,,ii #aacth ,,congress #b;d ,session ,s4 #bdfa ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,june #aa1 #bjad ,mr4 ,rockefeller introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xxi of the ,social ,security ,act to extend and improve the ,children's ,health ,insurance ,program1 and for other purposes4 #a4 ,short title2 amendments to ,social ,security ,act2 references2 table of contents 7a7 ,short title ,this ,act may be cited as the ,,chip ,extension ,act of #bjad4 7b7 ,amendments to ,social ,security ,act ,except as otherwise specifically provided1 whenever in this ,act an amendment is expressed in terms of an amendment to or repeal of a section or other provision1 the reference shall be considered to be made to that section or other provision of the ,social ,security ,act4 7c7 ,references to ,,chip2 ,medicaid2 ,secretary ,in this ,act3 7#a7 ,,chip ,the term ,,chip means the program established under title ,,xxi of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;aa et seq47 7whether implemented under title ,,xix1 ,,xxi1 or both1 of the ,social ,security ,act74 7#b7 ,medicaid ,the term ,medicaid means the program for medical assistance established under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7#c7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7d7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 amendments to ,social ,security ,act2 references2 table of contents4 ,sec4 #b4 ,purposes4 ,sec4 #c4 ,general effective date2 exception for ,state legislation2 reliance on law4 ,,title ,i--,financing ,sec4 #aja4 ,extension of ,,chip4 ,sec4 #ajb4 ,continuation and update of performance incentives4 ,sec4 #ajc4 ,funds to address any ,federal funding shortfalls for ,states4 ,,title ,,ii--,eligibility and ,enrollment ,subtitle ,a--,coverage ,continuity ,sec4 #bja4 ,state option to increase upper age limit for children with special health care needs4 ,sec4 #bjb4 ,improving coverage transitions from ,medicaid or ,,chip to coverage under a qualified health plan4 ,sec4 #bjc4 ,assuring coverage continuity for former foster care children4 ,subtitle ,b--,enrollment ,simplification and ,improvements ,sec4 #baa4 ,automatic enrollment for newborns under ,,chip4 ,sec4 #bab4 ,express ,lane ,eligibility extension and application to pregnant women1 foster children1 and children with special health care needs4 ,sec4 #bac4 ,outreach to targeted populations4 ,,title ,,iii--,affordability ,sec4 #cja4 ,strengthened cost sharing protections under ,medicaid and ,,chip4 ,,title ,,iv--,benefits ,sec4 #dja4 ,preventive health services4 ,sec4 #djb4 ,timely immunization coverage4 ,,title ,v--,access and ,quality ,subtitle ,a--,pediatric ,quality ,measures ,sec4 #eja4 ,extending the pediatric quality measures program4 ,sec4 #ejb4 ,improving the effectiveness of the pediatric quality measures4 ,sec4 #ejc4 ,annual ,state reports regarding ,state-specific quality of care measures applied under ,medicaid or ,,chip4 ,sec4 #ejd4 ,advisory panel regarding pediatric quality4 ,sec4 #eje4 ,extending and expanding demonstration projects4 ,subtitle ,b--,maternal1 ,infant1 and ,early ,childhood ,home ,visiting ,program ,sec4 #eaa4 ,supporting evidence-based care coordination in communities4 ,subtitle ,c--,comparative study of ,medicaid1 ,,chip1 and qualified health plans ,sec4 #eba4 ,,gao study and report4 ,,title ,,vi--,budgetary ,effects ,sec4 #fja4 ,budgetary effect of this ,act4 #b4 ,purposes ,the purposes of this ,act are to ensure the extension of ,,chip1 safeguard child-specific health coverage for millions of children1 and make improvements to promote children's access to cost-effective1 high-quality health care4 #c4 ,general effective date2 exception for ,state legislation2 reliance on law 7a7 ,general effective date ,unless otherwise provided in this ,act1 subject to subsections 7b7 and 7c71 this ,act and the amendments made by this ,act shall take effect on ,october #a1 #bjae1 and shall apply to child health assistance and medical assistance provided on or after that date4 7b7 ,exception for ,state legislation ,in the case of a ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 or a ,state child health plan under title ,,xxi of such ,act 7#db ,u4,s4,c4 #acig;aa et seq471 which the ,secretary determines requires ,state legislation in order for the respective plan to meet #a or more additional requirements imposed by amendments made by this ,act1 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 an 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 shall be considered to be a separate regular session of the ,state legislature4 7c7 ,reliance on law ,with respect to amendments made by this ,act that become effective as of a date-- 7#a7 such amendments are effective as of such date whether or not regulations implementing such amendments have been issued2 and 7#b7 ,federal financial participation for medical assistance or child health assistance furnished under title ,,xix or ,,xxi1 respectively1 of the ,social ,security ,act on or after such date by a ,state in good faith reliance on such amendments before the date of promulgation of final regulations1 if any1 to carry out such amendments 7or before the date of guidance1 if any1 regarding the implementation of such amendments7 shall not be denied on the basis of the ,state's failure to comply with such regulations or guidance4 ,i ,financing #aja4 ,extension of ,,chip 7a7 ,funding 7#a7 ,in general ,section #bajd7;a7 7#db ,u4,s4,c4 #acig;dd7a77 is amended-- 7,a7 in paragraph 7#ag71 by striking and at the end2 7,b7 by striking paragraph 7#ah7 and inserting the following3 7#ah7 for fiscal year #bjae1 #ba1jfa1jjj1jjj2 2 and 7,c7 by adding at the end the following new paragraphs3 7#ai7 for fiscal year #bjaf1 #ai1cjj1jjj1jjj2 7#bj7 for fiscal year #bjag1 #bj1cjj1jjj1jjj2 7#ba7 for fiscal year #bjah1 #ba1cjj1jjj1jjj2 and 7#bb7 for fiscal year #bjai1 for purposes of making #b semi-annual allotments-- 7,a7 #b1hej1jjj1jjj for the period beginning on ,october #a1 #bjah1 and ending on ,march #ca1 #bjai1 and 7,b7 #b1hej1jjj1jjj for the period beginning on ,april #a1 #bjai1 and ending on ,september #cj1 #bjai4 4 7#b7 ,prevention of duplicate appropriations for fiscal year #bjae ,expenditures made under section #bajd7;a77#ah7 of the ,social ,security ,act 7#db ,u4,s4,c4 #achg;dd7a77#ah77 pursuant to the amendments made by section #ajbjc of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 for fiscal year #bjae shall be charged to the appropriation provided by the amendment made by paragraph 7#a7 to such section for that fiscal year4 7b7 ,allotments 7#a7 ,in general ,section #bajd7m7 7#db ,u4,s4,c4 #acig;dd7m77 is amended-- 7,a7 in paragraph 7#c7-- 7i7 by striking #bjae in the paragraph heading and inserting #bjai2 7ii7 in subparagraph 7,a71 by striking paragraph 7#ah7 and inserting paragraph 7#bb72 7iii7 in subparagraph 7,b71 by striking paragraph 7#ah7 and inserting paragraph 7#bb72 7iv7 in subparagraph 7,c7-- 7,i7 by striking #bjad each place it appears and inserting #bjah2 and 7,,ii7 by striking #bjae and inserting #bjai2 and 7v7 in subparagraph 7,d7-- 7,i7 in clause 7i71 by striking the sum of-- and all that follows through #bjji2 and inserting the amount made available under subsection 7a77#bb77;,a712 and 7,,ii7 in subclause 7,,ii7 of clause 7ii71 by striking subsection 7a77#ah77;,b7 and inserting subsection 7a77#bb77;,b72 7,b7 in paragraph 7#d71 by striking #bjae and inserting #bjai2 7,c7 in paragraph 7#h7-- 7i7 by striking #bjae in the paragraph heading and inserting #bjai2 and 7ii7 by striking for a period in fiscal year #bjae and inserting for a period in fiscal year #bjai2 and 7,d7 by adding at the end the following new paragraph3 7#i7 ,rebasing and growth factor update rules for fiscal years after fiscal year #bjad ,subject to paragraphs 7#c71 7#d71 and 7#f71 from the amount made available under subsection 7a7 for each fiscal year after fiscal year #bjad1 the ,secretary shall compute a ,state allotment for each ,state 7including the ,district of ,columbia and each commonwealth and territory7 for each such fiscal year as follows3 7,a7 ,rebasing in odd-numbered fiscal years ,if the fiscal year is an odd-numbered fiscal year1 the allotment of the ,state is equal to the ,federal payments to the ,state that are attributable to 7and countable towards7 the total amount of allotments available under this section to the ,state in the preceding fiscal year 7including any payments made to the ,state under subsections 7n7 and 7o7 for the preceding fiscal year as well as amounts redistributed to the ,state in the preceding fiscal year71 multiplied by the allotment increase factor under paragraph 7#e7 for the fiscal year4 7,b7 ,growth factor update for even-numbered fiscal years ,if the fiscal year is an even-numbered fiscal year1 the allotment of the ,state is equal to the sum of-- 7i7 the amount of the ,state allotment for the preceding fiscal year2 and 7ii7 the amount of any payments made to the ,state under subsections 7n7 and 7o7 for the preceding fiscal year1 multiplied by the allotment increase factor under paragraph 7#e7 for the fiscal year4 4 7#b7 ,one-time appropriation for fiscal year #bjai ,section #ajh of the ,children's ,health ,insurance ,program ,reauthorization ,act of #bjji 7,public ,law #aaa-c71 as amended by section #ajbjc7;d77#b77;,f7 of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 is amended by striking #ae1cfa1jjj1jjj and all that follows through the second sentence1 and inserting #af1gjj1jjj1jjj to accompany the allotment made for the period beginning on ,october #a1 #bjah1 and ending on ,march #ca1 #bjai1 under section #bajd7;a77#bb77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7a77#bb77;,a771 to remain available until expended4 ,such amount shall be used to provide allotments to ,states under paragraph 7#c7 of section #bajd7m7 of such ,act 7#db ,u4,s4,c4 #acig;dd7m77 for the first #f months of fiscal year #bjai in the same manner as allotments are provided under subsection 7a77#bb77;,a7 of such section #bajd and subject to the same terms and conditions as apply to the allotments provided from such subsection 7a77#bb77;,a744 7#c7 ,conforming amendments ,section #bajd7m7 7#db ,u4,s4,c4 #acig;dd7m77 is amended-- 7,a7 in the subsection heading1 by striking #bjae and inserting #bjai2 and 7,b7 in paragraph 7#f7-- 7i7 in subparagraph 7,a71 by striking #bjae and inserting #bjai2 and 7ii7 in the second sentence1 by striking or fiscal year #bjad and inserting fiscal year #bjad1 fiscal year #bjaf1 or fiscal year #bjah4 7c7 ,extension of qualifying states option ,section #baje7;g77#d7 7#db ,u4,s4,c4 #acig;ee7g77#d77 is amended-- 7#a7 in the paragraph heading1 by striking #bjae and inserting #bjai2 and 7#b7 in subparagraph 7,a71 by striking #bjae and inserting #bjai4 #ajb4 ,continuation and update of performance incentives 7a7 ,extension through fiscal year #bjai ,section #baje7;a77#c7 7#db ,u4,s4,c4 #acig;ee7a77#c77 is amended-- 7#a7 in subparagraph 7,a71 by striking #bjac and inserting #bjai2 7#b7 in subparagraph 7,e7-- 7,a7 in clause 7ii7-- 7i7 by striking subclause 7,i7 and inserting the following3 7,i7 ,unobligated national allotment ,as of ,december #ca of fiscal year #bjji1 and as of ,december #ca of each succeeding fiscal year through fiscal year #bjae1 the portion1 if any1 of the amount appropriated under section #bajd7;a7 for such fiscal year that is unobligated for allotment to a ,state under section #bajd7m7 for such fiscal year or set aside under subsection 7a77#c7 or 7b77#b7 of section #baaa for such fiscal year4 2 7ii7 in subclause 7,,ii71 by striking #bjac and inserting #bjae2 and 7iii7 in subclause 7,,iii71 by striking #bjac and inserting #bjae2 7,b7 by redesignating clause 7iii7 as clause 7iv72 and 7,c7 by inserting after clause 7ii71 the following new clause3 7iii7 ,appropriation for fiscal years #bjaf through #bjai ,out of any money in the ,treasury not otherwise appropriated1 there are appropriated #gej1jjj1jjj for each of fiscal years #bjaf through #bjai for making payments under this paragraph4 ,amounts appropriated for a fiscal year under this clause shall remain available for making payments under this paragraph through ,december #ca of the following fiscal year4 ,any amount of such appropriations that remains unexpended or unobligated as of such date shall be transferred and made available on ,january #a of such following fiscal year for making payments under section #bajd7o74 2 and 7#c7 in subparagraph 7,f77iii71 by striking #bjac and inserting #bjai4 7b7 ,updated performance incentive criteria for fiscal years #bjae through #bjai ,section #baje7;a7 7#db ,u4,s4,c4 #acig;ee7a77 is amended-- 7#a7 in paragraph 7#c77;,a71 by inserting or 7#e7 after paragraph 7#d72 7#b7 in paragraph 7#d7-- 7,a7 in the heading1 by inserting for fiscal years before fiscal year #bjae after for children2 and 7,b7 in the matter preceding subparagraph 7,a71 by striking for a fiscal year if and inserting for a fiscal year before fiscal year #bjae if2 and 7#c7 by adding at the end the following new paragraph3 7#e7 ,enrollment and retention provisions for children for fiscal years after fiscal year #bjad 7,a7 ,in general ,for purposes of paragraph 7#c77;,a71 a ,state meets the condition of this paragraph for a fiscal year after fiscal year #bjad if it is implementing at least #g of the enrollment and retention provisions specified in subparagraph 7,b7 7treating each clause of that subparagraph as a separate enrollment and retention provision7 throughout the entire fiscal year and achieves a program rating of effective or highly effective under metrics established by the ,secretary under subparagraph 7,c7 for the fiscal year 7beginning with the first fiscal year for which such metrics are established74 7,b7 ,enrollment and retention provisions ,the enrollment and retention provisions specified in this subparagraph are the following3 7i7 #ab-month continuous eligibility ,the ,state has elected the option of continuous eligibility for a full #ab months under title ,,xix for all children described in section #aijb7;e77#ab7 and applies such policy under its ,state child health plan under this title4 7ii7 ,express ,lane ,eligibility ,the ,state is implementing the option described in section #aijb7;e77#ac7 under title ,,xix as well as1 pursuant to section #bajg7;e77#a71 under this title4 7iii7 ,presumptive eligibility ,the ,state is implementing section #aibj;,a under title ,,xix as well as1 pursuant to section #bajg7;e77#a71 under this title4 7iv7 ,elimination of ,,chip premiums ,in the case of any targeted low-income child or a targeted low-income pregnant woman1 the ,state child health plan does not impose any enrollment fee1 premium1 or similar charge4 7v7 ,premium assistance for employer-sponsored plans ,the ,state has opted to offer a premium assistance subsidy for qualified employer-sponsored coverage by implementing section #aijf;,a under title ,,xix or the option described in section #baje7;c77#aj7 under this title4 7vi7 ,comprehensive coverage for pregnant women ,if the ,state has elected to offer pregnancy-related assistance to targeted low-income women 7as defined in section #baab7;d77#b77 under section #baab1 the ,state also has elected to include1 as part of such pregnancy-related assistance and as part of the medical assistance provided to women under section #aijb7;e77#e7 while pregnant and during the #fj-;day period described in such section-- 7,i7 dental services necessary to prevent disease and promote oral health1 restore oral structure to health and function1 and treat emergency conditions2 7,,ii7 vision services1 including vision screening and corrective lenses2 and 7,,iii7 all services covered under the ,state child health plan4 7vii7 ,improved coverage for pregnant women ,if the ,state has elected to offer pregnancy-related assistance to targeted low-income women 7as defined in section #baab7;d77#b77 under section #baab-- 7,i7 the ,state also has elected to provide that a pregnant woman who is determined to be eligible for pregnancy-related assistance under the amendment to the ,state child health plan under section #baab shall remain eligible for those benefits until the end of a period 7not to exceed #ab months7 following the determination2 and 7,,ii7 the ,state is implementing section #aijf;,a under title ,,xix4 7viii7 ,supplemental dental coverage ,the ,state has elected to provide dental-only supplemental coverage under section #baaj7;b77#e74 7ix7 ,raising ,,chip eligibility age to align with ,medicaid eligibility age ,if the ,state has elected to provide eligibility as a child under the ,state plan under title ,,xix for an individual who has attained age #ai or #bj1 the ,state has elected to apply the same age under the ,state plan under this title for purposes of eligibility as a child4 7x7 ,increase in income eligibility 7,i7 ,up to at least #cjj percent of the poverty line ,the ,state has elected to extend eligibility for medical assistance under the ,state plan under title ,,xix or eligibility for child health assistance under the ,state child health plan to any otherwise eligible child whose family income does not exceed #cjj percent of the poverty line for a family of the size involved4 7,,ii7 ,rule of construction ,nothing in subclause 7,i7 shall be construed as prohibiting a ,state from extending eligibility for medical assistance under the ,state plan under title ,,xix or eligibility for child health assistance under the ,state child health plan to any otherwise eligible child whose family income exceeds #cjj percent of the poverty line4 7xi7 ,prohibiting lockout periods ,the ,state child health plan permits an individual whose coverage under the plan has been terminated for failure to make premium payments to be immediately reenrolled upon payment of outstanding premiums1 with coverage retroactive to the beginning of the most recent month for which an outstanding premium has been paid1 and shall not impose any waiting period or enrollment fee as a condition of reenrollment4 7xii7 ,,chip coverage for children of state employees ,the ,state offers enrollment in the ,state child health plan for a child who is a member of a family that is eligible for health benefits coverage under a ,state health benefits plan on the basis of a family member's employment with a public agency in accordance with section #baaj7;b77#f7 and provides resources to help the family member so employed compare the coverage options for the family member's child under the ,state health benefits plan on the basis of cost and provider networks4 7xiii7 ,interagency coordination for juvenile justice youth ,the ,state-- 7,i7 does not terminate 7but may suspend7 enrollment under a ,state plan for medical assistance for any individual under age #ba on the basis that the individual is an inmate of a public institution 7as defined in section #dce4ajaj of title #db1 ,code of ,federal ,regulations72 7,,ii7 informs such individual immediately upon release from such public institution that the individual's eligibility for medical assistance is no longer suspended and the limitations on medical assistance under the subdivision 7,a7 following paragraph 7#bi7 of section #aije7;a7 