MEDICAID, SCHIP, AND OTHER HEALTH PROVISIONS IN H.R. 5661: MEDICARE, MEDICAID, AND SCHIP BENEFITS IMPROVEMENT AND PROTECTION ACT OF 2000

CRS Report for Congress
H.R. 5661: Medicare, Medicaid, and SCHIP
provement and Protection Act of 2000
Updated January 4, 2001
Jean Hearne
Elicia Herz
Specialists in Social Legislation
Evelyne Baumrucker
Analyst in Social Legislation
Domestic Social Policy Division

Congressional Research Service ˜ The Library of Congress

Medicaid, SCHIP and Other Health Provisions in H.R. 5661:
Medicare, Medicaid, and SCHIP Benefits Improvement and
Protection Act of 2000
Summary
While largely comprised of Medicare provisions, the Medicare, Medicaid, and
SCHIP Benefits Improvement and Protection Act of 2000 (H.R. 5661), a compromise
agreement between House and Senate committees and the leadership, includes a
number of important changes to Medicaid and the State Children’s Health Insurance
Program (SCHIP). It also includes major provisions amending other programs. The
provisions of H.R. 5661 are incorporated, by reference into H.R. 4577, the
Consolidated Appropriations Act 2001. H.R. 4577 was passed by the House and
Senate on December 15, 2000 and was signed into law on December 21 (P.L. 106-

554).

Among the major Medicaid modifications are several provisions affecting
disproportionate share hospital (DSH) payments provided to hospitals that treat a
disproportionate share of uninsured and Medicaid enrollees. The agreement
increases the disproportionate share hospital allotments for states. It also extends a
special DSH payment rule for public hospitals in California to qualifying facilities
in all states, and provides additional funds to certain public hospitals not receiving
DSH payments. In addition to these DSH provisions, the bill replaces cost-based
reimbursement with a prospective payment system for Federally Qualified Health
Centers (FQHCs) and Rural Health Centers (RHCs). The agreement also modifies
proposed rules governing upper payment limits on inpatient and outpatient services
provided by certain types of facilities, and requires that the final regulations be issued
by the end of 2000.
One major SCHIP provision extends the availability of unused funds from
FY1998 and FY1999 and redistributes these unused funds among both those states
that spend and those that do not spend their full original allotments for these years.
Current law requires that these unused funds be distributed only to those states that
spend their allotments.
Among other major provisions, the agreement requires that outreach efforts be
implemented to identify individuals who may be eligible for Medicaid payment of
Medicare cost-sharing and to notify these persons of the availability of such
assistance. It increases the authorization of annual appropriations for the Maternal
and Child Health Services Block Grant under Title V. In addition, the bill extends
for 1 year, to FY2003, the authority for grants to be made for both the Special
Diabetes Program for Type I Diabetes and the Special Diabetes Programs for Indians
and increases total funding for FY2001 through FY2003. Finally, the agreement
provides an additional FY2001 direct appropriation for the Ricky Ray Hemophilia
Relief Fund.
For information on the Medicare provisions, see CRS Report RL30707,
Medicare Provisions in H.R. 5661: Medicare, Medicaid and SCHIP Benefits
Improvement and Protection Act of 2000 (available upon request).

Contents
In troduction ......................................................1
Recent Legislative Activity......................................3
Medicaid, SCHIP, and Other Provisions in the Medicare, Medicaid, and
SCHIP Benefits Improvement and Protection Act of 2000..............6
Title VII. Medicaid................................................6
Disproportionate Share Hospital Payments..........................6
New Prospective Payment System for FQHCs and RHCs..............9
Requests for Extension of Medicaid Waivers.......................10
Medicaid County-Organized Health Systems.......................11
Medicaid Upper Payment Limits.................................12
Alaska FMAP................................................13
Welfare-to-Work Transition....................................14
Determination of Medicaid Presumptive Eligibility for Low-Income
Children ................................................15
Development of Uniform QMB/SLMB Application Form.............15
Technical Corrections.........................................16
Title VIII. State Children’s Health Insurance Program....................17
Continued Availability and Redistribution of Unused SCHIP Funds.....17
Authority to Pay for Medicaid Expansion SCHIP Costs From
Title XXI Appropriation...................................18
Application of Medicaid Child Presumptive Eligibility Provisions......19
Title IX. Other Provisions..........................................20
Extension of Transition for Current PACE Waivers..................20
Continuing Certain PACE Operating Arrangements..................21
Flexibility in Exercising Waiver Authority.........................21
Outreach for Medicare Beneficiaries Eligible for Medicaid
Cost-Sharing Assistance ...................................22
Maternal and Child Health Block Grant...........................22
Diabetes ....................................................23
Appropriations for Ricky Ray Hemophilia Relief Fund...............23
Information on Nurse Staffing...................................24

Medicaid, SCHIP and Other Health Provisions
In H.R. 5661: Medicare, Medicaid,
And SCHIP Benefits Improvement and
Protection Act of 2000
Introduction
Medicaid is a joint federal-state entitlement program that pays for medical
assistance primarily for low-income persons who are aged, blind, disabled, members
of families with dependent children, and certain other pregnant women and children.
Within broad federal guidelines, each state designs and administers its own program.
Total program outlays in FY1999 were $180.9 billion. Federal outlays were $102.5
billion and state outlays were approximately $78.4 billion. The federal government
shares in a state’s Medicaid costs by means of a statutory formula designed to
provide a higher federal matching rate to states with lower per capita incomes. In
FY1999, federal matching rates ranged from 50% to 76% of a state’s expenditures
for Medicaid items and services. Overall, the federal government finances about

57% of all Medicaid costs.

The 105^th Congress made important changes to the Medicaid program through
the Balanced Budget Act of 1997 (BBA 97; P.L. 105-33).¹ That legislation included
provisions to achieve net Medicaid savings of about $13 billion between FY1998 and
FY2002, largely from reductions in supplemental payments to hospitals that serve a
disproportionate share of Medicaid and low-income patients. BBA 97 also
significantly increased the flexibility that states have to manage their Medicaid
programs. In particular, it gave states the option of requiring most beneficiaries to
enroll in managed care plans without seeking a federal waiver, and replaced federal
reimbursement requirements imposed by the Boren amendments with a public notice
process for setting payment rates for institutional services. The Act also required that
the previously existing cost-based reimbursement system for Federally Qualified
Health Centers (FQHCs) and Rural Health Clinics (RHCs) be phased out over a 6-
year period. Spending items in the Act included Medicaid coverage for additional
children, and increased assistance for low-income individuals to pay Medicare Part
B premiums.
The 106^th Congress made additional changes to Medicaid in 1999. On
November 29 of that year, the President signed the Consolidated Appropriations Act
for FY2000 (P.L. 106-113). Included in that bill by reference was the Medicare,
Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA 99), a bill
largely comprised of Medicare provisions, but which also included a number of
changes to Medicaid and the State Children’s Health Insurance Program (SCHIP;
described below).
In addition to technical amendments to BBA 97, BBRA 99 included provisions
allowing for increased Medicaid disproportionate share payments to hospitals for
certain states and the District of Columbia, and for extended access to a special $500
million fund to pay for Medicaid eligibility determinations resulting from welfare
reform for a longer period of time than allowed under previous law. BBRA 99 also
modified the schedule for phasing out cost-based reimbursement for FQHCs and
RHCs that had been included in the BBA 97.
SCHIP, enacted in BBA 97, is targeted at uninsured children who live in
families with income below twice the federal poverty level and who would not
otherwise be eligible for Medicaid. The program began in October 1997 with total
federal funding of nearly $40 billion for the period FY1998 through FY2007. States
may use SCHIP funds to provide coverage through health insurance that meets
specific standards for benefits and cost-sharing (known as separate state programs),
or through expansions of eligibility under Medicaid, or through a combination of
both options. SCHIP entitles states with approved SCHIP plans to pre-determined,
annual federal allotments based on a distribution formula set in law. Each state has
flexibility to define the group of targeted, low-income children who are eligible for
its SCHIP. Eligibility criteria may include, for example, geography, age, income and
resources, residency, disability status, access to other health insurance, and duration
of eligibility for SCHIP. All 50 states, the District of Columbia and five territories
had approved SCHIP plans. Among these, 22 are Medicaid expansions, 16 are new

¹ For a detailed description of the changes to Medicaid under BBA 97, see CRS Report 98-

132, Medicaid: 105^th Congress, by Melvina Ford and Richard Price.

or expanded separate state programs, and 17 will use both a Medicaid expansion and
a separate state program.
Changes to SCHIP in BBRA 99 included provisions to improve state-level data
collection; to evaluate the SCHIP (and Medicaid) programs with respect to outreach
and enrollment practices; and to create a clearinghouse to coordinate and consolidate
federal databases and reports on children’s health. In addition, BBRA 99 included
a number of changes to the formula used to distribute federal SCHIP funds among
the states, increased the amounts available for U.S. territories, and minor technical
changes.²
BBA 97 established the Program of All-Inclusive Care for the Elderly (PACE)
as a permanent provider under Medicare and as a special optional benefit under
Medicaid. Individuals eligible for PACE are those over age 55 who require a nursing
facility level of care covered in a state Medicaid program, and who meet other
eligibility requirements imposed under the program agreement. PACE providers
include public entities or private, not-for-profit organizations providing health and
long-term services on a capitated basis to eligible beneficiaries. They must provide
all items and services covered under Medicare and Medicaid. There are no limits on
amount, duration or scope of services and there are no cost-sharing requirements for
PACE enrollees.
The Maternal and Child Health (MCH) Services Block Grant Program (Title V
of the Social Security Act) has three components – formula block grants to 56 states
and territories for primary care services to mothers and children, Special Projects of
Regional and National Significance (SPRANS), and Community Integrated Service
Systems (CISS) grants. The formula grant program uses appropriated funds for a
wide variety of activities, including but not limited to, capacity and systems building,
public information and education, outreach and program linkage, technical
assistance, and direct health care services where no services are available. SPRANS
activities include maternal and child health research, training, genetic services,
hemophilia diagnostic and treatment centers, and maternal and child health
improvement projects. CISS grants seek to reduce infant mortality and improve the
health of mothers and children through development and expansion of integrated
services at the community level. The block grant requires that states match $3 in
funds or resources for every $4 in federal funds received, and that a minimum of 30%
of block grant funds be used to support programs for children with special health care
needs. For FY1994 forward, Title V authorizes to be appropriated $705 million
annually.
BBA 97 created two diabetes grant programs under the Public Health Service
Act. One grant program supports research into the prevention and cure of type I
diabetes, or insulin-dependent diabetes. The second grant program supports
prevention and treatment of diabetes in Indians. For FY1998 through FY2002, each

² For a detailed description of changes to Medicaid and SCHIP under BBRA 99, see CRS
Report RL30400, Medicaid and the State Children’s Health Insurance Program (SCHIP):
Provisions in the Consolidated Appropriations Act for FY2000, by Jean Hearne and Elicia
Herz.

program receives $30 million annually through funds transferred from the SCHIP
appropriation. BBA 97 also required evaluations of these grant programs with an
interim and final report due to Congress on January 1, 2000 and January 1, 2002,
respectively.
The Ricky Ray Hemophilia Relief Fund Act of 1998 (P.L. 105-369) established
a 5-year trust fund to make compassionate payments of $100,000 to certain
individuals with blood clotting disorders, such as hemophilia, who contracted HIV
(human immunodeficiency virus) through the use of anti-hemophiliac factor between
July 1, 1982 and December 31, 1987. The Act authorized appropriations to the trust
fund totaling $750 million. The fund received an initial appropriation of $75 million
in FY2000. H.R. 5661 provides a direct appropriation of $475 million for FY2001,
in addition to $105 million appropriated in the FY2001 Miscellaneous
Appropriations Act (H.R. 5666). The trust fund has, therefore, received a total of
$655 million, which is estimated to be sufficient to pay all the eligible claims.
Recent Legislative Activity
In late September and early October of 2000, the committees with jurisdiction
over the programs described above – the House Committee on Commerce and the
Senate Committee on Finance – introduced legislation that would affect these
programs. On September 27, 2000, the House Commerce Committee ordered
reported a bill, the Beneficiary Improvement and Protection Act of 2000 (H.R. 5291).
On October 5, 2000 William V. Roth Jr., the Senate Finance Committee Chairman,
introduced the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act
of 2000 (S. 3165).
On December 15, 2000, the Consolidated Appropriations Act 2001 (H.R. 4577)
was passed by the House and Senate; it was signed into law on December 21 (P.L.
106-554). It included, by reference, the Medicare, Medicaid, and SCHIP Benefits
Improvement and Protection Act of 2000 (H.R. 5661), a compromise agreement
between House and Senate committees and the leadership, which contained a
number of important changes to Medicaid and the State Children’s Health Insurance
Program (SCHIP). It also included major provisions amending other health
programs.
With respect to Medicaid, a number of changes are made to disproportionate
share hospital (DSH) funding. First, the agreement sets each state’s FY2001 DSH
allotment equal to its allotment for FY2000, increased by the percentage change in
the consumer price index for FY2000, subject to a ceiling of 12% of that state’s total
medical assistance payments. A parallel change is made for FY2002 allotments.
The bill also applies the 175% hospital-specific DSH limit to certain public hospitals
in all states (not just those in California as under current law) for a 2-year period.
Additional funds are provided for certain state public hospitals not receiving DSH
payments and having a low-income utilization rate in excess of 65%.
The are two other major Medicaid provisions in the agreement. The bill
replaces the current cost-based reimbursement arrangements for Federally Qualified
Health Centers and Rural Health Clinics with a new Medicaid prospective payment
system. The agreement also modifies proposed HHS rules governing upper payment

