[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4743 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 4743

  To amend the Social Security Act to improve access to prescription 
drugs for low-income Medicare beneficiaries, the Internal Revenue Code 
 and other Acts to improve access to health care coverage for seniors, 
 the self-employed, and children, and to amend the Federal Food, Drug, 
  and Cosmetic Act to improve meaningful access to reasonably priced 
                          prescription drugs.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 26, 2000

  Mr. Ganske introduced the following bill; which was referred to the 
  Committee on Commerce, and in addition to the Committee on Ways and 
 Means, for a period to be subsequently determined by the Speaker, in 
   each case for consideration of such provisions as fall within the 
                jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
  To amend the Social Security Act to improve access to prescription 
drugs for low-income Medicare beneficiaries, the Internal Revenue Code 
 and other Acts to improve access to health care coverage for seniors, 
 the self-employed, and children, and to amend the Federal Food, Drug, 
  and Cosmetic Act to improve meaningful access to reasonably priced 
                          prescription drugs.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Drug Availability 
and Health Care Access Improvement Act of 2000''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
 TITLE I--MEDICAID PRESCRIPTION DRUG COVERAGE FOR LOW-INCOME MEDICARE 
                             BENEFICIARIES

Sec. 101. Medicaid prescription drug coverage for low-income medicare 
                            beneficiaries.
  TITLE II--IMPROVED ACCESS OF AMERICANS TO HEALTH INSURANCE COVERAGE

 Subtitle A--Access of Medicare Beneficiaries to Medicare+Choice Plans

Sec. 201. Improved access to Medicare+Choice plans through an increase 
                            in the minimum Medicare+Choice capitation 
                            rate.
                Subtitle B--Access of the Self-Employed

Sec. 211. Deduction for 100 percent of health insurance costs of self-
                            employed individuals.
  Subtitle C--Improve the Coverage of Needy Children under the State 
  Children's Health Insurance Program (SCHIP) and the Medicaid Program

Sec. 221. Simplified outreach and enrollment.
Sec. 222. Family friendly coverage and enrollment.
Sec. 223. Expanded coverage options.
   TITLE III--IMPROVED ACCESS TO REASONABLY PRICED PRESCRIPTION DRUGS

Sec. 301. Clarification of certain responsibilities of Food and Drug 
                            Administration with respect to importation 
                            of drugs into United States.
Sec. 302. Increased consumer information in prescription drug 
                            advertising.
Sec. 303. Education about manufacturer programs for free drugs to 
                            patients.
Sec. 304. Sense of Congress regarding manufacturer pricing practices.

 TITLE I--MEDICAID PRESCRIPTION DRUG COVERAGE FOR LOW-INCOME MEDICARE 
                             BENEFICIARIES

SEC. 101. MEDICAID PRESCRIPTION DRUG COVERAGE FOR LOW-INCOME MEDICARE 
              BENEFICIARIES.

