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Title I — CHIP Extension and Other Medicaid and CHIP Provisions

H.R. 3921 · 115th Congress · Oct 3, 2017 · Lineage

I CHIP Extension and Other Medicaid and CHIP Provisions

Sec. 101 Five-year funding extension of the Children’s Health Insurance Program

(a)
Appropriation; total allotment— Section 2104(a) of the Social Security Act (42 U.S.C. 1397dd(a)) is amended—
(1)
in paragraph (19), by striking “and”;
(2)
in paragraph (20), by striking the period at the end and inserting a semicolon; and
(3)
by adding at the end the following new paragraphs:

“(21) for fiscal year 2018, $21,500,000,000;

“(22) for fiscal year 2019, $22,600,000,000;

“(23) for fiscal year 2020, $23,700,000,000;

“(24) for fiscal year 2021, $24,800,000,000; and

“(25) for fiscal year 2022, for purposes of making 2 semi-annual allotments—

“(A) $2,850,000,000 for the period beginning on October 1, 2021, and ending on March 31, 2022; and

“(B) $2,850,000,000 for the period beginning on April 1, 2022, and ending on September 30, 2022.”

(b)
Allotments—
(1)
In general— Section 2104(m) of the Social Security Act (42 U.S.C. 1397dd(m)) is amended—
(A)
in paragraph (2)—
(i)
in the heading, by striking “through 2016” and inserting “through 2022”; and
(ii)
in subparagraph (B)—
(I)
in the matter preceding clause (i), by striking “(19)” and inserting “(24)”;
(II)
in clause (ii), in the matter preceding subclause (I), by inserting “(other than fiscal year 2022)” after “even-numbered fiscal year”; and
(III)
in clause (ii)(I), by inserting “(or, in the case of fiscal year 2018, under paragraph (4))” after “clause (i)”;
(B)
in paragraph (5)—
(i)
by striking “or (4)” and inserting “(4), or (10)”; and
(ii)
by striking “or 2017” and inserting “, 2017, or 2022”;
(C)
in paragraph (7)—
(i)
in subparagraph (A), by striking “2017” and inserting “2022”;
(ii)
in subparagraph (B), in the matter preceding clause (i), by inserting “(or, in the case of fiscal year 2018, by not later than the date that is 60 days after the date of the enactment of the HEALTHY KIDS Act of 2017)” after “before the August 31 preceding the beginning of the fiscal year”; and
(iii)
in the matter following subparagraph (B), by striking “or fiscal year 2016” and inserting “fiscal year 2016, fiscal year 2018, fiscal year 2020, or fiscal year 2022”;
(D)
in paragraph (9)—
(i)
in the heading, by striking “fiscal years 2015 and 2017” and inserting “certain fiscal years”;
(ii)
by striking “or (4)” and inserting “, (4), or (10)”; and
(iii)
by striking “or fiscal year 2017” and inserting “, 2017, or 2022”; and
(E)
by adding at the end the following new paragraph:

“(10) For fiscal year 2022

“(A) First half—Subject to paragraphs (5) and (7), from the amount made available under subparagraph (A) of paragraph (25) of subsection (a) for the semi-annual period described in such subparagraph, increased by the amount of the appropriation for such period under section 101(b)(3) of the HEALTHY KIDS Act, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for such semi-annual period in an amount equal to the first half ratio (described in subparagraph (D)) of the amount described in subparagraph (C).

“(B) Second half—Subject to paragraphs (5) and (7), from the amount made available under subparagraph (B) of paragraph (25) of subsection (a) for the semi-annual period described in such subparagraph, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for such semi-annual period in an amount equal to the amount made available under such subparagraph, multiplied by the ratio of—

“(i) the amount of the allotment to such State under subparagraph (A); to

“(ii) the total of the amount of all of the allotments made available under such subparagraph.

“(C) Full year amount based on growth factor updated amount—The amount described in this subparagraph for a State is equal to the sum of—

“(i) the amount of the State allotment for fiscal year 2021 determined under paragraph (2)(B)(i); and

“(ii) the amount of any payments made to the State under subsection (n) for fiscal year 2021,

“(D) First half ratio—The first half ratio described in this subparagraph is the ratio of—

“(i) the sum of—

“(I) the amount made available under subsection (a)(25)(A); and

“(II) the amount of the appropriation for such period under section 101(b)(3) of the HEALTHY KIDS Act; to

“(ii) the sum of—

“(I) the amount described in clause (i); and

“(II) the amount made available under subsection (a)(25)(B).”

