Subtitle J_State Children's Health Insurance Program
CHAPTER 1_STATE CHILDREN'S HEALTH INSURANCE PROGRAM
SEC. 4901. ESTABLISHMENT OF PROGRAM.
(a) Establishment._The Social Security Act is amended by adding at the
end the following new title:
``TITLE XXI_STATE CHILDREN'S HEALTH INSURANCE PROGRAM
``SEC. 2101. PURPOSE; STATE CHILD HEALTH PLANS.
``(a) Purpose._The purpose of this title is to provide funds to States
to enable them to initiate and expand the provision of child health
assistance to uninsured, low-income children in an effective and
efficient manner that is coordinated with other sources of health
benefits coverage for children. Such assistance shall be provided
primarily for obtaining health benefits coverage through_
``(1) obtaining coverage that meets the requirements of section 2103, or
``(2) providing benefits under the State's medicaid plan under title
XIX,
or a combination of both.
``(b) State Child Health Plan Required._A State is not eligible for
payment under section 2105 unless the State has submitted to the
Secretary under section 2106 a plan that_
``(1) sets forth how the State intends to use the funds provided under
this title to provide child health assistance to needy children
consistent with the provisions of this title, and
``(2) has been approved under section 2106.
``(c) State Entitlement._This title constitutes budget authority in
advance of appropriations Acts and represents the obligation of the
Federal Government to provide for the payment to States of amounts
provided under section 2104.
``(d) Effective Date._No State is eligible for payments under section
2105 for child health assistance for coverage provided for periods
beginning before October 1, 1997.
``SEC. 2102. GENERAL CONTENTS OF STATE CHILD HEALTH PLAN; ELIGIBILITY;
OUTREACH.
``(a) General Background and Description._A State child health plan
shall include a description, consistent with the requirements of this
title, of_
``(1) the extent to which, and manner in which, children in the State,
including targeted low-income children and other classes of children
classified by income and other relevant factors, currently have
creditable health coverage (as defined in section 2110(c)(2));
``(2) current State efforts to provide or obtain creditable health
coverage for uncovered children, including the steps the State is taking
to identify and enroll all uncovered children who are eligible to
participate in public health insurance programs and health insurance
programs that involve public-private partnerships;
``(3) how the plan is designed to be coordinated with such efforts to
increase coverage of children under creditable health coverage;
``(4) the child health assistance provided under the plan for targeted
low-income children, including the proposed methods of delivery, and
utilization control systems;
``(5) eligibility standards consistent with subsection (b);
``(6) outreach activities consistent with subsection (c); and
``(7) methods (including monitoring) used_
``(A) to assure the quality and appropriateness of care, particularly
with respect to well-baby care, well-child care, and immunizations
provided under the plan, and
``(B) to assure access to covered services, including emergency
services.
``(b) General Description of Eligibility Standards and Methodology._
``(1) Eligibility standards._
``(A) In general._The plan shall include a description of the standards
used to determine the eligibility of targeted low-income children for
child health assistance under the plan. Such standards may include (to
the extent consistent with this title) those relating to the geographic
areas to be served by the plan, age, income and resources (including any
standards relating to spenddowns and disposition of resources),
residency, disability status (so long as any standard relating to such
status does not restrict eligibility), access to or coverage under other
health coverage, and duration of eligibility. Such standards may not
discriminate on the basis of diagnosis.
``(B) Limitations on eligibility standards._Such eligibility standards_
``(i) shall, within any defined group of covered targeted low-income
children, not cover such children with higher family income without
covering children with a lower family income, and
``(ii) may not deny eligibility based on a child having a preexisting
medical condition.
``(2) Methodology._The plan shall include a description of methods of
establishing and continuing eligibility and enrollment.
``(3) Eligibility screening; coordination with other health coverage
programs._The plan shall include a description of procedures to be used
to ensure_
``(A) through both intake and followup screening, that only targeted
low-income children are furnished child health assistance under the
State child health plan;
``(B) that children found through the screening to be eligible for
medical assistance under the State medicaid plan under title XIX are
enrolled for such assistance under such plan;
``(C) that the insurance provided under the State child health plan does
not substitute for coverage under group health plans;
``(D) the provision of child health assistance to targeted low-income
children in the State who are Indians (as defined in section 4(c) of the
Indian Health Care Improvement Act, 25 U.S.C. 1603(c)); and
``(E) coordination with other public and private programs providing
creditable coverage for low-income children.
``(4) Nonentitlement._Nothing in this title shall be construed as
providing an individual with an entitlement to child health assistance
under a State child health plan.
``(c) Outreach and Coordination._A State child health plan shall include
a description of the procedures to be used by the State to accomplish
the following:
``(1) Outreach._Outreach to families of children likely to be eligible
for child health assistance under the plan or under other public or
private health coverage programs to inform these families of the
availability of, and to assist them in enrolling their children in, such
a program.
``(2) Coordination with other health insurance programs._Coordination of
the administration of the State program under this title with other
public and private health insurance programs.
``SEC. 2103. COVERAGE REQUIREMENTS FOR CHILDREN'S HEALTH INSURANCE.
``(a) Required Scope of Health Insurance Coverage._The child health
assistance provided to a targeted low-income child under the plan in the
form described in paragraph (1) of section 2101(a) shall consist,
consistent with subsection (c)(5), of any of the following:
``(1) Benchmark coverage._Health benefits coverage that is equivalent to
the benefits coverage in a benchmark benefit package described in
subsection (b).
``(2) Benchmark-equivalent coverage._Health benefits coverage that meets
the following requirements:
``(A) Inclusion of basic services._The coverage includes benefits for
items and services within each of the categories of basic services
described in subsection (c)(1).
``(B) Aggregate actuarial value equivalent to benchmark package._The
coverage has an aggregate actuarial value that is at least actuarially
equivalent to one of the benchmark benefit packages.
``(C) Substantial actuarial value for additional services included in
benchmark package._With respect to each of the categories of additional
services described in subsection (c)(2) for which coverage is provided
under the benchmark benefit package used under subparagraph (B), the
coverage has an actuarial value that is equal to at least 75 percent of
the actuarial value of the coverage of that category of services in such
package.
``(3) Existing comprehensive state-based coverage._Health benefits
coverage under an existing comprehensive State-based program, described
in subsection (d)(1).
``(4) Secretary-approved coverage._Any other health benefits coverage
that the Secretary determines, upon application by a State, provides
appropriate coverage for the population of targeted low-income children
proposed to be provided such coverage.
