text:
Page:United States Statutes at Large Volume 123.djvu/97

 123STA T .7 7 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9‘ ‘ (e)CHILD H O OD OBES I TYD E M O N ST RA TION P RO J E C T .— ‘‘( 1 ) AU THORITY TO CONDUCT DEMONSTRATION.— Th e S e c-r e ta r y,in c o n sul tation w ith the A dm inistrator o f the Centers for M edicare & Medicaid Ser v ices, shall conduct a demonstra- tion p ro j ect to develop a comprehensive and systematic model for reducin g childhood o b esity by awarding grants to eligible entities to carry out such project. Such model shall— ‘‘(A) identify, through self-assessment, behavioral ris k factors for obesity among children ‘‘( B ) identify, through self-assessment, needed clinical preventive and screening benefits among those children identified as target individuals on the basis of such risk factors; ‘‘(C) provide ongoing support to such target individuals and their families to reduce risk factors and promote the appropriate use of preventive and screening benefits; and ‘‘(D) be designed to improve health outcomes, satisfac- tion, q uality of life, and appropriate use of items and serv- ices for which medical assistance is available under title XI X or child health assistance is available under title XXI among such target individuals. ‘‘( 2 ) E LI G IBILITY ENTITIES.— F or purposes of this subsection, an eligible entity is any of the following ‘‘(A) A city, county, or Indian tribe. ‘‘(B) A local or tribal educational agency. ‘‘(C) An accredited university, college, or community college. ‘‘(D) A Federally-qualified health center. ‘‘(E) A local health department. ‘‘(F) A health care provider. ‘‘( G ) A community-based organi z ation. ‘‘( H ) Any other entity determined appropriate by the Secretary, including a consortia or partnership of entities described in any of subparagraphs (A) through (G). ‘‘( 3 ) U SEO F FUNDS.—An eligible entity awarded a grant under this subsection shall use the funds made available under the grant to— ‘‘(A) carry out community-based activities related to reducing childhood obesity, including by— ‘‘(i) forming partnerships with entities, including schools and other facilities providing recreational serv- ices, to establish programs for after school and weekend community activities that are designed to reduce child- hood obesity; ‘‘(ii) forming partnerships with daycare facilities to establish programs that promote healthy eating behaviors and physical activity; and ‘‘(iii) developing and evaluating community edu- cational activities targeting good nutrition and pro- moting healthy eating behaviors; ‘‘(B) carry out age-appropriate school-based activities that are designed to reduce childhood obesity, including by— ‘‘(i) developing and testing educational curricula and intervention programs designed to promote healthy eating behaviors and habits in youth, which may include—


text:
Page:United States Statutes at Large Volume 123.djvu/98

 123STA T .78PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9‘ ‘ (I)afterhou r sp h y s ic a l acti v ity pro g ra m s a nd ‘‘(II) science -b ased interventions w ith multiple components to prevent eating disorders including nutritional content , understanding and responding to hunger and satiety, positive body image develop- ment, positive self-esteem development, and learning life s k ills (such as stress management, communication skills, problemsolving and decision- making skills), as well as consideration of cultural and developmental issues, and the role of family, school, and community; ‘‘(ii) providing education and training to edu- cational professionals regarding how to promote a healthy lifestyle and a healthy school environment for children; ‘‘(iii) planning and implementing a healthy lifestyle curriculum or program with an emphasis on healthy eating behaviors and physical activity; and ‘‘(iv) planning and implementing healthy lifestyle classes or programs for parents or guardians, with an emphasis on healthy eating behaviors and physical activity for children; ‘‘( C ) carry out educational, counseling, promotional, and training activities through the local health care delivery systems including by — ‘‘(i) promoting healthy eating behaviors and phys- ical activity services to treat or prevent eating dis- orders, being overweight, and obesity; ‘‘(ii) providing patient education and counseling to increase physical activity and promote healthy eating behaviors; ‘‘(iii) training health professionals on how to iden- tify and treat obese and overweight individuals which may include nutrition and physical activity counseling; and ‘‘(iv) providing community education by a health professional on good nutrition and physical activity to develop a better understanding of the relationship between diet, physical activity, and eating disorders, obesity, or being overweight; and ‘‘( D ) provide, through q ualified health professionals, training and supervision for community health workers to— ‘‘(i) educate families regarding the relationship between nutrition, eating habits, physical activity, and obesity; ‘‘(ii) educate families about effective strategies to improve nutrition, establish healthy eating patterns, and establish appropriate levels of physical activity; and ‘‘(iii) educate and guide parents regarding the ability to model and communicate positive health behaviors . ‘‘( 4 ) PRIO RI TY .—In awarding grants under paragraph ( 1 ), the S ecretary shall give priority to awarding grants to eligible entities—

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/


text:
Page:United States Statutes at Large Volume 123.djvu/99

 123STA T .79PUBLIC LA W 111 – 3 —FE B. 4, 2 0 09 ‘ ‘ (A)tha t demons t r ate that the y ha v e p rev i o u s l y applied su c cess f ully for funds to carry out activities that see k to promote individual and community health and to prevent the incidence of chronic disease and that can cite pu b lished and peer - revie w ed research demonstratin g that the activities that the entities propose to carry out with funds made available under the grant are effective ‘‘( B ) that will carry out programs or activities that seek to accomplish a goal or goals set by the S tate in the H ealthy P eople 201 0 plan of the State; ‘‘( C ) that provide non- F ederal contributions , either in cash or in-kind, to the costs of funding activities under the grants; ‘‘( D ) that develop comprehensive plans that include a strategy for e x tending program activities developed under grants in the years following the fiscal years for which they receive grants under this subsection; ‘‘( E ) located in communities that are medically under- served, as determined by the Secretary; ‘‘(F) located in areas in which the average poverty rate is at least 1 5 0 percent or higher of the average poverty rate in the State involved, as determined by the Secretary; and ‘‘( G ) that submit plans that exhibit multisectoral, cooperative conduct that includes the involvement of a broad range of stakeholders, including — ‘‘(i) community-based organi z ations; ‘‘(ii) local governments; ‘‘(iii) local educational agencies; ‘‘(iv) the private sector; ‘‘(v) State or local departments of health; ‘‘(vi) accredited colleges, universities, and commu- nity colleges; ‘‘(vii) health care providers; ‘‘(viii) State and local departments of transpor- tation and city planning; and ‘‘(ix) other entities determined appropriate by the Secretary . ‘‘(5) P ROG R AMDESI G N .— ‘‘(A) I NI T IA L DESIGN.— N ot later than 1 year after the date of enactment of the Children ’ s Health Insurance Pro- gram R eauthorization Act of 200 9, the Secretary shall design the demonstration pro j ect. T he demonstration should draw upon promising, innovative models and incen- tives to reduce behavioral risk factors. The Administrator of the Centers for M edicare & Medicaid Services shall consult with the Director of the Centers for Disease Control and Prevention, the Director of the O ffice of Minority Health, the heads of other agencies in the Department of Health and Human Services, and such professional organizations, as the Secretary determines to be appro- priate, on the design, conduct, and evaluation of the dem- onstration. ‘‘(B) N U M B ER AND P RO J E C T AREAS.—Not later than 2 years after the date of enactment of the Children’s Health Insurance Program Reauthorization Act of 2009, the Sec- retary shall award 1 grant that is specifically designed Grants.De a dli nes.


text:
Page:United States Statutes at Large Volume 123.djvu/100

 123STA T .80PUBLIC LA W 111 – 3 —FE B. 4, 200 9tode te rmin e wh ether p ro g r a m s simi l ar to programs to b e c ond u cted b y other grantees under this subsection should be implemented with respect to the general popu - lation o f children who are eligible for child health assist- ance under S tate child health plans under title X X I in order to reduce the incidence of childhood obesity among such population .‘ ‘ (6)REPORT TO C O NG RE S S. —N ot later than 3 years after the date the Secretary implements the demonstration pro j ect under this subsection , the Secretary shall submit to C ongress a report that describes the project, e v aluates the effectiveness and cost effectiveness of the project, evaluates the beneficiary satisfaction under the project, and includes any such other information as the Secretary determines to be appropriate. ‘‘( 7 ) D E FI NITIONS.—In this subsection ‘‘( A ) F E D ER AL L Y - QU ALIFIED H EALTH CENTER.— T he term ‘Federally- q ualified health center ’ has the meaning given that term in section 1905 (l)( 2 )( B ). ‘‘(B) INDIAN TRI B E.—The term ‘Indian tribe’ has the meaning given that term in section 4 of the Indian H ealth Care Improvement Act (25 U .S.C. 1603). ‘‘(C) SELF-ASSESS M ENT.—The term ‘self-assessment’ means a form that— ‘‘(i) includes questions regarding— ‘‘(I) behavioral ris k factors ‘‘(II) needed preventive and screening services; and ‘‘(III) target individuals’ preferences for receiving follow-up information; ‘‘(ii) is assessed using such computer generated assessment programs; and ‘‘(iii) allows for the provision of such ongoing sup- port to the individual as the Secretary determines appropriate. ‘‘(D) O NGOING SUPPORT.—The term ‘ongoing support’ means— ‘‘(i) to provide any target individual with informa- tion, feedback, health coaching, and recommendations regarding— ‘‘(I) the results of a self-assessment given to the individual; ‘‘(II) behavior modification based on the self- assessment; and ‘‘(III) any need for clinical preventive and screening services or treatment including medical nutrition therapy; ‘‘(ii) to provide any target individual with referrals to community resources and programs available to assist the target individual in reducing health risks; and ‘‘(iii) to provide the information described in clause (i) to a health care provider, if designated by the target individual to receive such information. ‘‘( 8 ) AUTHORI Z ATION OF APPROPRIATIONS.—There is author- i z ed to be appropriated to carry out this subsection, $ 25,000,000 for the period of fiscal years 2009 through 2013.


