HIV AIDS Resource Guide/HIV-AIDS Resource Guide.iso/STAT/PROP_FED/HSA09.ASC

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     Title IX  AGGREGATE GOVERNMENT PAYMENTS
Table of Contents

Subtitle A    Aggregate State Payments


    Part 1   State Maintenance of Effort Payment

            Section 9001  State maintenance-of-effort
payment relating to non-cash assistance recipients
            Section 9002  Non-cash baseline amounts
          Section 9003  Updating of baseline amounts
            Section 9004  Non-cash assistance child and adult
defined

    Part 2   State Premium Payments

            Section 9011  State premium payment relating to
cash assistance recipients

            Section 9012  Determination of AFDC per capita
premium amount for regional alliances

            Section 9013  Determination of SSI per capita
premium amount for regional alliances

            Section 9014  Determination of number of AFDC and
SSI recipients

            Section 9015  Regional alliance adjustment factors

    Part 3   General and Miscellaneous Provisions


          Section 9021  Timing and manner of payments

             Section 9022  Review of payment level

            Section 9023  Special rules for Puerto Rico and
other territories

Subtitle B    Aggregate Federal Alliance Payments

            Section 9101  Federal premium payments for cash
assistance recipients

            Section 9102  Capped Federal alliance payments

Subtitle C    Borrowing Authority to Cover Cash-Flow Shortfalls

            Section 9201  Borrowing authority to cover cash-
flow shortfalls

Subtitle A    Aggregate State Payments

    Part 1   STATE MAINTENANCE OF EFFORT PAYMENT

            Section 9001   STATE MAINTENANCE-OF-EFFORT PAYMENT
RELATING TO NON-CASH ASSISTANCE RECIPIENTS.

    (a)  Payment. Each participating State shall provide for
each year (beginning with State's first year) for payment to
regional alliances in the State in the amounts specified in
subsection (b).

    (b)  Amount. Subject to sections 6005, 9023, and
9201(c)(2), the total amount of such payment for a year shall
be equal to the following:
        (1)  First year. In the case of the first year for a
State, the sum of
            (A)  the State non-cash, non-DSH baseline amount
for the State, determined under section 9002(a)(1) and updated
under section 9003(a)(1), and
            (B)  the State non-cash, DSH baseline amount for
the State, determined under section 9002(a)(2) and updated
under section 9003(a)(2).
        (2)  Subsequent year.In the case of any succeeding
year, the sum computed under paragraph (1) for the first year
updated to the year involved under section 9003(b) .
    (c)  Division Among Regional Alliances.In the case of a

State with more than one regional alliance, the payment

required to be made under this section shall be distributed

among the regional alliances in an equitable manner (determined

by the State) that takes into account, for each regional

alliance, the proportion of the non-cash baseline amount

(described in section 9002) that is attributable to individuals

who resided in the alliance area of the regional alliance.

Title IX, Subtitle A

           Section 9002   NON-CASH BASELINE AMOUNTS.

    (a)  Baseline Amounts.

        (1)  Non-dsh amount.The Secretary shall determine for
each State a non-cash, non-DSH baseline amount which is equal
to the sum of the following:


            (A)  Expenditures for comprehensive benefit package
for non-cash assistance children. The aggregate State medicaid
expenditures in fiscal year 1993 (as defined in subsection
(b)(1)) for the comprehensive benefit package for non-cash
assistance children (as defined in section 9004(a)).


            (B)  Expenditures for comprehensive benefit package
for non-cash assistance adults. The aggregate State medicaid
expenditures in fiscal year 1993 for the comprehensive benefit
package for non-cash assistance adults (as defined in section
9004(b)).


            (C)  Expenditures for additional benefits for
certain children receiving afdc or ssi. The aggregate medicaid
expenditures in fiscal year 1993 for all medically necessary
items and services described in section 1905(a) of the Social
Security Act (including items and services described in section
1905(r) of such Act but excluding long-term care services
described in section 1933(c) of such Act) for qualified
children described in section 1934(b)(1) of such Act who are
AFDC or SSI recipients.


        (2)  DSH amount. The Secretary shall determine for each
State a non-cash, DSH baseline amount which is equal to the DSH
expenditures in fiscal year 1993 (as defined in subsection
(b)(2)).


     (b)  State Medicaid Expenditures and DSH Expenditures
Defined.