    (a) In General.--Section 1902(a)(10) of the Social Security Act (42 
U.S.C. 1396a(a)(10)) is amended--
            (1) by striking ``and'' at the end of subparagraph (F);
            (2) by adding ``and'' at the end of subparagraph (G); and
            (3) by inserting after subparagraph (G) the following new 
        subparagraph:
                    ``(H) for making medical assistance available for 
                prescribed drugs (in the same amount, duration, and 
                scope as for individuals described in subparagraph (A)) 
                for qualified medicare beneficiaries described in 
                section 1905(p)(1) and for individuals who would be 
                such qualified medicare beneficiaries but for the fact 
                that their income exceeds the income level established 
                by the State under section 1905(p)(2) but is less than 
                175 percent of the official poverty line (referred to 
                in such section) for a family of the size involved;''.
    (b) 100 Percent Federal Financing of Additional Costs.--Section 
1903(a) of such Act (42 U.S.C. 1396b(a)) is amended--
            (1) by redesignating paragraph (7) as paragraph (8); and
            (2) by adding after paragraph (6) the following new 
        paragraph:
            ``(7) an amount equal to 100 percent of amounts as expended 
        as medical assistance for prescribed drugs described in section 
        1902(a)(10)(H) to individuals who are eligible for such 
        assistance only on the basis of such section; and''.
    (c) Permitting Charging of Sliding Scale Premiums for Qualifying 
Individuals With Incomes Above 135 Percent of Poverty Line.--Section 
1916 of such Act is amended--
            (1) in subsection (b), by striking ``or (E)'' and inserting 
        ``, (E), or (H)''; and
            (2) in subsection (d)--
                    (A) by inserting ``(1)'' after ``(d)'', and
                    (B) by adding at the end the following new 
                paragraph:
    ``(2)(A) With respect to an individual described in section 
1902(a)(10)(H) whose income (as determined under section 1905(p)(1)(B)) 
exceeds 135 percent of the official poverty line referred to in that 
section, the State plan of a State shall provide for the charging of a 
premium (expressed as a percentage of the average actuarial cost of the 
benefits described in section 1902(a)(10)(H) provided with respect to 
individuals described in such section) according to a sliding scale 
under which such percentage increases from 0 percent to 100 percent, in 
reasonable increments (as determined by the Secretary), as the 
individual's income increases from 135 percent of such poverty line to 
175 percent of such poverty line.
    ``(B) A State shall not require prepayment of a premium imposed 
pursuant to subparagraph (A) and shall not terminate eligibility of an 
individual 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. 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) A State may permit State or local funds available under other 
programs to be used for payment of a premium imposed under subparagraph 
(A). Payment of a premium with such funds shall not be counted as 
income to the individual with respect to whom such payment is made.''.
    (d) Effective Date.--The amendments made by this section take 
effect on January 1, 2001.

  TITLE II--IMPROVED ACCESS OF AMERICANS TO HEALTH INSURANCE COVERAGE

 Subtitle A--Access of Medicare Beneficiaries to Medicare+Choice Plans

SEC. 201. IMPROVED ACCESS TO MEDICARE+CHOICE PLANS THROUGH AN INCREASE 
              IN THE MINIMUM MEDICARE+CHOICE CAPITATION RATE.

    (a) In General.--Section 1853(c)(1)(B)(ii) of the Social Security 
Act (42 U.S.C. 1395w-23(c)(1)(B)(ii)) is amended--
            (1) by striking ``(ii) For a succeeding year'' and 
        inserting ``(ii)(I) Subject to subclause (II), for a succeeding 
        year''; and
            (2) by adding at the end the following new subclause:
                            ``(II) For 2001 for any of the 50 States 
                        and the District of Columbia, $600.''.
    (b) Effective Date.--The amendments made by subsection (a) apply to 
years beginning with 2001.

                Subtitle B--Access of the Self-Employed

SEC. 211. DEDUCTION FOR 100 PERCENT OF HEALTH INSURANCE COSTS OF SELF-
              EMPLOYED INDIVIDUALS.

    (a) In General.--Paragraph (1) of section 162(l) of the Internal 
Revenue Code of 1986 is amended to read as follows:
            ``(1) Allowance of deduction.--In the case of an individual 
        who is an employee within the meaning of section 401(c)(1), 
        there shall be allowed as a deduction under this section an 
        amount equal to 100 percent of the amount paid during the 
        taxable year for insurance which constitutes medical care for 
        the taxpayer and the taxpayer's spouse and dependents.''.
    (b) Clarification of Limitations on Other Coverage.--The first 
sentence of section 162(l)(2)(B) of such Code is amended to read as 
follows: ``Paragraph (1) shall not apply to any taxpayer for any 
calendar month for which the taxpayer participates in any subsidized 
health plan maintained by any employer (other than an employer 
described in section 401(c)(4)) of the taxpayer or the spouse of the 
taxpayer.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 1999.

  Subtitle C--Improve the Coverage of Needy Children under the State 
  Children's Health Insurance Program (SCHIP) and the Medicaid Program

SEC. 221. SIMPLIFIED OUTREACH AND ENROLLMENT.

