Title IV, SEC. 4222. ESTABLISHMENT OF PROGRAM FOR POVERTY-LEVEL CHILDREN WITH SPECIAL NEEDS. (a) Establishment of Program. Title XIX, as amended by sections 4201 and 4213 and by subsection (b), is amended by redesignating section 1934 as section 1935 and by inserting after section 1933 the following new section: ``services for poverty-level children with special needs ``Sec 1934. (a) Establishment of Program. There is hereby established a program under which the Secretary shall make payments on behalf of each qualified child (as defined in subsection (b)) during a year for all medically necessary items and services described in section 1905(a) (including items and services described in section 1905(r) but excluding long-term care services described in section 1933(c)) that are not included in the comprehensive benefit package under subtitle B of title I of the Health Security Act. ``(b) Qualified Child Defined. ``(1) In general. In this section, a `qualified child' is an eligible individual (as defined in section 1001(c)) who ``(A) for years prior to 1998, is a resident of a participating State under the Health Security Act; ``(B) is under the age of 18; and ``(C) meets the requirements relating to financial eligibility described in paragraph (2). ``for kids over 6, is 100%: missing date; at 100% (vo. 133%); also excluded children eligible by virtue of medcailly needy; ``(2) Requirements relating to financial eligibility. An individual meets the requirements of this paragraph if ``(A) the individual is an AFDC recipient or an SSI recipient (as such terms are defined in section 1902 of the Health Security Act); ``(B) the individual is eligible to receive medical assistance under the State plan under section 1902(a)(10)(C); or ``(C) the individual is ``(i) under one year of age and has adjusted family income at or below 133 percent of the applicable poverty level (as defined in section 1902(25)(A) of the Health Security Act) (or, in the case of a State that established an income level greater than 133 percent for individuals under 1 year of age for purposes of section 1902(l)(2)(A) as of October 1, 1993, an income level which is a percentage of such level not greater than 185 percent), ``(ii) the individual has attained 1 year of age but is under 6 years of age and has adjusted family income at or below 133 percent of the applicable poverty level (as defined in section 1902(25)(A) of the Health Security Act), or ``(iii) the individual was born after September 30, 1983, has attained 6 years of age, and has adjusted family income at or below 100 percent of the applicable poverty level (as defined in section 1902(25)(A) of the Health Security Act). ``(3) Enrollment procedures. ``(A) In general. Not later than July 1, 1995, the Secretary shall establish procedures for the enrollment of qualified children in the program under this section under which ``(i) essential community providers certified by the Secretary under subpart B of part 2 of subtitle F of title I of the Health Security Act serve as enrollment sites for the program; and ``(ii) any forms used for enrollment purposes are designed to make the enrollment as simple as practicable. ``(B) Individuals under alliance plans automatically enrolled. The Secretary shall establish a process under which an individual who is a qualified child under paragraph (1) and is enrolled in an alliance health plan (as defined in section 1300 of the Health Security Act) shall automatically be deemed to have met any enrollment requirements established under paragraph (1). ``(c) Additional Responsibilities of Secretary. Not later than July 1, 1995, the Secretary shall promulgate such regulations as are necessary to establish and operate the program under this section, including regulations with respect to the following: ``(1) The benefits to be provided and the circumstances under which such benefits shall be considered medically necessary. ``(2) Procedures for the periodic redetermination of an individual's eligibility for benefits. ``(3) Qualification criteria for providers participating in the program. ``(4) Payment amounts for services provided under the program, the methodology used to determine such payment amounts, and the procedures for making payments to providers. ``(5) Standards to ensure the quality of services and the coordination of services under the program with services under the comprehensive benefit package, as well as services under parts B and H of the Individuals With Disabilities Education Act, title V, and any other program providing health care, remedial, educational, and social services to qualified children as the Secretary may identify. ``(6) Hearing and appeals for individuals adversely affected by any determination by the Secretary under the program. ``(7) Such other requirements as the Secretary determines to be necessary for the proper and efficient administration of the program. ``(d) Federal Payment for Program. ``(1) In general. Subject to paragraph (2), the Secretary shall pay 100 percent of the costs of providing benefits under this program in a year, including all administrative expenses. ``(2) Annual limit on expenditures. The total amount of Federal expenditures that may be made under this section in a year may not exceed ``(A) for a year prior to 1998, an amount equal to the percentage of total expenditures for medical assistance under State plans under this title during fiscal year 1993 for services described in subsection (a) furnished to qualified children that is attributable to States in which the program is in operation during the year (adjusted to take into account the operation of the program under this section on a calendar year basis) ``(i) adjusted to take into account any increases or decreases in the number of qualified children under the most recent decennial census, as adjusted by the most recent current population survey for the year in question, and ``(ii) adjusted by the applicable percentage applied to the State non-cash baseline amount for the year under section 9003(a) of the Health Security Act; and ``(B) for 1998, the total expenditures for medical assistance under State plans under this title during 1993 for services described in subsection (a) furnished to qualified children (adjusted to take into account the operation of the program under this section on a calendar year basis) ``(i) adjusted to take into account any increases or decreases in the number of qualified children under the most recent decennial census, as adjusted by the most recent current population survey for the year in question, and ``(ii) adjusted by the update applied to the State non-cash baseline amount for the year under section 9003(b) of the Health Security Act; and ``(C) for each succeeding year, the limit established under this paragraph for the previous year (adjusted to take into account the operation of the program under this section on a calendar year basis), adjusted by the update applied to the State non-cash baseline amount for the year under section 9003(b) of the Health Security Act.''. (b) Repeal of Alternative Eligibility Standards for Children in Participating States. Section 1902(r)(2) (42 U.S.C. 1396a(r)(2)) is amended by adding at the end the following new subparagraph: ``(C) Subparagraph (A) shall not apply with respect to the determination of income and resources for children under age 18 under the State plan of a State (other than under the State plan of a State that utilized an alternative methodology pursuant to such subparagraph as of October 1, 1993) ``(i) in the case of a State that is a participating State under the Health Security Act for a year prior to 1998, for quarters beginning on or after January 1 of the first year for which the State is such a participating State; and ``(ii) in the case of any State not described in clause (i), for quarters beginning on or after January 1, 1998.''.