subsection (c) of section 4980h of the internal revenue code of 1986, as added by section 1513, is amended by adding at the end the following new paragraph: "(3) special rules for employers providing free choice vouchers.-no assessable payment shall be imposed under paragraph (1) for any month with respect to any employee to whom the employer provides a free choice voucher under section 10108 of the patient protection and affordable care act for such month." (b) effective date. the amendment made by this paragraph shall apply to months beginning after december 31, 2013. (2) notification requirement.-section 18b(a)(3) of the fair labor standards act of 1938, as added by section 1512, is amended- (a) by inserting "and the employer does not offer a free choice voucher" after "exchange"; and (b) by striking "will lose" and inserting "may lose". (j) employer reporting. (1) in general. subsection (a) of section 6056 of the internal revenue code of 1986, as added by section 1514, is amended by inserting "and

employer" before "shall". (2) offering employers.-subsection (f) of section 6056 of such code, as added by section 1514, is amended to read as follows: "(f) definitions. for purposes of this section- "(1) offering employer.- "(a) in general. the term 'offering employer' means any offering employer (as defined in section 10108(b) of the patient protection and affordable care act) if the required contribution (within the meaning of section 5000a(e)(1)(b)(i)) of any employee exceeds 8 percent of the wages (as defined in section 3121(a)) paid to such employee by such employer. "(b) indexing. in the case of any calendar year

beginning after 2014, the 8 percent under subparagraph (a) shall be adjusted for the calendar year to reflect the rate of premium growth between the preceding calendar year and 2013 over the rate of income growth for such period. "(2) other definitions. any term used in this section which is also used in section 4980h shall have the meaning given such term by section 4980h.". (3) conforming amendments. (a) the heading of section 6056 of such code, as added by section 1514, is amended by striking "large" and inserting "certain". (b) section 6056(b)(2)(c) of such code is amended- (i) by inserting "in the case of an applicable large employer," before "the length" in clause (i); (ii) by striking "and" at the end of clause (iii); (iii) by striking "applicable large employer" in clause (iv) and inserting "employer"; (iv) by inserting "and" at the end of clause (iv); and

(v) by inserting at the end the following new clause: "(v) in the case of an offering employer, the option for which the employer pays the largest portion of the cost of the plan and the portion of the cost paid by the employer in each of the enrollment categories under such option,". (c) section 6056(d)(2) of such code is amended by inserting "or offering employer" after "applicable large employer". (d) section 6056(e) of such code is amended by inserting "or offering employer" after "applicable large employer". (e) section 6724(d)(1)(b)(xxv) of such code, as added by section 1514, is amended by striking "large" and inserting "certain". (f) section 6724(d)(2)(hh) of such code, as added by section 1514, is amended by striking

"large" and inserting "certain". (g) the table of sections for subpart d of part iii of subchapter a of chapter 1 of such code, as amended by section 1514, is amended by striking "large employers" in the item relating to section 6056 and inserting "certain employers". (4) effective date. the amendments made by this subsection shall apply to periods beginning after december 31, 2013. sec. 10109. development of standards for financial and administrative transactions. (a) additional transaction standards and operating rules. (1) development of additional transaction standards and operating rules. section 1173(a) of the social security act (42 u.s.c. 1320d-2(a)), as amended by section 1104(b)(2), is amended- (a) in paragraph (1)(b), by inserting before the period the following: ", and subject to the

requirements under paragraph (5)"; and (b) by adding at the end the following new paragraph: "(5) consideration of standardization of activities and items. "(a) in general. for purposes of carrying out paragraph (1)(b), the secretary shall solicit, not later than january 1, 2012, and not less than every 3 years thereafter, input from entities described in subparagraph (b) on- "(i) whether there could be greater uniformity in financial and administrative activities and items, as determined appropriate by the secretary; and "(ii) whether such activities should be considered financial and administrative transactions (as described in paragraph (1)(b)) for which the adoption of standards and operating rules would improve the operation of the health care system and reduce administrative costs. "(b) solicitation of input. for purposes of subparagraph (a), the secretary shall seek input from- "(i) the national committee on vital and health statistics, the

health information technology policy committee, and the health information technology standards committee; and "(ii) standard setting organizations and stakeholders, as determined appropriate by the secretary." (b) activities and items for initial consideration. for purposes of section 1173(a)(5) of the social security act, as added by subsection (a), the secretary of health and human services (in this section referred to as the "secretary") shall, not later than january 1, 2012, seek input on activities and items relating to the following areas: (1) whether the application process, including the use of a uniform application form, for enrollment of health care providers by health plans could be made electronic and standardized. (2) whether standards and operating rules described in section 1173 of the social security act should apply to the health care transactions of automobile insurance, worker's compensation, and other programs or persons not described in

section 1172(a) of such act (42 u.s.c. 1320d-1(a)). (3) whether standardized forms could apply to financial audits required by health plans, federal and state agencies (including state auditors, the office of the inspector general of the department of health and human services, and the centers for medicare & medicaid services), and other relevant entities as determined appropriate by the secretary. (4) whether there could be greater transparency and consistency of methodologies and processes used to establish claim edits used by health plans (as described in section 1171(5) of the social security act (42 u.s.c. 1320d(5))). (5) whether health plans should be required to publish their timeliness of payment rules. (c) icd coding crosswalks. (1) icd-9 to icd-10 crosswalk. the secretary shall task the icd-9-cm coordination and maintenance committee to convene

a meeting, not later than january 1, 2011, to receive input from appropriate stakeholders (including health plans, health care providers, and clinicians) regarding the crosswalk between the ninth and tenth revisions of the international classification of diseases (icd-9 and icd-10, respectively) that is posted on the website of the centers for medicare & medicaid services, and make recommendations about appropriate revisions to such crosswalk. (2) revision of crosswalk. for purposes of the crosswalk described in paragraph (1), the secretary shall make appropriate revisions and post any such revised crosswalk on the website of the centers for medicare & medicaid services. (3) use of revised crosswalk. for purposes of paragraph (2), any revised crosswalk shall be treated as a code set for which a standard has been adopted by the secretary for purposes of section 1173(c)(1)(b) of the social security act (42 u.s.c. 1320d-2(c)(1)(b)).

