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Title II — Coverage Stability and Reduced Bureaucracy

H.R. 5364 · 113th Congress · Jul 31, 2014 · Lineage

II Coverage Stability and Reduced Bureaucracy

Sec. 201 Improving coverage stability

(a)
In general— Section 2102(b)(1)(B) of the Social Security Act (42 U.S.C. 1397bb(b)(1)(B)) is amended—
(1)
in clause (iii), by striking “in the case of a targeted low-income pregnant woman provided pregnancy-related assistance under section 2112”; and
(2)
in clause (iv), by striking “at State option,”.
(b)
Conforming amendments—
(1)
Section 2105(c)(10) of the Social Security Act (42 U.S.C. 1397(ee)(10)) is amended—
(A)
by striking subparagraph (F); and
(B)
by redesignating subparagraphs (G) through (M) as subparagraphs (F) through (L), respectively.
(2)
Section 2112(b)(5) of the Social Security Act (42 U.S.C. 1397ll(b)(5)) is amended—
(A)
in the heading, by striking “or waiting period”; and
(B)
by striking “or any waiting period” and all that follows through “receipt of such assistance”.
(c)
Effective date— The amendments made by this section shall take effect on the date of enactment of this Act.

Sec. 202 Assuring care continuity during transitions among CHIP, Medicaid, and qualified health plans

(a)
Minimum essential coverage—
(1)
In general— Section 5000A(f) of the Internal Revenue Code of 1986 is amended by adding at the end the following:

“(6) Pregnancy-related assistance under CHIP—With respect to a targeted low-income pregnant woman (as defined in section 2112(d)(2) of the Social Security Act (42 U.S.C. 1397ll(d)(2))), notwithstanding paragraph (1)(A)(iii), the term minimum essential coverage, at the option of such a woman, shall not include pregnancy-related assistance (as defined in section 2112(d)(1) of the Social Security Act (42 U.S.C. 1397ll(d)(1))).”

(2)
Effective date— The amendment made by this subsection applies to taxable years beginning after December 31, 2014.
(b)
Continuity of care— The Secretary of Health and Human Services shall issue regulations for purposes of ensuring continuity of care for children who—
(1)
are undergoing an active course of treatment; and
(2)
involuntarily change coverage under health insurance, the State plan under the Medicaid program under title XIX of the Social Security Act, or the State child health plan under title XXI of such Act during such course of treatment for any reason, including a reason related to a change in income, health plan termination, or a material change or changes to the plan’s health benefits coverage.
(c)
Ensuring comparability of coverage—
(1)
In general— Not later than 18 months after the date of the enactment of the CHIP Extension and Improvement Act of 2014, the Secretary of Health and Human Services shall review, with respect to a State, the benefits (by each benefit class) offered for children and the cost-sharing imposed with respect to such benefits by qualified health plans offered through an Exchange established under title I of the Patient Protection and Affordable Care Act in the State. The Secretary shall make the findings of such review available on the public Internet site of the Department of Health and Human Services.
(2)
Regulations required— If, following such review, the Secretary determines that benefits and cost-sharing protections referred to in paragraph (1) are not comparable to the benefits (by each benefit class) offered and cost-sharing protections provided under the State child health plan under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.) in the State, the Secretary, not later than January 1, 2017, shall issue a rule, to apply with respect to plan years beginning in 2019, establishing requirements designed to ensure that such qualified health plans offer benefits and cost-sharing protections that are comparable to the benefits and cost-sharing protections provided under such State child health plan for plan year 2019.

Sec. 203 State flexibility to provide for continuous eligibility

Section 1902(e)(12) of the Social Security Act (42 U.S.C. 1396a(e)(12)) is amended to read as follows:

“(12) Continuous eligibility option

“(A) Children—At the option of the State, the plan may provide that a child (as defined in paragraph (13)(G)) who is determined to be eligible for benefits under a State plan approved under this title under subsection (a)(10)(A) shall remain eligible for those benefits until the earlier of—

“(i) the end of a period (not to exceed 12 months) following the determination; or

“(ii) the time that the child exceeds the age specified in such paragraph (13)(G).

“(B) Certain nonelderly adults

“(i) In general—At the option of the State, the plan may provide that in the case of an eligible adult who is determined to be eligible for benefits under a State plan approved under this title (or a waiver of such plan), the eligible adult shall remain eligible for those benefits until the end of a period (not to exceed 12 months) following the determination.

“(ii) Eligible adult defined—In this subparagraph, the term “eligible adult” means—

“(I) an individual (other than a child) whose income eligibility under the State plan or under a waiver of the plan for medical assistance is determined under paragraph (14); and

“(II) an individual included in any other group of individuals the Secretary determines appropriate.”

Sec. 204 State flexibility to use administrative simplification policies for enrollment

(a)
Permanent extension of Medicaid and CHIP express lane option— Section 1902(e)(13) of the Social Security Act (42 U.S.C. 1396a(e)(13)) is amended by striking subparagraph (I).
(b)
Extending Express Lane eligibility to adults— Section 1902(e)(13)(A) of the Social Security Act (42 U.S.C. 1396a(e)(13)(A)) is amended by adding at the end the following new clause:

“(iii) State option to extend express lane eligibility to adults

“(I) In general—At the option of the State, the State may apply the provisions of this paragraph with respect to determining eligibility under this title for an eligible individual (as defined in subclause (II)). In applying this paragraph in the case of a State making such an option, any reference in this paragraph to a child with respect to this title (other than a reference to child health assistance) shall be deemed to be a reference to an eligible individual.

“(II) Eligible individual defined—In this clause, the term “eligible individual” means—

“(aa) any individual (other than a child) whose income eligibility under the State plan or under a waiver of the plan for medical assistance is determined under paragraph (14); and

“(bb) an individual included in any other group of individuals the Secretary determines appropriate.”

Sec. 205 Outreach to targeted populations

(a)
Outreach and enrollment grants— Section 2113 of the Social Security Act (42 U.S.C. 1397mm) is amended—
(1)
in subsection (a)—
(A)
in paragraph (1), by striking “during the period of fiscal years 2009 through 2015 ”; and
(B)
in paragraph (2)—
(i)
in the heading, by striking “Ten percent set aside” and inserting “Set aside”; and
(ii)
by striking “10 percent” and inserting “15 percent”; and
(2)
in subsection (g), by inserting “and $40,000,000 for each fiscal year thereafter, to remain available until expended” after “2015,”.
(b)
Requirement that managed care organizations provide language services to enrollees— Section 1932(b) of the Social Security Act (42 U.S.C. 1396u–2(b)) is amended by adding at the end the following new paragraph:

“(9) Language services—Each contract with a managed care entity under section 1903(m) or under section 1905(t)(3) shall require the entity to provide and pay for language services, including oral interpretation and written translation services, for an individual and the parent or guardian of such individual who is eligible for medical assistance under the State plan under this title and is enrolled with the entity and is limited English proficient when interacting with the entity or with any provider receiving payment from the entity. Such language services shall be provided in conjunction with all covered items and services that are available to such individuals under the contract.”

(c)
Medicaid health care disparities— Section 1946 of the Social Security Act (42 U.S.C. 1396w–5) is amended by adding at the end the following new subsection:

“(d) Appropriation—Out of any funds in the Treasury not otherwise appropriated, there are appropriated to carry out this section $20,000,000, to remain available until expended.”

(d)
Effective date— The amendments made by this section take effect on the date of enactment of this Act.