S 448 IS 108th CONGRESS 1st Session S. 448 To leave no child behind. IN THE SENATE OF THE UNITED STATES February 26, 2003 Mr. DODD (for himself, Mr. KENNEDY, and Mr. DAYTON) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To leave no child behind. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE. This Act may be cited as the `Leave No Child Behind Act of 2003'. SEC. 2. TABLE OF CONTENTS. The table of contents for this Act is as follows: TITLE I--HEALTHY START--CHILDREN'S HEALTH INSURANCE Subtitle A--Children's Health Insurance Sec. 1001. Medikids health insurance. Sec. 1002. Benefits for all children born after 2002. Sec. 1003. Medikids premium. Sec. 1004. Refundable credit for cost-sharing expenses under Medikids program. Sec. 1005. Report on long-term revenues. Subtitle B--Children's Health Insurance Eligibility Expansion and Enrollment Improvements Chapter 1--Eligibility Expansions SUBCHAPTER A--MEDICAID AND SCHIP Sec. 1101. Expansion of children's eligibility for medicaid and SCHIP. Sec. 1102. Optional coverage of legal immigrants under the medicaid program and title XXI. SUBCHAPTER B--FAMILY OPPORTUNITY ACT Sec. 1111. Short title; amendments to Social Security Act. Sec. 1112. Opportunity for families of disabled children to purchase medicaid coverage for such children. Sec. 1113. Treatment of inpatient psychiatric hospital services for individuals under age 21 in home or community-based services waivers. Sec. 1114. Demonstration of coverage under the medicaid program of children with potentially severe disabilities. Sec. 1115. Development and support of family-to-family health information centers. Sec. 1116. Restoration of medicaid eligibility for certain SSI beneficiaries. Chapter 2--Enrollment Improvements Sec. 1121. Application of simplified title XXI procedures under the medicaid program. Sec. 1122. Automatic enrollment of children born to title XXI parents. Chapter 3--Effective Date Sec. 1131. Effective date. Subtitle C--Improving Access to Care Chapter 1--Commission Sec. 1201. Commission on Children's Access To Care. Chapter 2--Children's Health Insurance Accountability Sec. 1211. Short title. Sec. 1212. Findings. Sec. 1213. Amendments to the Public Health Service Act. Sec. 1214. Amendments to the employee retirement income security act of 1974. Sec. 1215. Studies. Sec. 1216. Effective dates. Chapter 3--EPSDT Sec. 1221. Collection of data regarding the delivery of EPSDT services. Subtitle D--Reducing Public Health Risks Chapter 1--Asthma Treatments Sec. 1301. Findings. Sec. 1302. Asthma, vision, and hearing screening for Early Head Start and Head Start Programs. Sec. 1303. Asthma, vision, and hearing screening and treatment for children enrolled in public schools. Sec. 1304. General effective date. Chapter 2--Increase in Funding for HUD Programs Sec. 1311. Lead-based paint hazard control grants. Sec. 1312. Healthy homes initiative program. Chapter 3--Youth Smoking Cessation and Education Sec. 1321. Short title. SUBCHAPTER A--PROTECTION OF CHILDREN FROM TOBACCO Part I--Food and Drug Administration Jurisdiction and General Authority Sec. 1331. Reference. Sec. 1332. Statement of general authority. Sec. 1333. Nonapplicability to other drugs or devices. Sec. 1334. Conforming amendments to confirm jurisdiction. Sec. 1335. General rule. Sec. 1336. Safety and efficacy standard and recall authority. Part II--Regulation of Tobacco Products Sec. 1341. Performance standards. Sec. 1342. Application of Federal Food, Drug, and Cosmetic Act to tobacco products. Sec. 1343. Funding. Sec. 1344. Repeals. SUBCHAPTER B--MISCELLANEOUS PROVISIONS Sec. 1351. Nonapplication to tobacco producers. Sec. 1352. Equal treatment of retail outlets. Chapter 4--Coverage of Childhood Immunizations Sec. 1361. Short title. Sec. 1362. Amendments to the Employee Retirement Income Security Act of 1974. Sec. 1363. Amendments to the Public Health Service Act. Sec. 1364. Amendments to the Internal Revenue Code of 1986. Sec. 1365. Effective dates. Subtitle E--Reducing Environmental Health Risks Chapter 1--Environmental Protection of Children Sec. 1401. Short title. Sec. 1402. Environmental protection for children and other vulnerable subpopulations. Sec. 1403. Conforming amendment. Sec. 1413. Conforming amendment. Sec. 1414. Effective date. TITLE II--HEALTHY START--SUPPORT FOR HEALTHY DEVELOPMENT Subtitle A--Promotion of State and Local Support Sec. 2001. State and local parenting support and education grant program. Subtitle B--Family and Medical Leave Expansion Sec. 2101. Short title. Sec. 2102. Findings. Chapter 1--Family Income to Respond to Significant Transitions Sec. 2111. Short title. Sec. 2112. Purposes. Sec. 2113. Definitions. Sec. 2114. Demonstration projects. Sec. 2115. Notification. Sec. 2116. Evaluations and reports. Sec. 2117. Authorization of appropriations. Sec. 2118. Technical and conforming amendments. Chapter 2--Family Friendly Workplaces Sec. 2121. Short title. Sec. 2122. Coverage of employees. Chapter 3--Employment Protection for Battered Women Sec. 2131. Entitlement to leave for addressing domestic violence for non-Federal employees. Sec. 2132. Entitlement to leave for addressing domestic violence for Federal employees. Sec. 2133. Existing leave usable for domestic violence. Chapter 4--Federal Employees Paid Parental Leave Sec. 2141. Short title. Sec. 2142. Demonstration project. Sec. 2143. Technical and conforming amendments. Sec. 2144. Effective date. Chapter 5--Time for Schools Sec. 2151. Short title. Sec. 2152. General requirements for leave. Sec. 2153. School involvement leave for civil service employees. Sec. 2154. Effective date. Subtitle C--Health Care for the Uninsured Sec. 2201. Familycare coverage of parents under the medicaid program and title XXI. Subtitle D--Awareness of Environmental Risks to Children Sec. 2301. Short title. Sec. 2302. Finding. Chapter 1--Children's Environmental Protection SUBCHAPTER A--DISCLOSURE OF INDUSTRIAL RELEASES THAT PRESENT A SIGNIFICANT RISK TO CHILDREN Sec. 2311. Reporting requirements. SUBCHAPTER B--DISCLOSURE OF HIGH HEALTH RISK CHEMICALS IN CHILDREN'S CONSUMER PRODUCTS Sec. 2321. List of toxic chemicals. Sec. 2322. Reporting of toxic chemicals in consumer products. Sec. 2323. Exemptions. Sec. 2324. Private citizen enforcement. Chapter 2--Public Right To Know About Toxic Chemical Use Sec. 2331. Disclosure of toxic chemical use by comparable facilities. Sec. 2332. Disclosure of toxic chemical use. Sec. 2333. Streamlined data collection and dissemination. Sec. 2334. Trade secret protection. Subtitle E--Promoting Responsible Fatherhood Chapter 1--Block Grants Sec. 2401. Block grants to States to encourage media campaigns. Sec. 2402. Responsible fatherhood block grant. Chapter 2--National Clearinghouse Sec. 2411. National clearinghouse for responsible fatherhood programs. TITLE III--HEAD START AND CHILD CARE Subtitle A--Infants and Toddlers Sec. 3001. Reservation of Head Start Act funds for infants and toddlers. Sec. 3002. Reservation of child care and development block grant funds for infants and toddlers. Subtitle B--Child Care Access Chapter 1--Improving Access to Child Care Sec. 3011. Incentive grants to States. Sec. 3012. Payment rates. Chapter 2--Improvements in Access to Child Care Sec. 3111. Goals. Sec. 3112. Authorization of appropriations. Sec. 3113. State plan requirements. Sec. 3114. Funds for indian tribes. Sec. 3115. Definitions. Subtitle C--Child Care Quality Improvement Chapter 1--Focus on Committed and Underpaid Staff for Children's Sake Sec. 3201. Short title. Sec. 3202. Findings and purpose. Sec. 3203. Definitions. Sec. 3204. Funds for child care provider development and retention grants and for child care provider scholarships. Sec. 3205. Allotments to States. Sec. 3206. Application and plan. Sec. 3207. Child care provider development and retention grant program. Sec. 3208. Child care provider scholarship program. Sec. 3209. Annual report. Sec. 3210. Authorization of appropriations. Chapter 2--Strengthening Quality Through the Child Care and Development Block Grant Sec. 3231. State plan. Sec. 3232. Child care quality improvements. Sec. 3233. Administration and enforcement. Chapter 3--Child Care Centers in Federal Facilities Sec. 3241. Short title. Sec. 3242. Definitions. Sec. 3243. Providing quality child care in Federal facilities. Sec. 3244. Federal child care evaluation. Sec. 3245. Child care services for Federal employees. Sec. 3246. Miscellaneous provisions relating to child care provided by Federal agencies. Chapter 4--Early Learning Sec. 3251. Amendments to the Early Learning Opportunities Act. Chapter 5--Child Care Facilities Financing Sec. 3261. Short title. Sec. 3262. Technical and financial assistance grants. Subtitle D--Head Start Access and Improvement Sec. 3301. Authorization of appropriations. Subtitle E--Education Improvements Chapter 1--Increasing Access to Quality Prekindergarten Programs Sec. 3401. Prekindergarten programs. Chapter 2--Increasing the Availability of Books Sec. 3411. Short title. Sec. 3412. Findings. Sec. 3413. Definitions. Sec. 3414. Grants to State agencies. Sec. 3415. Contracts to child care resource and referral agencies. Sec. 3416. Use of funds. Sec. 3417. Report to Congress. Sec. 3418. Special postage stamps for child literacy. Sec. 3419. Authorization of appropriations. Chapter 3--Quality Teaching and Leadership SUBCHAPTER A--AMENDMENT TO TITLE II OF THE ELEMENTARY AND SECONDARY EDUCATION ACT OF 1965 Sec. 3421. Amendments to title II. SUBCHAPTER B--NATIONAL BOARD CERTIFICATION PROGRAM Sec. 3431. Purpose. Sec. 3432. Grants to expand participation in the national board certification program. SUBCHAPTER C--STUDENT LOAN FORGIVENESS FOR TEACHERS Sec. 3441. Student loan forgiveness for teachers. Chapter 4--School Construction SUBCHAPTER A--SCHOOL MODERNIZATION BONDS Sec. 3451. Short title. Sec. 3452. Expansion of incentives for public schools. Sec. 3453. Application of certain labor standards on construction projects financed under public school modernization program. SUBCHAPTER B--SCHOOLS AS CENTERS OF THE COMMUNITY Sec. 3461. Findings. Sec. 3462. Purpose. Sec. 3463. Program authorized. Sec. 3464. Use of funds. Sec. 3465. Applications. Sec. 3466. Authorization of appropriations. Chapter 5--Child Opportunity Zone Family Centers Sec. 3471. Child opportunity zone family centers. TITLE IV--FAIR START--LIFTING CHILDREN OUT OF POVERTY Subtitle A--Expanding the Child Tax Credit Sec. 4001. Expansion of child tax credit; credit made partially refundable. Subtitle B--Strengthening the Earned Income Tax Credit Sec. 4101. Short title. Sec. 4102. Increased earned income tax credit for 2 or more qualifying children. Sec. 4103. Simplification of definition of earned income. Sec. 4104. Simplification of definition of child dependent. Sec. 4105. Modification of joint return requirement for earned income tax credit. Subtitle C--Expanding the Dependent Care Tax Credit Sec. 4201. Dependent care tax credit. TITLE V--FAIR START--SUPPORT TO PROMOTE WORK AND REDUCE POVERTY Subtitle A--Gateways Grant Program Sec. 5001. Gateways grant program. Subtitle B--Support From Both Parents Chapter 1--Child Support Distribution Sec. 5101. Short title. SUBCHAPTER A--DISTRIBUTION OF CHILD SUPPORT Sec. 5111. Distribution of child support collected by States on behalf of children receiving certain welfare benefits. SUBCHAPTER B--REVIEW AND ADJUSTMENT OF CHILD SUPPORT ORDERS Sec. 5116. Mandatory review and modification of child support orders for TANF recipients. SUBCHAPTER C--DEMONSTRATIONS OF EXPANDED INFORMATION AND ENFORCEMENT Sec. 5121. Guidelines for involvement of public non-IV-D child support enforcement agencies in child support enforcement. Sec. 5122. Demonstrations involving establishment and enforcement of child support obligations by public non-IV-D child support enforcement agencies. Sec. 5123. GAO report to Congress on private child support enforcement agencies. Sec. 5124. Effective date. SUBCHAPTER D--EXPANDED ENFORCEMENT Sec. 5126. Decrease in amount of child support arrearage triggering passport denial. Sec. 5127. Use of tax refund intercept program to collect past-due child support on behalf of children who are not minors. Sec. 5128. Garnishment of compensation paid to veterans for service-connected disabilities in order to enforce child support obligations. SUBCHAPTER E--MISCELLANEOUS Sec. 5131. Report on undistributed child support payments. Sec. 5132. Use of new hire information to assist in administration of unemployment compensation programs. Sec. 5133. Immigration provisions. Sec. 5134. Correction of errors in conforming amendments in the Welfare-to-Work and Child Support Amendments of 1999. Sec. 5135. Increase in payment rate to States for expenditures for short-term training of staff of certain child welfare agencies. Sec. 5136. Effective date. Chapter 2--Child Support Demonstration Programs Sec. 5141. Short title. Sec. 5142. Purposes. Sec. 5143. Definitions. Sec. 5144. Establishment of child support assurance demonstration projects. Subtitle C--Fair Wages and Unemployment Insurance Chapter 1--Fair Minimum Wage Sec. 5201. Short title. Sec. 5202. Minimum wage. Sec. 5203. Applicability of minimum wage to the commonwealth of the northern mariana islands. Chapter 2--Livable Wages for Employees Under Federal Contracts Sec. 5211. Short title. Sec. 5212. Findings. Sec. 5213. Poverty level wage. Sec. 5214. Effective date. Chapter 3--Unemployment Insurance Sec. 5221. Parity for part-time workers, fair counting of wages, and use of improved technology for making wage data available. Sec. 5222. Ensuring unemployment compensation for individuals that are separated from employment due to domestic violence. Sec. 5223. Loss of child care as good cause for leaving employment. Subtitle D--Jobs for Low-Income Parents Sec. 5301. Disregard of months engaged in work for purposes of 5-year TANF assistance limit. Sec. 5302. Replacement of caseload reduction credit with employment credit. Sec. 5303. States to receive partial credit toward work participation rate for recipients engaged in part-time work. Sec. 5304. TANF recipients who qualify for supplemental security income benefits removed from work participation rate calculation for entire year. Sec. 5305. Elimination of limit on number of TANF recipients enrolled in vocational education or high school who may be counted towards the work participation requirement. Sec. 5306. Counting of up to 2 years of vocational or educational training (including postsecondary education), work-study, and related internships as work activities. Sec. 5307. Limited counting of certain activities leading to employment as work activity. Sec. 5308. Elimination of separate work participation rate for 2-parent families. Sec. 5309. Addition of poverty reduction bonus to TANF. Sec. 5310. Participation in workforce investment boards. Sec. 5311. Clarification of TANF purpose. Sec. 5312. Effective date. Subtitle E--Incentives To Serve Families Sec. 5401. Development of model caseworker