H.R. 506 (Baldwin)

Target population(s)
Uninsured in states receiving grants.

State Grant Approval Authority

State Grant approval authority
State Health Innovation Commission

Structure and membership
21 members: Secretary of HHS and, on a bipartisan basis: 4 governors appointed by the National Governors Association; 2 state legislators appointed by the National Conference of State Legislators; 2 county officials appointed by the National Association of Counties; 2 mayors appointed by the US Conference of Mayors and 2 tribe members appointed by the National Congress of American Indians. Also, 2 individuals each appointed by the Speaker of the House; the House Minority Leader; the Senate Majority and Minority Leaders. Chairperson elected by Commission.

Duties
Provides states with options for reform program applications, based on 2/3 vote of Commission; establishes minimum performance measures on coverage quality and costs; reviews state plans; determines whether to approve and submit a state application to the Congress; monitors and reports on progress of approved state programs; recommends to the Secretary and Congress ways to minimize effects of state programs on multi-state employers, providers, and plans. May negotiate with states in a public forum and hold hearings. Must hold an annual meeting with participating states. At the end of the 5-year period of state grants, Commission reports to Congress on the progress of state programs in meeting goals and recommend future actions, including continuation of program. In consultation with the Institute of Medicine, submits an evaluation of state programs.

Administration/Staffing
Chairperson appoints executive director and other personnel. Executive director confirmed by Commission. Annual appropriations of $3 million authorized to fund Commission activities in Fiscal Year 2008 and each year thereafter.

State Grant Approval Process

State Plan Requirements
State plans submitted to the Commission must provide specific 5-year targets for reducing the number of uninsured individuals and reducing administrative costs; describe the manner in which access to health coverage will be expanded; the minimum benefits to be provided; coordination with existing programs; improvements in services to medically underserved; quality improvements; 5-year target for reducing administrative costs; the financing and estimated expenditures under the plan.

State Plan Benefits
State may not permit pre-existing condition exclusions for any benefit under the state program, except as permitted under federal law when the state is paying for group health insurance.

Application and approval process
Secretary and Commission make initial review of application within 60 days and advise the state of the need for additional information. Final determination within 90 days of completion of initial review; requires 2/3 vote of Commission for approval. Grants approved by Commission deemed to be approved unless disapproved by the Congress under expedited Congressional consideration. States may apply for the entire state or for regions of two or more states. Local governments may apply if state does not or Secretary permits.

Terms of Grants
Grants for up to 5 years; may be extended for subsequent 5-year periods. Amount of grants to be based upon the Commission recommendations and subject to appropriations. In funding grants approved by the Commission, the Secretary shall fund a diversity of approaches; give priority to programs aimed at improving access to children, youth and other vulnerable populations. State must maintain expenditures for health care coverage not less than those for the year prior to receiving the grant.

Federal waivers
Commission approval does not include the approval of state proposals involving waivers or modifications to federal law. Nothing in the bill or in Section 1115 of the Social Security Act should be construed as authorizing changes to Medicaid or the State Children's Health Insurance Program. States may not apply more restrictive Medicaid eligibility than current law.

State Reporting Requirements
Annual reports to Commission detailing compliance with the requirements of the approved plan.

Expedited legislative procedure
Commission's list of state applications recommended for approval will be introduced as a joint resolution in the House and the Senate, no later than 90 days prior to October 1st, each year. Expedited procedures provided for committee, House and Senate consideration. Applications approved by the Commission are funded subject to available appropriations, unless disapproved by Congress.

Financing
Authorizes such sums as necessary in each fiscal year.

Effective date
Commission to be appointed within 90 days after enactment.

Other provisions in bill
Prohibits payment for health assistance provided for an individual to the extent that payments would otherwise be made under a private plan that limits or excludes payment for services to enrollees because they are eligible under the state plan. Prohibits duplicate federal payments under state grant program and other federal programs.