F:\P11\NHI\TRICOMM\AAHCA09_001.

XML

753
1 quarters beginning after the date of the enactment
2 of this subsection and before CHIP MOE termi-
3 nation date specified in paragraph (3), a State shall
4 not have in effect eligibility standards, methodolo-
5 gies, or procedures under its State child health plan
6 under title XXI (including any waiver under such
7 title or under section 1115 that is permitted to con-
8 tinue effect) that are more restrictive than the eligi-
9 bility standards, methodologies, or procedures, re-
10 spectively, under such plan (or waiver) as in effect
11 on June 16, 2009.
12 ‘‘(2) LIMITATION.—Paragraph (1) shall not be
13 construed as preventing a State from imposing a
14 limitation described in section 2110(b)(5)(C)(i)(II)
15 for a fiscal year in order to limit expenditures under
16 its State child health plan under title XXI to those
17 for which Federal financial participation is available
18 under section 2105 for the fiscal year.
19 ‘‘(3) CHIP MOE TERMINATION DATE.—In para-
20 graph (1), the ‘CHIP MOE termination date’ for a
21 State is the date that is the first day of Y1 (as de-
22 fined in section 100(c) of the America’s Affordable
23 Health Choices Act of 2009) or, if later, the first
24 day after such date that both of the following deter-
25 minations have been made:

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00753 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

754
1 ‘‘(A) The Health Choices Commissioner
2 has determined that the Health Insurance Ex-
3 change has the capacity to support the partici-
4 pation of CHIP enrollees who are Exchange-eli-
5 gible individuals (as defined in section 202(b) of
6 the America’s Affordable Health Choices Act of
7 2009),
8 ‘‘(B) The Secretary has determined that
9 such Exchange, the State, and employers have
10 procedures in effect to ensure the timely transi-
11 tion without interruption of coverage of CHIP
12 enrollees from assistance under title XXI to ac-
13 ceptable coverage (as defined for purposes of
14 such Act).
15 In this paragraph, the term ‘CHIP enrollee’ means
16 a targeted low-income child or (if the State has
17 elected the option under section 2112, a targeted
18 low-income pregnant woman) who is or otherwise
19 would be (but for acceptable coverage) eligible for
20 child health assistance or pregnancy-related assist-
21 ance, respectively, under the State child health plan
22 referred to in paragraph (1).’’.
23 (b) MEDICAID MAINTENANCE OF EFFORT; SIMPLI-
24 FYING AND COORDINATING ELIGIBILITY RULES BE-
25 TWEEN EXCHANGE AND MEDICAID.—

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00754 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

755
1 (1) IN GENERAL.—Section 1903 of such Act
2 (42 U.S.C. 1396b) is amended by adding at the end
3 the following new subsection:
4 ‘‘(aa) MAINTENANCE OF MEDICAID EFFORT; SIMPLI-
5 FYING AND COORDINATING ELIGIBILITY RULES BE-
6 TWEEN HEALTH INSURANCE EXCHANGE AND MED-
7 ICAID.—

8 ‘‘(1) MAINTENANCE OF EFFORT.—A State is

9 not eligible for payment under subsection (a) for a
10 calendar quarter beginning after the date of the en-
11 actment of this subsection if eligibility standards,
12 methodologies, or procedures under its plan under
13 this title (including any waiver under this title or
14 under section 1115 that is permitted to continue ef-
15 fect) that are more restrictive than the eligibility
16 standards, methodologies, or procedures, respec-
17 tively, under such plan (or waiver) as in effect on
18 June 16, 2009. The Secretary shall extend such a
19 waiver (including the availability of Federal financial
20 participation under such waiver) for such period as
21 may be required for a State to meet the requirement
22 of the previous sentence.
23 ‘‘(2) REMOVAL OF ASSET TEST FOR CERTAIN

24 ELIGIBILITY CATEGORIES.—

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00755 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

756
1 ‘‘(A) IN GENERAL.—A State is not eligible
2 for payment under subsection (a) for a calendar
3 quarter beginning on or after the first day of
4 Y1 (as defined in section 100(c) of the Amer-
5 ica’s Affordable Health Choices Act of 2009), if
6 the State applies any asset or resource test in
7 determining (or redetermining) eligibility of any
8 individual on or after such first day under any
9 of the following:
10 ‘‘(i) Subclause (I), (III), (IV), or (VI)
11 of section 1902(a)(10)(A)(i).
12 ‘‘(ii) Subclause (II), (IX), (XIV) or
13 (XVII) of section 1902(a)(10)(A)(ii).
14 ‘‘(iii) Section 1931(b).
15 ‘‘(B) OVERRIDING CONTRARY PROVISIONS;

16 REFERENCES.—The provisions of this title that

17 prevent the waiver of an asset or resource test
18 described in subparagraph (A) are hereby
19 waived.
20 ‘‘(C) REFERENCES.—Any reference to a
21 provision described in a provision in subpara-
22 graph (A) shall be deemed to be a reference to
23 such provision as modified through the applica-
24 tion of subparagraphs (A) and (B).’’.