``(b) Benchmark Benefit Packages._The benchmark benefit packages are as
follows:
``(1) FEHBP-equivalent children's health insurance coverage._The
standard Blue Cross/Blue Shield preferred provider option service
benefit plan, described in and offered under section 8903(1) of title 5,
United States Code.
``(2) State employee coverage._A health benefits coverage plan that is
offered and generally available to State employees in the State
involved.
``(3) Coverage offered through hmo._The health insurance coverage plan
that_
``(A) is offered by a health maintenance organization (as defined in
section 2791(b)(3) of the Public Health Service Act), and
``(B) has the largest insured commercial, non-medicaid enrollment of
covered lives of such coverage plans offered by such a health
maintenance organization in the State involved.
``(c) Categories of Services; Determination of Actuarial Value of
Coverage._
``(1) Categories of basic services._For purposes of this section, the
categories of basic services described in this paragraph are as follows:
``(A) Inpatient and outpatient hospital services.
``(B) Physicians' surgical and medical services.
``(C) Laboratory and x-ray services.
``(D) Well-baby and well-child care, including age-appropriate
immunizations.
``(2) Categories of additional services._For purposes of this section,
the categories of additional services described in this paragraph are as
follows:
``(A) Coverage of prescription drugs.
``(B) Mental health services.
``(C) Vision services.
``(D) Hearing services.
``(3) Treatment of other categories._Nothing in this subsection shall be
construed as preventing a State child health plan from providing
coverage of benefits that are not within a category of services
described in paragraph (1) or (2).
``(4) Determination of actuarial value._The actuarial value of coverage
of benchmark benefit packages, coverage offered under the State child
health plan, and coverage of any categories of additional services under
benchmark benefit packages and under coverage offered by such a plan,
shall be set forth in an actuarial opinion in an actuarial report that
has been prepared_
``(A) by an individual who is a member of the American Academy of
Actuaries;
``(B) using generally accepted actuarial principles and methodologies;
``(C) using a standardized set of utilization and price factors;
``(D) using a standardized population that is representative of
privately insured children of the age of children who are expected to be
covered under the State child health plan;
``(E) applying the same principles and factors in comparing the value of
different coverage (or categories of services);
``(F) without taking into account any differences in coverage based on
the method of delivery or means of cost control or utilization used; and
``(G) taking into account the ability of a State to reduce benefits by
taking into account the increase in actuarial value of benefits coverage
offered under the State child health plan that results from the
limitations on cost sharing under such coverage.
The actuary preparing the opinion shall select and specify in the
memorandum the standardized set and population to be used under
subparagraphs (C) and (D).
``(5) Construction on prohibited coverage._Nothing in this section shall
be construed as requiring any health benefits coverage offered under the
plan to provide coverage for items or services for which payment is
prohibited under this title, notwithstanding that any benchmark benefit
package includes coverage for such an item or service.
``(d) Description of Existing Comprehensive State-Based Coverage._
``(1) In general._A program described in this paragraph is a child
health coverage program that_
``(A) includes coverage of a range of benefits;
``(B) is administered or overseen by the State and receives funds from
the State;
``(C) is offered in New York, Florida, or Pennsylvania; and
``(D) was offered as of the date of the enactment of this title.
``(2) Modifications._A State may modify a program described in paragraph
(1) from time to time so long as it continues to meet the requirement of
subparagraph (A) and does not reduce the actuarial value of the coverage
under the program below the lower of_
``(A) the actuarial value of the coverage under the program as of the
date of the enactment of this title, or
``(B) the actuarial value described in subsection (a)(2)(B),
evaluated as of the time of the modification.
``(e) Cost-Sharing._
``(1) Description; general conditions._
``(A) Description._A State child health plan shall include a
description, consistent with this subsection, of the amount (if any) of
premiums, deductibles, coinsurance, and other cost sharing imposed. Any
such charges shall be imposed pursuant to a public schedule.
``(B) Protection for lower income children._The State child health plan
may only vary premiums, deductibles, coinsurance, and other cost sharing
based on the family income of targeted low-income children in a manner
that does not favor children from families with higher income over
children from families with lower income.
``(2) No cost sharing on benefits for preventive services._The State
child health plan may not impose deductibles, coinsurance, or other cost
sharing with respect to benefits for services within the category of
services described in subsection (c)(1)(D).
``(3) Limitations on premiums and cost-sharing._
``(A) Children in families with income below 150 percent of poverty
line._In the case of a targeted low-income child whose family income is
at or below 150 percent of the poverty line, the State child health plan
may not impose_
``(i) an enrollment fee, premium, or similar charge that exceeds the
maximum monthly charge permitted consistent with standards established
to carry out section 1916(b)(1) (with respect to individuals described
in such section); and
``(ii) a deductible, cost sharing, or similar charge that exceeds an
amount that is nominal (as determined consistent with regulations
referred to in section 1916(a)(3), with such appropriate adjustment for
inflation or other reasons as the Secretary determines to be
reasonable).
``(B) Other children._For children not described in subparagraph (A),
subject to paragraphs (1)(B) and (2), any premiums, deductibles, cost
sharing or similar charges imposed under the State child health plan may
be imposed on a sliding scale related to income, except that the total
annual aggregate cost-sharing with respect to all targeted low-income
children in a family under this title may not exceed 5 percent of such
family's income for the year involved.
``(4) Relation to medicaid requirements._Nothing in this subsection
shall be construed as affecting the rules relating to the use of
enrollment fees, premiums, deductions, cost sharing, and similar charges
in the case of targeted low-income children who are provided child
health assistance in the form of coverage under a medicaid program under
section 2101(a)(2).
``(f) Application of Certain Requirements._
``(1) Restriction on application of preexisting condition exclusions._
``(A) In general._Subject to subparagraph (B), the State child health
plan shall not permit the imposition of any preexisting condition
exclusion for covered benefits under the plan.
``(B) Group health plans and group health insurance coverage._If the
State child health plan provides for benefits through payment for, or a
contract with, a group health plan or group health insurance coverage,
the plan may permit the imposition of a preexisting condition exclusion
but only insofar as it is permitted under the applicable provisions of
part 7 of subtitle B of title I of the Employee Retirement Income
Security Act of 1974 and title XXVII of the Public Health Service Act.
``(2) Compliance with other requirements._Coverage offered under this
section shall comply with the requirements of subpart 2 of part A of
title XXVII of the Public Health Service Act insofar as such
requirements apply with respect to a health insurance issuer that offers
group health insurance coverage.
``SEC. 2104. ALLOTMENTS.