        (1)  Aggregate state medicaid expenditures.

            (A)  In general. In this section, the term
"aggregate State medicaid expenditures" means, with respect to
specified individuals and a State in fiscal year 1993, the
amount of payments under the State medicaid plan with respect
to medical assistance furnished for such individuals for
calendar quarters in fiscal year 1993, less the amount of
Federal financial participation paid to the State with respect
to such assistance, and not including any DSH expenditures.

            (B)  Limited to payments for services. In applying
subparagraph (A), payments under the State medicaid plan shall
not be included unless Federal financial participation is
provided with respect to such payments under section 1903(a)(1)
of the Social Security Act and such payments shall not include
payments for medicare cost-sharing (as defined in section
1905(p)(3) of the Social Security Act).

        (2)  DSH expenditures. In this section, the term "DSH
expenditures" means, with respect to fiscal year 1993, payments
made under section 1923 of the Social Security Act in fiscal
year 1993 multiplied by proportion of payments for medical
assistance for hospital services (including psychiatric
hospital services) under the State medicaid plan in fiscal year
1993 that is attributable to non-cash assistance adults and non-
cash assistance children.

        (3)  Adjustment authorized to take into account cash
flow variations. If the Secretary finds that a State took an
action that had the effect of shifting the timing of medical
assistance payments under the State medicaid plan between
quarters or fiscal years in a manner so that the payments made
in fiscal year 1993 do not accurately reflect the value of the
medical assistance provided with respect to items and services
furnished in that fiscal year, the Secretary may provide for
such adjustment in the amounts computed under this subsection
as may be necessary so that the non-cash baseline amounts
determined under this section accurately reflects such value.

        (4)  Treatment of disallowances. The amounts determined
under this subsection shall take into account amounts (or an
estimate of amounts) disallowed.

    (c)  Application to Particular Items and Services in
Comprehensive Benefit Package. For purposes of subsection
(a)(1), in determining the aggregate State medicaid
expenditures for a category of items and services (within the
comprehensive benefit package) furnished in a State, there
shall be counted only that proportion of such expenditures that
were attributable to items and services included in the
comprehensive benefit package (taking into account any
limitation on amount, duration, or scope of items and services
included in such package).

            Section 9003   UPDATING OF BASELINE AMOUNTS.

    (a)  Initial Update Through the First Year.

        (1)  Non-cash, non-dsh baseline amount.The Secretary
shall update the non-cash, non-DSH baseline amount determined
under section 9002(a)(1) for each State from fiscal year 1993
through the first year, by the following percentage:

            (A)  If such first year is 1996, the applicable
percentage is 56.6 percent.
            (B)  If such first year is 1997, the applicable
percentage is 78.1 percent.
            (C)  If such first year is 1998, the applicable
percentage is 102.2 percent.
        (2)  Non-cash, dsh baseline amount. The Secretary shall
update the non-cash, DSH baseline amount determined under
section 9002(a)(2) for each State from fiscal year 1993 through
the first year, by the following percentage:
            (A)  If such first year is 1996, the applicable
percentage is 45.9 percent.
            (B)  If such first year is 1997, the applicable
percentage is 61.8 percent.
            (C)  If such first year is 1998, the applicable
percentage is 79.0 percent.
        (3)  Adjustment authorized to take into account cash
flow variations. In determining the updates under paragraphs
(1) and (2), the Secretary may provide for an adjustment in a
manner similar to the adjustment permitted under section
9002(b)(3).
    (b)  Update For Subsequent Years. For each State for each
year after the first year, the Board shall update the non-cash
baseline amount (as previously updated under this subsection)
by the product of
        (1)  1 plus the general health care inflation factor
(as defined in section 6001(a)(3)) for the year, and
        (2)  1 plus the annual percentage increase in the
population of the United States of individuals who are under 65
years of age (as estimated by the Board based on projections
made by the Bureau of Labor Statistics of the Department of
Labor) for the year.
            Section 9004   NON-CASH ASSISTANCE CHILD AND ADULT
DEFINED.
    (a)  Non-Cash Assistance Child. In this part, the term "non
cash assistance child" means a child described in section
1934(b)(1) of the Social Security Act (as inserted by section
4222(a)) who is not a medicare-eligible individual.
    (b)  Non-Cash Assistance Adult. In this part, the term "non
cash assistance adult" means an individual who is
        (1)  over 21 years,
        (2)  is a citizen or national of the United States or
an alien who is lawfully admitted for permanent residence or
otherwise permanently residing in the United States under color
of law, and
      (3)  is not an AFDC or SSI recipient or a medicare-
eligible individual.