text:
Page:United States Statutes at Large Volume 123.djvu/101

 123STA T .8 1 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9‘ ‘ (f)DEV E LOPM E NT O FM O D EL E LE C T R ON I C H E A LT HR ECORD F ORMAT FOR C HILDREN ENROLLED IN MEDICAID OR CH IP.— ‘‘( 1 )IN G ENERAL.— Notla t er t h a nJ an u ar y 1 ,20 10, the S e c retary s hall esta b l i sha p ro g ra m to encourage the d e v elop - ment and dissemination of a model electronic health record format for children enrolled in the State plan under title X IX or the State child health plan under title XXI that is— ‘‘( A ) sub j ect to State la w s, accessible to parents, care- givers, and other consumers for the sole purpose of dem- onstrating compliance with school or leisure activity re q uirements, such as appropriate immuni z ations or physicals ‘‘( B ) designed to allow interoperable e x changes that conform with Federal and State privacy and security requirements; ‘‘(C) structured in a manner that permits parents and caregivers to view and understand the extent to which the care their children receive is clinically appropriate and of high quality; and ‘‘(D) capable of being incorporated into, and otherwise compatible with, other standards developed for electronic health records. ‘‘(2) F U NDING.— $5 ,000,000 of the amount appropriated under subsection (i) for a fiscal year shall be used to carry out this subsection. ‘‘(g) STUD Y OF PEDIATRIC HEALTH AND HEALTH CARE Q UALITY MEA S URES.— ‘‘(1) IN GENERAL.—Not later than July 1, 2010, the Institute of Medicine shall study and report to Congress on the extent and quality of efforts to measure child health status and the quality of health care for children across the age span and in relation to preventive care, treatments for acute conditions, and treatments aimed at ameliorating or correcting physical, mental, and developmental conditions in children. In conducting such study and preparing such report, the Institute of Medicine shall— ‘‘(A) consider all of the major national population-based reporting systems sponsored by the Federal G overnment that are currently in place, including reporting require- ments under Federal grant programs and national popu- lation surveys and estimates conducted directly by the Federal Government; ‘‘(B) identify the information regarding child health and health care quality that each system is designed to capture and generate, the study and reporting periods cov- ered by each system, and the extent to which the informa- tion so generated is made widely available through publica- tion; ‘‘(C) identify gaps in k nowledge related to children ’ s health status, health disparities among subgroups of chil- dren, the effects of social conditions on children’s health status and use and effectiveness of health care, and the relationship between child health status and family income, family stability and preservation, and children’s school readiness and educational achievement and attainment; and Deadlin e .R e ports . Deadline.


text:
Page:United States Statutes at Large Volume 123.djvu/102

 123STA T .8 2 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9‘ ‘ (D)maker e co mme nd a ti on s re g arding im p ro v ing and strengt h ening the time l iness ,qu alit y , andpu b lic trans - parency and accessibility o f information about child health and health care quality . ‘‘( 2 ) FUNDI N G . —U pto $1, 0 00,000 of the amount appro- priated under subsection (i) for a fiscal year shall be used to carry out this subsection. ‘‘(h) R U LEOFC ON STR U C TION.— N ot w ithstanding any other provision in this section, no evidence based quality measure devel- oped, published, or used as a basis of measurement or reporting under this section may be used to establish an irrebuttable presumption regarding either the medical necessity of care or the ma x imum permissible coverage for any individual child who is eligible for and receiving medical assistance under title XI Xor child health assistance under title XXI. ‘‘(i) AP PROPRI A TION.— O ut of any funds in the T reasury not otherwise appropriated, there is appropriated for each of fiscal years 200 9 through 201 3 ,$ 45 ,000,000 for the purpose of carrying out this section (other than subsection (e)). Funds appropriated under this subsection shall remain available until expended. ’ ’. (b) INCREASED M ATC H ING RATE FOR COLLECTING AND REPORTING ON CHILD H EALTH MEASURES.— S ection 1903(a)(3)(A) (42 U.S.C. 139 6 b(a)(3)(A)), is amended— (1) by striking ‘‘and’’ at the end of clause (i) and (2) by adding at the end the following new clause ‘‘(iii) an amount equal to the Federal medical assistance percentage (as defined in section 1905(b)) of so much of the sums expended during such quarter (as found necessary by the Secretary for the proper and efficient administration of the State plan) as are attributable to such developments or modifications of systems of the type described in clause (i) as are necessary for the efficient collection and reporting on child health measures; and’’. SEC.402 . IMPROV E DA VAI L A B ILI TY O F P U BLIC I N FORMATION RE G ARDING ENROLLMENT OF C H ILDREN IN CHIP AND MEDICAID. (a) INCLUSION OF P ROCESS AND ACCESS MEASURES IN ANNUAL STATE REPORTS.—Section 210 8 (42 U.S.C. 139 7 hh) is amended— (1) in subsection (a), in the matter preceding paragraph (1), by striking ‘‘The State’’ and inserting ‘‘Sub j ect to subsection (e), the State’’; and (2) by adding at the end the following new subsection: ‘‘(e) INFOR M ATION RE Q UIRED FOR INCLUSION IN STATE ANNUAL REPORT.—The State shall include the following information in the annual report required under subsection (a): ‘‘(1) E ligibility criteria, enrollment, and retention data (including data with respect to continuity of coverage or dura- tion of benefits). ‘‘(2) Data regarding the extent to which the State uses process measures with respect to determining the eligibility of children under the State child health plan, including meas- ures such as 12-month continuous eligibility, self-declaration of income for applications or renewals, or presumptive eligi- bility. ‘‘(3) Data regarding denials of eligibility and redetermina- tions of eligibility. Recom me nda-ti on s.


text:
Page:United States Statutes at Large Volume 123.djvu/103

 123STA T .8 3 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9‘ ‘ (4)Dat a reg ar din ga c ce s st op ri m ar y and specia l ty ser v- ices , access to net w or k so f care, and care coordination provided u nder t h e S tate child health plan, using q uality care and con- sumer satisfaction measures included in the C onsumer A ssess- ment of H ealthcare P roviders and Systems (CAHPS) survey . ‘‘( 5 ) I f the State provides child health assistance in the form of premium assistance for the purchase of coverage under a group health plan, data regarding the provision of such assist- ance, including the e x tent to which employer-sponsored health insurance coverage is availa b le for children eligible for child health assistance under the State child health plan, the range of the monthly amount of such assistance provided on behalf of a child or family, the number of children or families provided such assistance on a monthly basis, the income of the children or families provided such assistance, the benefits and cost- sharing protection provided under the State child health plan to supplement the coverage purchased with such premium assistance, the effective strategies the State engages in to reduce any administrative barriers to the provision of such assistance, and, the effects, if any, of the provision of such assistance on preventing the coverage provided under the State child health plan from substituting for coverage provided under employer-sponsored health insurance offered in the State. ‘‘( 6 ) T o the extent applicable, a description of any State activities that are designed to reduce the number of uncovered children in the State, including through a State health insur- ance connector program or support for innovative private health coverage initiatives. ’ ’. (b) S TAND A R D IZE D R E PO RTIN GF OR M AT. — ( 1 ) IN GENERA L .— N ot later than 1 year after the date of enactment of this Act, the Secretary shall specify a standard- i z ed format for States to use for reporting the information required under section 2 1 08 (e) of the Social Security Act, as added by subsection (a)(2). (2) TRAN S ITION PERIOD F OR STATES.— E ach State that is required to submit a report under subsection (a) of section 2108 of the Social Security Act that includes the information required under subsection (e) of such section may use up to 3 reporting periods to transition to the reporting of such information in accordance with the standardized format speci- fied by the Secretary under paragraph (1). (c) ADDITIONAL F U NDING FOR T H ESE C RETAR Y TO IMPRO V E TIME- LINESS OF DATA REPORTING AND ANALYSIS FOR PURPOSES OF DETER- MINING ENROLLMENT INCREASES U NDER M EDICAID AND CHIP.— (1) APPROPRIATION.—There is appropriated, out of any money in the Treasury not otherwise appropriated, $ 5,000,000 to the Secretary for fiscal year 200 9 for the purpose of improving the timeliness of the data reported and analyzed from the Medicaid Statistical Information System (MSIS) for purposes of providing more timely data on enrollment and eligibility of children under Medicaid and CHIP and to provide guidance to States with respect to any new reporting require- ments related to such improvements. Amounts appropriated under this paragraph shall remain available until expended. (2) RE Q UIREMENTS.—The improvements made by the Sec- retary under paragraph (1) shall be designed and implemented (including with respect to any necessary guidance for States 42USC1397h h note.


