[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4825 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 4825

 To amend title XIX of the Social Security Act to provide families of 
 disabled children with the opportunity to purchase coverage under the 
      Medicaid Program for such children, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 12, 2000

   Mr. Sessions (for himself, Mr. Waxman, Mr. Upton, Mr. Barrett of 
 Wisconsin, Ms. Pryce of Ohio, Mr. Strickland, Mr. Hayworth, Mr. Brown 
of Ohio, Mr. Dreier, Mr. Lazio, Mr. Dingell, Mr. Doggett, Mr. Ramstad, 
 Mr. Nussle, Mr. Nethercutt, Mr. Gilchrest, and Mr. Tauzin) 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 families of 
 disabled children with the opportunity to purchase coverage under the 
      Medicaid Program for such 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; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Family Opportunity 
Act of 2000''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Opportunity for families of disabled children to purchase 
                            medicaid coverage for such children.
Sec. 3. Treatment of inpatient psychiatric hospital services for 
                            individuals under age 21 in home or 
                            community-based services waivers.
Sec. 4. Demonstration of coverage under the medicaid program of 
                            children with potentially severe 
                            disabilities.
Sec. 5. Development and support of family-to-family health information 
                            centers.
Sec. 6. Restoration of medicaid eligibility for certain SSI 
                            beneficiaries.

SEC. 2. OPPORTUNITY FOR FAMILIES OF DISABLED CHILDREN TO PURCHASE 
              MEDICAID COVERAGE FOR SUCH CHILDREN.

    (a) State Option To Allow Families of Disabled Children To Purchase 
Medicaid Coverage for Such Children.--
            (1) In general.--Section 1902 of the Social Security Act 
        (42 U.S.C. 1396a), as amended by the Foster Care Independence 
        Act of 1999 (Public Law 106-169; 113 Stat. 1822) and the Ticket 
        to Work and Work Incentives Improvement Act of 1999 (Public Law 
        106-170; 113 Stat. 1860), is amended--
                    (A) in subsection (a)(10)(A)(ii)--
                            (i) by striking ``or'' at the end of 
                        subclause (XVI);
                            (ii) by adding ``or'' at the end of 
                        subclause (XVII); and
                            (iii) by adding at the end the following 
                        new subclause:
                                    ``(XVIII) who are disabled children 
                                described in subsection (aa);''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(aa)(1) Individuals described in this subsection are 
individuals--
            ``(A) who have not attained 21 years of age;
            ``(B) who would be considered disabled under section 
        1614(a)(3)(C) (determined without regard to the reference to 
        age in that section) but for having family income or resources 
        (as determined under title XVI for children) that exceed the 
        requirements for receipt of supplemental security income 
        benefits; and
            ``(C) whose family income (as so determined) does not 
        exceed--
                    ``(i) 600 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; or
                    ``(ii) such higher percent of such poverty line as 
                a State may establish, except that no Federal financial 
                participation shall be provided under section 1903(a) 
                for any medical assistance provided to an individual 
                who would not be described in this subsection but for 
                this clause.
    ``(2) A State shall provide the same amount, duration, and scope of 
medical assistance under the State plan to an individual described in 
paragraph (1) who has attained age 18 but has not attained age 21 as 
the State provides under the State plan to an individual who has not 
attained age 18.''.
            (2) Interaction with employer-sponsored family coverage.--
        Section 1902(aa) of the Social Security Act (42 U.S.C. 
        1396a(aa)), as added by paragraph (1), is amended by adding at 
        the end the following new paragraph:
    ``(3)(A) If an employer of a parent or caretaker relative of an 
individual described in paragraph (1) offers family coverage under a 
group health plan (as defined in section 2791(a) of the Public Health 
Service Act), the State may--
            ``(i) require such parent or caretaker relative to apply 
        for, enroll in, and pay premiums for, such coverage as a 
        condition of such parent's or caretaker relative's child being 
        or remaining eligible for medical assistance under subsection 
        (a)(10)(A)(ii)(XVIII) if the parent or caretaker relative is 
        determined eligible for such coverage and the employer 
        contributes at least 50 percent of the total cost of annual 
        premiums for such coverage; and
            ``(ii) if such coverage is obtained--
                    ``(I) subject to paragraph (2) of section 1916(h), 
                reduce the premium imposed by the State under that 
                section (if any) in an amount that reasonably reflects 
                the premium contribution made by the family for private 
                coverage on behalf of a child with a disability; and
                    ``(II) treat such coverage as a third party 
                liability under subsection (a)(25).
    ``(B) In the case of a parent or caretaker relative to which 
subparagraph (A) applies--
            ``(i) if the family income (as so determined) of such 
        parent or caretaker relative does not exceed 300 percent of the 
        income official poverty line (as so defined), a State may 
        provide for payment of any portion of the annual premium for 
        such family coverage that the parent or caretaker relative is 
        required to pay; and
            ``(ii) any payments made by the State under clause (i) 
        shall be considered, for purposes of section 1903(a), to be 
        payments for medical assistance.''.
    (b) State Option To Impose Income-Related Premiums.--Section 1916 
of the Social Security Act (42 U.S.C. 1396o), as amended by the Ticket 
to Work and Work Incentives Improvement Act of 1999 (Public Law 106-
170; 113 Stat. 1860), is amended--
            (1) in subsection (a), by striking ``subsection (g)'' and 
        inserting ``subsections (g) and (h)''; and
            (2) by adding at the end the following new subsection:
    ``(h)(1) With respect to disabled children provided medical 
assistance under section 1902(a)(10)(A)(ii)(XVIII), subject to 
paragraph (2), a State may (in a uniform manner for such children) 
require the families of such children to pay monthly premiums set on a 
sliding scale based on family income (as determined under title XVI for 
children).
    ``(2) A premium requirement imposed under paragraph (1) may only 
apply to the extent that--
            ``(A) the aggregate amount of such premium and any premium 
        that the parent or caretaker relative is required to pay for 
        family coverage under section 1902(aa)(3)(A)(i) does not exceed 
        5 percent of the family's income; and
            ``(B) the requirement is imposed consistent with section 
        1902(aa)(3)(A)(ii)(I).
    ``(3) A State shall not require prepayment of a premium imposed 
pursuant to paragraph (1) and shall not terminate eligibility of a 
child under section 1902(a)(10)(A)(ii)(XVIII) 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 from the 
date on which the premium became past due. 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) Increased Federal Financial Assistance for Administrative 
Costs.--Section 1903(a)(7) of the Social Security Act (42 U.S.C. 
1396b(a)(7)) is amended--
            (1) by inserting ``(A)'' after ``(7)'';
            (2) by striking the period and inserting ``, and''; and
            (3) by adding at the end the following new subparagraph:
            ``(B) 90 percent of the sums expended during such a quarter 
        within the twelve-quarter period beginning with the first 
        quarter in which a payment is made to the State pursuant to 
        this subparagraph.''.
    (d) Conforming Amendment.--Section 1903(f)(4) of the Social 
Security Act (42 U.S.C. 1396b(f)(4)) is amended in the matter preceding 
subparagraph (A) by inserting ``1902(a)(10)(A)(ii)(XVIII)'' before 
``1905(p)(1)''.
    (e) Effective Date.--The amendments made by this section shall 
apply to medical assistance for items and services furnished on or 
after October 1, 2000.

