,,ib ,union ,calendar ,no4 #bfc #aaeth ,,congress #ast ,session ,h4 ,r4 #ciba ,report ,no4 #aae-ceh1 ,part ,i ,,in ,,the ,,house ,,of ,,representatives ,october #c1 #bjag ,mr4 ,burgess introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,october #ai1 #bjag ,reported from the ,committee on ,energy and ,commerce with an amendment ,strike out all after the enacting clause and insert the part printed in italic ,october #ai1 #bjag,referral to the ,committee on ,ways and ,means extended for a period ending not later than ,october #bc1 #bjag ,october #bc1 #bjag,the ,committee on ,ways and ,means discharged2 committed to the ,committee of the ,whole ,house on the ,state of the ,union and ordered to be printed,for text of introduced bill1 see copy of bill as introduced on ,october #c1 #bjag ,a ,,bill ,to extend funding for the ,children's ,health ,insurance ,program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,helping ,ensure ,access for ,little ,ones1 ,toddlers1 and ,hopeful ,youth by ,keeping ,insurance ,delivery ,stable ,act of #bjag or the ,,healthy ,,kids ,act4 #b4 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title4 ,sec4 #b4 ,table of contents4 ,title ,i--,,chip ,extension and ,other ,medicaid and ,,chip ,provisions ,sec4 #aja4 ,five-year funding extension of the ,children's ,health ,insurance ,program4 ,sec4 #ajb4 ,extension of certain programs and demonstration projects4 ,sec4 #ajc4 ,extension of outreach and enrollment program4 ,sec4 #ajd4 ,extension and reduction of additional ,federal financial participation for ,,chip4 ,sec4 #aje4 ,modifying reduction in ,medicaid ,,dsh allotments4 ,sec4 #ajf4 ,puerto ,rico and the ,virgin ,islands ,medicaid payments4 ,title ,,ii--,offsets ,sec4 #bja4 ,medicaid third party liability provisions4 ,sec4 #bjb4 ,treatment of lottery winnings and other lump-sum income for purposes of income eligibility under ,medicaid4 ,sec4 #bjc4 ,adjustments to ,medicare part ,b and part ,d premium subsidies for higher income individuals4 ,i ,,chip ,extension and ,other ,medicaid and ,,chip ,provisions #aja4 ,five-year funding extension of the ,children's ,health ,insurance ,program 7a7 ,appropriation2 total allotment ,section #bajd7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7a77 is amended-- 7#a7 in paragraph 7#ai71 by striking and2 7#b7 in paragraph 7#bj71 by striking the period at the end and inserting a semicolon2 and 7#c7 by adding at the end the following new paragraphs3 7#ba7 for fiscal year #bjah1 #ba1ejj1jjj1jjj2 7#bb7 for fiscal year #bjai1 #bb1fjj1jjj1jjj2 7#bc7 for fiscal year #bjbj1 #bc1gjj1jjj1jjj2 7#bd7 for fiscal year #bjba1 #bd1hjj1jjj1jjj2 and 7#be7 for fiscal year #bjbb1 for purposes of making #b semi-annual allotments-- 7,a7 #b1hej1jjj1jjj for the period beginning on ,october #a1 #bjba1 and ending on ,march #ca1 #bjbb2 and 7,b7 #b1hej1jjj1jjj for the period beginning on ,april #a1 #bjbb1 and ending on ,september #cj1 #bjbb4 4 7b7 ,allotments 7#a7 ,in general ,section #bajd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7m77 is amended-- 7,a7 in paragraph 7#b7-- 7i7 in the heading1 by striking through #bjaf and inserting through #bjbb2 and 7ii7 in subparagraph 7,b7-- 7,i7 in the matter preceding clause 7i71 by striking 7#ai7 and inserting 7#bd72 7,,ii7 in clause 7ii71 in the matter preceding subclause 7,i71 by inserting 7other than fiscal year #bjbb7 after even-numbered fiscal year2 and 7,,iii7 in clause 7ii77,i71 by inserting 7or1 in the case of fiscal year #bjah1 under paragraph 7#d77 after clause 7i72 7,b7 in paragraph 7#e7-- 7i7 by striking or 7#d7 and inserting 7#d71 or 7#aj72 and 7ii7 by striking or #bjag and inserting 1 #bjag1 or #bjbb2 7,c7 in paragraph 7#g7-- 7i7 in subparagraph 7,a71 by striking #bjag and inserting #bjbb2 7ii7 in subparagraph 7,b71 in the matter preceding clause 7i71 by inserting 7or1 in the case of fiscal year #bjah1 by not later than the date that is #fj days after the date of the enactment of the ,,healthy ,,kids ,act of #bjag7 after before the ,august #ca preceding the beginning of the fiscal year2 and 7iii7 in the matter following subparagraph 7,b71 by striking or fiscal year #bjaf and inserting fiscal year #bjaf1 fiscal year #bjah1 fiscal year #bjbj1 or fiscal year #bjbb2 7,d7 in paragraph 7#i7-- 7i7 in the heading1 by striking fiscal years #bjae and #bjag and inserting certain fiscal years2 7ii7 by striking or 7#d7 and inserting 1 7#d71 or 7#aj72 and 7iii7 by striking or fiscal year #bjag and inserting 1 #bjag1 or #bjbb2 and 7,e7 by adding at the end the following new paragraph3 7#aj7 ,for fiscal year #bjbb 7,a7 ,first half ,subject to paragraphs 7#e7 and 7#g71 from the amount made available under subparagraph 7,a7 of paragraph 7#be7 of subsection 7a7 for the semi-annual period described in such subparagraph1 increased by the amount of the appropriation for such period under section #aja7;b77#c7 of the ,,healthy ,,kids ,act1 the ,secretary shall compute a ,state allotment for each ,state 7including the ,district of ,columbia and each commonwealth and territory7 for such semi-annual period in an amount equal to the first half ratio 7described in subparagraph 7,d77 of the amount described in subparagraph 7,c74 7,b7 ,second half ,subject to paragraphs 7#e7 