[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 28 Introduced in Senate (IS)]

103d CONGRESS
  1st Session
                                 S. 28

To improve the health of the Nation's children, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

             January 21 (legislative day, January 5), 1993

  Mr. McCain introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To improve the health of the Nation's children, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Children's Health Care Improvement 
Act of 1993''.

SEC. 2. FINDINGS.

    Congress finds that--
            (1) America's children represent the hope and future of our 
        country, and are a resource we cannot afford to squander;
            (2) Americans under 18 represent one-fourth of those 
        without health insurance, with nearly 9.8 million children 
        completely uninsured;
            (3) uninsured children are less likely to see a doctor for 
        preventive or basic care and more likely to visit the more 
        expensive emergency room setting for care when they become ill;
            (4) uninsured children are more likely to miss school and 
        may not learn as effectively as insured children;
            (5) elementary and secondary schools provide a large 
        applicant pool for insurance, much like that of a university, 
        permitting children to join with their peers in purchasing 
        insurance will result in lower rates;
            (6) the WIC, Medicaid and Maternal and Child Health block 
        grant programs each provide critical services to low income 
        mothers and children, but barriers to services exist due to the 
        fact that in most States these programs have individual 
        eligibility processes;
            (7) routine immunization of children against common disease 
        is cost effective and an effective measure against disease 
        proliferation;
            (8) migrant and community health centers are a critical 
        link to preventive and primary health care services, and there 
        is a need for expansion of this critical program; and
            (9) early identification and monitoring of those children 
        and mothers at risk of abuse or neglect to ensure that they 
        have access to health and social services is cost effective.

                 TITLE I--SCHOOL-BASED HEALTH INSURANCE

SEC. 101. ESTABLISHMENT OF PROGRAM.

    (a) In General.--The Secretary of Education, in consultation with 
the Secretary of Health and Human Services, shall establish a program 
under which local educational agencies (as such term is defined in 
section 1471(12) of the Elementary and Secondary Education Act of 1965) 
shall offer basic health insurance coverage to eligible students in 
such schools.
    (b) Requirements.--
            (1) Applicability.--The provisions of this section shall 
        apply to each local education agency that receives Federal 
        educational assistance.
            (2) State education departments.--
                    (A) Policies.--The department of education for a 
                State shall determine the types of health insurance 
                policies that should be offered under this section by 
                local education agencies of such State. In making such 
                determination, the department shall ensure that 
                coverage under a fee-for-service plan and a managed 
                care plan is available to the local educational 
                agencies in the State.
                    (B) Annual reports.--The department of education 
                for a State shall annually prepare and submit to the 
                Secretary of Education a report that describes the 
                health insurance policies offered under this section in 
                the public schools in such State.
            (3) Health insurance coverage.--The Secretary of Health and 
        Human Services, shall determine the minimum requirements that 
        any health insurance plan offered under this section must meet, 
        including--
                    (A) the primary, preventative, medical, emergency 
                and surgical care services and benefits to be covered 
                under such plan; and
                    (B) any other matter determined appropriate by such 
                Secretary.
            (4) Local administration.--The department of education for 
        a State shall administer the requirements of this section 
        through the local educational agencies.
    (c) Eligible Students.--To be eligible to be covered under a health 
insurance plan offered by a local educational agency, an individual 
shall--
            (1) not be more than 18 years of age and reside in the 
        school district;
            (2) be uninsured for a period of not less than 6 months 
        prior to the date on which coverage under the plan offered by 
        such school would commence;
            (3) not be covered or enrolled under title XIX of the 
        Social Security Act or under any other public health insurance 
        program; and
            (4) meet any other requirements determined appropriate by 
        the State department of education or the Secretary of 
        Education.
    (d) Enforcement.--If the Secretary determines that a local 
educational agency is not in compliance with the requirements of this 
section, the Secretary may withhold, or request a remittance, of not to 
exceed 10 percent of the total amount of Federal educational assistance 
to be made available, or previously made available, to such local 
educational agency for the fiscal year during which such noncompliance 
is occurring.
    (f) Construction.--This section shall not be construed as requiring 
the purchase of policies under this section.
    (g) Administrative Support.--The Secretary may provide assistance 
to local educational agencies to assist such agencies in off-setting 
the additional administrative costs to such agencies in complying with 
this section.
    (h) Regulations.--Not later than 180 days after the date of 
enactment of this Act, the Secretary of Education shall promulgate 
regulations necessary to carry out this section.