(4) subsequent crosswalks. for subsequent revisions of the international classification of diseases that are adopted by the secretary as a standard code set under section 1173(c) of the social security act (42 u.s.c. 1320d-2(c)), the secretary shall, after consultation with the appropriate stakeholders, post on the website of the centers for medicare & medicaid services a crosswalk between the previous and subsequent version of the international classification of diseases not later than the date of implementation of such subsequent revision. subtitle b-provisions relating to title ii part i-medicaid and chip sec. 10201. amendments to the social security act and title ii of this act. (a) (1) section 1902(a)(10)(a)(i)(ix) of the social security act (42 u.s.c.

1396a(a)(10)(a)(i)(ix)), as added by section 2004(a), is amended to read as follows: " "(ix) who- "(aa) are under 26 years of age; "(bb) are not described in or enrolled under any of subclauses (i) through (vii) of this clause or are described in any of such subclauses but have income that exceeds the level of income applicable under the state plan for eligibility to enroll for medical assistance under such subclause; "(cc) were in foster care under the responsibility of the state on the date of attaining 18 years of age or such higher age as the state has elected under section 475(8)(b)(iii); and "(dd) were enrolled in the state plan under this title or under a waiver of the plan while in such foster care;". (2) section 1902(a)(10) of the

social security act (42 u.s.c. 1396a(a)(10), as amended by section 2001(a)(5)(a), is amended in the matter following subparagraph (g), by striking "and (xv)" and inserting "(xv)", and by inserting "and (xvi) if an individual is described in subclause (ix) of subparagraph (a)(i) and is also described in subclause (viii) of that subparagraph, the medical assistance shall be made available to the individual through subclause (ix) instead of through subclause (viii)" before the semicolon. (3) section 2004(d) of this act is amended by striking "2019" and inserting "2014". (b) section 1902(k)(2) of the social security act (42 u.s.c. 1396a(k)(2)), as added by section 2001(a)(4)(a), is amended by striking "january 1, 2011" and inserting "april 1, 2010".

(c) section 1905 of the social security act (42 u.s.c. 1396d), as amended by sections 2001(a)(3), 2001(a)(5)(c), 2006, and 4107(a)(2), is amended- (1) in subsection (a), in the matter preceding paragraph (1), by inserting in clause (xiv), "or 1902(a)(10)(a)(i)(ix)" before the comma; (2) in subsection (b), in the first sentence, by inserting ", (z)," before "and (aa)"; (3) in subsection (y)- (a) in paragraph (1)(b)(ii)(ii), in the first sentence, by inserting "includes inpatient hospital services," after "100 percent of the poverty line, that"; and (b) in paragraph (2)(a), by

striking "on the date of enactment of the patient protection and affordable care act" and inserting "as of december 1, 2009"; (4) by inserting after subsection (y) the following: "(z) equitable support for certain states. "(1) (a) during the period that begins on january 1, 2014, and ends on september 30, 2019, notwithstanding subsection (b), the federal medical assistance percentage otherwise determined under subsection (b) with respect to a fiscal year occurring during that period shall be increased by 2.2 percentage points for any state described in subparagraph (b) for amounts expended for medical assistance for individuals who are not newly eligible (as defined in subsection (y)(2)) individuals described in subclause (viii) of section 1902(a)(10)(a)(i). "(b) for purposes of subparagraph (a), a state described in this subparagraph is a state that- "(i) is an expansion state

described in subsection (y)(1)(b)(ii)(ii); "(ii) the secretary determines will not receive any payments under this title on the basis of an increased federal medical assistance percentage under subsection (y) for expenditures for medical assistance for newly eligible individuals (as so defined); and "(iii) has not been approved by the secretary to divert a portion of the dsh allotment for a state to the costs of providing medical assistance or other health benefits coverage under a waiver that is in effect on july 2009. "(2) (a) during the period that begins on january 1, 2014, and ends on december 31, 2016, notwithstanding subsection (b), the federal medical assistance percentage otherwise determined under subsection (b) with respect to all or any portion of a fiscal year occurring during that period shall be increased by .5 percentage point for a state described in subparagraph (b) for amounts expended for medical assistance under the

state plan under this title or under a waiver of that plan during that period. "(b) for purposes of subparagraph (a), a state described in this subparagraph is a state that- "(i) is described in clauses (i) and (ii) of paragraph (1)(b); and "(ii) is the state with the highest percentage of its population insured during 2008, based on the current population survey. "(3) notwithstanding subsection (b) and paragraphs (1) and (2) of this subsection, the federal medical assistance percentage otherwise determined under subsection (b) with respect to all or any portion of a fiscal year that begins on or after january 1, 2017, for the state of nebraska, with respect to amounts expended for newly eligible individuals described in subclause (viii) of section 1902(a)(10)(a)(i), shall be determined as provided for under subsection (y)(1)(a) (notwithstanding the period "(4) the increase in the federal