will no longer apply 7unless and until there is a determination that the individual no longer meets the ,state or ,federal eligibility requirements for such medical assistance72 7,,iii7 processes any application for medical assistance submitted by1 or on behalf of any individual under age #ba who is an inmate of a public institution 7as defined in section #dce4ajaj of title #db1 ,code of ,federal ,regulations7 notwithstanding that the individual is such an inmate2 and 7,,iv7 screens any individual under age #ba who is such an inmate for eligibility for medical assistance under title ,,xix or child health assistance under this title and assists those individuals who are identified as likely to be eligible for either such assistance in applying for either such assistance and enrolling in either such plan4 7xiv7 ,extended coverage for children with special health care needs ,the ,state has elected to extend eligibility for child health assistance under the ,state child health plan 7whether implemented under this title1 title ,,xix1 or both7 to individuals under age #bf with special health care needs by implementing the option described in section #baaj7;c77#a77;,b74 7,c7 ,metrics for evaluating program effectiveness ,the ,secretary shall establish metrics for evaluating the effectiveness of the ,state program established under this title 7whether implemented under this title1 title ,,xix1 or both74 ,such metrics shall include a system for rating ,states as effective1 highly effective1 or in need of improvement4 4 #ajc4 ,funds to address any ,federal funding shortfalls for ,states 7a7 ,in general ,section #bajd 7#db ,u4,s4,c4 #acig;dd7 is amended by adding at the end the following new subsection3 7o7 ,fund ,to alleviate ,,chip shortfalls 7#a7 ,establishment ,there is hereby established in the ,treasury of the ,united ,states a fund which shall be known as the ,,chip ,shortfall ,fund 7in this subsection referred to as the ,fund74 ,amounts in the ,fund shall be available without further appropriations for payments under this subsection and shall remain available until expended4 7#b7 ,deposits into fund 7,a7 ,initial appropriation ,out of any money in the ,treasury of the ,united ,states not otherwise appropriated1 there are appropriated to the ,fund #c1hfj1jjj1jjj for fiscal year #bjaf4 7,b7 ,transfers ,notwithstanding any other provision of this title1 the following amounts shall also be available1 without fiscal year limitation1 for making payments from the ,fund3 7i7 ,unobligated national allotment for fiscal years beginning with fiscal year #bjaf ,as of ,january #a of fiscal year #bjag1 and as of ,january #a of each succeeding fiscal year1 the portion1 if any1 of the amount appropriated under subsection 7a7 for the preceding fiscal year that is unobligated for allotment to a ,state under subsection 7m7 for such preceding fiscal year4 7ii7 ,unexpended allotments not used for redistribution ,as of ,november #ae of fiscal year #bjaf and each succeeding fiscal year1 the total amount of allotments made to ,states under subsection 7a7 for the second preceding fiscal year that is not expended or redistributed under subsection 7f7 during the period in which such allotments are available for obligation4 7iii7 ,unexpended child enrollment contingency funds ,as of ,october #a1 #bjae1 any unobligated amount in the ,child ,enrollment ,contingency ,fund under subsection 7n74 7iv7 ,unexpended performance incentive funds ,as of ,january #a1 #bjag1 and as of ,january #a of each succeeding calendar year1 the portion1 if any1 of the amount appropriated under subparagraph 7,e77iii7 of section #baje7;a77#c7 for the preceding fiscal year that is not expended or obligated under such section for such preceding fiscal year4 7,c7 ,investment of fund ,the ,secretary of the ,treasury shall invest in interest bearing securities of the ,united ,states such currently available portions of the ,fund as are not immediately required for payments from the ,fund4 ,the income derived from these investments shall constitute a part of the ,fund4 7#c7 ,shortfall fund payments 7,a7 ,payments to shortfall ,states ,for each of fiscal years #bjaf through #bjbj1 if the ,secretary determines that a ,state is a shortfall ,state described in paragraph 7#d7 for that fiscal year1 the ,secretary shall pay the ,state from the ,fund1 in addition to any other payments made to a ,state under this title for the fiscal year1 an amount equal to the amount described in subparagraph 7,b7 for the ,state and fiscal year4 7,b7 ,amount described ,with respect to a ,state and a fiscal year1 the amount described in this subparagraph is the amount of projected expenditures for the ,state under this title for the fiscal year that exceeds the sum determined under paragraph 7#d7 for the ,state and fiscal year4 7,c7 ,proportional reduction ,if the sum of the amounts otherwise payable under this paragraph for a fiscal year exceeds the amount available in the ,fund for the fiscal year1 the amount to be paid under this paragraph to each ,state for the fiscal year shall be reduced proportionally4 7,d7 ,application to commonwealths and territories ,no payment shall be made under this paragraph to a commonwealth or territory described in subsection 7c77#c7 until such time as the ,secretary determines that there are in effect methods1 satisfactory to the ,secretary1 for the collection and reporting of reliable data regarding the expenditures under the ,state child health plan in order to accurately determine the commonwealth's or territory's eligibility for1 and amount of payment1 under this paragraph4 7#d7 ,shortfall states described ,for purposes of paragraph 7#c71 with respect to a fiscal year1 a shortfall ,state is a ,state for which the ,secretary estimates on the basis of the most recent data available to the ,secretary1 that the projected expenditures for the ,state for the fiscal year under this title 7whether the ,state plan is implemented under this title1 title ,,xix1 or both7 will exceed the sum of-- 7,a7 the amount of the ,state's allotments for any preceding fiscal years that remains available for expenditure and that will not be expended by the end of the immediately preceding fiscal year2 7,b7 the amount 7if any7 that will be redistributed to the ,state under subsection 7f7 for the fiscal year2 7,c7 the amount 7if any7 of the child enrollment contingency fund payment under subsection 7n7 for the fiscal year2 and 7,d7 the amount of the ,state's allotment for the fiscal year4 7#e7 ,retrospective adjustment ,the ,secretary may adjust the determinations made under this subsection with respect to a ,state and fiscal year as necessary on the basis of the amounts reported by ,states not later than ,november #cj of the succeeding fiscal year1 as approved by the ,secretary4 4 7b7 ,technical amendments ,section #bajd7;f7 7#db ,u4,s4,c4 #acig;dd7f77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 by striking shortfall ,states and inserting redistribution ,states2 and 7,b7 by striking shortfall described and inserting deficit described2 and 7#b7 in paragraph 7#b7-- 7,a7 in the paragraph heading1 by striking ,shortfall and inserting ,redistribution2 7,b7 in subparagraph 7,a71 by striking shortfall ,state and inserting redistribution ,state2 and 7,c7 in subparagraph 7,b7-- 7i7 by striking shortfalls and inserting deficits2 and 7ii7 by striking shortfall ,state and inserting redistribution ,state4 ,,ii ,eligibility and ,enrollment ,a ,coverage ,continuity #bja4 ,state option to increase upper age limit for children with special health care needs ,section #baaj7;c77#a7 7#db ,u4,s4,c4 #baaj7;c77#a77 is amended-- 7#a7 by striking ,the term and inserting the following3 7,a7 ,in general ,subject to subparagraph 7,b71 the term 2 and 7#b7 by adding at the end the following3 7,b7 ,children with special health care needs ,at ,state option1 such term includes an individual under #bf years of age who has or is at an increased risk of a chronic physical1 developmental1 behavioral1 or emotional condition and who also requires health and related services of a type or amount beyond that required by children typically4 4 #bjb4 ,improving coverage transitions from ,medicaid or ,,chip to coverage under a qualified health plan 7a7 ,state coordination requirement ,section #baje7;d77#c77;,b7 7#db ,u4,s4,c4 #acig;ee7d77#c77;,b77 is amended-- 7#a7 in the subparagraph heading1 by striking shortfalls and inserting shortfalls2 coordination requirements for transitioning to or from ,exchange coverage2 7#b7 in the first sentence1 by striking ,in the event and inserting the following3 7i7 ,exchange coverage as a result of funding shortfalls ,in the event 2 and 7#c7 by adding at the end the following3 7ii7 ,coordination requirements for transitioning to or from ,exchange coverage ,the ,state shall establish procedures to eliminate gaps in coverage and to assist a child's and pregnant woman's transition from coverage under the ,state plan under title ,,xix or the ,state child health plan under this title 7whether implemented under this title1 title ,,xix1 or both7 to coverage under a qualified health plan that has been certified by the ,secretary under subparagraph 7,c7 and is offered through an ,exchange and from coverage under a qualified health plan to coverage under the ,state plan under title ,,xix or the ,state child health plan under this title4 ,such procedures-- 7,i7 shall provide for coverage for the child's or pregnant woman's medical home1 regardless of whether the medical home providers are participating providers under the ,state plan under title ,,xix or