,,ii  #aac? ,,congress  #b;d ,session   
,s4 #bdfa  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #aa1 #bjad ,mr4  
,rockefell] introduc$ ! foll[+ bill2 :i*
 0 read twice & ref]r$ to ! ,committee  
on ,f9ance  ,a ,,bill  ,to am5d title   
,,xxi ( ! ,social ,security ,act to     
ext5d & improve ! ,*ildr5's ,heal?      
,insurance ,program1 & = o!r purposes4  
#a4 ,%ort title2 am5dm5ts to ,social    
,security ,act2 ref]5ces2 table (       
cont5ts  7a7 ,%ort title  ,?is ,act may 
be cit$ z ! ,,*ip ,ext5sion ,act (      
#bjad4  7b7 ,am5dm5ts to ,social        
,security ,act ,except z o!rwise        
specifically provid$1 :5ev] 9 ?is ,act  
an am5dm5t is express$ 9 t]ms ( an      
am5dm5t to or repeal ( a section or o!r 
provision1 ! ref]5ce %all be consid]$ to
 be made to t section or o!r provision (
 ! ,social ,security ,act4  7c7         
,ref]5ces to ,,*ip2 ,m$icaid2 ,secret>y 
,9 ?is ,act3  7#a7 ,,*ip ,! t]m ,,*ip   
means ! program e/abli%$ "u title ,,xxi 
( ! ,social ,security ,act 7#db         

,u4,s4,c4 #acig;aa et seq47 7:e!r       
implem5t$ "u title ,,xix1 ,,xxi1 or bo?1
 ( ! ,social ,security ,act74  7#b7     
,m$icaid ,! t]m ,m$icaid means ! program
 = m$ical assi/ance e/abli%$ "u title   
,,xix ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acif et seq474  7#c7         
,secret>y ,! t]m ,secret>y means !      
,secret>y ( ,heal? & ,human ,s]vices4   
7d7 ,table ( cont5ts ,! table ( cont5ts 
= ?is ,act is z foll[s3 ,sec4 #a4 ,%ort 
title2 am5dm5ts to ,social ,security    
,act2 ref]5ces2 table ( cont5ts4 ,sec4  
#b4 ,purposes4 ,sec4 #c4 ,g5]al         
effective date2 exception = ,/ate       
legislation2 reliance on law4 ,,title   
,i--,f9anc+ ,sec4 #aja4 ,ext5sion (     
,,*ip4 ,sec4 #ajb4 ,cont9uation & update
 ( p]=mance inc5tives4 ,sec4 #ajc4      
,funds to address any ,f$]al fund+      
%ortfalls = ,/ates4 ,,title             
,,ii--,eligibility & ,enrollm5t         
,subtitle ,a--,cov]age ,cont9uity ,sec4 
#bja4 ,/ate option to increase upp] age 
limit = *ildr5 ) special heal? c>e ne$s4

 ,sec4 #bjb4 ,improv+ cov]age           
transitions f ,m$icaid or ,,*ip to      
cov]age "u a qualifi$ heal? plan4 ,sec4 
#bjc4 ,assur+ cov]age cont9uity = =m]   
fo/] c>e *ildr54 ,subtitle              
,b--,enrollm5t ,simplification &        
,improvem5ts ,sec4 #baa4 ,automatic     
enrollm5t = newborns "u ,,*ip4 ,sec4    
#bab4 ,express ,lane ,eligibility       
ext5sion & application to pregnant wom51
 fo/] *ildr51 & *ildr5 ) special heal?  
c>e ne$s4 ,sec4 #bac4 ,outrea* to t>get$
 populations4 ,,title                   
,,iii--,af=dability ,sec4 #cja4 ,/r5g!n$
 co/ %>+ protections "u ,m$icaid &      
,,*ip4 ,,title ,,iv--,b5efits ,sec4     
#dja4 ,prev5tive heal? s]vices4 ,sec4   
#djb4 ,timely immunization cov]age4     
,,title ,v--,access & ,quality ,subtitle
 ,a--,p$iatric ,quality ,measures ,sec4 
#eja4 ,ext5d+ ! p$iatric quality        
measures program4 ,sec4 #ejb4 ,improv+ !
 effectiv5ess ( ! p$iatric quality      
measures4 ,sec4 #ejc4 ,annual ,/ate     
reports reg>d+ ,/ate-specific quality ( 

c>e measures appli$ "u ,m$icaid or      
,,*ip4 ,sec4 #ejd4 ,advisory panel      
reg>d+ p$iatric quality4 ,sec4 #eje4    
,ext5d+ & exp&+ demon/ration projects4  
,subtitle ,b--,mat]nal1 ,infant1 & ,e>ly
 ,*ildhood ,home ,visit+ ,program ,sec4 
#eaa4 ,support+ evid5ce-bas$ c>e        
coord9ation 9 communities4 ,subtitle    
,c--,comp>ative /udy ( ,m$icaid1 ,,*ip1 
& qualifi$ heal? plans ,sec4 #eba4 ,,gao
 /udy & report4 ,,title ,,vi--,budget>y 
,effects ,sec4 #fja4 ,budget>y effect ( 
?is ,act4  #b4 ,purposes ,! purposes (  
?is ,act are to ensure ! ext5sion (     
,,*ip1 safegu>d *ild-specific heal?     
cov]age = millions ( *ildr51 & make     
improvem5ts to promote *ildr5's access  
to co/-effective1 high-quality heal?    
c>e4  #c4 ,g5]al effective date2        
exception = ,/ate legislation2 reliance 
on law  7a7 ,g5]al effective date       
,unless o!rwise provid$ 9 ?is ,act1     
subject to subsections 7b7 & 7c71 ?is   
,act & ! am5dm5ts made by ?is ,act %all 
take effect on ,octob] #a1 #bjae1 & %all

 apply to *ild heal? assi/ance & m$ical 
assi/ance provid$ on or aft] t date4    
7b7 ,exception = ,/ate legislation ,9 ! 
case ( a ,/ate plan "u title ,,xix ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acif et seq47 or a ,/ate *ild heal?    
plan "u title ,,xxi ( su* ,act 7#db     
,u4,s4,c4 #acig;aa et seq471 :i* !      
,secret>y det]m9es requires ,/ate       
legislation 9 ord] = ! respective plan  
to meet #a or m additional requirem5ts  
impos$ by am5dm5ts made by ?is ,act1 !  
respective plan %all n be reg>d$ z fail+
 to comply ) ! requirem5ts ( su* title  
solely on ! basis ( its failure to meet 
su* an additional requirem5t be=e ! fir/
 day ( ! fir/ cal5d> qu>t] beg9n+ aft] !
 close ( ! fir/ regul> session ( ! ,/ate
 legislature t beg9s aft] ! date (      
enactm5t ( ?is ,act4 ,= purposes ( !    
previ\s s5t5ce1 9 ! case ( a ,/ate t has
 a #b-ye> legislative session1 ea* ye> (
 ! session %all be consid]$ to be a     
sep>ate regul> session ( ! ,/ate        
legislature4  7c7 ,reliance on law ,)   

respect to am5dm5ts made by ?is ,act t  
become effective z ( a date--  7#a7 su* 
am5dm5ts are effective z ( su* date :e!r
 or n regulations implem5t+ su* am5dm5ts
 h be5 issu$2 &  7#b7 ,f$]al f9ancial   
p>ticipation = m$ical assi/ance or *ild 
heal? assi/ance furni%$ "u title ,,xix  
or ,,xxi1 respectively1 ( ! ,social     
,security ,act on or aft] su* date by a 
,/ate 9 good fai? reliance on su*       
am5dm5ts be=e ! date ( promulgation (   
f9al regulations1 if any1 to c>ry out   
su* am5dm5ts 7or be=e ! date ( guidance1
 if any1 reg>d+ ! implem5tation ( su*   
am5dm5ts7 %all n be d5i$ on ! basis ( ! 
,/ate's failure to comply ) su*         
regulations or guidance4  ,i ,f9anc+    
#aja4 ,ext5sion ( ,,*ip  7a7 ,fund+     
7#a7 ,9 g5]al ,section #bajd7;a7 7#db   
,u4,s4,c4 #acig;dd7a77 is am5d$--  7,a7 
9 p>agraph 7#ag71 by /rik+ & at ! end2  
7,b7 by /rik+ p>agraph 7#ah7 & ins]t+ ! 
foll[+3  7#ah7 = fiscal ye> #bjae1      
#ba1jfa1jjj1jjj2  2 &  7,c7 by add+ at !
 end ! foll[+ new p>agraphs3  7#ai7 =   

fiscal ye> #bjaf1 #ai1cjj1jjj1jjj2      
7#bj7 = fiscal ye> #bjag1               
#bj1cjj1jjj1jjj2  7#ba7 = fiscal ye>    
#bjah1 #ba1cjj1jjj1jjj2 &  7#bb7 =      
fiscal ye> #bjai1 = purposes ( mak+ #b  
semi-annual allotm5ts-- 7,a7            
#b1hej1jjj1jjj = ! p]iod beg9n+ on      
,octob] #a1 #bjah1 & end+ on ,m>* #ca1  
#bjai1 &  7,b7 #b1hej1jjj1jjj = ! p]iod 
beg9n+ on ,april #a1 #bjai1 & end+ on   
,septemb] #cj1 #bjai4  4  7#b7          
,prev5tion ( duplicate appropriations = 
fiscal ye> #bjae ,exp5ditures made "u   
section #bajd7;a77#ah7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#achg;dd7a77#ah77 pursuant to ! am5dm5ts
 made by section #ajbjc ( ! ,pati5t     
,protection & ,af=dable ,c>e ,act       
7,public ,law #aaa-adh7 = fiscal ye>    
#bjae %all be *>g$ to ! appropriation   
provid$ by ! am5dm5t made by p>agraph   
7#a7 to su* section = t fiscal ye>4  7b7
 ,allotm5ts  7#a7 ,9 g5]al ,section     
#bajd7m7 7#db ,u4,s4,c4 #acig;dd7m77 is 
am5d$-- 7,a7 9 p>agraph 7#c7-- 7i7 by   

/rik+ #bjae 9 ! p>agraph head+ & ins]t+ 
#bjai2  7ii7 9 subp>agraph 7,a71 by     
/rik+ p>agraph 7#ah7 & ins]t+ p>agraph  
7#bb72  7iii7 9 subp>agraph 7,b71 by    
/rik+ p>agraph 7#ah7 & ins]t+ p>agraph  
7#bb72  7iv7 9 subp>agraph 7,c7-- 7,i7  
by /rik+ #bjad ea* place x appe>s &     
ins]t+ #bjah2 &  7,,ii7 by /rik+ #bjae &
 ins]t+ #bjai2 &  7v7 9 subp>agraph     
7,d7-- 7,i7 9 clause 7i71 by /rik+ ! sum
 (-- & all t foll[s ?r\gh #bjji2 &      
ins]t+ ! am\nt made available "u        
subsection 7a77#bb77;,a712 &  7,,ii7 9  
subclause 7,,ii7 ( clause 7ii71 by /rik+
 subsection 7a77#ah77;,b7 & ins]t+      
subsection 7a77#bb77;,b72  7,b7 9       
p>agraph 7#d71 by /rik+ #bjae & ins]t+  
#bjai2  7,c7 9 p>agraph 7#h7-- 7i7 by   
/rik+ #bjae 9 ! p>agraph head+ & ins]t+ 
#bjai2 &  7ii7 by /rik+ = a p]iod 9     
fiscal ye> #bjae & ins]t+ = a p]iod 9   
fiscal ye> #bjai2 &  7,d7 by add+ at !  
end ! foll[+ new p>agraph3  7#i7 ,rebas+
 & gr[? factor update rules = fiscal    
ye>s aft] fiscal ye> #bjad ,subject to  

p>agraphs 7#c71 7#d71 & 7#f71 f ! am\nt 
made available "u subsection 7a7 = ea*  
fiscal ye> aft] fiscal ye> #bjad1 !     
,secret>y %all compute a ,/ate allotm5t 
= ea* ,/ate 7includ+ ! ,di/rict (       
,columbia & ea* commonweal? & t]ritory7 
= ea* su* fiscal ye> z foll[s3 7,a7     
,rebas+ 9 odd-numb]$ fiscal ye>s ,if !  
fiscal ye> is an odd-numb]$ fiscal ye>1 
! allotm5t ( ! ,/ate is equal to !      
,f$]al paym5ts to ! ,/ate t are         
attributable to 7& c\ntable t[>ds7 !    
total am\nt ( allotm5ts available "u ?is
 section to ! ,/ate 9 ! prec$+ fiscal   
ye> 7includ+ any paym5ts made to ! ,/ate
 "u subsections 7n7 & 7o7 = ! prec$+    
fiscal ye> z well z am\nts r$i/ribut$ to
 ! ,/ate 9 ! prec$+ fiscal ye>71        
multipli$ by ! allotm5t increase factor 
"u p>agraph 7#e7 = ! fiscal ye>4  7,b7  
,gr[? factor update = ev5-numb]$ fiscal 
ye>s ,if ! fiscal ye> is an ev5-numb]$  
fiscal ye>1 ! allotm5t ( ! ,/ate is     
equal to ! sum (-- 7i7 ! am\nt ( ! ,/ate
 allotm5t = ! prec$+ fiscal ye>2 &  7ii7