and 7#g71 from the amount made available under subparagraph 7,b7 of paragraph 7#be7 of subsection 7a7 for the semi-annual period described in such subparagraph1 the ,secretary shall compute a ,state allotment for each ,state 7including the ,district of ,columbia and each commonwealth and territory7 for such semi-annual period in an amount equal to the amount made available under such subparagraph1 multiplied by the ratio of-- 7i7 the amount of the allotment to such ,state under subparagraph 7,a72 to 7ii7 the total of the amount of all of the allotments made available under such subparagraph4 7,c7 ,full year amount based on growth factor updated amount ,the amount described in this subparagraph for a ,state is equal to the sum of-- 7i7 the amount of the ,state allotment for fiscal year #bjba determined under paragraph 7#b77;,b77i72 and 7ii7 the amount of any payments made to the ,state under subsection 7n7 for fiscal year #bjba1 multiplied by the allotment increase factor under paragraph 7#f7 for fiscal year #bjbb4 7,d7 ,first half ratio ,the first half ratio described in this subparagraph is the ratio of-- 7i7 the sum of-- 7,i7 the amount made available under subsection 7a77#be77;,a72 and 7,,ii7 the amount of the appropriation for such period under section #aja7;b77#c7 of the ,,healthy ,,kids ,act2 to 7ii7 the sum of-- 7,i7 the amount described in clause 7i72 and 7,,ii7 the amount made available under subsection 7a77#be77;,b74 4 7#b7 ,technical amendment ,section #bajd7m77#b77;,a7 of such ,act 7#db ,u4,s4,c4 #acig;dd7m77#b77;,a77 is amended by striking the allotment increase factor under paragraph 7#e7 each place it appears and inserting the allotment increase factor under paragraph 7#f74 7#c7 ,one-time appropriation for fiscal year #bjbb ,there is appropriated to the ,secretary of ,health and ,human ,services1 out of any money in the ,treasury not otherwise appropriated1 #bj1bjj1jjj1jjj to accompany the allotment made for the period beginning on ,october #a1 #bjba1 and ending on ,march #ca1 #bjbb1 under paragraph 7#be77;,a7 of section #bajd7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7a77 7as added by subsection 7a77#c771 to remain available until expended4 ,such amount shall be used to provide allotments to ,states under paragraph 7#aj7 of section #bajd7m7 of such ,act 7as added by subsection 7b77#a77;,e77 for the first #f months of fiscal year #bjbb in the same manner as allotments are provided under subsection 7a77#be77;,a7 of such section #bajd and subject to the same terms and conditions as apply to the allotments provided from such subsection 7a77#be77;,a74 7c7 ,extension of the ,child ,enrollment ,contingency ,fund ,section #bajd7n7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7n77 is amended-- 7#a7 in paragraph 7#b7-- 7,a7 in subparagraph 7,a77ii7-- 7i7 by striking #bjaj1 #bjaa1 #bjab1 #bjac1 #bjad1 and #bjaf and inserting #bjaj through #bjad1 #bjaf1 and #bjah through #bjba2 and 7ii7 by striking fiscal year #bjae and fiscal year #bjag and inserting fiscal years #bjae1 #bjag1 and #bjbb2 and 7,b7 in subparagraph 7,b7-- 7i7 by striking #bjaj1 #bjaa1 #bjab1 #bjac1 #bjad1 and #bjaf and inserting #bjaj through #bjad1 #bjaf1 and #bjah through #bjba2 and 7ii7 by striking fiscal year #bjae and fiscal year #bjag and inserting fiscal years #bjae1 #bjag1 and #bjbb2 and 7#b7 in paragraph 7#c77;,a71 in the matter preceding clause 7i71 by striking or a semi-annual allotment period for fiscal year #bjae or #bjag and inserting or in any of fiscal years #bjah through #bjba 7or a semi-annual allotment period for fiscal year #bjae1 #bjag1 or #bjbb74 7d7 ,extension of qualifying states option ,section #baje7;g77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7g77#d77 is amended-- 7#a7 in the heading1 by striking through #bjag and inserting through #bjbb2 and 7#b7 in subparagraph 7,a71 by striking #bjag and inserting #bjbb4 7e7 ,extension of express lane eligibility option ,section #aijb7;e77#ac77;,i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#ac77;,i77 is amended by striking #bjag and inserting #bjbb4 7f7 ,assurance of affordability standard for children and families 7#a7 ,in general ,section #baje7;d77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7d77#c77 is amended-- 7,a7 in the paragraph heading1 by striking until ,october #a1 #bjai and inserting through ,september #cj1 #bjbb2 and 7,b7 in subparagraph 7,a71 in the matter preceding clause 7i7-- 7i7 by striking #bjai and inserting #bjbb2 and 7ii7 by striking ,the preceding sentence shall not be construed as preventing a ,state during such period and inserting ,during the period that begins on ,october #a1 #bjai1 and ends on ,september #cj1 #bjbb1 the preceding sentence shall only apply with respect to children in families whose income does not exceed #cjj percent of the poverty line 7as defined in section #baaj7;c77#e77 applicable to a family of the size involved4 ,the preceding sentences shall not be construed as preventing a ,state during any such periods4 7#b7 ,conforming amendments ,section #aijb7;gg77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7gg77#b77 is amended-- 7,a7 in the paragraph heading1 by striking until ,october #a1 #bjai and inserting through ,september #cj1 #bjbb2 and 7,b7 by striking ,september #cj1 #bjai1 and inserting ,september #cj1 #bjbb 7but during the period that begins on ,october #a1 #bjai1 and ends on ,september #cj1 #bjbb1 only with respect to children in families whose income does not exceed #cjj percent of the poverty line 7as defined in section #baaj7;c77#e77 applicable to a family of the size involved74 7g7 ,,chip look-,alike plans 7#a7 ,blending risk pools ,section #bajg of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7 is amended by adding at the end the following3 7g7 ,use of blended risk pools 7#a7 ,in general ,nothing in this title 7or any other provision of ,federal law7 shall be construed as preventing a ,state from considering children enrolled in a qualified ,,chip look-alike program and children enrolled in a ,state child health plan under this title 7or a waiver of such plan7 as members of a single risk pool4 7#b7 ,qualified ,,chip look-alike program ,in this subsection1 the term qualified ,,chip look-alike program means a ,state program-- 7,a7 under which children who are under the age of #ai and are not eligible to receive medical assistance under title ,,xix or child health assistance under this title may purchase coverage through the ,state that provides benefits that are at least identical to the benefits provided under the ,state child health plan under this title 7or a waiver of such plan72 and 7,b7 that is funded exclusively through non-,federal funds1 including funds received by the ,state in the form of premiums for the purchase of such coverage4 4 7#b7 ,coverage rule 7,a7 ,in general ,section #ejjj;,a7f77#a7 of the ,internal ,revenue ,code of #aihf is amended in subparagraph 7,a77iii71 by inserting or under a qualified ,,chip look-alike program 7as defined in section #bajg7;g7 of the ,social ,security ,act7 before the comma at the end4 7,b7 ,effective date ,the amendment made by subparagraph 7,a7 shall apply with respect to taxable years beginning after ,december #ca1 #bjag4 #ajb4 ,extension of certain programs and demonstration projects 7a7 ,childhood obesity demonstration project ,section #aaci;,a7e77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;a7e77#h77 is amended-- 7#a7 by striking and #aj1jjj1jjj and inserting 1 #aj1jjj1jjj2 and 7#b7 by inserting after #bjag the following3 1 and #be1jjj1jjj for the period of fiscal years #bjah through #bjbb4 7b7 ,pediatric quality measures program ,section #aaci;,a7i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;a7i77 is amended-- 7#a7 by striking ,out of any and inserting the following3 7#a7 ,in general ,out of any 2 7#b7 by striking there is appropriated for each and inserting 8there is appropriated-- 7,a7 for each 2 7#c7 by striking 1 and there is appropriated for the period and inserting 82 7,b7 for the period 2 7#d7 by striking 4 ,funds appropriated under this subsection shall remain available until expended4 and inserting 2 and2 and 7#e7 by adding at the end the following3 7,c7 for the period of fiscal years #bjah through #bjbb1 #ge1jjj1jjj for the purpose of carrying out this section 7other than subsections 7e71 7f71 and 7g774 7#b7 ,availability ,funds appropriated under this subsection shall remain available until expended4 4 #ajc4 ,extension of outreach and enrollment program 7a7 ,in general ,section #baac of the ,social ,security ,act 7#db ,u4,s4,c4 #acigmm7 is amended-- 7#a7 in subsection 7a77#a71 by striking #bjag and inserting #bjbb2 and 7#b7 in subsection 7g7-- 7,a7 by striking and #dj1jjj1jjj and inserting 1 #dj1jjj1jjj2 and 7,b7 by inserting after #bjag the following3 1 and #ajj1jjj1jjj for the period of fiscal years #bjah through #bjbb4 7b7 ,making parent mentors eligible to receive grants ,section #baac7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acigmm7f77 is amended-- 7#a7 in paragraph 7#a71 by adding at the end the following new subparagraph3 7,h7 ,parent mentors4 2 and 7#b7 by adding at the end the following new paragraph3 7#e7 ,parent mentor ,the term parent mentor means an individual who-- 7,a7 is a parent or guardian of at least one child who is an eligible child under this title or title ,,xix2 and 7,b7 is trained to assist families with children who have no health insurance coverage with respect to improving the social determinants of the health of such children1 including by providing-- 7i7 education about health insurance coverage1 including1 with respect to obtaining such coverage1 eligibility criteria and application and renewal processes2 7ii7 assistance with completing and submitting applications for health insurance coverage2 7iii7 a liaison between families and representatives of ,state plans under title ,,xix or ,state child health plans under this title2 7iv7 guidance on identifying medical and dental homes and community pharmacies for children2 and 7v7 assistance and referrals to successfully address social determinants of children's health1 including poverty1 food insufficiency1 and housing4 4 #ajd4 ,extension and reduction of additional ,federal financial participation for ,,chip ,section #baje7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7b77 is amended in the second sentence by inserting and during the period that begins on ,october #a1 #bjai1 and ends on ,september #cj1 #bjbj1 the enhanced ,,fmap determined for a ,state for a fiscal year 7or for any portion of a fiscal year occurring during such period7 shall be increased by #aa4e percentage points after #bc percentage points14 #aje4 ,modifying reduction in ,medicaid ,,dsh allotments ,section #aibc7;f77#g77;,a77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7;f77#g77;,a77ii77 is amended-- 7#a7 by striking subclause 7,i7 and redesignating subclauses 7,,ii7 through 7,,viii7 as subclauses 7,i7 through 7,,vii71 respectively2 7#b7 in subclause 7,,vi71 as redesignated by paragraph 7#a71 by striking at the end and2 7#c7 in subclause 7,,vii71 as redesignated by paragraph 7#a71 by striking at the end the period and inserting a semicolon2 and 7#d7 by adding at the end the following new subclauses3 7,,viii7 #h1jjj1jjj1jjj for fiscal year #bjbf2 and 7,,ix7 #h1jjj1jjj1jjj for fiscal year #bjbg4 4 #ajf4 ,puerto ,rico and the ,virgin ,islands ,medicaid payments 7a7 ,increased cap ,section #aajh7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh7;g77 is amended-- 7#a7 in paragraph 7#b7-- 7,a7 in subparagraph 7,a71 by inserting 7or1 with respect to fiscal years #bjah and #bjai1 increased by such percentage increase plus one percentage point7 after beginning of the fiscal year2 and 7,b7 in subparagraph 7,b71 by inserting 7or1 with respect to fiscal years #bjah and #bjai1 increased by such percentage increase plus one percentage point7 after percentage increase referred to in subparagraph 7,a72 7#b7 in paragraph 7#e7-- 7,a7 in subparagraph 7,a71 by striking subparagraph 7,b7 and inserting subparagraphs 7,b71 7,c71 7,d71 7,e71 and 7,f72 and 7,b7 by adding at the end the following new subparagraphs3 7,c7 ,the amount of the increase otherwise provided under subparagraph 7,a7 for ,puerto ,rico shall be further increased by #hhj1jjj1jjj4 7,d7 7i7 ,for the period beginning ,october #a1 #bjag1 and ending ,december #ca1 #bjai1 the amount of the increase otherwise provided under subparagraph 7,a7 for ,puerto ,rico shall be further increased by #abj1jjj1jjj if the ,financial ,oversight and ,management ,board for ,puerto ,rico established under section #aja of the ,puerto ,rico ,oversight1 ,management1 and ,economic ,stability ,act 7#dh ,u4,s4,c4 #baba7 certifies by a majority vote that ,puerto ,rico has taken reasonable and appropriate steps during such period to-- 7,i7 reduce fraud1 waste1 and abuse under the program under title ,,xix2 7,,ii7 implement strategies to reduce unnecessary1 inefficient1 or excessive spending under title ,,xix2 7,,iii7 improve the use and availability of ,medicaid data for program operation and oversight2 and 7,,iv7 improve the quality of care and patient experience for individuals enrolled under the program under title ,,xix4 7ii7 ,as a condition of any additional increase pursuant to clause 7i71 not later than ,october #a1 #bjah1 ,puerto ,rico shall submit to the ,financial ,oversight and ,management ,board for ,puerto ,rico a report regarding steps taken to achieve each of the goals described in subclauses 7,i7 through 7,,iv7 of clause 7i74 7,e7 ,payments under section #aijc7;a77#h7 for a quarter of a fiscal year shall not be taken into account in applying subsection 7f7 7as increased in accordance with this paragraph and paragraphs 7#a71 7#b71 7#c71 and 7#d77 to ,puerto ,rico or the ,virgin ,islands for such fiscal year4 7,f7 7i7 ,for the period beginning ,october #a1 #bjag1 and ending ,december #ca1 #bjai1 the amount of the increase otherwise provided under subparagraph 7,a7 for the ,virgin ,islands shall be further increased by an amount equal to the per capita equivalent of the total amount of the increase provided for ,puerto ,rico under subparagraphs 7,c7 and 7,d7 for such period4 7ii7 ,for purposes of clause 7i71 the term per capita equivalent means the ratio of-- 7,i7 the population of the ,virgin ,islands1 as determined by the most recent census estimate released by the ,bureau of the ,census before ,september #d1 #bjag2 to 7,,ii7 the population of ,puerto ,rico1 as so determined4 4 7b7 ,federal match for medical personnel and fraud reduction ,section #aijc7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77 is amended-- 7#a7 in paragraph 7#b77;,a71 by inserting subject to paragraph 7#h71 before an amount2 7#b7 in paragraph 7#f7-- 7,a7 in subparagraph 7,b71 by inserting subject to paragraph 7#h71 before #ge per centum2 and 7,b7 by striking at the end plus2 7#c7 in paragraph 7#g71 by striking at the end the period and inserting 2 plus 2 and 7#d7 by adding at the end the following new paragraph3 7#h7 for quarters during the period beginning ,january #a1 #bjah1 and ending ,december #ca1 #bjai1 paragraphs 7#b77;,a7 and 7#f7 shall apply with respect to ,puerto ,rico and the ,virgin ,islands as if-- 7,a7 the reference to #ge per centum in paragraph 7#b77;,a7 were a reference to #ij per centum2 and 7,b7 the reference to #ge per centum in paragraph 7#f77;,b7 were a reference to #ij per centum4 4 ,,ii ,offsets #bja4 ,medicaid third party liability provisions 7a7 ,medicaid third party liability 7#a7 ,delay of ,bipartisan ,budget ,act of #bjac third party liability provisions 7,a7 ,in general ,section #bjb7;c7 of the ,bipartisan ,budget ,act of #bjac 7,public ,law #aac-fg2 #abg ,stat4 #aagg2 #db ,u4,s4,c4 #acif;a note71 as amended by section #baa of the ,protecting ,access to ,medicare ,act of #bjad 7,public ,law #aac-ic2 #abh ,stat4 #ajdg2 #db ,u4,s4,c4 #acif;a note7 and section #bbj of the ,medicare ,access and ,,chip ,reauthorization ,act of #bjae 7,public ,law #aad-aj71 is amended by striking #bjag and inserting #bjai4 7,b7 ,effective date2 treatment ,the amendment made by subparagraph 7,a7 shall take effect on ,september #cj1 #bjag1 and shall apply with respect to claims generated or filed after such date4 7#b7 ,clarification of definitions applicable to third party liability 7,a7 ,in general ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is amended by adding at the end the following new subsection3 7nn7 ,responsible ,third ,party and ,health ,insurer ,definitions ,for purposes of subsection 7a77#be7 and section #aijc7;d77#b77;,b73 7#a7 ,responsible third party ,the term responsible third party means a health insurer1 an accountable care organization1 or any other party that is1 by statute1 contract1 or agreement1 legally responsible for payment of a claim for a health care item or service4 ,such term does not include a party if payment by such party has been made or can reasonably be expected to be made under a workmen's compensation law or plan of the ,united ,states or a ,state1 or under an automobile or liability insurance policy or plan 7including a self-insured plan71 or under no fault insurance4 7#b7 ,health insurer ,the term health insurer means a group health plan1 as defined in section #fjg7a7 of the ,employee ,retirement ,income ,security ,act of #aigd1 a self-insured plan1 a fully-insured plan1 a service benefit plan1 a medicaid managed care plan under section #aijc7m7 or #aicb1 a pharmacy benefit manager1 and any other health plan determined appropriate by the ,secretary4 4 7,b7 ,conforming amendments ,section #aijb7;a77#be7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#be77 is amended-- 7i7 in subparagraph 7,a71 in the matter preceding clause 7i71 by striking third parties and all that follows through item or service7 and inserting responsible third parties2 7ii7 in subparagraph 7,g71 by striking health insurer and all that follows through item or service7 and inserting responsible third party2 7iii7 in subparagraph 7,i71 in the matter preceding clause 7i71 by striking health insurers and all that follows through item or service and inserting responsible third parties2 and 7iv7 by inserting responsible before third each place it appears in subparagraphs 7,a77i71 7,a77ii71 7,c71 7,d71 and 7,h74 7#c7 ,removal of special treatment of certain types of care and payments under ,medicaid third party liability rules ,section #aijb7;a77#be7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#be771 as amended by section #bjb7;c7 of the ,bipartisan ,budget ,act of #bjac 7after application of paragraph 7#a771 is amended by striking subparagraphs 7,e7 and 7,f74 7#d7 ,clarification of role of health insurers with respect to third party liability 7,a7 ,in general ,section #aijb7;a77#be7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#be771 as amended by paragraph 7#c71 is further amended by inserting after subparagraph 7,d7 the following new subparagraphs3 7,e7 that1 in the case of a ,state that provides medical assistance under this title through a contract with a health insurer1 such contract shall specify whether the ,state is-- 7i7 delegating to such insurer all or some of its right of recovery from a responsible third party for an item or service for which payment has been made under the ,state plan 7or under a waiver of the plan72 and 7ii7 transferring to such insurer all or some of the assignment to the ,state of any right of an individual or other entity to payment from a responsible third party for an item or service for which payment has been made under the ,state plan 7or under a waiver of the plan72 7,f7 that1 in the case of a ,state that elects an option described in clause 7i7 or 7ii7 of subparagraph 7,e7 with respect to a health insurer1 the ,state shall provide assurances to the ,secretary that the ,state laws referred to in subparagraph 7,i7 confer to the health insurer the authority of the ,state with respect to the requirements specified in clauses 7i7 through 7iv7 of such subparagraph2 4 7,b7 ,treatment of collected amounts ,section #aijc7;d77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7d77#b77;,b77 is amended by adding at the end the following3 ,for purposes of this subparagraph1 reimbursements made by a responsible third party to health insurers pursuant to section #aijb7;a77#be77;,e7 shall be treated in the same manner as reimbursements made to a ,state under the previous sentence44 7#e7 ,increasing ,state flexibility with respect to third party liability ,section #aijb7;a77#be77;,i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#be77;,i77 is amended-- 7,a7 in clause 7i71 by striking medical assistance under the ,state plan and inserting medical assistance under a ,state plan 7or under a waiver of the plan72 7,b7 by striking clause 7ii7 and inserting the following new clause3 7ii7 accept-- 7,i7 any ,state's right of recovery and the assignment