(2)
Technical amendment— Section 2104(m)(2)(A) of such Act (42 U.S.C. 1397dd(m)(2)(A)) is amended by striking “the allotment increase factor under paragraph (5)” each place it appears and inserting “the allotment increase factor under paragraph (6)”.
(3)
One-time appropriation for fiscal year 2022— There is appropriated to the Secretary of Health and Human Services, out of any money in the Treasury not otherwise appropriated, $20,200,000,000 to accompany the allotment made for the period beginning on October 1, 2021, and ending on March 31, 2022, under paragraph (25)(A) of section 2104(a) of the Social Security Act (42 U.S.C. 1397dd(a)) (as added by subsection (a)(3)), to remain available until expended. Such amount shall be used to provide allotments to States under paragraph (10) of section 2104(m) of such Act (as added by subsection (b)(1)(E)) for the first 6 months of fiscal year 2022 in the same manner as allotments are provided under subsection (a)(25)(A) of such section 2104 and subject to the same terms and conditions as apply to the allotments provided from such subsection (a)(25)(A).
(c)
Extension of the Child Enrollment Contingency Fund— Section 2104(n) of the Social Security Act (42 U.S.C. 1397dd(n)) is amended—
(1)
in paragraph (2)—
(A)
in subparagraph (A)(ii)—
(i)
by striking “2010, 2011, 2012, 2013, 2014, and 2016” and inserting “2010 through 2014, 2016, and 2018 through 2021”; and
(ii)
by striking “fiscal year 2015 and fiscal year 2017” and inserting “fiscal years 2015, 2017, and 2022”; and
(B)
in subparagraph (B)—
(i)
by striking “2010, 2011, 2012, 2013, 2014, and 2016” and inserting “2010 through 2014, 2016, and 2018 through 2021”; and
(ii)
by striking “fiscal year 2015 and fiscal year 2017” and inserting “fiscal years 2015, 2017, and 2022”; and
(2)
in paragraph (3)(A), in the matter preceding clause (i), by striking “or a semi-annual allotment period for fiscal year 2015 or 2017” and inserting “or in any of fiscal years 2018 through 2021 (or a semi-annual allotment period for fiscal year 2015, 2017, or 2022)”.
(d)
Extension of qualifying states option— Section 2105(g)(4) of the Social Security Act (42 U.S.C. 1397ee(g)(4)) is amended—
(1)
in the heading, by striking “through 2017” and inserting “through 2022”; and
(2)
in subparagraph (A), by striking “2017” and inserting “2022”.
(e)
Extension of express lane eligibility option— Section 1902(e)(13)(I) of the Social Security Act (42 U.S.C. 1396a(e)(13)(I)) is amended by striking “2017” and inserting “2022”.
(f)
Assurance of affordability standard for children and families—
(1)
In general— Section 2105(d)(3) of the Social Security Act (42 U.S.C. 1397ee(d)(3)) is amended—
(A)
in the paragraph heading, by striking “until October 1, 2019” and inserting “through September 30, 2022”; and
(B)
in subparagraph (A), in the matter preceding clause (i)—
(i)
by striking “2019” and inserting “2022”; and
(ii)
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 1, 2019, and ends on September 30, 2022, the preceding sentence shall only apply with respect to children in families whose income does not exceed 300 percent of the poverty line (as defined in section 2110(c)(5)) applicable to a family of the size involved. The preceding sentences shall not be construed as preventing a State during any such periods”.
(2)
Conforming amendments— Section 1902(gg)(2) of the Social Security Act (42 U.S.C. 1396a(gg)(2)) is amended—
(A)
in the paragraph heading, by striking “until October 1, 2019” and inserting “through September 30, 2022”; and
(B)
by striking “September 30, 2019,” and inserting “September 30, 2022 (but during the period that begins on October 1, 2019, and ends on September 30, 2022, only with respect to children in families whose income does not exceed 300 percent of the poverty line (as defined in section 2110(c)(5)) applicable to a family of the size involved)”.
(g)
CHIP look-Alike plans—
(1)
Blending risk pools— Section 2107 of the Social Security Act (42 U.S.C. 1397gg) is amended by adding at the end the following:

“(g) Use of blended risk pools

“(1) In general—Nothing in this title (or any other provision of Federal law) 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 (or a waiver of such plan) as members of a single risk pool.