    Part 2   STATE PREMIUM PAYMENTS
            Section 9011   STATE PREMIUM PAYMENT RELATING TO
CASH ASSISTANCE RECIPIENTS.

    (a)  In General. Subject to subsection (c), each
participating State shall provide in each year (beginning with
the State's first year) for payment to each regional alliance
in the State of an amount equal to the State medical assistance
percentage (as defined in subsection (b)) of 95 percent of the
sum of the following products:

        (1)  AFDC portion. The product of

            (A)  the AFDC per capita premium amount for the
regional alliance for the year (determined under section
9012(a)), and

            (B)  the number of AFDC recipients residing in the
alliance area in the year (as determined under section
9014(b)(1)).

        (2)  SSI portion.The product of

            (A)  the SSI per capita premium amount for the
regional alliance for the year (determined under section 9013),
and

            (B)  the number of SSI recipients residing in the
alliance area in the year (as determined under section
9014(b)(1)).

    (b)  State Medical Assistance Percentage Defined. In
subsection (a), the term "State medical assistance percentage"
means, for a State for a quarter in a fiscal year, 100 percent
minus the Federal medical assistance percentage (as defined in
section 1905(b) of the Social Security Act) for the State for
the fiscal year.

    (c)  Additional Amount. The amount of payment under
subsection (a) for a State for a year shall be increased by the
State medical assistance percentage multiplied by the sum of
the following:

        (1)  Amount of special increase in premium discount.The
aggregate increase in the premium discounts under section 6104
for AFDC and SSI families enrolled in regional alliance health
plans in the State that is attributable to subsection (b)(2) of
such section, and

        (2)  Amount of basic cost sharing reduction. The amount
of any cost sharing reduction under section 1371(c)(1) for such
families.

            Section 9012   DETERMINATION OF AFDC PER CAPITA
PREMIUM AMOUNT FOR REGIONAL ALLIANCES.

  (a)  In General. For each regional alliance in a State for
each year, the Secretary shall determine an AFDC per capita
premium amount in accordance with this section. Such amount is
equal to (1)  the per capita State medicaid expenditures for
the comprehensive benefit package for AFDC recipients for the
State for the year (as determined under subsection (b)),
multiplied by

        (2)  the regional alliance adjustment factor
(determined under section 9015) for the year for the regional
alliance.

    (b)  Per Capita State Medicaid Expenditures Defined. The
"per capita State medicaid expenditures for the comprehensive
benefit package for AFDC recipients" for a State for a year is
equal to
the base per capita expenditures (described in subsection
(c)), updated to the year involved under subsection (d)).

    (c)  Base Per Capita Expenditures.The "base per capita
expenditures" described in this subsection, for a State for a
year, is

        (1)  the baseline medicaid expenditures (as defined in
subsection (e)) for the State, divided by

        (2)  the number of AFDC recipients enrolled in the
State medicaid plan in fiscal year 1993, as determined under
section 9014(a).

    (d)  Updating.

      (1)  Initial update through year before first year.

            (A)  In general.The Secretary shall update the
base per capita expenditures described in subsection (c) for
each State from fiscal year 1993 through the year before first
year, by the applicable percentage specified in subparagraph
(B), or, if less, the increase percentage specified in
subparagraph (C).

          (B)  Applicable percentage.For purposes of
subparagraph (A), the applicable percentage specified in this
    subparagraph, in the case of a State in which the first

    year is (i)  1996 is 32.2 percent,

    (ii)  1997 is 46.6 percent, or

    (iii)  1998 is 62.1 percent.

            (C)  Increase percentage.

    (i)  In general. The increase percentage for a State
specified in this subparagraph is the Secretary's estimate of
the percentage increase in the per capita expenditures
specified in clause (ii) from fiscal year 1993 through the year
before the first year, adjusted so as to eliminate any change
in medicaid expenditures that is attributable to a reduction in
the scope of services, an arbitrary reduction in payment rates,
or a reduction in access to high quality services under the
State medicaid plan.