to any ,state of any right of an individual or other entity to payment from the party for an item or service for which payment has been made under the respective ,state's plan 7or under a waiver of the plan72 and 7,,ii7 as a valid authorization of the responsible third party for the furnishing of an item or service to an individual eligible to receive medical assistance under this title1 an authorization made on behalf of such individual under the ,state plan 7or under a waiver of such plan7 for the furnishing of such item or service to such individual2 2 7,c7 in clause 7iii7-- 7i7 by striking respond to and inserting not later than #fj days after receiving2 and 7ii7 by striking 2 and at the end and inserting 1 respond to such inquiry2 and2 and 7,d7 in clause 7iv71 by inserting a failure to obtain a prior authorization1 after claim form14 7#f7 ,state incentive to pursue third party liability for newly eligibles ,section #aijc7;d77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7d77#b77;,b771 as amended by paragraph 7#d77;,b71 is further amended by adding at the end the following3 ,in the case of expenditures for medical assistance provided during #bjag and subsequent years for individuals described in subclause 7,,viii7 of section #aijb7;a77#aj77;,a77i71 in determining the amount1 if any1 of overpayment under this subparagraph with respect to such medical assistance1 the ,secretary shall apply the ,federal medical assistance percentage for the ,state under section #aije7;b71 notwithstanding the application of section #aije7y744 7b7 ,compliance with third party insurance reporting ,section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 is amended by inserting after subsection 7m7 the following new subsection3 7n7 7#a7 ,for any year beginning after #bjbj 7or a sooner year as provided in paragraph 7#b771 if a ,state fails to comply with the requirements of section #aijb7;a77#be7 with respect to each calendar quarter in such year1 the ,secretary may reduce the ,federal medical assistance percentage by #j4a percentage point for calendar quarters in each subsequent year in which the ,state fails to so comply 7and cumulatively for a failure to so comply for a period of consecutive years74 7#b7 ,the ,secretary may apply paragraph 7#a7-- 7,a7 for any year beginning after #bjah1 if a ,state fails to comply with the requirements of section #aijb7;a77#be7 with respect to payment for items and services furnished to individuals described in subclause 7,,viii7 of section #aijb7;a77#aj77;,a77i7 or non-expansion individuals2 and 7,b7 for any year beginning after #bjai1 if a ,state fails to comply with the requirements of section #aijb7;a77#be7 with respect to payment for items and services furnished to individuals described in subdivision 7i71 7iii71 or 7iv7 of section #aije7;a74 7#c7 ,for purposes of this subsection1 the term non-expansion individual means1 with respect to a ,state for a month1 an individual who is-- 7,a7 eligible for medical assistance for items or services under this title and enrolled under the ,state plan 7or a waiver of such plan7 under this title for the month2 7,b7 not under #ai years of age2 7,c7 not #fe years of age or older2 and 7,d7 not eligible for medical assistance under this title on the basis of being blind or disabled4 4 7c7 ,application to ,,chip 7#a7 ,in general ,section #bajg7;e77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77 is amended-- 7,a7 by redesignating subparagraphs 7,b7 through 7,r7 as subparagraphs 7,c7 through 7,s71 respectively2 and 7,b7 by inserting after subparagraph 7,a7 the following new subparagraph3 7,b7 ,section #aijb7;a77#be7 7relating to third party liability74 4 7#b7 ,mandatory reporting ,section #aijb7;a77#be77;,i77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#be77;,i77i771 as amended by subsection 7a77#e71 is further amended-- 7,a7 by striking 7and1 at ,state option1 child and inserting and child2 and 7,b7 by striking title ,,xxi7 and inserting title ,,xxi4 7d7 ,training on third party liability ,section #aicf of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#f7 is amended-- 7#a7 in subsection 7b77#d71 by striking and quality of care and inserting 1 quality of care1 and the liability of responsible third parties 7as defined in section #aijb7nn772 and 7#b7 by adding at the end the following new subsection3 7f7 ,third party liability training ,with respect to education or training activities carried out pursuant to subsection 7b77#d7 with respect to the liability of responsible third parties 7as defined in section #aijb7nn7 for payment for items and services furnished under ,state plans 7or under waivers of such plans77 under this title1 the ,secretary shall-- 7#a7 publish 7and update on an annual basis7 on the public ,internet website of the ,centers for ,medicare ,medicaid ,services a dedicated ,internet page containing best practices to be used in assessing such liability2 7#b7 monitor efforts to assess such liability and analyze the challenges posed by that assessment2 7#c7 distribute to ,state agencies administering the ,state plan under this title information related to such efforts and challenges2 and 7#d7 provide guidance to such ,state agencies with respect to ,state oversight