,,ii #aacth ,,congress #b;d ,session ,s4 #aihj ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,february #c1 #bjad,mr4 ,rockefeller introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend titles ,,xix and ,,xxi of the ,social ,security ,act to provide for #ab-month continuous enrollment under the ,medicaid program and ,children's ,health ,insurance ,program and to promote quality care4 #a4 ,short title ,this ,act may be cited as the ,medicaid and ,,chip ,continuous ,quality ,act of #bjad4 #b4 ,findings ,congress finds the following3 7#a7 ,every year millions of people are enrolled in ,medicaid and the ,children's ,health ,insurance ,program 7in this section referred to as ,,chip71 but subsequently lose their coverage1 despite still being eligible1 because of inefficient and cumbersome paperwork and logistical requirements4 7#b7 ,data show that the typical enrollee receives ,medicaid coverage for about three-quarters of the year4 ,coverage periods are lower for non-elderly1 non-disabled adults than for those with disabilities1 seniors1 and children4 7#c7 ,medicaid enrollees with coverage disruption are more likely to be hospitalized for illnesses like asthma1 diabetes1 or cardiovascular disease that can be effectively managed through ongoing primary medical care and medication1 are less likely to be screened for breast cancer1 and may have poorer cancer outcomes4 7#d7 ,children enrolled in ,,chip also experience disruptions in health coverage and care4 ,for example1 during just a one-year period1 over one-third of ,,chip enrollees were also enrolled in a ,state's ,medicaid program4 ,transitions between ,medicaid and ,,chip can cause disruptions in care because the health care coverage and participating providers vary between the two programs4 7#e7 ,interruptions in coverage can impair the receipt of effective primary care and lead to expensive hospitalizations or emergency room visits4 7#f7 ,unnecessary enrollment1 disenrollment and reenrollment in ,medicaid and ,,chip result in higher administrative expenses for reenrollment and result in more people uninsured at any given time4 7#g7 ,stable coverage under ,medicaid and ,,chip lowers average monthly medical costs4 ,continuous enrollment also permits better prevention and disease management1 leading to fewer serious illnesses and hospitalizations4 7#h7 ,children with stable coverage are less likely to have unmet medical needs1 allowing children to receive the preventive care that is necessary to help them grow into healthy adults4 7#i7 ,for the majority of ,medicaid enrollees who are served by ,primary ,care ,case ,management 7,,pccm7 or fee-for-service arrangements1 there are no ,federal requirements for comparable quality monitoring or improvement4 ,no structured oversight exists for ,medicaid enrollees when they move between fee-for-service and capitated managed care plans4 ,thus1 there currently is no ability to make fair assessments across all modes of care for ,medicaid enrollees4 #c4 #ab-month continuous enrollment 7a7 ,requirement of #ab-,month continuous enrollment under ,medicaid 7#a7 ,in general ,section #aijb7;e77#ab7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e771 is amended to read as follows3 7#ab7 #ab-month continuous enrollment 7,a7 ,in general ,notwithstanding any other provision of this title1 a ,state plan approved under this title 7or under any waiver of such plan approved pursuant to section #aaae or section #aiae71 shall provide that an individual who is determined to be eligible for benefits under such plan 7or waiver7 shall remain eligible and enrolled for such benefits through the end of the month in which the #ab-month period 7beginning on the date of determination of eligibility7 ends4 7,b7 ,promoting retention of eligible and enrolled persons beyond #ab months ,the ,secretary shall-- 7i7 identify methods that promote the retention of individuals who are enrolled under the ,state plan and who remain eligible for medical assistance beyond the #ab-month period described in subparagraph 7,a72 and 7ii7 actively promote the adoption of such enrollment retention methods by ,states1 which should include but not be limited to issuing guidance and developing resources on ,state best practices4 7,c7 ,enrollment and retention reporting 7i7 ,in general ,not later than ,september #cj1 #bjad1 the ,secretary shall publish the procedures that ,states are expected to use to provide annual enrollment and retention reports beginning ,september #cj1 #bjae4 7ii7 ,state reporting requirements ,at a minimum1 such reporting procedures shall include a description of ,state eligibility criteria and enrollment procedures under this title1 and data regarding enrollment and retention using