   (ii)  Per capita expenditures.The per capita expenditures
specified in this clause for a year is the quotient of the
baseline medicaid expenditures for the State for the year,
divided by the number of AFDC recipients enrolled in the State
medicaid plan for the year.

            (D)  Adjustment authorized to take into account
cash flow variations.In determining the update under paragraph
(1), the Secretary may provide for an adjustment in a manner
similar to the adjustment permitted under section 9002(b)(3).

        (2)  Update for subsequent years. For each State for
the first year and for each year after the first year, the
Board shall update the base per capita expenditures described
in subsection (c) (as previously updated under this subsection)
by a factor equal to 1 plus the general health care inflation
factor (as defined in section 6001(a)(3)) for the year.

     (e)  Determination of Baseline Medicaid Expenditures.

        (1)  In general. For purposes of subsection (c)(1), the
"baseline medicaid expenditures" for a State is the gross
amount of payments under the State medicaid plan with respect
to medical assistance furnished, for items and services
included in the comprehensive benefit package, for AFDC
recipients for calendar quarters in fiscal year 1993, but does
not include such expenditures for which no Federal financial
participation is provided under such plan.

        (2)  Disproportionate share payments not included. In
applying paragraph (1), payments made under section 1923 of the
Social Security Act shall not be counted in the gross amount of
payments.

        (3)  Treatment of disallowances. The amount determined
under this subsection shall take into account amounts (or an
estimate ofamounts) disallowed.

    (f)  Application to Particular Items and Services in
Comprehensive Benefit Package. For purposes of this section, in
determining the per capita State medicaid expenditures for a
category of items and services (within the comprehensive
benefit package) furnished in a State, there shall be counted
only that proportion of such expenditures (determined only with
respect to medical assistance furnished to AFDC recipients)
that were attributable to items and services included in the
comprehensive benefit package (taking into account any
limitation on amount, duration, or scope of items and services
included in such package).

            Section 9013   DETERMINATION OF SSI PER CAPITA
PREMIUM AMOUNT FOR REGIONAL ALLIANCES.

    For each regional alliance in a State for each year, the
Secretary shall determine an SSI per capita premium amount in
accordance with this section. Such amount shall be determined
in the same manner as the AFDC per capita premium amount for
the regional alliance is determined under section 9012 except
that, for purposes of this section

        (1)  any reference in such section (or in sections
referred to in such section) to an "AFDC recipient" is deemed a
reference to an SSI recipient", and

        (2)  the following percents shall be substituted for

the percents specified in section 9012(d)(1)(B):

            (A)  For 1996, 29.4 percent.

            (B)  For 1997, 43.7 percent. (C)  For 1998, 58.8

            percent.

Section 9014   DETERMINATION OF NUMBER OF AFDC AND
SSI RECIPIENTS.

    (a)  Baseline. For purposes of section 9012 and section
9013, the number of AFDC recipients and SSI recipients for a
State for fiscal year 1993 shall be determined based on actual
reports submitted by the State to the Secretary. In the case of
individuals who were not recipients for the entire fiscal year,
the number shall take into account only the portion of the year
in which they were such recipients. The Secretary may audit
such reports.

    (b)  Subsequent Years.

      (1)  Payments. For purposes of section 9011(a), the
number of AFDC and SSI recipients enrolled in regional alliance
health plans for a regional alliance shall be determined on a
monthly basis based on actual enrollment.

      (2)  Computation of regional adjustment factors and
blended plan payment rates. For purposes of computing regional
alliance adjustment factors under section 9015 and the AFDC and
SSI proportions under section 6202, the number of AFDC and SSI
recipients for a regional alliance in a State for a year
(beginning with 1997) shall be determined by the State before
the date the State is required to compute AFDC and SSI
proportions under section 6202 based on the best available
estimate of such proportion in the previous year.

            Section 9015   REGIONAL ALLIANCE ADJUSTMENT
FACTORS.
    (a)  In General. If a State
        (1)  has more than one regional alliance operating in
the State for a year, the State shall compute under this
section a regional alliance adjustment factor for each such
regional alliance for the year in accordance with subsection
(b), or
      (2)  has only one regional alliance for a year, the
regional alliance adjustment factor under this section is 1.

  (b)  Rules. The adjustment factors under subsection (a)(1)
for a year shall be computed in a manner so that

        (1)  such factors for the different regional alliances
reflect

            (A)  the variation in regional alliance per capita
premium targets (determined under section 6003), and

            (B)  the variation in base per capita expenditures
for medicaid across regional alliances; and

        (2)  the weighted average of such factors is 1.

