CHIPRA AUTHORIZING LEGISLATION
PUBLIC LAW 111–3—FEB. 4, 2009
CHILDREN’S HEALTH INSURANCE PROGRAM
REAUTHORIZATION ACT OF 2009
123 STAT. 8 PUBLIC LAW 111–3—FEB. 4, 2009
Public Law 111–3
111th Congress
An Act
To amend title XXI of the Social Security Act to extend and improve the Children’s
Health Insurance Program, and for other purposes.
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT;
REFERENCES; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the ‘‘Children’s
Health Insurance Program Reauthorization Act of 2009’’.
(b) AMENDMENTS TO SOCIAL SECURITY ACT.—Except as otherwise
specifically provided, whenever in this Act an amendment
is expressed in terms of an amendment to or repeal of a section
or other provision, the reference shall be considered to be made
to that section or other provision of the Social Security Act.
(c) REFERENCES TO CHIP; MEDICAID; SECRETARY.—In this Act:
(1) CHIP.—The term ‘‘CHIP’’ means the State Children’s
Health Insurance Program established under title XXI of the
Social Security Act (42 U.S.C. 1397aa et seq.).
(2) MEDICAID.—The term ‘‘Medicaid’’ means the program
for medical assistance established under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).
(3) SECRETARY.—The term ‘‘Secretary’’ means the Secretary
of Health and Human Services.
(d) TABLE OF CONTENTS.—The table of contents of this Act
is as follows:
Sec. 1. Short title; amendments to Social Security Act; references; table of contents.
Sec. 2. Purpose.
Sec. 3. General effective date; exception for State legislation; contingent effective
date; reliance on law.
TITLE I—FINANCING
Subtitle A—Funding
Sec. 104. CHIP performance bonus payment to offset additional enrollment costs
resulting from enrollment and retention efforts.
TITLE II—OUTREACH AND ENROLLMENT
Subtitle A—Outreach and Enrollment Activities
Sec. 201. Grants and enhanced administrative funding for outreach and enrollment.
Sec. 202. Increased outreach and enrollment of Indians.
Sec. 203. State option to rely on findings from an Express Lane agency to conduct
simplified eligibility determinations.
Subtitle B—Reducing Barriers to Enrollment
Sec. 211. Verification of declaration of citizenship or nationality for purposes of eligibility
for Medicaid and CHIP.
Sec. 212. Reducing administrative barriers to enrollment.
Sec. 213. Model of Interstate coordinated enrollment and coverage process.
Sec. 214. Permitting States to ensure coverage without a 5-year delay of certain
children and pregnant women under the Medicaid program and CHIP.
TITLE III—REDUCING BARRIERS TO PROVIDING PREMIUM ASSISTANCE
Subtitle A—Additional State Option for Providing Premium Assistance
Sec. 301. Additional State option for providing premium assistance.
Sec. 302. Outreach, education, and enrollment assistance.
Subtitle B—Coordinating Premium Assistance With Private Coverage
Sec. 311. Special enrollment period under group health plans in case of termination
of Medicaid or CHIP coverage or eligibility for assistance in purchase of
employment-based coverage; coordination of coverage.
TITLE IV—STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES
Sec. 401. Child health quality improvement activities for children enrolled in Medicaid
or CHIP.
Sec. 402. Improved availability of public information regarding enrollment of children
in CHIP and Medicaid.
Sec. 403. Application of certain managed care quality safeguards to CHIP.
TITLE V—IMPROVING ACCESS TO BENEFITS
Sec. 501. Dental benefits.
Sec. 502. Mental health parity in CHIP plans.
Sec. 503. Application of prospective payment system for services provided by Federally-
qualified health centers and rural health clinics.
Sec. 504. Premium grace period.
Sec. 505. Clarification of coverage of services provided through school-based health
centers.
Sec. 506. Medicaid and CHIP Payment and Access Commission.
TITLE VI—PROGRAM INTEGRITY AND OTHER MISCELLANEOUS
PROVISIONS
Subtitle A—Program Integrity and Data Collection
Sec. 601. Payment error rate measurement (‘‘PERM’’).
Sec. 602. Improving data collection.
Sec. 603. Updated Federal evaluation of CHIP.
Sec. 604. Access to records for IG and GAO audits and evaluations.
Sec. 605. No Federal funding for illegal aliens; disallowance for unauthorized expenditures.
Subtitle B—Miscellaneous Health Provisions
Sec. 611. Deficit Reduction Act technical corrections.
Sec. 612. References to title XXI.
Sec. 613. Prohibiting initiation of new health opportunity account demonstration
programs.
Sec. 614. Adjustment in computation of Medicaid FMAP to disregard an extraordinary
employer pension contribution.
AW
123 STAT. 10 PUBLIC LAW 111–3—FEB. 4, 2009
Sec. 615. Clarification treatment of regional medical center.
Sec. 616. Extension of Medicaid DSH allotments for Tennessee and Hawaii.
Sec. 617. GAO report on Medicaid managed care payment rates.
Subtitle C—Other Provisions
Sec. 621. Outreach regarding health insurance options available to children.
Sec. 622. Sense of the Senate regarding access to affordable and meaningful health
insurance coverage.
TITLE VII—REVENUE PROVISIONS
Sec. 701. Increase in excise tax rate on tobacco products.
Sec. 702. Administrative improvements.
Sec. 703. Treasury study concerning magnitude of tobacco smuggling in the United
States.
Sec. 704. Time for payment of corporate estimated taxes.
SEC. 2. PURPOSE.
It is the purpose of this Act to provide dependable and stable
funding for children’s health insurance under titles XXI and XIX
of the Social Security Act in order to enroll all six million uninsured
children who are eligible, but not enrolled, for coverage today
through such titles.
SEC. 3. GENERAL EFFECTIVE DATE; EXCEPTION FOR STATE LEGISLATION;
CONTINGENT EFFECTIVE DATE; RELIANCE ON LAW.
(a) GENERAL EFFECTIVE DATE.—Unless otherwise provided in
this Act, subject to subsections (b) through (d), this Act (and the
amendments made by this Act) shall take effect on April 1, 2009,
and shall apply to child health assistance and medical assistance
provided on or after that date.
(b) EXCEPTION FOR STATE LEGISLATION.—In the case of a State
plan under title XIX or State child health plan under XXI of
the Social Security Act, which the Secretary of Health and Human
Services determines requires State legislation in order for the
respective plan to meet one or more additional requirements
imposed by amendments made by this Act, the respective plan
shall not be regarded as failing to comply with the requirements
of such title solely on the basis of its failure to meet such an
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 enactment of
this Act. For purposes of the previous sentence, in the case of
a State that has a 2-year legislative session, each year of the
session shall be considered to be a separate regular session of
the State legislature.
(c) COORDINATION OF CHIP FUNDING FOR FISCAL YEAR 2009.—
Notwithstanding any other provision of law, insofar as funds have
been appropriated under section 2104(a)(11), 2104(k), or 2104(l)
of the Social Security Act, as amended by section 201 of Public
Law 110–173, to provide allotments to States under CHIP for
fiscal year 2009—
(1) any amounts that are so appropriated that are not
so allotted and obligated before April 1, 2009 are rescinded;
and
(2) any amount provided for CHIP allotments to a State
under this Act (and the amendments made by this Act) for
such fiscal year shall be reduced by the amount of such appropriations
so allotted and obligated before such date.
(d) RELIANCE ON LAW.—With respect to amendments made
by this Act (other than title VII) that become effective as of a
date—
42 USC 1396
note.
42 USC 1396
note.
AW
PUBLIC LAW 111–3—FEB. 4, 2009 123 STAT. 11
(1) such amendments are effective as of such date whether
or not regulations implementing such amendments have been
issued; and
(2) Federal financial participation for medical assistance
or child health assistance furnished under title XIX or XXI,
respectively, of the Social Security Act on or after such date
by a State in good faith reliance on such amendments before
the date of promulgation of final regulations, if any, to carry
out such amendments (or before the date of guidance, if any,
regarding the implementation of such amendments) shall not
be denied on the basis of the State’s failure to comply with
such regulations or guidance.
