[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4767 Introduced in House (IH)]







105th CONGRESS
  2d Session
                                H. R. 4767

 To amend titles XIX and XXI of the Social Security Act to improve the 
coverage of needy children under the State Children's Health Insurance 
               Program (SCHIP) and the Medicaid Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 9, 1998

 Ms. DeGette introduced the following bill; which was referred to the 
                         Committee on Commerce

_______________________________________________________________________

                                 A BILL


 
 To amend titles XIX and XXI of the Social Security Act to improve the 
coverage of needy children under the State Children's Health Insurance 
               Program (SCHIP) and the Medicaid Program.

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

SECTION 1. SHORT TITLE; REFERENCES IN ACT; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Improved 
Children's Health Coverage Act of 1998''.
    (b) References to Social Security Act.--Except as otherwise 
expressly provided, whenever in this Act an amendment or repeal 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 a 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; references in Act; table of contents.
Sec. 2. Simplified outreach and enrollment.
Sec. 3. Family friendly coverage and enrollment.
Sec. 4. Expanded coverage options.

SEC. 2. SIMPLIFIED OUTREACH AND ENROLLMENT.

    (a) Use of Uniform Application and Coordinated Enrollment 
Process.--
            (1) SCHIP program.--Section 2102 (42 U.S.C. 1397bb) is 
        amended by adding at the end the following new subsection:
    ``(d) Development and Use of Uniform Application Forms and 
Coordinated Enrollment Process.--
            ``(1) In general.--A State child health plan shall provide, 
        by not later than October 1, 1999, for--
                    ``(A) the development and use of a uniform, 
                simplified application form which is used both for 
                purposes of establishing eligibility for benefits under 
                this title and also under title XIX;
                    ``(B) an enrollment process that is coordinated 
                with that under title XIX so that a family need only 
                interact with a single agency in order to determine 
                whether a child is eligible for benefits under this 
                title or title XIX; and
                    ``(C) acceptance and timely response to telephone 
                inquiries and other electronic communications received 
                through the national toll-free system established under 
                section 3 of the Improved Children's Health Coverage 
                Act of 1998.''.
            (2) Medicaid conforming amendment.--
                    (A) In general.--Section 1902(a) (42 U.S.C. 
                1396a(a)) is amended--
                            (i) by striking the period at the end of 
                        paragraph (65) and inserting ``; and'', and
                            (ii) by inserting after paragraph (65) the 
                        following new paragraph:
            ``(66) provide, by not later than October 1, 1999, in the 
        case of a State with a State child health plan under title XXI 
        for--
                    ``(A) the development and use of a uniform, 
                simplified application form which is used both for 
                purposes of establishing eligibility for benefits under 
                this title and also under title XXI;
                    ``(B) establishment and operation of an enrollment 
                process that is coordinated with that under title XXI 
                so that a family need only interact with a single 
                agency in order to determine whether a child is 
                eligible for benefits under this title or title XXI; 
                and
                    ``(C) acceptance and timely response to telephone 
                inquiries and other electronic communications received 
                through the national toll-free system established under 
                section 3 of the Improved Children's Health Coverage 
                Act of 1998.''.
                    (B) Effective date.--The amendments made by 
                subparagraph (A) apply to calendar quarters beginning 
                on or after October 1, 1999.
    (b) National Toll-free Information Line.--The Secretary of Health 
and Human Services shall establish, in coordination with State agencies 
responsible for administration of State Medicaid and child health 