training materials. Sec. 5402. Exception to limit on TANF administrative expenditures for caseworker bonuses and other State initiatives to eliminate barriers to work. Sec. 5403. Strengthening of TANF individual responsibility plans. Sec. 5404. Effective date. Subtitle F--Addressing Work Barriers Sec. 5501. Funding for access to jobs program. Sec. 5502. Requirement to identify and provide services to address barriers to employment of TANF recipients. Sec. 5503. State option to establish exceptions from time limit for receipt of TANF assistance based on severe barriers to employment. Sec. 5504. Effective date. Subtitle G--Protection for Families in Need Sec. 5601. Earn-back of months of TANF assistance. Sec. 5602. Establishment of a fair conciliation process for families under TANF. Sec. 5603. Treatment of aliens under the TANF program. Sec. 5604. Effective date. Subtitle H--TANF Reauthorization Sec. 5701. Reauthorization of TANF State family assistance grants. Sec. 5702. Prohibition on supplantation of TANF funds. TITLE VI--FAIR START Subtitle A--Child and Adult Care Food Program Sec. 6001. Participation of for-profit care centers in child and adult care food program. Sec. 6002. Categorical eligibility requirements. Sec. 6003. Increase in administrative reimbursement rates. Sec. 6004. Program for at-risk school children. Subtitle B--Food Stamp Program Sec. 6101. Restoration of food stamp benefits for qualified aliens. Sec. 6102. Conforming food stamp and medicaid income definitions; simplified income calculations. Sec. 6103. Prevention of hunger among families with children. Sec. 6104. Encouragement of collection of child support. Sec. 6105. Elimination of excess shelter expense deduction cap for families with high shelter costs. Sec. 6106. Periodic redetermination of eligibility. Sec. 6107. Transitional benefits option. Sec. 6108. Improving State incentives to serve working families. TITLE VII--FAIR START HOUSING Subtitle A--Section 8 Vouchers Sec. 7001. Rental assistance voucher program. Sec. 7002. Voucher success fund. Subtitle B--National Affordable Housing Trust Fund Sec. 7101. Purposes. Sec. 7102. National Affordable Housing Trust Fund. Sec. 7103. Administration of National Affordable Housing Trust Fund. Sec. 7104. Regulations. Subtitle C--Housing Preservation Matching Grants Sec. 7201. Short title. Sec. 7202. Findings and purposes. Sec. 7203. Definitions. Sec. 7204. Authority. Sec. 7205. Applications. Sec. 7206. Use of grants. Sec. 7207. Grant amount limitation. Sec. 7208. Matching requirements. Sec. 7209. Treatment of subsidy layering requirements. Sec. 7210. Regulations. Sec. 7211. Authorization of appropriations. TITLE VIII--SAFE START Subtitle A--Promotion of Permanency for Children Sec. 8001. Reimbursement for preventive, protective, crisis, permanency, independent living, and post-permanency services and activities. Sec. 8002. Child and family service plan and case reviews. Sec. 8003. Kinship guardianship assistance payments for children. Sec. 8004. Elimination of financial eligibility requirement for foster care maintenance and adoption assistance payments. Sec. 8005. Establishment of uniform Federal matching rate. Sec. 8006. Elimination of disincentive for foster parents to adopt children with special needs who have been in their foster care. Sec. 8007. Extension of adoption assistance payments. Sec. 8008. Reimbursement for room and board in foster family homes, child care institutions, or supervised living arrangements for young people aging out of foster care. Sec. 8009. Additional accountability. Sec. 8010. Authority of indian tribes to receive Federal funds for foster care and adoption assistance. Subtitle B--Social Services Block Grant Sec. 8101. Short title. Sec. 8102. Findings. Sec. 8103. Restoration of authority to transfer up to 10 percent of TANF funds to the Social Services Block Grant. Sec. 8104. Restoration of funds for the Social Services Block Grant. Sec. 8105. Requirement to submit annual report on State activities. Subtitle C--Child Protection and Alcohol and Drug Partnerships Sec. 8201. Short title. Sec. 8202. Child protection/alcohol and drug partnerships for children. Subtitle D--Permanency Grants Sec. 8301. Establishment of permanency grants program. Subtitle E--Addressing the Needs of Children Exposed to Domestic Violence Sec. 8401. Findings. Sec. 8402. Purpose. Sec. 8403. Amendments to Acts addressing the needs of children exposed to domestic violence. Subtitle F--Enhancing Healthy Emotional Development in Young Children Sec. 8501. Enhancing healthy emotional development. TITLE IX--SUCCESSFUL TRANSITION TO ADULTHOOD Subtitle A--Youth Development Chapter 1--Short Title; Policy; Definitions Sec. 9001. Short title. Sec. 9002. A national youth policy. Sec. 9003. Definitions. Chapter 2--Grants for State and Community Programs Sec. 9101. Purpose. Sec. 9102. Authorization of appropriations. Sec. 9103. Allotments to States. Sec. 9104. State youth development agencies and youth development areas. Sec. 9105. State youth development plans. Sec. 9106. Distribution of funds for State activities and area allocations. Sec. 9107. Youth development consortia. Sec. 9108. Area youth development plans. Sec. 9109. Grants and contracts to eligible entities. Sec. 9110. Eligible entities. Sec. 9111. Applications. Sec. 9112. Youth development programs. Chapter 3--Accountability Sec. 9201. Purposes. Sec. 9202. Federal level accountability. Sec. 9203. State level accountability. Sec. 9204. Local level accountability. Sec. 9205. State audit. Chapter 4--Training, Research, and Evaluation Sec. 9301. Purpose. Sec. 9302. Grants and contracts. Sec. 9303. Authorization of appropriations. Subtitle E--Coordination of National Youth Policy Sec. 9401. Coordinating Council for National Youth Policy. Subtitle B--Youth Programs Sec. 9201. Americorps. Sec. 9202. Youthbuild program. Sec. 9203. Youth workforce investment activities. Sec. 9204. Transition training for reintegrating youth offenders. TITLE X--SAFE START--JUVENILE JUSTICE Subtitle A--Juvenile Delinquency Prevention and Protection Sec. 10001. Definition of juvenile. Sec. 10002. State plan allocation. Sec. 10003. State plan requirements. Subtitle B--Mental Health Juvenile Justice Sec. 10101. Short title. Sec. 10102. Training of justice system personnel. Sec. 10103. Block grant funding for treatment and diversion programs. Sec. 10104. Initiative for comprehensive, intersystem programs. Sec. 10105. Federal Coordinating Council on the Criminalization of Juveniles With Mental Disorders. Sec. 10106. Mental health screening and treatment for prisoners. Sec. 10107. Inapplicability of amendments. Subtitle C--Juvenile Justice and Accountability Sec. 10201. Increase in funding for title III of the JJDPA. Sec. 10202. Funding for the services for youthful offenders. TITLE XI--SAFE START--GUN SAFETY Subtitle A--Closing the Gun Show Loophole Sec. 11001. Extension of Brady background checks to gun shows. Subtitle B--Child Safety Locks Sec. 11101. Requirement of child handgun safety locks. Subtitle C--Unlawful Weapons Transfers Sec. 11201. Unlawful weapons transfers to juveniles. Subtitle D--Large Capacity Ammunition Feeding Devices Sec. 11301. Ban on importing large capacity ammunition feeding devices. Subtitle E--Enforcement of Gun Laws Sec. 11401. Enhance enforcement of gun violence laws. Subtitle F--Miscellaneous Sec. 11501. Study of marketing practices of the firearms industry. Sec. 11502. Regulation of internet firearms transfers. Sec. 11503. Reduction of gun trafficking. TITLE XII--MISCELLANEOUS Sec. 12001. Advisory Committee on Private Sector Support for Children and Families. Sec. 12002. Improvement of data collection and reporting regarding children and families. TITLE I--HEALTHY START--CHILDREN'S HEALTH INSURANCE Subtitle A--Children's Health Insurance SEC. 1001. MEDIKIDS HEALTH INSURANCE. (a) SHORT TITLE OF SUBTITLE- This subtitle may be cited as the `MediKids Health Insurance Act of 2003'. (b) FINDINGS- Congress finds the following: (1) More than 11 million American children are uninsured. (2) Children who are uninsured receive less medical care and less preventive care and have a poorer level of health, which result in lifetime costs to themselves and to the entire American economy. (3) Although SCHIP and Medicaid are successfully extending a health coverage safety net to a growing portion of the vulnerable low-income population of uninsured children, we now see that they alone cannot achieve 100 percent health insurance coverage for our nation's children due to inevitable gaps during outreach and enrollment, fluctuations in eligibility, and variations in access to private insurance at all income levels. (4) As all segments of our society continue to become more and more transient, with many changes in employment over the working lifetime of parents, the need for a reliable safety net of health insurance which follows children across State lines, already a major problem for the children of migrant and seasonal farmworkers, will become a major concern for all families in the United States. (5) The Medicare program has successfully evolved over the years to provide a stable, universal source of health insurance for the nation's disabled and those over age 65, and therefore provides a tested model for designing a program to reach out to America's children. (6) The problem of insuring 100 percent of all American children could be gradually solved by automatically enrolling all children born after December 31, 2004, in a program modeled after Medicare (and to be known as `MediKids'), and allowing those children to be transferred into other equivalent or better insurance programs, including either private insurance, SCHIP, or Medicaid, if they are eligible to do so, but maintaining the child's default enrollment in MediKids for any times when the child's access to other sources of insurance is lost. (7) A family's freedom of choice to use other insurers to cover children would not be interfered with in any way, and children eligible for SCHIP and Medicaid would continue to be enrolled in those programs, but the underlying safety net of MediKids would always be available to cover any gaps in insurance due to changes in medical condition, employment, income, or marital status, or other changes affecting a child's access to alternate forms of insurance. (8) The MediKids program can be administered without impacting the finances or status of the existing Medicare program. (9) The MediKids benefit package can be tailored to the special needs of children and updated over time. (10) The financing of the program can be administered without difficulty by a yearly payment of affordable premiums through a family's tax filing (or adjustment of a family's earned income tax credit). (11) The cost of the program will gradually rise as the number of children using MediKids as the insurer of last resort increases, and a future Congress always can accelerate or slow down the enrollment process as desired, while the societal costs for emergency room usage, lost productivity and work days, and poor health status for the next generation of Americans will decline. (12) Over time 100 percent of American children will always have basic health insurance, and we can therefore expect a healthier, more equitable, and more productive society. SEC. 1002. BENEFITS FOR ALL CHILDREN BORN AFTER 2002. (a) IN GENERAL- The Social Security Act is amended by adding at the end the following new title: `TITLE XXII--MEDIKIDS PROGRAM `SEC. 2201. ELIGIBILITY. `(a) ELIGIBILITY OF INDIVIDUALS BORN AFTER DECEMBER 31, 2004; ALL CHILDREN UNDER 23 YEARS OF AGE IN SIXTH YEAR- An individual who meets the following requirements with respect to a month is eligible to enroll under this title with respect to such month: `(1) AGE- `(A) FIRST YEAR- During the first year in which this title is effective, the individual has not attained 6 years of age. `(B) SECOND YEAR- During the second year in which this title is effective, the individual has not attained 11 years of age. `(C) THIRD YEAR- During the third year in which this title is effective, the individual has not attained 16 years of age. `(D) FOURTH YEAR- During the fourth year in which this title is effective, the individual has not attained 21 years of age. `(E) FIFTH AND SUBSEQUENT YEARS- During the fifth year in which this title is effective and each subsequent year, the individual has not attained 23 years of age. `(2) CITIZENSHIP- The individual is a citizen or national of the United States or is lawfully residing in the United States. `(b) ENROLLMENT PROCESS- An individual may enroll in the program established under this title only in such manner and form as may be prescribed by regulations, and only during an enrollment period prescribed by the Secretary consistent with the provisions of this section. Such regulations shall provide a process under which-- `(1) individuals who are born in the United States after December 31, 2002, are deemed to be enrolled at the time of birth and a parent or guardian of such an individual is permitted to pre-enroll in the month prior to the expected month of birth; `(2) individuals who are born outside the United States after such date and who become eligible to enroll by virtue of immigration into (or an adjustment of immigration status in) the United States are deemed enrolled at the time of entry or adjustment of status; `(3) eligible individuals may otherwise be enrolled at such other times and manner as the Secretary shall specify, including the use of outstationed eligibility sites as described in section 1902(a)(55)(A) and the use of presumptive eligibility provisions like those described in section 1920A; and `(4) at the time of automatic enrollment of a child, the Secretary provides for issuance to a parent or custodian of the individual a card evidencing coverage under this title and for a description of such coverage. The provisions of section 1837(h) apply with respect to enrollment under this title in the same manner as they apply to enrollment under part B of title XVIII. `(c) DATE COVERAGE BEGINS- `(1) IN GENERAL- The period during which an individual is entitled to benefits under this title shall begin as follows, but in no case earlier than January 1, 2005: `(A) In the case of an individual who is enrolled under paragraph (1) or (2) of subsection (b), the date of birth or date of obtaining appropriate citizenship or immigration status, as the case may be. `(B) In the case of an another individual who enrolls (including pre-enrolls) before the month in which the individual satisfies eligibility for enrollment under subsection (a), the first day of such month of eligibility. `(C) In the case of an another individual who enrolls during or after the month in which the individual first satisfies eligibility for enrollment under such subsection, the first day of the following month. `(2) AUTHORITY TO PROVIDE FOR PARTIAL MONTHS OF COVERAGE- Under regulations, the