[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 321 Reported in Senate (RS)]
Calendar No. 582
107th CONGRESS
2d Session
S. 321
[Report No. 107-265]
To amend title XIX of the Social Security Act to provide families of
disabled children with the opportunity to purchase coverage under the
medicaid program for such children, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
February 13, 2001
Mr. Grassley (for himself, Mr. Kennedy, Mr. Jeffords, Mr. Baucus, Ms.
Snowe, Mr. Rockefeller, Mr. Daschle, Mr. Breaux, Mr. Conrad, Mr.
Graham, Mr. Bingaman, Mr. Kerry, Mr. Torricelli, Mrs. Lincoln, Mr.
Akaka, Mr. Bayh, Mr. Biden, Mrs. Boxer, Mr. Byrd, Mr. L. Chafee, Mr.
Cleland, Mrs. Clinton, Ms. Collins, Mr. Corzine, Mr. Crapo, Mr. Dayton,
Mr. DeWine, Mr. Dodd, Mr. Domenici, Mr. Dorgan, Mr. Durbin, Mr.
Edwards, Mrs. Feinstein, Mr. Frist, Mr. Harkin, Mr. Helms, Mr. Inouye,
Mr. Johnson, Mr. Kohl, Ms. Landrieu, Mr. Leahy, Mr. Levin, Mr.
Lieberman, Mr. Lugar, Ms. Mikulski, Mrs. Murray, Mr. Nelson of Florida,
Mr. Reed, Mr. Reid, Mr. Roberts, Mr. Santorum, Mr. Sarbanes, Mr.
Schumer, Mr. Smith of Oregon, Mr. Thomas, Mr. Thurmond, Mr. Warner, Mr.
Wellstone, Mr. Hollings, Ms. Stabenow, Mr. Miller, Mr. Hutchinson, Ms.
Cantwell, Mr. Enzi, Mr. Hagel, Mrs. Carnahan, Mr. Bond, Mr. Hatch, Mr.
Cochran, Mr. Specter, Mr. Burns, Mrs. Hutchison, Mr. Bunning, Mr.
Ensign, Mr. Carper, and Mr. Murkowski) introduced the following bill;
which was read twice and referred to the Committee on Finance
September 9, 2002
Reported by Mr. Baucus, with an amendment
[Strike out all after the enacting clause and insert the part printed
in italic]
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to provide families of
disabled children with the opportunity to purchase coverage under the
medicaid program for such children, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
<DELETED>SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT;
TABLE OF CONTENTS.</DELETED>
<DELETED> (a) Short Title.--This Act may be cited as the ``Family
Opportunity Act of 2001'' or the ``Dylan Lee James Act''.</DELETED>
<DELETED> (b) Amendments to Social Security Act.--Except as
otherwise specifically provided, whenever in this Act an amendment is
expressed in terms of an amendment to or repeal of a section or other
provision, the reference shall be considered to be made to that section
or other provision of the Social Security Act.</DELETED>
<DELETED> (c) Table of Contents.--The table of contents of this Act
is as follows:</DELETED>
<DELETED>Sec. 1. Short title; amendments to Social Security Act; table
of contents.
<DELETED>Sec. 2. Opportunity for families of disabled children to
purchase medicaid coverage for such
children.
<DELETED>Sec. 3. Treatment of inpatient psychiatric hospital services
for individuals under age 21 in home or
community-based services waivers.
<DELETED>Sec. 4. Demonstration of coverage under the medicaid program
of children with potentially severe
disabilities.
<DELETED>Sec. 5. Development and support of family-to-family health
information centers.
<DELETED>Sec. 6. Restoration of medicaid eligibility for certain SSI
beneficiaries.