SEC. 102. REFUNDABLE TAX CREDIT FOR CHILDREN'S HEALTH INSURANCE 
              EXPENSES.

    (a) In General.--Subpart C of part IV of subchapter A of chapter 1 
of the Internal Revenue Code of 1986 (relating to refundable personal 
credits) is amended by inserting after section 34 the following new 
section:

``SEC. 34A. CHILDREN'S HEALTH INSURANCE EXPENSES.

    ``(a) Allowance of Credit.--In the case of an individual, there 
shall be allowed as a credit against the tax imposed by this subtitle 
for the taxable year an amount equal to the qualified health insurance 
expenses paid by such individual during the taxable year.
    ``(b) Qualified Health Insurance Expenses.--For purposes of this 
section--
            ``(1) In general.--The term `qualified health insurance 
        expenses' means amounts paid during the taxable year for 
        medical care (within the meaning of section 213(d)(1)(C)) with 
        respect to insurance policies issued pursuant to any program 
        approved under section 101 of the Children's Health Care 
        Improvement Act. For purposes of the preceding sentence, the 
        rules of section 213(d)(6) shall apply.
            ``(2) Dollar limit on qualified health insurance 
        expenses.--The amount of the qualified health insurance 
        expenses paid during any taxable year which may be taken into 
        account under subsection (a) shall not exceed $1,000 per 
        qualifying child adjusted under regulations promulgated by the 
        Secretary to reflect any increase in the consumer price index.
            ``(3) Phaseout.--In the case of any taxpayer whose adjusted 
        gross income exceeds 100 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, the dollar amount under paragraph 
        (2) shall be reduced (but not below zero) by the percentage by 
        which such income exceeds such poverty line.
            ``(4) Election not to take credit.--A taxpayer may elect 
        for any taxable year to have amounts described in paragraph (1) 
        not treated as qualified health insurance expenses.
            ``(5) Coordination with health insurance premium credit.--
        Paragraph (1) shall not apply to any amount taken into account 
        in computing the amount of the credit allowed under section 32.
            ``(6) Subsidized expenses.--No expense shall be treated as 
        a qualified health insurance expense if--
                    ``(A) such expense is paid, reimbursed, or 
                subsidized (whether by being disregarded for purposes 
                of another program or otherwise) by the Federal 
                Government, a State or local government, or any agency 
                or instrumentality thereof under title XIX of the 
                Social Security Act, and
                    ``(B) the payment, reimbursement, or subsidy of 
                such expense is not includible in the gross income of 
                the recipient.
    ``(c) Qualifying Child.--For purposes of this section, the term 
`qualifying child' has the meaning given to such term by section 
32(c)(3) (determined without regard to subparagraph (A)(iii)).
    ``(d) Coordination with Advance Payments of Credit.--
            ``(1) Recapture of excess advance payments.--If any payment 
        in excess of the amount of the credit allowable under this 
        section is made to the individual under 7524 during any 
        calendar year, then the tax imposed by this chapter for the 
        individual's last taxable year beginning in such calendar year 
        shall be increased by the aggregate amount of such payments.
            ``(2) Reconciliation of payments advanced and credit 
        allowed.--Any increase in tax under paragraph (1) shall not be 
        treated as tax imposed by this chapter for purposes of 
        determining the amount of any credit (other than the credit 
        allowed by subsection (a)) allowable under this subpart.
    ``(f) Reduction of Credit to Taxpayers Subject to Alternative 
Minimum Tax.--The credit allowed under this section for the taxable 
year shall be reduced by the amount of tax imposed by section 55 
(relating to alternative minimum tax) with respect to such taxpayer for 
such taxable year.
    ``(d) Regulations.--The Secretary shall prescribe such regulations 
as may be necessary to carry out the purposes of this section.''
    (b) Advance Payment of Credit.--
            (1) In general.--Chapter 77 of the Internal Revenue Code of 
        1986 (relating to miscellaneous provisions) is amended by 
        inserting after section 7523 the following new section:

``SEC. 7524. ADVANCE PAYMENT OF CREDIT FOR CHILDREN'S HEALTH INSURANCE 
              EXPENSES.

    ``(a) General Rule.--The Secretary of the Treasury shall make 
advance payments of refunds to which eligible taxpayers are entitled by 
reason of section 34A.
    ``(b) Eligible Taxpayer.--For purposes of this section, the term 
`eligible taxpayer' means, with respect to any taxable year, any 
taxpayer if the taxpayer furnishes, at such time and in such manner as 
the Secretary may prescribe, to the Secretary such information as the 
Secretary may require in order to--
            ``(1) determine if the individual will be eligible to 
        receive the credit provided by section 34A for the taxable 
        year, and
            ``(2) estimate the amount of qualified health insurance 
        expenses (as defined in section 34A(b)) for the calendar year.
    ``(c) Payments.--The Secretary shall make payment of the amount 
determined under subsection (b)(2) upon receipt of the information 
described in subsection (b).
    ``(d) Regulations.--The Secretary shall prescribe such regulations 
as may be necessary to carry out the purposes of this section.''
    (c) Conforming Amendment.--Section 213 of the Internal Revenue Code 
of 1986 (relating to deduction for medical, dental, etc., expenses) is 
amended by adding the following new subsection:
    ``(g) Coordination With Health Insurance Expenses Credit Under 
Section 34A.--The amount otherwise taken into account under subsection 
(a) as expenses paid for medical care shall be reduced by the amount 
(if any) of the children's health insurance expenses credit allowable 
to the taxpayer for the taxable year under section 34A.''
    (d) Technical Amendment.--Paragraph (2) of section 1324(b) of title 
31, United States Code, is amended by inserting before the period ``or 
from section 34A of such Code''.
    (e) Clerical Amendments.--
            (1) The table of sections for subpart A of part IV of 
        subchapter A of chapter 1 of the Internal Revenue Code of 1986 
        is amended by inserting after the item relating to section 34 
        the following new item:

                              ``Sec. 34A. Children's health insurance 
                                        expenses.''
            (2) The table of sections for chapter 77 of such Code is 
        amended by inserting after the item relating to section 7523 
        the following new item:

                              ``Sec. 7524. Advance payment of credit 
                                        for children's health insurance 
                                        expenses.''
    (f) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 1992.

 TITLE II--WIC PROGRAM, MATERNAL AND CHILD HEALTH SERVICES BLOCK GRANT 
                         PROGRAM, AND MEDICAID

SEC. 201. DEVELOPMENT OF UNIFORM APPLICATION FORM AND PROCESS.

    (a) Uniform Model Application Form and Process.--The Secretary of 
Health and Human Services (hereafter referred to in this title as the 
``Secretary''), working in consultation with the Secretary of 
Agriculture, shall develop a single model uniform application form and 
process to be utilized in applying for and obtaining benefits under the 
Special Supplemental Food Program under section 17 of the Child 
Nutrition Act of 1966 (42 U.S.C. 1786), the Maternal and Child Health 
Services Block Grant Program under title V of the Social Security Act 
(42 U.S.C. 701 et seq.), and the medicaid program under title XIX of 
the Social Security Act (42 U.S.C. 1396 et. seq.). The Secretary of 
Health and Human Services shall provide any waivers necessary to carry 
out this section.
    (b) Availability of Form and Process.--The single model uniform 
application form and process shall be made available to States electing 
to adopt such form and process for use in applying for and obtaining 
benefits under such programs.
    (c) Outreach Program.--The Secretary, working in consultation with 
the Secretary of Agriculture, shall provide an outreach program for 
States electing to adopt the single model uniform application form and 
process. The outreach program shall be designed to inform recipients 
and potential recipients of benefits under the Special Supplemental 
Food Program under section 17 of the Child Nutrition Act of 1966 (42 
U.S.C. 1786), the Maternal and Child Health Services Block Grant 
Program under title V of the Social Security Act (42 U.S.C. 701 et 
seq.), and the medicaid program under title XIX of the Social Security 
Act (42 U.S.C. 1396 et seq.) of the option to apply for benefits under 
those programs using the single model uniform application form and 
process.