TITLE I—FINANCING
Subtitle A—Funding
SEC. 101. EXTENSION OF CHIP.
SEC. 104. CHIP PERFORMANCE BONUS PAYMENT TO OFFSET ADDITIONAL
ENROLLMENT COSTS RESULTING FROM ENROLLMENT
AND RETENTION EFFORTS.
Section 2105(a) (42 U.S.C. 1397ee(a)) is amended by adding
at the end the following new paragraphs:
‘‘(3) PERFORMANCE BONUS PAYMENT TO OFFSET ADDITIONAL
MEDICAID AND CHIP CHILD ENROLLMENT COSTS RESULTING FROM
ENROLLMENT AND RETENTION EFFORTS.—
‘‘(A) IN GENERAL.—In addition to the payments made
under paragraph (1), for each fiscal year (beginning with
fiscal year 2009 and ending with fiscal year 2013), the
Secretary shall pay from amounts made available under
subparagraph (E), to each State that meets the condition
under paragraph (4) for the fiscal year, an amount equal
to the amount described in subparagraph (B) for the State
and fiscal year. The payment under this paragraph shall
be made, to a State for a fiscal year, as a single payment
not later than the last day of the first calendar quarter
of the following fiscal year.
‘‘(B) AMOUNT FOR ABOVE BASELINE MEDICAID CHILD
ENROLLMENT COSTS.—Subject to subparagraph (E), the
amount described in this subparagraph for a State for
a fiscal year is equal to the sum of the following amounts:
‘‘(i) FIRST TIER ABOVE BASELINE MEDICAID
ENROLLEES.—An amount equal to the number of first
Deadline.
Applicability.
AW
123 STAT. 18 PUBLIC LAW 111–3—FEB. 4, 2009
tier above baseline child enrollees (as determined
under subparagraph (C)(i)) under title XIX for the
State and fiscal year, multiplied by 15 percent of the
projected per capita State Medicaid expenditures (as
determined under subparagraph (D)) for the State and
fiscal year under title XIX.
‘‘(ii) SECOND TIER ABOVE BASELINE MEDICAID
ENROLLEES.—An amount equal to the number of second
tier above baseline child enrollees (as determined
under subparagraph (C)(ii)) under title XIX for the
State and fiscal year, multiplied by 62.5 percent of
the projected per capita State Medicaid expenditures
(as determined under subparagraph (D)) for the State
and fiscal year under title XIX.
‘‘(C) NUMBER OF FIRST AND SECOND TIER ABOVE BASELINE
CHILD ENROLLEES; BASELINE NUMBER OF CHILD
ENROLLEES.—For purposes of this paragraph:
‘‘(i) FIRST TIER ABOVE BASELINE CHILD
ENROLLEES.—The number of first tier above baseline
child enrollees for a State for a fiscal year under title
XIX is equal to the number (if any, as determined
by the Secretary) by which—
‘‘(I) the monthly average unduplicated number
of qualifying children (as defined in subparagraph
(F)) enrolled during the fiscal year under the State
plan under title XIX, respectively; exceeds
‘‘(II) the baseline number of enrollees
described in clause (iii) for the State and fiscal
year under title XIX, respectively;
but not to exceed 10 percent of the baseline number
of enrollees described in subclause (II).
‘‘(ii) SECOND TIER ABOVE BASELINE CHILD
ENROLLEES.—The number of second tier above baseline
child enrollees for a State for a fiscal year under title
XIX is equal to the number (if any, as determined
by the Secretary) by which—
‘‘(I) the monthly average unduplicated number
of qualifying children (as defined in subparagraph
(F)) enrolled during the fiscal year under title XIX
as described in clause (i)(I); exceeds
‘‘(II) the sum of the baseline number of child
enrollees described in clause (iii) for the State
and fiscal year under title XIX, as described in
clause (i)(II), and the maximum number of first
tier above baseline child enrollees for the State
and fiscal year under title XIX, as determined
under clause (i).
‘‘(iii) BASELINE NUMBER OF CHILD ENROLLEES.—
Subject to subparagraph (H), the baseline number of
child enrollees for a State under title XIX—
‘‘(I) for fiscal year 2009 is equal to the monthly
average unduplicated number of qualifying children
enrolled in the State plan under title XIX
during fiscal year 2007 increased by the population
growth for children in that State from 2007 to
2008 (as estimated by the Bureau of the Census)
plus 4 percentage points, and further increased
PUBLIC LAW 111–3—FEB. 4, 2009 123 STAT. 19
by the population growth for children in that State
from 2008 to 2009 (as estimated by the Bureau
of the Census) plus 4 percentage points;
‘‘(II) for each of fiscal years 2010, 2011, and
2012, is equal to the baseline number of child
enrollees for the State for the previous fiscal year
under title XIX, increased by the population
growth for children in that State from the calendar
year in which the respective fiscal year begins
to the succeeding calendar year (as estimated by
the Bureau of the Census) plus 3.5 percentage
points;
‘‘(III) for each of fiscal years 2013, 2014, and
2015, is equal to the baseline number of child
enrollees for the State for the previous fiscal year
under title XIX, increased by the population
growth for children in that State from the calendar
year in which the respective fiscal year begins
to the succeeding calendar year (as estimated by
the Bureau of the Census) plus 3 percentage
points; and
‘‘(IV) for a subsequent fiscal year is equal to
the baseline number of child enrollees for the State
for the previous fiscal year under title XIX,
increased by the population growth for children
in that State from the calendar year in which
the fiscal year involved begins to the succeeding
calendar year (as estimated by the Bureau of the
Census) plus 2 percentage points.
‘‘(D) PROJECTED PER CAPITA STATE MEDICAID EXPENDITURES.—
For purposes of subparagraph (B), the projected
per capita State Medicaid expenditures for a State and
fiscal year under title XIX is equal to the average per
capita expenditures (including both State and Federal
financial participation) for children under the State plan
under such title, including under waivers but not including
such children eligible for assistance by virtue of the receipt
of benefits under title XVI, for the most recent fiscal year
for which actual data are available (as determined by the
Secretary), increased (for each subsequent fiscal year up
to and including the fiscal year involved) by the annual
percentage increase in per capita amount of National
Health Expenditures (as estimated by the Secretary) for
the calendar year in which the respective subsequent fiscal
year ends and multiplied by a State matching percentage
equal to 100 percent minus the Federal medical assistance
percentage (as defined in section 1905(b)) for the fiscal
year involved.
‘‘(E) AMOUNTS AVAILABLE FOR PAYMENTS.—
‘‘(i) INITIAL APPROPRIATION.—Out of any money in
the Treasury not otherwise appropriated, there are
appropriated $3,225,000,000 for fiscal year 2009 for
making payments under this paragraph, to be available
until expended.
‘‘(ii) TRANSFERS.—Notwithstanding any other
provision of this title, the following amounts shall also
AW
123 STAT. 20 PUBLIC LAW 111–3—FEB. 4, 2009
be available, without fiscal year limitation, for making
payments under this paragraph:
‘‘(I) UNOBLIGATED NATIONAL ALLOTMENT.—
‘‘(aa) FISCAL YEARS 2009 THROUGH 2012.—
As of December 31 of fiscal year 2009, and
as of December 31 of each succeeding fiscal
year through fiscal year 2012, the portion, if
any, of the amount appropriated under subsection
(a) for such fiscal year that is unobligated
for allotment to a State under subsection
(m) for such fiscal year or set aside under
subsection (a)(3) or (b)(2) of section 2111 for
such fiscal year.
