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TheWeekInCongress.com (TM)

Week Ending August 3, 2007

 

S.1893 An original bill to amend title XXI of the Social Security Act to reauthorize the State Children's Health Insurance Program, and for other purposes.

 

The bill is the Senate effort to modify and reauthorize the State Children’s Health Insurance Program through which several million uninsured low-income children, some pregnant women and some adults would be covered through the Federal Medicare system and the Federal / State Medicaid program. The bill substitutes the text on a House-passed bill, HR 976, that offers various tax incentives to small businesses. HR 976 offered tax breaks to help small businesses deal with the minimum wage increase that was passed by the house in HR 2. The minimum wage increase was passed and signed into law as part of HR 2206, the bill providing supplemental spending for Iraq, Afghanistan, disaster relief and other purposes. The inclusion of the minimum wage increase originally included the small business tax provisions but they were not included in HR 2206.

 

S 1893 parallels a stand alone House bill that also deals with SCHIP but goes further to include revisions to Medicare programs and procedures in general.

 

Program 'expansion'

One of the ways SCHIP determines the eligibility for participation in the program is assessing the beneficiary's financial position in regard to the Federal poverty level, generally 150%. The poverty level is changed with each census. Currently it is around $20,000. The bill is seen as expanding the SCHIP program by allowing States to qualify applicants at a higher percentage above the level of income considered low-income. The bill also expands the program by assuming a percentage increase of low-income children each year who would be served by the program.

 

In response to reports and concerns that SCHIP also provides health insurance to adults the bill aims to phase out that practice over a few years. The main provision prohibits States from spending funds allow for States to “to provide child health assistance or other health benefits coverage to a non-pregnant childless adult” beginning October 2008. States may be eligible for a block grant that would allow them to continue that coverage into 2009. States can apply for a waiver allowing for nonpregnant, childless adult coverage and if not granted or denied the waiver by September 30, 2009 can deem the waiver approved.

 

No new waivers can be approved to provide coverage to a parent of a targeted low-income child after October 1, 2009.

 

Various grants are available to States to improve outreach to potential child beneficiaries including those in minority, underserved and Native American populations. The effort is coupled with efforts to lower barriers to outreach and premium assistance. The bill tends to leave open to the States, the criteria for establishing citizenship but provides that the State can check the applicant’s social security number. If invalid, the applicant must be informed of the denial of qualification within about 90 days maximum.

 

Assistance with paying premiums is also a State option and can be done directly or through a parent’s employer. The Employer has the option not to participate.

 

Quality of healthcare

The Secretary is required to develop an initial, recommended core set of child health quality measures for use by State programs to include availability of care and the specific areas of care provided. Similar standards are to be created for pediatric care.

 

The bill provides for mental health parity and dental care through grants for the purpose of carrying out programs and activities that are designed to improve the availability of dental services and strengthen dental coverage for targeted low-income children. Requirements to qualify for mental health or substance abuse treatment may not be any higher than required qualifications for any other benefits.

 

Revenues

The bill would raise funds through an excise tax on tobacco product to include cigarettes, cigars, pipe and chewing tobacco, snuff and cigarette papers. Those who sell the products would collect the taxes and would be given a $500 tax credit. The new tax begins on products held after January 1, 2009.

 A tax would apply to articles in Foreign Trade Zones on which internal revenue taxes have been determined, or customs duties have been liquidated.

 

Sponsor:  Senator Max Baucus (D-MT)

Vote: The bill passed the Senate amended (to include the text of S 1893) August 2, 2007 68 to 31 RV 307

Cost to the taxpayers: “CBO estimates that enacting this legislation would increase federal direct spending by $35.2 billion over the 2008-2012 period and by $71.0 billion over the 2008-2017 period. CBO and JCT estimate that net revenues would increase under the bill by $36.1 billion over the next five years and $72.8 billion over the 10-year period. A portion of that increase would be in off-budget revenues: $0.8 billion for the 2008-2012 period and $1.1 billion over the 2008-2017 period. On balance, the spending and revenue changes would reduce federal on-budget deficits by $0.1 billion through 2012 and $0.8 billion for the 2008-2017 period.”

