Reps. Gene Green (D-TX) and Frank Pallone, Jr. (D-NJ) introduced H.R. 919, the CHIP Extension and Improvement Act of 2015. This legislation would extend funding for the Children’s Health Insurance Program (CHIP), continue pediatric quality efforts authorized under the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) and improve access to coverage.
Below is a summary of those aspects of the bill that are of most interest to children’s hospitals.
Extending Funding for CHIP
- Extending funding for CHIP for four additional years— through FY 2019: Without Congressional action, federal funding for CHIP will not be provided to the states after fiscal year (FY) 2015. H.R. 919 would prevent a lapse in funding and ensure states are able to maintain their CHIP programs so that children do not experience coverage disruptions.
- Maintaining increased federal CHIP matching funds: The Affordable Care Act (ACA) authorized a 23 percentage point increase of the federal CHIP match to states starting in 2016. H.R. 919 would fund CHIP at levels that account for the increased federal funds.
- Continuing state performance incentives through FY 2019: CHIPRA allowed states to receive incentive payments for improving enrollment and retention of CHIP coverage through FY 2013. H.R. 919 would reauthorize state performance incentives through FY 2019 and provide new funding for the program.
Extending Pediatric Quality Initiatives
- Continuing pediatric quality efforts through FY 2019: CHIPRA established the first national investment in pediatric quality, an effort championed by children’s hospitals, but funding is expected to expire in 2015. H.R. 919 would continue the CHIPRA pediatric quality initiatives and extend funding for pediatric quality through FY 2019.
- Requiring state reporting of pediatric quality measures: Currently, states voluntarily report on the pediatric core set of measures, which has led to inconsistent reporting. H.R. 919 would require states to report on the full set of pediatric core measures five years after enactment of the legislation and provide technical assistance to assist state reporting efforts.
- Incentivizing states for pediatric quality activities: H.R. 919 would provide an increased federal match rate for eligible expenditures associated with the collection and reporting of child health quality measures through FY2019. The bill would also provide technical assistance to states.
Maintaining Medicaid Payment Equity
- Extending the Medicaid primary care payment increase through 2019: The ACA allowed certain provider, including pediatricians and pediatric sub-specialists, to receive increased Medicaid payments for primary care services in 2013 and 2014. This effort recognized the difference in reimbursement between Medicare and Medicaid providers. H.R. 919 would extend payment equity through the end of 2019 to ensure Medicaid payments are no less than Medicare payments.
- Providing payment equity to more Medicaid providers: Currently, only certain primary care physicians are eligible for the Medicaid primary care payment increase. H.R. 919 would extend payment equity to neurologists, psychiatrists, obstetricians/gynecologists, nurse practitioners, physician assistants, clinical nurse specialists and certified nurse midwives.
Protecting Coverage Continuity
- Maintaining comparability certification standards for exchange plans: The ACA allows states to transition children enrolled in CHIP to exchange plans the Secretary of Health and Human Services (HHS) certifies as comparable to CHIP beginning in FY 2016. H.R. 919 would extend the time-frame to certify exchange plans as comparable and require HHS to establish requirements to ensure exchange plans offer comparable benefits and cost-sharing protections as CHIP by 2019.
- Improving coverage transitions for children: H.R. 919 would require HHS to issue regulations to ensure continuity of care for children who are undergoing an active course of treatment and involuntarily transition from Medicaid and CHIP.
Improving Access to Coverage
- Making express lane eligibility (ELE) a permanent state option: CHIPRA provided states the option to streamline Medicaid and CHIP eligibility determinations by accepting eligibility for other income based programs (e.g. SNAP, National School Lunch Program). The authority for ELE expires at the end of FY 2015. H.R. 919 would make ELE a permanent state option, eliminating the need for Congress to reauthorize the program each year. H.R. 919 also provides states the option to extend ELE to adult enrollment.
- Providing continuous coverage and eligibility for children and adults: H.R. 919 provides states flexibility to ensure uninterrupted coverage by allowing children and adults to be enrolled in Medicaid and CHIP for 12 continuous months before renewing their eligibility.