 ! am\nt ( any paym5ts made to ! ,/ate  
"u subsections 7n7 & 7o7 = ! prec$+     
fiscal ye>1  multipli$ by ! allotm5t    
increase factor "u p>agraph 7#e7 = !    
fiscal ye>4  4  7#b7 ,"o-"t             
appropriation = fiscal ye> #bjai        
,section #ajh ( ! ,*ildr5's ,heal?      
,insurance ,program ,reau?orization ,act
 ( #bjji 7,public ,law #aaa-c71 z am5d$ 
by section #ajbjc7;d77#b77;,f7 ( !      
,pati5t ,protection & ,af=dable ,c>e    
,act 7,public ,law #aaa-adh71 is am5d$  
by /rik+ #ae1cfa1jjj1jjj & all t foll[s 
?r\gh ! second s5t5ce1 & ins]t+         
#af1gjj1jjj1jjj to accompany ! allotm5t 
made = ! p]iod beg9n+ on ,octob] #a1    
#bjah1 & end+ on ,m>* #ca1 #bjai1 "u    
section #bajd7;a77#bb77;,a7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acig;dd7a77#bb77;,a771 to rema9        
available until exp5d$4 ,su* am\nt %all 
be us$ to provide allotm5ts to ,/ates "u
 p>agraph 7#c7 ( section #bajd7m7 ( su* 
,act 7#db ,u4,s4,c4 #acig;dd7m77 = !    
fir/ #f mon?s ( fiscal ye> #bjai 9 !    

same mann] z allotm5ts are provid$ "u   
subsection 7a77#bb77;,a7 ( su* section  
#bajd & subject to ! same t]ms &        
conditions z apply to ! allotm5ts       
provid$ f su* subsection 7a77#bb77;,a744
  7#c7 ,con=m+ am5dm5ts ,section        
#bajd7m7 7#db ,u4,s4,c4 #acig;dd7m77 is 
am5d$-- 7,a7 9 ! subsection head+1 by   
/rik+ #bjae & ins]t+ #bjai2 &  7,b7 9   
p>agraph 7#f7-- 7i7 9 subp>agraph 7,a71 
by /rik+ #bjae & ins]t+ #bjai2 &  7ii7 9
 ! second s5t5ce1 by /rik+ or fiscal ye>
 #bjad & ins]t+ fiscal ye> #bjad1 fiscal
 ye> #bjaf1 or fiscal ye> #bjah4  7c7   
,ext5sion ( qualify+ /ates option       
,section #baje7;g77#d7 7#db ,u4,s4,c4   
#acig;ee7g77#d77 is am5d$-- 7#a7 9 !    
p>agraph head+1 by /rik+ #bjae & ins]t+ 
#bjai2 &  7#b7 9 subp>agraph 7,a71 by   
/rik+ #bjae & ins]t+ #bjai4  #ajb4      
,cont9uation & update ( p]=mance        
inc5tives  7a7 ,ext5sion ?r\gh fiscal   
ye> #bjai ,section #baje7;a77#c7 7#db   
,u4,s4,c4 #acig;ee7a77#c77 is am5d$--   
7#a7 9 subp>agraph 7,a71 by /rik+ #bjac 

& ins]t+ #bjai2  7#b7 9 subp>agraph     
7,e7-- 7,a7 9 clause 7ii7-- 7i7 by /rik+
 subclause 7,i7 & ins]t+ ! foll[+3  7,i7
 ,unobligat$ national allotm5t ,z (     
,decemb] #ca ( fiscal ye> #bjji1 & z (  
,decemb] #ca ( ea* succe$+ fiscal ye>   
?r\gh fiscal ye> #bjae1 ! portion1 if   
any1 ( ! am\nt appropriat$ "u section   
#bajd7;a7 = su* fiscal ye> t is         
unobligat$ = allotm5t to a ,/ate "u     
section #bajd7m7 = su* fiscal ye> or set
 aside "u subsection 7a77#c7 or 7b77#b7 
( section #baaa = su* fiscal ye>4  2    
7ii7 9 subclause 7,,ii71 by /rik+ #bjac 
& ins]t+ #bjae2 &  7iii7 9 subclause    
7,,iii71 by /rik+ #bjac & ins]t+ #bjae2 
7,b7 by r$esignat+ clause 7iii7 z clause
 7iv72 &  7,c7 by ins]t+ aft] clause    
7ii71 ! foll[+ new clause3  7iii7       
,appropriation = fiscal ye>s #bjaf ?r\gh
 #bjai ,out ( any money 9 ! ,treasury n 
o!rwise appropriat$1 !re are appropriat$
 #gej1jjj1jjj = ea* ( fiscal ye>s #bjaf 
?r\gh #bjai = mak+ paym5ts "u ?is       
p>agraph4 ,am\nts appropriat$ = a fiscal

 ye> "u ?is clause %all rema9 available 
= mak+ paym5ts "u ?is p>agraph ?r\gh    
,decemb] #ca ( ! foll[+ fiscal ye>4 ,any
 am\nt ( su* appropriations t rema9s    
unexp5d$ or unobligat$ z ( su* date %all
 be transf]r$ & made available on       
,janu>y #a ( su* foll[+ fiscal ye> =    
mak+ paym5ts "u section #bajd7o74  2 &  
7#c7 9 subp>agraph 7,f77iii71 by /rik+  
#bjac & ins]t+ #bjai4  7b7 ,updat$      
p]=mance inc5tive crit]ia = fiscal ye>s 
#bjae ?r\gh #bjai ,section #baje7;a7    
7#db ,u4,s4,c4 #acig;ee7a77 is am5d$--  
7#a7 9 p>agraph 7#c77;,a71 by ins]t+ or 
7#e7 aft] p>agraph 7#d72  7#b7 9        
p>agraph 7#d7-- 7,a7 9 ! head+1 by      
ins]t+ = fiscal ye>s be=e fiscal ye>    
#bjae aft] = *ildr52 &  7,b7 9 ! matt]  
prec$+ subp>agraph 7,a71 by /rik+ = a   
fiscal ye> if & ins]t+ = a fiscal ye>   
be=e fiscal ye> #bjae if2 &  7#c7 by    
add+ at ! end ! foll[+ new p>agraph3    
7#e7 ,enrollm5t & ret5tion provisions = 
*ildr5 = fiscal ye>s aft] fiscal ye>    
#bjad  7,a7 ,9 g5]al ,= purposes (      

p>agraph 7#c77;,a71 a ,/ate meets !     
condition ( ?is p>agraph = a fiscal ye> 
aft] fiscal ye> #bjad if x is implem5t+ 
at lea/ #g ( ! enrollm5t & ret5tion     
provisions specifi$ 9 subp>agraph 7,b7  
7treat+ ea* clause ( t subp>agraph z a  
sep>ate enrollm5t & ret5tion provision7 
?r\gh\t ! entire fiscal ye> & a*ieves a 
program rat+ ( effective or highly      
effective "u metrics e/abli%$ by !      
,secret>y "u subp>agraph 7,c7 = ! fiscal
 ye> 7beg9n+ ) ! fir/ fiscal ye> = :i*  
su* metrics are e/abli%$74  7,b7        
,enrollm5t & ret5tion provisions ,!     
enrollm5t & ret5tion provisions specifi$
 9 ?is subp>agraph are ! foll[+3 7i7    
#ab-mon? cont9u\s eligibility ,! ,/ate  
has elect$ ! option ( cont9u\s          
eligibility = a full #ab mon?s "u title 
,,xix = all *ildr5 describ$ 9 section   
#aijb7;e77#ab7 & applies su* policy "u  
its ,/ate *ild heal? plan "u ?is title4 
7ii7 ,express ,lane ,eligibility ,!     
,/ate is implem5t+ ! option describ$ 9  
section #aijb7;e77#ac7 "u title ,,xix z 

well z1 pursuant to section             
#bajg7;e77#a71 "u ?is title4  7iii7     
,presumptive eligibility ,! ,/ate is    
implem5t+ section #aibj;,a "u title     
,,xix z well z1 pursuant to section     
#bajg7;e77#a71 "u ?is title4  7iv7      
,elim9ation ( ,,*ip premiums ,9 ! case (
 any t>get$ l[-income *ild or a t>get$  
l[-income pregnant woman1 ! ,/ate *ild  
heal? plan does n impose any enrollm5t  
fee1 premium1 or simil> *>ge4  7v7      
,premium assi/ance = employ]-sponsor$   
plans ,! ,/ate has opt$ to (f] a premium
 assi/ance subsidy = qualifi$           
employ]-sponsor$ cov]age by implem5t+   
section #aijf;,a "u title ,,xix or !    
option describ$ 9 section #baje7;c77#aj7
 "u ?is title4  7vi7 ,compreh5sive      
cov]age = pregnant wom5 ,if ! ,/ate has 
elect$ to (f] pregnancy-relat$ assi/ance
 to t>get$ l[-income wom5 7z def9$ 9    
section #baab7;d77#b77 "u section #baab1
 ! ,/ate also has elect$ to include1 z  
"p ( su* pregnancy-relat$ assi/ance & z 
"p ( ! m$ical assi/ance provid$ to wom5 

"u section #aijb7;e77#e7 :ile pregnant &
 dur+ ! #fj-;day p]iod describ$ 9 su*   
section-- 7,i7 d5tal s]vices necess>y to
 prev5t disease & promote oral heal?1   
re/ore oral /ructure to heal? &         
function1 & treat em]g5cy conditions2   
7,,ii7 vision s]vices1 includ+ vision   
scre5+ & corrective l5ses2 &  7,,iii7   
all s]vices cov]$ "u ! ,/ate *ild heal? 
plan4  7vii7 ,improv$ cov]age = pregnant
 wom5 ,if ! ,/ate has elect$ to (f]     
pregnancy-relat$ assi/ance to t>get$    
l[-income wom5 7z def9$ 9 section       
#baab7;d77#b77 "u section #baab-- 7,i7 !
 ,/ate also has elect$ to provide t a   
pregnant woman :o is det]m9$ to be      
eligible = pregnancy-relat$ assi/ance "u
 ! am5dm5t to ! ,/ate *ild heal? plan "u
 section #baab %all rema9 eligible = ^? 
b5efits until ! end ( a p]iod 7n to     
exce$ #ab mon?s7 foll[+ ! det]m9ation2 &
  7,,ii7 ! ,/ate is implem5t+ section   
#aijf;,a "u title ,,xix4  7viii7        
,supplem5tal d5tal cov]age ,! ,/ate has 
elect$ to provide d5tal-only supplem5tal

 cov]age "u section #baaj7;b77#e74  7ix7
 ,rais+ ,,*ip eligibility age to align )
 ,m$icaid eligibility age ,if ! ,/ate   
has elect$ to provide eligibility z a   
*ild "u ! ,/ate plan "u title ,,xix = an
 individual :o has atta9$ age #ai or    
#bj1 ! ,/ate has elect$ to apply ! same 
age "u ! ,/ate plan "u ?is title =      
purposes ( eligibility z a *ild4  7x7   
,increase 9 income eligibility  7,i7 ,up
 to at lea/ #cjj p]c5t ( ! pov]ty l9e ,!
 ,/ate has elect$ to ext5d eligibility =
 m$ical assi/ance "u ! ,/ate plan "u    
title ,,xix or eligibility = *ild heal? 
assi/ance "u ! ,/ate *ild heal? plan to 
any o!rwise eligible *ild ^: family     
income does n exce$ #cjj p]c5t ( !      
pov]ty l9e = a family ( ! size involv$4 
7,,ii7 ,rule ( con/ruction ,no?+ 9      
subclause 7,i7 %all be con/ru$ z        
prohibit+ a ,/ate f ext5d+ eligibility =
 m$ical assi/ance "u ! ,/ate plan "u    
title ,,xix or eligibility = *ild heal? 
assi/ance "u ! ,/ate *ild heal? plan to 
any o!rwise eligible *ild ^: family     

income exce$s #cjj p]c5t ( ! pov]ty l9e4
  7xi7 ,prohibit+ lock\t p]iods ,! ,/ate
 *ild heal? plan p]mits an individual ^:
 cov]age "u ! plan has be5 t]m9at$ =    
failure to make premium paym5ts to be   
imm$iately re5roll$ ^u paym5t ( out/&+  
premiums1 ) cov]age retroactive to !    
beg9n+ ( ! mo/ rec5t mon? = :i* an      
out/&+ premium has be5 paid1 & %all n   
impose any wait+ p]iod or enrollm5t fee 
z a condition ( re5rollm5t4  7xii7 ,,*ip
 cov]age = *ildr5 ( /ate employees ,!   
,/ate (f]s enrollm5t 9 ! ,/ate *ild     
heal? plan = a *ild :o is a memb] ( a   
family t is eligible = heal? b5efits    
cov]age "u a ,/ate heal? b5efits plan on
 ! basis ( a family memb]'s employm5t ) 
a public ag5cy 9 accordance ) section   
#baaj7;b77#f7 & provides res\rces to    
help ! family memb] s employ$ comp>e !  
cov]age options = ! family memb]'s *ild 
"u ! ,/ate heal? b5efits plan on ! basis
 ( co/ & provid] networks4  7xiii7      
,int]ag5cy coord9ation = juv5ile ju/ice 
y\? ,! ,/ate-- 7,i7 does n t]m9ate 7b   