Secretary may, in the Secretary's discretion, provide for coverage periods that include portions of a month in order to avoid lapses of coverage. `(3) LIMITATION ON PAYMENTS- No payments may be made under this title with respect to the expenses of an individual enrolled under this title unless such expenses were incurred by such individual during a period which, with respect to the individual, is a coverage period under this section. `(d) EXPIRATION OF ELIGIBILITY- An individual's coverage period under this part shall continue until the individual's enrollment has been terminated because the individual no longer meets the requirements of subsection (a) (whether because of age or change in immigration status). `(e) ENTITLEMENT TO MEDIKIDS BENEFITS FOR ENROLLED INDIVIDUALS- An individual enrolled under this section is entitled to the benefits described in section 2202. `(f) LOW-INCOME INFORMATION- At the time of enrollment of a child under this title, the Secretary shall make an inquiry as to whether or not the family income of the family that includes the child is less than 150 percent of the poverty line for a family of the size involved. If the family income is below such level, the Secretary shall encode in the identification card issued in connection with eligibility under this title a code indicating such fact. The Secretary also shall provide for a toll-free telephone line at which providers can verify whether or not such a child is in a family the income of which is below such level. `(g) CONSTRUCTION- Nothing in this title shall be construed as requiring (or preventing) an individual who is enrolled under this section from seeking medical assistance under a State medicaid plan under title XIX or child health assistance under a State child health plan under title XXI. `SEC. 2202. BENEFITS. `(a) SECRETARIAL SPECIFICATION OF BENEFIT PACKAGE- `(1) IN GENERAL- The Secretary shall specify the benefits to be made available under this title consistent with the provisions of this section and in a manner designed to meet the health needs of children. `(2) UPDATING- The Secretary shall update the specification of benefits over time to ensure the inclusion of age-appropriate benefits as the enrollee population gets older. `(3) ANNUAL UPDATING- The Secretary shall establish procedures for the annual review and updating of such benefits to account for changes in medical practice, new information from medical research, and other relevant developments in health science. `(4) INPUT- The Secretary shall seek the input of the pediatric community in specifying and updating such benefits. `(5) LIMITATION ON UPDATING- In no case shall updating of benefits under this subsection result in a failure to provide benefits required under subsection (b). `(b) INCLUSION OF CERTAIN BENEFITS- `(1) MEDICARE CORE BENEFITS- Such benefits shall include (to the extent consistent with other provisions of this section) at least the same benefits (including coverage, access, availability, duration, and beneficiary rights) that are available under parts A and B of title XVIII. `(2) ALL REQUIRED MEDICAID BENEFITS- Such benefits shall also include all items and services for which medical assistance is required to be provided under section 1902(a)(10)(A) to individuals described in such section, including early and periodic screening, diagnostic services, and treatment services. `(3) INCLUSION OF PRESCRIPTION DRUGS- Such benefits also shall include (as specified by the Secretary) prescription drugs and biologicals. `(4) COST-SHARING- `(A) IN GENERAL- Subject to subparagraph (B), such benefits also shall include the cost-sharing (in the form of deductibles, coinsurance, and copayments) applicable under title XVIII with respect to comparable items and services, except that no cost-sharing shall be imposed with respect to early and periodic screening and diagnostic services included under paragraph (2). `(B) NO COST-SHARING FOR LOWEST INCOME CHILDREN- Such benefits shall not include any cost-sharing for children in families the income of which (as determined for purposes of section 1905(p)) does not exceed 150 percent of the official income poverty line (referred to in such section) applicable to a family of the size involved. `(C) REFUNDABLE CREDIT FOR COST-SHARING FOR OTHER LOW-INCOME CHILDREN- For a refundable credit for cost-sharing in the case of children in certain families, see section 35A of the Internal Revenue Code of 1986. `(c) PAYMENT SCHEDULE- The Secretary, with the assistance of the Medicare Payment Advisory Commission, shall develop and implement a payment schedule for benefits covered under this title. To the extent feasible, such payment schedule shall be consistent with comparable payment schedules and reimbursement methodologies applied under parts A and B of title XVIII. `(d) INPUT- The Secretary shall specify such benefits and payment schedules only after obtaining input from appropriate child health providers and experts. `(e) ENROLLMENT IN HEALTH PLANS- The Secretary shall provide for the offering of benefits under this title through enrollment in a health benefit plan that meets the same (or similar) requirements as the requirements that apply to Medicare+Choice plans under part C of title XVIII. In the case of individuals enrolled under this title in such a plan, the Medicare+Choice capitation rate described in section 1853(c) shall be adjusted in an appropriate manner to reflect differences between the population served under this title and the population under title XVIII. `SEC. 2203. PREMIUMS. `(a) AMOUNT OF MONTHLY PREMIUMS- `(1) IN GENERAL- The Secretary shall, during September of each year (beginning with 2004), establish a monthly MediKids premium. Subject to paragraph (2), the monthly MediKids premium for a year is equal to 1/12 of the annual premium rate computed under subsection (b). `(2) ELIMINATION OF MONTHLY PREMIUM FOR DEMONSTRATION OF EQUIVALENT COVERAGE (INCLUDING COVERAGE UNDER LOW-INCOME PROGRAMS)- The amount of the monthly premium imposed under this section for an individual for a month shall be zero in the case of an individual who demonstrates to the satisfaction of the Secretary that the individual has basic health insurance coverage for that month the actuarial value of which, as determined by the Secretary, is at least actuarially equivalent to the benefits available under this title. For purposes of the previous sentence enrollment in a medicaid plan under title XIX, a State child health insurance plan under title XXI, or under the medicare program under title XVIII is deemed to constitute basic health insurance coverage described in such sentence. `(b) ANNUAL PREMIUM- `(1) NATIONAL, PER CAPITA AVERAGE- The Secretary shall estimate the average, annual per capita amount that would be payable under this title with respect to individuals residing in the United States who meet the requirement of section 2201(a)(1) as if all such individuals were eligible for (and enrolled) under this title during the entire year (and assuming that section 1862(b)(2)(A)(i) did not apply). `(2) ANNUAL PREMIUM- Subject to subsection (d), the annual premium under this subsection for months in a year is equal to 25 percent of the average, annual per capita amount estimated under paragraph (1) for the year. `(c) PAYMENT OF MONTHLY PREMIUM- `(1) PERIOD OF PAYMENT- In the case of an individual who participates in the program established by this title, subject to subsection (d), the monthly premium shall be payable for the period commencing with the first month of the individual's coverage period and ending with the month in which the individual's coverage under this title terminates. `(2) COLLECTION THROUGH TAX RETURN- For provisions providing for the payment of monthly premiums under this subsection, see section 59B of the Internal Revenue Code of 1986. `(3) PROTECTIONS AGAINST FRAUD AND ABUSE- The Secretary shall develop, in coordination with States and other health insurance issuers, administrative systems to ensure that claims which are submitted to more than one payor are coordinated and duplicate payments are not made. `(d) REDUCTION IN PREMIUM FOR CERTAIN LOW-INCOME FAMILIES- For provisions reducing the premium under this section for certain low-income families, see section 59B(c) of the Internal Revenue Code of 1986. `SEC. 2204. MEDIKIDS TRUST FUND. `(a) ESTABLISHMENT OF TRUST FUND- `(1) IN GENERAL- There is hereby created on the books of the Treasury of the United States a trust fund to be known as the `MediKids Trust Fund' (in this section referred to as the `Trust Fund'). The Trust Fund shall consist of such gifts and bequests as may be made as provided in section 201(i)(1) and such amounts as may be deposited in, or appropriated to, such fund as provided in this title. `(2) PREMIUMS- Premiums collected under section 2203 shall be transferred to the Trust Fund. `(b) INCORPORATION OF PROVISIONS- `(1) IN GENERAL- Subject to paragraph (2), subsections (b) through (i) of section 1841 shall apply with respect to the Trust Fund and this title in the same manner as they apply with respect to the Federal Supplementary Medical Insurance Trust Fund and part B, respectively. `(2) MISCELLANEOUS REFERENCES- In applying provisions of section 1841 under paragraph (1)-- `(A) any reference in such section to `this part' is construed to refer to title XXII; `(B) any reference in section 1841(h) to section 1840(d) and in section 1841(i) to sections 1840(b)(1) and 1842(g) are deemed references to comparable authority exercised under this title; `(C) payments may be made under section 1841(g) to the Trust Funds under sections 1817 and 1841 as reimbursement to such funds for payments they made for benefits provided under this title; and `(D) the Board of Trustees of the MediKids Trust Fund shall be the same as the Board of Trustees of the Federal Supplementary Medical Insurance Trust Fund. `SEC. 2205. OVERSIGHT AND ACCOUNTABILITY. `(a) THROUGH ANNUAL REPORTS OF TRUSTEES- The Board of Trustees of the MediKids Trust Fund under section 2204(b)(1) shall report on an annual basis to Congress concerning the status of the Trust Fund and the need for adjustments in the program under this title to maintain financial solvency of the program under this title. `(b) PERIODIC GAO REPORTS- The Comptroller General of the United States shall periodically submit to Congress reports on the adequacy of the financing of coverage provided under this title. The Comptroller General shall include in such report such recommendations for adjustments in such financing and coverage as the Comptroller General deems appropriate in order to maintain financial solvency of the program under this title. `SEC. 2206. INCLUSION OF CARE COORDINATION SERVICES. `(a) IN GENERAL- `(1) PROGRAM AUTHORITY- The Secretary, beginning in 2004, may implement a care coordination services program in accordance with the provisions of this section under which, in appropriate circumstances, eligible individuals may elect to have health care services covered under this title managed and coordinated by a designated care coordinator. `(2) ADMINISTRATION BY CONTRACT- The Secretary may administer the program under this section through a contract with an appropriate program administrator. `(3) COVERAGE- Care coordination services furnished in accordance with this section shall be treated under this title as if they were included in the definition of medical and other health services under section 1861(s) and benefits shall be available under this title with respect to such services without the application of any deductible or coinsurance. `(b) ELIGIBILITY CRITERIA; IDENTIFICATION AND NOTIFICATION OF ELIGIBLE INDIVIDUALS- `(1) INDIVIDUAL ELIGIBILITY CRITERIA- The Secretary shall specify criteria to be used in making a determination as to whether an individual may appropriately be enrolled in the care coordination services program under this section, which shall include at least a finding by the Secretary that for cohorts of individuals with characteristics identified by the Secretary, professional management and coordination of care can reasonably be expected to improve processes or outcomes of health care and to reduce aggregate costs to the programs under this title. `(2) PROCEDURES TO FACILITATE ENROLLMENT- The Secretary shall develop and implement procedures designed to facilitate enrollment of eligible individuals in the program under this section. `(c) ENROLLMENT OF INDIVIDUALS- `(1) SECRETARY'S DETERMINATION OF ELIGIBILITY- The Secretary shall determine the eligibility for services under this section of individuals who are enrolled in the program under this section and who make application for such services in such form and manner as the Secretary may prescribe. `(2) ENROLLMENT PERIOD- `(A) EFFECTIVE DATE AND DURATION- Enrollment of an individual in the program under this section shall be effective as of the first day of the month following the month in which the Secretary approves the individual's application under paragraph (1), shall remain in effect for one month (or such longer period as the Secretary may specify), and shall be automatically renewed for additional periods, unless terminated in accordance with such procedures as the Secretary shall establish by regulation. Such procedures shall permit an individual to disenroll for cause at any time and without cause at re-enrollment intervals. `(B) LIMITATION ON REENROLLMENT- The Secretary may establish limits on an individual's eligibility to reenroll in the program under this section if the individual has disenrolled from the program more than once during a specified time period. `(d) PROGRAM- The care coordination services program under this section shall include the following elements: `(1) BASIC CARE COORDINATION SERVICES- `(A) IN GENERAL- Subject to the cost-effectiveness criteria specified in subsection (b)(1), except as otherwise provided in this section, enrolled individuals shall receive services described in section 1905(t)(1) and may receive additional items and services as described in subparagraph (B). `(B) ADDITIONAL BENEFITS- The Secretary may specify additional benefits for which payment would not otherwise be made under this title that may be available to individuals enrolled in the program under this section (subject to an assessment by the care coordinator of an individual's circumstance and need for such benefits) in order to encourage enrollment in, or to improve the effectiveness of, such program. `(2) CARE COORDINATION REQUIREMENT- Notwithstanding any other provision of this title, the Secretary may provide that an individual enrolled in the program under this section may be entitled to payment under this title for any specified health care items or services only if the items or services have been furnished by the care coordinator, or coordinated through the care coordination services program. Under such provision, the Secretary shall prescribe exceptions for emergency