<DELETED>SEC. 2. OPPORTUNITY FOR FAMILIES OF DISABLED CHILDREN TO
PURCHASE MEDICAID COVERAGE FOR SUCH CHILDREN.</DELETED>
<DELETED> (a) State Option To Allow Families of Disabled Children To
Purchase Medicaid Coverage for Such Children.--</DELETED>
<DELETED> (1) In general.--Section 1902 (42 U.S.C. 1396a),
as amended by section 2(a) of the Breast and Cervical Cancer
Prevention and Treatment Act of 2000 (Public Law 106-354; 114
Stat. 1381) and section 702(b) of the Medicare, Medicaid, and
SCHIP Benefits Improvement and Protection Act of 2000 (as
enacted into law by section 1(a)(6) of Public Law 106-554), is
amended--</DELETED>
<DELETED> (A) in subsection (a)(10)(A)(ii)--
</DELETED>
<DELETED> (i) by striking ``or'' at the end
of subclause (XVII);</DELETED>
<DELETED> (ii) by adding ``or'' at the end
of subclause (XVIII); and</DELETED>
<DELETED> (iii) by adding at the end the
following new subclause:</DELETED>
<DELETED> ``(XIX) who are disabled
children described in subsection
(cc)(1);''; and</DELETED>
<DELETED> (B) by adding at the end the following new
subsection:</DELETED>
<DELETED> ``(cc)(1) Individuals described in this paragraph are
individuals--</DELETED>
<DELETED> ``(A) who have not attained 18 years of
age;</DELETED>
<DELETED> ``(B) who would be considered disabled under
section 1614(a)(3)(C) (determined without regard to the
reference to age in that section) but for having earnings or
deemed income or resources (as determined under title XVI for
children) that exceed the requirements for receipt of
supplemental security income benefits; and</DELETED>
<DELETED> ``(C) whose family income does not exceed such
income level as the State establishes and does not exceed--
</DELETED>
<DELETED> ``(i) 300 percent of the income official
poverty line (as defined by the Office of Management
and Budget, and revised annually in accordance with
section 673(2) of the Omnibus Budget Reconciliation Act
of 1981) applicable to a family of the size involved;
or</DELETED>
<DELETED> ``(ii) such higher percent of such poverty
line as a State may establish, except that no Federal
financial participation shall be provided under section
1903(a) for any medical assistance provided to an
individual who would not be described in this
subsection but for this clause.''.</DELETED>
<DELETED> (2) Interaction with employer-sponsored family
coverage.--Section 1902(cc) (42 U.S.C. 1396a(cc)), as added by
paragraph (1), is amended by adding at the end the following
new paragraph:</DELETED>
<DELETED> ``(2)(A) If an employer of a parent of an individual
described in paragraph (1) offers family coverage under a group health
plan (as defined in section 2791(a) of the Public Health Service Act),
the State may--</DELETED>
<DELETED> ``(i) require such parent to apply for, enroll in,
and pay premiums for, such coverage as a condition of such
parent's child being or remaining eligible for medical
assistance under subsection (a)(10)(A)(ii)(XIX) if the parent
is determined eligible for such coverage and the employer
contributes at least 50 percent of the total cost of annual
premiums for such coverage; and</DELETED>
<DELETED> ``(ii) if such coverage is obtained--</DELETED>
<DELETED> ``(I) subject to paragraph (2) of section
1916(h), reduce the premium imposed by the State under
that section (if any) in an amount that reasonably
reflects the premium contribution made by the parent
for private coverage on behalf of a child with a
disability; and</DELETED>
<DELETED> ``(II) treat such coverage as a third
party liability under subsection (a)(25).</DELETED>
<DELETED> ``(B) In the case of a parent to which subparagraph (A)
applies, if the family income of such parent does not exceed 300
percent of the income official poverty line (referred to in paragraph
(1)(C)(i)), a State may provide for payment of any portion of the
annual premium for such family coverage that the parent is required to
pay. Any payments made by the State under this subparagraph shall be
considered, for purposes of section 1903(a), to be payments for medical
assistance.''.</DELETED>
<DELETED> (b) State Option To Impose Income-Related Premiums.--
Section 1916 (42 U.S.C. 1396o) is amended--</DELETED>
<DELETED> (1) in subsection (a), by striking ``subsection
(g)'' and inserting ``subsections (g) and (h)''; and</DELETED>
<DELETED> (2) by adding at the end the following new
subsection:</DELETED>
<DELETED> ``(h)(1) With respect to disabled children provided
medical assistance under section 1902(a)(10)(A)(ii)(XIX), subject to
paragraph (2), a State may (in a uniform manner for such children)
require the families of such children to pay monthly premiums set on a
sliding scale based on family income.</DELETED>
<DELETED> ``(2) A premium requirement imposed under paragraph (1)
may only apply to the extent that--</DELETED>
<DELETED> ``(A) the aggregate amount of such premium and any
premium that the parent is required to pay for family coverage
under section 1902(cc)(2)(A)(i) does not exceed 5 percent of
the family's income; and</DELETED>
<DELETED> ``(B) the requirement is imposed consistent with
section 1902(cc)(2)(A)(ii)(I).</DELETED>
<DELETED> ``(3) A State shall not require prepayment of a premium
imposed pursuant to paragraph (1) and shall not terminate eligibility
of a child under section 1902(a)(10)(A)(ii)(XIX) for medical assistance
under this title on the basis of failure to pay any such premium until
such failure continues for a period of not less than 60 days from the
date on which the premium became past due. The State may waive payment
of any such premium in any case where the State determines that
requiring such payment would create an undue hardship.''.</DELETED>
<DELETED> (c) Conforming Amendment.--Section 1903(f)(4) (42 U.S.C.