``(a) Appropriation; Total Allotment._For the purpose of providing
allotments to States under this section, there is appropriated, out of
any money in the Treasury not otherwise appropriated_
``(1) for fiscal year 1998, $4,275,000,000;
``(2) for fiscal year 1999, $4,275,000,000;
``(3) for fiscal year 2000, $4,275,000,000;
``(4) for fiscal year 2001, $4,275,000,000;
``(5) for fiscal year 2002, $3,150,000,000;
``(6) for fiscal year 2003, $3,150,000,000;
``(7) for fiscal year 2004, $3,150,000,000;
``(8) for fiscal year 2005, $4,050,000,000;
``(9) for fiscal year 2006, $4,050,000,000; and
``(10) for fiscal year 2007, $5,000,000,000.
``(b) Allotments to 50 States and District of Columbia._
``(1) In general._Subject to paragraph (4) and subsection (d), of the
amount available for allotment under subsection (a) for a fiscal year,
reduced by the amount of allotments made under subsection (c) for the
fiscal year, the Secretary shall allot to each State (other than a State
described in such subsection) with a State child health plan approved
under this title the same proportion as the ratio of_
``(A) the product of (i) the number of children described in paragraph
(2) for the State for the fiscal year and (ii) the State cost factor for
that State (established under paragraph (3)); to
``(B) the sum of the products computed under subparagraph (A).
``(2) Number of children._
``(A) In general._The number of children described in this paragraph for
a State for_
``(i) each of fiscal years 1998 through 2000 is equal to the number of
low-income children in the State with no health insurance coverage for
the fiscal year;
``(ii) fiscal year 2001 is equal to_
``(I) 75 percent of the number of low-income children in the State for
the fiscal year with no health insurance coverage, plus
``(II) 25 percent of the number of low-income children in the State for
the fiscal year; and
``(iii) each succeeding fiscal year is equal to_
``(I) 50 percent of the number of low-income children in the State for
the fiscal year with no health insurance coverage, plus
``(II) 50 percent of the number of low-income children in the State for
the fiscal year.
``(B) Determination of number of children._For purposes of subparagraph
(A), a determination of the number of low-income children (and of such
children who have no health insurance coverage) for a State for a fiscal
year shall be made on the basis of the arithmetic average of the number
of such children, as reported and defined in the 3 most recent March
supplements to the Current Population Survey of the Bureau of the Census
before the beginning of the fiscal year.
``(3) Adjustment for geographic variations in health costs._
``(A) In general._For purposes of paragraph (1)(A)(ii), the `State cost
factor' for a State for a fiscal year equal to the sum of_
``(i) 0.15, and
``(ii) 0.85 multiplied by the ratio of_
``(I) the annual average wages per employee for the State for such year
(as determined under subparagraph (B)), to
``(II) the annual average wages per employee for the 50 States and the
District of Columbia.
``(B) Annual average wages per employee._For purposes of subparagraph
(A), the `annual average wages per employee' for a State, or for all the
States. for a fiscal year is equal to the average of the annual wages
per employee for the State or for the 50 States and the District of
Columbia for employees in the health services industry (SIC code 8000),
as reported by the Bureau of Labor Statistics of the Department of Labor
for each of the most recent 3 years before the beginning of the fiscal
year involved.
``(4) Floor for states._Subject to paragraph (5), in no case shall the
amount of the allotment under this subsection for one of the 50 States
or the District of Columbia for a year be less than $2,000,000. To the
extent that the application of the previous sentence results in an
increase in the allotment to a State above the amount otherwise
provided, the allotments for the other States and the District of
Columbia under this subsection shall be reduced in a pro rata manner
(but not below $2,000,000) so that the total of such allotments in a
fiscal year does not exceed the amount otherwise provided for allotment
under paragraph (1) for that fiscal year.
``(c) Allotments to Territories._
``(1) In general._Of the amount available for allotment under subsection
(a) for a fiscal year, subject to subsection (d), the Secretary shall
allot 0.25 percent among each of the commonwealths and territories
described in paragraph (3) in the same proportion as the percentage
specified in paragraph (2) for such commonwealth or territory bears to
the sum of such percentages for all such commonwealths or territories so
described.
``(2) Percentage._The percentage specified in this paragraph for_
``(A) Puerto Rico is 91.6 percent,
``(B) Guam is 3.5 percent,
``(C) Virgin Islands is 2.6 percent,
``(D) American Samoa is 1.2 percent, and
``(E) the Northern Mariana Islands is 1.1 percent.
``(3) Commonwealths and territories._A commonwealth or territory
described in this paragraph is any of the following if it has a State
child health plan approved under this title:
``(A) Puerto Rico.
``(B) Guam.
``(C) the Virgin Islands.
``(D) American Samoa.
``(E) the Northern Mariana Islands.
``(d) Certain Medicaid Expenditures Counted Against Individual State
Allotments._The amount of the allotment otherwise provided to a State
under subsection (b) or (c) for a fiscal year shall be reduced by the
sum of_
``(1) the amount (if any) of the payments made to that State under
section 1903(a) for calendar quarters during such fiscal year that is
attributable to the provision of medical assistance to a child during a
presumptive eligibility period under section 1920A, and
``(2) the amount of payments under such section during such period that
is attributable to the provision of medical assistance to a child for
which payment is made under section 1903(a)(1) on the basis of an
enhanced FMAP under section 1905(b).
``(e) 3-Year Availability of Amounts Allotted._Amounts allotted to a
State pursuant to this section for a fiscal year shall remain available
for expenditure by the State through the end of the second succeeding
fiscal year; except that amounts reallotted to a State under subsection
(f) shall be available for expenditure by the State through the end of
the fiscal year in which they are reallotted.
``(f) Procedure for Redistribution of Unused Allotments._The Secretary
shall determine an appropriate procedure for redistribution of
allotments from States that were provided allotments under this section
for a fiscal year but that do not expend all of the amount of such
allotments during the period in which such allotments are available for
expenditure under subsection (e), to States that have fully expended the
amount of their allotments under this section.
``SEC. 2105. PAYMENTS TO STATES.
``(a) In General._Subject to the succeeding provisions of this section,
the Secretary shall pay to each State with a plan approved under this
title, from its allotment under section 2104 (taking into account any
adjustment under section 2104(d)), an amount for each quarter equal to
the enhanced FMAP of expenditures in the quarter_
``(1) for child health assistance under the plan for targeted low-income
children in the form of providing health benefits coverage that meets
the requirements of section 2103; and
``(2) only to the extent permitted consistent with subsection (c)_
``(A) for payment for other child health assistance for targeted
low-income children;
``(B) for expenditures for health services initiatives under the plan
for improving the health of children (including targeted low-income
children and other low-income children);
``(C) for expenditures for outreach activities as provided in section
2102(c)(1) under the plan; and
``(D) for other reasonable costs incurred by the State to administer the
plan.