medical services as described in section 1852(d)(3), and other exceptions determined by the Secretary for the delivery of timely and needed care. `(e) CARE COORDINATORS- `(1) CONDITIONS OF PARTICIPATION- In order to be qualified to furnish care coordination services under this section, an individual or entity shall-- `(A) be a health care professional or entity (which may include physicians, physician group practices, or other health care professionals or entities the Secretary may find appropriate) meeting such conditions as the Secretary may specify; `(B) have entered into a care coordination agreement; and `(C) meet such criteria as the Secretary may establish (which may include experience in the provision of care coordination or primary care physician's services). `(2) AGREEMENT TERM; PAYMENT- `(A) DURATION AND RENEWAL- A care coordination agreement under this subsection shall be for one year and may be renewed if the Secretary is satisfied that the care coordinator continues to meet the conditions of participation specified in paragraph (1). `(B) PAYMENT FOR SERVICES- The Secretary may negotiate or otherwise establish payment terms and rates for services described in subsection (d)(1). `(C) LIABILITY- Case coordinators shall be subject to liability for actual health damages which may be suffered by recipients as a result of the care coordinator's decisions, failure or delay in making decisions, or other actions as a care coordinator. `(D) TERMS- In addition to such other terms as the Secretary may require, an agreement under this section shall include the terms specified in subparagraphs (A) through (C) of section 1905(t)(3). `SEC. 2207. ADMINISTRATION AND MISCELLANEOUS. `(a) IN GENERAL- Except as otherwise provided in this title-- `(1) the Secretary shall enter into appropriate contracts with providers of services, other health care providers, carriers, and fiscal intermediaries, taking into account the types of contracts used under title XVIII with respect to such entities, to administer the program under this title; `(2) individuals enrolled under this title shall be treated for purposes of title XVIII as though the individual were entitled to benefits under part A and enrolled under part B of such title; `(3) benefits described in section 2202 that are payable under this title to such individuals shall be paid in a manner specified by the Secretary (taking into account, and based to the greatest extent practicable upon, the manner in which they are provided under title XVIII); `(4) provider participation agreements under title XVIII shall apply to enrollees and benefits under this title in the same manner as they apply to enrollees and benefits under title XVIII; and `(5) individuals entitled to benefits under this title may elect to receive such benefits under health plans in a manner, specified by the Secretary, similar to the manner provided under part C of title XVIII. `(b) COORDINATION WITH MEDICAID AND SCHIP- Notwithstanding any other provision of law, individuals entitled to benefits for items and services under this title who also qualify for benefits under title XIX or XXI or any other Federally funded program may continue to qualify and obtain benefits under such other title or program, and in such case such an individual shall elect either-- `(1) such other title or program to be primary payor to benefits under this title, in which case no benefits shall be payable under this title and the monthly premium under section 2203 shall be $0; or `(2) benefits under this title shall be primary payor to benefits provided under such program or title, in which case the Secretary shall enter into agreements with States as may be appropriate to provide that, in the case of such individuals, the benefits under titles XIX and XXI or such other program (including reduction of cost-sharing) are provided on a `wrap-around' basis to the benefits under this title.'. (b) CONFORMING AMENDMENTS TO SOCIAL SECURITY ACT PROVISIONS- (1) Section 201(i)(1) of the Social Security Act (42 U.S.C. 401(i)(1)) is amended by striking `or the Federal Supplementary Medical Insurance Trust Fund' and inserting `the Federal Supplementary Medical Insurance Trust Fund, or the MediKids Trust Fund'. (2) Section 201(g)(1)(A) of such Act (42 U.S.C. 401(g)(1)(A)) is amended by striking ` and the Federal Supplementary Medical Insurance Trust Fund established by title XVIII' and inserting `, the Federal Supplementary Medical Insurance Trust Fund, and the MediKids Trust Fund established by title XVIII'. (3) Section 1853(c) of such Act (42 U.S.C. 1395w-23(c)) is amended-- (A) in paragraph (1), by striking `and (7)' and inserting `, (7), and (8)', and (B) by adding at the end the following: `(8) ADJUSTMENT FOR MEDIKIDS- In applying this subsection with respect to individuals entitled to benefits under title XXII, the Secretary shall provide for an appropriate adjustment in the Medicare+Choice capitation rate as may be appropriate to reflect differences between the population served under such title and the population under parts A and B.'. (c) MAINTENANCE OF MEDICAID ELIGIBILITY AND BENEFITS FOR CHILDREN- (1) IN GENERAL- In order for a State to continue to be eligible for payments under section 1903(a) of the Social Security Act (42 U.S.C. 1396b(a))-- (A) the State may not reduce standards of eligibility, or benefits, provided under its State medicaid plan under title XIX of the Social Security Act or under its State child health plan under title XXI of such Act for individuals under 23 years of age below such standards of eligibility, and benefits, in effect on the date of the enactment of this Act; and (B) the State shall demonstrate to the satisfaction of the Secretary of Health and Human Services that any savings in State expenditures under title XIX or XXI of the Social Security Act that results from children from enrolling under title XXII of such Act shall be used in a manner that improves services to beneficiaries under title XIX of such Act, such as through increases in provider payment rates, expansion of eligibility, improved nurse and nurse aide staffing and improved inspections of nursing facilities, and coverage of additional services. (2) MEDIKIDS AS PRIMARY PAYOR- In applying title XIX of the Social Security Act, the MediKids program under title XXII of such Act shall be treated as a primary payor in cases in which the election described in section 2207(b)(2) of such Act, as added by subsection (a), has been made. (d) EXPANSION OF MEDPAC MEMBERSHIP TO 19- (1) IN GENERAL- Section 1805(c) of the Social Security Act (42 U.S.C. 1395b-6(c)) is amended-- (A) in paragraph (1), by striking `17' and inserting `19'; and (B) in paragraph (2)(B), by inserting `experts in children's health,' after `other health professionals,'. (2) INITIAL TERMS OF ADDITIONAL MEMBERS- (A) IN GENERAL- For purposes of staggering the initial terms of members of the Medicare Payment Advisory Commission under section 1805(c)(3) of the Social Security Act (42 U.S.C. 1395b-6(c)(3)), the initial terms of the 2 additional members of the Commission provided for by the amendment under subsection (a)(1) are as follows: (i) One member shall be appointed for 1 year. (ii) One member shall be appointed for 2 years. (B) COMMENCEMENT OF TERMS- Such terms shall begin on January 1, 2004. SEC. 1003. MEDIKIDS PREMIUM. (a) GENERAL RULE- Subchapter A of chapter 1 of the Internal Revenue Code of 1986 (relating to determination of tax liability) is amended by adding at the end the following new part: `PART VIII--MEDIKIDS PREMIUM `Sec. 59B. MediKids premium. `SEC. 59B. MEDIKIDS PREMIUM. `(a) IMPOSITION OF TAX- In the case of an individual to whom this section applies, there is hereby imposed (in addition to any other tax imposed by this subtitle) a MediKids premium for the taxable year. `(b) INDIVIDUALS SUBJECT TO PREMIUM- `(1) IN GENERAL- This section shall apply to an individual if the taxpayer has a MediKid at any time during the taxable year. `(2) MEDIKID- For purposes of this section, the term `MediKid' means, with respect to a taxpayer, any individual with respect to whom the taxpayer is required to pay a premium under section 2203(c) of the Social Security Act for any month of the taxable year. `(c) AMOUNT OF PREMIUM- For purposes of this section, the MediKids premium for a taxable year is the sum of the monthly premiums under section 2203 of the Social Security Act for months in the taxable year. `(d) EXCEPTIONS BASED ON ADJUSTED GROSS INCOME- `(1) EXEMPTION FOR VERY LOW-INCOME TAXPAYERS- `(A) IN GENERAL- No premium shall be imposed by this section on any taxpayer having an adjusted gross income not in excess of the exemption amount. `(B) EXEMPTION AMOUNT- For purposes of this paragraph, with respect to a family, the exemption amount is the amount equal to 150 percent of the income official poverty line (as defined by the Office of Management and Budget, and revised annually in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981) applicable to a family of the size involved. `(C) PHASEOUT OF EXEMPTION- In the case of a taxpayer having an adjusted gross income which exceeds the exemption amount but does not exceed twice the exemption amount, the premium shall be the amount which bears the same ratio to the premium which would (but for this subparagraph) apply to the taxpayer as such excess bears to the exemption amount. `(2) PREMIUM LIMITED TO 5 PERCENT OF ADJUSTED GROSS INCOME- In no event shall any taxpayer be required to pay a premium under this section in excess of an amount equal to 5 percent of the taxpayer's adjusted gross income. `(e) COORDINATION WITH OTHER PROVISIONS- `(1) NOT TREATED AS MEDICAL EXPENSE- For purposes of this chapter, any premium paid under this section shall not be treated as expense for medical care. `(2) NOT TREATED AS TAX FOR CERTAIN PURPOSES- The premium paid under this section shall not be treated as a tax imposed by this chapter for purposes of determining-- `(A) the amount of any credit allowable under this chapter, or `(B) the amount of the minimum tax imposed by section 55. `(3) TREATMENT UNDER SUBTITLE F- For purposes of subtitle F, the premium paid under this section shall be treated as if it were a tax imposed by section 1.'. (b) TECHNICAL AMENDMENTS- (1) Subsection (a) of section 6012 of such Code is amended by inserting after paragraph (9) the following new paragraph: `(10) Every individual liable for a premium under section 59B.'. (2) The table of parts for subchapter A of chapter 1 of such Code is amended by adding at the end the following new item: `Part VIII. MediKids premium.'. (c) EFFECTIVE DATE- The amendments made by this section shall apply to months beginning after December 2004, in taxable years ending after such date. SEC. 1004. REFUNDABLE CREDIT FOR COST-SHARING EXPENSES UNDER MEDIKIDS PROGRAM. (a) IN GENERAL- Subpart C of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986 (relating to refundable credits) is amended by inserting after section 35 the following new section: `SEC. 35A. COST-SHARING EXPENSES UNDER MEDIKIDS PROGRAM. `(a) ALLOWANCE OF CREDIT- In the case of an individual who has a MediKid (as defined in section 59B) at any time during the taxable year, there shall be allowed as a credit against the tax imposed by this subtitle an amount equal to 50 percent of the amount paid by the taxpayer during the taxable year as cost-sharing under section 2202(b)(4) of the Social Security Act. `(b) LIMITATION BASED ON ADJUSTED GROSS INCOME- The amount of the credit which would (but for this subsection) be allowed under this section for the taxable year shall be reduced (but not below zero) by an amount which bears the same ratio to such amount of credit as the excess of the taxpayer's adjusted gross income for such taxable year over the exemption amount (as defined in section 59B(d)) bears to such exemption amount.'. (b) TECHNICAL AMENDMENTS- (1) Paragraph (2) of section 1324(b) of title 31, United States Code, is amended by inserting `or 35A' after `35'. (2) The table of sections for subpart C of part IV of subchapter A of chapter 1 of such Code is amended by inserting after the item relating to section 25 the following new item: `Sec. 35A. Cost-sharing expenses under MediKids program.'. (c) EFFECTIVE DATE- The amendments made by this section shall apply to taxable years beginning after December 31, 2004. SEC. 1005. REPORT ON LONG-TERM REVENUES. Within 1 year after the date of enactment of this title, the Secretary of the Treasury shall propose a gradual schedule of progressive tax changes to fund the program under title XXII of the Social Security Act, as the number of enrollees grows in the out-years. Subtitle B--Children's Health Insurance Eligibility Expansion and Enrollment Improvements CHAPTER 1--ELIGIBILITY EXPANSIONS Subchapter A--Medicaid and SCHIP SEC. 1101. EXPANSION OF CHILDREN'S ELIGIBILITY FOR MEDICAID AND SCHIP. (a) EXPANSION OF INCOME ELIGIBILITY UNDER SCHIP- Section 2110(c)(4) of the Social Security Act (42 U.S.C. 42 U.S.C. 1397jj(c)(4)) is amended by striking `200' and inserting `300'. (b) MANDATORY BUY-IN COVERAGE- (1) MEDICAID- (A) IN GENERAL- Section 1902(a)(10)(A)(i) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)(i)) is amended-- (i) by striking `or' at the end of subclause (VI); (ii) by striking the semicolon at the end of subclause (VII) and insert `, or'; and (iii) by adding at the end the following: `(VIII) who are children in families whose income exceeds 300 percent of the income official poverty line (as defined by the Office of Management and Budget, and revised annually in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981) applicable to a family of the size involved subject, notwithstanding section 1916, to payment of premiums or other cost-sharing charges (set on a sliding scale based on income) that the State may determine;'. (B) CONFORMING AMENDMENT- Section 1903(f)(4) of such Act (42 U.S.C. 1396b(f)(4)) is amended by inserting `1902(a)(10)(A)(i)(VIII),' after `1902(a)(10)(A)(i)(VII),'. (2) SCHIP- Section 2107(e)(1) of such Act (42 U.S.C. 1397gg(e)(1)) is amended by adding at the end the following new subparagraph: `(E) Section 1902(a)(10)(A)(i)(VIII) (relating to buy-in coverage for children whose family income exceeds 300 percent of the poverty line).'. (c) EFFECTIVE DATE- The amendments made by this section apply to medical assistance and child health assistance provided on or after October 1, 2003. SEC. 1102. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS UNDER THE MEDICAID PROGRAM AND TITLE XXI. (a) MEDICAID PROGRAM- Section 1903(v) of the Social Security Act (42 U.S.C. 1396b(v)) is amended-- (1) in paragraph (1), by striking `paragraph (2)' and inserting `paragraphs (2) and (4)'; and (2) by adding at the end the following: `(4)(A) A State may elect (in a plan amendment under this title) to provide medical assistance under this title for aliens who are lawfully residing in the United States (including battered aliens described in section 431(c) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996) and who are otherwise eligible for such assistance, within any of the following eligibility categories: `(i) PREGNANT WOMEN- Women during pregnancy (and during the 60-day period beginning on the last day of the pregnancy). `(ii) CHILDREN- Children (as defined under such plan), including optional targeted low-income children described in section 1905(u)(2)(B). `(B)(i) In the case of a State that has elected to provide medical assistance to a category of aliens under subparagraph (A), no debt shall accrue under an affidavit of support against any sponsor of such an alien on the basis of provision of assistance to such category and the cost of such assistance shall not be considered as an unreimbursed cost. `(ii) The provisions of sections 401(a), 402(b), 403, and 421 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 shall not apply to a State that makes an election under subparagraph (A).'. (b) TITLE XXI- Section 2107(e)(1) of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended by adding at the end the following: `(E) Section 1903(v)(4) (relating to optional coverage of permanent resident alien children), but only if the State has elected to apply such section to that category of children under title XIX.'. (c) EFFECTIVE DATE- The amendments made by this section take effect on October 1, 2003, and apply to medical assistance and child health assistance furnished on or after such date. Subchapter B--Family Opportunity Act SEC. 1111. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT. (a) SHORT TITLE- This subchapter may be cited as the `Family Opportunity Act of 2003' or the `Dylan Lee James Act'. (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. SEC. 1112. OPPORTUNITY FOR FAMILIES OF DISABLED CHILDREN TO PURCHASE MEDICAID COVERAGE FOR SUCH CHILDREN. (a) STATE OPTION TO ALLOW FAMILIES OF DISABLED CHILDREN TO PURCHASE MEDICAID COVERAGE FOR SUCH CHILDREN- (1) IN GENERAL- Section 1902 (42 U.S.C. 1396a) is amended-- (A) in subsection (a)(10)(A)(ii)-- (i) by striking `or' at the end of subclause (XVII); (ii) by adding `or' at the end of subclause (XVIII); and (iii) by adding at the end the following new subclause: `(XIX) who are disabled children described in subsection (cc)(1);'; and (B) by adding at the end the following new subsection: `(cc)(1) Individuals described in this paragraph are individuals-- `(A) who have not attained 18 years of age; `(B) who would be considered disabled under section 1614(a)(3)(C) (determined without regard to the reference to age in that section) but for having earnings or deemed income or resources (as determined under title XVI for children) that exceed the requirements for receipt of supplemental security income benefits; and `(C) whose family income does not exceed such income level as the State establishes and does not exceed-- `(i) 300 percent of the income official poverty line (as defined by the Office of Management and Budget, and revised annually in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981) applicable to a family of the size involved; or `(ii) such higher percent of such poverty line as a State may establish, except that no Federal financial participation shall be provided under section 1903(a) for any medical assistance provided to an individual who would not be described in this subsection but for this clause.'. (2) INTERACTION WITH EMPLOYER-SPONSORED FAMILY COVERAGE- Section 1902(cc) (42 U.S.C. 1396a(cc)), as added by paragraph (1), is amended by adding at the end the following new paragraph: `(2)(A) If an employer of a parent of an individual described in paragraph (1) offers family coverage under a group health plan (as defined in section 2791(a) of the Public Health Service Act), the State may-- `(i) require such parent to apply for, enroll in, and pay premiums for, such coverage as a condition of such parent's child being or remaining eligible for medical assistance under subsection (a)(10)(A)(ii)(XIX) if the parent is determined eligible for such coverage and the employer contributes at least 50 percent of the total cost of annual premiums for such coverage; and `(ii) if such coverage is obtained-- `(I) subject to paragraph (2) of section 1916(h), reduce the premium imposed by the State under that section (if any) in an amount that reasonably reflects the premium contribution made by the parent for private coverage on behalf of a child with a disability; and `(II) treat such coverage as a third party liability under subsection (a)(25). `(B) In the case of a parent to which subparagraph (A) applies, if the family income of such parent does not exceed 300 percent of the income official poverty line (referred to in paragraph (1)(C)(i)), a State may provide for payment of any portion of the annual premium for such family coverage that the parent is required to pay. Any payments made by the State under this subparagraph shall be considered, for purposes of section 1903(a), to be payments for medical assistance.'. (b) STATE OPTION TO IMPOSE INCOME-RELATED PREMIUMS- Section 1916 (42 U.S.C. 1396o) is amended-- (1) in subsection (a), by striking `subsection (g)' and inserting `subsections (g) and (h)'; and (2) by adding at the end the following new subsection: `(h)(1) With respect to disabled children provided medical assistance under section 1902(a)(10)(A)(ii)(XIX), subject to paragraph (2), a State may (in a uniform manner for such children) require the families of such children to pay monthly premiums set on a sliding scale based on family income. `(2) A premium requirement imposed under paragraph (1) may only apply to the extent that-- `(A) the aggregate amount of such premium and any premium that the parent is required to pay for family coverage under section 1902(cc)(2)(A)(i) does not exceed 5 percent of the family's income; and `(B) the requirement is imposed consistent with section 1902(cc)(2)(A)(ii)(I). `(3) A State shall not require prepayment of a premium imposed pursuant to paragraph (1) and shall not terminate eligibility of a child under section 1902(a)(10)(A)(ii)(XIX) for medical assistance under this title on the basis of failure to pay any such premium until such failure continues for a period of not less than 60 days from the date on which the premium became past due. The State may waive payment of any such premium in any case where the State determines that requiring such payment would create an undue hardship.'. (c) CONFORMING AMENDMENT- Section 1903(f)(4) (42 U.S.C. 1396b(f)(4)) is amended in the matter preceding subparagraph (A) by inserting `1902(a)(10)(A)(ii)(XIX),' after `1902(a)(10)(A)(ii)(XVIII),'. (d) EFFECTIVE DATE- The amendments made by this section shall apply to medical assistance for items and services furnished on or after January 1, 2004. SEC. 1113. TREATMENT OF INPATIENT PSYCHIATRIC HOSPITAL SERVICES FOR INDIVIDUALS UNDER AGE 21 IN HOME OR COMMUNITY-BASED SERVICES WAIVERS. (a) IN GENERAL- Section 1915(c) (42 U.S.C. 1396n(c)) is amended-- (1) in paragraph (1)-- (A) in the first sentence, by inserting `, or inpatient psychiatric hospital services for individuals under age 21,' after `intermediate care facility for the mentally retarded'; and (B) in the second sentence, by inserting `, or inpatient psychiatric hospital services for individuals under age 21' before the period; (2) in paragraph (2)(B), by striking `or services in an intermediate care facility for the mentally retarded' each place it appears and inserting `, services in an intermediate care facility for the mentally retarded, or inpatient psychiatric hospital services for individuals under age 21'; (3) by striking paragraph (2)(C) and inserting the following: `(C) such individuals who are determined to be likely to require the level of care provided in a hospital, nursing facility, or intermediate care facility for the mentally retarded, or inpatient psychiatric hospital services for individuals under age 21, are informed of the feasible alternatives, if available under the waiver, at the choice of such individuals, to the provision of inpatient hospital services, nursing facility services, services in an intermediate care facility for the mentally retarded, or inpatient psychiatric hospital services for individuals under age 21;'; and (4) in paragraph (7)(A)-- (A) by inserting `, or inpatient psychiatric hospital services for individuals under age 21,' after `intermediate care facility for the mentally retarded'; and (B) by inserting `, or who would require inpatient psychiatric hospital services for individuals under age 21' before the period. (b) EFFECTIVE DATE- The amendments made by subsection (a) apply with respect to medical assistance provided on or after January 1, 2003. SEC. 1114. DEMONSTRATION OF COVERAGE UNDER THE MEDICAID PROGRAM OF CHILDREN WITH POTENTIALLY SEVERE DISABILITIES. (a) STATE APPLICATION- A State may apply to the Secretary of Health and Human Services (in this section referred to as the `Secretary') for approval of a demonstration project (in this section referred to as a `demonstration project') under which up to a specified maximum number of children with a potentially severe disability (as defined in subsection (b)) are provided medical assistance under the State medicaid plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.). (b) CHILD WITH A POTENTIALLY SEVERE DISABILITY DEFINED- (1) IN GENERAL- In this section, the term `child with a potentially severe disability' means, with respect to a demonstration project, an individual who-- (A) has not attained 21 years of age; (B) has a physical or mental condition, disease, disorder (including a congenital birth defect or a metabolic condition), injury, or developmental disability that was incurred before the individual attained such age; and (C) is reasonably expected, but for the receipt of medical assistance under the State medicaid plan, to reach the level of disability defined under section 1614(a)(3) of the Social Security Act (42 U.S.C. 1382c(a)(3)), (determined without regard to the reference to age in subparagraph (C) of that section). (2) EXCEPTION- Such term does not include an individual who would be considered disabled under section 1614(a)(3)(C) of the Social Security Act (42 U.S.C. 1382c(a)(3)(C)) (determined without regard to the reference to age in that section). (c) APPROVAL OF DEMONSTRATION PROJECTS- (1) IN GENERAL- Subject to paragraph (3), the Secretary shall approve applications under subsection (a) that meet the requirements of paragraph (2) and such additional terms and conditions as the Secretary may require. The Secretary may waive the requirement of section 1902(a)(1) of the Social Security Act (42 U.S.C. 1396a(a)(1)) to allow for sub-State demonstrations. (2) TERMS AND CONDITIONS OF DEMONSTRATION PROJECTS- The Secretary may not approve a demonstration project under this section unless the State provides assurances satisfactory to the Secretary that the following conditions are or will be met: (A) INDEPENDENT EVALUATION- The State provides for an independent evaluation of the project to be conducted during fiscal year 2006. (B) CONSULTATION FOR DEVELOPMENT OF CRITERIA- The State consults with appropriate pediatric health professionals in establishing the criteria for determining whether a child has a potentially severe disability. (C) ANNUAL REPORT- The State submits an annual report to the Secretary (in a uniform form and manner established by the Secretary) on the use of funds provided under the grant that includes the following: (i) Enrollment and financial statistics on-- (I) the total number of children with a potentially severe disability enrolled in the demonstration project, disaggregated by disability; (II) the services provided by category or code and the cost of each service so categorized or coded; and (III) the number of children enrolled in the demonstration project who also receive services through private insurance. (ii) With respect to the report submitted for fiscal year 2008, the results of the independent evaluation conducted under subparagraph (A). (iii) Such additional information as the Secretary may require. (3) LIMITATIONS ON FEDERAL FUNDING- (A) APPROPRIATION- (i) IN GENERAL- Out of any funds in the Treasury not otherwise appropriated, there is appropriated to carry out this section-- (I) $16,666,000 for each of fiscal years 2004 and 2005; and (II) $16,667,000 for each of fiscal years 2006 through 2009. (ii) BUDGET AUTHORITY- Clause (i) constitutes budget authority in advance of appropriations Acts and represents the obligation of the Federal Government to provide for the payment of the amounts appropriated under clause (i). (B) LIMITATION ON PAYMENTS- In no case may-- (i) the aggregate amount of payments made by the Secretary to States under this section exceed $100,000,000; (ii) the aggregate amount of payments made by the Secretary to States for administrative expenses relating to the evaluations and annual reports required under subparagraphs (A) and (C) of paragraph (2) exceed $2,000,000 of such $100,000,000; or (iii) payments be provided by the Secretary for a fiscal year after fiscal year 2010. (C) FUNDS ALLOCATED TO STATES- (i) IN GENERAL- The Secretary shall allocate funds to States based on their applications and the availability of funds. In making such allocations, the Secretary shall ensure an equitable distribution of funds among States with large populations and States with small populations. (ii) AVAILABILITY- Funds allocated to a State under a grant made under this section for a fiscal year shall remain available until expended. (D) FUNDS NOT ALLOCATED TO STATES- Funds not allocated to States in the fiscal year for which they are appropriated shall remain available in succeeding fiscal years for allocation by the Secretary using the allocation formula established under this section. (E) PAYMENTS TO STATES- The Secretary shall pay to each State with a demonstration project approved under this section, from its allocation under subparagraph (C), an amount for each quarter equal to the Federal medical assistance percentage (as defined in section 1905(b) of the Social Security Act (42 U.S.C. 1395d(b))) of expenditures in the quarter for medical assistance provided to children with a potentially severe disability. (d) RECOMMENDATION- Not later than October 1, 2007, the Secretary shall submit a recommendation to the Committee on Commerce of the House of Representatives and the Committee on Finance of the Senate regarding whether the demonstration project established under this section should be continued after fiscal year 2009. (e) STATE DEFINED- In this section, the term `State' has the meaning given such term for purposes of title XIX of the Social Security Act (42 U.S.C. 1396 et seq.). SEC. 1115. DEVELOPMENT AND SUPPORT OF FAMILY-TO-FAMILY HEALTH INFORMATION CENTERS. Section 501 (42 U.S.C. 701) is amended by adding at the end the following new subsection: `(c)(1) In addition to amounts appropriated under subsection (a) and retained under section 502(a)(1) for the purpose of carrying out activities described in subsection (a)(2), there is appropriated to the Secretary, out of any money in the Treasury not otherwise appropriated, for the purpose of enabling the Secretary (through grants, contracts, or otherwise) to provide for special projects of regional and national significance for the development and support of family-to-family health information centers described in paragraph (2), $10,000,000 for each of fiscal years 2004 through 2009. Funds appropriated under this paragraph shall remain available until expended. `(2) The family-to-family health information centers described in this paragraph are centers that-- `(A) assist families of children with disabilities or special health care needs to make informed choices about health care in order to promote good treatment decisions, cost-effectiveness, and improved health outcomes for such children; `(B) provide information regarding the health care needs of, and resources available for, children with disabilities or special health care needs; `(C) identify successful health delivery models for such children; `(D) develop with representatives of health care providers, managed care organizations, health care purchasers, and appropriate State agencies a model for collaboration between families of such children and health professionals; `(E) provide training and guidance regarding caring for such children; `(F) conduct outreach activities to the families of such children, health professionals, schools, and other appropriate entities and individuals; and `(G) are staffed by families of children with disabilities or special health care needs who have expertise in Federal and State public and private health care systems and health professionals. `(3) The provisions of this title that are applicable to the funds made available to the Secretary under section 502(a)(1) apply in the same manner to funds made available to the Secretary under paragraph (1).'