text:
Page:United States Statutes at Large Volume 123.djvu/65

 123STA T .45PUBLIC LA W 111 – 3 —FE B.4 , 2 0 0 9exc e pt t ha t in app ly in g thi s pa r agraph u n d er title X X I, there shall b e substituted fo r references to pro v isions of this title corresponding provisions w ithin title XXI .‘ ‘ (F)EXPRES S LAN EA G EN CY . — ‘‘(i) IN GENERAL.—In this paragraph, the ter m ‘Express L ane agency ’ means a public agency that— ‘‘(I) is determined by the S tate M edicaid agency or the State CH I P agency (as applicable) to be capable of ma k ing the determinations of one or more eligibility re q uirements described in subparagraph ( A )(i) ‘‘(II) is identified in the State Medicaid plan or the State CHIP plan; and ‘‘(III) notifies the child’s family— ‘‘(aa) of the information which shall be dis - closed in accordance with this paragraph; ‘‘(bb) that the information disclosed will be used solely for purposes of determining eligibility for medical assistance under the State Medicaid plan or for child health assistance under the State CHIP plan; and ‘‘(cc) that the family may elect to not have the information disclosed for such purposes; and ‘‘(I V ) enters into, or is sub j ect to, an interagency agreement to limit the disclosure and use of the information disclosed. ‘‘(ii) INCL U S IO NO F SPECIFIC PU B LIC AGENCIES.—Such term includes the following ‘‘(I) A public agency that determines eligibility for assistance under any of the following: ‘‘(aa) T he temporary assistance for needy fami- lies program funded under part A of title IV. ‘‘(bb) A State program funded under part D of title IV. ‘‘(cc) The State Medicaid plan. ‘‘(dd) The State CHIP plan. ‘‘(ee) The Food and N utrition Act of 20 0 8 ( 7U .S.C. 20 1 1 et seq.). ‘‘(ff) The Head Start Act ( 4 2 U.S.C. 9 801 et seq.). ‘‘(gg) The R ichard B . Russell National School Lunch Act (42 U.S.C. 17 5 1 et seq.). ‘‘(hh) The Child Nutrition Act of 19 6 6 (42 U.S.C. 1771 et seq.). ‘‘(ii) The Child Care and Development Block G rant Act of 1990 (42 U.S.C. 9858 et seq.). ‘‘(jj) The Stewart B. Mc K inney Homeless Assistance Act (42 U.S.C. 11 3 01 et seq.). ‘‘(kk) The United States Housing Act of 1937 (42 U.S.C. 1437 et seq.). ‘‘(ll) The Native American Housing Assistance and Self-Determination Act of 1996 (25 U.S.C. 4101 et seq.). ‘‘(II) A State-specified governmental agency that has fiscal liability or legal responsibility for the accuracy of the eligibility determination findings relied on by the State.


text:
Page:United States Statutes at Large Volume 123.djvu/66

 123STA T .46PUBLIC LA W 111 – 3 —FE B.4 , 2 0 0 9‘ ‘ (I II )Apublicagen c yth ati s sub j ect t o an inte r- agency agree m ent limiting the d isclosure and use o f the information disclosed for purposes of determining eligibility under the S tate M edicaid plan or the State CH I P plan . ‘‘(iii) EXCLUSION S. — Such term does not include an agency that determines eligibility for a program established under the Social Ser v ices B loc kG rant established under title X X or a private , for-profit organi z ation. ‘‘(iv) R UL E SO F CONS TR UCTION.— N othing in this para- graph shall be construed as— ‘‘(I) e x empting a State Medicaid agency from com- plying w ith the re q uirements of section 1902 (a)( 4 ) relating to merit-based personnel standards for employees of the State Medicaid agency and safeguards against conflicts of interest) or ‘‘(II) authorizing a State Medicaid agency that elects to use Express L ane agencies under this subparagraph to use the Express Lane option to avoid complying with such requirements for purposes of making eligibility determinations under the State Med- icaid plan. ‘‘(v) A D DITION A L DEFINITIONS.—In this paragraph ‘‘(I) STATE.— T he term ‘State ’ means 1 of the 5 0 States or the D istrict of Columbia. ‘‘(II) STATE C H I P A G ENC Y .—The term ‘State CHIP agency’ means the State agency responsible for admin- istering the State CHIP plan. ‘‘(III) STATE CHIP PLAN.—The term ‘State CHIP plan’ means the State child health plan established under title XXI and includes any waiver of such plan. ‘‘(I V ) STATE M EDICAID AGENCY.—The term ‘State Medicaid agency’ means the State agency responsible for administering the State Medicaid plan. ‘‘(V) STATE MEDICAID PLAN.—The term ‘State Med- icaid plan’ means the State plan established under title XIX and includes any waiver of such plan. ‘‘(G) CHILD DEFINED.— F or purposes of this paragraph, the term ‘child’ means an individual under 19 years of age, or, at the option of a State, such higher age, not to exceed 21 years of age, as the State may elect. ‘‘(H) STATE OPTION TO RELY ON STATE INCOME TAX DATA OR RETURN.—At the option of the State, a finding from an Express Lane agency may include gross income or adjusted gross income shown by State income tax records or returns. ‘‘(I) APPLICATION.—This paragraph shall not apply with respect to eligibility determinations made after September 3 0, 2013.’’. (2) CHIP.—Section 210 7 (e)(1) (42 U .S.C. 1397gg(e)(1)) is amended by redesignating subparagraphs (B), (C), and (D) as subparagraphs (C), (D), and (E), respectively, and by inserting after subparagraph (A) the following new subparagraph: ‘‘(B) Section 1902(e)(13) (relating to the State option to rely on findings from an Express Lane agency to help evaluate a child’s eligibility for medical assistance).’’. (b) E V ALUATION AND REPORT.—

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


text:
Page:United States Statutes at Large Volume 123.djvu/67

 123STA T .47PUBLIC LA W 111 – 3 —FE B.4 , 2 0 0 9(1)EVALU A TION.—TheS e cr e ta r ys ha l lc ondu ct ,b y g rant, contract, or i nteragency agree m ent, a com p rehensi v e, inde - pendent evaluation o f the option provided under the amend- ments made by subsection (a). Such evaluation shall include an analysis of the effectiveness of the option, and shall include— ( A ) obtaining a statistically valid sample of the children w ho were enrolled in the State M edicaid plan or the State CHIP plan through reliance on a finding made by an E x press L ane agency and determining the percentage of children who were erroneously enrolled in such plans ( B ) determining whether enrolling children in such plans through reliance on a finding made by an Express Lane agency improves the ability of a State to identify and enroll low-income, uninsured children who are eligible but not enrolled in such plans; (C) evaluating the administrative costs or savings related to identifying and enrolling children in such plans through reliance on such findings, and the extent to which such costs differ from the costs that the State otherwise would have incurred to identify and enroll low-income, uninsured children who are eligible but not enrolled in such plans; and ( D ) any recommendations for legislative or administra- tive changes that would improve the effectiveness of enrolling children in such plans through reliance on such findings. ( 2 ) REP O R TTO C ON G RE S S.— N ot later than September 30, 2012, the Secretary shall submit a report to Congress on the results of the evaluation under paragraph (1). (3) F UN D ING.— (A) IN GENERAL.— O ut of any funds in the Treasury not otherwise appropriated, there is appropriated to the Secretary to carry out the evaluation under this subsection $5 ,000,000 for the period of fiscal years 200 9 through 2012. (B) BUDGET AUT H ORIT Y .—Subparagraph (A) constitutes budget authority in advance of appropriations Act and rep- resents the obligation of the Federal G overnment to provide for the payment of such amount to conduct the evaluation under this subsection. (c) ELECTRONIC TRANS M ISSION O F INFORMATION.—Section 1902 ( 4 2 U .S.C. 139 6 a) is amended by adding at the end the following new subsection

‘(dd) ELECTRONIC TRANSMISSION OF INFORMATION.—If the State agency determining eligibility for medical assistance under this title or child health assistance under title X XI verifies an element of eligibility based on information from an Express Lane Agency (as defined in subsection (e)(13)(F)), or from another public agency, then the applicant ’ s signature under penalty of per j ury shall not be re q uired as to such element. Any signature requirement for an application for medical assistance may be satisfied through an electronic signature, as defined in section 1 7 10(1) of the Govern- ment Paperwor k Elimination Act (44 U.S.C. 3504 note). The require- ments of subparagraphs (A) and (B) of section 1137(d)(2) may be met through evidence in digital or electronic form.’’. (d) AUTHORI Z ATION OF INFORMATION DISCLOSURE.— Recom me nda-ti on s.S tatistics. Gr ants. C ontracts.


text:
Page:United States Statutes at Large Volume 123.djvu/68

 123STA T .48PUBLIC LA W 111 – 3 —FE B.4 , 2 0 0 9(1)INGE NE RAL.—TitleX IXi sam e nd ed by addin g att h e end the fo llo w ing new se c tion

‘ SEC.1942 . AUTHORIZ ATIO N TO RECEI V ERE L EVANT IN F OR M ATION. ‘ ‘(a) IN G ENERAL.— N otwithstanding any othe rp ro v ision of law , a F ederal or S tate agency or private entity in possession of the so u rces of data directly relevant to eligibility determinations under this title (including eligibility files maintained by Ex press L ane agencies described in section 1 902 (e)(1 3 )(F), information described in paragraph (2) or (3) of section 113 7 (a), vital records information about births in any State, and information described in sections 45 3(i) and 1902(a)(25)(I)) is authori z ed to convey such data or information to the State agency administering the State plan under this title, to the extent such conveyance meets the re q uirements of subsection (b). ‘‘(b) R E QUI RE M EN TSFO R C ON V E Y AN C E.— D ata or information may be conveyed pursuant to subsection (a) only if the following requirements are met: ‘‘(1) The individual whose circumstances are described in the data or information (or such individual ’ s parent, guardian, careta k er relative, or authorized representative) has either pro - vided advance consent to disclosure or has not ob j ected to disclosure after receiving advance notice of disclosure and a reasonable opportunity to object. ‘‘(2) Such data or information are used solely for the pur- poses of— ‘‘( A ) identifying individuals who are eligible or poten- tially eligible for medical assistance under this title and enrolling or attempting to enroll such individuals in the State plan and ‘‘( B ) verifying the eligibility of individuals for medical assistance under the State plan. ‘‘(3) An interagency or other agreement, consistent with standards developed by the Secretary— ‘‘(A) prevents the unauthorized use, disclosure, or modi- fication of such data and otherwise meets applicable Fed- eral requirements safeguarding privacy and data security; and ‘‘(B) requires the State agency administering the State plan to use the data and information obtained under this section to seek to enroll individuals in the plan. ‘‘(c) P ENALTIES FOR IM P ROPER DISCLOSURE.— ‘‘(1) CIVIL MONEY PENALTY.—A private entity described in the subsection (a) that publishes, discloses, or makes known in any manner, or to any extent not authorized by Federal law, any information obtained under this section is subject to a civil money penalty in an amount equal to $ 10,000 for each such unauthorized publication or disclosure. The provi- sions of section 112 8 A (other than subsections (a) and (b) and the second sentence of subsection (f)) shall apply to a civil money penalty under this paragraph in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a). ‘‘(2) CRIMINAL PENALTY.—A private entity described in the subsection (a) that willfully publishes, discloses, or makes known in any manner, or to any extent not authorized by Federal law, any information obtained under this section shall Ap p licab ili ty.42USC1396w– 2 no t e.