may susp5d7 enrollm5t "u a ,/ate plan = 
m$ical assi/ance = any individual "u age
 #ba on ! basis t ! individual is an    
inmate ( a public in/itution 7z def9$ 9 
section #dce4ajaj ( title #db1 ,code (  
,f$]al ,regulations72  7,,ii7 in=ms su* 
individual imm$iately ^u release f su*  
public in/itution t ! individual's      
eligibility = m$ical assi/ance is no    
long] susp5d$ & ! limitations on m$ical 
assi/ance "u ! subdivision 7,a7 foll[+  
p>agraph 7#bi7 ( section #aije7;a7 w no 
long] apply 7unless & until !re is a    
det]m9ation t ! individual no long]     
meets ! ,/ate or ,f$]al eligibility     
requirem5ts = su* m$ical assi/ance72    
7,,iii7 processes any application =     
m$ical assi/ance submitt$ by1 or on     
behalf ( any individual "u age #ba :o is
 an inmate ( a public in/itution 7z     
def9$ 9 section #dce4ajaj ( title #db1  
,code ( ,f$]al ,regulations7 not)/&+ t !
 individual is su* an inmate2 &  7,,iv7 
scre5s any individual "u age #ba :o is  
su* an inmate = eligibility = m$ical    

assi/ance "u title ,,xix or *ild heal?  
assi/ance "u ?is title & assi/s ^?      
individuals :o are id5tifi$ z likely to 
be eligible = ei!r su* assi/ance 9      
apply+ = ei!r su* assi/ance & enroll+ 9 
ei!r su* plan4  7xiv7 ,ext5d$ cov]age = 
*ildr5 ) special heal? c>e ne$s ,! ,/ate
 has elect$ to ext5d eligibility = *ild 
heal? assi/ance "u ! ,/ate *ild heal?   
plan 7:e!r implem5t$ "u ?is title1 title
 ,,xix1 or bo?7 to individuals "u age   
#bf ) special heal? c>e ne$s by         
implem5t+ ! option describ$ 9 section   
#baaj7;c77#a77;,b74  7,c7 ,metrics =    
evaluat+ program effectiv5ess ,!        
,secret>y %all e/abli% metrics =        
evaluat+ ! effectiv5ess ( ! ,/ate       
program e/abli%$ "u ?is title 7:e!r     
implem5t$ "u ?is title1 title ,,xix1 or 
bo?74 ,su* metrics %all include a sy/em 
= rat+ ,/ates z effective1 highly       
effective1 or 9 ne$ ( improvem5t4  4    
#ajc4 ,funds to address any ,f$]al fund+
 %ortfalls = ,/ates  7a7 ,9 g5]al       
,section #bajd 7#db ,u4,s4,c4 #acig;dd7 

is am5d$ by add+ at ! end ! foll[+ new  
subsection3  7o7 ,fund ,to alleviate    
,,*ip %ortfalls  7#a7 ,e/abli%m5t ,!re  
is h]eby e/abli%$ 9 ! ,treasury ( !     
,unit$ ,/ates a fund :i* %all be kn[n z 
! ,,*ip ,%ortfall ,fund 79 ?is          
subsection ref]r$ to z ! ,fund74 ,am\nts
 9 ! ,fund %all be available )\t fur!r  
appropriations = paym5ts "u ?is         
subsection & %all rema9 available until 
exp5d$4  7#b7 ,deposits into fund  7,a7 
,initial appropriation ,out ( any money 
9 ! ,treasury ( ! ,unit$ ,/ates n       
o!rwise appropriat$1 !re are appropriat$
 to ! ,fund #c1hfj1jjj1jjj = fiscal ye> 
#bjaf4  7,b7 ,transf]s ,not)/&+ any o!r 
provision ( ?is title1 ! foll[+ am\nts  
%all also be available1 )\t fiscal ye>  
limitation1 = mak+ paym5ts f ! ,fund3   
7i7 ,unobligat$ national allotm5t =     
fiscal ye>s beg9n+ ) fiscal ye> #bjaf ,z
 ( ,janu>y #a ( fiscal ye> #bjag1 & z ( 
,janu>y #a ( ea* succe$+ fiscal ye>1 !  
portion1 if any1 ( ! am\nt appropriat$  
"u subsection 7a7 = ! prec$+ fiscal ye> 

t is unobligat$ = allotm5t to a ,/ate "u
 subsection 7m7 = su* prec$+ fiscal ye>4
  7ii7 ,unexp5d$ allotm5ts n us$ =      
r$i/ribution ,z ( ,novemb] #ae ( fiscal 
ye> #bjaf & ea* succe$+ fiscal ye>1 !   
total am\nt ( allotm5ts made to ,/ates  
"u subsection 7a7 = ! second prec$+     
fiscal ye> t is n exp5d$ or r$i/ribut$  
"u subsection 7f7 dur+ ! p]iod 9 :i* su*
 allotm5ts are available = obligation4  
7iii7 ,unexp5d$ *ild enrollm5t cont+5cy 
funds ,z ( ,octob] #a1 #bjae1 any       
unobligat$ am\nt 9 ! ,*ild ,enrollm5t   
,cont+5cy ,fund "u subsection 7n74  7iv7
 ,unexp5d$ p]=mance inc5tive funds ,z ( 
,janu>y #a1 #bjag1 & z ( ,janu>y #a (   
ea* succe$+ cal5d> ye>1 ! portion1 if   
any1 ( ! am\nt appropriat$ "u           
subp>agraph 7,e77iii7 ( section         
#baje7;a77#c7 = ! prec$+ fiscal ye> t is
 n exp5d$ or obligat$ "u su* section =  
su* prec$+ fiscal ye>4  7,c7 ,inve/m5t (
 fund ,! ,secret>y ( ! ,treasury %all   
inve/ 9 int]e/ be>+ securities ( !      
,unit$ ,/ates su* curr5tly available    

portions ( ! ,fund z are n imm$iately   
requir$ = paym5ts f ! ,fund4 ,! income  
d]iv$ f ^! inve/m5ts %all con/itute a "p
 ( ! ,fund4  7#c7 ,%ortfall fund paym5ts
  7,a7 ,paym5ts to %ortfall ,/ates ,=   
ea* ( fiscal ye>s #bjaf ?r\gh #bjbj1 if 
! ,secret>y det]m9es t a ,/ate is a     
%ortfall ,/ate describ$ 9 p>agraph 7#d7 
= t fiscal ye>1 ! ,secret>y %all pay !  
,/ate f ! ,fund1 9 addition to any o!r  
paym5ts made to a ,/ate "u ?is title = !
 fiscal ye>1 an am\nt equal to ! am\nt  
describ$ 9 subp>agraph 7,b7 = ! ,/ate & 
fiscal ye>4  7,b7 ,am\nt describ$ ,)    
respect to a ,/ate & a fiscal ye>1 !    
am\nt describ$ 9 ?is subp>agraph is !   
am\nt ( project$ exp5ditures = ! ,/ate  
"u ?is title = ! fiscal ye> t exce$s !  
sum det]m9$ "u p>agraph 7#d7 = ! ,/ate &
 fiscal ye>4  7,c7 ,proportional        
r$uction ,if ! sum ( ! am\nts o!rwise   
payable "u ?is p>agraph = a fiscal ye>  
exce$s ! am\nt available 9 ! ,fund = !  
fiscal ye>1 ! am\nt to be paid "u ?is   
p>agraph to ea* ,/ate = ! fiscal ye>    

%all be r$uc$ proportionally4  7,d7     
,application to commonweal?s &          
t]ritories ,no paym5t %all be made "u   
?is p>agraph to a commonweal? or        
t]ritory describ$ 9 subsection 7c77#c7  
until su* "t z ! ,secret>y det]m9es t   
!re are 9 effect me?ods1 satisfactory to
 ! ,secret>y1 = ! collection & report+ (
 reliable data reg>d+ ! exp5ditures "u !
 ,/ate *ild heal? plan 9 ord] to        
accurately det]m9e ! commonweal?'s or   
t]ritory's eligibility =1 & am\nt (     
paym5t1 "u ?is p>agraph4  7#d7 ,%ortfall
 /ates describ$ ,= purposes ( p>agraph  
7#c71 ) respect to a fiscal ye>1 a      
%ortfall ,/ate is a ,/ate = :i* !       
,secret>y e/imates on ! basis ( ! mo/   
rec5t data available to ! ,secret>y1 t !
 project$ exp5ditures = ! ,/ate = !     
fiscal ye> "u ?is title 7:e!r ! ,/ate   
plan is implem5t$ "u ?is title1 title   
,,xix1 or bo?7 w exce$ ! sum (-- 7,a7 ! 
am\nt ( ! ,/ate's allotm5ts = any prec$+
 fiscal ye>s t rema9s available =       
exp5diture & t w n be exp5d$ by ! end ( 

! imm$iately prec$+ fiscal ye>2  7,b7 ! 
am\nt 7if any7 t w be r$i/ribut$ to !   
,/ate "u subsection 7f7 = ! fiscal ye>2 
7,c7 ! am\nt 7if any7 ( ! *ild enrollm5t
 cont+5cy fund paym5t "u subsection 7n7 
= ! fiscal ye>2 &  7,d7 ! am\nt ( !     
,/ate's allotm5t = ! fiscal ye>4  7#e7  
,retrospective adju/m5t ,! ,secret>y may
 adju/ ! det]m9ations made "u ?is       
subsection ) respect to a ,/ate & fiscal
 ye> z necess>y on ! basis ( ! am\nts   
report$ by ,/ates n lat] ?an ,novemb]   
#cj ( ! succe$+ fiscal ye>1 z approv$ by
 ! ,secret>y4  4  7b7 ,te*nical am5dm5ts
 ,section #bajd7;f7 7#db ,u4,s4,c4      
#acig;dd7f77 is am5d$-- 7#a7 9 p>agraph 
7#a7-- 7,a7 by /rik+ %ortfall ,/ates &  
ins]t+ r$i/ribution ,/ates2 &  7,b7 by  
/rik+ %ortfall describ$ & ins]t+ deficit
 describ$2 &  7#b7 9 p>agraph 7#b7--    
7,a7 9 ! p>agraph head+1 by /rik+       
,%ortfall & ins]t+ ,r$i/ribution2  7,b7 
9 subp>agraph 7,a71 by /rik+ %ortfall   
,/ate & ins]t+ r$i/ribution ,/ate2 &    
7,c7 9 subp>agraph 7,b7-- 7i7 by /rik+  

%ortfalls & ins]t+ deficits2 &  7ii7 by 
/rik+ %ortfall ,/ate & ins]t+           
r$i/ribution ,/ate4  ,,ii ,eligibility &
 ,enrollm5t  ,a ,cov]age ,cont9uity     
#bja4 ,/ate option to increase upp] age 
limit = *ildr5 ) special heal? c>e ne$s 
,section #baaj7;c77#a7 7#db ,u4,s4,c4   
#baaj7;c77#a77 is am5d$-- 7#a7 by /rik+ 
,! t]m & ins]t+ ! foll[+3  7,a7 ,9 g5]al
 ,subject to subp>agraph 7,b71 ! t]m  2 
&  7#b7 by add+ at ! end ! foll[+3  7,b7
 ,*ildr5 ) special heal? c>e ne$s ,at   
,/ate option1 su* t]m includes an       
individual "u #bf ye>s ( age :o has or  
is at an increas$ risk ( a *ronic       
physical1 developm5tal1 behavioral1 or  
emotional condition & :o also requires  
heal? & relat$ s]vices ( a type or am\nt
 beyond t requir$ by *ildr5 typically4  
4  #bjb4 ,improv+ cov]age transitions f 
,m$icaid or ,,*ip to cov]age "u a       
qualifi$ heal? plan  7a7 ,/ate          
coord9ation requirem5t ,section         
#baje7;d77#c77;,b7 7#db ,u4,s4,c4       
#acig;ee7d77#c77;,b77 is am5d$-- 7#a7 9 