medical assistance percentage for a state under paragraphs (1), (2), or (3) shall apply only for purposes of this title and shall not apply with respect to- "(a) disproportionate share hospital payments described in section 1923; "(b) payments under title iv; "(c) payments under title xxi; and "(d) payments under this title that are based on the enhanced fmap described in section 2105(b)."; (5) in subsection (aa), is (5) in subsection (aa), is amended by striking "without regard to this subsection and subsection (y)" and inserting "without regard to this subsection, subsection (y), subsection (z), and section 10202 of the patient protection and affordable care act" each place it appears; (6) by adding after subsection (bb), the following: "(cc) requirement for certain states.-notwithstanding subsections (y), (z), and (aa), in the case of a state that requires political subdivisions within the state to contribute toward the non-federal share of

expenditures required under the state plan under section 1902(a)(2), the state shall not be eligible for an increase in its federal medical assistance percentage under such subsections if it requires that political subdivisions pay a greater percentage of the non-federal share of such expenditures, or a greater percentage of the non-federal share of payments under section 1923, than the respective percentages that would have been required by the state under the state plan under this title, state law, or both, as in effect on december 31, 2009, and without regard to any such increase. voluntary contributions by a political subdivision to the non-federal share of expenditures under the state plan under this title or to the non-federal share of payments under section 1923, shall not be considered to be required contributions for purposes of this subsection. the treatment of voluntary contributions, and the treatment of contributions required by a

state under the state plan under this title, or state law, as provided by this subsection, shall also apply to the increases in the federal medical assistance percentage under section 5001 of the american recovery and reinvestment act of 2009." (d) section 1108(g)(4)(b) of the social security act (42 u.s.c. 1308(g)(4)(b)), as added by section 2005(b), iamded by striking "income eligibility level in effect for that population under title xix or under a waiver" and inserting "the highest income eligibility level in effect for parents under the commonwealth's or territory's state plan under title xix or under a waiver of the plan". (e) (1) section 1923(f) of the social security act (42 u.s.c. 1396r-4(f)), as amended by section 2551, is amended- (a) in paragraph (6)- (i) by striking the paragraph heading and inserting the following: "allotment

adjustments"; and (ii) in subparagraph (b), by adding at the end the following: "(iii) allotment for 2d, 3rd, and 4th quarter of fiscal year 2012, fiscal year 2013, and succeeding fiscal years. notwithstanding the table set forth in paragraph (2) or paragraph (7): "(i) 2d, 3rd, and 4th quarter of fiscal year 2012.-the dsh allotment for hawaii for the 2d, 3rd, and 4th quarters of fiscal year 2012 shall be $7,500,000. "(ii) treatment as a low-dsh state for fiscal year 2013 and succeeding fiscal years. with respect to fiscal year 2013, and each fiscal year thereafter, the dsh allotment for hawaii shall be increased in the same manner as allotments for low dsh states are increased for such fiscal year under clause (iii) of paragraph (5)(b). "(iii) certain hospital

payments.-the secretary may not impose a limitation on the total amount of payments made to hospitals under the quest section 1115 demonstration project except to the extent that such limitation is necessary to ensure that a hospital does not receive payments in excess of the amounts described in subsection (g), or as necessary to ensure that such payments under the waiver and such payments pursuant to the allotment provided in this clause do not, in the aggregate in any year, exceed the amount that the secretary determines is equal to the federal medical assistance percentage component attributable to disproportionate share hospital payment adjustments for such year that is reflected in the budget neutrality provision of the quest demonstration project."; and (b) in paragraph (7)- (i) in subparagraph (a), in the matter preceding clause (i), by striking "subparagraph (e)" and inserting "subparagraphs (e) and (g)";

(ii) in subparagraph (b)- (i) in clause (i), by striking subclauses (i) and (ii), and inserting the following: "(i) if the state is a low dsh state described in paragraph (5)(b) and has spent not more than 99.90 percent of the dsh allotments for the state on average for the period of fiscal years 2004 through 2008, as of september 30, 2009, the applicable percentage is equal to 25 percent; "(ii) if the state is a low dsh state described in paragraph (5)(b) and has spent more than 99.90 percent of the dsh allotments for the state on average for the period of fiscal years 2004 through 2008, as of september 30, 2009, the applicable percentage is equal to 17.5 percent; "(iii) if the state is not a low dsh state described in paragraph (5)(b) and has spent not more than 99.90 percent of the dsh

allotments for the state on average for the period of fiscal years 2004 through 2008, as of september 30, 2009, the applicable percentage is equal to 50 percent; and "(iv) if the state is not a low dsh state described in paragraph (5)(b) and has spent more than 99.90 percent of the dsh allotments for the state on average for the period of fiscal years 2004 through 2008, as of september 30, 2009, the applicable percentage is equal to 35 percent."; (ii) in clause (ii), by striking subclauses (i) and (ii), and inserting the following: "(i) if the state is a low dsh state described in paragraph (5)(b) and has spent not more than 99.90 percent of the dsh allotments for the state on average for the period of fiscal years 2004 through 2008, as of september 30, 2009, the applicable percentage is equal to the product of the percentage

reduction in uncovered individuals for the fiscal year from the preceding fiscal year and 27.5 percent; "(ii) if the state is a low dsh state described in paragraph (5)(b) and has spent more than 99.90 percent of the dsh allotments for the state on average for the period of fiscal years 2004 through 2008, as of september 30, 2009, the applicable percentage is equal to the product of the percentage reduction in uncovered individuals for the fiscal year from the preceding fiscal year and 20 percent; "(iii) if the state is not a low dsh state described in paragraph (5)(b) and has spent not more than 99.90 percent of the dsh allotments for the state on average for the period of fiscal years 2004 through 2008, as of september 30, 2009, the applicable percentage is equal to the product of the percentage reduction in uncovered individuals for the fiscal year