text:
Page:United States Statutes at Large Volume 123.djvu/69

 123STA T .49PUBLIC LA W 111 – 3 —FE B.4 , 2 0 09 befin e d n otm o r et ha n $10, 000 or im p ri s oned not more than 1 y ear, or both, for ea c hs u ch unauthori z ed pub l ication or disclosure .‘ ‘ ( d )RULEOFC O NSTR U C T I ON. —T he limitations and re q uire - ments that apply to disclosure pursuant to this section shall not be construed to prohibit the con v eyance or disclosure of data or information other w ise permitted under F ederal law (without re g ard to this section). ’ ’. ( 2 ) CONFOR M IN GA MEN D MENT TO TITLE X XI.— S ection 210 7 (e)(1) ( 4 2 U .S.C. 1 39 7gg(e)(1)), as amended by subsection (a)(2), is amended by adding at the end the following new subparagraph ‘‘(F) Section 1942 (relating to authorization to receive data directly relevant to eligibility determinations).’’. (3) CONFORMING AMENDMENT TO P RO V IDE ACCESS TO DATA A B OUT ENROLLMENT IN INSURANCE FOR PURPOSES OF EVALU- ATING APPLICATIONS AND FOR C H IP.—Section 1902(a)(2 5 )( I )(i) (42 U.S.C. 139 6 a(a)(25)(I)(i)) is amended— ( A ) by inserting ‘‘(and, at State option, individuals who apply or whose eligibility for medical assistance is being evaluated in accordance with section 1902(e)(13)( D ))’’ after ‘‘with respect to individuals who are eligible’’ and ( B ) by inserting ‘‘under this title (and, at State option, child health assistance under title X XI)’’ after ‘‘the State plan’’. (e) AUTHORI Z ATION FOR STATES E LECTING EXPRESS L ANE O PTION TO RECEIVE CERTAIN DATA DIRECTL Y RELEVANT TO DETER- MINING ELIGIBILITY AND CORRECT AMOUNT OF ASSISTANCE.—The Secretary shall enter into such agreements as are necessary to permit a State that elects the E x press Lane option under section 1902(e)(13) of the Social Security Act to receive data directly rel- evant to eligibility determinations and determining the correct amount of benefits under a State child health plan under C H I P or a State plan under M edicaid from the following: (1) The N ational Directory of New Hires established under section 453(i) of the Social Security Act (42 U.S.C. 653(i)). (2) Data regarding enrollment in insurance that may help to facilitate outreach and enrollment under the State Medicaid plan, the State CHIP plan, and such other programs as the Secretary may specify. (f) EFFECTIVE DATE.—The amendments made by this section are effective on the date of the enactment of this Act. Subti t leB—R e d u c i ng B ar rier s t oE nroll m ent SEC.21 1. V E RIF IC AT I ON OF D EC L ARATION OF CITI Z ENS H I P OR NATIONALIT Y FOR P U RPOSES OF ELI G I B ILITY FOR M ED - ICAID AND CHIP. (a) ALTERNATIVE STATE PROCESS FOR V ERIFICATION OF DEC- LARATION OF CITIZENSHIP OR NATIONALITY FOR PURPOSES OF ELIGI- BILITY FOR MEDICAID.— (1) ALTERNATIVE TO DOCUMENTATION RE Q UIREMENT.— (A) IN GENERAL.—Section 1902 (42 U.S.C. 1396a), as amended by section 203(c), is amended— (i) in subsection (a)(46)— 42USC1396anote. Cont r a c t s . 42 USC 1396 w– 2 note.


text:
Page:United States Statutes at Large Volume 123.djvu/70

 123STA T .50PUBLIC LA W 111 – 3 —FE B. 4, 200 9(I)byinsert in g‘ ‘( A ) ’ ’ af ter ‘‘( 46 )’’ (II) by a d ding ‘‘and’’ after t h ese m i col on; and (III) by adding at the end the follo w ing new s u b p aragraph ‘‘( B ) pro v ide , with respect to an individual declaring to be a citi z en or national of the U nited S tates for purposes of establishing eligibility under this title, that the State shall satisfy the re q uirements of — ‘‘(i) section 1903 ( x ); or ‘‘(ii) subsection (ee);’’; and (ii) by adding at the end the following new sub - section: ‘‘(ee)(1) F or purposes of subsection (a)(46)(B)(ii), the require- ments of this subsection with respect to an individual declaring to be a citizen or national of the United States for purposes of establishing eligibility under this title, are, in lieu of requiring the individual to present satisfactory documentary evidence of citi- zenship or nationality under section 1903(x) (if the individual is not described in paragraph ( 2 ) of that section), as follows: ‘‘(A) T he State submits the name and social security number of the individual to the C ommissioner of Social Security as part of the program established under paragraph (2) . ‘‘(B) If the State receives notice from the Commissioner of Social Security that the name or social security number, or the declaration of citizenship or nationality, of the individual is inconsistent with information in the records maintained by the Commissioner— ‘‘(i) the State ma k es a reasonable effort to identify and address the causes of such inconsistency, including through typographical or other clerical errors, by contacting the individual to confirm the accuracy of the name or social security number submitted or declaration of citizen- ship or nationality and by taking such additional actions as the Secretary, through regulation or other guidance, or the State may identify, and continues to provide the individual with medical assistance while making such effort; and ‘‘(ii) in the case such inconsistency is not resolved under clause (i), the State— ‘‘(I) notifies the individual of such fact; ‘‘(II) provides the individual with a period of 90 days from the date on which the notice required under subclause (I) is received by the individual to either present satisfactory documentary evidence of citizen- ship or nationality (as defined in section 1903(x)(3)) or resolve the inconsistency with the Commissioner of Social Security (and continues to provide the indi- vidual with medical assistance during such 90-day period); and ‘‘(III) disenrolls the individual from the State plan under this title within 30 days after the end of such 90-day period if no such documentary evidence is pre- sented or if such inconsistency is not resolved. ‘‘(2)(A) E ach State electing to satisfy the requirements of this subsection for purposes of section 1902(a)(46)(B) shall establish a program under which the State submits at least monthly to the Commissioner of Social Security for comparison of the name Submis si on.Deadl ine. Deadline. T ime p e r iod. N o t i f i c ation. Submission.


text:
Page:United States Statutes at Large Volume 123.djvu/71

 123STA T .5 1 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9andsoci a l s e c ur i ty nu mb er , o f eac h indi v idual ne w ly enrolled in the S tate p lan under this title that month who is not described in section 1903(x) ( 2 ) and who declares to be a U nited States citi z en or national, with information in records maintained by the C ommis - sioner .‘ ‘( B ) I n establishin g the State program under this paragraph, the State may enter into an agreement with the Commissioner of Social Security — ‘‘(i) to provide, through an on-line system or otherwise, for the electronic submission of, and response to, the informa- tion submitted under subparagraph ( A ) for an individual enrolled in the State plan under this title who declares to be citizen or national on at least a monthly basis or ‘‘(ii) to provide for a determination of the consistency of the information submitted with the information maintained in the records of the Commissioner through such other method as agreed to by the State and the Commissioner and approved by the Secretary, provided that such method is no more burden- some for individuals to comply with than any burdens that may apply under a method described in clause (i). ‘‘(C) T he program established under this paragraph shall pro- vide that, in the case of any individual who is re q uired to submit a social security number to the State under subparagraph (A) and who is unable to provide the State with such number, shall be provided with at least the reasonable opportunity to present satisfactory documentary evidence of citizenship or nationality (as defined in section 1903(x)(3)) as is provided under clauses (i) and (ii) of section 113 7 (d)( 4 )(A) to an individual for the submittal to the State of evidence indicating a satisfactory immigration status. ‘‘(3)(A) The State agency implementing the plan approved under this title shall, at such times and in such form as the Secretary may specify, provide information on the percentage each month that the inconsistent submissions bears to the total submissions made for comparison for such month. F or purposes of this subpara- graph, a name, social security number, or declaration of citizenship or nationality of an individual shall be treated as inconsistent and included in the determination of such percentage only if— ‘‘(i) the information submitted by the individual is not consistent with information in records maintained by the Commissioner of Social Security; ‘‘(ii) the inconsistency is not resolved by the State; ‘‘(iii) the individual was provided with a reasonable period of time to resolve the inconsistency with the Commissioner of Social Security or provide satisfactory documentation of citi- zenship status and did not successfully resolve such inconsist- ency; and ‘‘(iv) payment has been made for an item or service fur- nished to the individual under this title. ‘‘(B) If, for any fiscal year, the average monthly percentage determined under subparagraph (A) is greater than 3 percent— ‘‘(i) the State shall develop and adopt a corrective plan to review its procedures for verifying the identities of individ- uals see k ing to enroll in the State plan under this title and to identify and implement changes in such procedures to improve their accuracy; and ‘‘(ii) pay to the Secretary an amount equal to the amount which bears the same ratio to the total payments under the Plans. P rocedu res.


text:
Page:United States Statutes at Large Volume 123.djvu/72

 123STA T .5 2 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9Sta t epl a nfor t h ef isc al y ear for pro v i d in gm edical assistance to individ u als w ho provided inconsistent information as the num b er of individuals with inconsistent information in e x cess of 3 percent of such total submitted bears to the total number of individuals with inconsistent information .‘ ‘ (C)T he Secretary may waive , in certain limited cases, all or part of the payment under subparagraph ( B )(ii) if the State is unable to reach the allowable error rate despite a good faith effort by such State. ‘‘( D ) Subparagraphs ( A ) and (B) shall not apply to a State for a fiscal year if there is an agreement described in paragraph ( 2 )(B) in effect as of the close of the fiscal year that provides for the submission on a real - time basis of the information described in such paragraph. ‘‘( 4 ) N othing in this subsection shall affect the rights of any individual under this title to appeal any disenrollment from a State plan. ’ ’. (B) C OST SO FIMPLE ME N TIN GA N D MAINTAINING S Y STEM. — Section 190 3(a)(3) (42 U .S.C. 139 6 b(a)(3)) is amended— (i) by stri k ing ‘‘plus’’ at the end of subparagraph ( E ) and inserting ‘‘and’’, and (ii) by adding at the end the following new subparagraph ‘‘( F )(i) 90 percent of the sums expended during the q uarter as are attributable to the design, development, or installation of such mechani z ed verification and informa- tion retrieval systems as the Secretary determines are nec- essary to implement section 1902(ee) (including a system described in paragraph (2)(B) thereof), and ‘‘(ii) 75 percent of the sums expended during the quarter as are attributable to the operation of systems to which clause (i) applies, plus’’. (2) L IMITATION ON W AI V E R A U T H ORITY.—Notwithstanding any provision of section 1115 of the Social Security Act (42 U.S.C. 1315), or any other provision of law, the Secretary may not waive the requirements of section 1902(a)(46)(B) of such Act (42 U.S.C. 1396a(a)(46)(B)) with respect to a State. (3) CONFORMING AMENDMENTS.—Section 1903 (42 U.S.C. 1396b) is amended— (A) in subsection (i)(22), by striking ‘‘subsection (x)’’ and inserting ‘‘section 1902(a)(46)(B)’’ and (B) in subsection (x)(1), by striking ‘‘subsection (i)(22)’’ and inserting ‘‘section 1902(a)(46)(B)(i)’’. (4) APPROPRIATION.— O ut of any money in the Treasury of the United States not otherwise appropriated, there are appropriated to the Commissioner of Social Security $ 5,000,000 to remain available until expended to carry out the Commis- sioner’s responsibilities under section 1902(ee) of the Social Security Act, as added by subsection (a). (b) CLARIFI C ATION OF R E Q UIREMENTS RELATING TO P RESEN- TATION OF SATISFACTORY DOCUMENTARY EVIDENCE OF CITI Z ENSHIP OR NATIONALITY.— (1) ACCEPTANCE OF DOCUMENTARY EVIDENCE ISSUED B YA FEDERALLY RECOGNIZED INDIAN TRIBE.—Section 1903(x)(3)(B) (42 U.S.C. 1396b(x)(3)(B)) is amended— (A) by redesignating clause (v) as clause (vi); and 42USC1396anote.W a iv e r a u t h orit y .