! subp>agraph head+1 by /rik+ %ortfalls 
& ins]t+ %ortfalls2 coord9ation         
requirem5ts = transition+ to or f       
,ex*ange cov]age2  7#b7 9 ! fir/ s5t5ce1
 by /rik+ ,9 ! ev5t & ins]t+ ! foll[+3  
7i7 ,ex*ange cov]age z a result ( fund+ 
%ortfalls ,9 ! ev5t  2 &  7#c7 by add+  
at ! end ! foll[+3  7ii7 ,coord9ation   
requirem5ts = transition+ to or f       
,ex*ange cov]age ,! ,/ate %all e/abli%  
proc$ures to elim9ate gaps 9 cov]age &  
to assi/ a *ild's & pregnant woman's    
transition f cov]age "u ! ,/ate plan "u 
title ,,xix or ! ,/ate *ild heal? plan  
"u ?is title 7:e!r implem5t$ "u ?is     
title1 title ,,xix1 or bo?7 to cov]age  
"u a qualifi$ heal? plan t has be5      
c]tifi$ by ! ,secret>y "u subp>agraph   
7,c7 & is (f]$ ?r\gh an ,ex*ange & f    
cov]age "u a qualifi$ heal? plan to     
cov]age "u ! ,/ate plan "u title ,,xix  
or ! ,/ate *ild heal? plan "u ?is title4
 ,su* proc$ures-- 7,i7 %all provide =   
cov]age = ! *ild's or pregnant woman's  
m$ical home1 reg>dless ( :e!r ! m$ical  

home provid]s are p>ticipat+ provid]s "u
 ! ,/ate plan "u title ,,xix or ! ,/ate 
*ild heal? plan "u ?is title1 = a       
transitional "t to be det]m9$ "u        
regulations promulgat$ by ! ,secret>y2  
7,,ii7 9 ! case ( a *ild or pregnant    
woman ) a *ronic or complex condition1  
%all provide t ! ,/ate plan "u title    
,,xix1 or ! ,/ate *ild heal? plan "u ?is
 title 7z applicable7 %all p]mit ! *ild 
or pregnant woman to cont9ue to receive 
treatm5t f a non-network provid] = a    
transitional p]iod z det]m9$ "u         
regulations promulgat$ by ! ,secret>y2  
7,,iii7 %all require t if ! b5efits     
available & co/-%>+ impos$ "u a qualifi$
 heal? plan available to ! *ild or      
pregnant woman 7z applicable7 are n     
comp>able to ! b5efits & cov]age        
available to ! *ild or pregnant woman "u
 ! ,/ate plan "u title ,,xix or ! ,/ate 
*ild heal? plan "u ?is title 7z         
applicable7 ! *ild or pregnant woman    
%all rema9 enroll$ 9 ! ,/ate plan "u    
title ,,xix or ! ,/ate *ild heal? plan  

"u ?is title = s long z ! *ild or       
pregnant woman is o!rwise eligible =    
cov]age "u ! title ,,xix or ,,xxi ,/ate 
plans2 &  7,,iv7 %all e/abli% a sy/em "u
 :i* ! ,/ate %all record all transitions
 ( *ildr5 & pregnant wom5 f cov]age "u !
 ,/ate plan "u title ,,xix or ! ,/ate   
*ild heal? plan "u ?is title to cov]age 
"u a qualifi$ heal? plan & f cov]age "u 
a qualifi$ heal? plan to cov]age "u !   
,/ate plan "u title ,,xix or ! ,/ate    
*ild heal? plan "u ?is title & submit a 
report to ! ,secret>y ea* fiscal qu>t] t
 includes data on ! numb] ( *ildr5 &    
pregnant wom5 :o made su* transitions 9 
! prec$+ fiscal qu>t]4  4  7b7          
,c]tification requirem5t ,section       
#baje7;d77#c77;,c7 7#db ,u4,s4,c4       
#acig;ee7d77#c77;,c77 is am5d$-- 7#a7 9 
! subp>agraph head+1 by /rik+ ,p$iatric2
  7#b7 by /rik+ ,) respect to & ins]t+ !
 foll[+3  7i7 ,9 g5]al ,) respect to  2 
7#c7 by ins]t+ & pregnant wom5 aft]     
*ildr5 ea* place x appe>s2  7#d7 by     
/rik+ are at lea/ comp>able to ! b5efits

 (f]$ & co/-%>+ protections provid$ "u !
 ,/ate *ild heal? plan & ins]t+ meet !  
comp>ability /&>ds describ$ 9 clause    
7ii7 & ! cont9u\s cov]age requirem5ts   
describ$ 9 clause 7iii72 &  7#e7 by add+
 at ! end ! foll[+ new clauses3  7ii7   
,comp>ability /&>ds ,! ,secret>y %all   
develop1 9 consultation ) non-gov]nm5t  
/akehold] entities 7includ+ n less ?an  
#a national non-pr(it organization      
focus$ on *ildr5's advocacy71           
comp>ability /&>ds = qualifi$ heal?     
plans seek+ c]tification "u clause 7i74 
,su* /&>ds mu/ include /&>ds = ! foll[+ 
areas3 7,i7 ,af=dability ,! plan mu/ be 
comp>able to ! ,/ate *ild heal? plan 9  
t]ms ( af=dability1 includ+ premiums1   
d$uctibles1 co-paym5ts1 co-insurance1   
m$ical home ma9t5ance co/s1 & ! co/ (   
pur*as+ supplem5t>y cov]age = heal?     
b5efits & s]vices t are cov]$ "u ! ,/ate
 *ild heal? plan b are n cov]$ "u !     
qualifi$ heal? plan4  7,,ii7 ,b5efits ,!
 plan mu/ be comp>able to ! ,/ate *ild  
heal? plan 9 t]ms ( p$iatric &          

pregnancy-relat$ b5efits4  7,,iii7      
,network adequacy ,! plan mu/ be        
comp>able to ! ,/ate *ild heal? plan 9  
t]ms ( access to appropriate provid]s ( 
p$iatric & pregnancy-relat$ s]vices1 &  
mu/ provide flexibility = *ildr5 )      
special heal? c>e ne$s to rema9 9 _!    
m$ical home or seek appropriate p$iatric
 sub-speciali/s4  7iii7 ,cont9u\s       
cov]age requirem5ts ,! ,secret>y %all   
require heal? plans seek+ c]tification z
 qualifi$ heal? plans = purposes ( an   
,am]ican ,heal? ,b5efits ,ex*ange to    
ensure t-- 7,i7 ) respect to a *ild or  
pregnant woman :o is transition+ f      
cov]age "u a ,/ate *ild heal? plan or a 
,/ate plan "u title ,,xix-- 7aa7 cov]age
 "u ! qualifi$ heal? plan %all be       
effective z ( ! #fj-;day p]iod prec$+ ! 
date on :i* ! fir/ premium paym5t is    
made = su* cov]age2  7bb7 cov]age "u !  
,/ate *ild heal? plan or ,/ate plan "u  
title ,,xix %all rema9 9 effect dur+ !  
#cj-;day p]iod t prec$es ! #fj-;day     
p]iod describ$ 9 item 7aa72  7cc7 !     

qualifi$ heal? plan %all provide cov]age
 = a *ild's or a pregnant woman's m$ical
 home1 reg>dless ( :e!r ! m$ical home   
provid] is )9 ! network ( ! plan1 to    
all[ ! *ild or pregnant woman to f9i% a 
c\rse ( treatm5t = an acute illness or a
 treatm5t or surg]y s*$ul$ prior to !   
effective date = cov]age "u ! plan "u   
item 7aa7 or = a p]iod ( up to #ij days 
if1 by ! end ( su* p]iod1 ! *ild or     
pregnant woman is enroll$ ) a m$ical    
home provid] t is )9 ! network ( ! plan2
 &  7dd7 9 ! case ( a *ild or pregnant  
woman ) a *ronic or complex condition1 !
 qualifi$ heal? plan %all p]mit ! *ild  
or pregnant woman to cont9ue to receive 
treatm5t f a non-network provid] = a    
transitional "t t is n less ?an #ij     
days1 or until ! *ild or pregnant woman 
c be enroll$ ) an 9-network provid]2    
7,,ii7 simil> requirem5ts apply )       
respect to any *ild or pregnant woman :o
 transitions f cov]age "u a qualifi$    
heal? plan to cov]age "u ! ,/ate *ild   
heal? plan or ! ,/ate plan "u title     

,,xix 9 accordance ) subp>agraph        
7,b77ii72 &  7,,iii7 a *ild or pregnant 
woman transition+ to or f cov]age "u !  
,/ate *ild heal? plan or ! ,/ate plan "u
 title ,,xix & a qualifi$ heal? plan is 
in=m$ ( ! diff]5ces betwe5 ! b5efits    
available & co/-%>+ impos$ "u ! cov]age 
! *ild or pregnant woman is transition+ 
f & into1 & t ! pregnant woman or ! p>5t
 or gu>dian ( ! *ild has ! option (     
elect+ to rema9 enroll$ 9 :i*ev] cov]age
 is ! mo/ af=dable or provides ! be/    
b5efits = ! *ild or pregnant woman = su*
 p]iod z ! ,secret>y %all specify4  4   
7c7 ,prohibition on transition+         
,,*ip-,eligible *ildr5 ,no *ild :o is   
eligible = cov]age "u ,,*ip %all be     
transition$ f a ,/ate *ild heal? plan to
 a qualifi$ heal? plan unless t plan is 
c]tifi$ "u section #baje7;d77#c77;,c7 ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#acig;ee7d77#c77;,c77 7z am5d$ by       
subsection 7b774  7d7 ,m9imum ess5tial  
cov]age  7#a7 ,9 g5]al ,section         
#ejjj;,a7f7 ( ! ,int]nal ,rev5ue ,code (

 #aihf is am5d$ by add+ at ! end !      
foll[+3  7#f7 ,pregnancy-relat$         
assi/ance "u ,,*ip ,) respect to a      
t>get$ l[-income pregnant woman 7z def9$
 9 section #baab7;d77#b7 ( ! ,social    
,security ,act71 not)/&+ p>agraph       
7#a77;,a77iii71 ! t]m m9imum ess5tial   
cov]age1 at ! option ( su* a woman1 %all
 n include pregnancy-relat$ assi/ance 7z
 def9$ 9 section #baab7;d77#a7 ( !      
,social ,security ,act74  4  7#b7       
,effective date ,! am5dm5t made by ?is  
subsection applies to taxable ye>s      
beg9n+ aft] ,decemb] #ca1 #bjad4  #bjc4 
,assur+ cov]age cont9uity = =m] fo/] c>e
 *ildr5  7a7 ,9 g5]al ,section          
#aijb7;a77#aj77;,a77i77,,ix7 7#db       
,u4,s4,c4 #acif;a7a77#aj77;,a77i77,,ix77
 is am5d$-- 7#a7 9 item 7cc71 by /rik+  
responsibility ( ! ,/ate & ins]t+       
responsibility ( a ,/ate2 &  7#b7 9 item
 7dd71 by /rik+ ! ,/ate plan "u ?is     
title or "u a waiv] ( ! & ins]t+ a ,/ate
 plan "u ?is title or "u a waiv] ( su*  
a4  7b7 ,effective date ,! am5dm5ts made

 by ?is section %all take effect on !   
date ( enactm5t ( ?is ,act4  ,b         
,enrollm5t ,simplification &            
,improvem5ts  #baa4 ,automatic enrollm5t
 = newborns "u ,,*ip  7a7 ,9 g5]al      
,section #bajg7;e77#a7 7#db ,u4,s4,c4   
#acig;gg7e77#a77 is am5d$-- 7#a7 by     
r$esignat+ subp>agraphs 7,e7 ?r\gh 7,o7 
z subp>agraphs 7,f7 ?r\gh 7,p71         
respectively2 &  7#b7 by ins]t+ aft]    
subp>agraph 7,d7 ! foll[+ new           
subp>agraph3  7,e7 ,section             
#aijb7;e77#d7 7relat+ to automatic      
cov]age = newborns ?r\gh age #a74  4    
7b7 ,effective date ,! am5dm5ts made by 
?is section %all take effect on ! date (
 enactm5t ( ?is ,act4  #bab4 ,express   
,lane ,eligibility ext5sion &           
application to pregnant wom51 fo/]      
*ildr51 & *ildr5 ) special heal? c>e    
ne$s  7a7 ,9 g5]al ,section             
#aijb7;e77#ac7 7#db ,u4,s4,c4           
#acif;a7e77#ac77 is am5d$-- 7#a7 9      
subp>agraph 7,a71 by add+ at ! end !    
foll[+ new clause3  7iii7 ,/ate option  

to ext5d express lane eligibility to    
pregnant wom5 ,at ! option ( ! ,/ate1 ! 
,/ate may apply ! provisions ( ?is      
p>agraph ) respect to det]m9+           
eligibility "u ?is title = a pregnant   
woman4 ,9 apply+ ?is p>agraph 9 ! case (
 a ,/ate elect+ su* an option1 any      
ref]5ce 9 ?is p>agraph to a *ild )      
respect to ?is title 7o!r ?an a ref]5ce 
to *ild heal? assi/ance7 %all be deem$  
to be a ref]5ce to a pregnant woman4  2 
7#b7 9 subp>agraph 7,g71 by add+ at !   
end ! foll[+ new s5t5ce3 ,not)/&+ ! age 
limit specifi$ 9 ! prec$+ s5t5ce1 su*   
t]m includes an individual describ$ 9   
subsection 7a77#aj77;,a77i77,,ix7 &1 at 
! option ( ! ,/ate1 an individual       
describ$ 9 section #baaj7;c77#a77;,b742 
&  7#c7 by /rik+ subp>agraph 7,i74  7b7 
,effective date ,! am5dm5ts made by ?is 
section %all take effect on ! date (    
enactm5t ( ?is ,act4  #bac4 ,outrea* to 
t>get$ populations  7a7 ,outrea* &      
enrollm5t grants ,section #baac 7#db    
,u4,s4,c4 #acigmm7 is am5d$-- 7#a7 9    