insurance programs and by not later than October 1, 1999, for a 
national toll-free telephone number that individuals may access to 
obtain information on coverage of children under such programs.
    (c) Financial Incentives To Promote Appropriate Enrollment.--
            (1) Eliminating limitation on administrative expenditures 
        for enrollment and outreach activities.--Section 2105 (42 
        U.S.C. 1397ee) is amended--
                    (A) in subsection (a)(2)(D), by striking the period 
                and inserting the following: ``, including costs to 
                administer section 2102(d) regardless of whether such 
                expenditures might also be related to the 
                administration of title XIX.
The Secretary shall permit common administrative expenditures described 
in paragraph (2)(D) between this title and title XIX to be paid for 
under this title.'';
                    (B) in subsection (c)(2)(A), by striking 
                ``paragraph (1)'' and inserting ``paragraphs (1) and 
                (2)(C)''; and
                    (C) by adding at the end of subsection (c)(2) the 
                following:
                    ``(C) Exception for coordinated outreach and 
                enrollment expenditures.--The limitation under 
                subparagraph (A) on expenditures for items described in 
                subsection (a)(2) shall not apply to reasonable 
                administrative costs incurred in carrying out section 
                2102(d) or described in the last sentence of subsection 
                (a).''.
            (2) Additional activities to assure appropriate 
        enrollment.--Section 2105 is further amended by adding at the 
        end the following new subsection:
    ``(e) Audits of Enrollment Processes; Disallowance Based on Such 
Audits.--
            ``(1) Periodic audits.--Each State shall provide for 
        periodic independent audits of the enrollment practices to 
        determine the extent to which children provided assistance 
        under this title are eligible for medical assistance under 
        title XIX (and, therefore, should be provided assistance under 
        that title rather than under this title).
            ``(2) Disallowance based on extrapolation of audit 
        results.--Insofar as an audit under paragraph (1) finds that 
        the proportion of children provided assistance in a State under 
        this title are eligible for medical assistance under title XIX 
        exceeds 5 percent, the Secretary shall provide that the 
        reference to the enhanced FMAP in subsection (a) shall be 
        treated as a reference to the Federal medical assistance 
        percentage (as defined in the first sentence of section 
        1905(b)) with respect to expenditures for child health 
        assistance for such excess proportion of child health 
        assistance.''.
            (3) Effective date.--The amendments made by this subsection 
        take effect on the date of the enactment of this Act and apply 
        to expenditures made on or after the date of the enactment of 
        this Act.
    (d) Additional Entities Qualified to Determine Medicaid Presumptive 
Eligibility for Low-income Children.--
            (1) Section 1920A(b)(3)(A)(i) (42 U.S.C. 1396r-
        1a(b)(3)(A)(i)) is amended--
                    (A) by striking ``or (II)'' and inserting ``, 
                (II)''; and
                    (B) by inserting ``eligibility of a child for 
                medical assistance under the State plan under this 
                title, or eligibility of a child for child health 
                assistance under the program funded under title XXI, or 
                (III) is an elementary school or secondary school, as 
                such terms are defined in section 14101 of the 
                Elementary and Secondary Education Act of 1965 (20 
                U.S.C. 8801), an elementary or secondary school 
                operated or supported by the Bureau of Indian Affairs, 
                a State child support enforcement agency, a child care 
                resource and referral agency, or a State office or 
                private contractor that accepts applications for or 
                administers a program funded under part A of title IV 
                or that determines eligibility for any assistance or 
                benefits provided under any program of public or 
                assisted housing that receives Federal funds, including 
                the program under section 8 or any other section of the 
                United States Housing Act of 1937 (42 U.S.C. 1437 et 
                seq.)'' before the semicolon.