text:
Page:United States Statutes at Large Volume 123.djvu/73

 123STA T .5 3 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9(B)byinsert in gaf ter cl a u se (i v ) , t h ef o llo w ing new clause

‘(v)( I ) Ex ce p t as provi d ed in subclause (II), a docu m ent issued by a federally recogni z ed Indian tribe evidencing mem - bership or enrollment in, or affiliation with, such tribe (such as a tribal enrollment card or certificate of degree of Indian blood) . ‘‘(II) W ith respect to those federally recognized Indian tribes located within S tates having an international border whose membership includes individuals who are not citizens of the U nited States, the Secretary shall, after consulting with such tribes, issue regulations authorizing the presentation of such other forms of documentation (including tribal documentation, if appropriate) that the Secretary determines to be satisfactory documentary evidence of citizenship or nationality for purposes of satisfying the re q uirement of this subsection. ’ ’. ( 2 ) REQUIR E M E NT T OP RO V I D ERE AS ONA BL E OPPORTUNIT Y TO PRESENT SATIS F A C TORY DOCUMENTARY EVIDENCE. — Section 1903 (x) ( 4 2 U.S. C . 139 6 b(x)) is amended by adding at the end the following new paragraph: ‘‘(4) In the case of an individual declaring to be a citizen or national of the United States with respect to whom a State requires the presentation of satisfactory documentary evidence of citizenship or nationality under section 1902(a)(46)(B)(i), the indi- vidual shall be provided at least the reasonable opportunity to present satisfactory documentary evidence of citizenship or nation- ality under this subsection as is provided under clauses (i) and (ii) of section 113 7 (d)(4)( A ) to an individual for the submittal to the State of evidence indicating a satisfactory immigration status.’’. (3) C H ILDREN BORN IN THE UNITED STATES TO MOTHERS ELI G IBLE FOR MEDICAID.— (A) CLARIFICATION OF RULES.—Section 1903(x) (42 U.S.C. 1396b(x)), as amended by paragraph (2), is amended— (i) in paragraph (2)— (I) in subparagraph (C), by stri k ing ‘‘or’’ at the end (II) by redesignating subparagraph ( D )as subparagraph (E); and (III) by inserting after subparagraph (C) the following new subparagraph: ‘‘(D) pursuant to the application of section 1902(e)(4) (and, in the case of an individual who is eligible for medical assistance on such basis, the individual shall be deemed to have provided satisfactory documentary evidence of citizenship or nationality and shall not be required to provide further documentary evi- dence on any date that occurs during or after the period in which the individual is eligible for medical assistance on such basis); or’’; and (ii) by adding at the end the following new para- graph: ‘‘( 5 ) N othing in subparagraph (A) or (B) of section 1902(a)(46), the preceding paragraphs of this subsection, or the Deficit Reduction Act of 2005, including section 6036 of such Act, shall be construed as changing the requirement of section 1902(e)(4) that a child born in the United States to an alien mother for whom medical assistance for the delivery of such child is available as treatment Regulations.


text: Dictionary of National Biography, 1885-1900/Monteage, Stephen


text:
Page:United States Statutes at Large Volume 123.djvu/74

 123STA T .54PUBLIC LA W 111 – 3 —FE B.4 , 2 0 0 9ofanem e rg en cy me di ca l condi t ion pu r s uant to su b section (v) s h all be deemed eligible for medical assistance during the first year of such child ’ s life . ’’. ( B ) STA T ER E QUI RE M E N TT O I S SUE SE P ARATE I D ENTI -F I C ATION NUM B ER. — Section 1902 (e)( 4 ) (42 U .S. C . 1 3 9 6 a(e)(4)) is amended by adding at the end the follo w ing new sentence

‘ N otwithstanding the preceding sentence , in the case of a child who is born in the United States to an alien mother for whom medical assistance for the delivery of the child is made available pursuant to section 1903(v), the State immediately shall issue a separate identification number for the child upon notification by the facility at which such delivery occurred of the child’s birth.’’. (4) T EC H NICA L AMENDMENTS.—Section 1903( x )(2) (42 U.S.C. 1396b(x)) is amended— ( A ) in subparagraph (B)— (i) by realigning the left margin of the matter preceding clause (i) 2 ems to the left and (ii) by realigning the left margins of clauses (i) and (ii), respectively, 2 ems to the left; and (B) in subparagraph (C)— (i) by realigning the left margin of the matter preceding clause (i) 2 ems to the left; and (ii) by realigning the left margins of clauses (i) and (ii), respectively, 2 ems to the left. (c) APPLICATION OF D OCUMENTATION S Y STEM TO C HIP .— (1) IN G ENERAL.—Section 210 5 (c) (42 U.S.C. 139 7 ee(c)), as amended by section 114(a), is amended by adding at the end the following new paragraph: ‘‘(9) CITI Z ENSHIP DOCUMENTATION REQUIREMENTS.— ‘‘(A) IN GENERAL.—No payment may be made under this section with respect to an individual who has, or is, declared to be a citi z en or national of the United States for purposes of establishing eligibility under this title unless the State meets the re q uirements of section 1902(a)(46)(B) with respect to the individual. ‘‘(B) E NHANCED PAYMENTS.—Notwithstanding sub- section (b), the enhanced FM AP with respect to payments under subsection (a) for expenditures described in clause (i) or (ii) of section 1903(a)(3)(F) necessary to comply with subparagraph (A) shall in no event be less than 90 percent and 75 percent, respectively.’’. (2) NONAPPLICATION OF ADMINISTRATI V EE X PENDITURES CAP.—Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)(C)), as amended by section 202(b), is amended by adding at the end the following: ‘‘(ii) EXPENDITURES TO COMPLY W ITH CITIZENSHIP OR NATIONALITY VERIFICATION REQUIREMENTS.— Expenditures necessary for the State to comply with paragraph (9)(A).’’. (d) EFFECTIVE DATE.— (1) IN GENERAL.— (A) IN GENERAL.—Except as provided in subparagraph (B), the amendments made by this section shall ta k e effect on J anuary 1, 2010. 42USC1396anote.


text:
Page:United States Statutes at Large Volume 123.djvu/75

 123STA T .5 5 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9(B)TECHNI C AL A M EN D MEN TS.— T heam e nd men ts made by — ( i ) p a r a g raphs ( 1 ) , ( 2 ),and( 3 ) of s u bse c tion (b) sha l lta k e effect as if included in the enactment of section 60 36 of the D eficit R eduction A ct of 200 5 ( P ublic L a w 10 9– 1 7 1 120 S tat. 8 0); and (ii) paragraph ( 4 ) of subsection (b) shall take effect as if included in the enactment of section 405 of di v i - sionBoftheTa x Relief and H ealth C are Act of 2006 (Public Law 109–432; 120 Stat. 2996). (2) REST OR ATION O F ELI G I B ILIT Y .— I n the case of an indi- vidual who, during the period that began on J uly 1, 2006, and ends on O ctober 1, 2009, was determined to be ineligible for medical assistance under a State M edicaid plan, including any waiver of such plan, solely as a result of the application of subsections (i)(22) and (x) of section 1903 of the Social Security Act (as in effect during such period), but who would have been determined eligible for such assistance if such sub- sections, as amended by subsection (b), had applied to the individual, a State may deem the individual to be eligible for such assistance as of the date that the individual was determined to be ineligible for such medical assistance on such basis. (3) S P ECIAL TRANSITION R U LE FOR INDIANS.—During the period that begins on July 1, 2006, and ends on the effective date of final regulations issued under subclause (II) of section 1903(x)(3)(B)(v) of the Social Security Act (42 U .S.C. 1396b(x)(3)(B)(v)) (as added by subsection (b)(1)(B)), an indi- vidual who is a member of a federally-recogni z ed Indian tribe described in subclause (II) of that section who presents a docu- ment described in subclause (I) of such section that is issued by such Indian tribe, shall be deemed to have presented satis- factory evidence of citizenship or nationality for purposes of satisfying the re q uirement of subsection (x) of section 1903 of such Act. SEC.21 2. R E DU C INGA D M INIS T RATI V E B ARRIERS T O ENRO L LMENT. Section 2102(b) (42 U.S.C. 1397bb(b)) is amended— (1) by redesignating paragraph (4) as paragraph (5); and (2) by inserting after paragraph (3) the following new para- graph

‘(4) REDUCTION OF ADMINISTRATI V E BARRIERS TO ENROLL- MENT.— ‘‘(A) IN GENERAL.—Sub j ect to subparagraph (B), the plan shall include a description of the procedures used to reduce administrative barriers to the enrollment of chil- dren and pregnant women who are eligible for medical assistance under title X IX or for child health assistance or health benefits coverage under this title. Such proce- dures shall be established and revised as often as the State determines appropriate to take into account the most recent information available to the State identifying such barriers. ‘‘(B) DEEMED COMPLIANCE IF J OINT APPLICATION AND RENE W AL PROCESS THAT PERMITS APPLICATION OTHER THAN IN PERSON.—A State shall be deemed to comply with subparagraph (A) if the State ’ s application and renewal Plans. P rocedu res. Tim e p eriod. Time period.


text:
Page:United States Statutes at Large Volume 123.djvu/76

 123STA T .56PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9formsand s up p le men t al forms (i fan y) and information v erifi c ation process is t h e same for purposes of esta b lishin g and rene w ing eligibility for children and pregnant women for medical assistance under title XI X and child health assistance under this title , and such process does not re q uire an application to be made in person or a face - to-face interview .’ ’. SEC.213 . MOD E L O FINT E R ST A TE COORDINATED ENROLLMENT AND CO V ERA G E P ROCESS. (a) I NGE NE RAL . — In order to assure continuity of coverage of low-income children under the M edicaid program and the S tate C hildren’s H ealth Insurance P rogram (CHIP), not later than 18 months after the date of the enactment of this A ct, the Secretary of Health and Human Services, in consultation with State Medicaid and CHIP directors and organi z ations representing program bene- ficiaries, shall develop a model process for the coordination of the enrollment, retention, and coverage under such programs of children who, because of migration of families, emergency evacuations, nat- ural or other disasters, public health emergencies, educational needs, or otherwise, frequently change their State of residency or otherwise are temporarily located outside of the State of their residency. (b) R E PO R T TO CON G RE S S.—After development of such model process, the Secretary of Health and Human Services shall submit to Congress a report describing additional steps or authority needed to ma k e further improvements to coordinate the enrollment, reten- tion, and coverage under CHIP and Medicaid of children described in subsection (a). SEC. 21 4 . PERMITTING STATES TO ENS U RE COVERAGE W IT H OUT A 5-Y EAR DELAY OF CERTAIN CHILDREN AND PREGNANT WOMEN UNDER THE MEDICAID PROGRAM AND CHIP. (a) ME DIC AID PROGRA M .—Section 1 903 (v) ( 42U .S.C. 139 6 b(v)) is amended— (1) in paragraph (1), by striking ‘ ‘paragraph (2)’’ and inserting ‘‘paragraphs (2) and (4)’’ and (2) by adding at the end the following new paragraph ‘‘(4)(A) A State may elect (in a plan amendment under this title) to provide medical assistance under this title, notwithstanding sections 401(a), 402(b), 403, and 421 of the Personal Responsibility and W ork O pportunity Reconciliation Act of 1996, to children and pregnant women who are lawfully residing in the United States (including battered individuals described in section 431(c) of such Act) and who are otherwise eligible for such assistance, within either or both of the following eligibility categories: ‘‘(i) PREGNANT W OMEN.—Women during pregnancy (and during the 60-day period beginning on the last day of the pregnancy). ‘‘(ii) C H ILDREN.—Individuals under 21 years of age, including optional targeted low-income children described in section 190 5 (u)(2)( B ). ‘‘(B) In the case of a State that has elected to provide medical assistance to a category of aliens under subparagraph (A), no debt shall accrue under an affidavit of support against any sponsor of such an alien on the basis of provision of assistance to such category and the cost of such assistance shall not be considered as an unreimbursed cost. Deadlin e .42USC1396 n ot e.