subsection 7a77#a71 by /rik+ dur+ !     
p]iod ( fiscal ye>s #bjji ?r\gh #bjae 2 
&  7#b7 9 subsection 7g71 by ins]t+ &   
#dj1jjj1jjj = ea* fiscal ye> !reaft]1   
aft] #bjae14  7b7 ,outrea* to           
non-,engli% speak]s & o!r populations   
7#a7 ,national enrollm5t campaign       
requirem5ts ,su* section #baac is       
am5d$-- 7,a7 9 subsection 7h71 by /rik+ 
,su* campaign & ins]t+ ,9 addition to ! 
requirem5ts describ$ 9 subsection 7i71  
su* campaign2 &  7,b7 by add+ at ! end !
 foll[+ subsection3  7i7 ,requir$       
elem5ts ( national enrollm5t campaign   
,beg9n+ ) fiscal ye> #bjae1 ea* ( !     
foll[+ initiatives %all be "p ( !       
national enrollm5t campaign3 7#a7       
,initiative to increase enrollm5t among 
individuals ) limit$ ,engli% pr(ici5cy  
,an initiative to increase enrollm5t 9 !
 ,/ate *ild heal? plan "u ?is title or !
 ,/ate plan "u title ,,xix ( *ildr5 f   
families t speak a prim>y language o!r  
?an ,engli% t %all include-- 7,a7       
language s]vices1 includ+ oral int]pret+

 & writt5 translation s]vices1 =        
individuals ) limit$ pr(ici5cy 9        
,engli%2 &  7,b7 o!r culturally         
appropriate ef=ts to increase enrollm5t 
( su* *ildr54  7#b7 ,initiative to      
increase enrollm5t ( *ildr5 9 families )
 complex or multiple cov]age s\rces ,an 
initiative to id5tify & increase        
enrollm5t 9 ! ,/ate *ild heal? plan "u  
?is title or ! ,/ate plan "u title ,,xix
 ( *ildr5 f families :o h multiple      
cov]age s\rces or o!r cov]age           
complexities1 includ+ *ildr5 9 fo/] c>e 
& *ildr5 subject to a m$ical *ild       
support ord]4  4  7#b7 ,increas$        
reimbursem5t = ,/ate sp5d+ on language  
s]vices  7,a7 ,m$icaid ,section         
#aijc7;a77#b77;,e7 7#db ,u4,s4,c4       
#acif;b7a77#b77;,e77 is am5d$ by /rik+  
#ge p]c5t & ins]t+ ! high] ( #ij p]c5t  
or ! sum ( ! enhanc$ ,,fmap 7z def9$ 9  
section #baje7;b77 plus #e p]c5tage     
po9ts 7n to exce$ #ajj p]c5t74  7,b7    
,,*ip ,section #baje7;a77#a7 7#db       
,u4,s4,c4 #acig;ee7a77#a77 is am5d$ 9 ! 

matt] prec$+ p>agraph 7#a71 by /rik+ !  
high] ( #ge p]c5t or ! sum ( ! enhanc$  
,,fmap plus #e p]c5tage po9ts & ins]t+ !
 high] ( #ij p]c5t or ! sum ( ! enhanc$ 
,,fmap plus #e p]c5tage po9ts 7n to     
exce$ #ajj p]c5t74  7#c7 ,requirem5t t  
manag$ c>e organizations provide        
language s]vices to enrollees ,section  
#aicb7;b7 7#db ,u4,s4,c4 #acifu-#b7;b77 
is am5d$ by add+ at ! end ! foll[+ new  
p>agraph3  7#i7 ,language s]vices ,ea*  
contract ) a m$icaid manag$ c>e         
organization "u section #aijc7m7 %all   
require ! organization to provide 7at no
 co/ to ! individual7 language s]vices1 
includ+ oral int]pret+ & writt5         
translation s]vices1 to any individual  
:o is eligible = m$ical assi/ance "u !  
,/ate plan "u ?is title & is enroll$ ) !
 organization & to a p>5t or gu>dian (  
su* individual if su* individual1 p>5t1 
or gu>dian is 9 ne$ ( su* s]vices :5    
int]act+ ) ! organization or ) any      
provid] receiv+ paym5t f ! organization4
  4  7#d7 ,translation ( applications & 

o!r vital docum5ts  7,a7 ,m$icaid       
,section #aijb7;a7 7#db ,u4,s4,c4       
#acif;a7a77 is am5d$--  7i7 by /rik+ &  
at ! end ( p>agraph 7#hj72  7ii7 by     
/rik+ ! p]iod at ! end ( p>agraph 7#ha7 
& ins]t+ 2 &2 &  7iii7 by ins]t+ aft]   
p>agraph 7#ha7 ! foll[+ new p>agraph3   
7#hb7 provide = ! translation ( all     
docum5ts & mat]ials necess>y to make    
application = m$ical assi/ance "u !     
plan1 & su* o!r docum5ts & mat]ials z ! 
,secret>y may specify1 includ+ any su*  
docum5ts & mat]ials t are available via 
a website1 into ! prim>y language spok5 
by any limit$ ,engli% pr(ici5cy gr\p 9 !
 ,/ate ) a population ( at lea/ #ajjj   
individuals or t con/itutes #e p]c5t ( !
 ,/ate population4  4  7,b7 ,,*ip       
,section #bajg7;e77#a71 z am5d$ by      
section #bba1 is am5d$-- 7i7 by         
r$esignat+ subp>agraphs 7,e7 ?r\gh 7,p7 
z subp>agraphs 7,f7 ?r\gh 7,q71         
respectively2 &  7ii7 by ins]t+ aft]    
subp>agraph 7,d7 ! foll[+ subp>agraph3  
7,e7 ,section #aijb7;a77#hb7 7relat+ to 

! translation ( docum5ts & mat]ials74  4
  7c7 ,prim>y language data collection  
7#a7 ,data f eligible entities ,section 
#baac7;c77#d77;,b7 7#db ,u4,s4,c4       
#acigmm7c77#d77;,b77 is am5d$ by ins]t+ 
"u ?is title & title ,,xix1 individual  
data on ! prim>y language ( enrollees "u
 ?is title & title ,,xix 7& = su*       
enrollees :o are m9ors or incapacitat$1 
data on ! prim>y language ( _! p>5ts or 
gu>dians7 aft] enrollm5t data4  7#b7    
,annual report  7,a7 ,,*ip ,section     
#bajh 7#db ,u4,s4,c4 #acig;hh7 is       
am5d$-- 7i7 by r$esignat+ ! subsection  
7e7 add$ by section #eja7;e77#b7 (      
,public ,law #aaa-c z subsection 7f72 & 
7ii7 9 p>agraph 7#a7 ( ! subsection 7e7 
add$ by section #djb ( ,public ,law     
#aaa-c1 by ins]t+ & prim>y language aft]
 duration ( b5efits4  7,b7 ,m$icaid     
,section #aidf7;c7 7#db ,u4,s4,c4       
#acifw-#e7;c77 is am5d$ by ins]t+       
demographic be=e data on heal? c>e      
disp>ities4  7d7 ,effective date ,!     
am5dm5ts made by ?is section %all take  

effect on ! date ( enactm5t ( ?is ,act4 
,,iii ,af=dability  #cja4 ,/r5g!n$ co/  
%>+ protections "u ,m$icaid & ,,*ip  7a7
 ,m$icaid  7#a7 ,9 g5]al ,section #aiaf 
7#db ,u4,s4,c4 #acifo7 is am5d$-- 7,a7 9
 subsection 7a7-- 7i7 9 subp>agraph 7,e7
 ( p>agraph 7#b71 by /rik+ & at ! end2  
7ii7 9 p>agraph 7#c7-- 7,i7 by ins]t+   
subject to p>agraph 7#d71 be=e any      
d$uction2 &  7,,ii7 by /rik+ ! p]iod at 
! end & ins]t+ 2 &2 &  7iii7 by add+ at 
! end ! foll[+ new p>agraph3  7#d7 !    
total annual aggregate am\nt ( any      
premium1 enrollm5t fee1 d$uction1 co/   
%>+1 or simil> *>ge impos$ "u ! plan )  
respect to su* individuals & _! families
 %all n exce$ #e p]c5t ( ! family income
 ( ! individual involv$1 z appli$ on a  
qu>t]ly or mon?ly basis 7z specifi$ by !
 ,/ate74  2  7,b7 9 subsection 7b7-- 7i7
 9 subp>agraph 7,e7 ( p>agraph 7#b71 by 
/rik+ & at ! end2  7ii7 9 p>agraph      
7#c7-- 7,i7 by ins]t+ subject to        
p>agraph 7#d7 be=e any d$uction2 &      
7,,ii7 by /rik+ ! p]iod at ! end &      

ins]t+ 2 &2 &  7iii7 by add+ at ! end ! 
foll[+ new p>agraph3  7#d7 ! total      
annual aggregate am\nt ( any premium1   
enrollm5t fee1 d$uction1 co/ %>+1 or    
simil> *>ge impos$ "u ! plan ) respect  
to su* individuals & _! families %all n 
exce$ #e p]c5t ( ! family income ( !    
individual involv$1 z appli$ on a       
qu>t]ly or mon?ly basis 7z specifi$ by !
 ,/ate74  2  7,c7 9 subsection 7d71 by  
ins]t+ 1 & provid$ t ! total annual     
aggregate am\nt ( any su* premium1 & any
 enrollm5t fee1 d$uction1 co/ %>+1 or   
simil> *>ge impos$ "u ! plan ) respect  
to su* individuals & _! families %all n 
exce$ #e p]c5t ( ! family income ( !    
individual involv$1 z appli$ on a       
qu>t]ly or mon?ly basis 7z specifi$ by !
 ,/ate7 be=e ! p]iod2 &  7,d7 by add+ at
 ! end ! foll[+ new subsection3  7k7    
,co/ %>+ track+2 susp5sion ( *>ges2     
notification requirem5ts  7#a7 ,track+  
,if ! ,/ate plan imposes premiums1      
enrollm5t fees1 d$uctions1 co/ %>+1 or  
simil> *>ges "u ?is section t1 toge!r ) 

any su* *>ges impos$ "u section         
#aiaf;,a1 c\ld cause families to h      
out-(-pocket exp5ses t exce$ a total    
aggregate co/ %>+ limit impos$ "u       
subsection 7a77#d7 or 7b77#d7 = ! mon?  
or qu>t] 7z specifi$ by ! ,/ate71 !     
,/ate %all e/abli% a process = track+ & 
aggregat+ su* exp5ses 7includ+ exp5ses  
incurr$ = sep>ately adm9i/]$ b5efits7   
t-- 7,a7 does n rely on docum5tation    
provid$ by ! individual or ! family2    
7,b7 is communicat$ 9 a mann] design$ to
 ensure ! privacy ( pati5t-relat$       
in=mation2 &  7,c7 all[s = coord9ation )
 manag$ c>e entities 7z def9$ 9 section 
#aicb7;a77#a77;,b77 t are "u contract ) 
! ,/ate4  7#b7 ,susp5sion ( *>ges ,:5 a 
family rea*es any limit = a p]iod impos$
 on premiums1 d$uctions1 co/ %>+1 or    
simil> *>ges "u ?is section1 no fur!r   
premiums1 d$uctions1 co/ %>+1 or simil> 
*>ges 7or any portions !re(7 %all be    
impos$ on any individual 9 ! family :o  
is eligible = & receiv+ m$ical assi/ance
 "u ! plan = ! rema9d] ( ! p]iod4  7#c7 

,notification requirem5ts ,) respect to 
a limit impos$ on premiums1 d$uctions1  
co/ %>+1 or simil> *>ges "u ?is section 
! ,/ate plan %all provide = !           
notification ( provid]s & ea* family to 
:i* su* a limit applies-- 7,a7 ( any su*
 limit applicable to ! family2  7,b7 :5 
! family has incurr$ out-(-pocket       
exp5ses up to any su* limit2 &  7,c7 :5 
a family rea*es any su* limit = a p]iod1
 t ! limit has be5 rea*$ & t no fur!r   
premiums1 d$uctions1 co/ %>+1 or simil> 
*>ges 7or portions !re(7 %all be impos$ 
on any individual 9 ! family :o is      
eligible = & receiv+ m$ical assi/ance "u
 ! plan = ! rema9d] ( su* mon? or qu>t]4
  7#d7 ,reassessm5t process ,! ,/ate    
%all e/abli% a process = families t     
include an individual :o is eligible = &
 receiv+ m$ical assi/ance "u ! plan to  
reque/ a reassessm5t ( ! family's       
aggregate limit on premiums1 d$uctions1 
co/ %>+1 or simil> *>ges if ! family has
 a *ange 9 circum/ances1 9 accordance ) 
crit]ia specifi$ by ! ,secret>y4  7#e7  