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00756 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

757
1 (2) CONFORMING AMENDMENTS.—(A) Section
2 1902(a)(10)(A) of such Act (42 U.S.C.
3 1396a(a)(10)(A)) is amended, in the matter before
4 clause (i), by inserting ‘‘subject to section
5 1903(aa)(2),’’ after ‘‘(A)’’.
6 (B) Section 1931(b)(2) of such Act (42 U.S.C.
7 1396u–1(b)(1)) is amended by inserting ‘‘subject to
8 section 1903(aa)(2)’’ after ‘‘and (3)’’.
9 (c) STANDARDS FOR BENCHMARK PACKAGES.—Sec-
10 tion 1937(b) of such Act (42 U.S.C. 1396u–7(b)) is
11 amended—
12 (1) in paragraph (1), by inserting ‘‘subject to
13 paragraph (5)’’; and
14 (2) by adding at the end the following new
15 paragraph:
16 ‘‘(5) MINIMUM STANDARDS.—Effective January
17 1, 2013, any benchmark benefit package (or bench-
18 mark equivalent coverage under paragraph (2))
19 must meet the minimum benefits and cost-sharing
20 standards of a basic plan offered through the Health
21 Insurance Exchange.’’.
22 SEC. 1704. REDUCTION IN MEDICAID DSH.

23 (a) REPORT.—
24 (1) IN GENERAL.—Not later than January 1,
25 2016, the Secretary of Health and Human Services

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00757 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

758
1 (in this title referred to as the ‘‘Secretary’’) shall
2 submit to Congress a report concerning the extent to
3 which, based upon the impact of the health care re-
4 forms carried out under division A in reducing the
5 number of uninsured individuals, there is a contin-
6 ued role for Medicaid DSH. In preparing the report,
7 the Secretary shall consult with community-based
8 health care networks serving low-income bene-
9 ficiaries.
10 (2) MATTERS TO BE INCLUDED.—The report
11 shall include the following:
12 (A) RECOMMENDATIONS.—Recommenda-
13 tions regarding—
14 (i) the appropriate targeting of Med-
15 icaid DSH within States; and
16 (ii) the distribution of Medicaid DSH
17 among the States.
18 (B) SPECIFICATION OF DSH HEALTH RE-

19 FORM METHODOLOGY.—The DSH Health Re-

20 form methodology described in paragraph (2) of
21 subsection (b) for purposes of implementing the
22 requirements of such subsection.
23 (3) COORDINATION WITH MEDICARE DSH RE-

24 PORT.—The Secretary shall coordinate the report

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00758 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

759
1 under this subsection with the report on Medicare
2 DSH under section 1112.
3 (4) MEDICAID DSH.—In this section, the term
4 ‘‘Medicaid DSH’’ means adjustments in payments
5 under section 1923 of the Social Security Act for in-
6 patient hospital services furnished by dispropor-
7 tionate share hospitals.
8 (b) MEDICAID DSH REDUCTIONS.—
9 (1) IN GENERAL.—The Secretary shall reduce
10 Medicaid DSH so as to reduce total Federal pay-
11 ments to all States for such purpose by
12 $1,500,000,000 in fiscal year 2017, $2,500,000,000
13 in fiscal year 2018, and $6,000,000,000 in fiscal
14 year 2019.
15 (2) DSH HEALTH REFORM METHODOLOGY.—

16 The Secretary shall carry out paragraph (1) through

17 use of a DSH Health Reform methodology issued by
18 the Secretary that imposes the largest percentage re-
19 ductions on the States that—
20 (A) have the lowest percentages of unin-
21 sured individuals (determined on the basis of
22 audited hospital cost reports) during the most
23 recent year for which such data are available;
24 or

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00759 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

760
1 (B) do not target their DSH payments
2 on—
3 (i) hospitals with high volumes of
4 Medicaid inpatients (as defined in section
5 1923(b)(1)(A) of the Social Security Act
6 (42 U.S.C. 1396r–4(b)(1)(A)); and
7 (ii) hospitals that have high levels of
8 uncompensated care (excluding bad debt).
9 (3) DSH ALLOTMENT PUBLICATIONS.—

10 (A) IN GENERAL.—Not later than the pub-

11 lication deadline specified in subparagraph (B),
12 the Secretary shall publish in the Federal Reg-
13 ister a notice specifying the DSH allotment to
14 each State under 1923(f) of the Social Security
15 Act for the respective fiscal year specified in
16 such subparagraph, consistent with the applica-
17 tion of the DSH Health Reform methodology
18 described in paragraph (2).
19 (B) PUBLICATAION DEADLINE.—The pub-
20 lication deadline specified in this subparagraph
21 is—
22 (i) January 1, 2016, with respect to
23 DSH allotments described in subparagraph
24 (A) for fiscal year 2017;

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00760 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC