3200 , America's Affordable Health Choices Act of 2009, as introduced on July 14, 2009, was referred to the House Committees on Energy and Commerce, Ways and Means, Education and Labor, Oversight and Government Reform, and the Budget, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. 3200 on July 17, 2009. 3200 proposes sweeping reforms of the U.S. health insurance and health care system. The three major components of H.R. 3200 are designated Divisions A, B, and C. Division A, "Affordable Health Care Choices," focuses on reducing the number of uninsured, restructuring the private health insurance market, setting minimum standards for health benefits, and providing financial assistance to certain individuals and, in some cases, small employers. Division B, "Medicare and Medicaid Improvements," proposes modifications to the largest two health insurance programs to make them consistent with the changes proposed in Division A and to amend other provisions in existing federal statute. Division B also introduces a number of technical changes intended to improve quality of care, reduce federal and state expenditures, and address coverage gaps for both Medicare and Medicaid. For Medicaid, among other major proposals, Division B would expand Medicaid eligibility for traditional and non-traditional (mostly childless adults) beneficiary categories up to 133⅓% of the Federal Poverty Level (FPL). Division C, "Public Health and Workforce Development," would amend and expand existing health professions and nursing workforce programs. Financing. Payments to Territories. Demonstrations and Pilot Programs. Miscellaneous. Medicaid and Health Insurance Reform

			Mandatory Eligibility Expansions

H.R. Provisions of H.R. 3200 , as of January 1, 2010, tobacco cessation products would be removed from Medicaid's excluded drug list. States have the option of covering language translation or interpretation services as a benefit, so Medicaid programs could receive federal financial participation for these services. Under H.R. The Medicaid financing provisions in H.R. The proposed changes would affect Medicaid purchases of prescription drugs, disproportionate share hospital (DSH) payments, and graduate medical education (GME) payments. A number of changes to these allotments occurred after that time. 3200 would make a technical correction to the definition of Medicaid medical assistance to include payment for part or all of the cost of care and services, or the care and services themselves, or both covered under a state's Medicaid program on behalf of individuals eligible for benefits. To help the Secretary monitor prescription drug rebates, H.R. These requirements include reporting and monitoring waste, fraud, and abuse. Require Providers and Suppliers to Adopt Programs to Reduce Waste, Fraud, and Abuse

Under H.R. 3200 would extend the period for states to repay overpayments to one year when the overpayment is due to fraud. 3200 , the Secretary would be required to establish an accountable care pilot program under Medicaid, and would apply one or more of the models for the Medicare program also included in this bill. 3200 the Secretary would be required to establish a three-year Medicaid demonstration project in which eligible states would be required to reimburse certain IMDs that are not publicly owned or operated for services provided to Medicaid eligibles between the ages of 21 and 65 who are in need of medical assistance to stabilize an emergency medical condition.
The 111th Congress has devoted considerable effort to health reform that seeks to increase health insurance coverage for more Americans and help to control increasing costs, while improving quality and patient outcomes. Health reform legislation, America's Affordable Health Choices Act of 2009 (H.R. 3200), was introduced in the House on July 17, 2009, and ordered reported by the Committee on Energy and Commerce on July 31, 2009. H.R. 3200 proposes sweeping reforms of the health care delivery system, which are described in the three major components of H.R. 3200 designated Divisions A, B, and C. Division A, "Affordable Health Care Choices," focuses on reducing the number of uninsured, restructuring the private health insurance market, setting minimum standards for health benefits, and providing financial assistance to certain individuals and, in some cases, small employers. Division B, "Medicare and Medicaid Improvements," proposes modifications to the largest two health insurance programs to make them consistent with the changes proposed in Division A and to amend other provisions in existing federal statute. Division C, "Public Health and Workforce Development," would amend and expand existing health professions and nursing workforce programs.
This report summarizes the 34 Medicaid provisions in Division B of H.R. 3200. Due to the breadth of the changes proposed in H.R. 3200, some provisions of Divisions A and C also could affect Medicaid, but these are not Medicaid-specific. Division B also introduces a number of technical changes intended to improve quality of care, reduce federal and state expenditures, and address coverage gaps. The Division B provisions would introduce changes or new provisions to Medicaid eligibility; benefits; financing; waste, fraud, and abuse; payments to territories; demonstrations and pilot programs; and other miscellaneous Medicaid components. A major provision in Division B would expand Medicaid eligibility for traditional and non-traditional (mostly childless adults) beneficiary categories to 133⅓% of the Federal Poverty Level. States would receive 100% federal medical assistance percentage (FMAP) matching rates for these expanded beneficiary categories for two fiscal years (FY2013-FY2014) and then 90% thereafter (FY2015 and beyond). Another eligibility expansion would permit states the option of covering extremely high prescription drug expenditures for individuals already eligible for Medicaid when their incomes exceeded customary levels. Under benefits, Medicaid programs would be required to cover preventive services, receive higher FMAP rates to cover translations or interpretation services, and tobacco cessation products would be removed from Medicaid's excluded drug list.
There are a number of financing changes that would affect Medicaid under H.R. 3200, including reducing Medicaid disproportionate share hospital (DSH) payments by $10 billion by FY2019, increasing prescription drug rebates, and extending prescription drug discounts to Medicaid-managed care enrollees. There are a number of additional waste, fraud, and abuse provisions affecting Medicaid and the Children's Health Insurance Program (CHIP). These provisions include requirements to deny payment for health care acquired conditions, require new Medicaid Integrity Program evaluations and reports, increase the amount of time states would have to repay overpayments to one year when the overpayments were due to fraud, and require states to implement a national correct coding initiative, similar to the Medicare program. Under H.R. 3200, spending caps for the territories would be increased, and a series of demonstrations would be approved for Medicaid, including a medical home program, an accountable care organization program, and a program for stabilization of emergency medical conditions by privately owned or operated mental disease institutions.