,application ( requirem5ts ,!           
requirem5ts ( ?is subsection %all apply 
9 ! same mann] to limits impos$ "u      
subsections 7c71 7d71 7g71 & 7i74  4    
7#b7 ,/ate option = alt]native premiums 
& co/ %>+ ,section #aiaf;,a7b7 7#db     
,u4,s4,c4 #acifo-#a7;b77 is am5d$-- 7,a7
 9 p>agraphs 7#a77;,b77ii7 & 7#b77;,a71 
by ins]t+ or section #aiaf aft]         
subsection 7c7 or 7e7 9 ea* place x     
appe>s2 &  7,b7 by add+ at ! end !      
foll[+ new p>agraph3  7#g7 ,co/ %>+     
track+2 susp5sion ( *>ges2 notification 
requirem5ts  7,a7 ,track+ ,if ! ,/ate   
plan imposes premiums or co/ %>+ "u ?is 
section t1 toge!r ) co/ %>+ impos$ "u   
section #aiaf1 c\ld cause families to h 
out-(-pocket exp5ses t exce$ ! total    
aggregate limit impos$ "u p>agraph 7#a7 
or 7#b7 ( ?is subsection = a mon? or    
qu>t] 7z specifi$ by ! ,/ate71 ! ,/ate  
%all e/abli% a process = track+ &       
aggregat+ su* exp5ses 7includ+ exp5ses =
 sep>ately adm9i/]$ b5efits7 t-- 7i7    
does n rely on docum5tation provid$ by !

 individual or ! family2  7ii7 is       
communicat$ 9 a mann] design$ to ensure 
! privacy ( pati5t-relat$ in=mation2 &  
7iii7 all[s = coord9ation ) manag$ c>e  
entities 7z def9$ 9 section             
#aicb7;a77#a77;,b77 t are "u contract ) 
! ,/ate4  7,b7 ,susp5sion ( *>ges ,:5 a 
family rea*es any limit = a p]iod impos$
 on premiums or co/ %>+ "u ?is section1 
no fur!r premiums or co/ %>+ 7or any    
portions !re(7 %all be impos$ on any    
individual 9 ! family :o is eligible = &
 receiv+ m$ical assi/ance "u ! plan = ! 
rema9d] ( ! p]iod4  7,c7 ,notification  
requirem5ts ,) respect to a limit impos$
 on premiums or co/ %>+ "u p>agraph 7#a7
 or 7#b7 ( ?is subsection ! ,/ate plan  
%all provide = ! notification ( provid]s
 & ea* family to :i* su* a limit        
applies-- 7i7 ( any su* limit applicable
 to ! family2  7ii7 :5 ! family has     
incurr$ out-(-pocket exp5ses up to any  
su* limit2 &  7iii7 :5 a family rea*es  
su* a limit = a p]iod1 t ! limit has be5
 rea*$ & t no fur!r premiums or co/ %>+ 

7or portions !re(7 %all be impos$ on any
 individual 9 ! family :o is eligible = 
& receiv+ m$ical assi/ance "u ! plan = !
 rema9d] ( su* mon? or qu>t]4  7,d7     
,reassessm5t process ,! ,/ate %all      
e/abli% a process = families t include  
an individual :o is eligible = & receiv+
 m$ical assi/ance "u ! plan to reque/ a 
reassessm5t ( ! family's aggregate limit
 on premiums1 d$uctions1 co/ %>+1 or    
simil> *>ges if ! family has a *ange 9  
circum/ances1 9 accordance ) crit]ia    
specifi$ by ! ,secret>y4  4  7#c7       
,manag$ c>e organizations ,section      
#aicb7;a77#e7 7#db ,u4,s4,c4            
#acifu-#b7;a77#e77 is am5d$ by add+ at !
 end ! foll[+ new subp>agraph3  7,e7    
,coord9ation ) provid]s on co/ %>+ ,!   
,/ate %all require t a manag$ c>e entity
 ) a contract ) ! ,/ate1 z a condition (
 su* contract1 comply ) ! requirem5ts ( 
sections #aiaf & #aiaf;,a 7z            
applicable71 = su* individuals :o are   
enroll$ ) ! organization or entity &    
coord9ate ) ! ,/ate ) respect to track+ 

& aggregat+ an enrollee's family's      
out-(-pocket exp5ses = premiums1        
d$uctions1 co/ %>+1 or simil> *>ges4  4 
7#d7 ,con=m+ am5dm5ts ,section          
#aiaf;,a7a77#b77;,b7 7#db ,u4,s4,c4     
#acifo-#a7;a77#b77;,b77 is am5d$-- 7,a7 
by ins]t+ & ! track+1 susp5sion1 &      
notification requirem5ts "u subsection  
7b77#g7 be=e %all apply2 &  7,b7 by     
ins]t+ & requirem5ts aft] limitations4  
7b7 ,,*ip  7#a7 ,9 g5]al ,section       
#bajc7;e7 7#db ,u4,s4,c4 #acig;cc7e77 is
 am5d$-- 7,a7 by /rik+ p>agraphs 7#b7 & 
7#d72  7,b7 by r$esignat+ p>agraph 7#c7 
z p>agraph 7#b72  7,c7 9 p>agraph 7#b7  
7z s r$esignat$7-- 7i7 by /rik+         
subp>agraph 7,b72  7ii7 by r$esignat+   
subp>agraph 7,c7 z subp>agraph 7,d72 &  
7iii7 by ins]t+ aft] subp>agraph 7,a7 ! 
foll[+ new subp>agraphs3  7,b7 ,no co/  
%>+ = pregnancy-relat$ assi/ance ,!     
,/ate *ild heal? plan may n impose      
d$uctions1 co/ %>+1 or simil> *>ges )   
respect to pregnancy-relat$ assi/ance4  
7,c7 ,application ( ,m$icaid co/ %>+    

limits ,subject to subp>agraphs 7,a7 &  
7,b7 & p>agraph 7#c71 ! ,/ate *ild heal?
 plan may only impose d$uctions1 co/    
%>+1 or simil> *>ges to ! ext5t t su*   
*>ges d n exce$ ! nom9al limits set "u  
section #aiaf7;a77#c74  2 &  7,d7 by    
add+ at ! end ! foll[+ new p>agraph3    
7#c7 ,additional requirem5ts  7,a7 ,9   
g5]al ,subject to p>agraph 7#b77;,a71   
any premiums1 d$uctions1 co/ %>+1 or    
simil> *>ges impos$ "u ! ,/ate *ild     
heal? plan = m$ical or d5tal b5efits may
 be impos$ on a slid+ scale relat$ to   
income1 except t ! total annual         
aggregate co/ %>+ impos$ = su* b5efits )
 respect to all individuals 9 a family t
 includes a t>get$ l[-income *ild or a  
t>get$ l[-income pregnant woman "u ?is  
title %all n exce$ #e p]c5t ( su*       
family's income = ! ye> involv$4  7,b7  
,d5tal-only supplem5tal cov]age ,)      
respect to d5tal-only supplem5tal       
cov]age (f]$ "u section #baaj7;b77#e71 !
 total annual aggregate co/ %>+ impos$ =
 su* cov]age %all n exce$ #e p]c5t ( a  

family's income = ! ye> involv$1 m9us ! 
am\nt ! family is requir$ to pay dur+   
su* ye> 9 premiums1 d$uctions1 co/ %>+1 
or simil> *>ges = heal? c>e s]vices =   
*ildr5 9 ! family enroll$ 9 a gr\p heal?
 plan or heal? insurance cov]age (f]$   
?r\gh an employ]4  7,c7 ,track+ (       
exp5ses2 susp5sion ( *>ges2 notice2     
reassessm5ts ,if ! ,/ate *ild heal? plan
 imposes premiums1 d$uctions1 co/ %>+1  
or simil> *>ges t c\ld cause families t 
include a t>get$ l[-income *ild or a    
t>get$ l[-income pregnant woman to h    
out-(-pocket exp5ses t exce$ ! aggregate
 co/ %>+ limit impos$ "u subp>agraph    
7,a7 = ! ye>1 ! ,/ate %all-- 7i7 e/abli%
 a process = track+ & aggregat+ su*     
exp5ses 7includ+ exp5ses incurr$ =      
sep>ately adm9i/]$ b5efits7 t-- 7,i7    
does n rely on docum5tation provid$ by !
 t>get$ l[-income *ild1 ! t>get$        
l[-income pregnant woman1 or ! family2  
7,,ii7 is communicat$ 9 a mann] design$ 
to ensure ! privacy ( pati5t-relat$     
in=mation2 &  7,,iii7 all[s =           

coord9ation ) manag$ c>e entities &     
manag$ c>e organizations t are "u       
contract ) ! ,/ate2  7ii7 :5 a family   
rea*es ! aggregate co/-%>+ limit = a ye>
 impos$ "u subp>agraph 7,a71 n impose   
any fur!r premiums or co/ %>+ 7or any   
portions !re(7 on any t>get$ l[-income  
*ild or t>get$ l[-income pregnant woman 
9 ! family = ! rema9d] ( ! ye>2  7iii7  
notify provid]s & ea* family t includes 
a t>get$ l[-income *ild or a t>get$     
l[-income pregnant woman-- 7,i7 ( !     
annual aggregate limits on out-(-pocket 
exp5ses applicable to ! family2  7,,ii7 
:5 ! family has incurr$ out-(-pocket    
exp5ses up to ! annual aggregate family 
limit impos$ "u subp>agraph 7,a72 &     
7,,iii7 :5 a family rea*es ! aggregate  
out-(-pocket exp5ses limit = a ye>1 t ! 
limit has be5 rea*$ & t no fur!r        
premiums1 d$uctions1 co/ %>+1 or simil> 
*>ges 7or portions !re(7 %all be impos$ 
on any t>get$ l[-income *ild or t>get$  
l[-income pregnant woman 9 ! family = ! 
rema9d] ( su* ye>2 &  7iv7 e/abli% a    

process = families t include a t>get$   
l[-income *ild or a t>get$ l[-income    
pregnant woman to reque/ a reassessm5t (
 ! family's annual aggregate limit on   
premiums1 d$uctions1 co/ %>+1 or simil> 
*>ges if ! family has a *ange 9         
circum/ances1 9 accordance ) crit]ia    
specifi$ by ! ,secret>y4  4  7#b7       
,manag$ c>e organizations ,section      
#bajc7;f7 7#db ,u4,s4,c4 #acig;cc7f77 is
 am5d$ by add+ at ! end foll[+ new      
p>agraph3  7#d7 ,coord9ation ) provid]s 
on co/ %>+ ,! ,/ate %all require t a    
manag$ c>e entity or a manag$ c>e       
organization ) a contract ) ! ,/ate1 z a
 condition ( su* contract1 comply ) !   
requirem5ts ( #bajc7;e7 & coord9ate ) ! 
,/ate ) respect to 9 track+ & aggregat+ 
an enrollee's family's out-(-pocket     
exp5ses = co/ %>+ z requir$ "u          
subsection 7e77#c77;,c74  4  7c7 ,con=m+
 am5dm5ts  7#a7 ,section                
#baje7;c77#aj77;,c77i7 7#db ,u4,s4,c4   
#acig;ee7c77#aj77;,c77i77 is am5d$ by   
/rik+ p>agraph 7#c77;,b7 (4  7#b7       

,section #baab7;b77#f7 7#db ,u4,s4,c4   
#acigll7b77#f77 is am5d$ by /rik+       
p>agraph 7#c77;,b7 (4  ,,iv ,b5efits    
#dja4 ,prev5tive heal? s]vices  7a7     
,prev5tive heal? s]vices  7#a7 ,m$icaid 
,section #aije 7#db ,u4,s4,c4 #acif;d7  
is am5d$--  7,a7 9 subsection 7a77#d7-- 
7i7 by /rik+ & be=e 7,d72 &  7ii7 by    
ins]t+ be=e ! semicolon at ! end !      
foll[+ new subp>agraph3 2 & 7,e7        
prev5tive s]vices describ$ 9 subsection 
7ee72 &  7,b7 by add+ at ! end ! foll[+ 
new subsection3  7ee7 ,prev5tive        
,s]vices  7#a7 ,9 g5]al ,= purposes (   
subsection 7a77#d77;,e71 ! prev5tive    
s]vices describ$ 9 ?is subsection are   
diagno/ic1 scre5+1 & prev5tive s]vices n
 o!rwise describ$ 9 subsection 7a7 or   
requir$ by subsection 7r7 t ! ,secret>y 
det]m9es are appropriate = *ildr5 or    
pregnant wom5 entitl$ to m$ical         
assi/ance "u ?is title1 includ+-- 7,a7  
evid5ce-bas$ items or s]vices t h 9     
effect a rat+ ( ,a or ,b 9 ! curr5t     
recomm5dations ( ! ,unit$ ,/ates        