the ,state child health plan under this title1 for a transitional time to be determined under regulations promulgated by the ,secretary2 7,,ii7 in the case of a child or pregnant woman with a chronic or complex condition1 shall provide that the ,state plan under title ,,xix1 or the ,state child health plan under this title 7as applicable7 shall permit the child or pregnant woman to continue to receive treatment from a non-network provider for a transitional period as determined under regulations promulgated by the ,secretary2 7,,iii7 shall require that if the benefits available and cost-sharing imposed under a qualified health plan available to the child or pregnant woman 7as applicable7 are not comparable to the benefits and coverage available to the child or pregnant woman under the ,state plan under title ,,xix or the ,state child health plan under this title 7as applicable7 the child or pregnant woman shall remain enrolled in the ,state plan under title ,,xix or the ,state child health plan under this title for so long as the child or pregnant woman is otherwise eligible for coverage under the title ,,xix or ,,xxi ,state plans2 and 7,,iv7 shall establish a system under which the ,state shall record all transitions of children and pregnant women from coverage under the ,state plan under title ,,xix or the ,state child health plan under this title to coverage under a qualified health plan and from coverage under a qualified health plan to coverage under the ,state plan under title ,,xix or the ,state child health plan under this title and submit a report to the ,secretary each fiscal quarter that includes data on the number of children and pregnant women who made such transitions in the preceding fiscal quarter4 4 7b7 ,certification requirement ,section #baje7;d77#c77;,c7 7#db ,u4,s4,c4 #acig;ee7d77#c77;,c77 is amended-- 7#a7 in the subparagraph heading1 by striking ,pediatric2 7#b7 by striking ,with respect to and inserting the following3 7i7 ,in general ,with respect to 2 7#c7 by inserting and pregnant women after children each place it appears2 7#d7 by striking are at least comparable to the benefits offered and cost-sharing protections provided under the ,state child health plan and inserting meet the comparability standards described in clause 7ii7 and the continuous coverage requirements described in clause 7iii72 and 7#e7 by adding at the end the following new clauses3 7ii7 ,comparability standards ,the ,secretary shall develop1 in consultation with non-government stakeholder entities 7including not less than #a national non-profit organization focused on children's advocacy71 comparability standards for qualified health plans seeking certification under clause 7i74 ,such standards must include standards for the following areas3 7,i7 ,affordability ,the plan must be comparable to the ,state child health plan in terms of affordability1 including premiums1 deductibles1 co-payments1 co-insurance1 medical home maintenance costs1 and the cost of purchasing supplementary coverage for health benefits and services that are covered under the ,state child health plan but are not covered under the qualified health plan4 7,,ii7 ,benefits ,the plan must be comparable to the ,state child health plan in terms of pediatric and pregnancy-related benefits4 7,,iii7 ,network adequacy ,the plan must be comparable to the ,state child health plan in terms of access to appropriate providers of pediatric and pregnancy-related services1 and must provide flexibility for children with special health care needs to remain in their medical home or seek appropriate pediatric sub-specialists4 7iii7 ,continuous coverage requirements ,the ,secretary shall require health plans seeking certification as qualified health plans for purposes of an ,american ,health ,benefits ,exchange to ensure that-- 7,i7 with respect to a child or pregnant woman who is transitioning from coverage under a ,state child health plan or a ,state plan under title ,,xix-- 7aa7 coverage under the qualified health plan shall be effective as of the #fj-;day period preceding the date on which the first premium payment is made for such coverage2 7bb7 coverage under the ,state child health plan or ,state plan under title ,,xix shall remain in effect during the #cj-;day period that precedes the #fj-;day period described in item 7aa72 7cc7 the qualified health plan shall provide coverage for a child's or a pregnant woman's medical home1 regardless of whether the medical home provider is within the network of the plan1 to allow the child or pregnant woman to finish a course of treatment for an acute illness or a treatment or surgery scheduled prior to the effective date for coverage under the plan under item 7aa7 or for a period of up to #ij days if1 by the end of such period1 the child or pregnant woman is enrolled with a medical home provider that is within the network of the plan2 and 7dd7 in the case of a child or pregnant woman with a chronic or complex condition1 the qualified health plan shall permit the child or pregnant woman to continue to receive treatment from a non-network provider for a transitional time that is not less than #ij days1 or until the child or pregnant woman can be enrolled with an in-network provider2 7,,ii7 similar requirements apply with respect to any child or pregnant woman who transitions from coverage under a qualified health plan to coverage under the ,state child health plan or the ,state plan under title ,,xix in accordance with subparagraph 7,b77ii72 and 7,,iii7 a child or pregnant woman transitioning to or from coverage under the ,state child health plan or the ,state plan under title ,,xix and a qualified health plan is informed of the differences between the benefits available and cost-sharing imposed under the coverage the child or pregnant woman is transitioning from and into1 and that the pregnant woman or the parent or guardian of the child has the option of electing to remain enrolled in whichever coverage is the most affordable or provides the best benefits for the child or pregnant woman for such period as the ,secretary shall specify4 4 7c7 ,prohibition on transitioning ,,chip-,eligible children ,no child who is eligible for coverage under ,,chip shall be transitioned from a ,state child health plan to a qualified health plan unless that plan is certified under section #baje7;d77#c77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7d77#c77;,c77 7as amended by subsection 7b774 7d7 ,minimum essential coverage 7#a7 ,in general ,section #ejjj;,a7f7 of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following3 7#f7 ,pregnancy-related assistance under ,,chip ,with respect to a targeted low-income pregnant woman 7as defined in section #baab7;d77#b7 of the ,social ,security ,act71 notwithstanding paragraph 7#a77;,a77iii71 the term minimum essential coverage1 at the option of such a woman1 shall not include pregnancy-related assistance 7as defined in section #baab7;d77#a7 of the ,social ,security ,act74 4 7#b7 ,effective date ,the amendment made by this subsection applies to taxable years beginning after ,december #ca1 #bjad4 #bjc4 ,assuring coverage continuity for former foster care children 7a7 ,in general ,section #aijb7;a77#aj77;,a77i77,,ix7 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77i77,,ix77 is amended-- 7#a7 in item 7cc71 by striking responsibility of the ,state and inserting responsibility of a ,state2 and 7#b7 in item 7dd71 by striking the ,state plan under this title or under a waiver of the and inserting a ,state plan under this title or under a waiver of such a4 7b7 ,effective date ,the amendments made by this section shall take effect on the date of enactment of this ,act4 ,b ,enrollment ,simplification and ,improvements #baa4 ,automatic enrollment for newborns under ,,chip 7a7 ,in general ,section #bajg7;e77#a7 7#db ,u4,s4,c4 #acig;gg7e77#a77 is amended-- 7#a7 by redesignating subparagraphs 7,e7 through 7,o7 as subparagraphs 7,f7 through 7,p71 respectively2 and 7#b7 by inserting after subparagraph 7,d7 the following new subparagraph3 7,e7 ,section #aijb7;e77#d7 7relating to automatic coverage for newborns through age #a74 4 7b7 ,effective date ,the amendments made by this section shall take effect on the date of enactment of this ,act4 #bab4 ,express ,lane ,eligibility extension and application to pregnant women1 foster children1 and children with special health care needs 7a7 ,in general ,section #aijb7;e77#ac7 7#db ,u4,s4,c4 #acif;a7e77#ac77 is amended-- 7#a7 in subparagraph 7,a71 by adding at the end the following new clause3 7iii7 ,state option to extend express lane eligibility to pregnant women ,at the option of the ,state1 the ,state may apply the provisions of this paragraph with respect to determining eligibility under this title for a pregnant woman4 ,in applying this paragraph in the case of a ,state electing such an option1 any reference in this paragraph to a child with respect to this title 7other than a reference to child health assistance7 shall be deemed to be a reference to a pregnant woman4 2 7#b7 in subparagraph 7,g71 by adding at the end the following new sentence3 ,notwithstanding the age limit specified in the preceding sentence1 such term includes an individual described in subsection 7a77#aj77;,a77i77,,ix7 and1 at the option of the ,state1 an individual described in section #baaj7;c77#a77;,b742 and 7#c7 by striking subparagraph 7,i74 7b7 ,effective date ,the amendments made by this section shall take effect on the date of enactment of this ,act4 #bac4 ,outreach to targeted populations 7a7 ,outreach and enrollment grants ,section #baac 7#db ,u4,s4,c4 #acigmm7 is amended-- 7#a7 in subsection 7a77#a71 by striking during the period of fiscal years #bjji through #bjae 2 and 7#b7 in subsection 7g71 by inserting and #dj1jjj1jjj for each fiscal year thereafter1 after #bjae14 7b7 ,outreach to non-,english speakers and other populations 7#a7 ,national enrollment campaign requirements ,such section #baac is amended-- 7,a7 in subsection 7h71 by striking ,such campaign and inserting ,in addition to the requirements described in subsection 7i71 such campaign2 and 7,b7 by adding at the end the following subsection3 7i7 ,required elements of national enrollment campaign ,beginning with fiscal year #bjae1 each of the following initiatives shall be part of the national enrollment campaign3 7#a7 ,initiative to increase enrollment among individuals with limited ,english proficiency ,an initiative to increase enrollment in the ,state child health plan under this title or the ,state plan under title ,,xix of children from families that speak a primary language other than ,english that shall include-- 7,a7 language services1 including oral interpreting and written translation services1 for individuals with limited proficiency in ,english2 and 7,b7 other culturally appropriate efforts to increase enrollment of such children4 7#b7 ,initiative to increase enrollment of children in families with complex or multiple coverage sources ,an initiative to identify and increase enrollment in the ,state child health plan under this title or the ,state plan under title ,,xix of children from families who have multiple coverage sources or other coverage complexities1 including children in foster care and children subject to a medical child support order4 4 7#b7 ,increased reimbursement for ,state spending on language services 7,a7 ,medicaid ,section #aijc7;a77#b77;,e7 7#db ,u4,s4,c4 #acif;b7a77#b77;,e77 is amended by striking #ge percent and inserting the higher of #ij percent or the sum of the enhanced ,,fmap 7as defined in section #baje7;b77 plus #e percentage points 7not to exceed #ajj percent74 7,b7 ,,chip ,section #baje7;a77#a7 7#db ,u4,s4,c4 #acig;ee7a77#a77 is amended in the matter preceding paragraph 7#a71 by striking the higher of #ge percent or the sum of the enhanced ,,fmap plus #e percentage points and inserting the higher of #ij percent or the sum of the enhanced ,,fmap plus #e percentage points 7not to exceed #ajj percent74 7#c7 ,requirement that managed care organizations provide language services to enrollees ,section #aicb7;b7 7#db ,u4,s4,c4 #acifu-#b7;b77 is amended by adding at the end the following new paragraph3 7#i7 ,language services ,each contract with a medicaid managed care organization under section #aijc7m7 shall require the organization to provide 7at no cost to the individual7 language services1 including oral interpreting and written translation services1 to any individual who is eligible for medical assistance under the ,state plan under this title and is enrolled with the organization and to a parent or guardian of such individual if such individual1 parent1 or guardian is in need of such services when interacting with the organization or with any provider receiving payment from the organization4 4 7#d7 ,translation of applications and other vital documents 7,a7 ,medicaid ,section #aijb7;a7 7#db ,u4,s4,c4 #acif;a7a77 is amended-- 7i7 by striking and at the end of paragraph 7#hj72 7ii7 by striking the period at the end of paragraph 7#ha7 and inserting 2 and2 and 7iii7 by inserting after paragraph 7#ha7 the following new paragraph3 7#hb7 provide for the translation of all documents and materials necessary to make application for medical assistance under the plan1 and such other documents and materials as the ,secretary may specify1 including any such documents and materials that are available via a website1 into the primary language spoken by any limited ,english proficiency group in the ,state with a population of at least #ajjj individuals or that constitutes #e percent of the ,state population4 4 7,b7 ,,chip ,section #bajg7;e77#a71 as amended by section #bba1 is amended-- 7i7 by redesignating subparagraphs 7,e7 through 7,p7 as subparagraphs 7,f7 through 7,q71 respectively2 and 7ii7 by inserting after subparagraph 7,d7 the following subparagraph3 7,e7 ,section #aijb7;a77#hb7 7relating to the translation of documents and materials74 4 7c7 ,primary language data collection 7#a7 ,data from eligible entities ,section #baac7;c77#d77;,b7 7#db ,u4,s4,c4 #acigmm7c77#d77;,b77 is amended by inserting under this title and title ,,xix1 individual data on the primary language of enrollees under this title and title ,,xix 7and for such enrollees who are minors or incapacitated1 data on the primary language of their parents or guardians7 after enrollment data4 7#b7 ,annual report 7,a7 ,,chip ,section #bajh 7#db ,u4,s4,c4 #acig;hh7 is amended-- 7i7 by redesignating the subsection 7e7 added by section #eja7;e77#b7 of ,public ,law #aaa-c as subsection 7f72 and 7ii7 in paragraph 7#a7 of the subsection 7e7 added by section #djb of ,public ,law #aaa-c1 by inserting and primary language after duration of benefits4 7,b7 ,medicaid ,section #aidf7;c7 7#db ,u4,s4,c4 #acifw-#e7;c77 is amended by inserting demographic before data on health care disparities4 7d7 ,effective date ,the amendments made by this section shall take effect on the date of enactment of this ,act4 ,,iii ,affordability #cja4 ,strengthened cost sharing protections under ,medicaid and ,,chip 7a7 ,medicaid 7#a7 ,in general ,section #aiaf 7#db ,u4,s4,c4 #acifo7 is amended-- 7,a7 in subsection 7a7-- 7i7 in subparagraph 7,e7 of paragraph 7#b71 by striking and at the end2 7ii7 in paragraph 7#c7-- 7,i7 by inserting subject to paragraph 7#d71 before any deduction2 and 7,,ii7 by striking the period at the end and inserting 2 and2 and 7iii7 by adding at the end the following new paragraph3 7#d7 the total annual aggregate amount of any premium1 enrollment fee1 deduction1 cost sharing1 or similar charge imposed under the plan with respect to such individuals and their families shall not exceed #e percent of the family income of the individual involved1 as applied on a quarterly or monthly basis 7as specified by the ,state74 2 7,b7 in subsection 7b7-- 7i7 in subparagraph 7,e7 of paragraph 7#b71 by striking and at the end2 7ii7 in paragraph 7#c7-- 7,i7 by inserting subject to paragraph 7#d7 before any deduction2 and 7,,ii7 by striking the period at the end and inserting 2 and2 and 7iii7 by adding at the end the following new paragraph3 7#d7 the total annual aggregate amount of any premium1 enrollment fee1 deduction1 cost sharing1 or similar charge imposed under the plan with respect to such individuals and their families shall not exceed #e percent of the family income of the individual involved1 as applied on a quarterly or monthly basis 7as specified by the ,state74 2 7,c7 in subsection 7d71 by inserting 1 and provided that the total annual aggregate amount of any such premium1 and any enrollment fee1 deduction1 cost sharing1 or similar charge imposed under the plan with respect to such individuals and their families shall not exceed #e percent of the family income of the individual involved1 as applied on a quarterly or monthly basis 7as specified by the ,state7 before the period2 and 7,d7 by adding at the end the following new subsection3 7k7 ,cost sharing tracking2 suspension of charges2 notification requirements 7#a7 ,tracking ,if the ,state plan imposes premiums1 enrollment fees1 deductions1 cost sharing1 or similar charges under this section that1 together with any such charges imposed under section #aiaf;,a1 could cause families to have out-of-pocket expenses that exceed a total aggregate cost sharing limit imposed under subsection 7a77#d7 or 7b77#d7 for the month or quarter 7as specified by the ,state71 the ,state shall establish a process for tracking and aggregating such expenses 7including expenses incurred for separately administered benefits7 that-- 7,a7 does not rely on documentation provided by the individual or the family2 7,b7 is communicated in a manner designed to ensure the privacy of patient-related information2 and 7,c7 allows for coordination with managed care entities 7as defined in section #aicb7;a77#a77;,b77 that are under contract with the ,state4 7#b7 ,suspension of charges ,when a family reaches any limit for a period imposed on premiums1 deductions1 cost sharing1 or similar charges under this section1 no further premiums1 deductions1 cost sharing1 or similar charges 7or any portions thereof7 shall be imposed on any individual in the family who is eligible for and receiving medical assistance under the plan for the remainder of the period4 7#c7 ,notification requirements ,with respect to a limit imposed on premiums1 deductions1 cost sharing1 or similar charges under this section the ,state plan shall provide for the notification of providers and each family to which such a limit applies-- 7,a7 of any such limit applicable to the family2 7,b7 when the family has incurred out-of-pocket expenses up to any such limit2 and 7,c7 when a family reaches any such limit for a period1 that the limit has been reached and that no further premiums1 deductions1 cost sharing1 or similar charges 7or portions thereof7 shall be imposed on any individual in the family who is eligible for and receiving medical assistance under the plan for the remainder of such month or quarter4 7#d7 ,reassessment process ,the ,state shall establish a process for families that include an individual who is eligible for and receiving medical assistance under the plan to