or have active input from an advisory board consisting of individuals and businesses participating in the group.
Membership
In general
A qualified small employer purchasing group shall accept all small employers residing within the area served by the group as members if such employers request such membership.
Voting
Members of a qualified small employer purchasing group shall have voting rights consistent with the rules established by the State.
Duties of Qualified Small Employer Purchasing Groups
Each qualified small employer purchasing group shall—
enter into agreements with insurers offering qualified group health plans;
enter into agreements with small employers for the purchase of health insurance;
enroll only eligible employees, eligible individuals, and the dependents of such employees and individuals in group health plans; and
provide enrollee information to the State.
Limitation on Activities
A qualified small employer purchasing group shall not—
perform any activity involving approval or enforcement of payment rates for providers;
assume financial risk in relation to any such health plan; or
perform other activities identified by the State as being inconsistent with the performance of its duties.
Rules of Construction
Establishment not required
Nothing in this section shall be construed as requiring that a State organize, operate, or otherwise establish a qualified small employer purchasing group, or otherwise require the establishment of purchasing groups.
Voluntary participation
Nothing in this section shall be construed as requiring any individual or small employer to purchase a group health plan exclusively through a qualified small employer purchasing group.
Definition
In this subtitle, the term small employer means an employer that employs at least 1, but not more than 50, employees. Such term shall include sole proprietorships and self-employed individuals.
Health Benefits Information for Small Employers
Grant program to facilitate health benefits information for small employers
In General
The Small Business Administration shall award grants to 1 or more States, local governments, and nonprofit organizations for the purposes of—
demonstrating new and effective ways to provide information about the benefits of health insurance to small employers, including tax benefits, increased productivity of employees, and decreased turnover of employees;
making small employers aware of their current rights in the marketplace under Federal and State health insurance reform laws; and
making small employers aware of the tax treatment of insurance premiums.
Authorization
There is authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2008 through 2012.
Grant Program To Encourage State Innovation
Grant program to encourage State innovation
In General
The Secretary of Health and Human Services (in this
section referred to as the Secretary
) shall establish a program
(in this section referred to as the program
) to award
demonstration grants under this section to States to allow States to
demonstrate the effectiveness of innovative ways to increase access to health
insurance through market reforms and other innovative means. Such innovative
means may include any of the following:
Alternative group purchasing or pooling arrangements, such as purchasing cooperatives for small businesses, reinsurance pools, or high risk pools.
Individual or small group market reforms.
Consumer education and outreach.
Subsidies to individuals, employers, or both, in obtaining health insurance.
Scope; Duration
The program shall be limited to not more than 10 States and to a total period of 5 years, beginning on the date the first demonstration grant is made.
Conditions for Demonstration Grants
In general
The Secretary may not provide for a demonstration grant to a State under the program unless the Secretary finds that under the proposed demonstration grant—
the State will provide for demonstrated increase of access for some portion of the existing uninsured population through a market innovation (other than merely through a financial expansion of a program initiated before the date of enactment of this Act);
the State will comply with applicable Federal laws;
the State will not discriminate among participants on the basis of any health status-related factor (as defined in section 2791(d)(9) of the Public Health Service Act (42 U.S.C. 300gg–91(d)(9)), except to the extent a State wishes to focus on populations that otherwise would not obtain health insurance because of such factors; and
the State will provide for such evaluation, in coordination with the evaluation required under subsection (d), as the Secretary may specify.
Application
The Secretary shall not provide a demonstration grant under the program to a State unless—
the State submits to the Secretary such an application, in such a form and manner, as the Secretary specifies;
the application includes information regarding how the demonstration grant will address issues such as governance, targeted population, expected cost, and the continuation after the completion of the demonstration grant period; and
the Secretary determines that the demonstration grant will be used consistent with this section.
Focus
A demonstration grant proposal under this section need not cover all uninsured individuals in a State or all health care benefits with respect to such individuals.
Evaluation
The Secretary shall enter into a contract with an appropriate entity outside the Department of Health and Human Services to conduct an overall evaluation of the program at the end of the program period. Such evaluation shall include an analysis of improvements in access, costs, quality of care, or choice of coverage, under different demonstration grants.
Option To Provide for Initial Planning Grants
Notwithstanding the previous provisions of this section, under the program the Secretary may provide for a portion of the amounts appropriated under subsection (f) (not to exceed $5,000,000) to be made available to any State for initial planning grants to permit States to develop demonstration grant proposals under the previous provisions of this section.
Authorization of Appropriations
There are authorized to be appropriated such sums as may be necessary to carry out this section. Amounts appropriated under this subsection shall remain available until expended.
State Defined
In this section, the term State has the meaning given such term for purposes of title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).
EXPANSION OF ACCESS TO AFFORDABLE HEALTH CARE FOR INDIVIDUALS AND FAMILIES
Internal Revenue Code Provisions
Refundable health insurance costs credit
Allowance of Credit
In general
Subpart C of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986 (relating to refundable personal credits) is amended by redesignating section 36 as section 37 and inserting after section 35 the following:
Health insurance costs for uninsured eligible individuals
Allowance of Credit
In the case of an uninsured eligible individual, there shall be allowed as a credit against the tax imposed by this subtitle for the taxable year an amount equal to the amount paid by the taxpayer during such taxable year for qualified health insurance for the taxpayer and the taxpayer’s spouse and dependents.
Limitations
In general
The amount allowed as a credit under subsection (a) to the taxpayer for the taxable year shall not exceed the lesser of—
the sum of the monthly limitations for coverage months during such taxable year for the individuals referred to in subsection (a) for whom the taxpayer paid during the taxable year any amount for coverage under qualified health insurance, or
90 percent of the amount paid by the taxpayer during such taxable year for qualified health insurance for such individuals.
Monthly limitation
In general
The monthly limitation for an individual for each coverage month of such individual during the taxable year is the amount equal to 1/12 of—
$1,000 if such individual is the taxpayer,
$1,000 if—
such individual is the spouse of the taxpayer,
the taxpayer and such spouse are married as of the first day of such month, and
the taxpayer files a joint return for the taxable year, and
$500 if such individual is an individual for whom a deduction under section 151(c) is allowable to the taxpayer for such taxable year.
Limitation to 2 dependents
Not more than 2 individuals may be taken into account by the taxpayer under subparagraph (A)(iii).
Special rule for married individuals
In the case of an individual—
who is married (within the meaning of section 7703) as of the close of the taxable year but does not file a joint return for such year, and
who does not live apart from such individual’s spouse at all times during the taxable year,
Phaseout of credit
In general
The amount which would (but for this paragraph) be taken into account under subsection (a) shall be reduced (but not below zero) by the amount determined under subparagraph (B).
Amount of reduction
The amount determined under this subparagraph is the amount which bears the same ratio to the amount which would be so taken into account for the taxable year as—
the excess of—
the taxpayer’s modified adjusted gross income for the preceding taxable year, over
$15,000 ($25,000 in the case of family coverage), bears to
$15,000 ($35,000 in the case of family coverage).
Modified adjusted gross income
The term modified adjusted gross income means adjusted gross income determined—
without regard to this section and sections 911, 931, and 933, and
after application of sections 86, 135, 137, 219, 221, and 469.
Coverage month
For purposes of this subsection—
In general
The term coverage month means, with respect to an individual, any month if—
as of the first day of such month such individual is covered by qualified health insurance, and
the premium for coverage under such insurance for such month is paid by the taxpayer.
Employer-subsidized coverage
In general
Such term shall not include any month for which such individual is eligible to participate in any subsidized health plan (within the meaning of section 162(l)(2)) maintained by any employer of the taxpayer or of the spouse of the taxpayer.
Premiums to nonsubsidized plans
If an employer of the taxpayer or the spouse of the taxpayer maintains a health plan which is not a subsidized health plan (as so defined) and which constitutes qualified health insurance, employee contributions to the plan shall be treated as amounts paid for qualified health insurance.
Cafeteria plan and flexible spending account beneficiaries
Such term shall not include any month during a taxable year if any amount is not includible in the gross income of the taxpayer for such year under section 106 with respect to—
a benefit chosen under a cafeteria plan (as defined in section 125(d)), or
a benefit provided under a flexible spending or similar arrangement.
Medicare and medicaid
Such term shall not include any month with respect to an individual if, as of the first day of such month, such individual—
is entitled to any benefits under title XVIII of the Social Security Act, or
is a participant in the program under title XIX or XXI of such Act.
Certain other coverage
Such term shall not include any month during a taxable year with respect to an individual if, at any time during such year, any benefit is provided to such individual under—
chapter 89 of title 5, United States Code,
chapter 55 of title 10, United States Code,
chapter 17 of title 38, United States Code, or
any medical care program under the Indian Health Care Improvement Act.
Prisoners
Such term shall not include any month with respect to an individual if, as of the first day of such month, such individual is imprisoned under Federal, State, or local authority.
Insufficient presence in united states
Such term shall not include any month during a taxable year with respect to an individual if such individual is present in the United States on fewer than 183 days during such year (determined in accordance with section 7701(b)(7)).
Coordination with deduction for health insurance costs of self-employed individuals
In the case of a taxpayer who is eligible to deduct any amount under section 162(l) for the taxable year, this section shall apply only if the taxpayer elects not to claim any amount as a deduction under such section for such year.