    (a) Use of Uniform Application and Coordinated Enrollment 
Process.--
            (1) SCHIP program.--Section 2102 of the Social Security Act 
        (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.--A State child health plan shall 
provide, by not later than the first day of the first month that begins 
more than 6 months after the date of the enactment of this subsection, 
for--
          ``(1) 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;
            ``(2) 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
            ``(3) acceptance and timely response to telephone inquiries 
        and other electronic communications received through the 
        national toll-free system established under section 222 of the 
        Drug Availability and Health Care Access Improvement Act of 
        2000.''.
            (2) Medicaid conforming amendment.--
                    (A) In general.--Section 1902(a) of such Act (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 the first day of the 
        first month that begins more than 6 months after the date of 
        the enactment of this paragraph, 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 222 of the Drug Availability and Health Care 
                Access Improvement Act of 2000.''.
                    (B) Effective date.--The amendments made by 
                subparagraph (A) apply to calendar quarters beginning 
                more than 6 months after the date of the enactment of 
                this Act.
    (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 the first day of the first 
month that begins more than 6 months after the date of the enactment of 
this subsection, 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) Expanded availability of funding for administrative 
        costs related to outreach and eligibility determinations.--
        Section 1931(h) of the Social Security Act (42 U.S.C. 1396u-
        1(h)) is amended--
                    (A) in the matter preceding paragraph (1), by 
                striking ``Transitional'' and all that follows through 
                ``Costs'' and inserting ``Increased Federal Matching 
                Rate for Administrative Costs Related to Certain 
                Outreach and Eligibility Determinations'';
                    (B) in paragraph (2), by inserting ``either'' after 
                ``attributable'' and by inserting before the period at 
                the end the following: ``or to administrative costs of 
                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'';
                    (C) in paragraph (3), by striking ``and ending with 
                fiscal year 2000''; and
                    (D) by striking paragraph (4) and inserting the 
                following:
            ``(4) Encouraging use of local and community-based 
        organizations in outreach and enrollment activities.--The 
        Secretary shall establish a procedure under which, if States do 
        not otherwise obligate the amounts made available under this 
        subsection, local and community-based public or nonprofit 
        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 
        be 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.''.
            (2) Use of 3 percent of schip funds at 90 percent federal 
        match for enrollment and outreach activities.--Section 2105(b) 
        of such Act (42 U.S.C. 1397ee(b)) is amended--
                    (A) by designating the matter following the dash as 
                a paragraph (1) with appropriate indentation and with 
                the heading ``(1) In general'';
                    (B) by inserting ``subject to paragraph (2)'' after 
                ``(a)'';
                    (C) by striking ``(1)'' and ``(2)'' and inserting 
                ``(A)'' and ``(B)'', respectively; and
                    (D) by adding at the end the following paragraph:
            ``(2) Special rule for certain enrollment and outreach 
        activities.--
                    ``(A) In general.--For purposes of subsection (a), 
                in the case of a State that meets the requirement of 
                subparagraph (B), and subject to subparagraph (C), the 
                `enhanced FMAP' is equal to 90 percent with respect to 
                amounts expended on enrollment and outreach activities.
                    ``(B) Requirements.--Subparagraph (A) shall only 
                apply to a State if the State meets the following 
                requirements:
                            ``(i) No asset test.--The State does not 
                        impose an asset test for eligibility under the 
                        State child health plan or under section 
                        1902(l) with respect to children.
                            ``(ii) Compliance with outstationing 
                        requirement.--The Secretary finds that the 
                        State is providing for the receipt and initial 
                        processing of applications of certain 
                        individuals at facilities defined as 
                        disproportionate share hospitals under section 
                        1923(a)(1)(A) and Federally-qualified health 
                        centers described in section 1905(1)(2)(B) 
                        consistent with the requirements of section 
                        1902(a)(55).
                            ``(iii) Compliance with simplified outreach 
                        and enrollment provisions.--The Secretary finds 
                        that the State is providing for outreach and 
                        enrollment under this title and title XIX 
                        consistent with the requirements of sections 
                        2102(c), 2102(d), and 1902(a)(66).
                    ``(C) Limitation to 3 percent of annual 
                allotment.--Subparagraph (A) shall not apply to amounts 
                expended by a State in a fiscal year in excess of 3 
                percent of the amount of the amount of its allotment 
                under section 2104 for that fiscal year.''.
            (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.--Section 1920A(b)(3)(A)(i) of such 
Act (42 U.S.C. 1396r-1a(b)(3)(A)(i)) is amended--
            (1) by striking ``or (II)'' and inserting ``, (II)''; and
            (2) 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, (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.), or (IV) any other 
        entity the State so deems'' before the semicolon.