    (c)  Use of Same Data. The weighted average under
subsection (b)(2) shall be determined based on the number of
AFDC recipients or SSI recipients (as the case may be) enrolled
in each regional alliance in a State (as determined for each
regional alliance under section 9014(b)(2)).

    (d)  Clarification of Separate Computations. Determinations
of adjustment factors under this section shall be made
separately for AFDC recipients and for SSI recipients.

    Part 3   GENERAL AND MISCELLANEOUS PROVISIONS
            Section 9021   TIMING AND MANNER OF PAYMENTS.
  The provisions of paragraphs (1) and (2) of section 9101(b)
apply to payments by a State under this subtitle in the same
manner as they apply to payments by the Secretary under section
9101, and any reference in such provisions to the Secretary is
deemed a reference to the State.

            Section 9022   REVIEW OF PAYMENT LEVEL.

    (a)  In General. The National Health Board shall review
from time to time the appropriateness of the levels of payments
required of States under
        this subtitle.

    (b)  Report. The Board may report to the Congress on such
adjustments as should be made to assure an equitable
distribution of State payments under this Act, taking into
account the revenue base in each of the States.

  (c)  Limit on Authority. Nothing in this subtitle shall be
construed as permitting the Board to change the amount of the
payments required by States under the previous sections in this
subtitle.

            Section 9023   SPECIAL RULES FOR PUERTO RICO AND
OTHER TERRITORIES.

    (a)  Waiver Authority. Notwithstanding any other
requirement of this title or title VI, the Secretary may waive
or modify any requirement of this title or title VI (other than
financial contribution and subsidy requirements) with respect
to Puerto Rico, the Virgin Islands, Guam, American Samoa, and
the Northern Mariana Islands, consistent with this section, to
accommodate their unique geographic and social conditions and
features of their health care systems.

    (b)  Territorial Maintenance of Effort and Division of
Financial Responsibility.

        (1)  In general. In the case of such a Commonwealth or
territory, the Secretary shall determine the State payments
under part 1 taking into account

            (A)  payments that qualify for Federal financial
participation under the medicaid program,

           (B)  payments that would qualify for such
participation in the absence of section 1108(c) of the Social
Security Act, and

            (C)  other factors that the Secretary may consider.

        (2)  Cash assistance recipients. With respect to such
Commonwealths and territories not covered under the
supplementary security income program, in this Act, the term
"SSI recipient" includes an individual receiving aid under a
territorial program for the aged, blind, or disabled under the
Social Security Act. Title IX, Subtitle B

Subtitle B    Aggregate Federal Alliance Payments

            Section 9101   FEDERAL PREMIUM PAYMENTS FOR CASH
ASSISTANCE RECIPIENTS.

    (a)  Amount.

        (1)  In general. The Secretary shall provide each year
(beginning with a State's first year) for payment to each
regional alliance of an amount equal to the Federal medical
assistance percentage (as defined in section 1905(b) of the
Social Security Act) of (A) 95 percent of the sum of the
products described in section 9011(a) for that State for that
fiscal year, plus (B) the sum described in section 9011(c).

        (2)  Special rules for single-payer States. In
determining the products referred to in paragraph (1) in the
case of a single-payer State, the State is deemed to be a
single regional alliance and the regional alliance adjustment
factor
(under section 9015) is deemed to be 1.
    (b)  Timing and Manner of Payment.
        (1)  In general. Amounts required to be paid under this
section shall be paid on a periodic basis that reflects the
cash flow requirements of regional alliances for payments under
this section in order to meet obligations established under
this Act and, in consultation with the Secretary of the
Treasury, the cash management interests of the Federal
Government.
        (2)  Periodic provision of information. Each regional
alliance shall periodically transmit to the Secretary such
information as the Secretary may require to make such payments.
        (3)  Reconciliation.
            (A)  Preliminary. At such time after the end of
each year as the Secretary shall specify, the State shall
submit to the Secretary such information as the Secretary may
require to do a preliminary reconciliation of the amounts paid
under this section and the amounts due.
            (B)  Final. No later than June 30 of each year, the
Secretary shall provide for a final reconciliation for such
payments for quarters in the previous year. Amounts
subsequently payable are subject to adjustment to reflect the
results of such reconciliation.
            (C)  Audit. Payments under this section are subject
to audits by the Secretary in accordance with rules established
by the Secretary.
            Section 9102   CAPPED FEDERAL ALLIANCE PAYMENTS.
    (a)  Capped Entitlement.
      (1)  Payment. The Secretary shall provide for each
calendar quarter (beginning on or after January 1, 1996) for
payment to each regional alliance of an amount equal to the
capped Federal alliance payment amount (as defined in
subsection (b)(1)) for the regional alliance for the quarter.