‘‘(bb) FIRST HALF OF FISCAL YEAR 2013.—
As of December 31 of fiscal year 2013, the
portion, if any, of the sum of the amounts
appropriated under subsection (a)(16)(A) and
under section 108 of the Children’s Health
Insurance Reauthorization Act of 2009 for the
period beginning on October 1, 2012, and
ending on March 31, 2013, that is unobligated
for allotment to a State under subsection (m)
for such fiscal year or set aside under subsection
(b)(2) of section 2111 for such fiscal
year.
‘‘(cc) SECOND HALF OF FISCAL YEAR 2013.—
As of June 30 of fiscal year 2013, the portion,
if any, of the amount appropriated under subsection
(a)(16)(B) for the period beginning on
April 1, 2013, and ending on September 30,
2013, that is unobligated for allotment to a
State under subsection (m) for such fiscal year
or set aside under subsection (b)(2) of section
2111 for such fiscal year.
‘‘(II) UNEXPENDED ALLOTMENTS NOT USED FOR
REDISTRIBUTION.—As of November 15 of each of
fiscal years 2010 through 2013, the total amount
of allotments made to States under section 2104
for the second preceding fiscal year (third preceding
fiscal year in the case of the fiscal year
2006, 2007, and 2008 allotments) that is not
expended or redistributed under section 2104(f)
during the period in which such allotments are
available for obligation.
‘‘(III) EXCESS CHILD ENROLLMENT CONTINGENCY
FUNDS.—As of October 1 of each of fiscal
years 2010 through 2013, any amount in excess
of the aggregate cap applicable to the Child Enrollment
Contingency Fund for the fiscal year under
section 2104(n).
‘‘(IV) UNEXPENDED TRANSITIONAL COVERAGE
BLOCK GRANT FOR NONPREGNANT CHILDLESS
ADULTS.—As of October 1, 2011, any amounts set
aside under section 2111(a)(3) that are not
expended by September 30, 2011.
‘‘(iii) PROPORTIONAL REDUCTION.—If the sum of the
amounts otherwise payable under this paragraph for
LAW
PUBLIC LAW 111–3—FEB. 4, 2009 123 STAT. 21
a fiscal year exceeds the amount available for the
fiscal year under this subparagraph, the amount to
be paid under this paragraph to each State shall be
reduced proportionally.
‘‘(F) QUALIFYING CHILDREN DEFINED.—
‘‘(i) IN GENERAL.—For purposes of this subsection,
subject to clauses (ii) and (iii), the term ‘qualifying
children’ means children who meet the eligibility criteria
(including income, categorical eligibility, age, and
immigration status criteria) in effect as of July 1, 2008,
for enrollment under title XIX, taking into account
criteria applied as of such date under title XIX pursuant
to a waiver under section 1115.
‘‘(ii) LIMITATION.—A child described in clause (i)
who is provided medical assistance during a presumptive
eligibility period under section 1920A shall be
considered to be a ‘qualifying child’ only if the child
is determined to be eligible for medical assistance
under title XIX.
‘‘(iii) EXCLUSION.—Such term does not include any
children for whom the State has made an election
to provide medical assistance under paragraph (4) of
section 1903(v).
‘‘(G) APPLICATION TO COMMONWEALTHS AND TERRITORIES.—
The provisions of subparagraph (G) of section
2104(n)(3) shall apply with respect to payment under this
paragraph in the same manner as such provisions apply
to payment under such section.
‘‘(H) APPLICATION TO STATES THAT IMPLEMENT A MEDICAID
EXPANSION FOR CHILDREN AFTER FISCAL YEAR 2008.—
In the case of a State that provides coverage under section
115 of the Children’s Health Insurance Program Reauthorization
Act of 2009 for any fiscal year after fiscal year
2008—
‘‘(i) any child enrolled in the State plan under
title XIX through the application of such an election
shall be disregarded from the determination for the
State of the monthly average unduplicated number
of qualifying children enrolled in such plan during
the first 3 fiscal years in which such an election is
in effect; and
‘‘(ii) in determining the baseline number of child
enrollees for the State for any fiscal year subsequent
to such first 3 fiscal years, the baseline number of
child enrollees for the State under title XIX for the
third of such fiscal years shall be the monthly average
unduplicated number of qualifying children enrolled
in the State plan under title XIX for such third fiscal
year.
‘‘(4) ENROLLMENT AND RETENTION PROVISIONS FOR CHILDREN.—
For purposes of paragraph (3)(A), a State meets the
condition of this paragraph for a fiscal year if it is implementing
at least 5 of the following enrollment and retention provisions
(treating each subparagraph as a separate enrollment and
retention provision) throughout the entire fiscal year:
‘‘(A) CONTINUOUS ELIGIBILITY.—The State has elected
the option of continuous eligibility for a full 12 months
LAW
123 STAT. 22 PUBLIC LAW 111–3—FEB. 4, 2009
for all children described in section 1902(e)(12) under title
XIX under 19 years of age, as well as applying such policy
under its State child health plan under this title.
‘‘(B) LIBERALIZATION OF ASSET REQUIREMENTS.—The
State meets the requirement specified in either of the following
clauses:
‘‘(i) ELIMINATION OF ASSET TEST.—The State does
not apply any asset or resource test for eligibility for
children under title XIX or this title.
‘‘(ii) ADMINISTRATIVE VERIFICATION OF ASSETS.—
The State—
‘‘(I) permits a parent or caretaker relative who
is applying on behalf of a child for medical assistance
under title XIX or child health assistance
under this title to declare and certify by signature
under penalty of perjury information relating to
family assets for purposes of determining and
redetermining financial eligibility; and
‘‘(II) takes steps to verify assets through
means other than by requiring documentation from
parents and applicants except in individual cases
of discrepancies or where otherwise justified.
‘‘(C) ELIMINATION OF IN-PERSON INTERVIEW REQUIREMENT.—
The State does not require an application of a
child for medical assistance under title XIX (or for child
health assistance under this title), including an application
for renewal of such assistance, to be made in person nor
does the State require a face-to-face interview, unless there
are discrepancies or individual circumstances justifying an
in-person application or face-to-face interview.
‘‘(D) USE OF JOINT APPLICATION FOR MEDICAID AND
CHIP.—The application form and supplemental forms (if
any) and information verification process is the same for
purposes of establishing and renewing eligibility for children
for medical assistance under title XIX and child health
assistance under this title.
‘‘(E) AUTOMATIC RENEWAL (USE OF ADMINISTRATIVE
RENEWAL).—
‘‘(i) IN GENERAL.—The State provides, in the case
of renewal of a child’s eligibility for medical assistance
under title XIX or child health assistance under this
title, a pre-printed form completed by the State based
on the information available to the State and notice
to the parent or caretaker relative of the child that
eligibility of the child will be renewed and continued
based on such information unless the State is provided
other information. Nothing in this clause shall be construed
as preventing a State from verifying, through
electronic and other means, the information so provided.
‘‘(ii) SATISFACTION THROUGH DEMONSTRATED USE
OF EX PARTE PROCESS.—A State shall be treated as
satisfying the requirement of clause (i) if renewal of
eligibility of children under title XIX or this title is
determined without any requirement for an in-person
interview, unless sufficient information is not in the
State’s possession and cannot be acquired from other
AW
PUBLIC LAW 111–3—FEB. 4, 2009 123 STAT. 23
sources (including other State agencies) without the
participation of the applicant or the applicant’s parent
or caretaker relative.
‘‘(F) PRESUMPTIVE ELIGIBILITY FOR CHILDREN.—The
State is implementing section 1920A under title XIX as
well as, pursuant to section 2107(e)(1), under this title.
‘‘(G) EXPRESS LANE.—The State is implementing the
option described in section 1902(e)(13) under title XIX as
well as, pursuant to section 2107(e)(1), under this title.
‘‘(H) PREMIUM ASSISTANCE SUBSIDIES.—The State is
implementing the option of providing premium assistance
subsidies under section 2105(c)(10) or section 1906A.’’.
TITLE II—OUTREACH AND
ENROLLMENT
Subtitle A—Outreach and Enrollment
Activities
SEC. 201. GRANTS AND ENHANCED ADMINISTRATIVE FUNDING FOR
OUTREACH AND ENROLLMENT.