``(b) Enhanced FMAP._For purposes of subsection (a), the `enhanced
FMAP', for a State for a fiscal year, is equal to the Federal medical
assistance percentage (as defined in the first sentence of section
1905(b)) for the State increased by a number of percentage points equal
to 30 percent of the number of percentage points by which (1) such
Federal medical assistance percentage for the State, is less than (2)
100 percent; but in no case shall the enhanced FMAP for a State exceed
85 percent.
``(c) Limitation on Certain Payments for Certain Expenditures._
``(1) General limitations._Funds provided to a State under this title
shall only be used to carry out the purposes of this title (as described
in section 2101), and any health insurance coverage provided with such
funds may include coverage of abortion only if necessary to save the
life of the mother or if the pregnancy is the result of an act of rape
or incest.
``(2) Limitation on expenditures not used for medicaid or health
insurance assistance._
``(A) In general._Except as provided in this paragraph, payment shall
not be made under subsection (a) for expenditures for items described in
subsection (a) (other than paragraph (1)) for a quarter in a fiscal year
to the extent the total of such expenditures exceeds 10 percent of the
sum of_
``(i) the total Federal payments made under subsection (a) for such
quarter in the fiscal year, and
``(ii) the total Federal payments made under section 1903(a)(1) based on
an enhanced FMAP described in section 1905(u)(2) for such quarter.
``(B) Waiver authorized for cost-effective alternative._The limitation
under subparagraph (A) on expenditures for items described in subsection
(a)(2) shall not apply to the extent that a State establishes to the
satisfaction of the Secretary that_
``(i) coverage provided to targeted low-income children through such
expenditures meets the requirements of section 2103;
``(ii) the cost of such coverage is not greater, on an average per child
basis, than the cost of coverage that would otherwise be provided under
section 2103; and
``(iii) such coverage is provided through the use of a community-based
health delivery system, such as through contracts with health centers
receiving funds under section 330 of the Public Health Service Act or
with hospitals such as those that receive disproportionate share payment
adjustments under section 1886(d)(5)(F) or 1923.
``(3) Waiver for purchase of family coverage._Payment may be made to a
State under subsection (a)(1) for the purchase of family coverage under
a group health plan or health insurance coverage that includes coverage
of targeted low-income children only if the State establishes to the
satisfaction of the Secretary that_
``(A) purchase of such coverage is cost-effective relative to the
amounts that the State would have paid to obtain comparable coverage
only of the targeted low-income children involved, and
``(B) such coverage shall not be provided if it would otherwise
substitute for health insurance coverage that would be provided to such
children but for the purchase of family coverage.
``(4) Use of non-federal funds for state matching requirement._Amounts
provided by the Federal Government, or services assisted or subsidized
to any significant extent by the Federal Government, may not be included
in determining the amount of non-Federal contributions required under
subsection (a).
``(5) Offset of receipts attributable to premiums and other
cost-sharing._For purposes of subsection (a), the amount of the
expenditures under the plan shall be reduced by the amount of any
premiums and other cost-sharing received by the State.
``(6) Prevention of duplicative payments._
``(A) Other health plans._No payment shall be made to a State under this
section for expenditures for child health assistance provided for a
targeted low-income child under its plan to the extent that a private
insurer (as defined by the Secretary by regulation and including a group
health plan (as defined in section 607(1) of the Employee Retirement
Income Security Act of 1974), a service benefit plan, and a health
maintenance organization) would have been obligated to provide such
assistance but for a provision of its insurance contract which has the
effect of limiting or excluding such obligation because the individual
is eligible for or is provided child health assistance under the plan.
``(B) Other federal governmental programs._Except as otherwise provided
by law, no payment shall be made to a State under this section for
expenditures for child health assistance provided for a targeted
low-income child under its plan to the extent that payment has been made
or can reasonably be expected to be made promptly (as determined in
accordance with regulations) under any other federally operated or
financed health care insurance program, other than an insurance program
operated or financed by the Indian Health Service, as identified by the
Secretary. For purposes of this paragraph, rules similar to the rules
for overpayments under section 1903(d)(2) shall apply.
``(7) Limitation on payment for abortions._
``(A) In general._Payment shall not be made to a State under this
section for any amount expended under the State plan to pay for any
abortion or to assist in the purchase, in whole or in part, of health
benefit coverage that includes coverage of abortion.
``(B) Exception._Subparagraph (A) shall not apply to an abortion only if
necessary to save the life of the mother or if the pregnancy is the
result of an act of rape or incest.
``(C) Rule of construction._Nothing in this section shall be construed
as affecting the expenditure by a State, locality, or private person or
entity of State, local, or private funds (other than funds expended
under the State plan) for any abortion or for health benefits coverage
that includes coverage of abortion.
``(d) Maintenance of Effort._
``(1) In medicaid eligibility standards._No payment may be made under
subsection (a) with respect to child health assistance provided under a
State child health plan if the State adopts income and resource
standards and methodologies for purposes of determining a child's
eligibility for medical assistance under the State plan under title XIX
that are more restrictive than those applied as of June 1, 1997.
``(2) In amounts of payment expended for certain state-funded health
insurance programs for children._
``(A) In general._The amount of the allotment for a State in a fiscal
year (beginning with fiscal year 1999) shall be reduced by the amount by
which_
``(i) the total of the State children's health insurance expenditures in
the preceding fiscal year, is less than
``(ii) the total of such expenditures in fiscal year 1996.
``(B) State children's health insurance expenditures._The term `State
children's health insurance expenditures' means the following:
``(i) The State share of expenditures under this title.
``(ii) The State share of expenditures under title XIX that are
attributable to an enhanced FMAP under section 1905(u).
``(iii) State expenditures under health benefits coverage under an
existing comprehensive State-based program, described section 2103(d).
``(e) Advance Payment; Retrospective Adjustment._The Secretary may make
payments under this section for each quarter on the basis of advance
estimates of expenditures submitted by the State and such other
investigation as the Secretary may find necessary, and may reduce or
increase the payments as necessary to adjust for any overpayment or
underpayment for prior quarters.
``SEC. 2106. PROCESS FOR SUBMISSION, APPROVAL, AND AMENDMENT OF STATE
CHILD HEALTH PLANS.