SEC. 202. DEMONSTRATION PROGRAM.

    (a) In General.--The Secretary shall make grants to not more than 
five States to enable such States to conduct demonstration projects for 
the purpose of encouraging women to obtain prenatal and well-baby care 
under the Special Supplemental Food Program under section 17 the Child 
Nutrition Act of 1966 (42 U.S.C. 1786), the Maternal and Child Health 
Services Block Grant Program under title V of the Social Security Act 
(42 U.S.C. 701 et seq.), and the medicaid program under title XIX of 
the Social Security Act (42 U.S.C. 1396 et seq.).
    (b) Application.--
            (1) Submission of application.--To be eligible to receive a 
        grant under this section a State shall prepare and submit to 
        the Secretary an application at such time, in such form, and 
        containing such information as the Secretary may require.
            (2) Review and approval of application.--The Secretary 
        shall review and approve each application submitted pursuant to 
        paragraph (1) in accordance with such criteria as the Secretary 
        finds appropriate.
    (c) Amount of Grant.--The amount of a grant to a State under this 
section shall be an amount that the Secretary finds reasonable and 
necessary for the development and implementation of the State's 
demonstration program.

SEC. 203. AUTHORIZATION OF APPROPRIATIONS.

    There are authorized to be appropriated such sums as may be 
necessary to carry out the purposes of this title.

  TITLE III--EXPANSION OF MIGRANT AND COMMUNITY HEALTH CENTER PROGRAM

SEC. 301. EXPANSION OF MIGRANT AND COMMUNITY HEALTH CENTER PROGRAM.

    (a) In General.--There are authorized to be appropriated, 
$250,000,000 to enable the Secretary of Health and Human Services to 
award grants for the planning and development of additional migrant and 
community health centers under sections 329 and 330 of the Public 
Health Service Act (42 U.S.C. 254b and 254c) in medically underserved 
areas or areas in which there is a high concentration of medically 
underserved populations.
    (b) Funding for Operations.--There are authorized to be 
appropriated, $290,000,000 in each fiscal year to enable the Secretary 
of Health and Human Services to provide operational assistance to 
migrant and community health centers developed under subsection (a).

     TITLE IV--REVISION OF NATIONAL HEALTH SERVICE CORPS PRIORITIES

SEC. 401. MISSION OF THE CORPS.

    Section 331(a) of the Public Health Service Act (42 U.S.C. 254d(a)) 
is amended by adding at the end thereof the following new paragraph:
    ``(4) It shall be a principal mission of the National Health 
Service Corps to increase the access to primary health care services of 
urban and inner-city poverty stricken target populations (particularly 
infants and children), rural residents, high-risk pregnant women, 
migrant workers and their families, substance abusers, and homeless 
individuals.''.

SEC. 402. PRIMARY CARE PHYSICIAN STRATEGY.

    (a) In General.--Subpart II of part D of title III of the Public 
Health Service Act (42 U.S.C. 254d et seq.) is amended by inserting 
after section 335, the following new section:

``SEC. 335A. PRIMARY CARE PHYSICIAN STRATEGY.