SEC. 3. TREATMENT OF INPATIENT PSYCHIATRIC HOSPITAL SERVICES FOR 
              INDIVIDUALS UNDER AGE 21 IN HOME OR COMMUNITY-BASED 
              SERVICES WAIVERS.

    (a) In General.--Section 1915(c) of the Social Security Act (42 
U.S.C. 1396n(c)) is amended--
            (1) in paragraph (1)--
                    (A) in the first sentence, by inserting ``, or 
                inpatient psychiatric hospital services for individuals 
                under age 21,'' after ``intermediate care facility for 
                the mentally retarded''; and
                    (B) in the second sentence, by inserting ``, or 
                inpatient psychiatric hospital services for individuals 
                under age 21'' before the period;
            (2) in paragraph (2)(B), by striking ``or services in an 
        intermediate care facility for the mentally retarded'' each 
        place it appears and inserting ``, services in an intermediate 
        care facility for the mentally retarded, or inpatient 
        psychiatric hospital services for individuals under age 21'';
            (3) by striking paragraph (2)(C) and inserting the 
        following:
            ``(C) such individuals who are determined to be likely to 
        require the level of care provided in a hospital, nursing 
        facility, or intermediate care facility for the mentally 
        retarded, or inpatient psychiatric hospital services for 
        individuals under age 21, are informed of the feasible 
        alternatives, if available under the waiver, at the choice of 
        such individuals, to the provision of inpatient hospital 
        services, nursing facility services, services in an 
        intermediate care facility for the mentally retarded, or 
        inpatient psychiatric hospital services for individuals under 
        age 21;''; and
            (4) in paragraph (7)(A)--
                    (A) by inserting ``, or inpatient psychiatric 
                hospital services for individuals under age 21,'' after 
                ``intermediate care facility for the mentally 
                retarded''; and
                    (B) by inserting ``, or who would require inpatient 
                psychiatric hospital services for individuals under age 
                21'' before the period.
    (b) Effective Date.--The amendments made by subsection (a) apply 
with respect to medical assistance provided on or after October 1, 
2000.