(a) GRANTS.—Title XXI (42 U.S.C. 1397aa et seq.), as amended
by section 111, is amended by adding at the end the following:
‘‘SEC. 2113. GRANTS TO IMPROVE OUTREACH AND ENROLLMENT.
‘‘(a) OUTREACH AND ENROLLMENT GRANTS; NATIONAL CAMPAIGN.—
‘‘(1) IN GENERAL.—From the amounts appropriated under
subsection (g), subject to paragraph (2), the Secretary shall
award grants to eligible entities during the period of fiscal
years 2009 through 2013 to conduct outreach and enrollment
42 USC 1397mm.
42 USC 1396d
note.
42 USC 1397ee
note.
W
123 STAT. 36 PUBLIC LAW 111–3—FEB. 4, 2009
efforts that are designed to increase the enrollment and participation
of eligible children under this title and title XIX.
‘‘(2) TEN PERCENT SET ASIDE FOR NATIONAL ENROLLMENT
CAMPAIGN.—An amount equal to 10 percent of such amounts
shall be used by the Secretary for expenditures during such
period to carry out a national enrollment campaign in accordance
with subsection (h).
‘‘(b) PRIORITY FOR AWARD OF GRANTS.—
‘‘(1) IN GENERAL.—In awarding grants under subsection
(a), the Secretary shall give priority to eligible entities that—
‘‘(A) propose to target geographic areas with high rates
of—
‘‘(i) eligible but unenrolled children, including such
children who reside in rural areas; or
‘‘(ii) racial and ethnic minorities and health disparity
populations, including those proposals that
address cultural and linguistic barriers to enrollment;
and
‘‘(B) submit the most demonstrable evidence required
under paragraphs (1) and (2) of subsection (c).
‘‘(2) TEN PERCENT SET ASIDE FOR OUTREACH TO INDIAN
CHILDREN.—An amount equal to 10 percent of the funds appropriated
under subsection (g) shall be used by the Secretary
to award grants to Indian Health Service providers and urban
Indian organizations receiving funds under title V of the Indian
Health Care Improvement Act (25 U.S.C. 1651 et seq.) for
outreach to, and enrollment of, children who are Indians.
‘‘(c) APPLICATION.—An eligible entity that desires to receive
a grant under subsection (a) shall submit an application to the
Secretary in such form and manner, and containing such information,
as the Secretary may decide. Such application shall include—
‘‘(1) evidence demonstrating that the entity includes members
who have access to, and credibility with, ethnic or lowincome
populations in the communities in which activities
funded under the grant are to be conducted;
‘‘(2) evidence demonstrating that the entity has the ability
to address barriers to enrollment, such as lack of awareness
of eligibility, stigma concerns and punitive fears associated
with receipt of benefits, and other cultural barriers to applying
for and receiving child health assistance or medical assistance;
‘‘(3) specific quality or outcomes performance measures to
evaluate the effectiveness of activities funded by a grant
awarded under this section; and
‘‘(4) an assurance that the eligible entity shall—
‘‘(A) conduct an assessment of the effectiveness of such
activities against the performance measures;
‘‘(B) cooperate with the collection and reporting of
enrollment data and other information in order for the
Secretary to conduct such assessments; and
‘‘(C) in the case of an eligible entity that is not the
State, provide the State with enrollment data and other
information as necessary for the State to make necessary
projections of eligible children and pregnant women.
‘‘(d) DISSEMINATION OF ENROLLMENT DATA AND INFORMATION
DETERMINED FROM EFFECTIVENESS ASSESSMENTS; ANNUAL
REPORT.—The Secretary shall—
AW
PUBLIC LAW 111–3—FEB. 4, 2009 123 STAT. 37
‘‘(1) make publicly available the enrollment data and
information collected and reported in accordance with subsection
(c)(4)(B); and
‘‘(2) submit an annual report to Congress on the outreach
and enrollment activities conducted with funds appropriated
under this section.
‘‘(e) MAINTENANCE OF EFFORT FOR STATES AWARDED GRANTS;
NO MATCH REQUIRED FOR ANY ELIGIBLE ENTITY AWARDED A
GRANT.—
‘‘(1) STATE MAINTENANCE OF EFFORT.—In the case of a
State that is awarded a grant under this section, the State
share of funds expended for outreach and enrollment activities
under the State child health plan shall not be less than the
State share of such funds expended in the fiscal year preceding
the first fiscal year for which the grant is awarded.
‘‘(2) NO MATCHING REQUIREMENT.—No eligible entity
awarded a grant under subsection (a) shall be required to
provide any matching funds as a condition for receiving the
grant.
‘‘(f) DEFINITIONS.—In this section:
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible entity’ means any
of the following:
‘‘(A) A State with an approved child health plan under
this title.
‘‘(B) A local government.
‘‘(C) An Indian tribe or tribal consortium, a tribal
organization, an urban Indian organization receiving funds
under title V of the Indian Health Care Improvement Act
(25 U.S.C. 1651 et seq.), or an Indian Health Service provider.
‘‘(D) A Federal health safety net organization.
‘‘(E) A national, State, local, or community-based public
or nonprofit private organization, including organizations
that use community health workers or community-based
doula programs.
‘‘(F) A faith-based organization or consortia, to the
extent that a grant awarded to such an entity is consistent
with the requirements of section 1955 of the Public Health
Service Act (42 U.S.C. 300x–65) relating to a grant award
to nongovernmental entities.
‘‘(G) An elementary or secondary school.
‘‘(2) FEDERAL HEALTH SAFETY NET ORGANIZATION.—The
term ‘Federal health safety net organization’ means—
‘‘(A) a Federally-qualified health center (as defined in
section 1905(l)(2)(B));
‘‘(B) a hospital defined as a disproportionate share
hospital for purposes of section 1923;
‘‘(C) a covered entity described in section 340B(a)(4)
of the Public Health Service Act (42 U.S.C. 256b(a)(4));
and
‘‘(D) any other entity or consortium that serves children
under a federally funded program, including the special
supplemental nutrition program for women, infants, and
children (WIC) established under section 17 of the Child
Nutrition Act of 1966 (42 U.S.C. 1786), the Head Start
and Early Head Start programs under the Head Start
Act (42 U.S.C. 9801 et seq.), the school lunch program
AW
123 STAT. 38 PUBLIC LAW 111–3—FEB. 4, 2009
established under the Richard B. Russell National School
Lunch Act, and an elementary or secondary school.
‘‘(3) INDIANS; INDIAN TRIBE; TRIBAL ORGANIZATION; URBAN
INDIAN ORGANIZATION.—The terms ‘Indian’, ‘Indian tribe’, ‘tribal
organization’, and ‘urban Indian organization’ have the
meanings given such terms in section 4 of the Indian Health
Care Improvement Act (25 U.S.C. 1603).
‘‘(4) COMMUNITY HEALTH WORKER.—The term ‘community
health worker’ means an individual who promotes health or
nutrition within the community in which the individual
resides—
‘‘(A) by serving as a liaison between communities and
health care agencies;
‘‘(B) by providing guidance and social assistance to
community residents;
‘‘(C) by enhancing community residents’ ability to effectively
communicate with health care providers;
‘‘(D) by providing culturally and linguistically appropriate
health or nutrition education;
‘‘(E) by advocating for individual and community health
or nutrition needs; and
‘‘(F) by providing referral and followup services.
‘‘(g) APPROPRIATION.—There is appropriated, out of any money
in the Treasury not otherwise appropriated, $100,000,000 for the
period of fiscal years 2009 through 2013, for the purpose of awarding
grants under this section. Amounts appropriated and paid under
the authority of this section shall be in addition to amounts appropriated
under section 2104 and paid to States in accordance with
section 2105, including with respect to expenditures for outreach
activities in accordance with subsections (a)(1)(D)(iii) and (c)(2)(C)
of that section.