“(2) Qualified CHIP look-alike program—In this subsection, the term qualified CHIP look-alike program means a State program—

“(A) under which children who are under the age of 19 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 (or a waiver of such plan); and

“(B) that is funded exclusively through non-Federal funds, including funds received by the State in the form of premiums for the purchase of such coverage.”

(2)
Coverage rule—
(A)
In general— Section 5000A(f)(1) of the Internal Revenue Code of 1986 is amended in subparagraph (A)(iii), by inserting “or under a qualified CHIP look-alike program (as defined in section 2107(g) of the Social Security Act)” before the comma at the end.
(B)
Effective date— The amendment made by subparagraph (A) shall apply with respect to taxable years beginning after December 31, 2017.

Sec. 102 Extension of certain programs and demonstration projects

(a)
Childhood obesity demonstration project— Section 1139A(e)(8) of the Social Security Act (42 U.S.C. 1320b–9a(e)(8)) is amended—
(1)
by striking “and $10,000,000” and inserting “, $10,000,000”; and
(2)
by inserting after “2017” the following: “, and $25,000,000 for the period of fiscal years 2018 through 2022”.
(b)
Pediatric quality measures program— Section 1139A(i) of the Social Security Act (42 U.S.C. 1320b–9a(i)) is amended—
(1)
by striking “Out of any” and inserting the following:

“(1) In general—Out of any”

(2)
by striking “there is appropriated for each” and inserting “there is appropriated—

“(A) for each”

(3)
by striking “, and there is appropriated for the period” and inserting “;

“(B) for the period”

(4)
by striking “. Funds appropriated under this subsection shall remain available until expended.” and inserting “; and”; and
(5)
by adding at the end the following:

“(C) for the period of fiscal years 2018 through 2022, $75,000,000 for the purpose of carrying out this section (other than subsections (e), (f), and (g)).

“(2) Availability—Funds appropriated under this subsection shall remain available until expended.”

Sec. 103 Extension of outreach and enrollment program

(a)
In general— Section 2113 of the Social Security Act (42 U.S.C. 1397mm) is amended—
(1)
in subsection (a)(1), by striking “2017” and inserting “2022”; and
(2)
in subsection (g)—
(A)
by striking “and $40,000,000” and inserting “, $40,000,000”; and
(B)
by inserting after “2017” the following: “, and $100,000,000 for the period of fiscal years 2018 through 2022”.
(b)
Making parent mentors eligible to receive grants— Section 2113(f) of the Social Security Act (42 U.S.C. 1397mm(f)) is amended—
(1)
in paragraph (1), by adding at the end the following new subparagraph:

“(H) Parent mentors.”

(2)
by adding at the end the following new paragraph:

“(5) Parent mentor—The term “parent mentor” means an individual who—

“(A) is a parent or guardian of at least one child who is an eligible child under this title or title XIX; and

“(B) 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 children, including by providing—

“(i) education about health insurance coverage, including, with respect to obtaining such coverage, eligibility criteria and application and renewal processes;

“(ii) assistance with completing and submitting applications for health insurance coverage;

“(iii) a liaison between families and representatives of State plans under title XIX or State child health plans under this title;

“(iv) guidance on identifying medical and dental homes and community pharmacies for children; and

“(v) assistance and referrals to successfully address social determinants of children’s health, including poverty, food insufficiency, and housing.”

Sec. 104 Extension and reduction of additional Federal financial participation for CHIP

Section 2105(b) of the Social Security Act (42 U.S.C. 1397ee(b)) is amended in the second sentence by inserting “and during the period that begins on October 1, 2019, and ends on September 30, 2020, the enhanced FMAP determined for a State for a fiscal year (or for any portion of a fiscal year occurring during such period) shall be increased by 11.5 percentage points” after “23 percentage points,”.