standardized reporting formats determined by the ,secretary4 7iii7 ,secretary report and publication ,the ,secretary shall annually publish enrollment and retention performance results for all ,states beginning not later than ,june #cj1 #bjaf4 7iv7 ,each such annual report shall include estimates of ,medicaid enrollment continuity ratios for each ,state4 ,in this clause1 the term enrollment continuity ratio means1 for a given group1 the ratio of the average monthly enrollment of that group in the fiscal year divided by the total unduplicated enrollment for that group in the fiscal year1 expressed as a percentage4 7v7 ,for purposes of such reports1 the ,secretary shall develop both overall ratios for all enrollees and separate ratios for the following categories3 7,i7 ,children4 7,,ii7 ,individuals whose eligibility category is related to being equal to or over the age of #fe4 7,,iii7 ,individuals whose eligibility category is related to disability or blindness4 7,,iv7 ,individuals whose eligibility category is related to their status as parents and caretaker relatives of children under #ai or who are otherwise not elderly1 blind or disabled adults4 4 7b7 ,requirement of #ab-,month continuous enrollment under ,,chip 7#a7 ,in general ,section #bajb7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;bb7b77 is amended by adding at the end the following new paragraph3 7#f7 ,requirement for #ab-month continuous enrollment ,notwithstanding any other provision of this title1 a ,state child health plan that provides child health assistance under this title through a means other than described in section #baja7;a77#b71 shall provide that an individual who is determined to be eligible for benefits under such plan shall remain eligible and enrolled for such benefits through the end of the month in which the #ab-month period 7beginning on the date of determination of eligibility7 ends4 4 7#b7 ,conforming amendment ,section #baje7;a77#d77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7a77#d77;,a77 is amended-- 7,a7 by striking has elected the option of and inserting is in compliance with the requirement for2 and 7,b7 by striking applying such policy under its ,state child health plan under this title and inserting in compliance with section #bajb7;b74 7c7 ,effective date 7#a7 ,in general ,except as provided in paragraph 7#b7 or 7#c71 the amendments made by subsections 7a7 and 7b7 shall apply to determinations 7and redeterminations7 of eligibility made on or after the date that is #ah months after the date of the enactment of this ,act4 7#b7 ,extension of effective date for state law amendment ,in the case of a ,state plan under title ,,xix or ,state child health plan under title ,,xxi of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq41 #db ,u4,s4,c4 #acig;aa et seq47 which the ,secretary of ,health and ,human ,services determines requires ,state legislation 7other than legislation appropriating funds7 in order for the respective plan to meet the additional requirement imposed by the amendment made by subsection 7a7 or 7b71 respectively1 the respective plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such applicable additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the ,state legislature that begins after the date of enactment of this ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of the session is considered to be a separate regular session of the ,state legislature4 7#c7 ,option to implement #ab-month continuous eligibility prior to effective date ,a ,state may elect through a ,state plan amendment under title ,,xix or ,,xxi of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq41 #db ,u4,s4,c4 #acig;aa et seq47 to apply the amendment made by subsection 7a7 or 7b71 respectively1 on any date prior to the #ah-month date specified in paragraph 7#a71 but not sooner than the date of the enactment of this ,act4 #d4 ,preventing the application under ,,chip of coverage waiting periods 7a7 ,in general ,section #bajb7;b77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;bb7b77#a77;,b77 is amended-- 7#a7 in clause 7iii7-- 7,a7 by striking in the case of and inserting in the case of a targeted low-income child 7including a child provided dental-only supplemental coverage under section #baaj7;b77#e77 or in the case of2 and 7,b7 by adding and after the semicolon2 7#b7 by striking clause 7iv72 and 7#c7 by redesignating clause 7v7 as clause 7iv74 7b7 ,conforming amendments ,section #baje7;c77#aj7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7c77#aj77 is amended by striking subparagraph 7,f7 and redesignating subparagraphs 7,g7 through 7,m7 as subparagraphs 7,f7 through 7,l71 respectively4 7c7 ,effective date ,the amendments made by this section