``(a) Initial Plan._
``(1) In general._As a condition of receiving payment under section
2105, a State shall submit to the Secretary a State child health plan
that meets the applicable requirements of this title.
``(2) Approval._Except as the Secretary may provide under subsection
(e), a State plan submitted under paragraph (1)_
``(A) shall be approved for purposes of this title, and
``(B) shall be effective beginning with a calendar quarter that is
specified in the plan, but in no case earlier than October 1, 1997.
``(b) Plan Amendments._
``(1) In general._A State may amend, in whole or in part, its State
child health plan at any time through transmittal of a plan amendment.
``(2) Approval._Except as the Secretary may provide under subsection
(e), an amendment to a State plan submitted under paragraph (1)_
``(A) shall be approved for purposes of this title, and
``(B) shall be effective as provided in paragraph (3).
``(3) Effective dates for amendments._
``(A) In general._Subject to the succeeding provisions of this
paragraph, an amendment to a State plan shall take effect on one or more
effective dates specified in the amendment.
``(B) Amendments relating to eligibility or benefits._
``(i) Notice requirement._Any plan amendment that eliminates or
restricts eligibility or benefits under the plan may not take effect
unless the State certifies that it has provided prior public notice of
the change, in a form and manner provided under applicable State law.
``(ii) Timely transmittal._Any plan amendment that eliminates or
restricts eligibility or benefits under the plan shall not be effective
for longer than a 60-day period unless the amendment has been
transmitted to the Secretary before the end of such period.
``(C) Other amendments._Any plan amendment that is not described in
subparagraph (B) and that becomes effective in a State fiscal year may
not remain in effect after the end of such fiscal year (or, if later,
the end of the 90-day period on which it becomes effective) unless the
amendment has been transmitted to the Secretary.
``(c) Disapproval of Plans and Plan Amendments._
``(1) Prompt review of plan submittals._The Secretary shall promptly
review State plans and plan amendments submitted under this section to
determine if they substantially comply with the requirements of this
title.
``(2) 90-day approval deadlines._A State plan or plan amendment is
considered approved unless the Secretary notifies the State in writing,
within 90 days after receipt of the plan or amendment, that the plan or
amendment is disapproved (and the reasons for disapproval) or that
specified additional information is needed.
``(3) Correction._In the case of a disapproval of a plan or plan
amendment, the Secretary shall provide a State with a reasonable
opportunity for correction before taking financial sanctions against the
State on the basis of such disapproval.
``(d) Program Operation._
``(1) In general._The State shall conduct the program in accordance with
the plan (and any amendments) approved under subsection (c) and with the
requirements of this title.
``(2) Violations._The Secretary shall establish a process for enforcing
requirements under this title. Such process shall provide for the
withholding of funds in the case of substantial noncompliance with such
requirements. In the case of an enforcement action against a State under
this paragraph, the Secretary shall provide a State with a reasonable
opportunity for correction before taking financial sanctions against the
State on the basis of such an action.
``(e) Continued Approval._An approved State child health plan shall
continue in effect unless and until the State amends the plan under
subsection (b) or the Secretary finds, under subsection (d), substantial
noncompliance of the plan with the requirements of this title.
``SEC. 2107. STRATEGIC OBJECTIVES AND PERFORMANCE GOALS; PLAN
ADMINISTRATION.
``(a) Strategic Objectives and Performance Goals._
``(1) Description._A State child health plan shall include a description
of_
``(A) the strategic objectives,
``(B) the performance goals, and
``(C) the performance measures,
the State has established for providing child health assistance to
targeted low-income children under the plan and otherwise for maximizing
health benefits coverage for other low-income children and children
generally in the State.
``(2) Strategic objectives._Such plan shall identify specific strategic
objectives relating to increasing the extent of creditable health
coverage among targeted low-income children and other low-income
children.
``(3) Performance goals._Such plan shall specify one or more performance
goals for each such strategic objective so identified.
``(4) Performance measures._Such plan shall describe how performance
under the plan will be_
``(A) measured through objective, independently verifiable means, and
``(B) compared against performance goals, in order to determine the
State's performance under this title.
``(b) Records, Reports, Audits, and Evaluation._
``(1) Data collection, records, and reports._A State child health plan
shall include an assurance that the State will collect the data,
maintain the records, and furnish the reports to the Secretary, at the
times and in the standardized format the Secretary may require in order
to enable the Secretary to monitor State program administration and
compliance and to evaluate and compare the effectiveness of State plans
under this title.
``(2) State assessment and study._A State child health plan shall
include a description of the State's plan for the annual assessments and
reports under section 2108(a) and the evaluation required by section
2108(b).
``(3) Audits._A State child health plan shall include an assurance that
the State will afford the Secretary access to any records or information
relating to the plan for the purposes of review or audit.
``(c) Program Development Process._A State child health plan shall
include a description of the process used to involve the public in the
design and implementation of the plan and the method for ensuring
ongoing public involvement.
``(d) Program Budget._A State child health plan shall include a
description of the budget for the plan. The description shall be updated
periodically as necessary and shall include details on the planned use
of funds and the sources of the non-Federal share of plan expenditures,
including any requirements for cost-sharing by beneficiaries.
``(e) Application of Certain General Provisions._The following sections
of this Act shall apply to States under this title in the same manner as
they apply to a State under title XIX:
``(1) Title xix provisions._
``(A) Section 1902(a)(4)(C) (relating to conflict of interest
standards).
``(B) Paragraphs (2), (16), and (17) of section 1903(i) (relating to
limitations on payment).
``(C) Section 1903(w) (relating to limitations on provider taxes and
donations).
``(2) Title xi provisions._
``(A) Section 1115 (relating to waiver authority).
``(B) Section 1116 (relating to administrative and judicial review), but
only insofar as consistent with this title.
``(C) Section 1124 (relating to disclosure of ownership and related
information).
``(D) Section 1126 (relating to disclosure of information about certain
convicted individuals).
``(E) Section 1128A (relating to civil monetary penalties).
``(F) Section 1128B(d) (relating to criminal penalties for certain
additional charges).
``(G) Section 1132 (relating to periods within which claims must be
filed).
``SEC. 2108. ANNUAL REPORTS; EVALUATIONS.
``(a) Annual Report._The State shall_
``(1) assess the operation of the State plan under this title in each
fiscal year, including the progress made in reducing the number of
uncovered low-income children; and
``(2) report to the Secretary, by January 1 following the end of the
fiscal year, on the result of the assessment.