‘‘(h) NATIONAL ENROLLMENT CAMPAIGN.—From the amounts
made available under subsection (a)(2), the Secretary shall develop
and implement a national enrollment campaign to improve the
enrollment of underserved child populations in the programs established
under this title and title XIX. Such campaign may include—
‘‘(1) the establishment of partnerships with the Secretary
of Education and the Secretary of Agriculture to develop
national campaigns to link the eligibility and enrollment systems
for the assistance programs each Secretary administers
that often serve the same children;
‘‘(2) the integration of information about the programs
established under this title and title XIX in public health awareness
campaigns administered by the Secretary;
‘‘(3) increased financial and technical support for enrollment
hotlines maintained by the Secretary to ensure that all
States participate in such hotlines;
‘‘(4) the establishment of joint public awareness outreach
initiatives with the Secretary of Education and the Secretary
of Labor regarding the importance of health insurance to
building strong communities and the economy;
‘‘(5) the development of special outreach materials for
Native Americans or for individuals with limited English proficiency;
and
‘‘(6) such other outreach initiatives as the Secretary determines
would increase public awareness of the programs under
this title and title XIX.’’.
AW
PUBLIC LAW 111–3—FEB. 4, 2009 123 STAT. 39
(b) ENHANCED ADMINISTRATIVE FUNDING FOR TRANSLATION OR
INTERPRETATION SERVICES UNDER CHIP AND MEDICAID.—
(1) CHIP.—Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)), as
amended by section 113, is amended—
(A) in the matter preceding subparagraph (A), by
inserting ‘‘(or, in the case of expenditures described in
subparagraph (D)(iv), the higher of 75 percent or the sum
of the enhanced FMAP plus 5 percentage points)’’ after
‘‘enhanced FMAP’’; and
(B) in subparagraph (D)—
(i) in clause (iii), by striking ‘‘and’’ at the end;
(ii) by redesignating clause (iv) as clause (v); and
(iii) by inserting after clause (iii) the following
new clause:
‘‘(iv) for translation or interpretation services in
connection with the enrollment of, retention of, and
use of services under this title by, individuals for whom
English is not their primary language (as found necessary
by the Secretary for the proper and efficient
administration of the State plan); and’’.
(2) MEDICAID.—
(A) USE OF MEDICAID FUNDS.—Section 1903(a)(2) (42
U.S.C. 1396b(a)(2)) is amended by adding at the end the
following new subparagraph:
‘‘(E) an amount equal to 75 percent of so much of the
sums expended during such quarter (as found necessary by
the Secretary for the proper and efficient administration of
the State plan) as are attributable to translation or interpretation
services in connection with the enrollment of, retention
of, and use of services under this title by, children of families
for whom English is not the primary language; plus’’.
(B) USE OF COMMUNITY HEALTH WORKERS FOR OUTREACH
ACTIVITIES.—
(i) IN GENERAL.—Section 2102(c)(1) of such Act
(42 U.S.C. 1397bb(c)(1)) is amended by inserting
‘‘(through community health workers and others)’’ after
‘‘Outreach’’.
(ii) IN FEDERAL EVALUATION.—Section 2108(c)(3)(B)
of such Act (42 U.S.C. 1397hh(c)(3)(B)) is amended
by inserting ‘‘(such as through community health
workers and others)’’ after ‘‘including practices’’.
SEC. 202. INCREASED OUTREACH AND ENROLLMENT OF INDIANS.
(a) IN GENERAL.—Section 1139 (42 U.S.C. 1320b–9) is amended
to read as follows:
‘‘SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, HEALTH CARE
FOR INDIANS UNDER TITLES XIX AND XXI.
‘‘(a) AGREEMENTS WITH STATES FOR MEDICAID AND CHIP OUTREACH
ON OR NEAR RESERVATIONS TO INCREASE THE ENROLLMENT
OF INDIANS IN THOSE PROGRAMS.—
‘‘(1) IN GENERAL.—In order to improve the access of Indians
residing on or near a reservation to obtain benefits under
the Medicaid and State children’s health insurance programs
established under titles XIX and XXI, the Secretary shall
encourage the State to take steps to provide for enrollment
on or near the reservation. Such steps may include outreach
efforts such as the outstationing of eligibility workers, entering
VerDate Nov 24 2008 10:41 Feb 17, 2009 Jkt 079139 PO 00000 Frm 00033 Fmt 6580 Sfmt 6581 E:\PUBLAW\PUBL003.111 GPO1 PsN: PUBL003 ebenthall on POQ96SHH1 with PUBLAW
123 STAT. 40 PUBLIC LAW 111–3—FEB. 4, 2009
into agreements with the Indian Health Service, Indian Tribes,
Tribal Organizations, and Urban Indian Organizations to provide
outreach, education regarding eligibility and benefits,
enrollment, and translation services when such services are
appropriate.
‘‘(2) CONSTRUCTION.—Nothing in paragraph (1) shall be
construed as affecting arrangements entered into between
States and the Indian Health Service, Indian Tribes, Tribal
Organizations, or Urban Indian Organizations for such Service,
Tribes, or Organizations to conduct administrative activities
under such titles.
‘‘(b) REQUIREMENT TO FACILITATE COOPERATION.—The Secretary,
acting through the Centers for Medicare & Medicaid Services,
shall take such steps as are necessary to facilitate cooperation
with, and agreements between, States and the Indian Health
Service, Indian Tribes, Tribal Organizations, or Urban Indian
Organizations with respect to the provision of health care items
and services to Indians under the programs established under title
XIX or XXI.
‘‘(c) DEFINITION OF INDIAN; INDIAN TRIBE; INDIAN HEALTH PROGRAM;
TRIBAL ORGANIZATION; URBAN INDIAN ORGANIZATION.—In
this section, the terms ‘Indian’, ‘Indian Tribe’, ‘Indian Health Program’,
‘Tribal Organization’, and ‘Urban Indian Organization’ have
the meanings given those terms in section 4 of the Indian Health
Care Improvement Act.’’.
(b) NONAPPLICATION OF 10 PERCENT LIMIT ON OUTREACH AND
CERTAIN OTHER EXPENDITURES.—Section 2105(c)(2) (42 U.S.C.
1397ee(c)(2)) is amended by adding at the end the following:
‘‘(C) NONAPPLICATION TO CERTAIN EXPENDITURES.—The
limitation under subparagraph (A) shall not apply with
respect to the following expenditures:
‘‘(i) EXPENDITURES TO INCREASE OUTREACH TO, AND
THE ENROLLMENT OF, INDIAN CHILDREN UNDER THIS
TITLE AND TITLE xix.—Expenditures for outreach activities
to families of Indian children likely to be eligible
for child health assistance under the plan or medical
assistance under the State plan under title XIX (or
under a waiver of such plan), to inform such families
of the availability of, and to assist them in enrolling
their children in, such plans, including such activities
conducted under grants, contracts, or agreements
entered into under section 1139(a).’’.
SEC. 203. STATE OPTION TO RELY ON FINDINGS FROM AN EXPRESS
LANE AGENCY TO CONDUCT SIMPLIFIED ELIGIBILITY
DETERMINATIONS.
(a) APPLICATION UNDER MEDICAID AND CHIP PROGRAMS.—
(1) MEDICAID.—Section 1902(e) (42 U.S.C. 1396a(e)) is
amended by adding at the end the following:
‘‘(13) EXPRESS LANE OPTION.—
‘‘(A) IN GENERAL.—
‘‘(i) OPTION TO USE A FINDING FROM AN EXPRESS LANE
AGENCY.—At the option of the State, the State plan may
provide that in determining eligibility under this title for
a child (as defined in subparagraph (G)), the State may
rely on a finding made within a reasonable period (as
determined by the State) from an Express Lane agency
AW
PUBLIC LAW 111–3—FEB. 4, 2009 123 STAT. 41
(as defined in subparagraph (F)) when it determines
whether a child satisfies one or more components of eligibility
for medical assistance under this title. The State
may rely on a finding from an Express Lane agency notwithstanding
sections 1902(a)(46)(B) and 1137(d) or any
differences in budget unit, disregard, deeming or other
methodology, if the following requirements are met:
‘‘(I) PROHIBITION ON DETERMINING CHILDREN INELIGIBLE
FOR COVERAGE.—If a finding from an Express
Lane agency would result in a determination that a
child does not satisfy an eligibility requirement for
medical assistance under this title and for child health
assistance under title XXI, the State shall determine
eligibility for assistance using its regular procedures.