Qualified Health Insurance
For purposes of this section, the term qualified health insurance means health insurance coverage (as defined in section 9832(b)(1)), including coverage under a COBRA continuation provision (as defined in section 9832(d)(1)).
Archer MSA Contributions
If a deduction would be allowed under section 220 to the taxpayer for a payment for the taxable year to the Archer MSA of an individual, subsection (a) shall not apply to the taxpayer for such taxable year.
Special Rules
Coordination with medical expense deduction
The amount which would (but for this paragraph) be taken into account by the taxpayer under section 213 for the taxable year shall be reduced by the credit (if any) allowed by this section to the taxpayer for such year.
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.
Coordination with advance payment
Rules similar to the rules of section 32(g) shall apply to any credit to which this section applies.
Expenses Must Be Substantiated
A payment for insurance to which subsection (a) applies may be taken into account under this section only if the taxpayer substantiates such payment in such form as the Secretary may prescribe.
Regulations
The Secretary shall prescribe such regulations as may be necessary to carry out the purposes of this section.
.
Information Reporting
In general
Subpart B of part III of subchapter A of chapter 61 of the Internal Revenue Code of 1986 (relating to information concerning transactions with other persons) is amended by inserting after section 6050V the following:
Returns relating to payments for qualified health insurance
In General
Any person who, in connection with a trade or business conducted by such person, receives payments during any calendar year from any individual for coverage of such individual or any other individual under creditable health insurance, shall make the return described in subsection (b) (at such time as the Secretary may by regulations prescribe) with respect to each individual from whom such payments were received.
Form and Manner of Returns
A return is described in this subsection if such return—
is in such form as the Secretary may prescribe, and
contains—
the name, address, and TIN of the individual from whom payments described in subsection (a) were received,
the name, address, and TIN of each individual who was provided by such person with coverage under creditable health insurance by reason of such payments and the period of such coverage,
the aggregate amount of payments described in subsection (a),
the qualified health insurance credit advance amount (as defined in section 7527A(e)) received by such person with respect to the individual described in subparagraph (A), and
such other information as the Secretary may reasonably prescribe.
Creditable Health Insurance
For purposes of this section, the term creditable health insurance means qualified health insurance (as defined in section 36(c)).
Statements To Be Furnished to Individuals With Respect to Whom Information Is Required
Every person required to make a return under subsection (a) shall furnish to each individual whose name is required under subsection (b)(2)(A) to be set forth in such return a written statement showing—
the name and address of the person required to make such return and the phone number of the information contact for such person,
the aggregate amount of payments described in subsection (a) received by the person required to make such return from the individual to whom the statement is required to be furnished,
the information required under subsection (b)(2)(B) with respect to such payments, and
the qualified health insurance credit advance amount (as defined in section 7528(e)) received by such person with respect to the individual described in paragraph (2).
Returns Which Would Be Required To Be Made by 2 or More Persons
Except to the extent provided in regulations prescribed by the Secretary, in the case of any amount received by any person on behalf of another person, only the person first receiving such amount shall be required to make the return under subsection (a).
.
Assessable penalties
Subparagraph (B)
of section 6724(d)(1) of such Code (relating to definitions) is amended by
striking and
at the end of clause (xx) and by inserting after
clause (xx) the following:
section 6050U (relating to returns relating to payments for qualified health insurance), and
.
Paragraph (2) of
section 6724(d) of such Code is amended by striking or
at the
end of subparagraph (BB), by striking the period at the end of the subparagraph
(CC) and inserting , or
, and by adding at the end the
following:
section 6050U(d) (relating to returns relating to payments for qualified health insurance).
.
Clerical amendment
The table of sections for subpart B of part III of subchapter A of chapter 61 of such Code is amended by inserting after the item relating to section 6050V the following:
Sec. 6050W. Returns relating to payments for qualified health insurance.
.
Criminal Penalty for Fraud
Subchapter B of chapter 75 of the Internal Revenue Code of 1986 (relating to other offenses) is amended by adding at the end the following:
Penalties for offenses relating to health insurance tax credit
Any person who knowingly misuses Department of the Treasury names, symbols, titles, or initials to convey the false impression of association with, or approval or endorsement by, the Department of the Treasury of any insurance products or group health coverage in connection with the credit for health insurance costs under section 36 shall on conviction thereof be fined not more than $10,000, or imprisoned not more than 1 year, or both.
.
Conforming Amendments
Section 162(l) of the Internal Revenue Code of 1986 is amended by adding at the end the following:
Election to have subsection apply
No deduction shall be allowed under paragraph (1) for a taxable year unless the taxpayer elects to have this subsection apply for such year.
.
Paragraph (2) of
section 1324(b) of title 31, United States Code, is amended by inserting before
the period , or from section 36 of such Code
.
The table of sections for subpart C of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986 is amended by striking the last item and inserting the following:
Sec. 36. Health insurance costs for uninsured eligible individuals.
Sec. 37. Overpayments of tax.
.
The table of sections for subchapter B of chapter 75 of such Code is amended by adding at the end the following:
Sec. 7276. Penalties for offenses relating to health insurance tax credit.
.
Effective Dates
In general
Except as provided in paragraph (2), the amendments made by this section shall apply to taxable years beginning after December 31, 2006, without regard to whether final regulations to carry out such amendments have been promulgated by such date.
Penalties
The amendments made by subsections (c) and (d)(4) shall take effect on the date of the enactment of this Act.
Advance payment of credit to issuers of qualified health insurance
In General
Chapter 77 of the Internal Revenue Code of 1986 (relating to miscellaneous provisions) is amended by inserting after section 7527 the following:
Advance Payment of health insurance credit for purchasers of qualified health insurance
General Rule
Every plan sponsor of a group health plan providing, or qualified health insurance issuer of, qualified health insurance to an eligible individual shall—
make qualified premium payments with respect to such individual in an amount equal to the qualified health insurance credit advance amount, and
treat such payments in the manner provided in subsection (g).
Eligible Individual
For purposes of this section, the term eligible individual means any individual—
who purchases qualified health insurance (as defined in section 36(c)), and
for whom a qualified health insurance credit eligibility certificate is in effect.
Definitions
For purposes of this section—
Qualified health insurance issuer
The term qualified health insurance issuer means a health insurance issuer described in section 9832(b)(2) (determined without regard to the last sentence thereof) offering coverage in connection with a group health plan.
Group health plan
The term group health plan has the meaning given such term by section 5000(b)(1) (determined without regard to subsection (d) thereof).
Qualified premium payments
The term qualified premium payments means any amount paid or incurred, cost incurred, or health coverage value provided, with respect to qualified health insurance for an eligible individual and the individual’s spouse and dependents. For purposes of the preceding sentence, in the case of a group health plan, the health coverage value is equal to the applicable premium under the plan for the qualified health insurance coverage provided to an eligible individual and the individual’s spouse and dependents, as determined under section 4980B.
Qualified Health Insurance Credit Eligibility Certificate
For purposes of this section, a qualified health insurance credit eligibility certificate is a statement furnished by an individual to a plan sponsor of a group health plan or qualified health insurance issuer which—
certifies that the individual will be eligible to receive the credit provided by section 36 for the taxable year,
estimates the amount of such credit for such taxable year, and
provides such other information as the Secretary may require for purposes of this section.
Qualified Health Insurance Credit Advance Amount
For purposes of this section, the term qualified health insurance credit advance amount means, with respect to any plan sponsor of a group health plan providing, or qualified health insurance issuer of, qualified health insurance, the amount of credit allowable under section 36 to the individual for the taxable year which is attributable to the insurance provided to the individual by such sponsor or issuer.
Required Documentation for Receipt of Payments of Advance Amount
No payment of a qualified health insurance credit advance amount with respect to any eligible individual may be made under subsection (a) unless the plan sponsor of the group health plan or qualified health insurance issuer provides to the Secretary—
the qualified health insurance credit eligibility certificate of such individual, and
the return relating to such individual under section 6050W.
Qualified Premium Payments To Be Treated as Payments of Withholding Amounts and Certain Employer Tax
In general
For purposes of this title, qualified premium payments made or costs incurred by the sponsor of a group health plan, or any entity designated by the sponsor to make such payments or incur such costs—
shall not be treated as compensation, and
shall be treated, in such manner as provided by the Secretary, as made out of—
amounts required to be deposited by the taxpayer as estimated income tax under section 6654 or 6655,
amounts required to be deducted and withheld under section 3401 (relating to wage withholding),
amounts of the taxes imposed under section 3111(a) or 50 percent of taxes imposed under section 1401(a) (relating to FICA employer taxes), or
amounts required to be deducted under section 3102 with respect to taxes imposed under section 3101(a) or 50 percent of taxes imposed under section 1401(a) (relating to FICA employee taxes),
Qualified premium payments exceed taxes due
In the case of any entity, if for any time period the aggregate qualified premium payments exceed the amounts described in paragraph (1)(B), the Secretary shall reduce amounts described in such paragraph for any succeeding time period as necessary to reflect such excess.
Failure to make qualified premium payments
For purposes of this title (including penalties), failure to make a qualified premium payment with respect to an eligible individual at the time provided therefor shall be treated as the failure at such time to deduct and withhold under chapter 24 of such Code in an amount equal to the amount of such qualified premium payments.
Regulations
The Secretary shall prescribe such regulations as may be necessary to carry out the purposes of this section.
.
Clerical Amendment
The table of sections for chapter 77 of the Internal Revenue Code of 1986 is amended by inserting after the item relating to section 7527 the following:
Sec. 7527A. Advance payment of health insurance credit for purchasers of qualified health insurance.
.
Effective Date
The amendments made by this section shall take effect on January 1, 2008, without regard to whether final regulations to carry out such amendments have been promulgated by such date.
Elimination of SCHIP Funding Shortfalls
Elimination of SCHIP funding shortfalls for fiscal year 2007
In general
Section 2104(h) of the Social Security Act (42 U.S.C. 1397dd(h)), as added by section 201 of the National Institutes of Health Reform Act of 2006, is amended to read as follows:
Special rule for redistribution of unspent fiscal year 2004 allotments and additional allotments To eliminate fiscal year 2007 funding shortfalls
Special rule for redistribution of fiscal year 2004 allotments
In general
In the case of a State that expends all of its allotment under subsection (b) or (c) of this section for fiscal year 2004 by the end of fiscal year 2006 and is an initial shortfall State described in subparagraph (B), the Secretary shall redistribute to the State under subsection (f) of this section (from the fiscal year 2004 allotments of other States) the following amount:
State
In the case of one of the 50 States or the District of Columbia, the amount specified in subparagraph (C)(i) (less the total of the amounts under clause (ii)), multiplied by the ratio of the amount specified in subparagraph (C)(ii) for the State to the amount specified in subparagraph (C)(iii).
Territory
In the case of a commonwealth or territory described in subsection (c)(3), an amount that bears the same ratio to 1.05 percent of the amount specified in subparagraph (C)(i) as the ratio of the commonwealth's or territory's fiscal year 2004 allotment under subsection (c) bears to the total of all such allotments for such fiscal year under such subsection.
Initial shortfall state described
For purposes of subparagraph (A), an initial shortfall State is a State with a State child health plan approved under this title for which the Secretary estimates, on the basis of the most recent data available to the Secretary as of the date of the enactment of this subsection, that the projected Federal expenditures under such plan for such State for fiscal year 2007 will exceed the sum of—
the amount of the State's allotments for each of fiscal years 2005 and 2006 that will not be expended by the end of fiscal year 2006; and
the amount of the State's allotment for fiscal year 2007.
Amounts used in computing redistributions for fiscal year 2004 allotments
For purposes of subparagraph (A)(i)—
the amount specified in this clause is the total amount of unspent fiscal year 2004 allotments available for redistribution under subsection (f);
the amount specified in this clause for an initial shortfall State is the amount the Secretary determines will eliminate the estimated shortfall described in subparagraph (B) for the State; and
the amount specified in this clause is the total sum of the amounts specified in clause (ii) for all initial shortfall States.
Additional allotments to eliminate fiscal year 2007 funding shortfalls remaining after redistribution of unspent fiscal year 2004 allotments
In general
In addition to the allotments provided under subsection (b) and (c) for fiscal year 2007, the Secretary shall allot to each remaining shortfall State described in subparagraph (B) such amount as the Secretary determines will eliminate the estimated shortfall described in such subparagraph for the State.
Remaining shortfall state described
For purposes of subparagraph (A), a remaining shortfall State is a State (including a commonwealth or territory described in subsection (c)(3)) with a State child health plan approved under this title for which the Secretary estimates, on the basis of the most recent data available to the Secretary as of the date of the enactment of this subsection, that the projected Federal expenditures under such plan for such State for fiscal year 2007 will exceed the sum of—
the amount of the State's allotments for each of fiscal years 2005 and 2006 that will not be expended by the end of fiscal year 2006;
the amount of the State's allotment for fiscal year 2007; and
the amount, if any, of unspent allotments for fiscal year 2004 that are to be redistributed to the State during fiscal year 2007 in accordance with subsection (f) and paragraph (1).
1-year availability; no redistribution of unexpended additional allotments
Notwithstanding subsections (e) and (f), amounts allotted to a remaining shortfall State pursuant to this paragraph shall only remain available for expenditure by the State through September 30, 2007. Any amounts of such allotments that remain unexpended as of such date shall not be subject to redistribution under subsection (f) and shall revert to the Treasury on October 1, 2007.
Appropriation; allotment authority
For the purpose of providing additional allotments to remaining shortfall States under this paragraph there is appropriated, out of any funds in the Treasury not otherwise appropriated, such sums as are necessary for fiscal year 2007.
.
Effective date
The amendments made by this section apply to items and services furnished on or after October 1, 2006, without regard to whether or not regulations implementing such amendments have been issued.
Period of effectiveness
Section 2104(h)(2) of the Social Security Act (as added by subsection (a)) shall terminate on September 30, 2007, and shall be considered to have expired notwithstanding section 257 of the Balanced Budget and Emergency Deficit Control Act of 1985 (2 U.S.C. 907).
Effect on provisions added by the National Institutes of Health Reform Act of 2006
The Social Security Act shall be administered as if section 2104(h) of such Act, as added by section 201(a) of the National Institutes of Health Reform Act, had not been enacted.
FamilyCare
Renaming of title XXI program
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:
FAMILYCARE PROGRAM
.
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.
FamilyCare coverage of parents under the Medicaid program and title XXI
Incentives To Implement FamilyCare Coverage
Under medicaid
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—
by
striking or
at the end of subclause (XVIII);
by
adding or
at the end of subclause (XIX); and
by adding at the end the following:
who are individuals described in subsection (k)(1) (relating to parents of categorically eligible children);
.
Parents described
Section 1902 of the Social Security Act is further amended by inserting after subsection (j) the following:
Individuals described in this paragraph are individuals—
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);
who are not otherwise eligible for medical assistance under such subsection, under section 1931, or under a waiver approved under section 1115 or otherwise (except under subsection (a)(10)(A)(ii)(XX)); and
whose family income exceeds the income 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 income level applicable to a child in the family under this title.
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) based on the ages of children described in subsection (l)(1) in order to ensure, to the maximum extent possible, that such individuals shall be enrolled in the same program as their children.
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.
In this subsection, the term parent includes an individual treated as a caregiver for purposes of carrying out section 1931.
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.
.
Enhanced matching funds available if certain conditions met
Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended—
in
the fourth sentence of subsection (b), by striking or subsection
(u)(3)
and inserting , (u)(3), or (u)(4)
; and
in subsection (u)—
by redesignating paragraph (4) as paragraph (6), and
by inserting after paragraph (3) the following:
For purposes of subsection (b) and section 2105(a)(1)—
FamilyCare parents
The expenditures described in this subparagraph are the expenditures described in the following clauses (i) and (ii):
Parents
If the conditions described in clause (iii) 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.
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 income level applicable under section 1902(l)(2)(A) to a family of the size involved as of January 1, 2007.
Conditions
The conditions described in this clause are the following:
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.
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.
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.
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, 2007, to be eligible for medical assistance as a parent under this title.
Definitions
For purposes of this subsection:
The term parent has the meaning given such term for purposes of section 1902(k)(1).
The term poverty line has the meaning given such term in section 2110(c)(5).
.
Appropriation from title xxi allotment for certain medicaid expansion costs
Section 2105(a)(1) of the Social Security Act is amended by striking
and
at the end of subparagraph (C), by striking the period at
the end of subparagraph (D) and inserting ; and
, and by adding
at the end the following:
for making expenditures for medical assistance that is attributable to expenditures described in section 1905(u)(4)(A).
.
Only counting enhanced portion for coverage of additional pregnant women
Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended—
in
the fourth sentence of subsection (b), by inserting (except in the case
of expenditures described in subsection (u)(5))
after do not
exceed
; and
in subsection (u), by inserting after paragraph (4) (as inserted by subparagraph (C)), the following:
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:
Regular fmap for expenditures for pregnant women with income above january 1, 2007 income level and below 185 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.
.
Under title xxi
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:
Optional FamilyCare coverage of parents of targeted low-income children
Optional Coverage
Notwithstanding any other provision of this title, a State child health plan may provide for coverage, through an amendment to its State child health plan under section 2102, of FamilyCare assistance for individuals who are targeted low-income parents in accordance with this section, but only if—
the State meets the conditions described in section 1905(u)(4)(A)(iii); and
the State elects to provide medical assistance under section 1902(a)(10)(A)(ii)(XX), under section 1931, or under a waiver under section 1115 to individuals described in section 1902(k)(1)(A)(i) and elects an applicable income level for such individuals that consistent with paragraphs (1)(B) and (2) of section 1902(k), ensures to the maximum extent possible, that those 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)).
.
Definitions
For purposes of this title:
FamilyCare assistance
The term FamilyCare 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.
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—
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;
in paragraph (3), January 1, 2007, shall be substituted for July 1, 1997; and
in paragraph (4), January 1, 2007, shall be substituted for March 31, 1997.
Parent
The term parent includes an individual treated as a caregiver for purposes of carrying out section 1931.
Optional treatment of pregnant women as parents
A State child health plan may treat a pregnant woman who is not otherwise a parent as a targeted low-income parent for purposes of this section but only if the State has established an income level under section 1902(l)(2)(A)(i) for pregnant women that is at least 185 percent of the income official poverty line described in such section.
References to Terms and Special Rules
In the case of, and with respect to, a State providing for coverage of FamilyCare assistance to targeted low-income parents under subsection (a), the following special rules apply:
Any reference in this title (other than subsection (b)) to a targeted low-income child is deemed to include a reference to a targeted low-income parent.
Any such reference to child health assistance with respect to such parents is deemed a reference to FamilyCare assistance.