1396b(f)(4)), as amended by section 710(a) of the Medicare, Medicaid,
and SCHIP Benefits Improvement and Protection Act of 2000 (as enacted
into law by section 1(a)(6) of Public Law 106-554), is amended in the
matter preceding subparagraph (A) by inserting
``1902(a)(10)(A)(ii)(XIX),'' after ``1902(a)(10)(A)
(ii)(XVIII),''.</DELETED>
<DELETED> (d) Technical Amendments.--</DELETED>
<DELETED> (1) Section 1902 (42 U.S.C. 1396a), as amended by
section 702(b) of the Medicare, Medicaid, and SCHIP Benefits
Improvement and Protection Act of 2000 (as enacted into law by
section 1(a)(6) of Public Law 106-554), is amended by
redesignating the subsection (aa) added by such section as
subsection (bb).</DELETED>
<DELETED> (2) Section 1902(a)(15) (42 U.S.C. 1396a(a)(15)),
as added by section 702(a)(2) of the Medicare, Medicaid, and
SCHIP Benefits Improvement and Protection Act of 2000 (as so
enacted into law), is amended by striking ``subsection (aa)''
and inserting ``subsection (bb)''.</DELETED>
<DELETED> (3) Section 1915(b) (42 U.S.C. 1396n(b)), as
amended by section 702(c)(2) of the Medicare, Medicaid, and
SCHIP Benefits Improvement and Protection Act of 2000 (as so
enacted into law), is amended by striking ``1902(aa)'' and
inserting ``1902(bb)''.</DELETED>
<DELETED> (e) Effective Date.--</DELETED>
<DELETED> (1) In general.--The amendments made by
subsections (a), (b), and (c) shall apply to medical assistance
for items and services furnished on or after January 1,
2002.</DELETED>
<DELETED> (2) Technical amendments.--The amendments made by
subsection (d) shall take effect as if included in the
enactment of section 702 of the Medicare, Medicaid, and SCHIP
Benefits Improvement and Protection Act of 2000 (as enacted
into law by section 1(a)(6) of Public Law 106-554).</DELETED>
<DELETED>SEC. 3. TREATMENT OF INPATIENT PSYCHIATRIC HOSPITAL SERVICES
FOR INDIVIDUALS UNDER AGE 21 IN HOME OR COMMUNITY-BASED
SERVICES WAIVERS.</DELETED>
<DELETED> (a) In General.--Section 1915(c) (42 U.S.C. 1396n(c)) is
amended--</DELETED>
<DELETED> (1) in paragraph (1)--</DELETED>
<DELETED> (A) in the first sentence, by inserting
``, or inpatient psychiatric hospital services for
individuals under age 21,'' after ``intermediate care
facility for the mentally retarded''; and</DELETED>
<DELETED> (B) in the second sentence, by inserting
``, or inpatient psychiatric hospital services for
individuals under age 21'' before the period;</DELETED>
<DELETED> (2) in paragraph (2)(B), by striking ``or services
in an intermediate care facility for the mentally retarded''
each place it appears and inserting ``, services in an
intermediate care facility for the mentally retarded, or
inpatient psychiatric hospital services for individuals under
age 21'';</DELETED>
<DELETED> (3) by striking paragraph (2)(C) and inserting the
following:</DELETED>
<DELETED> ``(C) such individuals who are determined to be
likely to require the level of care provided in a hospital,
nursing facility, or intermediate care facility for the
mentally retarded, or inpatient psychiatric hospital services
for individuals under age 21, are informed of the feasible
alternatives, if available under the waiver, at the choice of such
individuals, to the provision of inpatient hospital services, nursing
facility services, services in an intermediate care facility for the
mentally retarded, or inpatient psychiatric hospital services for
individuals under age 21;''; and</DELETED>
<DELETED> (4) in paragraph (7)(A)--</DELETED>
<DELETED> (A) by inserting ``, or inpatient
psychiatric hospital services for individuals under age
21,'' after ``intermediate care facility for the
mentally retarded''; and</DELETED>
<DELETED> (B) by inserting ``, or who would require
inpatient psychiatric hospital services for individuals
under age 21'' before the period.</DELETED>
<DELETED> (b) Effective Date.--The amendments made by subsection (a)