text:
Page:United States Statutes at Large Volume 123.djvu/104

 123STA T .84PUBLIC LA W 111 – 3 —FE B.4 , 2 0 0 9torep ort suchinf or ma tion in a comp l ete an d e x peditious manner ) so that ,b e g inning no later than O ctober 1, 20 0 9 , data regarding the enrollment of lo w- income children ( as defined in section 2110(c)( 4 ) of the S ocial Securit yA ct (42 U. S. C .1 3 9 7j j(c)(4)) of a State enrolled in the State plan under M edicaid or the State child health plan under C HIP with respect to a fiscal year shall be collected and analy z ed by the Secretary within 6 months of submission. (d) G AOS TUDYAN D REPOR TONA C CE S STOPR IM ARY AND SPE- CIA L ITY SER V ICES. — (1) IN G ENERAL.— T he Comptroller General of the United States shall conduct a study of children ’ s access to primary and specialty ser v ices under Medicaid and CHIP, including— (A) the extent to which providers are willing to treat children eligible for such programs ( B ) information on such children’s access to networ k s of care; (C) geographic availability of primary and specialty services under such programs; ( D ) the extent to which care coordination is provided for children’s care under Medicaid and CHIP; and ( E ) as appropriate, information on the degree of avail- ability of services for children under such programs. (2) REPORT.— N ot later than 2 years after the date of enact- ment of this Act, the Comptroller General shall submit a report to the Committee on F inance of the Senate and the Committee on Energy and Commerce of the House of Representatives on the study conducted under paragraph (1) that includes rec- ommendations for such Federal and State legislative and administrative changes as the Comptroller General determines are necessary to address any barriers to access to children’s care under Medicaid and CHIP that may exist. SEC.403 . AP P LI CA T I ON O F CE R TAIN M ANA G E D CARE QU ALIT Y SAFE - GUARDS TO C H IP. (a) IN GENERAL.—Section 2103(f) of Social Security Act (42 U.S.C. 1397bb(f)) is amended by adding at the end the following new paragraph

‘(3) COMPLIANCE W IT H MANAGED CARE RE Q UIREMENTS.— The State child health plan shall provide for the application of subsections (a)(4), (a)( 5 ), (b), (c), (d), and (e) of section 1932 (relating to re q uirements for managed care) to coverage, State agencies, enrollment brokers, managed care entities, and man- aged care organizations under this title in the same manner as such subsections apply to coverage and such entities and organizations under title X IX.’’. (b) E F FECTIVE DATE.—The amendment made by subsection (a) shall apply to contract years for health plans beginning on or after J uly 1, 2009. TI T LEV— I MPRO VI NGAC CE S STO B ENE F ITS SEC. 5 0 1 . DENTAL B ENEFITS. (a) COVERAGE.— 42USC1397c c note. 42 USC 1397cc.


text:
Page:United States Statutes at Large Volume 123.djvu/105

 123STA T .85PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9(1)INGE NE RAL.—Section2 1 03 ( 4 2 U .S. C . 13 97 cc) i sam en d ed— ( A )ins ub section (a)— (i)int h e matte r be f ore p ara g raph (1) , b y stri k ing ‘ ‘subsection (c)( 5 ) ’ ’ and inserting ‘‘paragraphs (5) and (7) of subsection (c)’’ and (ii) in paragraph (1), by inserting ‘‘at l east’’ after ‘‘that is’’; and ( B ) in subsection (c)— (i) by redesignating paragraph (5) as paragraph (7); and (ii) by inserting after paragraph (4), the follo w ing ‘‘(5) D EN T AL B ENE FI T S .— ‘‘(A) IN GENERAL.— T he child health assistance pro v ided to a targeted low - income child shall include coverage of dental services necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions. ‘‘(B) P ER M ITTING U SE O F D ENTAL BEN CH MAR KP LANS B Y CERTAIN STATES.—A State may elect to meet the re q uire- ment of subparagraph (A) through dental coverage that is equivalent to a benchmark dental benefit package described in subparagraph (C). ‘‘(C) BENCHMARK DENTAL BENEFIT PACKAGES.—The benchmark dental benefit packages are as follows: ‘‘(i) FEH BP CHILDREN’S DENTAL CO V ERAGE.—A dental benefits plan under chapter 8 9A of title 5, United States Code, that has been selected most fre- quently by employees seeking dependent coverage, among such plans that provide such dependent cov- erage, in either of the previous 2 plan years. ‘‘(ii) STATE EMPLOYEE DEPENDENT DENTAL COV- ERAGE.—A dental benefits plan that is offered and generally available to State employees in the State involved and that has been selected most frequently by employees seeking dependent coverage, among such plans that provide such dependent coverage, in either of the previous 2 plan years. ‘‘(iii) COVERAGE OFFERED THROUGH COMMERCIAL DENTAL PLAN.—A dental benefits plan that has the largest insured commercial, non-medicaid enrollment of dependent covered lives of such plans that is offered in the State involved.’’. (2) ASSURING ACCESS TO CARE.—Section 2102(a)(7)(B) (42 U.S.C. 1397bb(c)(2)) is amended by inserting ‘‘and services described in section 2103(c)(5)’’ after ‘‘emergency services’’. (3) EFFECTIVE DATE.—The amendments made by para- graphs (1) and (2) shall apply to coverage of items and services furnished on or after O ctober 1, 2009. (b) STATE OPTION TO PROVIDE DENTAL-ONLY SUPPLEMENTAL COVERAGE.— (1) IN GENERAL.—Section 2110(b) (42 U.S.C. 1397 j j(b)) is amended— (A) in paragraph (1)(C), by inserting ‘‘, subject to para- graph (5),’’ after ‘‘under title X IX or’’; and (B) by adding at the end the following new paragraph: 42USC1397b b note.


text:
Page:United States Statutes at Large Volume 123.djvu/106

 123STA T .86PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9‘ ‘ (5)OPTIONF O RS T A T E S W IT H A SEPARATE C HIP PRO G RA M TO PRO V I D E DENTA L- ONL Y S U PPLEMENTAL COVERAGE .— ‘‘( A ) I N GENERAL.— Subject t os ub par a g rap h s( B )a nd ( C ) ,i nthecaseo f an y chi l d w ho is enrolled in a group health plan or health insurance co v erage offered through ane m ployer who would, but for the application of para- graph ( 1 )(C), satisfy the re q uirements for being a targeted low-income child under a State child health plan that is implemented under this title, a State may waive the application of such paragraph to the child in order to provide— ‘‘(i) dental coverage consistent with the require- ments of subsection (c)(5) of section 2 1 03; or ‘‘(ii) cost-sharing protection for dental coverage consistent with such requirements and the require- ments of subsection (e)(3)(B) of such section. ‘‘(B) L IMITATION.—A State may limit the application of a waiver of paragraph (1)(C) to children whose family income does not e x ceed a level specified by the State, so long as the level so specified does not exceed the max- imum income level otherwise established for other children under the State child health plan. ‘‘(C) CONDITIONS.—A State may not offer dental-only supplemental coverage under this paragraph unless the State satisfies the following conditions ‘‘(i) INCOME ELIGI B ILITY.— T he State child health plan under this title— ‘‘(I) has the highest income eligibility standard permitted under this title (or a waiver) as of J anuary 1, 200 9 ‘‘(II) does not limit the acceptance of applica- tions for children or impose any numerical limita- tion, waiting list, or similar limitation on the eligi- bility of such children for child health assistance under such State plan; and ‘‘(III) provides benefits to all children in the State who apply for and meet eligibility standards. ‘‘(ii) N O MORE FAVORABLE TREATMENT.—The State child health plan may not provide more favorable dental coverage or cost-sharing protection for dental coverage to children provided dental-only supplemental coverage under this paragraph than the dental cov- erage and cost-sharing protection for dental coverage provided to targeted low-income children who are eligible for the full range of child health assistance provided under the State child health plan. ’ ’. (2) STATE OPTION TO WAIVE WAITING PERIOD.—Section 2102(b)(1)(B) ( 4 2 U .S.C. 139 7 bb(b)(1)(B)), as amended by section 111(b)(2), is amended— (A) in clause (ii), by stri k ing ‘‘and’’ at the end; (B) in clause (iii), by striking the period and inserting ‘‘; and’’; and (C) by adding at the end the following new clause: ‘‘(iv) at State option, may not apply a waiting period in the case of a child provided dental-only supplemental coverage under section 2110(b)(5).’’.