shall take effect on the date of enactment of this ,act4 #e4 ,performance bonuses for enrollment and retention improvements for certain individuals 7a7 ,medicaid ,section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 is amended by adding at the end the following new subsection3 7aa7 ,performance bonuses for enrollment and retention of low-,income individuals 7#a7 ,in general ,in addition to performance bonuses for enrollment and retention described in section #baje7;a7 7related to children71 a ,state may qualify for #a or more performance bonuses related to the enrollment and retention of individuals described in section #aijb7;e77#ab77;,c77iii77,,iii74 ,for purposes of this paragraph1 a ,state meets the condition of this paragraph for such individuals if1 for each category of individuals specified in section #aijb7;e77#ab77;,c77iii77,,iii7 and selected by the ,state for additional enrollment and retention provisions1 the ,state is implementing at least #c of the following enrollment and retention provisions 7treating each subparagraph as a separate enrollment and retention provision7 throughout the entire fiscal year3 7,a7 ,aligning treatment of income under medicaid with that of other insurance affordability programs ,the ,state implements policies1 including prorating income over annual periods1 so as to align its treatment of income for purposes of a determination of eligibility for medical assistance with that of other affordability insurance programs with the goal of eliminating inconsistent determinations among these programs4 7,b7 ,maintaining coverage for individuals during periods of transition 7i7 ,in general ,upon determination that an individual is no longer eligible for medical assistance1 the ,state implements policies to maintain eligibility for medical assistance1 including enrollment in the managed care organization in which the individual was enrolled at the time of the determination of ineligibility1 during the period of time in which-- 7,i7 eligibility-related information is transmitted to the other insurance affordability programs2 7,,ii7 a determination is made as to for which other insurance affordability program the individual is eligible2 and 7,,iii7 coverage in such program and any related managed care organization becomes effective4 7ii7 ,managed care organization continuity ,the ,state shall also implement policies to enroll the individual in the managed care organization in which the individual was a member prior to the loss of medical assistance eligibility1 if such managed care organization participates in the other insurance affordability program1 unless the individual voluntarily selects a separate managed care organization4 7,c7 ,enhanced data-sharing between agencies ,the ,state utilizes findings from an ,american ,health ,benefit ,exchange1 an ,express ,lane ,agency 7as identified by the ,state and as described in section #aijb7;e77#ac77;,f77 or the ,social ,security ,administration or other agencies administering employment1 educational1 or social services programs as identified by the ,state1 to document income1 assets1 residency1 age or other relevant information in determining or renewing eligibility4 7,d7 ,eligibility based on pending status ,the ,state maintains eligibility for enrollees whose renewal status has not yet been determined and for whom eligibility based on alternative eligibility criteria has not yet been ruled out4 7,e7 ,default reenrollment in managed care organization ,in the case of individuals who are determined to be eligible for medical assistance under this title after the loss of eligibility for fewer than #f months1 and who previously had been members of a managed care organization1 the ,state re-enrolls the individual in the managed care organization in which the individual was a member prior to the loss of eligibility1 unless the individual voluntarily selects a separate managed care organization4 7#b7 ,performance bonus payment to offset costs resulting from #ab-month continuous enrollment for medicaid enrollees 7,a7 ,authority to make bonus payments 7i7 ,in general ,in addition to the payments provided under section #baje7;a7 of the ,social ,security ,act1 subject to subparagraph 7,c7 the ,secretary shall make payments to a ,state 7beginning with fiscal year #bjaf7 that satisfies the requirements of subparagraph 7,b74 7ii7 ,regulations ,payments to ,states shall be allocated annually among ,states in accordance with regulations promulgated by the ,secretary not later than ,july #a1 #bjae4 7iii7 ,timing ,the payment under this paragraph shall be made1 to a ,state for a fiscal year1 as a single payment not later than the last day of the first calendar quarter of the following fiscal year to