‘‘(II) NOTICE REQUIREMENT.—For any child who
is found eligible for medical assistance under the State
plan under this title or child health assistance under
title XXI and who is subject to premiums based on
an Express Lane agency’s finding of such child’s income
level, the State shall provide notice that the child
may qualify for lower premium payments if evaluated
by the State using its regular policies and of the procedures
for requesting such an evaluation.
‘‘(III) COMPLIANCE WITH SCREEN AND ENROLL
REQUIREMENT.—The State shall satisfy the requirements
under subparagraphs (A) and (B) of section
2102(b)(3) (relating to screen and enroll) before
enrolling a child in child health assistance under title
XXI. At its option, the State may fulfill such requirements
in accordance with either option provided under
subparagraph (C) of this paragraph.
‘‘(IV) VERIFICATION OF CITIZENSHIP OR NATIONALITY
STATUS.—The State shall satisfy the requirements of
section 1902(a)(46)(B) or 2105(c)(9), as applicable for
verifications of citizenship or nationality status.
‘‘(V) CODING.—The State meets the requirements
of subparagraph (E).
‘‘(ii) OPTION TO APPLY TO RENEWALS AND REDETERMINATIONS.—
The State may apply the provisions of this paragraph
when conducting initial determinations of eligibility,
redeterminations of eligibility, or both, as described in the
State plan.
‘‘(B) RULES OF CONSTRUCTION.—Nothing in this paragraph
shall be construed—
‘‘(i) to limit or prohibit a State from taking any actions
otherwise permitted under this title or title XXI in determining
eligibility for or enrolling children into medical
assistance under this title or child health assistance under
title XXI; or
‘‘(ii) to modify the limitations in section 1902(a)(5) concerning
the agencies that may make a determination of
eligibility for medical assistance under this title.
‘‘(C) OPTIONS FOR SATISFYING THE SCREEN AND ENROLL
REQUIREMENT.—
‘‘(i) IN GENERAL.—With respect to a child whose eligibility
for medical assistance under this title or for child
health assistance under title XXI has been evaluated by
AW
123 STAT. 42 PUBLIC LAW 111–3—FEB. 4, 2009
a State agency using an income finding from an Express
Lane agency, a State may carry out its duties under subparagraphs
(A) and (B) of section 2102(b)(3) (relating to
screen and enroll) in accordance with either clause (ii)
or clause (iii).
‘‘(ii) ESTABLISHING A SCREENING THRESHOLD.—
‘‘(I) IN GENERAL.—Under this clause, the State
establishes a screening threshold set as a percentage
of the Federal poverty level that exceeds the highest
income threshold applicable under this title to the
child by a minimum of 30 percentage points or, at
State option, a higher number of percentage points
that reflects the value (as determined by the State
and described in the State plan) of any differences
between income methodologies used by the program
administered by the Express Lane agency and the
methodologies used by the State in determining eligibility
for medical assistance under this title.
‘‘(II) CHILDREN WITH INCOME NOT ABOVE
THRESHOLD.—If the income of a child does not exceed
the screening threshold, the child is deemed to satisfy
the income eligibility criteria for medical assistance
under this title regardless of whether such child would
otherwise satisfy such criteria.
‘‘(III) CHILDREN WITH INCOME ABOVE THRESHOLD.—
If the income of a child exceeds the screening threshold,
the child shall be considered to have an income above
the Medicaid applicable income level described in section
2110(b)(4) and to satisfy the requirement under
section 2110(b)(1)(C) (relating to the requirement that
CHIP matching funds be used only for children not
eligible for Medicaid). If such a child is enrolled in
child health assistance under title XXI, the State shall
provide the parent, guardian, or custodial relative with
the following:
‘‘(aa) Notice that the child may be eligible
to receive medical assistance under the State plan
under this title if evaluated for such assistance
under the State’s regular procedures and notice
of the process through which a parent, guardian,
or custodial relative can request that the State
evaluate the child’s eligibility for medical assistance
under this title using such regular procedures.
‘‘(bb) A description of differences between the
medical assistance provided under this title and
child health assistance under title XXI, including
differences in cost-sharing requirements and covered
benefits.
‘‘(iii) TEMPORARY ENROLLMENT IN CHIP PENDING SCREEN
AND ENROLL.—
‘‘(I) IN GENERAL.—Under this clause, a State
enrolls a child in child health assistance under title
XXI for a temporary period if the child appears eligible
for such assistance based on an income finding by
an Express Lane agency.
AW
PUBLIC LAW 111–3—FEB. 4, 2009 123 STAT. 43
‘‘(II) DETERMINATION OF ELIGIBILITY.—During such
temporary enrollment period, the State shall determine
the child’s eligibility for child health assistance under
title XXI or for medical assistance under this title
in accordance with this clause.
‘‘(III) PROMPT FOLLOW UP.—In making such a
determination, the State shall take prompt action to
determine whether the child should be enrolled in medical
assistance under this title or child health assistance
under title XXI pursuant to subparagraphs (A)
and (B) of section 2102(b)(3) (relating to screen and
enroll).
‘‘(IV) REQUIREMENT FOR SIMPLIFIED DETERMINATION.—
In making such a determination, the State shall
use procedures that, to the maximum feasible extent,
reduce the burden imposed on the individual of such
determination. Such procedures may not require the
child’s parent, guardian, or custodial relative to provide
or verify information that already has been provided
to the State agency by an Express Lane agency or
another source of information unless the State agency
has reason to believe the information is erroneous.
‘‘(V) AVAILABILITY OF CHIP MATCHING FUNDS
DURING TEMPORARY ENROLLMENT PERIOD.—Medical
assistance for items and services that are provided
to a child enrolled in title XXI during a temporary
enrollment period under this clause shall be treated
as child health assistance under such title.
‘‘(D) OPTION FOR AUTOMATIC ENROLLMENT.—
‘‘(i) IN GENERAL.—The State may initiate and determine
eligibility for medical assistance under the State Medicaid
plan or for child health assistance under the State
CHIP plan without a program application from, or on behalf
of, the child based on data obtained from sources other
than the child (or the child’s family), but a child can only
be automatically enrolled in the State Medicaid plan or
the State CHIP plan if the child or the family affirmatively
consents to being enrolled through affirmation in writing,
by telephone, orally, through electronic signature, or
through any other means specified by the Secretary or
by signature on an Express Lane agency application, if
the requirement of clause (ii) is met.
‘‘(ii) INFORMATION REQUIREMENT.—The requirement of
this clause is that the State informs the parent, guardian,
or custodial relative of the child of the services that will
be covered, appropriate methods for using such services,
premium or other cost sharing charges (if any) that apply,
medical support obligations (under section 1912(a)) created
by enrollment (if applicable), and the actions the parent,
guardian, or relative must take to maintain enrollment
and renew coverage.
‘‘(E) CODING; APPLICATION TO ENROLLMENT ERROR RATES.—
‘‘(i) IN GENERAL.—For purposes of subparagraph (A)(iv),
the requirement of this subparagraph for a State is that
the State agrees to—
‘‘(I) assign such codes as the Secretary shall
require to the children who are enrolled in the State
Procedures.