limits on inpatient and outpatient services provided by certain types of facilities, and
requires that final regulations be issued by the end of 2000. The proposed rules and
modifications made by the agreement close a loophole under which some states are
maximizing federal Medicaid payments arguably beyond the intent of federal statute.
Finally, the bill extends by 1 year the availability of transitional medical assistance
(TMA) for certain families no longer eligible for Medicaid on the basis of meeting
former Aid to Families with Dependent Children (AFDC) rules and adds several
entities to those qualified to make Medicaid presumptive eligibility determinations
for children. Under Medicaid presumptive eligibility rules, states are allowed to
temporarily enroll children whose family income appears to be below Medicaid
income standards, until a final formal determination of eligibility is made.
With respect to SCHIP, the agreement extends the availability of unused
FY1998 and FY1999 SCHIP allotments.³ Following specific formulas, these unspent
funds are redistributed to both those states that have and those that have not fully
exhausted their original allotments within required time frames. Current law
redistributes unused funds only to those states that spend their allotments. The bill
also authorizes the payment of costs of SCHIP Medicaid expansions and costs of
benefits provided during periods of presumptive eligibility from the SCHIP
appropriation rather than the Medicaid appropriation and clarifies states’ authority
to conduct presumptive eligibility determinations, as defined in Medicaid law, under
separate (non-Medicaid) SCHIP programs.
With respect to other programs, the agreement requires that outreach efforts be
implemented to identify individuals who may be eligible for Medicaid payment of
Medicare cost-sharing and that those individuals are notified of the availability of
such assistance. The agreement increases the authorization of annual appropriations
for the MCH Services Block Grant from $705 million to $850 million for FY2001
and thereafter. In addition, the bill extends for 1 year, to FY2003, the authority for
grants to be made for both the Special Diabetes Programs for Type I Diabetes and
the Special Diabetes Programs for Indians. It also increases total funding to $100
million each for FY2001 through FY2003. For FY2001 and FY2002, a portion of
these funds are transferred from the SCHIP appropriation. Finally, the agreement
provides for a direct appropriation of $475 million for FY2001, in addition to funds
appropriated in the FY2001 Labor-HHS-Education appropriations bill, for the Ricky
Ray Hemophilia Relief Fund.
The Congressional Budget Office (CBO) has released preliminary cost estimates
for the Benefits Improvement and Protection Act of 2000. CBO estimates that the
Medicaid , SCHIP and other program provisions would decrease federal outlays by
$16.6 billion over the 5-year period 2001 to 2005 and $69.2 billion over 10 years
(2001-2010). Among all of these provisions, the most significant in terms of its
impact on the federal budget is the revision to Medicaid’s upper payment limit

³ For a detailed description of changes to the allotment redistribution rules, see CRS Report
RS20628, State Children’s Health Insurance Program (SCHIP): Proposed Funding^th
Changes in the 106 Congress, by Evelyne P. Baumrucker (available upon request).

(UPL). The UPL changes in the bill would result in savings of $21.5 billion over 5
years and $76.7 billion over 10 years.⁴
The following side-by-side comparison provides a brief description of current
law and the changes to these programs under the Medicare, Medicaid and SCHIP
Benefits Improvement and Protection Act of 2000. These provisions start at Title VII
of the bill, the previous six titles being devoted to Medicare.
See CRS Report RL30703, Medicaid and SCHIP Provisions in H.R. 5291 and
S. 3165 (the 2000 Medicare “Refinement Bills”) for a side-by-side comparison of the
provisions in recent related bills. For detailed information on the Medicare
provisions contained in the Medicare, Medicaid, and SCHIP Benefits Improvement
and Protection Act of 2000, see CRS Report RL30707, Medicare Provisions in H.R.
5661: Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of

2000 (available upon request).

⁴ For a detailed description of changes to the Medicaid upper payment limit rules, see CRS
Report RS20726, Medicaid Upper Payment Limits and Intergovernmental Transfers:
Current Issues and Changes Made in H.R. 5661, by Elicia J. Herz (available upon request.)

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CRS-9
^{Current L}^a^w^A^greem^ent
ⁱ^{on 701.}⁽^c⁾^Applⁱ^c^atⁱ^{on of}^M^e^di^cai^d^In^{all s}^t^ates^bu^{t C}^a^lif^ornⁱ^a,^DSH^pay^m^en^ts^to^eachⁱⁿ^patien^t^g^eⁿ^e^ral^R^e^vⁱ^s^e^s^BBA^{97, as}^m^odi^fⁱ^{ed by}^BBR^A⁹⁹^,^so^t^h^at^t^h^{e 175%}
^{H Tra}ⁿ^s^itioⁿ^Ru^{le to}^Pu^b^lic^Ho^sp^ita^ls^h^o^sp^{ital ar}^{e lim}^ited^toⁿ^o^m^o^r^e^th^an^th^e^co^{sts o}^f^p^r^o^v^idⁱⁿ^gⁱⁿ^p^a^tien^t^h^o^sp^ital-^sp^ecifⁱ^{c DSH lim}^it^allo^wⁱⁿ^g^{DSH p}^a^y^m^en^{ts in}^am^o^uⁿ^t^{s u}^p
^{ll sta}^t^es^an^{d ou}^tpatien^t^s^e^rv^ices^{to Medicaid an}^{d u}ⁿⁱⁿ^s^u^r^{ed patien}^t^s^{at th}^at^{to 175%}^of^each^h^o^s^p^itals^cos^t^of^uⁿ^r^eⁱ^m^b^ur^s^e^{d care, f}^o^rm^erly
^h^o^s^p^{ital, les}^s^pay^m^en^ts^receiv^e^d^f^r^om^{or on}^beh^a^lf^of^{Medicaid an}^d^ap^p^lied^oⁿ^ly^to^cer^tain^p^u^b^lic^h^o^s^pⁱ^t^a^{ls in}^Calif^o^rⁿⁱ^{a, ap}^p^{lies to}
^uⁿⁱⁿ^s^u^r^{ed patien}^t^s^.^T^h^es^{e cos}^t^s^ar^{e con}^s^{idered to be u}ⁿ^r^eim^b^u^r^s^e^d^q^u^alif^yⁱⁿ^g^p^u^b^{lic h}^o^sp^{itals in}^{all states. T}^h^{e h}ⁱ^g^h^e^r^lim^it^w^o^u^l^d
^co^{sts. T}^h^{is cap}^–^th^{e h}^o^sp^ital-^sp^ecifⁱ^{c o}^r^f^acility^-^s^p^ecifⁱ^c^DSH^cap^appl^y^f^o^{r t}^w^{o s}^t^at^{e f}ⁱ^sc^a^l^y^e^ars^begⁱⁿⁿⁱⁿ^g^on^t^h^{e f}ⁱ^rs^t^day^of^t^h^e
^{– w}^a^s^p^h^as^ed-ⁱⁿ^f^o^{r certain}^pu^{blic h}^o^s^p^itals^{. Du}^rin^g^s^t^{ate f}ⁱ^s^cal^s^t^at^{e f}ⁱ^s^cal^y^{ear t}^h^at^begⁱⁿ^s^af^t^e^{r S}^e^pt^em^ber^30,^{2002 an}^{d en}^ds^on
^y^ears^begⁱⁿⁿⁱⁿ^g^bef^o^{re Jan}^u^a^ry^{1995, th}^os^{e h}^o^s^p^itals^cou^l^d^receiv^e^th^{e las}^t^day^of^th^{e s}^u^cceedin^g^s^t^at^e^fi^s^c^a^l^y^{ear. Hos}^p^itals^th^at
^D^S^H^pay^m^en^t^s^equ^a^l^t^o^200%^of^uⁿ^r^ei^m^b^u^r^s^e^{d cos}^t^s^.^A^f^t^e^r^w^o^u^l^d^q^u^alif^y^f^o^r^th^{e h}ⁱ^g^h^e^r^h^o^sp^ital-^sp^ecifⁱ^c^lim^it^w^o^u^l^d^b^e^th^o^s^e
^Jan^u^a^ry^{1995, al}^l^h^o^s^pⁱ^t^a^l^s^ex^cept^t^h^os^{e i}ⁿ^C^a^lⁱ^f^ornⁱ^{a, w}^e^{re l}ⁱ^mⁱ^t^e^d^owⁿ^e^{d or operat}^e^d^b^y^a^st^at^{e an}^{d m}^eet^t^h^{e m}ⁱⁿⁱ^m^u^m^f^e^deral
^t^oⁿ^o^m^o^{re t}^h^an^100%^of^uⁿ^r^ei^m^b^u^r^s^e^d^cos^t^s^.^H^o^s^pⁱ^t^a^l^s^qu^alⁱ^f^yⁱⁿ^g^requⁱ^r^em^en^t^s^f^o^{r di}^s^p^roportⁱ^oⁿ^a^t^e^s^h^{are h}^o^s^pⁱ^t^a^l^s^.^T^h^{e perm}^an^en^t
^f^o^{r th}^{e 200% ca}^p^d^u^rⁱ^ng^th^{e tran}^s^ition^{period w}^e^{re th}^os^{e w}^ith^a^ceilin^g^f^o^{r C}^a^lif^ornⁱ^{a w}^o^u^l^{d n}^o^{t be af}^f^ected.
^“hi^{gh d}ⁱ^sproportⁱ^oⁿ^a^t^e^s^h^{are”. H}^o^spⁱ^t^a^l^s^wⁱ^t^h^a^“hi^g^h
^di^s^p^roportⁱ^oⁿ^a^t^e^s^h^{are” w}^e^{re def}ⁱⁿ^e^{d as}^t^h^os^{e ow}ⁿ^e^{d or operat}^e^d^F^o^{r s}^t^at^es^operatⁱⁿ^g^uⁿ^d^er^w^aⁱ^v^ers^approv^ed^uⁿ^d^{er S}^ectⁱ^oⁿ^{1115 of}
ⁱ^{ki/CRS-RL30718}^b^y^{a state (}^o^r^b^y^anⁱⁿ^str^u^m^eⁿ^t^ality^o^r^uⁿ^{it o}^f^g^o^v^e^rⁿ^m^eⁿ^t^w^ithⁱⁿ^a^state)^w^ith^{a v}^e^r^y^hⁱ^g^h^Medⁱ^caidⁱⁿ^p^a^tien^t^u^tilizatioⁿ^r^a^{te o}^r^w^ith^th^{e So}^{cial Secu}^r^ity^A^c^{t, in}^cr^eased^p^a^y^m^en^{ts f}^o^r^p^u^b^{lic h}^o^sp^itals^uⁿ^d^er^th^is^p^r^o^v^isioⁿ^w^o^u^l^d^b^eⁱⁿ^clu^d^edⁱⁿ^th^{e b}^a^selin^{e ex}^p^eⁿ^d^itu^r^e
^g/w^m^o^r^e^Medⁱ^caidⁱⁿ^p^a^tien^t^d^a^y^s^th^an^an^y^o^t^h^e^r^h^o^sp^italⁱⁿ^th^e^state.^lim^{it f}^o^r^th^{e p}^u^r^p^o^s^{es o}^f^d^e^ter^mⁱⁿⁱⁿ^g^b^u^d^g^{et n}^e^u^t^r^a^lity^.
^s^.or
^le^ak^B^B^A⁹⁷ⁱⁿ^cr^eased^th^{e h}^o^sp^ital-^sp^ecifⁱ^{c lim}^{it f}^o^r^p^u^b^lic^h^o^sp^italsⁱⁿ
^C^a^lⁱ^f^ornⁱ^{a t}^o^175%^of^uⁿ^r^ei^m^b^u^r^s^e^{d cos}^t^s^.^T^h^{e 175%}^h^o^s^pⁱ^t^a^l
^://wiki^sp^ecifⁱ^c^cap^f^o^r^Calif^o^rⁿⁱ^{a w}^a^{s ef}^f^ectiv^{e f}^o^r^{a tr}^an^sitioⁿ^p^e^rⁱ^o^d^th^at
^h^ttp^en^{ded i}ⁿ^{1999. BB}^RA^{99 l}^a^t^e^{r perm}^an^en^t^l^y^ex^t^eⁿ^d^{ed t}^hⁱ^s
^h^o^sp^ital-^sp^ecifⁱ^{c lim}^{it f}^o^r^q^u^alif^yⁱⁿ^g^p^u^b^{lic h}^o^sp^{itals in}^Calif^o^rⁿⁱ^a.
^Bu^dg^etⁿ^e^u^t^ral^S^ectⁱ^oⁿ^{1115 w}^aⁱ^v^ers^al^l^o^w^s^t^at^es^t^o^f^o^reg^o^cert^aⁱⁿ
^Medⁱ^caid^r^u^{les to}^im^p^l^em^en^{t d}^e^m^oⁿ^s^tr^atioⁿ^s^.
ⁱ^{on 701. (}^d⁾^As^sⁱ^s^t^an^c^e^f^o^r^C^e^r^t^aiⁿ^No^p^r^o^v^isioⁿ^.^P^r^o^v^id^{es ad}^d^itioⁿ^a^{l f}^uⁿ^d^{s f}^o^r^cer^tain^p^u^b^{lic h}^o^s^pⁱ^t^a^l^s^t^h^a^t^a^r^e^:
^b^{lic Ho}^sp^ita^ls^o^wⁿ^e^d^o^r^o^p^e^r^a^ted^b^y^{a state (}^o^r^b^y^anⁱⁿ^str^u^m^eⁿ^t^ality^o^r^uⁿⁱ^t^o^f
^g^o^v^e^rn^m^eⁿ^t^w^ithⁱⁿ^{a s}^t^{ate); are n}^o^{t receiv}ⁱⁿ^g^{DSH pay}^m^en^ts^as^of
^{October 1, 2000; an}^d^h^a^v^e^a^low^-ⁱⁿ^com^e^u^tilization^{rate in}^ex^ces^s
^o^f⁶⁵^%^as^o^f^th^{e sam}^e^d^a^{te. Fu}ⁿ^d^{s p}^r^o^v^id^ed^uⁿ^d^er^th^is^sectioⁿ^to
^{states w}^ith^elig^ib^{le h}^o^sp^{itals ar}^{e in}^ad^d^itioⁿ^t^o^D^S^H^a^llo^tm^en^ts.
^T^h^{e total as}^sⁱ^s^t^an^{ce u}ⁿ^d^{er th}^is^s^ection^f^o^r^{all s}^t^ates^canⁿ^o^{t ex}^ceed
^th^{e f}^o^llowⁱⁿ^g^am^ouⁿ^t^s^:^{$15 m}^illion^f^o^r^FY2002;^$176^m^illion^f^o^r
^{2003; $269 m}^illion^f^o^{r 2004; $330 m}^illioⁿ^f^o^{r 2005; an}^{d $375}
^m^illion^f^o^{r FY2006 an}^{d each}^y^{ear th}^ereaf^ter.