of efforts under a medicaid managed care plan under section #aijc7m7 or #aicb to assess such liability4 4 7e7 ,development of model uniform fields for ,states ,to report third party information ,not later than ,january #a1 #bjai1 the ,secretary of ,health and ,human ,services shall1 in consultation with the ,states1 develop and make available to the ,states a model uniform reporting field that ,states may use for purposes of reporting to the ,secretary through the ,transformed ,medicaid ,statistical ,information ,system 7,t-,,msis7 7or a successor system71 or within ,,cms ,form #fd 7or any successor form71 information identifying responsible third parties 7as defined in subsection 7nn7 of section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a71 as added by subsection 7a77#b77;,a77 and other relevant information for ascertaining the legal responsibility of such third parties to pay for care and services available under the ,state plan 7or under a waiver of the plan7 under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7f7 ,effective date 7#a7 ,in general ,except as provided in paragraph 7#b71 this section and the amendments made by this section 7other than as specified in the preceding provisions of this section7 shall take effect on ,october #a1 #bjai1 and shall apply to medical assistance or child health assistance provided on or after such date4 7#b7 ,exception if ,state legislation required ,in the case of a ,state plan for medical assistance under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 or a ,state child health plan for child health assistance under title ,,xxi of such ,act 7#db ,u4,s4,c4 #acig;aa et seq471 that the ,secretary of ,health and ,human ,services determines requires ,state legislation 7other than legislation appropriating funds7 in order for the plan to meet the additional requirement imposed by the amendments made under this section1 such plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this 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 the 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 such session shall be deemed to be a separate regular session of the ,state legislature4 #bjb4 ,treatment of lottery winnings and other lump-sum income for purposes of income eligibility under ,medicaid 7a7 ,in general ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is amended-- 7#a7 in subsection 7a77#ag71 by striking 7e77#ad71 7e77#ad7 and inserting 7e77#ad71 7e77#ae72 and 7#b7 in subsection 7e7-- 7,a7 in paragraph 7#ad7 7relating to modified adjusted gross income71 by adding at the end the following new subparagraph3 7,j7 ,treatment of certain lottery winnings and income received as a lump sum 7i7 ,in general ,in the case of an individual who is the recipient of qualified lottery winnings 7pursuant to lotteries occurring on or after ,january #a1 #bjah7 or qualified lump sum income 7received on or after such date7 and whose eligibility for medical assistance is determined based on the application of modified adjusted gross income under subparagraph 7,a71 a ,state shall1 in determining such eligibility1 include such winnings or income 7as applicable7 as income received-- 7,i7 in the month in which such winnings or income 7as applicable7 is received if the amount of such winnings or income is less than #hj1jjj2 7,,ii7 over a period of #b months if the amount of such winnings or income 7as applicable7 is greater than or equal to #hj1jjj but less than #ij1jjj2 7,,iii7 over a period of #c months if the amount of such winnings or income 7as applicable7 is greater than or equal to #ij1jjj but less than #ajj1jjj2 and 7,,iv7 over a period of #c months plus #a additional month for each increment of #aj1jjj of such winnings or income 7as applicable7 received1 not to exceed a period of #abj months 7for winnings or income of #a1bfj1jjj or more71 if the amount of such winnings or income is greater than or equal to #ajj1jjj4 7ii7 ,counting in equal installments ,for purposes of subclauses 7,,ii71 7,,iii71 and 7,,iv7 of clause 7i71 winnings or income to which such subclause applies shall be counted in equal monthly installments over the period of months specified under such subclause4 7iii7 ,hardship exemption ,an individual whose income1 by application of clause 7i71 exceeds the applicable eligibility threshold established by the ,state1 shall continue to be eligible for medical assistance to the extent that the ,state determines1 under procedures established by the ,state 7in accordance with standards specified by the ,secretary71 that the denial of eligibility of the individual would cause an undue medical or financial hardship as determined on the basis of criteria established by the ,secretary4 7iv7 ,notifications and assistance required in case of loss of eligibility ,a ,state shall1 with respect to an individual who loses eligibility for medical assistance under the ,state plan 7or a waiver of such plan7 by reason of clause 7i7-- 7,i7 before the date on which the individual loses such eligibility1 inform the individual-- 7aa7 of the individual's opportunity to enroll in a qualified health plan offered through an ,exchange established under title ,i of the ,patient ,protection and ,affordable ,care ,act during the