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MORE INFORMATION

AMENDMENTS

TITLE I – FINANCING OF CHIP

TITLE II – OUTREACH AND ENROLLMENT

TITLE III – REDUCING BARRIERS TO ENROLLMENT

TITLE IV – REDUCING BARRIERS TO PROVIDING PREMIUM ASSISTANCE

TITLE V – STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES OF CHILDREN

TITLE VI – MISCELLANEOUS

TITLE VII – REVENUE PROVISIONS

 

 

TITLE I – FINANCING OF CHIP

`(11) for fiscal year 2008, $9,125,000,000;

`(12) for fiscal year 2009, $10,675,000,000;

`(13) for fiscal year 2010, $11,850,000,000;

`(14) for fiscal year 2011, $13,750,000,000; and

`(15) for fiscal year 2012, for purposes of making 2 semi-annual allotments--

`(A) $1,750,000,000 for the period beginning on October 1, 2011, and ending on March 31, 2012, and

`(B) $1,750,000,000 for the period beginning on April 1, 2012, and ending on September 30, 2012.'.

SEC. 102. ALLOTMENTS FOR THE 50 STATES AND THE DISTRICT OF COLUMBIA.

IN GENERAL- Subject to the succeeding paragraphs of this subsection, the Secretary shall for each of fiscal years 2008 through 2012 allot to each subsection (b) State from the available national allotment an amount equal to 110 percent of--

`(i) in the case of fiscal year 2008, the highest of the amounts determined under paragraph (2);

`(ii) in the case of each of fiscal years 2009 through 2011, the Federal share of the expenditures determined under subparagraph (B) for the fiscal year; and

`(iii) beginning with fiscal year 2012, subject to subparagraph (E), each semi-annual allotment determined under subparagraph (D).

ANNUAL ADJUSTMENT FOR HEALTH CARE COST GROWTH AND CHILD POPULATION GROWTH- The annual adjustment determined under this subparagraph for a fiscal year with respect to a State is equal to the product of the amounts determined under clauses (i) and (ii):

`(i) PER CAPITA HEALTH CARE GROWTH- 1 plus the percentage increase (if any) in the projected nominal per capita amount of National Health Expenditures for the calendar year that begins during the fiscal year involved over the preceding calendar year, as most recently published by the Secretary.

`(ii) CHILD POPULATION GROWTH- 1.01 plus the percentage change in the population of children under 19 years of age in the State from July 1 of the fiscal year preceding the fiscal year involved to July 1 of the fiscal year involved, as determined by the Secretary based on the most timely and accurate published estimates of the Bureau of the Census.

NUMBER OF LOW-INCOME CHILDREN IN THE STATE- The ratio of the number of low-income children in the State, as determined on the basis of the most timely and accurate published estimates of the Bureau of the Census, to the sum of the number of low-income children so determined.

 

SEC. 103. ONE-TIME APPROPRIATION.

There is appropriated to the Secretary, out of any money in the Treasury not otherwise appropriated, $12,500,000,000 to accompany the allotment made for the period beginning on October 1, 2011, and ending on March 31, 2012, under section 2104(a)(15)(A) of the Social Security Act (42 U.S.C. 1397dd(a)(15)(A)) (as added by section 101), to remain available until expended. Such amount shall be used to provide allotments to States under subsections (c)(5) and (i) of section 2104 of the Social Security Act (42 U.S.C. 1397dd) for the first 6 months of fiscal year 2012 in the same manner as allotments are provided.

 

GAO Study and Report- Not later than September 30, 2009, the Comptroller General of the United States shall submit a report to the appropriate committees of Congress regarding Federal funding under Medicaid and CHIP for Puerto Rico, the United States Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.

1) ESTABLISHMENT OF INCENTIVE POOL FROM UNOBLIGATED NATIONAL ALLOTMENT AND UNEXPENDED STATE ALLOTMENTS-

`(A) IN GENERAL- There is hereby established in the Treasury of the United States a fund which shall be known as the `CHIP Incentive Bonuses Pool' (in this subsection referred to as the `Incentive Pool'). Amounts in the Incentive Pool are authorized to be appropriated for payments.

UNEXPENDED TRANSITIONAL COVERAGE BLOCK GRANT FOR NONPREGNANT CHILDLESS ADULTS- On October 1, 2009, any amounts set aside under section 2111(a)(3) that are not expended by September 30, 2009.

INVESTMENT OF FUND- The Secretary of the Treasury shall invest, in interest bearing securities of the United States, such currently available portions of the Incentive Pool as are not immediately required for payments from the Pool. The income derived from these investments constitutes a part of the Incentive Pool.