text: Dictionary of National Biography, 1885-1900/Montefiore, Moses Haim


text:
Page:United States Statutes at Large Volume 123.djvu/107

 123STA T .87PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9(c)DENTALEDUC AT IO N F O RP ARENT S OF N E WB ORNS .—TheS ec -r e ta r ys ha l l d e v el op a n d im plement , thro ug h entities that f und or provide perinatal care services to targeted lo w -income children under a State child health plan under title X X I of the Social Security A ct, a program to deliver oral health educational materials that inform new parents a b out ris k s for, and prevention of, early childhood caries and the need for a dental visit within their newborn ’ s first year of life. (d) PRO V ISION OF DENTAL SERVICES T H ROU G H FQHC S.— ( 1 ) M EDICAID.—Section 1 902 (a) ( 4 2 U .S.C. 1 3 9 6 a(a)) is amended— (A) by striking ‘ ‘and’’ at the end of paragraph ( 7 0) ( B ) by striking the period at the end of paragraph (71) and inserting ‘‘; and’’; and (C) by inserting after paragraph (71) the following new paragraph ‘‘(72) provide that the State will not prevent a Federally- q ualified health center from entering into contractual relation- ships with private practice dental providers in the provision of Federally-qualified health center services.’’. (2) CHIP.—Section 2107(e)(1) (42 U.S.C. 1397g(e)(1)), as amended by subsections (a)(2) and (d)(2) of section 203, is amended by inserting after subparagraph (B) the following new subparagraph (and redesignating the succeeding subpara- graphs accordingly): ‘‘(C) Section 1902(a)(72) (relating to limiting FQHC contracting for provision of dental services).’’. (3) EFFECTIVE DATE.—The amendments made by this sub- section shall take effect on J anuary 1, 2009. (e) R E P ORTING INFOR M ATION ON DENTAL HEALTH.— (1) MEDICAID.—Section 1902(a)(43)(D)(iii) (42 U.S.C. 1396a(a)(43)(D)(iii)) is amended by inserting ‘‘and other information relating to the provision of dental services to such children described in section 210 8 (e)’’ after ‘‘receiving dental services,’’. (2) CHIP.—Section 2108 (42 U.S.C. 1397hh) is amended by adding at the end the following new subsection: ‘‘(e) INFORMATION ON DENTAL CARE FOR CHILDREN.— ‘‘(1) IN GENERAL.—Each annual report under subsection (a) shall include the following information with respect to care and services described in section 190 5 (r)(3) provided to targeted low-income children enrolled in the State child health plan under this title at any time during the year involved: ‘‘(A) The number of enrolled children by age grouping used for reporting purposes under section 1902(a)(43). ‘‘(B) For children within each such age grouping, information of the type contained in questions 12(a) – (c) of CMS Form 416 (that consists of the number of enrolled targeted low income children who receive any, preventive, or restorative dental care under the State plan). ‘‘(C) For the age grouping that includes children 8 years of age, the number of such children who have received a protective sealant on at least one permanent molar tooth. ‘‘(2) INCLUSION OF INFORMATION ON ENROLLEES IN MANAGED CARE PLANS.—The information under paragraph (1) shall include information on children who are enrolled in managed care plans and other private health plans and contracts with 42USC1396anote. 42 USC 139 7g g note. 42 USC 247 d– 9.


text:
Page:United States Statutes at Large Volume 123.djvu/108

 123STA T .8 8 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9suchplan sun dert h i s title shall pr ov ide f or the reportin g of such infor m ation by such plans to the S tate .’ ’. (3)EF F ECTIV E DA TE. —T he amendments made by this sub - section shall be effective for annual reports submitted for years beginning after date of enactment. (f) IMPRO VED A CCE S SI B I L IT Y OF D E N TAL P ROVIDER INFORMATION TO ENROLLEES U NDER M EDICAID AND CH IP.—The Secretary shall— ( 1 ) w or k with States , pediatric dentists, and other dental providers (including providers that are, or are affiliated with, a school of dentistry) to include, not later than 6 months after the date of the enactment of this Act, on the Insure K ids N ow website (http

/www.insurekidsnow.gov/) and hotline (1 –87 7–KIDS–N OW ) (or on any successor websites or hotlines) a current and accurate list of all such dentists and providers within each State that provide dental services to children enrolled in the State plan (or waiver) under Medicaid or the State child health plan (or waiver) under CHIP, and shall ensure that such list is updated at least q uarterly and ( 2 ) work with States to include, not later than 6 months after the date of the enactment of this Act, a description of the dental services provided under each State plan (or waiver) under Medicaid and each State child health plan (or waiver) under CHIP on such Insure Kids Now website, and shall ensure that such list is updated at least annually. (g) INCL U SION OF STATUS OF EFFORTS TO IMPROVE DENTAL CARE IN R EPORTS ON T H E Q UALITY OF CHILDREN’S HEALTH CARE UNDER MEDICAID AND CHIP.—Section 113 9 A(a), as added by section 40 1(a), is amended— (1) in paragraph (3)( B )(ii), by inserting ‘ ‘and, with respect to dental care, conditions requiring the restoration of teeth, relief of pain and infection, and maintenance of dental health’’ after ‘‘chronic conditions’’; and (2) in paragraph (6)(A)(ii), by inserting ‘‘dental care,’’ after ‘‘preventive health services,’’. (h) G AO STUDY AND REPORT.— (1) STUDY.—The Comptroller General of the United States shall provide for a study that e x amines— (A) access to dental services by children in underserved areas; (B) children’s access to oral health care, including preventive and restorative services, under Medicaid and CHIP, including— (i) the extent to which dental providers are willing to treat children eligible for such programs; (ii) information on such children’s access to net- works of care, including such networks that serve spe- cial needs children; and (iii) geographic availability of oral health care, including preventive and restorative services, under such programs; and (C) the feasibility and appropriateness of using quali- fied mid-level dental health providers, in coordination with dentists, to improve access for children to oral health serv- ices and public health overall. (2) REPORT.—Not later than 18 months year after the date of the enactment of this Act, the Comptroller General shall submit to Congress a report on the study conducted under Deadlin e s.42USC1396 n ot e. 42 USC 1396a note.


text:
Page:United States Statutes at Large Volume 123.djvu/109

 123STA T .89PUBLIC LA W 111 – 3 —FE B. 4, 2 0 09 par a g rap h(1).T h e rep o r ts ha l l inc l ud e reco m mendations f or such F ederal and S tate legislati v e and administrative changes as the C omptroller G eneral determines are necessar y to address any b arriers to access to oral health care , including preventive and restorative services, under M edicaid and C HIP that may e x ist. SEC.502 . M E NTALH EALTH P A RI T Y IN CHIP PLANS. (a) AS S URANCEOF PAR ITY . — Section 2 1 03 (c) ( 4 2 U .S.C. 13 97 cc(c)), as amended by section 5 01(a)(1)( B ), is amended by inserting after paragraph (5), the follo w ing

‘( 6 ) MENTA LH EALTH SER V ICES P ARITY.— ‘‘(A) IN G ENERAL.—In the case of a State child health plan that provides both medical and surgical benefits and mental health or substance use disorder benefits, such plan shall ensure that the financial re q uirements and treat - ment limitations applicable to such mental health or sub- stance use disorder benefits comply with the requirements of section 2705(a) of the Public Health Service Act in the same manner as such requirements apply to a group health plan. ‘‘(B) D EE M E D COMPLIANCE.—To the extent that a State child health plan includes coverage with respect to an individual described in section 1905(a)(4)(B) and covered under the State plan under section 1902(a)(10)(A) of the services described in section 1905(a)(4)(B) (relating to early and periodic screening, diagnostic, and treatment services defined in section 1905(r)) and provided in accordance with section 1902(a)(43), such plan shall be deemed to satisfy the requirements of subparagraph (A). ’ ’. (b) CONFORMING AMENDMENTS.—Section 2103 (42 U.S.C. 1397cc) is amended— (1) in subsection (a), as amended by section 501(a)(1)(A)(i), in the matter preceding paragraph (1), by inserting ‘‘, (6),’’ after ‘‘(5)’’ and (2) in subsection (c)(2), by stri k ing subparagraph (B) and redesignating subparagraphs (C) and (D) as subparagraphs (B) and (C), respectively. SEC. 50 3 . APPLICATI O NO F PROSPECTI V E PAYMENT SYSTEM FOR SERVICES PROVI D ED B Y FEDERALLY -QU ALIFIED HEALTH CENTERS AND RURAL HEALTH CLINICS. (a) APPLICATION OF PROSPECTIVE PAYMENT SYSTEM.— (1) IN GENERAL.—Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)), as amended by section 501(c)(2) is amended by inserting after subparagraph (C) the following new subpara- graph (and redesignating the succeeding subparagraphs accord- ingly): ‘‘(D) Section 1902(bb) (relating to payment for services provided by Federally-qualified health centers and rural health clinics).’’. (2) E FFECTIVE DATE.—The amendment made by paragraph (1) shall apply to services provided on or after O ctober 1, 2009. (b) TRANSITION GRANTS.— (1) APPROPRIATION.—Out of any funds in the Treasury not otherwise appropriated, there is appropriated to the Sec- retary for fiscal year 2009, $ 5,000,000, to remain available 42USC1397g g note.


text:
Page:United States Statutes at Large Volume 123.djvu/110

 123STA T .90PUBLIC LA W 111 – 3 —FE B. 4, 2009 untilexp en d ed ,for t h e purpo s eof aw ardin g grants to S tates with State c hild health plans under CHIP that are operated separatel y fro m the State M edicaid plan under title X IX of the Social Security A ct ( including any wai v er of such plan ) , or in com b ination with the State Medicaid plan, for expendi - tures related to transitioning to compliance with the re q uire- ment of section 2107 (e)(1)( D ) of the Social Security Act (as added by subsection (a)) to apply the prospective payment system established under section 1 9 02(bb) of the such Act ( 4 2 U. S.C. 1 3 9 6 a(bb)) to services provided by F ederally-qualified health centers and rural health clinics. (2) M ONIT O R IN GA N D R EP ORT. —T he Secretary shall monitor the impact of the application of such prospective payment system on the States described in paragraph (1) and, not later than O ctober 1, 2011, shall report to Congress on any effect on access to benefits, provider payment rates, or scope of bene- fits offered by such States as a result of the application of such payment system. SEC.504 . PR E MIU M G R A CE PERI OD . (a) IN G ENERA L .—Section 2103(e)(3) (42 U.S.C. 1397cc(e)(3)) is amended by adding at the end the following new subparagraph