from the preceding fiscal year and 55 percent; and "(iv) if the state is not a low dsh state described in paragraph (5)(b) and has spent more than 99.90 percent of the dsh allotments for the state on average for the period of fiscal years 2004 through 2008, as of september 30, 2009, the applicable percentage is equal to the product of the percentage reduction in uncovered individuals for the fiscal year from the preceding fiscal year and 40 percent."; (iii) in subparagraph (e), by striking "35 percent" and inserting "50 percent"; and (iv) by adding at the end the following: "(g) nonapplication.-the preceding provisions of this paragraph shall not apply to the dsh allotment determined for the state of hawaii for a fiscal year under paragraph (6).". (f) section 2551 of this act is amended by striking subsection (b). (g) section 2105(d)(3)(b) of the

social security act (42 u.s.c. 1397ee(d)(3)(b)), as added by section 2101(b)(1), is amended by adding at the end the following: "for purposes of eligibility for premium assistance for the purchase of a qualified health plan under section 36b of the internal revenue code of 1986 and reduced cost-sharing under section 1402 of the patient protection and affordable care act, children described in the preceding sentence shall be deemed to be ineligible for coverage under the state child health plan.". (h) clause (i) of subparagraph (c) of section 513(b)(2) of the social security act, as added by section 2953 of this act, is amended to read as follows: "(i) healthy relationships, including marriage and family interactions.". (i) section 1115 of the social security act (42 u.s.c. 1315) is amended by inserting after subsection (c) the following:

"(d) (1) an application or renewal of any experimental, pilot, or demonstration project undertaken under subsection (a) to promote the objectives of title xix or xxi in a state that would result in an impact on eligibility, enrollment, benefits, cost-sharing, or financing with respect to a state program under title xix or xxi (in this subsection referred to as a 'demonstration project') shall be considered by the secretary in accordance with the regulations required to be promulgated under paragraph (2). "(2) not later than 180 days after the date of enactment of this subsection, the secretary shall promulgate regulations relating to applications for, and renewals of, a demonstration project that provide for- "(a) a process for public notice and comment at the state level, including public hearings, sufficient to ensure a meaningful level of public input; "(b) requirements relating to- "(i) the goals of the program to be implemented or renewed under

the demonstration project; "(ii) the expected state and federal costs and coverage projections of the demonstration project; and "(iii) the specific plans of the state to ensure that the demonstration project will be in compliance with title xix or xxi; "(c) a process for providing public notice and comment after the application is received by the secretary, that is sufficient to ensure a meaningful level of public input; "(d) a process for the submission to the secretary of periodic reports by the state concerning the implementation of the demonstration project; and "(e) a process for the periodic evaluation by the secretary of the demonstration project. "(3) the secretary shall annually report to congress concerning actions taken by the secretary with respect to applications for demonstration projects under this section.". (j) subtitle f of title iii of this act is amended by adding at the end the following:

"sec. 3512. gao study and report on causes of action. "(a) study.- "(1) in general.-the comptroller general of the united states shall conduct a study of whether the development, recognition, or implementation of any guideline or other standards under a provision described in paragraph (2) would result in the establishment of a new cause of action or claim. "(2) provisions described.-the provisions described in this paragraph include the following: "(a) section 2701 (adult health quality measures). "(b) section 2702 (payment adjustments for health care acquired conditions). "(c) section 3001 (hospital value-based purchase program). "(d) section 3002 (improvements to the physician quality reporting initiative). "(e) section 3003 (improvements to the physician feedback program). "(f) section 3007 (value based payment modifier under physician fee schedule).

"(g) section 3008 (payment adjustment for conditions acquired in hospitals). "(h) section 3013 (quality measure development). "(i) section 3014 (quality measurement). "(j) section 3021 (establishment of center for medicare and medicaid innovation). "(k) section 3025 (hospital readmission reduction program). "(l) section 3501 (health care delivery system research, quality improvement). "(m) section 4003 (task force on clinical and preventive services). "(n) section 4301 (research to optimize deliver of public health services). "(b) report.-not later than 2 years after the date of enactment of this act, the comptroller general of the united states shall submit to the appropriate committees of congress, a report containing the findings made by the comptroller general under the study under subsection (a).".

sec. 10202. incentives for states to offer home and community-based services as a long-term care alternative to nursing homes. (a) state balancing incentive payments program.-notwithstanding section 1905(b) of the social security act (42 u.s.c. 1396d(b)), in the case of a balancing incentive payment state, as defined in subsection (b), that meets the conditions described in subsection (c), during the balancing incentive period, the federal medical assistance percentage determined for the state under section 1905(b) of such act and, if applicable, increased under subsection (z) or (aa) shall be increased by the applicable percentage points determined under subsection (d) with respect to eligible medical assistance expenditures described in subsection (e). (b) balancing incentive payment state.-a balancing incentive payment state is a state- (1) in which less than 50 percent of the total

expenditures for medical assistance under the state medicaid program for a fiscal year for long-term services and supports (as defined by the secretary under subsection (f))(1)) are for non-institutionally-based long-term services and supports described in subsection (f)(1)(b); (2) that submits an application and meets the conditions described in subsection (c); and (3) that is selected by the secretary to participate in the state balancing incentive payment program established under this section. (c) conditions.-the conditions described in this subsection are the following: (1) application.-the state submits an application to the secretary that includes, in addition to such other information as the secretary shall require- (a) a proposed budget that details the state's plan to expand and diversify medical assistance for non-institutionally-based long-term services and supports described in subsection (f)(1)(b) under the state medicaid program during the balancing incentive period and achieve the target spending percentage applicable to the state under paragraph (2), including through structural