which the performance payment applies4 7,b7 ,state eligibility for bonus payments ,a ,state shall be eligible for bonus payments under this subsection if-- 7i7 the ,state has adopted at least #c of the #e policies described in subparagraphs 7,a7 through 7,e7 of paragraph 7#a72 and 7ii7 the ,state is able to demonstrate improvement in the continuity of enrollment by aged1 blind1 and disabled and adult populations1 compared to its baseline performance in fiscal year #bjac4 7,c7 ,amounts available for payments 7i7 ,in general ,the total amount of payments under paragraphs 7#a7 and 7#b7 of this section shall be equal to #ejj1jjj1jjj for fiscal year #bjaf for making payments under this paragraph1 to be available until expended4 7ii7 ,budget authority ,this subsection constitutes budget authority in advance of appropriations ,acts and represents the obligation of the ,secretary to provide for the payment of amounts provided under this subsection4 7,d7 ,uses of enrollment and retention performance bonuses ,nothing in this section shall prohibit a ,state from establishing criteria which would permit the ,state to distribute a portion of the proceeds of any performance bonuses received pursuant to this section to financially support providers who have contributed to improved enrollment and retention activities4 ,for purposes of allocation of ,enrollment and ,retention ,performance ,bonuses the definition of provider shall have the meaning given to it in a ,state ,plan4 4 7b7 ,extension of ,,chip ,performance ,bonus ,to align with reauthorization of ,state allotments ,section #baje7;a77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7a77#c77 is amended-- 7#a7 in subparagraph 7,a71 by striking #bjac and inserting #bjae2 7#b7 in subparagraph 7,e77ii7-- 7,a7 in the heading for subclause 7,i77aa71 by striking #bjab and inserting #bjad2 7,b7 in subclause 7,i77aa7-- 7i7 by striking #bjab and inserting #bjad2 7ii7 by striking subsection 7a7 and inserting section #bajd7;a72 and 7iii7 by striking subsection 7m7 and inserting section #bajd7m72 7,c7 in the heading for subclause 7,i77bb71 by striking #bjac and inserting #bjae2 7,d7 in subclause 7,i77bb7-- 7i7 by striking fiscal year #bjac and inserting fiscal year #bjae2 7ii7 by striking subsection 7a77#af77;,a7 and inserting section #bajd7;a77#ah77;,a72 7iii7 by striking ,october #a1 #bjab1 and ending on ,march #ca1 #bjac and inserting ,october #a1 #bjad1 and ending on ,march #ca1 #bjae2 7iv7 by striking subsection 7m7 and inserting section #bajd7m72 and 7v7 by striking or set aside under subsection 7b77#b7 of section #baaa for such fiscal year2 7,e7 in the heading for subclause 7,i77cc71 by striking #bjac and inserting #bjae2 7,f7 in subclause 7,i77cc7-- 7i7 by striking #bjac each place it appears and inserting #bjae2 7ii7 by striking subsection 7a77#af77;,b7 and inserting section #bajd7;a77#ah77;,b72 7iii7 by striking subsection 7m7 and inserting section #bajd7m72 and 7iv7 by striking or set aside under subsection 7b77#b7 of section #baaa for such fiscal year2 7,g7 in subclause 7,,ii71 by striking #bjac and inserting #bjae2 and 7,h7 in subclause 7,,iii71 by striking #bjac and inserting #bjae2 and 7#c7 in subparagraph 7,f77iii71 by striking #bjac and inserting #bjae4 #f4 ,measuring and reporting on comparable health care quality measures for all persons enrolled in ,medicaid 7a7 ,quality assurance standards ,section #aicb7;c77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#b7;c77#a77 is amended in subparagraph 7,a71 by inserting after #aijc7m7 the following3 or comparable primary care case management services providers described in section #aije7t7 as well as health care services furnished in fee-for-service settings4 7b7 ,adult health quality measures ,title ,,xi of the ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq471 as amended by section #bgja of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 is amended at section #aaci;,b 7#db ,u4,s4,c4 #acbj;b-#i;b7-- 7#a7 by adding after 7b77#c7 the following3 7#d7 ,quality reporting for medicaid eligible adults ,beginning ,january #a1 #bjaf1 the ,secretary shall require ,states to use the measures and approaches identified in paragraph 7#c7 of this subsection to report on the initial core set of quality measures for ,medicaid eligible adults identified in paragraph 7#b71 subject to revisions made by 7#e77;,b7 of this subsection4 2 7#b7 by redesignating subsection 7b77#d7 as 7b77#e7 and 7b77#e7 as 7b77#f72 7#c7 in subsection 7d77#a77;,b7 inserting after ,section #aicg of this title the following3 or comparable primary care case management services providers described in section #aije7t7 as well as health care services furnished in fee-for-service settings2 and 7#d7 