SEC. 222. FAMILY FRIENDLY COVERAGE AND ENROLLMENT.

    (a) Assuring Coordination of Pediatric Providers Within a Family.--
            (1) In general.--Section 2103 of the Social Security Act 
        (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.--To the extent a State child health plan provides coverage 
other than through providing benefits under the State's medicaid plan 
under title XIX, the 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 are allowed to be seen by the same pediatric provider 
        or group of pediatric providers 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 2001.
    (b) Reduction in Burden of Administering Cost-Sharing Provisions.--
            (1) State responsible for assuring cap on cost-sharing not 
        exceeded.--Section 2103(e)(3) of such Act (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) of such Act (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 $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) of such Act (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 Before Disenrollment for Nonpayment of Premiums.--
            (1) In general.--Section 2103(e) of such Act (42 U.S.C. 
        1397ee(e)) is amended by adding at the end the following new 
        paragraph:
            ``(5) Disenrollment for nonpayment of premiums.--
                    ``(A) Notice of nonpayment.--If a State child 
                health plan requires the payment of a premium for 
                enrollment and such a premium is not paid on a timely 
                basis, the State shall provide, before terminating 
                coverage under the plan, for--
                            ``(i) notice of nonpayment at such time and 
                        at the beginning of the last month of the State 
                        specified enrollment period described in 
                        subparagraph (C) if the premium is still unpaid 
                        at that time; and
                            ``(ii) an opportunity for a hearing and a 
                        grace period (described in subparagraph (B)) in 
                        which the premium may be paid and no penalty 
                        will apply for the late payment.
                    ``(B) Grace period.--The grace period under this 
                subparagraph, in the case of nonpayment for a month--
                            ``(i) before the last month of a State 
                        specified enrollment period described in 
                        subparagraph (C), is for the remainder of the 
                        State specified enrollment period; or
                            ``(ii) for the last month of such period, 
                        is for a period of at least 1 month.
                    ``(C) State specified enrollment period.--For 
                purposes of applying this paragraph--
                            ``(i) the State child health plan shall 
                        specify an enrollment period, which shall be a 
                        period of at least 3 months; and
                            ``(ii) after each such enrollment period 
                        for an individual (if coverage is not 
                        terminated under the plan during such period), 
                        a new enrollment period (of the length 
                        specified in clause (i)) shall start again for 
                        the individual at the end of the previously 
                        specified enrollment period.
                    ``(D) Good cause waiver.--The State child health 
                plan shall establish rules allowing waiver for good 
                cause of termination of enrollment for nonpayment of 
                premiums.
                    ``(E) Permitting application of waiting period in 
                certain reenrollment cases.--In the case of a child 
                whose coverage under a State child health plan has been 
                terminated under this paragraph for nonpayment of 
                premiums and whose period of coverage under the plan 
                without premium payment exceeded 1 month, the plan may 
                require, as a condition of reenrollment under the plan, 
                a waiting period that equals the number of months of 
                such coverage without premium payment, but in no case 
                may such a waiting period exceed 3 months.''.
            (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. 223. EXPANDED COVERAGE OPTIONS.

