3962 , Affordable Health Care for America Act, was introduced in the House of Representatives on October 29, 2009. 3962 is based on H.R. 3200 , America's Affordable Health Choices Act of 2009, originally introduced on July 14, 2009, and reported separately on October 14, 2009, by three House Committees—Education and Labor, Energy and Commerce, and Ways and Means. 3962 was further modified by the manager's amendment posted on November 3, 2009. A Republican alternative amendment in the nature of a substitute, dated November 3, 2009, is addressed in a separate CRS report. 3962 as passed by the House on November 7, 2009. 3962

H.R. 3962 proposes sweeping reforms of the U.S. health insurance and health care system. The three major components of the bill 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 public health insurance programs to make them consistent with the changes proposed in Division A and to amend other provisions in existing federal statute. For Medicaid, among other major proposals, Division B would expand Medicaid eligibility for traditional and non-traditional beneficiary categories up to 150% of the federal poverty level (FPL). Division C, "Public Health and Workforce Development," would amend and expand existing health professions and nursing workforce programs. Waste, Fraud, and Abuse. Payments to Territories. Demonstrations and Pilot Programs. Full Medicaid benefits would be available to these "non-traditional" individuals, and would be fully financed by the federal government (i.e., the applicable federal medical assistance percentage would be 100%) for the periods before 2015, decreasing to 91% beginning in 2015. Provisions of H.R. This provision in H.R. The Medicaid financing provisions in H.R. Division B, Title VII—Medicaid and CHIP, Subtitle A—Medicaid and Health Reform contains a DSH financing provision, and Subtitle E—Financing, contains provisions on prescription drugs and GME. 3962 includes another provision (described below) that would increase Medicaid spending caps in the territories for each of FY2011 through FY2019. These requirements include reporting and monitoring waste, fraud, and abuse. States would be required under H.R. Accountable Care Organization Pilot Program

Under H.R. Demonstration Project for Stabilization of Emergency Medical Conditions by Institutions for Mental Diseases. 3962 , the "Indian Health Care Improvement Act Amendments of 2009," contains a number of sections related to improving American Indian and Alaska Natives' access to the Medicaid and CHIP programs. Expanded Payment

H.R. Studies and Reports

H.R. The Secretary's responsibilities for implementing the CMS office or program for coordination and protection for dual eligibles would include the following: 
(1) examination of Medicare and Medicaid payment systems to develop strategies to foster more integrated and higher quality care; 
(2) development of methods to facilitate dual eligibles' access to post-acute and community-based services and to identify actions to improve coordination of community-based care; 
(3) a study of enrollment in Medicare Savings Program or MSP (for both Medicare and Medicaid) to identify methods to more efficiently and effectively reach and enroll dual eligibles; 
(4) an assessment of communication strategies aimed at dual eligibles, including the Medicare website, 1-800-MEDICARE, and the Medicare handbook; 
(5) research and evaluation of areas where service utilization, quality, and access to cost sharing protection could be improved and an assessment of factors relating to enrollee satisfaction with services and delivery; 
(6) collection and dissemination to the public of data and a database that describes eligibility, benefits, and cost-sharing assistance available to dual eligibles by state; 
(7) support for coordination of state and federal contracting oversight for dual eligible coordination programs; 
(8) support for state Medicaid agencies by providing technical assistance for Medicaid and Medicare coordination initiatives to improve integration of acute and long-term care services for duals;
(9) monitoring total combined Medicare and Medicaid program expenditures in serving dual eligibles and making recommendations to optimize total quality and cost performance across both programs; and 
(10) coordination of Medicare Advantage plan activities under Medicare and Medicaid.
The 111th Congress has devoted considerable effort to health reform that seeks to increase health insurance coverage for more Americans and help to control costs, while improving quality and patient outcomes. The Affordable Health Choices for America Act (H.R. 3962) was introduced in the House of Representatives on October 29, 2009. H.R. 3962 is based on H.R. 3200, America's Affordable Health Choices Act of 2009, originally introduced on July 14, 2009, and reported separately on October 14, 2009, by three House Committees—Education and Labor, Energy and Commerce, and Ways and Means. H.R. 3962 was further modified by the manager's amendment posted on November 3, 2009. H.R. 3962, as passed by the House on November 7, 2009, proposes sweeping reforms of the health care delivery system, described in the three divisions. 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 small employers. Division B, "Medicare and Medicaid Improvements," proposes modifications to the largest two public health insurance programs to make them consistent with provisions 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. A Republican alternative amendment in the nature of a substitute, dated November 3, 2009, is addressed in a separate CRS report.
This report summarizes the major provisions affecting Medicaid and CHIP in H.R. 3962 (as passed), including modifications made by the manager's amendment. The report focuses primarily on provisions in Division B, Title VII—Medicaid and CHIP, plus selected provisions in Title IX—Miscellaneous Provisions. It also describes selected sections of Titles I and II of Division D, the Indian Health Care Improvement Act Amendments of 2009, related to improving access to Medicaid and CHIP for American Indians and Alaskan Natives. Due to the breadth of the changes proposed in H.R. 3962, some provisions of Divisions A and C also could affect Medicaid, but these are not Medicaid-specific. The Division B provisions would modify existing law and add new provisions affecting 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 beneficiary categories up to 150% of the federal poverty level. The federal government would fully finance the costs for certain of these expanded beneficiary categories for periods before 2015, decreasing to 91% beginning in 2015. With respect to benefits, Medicaid programs would be required to cover preventive services, and would be allowed to cover nurse home visitation and birthing center services.
There are a number of financing changes that would affect Medicaid under H.R. 3962, including reducing Medicaid disproportionate share hospital (DSH) payments by $10 billion by FY2019, increasing prescription drug rebates, and raising provider payments for certain primary care services. Additional waste, fraud, and abuse provisions affecting Medicaid and the Children's Health Insurance Program (CHIP) include requirements to deny payment for health care acquired conditions, require new Medicaid Integrity Program evaluations and reports, and require states to implement a national correct coding initiative, similar to the Medicare program. Under H.R. 3962, spending caps for the territories would be increased, and a series of demonstrations would be approved, including a medical home program, an accountable care organization program, and a program for stabilization of emergency medical conditions by mental disease institutions.