CRS-10
^{Current L}^a^w^A^greem^ent
^c^tⁱ^{on 701. (}^e⁾^D^S^H^Paym^ent^H^o^s^pⁱ^t^a^l^B^B^A⁹⁷^r^e^q^u^ir^ed^{each state to}^sub^m^{it to}^{the Sec}^r^e^t^a^r^y^{an annual}^Req^u^{ires th}^{e Secretary}^to^im^p^l^em^en^{t acco}^uⁿ^t^ab^ility^stan^d^a^rd^{s to}
^Standar^ds^report^des^c^ri^biⁿ^g^t^h^{e di}^s^p^roportⁱ^oⁿ^a^t^e^s^h^{are p}^a^y^m^en^t^s^m^a^{de t}^o^eⁿ^s^u^r^e^th^{at DSH pay}^m^en^ts^{are u}^s^{ed to reim}^bu^rs^{e s}^t^ates^an^d
^each^dis^p^roportion^a^{te s}^h^{are h}^o^s^p^ital.^h^o^s^pⁱ^t^a^l^s^th^{at are elig}^{ible f}^o^{r s}^u^ch^pay^m^en^ts^an^{d are oth}^e^rw^is^{e in}
^accordan^{ce w}^ith^{Medicaid s}^t^atu^t^ory^requ^irem^en^ts^.

ⁱ^{ki/CRS-RL30718}
^g/w
^s^.or
^le^ak
^://wiki
^h^ttp

CRS-11
Prospective Payment System for FQHCs and RHCs
^{Current L}^a^w^A^greem^ent
ⁱ^{on 702. N}^e^w^pr^os^pectⁱ^{ve paym}^e^nt^State^s^a^r^e^r^e^qu^{ired to pay}^FQHC^s^an^{d R}^H^C^s^am^ouⁿ^t^s^th^{at are at}^C^r^eates^{a n}^e^w^Medicaⁱ^d^pros^pectiv^{e pay}^m^en^{t s}^y^s^t^em^f^o^{r FQHC}^s
^{r Fed}^e^ra^{lly Qu}^a^lified^Hea^lth^{least a p}^e^r^cen^tag^e^o^f^t^h^e^f^acilities’^r^easoⁿ^ab^{le co}^{sts f}^o^r^p^r^o^v^idⁱⁿ^g^an^{d R}^H^C^s^{. Beg}ⁱⁿⁿⁱⁿ^gⁱⁿ^Jan^u^a^ry^of^F^Y^{2001, ex}ⁱ^s^tⁱⁿ^g^F^Q^H^C^s^an^d
^nt^e^r^s⁽^F^Q^H^C^s⁾^{and Rur}^a^l^H^e^al^t^h^s^e^rvⁱ^ces^–^100%^of^cos^t^s^f^o^{r s}^e^rvⁱ^ces^du^riⁿ^g^F^Y¹⁹⁹⁸^an^d^F^Y^1999;^R^H^C^s^w^o^u^l^d^b^e^p^aⁱ^d^{per v}ⁱ^sⁱ^t^pay^m^en^t^s^equ^a^l^t^o^100%^of^t^h^e
ⁿ^t^e^{rs (R}^HCs)^95%^f^o^{r F}^Y^{2000, F}^Y^{2001 an}^{d F}^Y^2002;^90%^f^o^r^F^Y^2003;^85%^f^o^r^av^erag^{e cos}^t^sⁱⁿ^cu^{rred du}^riⁿ^g¹⁹⁹⁹^aⁿ^d^{2000 adj}^u^s^t^{ed f}^o^{r an}^y
^F^Y^{2004. C}^o^s^t^-^b^as^{ed rei}^m^bu^rs^em^en^t^ex^pi^resⁱⁿ^{2005. In}^t^h^{e cas}^eⁱⁿ^cr^{ease o}^r^d^ecr^{ease in}^th^{e sco}^p^e^o^f^ser^v^ices^f^u^rⁿ^ish^e^d^.^Fo^r^en^tities
^of^{a cont}^r^a^c^t^b^e^tw^een^an^FQHC^{or R}^H^C^an^{d a m}^aⁿ^a^g^e^{d care}^fⁱ^rs^t^qu^alⁱ^f^yⁱⁿ^g^as^FQ^H^C^s^{or R}^H^C^s^af^t^e^{r 2000, t}^h^{e per v}ⁱ^sⁱ^t
^org^aⁿⁱ^zation^(MC^O^{), th}^{e MC}^{O m}^u^s^t^pay^th^{e FQHC}^o^r^R^H^C^at^p^a^y^m^en^ts^w^o^u^l^d^b^e^gⁱⁿⁱⁿ^th^{e f}ⁱ^r^s^{t y}^ear^th^{at th}^{e cen}^ter^o^r^clin^ic
^l^e^as^{t as}^m^u^ch^as^{it w}^o^u^l^{d pay}^an^y^oth^e^{r prov}^{ider f}^o^{r s}ⁱ^mⁱ^l^a^r^at^t^aⁱⁿ^s^qu^alⁱ^fⁱ^c^atⁱ^oⁿ^an^{d w}^o^u^l^{d be bas}^e^{d on}^100%^of^t^h^{e cos}^t^s
^s^e^rv^ices^{. States}^{are requ}^{ired to m}^a^k^e^s^u^pplem^en^tal^pay^m^en^ts^to^th^eⁱⁿ^cu^r^r^ed^d^u^rⁱⁿ^g^th^{at y}^ear^b^a^sed^oⁿ^th^{e r}^a^{tes estab}^lish^e^d^f^o^r^sim^ilar
^FQHC^s^an^{d R}^H^C^s^{, equ}^a^{l to th}^e^dif^f^e^ren^ce^betw^een^th^{e con}^t^racted^cen^ter^s^{or clin}^ics^w^ith^sⁱ^m^{ilar cas}^eloadsⁱⁿ^th^{e s}^a^m^e^{or adj}^acen^t
^am^ouⁿ^t^s^an^{d th}^{e cos}^t^-^b^as^{ed am}^ouⁿ^t^s^.^g^e^og^raph^ic^area.^In^th^{e abs}^eⁿ^{ce of}^s^u^ch^sⁱ^m^{ilar cen}^ters^{or clin}^ics^,
^t^h^{e m}^e^t^h^odol^og^y^w^o^u^l^{d be bas}^e^{d on}^t^h^at^u^s^ed^f^o^r^dev^e^l^opiⁿ^g^rat^e^s
ⁱ^{ki/CRS-RL30718}^f^o^{r es}^t^a^blⁱ^s^h^e^d^FQ^H^C^s^{or R}^H^C^s^{or s}^u^ch^m^e^t^h^odol^og^y^or
^g/w^reas^on^{able s}^p^ecifⁱ^cation^s^as^es^tab^lis^h^e^{d by}^th^{e Secretary}^.^{For each}
^s^.or^fⁱ^s^{cal y}^{ear th}^ereaf^ter,^per^vⁱ^s^{it pay}^m^en^ts^f^o^{r all FQHC}^s^an^{d R}^H^C^s
^le^ak^w^o^u^l^{d be equ}^a^{l to am}^ouⁿ^t^s^f^o^{r th}^e^precedin^g^fⁱ^s^{cal y}^{ear in}^creas^ed
^by^t^h^e^percen^tag^eⁱⁿ^creas^{e in}^th^{e Medicare Econ}^om^{ic In}^dex
^://wiki^{applicable to prim}^ary^{care s}^e^rvⁱ^ces^,^an^d^adj^u^s^t^{ed f}^o^{r an}^yⁱⁿ^creas^e^{or decreas}^eⁱⁿ^t^h^e^s^c^{ope of}^s^e^rv^ices^f^u^rn^is^h^e^{d du}^rin^g^th^{at f}ⁱ^s^cal
^h^ttp^y^ear.^Iⁿ^m^aⁿ^a^g^e^{d care con}^t^racts^,^States^m^u^s^t^m^a^k^e^s^u^pplem^en^tal
^p^a^y^m^en^{ts to}^th^{e cen}^ter^o^r^clin^{ic eq}^u^a^{l to}^th^{e d}ⁱ^f^f^e^r^eⁿ^{ce b}^e^tw^een
^c^o^nt^r^{acted am}^ouⁿ^t^s^an^{d th}^{e cos}^t^-^b^as^{ed am}^ouⁿ^t^s^.^A^ltern^ative
^p^a^y^m^eⁿ^t^m^e^t^h^o^d^s^w^o^u^l^d^b^e^p^e^r^m^itte^d^oⁿ^l^y^w^h^eⁿ^p^a^y^m^eⁿ^t^s^a^r^e^a^t
^{least eq}^u^a^{l to}^am^o^uⁿ^t^{s o}^t^h^e^r^w^{ise p}^r^o^v^id^ed^.
^Dir^{ects th}^{e C}^o^m^p^tr^o^ller^Gen^e^r^a^{l to}^p^r^o^v^id^{e f}^o^r^{a stu}^d^y^oⁿ^h^o^w^to
^rebas^e^{or ref}ⁱⁿ^e^cos^t^pay^m^en^t^m^e^t^h^ods^f^o^{r t}^h^{e s}^e^rvⁱ^ces^of^F^Q^H^C^s
^an^d^RHCs^.^T^h^e^r^e^p^o^r^{t w}^o^u^l^d^b^e^d^u^{e to}^Coⁿ^g^r^{ess n}^o^later^th^an⁴
^y^ears^af^{ter th}^{e date of}^en^actm^eⁿ^t^.

