[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 1646 Introduced in Senate (IS)]







106th CONGRESS
  1st Session
                                S. 1646

 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 SENATE OF THE UNITED STATES

                           September 28, 1999

Mrs. Lincoln (for herself, Ms. Landrieu, Mr. Smith of Oregon, Mr. Bayh, 
and Mrs. Feinstein) introduced the following bill; which was read twice 
                and referred to the Committee on Finance

_______________________________________________________________________

                                 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 Maternal 
and Children's Health Coverage Act''.
    (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.--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; and
            ``(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.''.
            (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 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; and
                    ``(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.''.
                    (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) Financial Incentives To Promote Appropriate Enrollment.--
            (1) Expanded availability of funding for administrative 
        costs related to outreach and eligibility determinations.--
        Section 1931(h) (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) 
        (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(l)(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.
    (c) Additional Entities Qualified To Determine Medicaid Presumptive 
Eligibility for Low-Income Children.--Section 1920A(b)(3)(A)(i) (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. 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.--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 2000.
    (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 $500)''.
            (3) Effective date.--The amendments made by this subsection 
        take 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) 
                and inserting a semicolon;
                    (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) (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. 4. 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) (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) Loss of schip eligibility.--Section 2102(b)(3) (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 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 (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) (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) 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.
    (d) 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 (if any) of the payments 
        made to that State under section 1903(a) 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 2000.
    (e) 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, 2000.
                                 <all>