SEC. 4. DEMONSTRATION OF COVERAGE UNDER THE MEDICAID PROGRAM OF 
              CHILDREN WITH POTENTIALLY SEVERE DISABILITIES.

    (a) State Application.--A State may apply to the Secretary of 
Health and Human Services (in this section referred to as the 
``Secretary'') for approval of a demonstration project (in this section 
referred to as a ``demonstration project'') under which up to a 
specified maximum number of children with a potentially severe 
disability (as defined in subsection (b)) are provided medical 
assistance under the State medicaid plan under title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.).
    (b) Child With a Potentially Severe Disability Defined.--
            (1) In general.--In this section, the term ``child with a 
        potentially severe disability'' means, with respect to a 
        demonstration project, an individual who--
                    (A) has not attained 6 years of age;
                    (B) has a physical or mental condition, disease, 
                disorder (including a congenital birth defect), injury, 
                or developmental disability that was incurred before 
                the individual attained such age; and
                    (C) is reasonably expected, but for the receipt of 
                medical assistance under the State medicaid plan, to 
                reach the level of disability defined under section 
                1614(a)(3) of the Social Security Act (42 U.S.C. 
                1382c(a)(3)), (determined without regard to the 
                reference to age in subparagraph (C) of that section).
            (2) Exception.--Such term does not include an individual 
        who would be considered disabled under section 1614(a)(3)(C) of 
        the Social Security Act (42 U.S.C. 1382c(a)(3)(C)) (determined 
        without regard to the reference to age in that section).
    (c) Approval of Demonstration Projects.--
            (1) In general.--Subject to paragraph (3), the Secretary 
        shall approve applications under subsection (a) that meet the 
        requirements of paragraph (2) and such additional terms and 
        conditions as the Secretary may require. The Secretary may 
        waive the requirement of section 1902(a)(1) of the Social 
        Security Act (42 U.S.C. 1396a(a)(1)) to allow for sub-State 
        demonstrations.
            (2) Terms and conditions of demonstration projects.--The 
        Secretary may not approve a demonstration project under this 
        section unless the State provides assurances satisfactory to 
        the Secretary that the following conditions are or will be met:
                    (A) Independent evaluation.--The State provides for 
                an independent evaluation of the project to be 
                conducted during fiscal year 2005.
                    (B) Consultation for development of criteria.--The 
                State consults with appropriate pediatric health 
                professionals in establishing the criteria for 
                determining whether a child has a potentially severe 
                disability.
                    (C) Annual report.--The State submits an annual 
                report to the Secretary (in a uniform form and manner 
                established by the Secretary) on the use of funds 
                provided under the grant that includes the following:
                            (i) Enrollment and financial statistics 
                        on--
                                    (I) the total number of children 
                                with a potentially severe disability 
                                enrolled in the demonstration project, 
                                disaggregated by disability;
                                    (II) the services provided by 
                                category or code and the cost of each 
                                service so categorized or coded; and
                                    (III) the number of children 
                                enrolled in the demonstration project 
                                who also receive services through 
                                private insurance.
                            (ii) With respect to the report submitted 
                        for fiscal year 2005, the results of the 
                        independent evaluation conducted under 
                        subparagraph (A).
                            (iii) Such additional information as the 
                        Secretary may require.
            (3) Limitations on federal funding.--
                    (A) Appropriation.--
                            (i) In general.--Out of any funds in the 
                        Treasury not otherwise appropriated, there is 
                        appropriated to carry out this section 
                        $16,667,000 for each of fiscal years 2001 
                        through 2006.
                            (ii) Budget authority.--Clause (i) 
                        constitutes budget authority in advance of 
                        appropriations Acts and represents the 
                        obligation of the Federal Government to provide 
                        for the payment of the amounts appropriated 
                        under clause (i).
                    (B) Limitation on payments.--In no case may--
                            (i) the aggregate amount of payments made 
                        by the Secretary to States under this section 
                        exceed $100,000,000;
                            (ii) the aggregate amount of payments made 
                        by the Secretary to States for administrative 
                        expenses relating to the evaluations and annual 
                        reports required under subparagraphs (B) and 
                        (D) of paragraph (2) exceed $2,000,000 of such 
                        $100,000,000; or
                            (iii) payments be provided by the Secretary 
                        for a fiscal year after fiscal year 2009.
                    (C) Funds allocated to states.--
                            (i) In general.--The Secretary shall 
                        allocate funds to States based on their 
                        applications and the availability of funds. In 
                        making such allocations, the Secretary shall 
                        ensure an equitable distribution of funds among 
                        States with large populations and States with 
                        small populations.
                            (ii) Availability.--Funds allocated to a 
                        State under a grant made under this section for 
                        a fiscal year shall remain available until 
                        expended.
                    (D) Funds not allocated to states.--Funds not 
                allocated to States in the fiscal year for which they 
                are appropriated shall remain available in succeeding 
                fiscal years for allocation by the Secretary using the 
                allocation formula established under this section.
                    (E) Payments to states.--The Secretary shall pay to 
                each State with a demonstration project approved under 
                this section, from its allocation under subparagraph 
                (C), an amount for each quarter equal to the Federal 
                medical assistance percentage (as defined in section 
                1905(b) of the Social Security Act (42 U.S.C. 
                1395d(b))) of expenditures in the quarter for medical 
                assistance provided to children with a potentially 
                severe disability.
    (d) Recommendation.--Not later than October 1, 2004, the Secretary 
shall submit a recommendation to the Committee on Commerce of the House 
of Representatives and the Committee on Finance of the Senate regarding 
whether the demonstration project established under this section should 
be continued after fiscal year 2006.
    (e) State Defined.--In this section, the term ``State'' has the 
meaning given such term for purposes of title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.).