. SEC. 1116. RESTORATION OF MEDICAID ELIGIBILITY FOR CERTAIN SSI BENEFICIARIES. (a) IN GENERAL- Section 1902(a)(10)(A)(i)(II) (42 U.S.C. 1396a(a)(10)(A)(i)(II)) is amended-- (1) by inserting `(aa)' after `(II)'; (2) by striking `or who are' and inserting `, (bb) who are'; and (3) by inserting before the comma at the end the following: `, or (cc) who are under 21 years of age and with respect to whom supplemental security income benefits would be paid under title XVI if subparagraphs (A) and (B) of section 1611(c)(7) were applied without regard to the phrase `the first day of the month following'. (b) EFFECTIVE DATE- The amendments made by subsection (a) shall apply to medical assistance for items and services furnished on or after the first day of the first calendar quarter that begins after the date of enactment of this Act. CHAPTER 2--ENROLLMENT IMPROVEMENTS SEC. 1121. APPLICATION OF SIMPLIFIED TITLE XXI PROCEDURES UNDER THE MEDICAID PROGRAM. (a) APPLICATION UNDER MEDICAID- (1) IN GENERAL- Section 1902(l) of the Social Security Act (42 U.S.C. 1396a(l)) is amended-- (A) in paragraph (3), by inserting `subject to paragraph (5)', after `Notwithstanding subsection (a)(17),'; and (B) by adding at the end the following: `(5) With respect to determining the eligibility of individuals under 19 years of age (or such higher age as the State has elected under paragraph (1)(D)) for medical assistance under subsection (a)(10)(A) notwithstanding any other provision of this title, if the State has established a State child health plan under title XXI-- `(A) the State may not apply a resource standard; `(B) the State shall use the same simplified eligibility form (that in no case shall be more than 4 pages and that permits application other than in person) as the State uses under such State child health plan with respect to such individuals; `(C) the State shall provide for initial eligibility determinations and redeterminations of eligibility using the same verification policies, forms, and frequency as the State uses for such purposes under such State child health plan with respect to such individuals; `(D) the State shall not require a face-to-face interview for purposes of initial eligibility determinations and redeterminations and shall allow for self-declaration of initial eligibility and recertification information; and `(E) the State shall coordinate the enrollment of children under this title and title XXI with the enrollment of such children and their families in other Federal means-tested public assistance programs, including child care programs, free or reduced price lunches or breakfasts under the Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et seq.), assistance under the special supplemental nutrition program for women, infants, and children (WIC) under section 17 of the Child Nutrition Act of 1966 (42 U.S.C. 1786), and benefits under the Food Stamp Act of 1977.'. (2) EFFECTIVE DATE- The amendments made by paragraph (1) apply to determinations of eligibility made on or after the date that is 1 year after the date of the enactment of this Act, whether or not regulations implementing such amendments have been issued. (3) DEVELOPMENT OF UNIFORM APPLICATION- Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services, in consultation with States and organizations with expertise in outreach to, and enrollment of, children without health insurance, shall develop a uniform application that meets the requirements of section 1902(l)(5) of the Social Security Act, as added by paragraph (1), and may be used in any State. (b) PRESUMPTIVE ELIGIBILITY- (1) IN GENERAL- Section 1920A(b)(3)(A)(i) of the Social Security Act (42 U.S.C. 1396r-1a(b)(3)(A)(i)) is amended by inserting `a child care resource and referral agency,' after `a State or tribal child support enforcement agency,'. (2) APPLICATION TO PRESUMPTIVE ELIGIBILITY FOR PREGNANT WOMEN UNDER MEDICAID- Section 1920(b) of the Social Security Act (42 U.S.C. 1396r-1(b)) is amended by adding at the end after and below paragraph (2) the following flush sentence: `The term `qualified provider' includes a qualified entity as defined in section 1920A(b)(3).'. (3) APPLICATION UNDER TITLE XXI- (A) IN GENERAL- Section 2107(e)(1)(D) of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended to read as follows: `(D) Sections 1920 and 1920A (relating to presumptive eligibility).'. (B) EXCEPTION FROM LIMITATION ON ADMINISTRATIVE EXPENSES- Section 2105(c)(2) of such Act (42 U.S.C. 1397ee(c)(2)) is amended by adding at the end the following: `(C) EXCEPTION FOR PRESUMPTIVE ELIGIBILITY EXPENDITURES- The limitation under subparagraph (A) on expenditures shall not apply to expenditures attributable to the application of section 1920 or 1920A (pursuant to section 2107(e)(1)(D)), regardless of whether the child is determined to be ineligible for the program under this title or title XIX.'. (C) CONFORMING ELIMINATION OF RESOURCE TEST- Section 2102(b)(1)(A) of such Act (42 U.S.C. 1397bb(b)(1)(A)) is amended-- (i) by striking `and resources (including any standards relating to spenddowns and disposition of resources)'; and (ii) by adding at the end the following: `Effective 1 year after the date of the enactment of the Leave No Child Behind Act of 2003, such standards may not include the application of a resource standard or test.'. (c) AUTOMATIC REASSESSMENT OF ELIGIBILITY FOR TITLE XXI AND MEDICAID BENEFITS FOR CHILDREN LOSING MEDICAID OR TITLE XXI ELIGIBILITY- (1) LOSS OF MEDICAID ELIGIBILITY- Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) is amended-- (A) by striking the period at the end of paragraph (65) and inserting `; and'; and (B) by inserting after paragraph (65) the following: `(66) provide, in the case of a State with a State child health plan under title XXI, that before medical assistance to a child (or a parent of a child) is discontinued under this title, a determination of whether the child (or parent) is eligible for benefits under title XXI shall be made and, if determined to be so eligible, the child (or parent) shall be automatically enrolled in the program under such title without the need for a new application.'. (2) LOSS OF TITLE XXI ELIGIBILITY- Section 2102(b)(3) (42 U.S.C. 1397bb(b)(3)) is amended by redesignating subparagraphs (D) and (E) as subparagraphs (E) and (F), respectively, and by inserting after subparagraph (C) the following: `(D) that before health assistance to a child (or a parent of a child) is discontinued under this title, a determination of whether the child (or parent) is eligible for benefits under title XIX is made and, if determined to be so eligible, the child (or parent) is automatically enrolled in the program under such title without the need for a new application;'. (3) EFFECTIVE DATE- The amendments made by paragraphs (1) and (2) apply to individuals who lose eligibility under the medicaid program under title XIX, or under a State child health insurance plan under title XXI, respectively, of the Social Security Act on or after the date that is 60 days after the date of the enactment of this Act. (d) PROVISION OF MEDICAID AND SCHIP APPLICATIONS AND INFORMATION UNDER THE SCHOOL LUNCH PROGRAM- Section 9(b)(2)(B) of the Richard B. Russell National School Lunch Act (42 U.S.C. 1758(b)(2)(B)) is amended-- (1) by striking `(B) Applications' and inserting `(B)(i) Applications'; and (2) by adding at the end the following: `(ii)(I) Applications for free and reduced price lunches that are distributed pursuant to clause (i) to parents or guardians of children in attendance at schools participating in the school lunch program under this Act shall also contain information on the availability of medical assistance under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) (commonly referred to as the `medicaid program') and of child health assistance under title XXI of such Act (commonly referred to as `SCHIP'), including information on how to obtain an application for assistance under such program. `(II) Information on the medicaid program and SCHIP under subclause (I) shall be provided on a form separate from the application form for free and reduced price lunches under clause (i).'. (e) 12-MONTHS CONTINUOUS ELIGIBILITY- (1) MEDICAID- Section 1902(e)(12) of the Social Security Act (42 U.S.C. 1396a(e)(12)) is amended-- (A) by striking `At the option of the State, the plan may' and inserting `The plan shall'; (B) by striking `an age specified by the State (not to exceed 19 years of age)' and inserting `19 years of age (or such higher age as the State has elected under subsection (l)(1)(D)) or who is eligible for medical assistance as the parent of such a child'; (C) in subparagraph (A), by striking `a period (not to exceed 12 months)' and inserting `the 12-month period beginning on the date'; and (D) in subparagraph (B), by inserting `or, in the case of a parent of a child, the child)' after `the individual'. (2) TITLE XXI- Section 2101(b)(2) of such Act (42 U.S.C. 1397aa(b)(2)) is amended by adding at the end the following: `Such methods shall provide 12-months continuous eligibility for children and parents under this title in the same manner as section 1902(e)(12) provides 12-months continuous eligibility for individuals described in such section under title XIX.'. SEC. 1122. AUTOMATIC ENROLLMENT OF CHILDREN BORN TO TITLE XXI PARENTS. Section 2102(b)(1) of the Social Security Act (42 U.S.C. 1397bb(b)(1)) is amended by adding at the end the following new subparagraph: `(C) AUTOMATIC ELIGIBILITY OF CHILDREN BORN TO A PARENT BEING PROVIDED FAMILYCARE- Such eligibility standards shall provide for automatic coverage of a child born to an individual who is provided assistance under this title in the same manner as medical assistance would be provided under section 1902(e)(4) to a child described in such section.'. CHAPTER 3--EFFECTIVE DATE SEC. 1131. EFFECTIVE DATE. (a) IN GENERAL- Subject to subsection (b), the amendments made by this subtitle take effect on the date of enactment of this Act. (b) EXTENSION OF EFFECTIVE DATE FOR STATE LAW AMENDMENT- In the case of a State plan under title XIX or XXI of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation in order for the plan to meet the additional requirements imposed by the amendments made by this subtitle, such State plan shall not be regarded as failing to comply with such requirements solely on the basis of its failure to meet the additional requirements 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 is considered to be a separate regular session of the State legislature. Subtitle C--Improving Access to Care CHAPTER 1--COMMISSION SEC. 1201. COMMISSION ON CHILDREN'S ACCESS TO CARE. (a) ESTABLISHMENT- There is established a Commission on Children's Access to Care (in this section referred to as the `Commission'). (b) MEMBERSHIP- (1) COMPOSITION- The Commission shall be composed of 11 members of whom-- (A) 3 members shall be appointed by the President; (B) 2 members shall be appointed by the Majority Leader of the Senate; (C) 2 members shall be appointed by the Speaker of the House of Representatives; (D) 2 members shall be appointed by the Minority Leader of the Senate; and (E) 2 members shall be appointed by the Minority Leader of the House of Representatives. (2) QUALIFICATIONS- Members of the Commission shall be appointed from among representatives of children's advocacy groups and children's health care providers. (3) TIMING OF APPOINTMENTS- Members of the Commission shall be appointed not later than 6 months after the date of enactment of this Act. (4) CHAIR- (A) IN GENERAL- The Commission shall select a Chair from among its members. (B) DUTIES- The Chair of the Commission shall be responsible for-- (i) the assignment of duties and responsibilities among staff personnel and their continuing supervision; and (ii) the use and expenditure of funds available to the Commission. (5) VACANCIES- Any vacancy on the Commission shall be filled in the same manner as the original incumbent was appointed. (6) TRAVEL EXPENSES- The members of the Commission shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for employees of agencies under subchapter I of chapter 57 of title 5, United States Code, while away from their homes or regular places of business in the performance of services for the Commission. (c) MEETINGS- (1) INITIAL MEETING- Not later than 30 days after the date on which all members of the Commission have been appointed, the Commission shall hold its first meeting. (2) TIME- The Commission shall meet at the call of the Chair. (3) QUORUM- A majority of the members of the Commission shall constitute a quorum, but a lesser number of members may hold hearings. (d) DUTIES- (1) IN GENERAL- The Commission shall conduct annual studies of children's access to health care. (2) MATTERS STUDIED- Each year the Commission shall study-- (A) the impact of payment rates under the medicaid and the State