``(b) State Evaluations._
``(1) In general._By March 31, 2000, each State that has a State child
health plan shall submit to the Secretary an evaluation that includes
each of the following:
``(A) An assessment of the effectiveness of the State plan in increasing
the number of children with creditable health coverage.
``(B) A description and analysis of the effectiveness of elements of the
State plan, including_
``(i) the characteristics of the children and families assisted under
the State plan including age of the children, family income, and the
assisted child's access to or coverage by other health insurance prior
to the State plan and after eligibility for the State plan ends,
``(ii) the quality of health coverage provided including the types of
benefits provided,
``(iii) the amount and level (including payment of part or all of any
premium) of assistance provided by the State,
``(iv) the service area of the State plan,
``(v) the time limits for coverage of a child under the State plan,
``(vi) the State's choice of health benefits coverage and other methods
used for providing child health assistance, and
``(vii) the sources of non-Federal funding used in the State plan.
``(C) An assessment of the effectiveness of other public and private
programs in the State in increasing the availability of affordable
quality individual and family health insurance for children.
``(D) A review and assessment of State activities to coordinate the plan
under this title with other public and private programs providing health
care and health care financing, including medicaid and maternal and
child health services.
``(E) An analysis of changes and trends in the State that affect the
provision of accessible, affordable, quality health insurance and health
care to children.
``(F) A description of any plans the State has for improving the
availability of health insurance and health care for children.
``(G) Recommendations for improving the program under this title.
``(H) Any other matters the State and the Secretary consider
appropriate.
``(2) Report of the secretary._The Secretary shall submit to Congress
and make available to the public by December 31, 2001, a report based on
the evaluations submitted by States under paragraph (1), containing any
conclusions and recommendations the Secretary considers appropriate.
``SEC. 2109. MISCELLANEOUS PROVISIONS.
``(a) Relation to Other Laws._
``(1) HIPAA._Health benefits coverage provided under section 2101(a)(1)
(and coverage provided under a waiver under section 2105(c)(2)(B)) shall
be treated as creditable coverage for purposes of part 7 of subtitle B
of title II of the Employee Retirement Income Security Act of 1974,
title XXVII of the Public Health Service Act, and subtitle K of the
Internal Revenue Code of 1986.
``(2) ERISA._Nothing in this title shall be construed as affecting or
modifying section 514 of the Employee Retirement Income Security Act of
1974 (29 U.S.C. 1144) with respect to a group health plan (as defined in
section 2791(a)(1) of the Public Health Service Act (42 U.S.C.
300ggÿ0991(a)(1)).
``SEC. 2110. DEFINITIONS.
``(a) Child Health Assistance._For purposes of this title, the term
`child health assistance' means payment for part or all of the cost of
health benefits coverage for targeted low-income children that includes
any of the following (and includes, in the case described in section
2105(a)(2)(A), payment for part or all of the cost of providing any of
the following), as specified under the State plan:
``(1) Inpatient hospital services.
``(2) Outpatient hospital services.
``(3) Physician services.
``(4) Surgical services.
``(5) Clinic services (including health center services) and other
ambulatory health care services.
``(6) Prescription drugs and biologicals and the administration of such
drugs and biologicals, only if such drugs and biologicals are not
furnished for the purpose of causing, or assisting in causing, the
death, suicide, euthanasia, or mercy killing of a person.
``(7) Over-the-counter medications.
``(8) Laboratory and radiological services.
``(9) Prenatal care and prepregnancy family planning services and
supplies.
``(10) Inpatient mental health services, other than services described
in paragraph (18) but including services furnished in a State-operated
mental hospital and including residential or other 24-hour
therapeutically planned structured services.
``(11) Outpatient mental health services, other than services described
in paragraph (19) but including services furnished in a State-operated
mental hospital and including community-based services.
``(12) Durable medical equipment and other medically-related or remedial
devices (such as prosthetic devices, implants, eyeglasses, hearing aids,
dental devices, and adaptive devices).
``(13) Disposable medical supplies.
``(14) Home and community-based health care services and related
supportive services (such as home health nursing services, home health
aide services, personal care, assistance with activities of daily
living, chore services, day care services, respite care services,
training for family members, and minor modifications to the home).
``(15) Nursing care services (such as nurse practitioner services, nurse
midwife services, advanced practice nurse services, private duty nursing
care, pediatric nurse services, and respiratory care services) in a
home, school, or other setting.
``(16) Abortion only if necessary to save the life of the mother or if
the pregnancy is the result of an act of rape or incest.
``(17) Dental services.
``(18) Inpatient substance abuse treatment services and residential
substance abuse treatment services.
``(19) Outpatient substance abuse treatment services.
``(20) Case management services.
``(21) Care coordination services.
``(22) Physical therapy, occupational therapy, and services for
individuals with speech, hearing, and language disorders.
``(23) Hospice care.
``(24) Any other medical, diagnostic, screening, preventive,
restorative, remedial, therapeutic, or rehabilitative services (whether
in a facility, home, school, or other setting) if recognized by State
law and only if the service is_
``(A) prescribed by or furnished by a physician or other licensed or
registered practitioner within the scope of practice as defined by State
law,
``(B) performed under the general supervision or at the direction of a
physician, or
``(C) furnished by a health care facility that is operated by a State or
local government or is licensed under State law and operating within the
scope of the license.
``(25) Premiums for private health care insurance coverage.
``(26) Medical transportation.
``(27) Enabling services (such as transportation, translation, and
outreach services) only if designed to increase the accessibility of
primary and preventive health care services for eligible low-income
individuals.
``(28) Any other health care services or items specified by the
Secretary and not excluded under this section.
``(b) Targeted Low-Income Child Defined._For purposes of this title_
``(1) In general._Subject to paragraph (2), the term `targeted
low-income child' means a child_
``(A) who has been determined eligible by the State for child health
assistance under the State plan;
``(B)(i) who is a low-income child, or
``(ii) is a child whose family income (as determined under the State
child health plan) exceeds the medicaid applicable income level (as
defined in paragraph (4)), but does not exceed 50 percentage points
above the medicaid applicable income level; and
``(C) who is not found to be eligible for medical assistance under title
XIX or covered under a group health plan or under health insurance
coverage (as such terms are defined in section 2791 of the Public Health
Service Act).
``(2) Children excluded._Such term does not include_
``(A) a child who is an inmate of a public institution or a patient in
an institution for mental diseases; or
``(B) 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 the State.
``(3) Special rule._A child shall not be considered to be described in
paragraph (1)(C) notwithstanding that the child is covered under a
health insurance coverage program that has been in operation since
before July 1, 1997, and that is offered by a State which receives no
Federal funds for the program's operation.