In applying section 2103(e)(3)(B) in the case of a family provided coverage under this section, the limitation on total annual aggregate cost-sharing shall be applied to the entire family.
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 income level
applicable to parents under section 1931 or under a waiver approved under
section 1115, or, in the case of a pregnant woman described in subsection
(b)(4), the income level established under section 1902(l)(2)(A).
In applying section 2102(b)(3)(B), any reference to children is deemed a reference to parents.
.
Additional allotment for states providing familycare
In general
Section 2104 of the Social Security Act (42 U.S.C. 1397dd), as amended by this Act, is amended by inserting after subsection (h) the following:
Additional Allotments for State Providing FamilyCare
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—
such sums as may be necessary to provide such coverage for fiscal year 2008, and
for fiscal year 2008 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).
State and territorial allotments
In general
In addition to the allotments provided under subsections (b), (c), (d), and (h), 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—
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
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.
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.
Use of additional allotment
Additional allotments provided under this subsection are not available for amounts expended before October 1, 2007. 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 FamilyCare assistance.
Requiring election to provide familycare 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 FamilyCare assistance.
.
Conforming amendments
Section 2104 of the Social Security Act (42 U.S.C. 1397dd) is amended—
in subsection
(a), by inserting or subsection (i),
after subsection
(d),
;
in subsection
(b)(1), by striking subsection (d)
and inserting
subsections (d) and (i)
; and
in subsection
(c)(1), by inserting or subsection (i),
after subsection
(d)
.
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—
in
the heading, by inserting and pregnancy-related
services
after preventive
services
; and
by
inserting before the period at the end the following: and for
pregnancy-related services
.
Effective date
The amendments made by this subsection apply to items and services furnished on or after October 1, 2007, whether or not regulations implementing such amendments have been issued.
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:
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 (as defined for purposes of section 1902(k)(1)) of a child with respect to whom such a period is provided under this section.
.
Conforming Amendments
Eligibility categories
Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended, in the matter before paragraph (1)—
by striking
or
at the end of clause (xii);
by inserting
or
at the end of clause (xiii); and
by inserting after clause (xiii) the following:
who are parents described (or treated as if described) in section 1902(k)(1),
.
Income limitations
Section 1903(f)(4) of the
Social Security Act (42 U.S.C.
1396b(f)(4)) is amended by inserting 1902(a)(10)(A)(ii)(XX),
after 1902(a)(10)(A)(ii)(XVIII),
.
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—
by striking
, and
at the end of clause (i) and inserting a semicolon;
by striking the
period at the end of clause (ii) and inserting ; and
; and
by adding at the end the following:
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.
.
Optional coverage of children through age 20 under the Medicaid program and title XXI
Medicaid
In general
Section 1902(l)(1)(D) of the
Social Security Act (42 U.S.C.
1396a(l)(1)(D)) is amended by inserting (or, at the election of a State,
20 or 21 years of age)
after 19 years of age
.
Conforming amendments
Section
1902(e)(3)(A) of the Social Security Act
(42 U.S.C. 1396a(e)(3)(A)) is amended by inserting (or 1 year
less than the age the State has elected under subsection (l)(1)(D))
after 18 years of age
.
Section
1902(e)(12) of the Social Security Act
(42 U.S.C. 1396a(e)(12)) is amended by inserting or such
higher age as the State has elected under subsection (l)(1)(D)
after
19 years of age
.
Section
1920A(b)(1) of the Social Security Act
(42 U.S.C. 1396r–1a(b)(1)) is amended by inserting or such
higher age as the State has elected under section 1902(l)(1)(D)
after
19 years of age
.
Section
1928(h)(1) of the Social Security Act
(42 U.S.C. 1396s(h)(1)) is amended by inserting or 1 year
less than the age the State has elected under section 1902(l)(1)(D)
before the period at the end.
Section
1932(a)(2)(A) of the Social Security Act
(42 U.S.C. 1396u–2(a)(2)(A)) is amended by inserting (or such
higher age as the State has elected under section 1902(l)(1)(D))
after
19 years of age
.
Title XXI
Section 2110(c)(1) of the
Social Security Act (42 U.S.C.
1397jj(c)(1)) is amended by inserting (or such higher age as the State
has elected under section 1902(l)(1)(D))
.
Effective Date
The amendments made by this section take effect on October 1, 2007, and apply to medical assistance and child health assistance provided on or after such date, whether or not regulations implementing such amendments have been issued.
Sense of the Senate Regarding Authority To Use SCHIP Funds To Purchase Family Coverage
It is the sense of the Senate that section 2105(c)(3) of the Social Security Act (42 U.S.C. 1397ee(c)(3)) permits States to use funds provided under the State children’s health insurance program established under title XXI of that Act (42 U.S.C. 1397aa et seq.) to help low-income working families and pregnant women eligible for assistance under that program pay their share of employer-sponsored health insurance coverage.
Simplified Enrollment
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:
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.
.
Application of simplified title XXI procedures under the Medicaid program
Application Under Medicaid
In general
Section 1902(l) of the Social Security Act (42 U.S.C. 1396a(l)) is amended—
in paragraph (3),
by inserting subject to paragraph (5),
, after
Notwithstanding subsection (a)(17),
; and
by adding at the end the following:
With respect to determining the eligibility of individuals under 19 years of age (or such higher age as the State has elected under paragraph (1)(D)) for medical assistance under subsection (a)(10)(A) and, separately, with respect to determining the eligibility of individuals for medical assistance under subsection (a)(10)(A)(ii)(XX), notwithstanding any other provision of this title, if the State has established a State child health plan under title XXI—
the State may not apply a resource standard;
the State shall use the same simplified eligibility form (including, if applicable, permitting application other than in person) as the State uses under such State child health plan with respect to such individuals;
the State shall provide for initial eligibility determinations and redeterminations of eligibility using verification policies, forms, and frequency that are no less restrictive than the policies, forms, and frequency the State uses for such purposes under such State child health plan with respect to such individuals; and
the State shall not require a face-to-face interview for purposes of initial eligibility determinations and redeterminations unless the State requires such an interview for such purposes under such child health plan with respect to such individuals.
.
Effective date
The amendments made by paragraph (1) apply to determinations of eligibility made on or after the date that is 1 year after the date of enactment of this Act, whether or not regulations implementing such amendments have been issued.
Presumptive Eligibility
In general
Section 1920A(b)(3)(A)(i) of the
Social Security Act (42 U.S.C.
1396r–1a(b)(3)(A)(i)) is amended by inserting a child care resource and
referral agency,
after a State or tribal child support
enforcement agency,
.
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).
.
Application under title xxi
In general
Section 2107(e)(1)(D) of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended to read as follows:
Sections 1920 and 1920A (relating to presumptive eligibility).
.
Conforming elimination of resource test
Section 2102(b)(1)(A) of such Act (42 U.S.C. 1397bb(b)(1)(A)) is amended—
by
striking and resources (including any standards relating to spenddowns
and disposition of resources)
; and
by
adding at the end the following: Effective 1 year after the date of
enactment of the Access to Affordable Health Care Act, such standards may not
include the application of a resource standard or test.
.
Automatic Reassessment of Eligibility for Title XXI and Medicaid Benefits for Children Losing Medicaid or Title XXI Eligibility
Loss of medicaid eligibility
Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) is amended—
by striking
and
at the end of paragraph (69),
by striking the
period at the end of paragraph (70) and inserting ; and
,
and
by inserting after paragraph (70) the following:
provide, in the case of a State with a State child health plan under title XXI, that before medical assistance to a child (or a parent of a child) is discontinued under this title, a determination of whether the child (or parent) is eligible for benefits under title XXI shall be made and, if determined to be so eligible, the child (or parent) shall be automatically enrolled in the program under such title without the need for a new application.
.
Loss of title xxi eligibility and coordination with medicaid
Section 2102(b) (42 U.S.C. 1397bb(b)) is amended—
in paragraph (3), by redesignating subparagraphs (D) and (E) as subparagraphs (E) and (F), respectively, and by inserting after subparagraph (C) the following:
that before health assistance to a child (or a parent of a child) is discontinued under this title, a determination of whether the child (or parent) is eligible for benefits under title XIX is made and, if determined to be so eligible, the child (or parent) is automatically enrolled in the program under such title without the need for a new application;
;
by redesignating paragraph (4) as paragraph (5); and
by inserting after paragraph (3) the following new paragraph:
Coordination with medicaid
The State shall coordinate the screening and enrollment of individuals under this title and under title XIX consistent with the following:
Information that is collected under this title or under title XIX which is needed to make an eligibility determination under the other title shall be transmitted to the appropriate administering entity under such other title in a timely manner so that coverage is not delayed and families do not have to submit the same information twice. Families shall be provided the information they need to complete the application process for coverage under both titles and be given appropriate notice of any determinations made on their applications for such coverage.
If a State does not use a joint application under this title and such title, the State shall—
promptly inform a child’s parent or caretaker in writing and, if appropriate, orally, that a child has been found likely to be eligible under title XIX;
provide the family with an application for medical assistance under such title and offer information about what (if any) further information, documentation, or other steps are needed to complete such application process;
offer assistance in completing such application process; and
promptly transmit the separate application under this title or the information obtained through such application, and all other relevant information and documentation, including the results of the screening process, to the State agency under title XIX for a final determination on eligibility under such title.