SEC. 106. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS ADULTS UNDER CHIP; CONDITIONS FOR COVERAGE OF PARENTS.

 

IN GENERAL- No funds shall be available under this title for child health assistance or other health benefits coverage that is provided to a nonpregnant childless adult under an applicable existing waiver after September 30, 2008.

`(B) EXTENSION UPON STATE REQUEST- If an applicable existing waiver described in subparagraph (A) would otherwise expire before October 1, 2008, and the State requests an extension of such waiver, the Secretary shall grant such an extension, but only through September 30, 2008.

OPTIONAL 1-YEAR TRANSITIONAL COVERAGE BLOCK GRANT FUNDED FROM STATE ALLOTMENT- Subject to paragraph (4)(B), each State for which coverage under an applicable existing waiver is terminated under paragraph (2)(A) may elect to provide nonpregnant childless adults who were provided child health assistance or health benefits coverage under the applicable existing waiver at any time during fiscal year 2008 with such assistance or coverage during fiscal year 2009, as if the authority to provide such assistance or coverage under an applicable existing waiver was extended through that fiscal year, but subject to the following terms and conditions:

`(A) BLOCK GRANT SET ASIDE FROM STATE ALLOTMENT- The Secretary shall set aside for the State an amount equal to the Federal share of the State's projected expenditures under the applicable existing waiver for providing child health assistance or health benefits coverage to all nonpregnant childless adults under such waiver for fiscal year 2008 (as certified by the State and submitted to the Secretary by not later than August 31, 2008, and without regard to whether any such individual lost coverage during fiscal year 2008 and was later provided child health assistance or other health benefits coverage under the waiver in that fiscal year), increased by the annual adjustment for fiscal year 2009 determined under section 2104(i)(2)(B)(i). The Secretary may adjust the amount set aside under the preceding sentence, as necessary, on the basis of the expenditure data for fiscal year 2008 reported by States on CMS Form 64 or CMS Form 21 not later than November 30, 2008, but in no case shall the Secretary adjust such amount after December 31, 2008.

STATE OPTION TO APPLY FOR MEDICAID WAIVER TO CONTINUE COVERAGE FOR NONPREGNANT CHILDLESS ADULTS-

`(A) IN GENERAL- Each State for which coverage under an applicable existing waiver is terminated under paragraph (2)(A) may submit, not later than June 30, 2009, an application to the Secretary for a waiver under section 1115 of the State plan under title XIX to provide medical assistance to a nonpregnant childless adult whose coverage is so terminated (in this subsection referred to as a `Medicaid nonpregnant childless adults waiver').

`(B) DEADLINE FOR APPROVAL- The Secretary shall make a decision to approve or deny an application for a Medicaid nonpregnant childless adults waiver submitted under subparagraph (A) within 90 days of the date of the submission of the application. If no decision has been made by the Secretary as of September 30, 2009, on the application of a State for a Medicaid nonpregnant childless adults waiver that was submitted to the Secretary by June 30, 2009, the application shall be deemed approved.

STANDARD FOR BUDGET NEUTRALITY- The budget neutrality requirement applicable with respect to expenditures for medical assistance under a Medicaid nonpregnant childless adults waiver shall--

`(i) in the case of fiscal year 2010, allow expenditures for medical assistance under title XIX for all such adults to not exceed the total amount of payments made to the State

the Secretary shall not on or after the date of the enactment of the Children's Health Insurance Program Reauthorization Act of 2007, approve or renew a waiver, experimental, pilot, or demonstration project that would allow funds made available under this title to be used to provide child health assistance or other health benefits coverage to a nonpregnant childless adult; and

`(B) notwithstanding the terms and conditions of an applicable existing waiver, the provisions of paragraphs (2) and (3) shall apply for purposes of any fiscal year beginning on or after October 1, 2008, in determining the period to which the waiver applies, the individuals eligible to be covered by the waiver, and the amount of the Federal payment under this title.

`SEC. 2112. OPTIONAL COVERAGE OF TARGETED LOW-INCOME PREGNANT WOMEN THROUGH A STATE PLAN AMENDMENT.

`(a) In General- Subject to the succeeding provisions of this section, a State may elect through an amendment to its State child health plan under section 2102 to provide pregnancy-related assistance under such plan for targeted low-income pregnant women.