        (2)  Entitlement. This section constitutes budget
authority in advance of appropriations Acts, and represents the
obligation of the Federal Government to provide for the payment
to regional alliances of the capped Federal alliance payment
amount under this section.

    (b)  Capped Federal Alliance Payment Amount.

        (1)  In general. In this section, the term "capped
Federal alliance payment amount" means, for a regional alliance
for a calendar quarter in a year and subject to subsection (e),
the amount by which

            (A)  \1/4\ of the total payment obligation
(described in paragraph (2)) for the alliance for the year,
exceeds

            (B)  \1/4\ of the total amounts receivable
(described in paragraph (3)) by the alliance for the year.

        (2)  Total payment obligation. The total payment
obligation described in this paragraph for an alliance for a
year is the total amount payable by the alliance for the
following:

            (A)  Plan payments (and certain cost sharing
reductions). Payments to regional alliance health plans under
section 1351 (including amounts attributable to cost sharing
reductions under section 1371, not including a reduction under
subsection (c)(2).
            (B)  Alliance administrative expenses. Payments
retained by the regional alliance for administration (in
accordance with section 1352).
        (3)  Total amounts receivable. The total amounts
receivable by a regional alliance for a year is the sum of the
following:
            (A)  Premiums. The amount payable to the regional
alliance for the family share of premiums, employer premiums,
and liabilities owed the alliance under subtitle B of title VI,
not taking into account any failure to make or collect such
payments.
            (B)  Other government payments. The amounts payable
to the regional alliance under sections 9001, 9011, and 9101,
and payable under section 1894 of the Social Security Act (as
added by section 4003) during the year.
        (4)  No payment for certain amounts.
            (A)  Uncollected alliance premiums. Each regional
alliance is responsible, under section 1345(a), for the
collection of all amounts owed the alliance (whether by
individuals, employers, or others and whether on the basis of
premiums owed, incorrect amounts of discounts or premium, cost
sharing, or other reductions made, or otherwise), and no
amounts are payable by the Federal Goverment under this section
with respect to the failure to collect any such amounts.
            (B)  Administrative errors.
    (i)  In general. Each participating State is responsible,
under section 1202(g), for the payment to regional alliances in
the State of amounts attributable to administrative errors
(described in clause (ii)).
   (ii)  Administrative errors described. The administrative
errors described in this clause include the following:

            (I)  An eligibility error rate for premium
discounts, liability reductions, and cost sharing reductions
under sections 6104 and 6123, section 6113,  and section 1371,
respectively, to the extent the applicable error rate exceeds
the maximum permissible error rate, specified by the applicable
Secretary under section 1361(b)(1)(C), with respect to the
section involved.

            (II)  Misappropriations or other regional alliance
expenditures that the Secretary finds are attributable to
malfeasance or misfeasance by the regional alliance or the
State.

        (5)  Special rules for single-payer states. In applying
this subsection in the case of a single-payer State, the
Secretary shall develop and apply a methodology for computing
an amount of payment (with respect to each calendar quarter)
that is equivalent to the amount of payment that would have
been made to all regional alliances in the State for the
quarter if the State were not a single-payer State.

     (c)  Determination of Capped Federal Alliance Payment
Amounts.

        (1)  Reports. At such time as the Secretary may require
before the beginning of each fiscal year, each regional
alliance shall submit to the Secretary such information as the
Secretary may require to estimate the capped Federal alliance
payment amount under this section for the succeeding calendar
year (and the portion of such year that falls in such fiscal
year).