    ``(a) Establishment of Strategy.--The Secretary shall develop and 
implement, using amounts appropriated under section 338(c), a strategy 
to provide incentives to encourage primary care physicians to serve--
            ``(1) in migrant or community health centers or in related 
        health programs; or
            ``(2) in medically underserved inner-city and rural areas.
    ``(b) Requirements.--The Secretary shall ensure that the strategy 
developed under subsection (a) requires the implementation of at least 
one of the programs described in paragraph (1) or (2) through the 
National Health Service Corps program.
            ``(1) Recruitment program.--Under the strategy developed 
        under subsection (a), the Secretary shall establish a program 
        under the National Health Service Corps to recruit individuals 
        from medically underserved areas to serve as Corps members in 
        the areas from which such individuals were recruited.
            ``(2) Continued service program.--Under the strategy 
        developed under subsection (a), the Secretary shall establish a 
        program under the National Health Service Corps to encourage 
        Corps members to continue to serve in medically underserved 
        areas after such individuals have discharged their service 
        obligations to the Corps. In determining the method by which to 
        encourage such individuals to continue such service, the 
        Secretary shall evaluate the desirability of providing 
        incentives for such individuals to start a private medical 
        practice or join medical groups, hospitals, and health care 
        systems operating in, or within a reasonable distance from, 
        such medically underserved areas.''.
    (b) Authorization of Appropriations.--Section 338 of such Act (42 
U.S.C. 254K) is amended by adding at the end thereof the following new 
subsection:
    ``(c) There are authorized to be appropriated to carry out section 
335A, $100,000,000 for each fiscal year.''.

                    TITLE V--CHILDHOOD IMMUNIZATIONS

SEC. 501. INCREASE IN AUTHORIZATION FOR CHILDHOOD IMMUNIZATIONS.

    Section 317(j)(1)(B) of the Public Health Service Act (42 U.S.C. 
247b(j)(1)(b)) is amended by striking out ``such sums as may be 
necessary'' and inserting in lieu thereof ``$240,000,000 for each of 
the fiscal years 1993 through 1997''.

                       TITLE VI--CHILDREN AT RISK

SEC. 601. ESTABLISHMENT OF HEALTHY START DEMONSTRATION PROGRAM.

    (a) In General.--The Secretary of Health and Human Services shall 
establish a demonstration program to award grants to five States to 
enable such States to implement healthy start programs that would track 
mothers and children at high-risk of abuse and neglect, and at risk of 
not receiving necessary services and care and enable such services to 
be obtained.
    (b) Eligibility.--To be eligible to receive a grant under this 
section a State shall prepare and submit to the Secretary of Health and 
Human Services an application at such time, in such manner, and 
containing such information as the Secretary may require, including a 
description of the program to be implemented in the State with amounts 
received under the grant.
    (c) Program Requirements.--
            (1) Distribution of funds.--In implementing a healthy start 
        program with amounts received under this section, a State shall 
        distribute funds through the State department of health to 
        community health centers or other community social service 
        programs that agree to perform identification and monitoring 
        activities with respect to at risk children.
            (2) Identification and tracking services.--In implementing 
        a healthy start program with amounts received under this 
        section, the department of health of a State shall develop and 
        implement, either directly or through agreements with entities 
        of the type described in paragraph (1), procedures to identify 
        and track infants born in target areas designated by such 
        department as areas in which children are more likely to be 
        subject to abuse or neglect.
            (3) Information.--In implementing a healthy start program 
        with amounts received under this section, a State shall require 
        that caseworkers providing services under such program to 
        mothers provide such mothers with information concerning 
        services or assistance available under the Special Supplemental 
        Food Program under section 17 of the Child Nutrition Act of 
        1966, the Food Stamp Act of 1977, titles V and XIX of the 
        Social Security Act and section 8 of the United States Housing 
        Act of 1937.
    (d) Model Screening Program.--The Secretary of Health and Human 
Services shall develop and implement, in States that receive assistance 
under this section, a screening program to identify children determined 
to be at risk of being subject to abuse or neglect.
    (e) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this section.

                                 <all>

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