text:
Page:United States Statutes at Large Volume 123.djvu/77

 123STA T .57PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9‘ ‘ (C)Aspartof t heS tate ’ so ng o i nge l igi b ilit y re d eter m ination re qu irements and pro c edures for an indi v idual provided medical assistance as a result of an election by the State under subpara - graph (A) , a State shall verify that the individual continues to la w fully reside in the U nited States using the documentation pre- sented to the State by the individual on initial enrollment .I f the State cannot successfully verify that the individual is lawfully residing in the United States in this manner, it shall require that the individual provide the State with further documentation or other evidence to verify that the individual is lawfully residing in the United States.’’. (b) C H I P. — Section 2107 (e)(1) ( 4 2 U.S.C. 1 39 7gg(e)(1)), as amended by sections 203(a)(2) and 203(d)(2), is amended by redesig- nating subparagraphs ( E )and( F ) as subparagraphs (F) and ( G ), respectively and by inserting after subparagraph ( D ) the following new subparagraph ‘‘(E) Paragraph (4) of section 1903(v) (relating to optional coverage of categories of lawfully residing immigrant children or pregnant women), but only if the State has elected to apply such paragraph with respect to such category of children or pregnant women under title X IX.’’. TI T LE III —R E DUC I NGBA RRIER S T OP RO V IDING PRE M IUM ASSISTANCE S ubti t le A—A d diti ona l State O p tion f o r Pro v idin g Pre m ium A s sistan c e SEC.301 . AD D IT I ON A L STATE O P TION F O R PRO V IDIN G PRE M I U M ASSISTANCE. (a) CHIP.— (1) I NGE NE RAL .—Section 210 5 (c) (42 U.S.C. 1397ee(c)), as amended by sections 114(a) and 211(c), is amended by adding at the end the following: ‘‘(10) S T ATE OP T I ONTOO F FER PRE M I U MA S SISTAN C E.— ‘‘(A) IN GENERAL.—A State may elect to offer a pre- mium assistance subsidy (as defined in subparagraph (C)) for qualified employer-sponsored coverage (as defined in subparagraph ( B )) to all targeted low-income children who are eligible for child health assistance under the plan and have access to such coverage in accordance with the requirements of this paragraph. N o subsidy shall be pro- vided to a targeted low-income child under this paragraph unless the child (or the child’s parent) voluntarily elects to receive such a subsidy. A State may not require such an election as a condition of receipt of child health assist- ance. ‘‘(B) Q UALIFIE D EMPLO Y ER-SPONSORED CO V ERAGE.— ‘‘(i) IN GENERAL.—Sub j ect to clause (ii), in this paragraph, the term ‘qualified employer-sponsored cov- erage’ means a group health plan or health insurance coverage offered through an employer— Verif i cat i on.


text:
Page:United States Statutes at Large Volume 123.djvu/78

 123STA T .58PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9‘ ‘ (I)tha t qu a lif i es as cr e d ita b lec ov era g eas a grou p health pla n under section 2701 (c)(1) of the P ublic H ealth S ervice A ct ‘‘(II) for w hich the e m plo y er contribution toward any premium for such coverage is at least 4 0 percent; and ‘‘(III) that is offered to all individuals in a manner that would be considered a nondiscrim - inatory eligibility classification for purposes of paragraph ( 3 )(A)(ii) of section 10 5 (h) of the Internal R evenue C odeof1 986 (but determined without regard to clause (i) of subparagraph ( B ) of such paragraph) . ‘‘(ii) EXCEPTION . — Such term does not include cov- erage consisting of— ‘‘(I) benefits provided under a health fle x ible spending arrangement (as defined in section 106(c)(2) of the Internal Revenue Code of 1986); or ‘‘(II) a high deductible health plan (as defined in section 223(c)(2) of such Code) , without regard to whether the plan is purchased in con j unction with a health savings account (as defined under section 223(d) of such Code). ‘‘(C) P R E M I U M AS SISTANCE SU B SI DY .— ‘‘(i) IN G ENERA L .—In this paragraph, the term ‘pre- mium assistance subsidy ’ means, with respect to a targeted low-income child, the amount equal to the difference between the employee contribution required for enrollment only of the employee under qualified employer-sponsored coverage and the employee con- tribution required for enrollment of the employee and the child in such coverage, less any applicable premium cost-sharing applied under the State child health plan (subject to the limitations imposed under section 2103(e), including the requirement to count the total amount of the employee contribution required for enrollment of the employee and the child in such cov- erage toward the annual aggregate cost-sharing limit applied under paragraph (3)(B) of such section). ‘‘(ii) STATE PAYMENT OPTION.—A State may provide a premium assistance subsidy either as reimbursement to an employee for out-of-poc k et expenditures or, sub- ject to clause (iii), directly to the employee’s employer. ‘‘(iii) EMPLOYER OPT-OUT.—An employer may notify a State that it elects to opt-out of being directly paid a premium assistance subsidy on behalf of an employee. In the event of such a notification, an employer shall withhold the total amount of the employee contribution required for enrollment of the employee and the child in the qualified employer-spon- sored coverage and the State shall pay the premium assistance subsidy directly to the employee. ‘‘(iv) T REATMENT AS C H ILD HEALTH ASSISTANCE.— Expenditures for the provision of premium assistance subsidies shall be considered child health assistance


text:
Page:United States Statutes at Large Volume 123.djvu/79

 123STA T .59PUBLIC LA W 111 – 3 —FE B. 4, 2 0 09 describ edi npa ra g rap h(1) ( C ) of s u bsec t ion (a) for pur - poses of m a k ing pa y ments under that subsection .‘ ‘( D ) AP P LICAT I ON O FSE CON D A RY PAYOR R U LES. —T he S tate sha l l be a secondary payor for any items or ser v ices provided under the q ualified employer-sponsored coverage for w hich the State provides child health assistance under the State child health plan. ‘‘( E ) R E Q UIRE M ENT TO PRO V IDE SUPPLEMENTAL COV- ERA G E FOR B ENEFITS AND COST-S H ARING PROTECTION PRO- VIDED UNDER THE STATE CHILD HEALTH PLAN.— ‘‘(i) I N GENERAL.— N otwithstanding section 2 11 0 (b)(1)(C) , the State shall provide for each targeted low-income child enrolled in qualified employer-spon- sored coverage, supplemental coverage consisting of— ‘‘(I) items or services that are not covered, or are only partially covered, under the qualified employer-sponsored coverage and ‘‘(II) cost-sharing protection consistent with section 210 3 (e). ‘‘(ii) RECORD K EEPING REQUIREMENTS.— F or pur- poses of carrying out clause (i), a State may elect to directly pay out-of-pocket e x penditures for cost- sharing imposed under the qualified employer-spon- sored coverage and collect or not collect all or any portion of such expenditures from the parent of the child. ‘‘(F) APPLICATION OF W AITING PERIOD IMPOSED UNDER THE STATE.—Any waiting period imposed under the State child health plan prior to the provision of child health assistance to a targeted low-income child under the State plan shall apply to the same extent to the provision of a premium assistance subsidy for the child under this paragraph. ‘‘( G ) O PT-OUT PERMITTED FOR ANY MONTH.—A State shall establish a process for permitting the parent of a targeted low-income child receiving a premium assistance subsidy to disenroll the child from the qualified employer- sponsored coverage and enroll the child in, and receive child health assistance under, the State child health plan, effective on the first day of any month for which the child is eligible for such assistance and in a manner that ensures continuity of coverage for the child. ‘‘( H ) APPLICATION TO PARENTS.—If a State provides child health assistance or health benefits coverage to par- ents of a targeted low-income child in accordance with section 2111(b), the State may elect to offer a premium assistance subsidy to a parent of a targeted low-income child who is eligible for such a subsidy under this para- graph in the same manner as the State offers such a subsidy for the enrollment of the child in qualified employer-sponsored coverage, except that— ‘‘(i) the amount of the premium assistance subsidy shall be increased to take into account the cost of the enrollment of the parent in the qualified employer- sponsored coverage or, at the option of the State if the State determines it cost-effective, the cost of the enrollment of the child ’ s family in such coverage; and Procedu re s.


text:
Page:United States Statutes at Large Volume 123.djvu/80

 123STA T .60PUBLIC LA W 111 – 3 —FE B. 4, 200 9‘ ‘ (i i )anyref eren c ein th i sp ara g raph t o a chi ld is dee m ed to incl u de a reference to the parent or , if applica b le under clause (i), the family of the child . ‘‘( I ) AD D IT I ONALS TAT E O P TION F O R PRO V IDIN G PRE M I U M ASSISTAN C E. — ‘‘(i) IN GENERAL.—A S tate may establish an employer - family premium assistance purchasing pool for employers w ith less than 250 employees who ha v e at least 1 employee who is a pregnant woman eligible for assistance under the State child health plan (including through the application of an option described in section 2112(f)) or a member of a family with at least 1 targeted low-income child and to provide a premium assistance subsidy under this paragraph for enrollment in coverage made available through such pool. ‘‘(ii) ACCESS TO C H OICE OF COVERAGE.—A State that elects the option under clause (i) shall identify and offer access to not less than 2 private health plans that are health benefits coverage that is e q uiva- lent to the benefits coverage in a benchmar k benefit package described in section 210 3 (b) or benchmark- equivalent coverage that meets the requirements of section 2103(a)(2) for employees described in clause (i). ‘‘(iii) C LARIFICATION OF PA Y MENT FOR ADMINISTRA- TIVE E X PENDITURES.— N othing in this subparagraph shall be construed as permitting payment under this section for administrative e x penditures attributable to the establishment or operation of such pool, except to the extent that such payment would otherwise be permitted under this title. ‘‘( J ) NO EFFECT ON PREMIUM ASSISTANCE W AIVER PRO- GRAMS.—Nothing in this paragraph shall be construed as limiting the authority of a State to offer premium assist- ance under section 1 9 0 6 or 1906A, a waiver described in paragraph (2)( B ) or (3), a waiver approved under section 1115, or other authority in effect prior to the date of enact- ment of the Children ’ s H ealth Insurance P rogram R eauthori z ation Act of 2009. ‘‘( K ) NOTICE OF AVAILA B ILITY.—If a State elects to pro- vide premium assistance subsidies in accordance with this paragraph, the State shall— ‘‘(i) include on any application or enrollment form for child health assistance a notice of the availability of premium assistance subsidies for the enrollment of targeted low-income children in qualified employer- sponsored coverage ‘‘(ii) provide, as part of the application and enroll- ment process under the State child health plan, information describing the availability of such sub- sidies and how to elect to obtain such a subsidy; and ‘‘(iii) establish such other procedures as the State determines necessary to ensure that parents are fully informed of the choices for receiving child health assist- ance under the State child health plan or through the receipt of premium assistance subsidies. Procedu re s.