CRS-12
of Medicaid Waivers
^{Current L}^a^w^A^greem^ent
ⁱ^{on 703. St}^r^e^am^lⁱⁿ^{ed appr}^oval^of^Uⁿ^{der S}^ectⁱ^oⁿ^{1115 of}^t^h^{e S}^o^ci^al^S^ecu^ri^t^y^A^c^t^,^st^a^t^es^m^a^y^obt^aiⁿ^Defⁱⁿ^e^{s th}^{e p}^r^o^{cess f}^o^r^s^u^b^m^ittin^g^req^u^{ests f}^o^{r an}^d^receivⁱⁿ^g
ⁱ^{nued s}^t^at^e-wⁱ^d^e^S^e^c^tⁱ^oⁿ¹¹¹⁵^w^a^iv^ers^of^com^p^lian^{ce w}^ith^{a b}^r^o^a^d^r^aⁿ^g^e^of^Medicaid^ex^ten^s^ion^s^of^{Medicaid dem}^oⁿ^s^tration^w^a^iv^ers^au^th^{orized u}ⁿ^d^er
^a^iver^s^r^e^q^u^ir^em^en^t^s^t^o^coⁿ^d^u^c^{t ex}^p^e^rⁱ^m^eⁿ^t^{al, p}^ilo^{t, o}^r^d^e^m^oⁿ^s^tr^atioⁿ^S^ection^{1115 of}^th^{e S}^o^{cial S}^ecu^rity^A^c^t^th^at^h^a^v^e^already^receiv^e^d
^proj^ect^s^.^W^aⁱ^v^e^r^s^a^r^{e approv}^{ed f}^o^{r a peri}^{od of}^{5 y}^ears^.^S^t^at^esⁱⁿ^{itial 3}^-^y^{ear ex}^ten^s^ioⁿ^s^{. It w}^o^u^l^d^req^u^{ire each}^st^{ate req}^u^estin^g
^wⁱ^s^hⁱⁿ^g^t^o^obt^aiⁿ^approv^al^f^o^{r peri}^ods^bey^oⁿ^d^{5 y}^ears^m^a^y^s^u^bmⁱ^t^,^s^u^ch^an^ex^t^eⁿ^sⁱ^oⁿ^t^o^s^u^bmⁱ^t^an^applⁱ^catⁱ^oⁿ^at^l^eas^t^{120 day}^s^pri^o^r
^du^riⁿ^g^t^h^{e 6-}^m^oⁿ^t^h^peri^{od en}^diⁿ^g¹^y^ear^bef^o^{re t}^h^{e dat}^e^t^h^{e w}^aⁱ^v^er^to^th^{e ex}^pⁱ^r^a^tioⁿ^d^a^{te o}^f^th^e^ex^istin^g^w^a^iv^er^{. No}^later^th^an⁴⁵^d^a^y^s
^w^o^u^l^d^o^t^h^e^r^w^ise^ex^pⁱ^r^e^{, a w}^r^itten^r^e^q^u^{est f}^o^r^an^ex^ten^s^ioⁿ^o^f^u^p^to^af^{ter th}^{e Secretary}^rec^e^iv^es^s^u^ch^application^,^th^{e Secretary}^w^o^u^l^d
^{3 y}^ears^.^b^e^r^e^q^u^ir^ed^toⁿ^o^tif^y^th^e^state^if^sh^{e in}^ten^d^{s to}^r^e^vⁱ^ew^th^{e ex}^istin^g
^ter^m^{s an}^d^coⁿ^d^itioⁿ^s^o^f^th^{e p}^r^o^j^{ect an}^d^w^o^u^l^dⁱⁿ^f^o^r^m^th^{e state o}^f
^propos^{ed ch}^an^g^e^sⁱⁿ^th^{e term}^s^an^{d con}^d^ition^s^of^th^{e w}^a^iv^er.^If^th^e
^Secr^e^t^a^r^y^f^a^{ils to}^p^r^o^v^id^{e su}^chⁿ^o^tif^icatioⁿ^,^th^{e r}^e^q^u^{est w}^o^u^l^d^b^e
^deem^{ed approv}^{ed. D}^u^riⁿ^g^t^h^{e 30-}^day^peri^{od beg}ⁱⁿⁿⁱⁿ^g^af^t^e^{r t}^h^e
ⁱ^{ki/CRS-RL30718}^Secretary^prov^ides^th^{e propos}^{ed te}^rm^s^an^{d con}^d^ition^s^{to th}^{e s}^t^ate,
^g/w^th^o^s^{e ter}^m^{s an}^d^coⁿ^d^itioⁿ^s^w^o^u^l^d^b^eⁿ^e^g^o^tiated^.^No^later^th^an¹²⁰
^s^.or^d^a^y^s^af^ter^th^{e d}^a^{te th}^{at th}^{e r}^e^q^u^{est f}^o^r^ex^ten^s^ioⁿ^w^a^s^su^b^m^itted⁽^o^r
^le^ak^s^u^ch^{later date}^a^s^ag^{reed to by}^th^{e ch}^ief^ex^ecu^tiv^{e of}^fⁱ^{cer of}^th^e
^s^t^{ate) th}^{e Secret}^a^r^y^w^o^{uld be requ}^ir^ed^to^ap^p^r^o^v^{e th}^{e ap}^p^licatioⁿ
^://wiki^su^b^j^{ect to}^th^{e ag}^r^eed^u^p^oⁿ^ter^m^{s an}^d^coⁿ^d^itioⁿ^s^o^r^{, in}^th^{e ab}^sen^c^e^o^f^an^ag^r^eem^en^{t, su}^ch^ter^m^{s an}^d^coⁿ^d^itioⁿ^s^th^at^ar^e^d^e^ter^mⁱⁿ^ed^b^y
^h^ttp^th^{e Secretary}^{to be reas}^on^ably^coⁿ^s^isten^t^w^ith^th^{e o}^v^er^{all o}^b^j^ectiv^e
^o^f^th^{e w}^a^iv^er^{, o}^r^dⁱ^sap^p^r^o^v^{e th}^{e ap}^p^licatioⁿ^.^I^f^t^h^e^w^a^iv^er^{is n}^o^t
^approv^{ed or di}^s^a^pprov^{ed du}^riⁿ^g^t^hⁱ^s^peri^{od, t}^h^e^requ^es^t^w^o^u^l^d^be
^d^eem^ed^ap^p^r^o^v^edⁱⁿ^th^{e ter}^m^{s an}^d^coⁿ^d^itioⁿ^s^{as h}^a^v^e^b^een^ag^r^eed
^{to (if}^an^y⁾^by^th^e^Secretary^an^{d th}^{e s}^t^{ate. A}^pprov^als^w^o^u^l^{d be f}^o^r
^periodsⁿ^o^{t to ex}^{ceed 3 y}^ears^an^{d w}^o^u^l^d^b^e^s^u^bj^{ect to th}^{e f}ⁱⁿ^a^l
^r^e^p^o^r^tin^g^an^d^ev^alu^a^tioⁿ^r^e^q^u^ir^em^en^{ts in}^cu^r^r^eⁿ^t^law^.

CRS-13
dicaid County-Organized Health Systems
^{Current L}^a^w^A^greem^ent
^c^tⁱ^oⁿ⁷⁰⁴^{. M}^e^di^cai^d^C^ount^y-O^r^gani^z^e^d^H^e^a^l^t^hⁱⁿ^surⁱ^{ng o}^r^gaⁿⁱ^z^a^tⁱ^o^{ns (}^H^I^O^s)^a^r^e^c^o^unt^y^-^sp^oⁿ^so^r^e^d^he^a^l^t^h^A^llo^w^s^th^{e cu}^r^r^eⁿ^t^ex^em^p^tioⁿ^f^o^r^th^r^{ee Calif}^o^rⁿⁱ^{a Health}^Iⁿ^su^rⁱⁿ^g
^lth^S^y^stems^m^aⁱⁿ^ten^aⁿ^ce^o^r^g^aⁿⁱ^zatioⁿ^s⁽^H^MOs)^{. Up}^to^th^r^ee^HI^Os^d^e^sigⁿ^a^ted^Org^aⁿⁱ^zation^s^(HIOs⁾^f^r^om^certaⁱⁿ^{Medicaid HMO con}^t^ractin^g
^by^th^e^s^t^ate^of^C^a^lif^ornⁱ^{a are ex}^em^{pt f}^r^om^certain^f^e^deral^s^t^atu^t^ory^requ^irem^en^ts^{to apply}^as^lon^g^asⁿ^o^m^o^re^th^an^14%^of^{all Medicaid}
^requ^irem^en^ts^f^o^{r Medicaid HMO con}^t^racts^.^T^h^e^ex^em^ption^on^ly^ben^e^fⁱ^ciariesⁱⁿ^C^a^lif^ornⁱ^{a are}^en^rolledⁱⁿ^th^os^e^HIOs^{. Ef}^f^ectiv^{e as}
^ap^p^{lies if}^t^h^{e HI}^{Os en}^r^o^{ll n}^o^m^o^r^e^th^an¹⁰^%^o^f^{all Med}ⁱ^caid^ifⁱⁿ^clu^d^edⁱⁿ^th^e^en^actm^eⁿ^t^of^th^{e C}^oⁿ^s^{olidated Om}ⁿⁱ^bu^s^B^u^dg^et
^b^eⁿ^e^fⁱ^ciar^{ies in}^Calif^o^rⁿⁱ^{a (}ⁿ^o^t^co^uⁿ^tin^g^q^u^alif^ied^Medⁱ^car^e^R^econ^c^iliation^A^c^{t of}^1985.

^ben^e^fⁱ^ciaries⁾^.
ⁱ^{ki/CRS-RL30718}
^g/w
^s^.or
^le^ak
^://wiki
^h^ttp

CRS-14
ent Limits
^{Current L}^a^w^A^greem^ent
ⁱ^{on 705}^.^D^e^adlⁱⁿ^{e f}^o^r^Is^s^{uance of}^{Medicaid s}^t^atu^t^{e re}^q^uⁱ^r^e^s^s^t^ates^{to s}^e^{t pay}^m^en^{t rates}^f^o^{r s}^e^rv^ices^R^e^q^uⁱ^r^e^s^t^h^e^Se^c^r^e^t^a^r^y^t^oⁱ^ssue^fi^na^l^r^e^gul^a^tⁱ^o^{ns go}^ve^rⁿⁱ^{ng up}^p^e^r
^nal^Regul^atⁱ^{on Rel}^a^tⁱ^{ng t}^o^M^e^di^cai^d^t^h^a^t^{are con}^s^is^ten^t^w^ith^ef^fⁱ^cien^cy^an^{d econ}^o^m^y^{. In}^accordan^ce^p^a^y^m^en^{t lim}^{its (}^U^P^L^s)^f^o^rⁱⁿ^p^a^tien^t^an^d^o^u^tp^atien^t^ser^vⁱ^c^e^s
^p^e^{r Pa}^ymen^{t Limits}^w^ith^th^{ese r}^e^q^u^ir^em^en^{ts, th}^{e Se}^c^r^e^t^ar^y^h^a^{s estab}^lish^e^d^,^th^r^o^u^g^h^p^r^o^v^id^ed^b^y^certain^ty^p^e^{s o}^f^f^{acilities n}^o^l^a^{ter th}^an^Decem^b^e^{r 3}¹^,
^r^e^g^u^l^atioⁿ^,^u^p^p^e^r^p^a^y^m^en^{t lim}^{its (}^U^P^L^s)^f^o^rⁱⁿ^p^a^tien^t^an^d²⁰⁰⁰^.^R^e^quⁱ^r^es^t^h^at^t^h^{e f}ⁱⁿ^a^l^reg^u^l^atⁱ^oⁿ^es^t^a^blⁱ^s^h^{a s}^e^parat^e^U^P^L
^o^u^tp^atien^t^se^r^v^{ices p}^r^o^v^id^ed^b^y^cer^tain^ty^p^e^{s o}^f^f^acilities.^f^o^rⁿ^oⁿ^-^stat^e^-^o^wⁿ^e^d^o^r^o^p^e^r^a^ted^g^o^v^e^rⁿ^m^eⁿ^t^f^{acilities b}^a^sed^oⁿ^a
^P^a^y^m^en^ts^m^a^yⁿ^o^{t ex}^{ceed es}^tim^ates^of^w^h^{at w}^o^u^l^{d h}^a^v^e^been^paid^propos^{ed ru}^l^e^anⁿ^o^uⁿ^{ced i}ⁿ^O^c^t^{ober, 2000.}
^f^o^{r th}^os^{e s}^e^rv^ices^uⁿ^d^{er Medicare pay}^m^eⁿ^{t prin}^ciples^{. R}^ecen^tly^,
^th^{e Secretary}^determⁱⁿ^{ed th}^{at cu}^rr^en^{t reg}^u^l^ation^s^{create a f}ⁱⁿ^aⁿ^c^ial^Req^u^ir^e^s^th^{e f}ⁱⁿ^a^{l r}^e^g^u^l^atioⁿ^to^stip^u^l^{ate a th}^ir^d^{set o}^f^r^u^les
ⁱⁿ^cen^tiv^{e f}^o^r^{states to}^m^a^k^e^hⁱ^g^h^e^r^th^an^u^s^u^a^{l p}^a^y^m^en^{ts to}ⁿ^oⁿ^-^g^o^v^e^rⁿⁱⁿ^g^th^{e tr}^an^sitioⁿ^p^e^rⁱ^o^d^f^o^r^c^e^r^t^aⁱⁿ^{states. T}^h^{is ad}^d^itioⁿ^a^l
^st^{ate g}^o^v^e^rⁿ^m^eⁿ^t^f^{acilities (}^e^.g^{., co}^uⁿ^t^y^an^d^city^p^r^o^v^id^er^s)^s^e^{t o}^f^r^u^{les w}^o^u^l^d^ap^p^l^y^to^{states w}^ith^p^a^y^m^en^{t ar}^r^aⁿ^g^e^m^eⁿ^t^s
^allo^wⁱⁿ^g^th^em^to^claim^hⁱ^g^h^e^r^f^e^d^e^r^a^{l m}^a^tchⁱⁿ^g^d^o^llar^s^{. T}^h^o^s^e^approv^ed^orⁱⁿ^ef^f^ect^on^{or bef}^o^{re O}^c^t^{ober 1, 1992, or}^uⁿ^d^er^w^hⁱ^c^h
^m^a^tchⁱⁿ^g^f^uⁿ^d^{s m}^a^y^b^e^tr^an^sf^er^r^e^d^f^r^o^m^th^{ese f}^{acilities b}^ack^to^th^e^cl^ai^m^s^f^o^{r f}^e^deral^m^a^t^c^hⁱⁿ^g^w^e^{re pai}^d^on^{or bef}^o^{re t}^h^at^dat^e^{, an}^d
ⁱ^{ki/CRS-RL30718}^s^t^ate^an^d^u^s^{ed to cov}^e^{r th}^{e s}^t^{ate s}^h^{are of}^Medicaid^cos^t^s^an^d/or^f^o^r^f^o^{r w}^h^ich^s^u^ch^pay^m^en^ts^ex^{ceed th}^{e UP}^L^s^es^tablis^h^e^{d u}ⁿ^d^{er th}^e
^g/w^ot^h^e^{r pu}^rpos^es^{. Propos}^{ed ru}^l^e^s^t^o^m^odi^f^y^Medi^cai^d^U^P^L^s^es^t^a^blⁱ^s^h^fⁱⁿ^a^l^r^e^g^u^l^atioⁿ^.^Fo^r^th^{ese states, a 6}^-^y^ear^tr^an^sitioⁿ^p^e^rⁱ^o^d^w^o^u^l^d
^s^.or^{a sep}^a^r^a^{te U}^P^L^f^o^rⁱⁿ^p^a^tien^t^ser^v^{ices p}^r^o^v^id^ed^b^yⁿ^oⁿ^-^state^appl^y^,^begⁱⁿⁿⁱⁿ^g^wⁱ^t^h^t^h^{e peri}^{od t}^h^at^begⁱⁿ^s^on^t^h^e^fⁱ^rs^t^s^t^at^e^fⁱ^s^cal
^le^ak^g^o^v^e^rⁿ^m^eⁿ^t^f^{acilities. A}^g^g^r^eg^{ate p}^a^y^m^en^{ts f}^o^rⁱⁿ^p^a^ti^en^{t ser}^v^ices^y^{ear t}^h^a^t^st^art^s^af^t^e^{r S}^e^pt^em^{ber 30, 2002 an}^{d en}^ds^on^S^e^pt^em^ber
^prov^{ided by}ⁿ^oⁿ^-^s^t^{ate pu}^{blic h}^o^s^p^itals^m^a^yⁿ^o^{t ex}^ceed^150%^o^f^{30, 2008. For ea}^c^h^y^{ear du}^rin^g^th^{e tran}^s^ition^{period, applicable}
^://wiki^es^tim^{ated pay}^m^eⁿ^t^s^bas^e^{d on}^{Medicare pay}^m^en^{t prin}^ciples^.^Paral^l^e^l^ru^l^e^s^{are propos}^{ed f}^o^{r ou}^t^p^atⁱ^eⁿ^t^ho^s^pⁱ^t^a^l^an^{d cl}ⁱⁿⁱ^c^s^t^ates^m^u^s^t^redu^{ce ex}^ces^s^pay^m^en^ts^by^15%.^Fu^ll^com^p^lian^ce^w^ith^fⁱⁿ^a^l^reg^u^l^atⁱ^oⁿ^sⁱ^s^requⁱ^r^{ed by}^O^c^t^{ober 1, 2008.}