Sec. 105 Modifying reduction in Medicaid DSH allotments

Section 1923(f)(7)(A)(ii) of the Social Security Act (42 U.S.C. 1396r–4(f)(7)(A)(ii)) is amended—
(1)
by striking subclause (I) and redesignating subclauses (II) through (VIII) as subclauses (I) through (VII), respectively;
(2)
in subclause (VI), as redesignated by paragraph (1), by striking at the end “and”;
(3)
in subclause (VII), as redesignated by paragraph (1), by striking at the end the period and inserting a semicolon; and
(4)
by adding at the end the following new subclauses:

“(VIII) $8,000,000,000 for fiscal year 2026; and

“(IX) $8,000,000,000 for fiscal year 2027.”

Sec. 106 Puerto Rico and the Virgin Islands Medicaid payments

(a)
Increased cap— Section 1108(g) of the Social Security Act (42 U.S.C. 1308(g)) is amended—
(1)
in paragraph (2)—
(A)
in subparagraph (A), by inserting “(or, with respect to fiscal years 2018 and 2019, increased by such percentage increase plus one percentage point)” after “beginning of the fiscal year”; and
(B)
in subparagraph (B), by inserting “(or, with respect to fiscal years 2018 and 2019, increased by such percentage increase plus one percentage point)” after “percentage increase referred to in subparagraph (A)”;
(2)
in paragraph (5)—
(A)
in subparagraph (A), by striking “subparagraph (B)” and inserting “subparagraphs (B), (C), (D), (E), and (F)”; and
(B)
by adding at the end the following new subparagraphs:

“(C) The amount of the increase otherwise provided under subparagraph (A) for Puerto Rico shall be further increased by $880,000,000.

“(D)

“(i) For the period beginning October 1, 2017, and ending December 31, 2019, the amount of the increase otherwise provided under subparagraph (A) for Puerto Rico shall be further increased by $120,000,000 if the Financial Oversight and Management Board for Puerto Rico established under section 101 of the Puerto Rico Oversight, Management, and Economic Stability Act (48 U.S.C. 2121) certifies by a majority vote that Puerto Rico has taken reasonable and appropriate steps during such period to—

“(I) reduce fraud, waste, and abuse under the program under title XIX;

“(II) implement strategies to reduce unnecessary, inefficient, or excessive spending under title XIX;

“(III) improve the use and availability of Medicaid data for program operation and oversight; and

“(IV) improve the quality of care and patient experience for individuals enrolled under the program under title XIX.

“(ii) As a condition of any additional increase pursuant to clause (i), not later than October 1, 2018, 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 (I) through (IV) of clause (i).

“(E) Payments under section 1903(a)(8) for a quarter of a fiscal year shall not be taken into account in applying subsection (f) (as increased in accordance with this paragraph and paragraphs (1), (2), (3), and (4)) to Puerto Rico or the Virgin Islands for such fiscal year.

“(F)

“(i) For the period beginning October 1, 2017, and ending December 31, 2019, the amount of the increase otherwise provided under subparagraph (A) 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 (C) and (D) for such period.

“(ii) For purposes of clause (i), the term “per capita equivalent” means the ratio of—

“(I) the population of the Virgin Islands, as determined by the most recent census estimate released by the Bureau of the Census before September 4, 2017; to

“(II) the population of Puerto Rico, as so determined.”

(b)
Federal match for medical personnel and fraud reduction— Section 1903(a) of the Social Security Act (42 U.S.C. 1396b(a)) is amended—
(1)
in paragraph (2)(A), by inserting “subject to paragraph (8),” before “an amount”;
(2)
in paragraph (6)—
(A)
in subparagraph (B), by inserting “subject to paragraph (8),” before “75 per centum”; and
(B)
by striking at the end “plus”;
(3)
in paragraph (7), by striking at the end the period and inserting “; plus” ; and
(4)
by adding at the end the following new paragraph:

“(8) for quarters during the period beginning January 1, 2018, and ending December 31, 2019, paragraphs (2)(A) and (6) shall apply with respect to Puerto Rico and the Virgin Islands as if—

“(A) the reference to “75 per centum” in paragraph (2)(A) were a reference to “90 per centum”; and

“(B) the reference to “75 per centum” in paragraph (6)(B) were a reference to “90 per centum”.”