text:
Page:United States Statutes at Large Volume 123.djvu/81

 123STA T .6 1 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9‘ ‘ (L)AP P LICAT I ON TO QU ALI F I ED E M PLO Y E R-S PONSORED B ENC H MAR K CO V ERA G E .—Ifagrouphe a lt h pla n or health i n s uran c eco v erage offere d through an e m plo y er is certified b y an actuary as health benefits coverage that is e q uivalent to the benefits coverage in a benchmar k benefit package described in section 2103 (b) or benchmark-equivalent cov- erage that meets the requirements of section 2103(a)(2) , the S tate may provide premium assistance subsidies for enrollment of targeted lo w -income children in such group health plan or health insurance coverage in the same manner as such subsidies are provided under this para- graph for enrollment in qualified employer-sponsored cov- erage, but without regard to the requirement to provide supplemental coverage for benefits and cost-sharing protec- tion provided under the State child health plan under subparagraph ( E ). ‘‘( M ) SATISFACTION OF COST-EFFECTIVENESS TEST.— P re- mium assistance subsidies for qualified employer-sponsored coverage offered under this paragraph shall be deemed to meet the requirement of subparagraph (A) of paragraph (3). ‘‘( N ) C OORDINATION W ITH MEDICAID.—In the case of a targeted low-income child who receives child health assistance through a State plan under title X IX and who voluntarily elects to receive a premium assistance subsidy under this section, the provisions of section 1 9 0 6 A shall apply and shall supersede any other provisions of this paragraph that are inconsistent with such section. ’ ’. (2) D ETERMINATION OF COST-EFFECTIVENESS FOR PREMIUM ASSISTANCE OR PURCHASE OF FAMILY COVERAGE.— (A) IN GENERAL.—Section 210 5 (c)(3)(A) ( 4 2 U .S.C. 139 7 ee(c)(3)(A)) is amended by striking ‘‘relative to’’ and all that follows through the comma and inserting ‘‘relative to ‘‘(i) the amount of e x penditures under the State child health plan, including administrative expendi- tures, that the State would have made to provide com- parable coverage of the targeted low-income child involved or the family involved (as applicable) or ‘‘(ii) the aggregate amount of expenditures that the State would have made under the State child health plan, including administrative expenditures, for providing coverage under such plan for all such chil- dren or families.’’. ( B ) NONAPPLICATION TO PREVIOUSLY APPROVED COV- ERAGE.— T he amendment made by subparagraph (A) shall not apply to coverage the purchase of which has been approved by the Secretary under section 2105(c)(3) of the Social Security Act prior to the date of enactment of this Act. (b) MEDICAID.—Title XIX is amended by inserting after section 1906 the following new section ‘‘PREMIUM ASSISTANCE OPTION FOR CHILDREN ‘‘SEC. 1906A. (a) IN G ENERAL.—A State may elect to offer a premium assistance subsidy (as defined in subsection (c)) for quali- fied employer-sponsored coverage (as defined in subsection (b)) to 42USC1396e– 1 . 42 USC 139 7 ee not e. Ap p licab ilit y .


text:
Page:United States Statutes at Large Volume 123.djvu/82

 123STA T .6 2 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9al l ind i v id u al s und er a g e 19who are en t itled to m edi c al assistance under this title ( and to the p arent o f such an individual ) who have access to such coverage if the S tate meets the re q uirements of this section .‘ ‘( b ) QUALIF I EDEMP L OY E R- SPO NS ORED C O V ERA G E. — ‘‘(1) I N GENERAL.—Sub j ect to paragraph ( 2 )), in this para- graph, the term ‘qualified emplo y er-sponsored coverage ’ means a group health plan or health insurance coverage offered through an employer— ‘‘( A ) that qualifies as creditable coverage as a group health plan under section 2 70 1(c)(1) of the P ublic H ealth Service Act ‘‘( B ) for which the employer contribution toward any premium for such coverage is at least 4 0 percent; and ‘‘(C) that is offered to all individuals in a manner that would be considered a nondiscriminatory eligibility classification for purposes of paragraph ( 3 )(A)(ii) of section 10 5 (h) of the Internal R evenue Code of 19 86 (but deter- mined without regard to clause (i) of subparagraph (B) of such paragraph). ‘‘(2) E XC EP T ION.—Such term does not include coverage con- sisting of— ‘‘(A) benefits provided under a health fle x ible spending arrangement (as defined in section 106(c)(2) of the Internal Revenue Code of 1986); or ‘‘(B) a high deductible health plan (as defined in section 223(c)(2) of such Code), without regard to whether the plan is purchased in conjunction with a health savings account (as defined under section 223(d) of such Code). ‘‘(3) T REATMENT AS T H IRD PARTY LIA B ILITY.—The State shall treat the coverage provided under qualified employer-sponsored coverage as a third party liability under section 1902(a)(25). ‘‘(c) PREMIUM ASSISTANCE SUBSIDY.—In this section, the term ‘premium assistance subsidy’ means the amount of the employee contribution for enrollment in the qualified employer-sponsored cov- erage by the individual under age 19 or by the individual’s family. Premium assistance subsidies under this section shall be considered, for purposes of section 1903(a), to be a payment for medical assist- ance. ‘‘(d) V OLUNTARY PARTICIPATION.— ‘‘(1) EMPLOYERS.—Participation by an employer in a pre- mium assistance subsidy offered by a State under this section shall be voluntary. An employer may notify a State that it elects to opt-out of being directly paid a premium assistance subsidy on behalf of an employee. ‘‘(2) BENEFICIARIES.— N o subsidy shall be provided to an individual under age 19 under this section unless the individual (or the individual’s parent) voluntarily elects to receive such a subsidy. A State may not require such an election as a condition of receipt of medical assistance. State may not require, as a condition of an individual under age 19 (or the individual’s parent) being or remaining eligible for medical assistance under this title, apply for enrollment in qualified employer-sponsored coverage under this section. ‘‘(3) O PT-OUT PERMITTED FOR ANY MONTH.—A State shall establish a process for permitting the parent of an individual under age 19 receiving a premium assistance subsidy to Procedu re s.


text:
Page:United States Statutes at Large Volume 123.djvu/83

 123STA T .6 3 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9disenrol l th e indi v id ua l f ro m the q ualified em p lo y er - sponsored c overa g e .‘ ‘ ( e )REQUIR E M E NTTOPAY PREMIUM S AN DC OST- SH ARIN G AND PRO V IDE SU P P L EMENTAL COVERAGE. —I n the case of the participa- tion of an individual under age 19 (or the individual ’ s parent) in a premium assistance su b sidy under this section for qualified employer-sponsored coverage , the State shall provide for payment of all enrollee premiums for enrollment in such coverage and all deductibles, coinsurance, and other cost-sharing obligations for items and services other w ise covered under the State plan under this title (e x ceeding the amount otherwise permitted under section 191 6 or, if applicable, section 1916 A ). The fact that an individual under age 19 (or a parent) elects to enroll in qualified employer- sponsored coverage under this section shall not change the individ- ual’s (or parent’s) eligibility for medical assistance under the State plan, except insofar as section 19 02 (a)(2 5 ) provides that payments for such assistance shall first be made under such coverage.’’. (c) G A O STUDY AND REPORT.— N ot later than J anuary 1, 2010, the Comptroller General of the U nited States shall study cost and coverage issues relating to any State premium assistance pro- grams for which F ederal matching payments are made under title X IX or XXI of the Social Security Act, including under waiver authority, and shall submit a report to the Committee on Finance of the Senate and the Committee on E nergy and Commerce of the H ouse of Representatives on the results of such study. SEC.302 . OUTR E A C H, E D UCAT I O N , AND ENRO L L M ENT ASSISTANCE. (a) REQUIREMENT TO IN C LUDE D ESCRIPTION O F OUTREACH, EDU- CATION, AND ENROLLMENT EFFORTS RELATED TO PREMIUM ASSIST- ANCE SU B SIDIES IN STATE CHILD HEALTH PLAN.—Section 2102(c) ( 4 2 U.S.C. 1 3 9 7 bb(c)) is amended by adding at the end the following new paragraph ‘‘(3) PREMIUM ASSISTANCE SUBSIDIES.—In the case of a State that provides for premium assistance subsidies under the State child health plan in accordance with paragraph (2)( B ), (3), or (10) of section 2105(c), or a waiver approved under section 1115, outreach, education, and enrollment assistance for fami- lies of children li k ely to be eligible for such subsidies, to inform such families of the availability of, and to assist them in enrolling their children in, such subsidies, and for employers likely to provide coverage that is eligible for such subsidies, including the specific, significant resources the State intends to apply to educate employers about the availability of premium assistance subsidies under the State child health plan.’’. (b) NONAPPLICATION OF 10 PERCENT L IMIT ON OUTREACH AND CERTAIN OTHER E X PENDITURES.—Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)(C)), as amended by section 211(c)(2), is amended by adding at the end the following new clause: ‘‘(iii) EXPENDITURES FOR OUTREACH TO INCREASE THE ENROLLMENT OF CHILDREN UNDER THIS TITLE AND TITLE xix THROUGH PREMIUM ASSISTANCE SUBSIDIES.— Expenditures for outreach activities to families of chil- dren likely to be eligible for premium assistance sub- sidies in accordance with paragraph (2)(B), (3), or (10), or a waiver approved under section 1115, to inform such families of the availability of, and to assist them in enrolling their children in, such subsidies, and to


text:
Page:United States Statutes at Large Volume 123.djvu/84

 123STA T .64PUBLIC LA W 111 – 3 —FE B.4 , 2 0 0 9employ e rs l ik ely t o pro v i d e qua li f ied employer - spo n - sored c overa g e ( as defined in su b paragrap h ( B) of such paragraph) , butnottoe x ceed an amount equal to 1.25 percent of the maximum amount permitted to be expended under subparagraph ( A ) for items described in subsection (a)(1)( D ). ’ ’. Subti t leB—Co o rd i na tin gP re m ium As sistan c e W it h Pri v ate Coverage SEC.31 1.S P EC IAL E NRO LL M EN T PERIO DU NDER G ROUP H EALTH PLANS IN CASE O F TERMINATION OF MEDICAID OR CHIP CO V ERAGE OR ELIGI B ILIT Y FOR ASSISTANCE IN PUR - CHASE OF EMPLOYMENT-BASED COVERAGE COORDINA- TION OF COVERAGE. (a) A MEND MEN TS T OI NTE R N ALR E V EN U E C ODE O F 1 986 . —S ec- tion 98 0 1(f) of the Internal Revenue Code of 1986 (relating to special enrollment periods) is amended by adding at the end the follo w ing new paragraph