        (2)  Estimation. Before the beginning of each year, the
Secretary shall estimate for each regional alliance the capped
Federal alliance payment amount for calendar quarters in such
year. Such estimate shall be based on factors including prior
financial experience in the alliance, future estimates of
income, wages, and employment, and other characteristics of the
area found relevant by the Secretary. The Secretary shall
transmit to Congress, on a timely basis consistent with the
timely appropriation of funds under this section, a report that
specifies an estimate of the total capped Federal alliance
payment amounts owed to regional alliances under this section
for the fiscal and calendar year involved.

  (d)  Payments to Regional Alliances. Subject to subsection
(e), the provisions of section 9101(b) apply to payments under
this section in the same manner as they apply to payments under
section 9101.

    (e)  Cap on Payments.

        (1)  In general. The total amount of the capped Federal
alliance payments made under this section for quarters in a
fiscal year may not exceed the cap specified under paragraph
(2) for the fiscal year.

        (2)  Cap. Subject to paragraphs (3) and (6)

            (A)  Fiscal years 1996 through 2000. The cap under

this paragraph

    (i)  for fiscal year 1996, is $10.3 billion,

         (ii)  for fiscal year 1997, is $28.3 billion,

    (iii)  for fiscal year 1998, is $75.6 billion, (iv)  for

    fiscal year 1999, is $78.9 billion, and (v)  for fiscal

    year 2000, is $81.0 billion.

(B)  Subsequent fiscal year. The cap under this
paragraph for a fiscal year after fiscal year 2000 is the cap
under this paragraph for the previous fiscal year (not taking
into account paragraph (3)) multiplied by the product of the
factors described in subparagraph (C) for that fiscal year and
for each previous year after fiscal year 2000.

           (C)  Factor. The factor described in this
subparagraph for a fiscal year is 1 plus the following:

    (i)  CPI. The percentage change in the CPI for the fiscal
year, determined based upon the percentage change in the
average of the CPI for the 12-month period ending with May 31
of the previous fiscal year over such average for the preceding
12-month period.

    (ii)  Population. The average annual percentage change in
the
population of the United States during the 3-year period ending
in the preceding calendar year, determined by the Board based
on data supplied by the Bureau of the Census.

    (iii)  Real gdp per capita. The average annual percentage
change in the real, per capita gross domestic product of the
United States during the 3-year period ending in the preceding
calendar year, determined by the Board based on data supplied
by the Department of Commerce.

        (3)  Carryforward. If the total of the capped Federal
alliance payment amounts for all regional alliances for all
calendar quarters in a fiscal year is less than the cap
specified in paragraph (2) for the fiscal year, then the amount
of such surplus shall be accumulated and will be available in
the case of a year in which the cap would otherwise be
breached.

        (4)  Notification.

            (A)  In general. If the Secretary anticipates that
the amount of the cap, plus any carryforward from a previous
year accumulated under paragraph (3), will not be sufficient
for a fiscal year, the Secretary shall notify the President,
the Congress, and each regional alliance. Such notification
shall include information about the anticipated amount of the
shortfall and the anticipated time when the shortfall will
first occur.

            (B)  Required action. Within 30 days after
receiving such a notice, the President shall submit to Congress
a report containing specific legislative recommendations for
actions which would eliminate the shortfall.

        (5)  Congressional consideration.

            (A)  Expedited consideration. If a joint resolution
the substance of which approves the specific recommendations
submitted under paragraph (4)(B) is introduced, subject to
subparagraph (B), the provisions of section 2908 (other than
subsection (a)) of the Defense Base Closure and Realignment Act
of 1990 shall apply to the consideration of the joint
resolution in the same manner as such provisions apply to a
joint resolution described in section 2908(a) of such Act.

            (B)  Special rules. For purposes of applying
subparagraph (A) with respect to such provisions, any reference
to the Committee on Armed Services of the House of
Representatives shall be deemed a reference to an appropriate
Committee of the House of Representatives (specified by the
Speaker of the House of Representatives at the time of
submission of recommendations under paragraph (4)) and any
reference to the Committee on Armed Services of the Senate
shall be deemed a reference to an appropriate Committee of the
Senate (specified by the Majority Leader of the Senate at the
time of submission of such recommendations).