^h^ttp^s^e^rv^ices^.^T^h^{e propos}^{ed ru}^les^als^o^s^p^ecif^y^tw^{o tran}^s^ition^periods^f^o^r
^s^t^ate^s^t^h^a^t^{are cu}^rren^tlyⁿ^oⁿ^c^om^plian^t^{. T}^h^es^{e ru}^les^v^a^ry^by^w^h^en
^en^h^aⁿ^{ced pay}^m^en^{t a}^r^r^aⁿ^g^e^m^eⁿ^t^s^w^e^{re in}^ef^f^{ect (bef}^{ore v}^e^rs^u^s^on
^{or af}^t^e^{r O}^c^t^{ober 1, 1999), t}^h^{e s}^t^artⁱⁿ^g^poiⁿ^t^f^o^{r t}^h^e^p^h^a^s^e^-^ou^t^of
^ex^istin^g^p^a^y^m^en^{t ar}^r^aⁿ^g^e^m^eⁿ^t^{s, th}^{e p}^e^r^cen^tag^e^r^e^d^u^ctioⁿⁱⁿ
^p^a^y^m^en^{ts ea}^c^h^y^e^a^r^{, an}^d^th^{e o}^v^er^{all len}^g^t^h^o^f^tim^{e p}^e^r^m^itted^f^o^r
^f^u^{ll ph}^as^e-^ou^{t. State f}ⁱ^s^cal^y^{ear 2000 w}^{ill s}^e^rv^{e as}^th^{e bas}^e^period
^f^o^{r det}^e^rmⁱⁿⁱⁿ^g^t^h^{e am}^ouⁿ^t^of^ex^ces^s^pay^m^en^t^s^abov^{e propos}^ed
^UP^L^s^th^{at m}^u^s^t^{be ph}^as^{ed ou}^t.

CRS-15
aska FMAP
^{Current L}^a^w^A^greem^ent
ⁱ^{on 706. Al}^as^{ka FM}^AP^T^h^{e f}^e^d^e^r^a^{l sh}^ar^{e o}^f^th^e^c^o^s^t^o^f^M^e^dⁱ^c^aⁱ^d^ser^v^{ices is}^eq^u^a^l^to^th^e^C^h^an^g^e^s^th^{e f}^o^rm^u^l^{a f}^o^{r calcu}^latin^g^th^{e s}^t^{ate percen}^tag^e^an^d^th^u^s
^f^e^deral^m^e^dical^as^sⁱ^s^t^an^ce^percen^tag^e^(FMA^P⁾^of^th^os^{e cos}^t^s^.^It^is^t^h^{e f}^e^deral^m^a^t^c^hⁱⁿ^g^pe^r^c^eⁿ^t^a^g^e^f^o^{r A}^l^as^k^a^f^o^{r F}^Y^{2001 t}^h^rou^g^h
^d^e^ter^m^ined^annually^acco^r^d^{ing to}^{a statuto}^r^y^f^o^r^m^{ula d}^e^signed^to^F^Y^{2005. T}^h^e^s^t^at^e^percen^t^a^g^e^f^o^{r A}^l^as^k^a^w^o^u^l^{d be cal}^cu^l^a^t^e^{d by}
^pay^{a h}ⁱ^g^h^e^{r f}^e^{deral m}^a^tchⁱⁿ^g^as^sⁱ^s^t^an^{ce percen}^tag^e^t^o^s^t^ates^w^ith^u^sⁱⁿ^g^an^ad^j^u^sted^p^e^r^cap^{ita in}^co^m^e^c^a^l^c^u^latioⁿⁱⁿ^stead^o^f^th^e
^lo^w^e^r^p^e^r^cap^{ita in}^co^m^e^{s r}^e^lativ^{e to}^th^{e n}^a^tioⁿ^a^{l av}^er^ag^e.^s^t^ate-^wⁱ^{de av}^erag^{e per capita in}^com^e^g^eⁿ^e^rally^u^s^{ed. T}^h^e
^adj^u^s^t^ed^per^capitaⁱⁿ^com^e^f^o^{r A}^l^as^k^a^w^o^u^l^{d be calcu}^{lated as}^th^e
^B^B^A^{97 in}^clu^d^{ed a prov}^is^ion^th^{at s}^e^t^t^h^e^FMA^P^f^o^{r A}^l^as^k^a^at^th^{ree y}^{ear av}^erag^{e per capita in}^com^e^f^o^r^th^{e s}^t^{ate div}ⁱ^{ded by}^1.05.

^59.8%^f^o^{r F}^Y^{1998 t}^h^ro^{ugh FY}^2000.
ⁱ^{ki/CRS-RL30718}
^g/w
^s^.or
^le^ak
^://wiki
^h^ttp

CRS-16
Transition
^{Current L}^a^w^A^greem^ent
ⁱ^{on 707. 1-Y}^e^ar^Ext^e^nsⁱ^{on of}^W^e^l^f^a^r^e^-t^o-W^o^r^k^In¹⁹⁹⁶^,^T^e^m^porary^A^s^sⁱ^s^t^an^{ce f}^o^{r Needy}^Fam^ilies^Ex^ten^d^s^by^{1 y}^{ear (to Septem}^{ber 30, 2002)}^th^{e av}^ailability
^ansⁱ^tⁱ^on.^(T^A^N^{F) rep}^l^aced^Aⁱ^d^to^Fam^{ilies w}^ith^Dep^eⁿ^d^en^t^o^f^T^M^A^f^o^r^f^a^m^{ilies n}^o^loⁿ^g^e^r^elⁱ^g^ib^{le f}^o^r^Medⁱ^caid^oⁿ
^C^h^ildren^(A^FDC⁾^as^th^{e m}^a^j^o^{r cas}^h^as^sⁱ^s^t^an^{ce prog}^ram^f^o^r^th^{e bas}ⁱ^s^of^m^eetin^g^f^o^rm^{er A}^F^DC^ru^les^.

^lo^w^-ⁱⁿ^co^m^e^f^a^m^{ilies. T}^A^{NF elig}^ib^ility^d^o^e^{s n}^o^{t co}ⁿ^f^er
^au^to^m^a^{tic Med}ⁱ^caid^elig^ib^ility^{. Med}ⁱ^caid^en^titlem^eⁿ^t^w^a^s
^r^e^tain^ed^f^o^rⁱⁿ^dⁱ^vⁱ^d^u^{als w}^h^o^m^eet^th^e^r^e^q^u^ir^em^en^ts^o^f^th^e
^f^o^rm^{er A}^F^D^C^prog^ramⁱⁿ^ef^f^ect^on^Ju^l^y^{16, 1}⁹^{96 (an}^d
^su^b^s^eq^u^eⁿ^tly^m^o^dⁱ^fⁱ^ed^{, if}^ap^p^licab^le)^.^T^r^an^sitioⁿ^a^l
^m^e^dical^as^sⁱ^s^t^an^{ce (T}^MA^{) is}^prov^{ided f}^o^rⁱⁿ^divⁱ^du^als^w^h^o
^w^oul^d^o^t^herw^is^{e los}^e^{Medicaid du}^{e to certain}^ch^an^g^e^sⁱⁿ
^em^p^l^o^y^m^eⁿ^t^o^rⁱⁿ^co^m^e^{. Sp}^eci^fⁱ^c^a^lly^w^h^en^elig^ib^ility
^uⁿ^d^{er ol}^{d A}^F^D^C^ru^l^e^sⁱ^s^l^o^s^t^du^{e t}^o^h^o^u^r^s^of^{or i}ⁿ^com^e
ⁱ^{ki/CRS-RL30718}^f^r^om^em^pl^oy^m^eⁿ^t^,^or^l^o^s^s^of^{a t}ⁱ^m^e-^lⁱ^mⁱ^t^e^{d earn}^e^{d i}ⁿ^com^e
^g/w^di^s^r^eg^{ard, (an}^d^t^h^e^p^e^r^s^oⁿ^qu^alⁱ^fⁱ^e^{d f}^o^{r Medi}^cai^{d on}^t^h^e
^s^.or^ba^sⁱ^s^o^f^{old A}^F^DC^ru^lesⁱⁿ^{at leas}^{t 3 of}^th^{e precedin}^g⁶
^le^ak^m^oⁿ^t^h^s⁾^,^T^M^A^{is av}^ailab^l^{e f}^o^r^th^e^s^u^b^s^eq^u^eⁿ^t⁶^to¹²
^m^o^nt^hs.
^://wiki^T^M^A^w^{ill s}^uⁿ^s^{et at th}^{e en}^{d of}^FY2001.
^h^ttp

CRS-17
ination of Medicaid Presumptive Eligibility for Low-Income Children
^{Current L}^a^w^A^greem^ent
^s^Quali^{fied to Deter}^m^ine^Un^d^e^r^Medⁱ^caid^p^r^esu^m^p^tⁱ^v^e^elig^ib^ility^r^u^{les, states ar}^e^A^d^d^s^sev^e^r^a^{l en}^{tities to}^th^e^list^o^f^th^o^s^{e q}^u^alif^ied^to^m^a^k^e
ⁱ^ca^id^P^r^esu^m^p^{tive Elig}^ib^{ility fo}^{r Lo}^w-^Iⁿ^co^me^allo^w^e^d^to^tem^p^o^r^ar^ily^en^r^o^ll^c^hⁱ^l^d^r^en^w^h^o^s^{e f}^a^m^ily^Medⁱ^caid^p^r^esu^m^p^tiv^{e elig}^ib^ility^d^e^ter^mⁱⁿ^a^tioⁿ^s^f^o^r
^ild^ren^.ⁱⁿ^com^e^appears^{to be below}^Medicaⁱ^dⁱⁿ^com^e^s^t^an^dards^,^ch^ild^r^eⁿ^.^T^h^{ese in}^clu^d^{e ag}^en^{cies th}^{at d}^e^ter^mⁱⁿ^e^elig^ib^ility
^uⁿ^til^a^fⁱⁿ^a^{l f}^o^r^m^{al d}^e^ter^mⁱⁿ^atioⁿ^o^f^elig^ib^ility^{is m}^a^d^e^.^f^o^{r Medicaid or th}^{e State C}^h^ildren^’^s^Health^In^s^u^ran^c^e
^Fo^r^ch^ild^r^eⁿ^,^en^{tities q}^u^alif^ied^t^o^m^a^k^e^p^r^esu^m^p^tiv^e^P^r^og^ram^(SC^H^IP^{); certain}^elem^en^tary^an^{d s}^econ^d^ary
^elig^ib^ility^d^e^ter^mⁱⁿ^atioⁿ^sⁱⁿ^clu^d^e^Medⁱ^caid^p^r^o^v^id^er^{s, an}^d^s^c^h^ool^s^;^s^t^at^e^or^t^rⁱ^b^al^chⁱ^l^d^s^u^pport^en^f^o^rcem^en^t^ag^en^ci^es^;
^ag^en^{cies th}^{at d}^e^ter^mⁱⁿ^{e elig}^ib^ility^f^o^r^Hea^d^S^t^ar^t,^cert^aⁱⁿ^org^aⁿⁱ^zatⁱ^oⁿ^s^provⁱ^dⁱⁿ^g^em^erg^eⁿ^c^y^f^{ood an}^d
^s^u^bs^{idized ch}^{ild care, or}^th^{e Spec}ⁱ^a^l^Su^pplem^en^{tal Food}^sh^elter^to^th^{e h}^o^m^e^{less; en}^{tities in}^v^o^lv^edⁱⁿ^en^r^o^llm^en^t
^P^r^og^ram^f^o^{r Wom}^eⁿ^,^In^f^aⁿ^t^s^an^{d C}^hⁱ^l^d^ren^(WIC^).^uⁿ^d^{er Medi}^cai^d,^T^A^N^F^{, S}^C^H^I^{P, or t}^h^at^det^e^rmⁱⁿ^e
^elig^ib^ility^f^o^r^f^e^d^e^r^a^lly^f^uⁿ^d^ed^h^o^u^sⁱⁿ^g^assistan^{ce; o}^r^an^y
^o^t^h^e^r^eⁿ^tity^d^eem^ed^b^y^{a state, as ap}^p^r^o^v^ed^b^y^th^e
^Secretary^of^{HHS. Ef}^f^ectiv^{e u}^pon^en^actm^eⁿ^t^.
ⁱ^{ki/CRS-RL30718}
^g/w
^s^.orvelopment of Uniform QMB/SLMB Application Form
^le^ak
^{Current L}^a^w^A^greem^ent
^://wiki
^h^ttp^o^r^{m QM}^B/SL^M^Bⁱ^c^atⁱ^{on For}^m^No^p^r^o^v^isioⁿ^.^Req^u^ir^{es th}^{e Secr}^etar^y^o^f^H^H^S^t^o^d^e^v^e^lo^p^a^sim^p^lif^ied^,ⁿ^a^tⁱ^o^na^l^application^f^o^rm^{to be u}^s^{ed, at s}^t^{ate option}^,^by
^Qu^alif^{ied Medicare B}^eⁿ^e^fⁱ^ciaries⁽^Q^MB^s⁾^an^{d Specif}ⁱ^ed
^L^o^w^-In^com^e^{Medicare B}^eⁿ^e^fⁱ^ciaries^(SL^M^B^s^{) apply}ⁱⁿ^g
^f^o^{r m}^e^{dical as}^sⁱ^s^t^an^{ce w}^ith^{Medicare cos}^t^-^s^h^a^rin^g^.
^Ef^f^ectiv^{e 1 y}^{ear af}^{ter th}^{e date of}^en^actm^eⁿ^t^.