‘( 3 )S P E CI AL RULES RELATIN G TO MEDICAID AND C H IP.— ‘‘(A) IN GENERAL.—A group health plan shall permit an employee who is eligible, but not enrolled, for coverage under the terms of the plan (or a dependent of such an employee if the dependent is eligible, but not enrolled, for coverage under such terms) to enroll for coverage under the terms of the plan if either of the following conditions is met: ‘‘(i) T ERMINATION OF MEDICAID OR CHIP COV- ERAGE.—The employee or dependent is covered under a M edicaid plan under title X IX of the Social Security Act or under a State child health plan under title XXI of such Act and coverage of the employee or dependent under such a plan is terminated as a result of loss of eligibility for such coverage and the employee requests coverage under the group health plan not later than 60 days after the date of termination of such coverage. ‘‘(ii) E LIGI B ILIT Y FOR EMPLOYMENT ASSISTANCE UNDER MEDICAID OR CHIP.—The employee or dependent becomes eligible for assistance, with respect to coverage under the group health plan under such Medicaid plan or State child health plan (including under any waiver or demonstration pro j ect conducted under or in relation to such a plan), if the employee requests coverage under the group health plan not later than 60 days after the date the employee or dependent is determined to be eligible for such assistance. ‘‘(B) EMPLOYEE OUTREACH AND DISCLOSURE.— ‘‘(i) O UTREACH TO EMPLOYEES REGARDING AVAIL- ABILITY OF MEDICAID AND CHIP COVERAGE.— ‘‘(I) IN GENERAL.—Each employer that main- tains a group health plan in a State that provides medical assistance under a State Medicaid plan under title XIX of the Social Security Act, or child health assistance under a State child health plan under title XXI of such Act, in the form of premium Notif i ca tio n.De a dl ine s . 26USC9801 .


text:
Page:United States Statutes at Large Volume 123.djvu/85

 123STA T .65PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9as s i s t a ncefor t h e pu rchase of co v era g eun d era group hea l th plan , shall provide to each e m plo y ee a w ritten notice informing the employee of poten - tial opportunities then currently availa b le in the S tate in which the employee resides for premium assistance under such plans for health coverage of the employee or the employee ’ s dependents .F or purposes of compliance with this clause, the employer may use any State-specific model notice developed in accordance with section 701( f ) ( 3 )( B )(i)( I I) of the E mployee R etirement Income Security A ctof1 9 7 4 ( 2 9 U .S. C . 11 8 1(f)(3)(B)(i)(II)). ‘ ‘(II) OPTION TOP R O V I DEC ONC U RRENT W IT H PROVI S ION O F P LA N M ATERIALS TO EMPLO Y EE. — An employer may provide the model notice applicable to the State in which an employee resides concur- rent with the furnishing of materials notifying the employee of health plan eligibility, concurrent with materials provided to the employee in connection with an open season or election process conducted under the plan, or concurrent with the furnishing of the summary plan description as provided in section 104(b) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1024). ‘‘(ii) D ISCLOSURE A B OUT G ROUP HEALTH PLAN BENE- FITS TO STATES FOR MEDICAID AND CHIP ELIGIBLE INDIVIDUALS.—In the case of a participant or bene- ficiary of a group health plan who is covered under a M edicaid plan of a State under title X IX of the Social Security Act or under a State child health plan under title XXI of such Act, the plan administrator of the group health plan shall disclose to the State, upon re q uest, information about the benefits available under the group health plan in sufficient specificity, as determined under regulations of the Secretary of H ealth and Human Services in consultation with the Secretary that require use of the model coverage coordination disclosure form developed under section 311(b)(1)(C) of the Children’s Health Insurance P ro- gram Reauthori z ation Act of 2009, so as to permit the State to ma k e a determination (under paragraph (2)(B), (3), or (10) of section 210 5 (c) of the Social Secu- rity Act or otherwise) concerning the cost-effectiveness of the State providing medical or child health assist- ance through premium assistance for the purchase of coverage under such group health plan and in order for the State to provide supplemental benefits required under paragraph (10)(E) of such section or other authority.’’. (b) CONFORMING AMENDMENTS.— (1) AMENDMENTS TO EMPLOYEE RETIREMENT INCOME SECU- RITY ACT.— (A) IN GENERAL.—Section 701(f) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1181(f)) is amended by adding at the end the following new para- graph


text:
Page:United States Statutes at Large Volume 123.djvu/86

 123STA T .6 6 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9‘ ‘ (3)SPECIALRU LE SFO R APPLICA T IO N IN CASE OF M E D ICAID AND C H IP .— ‘‘( A ) I N G ENERAL.—A grouphealt h pla n, an d a health i n s uran c e issuer o f fering group health insurance co v erage in connection w ith a group health plan, shall per m it an emplo y ee who is eligi b le, but not enrolled, for coverage under the terms of the plan (or a dependent of such an employee if the dependent is eligible, but not enrolled, for coverage under such terms) to enroll for coverage under the terms of the plan if either of the following conditions is met ‘‘(i) T ERMINATION OF MEDICAID OR CHIP CO V- ERAGE.—The employee or dependent is covered under a M edicaid plan under title X IX of the Social Security Act or under a State child health plan under title XXI of such Act and coverage of the employee or dependent under such a plan is terminated as a result of loss of eligibility for such coverage and the employee re q uests coverage under the group health plan (or health insurance coverage) not later than 60 days after the date of termination of such coverage. ‘‘(ii) E LIGI B ILIT Y FOR EMPLOYMENT ASSISTANCE UNDER MEDICAID OR CHIP.—The employee or dependent becomes eligible for assistance, with respect to coverage under the group health plan or health insurance cov- erage, under such Medicaid plan or State child health plan (including under any waiver or demonstration pro j ect conducted under or in relation to such a plan), if the employee requests coverage under the group health plan or health insurance coverage not later than 60 days after the date the employee or dependent is determined to be eligible for such assistance. ‘‘( B ) C OORDINATION W ITH MEDICAID AND CHIP.— ‘‘(i) O UTREACH TO EMPLOYEES REGARDING AVAIL- ABILITY OF MEDICAID AND CHIP COVERAGE.— ‘‘(I) IN GENERAL.—Each employer that main- tains a group health plan in a State that provides medical assistance under a State Medicaid plan under title XIX of the Social Security Act, or child health assistance under a State child health plan under title XXI of such Act, in the form of premium assistance for the purchase of coverage under a group health plan, shall provide to each employee a written notice informing the employee of poten- tial opportunities then currently available in the State in which the employee resides for premium assistance under such plans for health coverage of the employee or the employee ’ s dependents. ‘‘(II) MODEL NOTICE.— N ot later than 1 year after the date of enactment of the Children’s H ealth Insurance P rogram R eauthori z ation Act of 2 00 9, the Secretary and the Secretary of Health and Human Services, in consultation with D irec- tors of State Medicaid agencies under title XIX of the Social Security Act and Directors of State CHIP agencies under title XXI of such Act, shall jointly develop national and State-specific model Deadlin e .Not i f i c ation. Deadline s .


text: Dictionary of National Biography, 1885-1900/Monteath, George Cunningham


text:
Page:United States Statutes at Large Volume 123.djvu/87

 123STA T .67PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9noticesf o rpu rposes of su b p a ra g rap h(A).T he S ec - retar y sha l l pro v i d ee m ployers w ith such model notices so as to enable employers to timely comply with the re q uirements of subparagraph (A). Such model notices shall include information regarding how an employee may contact the State in which the employee resides for additional information regarding potential opportunities for such pre- mium assistance , including how to apply for such assistance. ‘ ‘( I II) OPTION TOP R O V I DEC ONC U RRENT W IT H PROVI S ION O F P LA N M ATERIALS TO EMPLO Y EE. — An employer may provide the model notice applicable to the State in which an employee resides concur- rent with the furnishing of materials notifying the employee of health plan eligibility, concurrent with materials provided to the employee in connection with an open season or election process conducted under the plan, or concurrent with the furnishing of the summary plan description as provided in section 104 (b). ‘‘(ii) D ISCLOSURE A B OUT G ROUP HEALTH PLAN BENE- FITS TO STATES FOR MEDICAID AND CHIP ELIGIBLE INDIVIDUALS.—In the case of a participant or bene- ficiary of a group health plan who is covered under a M edicaid plan of a State under title X IX of the Social Security Act or under a State child health plan under title XXI of such Act, the plan administrator of the group health plan shall disclose to the State, upon request, information about the benefits available under the group health plan in sufficient specificity, as determined under regulations of the Secretary of H ealth and Human Services in consultation with the Secretary that require use of the model coverage coordination disclosure form developed under section 3 11(b)(1)( C ) of the Children ’ s Health Insurance P ro- gram R eauthori z ation Act of 2 00 9, so as to permit the State to ma k e a determination (under paragraph (2)( B ), (3), or (10) of section 210 5 (c) of the Social Secu- rity Act or otherwise) concerning the cost-effectiveness of the State providing medical or child health assist- ance through premium assistance for the purchase of coverage under such group health plan and in order for the State to provide supplemental benefits required under paragraph (10)( E ) of such section or other authority.’’. (B) CONFORMING AMENDMENT.—Section 102(b) of the Employee Retirement Income Security Act of 19 7 4 (29 U .S.C. 1022(b)) is amended— (i) by striking ‘‘and the remedies’’ and inserting ‘‘, the remedies’’ and (ii) by inserting before the period the following ‘‘, and if the employer so elects for purposes of com- plying with section 701(f)(3)(B)(i), the model notice applicable to the State in which the participants and beneficiaries reside’’.


text:
Page:Artabanzanus (Ferrar, 1896).djvu/157

Rh hear the Prince of Wales and Mr. Gladstone speaking in public assemblies, and bands of music playing fifty years ago. It is possible that we can hear the cries of an infant in its cradle who is now the ruler of an empire; or the voice of a darling daughter singing "Meet me by moonlight alone," who has long since departed from our sight. By means of steam, the vapour of boiling water, we can travel in luxurious carriages, which are made to roll along iron rails at the rate of sixty and even seventy miles an hour. The same mighty power enables us to fly in large ships like palaces, without sails, and against wind and tide, at the rate of fifteen or twenty miles an hour. Our ships of war are protected by iron or steel plates from ten to twenty inches thick, and some of them are armed with guns which can send shot or shell of one thousand pounds in weight a distance of six or seven miles. Our torpedoes can blow up the mightiest vessels. Our rams can shatter and sink ships which cost a million of money.'

'Is all this true?' asked the Doctor, laying down his pipe.

'Most certainly, sir; I should never think of telling you a lie.'

'I believe you to be a true man, Ubertus,' he said. 'If I did not so believe, I would say you were the greatest liar that ever put his feet into boots.'

'And now, my dear Doctor,' said I, 'since I have told you so much that is new to you, will you allow me to ask what was that music which aroused me from my insensibility, and which I heard again on that day when I told you—my singular dream.'

