[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3779 Introduced in House (IH)]







105th CONGRESS
  2d Session
                                H. R. 3779

   To amend title XIX of the Social Security Act to provide medical 
assistance for breast and cervical cancer-related treatment services to 
  certain women screened and found to have breast or cervical cancer 
              under a Federally funded screening program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 30, 1998

 Mr. Lazio of New York (for himself and Mrs. Kennelly of Connecticut) 
 introduced the following bill; which was referred to the Committee on 
                                Commerce

_______________________________________________________________________

                                 A BILL


 
   To amend title XIX of the Social Security Act to provide medical 
assistance for breast and cervical cancer-related treatment services to 
  certain women screened and found to have breast or cervical cancer 
              under a Federally funded screening program.

    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 ``Breast and Cervical Cancer Treatment 
Act of 1998''.

SEC. 2. OPTIONAL MEDICAID COVERAGE OF CERTAIN BREAST OR CERVICAL CANCER 
              PATIENTS.

    (a) Coverage as Optional Categorically Needy Group.--Section 
1902(a)(10)(A)(ii) of the Social Security Act (42 U.S.C. 
1396a(a)(10)(A)(ii)) is amended--
            (1) in subclause (XIII), by striking ``or'' at the end;
            (2) in subclause (XIV), by adding ``or'' at the end; and
            (3) by adding at the end the following:
                                    ``(XV) who are described in 
                                subsection (aa)(1) (relating to certain 
                                breast or cervical cancer patients);''.
    (b) Group and Benefit Described.--Section 1902 of the Social 
Security Act (42 U.S.C. 1396a) is amended by adding at the end the 
following:
    ``(aa)(1) Individuals described in this paragraph are individuals 
who--
            ``(A) are not described in subsection (a)(10)(A)(i);
            ``(B) have not attained age 65;
            ``(C) satisfy income and resource requirements to be 
        treated as a low-income woman for purposes of being given 
        priority under section 1504 of the Public Health Service Act 
        (42 U.S.C. 300n); and
            ``(D) are not otherwise covered under creditable coverage, 
        as defined in section 2701(c) of the Public Health Service Act 
        (45 U.S.C. 300gg(c)).
    ``(2) For purposes of this title, the term `breast or cervical 
cancer-related treatment services' means services that are medically 
necessary or appropriate for the treatment of breast or cervical cancer 
and complications arising from such treatment and for which medical 
assistance is made available under the State plan to individuals 
described in subsection (a)(10)(A)(i).''.
    (c) Presumptive Eligibility.--
            (1) In general.--Title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.) is amended by inserting after section 
        1920A the following:

    ``presumptive eligibility for certain breast or cervical cancer 
                                patients