AW
123 STAT. 44 PUBLIC LAW 111–3—FEB. 4, 2009
Medicaid plan or the State CHIP plan through reliance
on a finding made by an Express Lane agency for
the duration of the State’s election under this paragraph;
‘‘(II) annually provide the Secretary with a statistically
valid sample (that is approved by Secretary)
of the children enrolled in such plans through reliance
on such a finding by conducting a full Medicaid eligibility
review of the children identified for such sample
for purposes of determining an eligibility error rate
(as described in clause (iv)) with respect to the enrollment
of such children (and shall not include such children
in any data or samples used for purposes of
complying with a Medicaid Eligibility Quality Control
(MEQC) review or a payment error rate measurement
(PERM) requirement);
‘‘(III) submit the error rate determined under subclause
(II) to the Secretary;
‘‘(IV) if such error rate exceeds 3 percent for either
of the first 2 fiscal years in which the State elects
to apply this paragraph, demonstrate to the satisfaction
of the Secretary the specific corrective actions
implemented by the State to improve upon such error
rate; and
‘‘(V) if such error rate exceeds 3 percent for any
fiscal year in which the State elects to apply this
paragraph, a reduction in the amount otherwise payable
to the State under section 1903(a) for quarters
for that fiscal year, equal to the total amount of erroneous
excess payments determined for the fiscal year
only with respect to the children included in the sample
for the fiscal year that are in excess of a 3 percent
error rate with respect to such children.
‘‘(ii) NO PUNITIVE ACTION BASED ON ERROR RATE.—
The Secretary shall not apply the error rate derived from
the sample under clause (i) to the entire population of
children enrolled in the State Medicaid plan or the State
CHIP plan through reliance on a finding made by an
Express Lane agency, or to the population of children
enrolled in such plans on the basis of the State’s regular
procedures for determining eligibility, or penalize the State
on the basis of such error rate in any manner other than
the reduction of payments provided for under clause (i)(V).
‘‘(iii) RULE OF CONSTRUCTION.—Nothing in this paragraph
shall be construed as relieving a State that elects
to apply this paragraph from being subject to a penalty
under section 1903(u), for payments made under the State
Medicaid plan with respect to ineligible individuals and
families that are determined to exceed the error rate permitted
under that section (as determined without regard
to the error rate determined under clause (i)(II)).
‘‘(iv) ERROR RATE DEFINED.—In this subparagraph, the
term ‘error rate’ means the rate of erroneous excess payments
for medical assistance (as defined in section
1903(u)(1)(D)) for the period involved, except that such
payments shall be limited to individuals for which eligibility
determinations are made under this paragraph and
Submission.
Deadline.
Statistics.
W
PUBLIC LAW 111–3—FEB. 4, 2009 123 STAT. 45
except that in applying this paragraph under title XXI,
there shall be substituted for references to provisions of
this title corresponding provisions within title XXI.
‘‘(F) EXPRESS LANE AGENCY.—
‘‘(i) IN GENERAL.—In this paragraph, the term ‘Express
Lane agency’ means a public agency that—
‘‘(I) is determined by the State Medicaid agency
or the State CHIP agency (as applicable) to be capable
of making the determinations of one or more eligibility
requirements described in subparagraph (A)(i);
‘‘(II) is identified in the State Medicaid plan or
the State CHIP plan; and
‘‘(III) notifies the child’s family—
‘‘(aa) of the information which shall be disclosed
in accordance with this paragraph;
‘‘(bb) that the information disclosed will be
used solely for purposes of determining eligibility
for medical assistance under the State Medicaid
plan or for child health assistance under the State
CHIP plan; and
‘‘(cc) that the family may elect to not have
the information disclosed for such purposes; and
‘‘(IV) enters into, or is subject to, an interagency
agreement to limit the disclosure and use of the
information disclosed.
‘‘(ii) INCLUSION OF SPECIFIC PUBLIC AGENCIES.—Such
term includes the following:
‘‘(I) A public agency that determines eligibility for
assistance under any of the following:
‘‘(aa) The temporary assistance for needy families
program funded under part A of title IV.
‘‘(bb) A State program funded under part D
of title IV.
‘‘(cc) The State Medicaid plan.
‘‘(dd) The State CHIP plan.
‘‘(ee) The Food and Nutrition Act of 2008 (7
U.S.C. 2011 et seq.).
‘‘(ff) The Head Start Act (42 U.S.C. 9801 et
seq.).
‘‘(gg) The Richard B. Russell National School
Lunch Act (42 U.S.C. 1751 et seq.).
‘‘(hh) The Child Nutrition Act of 1966 (42
U.S.C. 1771 et seq.).
‘‘(ii) The Child Care and Development Block
Grant Act of 1990 (42 U.S.C. 9858 et seq.).
‘‘(jj) The Stewart B. McKinney Homeless
Assistance Act (42 U.S.C. 11301 et seq.).
‘‘(kk) The United States Housing Act of 1937
(42 U.S.C. 1437 et seq.).
‘‘(ll) The Native American Housing Assistance
and Self-Determination Act of 1996 (25 U.S.C.
4101 et seq.).
‘‘(II) A State-specified governmental agency that
has fiscal liability or legal responsibility for the
accuracy of the eligibility determination findings relied
on by the State.
W
123 STAT. 46 PUBLIC LAW 111–3—FEB. 4, 2009
‘‘(III) A public agency that is subject to an interagency
agreement limiting the disclosure and use of
the information disclosed for purposes of determining
eligibility under the State Medicaid plan or the State
CHIP plan.
‘‘(iii) EXCLUSIONS.—Such term does not include an
agency that determines eligibility for a program established
under the Social Services Block Grant established under
title XX or a private, for-profit organization.
‘‘(iv) RULES OF CONSTRUCTION.—Nothing in this paragraph
shall be construed as—
‘‘(I) exempting a State Medicaid agency from complying
with the requirements of section 1902(a)(4)
relating to merit-based personnel standards for
employees of the State Medicaid agency and safeguards
against conflicts of interest); or
‘‘(II) authorizing a State Medicaid agency that
elects to use Express Lane agencies under this
subparagraph to use the Express Lane option to avoid
complying with such requirements for purposes of
making eligibility determinations under the State Medicaid
plan.
‘‘(v) ADDITIONAL DEFINITIONS.—In this paragraph:
‘‘(I) STATE.—The term ‘State’ means 1 of the 50
States or the District of Columbia.
‘‘(II) STATE CHIP AGENCY.—The term ‘State CHIP
agency’ means the State agency responsible for administering
the State CHIP plan.
‘‘(III) STATE CHIP PLAN.—The term ‘State CHIP
plan’ means the State child health plan established
under title XXI and includes any waiver of such plan.
‘‘(IV) STATE MEDICAID AGENCY.—The term ‘State
Medicaid agency’ means the State agency responsible
for administering the State Medicaid plan.
‘‘(V) STATE MEDICAID PLAN.—The term ‘State Medicaid
plan’ means the State plan established under
title XIX and includes any waiver of such plan.
‘‘(G) CHILD DEFINED.—For purposes of this paragraph, the
term ‘child’ means an individual under 19 years of age, or,
at the option of a State, such higher age, not to exceed 21
years of age, as the State may elect.
‘‘(H) STATE OPTION TO RELY ON STATE INCOME TAX DATA
OR RETURN.—At the option of the State, a finding from an
Express Lane agency may include gross income or adjusted
gross income shown by State income tax records or returns.
‘‘(I) APPLICATION.—This paragraph shall not apply with
respect to eligibility determinations made after September 30,
2013.’’.
(2) CHIP.—Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)) is
amended by redesignating subparagraphs (B), (C), and (D) as
subparagraphs (C), (D), and (E), respectively, and by inserting
after subparagraph (A) the following new subparagraph:
‘‘(B) Section 1902(e)(13) (relating to the State option
to rely on findings from an Express Lane agency to help
evaluate a child’s eligibility for medical assistance).’’.