,prev5tive ,s]vices ,task ,=ce2  7,b7 ) 
respect to pregnant wom51 immunizations 
t h 9 effect a recomm5dation f !        
,advisory ,committee on ,immunization   
,practices ( ! ,c5t]s = ,disease        
,control & ,prev5tion ) respect to !    
individual involv$2  7,c7 ) respect to  
infants1 *ildr51 & adolesc5ts1          
evid5ce-in=m$ prev5tive c>e & scre5+s   
provid$ = 9 ! compreh5sive guidel9es    
support$ by ! ,heal? ,res\rces &        
,s]vices ,adm9i/ration2 &  7,d7 )       
respect to wom51 su* additional         
prev5tive c>e & scre5+s n describ$ 9 ?is
 p>agraph z provid$ = 9 compreh5sive    
guidel9es support$ by ! ,heal? ,res\rces
 & ,s]vices ,adm9i/ration = purposes (  
?is p>agraph4  7#b7 ,additional s]vices 
,no?+ 9 ?is subsection %all be con/ru$  
to limit ! application ( any requirem5t 
( subsection 7r7 or to prohibit a ,/ate 
plan "u ?is title f provid+ cov]age =   
s]vices 9 addition to ^? recomm5d$ by   
,unit$ ,/ates ,prev5tive ,s]vices ,task 
,=ce or to prohibit cov]age ( s]vices4  

4  7#b7 ,elim9ation ( co/-,%>+  7,a7    
,subsections 7a77#b77;,d7 & 7b77#b77;,d7
 ( section #aiaf 7#db ,u4,s4,c4 #acifo7 
are ea* am5d$ by ins]t+ prev5tive       
s]vices describ$ 9 section #aije7;ee71  
aft] em]g5cy s]vices 7z def9$ by !      
,secret>y714  7,b7 ,section             
#aiaf;,a7a77#a7 7#db ,u4,s4,c4          
#acifo-#a7;a77#a77 is am5d$ by ins]t+ 1 
prev5tive s]vices describ$ 9 section    
#aije7;ee71 aft] subsection 7c74  7#c7  
,int]val p]iod = inclusion ( new        
recomm5dations 9 ,/ate plans ,) respect 
to a recomm5dation issu$ on or aft] !   
date ( enactm5t ( ?is ,act t adds new   
prev5tive s]vices to ! requirem5ts      
describ$ 9 subsection 7ee7 ( section    
#aije ( ! ,social ,security ,act1 !     
,secret>y %all e/abli% a maximum int]val
 p]iod1 :i* %all n be long] ?an #f      
mon?s1 betwe5 ! date on :i* !           
recomm5dation is issu$ & ! plan ye> =   
:i* a ,/ate plan = m$ical assi/ance "u  
title ,,xix ( ! ,social ,security ,act  
%all be requir$ to include su* prev5tive

 s]vice4  7b7 ,,*ip ,section #bajc 7#db 
,u4,s4,c4 #acig;cc7 is am5d$-- 7#a7 9   
subsection 7a71 9 ! matt] prec$+        
p>agraph 7#a71 by /rik+ & 7#g7 & ins]t+ 
7#g71 & 7#h72 &  7#b7 9 subsection 7c7--
 7,a7 by r$esignat+ p>agraph 7#h7 z     
p>agraph 7#i72 &  7,b7 by ins]t+ aft]   
p>agraph 7#g71 ! foll[+ new p>agraph3   
7#h7 ,prev5tive s]vices ,! *ild heal?   
assi/ance provid$ to a t>get$ l[-income 
*ild & pregnancy-relat$ assi/ance       
provid$ to a t>get$ l[-income pregnant  
woman %all include cov]age ( prev5tive  
s]vices = *ildr5 or pregnant wom5       
requir$ "u a ,/ate plan "u title ,,xix  
"u subsections 7a77#d77;,e7 & 7ee7 (    
section #aije & no d$uctible1 co/ %>+ or
 simil> *>ge %all be impos$ "u ! ,/ate  
*ild heal? plan ) respect to su*        
s]vices4  4  #djb4 ,timely immunization 
cov]age  7a7 ,cov]age = newly approv$   
vacc9es )9 #cj days  7#a7 ,9 g5]al      
,section #aibh7;e7 7#db ,u4,s4,c4       
#acifs7e77 is am5d$ by add+ at ! end !  
foll[+ new s5t5ce3 ,ea* revision ( ! li/

 e/abli%$ by su* ,advisory ,committee   
%all apply to ! pur*ase1 deliv]y1 &     
adm9i/ration ( p$iatric vacc9es "u ?is  
section n lat] ?an #cj days aft] ! date 
su* ,advisory ,committee approves !     
revision44  7#b7 ,con=m+ am5dm5t        
,section #bajc7;c77#a77;,d7 7#db        
,u4,s4,c4 #acig;cc7c77#a77;,d77 is am5d$
 by ins]t+ 9 accordance ) ! s*$ule      
ref]r$ to 9 section                     
#aibh7;c77#b77;,b77i7 = p$iatric vacc9es
 aft] immunizations4  7b7 ,treatm5t (   
,,*ip-,eligible *ildr5 z f$]ally        
vacc9e-,eligible *ildr5 ,section        
#aibh7;b77#b7 7#db ,u4,s4,c4            
#acifs7b77#b77 is am5d$-- 7#a7 9        
subp>agraph 7,a77i71 by ins]t+ or       
,,*ip-eligible aft] m$icaid-eligible2 & 
7#b7 9 subp>agraph 7,b71 by /rik+ clause
 7i7 & ins]t+ ! foll[+3  7i7 ,! t]m     
m$icaid-eligible or ,,*ip-eligible *ild 
means1 ) respect to a *ild1 a *ild :o is
 entitl$ to m$ical assi/ance "u a ,/ate 
plan approv$ "u ?is title or a waiv] (  
su* plan1 or :o is eligible = *ild heal?

 assi/ance "u a ,/ate *ild heal? plan   
approv$ "u title ,,xxi4  4  7c7 ,cod+ = 
vacc9e adm9i/ration ,section #aibh 7#db 
,u4,s4,c4 #acifs7 is am5d$-- 7#a7 by    
/rik+ subsection 7g7 & ins]t+3  7g7     
,res]v$4  2 &  7#b7 9 subsection        
7h77#f71 by /rik+ a vacc9e & ins]t+ ea* 
vacc9e compon5t4  7d7 ,effective date ,!
 am5dm5ts made by ?is section %all take 
effect on ! date ( enactm5t ( ?is ,act4 
,v ,access & ,quality  ,a ,p$iatric     
,quality ,measures  #eja4 ,ext5d+ !     
p$iatric quality measures program  7a7  
,9 g5]al ,section #aaci;,a7i7 7#db      
,u4,s4,c4 #acbj;b-#i;a7i77 is am5d$ by  
ins]t+ 1 & = ea* ( fiscal ye>s #bjad    
?r\gh #bjai1 #ej1jjj1jjj1 aft]          
#de1jjj1jjj4  7b7 ,effective date ,!    
am5dm5t made by ?is section %all take   
effect on ! date ( enactm5t ( ?is ,act4 
#ejb4 ,improv+ ! effectiv5ess ( !       
p$iatric quality measures  7a7 ,9 g5]al 
,section #aaci;,a7b7 7#db ,u4,s4,c4     
#acbj;b-#i;a7b77 is am5d$-- 7#a7 9      
p>agraph 7#d7-- 7,a7 9 subp>agraph 7,a71

 by /rik+ & at ! end2  7,b7 9           
subp>agraph 7,b71 by /rik+ ! p]iod at ! 
end & ins]t+ 2 &2 &  7,c7 by add+ at !  
end ! foll[+ new subp>agraph3  7,c7     
e/abli% a program to cont9ue & enhance  
p$iatric quality measures program c5t]s 
( excell5ce1 :i* may include develop+   
c5t]s ( excell5ce ) a p>ticul> emphasis 
on pati5t & family exp]i5ce & p$iatric  
populations t are small 9 size & may be 
mo/ effectively address$ by aggregat+   
data across multiple ,/ates1 includ+    
p$iatric populations ) m$ical complexity
 & p$iatric populations ) r>e           
conditions4  2 &  7#b7 by am5d+ p>agraph
 7#e7 to read z foll[s3  7#e7 ,revis+1  
/r5g!n+1 & improv+ initial core measures
  7,a7 ,9 g5]al ,! ,secret>y %all       
annually publi% recomm5d$ *anges to !   
core measures describ$ 9 subsection 7a7 
t-- 7i7 are consi/5t ) ! purposes ( !   
p$iatric quality measures program       
e/abli%$ "u p>agraph 7#a72  7ii7 meet ! 
conditions specifi$ 9 p>agraph 7#b72    
7iii7 7 develop$ by ! ,secret>y 9       

consultation ) ! entities specifi$ 9    
subp>agraphs 7,a7 ?r\gh 7,h7 ( p>agraph 
7#c72 &  7iv7 7 develop$1 validat$1 or  
te/$ ?r\gh a grant aw>d$ "u p>agraph    
7#d74  7,b7 ,additional recomm5d$ *anges
 ,beg9n+ n lat] ?an #a ye> aft] ! date (
 enactm5t ( ! ,,*ip ,ext5sion ,act (    
#bjad1 ! recomm5d$ *anges publi%$ "u    
subp>agraph 7,a7 %all include *anges--  
7i7 to measure ! type ( *ildr5's heal?  
insurance cov]age or o!r heal? b5efits  
cov]age available ov] "t1 9 addition to 
! pres5ce1 /ability1 & duration ( su*   
heal? insurance cov]age or su* heal?    
b5efits cov]age ov] "t1 = purposes (    
exam9+ enrollm5t *anges ( a *ild f "o   
type ( cov]age to ano!r2  7ii7 to ensure
 t ! measures reflect ! c>e provid$ to !
 div]se p$iatric population1 includ+    
adolesc5ts & *ildr5 ) special heal? c>e 
ne$s1 & ! managem5t ( acute & *ronic    
conditions2  7iii7 to ensure t !        
measures reflect c>e provid$ 9 div]se   
heal? c>e sett+s1 includ+ bo? inpati5t &
 ambulatory sett+s2  7iv7 to enc\rage ! 

developm5t1 implem5tation1 & /ew>d%ip ( 
core measures t c be us$ at ! ,/ate1    
hospital1 practice1 & plan levels1      
includ+ a su/a9able me*anism to ma9ta9 &
 dissem9ate su* measures & collect &    
report data on su* measures2 &  7v7 to  
facilitate ! adoption1 dissem9ation1    
/ew>d%ip1 & report+ ( su* measures z    
well z measures develop$ ?r\gh !        
p$iatric quality measures program at !  
,/ate1 hospital1 practice1 & plan levels
 & across diff]5t heal? c>e deliv]y &   
cov]age sy/ems1 includ+ cov]age provid$ 
?r\gh ! ,ex*anges e/abli%$ "u title ,i (
 ! ,pati5t ,protection & ,af=dable ,c>e 
,act4  4  7b7 ,effective date ,!        
am5dm5ts made by ?is section %all take  
effect on ! date ( enactm5t ( ?is ,act4 
#ejc4 ,annual ,/ate reports reg>d+      
,/ate-specific quality ( c>e measures   
appli$ "u ,m$icaid or ,,*ip  7a7 ,9     
g5]al ,section #aaci;,a7c7 7#db         
,u4,s4,c4 #acbj;b-#i;a7c77 is am5d$ by  
add+ at ! end ! foll[+ new p>agraph3    
7#c7 ,data collection & report+ on full 

set ( core measures ,beg9n+ n lat] ?an  
#e ye>s aft] ! date ( enactm5t ( ?is    
p>agraph1 ! in=mation report$ "u        
p>agraph 7#a7 %all include              
,/ate-specific in=mation on ! full set (
 p$iatric core measures4  4  7b7        
,effective date ,! am5dm5t made by ?is  
section %all take effect on ! date (    
enactm5t ( ?is ,act4  #ejd4 ,advisory   
panel reg>d+ p$iatric quality  7a7 ,9   
g5]al ,section #aaci;,a7g7 7#db         
,u4,s4,c4 #acbj;b-#i;a7g77 is am5d$--   
7#a7 9 ! subsection head+1 by /rik+     
,/udy ( & ins]t+ ,/udies & reports on2  
7#b7 by r$esignat+ p>agraph 7#b7 z      
p>agraph 7#d72 &  7#c7 by ins]t+ aft]   
p>agraph 7#a7 ! foll[+ new p>agraphs3   
7#b7 ,exp]t panel ,! ,secret>y %all     
conv5e a panel1 compos$ ( heal? exp]ts  
7includ+ exp]ts employ$ by ! ,f$]al     
,gov]nm5t & exp]ts n s employ$7 to      
e/abli% priorities & goals = *ild heal? 
z recomm5d$ 9 ! report submitt$ "u      
p>agraph 7#a7 by ! ,in/itute ( ,m$ic9e4 
,su* panel %all-- 7,a7 advise & make    