'Yes—ha! your dream—your dream! And you dared to dream that my darling Helen embraced and kissed you, and showed you the Star of Victory; and you saw her mansion, and walked in her garden by her side; but, great God! is it to be always thus? Hush, Julius; keep silence,


text:
Page:United States Statutes at Large Volume 123.djvu/88

 123STA T .68PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9(C)WORKING GRO UPT O DEV E L OP M ODEL C OVER A GE COORDINATION DI S CLOSURE F ORM .— ( i ) M EDICAID , C H IP, AND EMPLO Y ER - SPONSORED COVERAGE COORDINATION W ORKING GROUP.— ( I ) IN GENERAL.— Notla t er t h a n60d a ys a f ter the date of ena c t m ent of this A ct, the S ecretary of H ealth and H u man Ser v ices and the Secretary of L a b or shall j ointly establish a Medicaid, CHI P , and E m p loyer-Sponsored Covera g e Coordination Wor k ing G roup (in this subparagraph referred to as the ‘ ‘Working Group ’ ’). T he purpose of the Working Group shall be to develop the model cov- erage coordination disclosure form described in subclause (II) and to identify the impediments to the effective coordination of coverage available to families that include employees of employers that maintain group health plans and members w ho are eligible for medical assistance under title X IX of the Social Security Act or child health assistance or other health benefits coverage under title XXI of such Act. (II) MODEL COVERAGE COORDINATION DISCLO- SURE FORM DESCRI B ED.—The model form described in this subclause is a form for plan administrators of group health plans to complete for purposes of permitting a State to determine the availability and cost-effectiveness of the coverage available under such plans to employees who have family members who are eligible for premium assistance offered under a State plan under title XIX or XXI of such Act and to allow for coordination of cov- erage for enrollees of such plans. Such form shall provide the following information in addition to such other information as the Working Group determines appropriate (aa) A determination of whether the employee is eligible for coverage under the group health plan. (bb) The name and contract information of the plan administrator of the group health plan. (cc) The benefits offered under the plan. (dd) The premiums and cost-sharing re q uired under the plan. (ee) Any other information relevant to cov- erage under the plan. (ii) MEMBERSHIP.—The Working Group shall con- sist of not more than 3 0 members and shall be com- posed of representatives of— (I) the D epartment of Labor (II) the Department of Health and Human Services; (III) State directors of the Medicaid program under title XIX of the Social Security Act; (I V ) State directors of the State Children’s Health Insurance Program under title XXI of the Social Security Act; Deadlin e .Est a b lis hm ent. 29USC1 1 8 1 n o te.


text:
Page:United States Statutes at Large Volume 123.djvu/89

 123STA T .69PUBLIC LA W 111 – 3 —FE B. 4, 2 0 09 (V)employ e rs,inc l ud in g o w ners o f sm a ll b usinesses and th eir trade or industry representa - ti v es and certified human resource and payroll professionals (V I ) plan administrators and plan sponsors of group health plans (as defined in section 607 ( 1 ) of the E mployee R etirement Income S ecurity A ct of1 9 7 4 ); (VII) health insurance issuers; and (VIII) children and other beneficiaries of med- ical assistance under title X IX of the Social Secu- rity Act or child health assistance or other health benefits coverage under title XXI of such Act . (iii) COMPENSATI ON. —T he members of the W or k ing G roup shall serve without compensation. (iv) A D MINIST R ATI V ES U PPORT.—The D epartment of H ealth and Human Services and the Department of L abor shall j ointly provide appropriate administrative support to the Working Group, including technical assistance. The Working Group may use the services and facilities of either such Department, with or with- out reimbursement, as jointly determined by such Departments. (v) REPORT.— (I) REPORT BYW OR K IN G GROUP TO T H ESE C RE- TARIES.— N ot later than 1 8 months after the date of the enactment of this Act, the Working Group shall submit to the Secretary of Labor and the Secretary of Health and Human Services the model form described in clause (i)(II) along with a report containing recommendations for appropriate meas- ures to address the impediments to the effective coordination of coverage between group health plans and the State plans under titles XIX and XXI of the Social Security Act. (II) REPORT BY SECRETARIES TO THE CON- GRESS.—Not later than 2 months after receipt of the report pursuant to subclause (I), the Secre- taries shall jointly submit a report to each House of the Congress regarding the recommendations contained in the report under such subclause. (vi) TERMINATION.—The Working Group shall terminate 3 0 days after the date of the issuance of its report under clause (v). (D) E F FECTIVE DATES.—The Secretary of Labor and the Secretary of Health and Human Services shall develop the initial model notices under section 701(f)(3)( B )(i)(II) of the Employee Retirement Income Security Act of 1974, and the Secretary of Labor shall provide such notices to employers, not later than the date that is 1 year after the date of enactment of this Act, and each employer shall provide the initial annual notices to such employer ’ s employees beginning with the first plan year that begins after the date on which such initial model notices are first issued. The model coverage coordination disclosure form developed under subparagraph (C) shall apply with respect to re q uests made by States beginning with the Ap p licab ili ty.No ti f icatio n . De a d line. 29USC1 1 8 1 note.


text:
Page:United States Statutes at Large Volume 123.djvu/90

 123STA T .70PUBLIC LA W 111 – 3 —FE B. 4, 200 9firstplanye art h at b e g ins after the d ate o n w hi c hs u ch m odel co v erage coordination disclosure form is first issued .(E) E NFORCEM EN T . —S ection 502 of the Employee R etirement I ncome Security A ct of 1974 (29 U .S. C . 11 3 2) is amended— (i) in subsection (a)( 6 ) , by stri k ing ‘ ‘or ( 8 ) ’ ’ and inserting ‘‘(8), or (9)’’ and (ii) in subsection (c), by redesignating paragraph (9) as paragraph (10), and by inserting after paragraph (8) the following ‘‘(9)(A) T he Secretary may assess a civil penalty against any employer of up to $ 100 a day from the date of the employer’s failure to meet the notice re q uirement of section 701(f)(3)( B )(i)(I). F or purposes of this subparagraph, each violation with respect to any single employee shall be treated as a separate violation. ‘‘(B) The Secretary may assess a civil penalty against any plan administrator of up to $100 a day from the date of the plan administrator’s failure to timely provide to any State the informa - tion required to be disclosed under section 701(f)(3)(B)(ii). For pur- poses of this subparagraph, each violation with respect to any single participant or beneficiary shall be treated as a separate violation.’’. (2) AMEN D MENT S TO PUBLI C H E A LTH SER V ICE ACT.—Section 2701(f) of the P ublic H ealth Service Act (42 U.S.C. 300gg(f)) is amended by adding at the end the following new paragraph: ‘‘(3) SPECIAL RULES FOR APPLICATION IN CASE OF MEDICAID AND CHIP.— ‘‘(A) IN G ENERAL.—A group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, shall permit an employee who is eligible, but not enrolled, for coverage under the terms of the plan (or a dependent of such an employee if the dependent is eligible, but not enrolled, for coverage under such terms) to enroll for coverage under the terms of the plan if either of the following conditions is met: ‘‘(i) TERMINATION OF MEDICAID OR CHIP COV- ERAGE.—The employee or dependent is covered under a M edicaid plan under title X IX of the Social Security Act or under a State child health plan under title XXI of such Act and coverage of the employee or dependent under such a plan is terminated as a result of loss of eligibility for such coverage and the employee requests coverage under the group health plan (or health insurance coverage) not later than 60 days after the date of termination of such coverage. ‘‘(ii) ELIGIBILIT Y FOR EMPLOYMENT ASSISTANCE UNDER MEDICAID OR CHIP.—The employee or dependent becomes eligible for assistance, with respect to coverage under the group health plan or health insurance cov- erage, under such Medicaid plan or State child health plan (including under any waiver or demonstration pro j ect conducted under or in relation to such a plan), if the employee requests coverage under the group health plan or health insurance coverage not later than 60 days after the date the employee or dependent is determined to be eligible for such assistance. Deadlin e s.


text:
Page:United States Statutes at Large Volume 123.djvu/91

 123STA T .7 1 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9‘ ‘ (B)CO O RDINAT ION W IT HME DI C AID AND CHI P.— ‘‘( i ) OU TREACH TO EMP L O Y EE S RE G ARDING A V AIL - A B ILITY O F MEDICAID AND CHIP COVERAGE.— ‘‘( I ) IN GENERAL.— Eachemploy e rt hat mai n - tain s a g ro u p health plan in a S tate that pro v i d es medical assistance under a State M edicaid plan under title X IXo f the Social Security A ct , or child health assistance under a State child health plan under title XXI of such Act, in the form of premium assistance for the purchase of coverage under a group health plan, shall provide to each employee a w ritten notice informing the employee of poten- tial opportunities then currently availa b le in the State in which the employee resides for premium assistance under such plans for health coverage of the employee or the employee ’ s dependents. F or purposes of compliance with this subclause, the employer may use any State-specific model notice developed in accordance with section 701 (f)( 3 )(B)(i)(II) of the Employee R etirement Income Security Act of 1 9 7 4 ( 2 9 U .S.C. 11 8 1(f)(3)(B)(i)(II)). ‘‘(II) OPTION TO PROVIDE CONCURRENT WITH PROVISION OF PLAN MATERIALS TO EMPLOYEE.—An employer may provide the model notice applicable to the State in which an employee resides concur- rent with the furnishing of materials notifying the employee of health plan eligibility, concurrent with materials provided to the employee in connection with an open season or election process conducted under the plan, or concurrent with the furnishing of the summary plan description as provided in section 104(b) of the Employee Retirement Income Security Act of 1974. ‘‘(ii) D ISCLOSURE ABOUT GROUP HEALTH PLAN BENE- FITS TO STATES FOR MEDICAID AND CHIP ELIGIBLE INDIVIDUALS.—In the case of an enrollee in a group health plan who is covered under a Medicaid plan of a State under title XIX of the Social Security Act or under a State child health plan under title XXI of such Act, the plan administrator of the group health plan shall disclose to the State, upon re q uest, informa- tion about the benefits available under the group health plan in sufficient specificity, as determined under regulations of the Secretary of H ealth and Human Services in consultation with the Secretary that require use of the model coverage coordination disclosure form developed under section 311(b)(1)(C) of the Children’s Health Insurance Reauthori z ation Act of 2009, so as to permit the State to ma k e a determina- tion (under paragraph (2)(B), (3), or (10) of section 210 5 (c) of the Social Security Act or otherwise) con- cerning the cost-effectiveness of the State providing medical or child health assistance through premium assistance for the purchase of coverage under such group health plan and in order for the State to provide Notif i ca tio n.


text:
Page:United States Statutes at Large Volume 123.djvu/92

 123STA T .7 2 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9sup p lem e nta l b ene fi ts r e q uire d under para g rap h(10) ( E ) o fsu c h section or other authorit y.’ ’. TI T LE I V—S T R E NG T H ENING QUA LIT YOFC ARE AN D HEALTH OUTCO M ES SEC.401 . C HILD HE A L T H QU ALIT Y I MPROV EME N T ACTIVITIES F OR CHILDREN ENROLLED IN MEDICAID OR CHIP. (a) DEV E LOPM E NT O FCHI L DH E A LTH QU ALIT YM EA S U R ES FOR CHILDREN ENROLLED IN MEDI C AID OR CHIP. —T itle XI ( 42U . S .C. 1 3 01 et seq.) is amended by inserting after section 113 9 the fol - lo w ing new section

‘SEC. 11 39 A. CHILD HEALTH QUALITY MEASURES. ‘ ‘(a) DEVELOPMENT OF AN INITIAL CORE SET OF HEALTH CARE QUALITY MEASURES FOR CHILDREN ENROLLED IN MEDICAID OR CHIP.— ‘‘(1) IN G ENERAL.— N ot later than J anuary 1 , 2010, the Secretary shall identify and publish for general comment an initial, recommended core set of child health quality measures for use by State programs administered under titles XIX and XXI, health insurance issuers and managed care entities that enter into contracts with such programs, and pro v iders of items and services under such programs. ‘‘(2) IDENTIFICATION OF INITIAL CORE MEASURES.—In con- sultation with the individuals and entities described in sub- section (b)(3), the Secretary shall identify e x isting quality of care measures for children that are in use under public and privately sponsored health care coverage arrangements, or that are part of reporting systems that measure both the presence and duration of health insurance coverage over time. ‘‘(3) R ECOMMENDATIONS AND DISSEMINATION.— B ased on such existing and identified measures, the Secretary shall pub- lish an initial core set of child health quality measures that includes (but is not limited to) the following: ‘‘( A ) The duration of children’s health insurance cov- erage over a 12-month time period. ‘‘(B) The availability and effectiveness of a full range of— ‘‘(i) preventive services, treatments, and services for acute conditions, including services to promote healthy birth, prevent and treat premature birth, and detect the presence or ris k of physical or mental condi- tions that could adversely affect growth and develop- ment and ‘‘(ii) treatments to correct or ameliorate the effects of physical and mental conditions, including chronic conditions, in infants, young children, school-age chil- dren, and adolescents. ‘‘(C) The availability of care in a range of ambulatory and inpatient health care settings in which such care is furnished. ‘‘(D) The types of measures that, taken together, can be used to estimate the overall national quality of health care for children, including children with special needs, and to perform comparative analyses of pediatric health Publicat i on.De a d line. Publication. 42USC13 2 06–9 a.