apply with respect to medical assistance provided on or after January
1, 2001.</DELETED>
<DELETED>SEC. 4. DEMONSTRATION OF COVERAGE UNDER THE MEDICAID PROGRAM
OF CHILDREN WITH POTENTIALLY SEVERE
DISABILITIES.</DELETED>
<DELETED> (a) State Application.--A State may apply to the Secretary
of Health and Human Services (in this section referred to as the
``Secretary'') for approval of a demonstration project (in this section
referred to as a ``demonstration project'') under which up to a
specified maximum number of children with a potentially severe
disability (as defined in subsection (b)) are provided medical
assistance under the State medicaid plan under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).</DELETED>
<DELETED> (b) Child With a Potentially Severe Disability Defined.--
</DELETED>
<DELETED> (1) In general.--In this section, the term ``child
with a potentially severe disability'' means, with respect to a
demonstration project, an individual who--</DELETED>
<DELETED> (A) has not attained 21 years of
age;</DELETED>
<DELETED> (B) has a physical or mental condition,
disease, disorder (including a congenital birth defect
or a metabolic condition), injury, or developmental
disability that was incurred before the individual
attained such age; and</DELETED>
<DELETED> (C) is reasonably expected, but for the
receipt of medical assistance under the State medicaid
plan, to reach the level of disability defined under
section 1614(a)(3) of the Social Security Act (42
U.S.C. 1382c(a)(3)), (determined without regard to the
reference to age in subparagraph (C) of that
section).</DELETED>
<DELETED> (2) Exception.--Such term does not include an
individual who would be considered disabled under section
1614(a)(3)(C) of the Social Security Act (42 U.S.C.
1382c(a)(3)(C)) (determined without regard to the reference to
age in that section).</DELETED>
<DELETED> (c) Approval of Demonstration Projects.--</DELETED>
<DELETED> (1) In general.--Subject to paragraph (3), the
Secretary shall approve applications under subsection (a) that
meet the requirements of paragraph (2) and such additional
terms and conditions as the Secretary may require. The
Secretary may waive the requirement of section 1902(a)(1) of
the Social Security Act (42 U.S.C. 1396a(a)(1)) to allow for
sub-State demonstrations.</DELETED>
<DELETED> (2) Terms and conditions of demonstration
projects.--The Secretary may not approve a demonstration
project under this section unless the State provides assurances
satisfactory to the Secretary that the following conditions are
or will be met:</DELETED>
<DELETED> (A) Independent evaluation.--The State
provides for an independent evaluation of the project
to be conducted during fiscal year 2006.</DELETED>
<DELETED> (B) Consultation for development of
criteria.--The State consults with appropriate
pediatric health professionals in establishing the
criteria for determining whether a child has a
potentially severe disability.</DELETED>
<DELETED> (C) Annual report.--The State submits an
annual report to the Secretary (in a uniform form and
manner established by the Secretary) on the use of
funds provided under the grant that includes the
following:</DELETED>
<DELETED> (i) Enrollment and financial
statistics on--</DELETED>
<DELETED> (I) the total number of
children with a potentially severe
disability enrolled in the
demonstration project, disaggregated by
disability;</DELETED>
<DELETED> (II) the services provided
by category or code and the cost of
each service so categorized or coded;
and</DELETED>
<DELETED> (III) the number of
children enrolled in the demonstration
project who also receive services
through private insurance.</DELETED>
<DELETED> (ii) With respect to the report
submitted for fiscal year 2006, the results of
the independent evaluation conducted under
subparagraph (A).</DELETED>
