SubtitleJ — Health Hippo

SubtitleJ

Note: this is a hand enrollment pursuant to Public Law 105-32.
H.R.2015
One Hundred Fifth Congress
of the
United States of America
AT THE FIRST SESSION

Begun and held at the City of Washington on Tuesday, the
seventh day of January, one thousand nine hundred and ninety-seven

An Act

Subtitle J–State Children’s Health
Insurance Program

Chapter 1–State Children’s Health Insurance Program
- Sec. 4901. Establishment of program.
Chapter 2–Expanded Coverage of Children Under Medicaid
Chapter 3–Diabetes Grant Programs

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.

(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.

(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.

(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).

(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.

(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. 300gg-91(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. 1320a-7(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”.

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.
104-193)) 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.