Sec. 102. Continuation and update of performance incentives
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Section 2105(a)(3) ( 42 U.S.C. 1397ee(a)(3) ) is amended— in subparagraph (A), by striking 2013 and inserting 2019 ; in subparagraph (E)— in clause (ii)— by striking subclause
(I)and inserting the following: As of December 31 of fiscal year 2009, and as of December 31 of each succeeding fiscal year through fiscal year 2015, the portion, if any, of the amount appropriated under section 2104(a) for such fiscal year that is unobligated for allotment to a State under section 2104(m) for such fiscal year or set aside under subsection (a)(3) or (b)(2) of section 2111 for such fiscal year. ; in subclause (II), by striking 2013 and inserting 2015 ; and in subclause (III), by striking 2013 and inserting 2015 ; by redesignating clause
(iii)as clause (iv); and by inserting after clause (ii), the following new clause: Out of any money in the Treasury not otherwise appropriated, there are appropriated $750,000,000 for each of fiscal years 2016 through 2019 for making payments under this paragraph. Amounts appropriated for a fiscal year under this clause shall remain available for making payments under this paragraph through December 31 of the following fiscal year. Any amount of such appropriations that remains unexpended or unobligated as of such date shall be transferred and made available on January 1 of such following fiscal year for making payments under section 2104(o). ; and in subparagraph (F)(iii), by striking 2013 and inserting 2019 . Section 2105(a) ( 42 U.S.C. 1397ee(a) ) is amended— in paragraph (3)(A), by inserting or
(5)after paragraph
(4); in paragraph (4)— in the heading, by inserting after for fiscal years before fiscal year 2015 ; and for children in the matter preceding subparagraph (A), by striking for a fiscal year if and inserting for a fiscal year before fiscal year 2015 if ; and by adding at the end the following new paragraph: For purposes of paragraph (3)(A), a State meets the condition of this paragraph for a fiscal year after fiscal year 2014 if it is implementing at least 7 of the enrollment and retention provisions specified in subparagraph
(B)(treating each clause of that subparagraph as a separate enrollment and retention provision) throughout the entire fiscal year and achieves a program rating of effective or highly effective under metrics established by the Secretary under subparagraph
(C)for the fiscal year (beginning with the first fiscal year for which such metrics are established). The enrollment and retention provisions specified in this subparagraph are the following: The State has elected the option of continuous eligibility for a full 12 months under title XIX for all children described in section 1902(e)(12) and applies such policy under its State child health plan under this title. The State is implementing the option described in section 1902(e)(13) under title XIX as well as, pursuant to section 2107(e)(1), under this title. The State is implementing section 1920A under title XIX as well as, pursuant to section 2107(e)(1), under this title. In the case of any targeted low-income child or a targeted low-income pregnant woman, the State child health plan does not impose any enrollment fee, premium, or similar charge. The State has opted to offer a premium assistance subsidy for qualified employer-sponsored coverage by implementing section 1906A under title XIX or the option described in section 2105(c)(10) under this title. If the State has elected to offer pregnancy-related assistance to targeted low-income women (as defined in section 2112(d)(2)) under section 2112, the State also has elected to include, as part of such pregnancy-related assistance and as part of the medical assistance provided to women under section 1902(e)(5) while pregnant and during the 60-day period described in such section— dental services necessary to prevent disease and promote oral health, restore oral structure to health and function, and treat emergency conditions; vision services, including vision screening and corrective lenses; and all services covered under the State child health plan. If the State has elected to offer pregnancy-related assistance to targeted low-income women (as defined in section 2112(d)(2)) under section 2112— the State also has elected to provide that a pregnant woman who is determined to be eligible for pregnancy-related assistance under the amendment to the State child health plan under section 2112 shall remain eligible for those benefits until the end of a period (not to exceed 12 months) following the determination; and the State is implementing section 1906A under title XIX. The State has elected to provide dental-only supplemental coverage under section 2110(b)(5). If the State has elected to provide eligibility as a child under the State plan under title XIX for an individual who has attained age 19 or 20, the State has elected to apply the same age under the State plan under this title for purposes of eligibility as a child. The State has elected to extend eligibility for medical assistance under the State plan under title XIX or eligibility for child health assistance under the State child health plan to any otherwise eligible child whose family income does not exceed 300 percent of the poverty line for a family of the size involved. Nothing in subclause
(I)shall be construed as prohibiting a State from extending eligibility for medical assistance under the State plan under title XIX or eligibility for child health assistance under the State child health plan to any otherwise eligible child whose family income exceeds 300 percent of the poverty line. The State child health plan permits an individual whose coverage under the plan has been terminated for failure to make premium payments to be immediately reenrolled upon payment of outstanding premiums, with coverage retroactive to the beginning of the most recent month for which an outstanding premium has been paid, and shall not impose any waiting period or enrollment fee as a condition of reenrollment. The State offers enrollment in the State child health plan for a child who is a member of a family that is eligible for health benefits coverage under a State health benefits plan on the basis of a family member's employment with a public agency in accordance with section 2110(b)(6) and provides resources to help the family member so employed compare the coverage options for the family member's child under the State health benefits plan on the basis of cost and provider networks. The State— does not terminate (but may suspend) enrollment under a State plan for medical assistance for any individual under age 21 on the basis that the individual is an inmate of a public institution (as defined in section 435.1010 of title 42, Code of Federal Regulations); informs such individual immediately upon release from such public institution that the individual's eligibility for medical assistance is no longer suspended and the limitations on medical assistance under the subdivision
(A)following paragraph
(29)of section 1905(a) will no longer apply (unless and until there is a determination that the individual no longer meets the State or Federal eligibility requirements for such medical assistance); processes any application for medical assistance submitted by, or on behalf of any individual under age 21 who is an inmate of a public institution (as defined in section 435.1010 of title 42, Code of Federal Regulations) notwithstanding that the individual is such an inmate; and screens any individual under age 21 who is such an inmate for eligibility for medical assistance under title XIX or child health assistance under this title and assists those individuals who are identified as likely to be eligible for either such assistance in applying for either such assistance and enrolling in either such plan. The State has elected to extend eligibility for child health assistance under the State child health plan (whether implemented under this title, title XIX, or both) to individuals under age 26 with special health care needs by implementing the option described in section 2110(c)(1)(B). The Secretary shall establish metrics for evaluating the effectiveness of the State program established under this title (whether implemented under this title, title XIX, or both). Such metrics shall include a system for rating States as effective , highly effective , or in need of improvement . .
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Sec. 102
Continuation and update of performance incentives
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