<DELETED> (iii) Such additional information
as the Secretary may require.</DELETED>
<DELETED> (3) Limitations on federal funding.--</DELETED>
<DELETED> (A) Appropriation.--</DELETED>
<DELETED> (i) In general.--Out of any funds
in the Treasury not otherwise appropriated,
there is appropriated to carry out this
section--</DELETED>
<DELETED> (I) $16,666,000 for each
of fiscal years 2002 and 2003;
and</DELETED>
<DELETED> (II) $16,667,000 for each
of fiscal years 2004 through
2007.</DELETED>
<DELETED> (ii) Budget authority.--Clause (i)
constitutes budget authority in advance of
appropriations Acts and represents the
obligation of the Federal Government to provide
for the payment of the amounts appropriated
under clause (i).</DELETED>
<DELETED> (B) Limitation on payments.--In no case
may--</DELETED>
<DELETED> (i) the aggregate amount of
payments made by the Secretary to States under
this section exceed $100,000,000;</DELETED>
<DELETED> (ii) the aggregate amount of
payments made by the Secretary to States for
administrative expenses relating to the
evaluations and annual reports required under
subparagraphs (A) and (C) of paragraph (2)
exceed $2,000,000 of such $100,000,000;
or</DELETED>
<DELETED> (iii) payments be provided by the
Secretary for a fiscal year after fiscal year
2010.</DELETED>
<DELETED> (C) Funds allocated to states.--</DELETED>
<DELETED> (i) In general.--The Secretary
shall allocate funds to States based on their
applications and the availability of funds. In
making such allocations, the Secretary shall
ensure an equitable distribution of funds among
States with large populations and States with
small populations.</DELETED>
<DELETED> (ii) Availability.--Funds
allocated to a State under a grant made under
this section for a fiscal year shall remain
available until expended.</DELETED>
<DELETED> (D) Funds not allocated to states.--Funds
not allocated to States in the fiscal year for which
they are appropriated shall remain available in
succeeding fiscal years for allocation by the Secretary
using the allocation formula established under this
section.</DELETED>
<DELETED> (E) Payments to states.--The Secretary
shall pay to each State with a demonstration project
approved under this section, from its allocation under
subparagraph (C), an amount for each quarter equal to
the Federal medical assistance percentage (as defined
in section 1905(b) of the Social Security Act (42
U.S.C. 1395d(b))) of expenditures in the quarter for
medical assistance provided to children with a
potentially severe disability.</DELETED>
<DELETED> (d) Recommendation.--Not later than October 1, 2005, the
Secretary shall submit a recommendation to the Committee on Commerce of
the House of Representatives and the Committee on Finance of the Senate
regarding whether the demonstration project established under this
section should be continued after fiscal year 2007.</DELETED>
<DELETED> (e) State Defined.--In this section, the term ``State''
has the meaning given such term for purposes of title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).</DELETED>
<DELETED>SEC. 5. DEVELOPMENT AND SUPPORT OF FAMILY-TO-FAMILY HEALTH
INFORMATION CENTERS.</DELETED>
<DELETED> Section 501 (42 U.S.C. 701) is amended by adding at the
end the following new subsection:</DELETED>
<DELETED> ``(c)(1) In addition to amounts appropriated under
subsection (a) and retained under section 502(a)(1) for the purpose of
carrying out activities described in subsection (a)(2), there is
appropriated to the Secretary, out of any money in the Treasury not
otherwise appropriated, for the purpose of enabling the Secretary
(through grants, contracts, or otherwise) to provide for special
projects of regional and national significance for the development and
support of family-to-family health information centers described in
paragraph (2), $10,000,000 for each of fiscal years 2002 through 2007.
