[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 724 Reported in Senate (RS)]
Calendar No. 541
107th CONGRESS
2d Session
S. 724
[Report No. 107-233]
To amend title XXI of the Social Security Act to provide for coverage
of pregnancy-related assistance for targeted low-income pregnant women.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
April 6, 2001
Mr. Bond (for himself, Mr. Breaux, Ms. Landrieu, Mrs. Lincoln, Ms.
Collins, Mr. Lieberman, Mr. Cochran, Mr. Lott, Mr. DeWine, Mr. Dodd,
Mr. Daschle, and Mr. Johnson) introduced the following bill; which was
read twice and referred to the Committee on Finance
August 1, 2002
Reported by Mr. Baucus, with an amendment and an amendment to the title
[Strike out all after the enacting clause and insert the part printed
in italic]
_______________________________________________________________________
A BILL
To amend title XXI of the Social Security Act to provide for coverage
of pregnancy-related assistance for targeted low-income pregnant women.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
<DELETED>SECTION 1. SHORT TITLE.</DELETED>
<DELETED> This Act may be cited as the ``Mothers and Newborns Health
Insurance Act of 2001''.</DELETED>
<DELETED>SEC. 2. OPTIONAL COVERAGE OF LOW-INCOME, UNINSURED PREGNANT
WOMEN UNDER A STATE CHILD HEALTH PLAN.</DELETED>
<DELETED> (a) In General.--Title XXI of the Social Security Act (42
U.S.C. 1397aa et seq.) is amended by adding at the end the
following:</DELETED>
<DELETED>``SEC. 2111. OPTIONAL COVERAGE OF LOW-INCOME, UNINSURED
PREGNANT WOMEN.</DELETED>
<DELETED> ``(a) Optional Coverage.--Notwithstanding any other
provision of this title, a State child health plan may provide for
coverage of pregnancy-related assistance for targeted low-income
pregnant women in accordance with this section.</DELETED>
<DELETED> ``(b) Definitions.--For purposes of this
section:</DELETED>
<DELETED> ``(1) Pregnancy-related assistance.--The term
`pregnancy-related assistance' has the meaning given the term
`child health assistance' in section 2110(a) as if any
reference to targeted low-income children were a reference to
targeted low-income pregnant women, except that the assistance
shall be limited to services related to pregnancy (which
include prenatal, delivery, and postpartum services) and to
other conditions that may complicate pregnancy and shall not
include pre-pregnancy services and supplies.</DELETED>
<DELETED> ``(2) Targeted low-income pregnant woman.--The
term `targeted low-income pregnant woman' has the meaning given
the term `targeted low-income child' in section 2110(b) as if
any reference to a child were deemed a reference to a woman
during pregnancy and through the end of the month in which the
60-day period (beginning on the last day of her pregnancy)
ends.</DELETED>
<DELETED> ``(c) References to Terms and Special Rules.--In the case
of, and with respect to, a State providing for coverage of pregnancy-
related assistance to targeted low-income pregnant women under
subsection (a), the following special rules apply:</DELETED>
<DELETED> ``(1) Any reference in this title (other than
subsection (b)) to a targeted low-income child is deemed to
include a reference to a targeted low-income pregnant
woman.</DELETED>
<DELETED> ``(2) Any such reference to child health
assistance with respect to such women is deemed a reference to
pregnancy-related assistance.</DELETED>
<DELETED> ``(3) Any such reference to a child is deemed a
reference to a woman during pregnancy and the period described
in subsection (b)(2).</DELETED>
<DELETED> ``(4) The reference in section 2107(e)(1)(D) to
section 1920A (relating to presumptive eligibility for
children) is deemed a reference to section 1920 (relating to
presumptive eligibility for pregnant women).</DELETED>
<DELETED> ``(5) The medicaid applicable income level is
deemed a reference to the income level established under
section 1902(l)(2)(A).</DELETED>
<DELETED> ``(6) Subsection (a) of section 2103 (relating to
required scope of health insurance coverage) shall not apply
insofar as a State limits coverage to services described in
subsection (b)(1) and the reference to such section in section
2105(a)(1) is deemed not to require, in such case, compliance
with the requirements of section 2103(a).</DELETED>
<DELETED> ``(7) There shall be no exclusion of benefits for
services described in subsection (b)(1) based on any pre-
existing condition, and no waiting period (including a waiting
period to carry out section 2102(b)(3)(C)) shall
apply.</DELETED>
<DELETED> ``(d) No Impact on Allotments.--Nothing in this section
shall be construed as affecting the amount of any initial allotment
provided to a State under section 2104(b).</DELETED>
<DELETED> ``(e) Application of Funding Restrictions.--The coverage
under this section (and the funding of such coverage) is subject to the