recomm5dations to ! ,secret>y reg>d+    
*anges t may be made to ! core measures 
describ$ 9 subsection 7a72  7,b7 e/abli%
 /&>ds = ! timel9ess & accuracy ( data s
 collect$ & report$2 &  7,c7 review &   
make recomm5dations1 on an annual basis1
 = /rategies to enhance ! timel9ess1    
accuracy1 & utility ( ! core measures4  
7#c7 ,collect+ & report+ full set ( core
 measures ,n lat] ?an #a ye> aft] ! date
 ( enactm5t ( ?is p>agraph1 ! ,secret>y1
 9 consultation ) repres5tatives ( ,/ate
 ag5cies responsible = adm9i/]+ ,m$icaid
 & ! ,/ate ,*ildr5's ,heal? ,insurance  
,program & repres5tatives ( relevant    
provid] organizations1 %all submit to ! 
,committee on ,en]gy & ,comm]ce ( !     
,h\se ( ,repres5tatives & ! ,committee  
on ,f9ance ( ! ,s5ate a report          
id5tify+-- 7,a7 /rategies to address &  
ov]come b>ri]s to ,/ate collection ( &  
report+ ( ! full set ( p$iatric core    
measures2  7,b7 an analysis ( ! am\nt ( 
,f$]al fund+ ne$$ to inc5tivize ,/ates  
to collect & report on ! full set (     

p$iatric core measures2 &  7,c7 a       
/&>diz$ =mat & plan = ,/ates to collect 
& report on ! full set ( p$iatric core  
measures4  4  7b7 ,effective date ,!    
am5dm5ts made by ?is section %all take  
effect on ! date ( enactm5t ( ?is ,act4 
#eje4 ,ext5d+ & exp&+ demon/ration      
projects  7a7 ,/r5g!n+ demon/ration     
projects = improv+ ! quality ( *ildr5's 
heal? c>e & ! use ( heal? in=mation     
te*nology ,section #aaci;,a7d7 7#db     
,u4,s4,c4 #acbj;b-#i;a7d77 is am5d$--   
7#a7 9 p>agraph 7#a7-- 7,a7 9 ! matt]   
prec$+ subp>agraph 7,a7-- 7i7 by ins]t+ 
1 & dur+ ! p]iod ( fiscal ye>s #bjad    
?r\gh #bjai1 ! ,secret>y %all aw>d n    
less ?an #aj grants1 aft] #aj grants2 & 
7ii7 by ins]t+ 7includ+ oral c>e7 aft]  
heal? c>e2  7,b7 9 subp>agraph 7,c71 by 
/rik+ or at ! end2  7,c7 9 subp>agraph  
7,d71 by /rik+ ! p]iod at ! end & ins]t+
 a semicolon2 &  7,d7 by add+ at ! end !
 foll[+ new subp>agraphs3  7,e7 exam9e &
 address b>ri]s to effective deliv]y (  
p]9atal c>e & its impact on bir?        

outcomes & subsequ5t pregnancies &      
*ildr5's heal?2  7,f7 implem5t & exp&   
p$iatric & p]9atal le>n+ & quality      
improvem5t collaboratives on ! quality (
 *ildr5's & pregnant wom5's heal? c>e1  
includ+ improv+ pati5t outcomes1 r$uc+  
heal? co/s1 & address+ heal? disp>ities2
  7,g7 enc\rage & evaluate ! use at !   
,/ate level ( paym5t re=m & relat$      
policy proposals = purposes ( promot+   
high] quality ( c>e = *ildr51 includ+ ! 
%>$ sav+s program e/abli%$ "u section   
#ahii & o!r me?ods ( enc\rag+ integrat$ 
c>e models2 or  7,h7 ) respect to !     
model electronic heal? record =mat =    
*ildr5 develop$ & dissem9at$ "u         
subsection 7f7-- 7i7 assess ! ext5t to  
:i* ! =mat has be5 incorporat$ into     
widely us$ electronic heal? record      
=mats2  7ii7 implem5t /&>ds & activities
 t result 9 increas$ use ( su* =mat2 &  
7iii7 evaluate ! impact ( ! increas$ use
 ( su* =mat4  2  7#b7 9 p>agraph 7#b7-- 
7,a7 9 subp>agraph 7,a71 by /rik+ & at !
 end2  7,b7 9 subp>agraph 7,b71 by /rik+

 ! p]iod at ! end & ins]t+ 2 &2 &  7,c7 
by add+ at ! end ! foll[+ new           
subp>agraph3  7,c7 ) respect to grants  
aw>d$ = projects describ$ 9 p>agraph    
7#a77;,f71 su* grants %all be aw>d$ =   
projects t-- 7i7 give priority to       
collaboratives t w\ld h sub/antial      
impacts on ! p$iatric population by--   
7,i7 affect+ a l>ge p]c5tage ( su*      
population or by sub/antially improv+   
outcomes 9 a small] population2  7,,ii7 
r$uc+ ! co/ ( heal? c>e = *ildr51       
includ+ *ildr5 ) m$ically complex       
illnesses or *ronic conditions2  7,,iii7
 hav+ a high likelihood to r$uce        
disp>ities 9 heal? /atus2 or  7,,iv7    
pot5tially hav+ long-t]m heal? impacts  
by address+ *ildhood precursors to adult
 conditions2 &  7ii7 enc\rage           
coord9ation ) o!r s\rces ( fund+ 9 !    
expansion ( p$iatric le>n+              
collaboratives1 includ+ by coord9at+ c>e
 & utiliz+ community heal? work]s 7z    
def9$ 9 section #cii,v7k7 ( ! ,public   
,heal? ,s]vice ,act 7#db ,u4,s4,c4      

#bhj;g-#aa7k7774  2 &  7#c7 9 p>agraph  
7#d7-- 7,a7 by ins]t+ ,= ea* ( fiscal   
ye>s #bjji ?r\gh #bjac1 be=e            
#bj1jjj1jjj2 &  7,b7 by add+ at ! end ! 
foll[+ new s5t5ce3 ,= ea* ( fiscal ye>s 
#bjad ?r\gh #bjai1 #cf1jjj1jjj ( ! am\nt
 appropriat$ "u subsection 7i7 = a      
fiscal ye> %all be us$ to c>ry out ?is  
subsection44  7b7 ,ext5d+ fund+ =       
*ildhood obesity demon/ration projects  
,section #aaci;,a7e77#h7 7#db ,u4,s4,c4 
#acbj;b-#i;a7e77#h77 is am5d$ by ins]t+ 
1 & = ! p]iod ( fiscal ye>s #bjae ?r\gh 
#bjai1 #be1jjj1jjj aft] #bjad4  7c7     
,effective date ,! am5dm5ts made by ?is 
section %all take effect on ! date (    
enactm5t ( ?is ,act4  ,b ,mat]nal1      
,infant1 & ,e>ly ,*ildhood ,home ,visit+
 ,program  #eaa4 ,support+ evid5ce-bas$ 
c>e coord9ation 9 communities  7a7 ,9   
g5]al ,section #eaa7;j77#a7 7#db        
,u4,s4,c4 #gaa7;j77#a77 is am5d$ by     
/rik+ subp>agraph 7,f7 & ins]t+ !       
foll[+3  7,f7 #djj1jjj1jjj = ea* (      
fiscal ye>s #bjae ?r\gh #bjai4  4  7b7  

,prev5tion ( duplicate appropriations = 
fiscal ye> #bjae ,exp5ditures made      
pursuant to ! am5dm5ts made by section  
#bji ( ! ,protect+ ,access to ,m$ic>e   
,act ( #bjad 7,public ,law #aac-ic7 =   
fiscal ye> #bjae %all be *>g$ to !      
appropriation provid$ by ! am5dm5t made 
by subsection 7a7 = su* fiscal ye>4  7c7
 ,effective date ,! am5dm5t made by ?is 
section %all take effect on ! date (    
enactm5t ( ?is ,act4  ,c ,comp>ative    
/udy ( ,m$icaid1 ,,*ip1 & qualifi$ heal?
 plans  #eba4 ,,gao /udy & report  7a7  
,/udy ,! ,comptroll] ,g5]al ( ! ,unit$  
,/ates %all conduct a /udy ( ea* ,/ate 9
 :i* individuals eligible = m$ical      
assi/ance "u a ,/ate plan "u title ,,xix
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acif et seq47 or = *ild heal?
 assi/ance "u a ,/ate *ild heal? plan "u
 title ,,xxi ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #acig;aa et seq47 are    
provid$ su* assi/ance ?r\gh enrollm5t 9 
a qualifi$ heal? plan or                
employ]-sponsor$ insurance4 ,su* /udy   

%all det]m9e1 = ea* su* ,/ate-- 7#a7 !  
numb] ( su* individuals enroll$ 9 an    
employ]-sponsor$ heal? plan to :om      
wrap>\nd s]vices are (f]$2  7#b7 ! numb]
 ( su* individuals enroll$ 9 an         
employ]-sponsor$ heal? plan :o use      
wrap>\nd s]vices = any purpose dur+ !   
plan ye>2  7#c7 ! av]age co/ ( wrap>\nd 
s]vices p] individual enroll$ 9 an      
employ]-sponsor$ heal? plan :o uses su* 
s]vices2  7#d7 ! numb] ( su* individuals
 ) developm5tal disabilities 7z def9$ 9 
section #ajb7h7 ( ! ,developm5tal       
,disabilities ,assi/ance & ,bill (      
,rights ,act ( #bjjj 7#db ,u4,s4,c4     
#aejjb7h7771 enroll$ 9 an               
employ]-sponsor$ heal? plan :o us$      
wrap-ar\nd b5efits2  7#e7 ! numb] (     
disabl$ individuals enroll$ 9 an        
employ]-sponsor$ heal? plan :o use      
wrap>\nd b5efits = habilitative s]vices1
 rehabilitative s]vices1 or home heal?  
s]vices2  7#f7 ! numb] ( su* individuals
 enroll$ 9 qualifi$ heal? plans2  7#g7  
av]age premiums & co/-%>+ p] su*        

individual enroll$ 9 a qualifi$ heal?   
plan2 &  7#h7 comp>ative data ) respect 
to ! b5efits (f]$ to su* individuals "u 
qualifi$ heal? plans z comp>$ to !      
b5efits (f]$ to su* individuals "u ,/ate
 plans "u title ,,xix or ,,xxi ( !      
,social ,security ,act4  7b7 ,reports ,n
 lat] ?an #b ye>s aft] ! date ( !       
enactm5t ( ?is ,act1 ! ,comptroll]      
,g5]al ( ! ,unit$ ,/ates %all submit to 
! ,committee on ,en]gy & ,comm]ce ( !   
,h\se ( ,repres5tatives & ! ,committee  
on ,f9ance ( ! ,s5ate a report on !     
f9d+s ( ! /udy conduct$ "u subsection   
7a7 t includes any recomm5dations or    
propos$ legislation4 ,n lat] ?an #d ye>s
 aft] ! date ( enactm5t ( ?is ,act1 !   
,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all submit to ! ,committee on ,en]gy & 
,comm]ce ( ! ,h\se ( ,repres5tatives & !
 ,committee on ,f9ance ( ! ,s5ate an    
updat$ report on ! f9d+s ( ! /udy       
conduct$ "u subsection 7a7 t includes   
any recomm5dations or propos$           
legislation4  7c7 ,def9itions ,=        

purposes ( ?is section3 7#a7 ,qualifi$  
heal? plan ,! t]m qualifi$ heal? plan   
means a heal? plan t is (f]$ ?r\gh an   
,am]ican ,heal? ,b5efits ,ex*ange       
e/abli%$ "u ! ,pati5t ,protection &     
,af=dable ,c>e ,act 7,public ,law       
#aaa-adh74  7#b7 ,wrap>\nd s]vices ,!   
t]m wrap>\nd s]vices means s]vices      
provid$ by a ,/ate plan "u title ,,xix  
or ,,xxi ( ! ,social ,security ,act t   
are provid$ z a supplem5t to items or   
s]vices = :i* cov]age is n (f]$ or is   
limit$ "u a qualifi$ heal? plan or an   
employ]-sponsor$ heal? plan4  ,,vi      
,budget>y ,effects  #fja4 ,budget>y     
effect ( ?is ,act ,! budget>y effects ( 
?is ,act1 = ! purpose ( comply+ ) !     
,/atutory ,pay-,z-,y-,g ,act ( #bjaj1   
%all be det]m9$ by ref]5ce to ! late/   
/atem5t titl$ ,budget>y ,effects (      
,,paygo ,legislation = ?is ,act1        
submitt$ = pr9t+ 9 ! ,congressional     
,record by ! ,*airman ( ! ,committee on 
! ,budget ( ! ,h\se ( ,repres5tatives1 z
 long z su* /atem5t has be5 submitt$    

prior to ! vote on passage ( ?is ,act4