`(b) Conditions- A State may only elect the option under subsection (a) if the following conditions are satisfied:

`(1) MEDICAID INCOME ELIGIBILITY LEVEL FOR PREGNANT WOMEN OF AT LEAST 185 PERCENT OF POVERTY-

NO CHIP INCOME ELIGIBILITY LEVEL FOR PREGNANT WOMEN LOWER THAN THE STATE'S MEDICAID LEVEL

NO COVERAGE FOR HIGHER INCOME PREGNANT WOMEN WITHOUT COVERING LOWER INCOME PREGNANT WOMEN

 

NO PREEXISTING CONDITION EXCLUSION OR WAITING PERIOD- The State does not apply any exclusion of benefits for pregnancy-related assistance based on any preexisting condition or any waiting period.

 

Automatic Enrollment for Children Born to Women Receiving Pregnancy-Related Assistance- If a child is born to a targeted low-income pregnant woman who was receiving pregnancy-related assistance under this section on the date of the child's birth, the child shall be deemed to have applied for child health assistance under the State child health plan and to have been found eligible for such assistance under such plan or to have applied for medical assistance under title XIX and to have been found eligible for such assistance under such title, as appropriate, on the date of such birth and to remain eligible for such assistance until the child attains 1 year of age. During the period in which a child is deemed under the preceding sentence to be eligible for child health or medical assistance, the child health or medical assistance eligibility identification number of the mother shall also serve as the identification number of the child, and all claims shall be submitted and paid under such number (unless the State issues a separate identification number for the child before such period expires).

 

ESTABLISHMENT- There is hereby established in the Treasury of the United States a fund which shall be known as the `CHIP Contingency Fund' (in this subsection referred to as the `Fund'). Amounts in the Fund are authorized to be appropriated for payments under this subsection.

`(2) DEPOSITS INTO FUND-

`(A) INITIAL AND SUBSEQUENT APPROPRIATIONS- Subject to subparagraphs (B) and (E), out of any money in the Treasury of the United States not otherwise appropriated, there are appropriated to the Fund.

 

STAFFORD ACT OR PUBLIC HEALTH EMERGENCY

STATE ECONOMIC DOWNTURN- The State unemployment rate is at least 5.5 percent during any 13-consecutive week period.

EVENT RESULTING IN RISE IN PERCENTAGE OF LOW-INCOME CHILDREN WITHOUT HEALTH INSURANCE.

 

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TITLE II – OUTREACH AND ENROLLEMENT

TEN PERCENT SET ASIDE FOR NATIONAL ENROLLMENT CAMPAIGN

target geographic areas with high rates of--

`(i) eligible but unenrolled children, including such children who reside in rural areas; or

`(ii) racial and ethnic minorities and health disparity populations, including those proposals that address cultural and linguistic barriers to enrollment.

TEN PERCENT SET ASIDE FOR OUTREACH TO INDIAN CHILDREN

National Enrollment Campaign- From the amounts made available under subsection (a)(2), the Secretary shall develop and implement a national enrollment campaign to improve the enrollment of underserved child populations in the programs established under this title and title XIX. Such campaign may include--

`(1) the establishment of partnerships with the Secretary of Education and the Secretary of Agriculture to develop national campaigns to link the eligibility and enrollment systems for the assistance programs each Secretary administers that often serve the same children;

`(2) the integration of information about the programs established under this title and title XIX in public health awareness campaigns administered by the Secretary;

`(3) increased financial and technical support for enrollment hotlines maintained by the Secretary to ensure that all States participate in such hotlines;

`(4) the establishment of joint public awareness outreach initiatives with the Secretary of Education and the Secretary of Labor regarding the importance of health insurance to building strong communities and the economy;

`(5) the development of special outreach materials for Native Americans or for individuals with limited English proficiency; and

`(6) such other outreach initiatives as the Secretary determines would increase public awareness of the programs under this title and title XIX.'.

IN GENERAL- In order to improve the access of Indians residing on or near a reservation to obtain benefits under the Medicaid and State children's health insurance programs established under titles XIX and XXI, the Secretary shall encourage the State to take steps to provide for enrollment on or near the reservation. Such steps may include outreach efforts such as the outstationing of eligibility workers, entering into agreements with the Indian Health Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations to provide outreach, education regarding eligibility and benefits, enrollment, and translation services when such services are appropriate.