    (a) Automatic Reassessment of Eligibility for SCHIP and Medicaid 
Benefits for Children Losing Medicaid or SCHIP Eligibility.--
            (1) Loss of medicaid eligibility.--Section 1902(a)(66) of 
        the Social Security Act (42 U.S.C. 1396a(a)(66)), as inserted 
        by section 221(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) Loss of schip eligibility.--Section 2102(b)(3) of such 
        Act (42 U.S.C. 1397bb(b)(3)) is amended by redesignating 
        subparagraphs (D) and (E) as subparagraphs (E) and (F), 
        respectively, and by inserting after subparagraph (C) the 
        following new subparagraph:
                    ``(D) that there is an automatic assessment, in the 
                case of a child who loses eligibility for child health 
                assistance under this title on the basis of changes in 
                income, assets, or age, of whether the child is 
                eligible for medical assistance under title XIX;''.
            (3) Effective date.--The amendments made by paragraphs (1) 
        and (2) apply to children who lose eligibility under the 
        medicaid program under title XIX, or under a State child health 
        insurance plan under title XXI, respectively, 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 of the Social Security Act 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, but only if the State has established an 
income eligibility level under section 1902(l)(2)(A) for women 
described in section 1902(l)(1)(A) that is 185 percent of the income 
official poverty line.
    ``(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 and no waiting period (including any waiting period 
        imposed to carry out section 2102(b)(3)(C)) shall apply.
    ``(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) 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 children'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, 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 and the woman remains (or would 
remain if pregnant) eligible for such assistance. 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) State option to use enhanced fmap for coverage of 
        additional pregnant women under the medicaid program.--Section 
        1905 of such Act (42 U.S.C. 1396d) is amended--
                    (A) in subsection (b), by inserting ``and in the 
                case of a State plan that meets the condition described 
                in subsections (u)(1) and (u)(4)(A), with respect to 
                expenditures described in subsection (u)(4)(B) for the 
                State for a fiscal year'' after ``for a fiscal year,'';
                    (B) by redesignating paragraph (4) of subsection 
                (u) as paragraph (5); and
                    (C) by inserting after paragraph (3) of subsection 
                (u) the following new paragraph:
    ``(4)(A) The condition described in this subparagraph for a State 
plan is that the plan has established an income level under section 
1902(l)(2)(A) with respect to individuals described in section 
1902(l)(1)(A) that is 185 percent of the income official poverty line.
    ``(B) For purposes of subsection (b), the expenditures described in 
this paragraph are expenditures for medical assistance for women 
described in section 1902(l)(1)(A) whose income exceeds the income 
level established for such women under section 1902(l)(2)(A)(i) as of 
the date of the enactment of this paragraph but does not exceed than 
185 percent of the income official poverty line.''.
            (3) Conforming amendments.--Section 2102(b)(1)(B) of such 
        Act (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) 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 section 2111.''.
            (4) Effective date.--The amendments made by this subsection 
        take effect on the date of the enactment of this Act and apply 
        to allotments for all fiscal years.
    (c) State Option for Coverage of Qualified Alien Children Under 
Medicaid and Children's Health Insurance Programs.--
            (1) Medicaid.--
                    (A) Categorically needy.--Section 
                1902(a)(10)(a)(ii) of the Social Security Act (42 
                U.S.C. 1396a(a)(10)(A)(ii)) is amended--
                            (i) by striking ``or'' at the end of 
                        subclause (XIII);
                            (ii) by adding ``or'' at the end of 
                        subclause (XIV); and
                            (iii) 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;''.
                    (B) Medically needy.--Section 1902(a)(10)(C)(i)(I) 
                of such Act (42 U.S.C. 1396a(a)(10)(C)(i)(I)) is 
                amended by inserting ``(and such criteria may provide 
                for eligibility of individuals described in 
                subparagraph (A)(ii)(XV))'' after ``medical 
                assistance''.
            (2) Children's health insurance program.--Section 2110(b) 
        of such Act (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 qualified alien 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 any or all of 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).''.
            (3) Prohibition on seeking support from sponsor.--Section 
        213A(b) of the Immigration and Nationality Act (8 U.S.C. 
        1183a(b)) is amended by adding at the end the following new 
        paragraph:
            ``(4) Exception for child medicaid or schip assistance.--
        The preceding provisions of this subsection shall not apply 
        to--
                    ``(A) medical assistance furnished under the State 
                plan under title XIX of the Social Security Act to an 
                individual eligible for such assistance because of 
                subclause (XV) of paragraph (10)(A)(ii) of section 
                1902(a) of such Act (42 U.S.C. 1396a(a)) or because of 
                the reference to such subclause in paragraph (10)(C) of 
                such section; or
                    ``(B) child health assistance furnished under the 
                State child health plan under title XXI of such Act to 
                a child eligible for such assistance because of the 
                provisions of section 2110(b)(3)(B) of such Act (42 
                U.S.C. 1397jj(b)(3)(B)).''.
    (d) Clarification of Coverage Under Vaccine for Children Program.--
            (1) In general.--Section 1928(b)(2)(A)(ii) of the Social 
        Security Act (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) of such Act (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 2001.
    (f) Program Coordination With the Maternal and Child Health Program 
(Title V).--
            (1) In general.--Section 2102(b)(3) of such Act (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) of 
        such Act (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, 2000.

