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Section 10201

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 provided for in such paragraph].

'[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 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], is amended 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].'.