/* Under the base closing act no amendments are permitted. The
houses of congress are deemed to have approved the proprosal
unless the houses vote to reject within 90 days. A very fast
way to get an answer. */

        (6)  Method for adjusting the cap for changes in
inflation. If the inflation rate, as measured by the percentage
increase in the CPI, is projected to be significantly different
from the inflation rate projected by the Council of Economic
Advisors to the President as of October 1993, the Secretary may
adjust the caps under paragraph (2) so as to reflect such
deviation from the projection.
Title IX, Subtitle C
Subtitle C    Borrowing Authority to Cover Cash-flow Shortfalls
            Section 9201   BORROWING AUTHORITY TO COVER CASH-
FLOW SHORTFALLS.
    (a)  In General. The Secretary shall make available loans to
regional alliances in order to cover any period of temporary
cashflow shortfall attributable to any of the following:
        (1)  Any estimation discrepancy (including those
described in subsection (e)(1)).

        (2)  A period of temporary cash-flow shortfall
attributable to an administrative error (described in subsection
(e)(2)).

        (3)  A period of temporary cash-flow shortfall relating
to the relative timing during the year in which amounts are
received and payments are required to be made.

    (b)  Terms and Conditions.

        (1)  In general. Loans shall be made under this section
under terms and conditions, consistent with this subsection,
specified by the Secretary, in consultation with the Secretary
of the Treasury and taking into account Treasury cash management
rules.

        (2)  Period. Loans under this section shall be repayable
with interest over a period of not to exceed 2 years.

        (3)  Interest rate. The rate of interest on such loans
shall be at a rate determined by the Secretary of the Treasury
taking into consideration the current average rate on
outstanding marketable obligations of the United States.

        (4)  Appropriate payment adjustments. As a condition of
providing a loan under subsection (a)(1), the Secretary shall
require the regional alliance to make such adjustments under the
appropriate estimation adjustment provision (described in
subsection (f)) in order to assure the repayment of the amount
so borrowed.

        (5)  Limitation on loan balance outstanding to a
regional alliance. The total balance of loans outstanding at any
time to a regional alliance shall not exceed

            (A)  for the first year, 25 percent of the estimated
total premiums for the alliance for such year, or

            (B)  for a subsequent year, 25 percent of the actual
total premiums for the alliance for the previous year.

    (c)  Repayment.

      (1)  Estimation discrepancies and timing. Loans made
under paragraphs (1) and (3) of subsection (a) shall be repaid
through a reduction in the payment amounts otherwise required to
be made under section 9102 to the regional alliance.

        (2)  Administrative error. Loans made under subsection
(a)(2) shall be repaid through a temporary increase in the
amount
of the State maintenance-of-effort payment required under
section 9001.

    (d)  Reports. The Secretary shall annually report to
Congress on the loans made (and loan amounts repaid) under this
section.

    (e)  Sources of Discrepancy Described.

        (1)  Estimation discrepancies. The estimation
discrepancies described in this paragraph are discrepancies in
estimating the following:

            (A)  The average premium payments per family under
section 6122(b).

            (B)  The AFDC and SSI proportions under section
6202.

            (C)  The distribution of enrolled families in
different risk categories for purposes of section 1351(c).

            (D)  The distribution of enrollment in excess
premium plans (for purposes of calculating and applying the
reduced weighted average accepted bid under section
6105(c)(1)).

            (E)  The collection shortfalls (used in computing
the family collection shortfall add-on under section 6107).

        (2)  Administrative errors. The administrative errors
described in this  paragraph are errors described in section
9201(b)(4)(B)(ii).

    (f)  Estimation Adjustment Provisions Described. The
estimation adjustment provisions, referred to in subsection
(b)(4)) are the following adjustments (corresponding to the
respective estimation discrepancies specified in subsection
(d)(1)):

        (1)  Adjustments for average premium payments per
family under section 6122(b)(4).

        (2)  Adjustments in the AFDC and SSI proportions under
section 6202(d).

        (3)  Adjustments pursuant to the methodology described
in section 1541(b)(8).

        (4)  Adjustments in excess premium credit pursuant to
section 6105(b)(2).

        (5)  Adjustment in the collection shortfall add-on
under section 6107(b)(2)(C)).

    (g)  Advances; Limitations on Advances.

        (1)  In general. Subject to paragraph (2), the
Secretary of the Treasury is authorized to advance to the
Secretary, under terms and conditions determined by the
Secretary of the Treasury, amounts sufficient to cover the
loans made to regional alliances by the Secretary under this
section.

        (2)  Limitation. The total balance of Treasury advances
outstanding at any time to the Secretary under paragraph (1)
shall not exceed $3,500,000,000.