changes to how the state furnishes such assistance, such as through the establishment of a "no wrong door - single entry point system", optional presumptive eligibility, case management services, and the use of core standardized assessment instruments, and that includes a description of the new or expanded offerings of such services that the state will provide and the projected costs of such services; and (b) in the case of a state that proposes to expand the provision of home and community-based services under its state medicaid program through a state plan amendment under section 1915(i) of the social security act, at the option of the state, an election to increase the income eligibility for such services from 150 percent of the poverty line to such higher percentage as the state may establish for such purpose, not to exceed 300 percent of the supplemental security income benefit rate established by section 1611(b)(1) of the social security act (42 u.s.c. 1382(b)(1)). (2) target spending percentages.- (a) in the case of a balancing incentive payment state in which

less than 25 percent of the total expenditures for long-term services and supports under the state medicaid program for fiscal year 2009 are for home and community-based services, the target spending percentage for the state to achieve by not later than october 1, 2015, is that 25 percent of the total expenditures for long-term services and supports under the state medicaid program are for home and community-based services. (b) in the case of any other balancing incentive payment state, the target spending percentage for the state to achieve by not later than october 1, 2015, is that 50 percent of the total expenditures for long-term services and supports under the state medicaid program are for home and community-based services. (3) maintenance of eligibility requirements.-the state does not apply eligibility standards, methodologies, or procedures for determining eligibility for medical assistance for non-institutionally-based long-term services and supports described in subsection (f)(1)(b) under the state medicaid program that are more restrictive than the eligibility standards, methodologies, or

procedures in effect for such purposes on december 31, 2010. (4) use of additional funds.-the state agrees to use the additional federal funds paid to the state as a result of this section only for purposes of providing new or expanded offerings of non-institutionally-based long-term services and supports described in subsection (f)(1)(b) under the state medicaid program. (5) structural changes.-the state agrees to make, not later than the end of the 6-month period that begins on the date the state submits an application under this section, the following changes: (a) "no wrong door - single entry point system ".-development of a statewide system to enable consumers to access all long-term services and supports through an agency, organization, coordinated network, or portal, in accordance with such standards as the state shall establish and that shall provide information regarding the availability of such services, how to apply for such services, referral services for services and supports otherwise available in the community, and determinations of financial and functional

eligibility for such services and supports, or assistance with assessment processes for financial and functional eligibility. (b) conflict-free case management services.-conflict-free case management services to develop a service plan, arrange for services and supports, support the beneficiary (and, if appropriate, the beneficiary's caregivers) in directing the provision of services and supports for the beneficiary, and conduct ongoing monitoring to assure that services and supports are delivered to meet the beneficiary's needs and achieve intended outcomes. (c) core standardized assessment instruments.-development of core standardized assessment instruments for determining eligibility for non-institutionally-based long-term services and supports described in subsection (f)(1)(b), which shall be used in a uniform manner throughout the state, to determine a beneficiary's needs for training, support services, medical care, transportation, and other services, and develop an individual service plan to address such needs. (6) data collection.-the state agrees to collect from providers

of services and through such other means as the state determines appropriate the following data: (a) services data.-services data from providers of non-institutionally-based long-term services and supports described in subsection (f)(1)(b) on a per-beneficiary basis and in accordance with such standardized coding procedures as the state shall establish in consultation with the secretary. (b) quality data.-quality data on a selected set of core quality measures agreed upon by the secretary and the state that are linked to population-specific outcomes measures and accessible to providers. (c) outcomes measures.-outcomes measures data on a selected set of core population-specific outcomes measures agreed upon by the secretary and the state that are accessible to providers and include- (i) measures of beneficiary and family caregiver experience with providers; (ii) measures of beneficiary and family caregiver satisfaction with services; and (iii) measures for achieving desired outcomes appropriate to a specific beneficiary, including employment, participation in community life, health stability, and prevention

of loss in function. (d) applicable percentage points increase in fmap.-the applicable percentage points increase is- (1) in the case of a balancing incentive payment state subject to the target spending percentage described in subsection (c)(2)(a), 5 percentage points; and (2) in the case of any other balancing incentive payment state, 2 percentage points. (e) eligible medical assistance expenditures.- (1) in general.-subject to paragraph (2), medical assistance described in this subsection is medical assistance for non-institutionally-based long-term services and supports described in subsection (f)(1)(b) that is provided by a

balancing incentive payment state under its state medicaid program during the balancing incentive payment period. (2) limitation on payments.-in no case may the aggregate amount of payments made by the secretary to balancing incentive payment states under this section during the balancing incentive period exceed $3,000,000,000. (f) definitions.-in this section: (1) long-term services and supports defined.-the term "long-term services and supports" has the meaning given that term by secretary and may include any of the following (as defined for purposes of state medicaid programs): (a) institutionally-based long-term services and supports.-services provided in an institution, including the following: (i) nursing facility services. (ii) services in an intermediate care facility for the mentally retarded described in subsection (a)(15) of section 1905 of such act. (b) non-institutionally-based long-term services and

supports.- services not provided in an institution, including the following: (i) home and community-based services provided under subsection (c), (d), or (i) of section 1915 of such act or under a waiver under section 1115 of such act. (ii) home health care services. (iii) personal care services. (iv) services described in subsection (a)(26) of section 1905 of such act (relating to pace program services). (v) self-directed personal assistance services described in section 1915(j) of such act. (2) balancing incentive period.-the term "balancing incentive period" means the period that begins on october 1, 2011, and ends on september 30, 2015. (3) poverty line.-the term "poverty line" has the meaning given that term in section 2110(c)(5) of the social security act (42 u.s.c. 1397jj(c)(5)). (4) state medicaid program.-the term "state medicaid program" means the state program for medical assistance provided under a state plan under title xix of the social security act and under any waiver approved