Applicants are notified in writing of—
benefits (including restrictions on cost-sharing) under title XIX; and
eligibility rules that prohibit children who have been screened eligible for medical assistance under such title from being enrolled under this title, other than provisional temporary enrollment while a final eligibility determination is being made under such title.
If the agency administering this title is different from the agency administering a State plan under title XIX, such agencies shall coordinate the screening and enrollment of applicants for such coverage under both titles.
The coordination procedures established between the program under this title and under title XIX shall apply not only to the initial eligibility determination of a family but also to any renewals or redeterminations of such eligibility.
.
Effective date
The amendments made by paragraphs (1) and (2) apply to individuals who lose eligibility under the medicaid program under title XIX, or under a State child health insurance plan under title XXI, respectively, of the Social Security Act on or after October 1, 2007 (or, if later, 60 days after the date of enactment of this Act), whether or not regulations implementing such amendments have been issued.
Provision of Medicaid and CHIP Applications and Information Under the School Lunch Program
Section 9(b)(2)(B)(iii) of the Richard B. Russell National School Lunch Act (42 U.S.C. 1758(b)(2)(B)(iii)) is amended by adding at the end the following:
Notice of availability of health benefits under medicaid and chip
Descriptive material distributed in accordance with clause (i) shall also contain information (provided on a form separate from the application form for free and reduced price lunches) 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.
.
12 Months of Continuous Eligibility
Medicaid
Section 1902(e)(12) of the Social Security Act (42 U.S.C. 1396a(e)(12)) is amended—
by striking
At the option of the State, the plan may
and inserting
The plan shall
;
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
in subparagraph
(A), by striking a period (not to exceed 12 months)
and
inserting the 12-month period beginning on the date
.
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
12 months of continuous eligibility for children under this title in the same
manner that section 1902(e)(12) provides 12 months of continuous eligibility
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 12 months of
continuous eligibility for parents under this title in the same manner that
such section provides 12 months of continuous eligibility for parents described
in such section under title XIX.
.
Effective date
In general
The amendments made by this subsection take effect on October 1, 2007 (or, if later, 60 days after the date of enactment of this Act), whether or not regulations implementing such amendments have been issued.
State Option To Extend Medicaid Coverage to Certain Low-Income Individuals
State option to extend Medicaid coverage to certain low-income individuals
State Option
Section 1902(a)(10)(A)(ii) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)), as amended by section 212(a)(1)(A), is amended—
by striking
or
at the end of subclause (XIX);
by adding
or
at the end of subclause (XX); and
by adding at the end the following:
who are individuals who are not otherwise eligible for medical assistance under this subparagraph, or under a waiver approved under section 1115, or otherwise, as of the date of enactment of this subclause and whose family income does not exceed 125 percent of the income 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;
.
Conforming Amendments
Medical assistance eligibility categories
Section 1905(a) of such Act (42 U.S.C. 1396d(a)), as amended by section 212(e)(1), is amended in the matter preceding paragraph (1)—
by striking
or
at the end of clause (xiii);
by adding
or
at the end of clause (xiv); and
by inserting after clause (xiv) the following:
who are individuals described in section 1902(a)(10)(A)(ii)(XX),
.
Exemption from upper income limitation
Section 1903(f)(4) of such Act (42 U.S.C.
1396b(f)(4)), as amended by section 212(e)(2)(B), is amended by inserting
1902(a)(10)(A)(ii)(XXI),
after
1902(a)(10)(A)(ii)(XX),
.
Effective Dates
The amendments made by this subsection take effect on October 1, 2007.
Grants to Promote Innovative Outreach and Enrollment Under Medicaid and SCHIP
Grants to promote innovative outreach and enrollment under Medicaid and SCHIP
Grants for Expanded Outreach Activities
Title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.), as amended by section 212(a)(2), is amended by adding at the end the following:
Expanded outreach activities
In General
The Secretary shall award grants to eligible entities to—
conduct innovative outreach and enrollment efforts that are designed to increase the enrollment and participation of eligible children under this title and title XIX; and
promote understanding of the importance of health insurance coverage for prenatal care and children.
Priority for Award of Grants
In making grants under subsection (a), the Secretary shall give priority to—
eligible entities that propose to target geographic areas with high rates of—
eligible but unenrolled children, including such children who reside in rural areas; or
racial and ethnic minorities and health disparity populations, including those proposals that address cultural and linguistic barriers to enrollment; and
eligible entities that plan to engage in outreach efforts with respect to individuals described in paragraph (1) and that are—
Federal health safety net organizations; or
faith-based organizations or consortia.
Application
An eligible entity that desires to receive a grant under this section shall submit an application to the Secretary in such form and manner, and containing such information, as the Secretary may decide. Such application shall include—
quality and outcomes performance measures to evaluate the effectiveness of activities funded by a grant awarded under this section to ensure that the activities are meeting their goals; and
an assurance that the entity shall—
conduct an assessment of the effectiveness of such activities against such performance measures; and
collect and report enrollment data and other information determined as a result of conducting such assessments to the Secretary, in such form and manner as the Secretary shall require.
Dissemination of Enrollment Data and Information Determined from Effectiveness Assessments; Annual Report
The Secretary shall—
disseminate to eligible entities and make publicly available the enrollment data and information reported in accordance with subsection (c)(2)(B); and
submit an annual report to Congress on the outreach activities funded by grants awarded under this section.
Definitions
In this section:
Eligible entity
The term eligible entity means any of the following:
A State.
A Federal health safety net organization.
A national, local, or community-based public or nonprofit private organization.
A faith-based organization or consortia, to the extent that a grant awarded to such an entity is consistent with the requirements of section 1955 of the Public Health Service Act (42 U.S.C. 300x–65) relating to a grant award to nongovernmental entities.
An elementary or secondary school.
Federal health safety net organization
The term Federal health safety net organization means—
an Indian tribe, tribal organization, or an urban Indian organization receiving funds under title V of the Indian Health Care Improvement Act (25 U.S.C. 1651 et seq.);
a federally-qualified health center (as defined in section 1905(l)(2)(B));
a hospital defined as a disproportionate share hospital for purposes of section 1923;
a covered entity described in section 340B(a)(4) of the Public Health Service Act (42 U.S.C. 256b(a)(4)); and
any other entity or a consortium that serves children under a federally-funded program, including the special supplemental nutrition program for women, infants, and children (WIC) established under section 17 of the Child Nutrition Act of 1966 (42 U.S.C. 1786), the head start and early head start programs under the Head Start Act (42 U.S.C. 9801 et seq.), the school lunch program established under the Richard B. Russell National School Lunch Act, and an elementary or secondary school.
Indians; indian tribe; tribal organization; urban indian organization; service unit
The terms Indian, Indian tribe, tribal organization, urban Indian organization, and Service Unit have the meanings given such terms in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603).
Appropriation
There is appropriated, out of any money in the Treasury not otherwise appropriated, $50,000,000 for each of fiscal years 2008 and 2009 for the purpose of awarding grants under this section. Amounts appropriated and paid under the authority of this section shall be in addition to amounts appropriated under section 2104 and paid to States in accordance with section 2105.
.
Extending Use of Outstationed Workers To Accept Title XXI Applications
Section 1902(a)(55) of the
Social Security Act (42 U.S.C.
1396a(a)(55)) is amended by inserting , and applications for child
health assistance under title XXI
after
(a)(10)(A)(ii)(IX)
.
State option to provide for simplified determinations of a child’s financial eligibility for Medical assistance under medicaid or child health assistance under SCHIP
Medicaid
Section 1902(e) of the Social Security Act (42 U.S.C. 1396a(e)) is amended by adding at the end the following:
At the option of the State, the plan may provide that financial eligibility requirements for medical assistance are met for an individual who is under an age specified by the State (except as provided in subparagraph (C), not to exceed 21 years of age) by using a determination made within a reasonable period (as determined by the State) before its use for this purpose, of the individual’s family or household income, or if applicable for purposes of determining eligibility under this title or title XXI, assets or resources, by a Federal or State agency, or a public or private entity making such determination on behalf of such agency, specified by the plan, including (but not limited to) an agency administering the State program funded under part A of title IV, the Food Stamp Act of 1977, the Richard B. Russell National School Lunch Act, or the Child Nutrition Act of 1966, notwithstanding any differences in budget unit, disregard, deeming, or other methodology, but only if—
the agency has fiscal liabilities or responsibilities affected or potentially affected by such determination; and
any information furnished by the agency pursuant to this subparagraph is used solely for purposes of determining eligibility for medical assistance under this title or for child health assistance under title XXI.
Nothing in subparagraph (A) shall be construed—
to authorize the denial of medical assistance under this title or of child health assistance under title XXI to an individual who, without the application of this paragraph, would qualify for such assistance;
to relieve a State of the obligation under subsection (a)(8) to furnish medical assistance with reasonable promptness after the submission of an initial application that is evaluated or for which evaluation is requested pursuant to this paragraph; or
to relieve a State of the obligation to determine eligibility for medical assistance under this title or for child health assistance under title XXI on a basis other than family or household income (or, if applicable, assets or resources) if an individual is determined ineligible for such assistance on the basis of information furnished pursuant to this paragraph.
At the option of a State, the financial eligibility process described in subparagraph (A) may apply to an individual who is older than age 21 if the individual’s eligibility for medical assistance under this title is based on pregnancy or if the individual is a parent, guardian, or other caretaker relative of an individual found eligible under subparagraph (A).