request a reassessment of the family's aggregate limit on premiums1 deductions1 cost sharing1 or similar charges if the family has a change in circumstances1 in accordance with criteria specified by the ,secretary4 7#e7 ,application of requirements ,the requirements of this subsection shall apply in the same manner to limits imposed under subsections 7c71 7d71 7g71 and 7i74 4 7#b7 ,state option for alternative premiums and cost sharing ,section #aiaf;,a7b7 7#db ,u4,s4,c4 #acifo-#a7;b77 is amended-- 7,a7 in paragraphs 7#a77;,b77ii7 and 7#b77;,a71 by inserting or section #aiaf after subsection 7c7 or 7e7 in each place it appears2 and 7,b7 by adding at the end the following new paragraph3 7#g7 ,cost sharing tracking2 suspension of charges2 notification requirements 7,a7 ,tracking ,if the ,state plan imposes premiums or cost sharing under this section that1 together with cost sharing imposed under section #aiaf1 could cause families to have out-of-pocket expenses that exceed the total aggregate limit imposed under paragraph 7#a7 or 7#b7 of this subsection for a month or quarter 7as specified by the ,state71 the ,state shall establish a process for tracking and aggregating such expenses 7including expenses for separately administered benefits7 that-- 7i7 does not rely on documentation provided by the individual or the family2 7ii7 is communicated in a manner designed to ensure the privacy of patient-related information2 and 7iii7 allows for coordination with managed care entities 7as defined in section #aicb7;a77#a77;,b77 that are under contract with the ,state4 7,b7 ,suspension of charges ,when a family reaches any limit for a period imposed on premiums or cost sharing under this section1 no further premiums or cost sharing 7or any portions thereof7 shall be imposed on any individual in the family who is eligible for and receiving medical assistance under the plan for the remainder of the period4 7,c7 ,notification requirements ,with respect to a limit imposed on premiums or cost sharing under paragraph 7#a7 or 7#b7 of this subsection the ,state plan shall provide for the notification of providers and each family to which such a limit applies-- 7i7 of any such limit applicable to the family2 7ii7 when the family has incurred out-of-pocket expenses up to any such limit2 and 7iii7 when a family reaches such a limit for a period1 that the limit has been reached and that no further premiums or cost sharing 7or portions thereof7 shall be imposed on any individual in the family who is eligible for and receiving medical assistance under the plan for the remainder of such month or quarter4 7,d7 ,reassessment process ,the ,state shall establish a process for families that include an individual who is eligible for and receiving medical assistance under the plan to request a reassessment of the family's aggregate limit on premiums1 deductions1 cost sharing1 or similar charges if the family has a change in circumstances1 in accordance with criteria specified by the ,secretary4 4 7#c7 ,managed care organizations ,section #aicb7;a77#e7 7#db ,u4,s4,c4 #acifu-#b7;a77#e77 is amended by adding at the end the following new subparagraph3 7,e7 ,coordination with providers on cost sharing ,the ,state shall require that a managed care entity with a contract with the ,state1 as a condition of such contract1 comply with the requirements of sections #aiaf and #aiaf;,a 7as applicable71 for such individuals who are enrolled with the organization or entity and coordinate with the ,state with respect to tracking and aggregating an enrollee's family's out-of-pocket expenses for premiums1 deductions1 cost sharing1 or similar charges4 4 7#d7 ,conforming amendments ,section #aiaf;,a7a77#b77;,b7 7#db ,u4,s4,c4 #acifo-#a7;a77#b77;,b77 is amended-- 7,a7 by inserting and the tracking1 suspension1 and notification requirements under subsection 7b77#g7 before shall apply2 and 7,b7 by inserting and requirements after limitations4 7b7 ,,chip 7#a7 ,in general ,section #bajc7;e7 7#db ,u4,s4,c4 #acig;cc7e77 is amended-- 7,a7 by striking paragraphs 7#b7 and 7#d72 7,b7 by redesignating paragraph 7#c7 as paragraph 7#b72 7,c7 in paragraph 7#b7 7as so redesignated7-- 7i7 by striking subparagraph 7,b72 7ii7 by redesignating subparagraph 7,c7 as subparagraph 7,d72 and 7iii7 by inserting after subparagraph 7,a7 the following new subparagraphs3 7,b7 ,no cost sharing for pregnancy-related assistance ,the ,state child health plan may not impose deductions1 cost sharing1 or similar charges with respect to pregnancy-related assistance4 7,c7 ,application of ,medicaid cost sharing limits ,subject to subparagraphs 7,a7 and 7,b7 and paragraph 7#c71 the ,state child health plan may only impose deductions1 cost sharing1 or similar charges to the extent that such charges do not exceed the nominal limits set under section #aiaf7;a77#c74 2 and 7,d7 by adding at the end the following new paragraph3 7#c7 ,additional requirements 7,a7 ,in general ,subject to paragraph 7#b77;,a71 any premiums1 deductions1 cost sharing1 or similar charges imposed under the ,state child health plan for medical or dental benefits may be imposed on a sliding scale related to income1 except that the total annual aggregate cost sharing imposed for such benefits with respect to all individuals in a family that includes a targeted low-income child or a targeted low-income pregnant woman under this title shall not exceed #e percent of such family's income for the year involved4 7,b7 ,dental-only supplemental coverage ,with respect to dental-only supplemental coverage offered under section #baaj7;b77#e71 the total annual aggregate cost sharing imposed for such coverage shall not exceed #e percent of a family's income for the year involved1 minus the amount the family is required to pay during such year in premiums1 deductions1 cost sharing1 or similar charges for health care services for children in the family enrolled in a group health plan or health insurance coverage offered through an employer4 7,c7 ,tracking of expenses2 suspension of charges2 notice2 reassessments ,if the ,state child health plan imposes premiums1 deductions1 cost sharing1 or similar charges that could cause families that include a targeted low-income child or a targeted low-income pregnant woman to have out-of-pocket expenses that exceed the aggregate cost sharing limit imposed under subparagraph 7,a7 for the year1 the ,state shall-- 7i7 establish a process for tracking and aggregating such expenses 7including expenses incurred for separately administered benefits7 that-- 7,i7 does not rely on documentation provided by the targeted low-income child1 the targeted low-income pregnant woman1 or the family2 7,,ii7 is communicated in a manner designed to ensure the privacy of patient-related information2 and 7,,iii7 allows for coordination with managed care entities and managed care organizations that are under contract with the ,state2 7ii7 when a family reaches the aggregate cost-sharing limit for a year imposed under subparagraph 7,a71 not impose any further premiums or cost sharing 7or any portions thereof7 on any targeted low-income child or targeted low-income pregnant woman in the family for the remainder of the year2 7iii7 notify providers and each family that includes a targeted low-income child or a targeted low-income pregnant woman-- 7,i7 of the annual aggregate limits on out-of-pocket expenses applicable to the family2 7,,ii7 when the family has incurred out-of-pocket expenses up to the annual aggregate family limit imposed under subparagraph 7,a72 and 7,,iii7 when a family reaches the aggregate out-of-pocket expenses limit for a year1 that the limit has been reached and that no further premiums1 deductions1 cost sharing1 or similar charges 7or portions thereof7 shall be imposed on any targeted low-income child or targeted low-income pregnant woman in the family for the remainder of such year2 and 7iv7 establish a process for families that include a targeted low-income child or a targeted low-income pregnant woman to request a reassessment of the family's annual aggregate limit on premiums1 deductions1 cost sharing1 or similar charges if the family has a change in circumstances1 in accordance with criteria specified by the ,secretary4 4 7#b7 ,managed care organizations ,section #bajc7;f7 7#db ,u4,s4,c4 #acig;cc7f77 is amended by adding at the end following new paragraph3 7#d7 ,coordination with providers on cost sharing ,the ,state shall require that a managed care entity or a managed care organization with a contract with the ,state1 as a condition of such contract1 comply with the requirements of #bajc7;e7 and coordinate with the ,state with respect to in tracking and aggregating an enrollee's family's out-of-pocket expenses for cost sharing as required under subsection 7e77#c77;,c74 4 7c7 ,conforming amendments 7#a7 ,section #baje7;c77#aj77;,c77i7 7#db ,u4,s4,c4 #acig;ee7c77#aj77;,c77i77 is amended by striking paragraph 7#c77;,b7 of4 7#b7 ,section #baab7;b77#f7 7#db ,u4,s4,c4 #acigll7b77#f77 is amended by striking paragraph 7#c77;,b7 of4 ,,iv ,benefits #dja4 ,preventive health services 7a7 ,preventive health services 7#a7 ,medicaid ,section #aije 7#db ,u4,s4,c4 #acif;d7 is amended-- 7,a7 in subsection 7a77#d7-- 7i7 by striking and before 7,d72 and 7ii7 by inserting before the semicolon at the end the following new subparagraph3 2 and 7,e7 preventive services described in subsection 7ee72 and 7,b7 by adding at the end the following new subsection3 7ee7 ,preventive ,services 7#a7 ,in general ,for purposes of subsection 7a77#d77;,e71 the preventive services described in this subsection