restrictions of section 2105(c).''.</DELETED>
<DELETED> (b) Application of Qualified Entities to Presumptive
Eligibility for Pregnant Women Under Medicaid.--Section 1920(b) of the
Social Security Act (42 U.S.C. 1396r-1(b)) is amended by adding at the
end after and below paragraph (2) the following flush
sentence:</DELETED>
<DELETED>``The term `qualified provider' includes a qualified entity as
defined in section 1920A(b)(3).''.</DELETED>
<DELETED> (c) Conforming Amendments.--Section 2102(b)(1)(B) of the
Social Security Act (42 U.S.C. 1397bb(b)(1)(B)) is amended--</DELETED>
<DELETED> (1) by striking ``and'' at the end of clause
(i);</DELETED>
<DELETED> (2) by striking the period at the end of clause
(ii) and inserting ``, and''; and</DELETED>
<DELETED> (3) by adding at the end the following:</DELETED>
<DELETED> ``(iii) may not apply a waiting
period (including a waiting period to carry out
paragraph (3)(C)) in the case of a targeted
low-income child who is pregnant, if the State
provides for coverage of pregnancy-related
assistance for targeted low-income pregnant
women in accordance with section
2111.''.</DELETED>
<DELETED> (d) Effective Date.--The amendments made by this section
take effect on the date of enactment of this Act and apply to
allotments under title XXI of the Social Security Act (42 U.S.C. 1397aa
et seq.) for all fiscal years.</DELETED>
<DELETED>SEC. 3. AUTOMATIC ENROLLMENT FOR CHILDREN BORN TO WOMEN
RECEIVING PREGNANCY-RELATED ASSISTANCE.</DELETED>
<DELETED> (a) In General.--Section 2111 of the Social Security Act,
as added by section 2, is amended by adding at the end the
following:</DELETED>
<DELETED> ``(f) Automatic Enrollment for Children Born to Women
Receiving Pregnancy-Related Assistance.--Notwithstanding any other
provision of this title or title XIX, if a child is born to a targeted
low-income pregnant woman who was receiving pregnancy-related
assistance under this section on the date of the child's birth, the
child shall be deemed to have applied for child health assistance under
the State child health plan on the date of such birth, to have been
found eligible for such assistance under such plan (or, in the case of
a State that provides such assistance through the provision of medical
assistance under a plan under title XIX to have applied for medical
assistance under such title and to have been found eligible for such
assistance under such title on the date of such birth) and to remain
eligible for such assistance until the child attains 1 year of age, so
long as the child is a member of the woman's household.''.</DELETED>
<DELETED> (b) Effective Date.--The amendment made by subsection (a)
takes effect on the date of enactment of this Act and applies to
allotments under title XXI of the Social Security Act (42 U.S.C. 1397aa
et seq.) for all fiscal years.</DELETED>
<DELETED>SEC. 4. EXPANDED AVAILABILITY OF FUNDING FOR ADMINISTRATIVE
COSTS RELATED TO OUTREACH AND ELIGIBILITY
DETERMINATIONS.</DELETED>
<DELETED> Section 1931(h) of the Social Security Act (42 U.S.C.
1396u-1(h)) is amended--</DELETED>
<DELETED> (1) by striking the subsection heading and
inserting ``Increased Federal Matching Rate for Administrative
Costs Related to Outreach and Eligibility
Determinations'';</DELETED>
<DELETED> (2) in paragraph (2), by striking ``eligibility
determinations'' and all that follows and inserting
``determinations of the eligibility of children and pregnant
women for benefits under the State plan under this title or
title XXI, outreach to children and pregnant women likely to be
eligible for such benefits, and such other outreach- and
eligibility-related activities as the Secretary may approve.'';
and</DELETED>
<DELETED> (3) by adding at the end the following:</DELETED>
<DELETED> ``(4) Encouraging use of local and community-based
organizations in outreach and enrollment activities.--The
Secretary shall establish a procedure under which, if a State
does not otherwise obligate the amounts made available under
this subsection, local and community-based public or nonprofit
private organizations (including local and county governments,
public health departments, community health centers, children's
hospitals, and disproportionate share hospitals) may seek to
have administrative costs relating to outreach and enrollment
of children and pregnant women under this title and title XXI
treated as administrative costs of a State described in section
1903(a)(7), if such organizations have the permission of the
State involved. A State may require such an organization to
provide payment of such amounts as the State would otherwise be
responsible for in order to obtain payment under this
paragraph.''.</DELETED>
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Mothers and Newborns Health
Insurance Act of 2002''.