.
SCHIP
Section 2107(e)(1) of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended by adding at the end the following:
Section 1902(e)(13) (relating to the State option to base an individual’s eligibility for assistance on financial determinations made by a program providing nutrition or other public assistance (except that the State option under subparagraph (C) of such section shall apply under this title only if an individual is pregnant)).
.
Effective Date
The amendments made by this section take effect on October 1, 2007.
Demonstration Programs To Improve Medicaid and SCHIP Outreach to Homeless Individuals and Families
Demonstration programs to improve Medicaid and SCHIP outreach to homeless individuals and families
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.
Programs for Homeless Described
The programs described in this subsection are as follows:
Medicaid
The program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).
SCHIP
The program under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.).
TANF
The program under part A of title IV of the Social Security Act (42 U.S.C. 601 et seq.).
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.).
Food stamp program
The program under the Food Stamp Act of 1977 (7 U.S.C. 2011 et seq.).
Workforce investment act
The program under the Workforce Investment Act of 1999 (29 U.S.C. 2801 et seq.).
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)).
Other programs
Other public and private benefit programs that serve low-income individuals.
Appropriations
For the purposes of carrying out this section, there is appropriated for fiscal year 2008, out of any funds in the Treasury not otherwise appropriated, $10,000,000, to remain available until expended.
STRENGTHENING THE HEALTH CARE SAFETY NET
Increase in funding for the consolidated health centers program
It is the sense of the Senate that the amounts appropriated for consolidated health centers under section 330 of the Public Health Service Act (42 U.S.C. 254b) should be doubled over the 5-fiscal year period beginning with fiscal year 2008.
EXPANSION OF ACCESS TO HEALTH CARE IN RURAL AND UNDERSERVED AREAS
Expansion of funding
It is the sense of the Senate that the amounts appropriated for National Health Service Corps under subpart II of part D of title III of the Public Health Service Act (42 U.S.C. 254d et seq.) should be doubled over the 5-fiscal year period beginning with fiscal year 2008 to assist in provide support for physicians, dentists, and other health care clinicians who serve in rural and inner city areas.
Loan repayment and scholarship programs
Section 338C of the Public Health Service Act (42 U.S.C. 254m) is amended by adding at the end the following:
Notwithstanding any other provision of this title, periods of obligated service may be served and fulfilled on a part time basis if—
such part time service is agreed to by both the placement site or sites and the recipient of the scholarship or loan repayment; and
the recipient’s total obligation is fulfilled.
.
EXPANDED ACCESS TO AFFORDABLE LONG-TERM CARE
Treatment of premiums on qualified long-term care insurance contracts
In General
Part VII of subchapter B of chapter 1 of the Internal Revenue Code of 1986 (relating to additional itemized deductions) is amended by redesignating section 224 as section 225 and by inserting after section 223 the following new section:
Premiums on qualified Long-Term care insurance contracts
In General
In the case of an individual, there shall be allowed as a deduction an amount equal to the applicable percentage of the amount of eligible long-term care premiums (as defined in section 213(d)(10)) paid during the taxable year for coverage for the taxpayer, his spouse, and dependents under a qualified long-term care insurance contract (as defined in section 7702B(b)).
Applicable Percentage
For purposes of subsection (a)—
In general
Except as otherwise provided in this subsection, the applicable percentage shall be determined in accordance with the following table based on the number of years of continuous coverage (as of the close of the taxable year) of the individual under any qualified long-term care insurance contracts (as defined in section 7702B(b)):
| If the number of years of | The applicable long-term |
| continuous coverage is— | care percentage is— |
| Less than 1 | 60 |
| At least 1 but less than 2 | 70 |
| At least 2 but less than 3 | 80 |
| At least 3 but less than 4 | 90 |
| At least 4 | 100. |
Special rules for individuals who have attained age 55
In the case of an individual who has attained age 55 as of the close of the taxable year, the following table shall be substituted for the table in paragraph (1).
| If the number of years of | The applicable long-term |
| continuous coverage is— | care percentage is— |
| Less than 1 | 70 |
| At least 1 but less than 2 | 85 |
| At least 2 | 100. |
Only coverage after 2006 taken into account
Only coverage for periods after December 31, 2006, shall be taken into account under this subsection.
Continuous coverage
An individual shall not fail to be treated as having continuous coverage if the aggregate breaks in coverage during any 1-year period are less than 60 days.
Coordination With Other Deductions
Any amount paid by a taxpayer for any qualified long-term care insurance contract to which subsection (a) applies shall not be taken into account in computing the amount allowable to the taxpayer as a deduction under section 162(l) or 213(a).
.
Long-Term Care Insurance Permitted To Be Offered Under Cafeteria Plans and Flexible Spending Arrangements
Cafeteria plans
Section 125(f) of the Internal Revenue Code of 1986
(defining qualified benefits) is amended by inserting before the period at the
end ; except that such term shall include the payment of premiums for
any qualified long-term care insurance contract (as defined in section 7702B)
to the extent the amount of such payment does not exceed the eligible long-term
care premiums (as defined in section 213(d)(10)) for such
contract
.
Flexible spending arrangements
Section 106 of such Code (relating to contributions by an employer to accident and health plans) is amended by striking subsection (c).
Conforming Amendments
Section 62(a) of the Internal Revenue Code of 1986 is amended by inserting after paragraph (20) the following new item:
Premiums on qualified long-term care insurance contracts
The deduction allowed by section 224.
.
The table of sections for part VII of subchapter B of chapter 1 of such Code is amended by striking the last item and inserting the following new items:
Sec. 224. Premiums on qualified long-term care insurance contracts.
Sec. 225. Cross reference.
.
Effective Date
The amendments made by this section shall apply to taxable years beginning after December 31, 2006.
Credit for taxpayers with long-term care needs
In General
Subpart A of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986 (relating to nonrefundable personal credits) is amended by inserting after section 25D the following new section:
Credit for taxpayers with Long-Term care needs
Allowance of Credit
In general
There shall be allowed as a credit against the tax imposed by this chapter for the taxable year an amount equal to the applicable credit amount multiplied by the number of applicable individuals with respect to whom the taxpayer is an eligible caregiver for the taxable year.
Applicable credit amount
For purposes of paragraph (1), the applicable credit amount shall be determined in accordance with the following table:
| “For taxable years beginning | The applicable |
| in calendar year— | credit amount is— |
| 2005 | $1,000 |
| 2006 | 1,500 |
| 2007 | 2,000 |
| 2008 | 2,500 |
| 2009 or thereafter | 3,000. |
Limitation Based on Adjusted Gross Income
In general
The amount of the credit allowable under subsection (a) shall be reduced (but not below zero) by $100 for each $1,000 (or fraction thereof) by which the taxpayer’s modified adjusted gross income exceeds the threshold amount. For purposes of the preceding sentence, the term modified adjusted gross income means adjusted gross income increased by any amount excluded from gross income under section 911, 931, or 933.
Threshold amount
For purposes of paragraph (1), the term threshold amount means—
$150,000 in the case of a joint return, and
$75,000 in any other case.
Indexing
In the case of any taxable year beginning in a calendar year after 2007, each dollar amount contained in paragraph (2) shall be increased by an amount equal to the product of—
such dollar amount, and
the medical care
cost adjustment determined under section 213(d)(10)(B)(ii) for the calendar
year in which the taxable year begins, determined by substituting August
2006
for August 1996
in subclause (II) thereof.
Definitions
For purposes of this section—
Applicable individual
In general
The term applicable individual means, with respect to any taxable year, any individual who has been certified, before the due date for filing the return of tax for the taxable year (without extensions), by a physician (as defined in section 1861(r)(1) of the Social Security Act) as being an individual with long-term care needs described in subparagraph (B) for a period—
which is at least 180 consecutive days, and
a portion of which occurs within the taxable year.
Individuals with long-term care needs
An individual is described in this subparagraph if the individual meets any of the following requirements:
The individual is at least 6 years of age and—
is unable to perform (without substantial assistance from another individual) at least 3 activities of daily living (as defined in section 7702B(c)(2)(B)) due to a loss of functional capacity, or
requires substantial supervision to protect such individual from threats to health and safety due to severe cognitive impairment and is unable to perform, without reminding or cuing assistance, at least 1 activity of daily living (as so defined) or to the extent provided in regulations prescribed by the Secretary (in consultation with the Secretary of Health and Human Services), is unable to engage in age appropriate activities.
The individual is at least 2 but not 6 years of age and is unable due to a loss of functional capacity to perform (without substantial assistance from another individual) at least 2 of the following activities: eating, transferring, or mobility.
The individual is under 2 years of age and requires specific durable medical equipment by reason of a severe health condition or requires a skilled practitioner trained to address the individual’s condition to be available if the individual’s parents or guardians are absent.
Eligible caregiver
In general
A taxpayer shall be treated as an eligible caregiver for any taxable year with respect to the following individuals:
The taxpayer.
The taxpayer’s spouse.
An individual with respect to whom the taxpayer is allowed a deduction under section 151 for the taxable year.
An individual who would be described in clause (iii) for the taxable year if section 151(c)(1)(A) were applied by substituting for the exemption amount an amount equal to the sum of the exemption amount, the standard deduction under section 63(c)(2)(C), and any additional standard deduction under section 63(c)(3) which would be applicable to the individual if clause (iii) applied.