Funds appropriated under this paragraph shall remain available until
expended.</DELETED>
<DELETED> ``(2) The family-to-family health information centers
described in this paragraph are centers that--</DELETED>
<DELETED> ``(A) assist families of children with
disabilities or special health care needs to make informed
choices about health care in order to promote good treatment
decisions, cost-effectiveness, and improved health outcomes for
such children;</DELETED>
<DELETED> ``(B) provide information regarding the health
care needs of, and resources available for, children with
disabilities or special health care needs;</DELETED>
<DELETED> ``(C) identify successful health delivery models
for such children;</DELETED>
<DELETED> ``(D) develop with representatives of health care
providers, managed care organizations, health care purchasers,
and appropriate State agencies a model for collaboration
between families of such children and health
professionals;</DELETED>
<DELETED> ``(E) provide training and guidance regarding
caring for such children;</DELETED>
<DELETED> ``(F) conduct outreach activities to the families
of such children, health professionals, schools, and other
appropriate entities and individuals; and</DELETED>
<DELETED> ``(G) are staffed by families of children with
disabilities or special health care needs who have expertise in
Federal and State public and private health care systems and
health professionals.</DELETED>
<DELETED> ``(3) The provisions of this title that are applicable to
the funds made available to the Secretary under section 502(a)(1) apply
in the same manner to funds made available to the Secretary under
paragraph (1).''.</DELETED>
<DELETED>SEC. 6. RESTORATION OF MEDICAID ELIGIBILITY FOR CERTAIN SSI
BENEFICIARIES.</DELETED>
<DELETED> (a) In General.--Section 1902(a)(10)(A)(i)(II) (42 U.S.C.
1396a(a)(10)(A)(i)(II)) is amended--</DELETED>
<DELETED> (1) by inserting ``(aa)'' after
``(II)'';</DELETED>
<DELETED> (2) by striking ``or who are'' and inserting ``,
(bb) who are''; and</DELETED>
<DELETED> (3) by inserting before the comma at the end the
following: ``, or (cc) who are under 21 years of age and with
respect to whom supplemental security income benefits would be
paid under title XVI if subparagraphs (A) and (B) of section
1611(c)(7) were applied without regard to the phrase `the first
day of the month following'''.</DELETED>
<DELETED> (b) Effective Date.--The amendments made by subsection (a)
shall apply to medical assistance for items and services furnished on
or after the first day of the first calendar quarter that begins after
the date of enactment of this Act.</DELETED>
SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT; TABLE OF
CONTENTS.
(a) Short Title.--This Act may be cited as the ``Family Opportunity
Act of 2002'' or the ``Dylan Lee James Act''.
(b) Amendments to Social Security Act.--Except as otherwise
specifically provided, whenever in this Act an amendment is expressed
in terms of an amendment to or repeal of a section or other provision,
the reference shall be considered to be made to that section or other
provision of the Social Security Act.
(c) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; amendments to Social Security Act; table of
contents.
Sec. 2. Opportunity for families of disabled children to purchase
medicaid coverage for such children.
Sec. 3. Treatment of inpatient psychiatric hospital services for
individuals under age 21 in home or
community-based services waivers.
Sec. 4. Development and support of family-to-family health information
centers.
Sec. 5. Restoration of medicaid eligibility for certain SSI
beneficiaries.
SEC. 2. OPPORTUNITY FOR FAMILIES OF DISABLED CHILDREN TO PURCHASE
MEDICAID COVERAGE FOR SUCH CHILDREN.
(a) State Option To Allow Families of Disabled Children To Purchase
Medicaid Coverage for Such Children.--
(1) In general.--Section 1902 (42 U.S.C. 1396a) is
amended--
(A) in subsection (a)(10)(A)(ii)--
(i) by striking ``or'' at the end of
subclause (XVII);
(ii) by adding ``or'' at the end of
subclause (XVIII); and
(iii) by adding at the end the following
new subclause:
``(XIX) who are disabled children
described in subsection (cc)(1);''; and
(B) by adding at the end the following new
subsection:
``(cc)(1) Individuals described in this paragraph are individuals--
``(A) who have not attained 18 years of age;
``(B) who would be considered disabled under section
1614(a)(3)(C) but for having earnings or deemed income or
resources (as determined under title XVI for children) that
exceed the requirements for receipt of supplemental security
income benefits; and
``(C) whose family income does not exceed such income level
as the State establishes and does not exceed--
``(i) 250 percent of the income official poverty
line (as defined by the Office of Management and
Budget, and revised annually in accordance with section
673(2) of the Omnibus Budget Reconciliation Act of
1981) applicable to a family of the size involved; or
``(ii) such higher percent of such poverty line as
a State may establish, except that--
``(I) any medical assistance provided to an
individual whose family income exceeds 250
percent of such poverty line may only be
provided with State funds; and
``(II) no Federal financial participation
shall be provided under section 1903(a) for any
medical assistance provided to such an
individual.''.