``(4) Medicaid applicable income level._The term `medicaid applicable
income level' means, with respect to a child, the effective income level
(expressed as a percent of the poverty line) that has been specified
under the State plan under title XIX (including under a waiver
authorized by the Secretary or under section 1902(r)(2)), as of June 1,
1997, for the child to be eligible for medical assistance under section
1902(l)(2) for the age of such child.
``(c) Additional Definitions._For purposes of this title:
``(1) Child._The term `child' means an individual under 19 years of age.
``(2) Creditable health coverage._The term `creditable health coverage'
has the meaning given the term `creditable coverage' under section
2701(c) of the Public Health Service Act (42 U.S.C. 300gg(c)) and
includes coverage that meets the requirements of section 2103 provided
to a targeted low-income child under this title or under a waiver
approved under section 2105(c)(2)(B) (relating to a direct service
waiver).
``(3) Group health plan; health insurance coverage; etc._The terms
`group health plan', `group health insurance coverage', and `health
insurance coverage' have the meanings given such terms in section 2191
of the Public Health Service Act.
``(4) Low-income._The term `low-income child' means a child whose family
income is at or below 200 percent of the poverty line for a family of
the size involved.
``(5) Poverty line defined._The term `poverty line' has the meaning
given such term in section 673(2) of the Community Services Block Grant
Act (42 U.S.C. 9902(2)), including any revision required by such
section.
``(6) Preexisting condition exclusion._The term `preexisting condition
exclusion' has the meaning given such term in section 2701(b)(1)(A) of
the Public Health Service Act (42 U.S.C. 300gg(b)(1)(A)).
``(7) State child health plan; plan._Unless the context otherwise
requires, the terms `State child health plan' and `plan' mean a State
child health plan approved under section 2106.
``(8) Uncovered child._The term `uncovered child' means a child that
does not have creditable health coverage.''.
(b) Conforming Amendments._
(1) Definition of state._Section 1101(a)(1) is amended_
(A) by striking ``and XIX'' and inserting ``XIX, and XXI'', and
(B) by striking ``title XIX'' and inserting ``titles XIX and XXI''.
(2) Treatment as state health care program._Section 1128(h) (42 U.S.C.
1320aÿ097(h)) is amended by_
(A) in paragraph (2), by striking ``or'' at the end;
(B) in paragraph (3), by striking the period and inserting ``, or''; and
(C) by adding at the end the following:
``(4) a State child health plan approved under title XXI.''.
CHAPTER 2_EXPANDED COVERAGE OF CHILDREN UNDER MEDICAID
SEC. 4911. OPTIONAL USE OF STATE CHILD HEALTH ASSISTANCE FUNDS FOR
ENHANCED MEDICAID MATCH FOR EXPANDED MEDICAID ELIGIBILITY.
(a) Increased FMAP for Medical Assistance for Expanded Coverage of
Targeted Low-Income Children._Section 1905 of the Social Security Act
(42 U.S.C. 1396d), as amended by section 4702(a)(2), is amended_
(1) in subsection (b), by adding at the end the following new sentence:
``Notwithstanding the first sentence of this subsection, in the case of
a State plan that meets the condition described in subsection (u)(1),
with respect to expenditures described in subsection (u)(2)(A) or
subsection (u)(3) the Federal medical assistance percentage is equal to
the enhanced FMAP described in section 2105(b).''; and
(2) by adding at the end the following new subsection:
``(u)(1) The conditions described in this paragraph for a State plan are
as follows:
``(A) The State is complying with the requirement of section 2105(d)(1).
``(B) The plan provides for such reporting of information about
expenditures and payments attributable to the operation of this
subsection as the Secretary deems necessary in order to carry out
paragraph (2) and section 2104(d).
``(2)(A) For purposes of subsection (b), the expenditures described in
this subparagraph are expenditures for medical assistance for optional
targeted low-income children described in subparagraph (C), but not in
excess, for a State for a fiscal year, of the amount described in
subparagraph (B) for the State and fiscal year.
``(B) The amount described in this subparagraph, for a State for a
fiscal year, is the amount of the State's allotment under section 2104
(not taking into account reductions under section 2104(d)(2)) for the
fiscal year reduced by the amount of any payments made under section
2105 to the State from such allotment for such fiscal year.
``(C) For purposes of this paragraph, the term `optional targeted
low-income child' means a targeted low-income child as defined in
section 2110(b)(1) who would not qualify for medical assistance under
the State plan under this title based on such plan as in effect on April
15, 1997 (but taking into account the expansion of age of eligibility
effected through the operation of section 1902(l)(2)(D)).
``(3) For purposes of subsection (b), the expenditures described in this
subparagraph are expenditures for medical assistance for children who
are born before October 1, 1983, and who would be described in section
1902(l)(1)(D) if they had been born on or after such date, and who are
not eligible for such assistance under the State plan under this title
based on such State plan as in effect as of April 15, 1997.''.
(b) Establishment of Optional Eligibility Category._Section
1902(a)(10)(A)(ii) (42 U.S.C. 1396a(a)(10)(A)(ii)), as amended by
section 4733, is amended_
(1) in subclause (XII), by striking ``or'' at the end;
(2) in subclause (XIII), by adding ``or'' at the end; and
(3) by adding at the end the following:
``(XIV) who are optional targeted low-income children described in
section 1905(u)(2)(C);''.
(c) Effective Date._The amendments made by this section shall apply to
medical assistance for items and services furnished on or after October
1, 1997.
SEC. 4912. MEDICAID PRESUMPTIVE ELIGIBILITY FOR LOW-INCOME CHILDREN.
(a) In General._Title XIX of the Social Security Act is amended by
inserting after section 1920 the following new section:
``presumptive eligibility for children
``Sec. 1920A. (a) A State plan approved under section 1902 may provide
for making medical assistance with respect to health care items and
services covered under the State plan available to a child during a
presumptive eligibility period.
``(b) For purposes of this section:
``(1) The term `child' means an individual under 19 years of age.
``(2) The term `presumptive eligibility period' means, with respect to a
child, the period that_
``(A) begins with the date on which a qualified entity determines, on
the basis of preliminary information, that the family income of the
child does not exceed the applicable income level of eligibility under
the State plan, and
``(B) ends with (and includes) the earlier of_
``(i) the day on which a determination is made with respect to the
eligibility of the child for medical assistance under the State plan, or
``(ii) in the case of a child on whose behalf an application is not
filed by the last day of the month following the month during which the
entity makes the determination referred to in subparagraph (A), such
last day.