AUTHORIZATION TO RECEIVE PERTINENT INFORMATION

`Sec. 1939. (a) In General- Notwithstanding any other provision of law, a Federal or State agency or private entity in possession of the sources of data directly relevant to eligibility determinations under this title (including eligibility files, information described in paragraph (2) or (3) of section 1137(a), vital records information about births in any State, and information described in sections 453(i) and 1902(a)(25)(I)) is authorized to convey such data or information to the State agency administering the State plan

Criminal Penalty- A person described in subsection (a) who publishes, divulges, discloses, or makes known in any manner, or to any extent, not authorized by Federal law, any information obtained under this section shall be fined not more than $1,000 or imprisoned not more than 1 year, or both, for each such unauthorized activity.

 

 

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TITLE III – REDUCING BARRIERS TO ENROLLMENT

 

State Option To Verify Declaration of Citizenship or Nationality for Purposes of Eligibility for Medicaid Through Verification of Name and Social Security Number

The State submits the name and social security number of the individual to the Commissioner of Social Security. notifies the individual of such fact. provides the individual with an opportunity to cure the invalid determination with the Commissioner of Social Security, disenrolls the individual from the State plan under this title within 30 days.

Notwithstanding the preceding sentence, in the case of a child who is born in the United States to an alien mother for whom medical assistance for the delivery of the child is made available pursuant to section 1903(v), the State immediately shall issue a separate identification number for the child upon notification by the facility at which such delivery occurred of the child's birth.

IN GENERAL- No payment may be made under this section with respect to an individual who has, or is, declared to be a citizen or national of the United States for purposes of establishing eligibility

 

 

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TITLE IV – REDUCING BARRIERS TO PROVIDING PREMIUM ASSISTANCE

ADDITIONAL STATE OPTION FOR PROVIDING PREMIUM ASSISTANCE.

 

IN GENERAL- Subject to the succeeding provisions of this paragraph, a State may elect to offer a premium assistance subsidy (as defined in subparagraph (C)) for qualified employer-sponsored coverage (as defined in subparagraph (B)) to all targeted low-income children who are eligible for child health assistance under the plan and have access to such coverage.

EMPLOYER OPT-OUT- An employer may notify a State that it elects to opt-out of being directly paid a premium assistance subsidy on behalf of an employee. In the event of such a notification, an employer shall withhold the total amount of the employee contribution required for enrollment of the employee and the child in the qualified employer-sponsored coverage and the State shall pay the premium assistance subsidy directly to the employee.

State shall provide for each targeted low-income child enrolled in qualified employer-sponsored coverage, supplemental coverage consisting of--

`(I) items or services that are not covered, or are only partially covered, under the qualified employer-sponsored coverage; and

`(II) cost-sharing protection

IN GENERAL- A State may establish an employer-family premium assistance purchasing pool for employers with less than 250 employees who have at least 1 employee who is a pregnant woman eligible for assistance under the State child health plan (including through the application of an option described in section 2112(f)) or a member of a family with at least 1 targeted low-income child and to provide a premium assistance subsidy under this paragraph for enrollment in coverage made available through such pool.

SEC. 411. SPECIAL ENROLLMENT PERIOD UNDER GROUP HEALTH PLANS IN CASE OF TERMINATION OF MEDICAID OR CHIP COVERAGE OR ELIGIBILITY FOR ASSISTANCE IN PURCHASE OF EMPLOYMENT-BASED COVERAGE; COORDINATION OF COVERAGE.

IN GENERAL- A group health plan shall permit an employee who is eligible, but not enrolled, for coverage under the terms of the plan (or a dependent of such an employee if the dependent is eligible, but not enrolled, for coverage under such terms) to enroll for coverage under the terms of the plan.

 

 

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TITLE V – STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES OF CHILDREN

SEC. 501. CHILD HEALTH QUALITY IMPROVEMENT ACTIVITIES FOR CHILDREN ENROLLED IN MEDICAID OR CHIP

IN GENERAL- Not later than January 1, 2009, the Secretary shall identify and publish for general comment an initial, recommended core set of child health quality measures for use by State programs administered under titles XIX and XXI, health insurance issuers and managed care entities that enter into contracts with such programs, and providers of items and services under such programs.