children's health insurance programs on access to health care and provider participation in the delivery of health care to children; (B) the access to health care of children with special health care needs, particularly those in managed care delivery systems; (C) the access to, and delivery of, preventive health care to children; (D) Federal and State government efforts to collect data, report, evaluate, and monitor children's access to health care, including Federal and State government deficiencies in assessing children's access to health care; (E) the needs for supplemental and enabling services to improve children's access to health care, including translation and transportation services; and (F) other factors that impact the ability of families with children to gain access to health care services. (3) REPORTS- (A) IN GENERAL- Not later than 1 year after the date of the initial meeting of the Commission, and annually thereafter, the Commission shall submit to Congress and the President a report. (B) CONTENTS- Each report shall contain the results of the study conducted for that year and the Commission's recommendations to improve children's-- (i) health status; and (ii) access to health care. (e) POWERS OF THE COMMISSION- (1) HEARINGS- The Commission may hold hearings, sit and act at times and places, take testimony, and receive evidence as the Commission considers advisable to carry out this section. (2) INFORMATION FROM FEDERAL AGENCIES- The Commission may secure directly from any Federal department or agency such information as the Commission considers necessary to carry out this section. Upon request of the Chair of the Commission, the head of such department or agency shall furnish such information to the Commission. (3) POSTAL SERVICES- The Commission may use the United States mails in the same manner and under the same conditions as other departments and agencies of the Federal Government. (4) GIFTS- The Commission may accept, use, and dispose of gifts or donations of services or property. (f) STAFF AND ADMINISTRATIVE SUPPORT- (1) IN GENERAL- The Chair of the Commission may, without regard to the civil service laws and regulations, appoint and terminate an executive director and such other additional personnel as may be necessary to enable the Commission to perform its duties. The employment of an executive director shall be subject to confirmation by the Commission. (2) COMPENSATION- The Chair of the Commission may fix the compensation of the executive director and other personnel without regard to chapter 51 and subchapter III of chapter 53 of title 5, United States Code, relating to classification of positions and General Schedule pay rates, except that the rate of pay for the executive director and other personnel may not exceed the rate payable for level V of the Executive Schedule under section 5316 of title 5, United States Code. (3) DETAIL OF GOVERNMENT EMPLOYEES- Any Federal Government employee may be detailed to the Commission without reimbursement, and such detail shall be without interruption or loss of civil service status or privilege. (4) PROCUREMENT OF TEMPORARY AND INTERMITTENT SERVICES- The Chair of the Commission may procure temporary and intermittent services under section 3109(b) of title 5, United States Code, at rates for individuals which do not exceed the daily equivalent of the annual rate of basic pay prescribed for level V of the Executive Schedule under section 5316 of title 5, United States Code. CHAPTER 2--CHILDREN'S HEALTH INSURANCE ACCOUNTABILITY SEC. 1211. SHORT TITLE. This chapter may be cited as the `Children's Health Insurance Accountability Act of 2003'. SEC. 1212. FINDINGS. Congress makes the following findings: (1) Children have health and development needs that are markedly different than those for the adult population. (2) Children experience complex and continuing changes during the continuum from birth to adulthood in which appropriate health care is essential for optimal development. (3) The vast majority of work done on development methods to assess the effectiveness of health care services and the impact of medical care on patient outcomes and patient satisfaction has been focused on adults. (4) Health outcome measures need to be age, gender, and developmentally appropriate to be useful to families and children. (5) Costly disorders of adulthood often have their origins in childhood, making early access to effective health services in childhood essential. (6) More than 200 chronic conditions, disabilities and diseases affect children, including asthma, diabetes, sickle cell anemia, spina bifida, epilepsy, autism, cerebral palsy, congenital heart disease, mental retardation, and cystic fibrosis. These children need the services of specialists who have in depth knowledge about their particular condition. (7) Children's patterns of illness, disability and injury differ dramatically from adults. SEC. 1213. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT. (a) PATIENT PROTECTION STANDARDS- Title XXVII of the Public Health Service Act (42 U.S.C. 300gg et seq.) is amended-- (1) by redesignating part C as part D; and (2) by inserting after part B the following new part: `Part C--Children's Health Protection Standards `SEC. 2770. ACCESS TO CARE. `(a) Access to Appropriate Primary Care Providers- `(1) IN GENERAL- If a group health plan, or a health insurance issuer in connection with the provision of health insurance coverage, requires or provides for an enrollee to designate a participating primary care provider for a child of such enrollee-- `(A) the plan or issuer shall permit the enrollee to designate a physician who specializes in pediatrics as the child's primary care provider; and `(B) if such an enrollee has not designated such a provider for the child, the plan or issuer shall consider appropriate pediatric expertise in mandatorily assigning such an enrollee to a primary care provider. `(2) CONSTRUCTION- Nothing in paragraph (1) shall waive any requirements of coverage relating to medical necessity or appropriateness with respect to coverage of services. `(b) Access to Pediatric Specialty Services- `(1) Referral to specialty care for children requiring treatment by specialists- `(A) IN GENERAL- In the case of a child who is covered under a group health plan, or health insurance coverage offered by a health insurance issuer and who has a mental or physical condition, disability, or disease of sufficient seriousness and complexity to require diagnosis, evaluation or treatment by a specialist, the plan or issuer shall make or provide for a referral to a specialist who has extensive experience or training, and is available and accessible to provide the treatment for such condition or disease, including the choice of a nonprimary care physician specialist participating in the plan or a referral to a nonparticipating provider as provided for under subparagraph (D) if such a provider is not available within the plan. `(B) SPECIALIST DEFINED- For purposes of this subsection, the term `specialist' means, with respect to a condition, disability, or disease, a health care practitioner, facility, or center (such as a center of excellence) that has extensive pediatric expertise through appropriate training or experience to provide high quality care in treating the condition, disability or disease. `(C) REFERRALS TO PARTICIPATING PROVIDERS- A plan or issuer is not required under subparagraph (A) to provide for a referral to a specialist that is not a participating provider, unless the plan or issuer does not have an appropriate specialist that is available and accessible to treat the enrollee's condition and that is a participating provider with respect to such treatment. `(D) TREATMENT OF NONPARTICIPATING PROVIDERS- If a plan or issuer refers a child enrollee to a nonparticipating specialist, services provided pursuant to the referral shall be provided at no additional cost to the enrollee beyond what the enrollee would otherwise pay for services received by such a specialist that is a participating provider. `(E) SPECIALISTS AS PRIMARY CARE PROVIDERS- A plan or issuer shall have in place a procedure under which a child who is covered under health insurance coverage provided by the plan or issuer who has a condition or disease that requires specialized medical care over a prolonged period of time shall receive a referral to a pediatric specialist affiliated with the plan, or if not available within the plan, to a nonparticipating provider for such condition and such specialist may be responsible for and capable of providing and coordinating the child's primary and specialty care. `(2) Standing referrals- `(A) IN GENERAL- A group health plan, or health insurance issuer in connection with the provision of health insurance coverage of a child, shall have a procedure by which a child who has a condition, disability, or disease that requires ongoing care from a specialist may request and obtain a standing referral to such specialist for treatment of such condition. If the primary care provider in consultation with the medical director of the plan or issuer and the specialist (if any), determines that such a standing referral is appropriate, the plan or issuer shall authorize such a referral to such a specialist. Such standing referral shall be consistent with a treatment plan. `(B) TREATMENT PLANS- A group health plan, or health insurance issuer, with the participation of the family and the health care providers of the child, shall develop a treatment plan for a child who requires ongoing care that covers a specified period of time (but in no event less than a 6-month period). Services provided for under the treatment plan shall not require additional approvals or referrals through a gatekeeper. `(C) TERMS OF REFERRAL- The provisions of subparagraph (C) and (D) of paragraph (1) shall apply with respect to referrals under subparagraph (A) in the same manner as they apply to referrals under paragraph (1)(A). `(c) ADEQUACY OF ACCESS- For purposes of subsections (a) and (b), a group health plan or health insurance issuer in connection with health insurance coverage shall ensure that a sufficient number, distribution, and variety of qualified participating health care providers are available so as to ensure that all covered health care services, including specialty services, are available and accessible to all enrollees in a timely manner. `(d) COVERAGE OF EMERGENCY SERVICES- `(1) IN GENERAL- If a group health plan, or health insurance coverage offered by a health insurance issuer, provides any benefits for children with respect to emergency services (as defined in paragraph (2)(A)), the plan or issuer shall cover emergency services furnished under the plan or coverage-- `(A) without the need for any prior authorization determination; `(B) whether or not the physician or provider furnishing such services is a participating physician or provider with respect to such services; and `(C) without regard to any other term or condition of such coverage (other than exclusion of benefits, or an affiliation or waiting period, permitted under section 2701). `(2) DEFINITIONS- In this subsection: `(A) EMERGENCY MEDICAL CONDITION BASED ON PRUDENT LAYPERSON STANDARD- The term `emergency medical condition' means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in a condition described in clause (i), (ii), or (iii) of section 1867(e)(1)(A) of the Social Security Act. `(B) EMERGENCY SERVICES- The term `emergency services' means-- `(i) a medical screening examination (as required under section 1867 of the Social Security Act) that is within the capability of the emergency department of a hospital, including ancillary services routinely available to the emergency department to evaluate an emergency medical condition (as defined in subparagraph (A)); and `(ii) within the capabilities of the staff and facilities available at the hospital, such further medical examination and treatment as are required under section 1867 of such Act to stabilize the patient. `(3) REIMBURSEMENT FOR MAINTENANCE CARE AND POST-STABILIZATION CARE- A group health plan, and health insurance issuer offering health insurance coverage, shall provide, in covering services other than emergency services, for reimbursement with respect to services which are otherwise covered and which are provided to an enrollee other than through the plan or issuer if the services are maintenance care or post-stabilization care covered under the guidelines established under section 1852(d) of the Social Security Act (relating to promoting efficient and timely coordination of appropriate maintenance and post-stabilization care of an enrollee after an enrollee has been determined to be stable). `(e) PROHIBITION ON FINANCIAL BARRIERS- A health insurance issuer in connection with the provision of health insurance coverage may not impose any cost sharing for pediatric specialty services provided under such coverage to enrollee children in amounts that exceed the cost-sharing required for other specialty care under such coverage. `(f) CHILDREN WITH SPECIAL HEALTH CARE NEEDS- A health insurance issuer in connection with the provision of health insurance coverage shall ensure that such coverage provides special consideration for the provision of services to enrollee children with special health care needs. Appropriate procedures shall be implemented to provide care for children with special health care needs. The development of such procedures shall include participation by the families of such children. `(g) DEFINITIONS- In this part: `(1) CHILD- The term `child' means an individual who is under 19 years of age. `(2) CHILDREN WITH SPECIAL HEALTH CARE NEEDS- The term `children with special health care needs' means those children who have or are at elevated risk for chronic physical, developmental, behavioral or emotional conditions and who also require health and related services of a type and amount not usually required by children. `SEC. 2771. CONTINUITY OF CARE. `(a) IN GENERAL- If a contract between a health insurance issuer, in connection with the provision of health insurance coverage, and a health care provider is terminated (other than by the issuer for failure to meet applicable quality standards or for fraud) and an enrollee is undergoing a course of treatment from the provider at the time of such termination, the issuer shall-- `(1) notify the enrollee of such termination, and `(2) subject to subsection (c), permit the enrollee to continue the course of treatment with the provider during a transitional period (provided under subsection (b)). `(b) TRANSITIONAL PERIOD- `(1) IN GENERAL- Except as provided in paragraphs (2) through (4), the transitional period under this subsection shall extend for at least-- `(A) 60 days from the date of the notice to the enrollee of the provider's termination in the case of a primary care provider, or `(B) 120 days from such date in the case of another