‘(C) PRE M I U M GRA C E PERIOD.—The State child health plan— ‘‘(i) shall afford individuals enrolled under the plan a grace period of at least 30 days from the beginning of a new coverage period to ma k e premium payments before the individual ’ s coverage under the plan may be terminated and ‘‘(ii) shall provide to such an individual, not later than 7 days after the first day of such grace period, notice— ‘‘(I) that failure to make a premium payment within the grace period will result in termination of coverage under the State child health plan; and ‘‘(II) of the individual’s right to challenge the proposed termination pursuant to the applicable Federal regulations. For purposes of clause (i), the term ‘new coverage period’ means the month immediately following the last month for which the premium has been paid.’’. (b) EF FECTI V E DATE.—The amendment made by subsection (a) shall apply to new coverage periods beginning on or after the date of the enactment of this Act. SEC. 505. C L ARI F ICA T IO N OF CO V ERAGE OF SERVICES PROVIDED T H ROUGH SCHOOL -B ASED HEALTH CENTERS. (a) IN GENERAL.—Section 2103(c) (42 U.S.C. 1397cc(c)), as amended by section 5 01(a)(1)( B ), is amended by adding at the end the following new paragraph: ‘‘( 8 ) AVAILA B ILIT Y OF COVERAGE FOR ITEM S AND SERVICES FURNIS H ED THROUGH SCHOOL-BASED HEALTH CENTERS.— N othing in this title shall be construed as limiting a State’s ability to provide child health assistance for covered items and services that are furnished through school-based health centers (as defined in section 2110(c)(9)).’’. (b) DEFINITION.—Section 2110(c) (42 U.S.C. 1397 j j) is amended by adding at the end the following: 42USC1397c c note.


text:
Page:United States Statutes at Large Volume 123.djvu/111

 123STA T .9 1 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 09 ‘ ‘ (9)SCHO O L-BASED HEAL T HCE N TE R.— ‘‘( A ) I N G ENERAL.— Thet e rm ‘ sc h o o l - ba se d health ce n ter ’ means a health cl i nic that— ‘‘(i) is located in or near a school f acilit y ofa school district or board or of an Indian tribe or tribal or g ani z ation ‘‘(ii) is organized thro u gh school , community, and health p ro v ider relationships; ‘‘(iii) is administered by a sponsoring facility; ‘‘(iv) provides through health professionals primary health services to children in accordance w ith State and local law, including laws relating to licensure and certification; and ‘‘(v) satisfies such other re q uirements as a State may establish for the operation of such a clinic. ‘‘( B )S P ONSOR I NG F ACILIT Y .— F or purposes of subpara- graph (A)(iii), the term ‘sponsoring facility’ includes any of the following ‘‘(i) A hospital. ‘‘(ii) A public health department. ‘‘(iii) A community health center. ‘‘(iv) A nonprofit health care agency. ‘‘(v) A school or school system. ‘‘(vi) A program administered by the Indian H ealth Service or the Bureau of Indian Affairs or operated by an Indian tribe or a tribal organization.’’. SEC.506 . M E DI C A IDA N DC H I P PA Y MEN T AND ACCESS C O MMISSION. (a) IN G ENERAL.—Title X IX( 42U .S. C . 13 9 6 et seq.) is amended by inserting before section 19 0 1 the following new section: ‘‘ M EDICAID AND CHIP PAYMENT AND ACCESS COMMISSION ‘‘SEC. 1900. (a) E STABLISHMENT.—There is hereby established the M edicaid and CHI P Payment and Access Commission (in this section referred to as ‘MACPAC’). ‘‘(b) DU TIES.— ‘‘(1) R E V IE W OF ACCESS POLICIES AND ANNUAL REPORTS.— MACPAC shall— ‘‘(A) review policies of the Medicaid program estab- lished under this title (in this section referred to as ‘Med- icaid’) and the State Children’s Health Insurance Program established under title XXI (in this section referred to as ‘CHIP’) affecting children’s access to covered items and services, including topics described in paragraph (2); ‘‘(B) ma k e recommendations to Congress concerning such access policies; ‘‘(C) by not later than March 1 of each year (beginning with 2010), submit a report to Congress containing the results of such reviews and MACPAC’s recommendations concerning such policies; and ‘‘(D) by not later than J une 1 of each year (beginning with 2010), submit a report to Congress containing an e x amination of issues affecting Medicaid and CHIP, including the implications of changes in health care delivery in the United States and in the market for health care services on such programs. 42USC1396.


text:
Page:United States Statutes at Large Volume 123.djvu/112

 123STA T .9 2 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 09 ‘ ‘ (2)SPECIF IC TO PIC S TO B E R E V IE W E D.— S pecif ic al l y,MACP AC sh all r e v ie w a nd assess t hef o llowin g: ‘‘(A) MEDIC A IDA N DC H IP PA YM ENT PO L ICIES.—Pay m ent policies u nder Medicaid and C HI P, including— ‘‘(i) the factors affecting e x penditures for items and services in different sectors, including the process for updating hospital, s k illed nursing facility, physi - cian, F ederally- q ualified health center, rural health center, and other fees ‘‘(ii) payment methodologies; and ‘‘(iii) the relationship of such factors and meth- odologies to access and quality of care for Medicaid and CHIP b eneficiaries. ‘‘( B ) INTERACTION OF MEDICAID AND CHIP PAYMENT POLI- CIES WITH HEALTH CARE DELIVERY G ENERALLY.— T he effect of Medicaid and CHIP payment policies on access to items and services for children and other Medicaid and CHIP populations other than under this title or title X XI and the implications of changes in health care delivery in the U nited States and in the general market for health care items and services on Medicaid and CHIP. ‘‘(C) O THER ACCESS POLICIES.—The effect of other Med- icaid and CHIP policies on access to covered items and services, including policies relating to transportation and language barriers. ‘‘( 3 ) CREATION OF EARLY-WARNING SYSTEM.—MACPAC shall create an early-warning system to identify provider shortage areas or any other problems that threaten access to care or the health care status of Medicaid and CHIP beneficiaries. ‘‘( 4 ) COMMENTS ON CERTAIN SECRETARIAL REPORTS.—If the Secretary submits to Congress (or a committee of Congress) a report that is required by law and that relates to access policies, including with respect to payment policies, under Med- icaid or CHIP, the Secretary shall transmit a copy of the report to MACPAC. MACPAC shall review the report and, not later than 6 months after the date of submittal of the Secretary ’ s report to Congress, shall submit to the appropriate committees of Congress written comments on such report. Such comments may include such recommendations as MACPAC deems appropriate. ‘‘( 5 ) AGENDA AND ADDITIONAL REVIEWS.—MACPAC shall consult periodically with the chairmen and ranking minority members of the appropriate committees of Congress regarding MACPAC’s agenda and progress towards achieving the agenda. MACPAC may conduct additional reviews, and submit addi- tional reports to the appropriate committees of Congress, from time to time on such topics relating to the program under this title or title XXI as may be requested by such chairmen and members and as MACPAC deems appropriate. ‘‘(6) AVAILABILITY OF REPORTS.—MACPAC shall transmit to the Secretary a copy of each report submitted under this subsection and shall make such reports available to the public. ‘‘( 7 ) APPROPRIATE COMMITTEE OF CONGRESS.—For purposes of this section, the term ‘appropriate committees of Congress’ means the Committee on E nergy and Commerce of the House of R epresentatives and the Committee on Finance of the Senate.


text:
Page:United States Statutes at Large Volume 123.djvu/113

 123STA T .9 3 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 09 ‘ ‘ (8)VOTINGA N DREP ORTING RE QU IRE M ENT S.—Withresp e c t t o e a ch reco m me nd ation contained in a report s ub mitted under para g raph ( 1 ) , each member o fMACP AC sha l l v ote on the recommendation, and MACPAC shall include, b y member, the results of that vote in the report containing the recommenda - tion. ‘‘( 9 ) EX AMINATION O FB UDGET C ONSEQUENCES.— B efore ma k ing any recommendations, MACPAC shall e x amine the budget conse q uences of such recommendations, directly or through consultation w ith appropriate expert entities. ‘‘(c) MEMBERS H IP.— ‘‘(1) N UMBER AND APPOINTMENT.—MACPAC shall be com- posed of 1 7 members appointed by the Comptroller G eneral of the U nited S tates. ‘‘( 2 ) Q UA L IFICATIONS.— ‘‘(A) I N GENERAL.— T he membership of MACPAC shall include individuals who have had direct experience as enrollees or parents of enrollees in Medicaid or C H IP and individuals with national recognition for their expertise in F ederal safety net health programs, health finance and economics, actuarial science, health facility management, health plans and integrated delivery systems, reimburse- ment of health facilities, health information technology, pediatric physicians, dentists, and other providers of health services, and other related fields, who provide a mix of different professionals, broad geographic representation, and a balance between urban and rural representatives. ‘‘(B) INCLUSION.—The membership of MACPAC shall include (but not be limited to) physicians and other health professionals, employers, third-party payers, and individ- uals with expertise in the delivery of health services. Such membership shall also include consumers representing chil- dren, pregnant women, the elderly, and individuals with disabilities, current or former representatives of State agen- cies responsible for administering Medicaid, and current or former representatives of State agencies responsible for administering CHIP. ‘‘(C) MA J ORIT Y NONPRO V IDERS.—Individuals who are directly involved in the provision, or management of the delivery, of items and services covered under Medicaid or CHIP shall not constitute a ma j ority of the membership of MACPAC. ‘‘( D ) ETHICAL DISCLOSURE.—The Comptroller General of the United States shall establish a system for public disclosure by members of MACPAC of financial and other potential conflicts of interest relating to such members. Members of MACPAC shall be treated as employees of Congress for purposes of applying title I of the Ethics in Government Act of 1978 (Public L aw9 5– 521). ‘‘( 3 ) TERMS.— ‘‘(A) IN GENERAL.—The terms of members of MACPAC shall be for 3 years except that the Comptroller General of the United States shall designate staggered terms for the members first appointed. ‘‘(B) VACANCIES.—Any member appointed to fill a vacancy occurring before the expiration of the term for which the member ’ s predecessor was appointed shall be