CRS-18
^{Current L}^a^w^A^greem^ent
ⁱ^{on 710. T}^echni^cal^C^o^r^r^ectⁱ^ons^M^e^dⁱ^c^aⁱ^d^st^a^t^ut^e^prohⁱ^bⁱ^t^s^t^h^e^di^s^t^ri^bu^tⁱ^oⁿ^o^f^fe^d^e^r^a^l^Mak^e^s^techⁿⁱ^{cal am}^en^dm^en^ts^th^{at ex}^em^{pt f}^r^om^th^e^u^pper
^m^a^tchⁱⁿ^g^f^uⁿ^d^s^f^o^{r m}^e^dical^a^s^sⁱ^s^t^an^{ce prov}^{ided to}ⁱⁿ^co^m^e^lim^{it r}^u^{le th}^o^s^{e in}^dⁱ^vⁱ^d^u^a^l^{s m}^a^d^e^elig^ib^{le f}^o^r
ⁱ^ndivⁱ^du^als^w^h^os^{e f}^a^m^ilyⁱⁿ^com^e^ex^ceeds¹³³a^{% o}^f^the^{Medicaid, at s}^t^{ate option}^,^uⁿ^d^{er th}^e^Fos^t^{er C}^a^re
^am^o^unt^t^h^a^t^w^o^u^l^{d be pai}^d^t^o^{a f}^a^mⁱ^l^y^of^t^h^{e s}^a^m^e^sⁱ^ze^In^depen^d^en^c^e^A^c^t^of^{1999 an}^{d u}ⁿ^d^{er t}^h^{e Breas}^t^an^d
^uⁿ^d^{er ol}^{d A}^F^DC^ru^l^e^s^(as^m^odi^fⁱ^{ed). C}^e^rt^aiⁿ^cos^t^s^t^o^t^h^e^C^e^rvⁱ^cal^C^aⁿ^{cer Prev}^en^tⁱ^oⁿ^an^{d T}^r^eat^m^eⁿ^t^A^c^t^of^2000.

^f^a^m^ily^{are s}^{ubtracted to}^d^e^ter^mⁱⁿ^{e th}^{e ap}^p^licab^le
^co^uⁿ^t^ab^leⁱⁿ^co^m^e^{. Sp}^ecifⁱ^ed^elig^ib^ility^g^r^o^u^p^s^ar^e^ex^em^p^t
^f^r^o^m^th^{is u}^p^p^e^rⁱⁿ^co^m^e^lim^{it r}^u^le.
ⁱ^{ki/CRS-RL30718}
^g/w
^s^.or
^le^ak
^://wiki
^h^ttp

CRS-19
Title VIII. State Children’s Health Insurance Program
ntinued Availability and Redistribution of Unused SCHIP Funds
^{Current L}^a^w^A^greem^ent
ⁱ^on^{801. S}^p^e^cⁱ^a^l^R^u^l^e^f^o^r^Fuⁿ^d^s^f^o^{r th}^{e SC}^HIP^P^r^og^ram^{are au}^th^{orized an}^d^appropriated^f^o^r^Es^t^a^blⁱ^s^h^e^s^{a n}^e^w^m^e^t^h^{od f}^o^{r di}^s^t^ri^bu^tⁱⁿ^g^uⁿ^s^p^e^nt^F^Y^{1998 an}^d
^dⁱ^s^t^rⁱ^{bution and Availability o}^f^Uⁿ^u^s^e^d^F^Y^{1998 t}^h^ro^{ugh FY}^2007.^F^r^om^each^y^ear’^s^{appropriation}^,^a^s^t^ate^F^Y¹⁹⁹⁹^al^l^o^t^m^en^t^s^.^S^t^at^es^t^h^at^u^s^{e al}^l^t^h^ei^{r S}^C^H^I^{P al}^l^o^t^m^en^t^s^(f^or
^{1998 and FY}^{1999 SC}^H^I^{P Al}^l^o^t^m^ent^sⁱ^s^a^l^l^o^t^t^e^{d an}^am^ouⁿ^t^as^determⁱⁿ^{ed by}^{a f}^o^rm^u^l^{a s}^e^{t in}^law^.^each^of^th^os^{e y}^ears⁾^w^oul^d^r^e^ceiv^e^an^am^ouⁿ^t^equ^a^{l to es}^tim^ated
^Federal^f^uⁿ^d^sⁿ^o^t^drawⁿ^dowⁿ^f^r^om^{a s}^t^ate’^s^allotm^en^{t by}^th^{e en}^d^s^p^en^din^gⁱⁿ^ex^ces^s^of^th^{eir orig}ⁱⁿ^{al ex}^h^a^u^s^{ted allotm}^en^t^.^Each
^of^each^fⁱ^s^{cal y}^{ear con}^tⁱ^{nue to be av}^{ailable to th}^{at s}^t^{ate f}^o^{r 2}^territory^th^{at s}^p^en^ds^its^origⁱⁿ^al^allotm^en^{t w}^o^u^l^{d receiv}^e^an^am^ouⁿ^t
^ad^d^itioⁿ^a^{l f}ⁱ^{scal y}^ear^{s. A}^llo^tm^en^{ts n}^o^{t sp}^en^t^at^th^e^en^d^o^f³^y^ear^s^th^{at b}^ear^s^th^e^sam^e^r^a^tio^to¹^.⁰⁵^%^o^f^th^{e to}^{tal am}^o^uⁿ^t^av^ailab^l^{e f}^o^r
^w^{ill b}^e^r^e^dⁱ^strⁱ^b^u^ted^b^y^th^e^S^ecr^etar^y^o^f^Health^an^d^Hu^m^aⁿ^r^e^dⁱ^strⁱ^b^u^tioⁿ^{as th}^{e r}^a^tio^o^f^{its o}^r^igⁱⁿ^{al allo}^tm^en^{t to}^th^{e to}^tal
^Ser^v^{ices (}^HHS)^to^{states th}^{at h}^a^v^e^f^u^lly^sp^en^{t th}^eⁱ^r^o^rⁱ^gⁱⁿ^al^allo^tm^en^{t f}^o^r^{all ter}^r^ito^rⁱ^es.
^allo^tm^en^{ts f}^o^r^th^{at y}^ear^.^Redⁱ^strⁱ^b^u^ted^f^uⁿ^d^{s n}^o^{t sp}^en^{t b}^y^th^{e en}^d
^of^th^{e f}ⁱ^s^{cal y}^{ear in}^w^h^ich^th^ey^{are reallocated of}^fⁱ^cially^ex^pire.^States^th^{at do}^not^u^s^{e all th}^{eir SC}^HIP^allotm^en^{t w}^o^ul^d^receiv^e^an
ⁱ^{ki/CRS-RL30718}^A^{ll ad}^mⁱⁿⁱ^strativ^{e ex}^p^eⁿ^s^esⁱⁿ^c^l^u^dⁱⁿ^g^o^u^treach^activ^{ities are}^a^m^o^unt^e^q^ua^l^t^o^t^h^e^t^o^t^a^l^a^m^o^unt^o^f^unsp^e^nt^fund^s,^l^e^{ss a}^m^o^unt^s
^g/w^su^b^j^{ect to}^an^o^v^er^{all lim}^{it o}^f¹⁰^%^o^f^to^{tal p}^r^o^g^r^a^m^s^p^en^dⁱⁿ^g^p^e^r^fⁱ^s^{cal y}^ear.^dⁱ^strⁱ^b^u^ted^to^{states th}^{at f}^u^lly^ex^h^a^u^s^ted^th^eir^o^r^igⁱⁿ^{al a}^l^l^o^tm^en^ts,^m^u^ltip^lied^b^y^th^e^r^a^tio^o^f^{a state’}^{s u}ⁿ^s^p^eⁿ^t^o^r^igⁱⁿ^{al allo}^tm^en^{t to}^th^e
^s^.or^t^o^t^a^l^a^m^o^unt^o^f^unsp^e^nt^fund^s.^St^a^t^e^s^m^a^y^use^up^t^o¹⁰^%^o^f^t^h^e
^le^ak^retain^{ed FY1998 f}^uⁿ^d^s^f^o^{r ou}^treach^activ^ities^.
^://wiki^T^o^c^a^lcu^l^{ate th}^{e am}^ouⁿ^t^s^av^{ailable f}^o^{r redis}^t^ribu^tionⁱⁿ^each
^h^ttp^fo^rm^u^l^{a des}^c^{ribed abov}^{e, th}^{e Secretary}^w^o^u^l^{d u}^s^{e am}^ouⁿ^t^s
^reported^b^y^s^t^atesⁿ^o^{t later th}^an^Decem^{ber 15, 2000 f}^o^{r th}^e
^F^Y^{1998 redi}^s^t^ri^bu^tⁱ^oⁿ^an^{d N}^o^v^e^m^b^{er 30, 2001 f}^o^{r t}^h^{e F}^Y¹⁹⁹⁹
^redi^s^t^ri^bu^tⁱ^oⁿ^as^re^port^e^{d on}^H^C^F^A^F^o^rm^{64 or H}^C^F^A^F^o^rm^21,
^an^{d as}^approv^{ed by}^t^h^{e S}^ecret^ary^.^R^e^di^s^t^ri^bu^t^e^{d f}^uⁿ^d^s^w^o^ul^{d be}
^a^v^aⁱ^l^a^b^l^e^t^h^r^o^{ugh t}^h^e^eⁿ^d^o^f^FY^2002.

CRS-20
thority to Pay for Medicaid Expansion SCHIP Costs From Title XXI Appropriation
^{Current L}^a^w^A^greem^ent
ⁱ^{on 802. Aut}^horⁱ^t^y^t^o^{Pay f}^o^r^States^’^allotm^en^ts^uⁿ^d^{er SC}^HIP^pay^on^ly^th^e^f^e^deral^s^h^are^of^cos^t^s^A^u^th^orizes^th^{e pay}^m^en^{t of}^th^e^cos^t^s^of^SC^HIP^Medicaid
^e^di^cai^d^Expansⁱ^{on SCH}^I^{P cos}^t^s^f^r^om^as^s^o^{ciated w}^ith^s^e^par^a^{te (n}^on^-^M^{edicaid) SC}^HIP^prog^ram^s^{. T}^h^e^ex^pan^sⁱ^oⁿ^s^an^{d t}^h^{e cos}^t^s^of^ben^e^fⁱ^t^s^provⁱ^d^{ed dur}ⁱⁿ^g^peri^ods^of
^Ap^p^r^o^p^r^ia^tioⁿ^f^e^{deral s}^h^{are of}^cos^t^s^as^s^o^{ciated w}^ith^SC^HIP^{Medicaid ex}^pan^s^ion^s^p^r^esu^m^p^tiv^{e elig}^ib^ility^f^r^o^m^th^{e SCHI}^P^ap^p^r^o^p^r^iatioⁿ^r^a^t^h^e^r^th^an
^are^paid^f^o^{r u}ⁿ^d^{er Medicaid. State SC}^HIP^allotm^en^ts^are^redu^ced^f^r^om^th^{e Medicaid appropriation}^,^an^d^as^{a con}^f^ormⁱⁿ^g^am^en^dm^en^t,
^by^th^{e am}^ouⁿ^t^s^{paid u}ⁿ^d^{er Medicaid f}^o^{r S}^C^HIP^Medicaid^w^o^u^l^d^elimⁱⁿ^{ate th}^{e r}^e^q^u^ir^em^en^{t th}^{at state SCHI}^P^a^llo^tm^en^{ts b}^e
^e^x^p^a^nsi^o^{n c}^o^st^s.^redu^{ced by}^t^h^es^{e (f}^orm^e^{r) Medi}^cai^{d pay}^m^en^t^s^{. In}^a^d^dⁱ^tⁱ^on^,
^codi^fⁱ^es^propos^{ed ru}^l^e^s^reg^a^rdiⁿ^g^t^h^{e order}^of^pay^m^en^t^s^f^o^r
^P^r^esu^m^p^tiv^{e elig}^ib^ility^allo^w^s^p^r^egⁿ^aⁿ^t^w^o^m^eⁿ^an^d^ch^ild^r^eⁿⁱⁿ^ben^e^f^its^an^{d adm}ⁱⁿⁱ^s^t^r^a^tiv^{e cos}^t^s^f^r^om^s^t^ate-^s^p^ecifⁱ^{c SC}^HIP
^f^a^m^{ilies w}ⁱ^t^hⁱⁿ^co^m^e^th^{at ap}^p^ear^{s to}^b^e^b^e^lo^w^{a state’}^{s Med}ⁱ^caid^al^l^o^t^m^en^t^s^{. F}^o^{r f}ⁱ^s^cal^y^ears^{1998 t}^h^ro^ugh²⁰⁰⁰^oⁿ^l^y^,^au^t^h^ori^zes
ⁱⁿ^co^m^e^stan^d^a^r^d^{s to}^en^r^o^{ll tem}^p^o^r^ar^ilyⁱⁿ^Medⁱ^caid^,^uⁿ^{til a f}ⁱⁿ^a^l^t^h^{e t}^r^an^s^f^{er of}^uⁿ^e^x^p^en^ded^S^C^H^I^{P appropri}^a^tⁱ^oⁿ^s^t^o^t^h^{e Medi}^cai^d
^f^o^r^m^{al d}^e^t^e^r^mⁱⁿ^a^t^ioⁿ^o^f^elig^ib^ility^{is m}^a^d^e^{. T}^h^er^{e is n}^o^ex^p^r^ess^{appropriation}^accouⁿ^t^f^o^{r th}^{e pu}^rpos^{e of}^reim^bu^rsⁱⁿ^g^pay^m^en^ts
ⁱ^{ki/CRS-RL30718}^p^r^o^v^isioⁿ^f^o^r^p^r^esu^m^p^tiv^{e elig}^ib^ility^uⁿ^d^er^SCHI^P^.^Ho^w^e^v^e^r^,^th^e^as^s^o^{ciated w}^ith^SC^HIP^{Medicaid ex}^pan^s^ion^prog^ram^s^.