(2) Interaction with employer-sponsored family coverage.--
Section 1902(cc) (42 U.S.C. 1396a(cc)), as added by paragraph
(1)(B), is amended by adding at the end the following new
paragraph:
``(2)(A) If an employer of a parent of an individual described in
paragraph (1) offers family coverage under a group health plan (as
defined in section 2791(a) of the Public Health Service Act), the State
shall--
``(i) require such parent to apply for, enroll in, and pay
premiums for, such coverage as a condition of such parent's
child being or remaining eligible for medical assistance under
subsection (a)(10)(A)(ii)(XIX) if the parent is determined
eligible for such coverage and the employer contributes at
least 50 percent of the total cost of annual premiums for such
coverage; and
``(ii) if such coverage is obtained--
``(I) subject to paragraph (2) of section 1916(h),
reduce the premium imposed by the State under that
section in an amount that reasonably reflects the
premium contribution made by the parent for private
coverage on behalf of a child with a disability; and
``(II) treat such coverage as a third party
liability under subsection (a)(25).
``(B) In the case of a parent to which subparagraph (A) applies, a
State, subject to paragraph (1)(C)(ii), may provide for payment of any
portion of the annual premium for such family coverage that the parent
is required to pay. Any payments made by the State under this
subparagraph shall be considered, for purposes of section 1903(a), to
be payments for medical assistance.''.
(b) State Option To Impose Income-Related Premiums.--Section 1916
(42 U.S.C. 1396o) is amended--
(1) in subsection (a), by striking ``subsection (g)'' and
inserting ``subsections (g) and (h)''; and
(2) by adding at the end the following new subsection:
``(h)(1) With respect to disabled children provided medical
assistance under section 1902(a)(10)(A)(ii)(XIX), subject to paragraph
(2), a State may (in a uniform manner for such children) require the
families of such children to pay monthly premiums set on a sliding
scale based on family income.
``(2) A premium requirement imposed under paragraph (1) may only
apply to the extent that--
``(A) the aggregate amount of such premium and any premium
that the parent is required to pay for family coverage under
section 1902(cc)(2)(A)(i) does not exceed 5 percent of the
family's income; and
``(B) the requirement is imposed consistent with section
1902(cc)(2)(A)(ii)(I).
``(3) A State shall not require prepayment of a premium imposed
pursuant to paragraph (1) and shall not terminate eligibility of a
child under section 1902(a)(10)(A)(ii)(XIX) for medical assistance
under this title on the basis of failure to pay any such premium until
such failure continues for a period of not less than 60 days from the
date on which the premium became past due. The State may waive payment
of any such premium in any case where the State determines that
requiring such payment would create an undue hardship.''.
(c) Conforming Amendments.--Section 1903(f)(4) (42 U.S.C.
1396b(f)(4)) is amended in the matter preceding subparagraph (A), by
inserting ``1902(a)(10)(A)(ii)(XIX),'' after
``1902(a)(10)(A)(ii)(XVIII),''.
(d) Effective Date.--The amendments made by this section shall
apply to medical assistance for items and services furnished on or
after October 1, 2004.
SEC. 3. TREATMENT OF INPATIENT PSYCHIATRIC HOSPITAL SERVICES FOR
INDIVIDUALS UNDER AGE 21 IN HOME OR COMMUNITY-BASED
SERVICES WAIVERS.
(a) In General.--Section 1915(c) (42 U.S.C. 1396n(c)) is amended--
(1) in paragraph (1)--
(A) in the first sentence, by inserting ``, or
would require inpatient psychiatric hospital services
for individuals under age 21,'' after ``intermediate
care facility for the mentally retarded''; and
(B) in the second sentence, by inserting ``, or
would require inpatient psychiatric hospital services
for individuals under age 21'' before the period;
(2) in paragraph (2)(B), by striking ``or services in an
intermediate care facility for the mentally retarded'' each
place it appears and inserting ``services in an intermediate
care facility for the mentally retarded, or inpatient
psychiatric hospital services for individuals under age 21'';
(3) in paragraph (2)(C)--
(A) by inserting ``, or who are determined to be
likely to require inpatient psychiatric hospital
services for individuals under age 21,'' after ``, or
intermediate care facility for the mentally retarded'';
and
(B) by striking ``or services in an intermediate
care facility for the mentally retarded'' and inserting
``services in an intermediate care facility for the
mentally retarded, or inpatient psychiatric hospital
services for individuals under age 21''; and
(4) in paragraph (7)(A)--
(A) by inserting ``or would require inpatient
psychiatric hospital services for individuals under age
21,'' after ``intermediate care facility for the
mentally retarded,''; and
(B) by inserting ``or who would require inpatient
psychiatric hospital services for individuals under age
21'' before the period.