in subsection 7d77#b7 by inserting after 7#a7 the following3 including analysis of comparable quality measures for ,medicaid eligible adults who receive their health services through managed care1 primary care case management1 and fee-for-service settings4 7c7 ,pediatric health care measures 7#a7 ,in general ,title ,,xi of the ,social ,security ,act1 is amended at section #aaci;,a7a7 7#db ,u4,s4,c4 #acbj;b-#i;a7a77 by-- 7,a7 inserting after paragraph 7#d7 as if it were included upon enactment3 7#e7 ,reporting of pediatric health care measures ,not later than five years after the date of enactment of the ,medicaid ,continuous ,quality ,act of #bjab1 ,states shall use the procedures and approaches identified in paragraph 7#d7 to report information on the initial core measurement set regarding the quality of pediatric health care under titles ,,xix and ,,xxi4 2 7,b7 redesignating paragraphs 7#e71 7#f71 7#g7 and 7#h7 as 7#f71 7#g71 7#h7 and 7#i71 respectively2 and 7,c7 in subsection 7c77#a77;,b71 inserting after section #bajc of such ,act the following3 or comparable primary care case management services providers described in section #aije7t7 as well as health care services furnished in fee-for-service settings4 #g4 ,performance bonuses for significant achievement in ,medicaid quality performance ,section #aicb7;c77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#b7;c77#a77 is amended by adding at the end the following new subparagraph3 7,f7 ,performance bonus for quality performance achievement 7i7 ,in general ,the ,secretary shall establish a ,medicaid ,quality ,performance ,bonus fund for awarding performance bonuses to ,states for high attainment and improvement on a core set of quality measures related to the goals and purposes of the ,medicaid program4 7ii7 ,quality performance bonus methodology ,not later than three years after the date of enactment of this ,act1 the ,secretary shall establish a methodology for awarding ,medicaid ,quality ,performance bonuses to ,states not less than annually which will be based on the annual ,state reports required under section #aach;,b of title ,,xi of the ,social ,security ,act1 in accordance with regulations promulgated by the ,secretary4 7iii7 ,quality performance measurement bonuses ,medicaid ,quality ,performance ,bonus funds will be awarded to up to #aj ,states that meet thresholds established by the ,secretary for-- 7,i7 the top five ,states achieving the designation of superior quality performing ,state2 or 7,,ii7 five ,states demonstrating the greatest relative level of annual improvement in quality performance4 7iv7 ,initial appropriation ,the total amount of payments under this subparagraph shall be equal to #ejj1jjj1jjj for making payments under this subparagraph1 to be available until expended4 ,this subparagraph constitutes budget authority in advance of appropriations ,acts and represents the obligation of the ,secretary to provide for the payment of amounts provided under this subparagraph4 7v7 ,uses of quality performance bonus funds 7,i7 ,designation for quality improvement activities ,as a condition of receiving a bonus fund award under clause 7iii71 a ,state shall agree to designate at least #ge percent of the performance bonus funds for the development and operation of quality-related initiatives that will directly benefit providers1 including-- 7aa7 provider pay-for-performance programs2 7bb7 provider collaboration initiatives that have been demonstrated to improve performance on quality2 7cc7 provider quality improvement initiatives1 including those aimed at improving care for special and hard-to-reach populations2 and 7dd7 ,secretary-approved activities and initiatives that a ,state may pursue to encourage quality improvement and patient-focused high value care4 ,nothing in this subparagraph shall prohibit a ,state from establishing criteria for the ,state provider performance program that limits the award to a particular provider type7s71 that limits application to a specific geographic area1 or that directs incentive programs for quality-related activities for specific populations1 including individuals eligible under this title and title ,,xviii of the ,social ,security ,act1 hard-to-reach populations4 7,,ii7 ,remaining bonus funds ,states may designate up to #be percent of the quality performance bonus award for activities related to the goals and purposes of the program4 7vi7 ,definition of providers ,for purposes of allocation of ,medicaid ,quality ,performance ,bonuses the definition of provider shall have the meaning given to it in a ,state ,plan4 ,nothing in this section shall prohibit a ,state from investing bonus funds into quality improvement activities for managed care entities4 4