text:
Page:United States Statutes at Large Volume 123.djvu/114

 123STA T .94PUBLIC LA W 111 – 3 —FE B.4 , 2 0 09 ap p ointed on lyf o r t h ere m ainder of that term .A mem b er may s er v e after the e x piration of that member ’ s term u ntil asu c cessor has ta k en office. A vacancy in M A CP AC shall be filled in the manner in w hich the ori g inal appointment was made. ‘ ‘ (4) C OMPENSATI ON. —W hile serving on the business of MACPAC (including travel time) , a member of MACPAC shall be entitled to compensation at the per diem e q uivalent of the rate provided for level IV of the E xecutive S chedule under section 531 5 of title 5, U nited States Code and while so serving away from home and the member’s regular place of business, a member may be allowed travel expenses, as authori z ed by the Chairman of MACPAC. Physicians serving as personnel of MACPAC may be provided a physician comparability allow - ance by MACPAC in the same manner as G overnment physi- cians may be provided such an allowance by an agency under section 5 9 4 8 of title 5, United States Code, and for such purpose subsection (i) of such section shall apply to MACPAC in the same manner as it applies to the T ennessee Valley Authority. F or purposes of pay (other than pay of members of MACPAC) and employment benefits, rights, and privileges, all personnel of MACPAC shall be treated as if they were employees of the United States Senate. ‘‘(5) C H AI R MAN; V I C E CHAIRMAN.—The Comptroller General of the United States shall designate a member of MACPAC, at the time of appointment of the member as Chairman and a member as Vice Chairman for that term of appointment, except that in the case of vacancy of the Chairmanship or Vice Chairmanship, the Comptroller General of the United States may designate another member for the remainder of that member’s term. ‘‘( 6 ) MEETIN G S.—MACPAC shall meet at the call of the Chairman. ‘‘(d) D IRECTOR AN D STA F F;E X PERTS AND CONS UL TANTS.—Sub- j ect to such review as the Comptroller General of the United States deems necessary to assure the efficient administration of MACPAC, MACPAC may— ‘‘(1) employ and fix the compensation of an Executive Director (subject to the approval of the Comptroller General of the United States) and such other personnel as may be necessary to carry out its duties (without regard to the provi- sions of title 5, United States Code, governing appointments in the competitive service); ‘‘( 2 ) seek such assistance and support as may be required in the performance of its duties from appropriate Federal departments and agencies; ‘‘(3) enter into contracts or make other arrangements, as may be necessary for the conduct of the work of MACPAC (without regard to section 3 70 9ofthe R evised Statutes (41 U.S.C. 5)); ‘‘(4) make advance, progress, and other payments which relate to the work of MACPAC; ‘‘(5) provide transportation and subsistence for persons serving without compensation; and ‘‘(6) prescribe such rules and regulations as it deems nec- essary with respect to the internal organization and operation of MACPAC.


text:
Page:United States Statutes at Large Volume 123.djvu/115

 123STA T .95PUBLIC LA W 111 – 3 —FE B. 4, 2 0 09 ‘ ‘ (e)POWERS.— ‘‘( 1 ) OBTAIN IN G O F FI C IA LD ATA.— MAC PAC mays e cur e di rec tl y f r o ma n yde p artment or a g ency of t h e U nited S tates information necessary to ena b le it to carry out this section. Upon re q uest of the Chairman , the head of that department or agency shall furnish that information to MACPAC on an agreed upon schedule. ‘‘( 2 ) D ATA COLLECTION.— I n order to carry out its functions, MACPAC shall— ‘‘(A) utili z ee x isting information, both published and unpublished, w here possible, collected and assessed either by its own staff or under other arrangements made in accordance with this section ‘‘( B ) carry out, or award grants or contracts for, original research and experimentation, where existing information is inadequate; and ‘‘(C) adopt procedures allowing any interested party to submit information for MACPAC ’ suseinma k ing reports and recommendations. ‘‘( 3 ) ACCESS OF GAO TO INFOR M ATION.— T he Comptroller G eneral of the United States shall ha v e unrestricted access to all deliberations, records, and nonproprietary data of MACPAC, immediately upon request. ‘‘( 4 ) PERIODIC A U DIT.—MACPAC shall be sub j ect to periodic audit by the Comptroller General of the United States. ‘‘(f) AUT H ORI Z ATION OF A P PROPRIATIONS.— ‘‘(1) R E Q UEST FOR APPROPRIATIONS.—MACPAC shall submit requests for appropriations in the same manner as the Comp - troller General of the United States submits requests for appro- priations, but amounts appropriated for MACPAC shall be sepa- rate from amounts appropriated for the Comptroller General of the United States. ‘‘(2) AUTHORIZATION.—There are authorized to be appro- priated such sums as may be necessary to carry out the provi- sions of this section.’’. (b) DEADLINE FOR INITIAL APPOINTMENTS.— N ot later than J anuary 1, 2 0 10, the Comptroller General of the United States shall appoint the initial members of the Medicaid and C H IP Pay- ment and Access Commission established under section 1 9 00 of the Social Security Act (as added by subsection (a)). (c) ANNUAL REPORT ON MEDICAID.—Not later than January 1, 2010, and annually thereafter, the Secretary, in consultation with the Secretary of the Treasury, the Secretary of L abor, and the States (as defined for purposes of Medicaid), shall submit an annual report to Congress on the financial status of, enrollment in, and spending trends for, Medicaid for the fiscal year ending on September 30 of the preceding year. 42USC1396note. 42 USC 1396 note.


text:
Page:United States Statutes at Large Volume 123.djvu/116

 123STA T .96PUBLIC LA W 111 – 3 —FE B. 4, 2 0 09 TI T LEV I —PROG R AM I N TEGRIT Y AN D OT H ER MI SC ELLANEO U S PROVISIONS S ubti t le A—P rog r am I n tegrit y an d Data Colle c tion SEC.601 . PAYM E NT E R R O R RATE MEAS U REMENT (‘ ‘PERM ’ ’ ) . (a)EXPENDITUR E SR E LA TED T OC O M PLIAN C E W IT H RE Q UIRE - MENTS .— ( 1 ) ENHANCED PA Y MENTS.— Section2 1 05 (c) ( 4 2 U .S.C. 1 397 ee(c)) , a s a m en d ed by section 301(a), is amended by addin g att h e end the f o l lo w ing new p a r agraph

‘(11) ENHANCED PAYMENTS.— N otwithstanding s u bsection (b), the enhanced FMAP with respect to payments under sub- section (a) for e x penditures related to the administration of the payment error rate measurement (PERM) re q uirements applicable to the State child health plan in accordance with the I mproper Payments Information Act of 2002 and parts 431 and 457 of title 42, Code of Federal Regulations (or any related or successor guidance or regulations) shall in no e v ent be less than 90 percent. ’ ’. (2) EXCLUSION O F FROM CAP ON ADMINISTRATI V E EXPENDI- TURES.—Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)C)), as amended by section 302(b)), is amended by adding at the end the following: ‘‘(iv) PAYMENT ERROR RATE MEASUREMENT ( PERM ) EXPENDITURES.—Expenditures related to the adminis- tration of the payment error rate measurement (PERM) requirements applicable to the State child health plan in accordance with the Improper Payments Information Act of 2002 and parts 431 and 457 of title 42, Code of Federal Regulations (or any related or successor guidance or regulations).’’. (b) FINAL RULE REQUIRED T O B EINEFFECT FOR ALL STATES.— Notwithstanding parts 431 and 457 of title 42, Code of Federal Regulations (as in effect on the date of enactment of this Act), the Secretary shall not calculate or publish any national or State- specific error rate based on the application of the payment error rate measurement (in this section referred to as ‘‘PERM’’) require- ments to C H IP until after the date that is 6 months after the date on which a new final rule (in this section referred to as the ‘‘new final rule’’) promulgated after the date of the enactment of this Act and implementing such requirements in accordance with the requirements of subsection (c) is in effect for all States. Any calculation of a national error rate or a State specific error rate after such new final rule in effect for all States may only be inclusive of errors, as defined in such new final rule or in guidance issued within a reasonable time frame after the effective date for such new final rule that includes detailed guidance for the specific methodology for error determinations. (c) REQUIREMENTS FOR NE W FINAL RULE.—For purposes of subsection (b), the requirements of this subsection are that the new final rule implementing the PERM requirements shall— (1) include— 42USC1397e e not e .