(b) Effective Date.--The amendments made by subsection (a) apply
with respect to medical assistance provided on or after January 1,
2003.
SEC. 4. DEVELOPMENT AND SUPPORT OF FAMILY-TO-FAMILY HEALTH INFORMATION
CENTERS.
Section 501 (42 U.S.C. 701) is amended by adding at the end the
following new subsection:
``(c)(1)(A) For the purpose of enabling the Secretary (through
grants, contracts, or otherwise) to provide for special projects of
regional and national significance for the development and support of
family-to-family health information centers described in paragraph
(2)--
``(i) there is appropriated to the Secretary, out of any
money in the Treasury not otherwise appropriated--
``(I) $3,000,000 for fiscal year 2003;
``(II) $4,000,000 for fiscal year 2004; and
``(III) $5,000,000 for fiscal year 2005; and
``(ii) there is authorized to be appropriated to the
Secretary, $5,000,000 for each of fiscal years 2006 and 2007.
``(B) Funds appropriated or authorized to be appropriated under
subparagraph (A) shall--
``(i) be in addition to amounts appropriated under
subsection (a) and retained under section 502(a)(1) for the
purpose of carrying out activities described in subsection
(a)(2); and
``(ii) remain available until expended.
``(2) The family-to-family health information centers described in
this paragraph are centers that--
``(A) assist families of children with disabilities or
special health care needs to make informed choices about health
care in order to promote good treatment decisions, cost-
effectiveness, and improved health outcomes for such children;
``(B) provide information regarding the health care needs
of, and resources available for, children with disabilities or
special health care needs;
``(C) identify successful health delivery models for such
children;
``(D) develop with representatives of health care
providers, managed care organizations, health care purchasers,
and appropriate State agencies a model for collaboration
between families of such children and health professionals;
``(E) provide training and guidance regarding caring for
such children;
``(F) conduct outreach activities to the families of such
children, health professionals, schools, and other appropriate
entities and individuals; and
``(G) are staffed by families of children with disabilities
or special health care needs who have expertise in Federal and
State public and private health care systems and health
professionals.
``(3) The Secretary shall develop family-to-family health
information centers described in paragraph (2) under this subsection in
accordance with the following:
``(A) With respect to fiscal year 2003, such centers shall
be developed in not less than 25 States.
``(B) With respect to fiscal year 2004, such centers shall
be developed in not less than 40 States.
``(C) With respect to fiscal year 2005, such centers shall
be developed in not less than 50 States and the District of
Columbia.
``(4) The provisions of this title that are applicable to the funds
made available to the Secretary under section 502(a)(1) apply in the
same manner to funds made available to the Secretary under paragraph
(1)(A).
``(5) For purposes of this subsection, the term `State' means each
of the 50 States and the District of Columbia.''.
SEC. 5. RESTORATION OF MEDICAID ELIGIBILITY FOR CERTAIN SSI
BENEFICIARIES.
(a) In General.--Section 1902(a)(10)(A)(i)(II) (42 U.S.C.
1396a(a)(10)(A)(i)(II)) is amended--
(1) by inserting ``(aa)'' after ``(II)'';
(2) by striking ``) and'' and inserting ``and'';
(3) by striking ``section or who are'' and inserting
``section), (bb) who are''; and
(4) by inserting before the comma at the end the following:
``, or (cc) who are under 21 years of age and with respect to
whom supplemental security income benefits would be paid under
title XVI if subparagraphs (A) and (B) of section 1611(c)(7)
were applied without regard to the phrase `the first day of the
month following'''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to medical assistance for items and services furnished on or
after the first day of the first calendar quarter that begins after the
date of enactment of this Act.
Calendar No. 582
107th CONGRESS
2d Session
S. 321
[Report No. 107-265]
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to provide families of
disabled children with the opportunity to purchase coverage under the
medicaid program for such children, and for other purposes.
_______________________________________________________________________
September 9, 2002
Reported with an amendment