An individual who would be described in clause (iii) for the taxable year if—
the requirements of clause (iv) are met with respect to the individual, and
the requirements of subparagraph (B) are met with respect to the individual in lieu of the support test of section 152(a).
Residency test
The requirements of this subparagraph are met if an individual has as his principal place of abode the home of the taxpayer and—
in the case of an individual who is an ancestor or descendant of the taxpayer or the taxpayer’s spouse, is a member of the taxpayer’s household for over half the taxable year, or
in the case of any other individual, is a member of the taxpayer’s household for the entire taxable year.
Special rules where more than 1 eligible caregiver
In general
If more than 1 individual is an eligible caregiver with respect to the same applicable individual for taxable years ending with or within the same calendar year, a taxpayer shall be treated as the eligible caregiver if each such individual (other than the taxpayer) files a written declaration (in such form and manner as the Secretary may prescribe) that such individual will not claim such applicable individual for the credit under this section.
No agreement
If each individual required under clause (i) to file a written declaration under clause (i) does not do so, the individual with the highest modified adjusted gross income (as defined in section 32(c)(5)) shall be treated as the eligible caregiver.
Married individuals filing separately
In the case of married individuals filing separately, the determination under this subparagraph as to whether the husband or wife is the eligible caregiver shall be made under the rules of clause (ii) (whether or not one of them has filed a written declaration under clause (i)).
Identification Requirement
No credit shall be allowed under this section to a taxpayer with respect to any applicable individual unless the taxpayer includes the name and taxpayer identification number of such individual, and the identification number of the physician certifying such individual, on the return of tax for the taxable year.
Taxable Year Must Be Full Taxable Year
Except in the case of a taxable year closed by reason of the death of the taxpayer, no credit shall be allowable under this section in the case of a taxable year covering a period of less than 12 months.
.
Conforming Amendments
Section
6213(g)(2) of the Internal Revenue Code of 1986 is amended by striking
and
at the end of subparagraph (L), by striking the period at
the end of subparagraph (M) and inserting , and
, and by
inserting after subparagraph (M) the following new subparagraph:
an omission of a correct TIN or physician identification required under section 25E(d) (relating to credit for taxpayers with long-term care needs) to be included on a return.
.
The table of sections for subpart A of part IV of subchapter A of chapter 1 of such Code is amended by inserting after the item relating to section 25D the following new item:
Sec. 25E. Credit for taxpayers with long-term care needs.
.
Effective Dates
The amendments made by this section shall apply to taxable years beginning after December 31, 2006.
Additional consumer protections for long-term care insurance
Additional Protections Applicable to Long-Term Care Insurance
Subparagraphs (A) and (B) of section 7702B(g)(2) of the Internal Revenue Code of 1986 (relating to requirements of model regulation and Act) are amended to read as follows:
In general
The requirements of this paragraph are met with respect to any contract if such contract meets—
Model regulation
The following requirements of the model regulation:
Section 6A (relating to guaranteed renewal or noncancellability), and the requirements of section 6B of the model Act relating to such section 6A.
Section 6B (relating to prohibitions on limitations and exclusions).
Section 6C (relating to extension of benefits).
Section 6D (relating to continuation or conversion of coverage).
Section 6E (relating to discontinuance and replacement of policies).
Section 7 (relating to unintentional lapse).
Section 8 (relating to disclosure), other than section 8F thereof.
Section 11 (relating to prohibitions against post claims underwriting).
Section 12 (relating to minimum standards).
Section 13 (relating to requirement to offer inflation protection), except that any requirement for a signature on a rejection of inflation protection shall permit the signature to be on an application or on a separate form.
Section 25 (relating to prohibition against preexisting conditions and probationary periods in replacement policies or certificates).
The provisions of section 26 relating to contingent nonforfeiture benefits, if the policyholder declines the offer of a nonforfeiture provision described in paragraph (4).
Model act
The following requirements of the model Act:
Section 6C (relating to preexisting conditions).
Section 6D (relating to prior hospitalization).
The provisions of section 8 relating to contingent nonforfeiture benefits, if the policyholder declines the offer of a nonforfeiture provision described in paragraph (4).
Definitions
For purposes of this paragraph—
Model provisions
The terms model regulation and model Act mean the long-term care insurance model regulation, and the long-term care insurance model Act, respectively, promulgated by the National Association of Insurance Commissioners (as adopted as of September 2000).
Coordination
Any provision of the model regulation or model Act listed under clause (i) or (ii) of subparagraph (A) shall be treated as including any other provision of such regulation or Act necessary to implement the provision.
Determination
For purposes of this section and section 4980C, the determination of whether any requirement of a model regulation or the model Act has been met shall be made by the Secretary.
.
Excise Tax
Paragraph (1) of section 4980C(c) of the Internal Revenue Code of 1986 (relating to requirements of model provisions) is amended to read as follows:
Requirements of model provisions
Model regulation
The following requirements of the model regulation must be met:
Section 9 (relating to required disclosure of rating practices to consumer).
Section 14 (relating to application forms and replacement coverage).
Section 15 (relating to reporting requirements), except that the issuer shall also report at least annually the number of claims denied during the reporting period for each class of business (expressed as a percentage of claims denied), other than claims denied for failure to meet the waiting period or because of any applicable preexisting condition.
Section 22 (relating to filing requirements for marketing).
Section 23 (relating to standards for marketing), including inaccurate completion of medical histories, other than paragraphs (1), (6), and (9) of section 23C, except that—
in addition to such requirements, no person shall, in selling or offering to sell a qualified long-term care insurance contract, misrepresent a material fact; and
no such requirements shall include a requirement to inquire or identify whether a prospective applicant or enrollee for long-term care insurance has accident and sickness insurance.
Section 24 (relating to suitability).
Section 29 (relating to standard format outline of coverage).
Section 30 (relating to requirement to deliver shopper’s guide).
Model act
The following requirements of the model Act must be met:
Section 6F (relating to right to return), except that such section shall also apply to denials of applications and any refund shall be made within 30 days of the return or denial.
Section 6G (relating to outline of coverage).
Section 6H (relating to requirements for certificates under group plans).
Section 6I (relating to policy summary).
Section 6J (relating to monthly reports on accelerated death benefits).
Section 7 (relating to incontestability period).
Definitions
For purposes of this paragraph, the terms model regulation and model Act have the meanings given such terms by section 7702B(g)(2)(B).
.
Effective Date
The amendments made by this section shall apply to policies issued more than 1 year after the date of the enactment of this Act.
PROMOTING HEALTHIER LIFESTYLES
Community partnerships to promote healthy lifestyles
Grants
The
Secretary of Health and Human Services (referred to in this title as the
Secretary
) shall award grants to States to enable such States to
provide assistance to eligible community partnerships that will carry out
activities to promote healthy lifestyles.
Eligibility
State
To be eligible to receive a grant under subsection (a), a State shall prepare and submit to the Secretary an application at such time, in such manner and containing such information as the Secretary may require.
Community partnership
To be eligible to receive assistance from a State under a grant under subsection (a), an entity shall—
be a partnership consisting of one or more public and private organizations (such as hospitals, health centers, other health care providers, employers, local educational agencies, community organizations, and public health organizations); and
prepare and submit to the State an application at such time, in such manner and containing such information as the State may require, including a description of the activities that the partnership will carry out with assistance provided under this section.
Activities
A State shall use amounts received under a grant under this section to support activities conducted by an eligible community partnership to promote health lifestyles, including—
activities to reduce the primary risk factors for diseases, such as smoking, obesity, and sedentary lifestyles;
implementing employee health promotion programs in the workplace using best practices to improve health access, education, and prevention promotion and disease management;
activities to decrease hospital inpatient admissions of individuals with chronic diseases; and
the development of programs relating to mental health and substance abuse.
Authorization of Appropriations
There are authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2008 through 2012.
Worksite wellness grant program
Grants
The Secretary shall award grants to States (through State health departments or other State agencies working in consultation with the State health agency) to enable such States to provide assistance to employers that employ not to exceed 100 employees to enable such employers to establish and operate worksite wellness programs for their employees.
Application
To be eligible to receive a grant under subsection (a), a State shall prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require, including—
a description of the manner in which the State intends to use amounts received under the grant; and
assurances that the State will only use amounts provided under such grant to provide assistance to employers that can demonstrate that they are in compliance with minimum program characteristics (relative to scope and regularity of services offered) that are developed by the Secretary in consultation with experts in public health and representatives of small employers.
Allocation
Grants shall be allocated among States based on the population of individuals employed by small employers in such States.
Program Characteristics
In developing minimum program characteristics under subsection (b)(2), the Secretary shall ensure that all activities established or enhanced under a grant under this section have clearly defined goals and objectives and demonstrate how receipt of such assistance will help to achieve established State or local health objectives based on the National Health Promotion and Disease Prevention Objectives.
Use of Funds
Amounts received under a grant awarded under subsection (a) shall be used by a State to provide grants to employers (as described in subsection (a)), nonprofit organizations, or public authorities, or to operate State-based worksite wellness programs.
Special Emphasis
In funding employer worksite wellness projects under this section, a State shall give special emphasis to—
the development of joint wellness programs between employers;
the development of employee assistance programs dealing with substance abuse;
maximizing the use of, and coordination with, existing community resources such as nonprofit health organizations; and
encouraging the participation of dependents of employees and retirees in wellness programs.
Authorization of Appropriations
There are authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2008 through 2012.