text:
Page:United States Statutes at Large Volume 123.djvu/117

 123STA T .97PUBLIC LA W 111 – 3 —FE B. 4, 2 0 09 (A)clear l yd e fin ed cri t eria f o r error s for b ot hS tates and p ro v iders ( B ) a clearly defined process for appealin g error deter -m inations by — (i) revie w contractors; or (ii) the agency and personnel described in section 431.97 4(a)( 2 ) of title 42 ,C ode of F ederal R eg u lations, as in effect on September 1, 2 0 07, responsible for the development, direction, implementation, and evalua- tion of eligibility reviews and associated activities; and (C) clearly defined responsibilities and deadlines for States in implementing any corrective action plans; and (2) provide that the payment error rate determined for a State shall not ta k e into account payment errors resulting from the State ’ s verification of an applicant’s self-declaration or self-certification of eligibility for, and the correct amount of, medical assistance or child health assistance, if the State process for verifying an applicant’s self-declaration or self-cer- tification satisfies the re q uirements for such process applicable under regulations promulgated by the Secretary or otherwise approved by the Secretary. (d) OPTIONF O R APP L I CA TION OF D ATA FOR STAT ES IN FIRST APPLICATION C Y CLE U N D ERT H E I NTERI M FINAL R U LE.—After the new final rule implementing the PE R M requirements in accordance with the requirements of subsection (c) is in effect for all States, a State for which the PERM requirements were first in effect under an interim final rule for fiscal year 2007 or under a final rule for fiscal year 200 8 may elect to accept any payment error rate determined in whole or in part for the State on the basis of data for that fiscal year or may elect to not have any payment error rate determined on the basis of such data and, instead, shall be treated as if fiscal year 2010 or fiscal year 2011 were the first fiscal year for which the PERM requirements apply to the State. (e) H ARMONI Z ATION OF ME Q C AND PERM.— (1) REDUCTION OF REDUNDANCIES.— T he Secretary shall review the Medicaid Eligibility Quality Control (in this sub- section referred to as the ‘ ‘MEQC’’) requirements with the PERM requirements and coordinate consistent implementation of both sets of requirements, while reducing redundancies. (2) STATE OPTION TO APPLY PERM DATA.—A State may elect, for purposes of determining the erroneous e x cess payments for medical assistance ratio applicable to the State for a fiscal year under section 1903(u) of the Social Security Act (42 U.S.C. 139 6 b(u)) to substitute data resulting from the application of the PERM requirements to the State after the new final rule implementing such requirements is in effect for all States for data obtained from the application of the MEQC requirements to the State with respect to a fiscal year. (3) STATE OPTION TO APPLY ME Q C DATA.—For purposes of satisfying the requirements of subpart Q of part 431 of title 42, Code of Federal Regulations, relating to Medicaid eligibility reviews, a State may elect to substitute data obtained through MEQC reviews conducted in accordance with section 1903(u) of the Social Security Act (42 U.S.C. 1396b(u)) for data required for purposes of PERM requirements, but only if the State


text:
Page:United States Statutes at Large Volume 123.djvu/118

 123STA T .98PUBLIC LA W 111 – 3 —FE B. 4, 2 0 09 MEQCrevi e wsa re b ase don a broad , re p resen t ative sa m p l e o f Medi c aid applicants or enrollees in t h e S tates .( f )IDENTIF I CA TI O NOFI MPR O V ED STATE - SPECIFIC SAMP L E SI Z E S . —T he Secretar y shall establish State-specific sample si z es for application of the P E R Mre qu irements with respect to State child health plans for fiscal years be g inning with the first fiscal year that begins on or after the date on which the new final rule is in effect for all States, on the basis of such information as the Secretary determines appropriate. In establishing such sample sizes, the Secretary shall, to the greatest e x tent prac- ticable— ( 1 ) minimize the administrative cost burden on States under Medicaid and C H IP and ( 2 ) maintain State flexibility to manage such programs. (g) TIME FOR PROM U L G ATION OF F INAL RULE.—The final rule implementing the PERM requirements under subsection (b) shall be promulgated not later than 6 months after the date of enactment of this A ct. SEC.602 . IMPROV I NGDAT ACO L LECTION. (a) INCREASED APPROPRIATION.—Section 21 09 (b)(2) ( 4 2 U .S.C. 1 3 9 7 ii(b)(2)) is amended by stri k ing ‘ ‘ $ 10,000,000 for fiscal year 2000 ’ ’ and inserting ‘‘$20,000,000 for fiscal year 2009’’. (b) USE OF ADDITIONAL FUNDS.—Section 2109(b) (42 U.S.C. 1397ii(b)), as amended by subsection (a), is amended— (1) by redesignating paragraph (2) as paragraph (4); and (2) by inserting after paragraph (1), the following new paragraphs ‘‘(2) ADDITIONAL RE Q UIREMENTS.—In addition to making the ad j ustments required to produce the data described in paragraph (1), with respect to data collection occurring for fiscal years beginning with fiscal year 2009, in appropriate consultation with the Secretary of Health and Human Services, the Secretary of Commerce shall do the following: ‘‘(A) Make appropriate adjustments to the Current Population Survey to develop more accurate State-specific estimates of the number of children enrolled in health coverage under title X IX or this title. ‘‘( B ) Make appropriate adjustments to the Current Population Survey to improve the survey estimates used to determine the child population growth factor under sec- tion 2104(m)( 5 )(B) and any other data necessary for car- rying out this title. ‘‘(C) Include health insurance survey information in the American Community Survey related to children. ‘‘( D ) Assess whether American Community Survey esti- mates, once such survey data are first available, produce more reliable estimates than the Current Population Survey with respect to the purposes described in subpara- graph (B). ‘‘(E) O n the basis of the assessment required under subparagraph (D), recommend to the Secretary of Health and Human Services whether American Community Survey estimates should be used in lieu of, or in some combination with, Current Population Survey estimates for the purposes described in subparagraph (B).


text:
Page:United States Statutes at Large Volume 123.djvu/119

 123STA T .9 9 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 09 ‘ ‘ (F)Conti n uemak in g t h ea dj u s tments des cr i b ed in the l ast sentence o fp aragraph ( 1 ) w ith respect to e x pansion of the sample si z e used in S tate sampling units , the number of sampling units in a State, and using an appropriate v erification element . ‘‘( 3 ) AUTHORI T YF OR TH ES E C RET A RY OF HEA L THA ND HU M AN SER V ICES TO TRANSITION TO THE USE OF ALL, OR SOME COM B INA - TION OF, ACS ESTIMATES U P ON RECOMMENDATION OF THE SEC- RETARY OF COMMERCE. —I f, on the basis of the assessment re q uired under paragraph ( 2 )( D ), the Secretar y of Commerce recommends to the Secretary of H ealth and Human Services that American Community Survey estimates should be used in lieu of, or in some combination with, Current P opulation Survey estimates for the purposes described in paragraph (2)( B ), the Secretary of Health and Human Services, in con- sultation with the States, may provide for a period during which the Secretary may transition from carrying out such purposes through the use of Current Population Survey esti- mates to the use of American Community Survey estimates (in lieu of, or in combination with the Current Population Survey estimates, as recommended), provided that any such transition is implemented in a manner that is designed to avoid adverse impacts upon States with approved State child health plans under this title. ’ ’. SEC.603 . UPDAT ED F EDE R A L E V ALUAT ION OFC H IP. Section 21 08 (c) ( 4 2 U .S.C. 13 97 hh(c)) is amended by striking paragraph ( 5 ) and inserting the following ‘‘(5) SUBSE Q UENT EVALUATION USIN G UPDATED INFORMA- TION.— ‘‘(A) IN GENERAL.— T he Secretary, directly or through contracts or interagency agreements, shall conduct an inde- pendent subsequent evaluation of 10 States with approved child health plans. ‘‘(B) SELECTION OF STATES AND MATTERS INCLUDED.— Paragraphs (2) and (3) shall apply to such subsequent evaluation in the same manner as such provisions apply to the evaluation conducted under paragraph (1). ‘‘(C) SUBMISSION TO CONGRESS.— N ot later than December 31, 2011, the Secretary shall submit to Congress the results of the evaluation conducted under this para- graph. ‘‘(D) FUNDING.— O ut of any money in the Treasury of the United States not otherwise appropriated, there are appropriated $ 10,000,000 for fiscal year 2010 for the purpose of conducting the evaluation authorized under this paragraph. Amounts appropriated under this subparagraph shall remain available for expenditure through fiscal year 2012.’’. SEC. 60 4 . ACCESS TO RECORDS FOR I G AND GAO AUDITS AND EVALUA - TIONS. Section 2108(d) (42 U.S.C. 1397hh(d)) is amended to read as follows: ‘‘(d) ACCESS TO R ECORDS FOR I G AND GAO AUDITS AND E VALUA- TIONS.—For the purpose of evaluating and auditing the program established under this title, or title X IX, the Secretary, the Office of Inspector General, and the Comptroller General shall have access Ap p licab ili ty.Con t r act s .