SEC. 5. DEVELOPMENT AND SUPPORT OF FAMILY-TO-FAMILY HEALTH INFORMATION 
              CENTERS.

    Section 501 of the Social Security Act (42 U.S.C. 701) is amended 
by adding at the end the following new subsection:
    ``(c)(1)(A) In addition to amounts appropriated under subsection 
(a) and retained under section 502(a)(1) for the purpose of carrying 
out activities described in subsection (a)(2), there is appropriated to 
the Secretary, out of any money in the Treasury not otherwise 
appropriated, for the purpose of enabling the Secretary (through 
grants, contracts, or otherwise) to provide for special projects of 
regional and national significance for the development and support of 
family-to-family health information centers described in paragraph (2), 
$10,000,000 for each of fiscal years 2001 through 2006.
    ``(B) Funds appropriated under subparagraph (A) shall remain 
available until expended.
    ``(2) The family-to-family health information centers described in 
this paragraph are centers that--
            ``(A) assist families of children with disabilities or 
        special health care needs to make informed choices about health 
        care in order to promote good treatment decisions, cost-
        effectiveness, and improved health outcomes for such children;
            ``(B) provide information regarding the health care needs 
        of, and resources available for, children with disabilities or 
        special health care needs;
            ``(C) identify successful health delivery models for such 
        children;
            ``(D) develop with representatives of health care 
        providers, managed care organizations, health care purchasers, 
        and appropriate State agencies a model for collaboration 
        between families of such children and health professionals;
            ``(E) provide training and guidance regarding caring for 
        such children;
            ``(F) conduct outreach activities to the families of such 
        children, health professionals, schools, and other appropriate 
        entities and individuals; and
            ``(G) are staffed by families of children with disabilities 
        or special health care needs who have expertise in Federal and 
        State public and private health care systems and health 
        professionals.
    ``(3) The provisions of this title that are applicable to the funds 
made available to the Secretary under section 502(a)(1) apply in the 
same manner to funds made available to the Secretary under paragraph 
(1).''.

SEC. 6. RESTORATION OF MEDICAID ELIGIBILITY FOR CERTAIN SSI 
              BENEFICIARIES.

    (a) In General.--Section 1902(a)(10)(A)(i)(II) of the Social 
Security Act (42 U.S.C. 1396a(a)(10)(A)(i)(II)) is amended--
            (1) by inserting ``(aa)'' after ``(II)'';
            (2) by striking ``or who are'' and inserting ``(bb) who 
        are''; and
            (3) by inserting before the comma at the end the following: 
        ``, or (cc) who are under 21 years of age and with respect to 
        whom supplemental security income benefits would be paid under 
        title XVI but for section 1611(c)(7)''.
    (b) Effective Date.--The amendments made by subsection (a) apply to 
medical assistance for items and services furnished on or after October 
1, 2000, except that a State may elect to apply such amendments to 
items and services furnished on or after any date after the date of the 
enactment of this Act and before October 1, 2000.
                                 <all>