special enrollment period specified in section #ihja7;f77#c7 of the ,internal ,revenue ,code of #aihf 7relating to loss of ,medicaid or ,,chip coverage72 and 7bb7 of the date on which the individual would no longer be considered ineligible by reason of clause 7i7 to receive medical assistance under the ,state plan or under any waiver of such plan and be eligible to reapply to receive such medical assistance2 and 7,,ii7 provide technical assistance to the individual seeking to enroll in such a qualified health plan4 7v7 ,qualified lottery winnings defined ,in this subparagraph1 the term qualified lottery winnings means winnings from a sweepstakes1 lottery1 or pool described in paragraph 7#c7 of section #ddjb of the ,internal ,revenue ,code of #aihf or a lottery operated by a multistate or multijurisdictional lottery association1 including amounts awarded as a lump sum payment4 7vi7 ,qualified lump sum income defined ,in this subparagraph1 the term qualified lump sum income means income that is received as a lump sum from one of the following sources3 7,i7 ,monetary winnings from gambling 7as defined by the ,secretary and including gambling activities described in section #aiee7;b77#d7 of title #ah1 ,united ,states ,code74 7,,ii7 ,damages received1 whether by suit or agreement and whether as lump sums or as periodic payments 7other than monthly payments71 on account of causes of action other than causes of action arising from personal physical injuries or physical sickness4 7,,iii7 ,income received as liquid assets from the estate 7as defined in section #aiag7;b77#d77 of a deceased individual4 2 and 7,b7 by striking 7#ad7 ,exclusion and inserting 7#ae7 ,exclusion4 7b7 ,rules of construction 7#a7 ,interception of lottery winnings allowed ,nothing in the amendment made by subsection 7a77#b77;,a7 shall be construed as preventing a ,state from intercepting the ,state lottery winnings awarded to an individual in the ,state to recover amounts paid by the ,state under the ,state ,medicaid plan under title ,,xix of the ,social ,security ,act for medical assistance furnished to the individual4 7#b7 ,applicability limited to eligibility of recipient of lottery winnings or lump sum income ,nothing in the amendment made by subsection 7a77#b77;,a7 shall be construed1 with respect to a determination of household income for purposes of a determination of eligibility for medical assistance under the ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 7or a waiver of such plan7 made by applying modified adjusted gross income under subparagraph 7,a7 of section #aijb7;e77#ad7 of such ,act 7#db ,u4,s4,c4 #acif;a7e77#ad771 as limiting the eligibility for such medical assistance of any individual that is a member of the household other than the individual who received qualified lottery winnings or qualified lump-sum income 7as defined in subparagraph 7,j7 of such section #aijb7;e77#ad71 as added by subsection 7a77#b77;,a7 of this section74 #bjc4 ,adjustments to ,medicare part ,b and part ,d premium subsidies for higher income individuals 7a7 ,in general ,section #ahci7;i77#c77;,c77i77,,ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acier7i77#c77;,c77i77,,ii77 is amended1 in the table1 by striking the last row and inserting the following new rows3 ,more than #afj1jjj but less than #ejj1jjjhj percent ,at least #ejj1jjjajj percent4 4 7b7 ,joint returns ,section #ahci7;i77#c77;,c77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acier7i77#c77;,c77ii77 is amended by inserting before the period the following3 except1 with respect to the dollar amounts applied in the last row of the table under subclause 7,,ii7 of such clause 7and the second dollar amount specified in the second to last row of such table71 clause 7i7 shall be applied by substituting dollar amounts which are #age percent of such dollar amounts for the calendar year4 7c7 ,inflation adjustment ,section #ahci7;i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acier7i77 is amended-- 7#a7 in paragraph 7#e7-- 7,a7 in subparagraph 7,a71 by striking ,in the case and inserting ,subject to subparagraph 7,c71 in the case2 7,b7 in subparagraph 7,b71 by striking subparagraph 7,a7 and inserting subparagraph 7,a7 or 7,c72 and 7,c7 by adding at the end the following new subparagraph3 7,c7 ,treatment of adjustments for certain higher income individuals 7i7 ,in general ,subparagraph 7,a7 shall not apply with respect to each dollar amount in paragraph 7#c7 of #ejj1jjj4 7ii7 ,adjustment beginning #bjbg ,in the case of any calendar year beginning after #bjbf1 each dollar amount in paragraph 7#c7 of #ejj1jjj shall be increased by an amount equal to-- 7,i7 such dollar amount1 multiplied by 7,,ii7 the percentage 7if any7 by which the average of the ,consumer ,price ,index for all urban consumers 7,united ,states city average7 for the #ab-month period ending with ,august of the preceding calendar year exceeds such average for the #ab-month period ending with ,august #bjbe4 2 and 7#b7 in paragraph 7#f77;,b71 by inserting 7other than #ejj1jjj7 after the dollar amounts4 ,october #bc1 #bjag ,the ,committee on ,ways and ,means discharged2 committed to the ,committee of the ,whole ,house on the ,state of the ,union and ordered to be printed