``(3)(A) Subject to subparagraph (B), the term `qualified entity' means
any entity that_
``(i)(I) is eligible for payments under a State plan approved under this
title and provides items and services described in subsection (a) or
(II) is authorized to determine eligibility of a child to participate in
a Head Start program under the Head Start Act (42 U.S.C. 9821 et seq.),
eligibility of a child to receive child care services for which
financial assistance is provided under the Child Care and Development
Block Grant Act of 1990 (42 U.S.C. 9858 et seq.), eligibility of an
infant or child to receive assistance under the special supplemental
nutrition program for women, infants, and children (WIC) under section
17 of the Child Nutrition Act of 1966 (42 U.S.C. 1786); and
``(ii) is determined by the State agency to be capable of making
determinations of the type described in paragraph (1)(A).
``(B) The Secretary may issue regulations further limiting those
entities that may become qualified entities in order to prevent fraud
and abuse and for other reasons.
``(C) Nothing in this section shall be construed as preventing a State
from limiting the classes of entities that may become qualified
entities, consistent with any limitations imposed under subparagraph
(B).
``(c)(1) The State agency shall provide qualified entities with_
``(A) such forms as are necessary for an application to be made on
behalf of a child for medical assistance under the State plan, and
``(B) information on how to assist parents, guardians, and other persons
in completing and filing such forms.
``(2) A qualified entity that determines under subsection (b)(1)(A) that
a child is presumptively eligible for medical assistance under a State
plan shall_
``(A) notify the State agency of the determination within 5 working days
after the date on which determination is made, and
``(B) inform the parent or custodian of the child at the time the
determination is made that an application for medical assistance under
the State plan is required to be made by not later than the last day of
the month following the month during which the determination is made.
``(3) In the case of a child who is determined by a qualified entity to
be presumptively eligible for medical assistance under a State plan, the
parent, guardian, or other person shall make application on behalf of
the child for medical assistance under such plan by not later than the
last day of the month following the month during which the determination
is made, which application may be the application used for the receipt
of medical assistance by individuals described in section 1902(l)(1).
``(d) Notwithstanding any other provision of this title, medical
assistance for items and services described in subsection (a) that_
``(1) are furnished to a child_
``(A) during a presumptive eligibility period,
``(B) by a entity that is eligible for payments under the State plan;
and
``(2) are included in the care and services covered by a State plan;
shall be treated as medical assistance provided by such plan for
purposes of section 1903.''.
(b) Conforming Amendments._
(1) Section 1902(a)(47) (42 U.S.C. 1396a(a)(47)) is amended by inserting
before the semicolon at the end the following: ``and provide for making
medical assistance for items and services described in subsection (a) of
section 1920A available to children during a presumptive eligibility
period in accordance with such section''.
(2) Section 1903(u)(1)(D)(v) (42 U.S.C. 1396b(u)(1)(D)(v)) is amended by
inserting before the period at the end the following: ``or for items and
services described in subsection (a) of section 1920A provided to a
child during a presumptive eligibility period under such section''.
(c) Effective Date._The amendments made by this section shall take
effect on the date of the enactment of this Act.
SEC. 4913. CONTINUATION OF MEDICAID ELIGIBILITY FOR DISABLED CHILDREN
WHO LOSE SSI BENEFITS.
(a) In General._Section 1902(a)(10)(A)(i)(II) (42 U.S.C.
1396a(a)(10)(A)(i)(II)) is amended by inserting ``(or were being paid as
of the date of the enactment of section 211(a) of the Personal
Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L.
104ÿ09193)) and would continue to be paid but for the enactment of that
section'' after ``title XVI''.
(b) Effective Date._The amendment made by subsection (a) applies to
medical assistance furnished on or after July 1, 1997.
CHAPTER 3_DIABETES GRANT PROGRAMS
SEC. 4921. SPECIAL DIABETES PROGRAMS FOR CHILDREN WITH TYPE I DIABETES.
Subpart I of part D of title III of the Public Health Service Act (42
U.S.C. 254b et seq.) is amended by adding at the end the following
section:
``SEC. 330B. SPECIAL DIABETES PROGRAMS FOR CHILDREN WITH TYPE I
DIABETES.
``(a) Type I Diabetes in Children._The Secretary shall make grants for
services for the prevention and treatment of type I diabetes in
children, and for research in innovative approaches to such services.
Such grants may be made to children's hospitals; grantees under section
330 and other federally qualified health centers; State and local health
departments; and other appropriate public or nonprofit private entities.
``(b) Funding._Notwithstanding section 2104(a) of the Social Security
Act, from the amounts appropriated in such section for each of fiscal
years 1998 through 2002, $30,000,000 is hereby transferred and made
available in such fiscal year for grants under this section.''.
SEC. 4922. SPECIAL DIABETES PROGRAMS FOR INDIANS.
Subpart I of part D of title III of the Public Health Service Act (42
U.S.C. 254b et seq.), as amended by section 4921, is further amended by
adding at the end the following section:
``SEC. 330C. SPECIAL DIABETES PROGRAMS FOR INDIANS.
``(a) In General._The Secretary shall make grants for providing services
for the prevention and treatment of diabetes in accordance with
subsection (b).
``(b) Services Through Indian Health Facilities._For purposes of
subsection (a), services under such subsection are provided in
accordance with this subsection if the services are provided through any
of the following entities:
``(1) The Indian Health Service.
``(2) An Indian health program operated by an Indian tribe or tribal
organization pursuant to a contract, grant, cooperative agreement, or
compact with the Indian Health Service pursuant to the Indian
Self-Determination Act.
``(3) An urban Indian health program operated by an urban Indian
organization pursuant to a grant or contract with the Indian Health
Service pursuant to title V of the Indian Health Care Improvement Act.
``(c) Funding._Notwithstanding section 2104(a) of the Social Security
Act, from the amounts appropriated in such section for each of fiscal
years 1998 through 2002, $30,000,000 is hereby transferred and made
available in such fiscal year for grants under this section.''.
SEC. 4923. REPORT ON DIABETES GRANT PROGRAMS.
(a) Evaluation._The Secretary of Health and Human Services shall conduct
an evaluation of the diabetes grant programs established under the
amendments made by this chapter.
(b) Reports._The Secretary shall submit to the appropriate committees of
Congress_
(1) an interim report on the evaluation conducted under subsection (a)
not later than January 1, 2000, and
(2) a final report on such evaluation not later than January 1, 2002.