Secretary shall publish an initial core set of child health quality measures that includes (but is not limited to) the following:

`(A) The duration of children's health insurance coverage over a 12-month time period.

`(B) The availability of a full range of--

`(i) preventive services, treatments, and services for acute conditions, including services to promote healthy birth and prevent and treat premature birth; and

`(ii) treatments to correct or ameliorate the effects of chronic physical and mental conditions in infants, young children, school-age children, and adolescents.

`(C) The availability of care in a range of ambulatory and inpatient health care settings in which such care is furnished.

`(D) The types of measures that, taken together, can be used to estimate the overall national quality of health care for children and to perform comparative analyses of pediatric health care quality and racial, ethnic, and socioeconomic disparities in child health and health care for children.

The Secretary shall disseminate information to States regarding best practices among States with respect to measuring and reporting on the quality of health care for children, and shall facilitate the adoption of such best practices. In developing best practices approaches, the Secretary shall give particular attention to State measurement techniques that ensure the timeliness and accuracy of provider reporting, encourage provider reporting compliance, encourage successful quality improvement strategies, and improve efficiency in data collection using health information technology.

Not later than January 1, 2010, and every 3 years thereafter, the Secretary shall report to Congress on--

`(A) the status of the Secretary's efforts to improve--

`(i) quality related to the duration and stability of health insurance coverage for children under titles XIX and XXI;

`(ii) the quality of children's health care under such titles, including preventive health services, health care for acute conditions, chronic health care, and health services to ameliorate the effects of physical and mental conditions and to aid in growth and development of infants, young children, school-age children, and adolescents with special health care needs; and

`(iii) the quality of children's health care under such titles across the domains of quality, including clinical quality, health care safety, family experience with health care, health care in the most integrated setting, and elimination of racial, ethnic, and socioeconomic disparities in health and health care;

ESTABLISHMENT OF PEDIATRIC QUALITY MEASURES PROGRAM- Not later than January 1, 2010, the Secretary shall establish a pediatric quality measures program to--

`(A) improve and strengthen the initial core child health care quality measures established by the Secretary under subsection (a);

`(B) expand on existing pediatric quality measures used by public and private health care purchasers and advance the development of such new and emerging quality measures; and

`(C) increase the portfolio of evidence-based, consensus pediatric quality measures available to public and private purchasers of children's health care services, providers, and consumers.

AUTHORITY TO CONDUCT DEMONSTRATION- The Secretary, in consultation with the Administrator of the Centers for Medicare & Medicaid Services, shall conduct a demonstration project to develop a comprehensive and systematic model for reducing childhood obesity by awarding grants to eligible entities to carry out such project. Such model shall--

`(A) identify, through self-assessment, behavioral risk factors for obesity among children;

`(B) identify, through self-assessment, needed clinical preventive and screening benefits among those children identified as target individuals on the basis of such risk factors;

`(C) provide ongoing support to such target individuals and their families to reduce risk factors and promote the appropriate use of preventive and screening benefits; and

`(D) be designed to improve health outcomes, satisfaction, quality of life, and appropriate use of items and services for which medical assistance is available under title XIX or child health assistance is available under title XXI among such target individuals.

In awarding grants under paragraph (1), the Secretary shall give priority to awarding grants to eligible entities--

`(A) that demonstrate that they have previously applied successfully for funds to carry out activities that seek to promote individual and community health and to prevent the incidence of chronic disease and that can cite published and peer-reviewed research demonstrating that the activities that the entities propose to carry out with funds made available under the grant are effective;

`(B) that will carry out programs or activities that seek to accomplish a goal or goals set by the State in the Healthy People 2010 plan of the State;

`(C) that provide non-Federal contributions, either in cash or in-kind, to the costs of funding activities under the grants;

`(D) that develop comprehensive plans that include a strategy for extending program activities developed under grants in the years following the fiscal years for which they receive grants under this subsection;

`(E) located in communities that are medically underserved, as determined by the Secretary;

`(F) located in areas in which the average poverty rate is at least 150 percent or higher of the average poverty rate in the State involved, as determined by the Secretary; and

`(G) that submit plans that exhibit multisectoral, cooperative conduct that includes the involvement of a broad range of stakeholders, including--

`(i) community-based organizations;

`(ii) local governments;

`(iii) local educational agencies;

`(iv) the private sector;

`(v) State or local departments of health;

`(vi) accredited colleges, universities, and community colleges;

`(vii) health care providers;

`(viii) State and local departments of transportation and city planning; and

`(ix) other entities determined appropriate by the Secretary.