with respect to such state plan. sec. 10203. extension of funding for chip through fiscal year 2015 and other chip-related provisions. (a) section 1311(c)(1) of this act is amended by striking "and" at the end of subparagraph (g), by striking the period at the end of subparagraph (h) and inserting "; and", and by adding at the end the following: "(i) report to the secretary at least annually and in such manner as the secretary shall require, pediatric quality reporting measures consistent with the pediatric quality reporting measures established under section 1139a of the social security act.". (b) effective as if included in the enactment of the children's health insurance program reauthorization act of 2009 (public law 111-3): (1) section 1906(e)(2) of the social security act (42 u.s.c. 1396e(e)(2)) is amended by striking "means" and all that follows through the period and inserting "has the meaning given that term in section 2105(c)(3)(a).". (2) (a) section 1906a(a) of the social security act (42 u.s.c.

1396e-1(a)), is amended by inserting before the period the following: "and the offering of such a subsidy is cost-effective, as defined for purposes of section 2105(c)(3)(a)". (b) this act shall be applied without regard to subparagraph (a) of section 2003(a)(1) of this act and that subparagraph and the amendment made by that subparagraph are hereby deemed null, void, and of no effect. (3) section 2105(c)(10) of the social security act (42 u.s.c. 1397ee(c)(10)) is amended- (a) in subparagraph (a), in the first sentence, by inserting before the period the following: "if the offering of such a subsidy is cost-effective, as defined for purposes of paragraph (3)(a)"; (b) by striking subparagraph (m); and (c) by redesignating subparagraph (n) as subparagraph (m). (4) section 2105(c)(3)(a) of the social security act (42 u.s.c. 1397ee(c)(3)(a)) is amended- (a) in the matter preceding clause (i), by striking "to" and inserting "to-"; and (b) in clause (ii), by striking

the period and inserting a semicolon. (c) section 2105 of the social security act (42 u.s.c. 1397ee), as amended by section 2101, is amended- (1) in subsection (b), in the second sentence, by striking "2013" and inserting "2015"; and (2) in subsection (d)(3)- (a) in subparagraph (a)- (i) in the first sentence, by inserting "as a condition of receiving payments under section 1903(a)," after "2019,"; (ii) in clause (i), by striking "or" at the end; (iii) by redesignating clause (ii) as clause (iii); and (iv) by inserting after clause (i), the following: "(ii) after september 30, 2015, enrolling children eligible to be targeted low-income children under the state child health plan in a qualified health plan that has been certified by the secretary under subparagraph (c); or"; (b) in subparagraph (b), by striking "provided coverage" and inserting "screened for eligibility for medical assistance under the state plan under title xix or a waiver of that plan and, if found eligible, enrolled in such plan or a waiver. in the case of such

children who, as a result of such screening, are determined to not be eligible for medical assistance under the state plan or a waiver under title xix, the state shall establish procedures to ensure that the children are enrolled in a qualified health plan that has been certified by the secretary under subparagraph (c) and is offered"; and (c) by adding at the end the following: "(c) certification of comparability of pediatric coverage offered by qualified health plans.-with respect to each state, the secretary, not later than april 1, 2015, shall review the benefits offered for children and the cost-sharing imposed with respect to such benefits by qualified health plans offered through an exchange established by the state under section 1311 of the patient protection and affordable care act and shall certify those plans that offer benefits for children and impose cost-sharing with respect to such benefits that the secretary determines are at least comparable to the benefits offered and cost-sharing protections provided under the state child health plan.". (d) (1) section 2104(a) of such act (42 u.s.c. 1397dd(a)) is amended-

(a) in paragraph (15), by striking "and" at the end; and (b) by striking paragraph (16) and inserting the following: "(16) for fiscal year 2013, $17,406,000,000; "(17) for fiscal year 2014, $19,147,000,000; and "(18) for fiscal year 2015, for purposes of making 2 semi-annual allotments- "(a) $2,850,000,000 for the period beginning on october 1, 2014, and ending on march 31, 2015, and "(b) $2,850,000,000 for the period beginning on april 1, 2015, and ending on september 30, 2015.". (2) (a) section 2104(m) of such act (42 u.s.c. 1397dd(m)), as amended by section 2102(a)(1), is amended- (i) in the subsection heading, by striking "2013" and inserting "2015"; (ii) in paragraph (2)- (i) in the paragraph heading, by

striking "2012" and inserting "2014"; and (ii) by adding at the end the following: "(b) fiscal years 2013 and 2014.-subject to paragraphs (4) and (6), from the amount made available under paragraphs (16) and (17) of subsection (a) for fiscal years 2013 and 2014, respectively, the secretary shall compute a state allotment for each state (including the district of columbia and each commonwealth and territory) for each such fiscal year as follows: "(i) rebasing in fiscal year 2013.-for fiscal year 2013, the allotment of the state is equal to the federal payments to the state that are attributable to (and countable towards) the total amount of allotments available under this section to the state in fiscal year 2012 (including payments made to the state under subsection (n) for fiscal year 2012 as well as amounts redistributed to the state in fiscal year 2012), multiplied by the allotment increase factor under paragraph (5) for fiscal year 2013. "(ii) growth factor update for