provider. `(2) INSTITUTIONAL CARE- The transitional period under this subsection for institutional or inpatient care from a provider shall extend until the discharge or termination of the period of institutionalization and shall include reasonable follow-up care related to the institutionalization and shall also include institutional care scheduled prior to the date of termination of the provider status. `(3) PREGNANCY- If-- `(A) an enrollee has entered the second trimester of pregnancy at the time of a provider's termination of participation, and `(B) the provider was treating the pregnancy before date of the termination, the transitional period under this subsection with respect to provider's treatment of the pregnancy shall extend through the provision of post-partum care directly related to the delivery. `(4) TERMINAL ILLNESS- `(A) IN GENERAL- If-- `(i) an enrollee was determined to be terminally ill (as defined in subparagraph (B)) at the time of a provider's termination of participation, and `(ii) the provider was treating the terminal illness before the date of termination, the transitional period under this subsection shall extend for the remainder of the enrollee's life for care directly related to the treatment of the terminal illness. `(B) DEFINITION- In subparagraph (A), an enrollee is considered to be `terminally ill' if the enrollee has a medical prognosis that the enrollee's life expectancy is 6 months or less. `(c) PERMISSIBLE TERMS AND CONDITIONS- An issuer may condition coverage of continued treatment by a provider under subsection (a)(2) upon the provider agreeing to the following terms and conditions: `(1) The provider agrees to continue to accept reimbursement from the issuer at the rates applicable prior to the start of the transitional period as payment in full. `(2) The provider agrees to adhere to the issuer's quality assurance standards and to provide to the issuer necessary medical information related to the care provided. `(3) The provider agrees otherwise to adhere to the issuer's policies and procedures, including procedures regarding referrals and obtaining prior authorization and providing services pursuant to a treatment plan approved by the issuer. `SEC. 2772. CONTINUOUS QUALITY IMPROVEMENT. `(a) IN GENERAL- A health insurance issuer that offers health insurance coverage for children shall establish and maintain an ongoing, internal quality assurance program that at a minimum meets the requirements of subsection (b). `(b) REQUIREMENTS- The internal quality assurance program of an issuer under subsection (a) shall-- `(1) establish and measure a set of health care, functional assessments, structure, processes and outcomes, and quality indicators that are unique to children and based on nationally accepted standards or guidelines of care; `(2) maintain written protocols consistent with recognized clinical guidelines or current consensus on the pediatric field, to be used for purposes of internal utilization review, with periodic updating and evaluation by pediatric specialists to determine effectiveness in controlling utilization; `(3) provide for peer review by health care professionals of the structure, processes, and outcomes related to the provision of health services, including pediatric review of pediatric cases; `(4) include in member satisfaction surveys, questions on child and family satisfaction and experience of care, including care to children with special needs; `(5) monitor and evaluate the continuity of care with respect to children; `(6) include pediatric measures that are directed at meeting the needs of at-risk children and children with chronic conditions, disabilities and severe illnesses; `(7) maintain written guidelines to ensure the availability of medications appropriate to children; `(8) use focused studies of care received by children with certain types of chronic conditions and disabilities and focused studies of specialized services used by children with chronic conditions and disabilities; `(9) monitor access to pediatric specialty services; and `(10) monitor child health care professional satisfaction. `(c) UTILIZATION REVIEW ACTIVITIES- `(1) COMPLIANCE WITH REQUIREMENTS- `(A) IN GENERAL- A health insurance issuer that offers health insurance coverage for children shall conduct utilization review activities in connection with the provision of such coverage only in accordance with a utilization review program that meets at a minimum the requirements of this subsection. `(B) DEFINITIONS- In this subsection: `(i) CLINICAL PEERS- The term `clinical peer' means, with respect to a review, a physician or other health care professional who holds a non-restricted license in a State and in the same or similar specialty as typically manages the pediatric medical condition, procedure, or treatment under review. `(ii) HEALTH CARE PROFESSIONAL- The term `health care professional' means a physician or other health care practitioner licensed or certified under State law to provide health care services and who is operating within the scope of such licensure or certification. `(iii) UTILIZATION REVIEW- The terms `utilization review' and `utilization review activities' mean procedures used to monitor or evaluate the clinical necessity, appropriateness, efficacy, or efficiency of health care services, procedures or settings for children, and includes prospective review, concurrent review, second opinions, case management, discharge planning, or retrospective review specific to children. `(2) WRITTEN POLICIES AND CRITERIA- `(A) WRITTEN POLICIES- A utilization review program shall be conducted consistent with written policies and procedures that govern all aspects of the program. `(B) USE OF WRITTEN CRITERIA- A utilization review program shall utilize written clinical review criteria specific to children and developed pursuant to the program with the input of appropriate physicians, including pediatricians, nonprimary care pediatric specialists, and other child health professionals. `(C) ADMINISTRATION BY HEALTH CARE PROFESSIONALS- A utilization review program shall be administered by qualified health care professionals, including health care professionals with pediatric expertise who shall oversee review decisions. `(3) USE OF QUALIFIED, INDEPENDENT PERSONNEL- `(A) IN GENERAL- A utilization review program shall provide for the conduct of utilization review activities only through personnel who are qualified and, to the extent required, who have received appropriate pediatric or child health training in the conduct of such activities under the program. `(B) PEER REVIEW OF ADVERSE CLINICAL DETERMINATIONS- A utilization review program shall provide that clinical peers shall evaluate the clinical appropriateness of adverse clinical determinations and divergent clinical options. `SEC. 2773. APPEALS AND GRIEVANCE MECHANISMS FOR CHILDREN. `(a) INTERNAL APPEALS PROCESS- A health insurance issuer in connection with the provision of health insurance coverage for children shall establish and maintain a system to provide for the resolution of complaints and appeals regarding all aspects of such coverage. Such a system shall include an expedited procedure for appeals on behalf of a child enrollee in situations in which the time frame of a standard appeal would jeopardize the life, health, or development of the child. `(b) EXTERNAL APPEALS PROCESS- A health insurance issuer in connection with the provision of health insurance coverage for children shall provide for an independent external review process that meets the following requirements: `(1) External appeal activities shall be conducted through clinical peers, a physician or other health care professional who is appropriately credentialed in pediatrics with the same or similar specialty and typically manages the condition, procedure, or treatment under review or appeal. `(2) External appeal activities shall be conducted through an entity that has sufficient pediatric expertise, including subspecialty expertise, and staffing to conduct external appeal activities on a timely basis. `(3) Such a review process shall include an expedited procedure for appeals on behalf of a child enrollee in which the time frame of a standard appeal would jeopardize the life, health, or development of the child. `SEC. 2774. ACCOUNTABILITY THROUGH DISTRIBUTION OF INFORMATION. `(a) IN GENERAL- A health insurance issuer in connection with the provision of health insurance coverage for children shall submit to enrollees (and prospective enrollees), and make available to the public, in writing the health-related information described in subsection (b). `(b) INFORMATION- The information to be provided under subsection (a) shall include a report of measures of structures, processes, and outcomes regarding each health insurance product offered to participants and dependents in a manner that is separate for both the adult and child enrollees, using measures that are specific to each group.'. (b) APPLICATION TO GROUP HEALTH INSURANCE COVERAGE- (1) IN GENERAL- Subpart 2 of part A of title XXVII of the Public Health Service Act (42 U.S.C. 300gg-4 et seq.) is amended by adding at the end the following new section: `SEC. 2707. CHILDREN'S HEALTH ACCOUNTABILITY STANDARDS. `(a) IN GENERAL- Each health insurance issuer shall comply with children's health accountability requirement under part C with respect to group health insurance coverage it offers. `(b) ASSURING COORDINATION- The Secretary of Health and Human Services and the Secretary of Labor shall ensure, through the execution of an interagency memorandum of understanding between such Secretaries, that-- `(1) regulations, rulings, and interpretations issued by such Secretaries relating to the same matter over which such Secretaries have responsibility under part C (and this section) and section 714 of the Employee Retirement Income Security Act of 1974 are administered so as to have the same effect at all times; and `(2) coordination of policies relating to enforcing the same requirements through such Secretaries in order to have a coordinated enforcement strategy that avoids duplication of enforcement efforts and assigns priorities in enforcement.'. (2) CONFORMING AMENDMENT- Section 2792 of the Public Health Service Act (42 U.S.C. 300gg-92) is amended by inserting `and section 2707(b)' after `of 1996'. (c) APPLICATION TO INDIVIDUAL HEALTH INSURANCE COVERAGE- Part B of title XXVII of the Public Health Service Act (42 U.S.C. 300gg-41 et seq.) is amended by inserting after section 2752 the following new section: `SEC. 2753. CHILDREN'S HEALTH ACCOUNTABILITY STANDARDS. `Each health insurance issuer shall comply with children's health accountability requirements under part C with respect to individual health insurance coverage it offers.'. (d) Modification of Preemption Standards- (1) GROUP HEALTH INSURANCE COVERAGE- Section 2723 of the Public Health Service Act (42 U.S.C. 300gg-23) is amended-- (A) in subsection (a)(1), by striking `subsection (b)' and inserting `subsections (b) and (c)'; (B) by redesignating subsections (c) and (d) as subsections (d) and (e), respectively; and (C) by inserting after subsection (b) the following new subsection: `(c) SPECIAL RULES IN CASE OF CHILDREN'S HEALTH ACCOUNTABILITY REQUIREMENTS- Subject to subsection (a)(2), the provisions of section 2707 and part C, and part D insofar as it applies to section 2707 or part C, shall not prevent a State from establishing requirements relating to the subject matter of such provisions so long as such requirements are at least as stringent on health insurance issuers as the requirements imposed under such provisions.'. (2) INDIVIDUAL HEALTH INSURANCE COVERAGE- Section 2762 of the Public Health Service Act (42 U.S.C. 300gg-62), as added by section 605(b)(3)(B) of Public Law 104-204, is amended-- (A) in subsection (a), by striking `subsection (b), nothing in this part' and inserting `subsections (b) and (c), nothing in this part', and (B) by adding at the end the following new subsection: `(c) SPECIAL RULES IN CASE OF CHILDREN'S HEALTH ACCOUNTABILITY REQUIREMENTS- Subject to subsection (b), the provisions of section 2753 and part C, and part D insofar as it applies to section 2753 or part C, shall not prevent a State from establishing requirements relating to the subject matter of such provisions so long as such requirements are at least as stringent on health insurance issuers as the requirements imposed under such section.'. SEC. 1214. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974. (a) IN GENERAL- Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended by adding at the end the following: `SEC. 714. CHILDREN'S HEALTH ACCOUNTABILITY STANDARDS. `(a) IN GENERAL- Subject to subsection (b), the provisions of part C of title XXVII of the Public Health Service Act shall apply under this subpart and part to a group health plan (and group health insurance coverage offered in connection with a group health plan) as if such part C were incorporated in this section. `(b) APPLICATION- In applying subsection (a) under this subpart and part, any reference in such part C-- `(1) to health insurance coverage is deemed to be a reference only to group health insurance coverage offered in connection with a group health plan and to also be a reference to coverage under a group health plan; `(2) to a health insurance issuer is deemed to be a reference only to such an issuer in relation to group health insurance coverage or, with respect to a group health plan, to the plan; `(3) to the Secretary is deemed to be a reference to the Secretary of Labor; `(4) to an applicable State authority is deemed to be a reference to the Secretary of Labor; and `(5) to an enrollee with respect to health insurance coverage is deemed to include a reference to a participant or beneficiary with respect to a group health plan.'. (b) MODIFICATION OF PREEMPTION STANDARDS- Section 731 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1191) is amended-- (1) in subsection (a)(1), by striking `subsection (b)' and inserting `subsections (b) and (c)'; (2) by redesignating subsections (c) and (d) as subsections (d) and (e), respectively; and (3) by inserting after subsection (b) the following new subsection: `(c) SPECIAL RULES IN CASE OF PATIENT ACCOUNTABILITY REQUIREMENTS- Subject to subsection (a)(2), the provisions of section 714 shall not prevent a State from establishing requirements relating to the subject matter of such provisions so long as such requirements are at least as stringent on group health plans and health insurance issuers in connection with group health insurance coverage as the requirements imposed under such provisions.'. (c) CONFORMING AMENDMENTS- (1) Section 732(a) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1191a(a)) is amended by striking `section 711' and inserting `sections 711 and 714'. (2) The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 is amended by inserting after the item relating to section 713 the