^g/w^Secretary^of^HHS^perm^its^s^t^ates^t^o^d^e^ve^l^o^p^e^q^ui^va^l^e^nt^p^r^o^c^e^d^ur^e^s
^s^.or^fo^r^se^p^a^r^a^te⁽ⁿ^oⁿ^-M^e^d^ic^aⁱ^d⁾^SCHI^P^p^r^o^g^r^a^m^s^thr^o^ugh^o^t^he^r^T^itle
^le^ak^XXI^au^th^o^r^ity^.
^://wiki
^h^ttp

CRS-21
edicaid Child Presumptive Eligibility Provisions
^{Current L}^a^w^A^greem^ent
ⁱ^on^803.^Applⁱ^c^atⁱ^{on of}^M^e^di^cai^d^C^hⁱ^l^d^Pr^es^um^ptⁱ^v^e^Un^d^e^r^Medⁱ^caid^p^r^esu^m^p^tⁱ^v^e^elig^ib^ility^r^u^{les, states ar}^e^Clar^ifⁱ^e^s^states’^au^th^o^r^ity^to^coⁿ^d^u^c^{t p}^r^esu^m^p^tiv^e
^ib^{ility Pro}^v^isioⁿ^s^.^allo^w^e^d^to^tem^p^o^r^ar^ily^en^r^o^ll^c^hⁱ^l^d^r^en^w^h^o^s^{e f}^a^m^ily^elig^ib^ility^d^e^ter^mⁱⁿ^atioⁿ^s^{, as d}^e^fⁱⁿ^e^dⁱⁿ^Medⁱ^caid^law^,
ⁱⁿ^com^e^appears^{to be below}^Medicaⁱ^dⁱⁿ^com^e^s^t^an^dards^,^uⁿ^d^{er s}^e^parat^e⁽ⁿ^on^-^M^edi^cai^{d) S}^C^H^I^{P prog}^ram^s^.

^uⁿ^til^a^fⁱⁿ^a^{l f}^o^r^m^{al d}^e^ter^mⁱⁿ^atioⁿ^o^f^elig^ib^ility^{is m}^a^d^e^.
^T^h^er^{e is n}^o^ex^p^r^{ess p}^r^o^v^isioⁿ^f^o^r^p^r^esu^m^p^tiv^{e elig}^ibⁱ^lity
^uⁿ^d^{er s}^e^{parate (n}^on^-^M^edicaid)^S^C^H^I^P^p^r^o^g^ram^s^.
^How^e^v^e^{r, th}^{e Secretary}^of^HHS^perm^its^s^t^ates^{to dev}^e^lop,
^f^o^{r s}^e^parat^e⁽ⁿ^on^-^M^edi^cai^d)^S^C^H^I^{P prog}^ram^s^{, procedu}^r^es
^th^{at ar}^{e sim}^ilar^to^th^o^s^{e p}^e^r^m^itted^uⁿ^d^er^Medⁱ^caid^.
ⁱ^{ki/CRS-RL30718}
^g/w
^s^.or
^le^ak
^://wiki
^h^ttp

CRS-22
Title IX. Other Provisions
for Current PACE Waivers
^{Current L}^a^w^A^greem^ent
^{ion of}^Tr^ans^ition^for^C^u^r^r^e^{nt W}^a^iver^s^OB^R^A⁸⁶^r^e^q^uⁱ^r^e^d^t^h^e^S^ecretary^to^g^r^an^t^w^a^iv^ers^of^P^e^r^m^{its th}^{e Secr}^etar^y^to^coⁿ^tⁱⁿ^u^e^to^o^p^e^r^a^{te th}^{e P}^r^o^g^r^a^m
^certain^{Medicare an}^{d Medicaid requ}^irem^en^ts^toⁿ^o^t^m^o^re^o^f^A^ll-^Iⁿ^clu^s^iv^{e Car}^e^f^o^r^th^{e Eld}^e^r^l^y⁽^P^A^C^E)^uⁿ^d^e^r
^t^h^an^{10 pu}^blⁱ^c^{or n}^oⁿ^-^profⁱ^t^pri^v^at^{e co}^m^m^uni^t^y^-^b^as^ed^w^aⁱ^v^ers^f^o^r^{a peri}^{od of}^{36 m}^oⁿ^t^h^s^(rat^h^e^{r t}^h^an^{24 m}^oⁿ^t^h^s^),
^o^r^g^aⁿⁱ^zatioⁿ^s^to^p^r^o^v^id^{e h}^ealth^an^d^loⁿ^g^-^t^e^r^m^car^e^an^{d s}^t^ates^m^a^y^{do s}^o^f^o^{r 4 y}^ears^(rath^{er th}^an^{3 y}^ears⁾^.

^s^e^rv^ices^on^{a capitated bas}ⁱ^s^to^f^r^ai^l^el^derl^y^pers^on^s^at^ri^s^k
^o^fⁱⁿ^s^titu^tⁱ^oⁿ^a^lⁱ^z^a^tⁱ^oⁿ^.^Th^e^s^e^p^r^o^j^e^c^t^s^,^kⁿ^o^wⁿ^a^s^t^h^e
^P^r^og^ram^of^A^l^l^-^In^cl^u^sⁱ^v^e^{Care f}^o^{r t}^h^{e El}^derl^y^(P^A^C^E),
^w^e^r^eⁱⁿ^ten^d^ed^to^d^e^ter^mⁱⁿ^{e w}^h^eth^e^r^an^ear^lier
^dem^oⁿ^s^t^r^atⁱ^o^{n prog}^ram^,^Oⁿ^-^L^ok^{, cou}^l^{d be repl}ⁱ^cat^ed
ⁱ^{ki/CRS-RL30718}^acros^s^th^{e co}^un^try^.^OB^R^A^{90 ex}^pan^d^{ed th}^{e n}^u^m^{ber of}^o^r^g^aⁿⁱ^zatioⁿ^s^elig^ib^{le f}^o^r^w^a^iv^er^{s to}¹⁵^.^B^B^A⁹⁷
^g/w^es^tablis^h^e^{d P}^A^C^E^a^s^{a perm}^an^en^{t prov}^{ider u}ⁿ^d^er
^s^.or^{Medicare an}^d^as^an^option^a^{l ben}^e^f^{it u}ⁿ^d^{er Medicaid. State}
^le^ak^Medⁱ^cai^d^p^r^o^g^r^a^m^s^ar^{e p}^e^r^m^itted^to^lim^{it th}^{e n}^u^m^b^e^r^o^f
^://wiki^pers^on^s^en^{rolled in}^P^A^C^E^prog^ram^s^.^T^h^{e Secretary}^w^a^s^r^e^q^u^ir^ed^to^issu^{e r}^e^g^u^l^atioⁿ^s^estab^lishⁱⁿ^g^r^e^q^u^ir^em^en^{ts f}^o^r
^h^ttp^PA^C^E^provⁱ^d^ers^(an^d^di^{d s}^o^wⁱ^t^h^an^ef^f^ectⁱ^v^{e dat}^e^of
^N^o^v^e^m^b^e^r²⁴^,¹⁹⁹⁹⁾^.^Th^e^S^e^c^r^e^t^a^r^y^m^a^y^c^oⁿ^tⁱⁿ^u^e^t^o
^opera^t^e^prog^ram^s^uⁿ^d^{er t}^h^{e pri}^o^{r l}^a^w^w^aⁱ^v^ers^f^o^{r a}
^tr^an^sitioⁿ^p^e^rⁱ^o^d^o^f²⁴^m^oⁿ^t^h^s^af^ter^p^u^b^l^icatioⁿ^o^f^th^e
^re^gul^a^tion^s^{, an}^{d s}^t^ates^m^a^y^{elect to con}^tin^u^e^{to operate a}
^P^A^CE^p^r^o^g^r^a^m^und^e^r^sp^e^cⁱ^a^l^a^r^r^a^nge^m^e^nt^{s fo}^r³^y^e^a^r^s
^af^{ter th}^{e Secretary}^’^s^reg^u^l^ation^s^.

CRS-23
ain PACE Operating Arrangements
^{Current L}^a^w^A^greem^ent
ⁱ^{on 902. C}^ontⁱ^nui^{ng of}^C^e^r^t^ai^{n O}^p^er^atⁱⁿ^g^BBA⁹⁷^e^s^t^a^blⁱ^s^h^e^{d PA}^C^E^as^{a perm}^an^en^t^part^of^t^h^e^If^prior^{to becom}ⁱⁿ^g^{a perm}^an^en^{t com}^pon^en^t^of^Medicare,
^r^angements^Per^m^itted^Medi^{care an}^{d Medi}^cai^{d prog}^r^a^m^s^aⁿ^{d prov}ⁱ^d^{ed f}^o^{r a}^a^P^A^CE^d^e^m^o^nst^r^a^tⁱ^o^{n p}^r^o^j^e^c^t^ha^d^c^o^nt^r^a^c^t^ua^l^o^r^o^t^he^r
^t^r^aⁿ^sitioⁿ^o^f^P^A^{CE f}^r^o^m^d^e^m^oⁿ^s^tr^atioⁿ^p^r^o^j^{ect statu}^s^to^o^p^e^r^a^tⁱ^{ng a}^r^r^a^nge^m^e^nt^{s t}^h^a^t^a^r^e^no^t^r^e^c^o^gni^z^e^d^und^e^r
^perm^an^en^t^prog^ram^s^t^at^u^s^.^perm^an^en^{t prog}^ram^reg^u^l^ation^s^{, requ}^ires^th^{e Secretary}^,ⁱⁿ
^coⁿ^s^u^ltatioⁿ^w^ith^th^{e state ag}^en^cy^,^to^p^e^r^m^it^it^to^coⁿ^tin^u^e
^und^e^r^suc^h^a^r^r^a^nge^m^e^nt^{s a}^s^l^o^ng^a^sⁱ^tⁱ^s^c^o^nsi^s^t^e^nt^wⁱ^t^h
^t^h^{e obj}^ectⁱ^v^es^of^t^h^{e PA}^C^E^prog^ram^.
uthority
^{Current L}^a^w^A^greem^ent
ⁱ^{ki/CRS-RL30718}^Exer^cisⁱ^{ng W}^a^iver^Author^ity^T^h^e^l^a^w^aⁿ^d^r^e^gul^a^tⁱ^oⁿ^s^f^o^{r PA}^C^E^requⁱ^r^{e t}^h^at^prog^ram^s^En^ables^th^{e Secretary}^{to ex}^er^{cise au}^th^o^r^ity^to^m^o^dⁱ^f^y^o^r
^g/w^{operate accordin}^g^{to a protocol.}^w^a^iv^{e Medicare or M}^e^dⁱ^{caid requ}^irem^en^ts^{to res}^pon^{d to}
^s^.or^t^h^{e n}^eeds^of^PA^C^E^prog^ram^s^rel^a^t^e^d^t^o^em^pl^oy^m^eⁿ^t^an^d
^le^ak^th^{e u}^s^{e of}^com^m^uⁿ^ity^care^ph^y^s^ician^s^.^T^h^{e Secretary}^m^u^s^t
^ap^p^r^o^v^{e r}^e^q^u^{ests f}^o^r^su^ch^w^a^iv^er^{s w}^ithⁱⁿ⁹⁰^d^a^y^s^o^f^th^e
^://wiki^{date th}^{e requ}^es^{t f}^o^{r w}^a^iv^{er is}^receiv^e^d.