SEC. 3. FAMILY FRIENDLY COVERAGE AND ENROLLMENT.

    (a) Assuring Coordination of Pediatric Providers Within a Family.--
            (1) In general.--Section 2103 (42 U.S.C. 1397cc) is amended 
        by adding at the end the following new subsection:
    ``(g) Steps Taken to Coordinate Provision of Pediatric Care Within 
a Family.--A State child health plan--
            ``(1) shall specify methods being used to ensure that 
        children within a family who are eligible for assistance under 
        the plan (or under a State plan under title XIX) are allowed to 
        be seen by the same pediatrician or group of pediatricians in a 
        manner that permits the coordinated receipt of care by children 
        in the same family; and
            ``(2) shall include a description of such methods in each 
        annual report submitted under section 2108(a).''.
            (2) Effective date.--The amendment made by paragraph (1) 
        applies on the date of the enactment of this Act and to reports 
        submitted for years beginning with 1999.
    (b) Reduction in Burden of Administering Cost-sharing Provisions.--
            (1) State responsible for assuring cap on cost-sharing not 
        exceeded.--Section 2103(e)(3) (42 U.S.C. 1397cc(e)(3)) is 
        amended by adding at the end the following new subparagraph:
                    ``(C) State and contractors responsible for 
                applying limitations on cost-sharing.--The State child 
                health plan shall provide that responsibility for 
                assuring compliance with the limitations on cost-
                sharing under this paragraph falls on the State and on 
                its contractors, and not on beneficiaries and their 
                families.''.
            (2) State option of flat limit on out-of-pocket 
        expenditures.--Section 2103(e)(3)(B) (42 U.S.C. 
        1397cc(e)(3)(B)) is amended by inserting before the period at 
        the end the following: ``(or, at the option of a State, a 
        limiting amount which is not greater than $500)''.
            (3) Effective date.--The amendment made by paragraph (1) 
        takes effect on the date that is 30 days after the date of the 
        enactment of this Act.
    (c) Prohibition of Waiting Periods.--
            (1) In general.--Section 2102(b)(1)(B) (42 U.S.C. 
        1397bb(b)(1)(B)) is amended--
                    (A) by striking ``and'' at the end of clause (i);
                    (B) by striking the period at the end of clause 
                (ii) and inserting ``; and''; and
                    (C) by adding at the end the following new clause:
                            ``(iii) shall not permit the use of any 
                        mandatory waiting period (including any such 
                        period in order to carry out paragraph (3)(C)), 
                        unless the Secretary finds that the imposition 
of such a period would not be contrary to the provisions of this 
title.''.
            (2) Effective date.--The amendments made by paragraph (1) 
        apply to assistance furnished on or after the date of the 
        enactment of this Act.
    (d) Grace Period and Prior Notice Before Disenrollment for 
Nonpayment of Premiums.--
            (1) In general.--Section 2103(e) (42 U.S.C. 1397ee(e)) is 
        amended by adding at the end the following new paragraph:
            ``(5) Grace period.--Before disenrolling a child under a 
        State child health plan for nonpayment of a premium, the plan 
        shall provide for notice in writing to the family involved and 
        a grace period (of not less than 30 days) in which payment may 
        be made without disenrollment.''.
            (2) Effective date.--The amendment made by paragraph (1) 
        applies to disenrollments occurring on or after the date that 
        is 30 days after the date of the enactment of this Act.

SEC. 4. EXPANDED COVERAGE OPTIONS.

    (a) Automatic Reassessment of Eligibility for SCHIP Benefits for 
Children Losing Medicaid Eligibility.--
            (1) In general.--Section 1902(a)(66) (42 U.S.C. 
        1396a(a)(66)), as inserted by section 2(a)(2), is amended--
                    (A) by striking ``and'' at the end of subparagraph 
                (B),
                    (B) by striking the period at the end of 
                subparagraph (C) and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(D) the automatic assessment, in the case of a 
                child who loses eligibility for medical assistance 
                under this title on the basis of changes in income, 
                assets, or age, of whether the child is eligible for 
                benefits under title XXI.''.
            (2) Effective date.--The amendments made by paragraph (1) 
        apply to children who lose eligibility under the medicaid 
        program under title XIX of the Social Security Act on or after 
        the date that is 30 days after the date of the enactment of 
        this Act.
    (b) Optional Coverage of Low-income, Uninsured Pregnant Women Under 
a State Child Health Plan.--
            (1) In general.--Title XXI is amended by adding at the end 
        the following new section:

``SEC. 2111. OPTIONAL COVERAGE OF LOW-INCOME, UNINSURED PREGNANT WOMEN.