   TITLE III--IMPROVED ACCESS TO REASONABLY PRICED PRESCRIPTION DRUGS

SEC. 301. CLARIFICATION OF CERTAIN RESPONSIBILITIES OF FOOD AND DRUG 
              ADMINISTRATION WITH RESPECT TO IMPORTATION OF DRUGS INTO 
              UNITED STATES.

    Section 801 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
381) is amended by adding at the end the following subsection:
    ``(g)(1) With respect to a drug being imported or offered for 
import into the United States, the Secretary may not send a warning 
notice to a person (including a pharmacist or wholesale importer) 
unless the following conditions are met:
            ``(A) The notice specifies, as applicable to the 
        importation of the drug, that the Secretary has made a 
        determination that--
                    ``(i) importation is in violation of section 801(a) 
                because the drug is or appears to be adulterated, 
                misbranded, or in violation of section 505;
                    ``(ii) importation is in violation of section 
                801(a) because the drug is forbidden or restricted in 
                sale in the country in which it was produced or from 
                which it was exported;
                    ``(iii) importation by any person other than the 
                manufacturer of the drug is in violation of section 
                801(d); or
                    ``(iv) importation is otherwise in violation of 
                Federal law.
            ``(B) The notice does not specify any provision described 
        in subparagraph (A) that is not applicable to the importation 
        of the drug.
            ``(C) The notice states the reasons underlying such 
        determination by the Secretary, including a brief application 
        to the principal facts involved of the provision of law 
        described in subparagraph (A) that is the basis of the 
        determination by the Secretary.
    ``(2) The term `warning notice', with respect to the importation of 
a drug, means a communication from the Secretary (written or otherwise) 
notifying a person, or clearly suggesting to the person, that importing 
the drug is, or appears to be, a violation of this Act.''.

SEC. 302. INCREASED CONSUMER INFORMATION IN PRESCRIPTION DRUG 
              ADVERTISING.

    Section 502(n) of the Federal Food, Drug, and Cosmetic Act (21 
U.S.C. 352(n)) is amended--
    (a) by striking ``in brief summary relating to side effects'' and 
inserting ``in comprehensive summary relating to side effects''; and
    (b) by inserting before ``except that'' the following: ``except 
that the regulations shall require that such comprehensive summary 
constitute not less than 50 percent of the content of an advertisement, 
and the regulations may not exempt reminder advertisements from the 
requirement of providing the comprehensive summary, and''.

SEC. 303. EDUCATION ABOUT MANUFACTURER PROGRAMS FOR FREE DRUGS TO 
              PATIENTS.

    The Secretary of Health and Human Services, acting through the 
Commissioner of Food and Drugs, shall in cooperation with manufacturers 
of prescription drugs carry out activities to inform patients of the 
existence of programs that are operated by such manufacturers to 
provide prescription drugs to patients without any charge to the 
patients.

SEC. 304. SENSE OF CONGRESS REGARDING MERGERS OF DRUG MANUFACTURERS.

    It is the sense of the Congress that--
            (1) the increased merger of drug manufacturers has resulted 
        in a decrease in price competition in the prescription drug 
        market and increased the potential for collusion in setting 
        prices; and
            (2) the Antitrust Division of the Department of Justice and 
        the Federal Trade Commission should give increased scrutiny to 
        the anti-competitive effects of such mergers.
                                 <all>