fiscal year 2014. for fiscal year 2014, the allotment of the state is equal to the sum of- "(i) the amount of the state allotment under clause (i) for fiscal year 2013; and "(ii) the amount of any payments made to the state under subsection (n) for fiscal year 2013 multiplied by the allotment increase factor under paragraph (5) for fiscal year 2014." (iii) in paragraph (3)- (i) in the paragraph heading, by striking "2013" and inserting "2015"; (ii) in subparagraphs (a) and (b), by striking "paragraph (16)" each place it appears and inserting "paragraph (18)"; (iii) in subparagraph (c)- the presiding officer: mr. a senator: mr. president, i ask that this bill be considered as read. the presiding officer: is there objection? objection is heard. the clerk will continue to read. (aa) by striking "2012" each place it appears and inserting "2014"; and (bb) by striking "2013" and inserting "2015"; and (iv) in subparagraph (d)- (aa) in clause (i)(i), by

striking "subsection (a)(16)(a)" and inserting "subsection (a)(18)(a)"; and (bb) in clause (ii)(ii), by striking "subsection (a)(16)(b)" and inserting "subsection (a)(18)(b)"; (iv) in paragraph (4), by striking "2013" and inserting "2015"; (v) in paragraph (6)- (i) in subparagraph (a), by striking "2013" and inserting "2015"; and (ii) in the flush language after and below subparagraph (b)(ii), by striking "or fiscal year 2012" and inserting ", fiscal year 2012, or fiscal year 2014"; and (vi) in paragraph (8)- (i) in the paragraph heading, by striking "2013" and inserting "2015"; and (ii) by striking "2013" and inserting "2015". (b) section 2104(n) of such act (42 u.s.c. 1397dd(n)) is amended- (i) in paragraph (2)- (i) in subparagraph (a)(ii)- (aa) by striking "2012" and inserting "2014"; and (bb) by striking "2013" and inserting "2015"; (ii) in subparagraph (b)- (aa) by striking "2012" and inserting "2014"; and

(bb) by striking "2013" and inserting "2015"; and (ii) in paragraph (3)(a), by striking "or a semi-annual allotment period for fiscal year 2013" and inserting "fiscal year 2013, fiscal year 2014, or a semi-annual allotment period for fiscal year 2015". (c) section 2105(g)(4) of such act (42 u.s.c. 1397ee(g)(4)) is amended- (i) in the paragraph heading, by striking "2013" and inserting "2015"; and (ii) in subparagraph (a), by striking "2013" and inserting "2015". (d) section 2110(b) of such act (42 u.s.c. 1397jj(b)) is amended- (i) in paragraph (2)(b), by inserting "except as provided in paragraph (6)," before "a child"; and (ii) by adding at the end the following new paragraph: "(6) exceptions to exclusion of children of employees of a public agency in the state.

"(a) in general. a child shall not be considered to be described in paragraph (2)(b) if- "(i) the public agency that employs a member of the child's family to which such paragraph applies satisfies subparagraph (b); or "(ii) subparagraph (c) applies to such child. "(b) maintenance of effort with respect to per person agency contribution for family coverage.-for purposes of subparagraph (a)(i), a public agency satisfies this subparagraph if the amount of annual agency expenditures made on behalf of each employee enrolled in health coverage paid for by the agency that includes dependent coverage for the most recent state fiscal year is not less than the amount of such expenditures made by the agency for the 1997 state fiscal year, increased by the percentage increase in the medical care expenditure category of the consumer price index for all-urban consumers (all items: u.s. city average) for such preceding fiscal year. "(c) hardship exception. for purposes of subparagraph (a)(ii), this subparagraph applies to a child if the state determines, on a case-by-case basis, that the annual aggregate amount of premiums and

cost-sharing imposed for coverage of the family of the child would exceed 5 percent of such family's income for the year involved." (e) section 2113 of such act (42 u.s.c. 1397mm) is amended- (i) in subsection (a)(1), by striking "2013" and inserting "2015"; and (ii) in subsection (g), by striking "$100,000,000 for the period of fiscal years 2009 through 2013" and inserting "$140,000,000 for the period of fiscal years 2009 through 2015". (f) section 108 of public law 111-3 is amended by striking "$11,706,000,000" and all that follows through the second sentence and inserting "$15,361,000,000 to accompany the allotment made for the period beginning on october 1, 2014, and ending on march 31, 2015, under section 2104(a)(18)(a) of the social security act (42 u.s.c. 1397dd(a)(18)(a)), to remain available until expended. such amount shall be used to provide allotments to states under

paragraph (3) of section 2104(m) of the social security act (42 u.s.c. 1397dd(m)) for the first 6 months of fiscal year 2015 in the same manner as allotments are provided under subsection (a)(18)(a) of such section 2104 and subject to the same terms and conditions as apply to the allotments provided from such subsection (a)(18)(a)." part ii-support for pregnant and parenting teens and women sec. 10211. definitions. in this part: (1) accompaniment. the term "accompaniment" means assisting, representing, and accompanying a woman in seeking judicial relief for child support, child custody, restraining orders, and restitution for harm to persons and property, and in filing criminal charges, and may include the payment of court costs and reasonable attorney

and witness fees associated therewith. (2) eligible institution of higher education. the term "eligible institution of higher education" means an institution of higher education (as such term is defined in section 101 of the higher education act of 1965 (20 u.s.c. 1001)) that has established and operates, or agrees to establish and operate upon the receipt of a grant under this part, a pregnant and parenting student services office. (3) community service center. the term "community service center" means a non-profit organization that provides social services to residents of a specific geographical area via direct service or by contract with a local governmental agency. (4) high school. the term "high school" means any public or private school that operates grades 10 through 12, inclusive, grades 9 through 12, inclusive or grades 7 through 12, inclusive. (5) intervention services. the term "intervention services" means, with respect to domestic violence, sexual violence, sexual assault, or stalking, 24-hour telephone hotline services for police protection and referral to shelters.