Development of Model Electronic Health Record Format for Children Enrolled in Medicaid or CHIP-

`(1) IN GENERAL- Not later than January 1, 2009, the Secretary shall establish a program to encourage the development and dissemination of a model electronic health record format for children enrolled in the State plan under title XIX or the State child health plan under title XXI that is--

`(A) subject to State laws, accessible to parents, caregivers, and other consumers for the sole purpose of demonstrating compliance with school or leisure activity requirements, such as appropriate immunizations or physicals;

`(B) designed to allow interoperable exchanges that conform with Federal and State privacy and security requirements;

`(C) structured in a manner that permits parents and caregivers to view and understand the extent to which the care their children receive is clinically appropriate and of high quality; and

`(D) capable of being incorporated into, and otherwise compatible with, other standards developed for electronic health records.

`(2) FUNDING- $5,000,000

Study of Pediatric Health and Health Care Quality Measures-

`(1) IN GENERAL- Not later than July 1, 2009, the Institute of Medicine shall study and report to Congress on the extent and quality of efforts to measure child health status and the quality of health care for children across the age span and in relation to preventive care, treatments for acute conditions, and treatments aimed at ameliorating or correcting physical, mental, and developmental conditions in children. In conducting such study and preparing such report, the Institute of Medicine shall--

`(A) consider all of the major national population-based reporting systems sponsored by the Federal Government that are currently in place, including reporting requirements under Federal grant programs and national population surveys and estimates conducted directly by the Federal Government;

`(B) identify the information regarding child health and health care quality that each system is designed to capture and generate, the study and reporting periods covered by each system, and the extent to which the information so generated is made widely available through publication;

`(C) identify gaps in knowledge related to children's health status, health disparities among subgroups of children, the effects of social conditions on children's health status and use and effectiveness of health care, and the relationship between child health status and family income, family stability and preservation, and children's school readiness and educational achievement and attainment; and

`(D) make recommendations regarding improving and strengthening the timeliness, quality, and public transparency and accessibility of information about child health and health care quality.

`(2) FUNDING- Up to $1,000,000

 

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TITLE VI – MISCELLANEOUS

`(5) MENTAL HEALTH SERVICES PARITY-

`(A) IN GENERAL- In the case of a State child health plan that provides both medical and surgical benefits and mental health or substance abuse benefits, such plan shall ensure that the financial requirements and treatment limitations applicable to such mental health or substance abuse benefits are no more restrictive than the financial requirements and treatment limitations applied to substantially all medical and surgical benefits covered by the plan.

`(1) IN GENERAL- From the amount appropriated under subsection (e), the Secretary shall award grants from amounts to eligible States for the purpose of carrying out programs and activities that are designed to improve the availability of dental services and strengthen dental coverage for targeted low-income children enrolled in State child health plans.

`(2) ELIGIBLE STATE- In this section, the term `eligible State' means a State with an approved State child health plan under this title that submits an application under subsection (b) that is approved by Secretary.

`(b) Application- An eligible State that desires to receive a grant under this paragraph shall submit an application to the Secretary in such form and manner, and containing such information, as the Secretary may require. Such application shall include--

`(1) a detailed description of the programs and activities proposed to be conducted with funds awarded under the grant;

`(2) quality and outcomes performance measures to evaluate the effectiveness of such activities; and

`(3) an assurance that the State shall--

`(A) conduct an assessment of the effectiveness of such activities against such performance measures; and

`(B) cooperate with the collection and reporting of data and other information determined as a result of conducting such assessments to the Secretary, in such form and manner as the Secretary shall require.

 

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TITLE VII – REVENUE PROVISIONS

SEC. 701. INCREASE IN EXCISE TAX RATE ON TOBACCO PRODUCTS.

(a) Cigars- Section 5701(a) of the Internal Revenue Code of 1986 is amended--

(1) by striking `$1.828 cents per thousand ($1.594 cents per thousand on cigars removed during 2000 or 2001)' in paragraph (1) and inserting `$50.00 per thousand',

(2) by striking `20.719 percent (18.063 percent on cigars removed during 2000 or 2001)' in paragraph (2) and inserting `53.13 percent', and

(3) by striking `$48.75 per thousand ($42.50 per thousand on cigars removed during 2000 or 2001)' in paragraph (2) and inserting `$10.00 per cigar'.