are diagnostic1 screening1 and preventive services not otherwise described in subsection 7a7 or required by subsection 7r7 that the ,secretary determines are appropriate for children or pregnant women entitled to medical assistance under this title1 including-- 7,a7 evidence-based items or services that have in effect a rating of ,a or ,b in the current recommendations of the ,united ,states ,preventive ,services ,task ,force2 7,b7 with respect to pregnant women1 immunizations that have in effect a recommendation from the ,advisory ,committee on ,immunization ,practices of the ,centers for ,disease ,control and ,prevention with respect to the individual involved2 7,c7 with respect to infants1 children1 and adolescents1 evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the ,health ,resources and ,services ,administration2 and 7,d7 with respect to women1 such additional preventive care and screenings not described in this paragraph as provided for in comprehensive guidelines supported by the ,health ,resources and ,services ,administration for purposes of this paragraph4 7#b7 ,additional services ,nothing in this subsection shall be construed to limit the application of any requirement of subsection 7r7 or to prohibit a ,state plan under this title from providing coverage for services in addition to those recommended by ,united ,states ,preventive ,services ,task ,force or to prohibit coverage of services4 4 7#b7 ,elimination of cost-,sharing 7,a7 ,subsections 7a77#b77;,d7 and 7b77#b77;,d7 of section #aiaf 7#db ,u4,s4,c4 #acifo7 are each amended by inserting preventive services described in section #aije7;ee71 after emergency services 7as defined by the ,secretary714 7,b7 ,section #aiaf;,a7a77#a7 7#db ,u4,s4,c4 #acifo-#a7;a77#a77 is amended by inserting 1 preventive services described in section #aije7;ee71 after subsection 7c74 7#c7 ,interval period for inclusion of new recommendations in ,state plans ,with respect to a recommendation issued on or after the date of enactment of this ,act that adds new preventive services to the requirements described in subsection 7ee7 of section #aije of the ,social ,security ,act1 the ,secretary shall establish a maximum interval period1 which shall not be longer than #f months1 between the date on which the recommendation is issued and the plan year for which a ,state plan for medical assistance under title ,,xix of the ,social ,security ,act shall be required to include such preventive service4 7b7 ,,chip ,section #bajc 7#db ,u4,s4,c4 #acig;cc7 is amended-- 7#a7 in subsection 7a71 in the matter preceding paragraph 7#a71 by striking and 7#g7 and inserting 7#g71 and 7#h72 and 7#b7 in subsection 7c7-- 7,a7 by redesignating paragraph 7#h7 as paragraph 7#i72 and 7,b7 by inserting after paragraph 7#g71 the following new paragraph3 7#h7 ,preventive services ,the child health assistance provided to a targeted low-income child and pregnancy-related assistance provided to a targeted low-income pregnant woman shall include coverage of preventive services for children or pregnant women required under a ,state plan under title ,,xix under subsections 7a77#d77;,e7 and 7ee7 of section #aije and no deductible1 cost sharing or similar charge shall be imposed under the ,state child health plan with respect to such services4 4 #djb4 ,timely immunization coverage 7a7 ,coverage for newly approved vaccines within #cj days 7#a7 ,in general ,section #aibh7;e7 7#db ,u4,s4,c4 #acifs7e77 is amended by adding at the end the following new sentence3 ,each revision of the list established by such ,advisory ,committee shall apply to the purchase1 delivery1 and administration of pediatric vaccines under this section not later than #cj days after the date such ,advisory ,committee approves the revision44 7#b7 ,conforming amendment ,section #bajc7;c77#a77;,d7 7#db ,u4,s4,c4 #acig;cc7c77#a77;,d77 is amended by inserting in accordance with the schedule referred to in section #aibh7;c77#b77;,b77i7 for pediatric vaccines after immunizations4 7b7 ,treatment of ,,chip-,eligible children as federally vaccine-,eligible children ,section #aibh7;b77#b7 7#db ,u4,s4,c4 #acifs7b77#b77 is amended-- 7#a7 in subparagraph 7,a77i71 by inserting or ,,chip-eligible after medicaid-eligible2 and 7#b7 in subparagraph 7,b71 by striking clause 7i7 and inserting the following3 7i7 ,the term medicaid-eligible or ,,chip-eligible child means1 with respect to a child1 a child who is entitled to medical assistance under a ,state plan approved under this title or a waiver of such plan1 or who is eligible for child health assistance under a ,state child health plan approved under title ,,xxi4 4 7c7 ,coding for vaccine administration ,section #aibh 7#db ,u4,s4,c4 #acifs7 is amended-- 7#a7 by striking subsection 7g7 and inserting3 7g7 ,reserved4 2 and 7#b7 in subsection 7h77#f71 by striking a vaccine and inserting each vaccine component4 7d7 ,effective date ,the amendments made by this section shall take effect on the date of enactment of this ,act4 ,v ,access and ,quality ,a ,pediatric ,quality ,measures #eja4 ,extending the pediatric quality measures program 7a7 ,in general ,section #aaci;,a7i7 7#db ,u4,s4,c4 #acbj;b-#i;a7i77 is amended by inserting 1 and for each of fiscal years #bjad through #bjai1 #ej1jjj1jjj1 after #de1jjj1jjj4 7b7 ,effective date ,the amendment made by this section shall take effect on the date of enactment of this ,act4 #ejb4 ,improving the effectiveness of the pediatric quality measures 7a7 ,in general ,section #aaci;,a7b7 7#db ,u4,s4,c4 #acbj;b-#i;a7b77 is amended-- 7#a7 in paragraph 7#d7-- 7,a7 in subparagraph 7,a71 by striking and at the end2 7,b7 in subparagraph 7,b71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following new subparagraph3 7,c7 establish a program to continue and enhance pediatric quality measures program centers of excellence1 which may include developing centers of excellence with a particular emphasis on patient and family experience and pediatric populations that are small in size and may be most effectively addressed by aggregating data across multiple ,states1 including pediatric populations with medical complexity and pediatric populations with rare conditions4 2 and 7#b7 by amending paragraph 7#e7 to read as follows3 7#e7 ,revising1 strengthening1 and improving initial core measures 7,a7 ,in general ,the ,secretary shall annually publish recommended changes to the core measures described in subsection 7a7 that-- 7i7 are consistent with the purposes of the pediatric quality measures program established under paragraph 7#a72 7ii7 meet the conditions specified in paragraph 7#b72 7iii7 were developed by the ,secretary in consultation with the entities specified in subparagraphs 7,a7 through 7,h7 of paragraph 7#c72 and 7iv7 were developed1 validated1 or tested through a grant awarded under paragraph 7#d74 7,b7 ,additional recommended changes ,beginning not later than #a year after the date of enactment of the ,,chip ,extension ,act of #bjad1 the recommended changes published under subparagraph 7,a7 shall include changes-- 7i7 to measure the type of children's health insurance coverage or other health benefits coverage available over time1 in addition to the presence1 stability1 and duration of such health insurance coverage or such health benefits coverage over time1 for purposes of examining enrollment changes of a child from one type of coverage to another2 7ii7 to ensure that the measures reflect the care provided to the diverse pediatric population1 including adolescents and children with special health care needs1 and the management of acute and chronic conditions2 7iii7 to ensure that the measures reflect care provided in diverse health care settings1 including both inpatient and ambulatory settings2 7iv7 to encourage the development1 implementation1 and stewardship of core measures that can be used at the ,state1 hospital1 practice1 and plan levels1 including a sustainable mechanism to maintain and disseminate such measures and collect and report data on such measures2 and 7v7 to facilitate the adoption1 dissemination1 stewardship1 and reporting of such measures as well as measures developed through the pediatric quality measures program at the ,state1 hospital1 practice1 and plan levels and across different health care delivery and coverage systems1 including coverage provided through the ,exchanges established under title ,i of the ,patient ,protection and ,affordable ,care ,act4 4 7b7 ,effective date ,the amendments made by this section shall take effect on the date of enactment of this ,act4 #ejc4 ,annual ,state reports regarding ,state-specific quality of care measures applied under ,medicaid or ,,chip 7a7 ,in general ,section #aaci;,a7c7 7#db ,u4,s4,c4 #acbj;b-#i;a7c77 is amended by adding at the end the following new paragraph3 7#c7 ,data collection and reporting on full set of core measures ,beginning not later than #e years after the date of enactment of this paragraph1 the information reported under paragraph 7#a7 shall include ,state-specific information on the full set of pediatric core measures4 4 7b7 ,effective date ,the amendment made by this section shall take effect on the date of enactment of this ,act4 #ejd4 ,advisory panel regarding pediatric quality 7a7 ,in general ,section #aaci;,a7g7 7#db ,u4,s4,c4 #acbj;b-#i;a7g77 is amended-- 7#a7 in the subsection heading1 by striking ,study of and inserting ,studies and reports on2 7#b7 by redesignating paragraph 7#b7 as paragraph 7#d72 and 7#c7 by inserting after paragraph 7#a7 the following new paragraphs3 7#b7 ,expert panel ,the ,secretary shall convene a panel1 composed