    ``Sec. 1920B. (a) State Option.--A State plan approved under 
section 1902 may provide for making medical assistance for breast or 
cervical cancer-related treatment services available to an individual 
described in section 1902(aa)(1) (relating to certain breast or 
cervical cancer patients) during a presumptive eligibility period.
    ``(b) Definitions.--For purposes of this section:
            ``(1) Presumptive eligibility period.--The term 
        `presumptive eligibility period' means, with respect to an 
        individual described in subsection (a), the period that--
                    ``(A) begins with the date on which a qualified 
                entity determines, on the basis of preliminary 
                information, that the individual is described in 
                section 1902(aa)(1), and
                    ``(B) ends with (and includes) the earlier of--
                            ``(i) the day on which a determination is 
                        made with respect to the eligibility of such 
                        individual for services under the State plan, 
                        or
                            ``(ii) in the case of such an individual 
                        who does not file an application by the last 
                        day of the month following the month during 
                        which the entity makes the determination 
                        referred to in subparagraph (A), such last day.
            ``(2) Qualified entity.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                term `qualified entity' means any entity that--
                            ``(i) is eligible for payments under a 
                        State plan approved under this title and 
                        provides breast or cervical cancer-related 
                        treatment services; and
                            ``(ii) is determined by the State agency to 
                        be capable of making determinations of the type 
                        described in paragraph (1)(A).
                    ``(B) Regulations.--The Secretary may issue 
                regulations further limiting those entities that may 
                become qualified entities in order to prevent fraud and 
                abuse and for other reasons.
                    ``(C) Rule of construction.--Nothing in this 
                paragraph shall be construed as preventing a State from 
                limiting the classes of entities that may become 
                qualified entities, consistent with any limitations 
                imposed under subparagraph (B).
    ``(c) Administration.--
            ``(1) In general.--The State agency shall provide qualified 
        entities with--
                    ``(A) such forms as are necessary for an 
                application to be made by an individual described in 
                subsection (a) for medical assistance under the State 
                plan, and
                    ``(B) information on how to assist such individuals 
                in completing and filing such forms.
            ``(2) Notification requirements.--A qualified entity that 
        determines under subsection (b)(1)(A) that an individual 
        described in subsection (a) is presumptively eligible for 
        medical assistance for breast or cervical cancer-related 
        treatment services under a State plan shall--
                    ``(A) notify the State agency of the determination 
                within 5 working days after the date on which 
                determination is made, and
                    ``(B) inform such individual at the time the 
                determination is made that an application for medical 
                assistance under the State plan is required to be made 
                by not later than the last day of the month following 
                the month during which the determination is made.
            ``(3) Application for medical assistance.--In the case of 
        an individual described in subsection (a) who is determined by 
        a qualified entity to be presumptively eligible for medical 
        assistance for breast or cervical cancer-related treatment 
        services under a State plan, the individual shall apply for 
        medical assistance under such plan by not later than the last 
day of the month following the month during which the determination is 
made.
    ``(d) Payment.--Notwithstanding any other provision of this title, 
medical assistance for breast or cervical cancer-related treatment 
services that--
            ``(1) are furnished to an individual described in 
        subsection (a)--
                    ``(A) during a presumptive eligibility period,
                    ``(B) by an entity that is eligible for payments 
                under the State plan; and
            ``(2) are included in the care and services covered by the 
        State plan;
shall be treated as medical assistance provided by such plan for 
purposes of section 1903(a)(5)(B).''.
            (2) Presumptive eligibility conforming amendments.--
                    (A) Section 1902(a)(47) of the Social Security Act 
                (42 U.S.C. 1396a(a)(47)) is amended by inserting before 
                the semicolon at the end the following: ``and provide 
                for making medical assistance for breast or cervical 
                cancer-related treatment services available to 
                individuals described in subsection (a) of section 
                1920B during a presumptive eligibility period in 
                accordance with such section''.
                    (B) Section 1903(u)(1)(D)(v) of such Act (42 U.S.C. 
                1396b(u)(1)(D)(v)) is amended--
                            (i) by striking ``or for'' and inserting 
                        ``, for''; and
                            (ii) by inserting before the period the 
                        following: ``, or for medical assistance for 
                        breast or cervical cancer-related treatment 
                        services provided to an individual described in 
                        subsection (a) of section 1920B during a 
                        presumptive eligibility period under such 
                        section''.
    (d) Enhanced Match.--Section 1903(a)(5) of the Social Security Act 
(42 U.S.C. 1396b(a)(5)) is amended--
            (1) by striking ``an'' and inserting ``(A) an'';
            (2) by adding ``plus'' after the semicolon; and
            (3) by adding at the end the following:
            ``(B) an amount equal to 75 percent of the sums expended 
        during such quarter which are attributable to the offering, 
        arranging, and furnishing (directly or on a contract basis) of 
        breast or cervical cancer-related treatment services; plus''.
    (e) Limitation on Benefits.--Section 1902(a)(10) of the Social 
Security Act (42 U.S.C. 1396a(a)(10)) is amended in the matter 
following subparagraph (F)--
            (1) by striking ``and (XIII)'' and inserting ``(XIII)''; 
        and
            (2) by inserting before the semicolon at the end the 
        following: ``, and (XIV) the medical assistance made available 
        to an individual described in subsection (aa)(1) who is 
        eligible for medical assistance only because of subparagraph 
        (A)(ii)(XV) shall be limited to medical assistance for breast 
        or cervical cancer-related treatment services''.
    (f) Conforming Amendments.--Section 1905(a) of the Social Security 
Act (42 U.S.C. 1396d(a)) is amended in the matter preceding paragraph 
(1)--
            (1) in clause (x), by striking ``or'' at the end;
            (2) in clause (xi), by adding ``or'' at the end; and
            (3) by inserting after clause (xi) the following:
            ``(xii) individuals described in section 1902(aa)(1),''.
    (g) Effective Date.--The amendments made by this section apply to 
medical assistance furnished on or after October 1, 1998, without 
regard to whether or not final regulations to carry out such amendments 
have been promulgated by such date.
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