text:
Page:United States Statutes at Large Volume 123.djvu/120

 123STA T . 1 0 0 PUBLIC LA W 111 – 3 —FE B. 4, 200 9toanyb oo ks, a c co u nts, re cor d s, corres p ondence, and ot h er docu -m ents that are re l ated to the e x pend i ture o fF ederal funds under this title and that are in the possession, custody, or control of S tates recei v in g Federal funds under this title or political subdivi- sions thereof, or any grantee or contractor of such States or political subdivisions .’ ’. SEC.605 . NOF E D E RAL F U ND I N G FOR ILLEGAL ALIENS DISALLO W- ANCE FOR UNAU TH ORI Z EDE XP ENDITURES. N othing in this A ct allo w s Federal payment for individuals who are not legal residents. T itles XI , XIX, and XXI of the Social Security Act provide for the disallowance of Federal financial participation for erroneous expenditures under M edicaid and under CH I P , respectively. Subti t leB—M i sc ell an e o us H ealt hPr o v isions SEC. 6 1 1. DEFICIT REDUCTION ACT TECHNICAL CORRECTIONS. ( a ) C LARIF I C A T I ON OF REQU IRE M ENT TO PRO V I D E E PS D T SERV- ICE S FOR ALL C H ILDREN IN B ENCHMAR K BENEFIT PACKA G ES U NDER MEDICAID. — Section 1937 (a)(1) ( 42 U.S.C. 139 6 u – 7(a)(1)), as inserted by section 6 0 44(a) of the Deficit Reduction Act of 200 5 (Public L aw 109–171, 120 Stat. 8 8), is amended— (1) in subparagraph (A)— (A) in the matter before clause (i)— (i) by striking ‘ ‘Notwithstanding any other provi- sion of this title’’ and inserting ‘‘Notwithstanding sec- tion 1902(a)(1) (relating to statewideness), section 1902(a)(10)(B) (relating to comparability) and any other provision of this title which would be directly contrary to the authority under this section and sub j ect to sub- section (E)’’ and (ii) by striking ‘‘enrollment in coverage that pro- vides’’ and inserting ‘‘coverage that’’; (B) in clause (i), by inserting ‘‘provides’’ after ‘‘(i)’’; and (C) by striking clause (ii) and inserting the following ‘‘(ii) for any individual described in section 1905(a)(4)(B) who is eligible under the State plan in accordance with paragraphs (10) and (17) of section 1902(a), consists of the items and services described in section 1905(a)(4)(B) (relating to early and periodic screening, diagnostic, and treatment services defined in section 1905(r)) and provided in accordance with the re q uirements of section 1902(a)(43).’’; (2) in subparagraph (C)— (A) in the heading, by striking ‘‘ wrap- ar ound ’’ and inserting ‘‘add it iona l ’’; and (B) by striking ‘‘wrap-around or’’; and (3) by adding at the end the following new subparagraph: ‘‘(E) RULE OF CONSTRUCTION.—Nothing in this para- graph shall be construed as— ‘‘(i) requiring a State to offer all or any of the items and services required by subparagraph (A)(ii) through an issuer of benchmark coverage described 42USC1396note.


text:
Page:United States Statutes at Large Volume 123.djvu/121

 123STA T . 1 0 1 PUBLIC LA W 111 – 3 —FE B. 4, 200 9insub s ect i o n ( b ) ( 1 )o r benc hma r k e q ui v a l ent covera g e d escribed in subsection (b)( 2 ) ‘(ii) p reventing a S tate f rom offering all or an y of the items and services required by subparagraph ( A )(ii) through an issuer of benchmark coverage described in subsection (b)(1) or benchmark equivalent coverage described in subsection (b)(2); or ‘‘(iii) affecting a child ’ s entitlement to care and services described in subsections (a)( 4 )( B )and(r)of section 1 905 and provided in accordance w ith section 1902(a)(4 3 ) whether provided through benchmark cov - erage , benchmark equivalent coverage, or otherwise . ’’. (b) COR R ECTI O N O FR EFERENCE TO C H I LD REN IN F O S TER C A RE RECEI V IN G CHILD W ELFARE SERVICES. — Section 193 7 (a)(2)(B)(viii) (42 U .S.C. 139 6 u – 7(a)(2)(B)(viii)), as inserted by section 6044(a) of the D eficit Reduction Act of 2005, is amended by striking ‘‘aid or assistance is made available under part B of title IV to children in foster care and individuals’’ and inserting ‘‘child welfare services are made available under part B of title IV on the basis of being a child in foster care or’’. (c) T RANS P ARENC Y .—Section 1937 (42 U.S.C. 1396u–7), as inserted by section 6044(a) of the Deficit Reduction Act of 2005, is amended by adding at the end the following ‘‘(c) PUB LICATION OF PROVISIONS AFFECTED.—With respect to a State plan amendment to provide benchmark benefits in accord- ance with subsections (a) and (b) that is approved by the Secretary, the Secretary shall publish on the Internet website of the Centers for M edicare & Medicaid Services, a list of the provisions of this title that the Secretary has determined do not apply in order to enable the State to carry out the plan amendment and the reason for each such determination on the date such approval is made, and shall publish such list in the Federal Register and not later than 30 days after such date of approval.’’. (d) E FFECTIVE DATE.—The amendments made by subsections (a), (b), and (c) of this section shall take effect as if included in the amendment made by section 6044(a) of the Deficit Reduction Act of 2005. SEC.612 . R E F ERE N CES TO T I T L E X XI. Section 704 of the Medicare, Medicaid, and SC H IP Balanced Budget Refinement Act of 1999, as enacted into law by division B of Public L aw 106–113 (113 Stat. 1501A–402) is repealed. SEC. 61 3 . P RO H I B ITIN G INITI A TION OF NE W HEALTH OPPORT U NIT Y ACCOUNT D E M ONSTRATION PROGRAMS. After the date of the enactment of this Act, the Secretary of Health and Human Services may not approve any new dem- onstration programs under section 193 8 of the Social Security Act (42 U.S.C. 1396u–8). SEC. 61 4 .AD J USTMENT IN COMPUTATION OF MEDICAID FMAP TO DIS - REGARD AN EXTRAORDINARY EMPLOYER PENSION CON- TRIBUTION. (a) IN G ENERAL.— O nly for purposes of computing the FMAP (as defined in subsection (e)) for a State for a fiscal year (beginning with fiscal year 2006) and applying the FMAP under title X IX of the Social Security Act, any significantly disproportionate 42USC1396dnote. 42 USC 1396 u–8 note. 42 USC 139 7a a note. 42 USC 1396u–7 note. W e bsi te. L ist. F ede r a lR e g ister ,p ubli c ation. D eadline.


text:
Page:United States Statutes at Large Volume 123.djvu/122

 123STA T . 1 0 2 PUBLIC LA W 111 – 3 —FE B. 4, 200 9employ e r pe nsi on or ins u r a n c e f un d con t ri b ution described in sub - section ( b ) s h all be disre g arded in computing the per capita income of such S tate , but shall not be disregarded in computing the per capita income for the continental U nited States (and A las k a) and H a w aii . (b) S IGN I F I CA N TLYD I SPRO PORTIONAT EEM PLOYER P ENSION AN DI NS U RANCE F UND C ONTRI B UTION. — ( 1 ) IN GENERAL.—For purposes of this section, a signifi- cantly disproportionate employer pension and insurance fund contribution described in this subsection with respect to a State is any identifiable employer contribution towards pension or other employee insurance funds that is estimated to accrue to residents of such State for a calendar year (beginning with calendar year 20 0 3 ) if the increase in the amount so estimated e x ceeds 2 5 percent of the total increase in personal income in that State for the year in v olved. (2) DATA TO BE USED.—For estimating and ad j ustment aF M AP already calculated as of the date of the enactment of this Act for a State with a significantly disproportionate employer pension and insurance fund contribution, the Sec- retary shall use the personal income data set originally used in calculating such FMAP. (3) SPECIAL AD J USTMENT FOR NEGATI V E GRO W T H .—If in any calendar year the total personal income growth in a State is negative, an employer pension and insurance fund contribu- tion for the purposes of calculating the State ’ sFMAPfora calendar year shall not exceed 125 percent of the amount of such contribution for the previous calendar year for the State. (c) HOLD HARMLESS.— N o State shall have its FMAP for a fiscal year reduced as a result of the application of this section. (d) R EPORT.—Not later than May 15, 200 9, the Secretary shall submit to the Congress a report on the problems presented by the current treatment of pension and insurance fund contributions in the use of B ureau of Economic Affairs calculations for the FMAP and for Medicaid and on possible alternative methodologies to miti- gate such problems. (e) FMAP DEFINED.—For purposes of this section, the term ‘ ‘FMAP’’ means the Federal medical assistance percentage, as defined in section 1905(b) of the Social Security Act ( 4 2 U.S.C. 139 6 (d)). SEC.615 . C LARIF ICA T I ON TREAT M ENT OF RE G IONAL ME D ICAL CENTER. (a) IN G ENERAL.—Nothing in section 1903(w) of the Social Security Act (42 U.S.C. 1396b(w)) shall be construed by the Sec- retary of Health and Human Services as prohibiting a State’s use of funds as the non-Federal share of expenditures under title X IX of such Act where such funds are transferred from or certified by a publicly-owned regional medical center located in another State and described in subsection (b), so long as the Secretary determines that such use of funds is proper and in the interest of the program under title XIX. (b) CENTER DESCRIBED.—A center described in this subsection is a publicly-owned regional medical center that— (1) provides level 1 trauma and burn care services (2) provides level 3 neonatal care services; 42USC1396bnote.