of health experts 7including experts employed by the ,federal ,government and experts not so employed7 to establish priorities and goals for child health as recommended in the report submitted under paragraph 7#a7 by the ,institute of ,medicine4 ,such panel shall-- 7,a7 advise and make recommendations to the ,secretary regarding changes that may be made to the core measures described in subsection 7a72 7,b7 establish standards for the timeliness and accuracy of data so collected and reported2 and 7,c7 review and make recommendations1 on an annual basis1 for strategies to enhance the timeliness1 accuracy1 and utility of the core measures4 7#c7 ,collecting and reporting full set of core measures ,not later than #a year after the date of enactment of this paragraph1 the ,secretary1 in consultation with representatives of ,state agencies responsible for administering ,medicaid and the ,state ,children's ,health ,insurance ,program and representatives of relevant provider organizations1 shall submit to the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,finance of the ,senate a report identifying-- 7,a7 strategies to address and overcome barriers to ,state collection of and reporting of the full set of pediatric core measures2 7,b7 an analysis of the amount of ,federal funding needed to incentivize ,states to collect and report on the full set of pediatric core measures2 and 7,c7 a standardized format and plan for ,states to collect and report on the full set of pediatric core measures4 4 7b7 ,effective date ,the amendments made by this section shall take effect on the date of enactment of this ,act4 #eje4 ,extending and expanding demonstration projects 7a7 ,strengthening demonstration projects for improving the quality of children's health care and the use of health information technology ,section #aaci;,a7d7 7#db ,u4,s4,c4 #acbj;b-#i;a7d77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 in the matter preceding subparagraph 7,a7-- 7i7 by inserting 1 and during the period of fiscal years #bjad through #bjai1 the ,secretary shall award not less than #aj grants1 after #aj grants2 and 7ii7 by inserting 7including oral care7 after health care2 7,b7 in subparagraph 7,c71 by striking or at the end2 7,c7 in subparagraph 7,d71 by striking the period at the end and inserting a semicolon2 and 7,d7 by adding at the end the following new subparagraphs3 7,e7 examine and address barriers to effective delivery of perinatal care and its impact on birth outcomes and subsequent pregnancies and children's health2 7,f7 implement and expand pediatric and perinatal learning and quality improvement collaboratives on the quality of children's and pregnant women's health care1 including improving patient outcomes1 reducing health costs1 and addressing health disparities2 7,g7 encourage and evaluate the use at the ,state level of payment reform and related policy proposals for purposes of promoting higher quality of care for children1 including the shared savings program established under section #ahii and other methods of encouraging integrated care models2 or 7,h7 with respect to the model electronic health record format for children developed and disseminated under subsection 7f7-- 7i7 assess the extent to which the format has been incorporated into widely used electronic health record formats2 7ii7 implement standards and activities that result in increased use of such format2 and 7iii7 evaluate the impact of the increased use of such format4 2 7#b7 in paragraph 7#b7-- 7,a7 in subparagraph 7,a71 by striking and at the end2 7,b7 in subparagraph 7,b71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following new subparagraph3 7,c7 with respect to grants awarded for projects described in paragraph 7#a77;,f71 such grants shall be awarded for projects that-- 7i7 give priority to collaboratives that would have substantial impacts on the pediatric population by-- 7,i7 affecting a large percentage of such population or by substantially improving outcomes in a smaller population2 7,,ii7 reducing the cost of health care for children1 including children with medically complex illnesses or chronic conditions2 7,,iii7 having a high likelihood to reduce disparities in health status2 or 7,,iv7 potentially having long-term health impacts by addressing childhood precursors to adult conditions2 and 7ii7 encourage coordination with other sources of funding in the expansion of pediatric learning collaboratives1 including by coordinating care and utilizing community health workers 7as defined in section #cii,v7k7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g-#aa7k7774 2 and 7#c7 in paragraph 7#d7-- 7,a7 by inserting ,for each of fiscal years #bjji through #bjac1 before #bj1jjj1jjj2 and 7,b7 by adding at the end the following new sentence3 ,for each of fiscal years #bjad through #bjai1 #cf1jjj1jjj of the amount appropriated under subsection 7i7 for a fiscal year shall be used to carry out this subsection44 7b7 ,extending funding for childhood obesity demonstration projects ,section #aaci;,a7e77#h7 7#db ,u4,s4,c4 #acbj;b-#i;a7e77#h77 is amended by inserting 1 and for the period of fiscal years #bjae through #bjai1 #be1jjj1jjj after #bjad4 7c7 ,effective date ,the amendments made by this section shall take effect on the date of enactment of this ,act4 ,b ,maternal1 ,infant1 and ,early ,childhood ,home ,visiting ,program #eaa4 ,supporting evidence-based care coordination in communities 7a7 ,in general ,section #eaa7;j77#a7 7#db ,u4,s4,c4 #gaa7;j77#a77 is amended by striking subparagraph 7,f7 and inserting the following3 7,f7 #djj1jjj1jjj for each of fiscal years #bjae through #bjai4 4 7b7 ,prevention of duplicate appropriations for fiscal year #bjae ,expenditures made pursuant to the amendments made by section #bji of the ,protecting ,access to ,medicare ,act of #bjad 7,public ,law #aac-ic7 for fiscal year #bjae shall be charged to the appropriation provided by the amendment made by subsection 7a7 for such fiscal year4 7c7 ,effective date ,the amendment made by this section shall take effect on the date of enactment of this ,act4 ,c ,comparative study of ,medicaid1 ,,chip1 and qualified health plans #eba4 ,,gao study and report 7a7 ,study ,the ,comptroller ,general of the ,united ,states shall conduct a study of each ,state in which individuals eligible for medical assistance under a ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 or for child health assistance under a ,state child health plan under title ,,xxi of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;aa et seq47 are provided such assistance through enrollment in a qualified health plan or employer-sponsored insurance4 ,such study shall determine1 for each such ,state-- 7#a7 the number of such individuals enrolled in an employer-sponsored health plan to whom wraparound services are offered2 7#b7 the number of such individuals enrolled in an employer-sponsored health plan who use wraparound services for any purpose during the plan year2 7#c7 the average cost of wraparound services per individual enrolled in an employer-sponsored health plan who uses such services2 7#d7 the number of such individuals with developmental disabilities 7as defined in section #ajb7h7 of the ,developmental ,disabilities ,assistance and ,bill of ,rights ,act of #bjjj 7#db ,u4,s4,c4 #aejjb7h7771 enrolled in an employer-sponsored health plan who used wrap-around benefits2 7#e7 the number of disabled individuals enrolled in an employer-sponsored health plan who use wraparound benefits for habilitative services1 rehabilitative services1 or home health services2 7#f7 the number of such individuals enrolled in qualified health plans2 7#g7 average premiums and cost-sharing per such individual enrolled in a qualified health plan2 and 7#h7 comparative data with respect to the benefits offered to such individuals under qualified health plans as compared to the benefits offered to such individuals under ,state plans under title ,,xix or ,,xxi of the ,social ,security ,act4 7b7 ,reports ,not later than #b years after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,finance of the ,senate a report on the findings of the study conducted under subsection 7a7 that includes any recommendations or proposed legislation4 ,not later than #d years after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,finance of the ,senate an updated report on the findings of the study conducted under subsection 7a7 that includes any recommendations or proposed legislation4 7c7 ,definitions ,for purposes of this section3 7#a7 ,qualified health plan ,the term qualified health plan means a health plan that is offered through an ,american ,health ,benefits ,exchange established under the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh74 7#b7 ,wraparound services ,the term wraparound services means services provided by a ,state plan under title ,,xix or ,,xxi of the ,social ,security ,act that are provided as a supplement to items or services for which coverage is not offered or is limited under a qualified health plan or an employer-sponsored health plan4 ,,vi ,budgetary ,effects #fja4 ,budgetary effect of this ,act ,the budgetary effects of this ,act1 for the purpose of complying with the ,statutory ,pay-,as-,you-,go ,act of #bjaj1 shall be determined by reference to the latest statement titled ,budgetary ,effects of ,,paygo ,legislation for this ,act1 submitted for printing in the ,congressional ,record by the ,chairman of the ,committee on the ,budget of the ,house of ,representatives1 as long as such statement has been submitted prior to the vote on passage of this ,act4