SEC. 2. STATE OPTION TO EXPAND OR ADD COVERAGE OF CERTAIN PREGNANT
WOMEN UNDER MEDICAID AND SCHIP.
(a) Medicaid.--
(1) Authority to expand coverage.--Section 1902(l)(2)(A)(i)
of the Social Security Act (42 U.S.C. 1396a(l)(2)(A)(i)) is
amended by inserting ``(or such higher percent as the State may
elect for purposes of expenditures for medical assistance for
pregnant women described in section 1905(u)(4)(A))'' after
``185 percent''.
(2) Enhanced matching funds available if certain conditions
met.--Section 1905 of the Social Security Act (42 U.S.C. 1396d)
is amended--
(A) in the fourth sentence of subsection (b), by
striking ``or subsection (u)(3)'' and inserting ``,
(u)(3), or (u)(4)''; and
(B) in subsection (u)--
(i) by redesignating paragraph (4) as
paragraph (5); and
(ii) by inserting after paragraph (3) the
following:
``(4) For purposes of the fourth sentence of subsection (b) and
section 2105(a), the expenditures described in this paragraph are the
following:
``(A) Certain pregnant women.--If the conditions described
in subparagraph (B) are met, expenditures for medical
assistance for pregnant women described in subsection (n) or
under section 1902(l)(1)(A) in a family the income of which
exceeds 185 percent of the poverty line, but does not exceed
the income eligibility level established under title XXI for a
targeted low-income child.
``(B) Conditions.--The conditions described in this
subparagraph are the following:
``(i) The State plans under this title and title
XXI do not provide coverage for pregnant women
described in subparagraph (A) with higher family income
without covering such pregnant women with a lower
family income.
``(ii) The State does not apply an effective income
level for pregnant women that is lower than the
effective income level (expressed as a percent of the
poverty line and considering applicable income
disregards) that has been specified under the State
plan under subsection (a)(10)(A)(i)(III) or (l)(2)(A)
of section 1902, as of January 1, 2002, to be eligible
for medical assistance as a pregnant woman.
``(C) Definition of poverty line.--In this subsection, the
term `poverty line' has the meaning given such term in section
2110(c)(5).''.
(3) Payment from title xxi allotment for medicaid expansion
costs; elimination of counting medicaid child presumptive
eligibility costs against title xxi allotment.--Section
2105(a)(1) of the Social Security Act (42 U.S.C. 1397ee(a)(1))
is amended--
(A) in the matter preceding subparagraph (A), by
striking ``(or, in the case of expenditures described
in subparagraph (B), the Federal medical assistance
percentage (as defined in the first sentence of section
1905(b)))''; and
(B) by striking subparagraph (B) and inserting the
following:
``(B) for the provision of medical assistance that
is attributable to expenditures described in section
1905(u)(4)(A);''.
(b) SCHIP.--
(1) Coverage.--Title XXI of the Social Security Act (42
U.S.C. 1397aa et seq.) is amended by adding at the end the
following:
``SEC. 2111. OPTIONAL COVERAGE OF TARGETED LOW-INCOME PREGNANT WOMEN.
``(a) Optional Coverage.--Notwithstanding any other provision of
this title, a State may provide for coverage, through an amendment to
its State child health plan under section 2102, of pregnancy-related
assistance for targeted low-income pregnant women in accordance with
this section, but only if--
``(1) the State has established an income eligibility level
for pregnant women under subsection (a)(10)(A)(i)(III) or
(l)(2)(A) of section 1902 that is at least 185 percent of the
income official poverty line; and
``(2) the State meets the conditions described in section
1905(u)(4)(B).
``(b) Definitions.--For purposes of this title:
``(1) Pregnancy-related assistance.--The term `pregnancy-
related assistance' has the meaning given the term child health
assistance in section 2110(a) as if any reference to targeted
low-income children were a reference to targeted low-income
pregnant women, except that the assistance shall be limited to
services related to pregnancy (which include prenatal,
delivery, and postpartum services and services described in
section 1905(a)(4)(C)) and to other conditions that may
complicate pregnancy.