(b) Cigarettes- Section 5701(b) of such Code is amended--

(1) by striking `$19.50 per thousand ($17 per thousand on cigarettes removed during 2000 or 2001)' in paragraph (1) and inserting `$50.00 per thousand', and

(2) by striking `$40.95 per thousand ($35.70 per thousand on cigarettes removed during 2000 or 2001)' in paragraph (2) and inserting `$104.9999 cents per thousand'.

(c) Cigarette Papers- Section 5701(c) of such Code is amended by striking `1.22 cents (1.06 cents on cigarette papers removed during 2000 or 2001)' and inserting `3.13 cents'.

(d) Cigarette Tubes- Section 5701(d) of such Code is amended by striking `2.44 cents (2.13 cents on cigarette tubes removed during 2000 or 2001)' and inserting `6.26 cents'.

(e) Smokeless Tobacco- Section 5701(e) of such Code is amended--

(1) by striking `58.5 cents (51 cents on snuff removed during 2000 or 2001)' in paragraph (1) and inserting `$1.50', and

(2) by striking `19.5 cents (17 cents on chewing tobacco removed during 2000 or 2001)' in paragraph (2) and inserting `50 cents'.

(f) Pipe Tobacco- Section 5701(f) of such Code is amended by striking `$1.0969 cents (95.67 cents on pipe tobacco removed during 2000 or 2001)' and inserting `$2.8126 cents'.

(g) Roll-Your-Own Tobacco- Section 5701(g) of such Code is amended by striking `$1.0969 cents (95.67 cents on roll-your-own tobacco removed during 2000 or 2001)' and inserting `$8.8889 cents'.

(h) Floor Stocks Taxes-

(1) IMPOSITION OF TAX- On tobacco products and cigarette papers and tubes manufactured in or imported into the United States which are removed before January 1, 2008, and held on such date for sale by any person, there is hereby imposed a tax in an amount equal to the excess of--

(A) the tax which would be imposed under section 5701 of the Internal Revenue Code of 1986 on the article if the article had been removed on such date, over

(B) the prior tax (if any) imposed under section 5701 of such Code on such article.

(2) CREDIT AGAINST TAX- Each person shall be allowed as a credit against the taxes imposed by paragraph (1) an amount equal to $500. Such credit shall not exceed the amount of taxes imposed by paragraph (1) on January 1, 2008, for which such person is liable.

(3) LIABILITY FOR TAX AND METHOD OF PAYMENT-

(A) LIABILITY FOR TAX- A person holding tobacco products, cigarette papers, or cigarette tubes on January 1, 2008, to which any tax imposed by paragraph (1) applies shall be liable for such tax.

(B) METHOD OF PAYMENT- The tax imposed by paragraph (1) shall be paid in such manner as the Secretary shall prescribe by regulations.

(C) TIME FOR PAYMENT- The tax imposed by paragraph (1) shall be paid on or before April 1, 2008.

ARTICLES IN FOREIGN TRADE ZONES- Notwithstanding the Act of June 18, 1934 (commonly known as the Foreign Trade Zone Act, 48 Stat. 998, 19 U.S.C. 81a et seq.) or any other provision of law, any article which is located in a foreign trade zone on January 1, 2008, shall be subject to the tax imposed by paragraph (1) if--

(A) internal revenue taxes have been determined, or customs duties liquidated, with respect to such article before such date pursuant to a request made under the 1st proviso of section 3(a) of such Act, or

(B) such article is held on such date under the supervision of an officer of the United States Customs and Border Protection of the Department of Homeland Security pursuant to the 2d proviso of such section 3(a).

SEC. 703. TIME FOR PAYMENT OF CORPORATE ESTIMATED TAXES.

Subparagraph (B) of section 401(1) of the Tax Increase Prevention and Reconciliation Act of 2005 is amended by striking `114.50 percent' and inserting `113.25 percent'.

(a) In General- Unless otherwise provided in this Act, subject to subsection (b), the amendments made by this Act shall take effect on October 1, 2007, and shall apply to child health assistance and medical assistance provided on or after that date without regard to whether or not final regulations to carry out such amendments have been promulgated by such date.

 

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