    ``(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.
    ``(b) Definitions.--For purposes of this section:
            ``(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 prepregnancy 
        services and supplies.
            ``(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.
    ``(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 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).
            ``(4) The medicaid applicable income level is deemed a 
        reference to the income level established under section 
        1902(l)(2)(A).
            ``(5) 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).
            ``(6) There shall be no exclusion of benefits for services 
        described in subsection (b)(1) based on any pre-existing 
        condition.
    ``(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).
    ``(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).
    ``(f) Deemed Eligibility for 1-Year for Children Born to 
Presumptively Eligible Targeted Pregnant Women.--If a child is born to 
a targeted low-income pregnant woman who was receiving pregnancy-
related assistance under this section at the time of the birth, the 
child shall be deemed, notwithstanding any other provision of this 
title, to be a targeted low-income child until the child attains 1 year 
of age.''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall take effect on the date of the enactment of this Act and 
        shall apply to allotments for all fiscal years
    (c) State Option for Coverage of Legal Immigrants Under the 
Medicaid and Children's Health Insurance Programs.--
            (1) Medicaid.--Section 1902(a)(10)(a)(ii) (42 U.S.C. 
        1396a(a)(10)(A)(ii)) is amended--
                    (A) by striking ``or'' at the end of subclause 
                (XIII);
                    (B) by adding ``or'' at the end of subclause (XIV); 
                and
                    (C) by adding at the end the following new 
                subclause:
                                    ``(XV) who are described in section 
                                1905(a)(i) and who would be eligible 
                                for medical assistance (or for a 
                                greater amount of medical assistance) 
                                under the State plan under this title 
                                but for the provisions of section 403 
                                or section 421 of Public Law 104-193, 
                                but the State may not exercise the 
                                option of providing medical assistance 
                                under this subclause with respect to a 
                                subcategory of individuals described in 
                                this subclause;''.
            (2) Children's health insurance program.--Section 2110(b) 
        (42 U.S.C. 1397jj(b)) is amended--
                    (A) in paragraph (1)(A), by inserting before the 
                semicolon ``(including, at the option of the State, a 
                child described in paragraph (3)(B))''; and
                    (B) in paragraph (3)--
                            (i) by striking ``Special rule.--'' and 
                        inserting ``Special rules.--
                            ``(i) Health insurance coverage.--'' by 
                        indenting the remainder of the text 
                        accordingly; and
                            (ii) by adding at the end the following new 
                        subparagraph:
                    ``(B) Eligibility for legal immigrant children.--
                For purposes of paragraph (1)(A), a child is described 
                in this subparagraph if--
                            ``(i) the child would be determined 
                        eligible for child health assistance under this 
                        title but for the provisions of sections 403 
                        and 421 of Public Law 104-193; and
                            ``(ii) the State exercises the option to 
                        provide medical assistance to the category of 
                        individuals described in section 
                        1902(a)(10)(A)(ii)(XV).''.
    (d) Clarification of Coverage Under Vaccine for Children Program.--
            (1) In general.--Section 1928(b)(2)(A)(ii) (42 U.S.C. 
        1396s(b)(2)(A)(ii)) is amended by inserting ``, except that for 
        purposes of this paragraph a child who is only insured under 
        title XXI shall be considered as being not insured'' after 
        ``not insured''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall take effect as if included in the enactment of the 
        Balanced Budget Act of 1997.
    (e) Elimination of Funding Offset for Exercise of Presumptive 
Eligibility Option.--
            (1) In general.--Section 2104(d) (42 U.S.C. 1397dd(d)) is 
        amended by striking ``shall be reduced by the sum of'' and all 
        that follows through ``(2) the amount of payments under such 
        section'' and inserting ``shall be reduced by the amount of 
        payments under section 1903(a)(1)''.
            (2) Effective date.--The amendment made by paragraph (1) 
        first applies for allotments for fiscal year 1999.
    (f) Program Coordination With the Maternal and Child Health Program 
(Title V).--
            (1) In general.--Section 2102(b)(3) (42 U.S.C. 
        1397bb(b)(3)) is amended--
                    (A) by striking ``and'' at the end of subparagraph 
                (D);
                    (B) by striking the period at the end of 
                subparagraph (E) and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(F) that operations and activities under this 
                title are developed and implemented in consultation and 
                coordination with the program operated by the State 
                under title V in areas including outreach and 
                enrollment, benefits and services, service delivery 
                standards, public health and social service agency 
                relationships, and quality assurance and data 
                reporting.''.
            (2) Conforming medicaid amendment.--Section 1902(a)(11) (42 
        U.S.C. 1306a(a)(11)) is amended--
                    (A) by striking ``and'' before ``(C)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (D) provide that operations and 
                activities under this title are developed and 
                implemented in consultation and coordination with the 
                program operated by the State under title V in areas 
                including outreach and enrollment, benefits and 
                services, service delivery standards, public health and 
                social service agency relationships, and quality 
                assurance and data reporting;''.
            (3) Effective date.--The amendments made by this subsection 
        take effect on January 1, 1999.
                                 <all>