``(2) Targeted low-income pregnant woman.--The term
`targeted low-income pregnant woman' means a woman--
``(A) during pregnancy and through the end of the
month in which the 60-day period (beginning on the last
day of her pregnancy) ends;
``(B) whose family income exceeds the effective
income level (expressed as a percent of the poverty
line and considering applicable income disregards) that
has been specified under subsection (a)(10)(A)(i)(III)
or (l)(2)(A) of section 1902, as of January 1, 2002, to
be eligible for medical assistance as a pregnant woman
under title XIX but does not exceed the income
eligibility level established under the State child
health plan under this title for a targeted low-income
child; and
``(C) who satisfies the requirements of paragraphs
(1)(A), (1)(C), (2), and (3) of section 2110(b).
``(c) References to Terms and Special Rules.--In the case of, and
with respect to, a State providing for coverage of pregnancy-related
assistance to targeted low-income pregnant women under subsection (a),
the following special rules apply:
``(1) Any reference in this title (other than in subsection
(b)) to a targeted low-income child is deemed to include a
reference to a targeted low-income pregnant woman.
``(2) Any such reference to child health assistance with
respect to such women is deemed a reference to pregnancy-
related assistance.
``(3) Any such reference to a child is deemed a reference
to a woman during pregnancy and the period described in
subsection (b)(2)(A).
``(4) In applying section 2102(b)(3)(B), any reference to
children found through screening to be eligible for medical
assistance under the State medicaid plan under title XIX is
deemed a reference to pregnant women.
``(5) There shall be no exclusion of benefits for services
described in subsection (b)(1) based on any preexisting
condition and no waiting period (including any waiting period
imposed to carry out section 2102(b)(3)(C)) shall apply.
``(6) Subsection (a) of section 2103 (relating to required
scope of health insurance coverage) shall not apply insofar as
a State limits coverage to services described in subsection
(b)(1) and the reference to such section in section
2105(a)(1)(C) is deemed not to require, in such case,
compliance with the requirements of section 2103(a).
``(7) In applying section 2103(e)(3)(B) in the case of a
pregnant woman provided coverage under this section, the
limitation on total annual aggregate cost-sharing shall be
applied to such pregnant woman.
``(8) The reference in section 2107(e)(1)(D) to section
1920A (relating to presumptive eligibility for children) is
deemed a reference to section 1920 (relating to presumptive
eligibility for pregnant women).
``(d) Automatic Enrollment for Children Born to Women Receiving
Pregnancy-Related Assistance.--If a child is born to a targeted low-
income pregnant woman who was receiving pregnancy-related assistance
under this section on the date of the child's birth, the child shall be
deemed to have applied for child health assistance under the State
child health plan and to have been found eligible for such assistance
under such plan or to have applied for medical assistance under title
XIX and to have been found eligible for such assistance under such
title, as appropriate, on the date of such birth and to remain eligible
for such assistance until the child attains 1 year of age. During the
period in which a child is deemed under the preceding sentence to be
eligible for child health or medical assistance, the child health or
medical assistance eligibility identification number of the mother
shall also serve as the identification number of the child, and all
claims shall be submitted and paid under such number (unless the State
issues a separate identification number for the child before such
period expires).''.
(2) Additional allotments for providing coverage of
pregnant women.--
(A) In general.--Section 2104 of the Social
Security Act (42 U.S.C. 1397dd) is amended by inserting
after subsection (c) the following:
``(d) Additional Allotments for Providing Coverage of Pregnant
Women.--
``(1) Appropriation; total allotment.--For the purpose of
providing additional allotments to States under this title,
there is appropriated, out of any money in the Treasury not
otherwise appropriated, for each of fiscal years 2003 through
2006, $200,000,000.
``(2) State and territorial allotments.--In addition to the
allotments provided under subsections (b) and (c), subject to
paragraphs (3) and (4), of the amount available for the
additional allotments under paragraph (1) for a fiscal year,
the Secretary shall allot to each State with a State child
health plan approved under this title--
``(A) in the case of such a State other than a
commonwealth or territory described in subparagraph
(B), the same proportion as the proportion of the
State's allotment under subsection (b) (determined
without regard to subsection (f)) to the total amount
of the allotments under subsection (b) for such States
eligible for an allotment under this paragraph for such
fiscal year; and
``(B) in the case of a commonwealth or territory
described in subsection (c)(3), the same proportion as
the proportion of the commonwealth's or territory's
allotment under subsection (c) (determined without
regard to subsection (f)) to the total amount of the
allotments under subsection (c) for commonwealths and
territories eligible for an allotment under this
paragraph for such fiscal year.