text:
Page:United States Statutes at Large Volume 123.djvu/93

 123STA T .7 3 PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9carequ a lity a nd racial , et h nic, and so cioecono m ic dis p ari - ties in child health and health care f or children .‘ ‘ (4)ENCOURAGEV O L UN T AR Y AN DS TANDARD IZ ED RE P ORTING. —N ot later than 2 years after the date of enactment of the C hildren ’ s H ealth I nsurance P ro g ram R eauthori z ation A ctof2 0 0 9, the S ecretary, in consultation w ith States, shall de v elop a standardized format for reporting information and procedures and approaches that encourage States to use the initial core measurement set to voluntarily report information regarding the quality of pediatric health care under titles X IX and XXI. ‘‘( 5 ) ADOPTION O FB EST PRACTICES IN I M PLEMENTING Q UALITY PROGRAMS.— T he Secretary shall disseminate informa- tion to States regarding b est practices among States with respect to measuring and reporting on the quality of health care for children, and shall facilitate the adoption of such best practices. In developing best practices approaches, the Secretary shall give particular attention to State measurement techniques that ensure the timeliness and accuracy of provider reporting, encourage provider reporting compliance, encourage successful quality improvement strategies, and improve effi- ciency in data collection using health information technology. ‘‘( 6 ) REPORTS TO CONGRESS.—Not later than J anuary 1, 2011, and every 3 years thereafter, the Secretary shall report to Congress on— ‘‘(A) the status of the Secretary’s efforts to improve— ‘‘(i) quality related to the duration and stability of health insurance coverage for children under titles XIX and XXI ‘‘(ii) the quality of children’s health care under such titles, including preventive health services, health care for acute conditions, chronic health care, and health services to ameliorate the effects of physical and mental conditions and to aid in growth and development of infants, young children, school-age chil- dren, and adolescents with special health care needs; and ‘‘(iii) the quality of children’s health care under such titles across the domains of quality, including clinical quality, health care safety, family e x perience with health care, health care in the most integrated setting, and elimination of racial, ethnic, and socio- economic disparities in health and health care; ‘‘( B ) the status of voluntary reporting by States under titles XIX and XXI, utilizing the initial core quality measurement set; and ‘‘(C) any recommendations for legislative changes needed to improve the quality of care provided to children under titles XIX and XXI, including recommendations for quality reporting by States. ‘‘( 7 ) TEC H NICAL ASSISTANCE.—The Secretary shall provide technical assistance to States to assist them in adopting and utilizing core child health quality measures in administering the State plans under titles XIX and XXI. ‘‘( 8 ) D EFINITION OF CORE SET.—In this section, the term ‘core set’ means a group of valid, reliable, and evidence-based quality measures that, ta k en together— Deadlin e .Proc ed u re s .


text:
Page:United States Statutes at Large Volume 123.djvu/94

 123STA T .74PUBLIC LA W 111 – 3 —FE B.4 , 2 0 0 9‘ ‘ (A)provide i nf or mat ion re g arding t h e qu a l it y of health c overage and health care for children ‘‘( B ) addre s s the needs of children throughout the developmental age span; and ‘‘( C ) allo w purchasers , families, and health care pro - viders to understand the quality of care in relation to the preventive needs of children, treatments aimed at man- aging and resolving acute conditions, and diagnostic and treatment services whose purpose is to correct or ameliorate physical, mental, or developmental conditions that could, if untreated or poorly treated, b ecome chronic . ‘‘(b) A DVANCI N G AND IMPRO VING PE DIA T RIC QU A L IT YM EA S - URES. — ‘‘( 1 ) E STA B LIS H MENT O F PEDIATRIC Q UALITY MEASURES PRO- GRAM.— N ot later than J anuary 1, 20 11, the S ecretary shall establish a pediatric quality measures program to— ‘‘(A) improve and strengthen the initial core child health care quality measures established by the Secretary under subsection (a); ‘‘(B) e x pand on existing pediatric quality measures used by public and private health care purchasers and advance the development of such new and emerging quality measures; and ‘‘(C) increase the portfolio of evidence-based, consensus pediatric quality measures available to public and private purchasers of children ’ s health care services, providers, and consumers. ‘‘(2) EVIDENCE-BASED MEASURES.— T he measures developed under the pediatric quality measures program shall, at a min- imum, be— ‘‘(A) evidence-based and, where appropriate, ris k ad j usted; ‘‘(B) designed to identify and eliminate racial and ethnic disparities in child health and the provision of health care; ‘‘(C) designed to ensure that the data required for such measures is collected and reported in a standard format that permits comparison of quality and data at a State, plan, and provider level; ‘‘( D ) periodically updated; and ‘‘(E) responsive to the child health needs, services, and domains of health care quality described in clauses (i), (ii), and (iii) of subsection (a)( 6 )(A). ‘‘( 3 ) PROCESS FOR PEDIATRIC QUALITY MEASURES PROGRAM.— In identifying gaps in existing pediatric quality measures and establishing priorities for development and advancement of such measures, the Secretary shall consult with— ‘‘(A) States; ‘‘(B) pediatricians, children’s hospitals, and other pri- mary and speciali z ed pediatric health care professionals (including members of the allied health professions) who specialize in the care and treatment of children, particu- larly children with special physical, mental, and develop- mental health care needs; ‘‘(C) dental professionals, including pediatric dental professionals; Deadlin e .


text:
Page:United States Statutes at Large Volume 123.djvu/95

 123STA T .75PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9‘ ‘ (D)healt h c a r e p r ovid er s that fu r n ish pri m ar y health care to children and families w ho live in ur b an and rural medically underserved communities or who are members of distinct population sub -g roups at heightened ris k for poor health outcomes ‘‘( E ) national organi z ations representing children , including children with disabilities and children with chronic conditions; ‘‘( F ) national organizations representing consumers and purchasers of children ’ s health care; ‘‘( G ) national organizations and individuals with e x per- tise in pediatric health q uality measurement; and ‘‘( H ) voluntary consensus standards setting organiza- tions and other organizations involved in the advancement of evidence-based measures of health care . ‘‘( 4 )D EV E LOPING ,V A LI D A T ING, AND TE S TING A PO R T F OLIO OF PEDIATRI CQU ALIT YM EASURES. —A s part of the program to advance pediatric quality measures, the S ecretary shall— ‘‘(A) award grants and contracts for the development, testing, and validation of new, emerging, and innovative evidence-based measures for children’s health care services across the domains of quality described in clauses (i), (ii), and (iii) of subsection (a)( 6 )(A); and ‘‘( B ) award grants and contracts for— ‘‘(i) the development of consensus on evidence- based measures for children’s health care services; ‘‘(ii) the dissemination of such measures to public and private purchasers of health care for children; and ‘‘(iii) the updating of such measures as necessary. ‘‘( 5 ) R EVISING, STRENGT H ENING, AND IMPROVING INITIAL CORE MEASURES.—Beginning no later than J anuary 1, 20 1 3 , and annually thereafter, the Secretary shall publish rec- ommended changes to the core measures described in subsection (a) that shall reflect the testing, validation, and consensus process for the development of pediatric quality measures described in subsection paragraphs (1) through (4). ‘‘(6) DEFINITION OF PEDIATRIC QUALITY MEASURE.— I n this subsection, the term ‘pediatric quality measure’ means a measurement of clinical care that is capable of being examined through the collection and analysis of relevant information, that is developed in order to assess 1 or more aspects of pedi- atric health care quality in various institutional and ambulatory health care settings, including the structure of the clinical care system, the process of care, the outcome of care, or patient experiences in care. ‘‘( 7 ) C ONSTRUCTION.— N othing in this section shall be con- strued as supporting the restriction of coverage, under title X IX or XXI or otherwise, to only those services that are evi- dence-based. ‘‘(c) ANNUAL STATE REPORTS REGARDING STATE-SPECIFIC Q UALITY OF CARE M EASURES APPLIED U NDER MEDICAID OR CHIP.— ‘‘(1) ANNUAL STATE REPORTS.—Each State with a State plan approved under title XIX or a State child health plan approved under title XXI shall annually report to the Secretary on the— Deadlin e s.Pub li c a t i o n.


text:
Page:United States Statutes at Large Volume 123.djvu/96

 123STA T .76PUBLIC LA W 111 – 3 —FE B. 4, 2 0 0 9‘ ‘ (A)Sta t e-sp e cif icc h i ld health qu alit ym easu r es applied b y the States u n der such plans , includin g measures described in subparagraphs (A) and ( B ) o f subsection (a)( 6 ) and ‘‘(B) State-specific information on the quality of health care furnished to children under such plans, including information collected through e x ternal quality re v ie w sof managed care organi z ations under section 1932 of the Social Security Act ( 4 2 U. S. C . 1396u – 4) and benchmar k plans under sections 193 7 and 21 0 3 of such Act (42 U.S.C. 1396u–7, 1397cc). ‘‘(2) PUBLICAT I ON . —N ot later than September 30, 2010, and annually thereafter, the Secretary shall collect, analyze, and make publicly available the information reported by States under paragraph (1). ‘‘(d) DEM ON S T R ATION PRO J ECTS F OR I M P RO V IN G T H E Q UALIT Y OF CHIL D REN ’ S H EALTH CARE AND THE USE OF HEALTH INFORMA- TION T ECHNOLOGY.— ‘‘(1) IN GENERAL.—During the period of fiscal years 2009 through 2013, the Secretary shall award not more than 10 grants to States and child health providers to conduct dem- onstration pro j ects to evaluate promising ideas for improving the quality of children’s health care provided under title X IX or XXI, including projects to— ‘‘(A) experiment with, and evaluate the use of, new measures of the quality of children’s health care under such titles (including testing the validity and suitability for reporting of such measures); ‘‘(B) promote the use of health information technology in care delivery for children under such titles; ‘‘(C) evaluate provider-based models which improve the delivery of children’s health care services under such titles, including care management for children with chronic condi- tions and the use of evidence-based approaches to improve the effectiveness, safety, and efficiency of health care serv- ices for children; or ‘‘(D) demonstrate the impact of the model electronic health record format for children developed and dissemi- nated under subsection (f) on improving pediatric health, including the effects of chronic childhood health conditions, and pediatric health care quality as well as reducing health care costs. ‘‘(2) R E Q UIREMENTS.—In awarding grants under this sub- section, the Secretary shall ensure that— ‘‘(A) only 1 demonstration project funded under a grant awarded under this subsection shall be conducted in a State; and ‘‘(B) demonstration projects funded under grants awarded under this subsection shall be conducted evenly between States with large urban areas and States with large rural areas. ‘‘(3) AUTHORITY FOR MULTISTATE PROJECTS.—A demonstra- tion project conducted with a grant awarded under this sub- section may be conducted on a multistate basis, as needed. ‘‘(4) F UNDING.— $ 20,000,000 of the amount appropriated under subsection (i) for a fiscal year shall be used to carry out this subsection. Timep e r i od.G r ants . D ead l ines.