^h^ttp

CRS-24
ciaries Eligible for Medicaid Cost-Sharing Assistance
^{Current L}^a^w^A^greem^ent
^Outr^each^{on Availability}^of^Medicaid^cov^e^rs^th^{e cos}^t^s^of^certaⁱⁿ^Medⁱ^car^{e f}ⁱⁿ^aⁿ^c^{ial o}^b^lig^atioⁿ^s^R^e^qu^ires^th^{e C}^o^m^mⁱ^s^sⁱ^on^{er of}^th^{e Social Secu}^rity^A^d^mⁱⁿⁱ^s^t^ration
^e^di^car^e^C^o^s^t^-s^harⁱ^{ng As}^sⁱ^s^t^{ance t}^o^f^o^{r qu}^alif^{ied Medicare ben}^e^fⁱ^ciaries^(QMB^s⁾^{, s}^p^ecifⁱ^{ed low}ⁱⁿ^c^o^m^e^t^o^con^d^u^c^{t ou}^treach^ef^f^o^rts^{to iden}^tif^yⁱⁿ^divⁱ^du^als^w^h^{o m}^a^y^be
^ib^{le Lo}^w^-ⁱⁿ^co^{me Med}ⁱ^ca^re^Medi^{care ben}^e^fⁱ^ci^ari^e^s^(S^L^M^Bs^{) an}^{d t}^w^o^gr^o^ups^of^“^q^u^a^lⁱ^fⁱ^e^d^elⁱ^gⁱ^b^l^e^f^o^{r Medicaid pay}^m^en^{t of}^{Medicare cos}^t^s^h^arin^g^an^{d to}
^e^ficia^riesⁱⁿ^divⁱ^du^als^”^ref^e^{rred t}^o^a^s^QI-¹^s^an^{d QI-}²^s^.^QMB^s^{are ag}^{ed or}ⁿ^o^tif^y^th^{ese p}^e^r^s^oⁿ^{s o}^f^th^{e av}^ailab^ility^o^f^su^ch^assi^s^t^an^{ce. T}^h^e
^di^s^a^bl^{ed pers}^on^s^wⁱ^t^hⁱⁿ^com^e^s^at^or^bel^o^w^t^h^{e f}^e^deral^pov^ert^y^lⁱⁿ^e^Co^m^mⁱ^ssi^oⁿ^e^r^w^o^ul^d^a^l^so^b^e^r^e^q^uⁱ^r^e^d^t^o^furⁿⁱ^s^h,^a^t^l^e^a^s^t^a^nnua^l^l^y^,
^an^d^{assets b}^e^lo^w^tw^{ice th}^{e SSI}^lev^e^{l. T}^h^{e o}^t^h^e^r^g^r^o^u^p^s^ar^e^a^lⁱ^s^t^of^s^u^chⁱⁿ^divⁱ^du^als^w^h^{o res}ⁱ^{de in}^each^s^t^{ate to th}^{at s}^t^ate’^s
^co^m^p^rⁱ^sed^o^f^o^t^h^e^r^lo^wⁱⁿ^co^m^e^-ⁱⁿ^d^iv^id^u^a^{ls w}^h^o^m^{eet all b}^u^t^t^h^e^ag^en^cy^res^pon^sⁱ^{ble f}^o^{r adm}ⁱⁿⁱ^s^t^erin^g^th^e^Medicaid^prog^ram^as^w^e^ll
ⁱⁿ^co^m^e^d^e^fⁱⁿ^itioⁿ^f^o^r^QMB^elig^ib^ility^.^as^{to an}^y^oth^e^r^a^p^p^r^{opriate s}^t^{ate ag}^en^cy^{. T}^h^{e lis}^{t s}^h^ou^{ld in}^clu^d^e
^th^{e n}^a^m^e^an^{d addres}^s^,^aⁿ^d^w^h^eth^e^{r s}^u^chⁱⁿ^divⁱ^du^als^h^a^v^e
^ex^perien^{ced redu}^ction^sⁱⁿ^{Social Secu}^rity^ben^e^f^its^{. A}^l^s^o^requ^ires
^th^{e Gen}^e^{ral A}^ccouⁿ^tin^g^Of^fⁱ^{ce to con}^d^u^c^{t a s}^t^u^d^y^of^th^{e im}^pact^of
ⁱ^{ki/CRS-RL30718}^th^{e o}^u^treach^activ^ities^o^f^th^{e Co}^m^mⁱ^ssioⁿ^{er to}^su^b^m^{it to}^Coⁿ^g^r^ess
^g/wⁿ^o^late^r^t^h^aⁿ^{18 m}^oⁿ^t^h^s^af^{ter s}^u^ch^ou^treach^begⁱⁿ^s^{. Ef}^f^ectiv^{e 1}
^s^.or^y^{ear af}^{ter date of}^en^actm^eⁿ^t^.
^le^ak
^://wikiternal and Child Health Block Grant
^h^ttp^{Current L}^a^w^A^greem^ent
ⁱ^{on. 921. Incr}^eas^eⁱⁿ^Aut^horⁱ^z^atⁱ^oⁿ^T^{itle V o}^f^th^{e So}^{cial Secu}^r^ity^A^c^{t au}^th^o^r^{izes an}^ap^p^r^o^p^r^iatioⁿ^o^f^Iⁿ^cr^{eases th}^{e au}^th^o^r^izatioⁿ^o^f^ap^p^r^o^p^r^iatioⁿ^s^f^o^r^th^{is g}^r^an^{t p}^r^o^g^r^a^m
^Appr^oprⁱ^a^tⁱ^ons^f^o^r^t^h^{e M}^a^t^e^r^nal^and^{$705 m}^illion^f^o^{r FY1994 an}^{d each}^fi^s^c^{al y}^{ear th}^ereaf^{ter f}^o^{r th}^e^{to $850 m}^illion^f^o^{r FY2001 an}^{d each}^fⁱ^s^{cal y}^{ear th}^ereaf^ter.

^ild^Hea^lth^S^e^{rvices Blo}^{ck Gra}ⁿ^t^Matern^{al an}^{d C}^h^{ild Health}^Serv^ices^B^l^ock^Gran^t.

CRS-25
^{Current L}^a^w^A^greem^ent
ⁱ^on^{931. Incr}^eas^eⁱⁿ^Appr^oprⁱ^a^tⁱ^ons^T^h^e^B^a^lan^{ced B}^u^dg^{et A}^c^{t of}^{1997 am}^en^{ded T}^itle^III^of^th^e^P^u^blic^Ex^t^eⁿ^d^s^f^o^r^{1 y}^{ear, t}^o^F^Y^{2003, t}^h^{e au}^t^h^ori^t^y^f^o^{r g}^r^an^t^s^t^o^{be m}^a^de
^Speci^al^Dⁱ^abet^e^s^Pr^ogr^am^s^f^o^r^T^y^pe^H^e^a^l^t^h^S^e^r^vⁱ^c^e^A^c^t^t^o^c^r^e^a^t^e^t^w^o^g^r^aⁿ^t^p^r^o^g^r^a^m^s^s^u^pportⁱⁿ^g^t^h^e^f^o^r^both^th^{e Special Diabetes}^P^r^og^ram^f^o^{r T}^y^{pe I Diabetes}^an^{d f}^o^r
ⁱ^abet^e^s^{and Indi}^ans^prev^en^tion^an^d^treatm^eⁿ^t^of^{, an}^{d res}^earch^relatin^g^{to, diabetes}^{. T}^h^e^th^{e Special}^Diabetes^P^r^og^ram^s^f^o^r^In^dian^s^.^A^l^s^o^ex^pan^d^s^f^uⁿ^dⁱⁿ^g
^fⁱ^rs^t^t^a^rg^et^s^di^abet^es^res^earch^an^d^t^h^{e s}^econ^d^s^u^pport^s^t^h^e^av^{ailable f}^o^{r th}^es^{e prog}^ram^s^{. For each}^g^r^an^t^p^r^o^g^r^a^m^,ⁱⁿ^creas^es
^prev^en^tion^an^{d treatm}^e^nt^s^e^rv^ices^of^diabetesⁱⁿ^In^dian^s^.^Each^{total f}^undⁱⁿ^g^{to $100 m}^illion^each^f^o^{r FY2001, FY2002 an}^d
^p^r^og^ram^receiv^e^s^{$30 m}^illion^f^o^{r each}^of^th^{e f}ⁱ^s^{cal y}^ear^s¹⁹⁹⁸^F^Y^{2003. F}^o^{r F}^Y^{2001 an}^{d F}^Y²^002,^{$30 m}^illioⁿ^of^th^{e $100}
^t^h^r^o^ugh^{2002, t}^r^an^s^f^{erred f}^r^om^t^h^{e S}^C^H^I^{P appropri}^a^tⁱ^oⁿ^.^m^illioⁿ^f^o^{r each}^p^r^o^g^ram^w^o^u^l^d^b^e^tran^sf^e^r^red^f^r^o^m^SCHIP^;^th^e
^re^m^aⁱⁿⁱⁿ^g^$70^m^illioⁿ^w^o^u^l^{d be}^dr^a^wⁿ^f^r^om^t^h^e^T^r^e^a^s^u^r^y^ou^t^of
^f^uⁿ^d^sⁿ^o^t^ot^h^e^rwⁱ^s^{e appropri}^a^t^e^{d. In}^F^Y^{2003, t}^h^e^en^tⁱ^r^{e $100}
^m^illioⁿ^w^o^u^l^d^b^e^d^r^awⁿ^f^r^o^m^t^h^e^T^r^easu^r^y^o^u^{t o}^f^f^uⁿ^d^{s n}^o^t
^o^t^h^e^r^w^{ise ap}^p^r^o^p^r^iated^.^Iⁿ^ad^d^itioⁿ^,^ex^ten^d^{s th}^{e d}^u^{e d}^a^{te o}ⁿ^fⁱⁿ^a^l
^ev^al^u^a^tⁱ^o^{n report}^s^f^o^{r t}^h^es^{e t}^w^{o g}^r^an^t^prog^ram^s^f^r^om^Jan^u^a^ry^1,
ⁱ^{ki/CRS-RL30718}^{2002 t}^o^Jan^u^a^ry^{1, 2003.}
^g/w
^s^.oricky Ray Hemophilia Relief Fund
^le^ak
^{Current L}^a^w^A^greem^ent
^://wiki
^h^ttpⁱ^{on 932. Appr}^oprⁱ^a^tⁱ^ons^f^o^r^Ri^cky^T^h^{e R}ⁱ^ck^y^R^a^y^Hem^oph^{ilia R}^e^lief^Fuⁿ^d^A^c^{t of}^{1998 (P}^.L^{. 105-}^P^r^o^v^id^{es f}^o^r^{a d}ⁱ^r^{ect ap}^p^r^o^p^r^iatioⁿ^to^th^{e R}ⁱ^c^k^y^R^a^y^tr^u^s^{t f}^uⁿ^d^o^f
^{y Hemo}^p^h^ilia^{Relief Fu}ⁿ^d^{369) es}^t^a^blⁱ^s^he^d^a^5-^y^{ear t}^r^u^s^t^f^uⁿ^d^t^o^m^a^k^e^com^p^as^sⁱ^on^at^e^$475^m^illio^{n f}^o^{r F}^Y^2001.^[N^ot^e^:^aⁿ^a^dd^ition^a^{l $105 m}^illion^w^a^s
^pay^m^en^ts^of^{$100,000 to h}^e^m^o^p^h^iliacs^w^h^{o con}^t^{racted HIV}^a^p^p^r^o^p^ri^at^{ed t}^o^t^h^{e f}^uⁿ^dⁱⁿ^t^h^{e F}^Y^{2001 Mi}^s^cel^l^aⁿ^e^ou^s
^thr^o^{ugh the}^use^o^f^aⁿ^ti-he^m^o^p^h^ilia^c^fa^c^t^o^r^b^e^tw^e^eⁿ^J^u^ly¹^,¹⁹⁸²^A^ppropri^a^tⁱ^oⁿ^s^A^c^t^(H^.R^{. 5666).]}

^an^{d Decem}^{ber 31, 1987. T}^h^{e A}^c^{t au}^th^orized^{appropriation}^s^to^th^e
^f^uⁿ^d^totalin^g^{$750 m}^illion^.^T^h^{e t}^r^us^t^fun^d^receiv^e^{d an}ⁱⁿ^itial
^{appropriation}^of^{$75 m}^illionⁱⁿ^FY2000.

CRS-26
ation on Nurse Staffing
^{Current L}^a^w^Agreem^ent
^{ting Of}^Infor^m^{ation on}^N^u^r^sⁱ^{ng Facility}^Medicar^{e an}^{d Medicaid s}^t^atu^t^{e delin}^eates^certain^Req^u^ir^{es Med}ⁱ^car^{e sk}^illedⁿ^u^r^sin^g^f^{acilities an}^d^Medⁱ^caid
^v^ices^r^e^q^u^ir^e^m^en^{ts f}^o^r^sk^illedⁿ^u^r^sin^g^an^dⁿ^u^r^sin^g^f^acilities,ⁿ^u^r^sin^g^f^{acilities to}^p^o^s^{t licen}^sed^an^d^uⁿ^liceⁿ^sedⁿ^u^r^se
^r^e^s^p^ectiv^ely^.^W^ith^r^e^g^a^r^d^to^staf^fⁱⁿ^g^,^f^{acilities m}^u^st^staf^fⁱⁿ^gⁱⁿ^f^o^rm^atioⁿ^d^a^ily^f^o^{r each}^sh^if^{t in}^th^{e f}^acility^,^an^d
^prov^{ide 24-}^h^o^u^r^licen^s^e^{d n}^u^r^sⁱⁿ^g^s^e^rv^ice^s^u^f^fⁱ^cien^{t to m}^eet^to^m^a^k^e^su^chⁱⁿ^f^o^r^m^atioⁿ^p^u^b^licly^av^ailab^l^{e, u}^p^oⁿ^r^e^q^u^est.
^t^h^e^nur^si^{ng ne}^e^d^{s o}^f^r^e^si^d^e^nt^s^aⁿ^d^m^u^st^,ⁱⁿ^ge^ne^r^a^l^,^use^t^h^e^Ef^f^ectⁱ^v^{e Jan}^u^a^ry^{1, 2003.}

^s^e^rv^ices^of^a^regⁱ^s^t^eredⁿ^u^r^s^e^{at leas}^{t 8 con}^s^ecu^tiv^{e h}^o^u^r^s
^{a day}^,^{7 day}^s^{a w}^eek^{. Nu}^rs^{e aides}^m^u^s^t^com^p^{lete train}ⁱⁿ^g
^an^{d com}^p^eten^cy^ev^alu^a^tion^pro^g^r^a^m^s^{. No s}^t^af^fⁱⁿ^g^-^to-
^resⁱ^den^t^ratios^{are s}^p^ecifⁱ^{ed in}^f^e^{deral s}^t^atu^t^e.
ⁱ^{ki/CRS-RL30718}
^g/w
^s^.or
^le^ak
^://wiki
^h^ttp