(b) EVALUATION AND REPORT.—
W
PUBLIC LAW 111–3—FEB. 4, 2009 123 STAT. 47
(1) EVALUATION.—The Secretary shall conduct, by grant,
contract, or interagency agreement, a comprehensive, independent
evaluation of the option provided under the amendments
made by subsection (a). Such evaluation shall include
an analysis of the effectiveness of the option, and shall
include—
(A) obtaining a statistically valid sample of the children
who were enrolled in the State Medicaid plan or the State
CHIP plan through reliance on a finding made by an
Express Lane agency and determining the percentage of
children who were erroneously enrolled in such plans;
(B) determining whether enrolling children in such
plans through reliance on a finding made by an Express
Lane agency improves the ability of a State to identify
and enroll low-income, uninsured children who are eligible
but not enrolled in such plans;
(C) evaluating the administrative costs or savings
related to identifying and enrolling children in such plans
through reliance on such findings, and the extent to which
such costs differ from the costs that the State otherwise
would have incurred to identify and enroll low-income,
uninsured children who are eligible but not enrolled in
such plans; and
(D) any recommendations for legislative or administrative
changes that would improve the effectiveness of
enrolling children in such plans through reliance on such
findings.
(2) REPORT TO CONGRESS.—Not later than September 30,
2012, the Secretary shall submit a report to Congress on the
results of the evaluation under paragraph (1).
(3) FUNDING.—
(A) IN GENERAL.—Out of any funds in the Treasury
not otherwise appropriated, there is appropriated to the
Secretary to carry out the evaluation under this subsection
$5,000,000 for the period of fiscal years 2009 through 2012.
(B) BUDGET AUTHORITY.—Subparagraph (A) constitutes
budget authority in advance of appropriations Act and represents
the obligation of the Federal Government to provide
for the payment of such amount to conduct the evaluation
under this subsection.
(c) ELECTRONIC TRANSMISSION OF INFORMATION.—Section 1902
(42 U.S.C. 1396a) is amended by adding at the end the following
new subsection:
‘‘(dd) ELECTRONIC TRANSMISSION OF INFORMATION.—If the State
agency determining eligibility for medical assistance under this
title or child health assistance under title XXI verifies an element
of eligibility based on information from an Express Lane Agency
(as defined in subsection (e)(13)(F)), or from another public agency,
then the applicant’s signature under penalty of perjury shall not
be required as to such element. Any signature requirement for
an application for medical assistance may be satisfied through
an electronic signature, as defined in section 1710(1) of the Government
Paperwork Elimination Act (44 U.S.C. 3504 note). The requirements
of subparagraphs (A) and (B) of section 1137(d)(2) may
be met through evidence in digital or electronic form.’’.
(d) AUTHORIZATION OF INFORMATION DISCLOSURE.—
Recommendations.
Statistics.
Grants.
Contracts.
W
123 STAT. 48 PUBLIC LAW 111–3—FEB. 4, 2009
(1) IN GENERAL.—Title XIX is amended by adding at the
end the following new section:
‘‘SEC. 1942. AUTHORIZATION TO RECEIVE RELEVANT INFORMATION.
‘‘(a) IN GENERAL.—Notwithstanding any other provision of law,
a Federal or State agency or private entity in possession of the
sources of data directly relevant to eligibility determinations under
this title (including eligibility files maintained by Express Lane
agencies described in section 1902(e)(13)(F), information described
in paragraph (2) or (3) of section 1137(a), vital records information
about births in any State, and information described in sections
453(i) and 1902(a)(25)(I)) is authorized to convey such data or
information to the State agency administering the State plan under
this title, to the extent such conveyance meets the requirements
of subsection (b).
‘‘(b) REQUIREMENTS FOR CONVEYANCE.—Data or information
may be conveyed pursuant to subsection (a) only if the following
requirements are met:
‘‘(1) The individual whose circumstances are described in
the data or information (or such individual’s parent, guardian,
caretaker relative, or authorized representative) has either provided
advance consent to disclosure or has not objected to
disclosure after receiving advance notice of disclosure and a
reasonable opportunity to object.
‘‘(2) Such data or information are used solely for the purposes
of—
‘‘(A) identifying individuals who are eligible or potentially
eligible for medical assistance under this title and
enrolling or attempting to enroll such individuals in the
State plan; and
‘‘(B) verifying the eligibility of individuals for medical
assistance under the State plan.
‘‘(3) An interagency or other agreement, consistent with
standards developed by the Secretary—
‘‘(A) prevents the unauthorized use, disclosure, or modification
of such data and otherwise meets applicable Federal
requirements safeguarding privacy and data security;
and
‘‘(B) requires the State agency administering the State
plan to use the data and information obtained under this
section to seek to enroll individuals in the plan.
‘‘(c) PENALTIES FOR IMPROPER DISCLOSURE.—
‘‘(1) CIVIL MONEY PENALTY.—A private entity described in
the subsection (a) that publishes, discloses, or makes known
in any manner, or to any extent not authorized by Federal
law, any information obtained under this section is subject
to a civil money penalty in an amount equal to $10,000 for
each such unauthorized publication or disclosure. The provisions
of section 1128A (other than subsections (a) and (b) and
the second sentence of subsection (f)) shall apply to a civil
money penalty under this paragraph in the same manner as
such provisions apply to a penalty or proceeding under section
1128A(a).
‘‘(2) CRIMINAL PENALTY.—A private entity described in the
subsection (a) that willfully publishes, discloses, or makes
known in any manner, or to any extent not authorized by
Federal law, any information obtained under this section shall
Applicability.
42 USC 1396w–2
note.
6580 W
PUBLIC LAW 111–3—FEB. 4, 2009 123 STAT. 49
be fined not more than $10,000 or imprisoned not more than
1 year, or both, for each such unauthorized publication or
disclosure.
‘‘(d) RULE OF CONSTRUCTION.—The limitations and requirements
that apply to disclosure pursuant to this section shall not
be construed to prohibit the conveyance or disclosure of data or
information otherwise permitted under Federal law (without regard
to this section).’’.
(2) CONFORMING AMENDMENT TO TITLE XXI.—Section
2107(e)(1) (42 U.S.C. 1397gg(e)(1)), as amended by subsection
(a)(2), is amended by adding at the end the following new
subparagraph:
‘‘(F) Section 1942 (relating to authorization to receive
data directly relevant to eligibility determinations).’’.
(3) CONFORMING AMENDMENT TO PROVIDE ACCESS TO DATA
ABOUT ENROLLMENT IN INSURANCE FOR PURPOSES OF EVALUATING
APPLICATIONS AND FOR CHIP.—Section 1902(a)(25)(I)(i)
(42 U.S.C. 1396a(a)(25)(I)(i)) is amended—
(A) by inserting ‘‘(and, at State option, individuals
who apply or whose eligibility for medical assistance is
being evaluated in accordance with section 1902(e)(13)(D))’’
after ‘‘with respect to individuals who are eligible’’; and
(B) by inserting ‘‘under this title (and, at State option,
child health assistance under title XXI)’’ after ‘‘the State
plan’’.
(e) AUTHORIZATION FOR STATES ELECTING EXPRESS LANE
OPTION TO RECEIVE CERTAIN DATA DIRECTLY RELEVANT TO DETERMINING
ELIGIBILITY AND CORRECT AMOUNT OF ASSISTANCE.—The
Secretary shall enter into such agreements as are necessary to
permit a State that elects the Express Lane option under section
1902(e)(13) of the Social Security Act to receive data directly relevant
to eligibility determinations and determining the correct
amount of benefits under a State child health plan under CHIP
or a State plan under Medicaid from the following:
(1) The National Directory of New Hires established under
section 453(i) of the Social Security Act (42 U.S.C. 653(i)).
(2) Data regarding enrollment in insurance that may help
to facilitate outreach and enrollment under the State Medicaid
plan, the State CHIP plan, and such other programs as the
Secretary may specify.
(f) EFFECTIVE DATE.—The amendments made by this section
are effective on the date of the enactment of this Act.
W
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Kristina Rall |
| File Modified | 0000-00-00 |
| File Created | 2021-01-30 |