Comprehensive school health education
In General
The Secretary shall use amounts appropriated in each fiscal year under subsection (d) to expand comprehensive school health education programs administered by the Centers for Disease Control and Prevention under sections 301 and 311 of the Public Health Service Act (42 U.S.C. 241 and 243).
Specified Use of Funds
In meeting the requirement of subsection (a), the Secretary shall expand the number of children receiving planned, sequential kindergarten through 12th grade comprehensive school education as a component of comprehensive programs of school health, including—
physical education programs that provide lifelong physical activity;
healthy school food service selections;
programs that promote a healthy and safe school environment;
schoolsite health promotion for faculty and staff;
integrated school and community health promotion efforts; and
school nursing disease prevention and health promotion services.
Coordination of Existing Programs
The Secretary of Health and Human Services, the Secretary of Education, and the Secretary of Agriculture, shall work cooperatively to coordinate existing school health education programs within the jurisdiction of their respective Departments in a manner that maximizes the efficiency and effectiveness of Federal expenditures for such programs.
Authorization of Appropriations
There are authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2008 through 2012.
MEDICARE FAIRNESS
Medicare Value and Quality Demonstration
Findings
The Senate makes the following findings:
The United States Government should reward physicians, hospitals, and other health care providers that provide high-quality, cost-effective health care to beneficiaries under the medicare program.
The Journal of
the American Medical Association has published quality indicators in an article
entitled Quality of Medical Care Delivered to Medicare Beneficiaries: A
Profile at State and National Levels
.
The cost of health care is—
reflected in the type and volume of physicians’ services and in physician ordering and prescribing behavior; and
reflected in the amount of the average payment to hospitals under the medicare program for each medicare beneficiary in each State.
Physician and hospital practice patterns contribute to the total cost and quality of care for each medicare beneficiary in each State.
The original medicare fee-for-service program under parts A and B of title XVIII of the Social Security Act does not include a mechanism to pay for interventions designed to improve quality of care. While the framework for payments to managed care organizations under the Medicare+Choice program under part C of such title allows for the reallocation of capitation revenues to cover such things as disease state management and quality improvement infrastructure, even the most optimistic projections for managed care enrollment leave the majority of medicare beneficiaries in the original medicare fee-for-service program.
Demonstration project to encourage the provision of high-quality, cost-effective inpatient hospital services
Purpose
The purpose of the demonstration project conducted under this section is to encourage the provision of high-quality, cost-effective health care to beneficiaries under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) by providing incentive payments to hospitals located in States in which high-quality and cost-effective services are being provided in order to finance further quality improvements.
Demonstration Project
Establishment
Not later than 6 months after the date of enactment of this Act, the Secretary shall establish a demonstration project under which—
the Secretary provides bonus payments to providers of inpatient hospital services that deliver high-quality health care at low costs in accordance with the methodology established by the Agency for Healthcare Research and Quality under paragraph (2); and
the Secretary funds a plan at each site to increase the number of providers of inpatient hospital services that provide high-quality, low-cost health care to beneficiaries under the Medicare program under title XVIII of the Social Security Act.
Value and quality ranking methodology
In general
The Agency for Healthcare Research and Quality shall establish a value and quality ranking methodology under which the Secretary awards bonus payments to providers of inpatient hospital services located in those States that demonstrate that such providers in the State are providing high value because of the high-quality, cost-effective health care services being provided to medicare beneficiaries.
Basis
The methodology established under subparagraph (A) shall be based on the Medicare quality indicators determined by the Secretary to be appropriate.
Sites
The Secretary shall select 2 States in which to conduct the demonstration project—
from among the top 25 States (as ranked using the methodology established under paragraph (2)) that are also among the group of 25 States with the lowest per capita cost to the Medicare program under title XVIII of the Social Security Act during the most recent 12-month period for which data are available; and
based upon information contained in applications submitted to the Secretary by such States at such time, in such form and manner, and containing such information as the Secretary may require.
Duration of project
The demonstration project shall be conducted over a 5-year period.
Reports
The Secretary shall submit to the appropriate committees of Congress interim reports on the demonstration project and a final report on the project within 6 months after the conclusion of the project together with recommendations for such legislative or administrative action as the Secretary determines appropriate.
Waiver
The Secretary shall waive such provisions of titles XI and XVIII of the Social Security Act (42 U.S.C. 1301 et seq. and 1395 et seq.) as may be necessary to conduct the demonstration project under this section.
Definitions
In this section:
Provider of inpatient hospital services
The term provider of inpatient hospital services means any individual or entity that receives payment under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) for providing an inpatient hospital service (as defined in section 1861(b) of such Act (42 U.S.C. 1395x(b))).
Secretary
The term Secretary means the Secretary of Health and Human Services.
Funding
There are appropriated from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) such sums as the Secretary determines are necessary to conduct the demonstration project under this section.
Demonstration project to encourage the provision of high-quality, cost-effective physicians’ services
Purpose
The purpose of the demonstration project conducted under this section is to encourage the provision of high-quality, cost-effective health care to beneficiaries under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) by providing incentive payments to physicians located in States in which high-quality and cost-effective services are being provided in order to finance further quality improvements.
Demonstration Project
Establishment
Not later than 6 months after the date of enactment of this Act, the Secretary shall establish a demonstration project under which—
the Secretary provides bonus payments to providers of physicians’ services that deliver high-quality, cost-effective health care in accordance with the methodology established by the Agency for Healthcare Research and Quality under paragraph (2); and
the Secretary funds a plan in each State to increase the number of providers of physicians’ services that provide high-quality, cost-effective health care to beneficiaries under the medicare program under title XVIII of the Social Security Act.
Value and quality ranking methodology
In general
The Agency for Healthcare Research and Quality shall establish a value and quality ranking methodology under which the Secretary awards bonus payments to providers of physicians’ services located in those States that demonstrate that such providers in the State are providing high value because of the high-quality, cost-effective health care services being provided to Medicare beneficiaries.
Basis
The methodology established under subparagraph (A) shall be based on the Medicare quality indicators determnined by the Secretary to be appropriate.
Sites
The Secretary shall select 2 States in which to conduct the demonstration project—
from among the top 25 States (as ranked using the methodology established under paragraph (2)) that are also among the 25 States with the lowest per capita cost to the Medicare program under title XVIII of the Social Security Act during the most recent 12-month period for which data are available; and
based upon information contained in applications submitted to the Secretary by such States at such time, in such form and manner, and containing such information as the Secretary may require.
Duration of project
The demonstration project shall be conducted over a 5-year period.
Reports
The Secretary shall submit to the appropriate committees of Congress interim reports on the demonstration project and a final report on the project within 6 months after the conclusion of the project together with recommendations for such legislative or administrative action as the Secretary determines appropriate.
Waiver
The Secretary shall waive such provisions of titles XI and XVIII of the Social Security Act (42 U.S.C. 1301 et seq. and 1395 et seq.) as may be necessary to conduct the demonstration project under this section.
Definitions
In this section:
Provider of physicians’ services
The term provider of physicians’ services means any individual or entity that receives payment under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) for providing physicians’ services (as defined in section 1861(q) of such Act (42 U.S.C. 1395x(q))).
Secretary
The term Secretary means the Secretary of Health and Human Services.
Funding
There are appropriated from the Federal Supplementary Medical Insurance Trust Fund under section 1841 of the Social Security Act (42 U.S.C. 1395t) such sums as the Secretary determines are necessary to conduct the demonstration project under this section.
Graduate Medical Education Demonstration
Clinical rotation demonstration project
Establishment
Not later than 6 months after the date of enactment of this Act, the Secretary shall establish a demonstration project that provides for demonstration grants designed to provide financial or other incentives to hospitals to attract educators and clinical practitioners so that hospitals that serve beneficiaries under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) who are residents of underserved areas may host clinical rotations.
Duration of Project
The demonstration project shall be conducted over a 5-year period.
Funding
In general
Subject to paragraph (2), the Secretary shall pay the costs of the demonstration project conducted under this section from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i).
Cap on funding
The Secretary may not expend more than $20,000,000 to conduct the demonstration project under this section.
Budget neutrality for demonstration project
Notwithstanding any other provision of law, the Secretary shall provide for an appropriate reduction in the aggregate amount of additional payments made under subsection (d)(5)(B) of section 1886 of the Social Security Act (42 U.S.C. 1395ww) for the indirect costs of medical education and for direct graduate medical education costs under subsection (h) of such section to reflect any increase in amounts expended from the Federal Hospital Insurance Trust Fund as a result of the demonstration project conducted under this section.
Reports
The Secretary shall submit to the appropriate committees of Congress interim reports on the demonstration project and a final report on such project within 6 months after the conclusion of the project together with recommendations for such legislative or administrative action as the Secretary determines appropriate.
Waiver
The Secretary shall waive such provisions of titles XI and XVIII of the Social Security Act (42 U.S.C. 1301 et seq. and 1395 et seq.) as may be necessary to conduct the demonstration project under this section.
Definitions
In this section:
Hospital
The term hospital means any subsection (d) hospital (as defined in section 1886(d)(1)(B) of the Social Security Act (42 U.S.C. 1395ww(d)(1)(B)) that had indirect or direct costs of medical education during the most recent cost reporting period preceding the date of enactment of this Act.
Secretary
The term Secretary means the Secretary of Health and Human Services.
Underserved area
The term underserved area means such medically underserved urban areas and medically underserved rural areas as the Secretary may specify.