(6) secretary. the term "secretary" means the secretary of health and human services. (7) state. the term "state" includes the district of columbia, any commonwealth, possession, or other territory of the united states, and any indian tribe or reservation. (8) supportive social services. the term "supportive social services" means transitional and permanent housing, vocational counseling, and individual and group counseling aimed at preventing domestic violence, sexual violence, sexual assault, or stalking. (9) violence. the term "violence" means actual violence and the risk or threat of violence. sec. 10212. establishment of pregnancy assistance fund. (a) in general. the secretary, in collaboration and coordination with the secretary of education (as appropriate), shall establish a pregnancy assistance fund to be administered by the secretary, for the purpose of awarding competitive grants to states to assist pregnant and parenting teens and women. (b) use of fund. a state may apply for a grant under subsection (a) to carry out any activities provided for in section 10213.

(c) applications. to be eligible to receive a grant under subsection (a), a state shall submit to the secretary an application at such time, in such manner, and containing such information as the secretary may require, including a description of the purposes for which the grant is being requested and the designation of a state agency for receipt and administration of funding received under this part. sec. 10213. permissible uses of fund. (a) in general. a state shall use amounts received under a grant under section 10212 for the purposes described in this section to assist pregnant and parenting teens and women. (b) institutions of higher education. (1) in general. a state may use amounts received under a grant under section 10212 to make funding available to eligible institutions of higher education to enable the eligible institutions to establish, maintain, or operate pregnant and parenting student services.

such funding shall be used to supplement, not supplant, existing funding for such services. (2) application. an eligible institution of higher education that desires to receive funding under this subsection shall submit an application to the designated state agency at such time, in such manner, and containing such information as the state agency may require. (3) matching requirement.-an eligible institution of higher education that receives funding under this subsection shall contribute to the conduct of the pregnant and parenting student services office supported by the funding an amount from non-federal funds equal to 25 percent of the amount of the funding provided. the non-federal share may be in cash or in-kind, fairly evaluated, including services, facilities, supplies, or equipment. (4) use of funds for assisting pregnant and parenting college students. an eligible institution of higher education that receives funding under this subsection shall use such funds to establish, maintain or operate pregnant and parenting student services and may use such funding for the following programs and activities: (a) conduct a needs assessment on campus and within the local community- (i) to assess pregnancy and parenting resources, located on the campus or within the local community, that are available to

meet the needs described in subparagraph (b); and (ii) to set goals for- (i) improving such resources for pregnant, parenting, and prospective parenting students; and (ii) improving access to such resources. (b) annually assess the performance of the eligible institution in meeting the following needs of students enrolled in the eligible institution who are pregnant or are parents: (i) the inclusion of maternity coverage and the availability of riders for additional family members in student health care. (ii) family housing. (iii) child care. (iv) flexible or alternative academic scheduling, such as telecommuting programs, to enable pregnant or parenting students to continue their education or stay in school. (v) education to improve parenting skills for mothers and fathers and to strengthen marriages. (vi) maternity and baby clothing, baby food (including formula), baby furniture, and similar items to assist parents and prospective parents in meeting the material needs of their children.

(vii) post-partum counseling. (c) identify public and private service providers, located on the campus of the eligible institution or within the local community, that are qualified to meet the needs described in subparagraph (b), and establishes programs with qualified providers to meet such needs. (d) assist pregnant and parenting students, fathers or spouses in locating and obtaining services that meet the needs described in subparagraph (b). (e) if appropriate, provide referrals for prenatal care and delivery, infant or foster care, or adoption, to a student who an office shall make such referrals only to service providers that serve the following types of individuals: (i) parents. (ii) prospective parents awaiting adoption. (iii) women who are pregnant and plan on parenting or placing the child for adoption. (iv) parenting or prospective parenting couples. (5) reporting. (a) annual report by institutions.

(i) in general. for each fiscal year that an eligible institution of higher education receives funds under this subsection, the eligible institution shall prepare and submit to the state, by the date determined by the state, a report that- (i) itemizes the pregnant and parenting student services office's expenditures for the fiscal year; (ii) contains a review and evaluation of the performance of the office in fulfilling the requirements of this section, using the specific performance criteria or standards established under subparagraph (b)(i); and (iii) describes the achievement of the office in meeting the needs listed in paragraph (4)(b) of the students served by the eligible institution, and the frequency of use of the office by such students. (ii) performance criteria. not later than 180 days before the date the annual report described in clause (i) is submitted, the state- (i) shall identify the specific performance criteria or standards that shall be used to prepare the report; and (ii) may establish the form or format of the report. (b) report by state. the state shall annually prepare and submit a report on the findings under this subsection, including the number of eligible institutions of higher education that were awarded funds and the number of students served by each pregnant and parenting student services office receiving funds under this section, to the secretary.

(c) support for pregnant and parenting teens. a state may use amounts received under a grant under section 10212 to make funding available to eligible high schools and community service centers t a senator: mr. president? i ask unanimous consent to dispense with the reading of the bill. a senator: i object. the presiding officer: the objection is heard. establish, maintain or operate pregnant and parenting services in the same general manner and in accordance with all conditions and requirements described in subsection (b), except that paragraph (3) of such subsection shall not apply for purposes of this subsection. (d) improving services for pregnant women who are victims of domestic violence, sexual violence, sexual assault, and