``(3) Use of additional allotment.--Additional allotments
provided under this subsection are not available for amounts
expended before October 1, 2002. Such amounts are available for
amounts expended on or after such date for child health
assistance for targeted low-income children, as well as for
pregnancy-related assistance for targeted low-income pregnant
women.
``(4) No payments unless election to expand coverage of
pregnant women.--No payments may be made to a State under this
title from an allotment provided under this subsection unless
the State provides pregnancy-related assistance for targeted
low-income pregnant women under this title, or provides medical
assistance for pregnant women under title XIX, whose family
income exceeds the effective income level applicable under
subsection (a)(10)(A)(i)(III) or (l)(2)(A) of section 1902 to a
family of the size involved as of January 1, 2002.''.
(B) Conforming amendments.--Section 2104 of the
Social Security Act (42 U.S.C. 1397dd) is amended--
(i) in subsection (a), in the matter
preceding paragraph (1), by inserting ``subject
to subsection (d),'' after ``under this
section,'';
(ii) in subsection (b)(1), by inserting
``and subsection (d)'' after ``Subject to
paragraph (4)''; and
(iii) in subsection (c)(1), by inserting
``subject to subsection (d),'' after ``for a
fiscal year,''.
(3) Additional conforming amendments.--
(A) No cost-sharing for pregnancy-related
benefits.--Section 2103(e)(2) of the Social Security
Act (42 U.S.C. 1397cc(e)(2)) is amended--
(i) in the heading, by inserting ``or
pregnancy-related services'' after ``preventive
services''; and
(ii) by inserting before the period at the
end the following: ``or for pregnancy-related
services''.
(B) No waiting period.--Section 2102(b)(1)(B) of
the Social Security Act (42 U.S.C. 1397bb(b)(1)(B)) is
amended--
(i) by striking ``, and'' at the end of
clause (i) and inserting a semicolon;
(ii) by striking the period at the end of
clause (ii) and inserting ``; and''; and
(iii) by adding at the end the following:
``(iii) may not apply a waiting period
(including a waiting period to carry out
paragraph (3)(C)) in the case of a targeted
low-income pregnant woman.''.
(c) Other Amendments to Medicaid.--
(1) Eligibility of a newborn.--Section 1902(e)(4) of the
Social Security Act (42 U.S.C. 1396a(e)(4)) is amended in the
first sentence by striking ``so long as the child is a member
of the woman's household and the woman remains (or would remain
if pregnant) eligible for such assistance''.
(2) Application of qualified entities to presumptive
eligibility for pregnant women under medicaid.--Section 1920(b)
of the Social Security Act (42 U.S.C. 1396r-1(b)) is amended by
adding at the end after and below paragraph (2) the following
flush sentence:
``The term `qualified provider' includes a qualified entity as defined
in section 1920A(b)(3).''.
(d) Effective Date.--The amendments made by this section apply to
items and services furnished on or after October 1, 2002, without
regard to whether regulations implementing such amendments have been
promulgated.
SEC. 3. REVIEW OF STATE AGENCY BLINDNESS AND DISABILITY DETERMINATIONS.
Section 1633 of the Social Security Act (42 U.S.C. 1383b) is
amended by adding at the end the following:
``(e)(1) The Commissioner of Social Security shall review
determinations, made by State agencies pursuant to subsection (a) in
connection with applications for benefits under this title on the basis
of blindness or disability, that individuals who have attained 18 years
of age are blind or disabled as of a specified onset date. The
Commissioner of Social Security shall review such a determination
before any action is taken to implement the determination.
``(2)(A) In carrying out paragraph (1), the Commissioner of Social
Security shall review--
``(i) at least 25 percent of all determinations referred to
in paragraph (1) that are made in fiscal year 2003; and
``(ii) at least 50 percent of all such determinations that
are made in fiscal year 2004 or thereafter.
``(B) In carrying out subparagraph (A), the Commissioner of Social
Security shall, to the extent feasible, select for review the
determinations which the Commissioner of Social Security identifies as
being the most likely to be incorrect.''.
Amend the title so as to read: ``A bill to amend titles XIX
and XXI of the Social Security Act to expand or add coverage of
pregnant women under the medicaid and State children's health
insurance program, and for other purposes.''.
Calendar No. 541
107th CONGRESS
2d Session
S. 724
[Report No. 107-233]
_______________________________________________________________________
A BILL
To amend title XXI of the Social Security Act to provide for coverage
of pregnancy-related assistance for targeted low-income pregnant women.
_______________________________________________________________________
August 1, 2002
Reported with an amendment and an amendment to the title